Indian Academy of Pediatrics Consensus Guidelines on Prevention and Management of Suicidal Behavior in Adolescents

Justification: Suicide is an important cause of adolescent mortality and morbidity in India. As pediatricians are often the first point of contact for adolescents and their families in the healthcare system, they need guidelines to screen, assess, manage and prevent adolescent suicidal behavior to ensure survival, health and mental well-being of this vulnerable population. Objectives: To formulate guidelines to aid pediatricians for prevention and management of adolescent suicidal behavior. Process: Indian Academy of Pediatrics, in association with Adolescent Health Academy, formed a multidisciplinary committee of subject experts in June, 2019 to formulate guidelines for adolescent suicide prevention and management. After a review of current scientific literature and preparation of draft guidelines, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by refining of draft guidelines, and discussions over e-mail where suggestions were incorporated and the final document was approved. Guidelines: Pediatricians should screen for mental distress, mental disorders and suicidal and para-suicidal (non-suicidal self-injury) behavior during adolescent health visits. Those with suicidal behavior should be referred to a psychiatrist after providing emergency healthcare, risk assessment, immediate counselling and formulation of a safety plan. Pediatricians should partner with the community and policymakers for primary and secondary prevention of adolescent suicide.

Spatial Mapping of Measles-Rubella Campaign in a Rural Area near Bengaluru, Karnataka, India

Immunization is animportant public health intervention.The Measles-Rubella (MR) campaign was launched during 2017in India for the elimination of measles.This study explored vaccination coverageandspatialmapping using QGIS and Google Earth Pro. WHO-EPI30 clusters sampling technique for evaluation of vaccination coverage was performed in villages within the rural area of a Medical College nearBengaluru.Seven children aged 2-15 years were surveyed per cluster, resulting in 210 children. Smartphones having GPS/Garmin GPS72H (handheld GPS receiver)were used for noting coordinates. Subsequently all these coordinates were plottedfor spatial mapping of vaccination coverage. The geospatial characteristics of the households surveyed were described using spatial mapping. Results indicate that 87.6% were immunized with MR Vaccine under the campaign, but 12.4% remained unimmunized, the reasons given being absence, ignorance, or refusal because of rumours concerning side-effects.The Measles-Rubella campaign coverage was found to be satisfactory. In addition the spatial mapping is a useful tool for measurement of coverage of a vaccination campaign. There was no clustering of unimmunized subjects observed on spatial mapping.

Clinical and Angiographic Profile of ST-elevation Myocardial Infarction in Premenopausal Women

 Introduction: Ischemic heart disease and its complications are on a rise in premenopausal women unlike previously thought that estrogen provides protective effects from cardiovascular diseases. There are less number of studies for premenopausal women with ST-elevation myocardial infarction and very few took into account the clinical and angiographic pattern. Purpose: In this study, we took into account clinical and angiographic pattern as well as certain risk factor profile. Materials and Methods: Women <50 years admitted in the Intensive Coronary Care Unit of Government Rajaji Hospital, Madurai, with ST-elevation myocardial infarction were taken into the study (43 in number). Their clinical presentation, risk factor profile, biochemical data, electrocardiogram and echo findings, and the angiographic findings were collected. The study was conducted over a period of 1 year. Results: In our study, most of them were diabetics, non-vegetarians were using sunflower oil or palm oil, and almost 100% had dyslipidemia. Most of them had anterior wall myocardial infarction with ejection fraction >40%. Most of them had singlevessel disease. Thirty days mortality was very less. In about five patients, none of the conventional risk factors for coronary artery disease (CAD) were present. Conclusion: Premenopausal women with ST-elevation myocardial infarction are on a rise in the current era, unlike previously thought. The previous studies were of comparative studies between premenopausal and postmenopausal women. Studies about the risk factors among this age group were very less. Although conventional risk factors such as diabetes and dyslipidemia played major role, some of the unusual risk factors and unidentified risk factors were found to contribute to the disease. Further studies are needed to identify the unusual risk factors for CAD present in this age group

A study focusing emerging risk factors in patients of acute myocardial infarction in South India

Background: Acute myocardial infarction (MI) is a significantly raising problem particularly in India. The various aspects of myocardial infarction such as risk factor profiles, clinical presentations and prognosis differ significantly in south Indian people when compared to others. This study was undertaken to study the association of socio-demographic and life-style factors with acute myocardial infarction in South India.Material: This was a prospective study included 100 patients admitted in ICCU for acute MI in Government Rajaji Hospital Madurai over a period of 1 year. History, ECG, CPK-MB, and 2-D Echo was done to diagnose MI.Results: In this study, 68% patients were males. In this study, 34% patients had diabetes, 42% had hypertension, 58% were smokers. In our study 70% patients had BMI between 25-30kg/m2. In this study, 86% patients had TGL more than 200mg/dl, 28% patients had LDL more than 100 mg/dl and 78% patients had NON-HDL more than 130 mg/dl. In this study, 9 patients had depression. In our study 61% male patients had waist hip ratio more than >1 and in females 69% patients had waist hip ratio more than >0.85. In our study, 22% patients had hemoglobin >16g/dl.Conclusion: Prevention of coronary artery syndrome by modifying the risk factors were crucial. Serum cholesterol, LDL cholesterol, BMI were not significant to predict ACS in our study Waist Hip ratio, Triglyceride, Non-HDL cholesterol, smoking and Depression were significant to predict acute coronary syndrome in this study

Cardiac involvement in adult patients with febrile thrombocytopenia diagnosed by bedside 2-D echocardiography

Background: Febrile thrombocytopenia due to various etiologies is very common in India. Its clinical manifestations range from asymptomatic infections to severe disease. Cardiac involvement in such systemic illness should be evaluated. Aim of present study is to evaluate cardiac involvement in patients with Febrile thrombocytopenia with platelets count less than 50,000/µL with the help of handheld echocardiography.Methods: Two hundred patients who had fever with thrombocytopenia were enrolled in the study. ECG and echocardiogram were done to all the patients. One-way ANOVA, Chi square test and correlation coefficient from Pearson correlation and P value of < 0.05 was taken as significant.Results: Out of 200 patients there were 146 males and 56 females. The mean age was 24.12yrs in males 28.32yrs in females .Rhythm abnormalities were present in 60 patients and the most common abnormality was sinus tachycardia; 17 patients had ascites and right pleural effusion; 24 patients presented with pericardial effusion and incidental diagnosis of CHD, RHD, and CAD were made; two patients had myocarditis as evidenced by global hypokinesia of left ventricle. All of those cardiac manifestations were common in Dengue Shock Syndrome.Conclusions: Cardiovascular manifestation in Febrile thrombocytopenia is relatively common ranging from pericarditis to myocarditis. Clinician should routinely screen patients with pyrexia with thrombocytopenia for cardiac manifestations. Early diagnosis at bed side may improve the outcome. Management of patients with pre-existing cardiac diseases should be individualized.

A Study Of The Dimensions Of The Human Tricuspid Valve

Background: With the advent of the prosthetic valves, which are being used by the cardiac surgeons to replacediseased or damaged valves, an accurate knowledge of the dimensions and size of the tricuspid valve will be ofimmense help. Surgical correction on the heart valves has given a new lease of life to patients. This study, so farhas been done mostly on the American and European races. Studies in the Indians, particularly South Indianshas been rare. Hence the present study.Materials and Methods: 96 hearts were studied which were collected from cadavers allotted to undergraduatestudents for dissection, over a period of time. Hearts were removed by dissection method. The circumference ofthe tricuspid valve was measured & the diameters of the tricuspid valve are measured in two separate dimensionsin two separate perpendicularly oriented planes at the maximally separated points which is described undermaterials & methods.Results: The results of the study are as follows: The dimensions of the tricuspid valve annulus range from 5.7 cm– 14.8 cm. No accessory leaflets were foundConclusions: The study of the dimensions of the tricuspid valve annulus dimensions is important for variouscardiac procedures. The knowledge of the annulus of the tricuspid valve is important for the cardiac surgeon intricuspid valve diseases like stenosis and regurgitation as it will help him plan palliative or corrective surgeryin the congenital or acquired heart diseases.

A Comparative Study On Social Media Addiction Between Public And Private High School Students Of Urban Bengaluru, India

Objective: Social media usage is a global consumer phenomenon that has risen exponentially in the last few years. Published Indian studies on social media addiction are scarce and social media associated health issues are an emerging health problem in India. Objectives: To assess and compare social media addiction between private and public high-school students and to assess health problems related to social media usage across these groups. Methods: This crosssectional study was completed in 2016. It was conducted in five private and five public high schools across wards of Bengaluru city that were selected by simple random sampling. The subjects were students studying in grades 8, 9 and 10 (aged between 12 and 16 years). A total of 760 subjects were recruited, 380 from public and 380 from private high schools. They were administered a pretested, semi-structured, self-administrated questionnaire in either the local language or English. Univariate and multivariate logistic regression were employed to establish any associations between social media addiction and various other factors. Results: In our samples, 60.95% of social media users studied in private schools and 39.05% in public schools (z = 10.31, p<0.001). The most commonly used social media applications were, Internet gaming (69.23%) in Public schools and WhatsApp (61.15%) in Private schools. The overall prevalence of social media addiction was 19.96% among users with significantly higher rates of selfreported addiction in private schools (z = 3.47, p < 0.001). A total of 70.67% of the subjects had one or more physical symptoms, i.e. neck pain, tension, strain on eyes and fatigue of which 67.42% and 72.75% were from public and private schools, respectively. Psychological changes, i.e. anger, lonely and frustration; and behavioural changes, i.e. sleep disturbance and neglect personal hygiene were observed in 67.42% and 51.01% of public and private school pupils, (z = 3.85, p < 0.001), respectively. Conclusion: Private school students were more prone for social media addiction. Majority had mild addiction. Addiction was associated with behavioural changes. A multitude of physical, psychological and behavioural problems were observed among social media users.

Global positioning system & Google Earth in the investigation of an outbreak of cholera in a village of Bengaluru Urban district, Karnataka.

Background & objectives: The global positioning system (GPS) technology along with Google Earth is used to measure (spatial map) the accurate distribution of morbidity, mortality and planning of interventions in the community. We used this technology to find out its role in the investigation of a cholera outbreak, and also to identify the cause of the outbreak. Methods: This study was conducted in a village near Bengaluru, Karnataka in June 2013 during a cholera outbreak. House-to-house survey was done to identify acute watery diarrhoea cases. A hand held GPS receiver was used to record north and east coordinates of the households of cases and these values were subsequently plotted on Google Earth map. Water samples were collected from suspected sources for microbiological analysis. Results: A total of 27 cases of acute watery diarrhoea were reported. Fifty per cent of cases were in the age group of 14-44 yr and one death was reported. GPS technology and Google Earth described the accurate location of household of cases and spot map generated showed clustering of cases around the suspected water sources. The attack rate was 6.92 per cent and case fatality rate was 3.7 per cent. Water samples collected from suspected sources showed the presence of Vibrio cholera O1 Ogawa. Interpretation & conclusions: GPS technology and Google Earth were easy to use, helpful to accurately pinpoint the location of household of cases, construction of spot map and follow up of cases. Outbreak was found to be due to contamination of drinking water sources.

Prevalence of Chronic Obstructive Pulmonary Disease and its Association with Tobacco Smoking and Environmental Tobacco Smoke Exposure among Rural Population.

A fi eld survey was conducted for chronic obstructive pulmonary disease (COPD) epidemiology in the rural fi eld practice area of Kempegowda Institute of Medical Sciences, Bangalore, India, which covers a population of 44,387 to fi nd out the prevalence of COPD in adult subjects of 35 years and above using cluster sampling technique and to determine the association of tobacco smoking, environmental tobacco smoking (ETS) exposure and type of cooking fuel used with COPD. The overall prevalence of COPD was 4.36%. The prevalence among males and females were 5.32% and 3.41% respectively. The prevalence was found to be increasing with an increase in age. The tobacco smoke and exposure to ETS was signifi cantly associated with higher odds of COPD with adjusted odds ratio 2.97 and 2.67 respectively. Thus, there was a signifi cant association between tobacco smoking and ETS exposure with COPD.

Partial HELLP syndrome with unilateral exudative retinal detachment treated conservatively

Peripartum vision loss, an uncommon, often reversible complication of pregnancy usually occurs in the setting of pre-eclampsia or eclampsia. The HELLP syndrome is characterized by hypertension, elevated liver enzymes and low platelets. This is a rare case of unilateral exudative retinal detachment associated with the Partial HELLP syndrome that occurred after delivery in a 23-year-old Indian woman. The retinal detachment subsequently reattached with good visual improvement under conservative treatment. This case highlights the importance of early intervention by the ophthalmologist when pregnant women complain about visual symptoms

Rural Rabies Prevention Project - A ‘One Health’ Experiment in India: An Overview.

Aim: To assess the feasibility of implementing "one health approach" to prevent human rabies and control animal rabies in a rural community. Study Design: Health services research in a rural setting. Place and Duration of Study: A medical college and a veterinary college along with an animal welfare organization delivered a wide array of "integrated services" in three villages' i.e. Kumbalagodu, Thagachikuppe and Gerupalya near Bangalore, India comprising a population of 10,220 persons for a period of two years from December, 2009 to November, 2011. The nearby three villages of Ramohally, Vinayakanagara and Bhimanakuppe with a population of 6,023 persons formed the control group, with no project inputs. Methodology: This consisted of household surveys at the beginning and end of two years ; rabies awareness campaigns; clinical and laboratory surveillance of rabies in dogs; rabies post-exposure prophylaxis (PEP) in humans; pre-exposure rabies prophylaxis (PrEP) by intradermal route in school children, pet dog owners and veterinarians ; mass dog vaccination and deworming; and sero-surveillance in both dogs and humans. Results: The ratio of veterinary and medical manpower in study villages was 1: 11 and dog to human ratio was 1: 23.The information, education and communication materials developed and used were domestic outdoor wall writings (11), domestic indoor annual wall calendar (2000), school book labels (1000); game charts (16); wall posters (65); flip chart (15); rabies educational DVD (1). There were 102 local cable television transmissions on rabies prevention. 69 persons received rabies PEP. PrEP was given to 368 school children, pet dog owners and veterinarians. Sixty one human serum samples were analyzed by rapid fluorescent focus inhibition test for rabies antibody detection. Sixteen veterinarians were trained to use direct rapid immunohistochemical test (dRIT) for rabies diagnosis. Six ruminants were confirmed rabid by dRIT. There were no cases of human rabies. The cost of entire project was US $ 85,958. Conclusion: A blend of medical, veterinary and animal welfare services were successfully delivered through a "one health" approach. Based on this success a "conceptual model" was evolved to propagate its replication in other rural communities across India.

Prevalence of domestic accidents in the rural field practice area of a medical college in Bangalore, Karnataka.

Domestic accidents are worldwide health problems. A cross-sectional study was conducted in the rural field practice area of Kempegowda Institute of Medical Sciences, Bangalore. A total of 5419 individuals were selected from 30 clusters (villages) using cluster sampling technique. Of the 5419 study population, 50.9% (2748) were males and the rest were females. The prevalence of domestic accidents in the rural community was found to be 9.6% (522 individuals who had sustained domestic accidents), was found to be more in females compared with males, which was statistically significant with P-value =0.0077 (Z value =9.09). Falls 43% (225) was the most common type of domestic accidents. The most common place of occurrence of domestic accidents was 46% (243) kitchen, most frequent site of injures in domestic accidents was upper limbs.

Rabies in a blind patient: Confusion after corneal transplantation.

Two blind persons received corneal transplants from a single donor who showed no signs of rabies before he died. One of the recipients, a young girl, died 16 days later of rabies and the other recipient survived. We discuss the possible mode of transmission of rabies to the first recipient and the management of the second recipient.

Global positioning system: A new tool to measure the distribution of anemia and nutritional status of children (5-10 years) in a rural area in south India.

Global positioning system (GPS) is a satellite-based navigation system that is of late being used in health care. Objectives: The aims of the study were to describe the geographical distribution and assess the prevalence of anemia and malnutrition in children aged 5-10 years with GPS. Subjects and Methods: This exploratory study was conducted over a period of 2 months in the rural field practice area of a medical college situated in Bangalore during June-July 2012. Children aged 5-10 years were the study subjects. Results: GPS was used for describing the geographical distribution of anemia and nutrition status on the Google earth map. The prevalence of anemia in the study subjects was 8.7%. The prevalence of underweight, stunting, thinness, and severe thinness among the study subjects was 52.8%, 28.5%, 23.5%, and 29.1%, respectively; however, overweight and obesity were observed only in 0.9% and 1.2% of the study subjects, respectively. Conclusion: GPS was easy to use and was able to demonstrate the actual distribution of morbidity at the household level in the rural area.

Chitosan/guargum-g-acrylamide semi IPN microspheres for controlled release studies of 5-Fluorouracil.

Chitosan and guargum-gt-acrylamide (CH-GG-g-AAm) semi interpenetrating microspheres (semi IPNMs) were prepared by water-in-oil (w/o) emulsion cross linking method using glutaraldehyde as a crosslinker. 5-fluorouracil (5-FU) is an anticancer drug was successfully loaded in these semi IPNMs. X-ray diffraction (XRD) and differential scanning calorimetric (DSC) examined the crystalline nature of drug after encapsulation into semi IPNMs. Scanning electron microscopy (SEM) shows the formation of semi IPNMs is spherical with size around 200 􀀀m. The encapsulation efficiency of 5-FU was achieved 58%. In-vitro release studies were performed basic (pH 7.4) buffer medium. The release patterns depend on graft polymer composition, effect of cross linker and drug content in the polymer matrices. In vitro release studies indicated the release of 5- FU more than 12 hours.

Prevalence of bronchial asthma and its association with smoking habits among adult population in rural area.

A cross-sectional study was conducted in the rural field practice area of Kempegowda Institute of Medical Sciences, Bangalore. A total of 3194 adult individuals (18-70 years) were selected from 30 villages (clusters) using a cluster-sampling technique. Individuals with symptoms suggestive of asthma were subjected for clinical examination for the diagnosis of asthma. Among the 3194 respondents, 1518 (47.5%) were males and 1676 (52.5%) were females. The prevalence of bronchial asthma was 2.88%. The prevalence of asthma was higher among those reporting a history of current smoking. Among current smokers, the number of cigarettes/bidis/hookah smoked daily did not differ (P > 0.05) between individuals without asthma and with asthma, whereas the mean number of years of smoking did differ (P < 0.001). There was significant association between tobacco smoking and bronchial asthma.

Anaplastic large-cell lymphoma with florid granulomatous reaction: a case report and review of literature.

Granulomatous reactions have been reported in association with lymphomas, more often with Hodgkins disease than with Non-Hodgkins Lymphoma. Not many reports are available on the association of anaplastic large-cell lymphoma with sarcoid-type granuloma. Herein, we report a case of an elderly female with generalized lymphadenopathy who had a florid granulomatous reaction almost masking the lymphoma cells in the lymph node biopsy. A detailed clinical history, careful histological examination and immunohistochemistry helped in attaining the correct diagnosis.

A clinico epidemiological study of tetanus cases admitted to epidemic disease hospital, Bangalore.

A descriptive study was conducted among tetanus cases admitted to epidemic disease hospital (EDH), Bangalore from October 2006 to March 2007 to describe the socio demographic characteristics of tetanus cases, the clinical presentation and the treatment given to tetanus cases. A total of 80 cases were admitted during this period. Out of the 80 tetanus cases, 71% were from rural area, 55% unimmunized, 47.5% were agricultural workers. A total of 25 (31.25%) deaths were observed during the study period. No case was administered anti tetanus serum outside the epidemic disease hospital.

Usefulness of direct recording scale as a new tool for growth monitoring.

The present study was conducted to assess the acceptability and usefulness of Direct Recording Scale (DRS) as a tool for growth monitoring of under five children in a rural community area of Karnataka among 46 mothers. A total of 40 children were followed up for one year, 50% mothers preferred having DRS at home, 87.5% mothers said DRS, helps in detecting undernutrition, 48% mothers needed no help in using DRS, 50% mothers were regular in weight recording, 87.5% mothers wanted the weight recording done once in three months. All families had accepted DRS as a tool for growth monitoring.