A Comparative Study on the Sexual Functioning among Men with and without Severe Mental Illness

Objective: The aim of the study isto compare the sexual functioning among men with and without severe mental illness. Materials and Methods: The study was conducted inPsychiatry Department, Sree Balaji Medical College and hospital, Chromepet, Chennai Tamilnadu, India from the period of August 2016 to February 2018 (18 months). Cross sectional analytical study: 1.Semi structured questionnaire to capture demographic variables, illness variable, type of sexual practice and their expectations from MHPs. 2. General health questionnaire(12) tamil and English, 3. CAGE screening tool for alcohol. 4. The Brief Male Sexual Function Inventory (BMSF) for males (70). Results: The study population covered 50% of men with severe mental illness and 50% of men without severe mental illness. Among the study population regarding the educational status it was inferred that 70% were literate and only 30% were illiterate.An attempt to identify the mental illness of the study population was made and it was found that among the total cases, the prevailing mental illness was Schizophrenia (27%). Bipolar affective disorder (17%) was ranked as second highest. Delusional disorder, major depressive disorder covered up to 4% and 1% respectively. The comparisons of quantitative variable between the groups were given in Table 7. The median (range) of the age in case was 40 (29, 58) and in controls was 39 (25, 55), which shows that the median value of age between the groups was not found to be statistically significant (P>0.05). The median value of general health questionnaire among the patients with severe mental illness was 26 (18, 34) and in controls it was 1 (0, 4) which shows that this median difference was highly significant (P<0.0001). The median value of CAGE among the cases was 1 (0, 4) and in normal males was 19 (15, 29) which shows that the median difference between the groups were found to be highly significant (P<0.0001). Similarly, the median difference of variables such as BSFI sexual drive, ejection score, ejaculation score, overall satisfaction score, problem assessment score and total score was found to highly significant (P<0.0001). This implies that the sexual function of men with severe mental illness differs significantly from the normal males. Conclusion: Sexual dysfunction is common among men with severe mental illness than persons without severe mental illness. The male patients with severe mental illness such as Schizophrenia, delusional disorders, BPAD, major depressive disorder have impaired sexual function compared with the persons without severe mental illness study group which is evident from the BFSI score(17 in persons with severe mental illness vs 34 in persons without severe mental illness) which is clinically significant. In our study, sexual dysfunction among the men with severe mental illness is not proportional to the duration of the illness & the age of the patients. Recommendations based on gender identity development, attachment, non-sexual and sexual abuse, puberty/adolescence.

Diabetic retinopathy screening uptake after health education with or without retinal imaging within the facility in two AYUSH hospitals in Hyderabad, India: A nonrandomized pilot study

Purpose: In India, people with diabetes (PwDM) often seek care in the government-approved alternative medicine system, AYUSH (Ayurveda, Yoga and naturopathy, Unani, Siddha and Homeopathy). The purpose of this pilot study was to assess whether health education plus retinal imaging for diabetic retinopathy (DR) within an AYUSH hospital increased the uptake of screening for DR compared with health education and referral. Methods: The study was a nonrandomized pilot conducted in two AYUSH hospitals. Both hospitals received intervention on educating the AYUSH practitioners about DR screening and distributing health education materials to diabetic patients. In one hospital in addition to education, retinal imaging by a trained technician with remote grading by an ophthalmologist was provided, while in another hospital PwDM were referred to nearby eye hospitals for screening. The uptake of screening was assessed through registers and phone calls. Results: At baseline, only 10.7% of 178 PwDM were aware of DR and only 8% had undergone DR screening. After the intervention, in the hospital where screening was provided, all (100%) eligible patients (101) underwent digital imaging, whereas in the other hospital only 25% of 77 eligible patients underwent screening in eye hospitals (P < 0.001). Conclusion: AYUSH hospitals could provide a feasible and acceptable location for providing DR screening services. Further studies are required to assess scale-up of such intervention.

A Prospective Study On Usage Pattern Of Corticosteroids In A Tertiary Care Hospital

Rational use of corticosteroids is very essential for improving patient safety on long term use. The present study aimed to study the prescribing usage pattern of corticosteroids in a tertiary care hospital. A prospective observational study was conducted in the department of dermatology, gynecology and general medicine in a tertiary care teaching hospital for the period of 6 months (August-February). All patients receiving any category of Steroid therapy were included and the prescribing and tapering pattern of steroids were reviewed. Prescribing pattern was observed and analysed in 132 participants during the study period. Cases were collected from the departments of Dermatology, General Medicine, Pediatrics and Gynecology in Gandhi Hospital, Secunderabad. All the prescriptions containing steroids were included in this study and the parameters evaluated were gender distribution, age of the patients, types of steroids according to the route of administration, number of prescribed daily dose (PDD) where compared with defined daily dose (DDD). In the collected 132 cases, 162 times corticosteroids were prescribed. The steroid utilization was found to be more in female patients, the maximum number of cases with corticosteroids was found in Dermatology department (39.4%). Particularly Injection Dexamethasone (24.7%) and Tablet Prednisolone (24.7%) are mostly prescribed. Most drugs were prescribed rationally although some factors like improper history, drug administration time and tapering were deviating away from rationality. Although most of the drugs were prescribed rationally, involvement of a Clinical pharmacist in patient care can help in more rational prescribing along with prevention and early detection of ADRs which can directly promote drug safety and better patient outcomes.

Impact Of Pharmacist Intervention On Medication Knowledge And Adherence In Hemodialysis Patients

Objective: The objectives of the study are to evaluate the medication knowledge and medication adherence in patients undergoing haemodialysis and to educate the patients regarding the importance of medication adherence through counseling by providing Patient Information Leaflets and to analyze its impact. Methods: 50 Patients were randomly divided into two groups (control and test). Patient data was collected and documented using the patient data collection form after obtaining their consent. Their knowledge and medication adherence were assessed using questionnaires and was quantified. Patients included in the test group were counseled using Patient Information Leaflets whereas the control group was not counseled. Re-assessment was done during follow up for both groups. Results: Paired t-test was done to check if there was a significant difference in both the test and control group, with and without the use of Patient Information Leaflets respectively. The study showed that the test group had significant improvement (P<0.05) in their medication adherence and knowledge whereas there was no significant change in the control group. Conclusion: Providing patient counseling and continuous education with efforts to improve awareness among haemodialysis patients could enhance adherence to therapies and thus could improve clinical outcomes and quality of life.

Genetic components in diabetic retinopathy.

Diabetic retinopathy (DR) is a serious complication of diabetes, which is fast reaching epidemic proportions worldwide. While tight glycemic control remains the standard of care for preventing the progression of DR, better insights into DR etiology require understanding its genetic basis, which in turn may assist in the design of novel treatments. During the last decade, genomic medicine is increasingly being applied to common multifactorial diseases such as diabetes and age‑related macular degeneration. The contribution of genetics to the initiation and progression of DR has been recognized for some time, but the involvement of specific genes and genetic variants remains elusive. Several investigations are currently underway for identifying DR susceptibility loci through linkage studies, candidate gene approaches, and genome‑wide association studies. Advent of next generation sequencing and high throughput genomic technologies, development of novel bioinformatics tools and collaborations among research teams should facilitate such investigations. Here, we review the current state of genetic studies in DR and discuss reported findings in the context of biochemical, cell biological and therapeutic advances. We propose the development of a consortium in India for genetic studies with large cohorts of patients and controls from limited geographical areas to stratify the impact of the environment. Uniform guidelines should be established for clinical phenotyping and data collection. These studies would permit identification of genetic loci for DR susceptibility in the Indian population and should be valuable for better diagnosis and prognosis, and for clinical management of this blinding disease.

Ectopic Eruption of a Transmigrated Mandibular Canine: A Rare Case Report.

Migration of teeth, both physiological as well as pathological, is a well-documented phenomenon. Transmigration, on the other hand, is a rare phenomenon where a tooth crosses the midline and migrates to the opposite side without any pathological influence. An impacted tooth especially canines migrate to a location some distance away but do not usually cross the midline. Even so, the tooth remains impacted. Here is a unique case of transmigration of a left mandibular canine, which has erupted labial to its counterpart on the right mandibular arch. Transmigration of the mandibular canine is a rare phenomenon. Even rare is an eruption of this transmigrated canine into the opposite arch where it can be mistaken as a supernumerary tooth.

Pigmented Basal Cell Carcinoma: A Case Report.

Basal cell carcinoma (BCC) which is also known as rodent ulcer is the most common type of skin cancer. Prolonged exposure to high-intensity ultraviolet radiation is regarded as the most common risk factor of BCC. This ionizing radiation can induce DNA damage such as point mutations, and single stranded DNA breaks. Other possible pathogenic mechanism includes the involvement of the tumor suppresser gene, and the members of sonic hedgehog signal transduction pathway. Pigmented BCC (PBCC) is a rare variant of BCC, of which only very few cases have been reported in literature. This is a case report of such a case of PBCC.

Efficacy of Diode Lasers in the Treatment of Oral Leukoplakia: A Case Report.

Leukoplakia of the buccal mucosa is considered a premalignant lesion according to the WHO classifi cation with a malignant transformation rate of 0-20%, especially among men above 40 years of age with a smoking history. Along with the active screening procedures, there is also growing brilliance in surgical interventions aimed at the eradication of such fatal diseases. Laser ablation using diode lasers is one such well-accepted prophylactic treatment modality among clinicians and patients along with low recurrence rates. We have aimed to support this article with the case report of the patient with leukoplakia, who was being treated with a diode laser that unveiled the brilliance of this technique with enhanced healing.

Extra Gingival Pyogenic Granuloma: Unusual Location for the Usual Lesion.

Pyogenic granuloma (PG) is a benign non-neoplastic mucocutaneous lesion formed in reaction to mild irritation or hormonal changes. Although this fairly common lesion has a striking predilection for the gingiva, it can also be found extra gingivally. The clinical diagnosis of such an uncommon extra gingival PG can be quite challenging as the lesions appear as smooth or lobulated red nodules with easy bleeding, occasionally ulcerated mimicking malignancies. The purpose of this article is to report an unusual case of extra gingival PG occurring on the upper lip. The diagnosis of oral lesions is complex due to distinct appearance of the same lesion and leads the clinician to consider lesions with different diagnostic methods.

Erosive Lichen Planus of the Oral Cavity: A Case Report.

Erosive lichen planus (LP) is a clinical form of oral LP characterized by the bilateral presentation of erosive and erythematous areas in the oral cavity usually the buccal mucosa with predominance in middle aged females with undue stress factors. In this article, we are giving a case report of a 56-year-old female patient who came to our Department of Oral Medicine and Radiology with a chief complaint of burning sensation of the mouth to hot and spicy food. The diagnosis was given as erosive LP. We also aim to review the literature and management of the lesion with reference to the same.

Changing paradigm of Cryptococcal meningitis: An eight-year experience from a tertiary hospital in South India.

Background: Cryptococcal meningitis (CM) is a common opportunistic fungal infection causing sub-acute meningitis with the potential for complications and signifi cant mortality. We conducted this study to describe the difference in presentation and outcome between HIV-infected and HIV-uninfected patients. Materials and Methods: Patients admitted to a tertiary care centre between 2005 and 2013 with confi rmed CM were included in the analysis. Details of the clinical presentation, laboratory fi ndings, treatment details, risk factors for infection and outcome were documented and analysed. Results: During the study period, 102 (87.2%) cases of CM occurred among HIV infected individuals, whereas 15 (12.8%) occurred among HIV-uninfected patients. HIV-infected patients with CM were younger compared with HIV-uninfected patients (38.2 ± 8.5 years vs. 45 ± 11.5 years; P = 0.07). The median duration of symptoms prior to presentation was shorter in the HIV-infected group (20 ± 32 vs. 30 ± 42; P = 0.03). There was no difference between the cerebrospinal fl uid (CSF) lymphocyte counts, CSF protein counts, and CSF sugar levels in both the groups. The diagnostic yield of Cryptococcus was similar with CSF India ink smear (89% vs. 87%), CSF fungal culture (95% vs. 87%), and blood culture (100% vs. 75%) in both the groups. Case fatality rate in the HIV-infected group was 30.6%, whereas there were no deaths in the HIV-uninfected group. Conclusion: HIV-infected patients with CM have a worse outcome compared to HIV-uninfected patients. The overall trend over 3 decades shows increasingly successful rates of treatment and hence early diagnosis and treatment are of paramount importance.

Multiple Supernumerary Teeth in a Non Syndromic Patient: Case Report.

Supernumerary teeth, also known as hyperdontia, is a term used to describe extra teeth that develop in addition to the 20 primary and 32 permanent teeth that we are predisposed to have. Hyperdontia is seen more commonly in the permanent dentition than primary teeth. Th e incidence in the permanent dentition is reported to vary between 0.1% and 3.8%, and its frequency in the primary dentition is found to be 0.3-0.8%. A 32-year-old male patient reported to the department of oral medicine and radiology with the chief complaint of stains and deposits, his clinical examination revealed 9 supernumerary teeth and panoramic radiographic revealed 3 more extra making a total of 12 supernumerary teeth.

Pesticide (Endosulfan) Levels in the Bone Marrow of Children with Hematological Malignancies.

Objectives: (1) To confirm the presence of Pesticide (Endosulfan) residues in the bone marrow (BM) of children with acute hematological malignancies and compare them with controls. (2) To ascertain if children with Endosulfan in their marrow reside in areas sprayed with Endosulfan. Study design: Case control study Setting: Pediatric oncology unit of a medical college teaching hospital in Dakshina Kannada district of Karnataka. Subjects: 26 patients with proven hematological malignancy and 26 age matched controls suffering from benign hematological disease. Methods: Endosulfan residues in the BM were estimated by gas chromatography – mass spectrometry (Minimum detection limit 10ng/mL). The subject’s geographical area of location (residence) was determined to see whether they belong to sprayed area or not. The Chi-square test was applied to see an association between exposure R E S E A R C H P A P E R status and hematological malignancy. Results: A total of 52 children were enrolled of which 26 were study cases and 26 were controls. Of the study and control groups, 84.7% and 73.1%, respectively were from exposed areas. The major (88.4%) illness in the study group was ALL, while ITP (50%) occurred most frequently in the control group. Six out of 26 study cases tested positive for endosulfan in the BM, against 1 out of 26 controls (P = 0.042). The Odds ratio was 7.5. All children who had endosulfan in the bone marrow originated from areas, where endosulfan is still being used. Conclusions: Children with hematological malignancy had raised levels of endosulfan in the bone marrow compared to those without. All the children with raised bone marrow Endosulfan levels were found to be from areas exposed to the pesticide.

Hepatoprotective properties of Caesalpinia sappan Linn. heartwood on carbon tetrachloride induced toxicity.

Aim of the study was to investigate the methanol and aqueous extracts of heartwood of C. sappan for its hepatoprotective activity against CCl4 induced toxicity in freshly isolated rat hepatocytes and animals. Freshly isolated rat hepatocytes were exposed to CCl4 (1%) along with/without various concentrations of methanolic and aqueous extract of C. sappan (1000-800 µg/ml) and the levels of selected liver enzymes were estimated. Antihepatotoxic effect of methanolic extract was observed in freshly isolated rat hepatocytes at concentrations 1000-800 µg/ml and was found to be similar to that of standard drug silymarin. Wistar strain albino rat model was used for the investigation of in vivo hepatoprotective properties of aqueous and methanolic extract of C. sappan (100 and 200 mg/kg body weight). Liver damage was induced by ip administration of CCl4 (30%) suspended in olive oil (1 ml/kg body weight). Both the tested extracts showed potent hepatoprotective activity at 200 mg/kg body weight test dose which was comparable with that of the standard silymarin used in similar test dose. The methanolic and aqueous extract was able to restore the biochemical levels to normal which were altered due to CCl4 intoxication in freshly isolated rat hepatocytes and also in animals.

Intraluminal migration of surgical sponge: gossypiboma

Surgical mop retained in the abdominal cavity following surgery is a serious but avoidable complication. The condition may manifest either as an exudative inflammatory reaction with formation of abscess, or aseptically with a fibrotic reaction developing into a mass. Intraluminal migration is relatively rare. We report the case of a 23 year old woman who presented after a previous caesarean section with intestinal obstruction. Plain abdominal radiograph and computed tomography confirmed the presence of gossypiboma. The patient underwent laparatomy and sponge removal. This report discusses the approach to, and manifestations of, migratory surgical gossypiboma

When is a bone scan study appropriate in asymptomatic men diagnosed with prostate cancer? / 亚洲男科学杂志(英文版)

<p><b>AIMS</b>To determine when a bone scan investigation is appropriate in asymptomatic men diagnosed with prostate cancer.</p><p><b>METHODS</b>Between November 2005 and July 2006, 317 men with prostate cancer underwent a bone scan study; 176 men fulfilled the inclusion criteria. Prostate-specific antigen (PSA) cut-offs as well as univariate and multivariate logistic regression analyses using digital rectal examination finding, biopsy Gleason scores and age were performed to determine when a bone scan study is likely to be of value.</p><p><b>RESULTS</b>Only 1/61 men (1.6%) with a serum PSA 20 ng/mL had a positive bone scan. However, 2/38 men (4.7%) with a serum PSA 20.1-40.0 ng/mL, 3/20 men (15%) with a serum PSA 40.1-60.0 ng/mL, 7/19 men (36.8%) with a serum PSA 60.1-100.0 ng/mL and 19/38 men (50%) with a serum PSA > 100.0 ng/mL had positive bone scans. Univariate and multivariate logistic regression analyses were uninformative in these groups.</p><p><b>CONCLUSION</b>Based on our findings, a bone scan is of limited value in asymptomatic prostate cancer patients presenting PSA =or< 20 ng/mL. Therefore, this investigation can be eliminated unless a curative treatment is contemplated. Furthermore, digital rectal examination finding, biopsy Gleason score and age are unhelpful in predicting those who might harbor bone metastasis.</p>

Protection by live Mycobacterium habana vaccine against Mycobacterium tuberculosis H37Rv challenge in mice.

BACKGROUND & OBJECTIVES: In recent years the efficacy of BCG vaccine against tuberculosis has been questioned and there is no alternative vaccine available. Several strategies are being applied to get a satisfactory vaccine. Two approaches are generally considered: the subunit vaccines and the whole cell vaccines. The objective of this investigation was to evaluate an avirulent mycobacteria, Mycobacterium habana, as a whole cell vaccine to protect mice from infection of M. tuberculosis H37Rv. METHODS: AKR and immunocompromised SJL/J mice were immunized with live M. habana vaccine. These mice were challenged with M. tuberculosis H37Rv eight weeks later along with unimmunized control mice. Protection by M. habana vaccine was measured through several parameters, which included survival of challenged mice, dissemination of challenge strain and histopathology of lung tissues. RESULTS: M. habana vaccinated animals were healthier than the unvaccinated mice after challenge with M. tuberculosis and survived with significant increase in mean survival time. The viable count of challenge strain was at least 100-fold less in vaccinated mice than the control mice. The lung tissues in unvaccinated mice showed marked bronchopneumonia with clusters of acid fast bacilli, whereas vaccinated mice showed small areas of damage and evidence of protection subsequently. INTERPRETATION & CONCLUSION: It may be concluded from the evidence presented here that mice vaccinated with M. habana were protected from challenge with M. tuberculosis in both normal and immunocompromised states.

Molecular diagnosis of infectious diseases.

The Polymerase Chain Reaction (PCR) is a revolutionary new means of amplifying, i.e., replicating, selected DNA sequences in vitro. This procedure is highly sensitive and rapid, requiring few hours for detection of amplified target DNA whereas it often takes several weeks for the identification of many fastidious organisms by culture. Studies have shown that as few as one microorganism can be detected by PCR. Therefore, it is revolutionizing our ability in the diagnosis of infectious diseases. Currently, this technique is very expensive and complex which will probably restrict its immediate role for diagnosing infections where the causative organism is impossible to culture or untypeable by conventional means. As further progress occurs, however, this powerful technique will be applied as a major new tool to diagnose infections and to the study of individual genome variations.

Human enterocyte adhesion of enteroadherent Escherichia coli.

Esch. coli strains manifesting localised (17), diffuse (8) or aggregative (17) phenotypes of adherence to HEp-2 cells were tested for their ability to adhere to human enterocytes isolated from duodenal biopsies of adult volunteers to obtain further evidence of their enteropathogenecity. Esch. coli strains H10407+; CFAI+ and LT+ STp+ STh+, F 294 B; a localised adherent strain positive with entero-adherent factor probe reported previously to attach to small intestinal enterocytes and F 582 C; LT- STp+ STh+ were the positive controls: H10407P (CFAI- mutant of H10407+) and K12 served as negative control strains. Adherence of variable degree was seen with 35.3 per cent of enteroaggregative Esch. coli (EAggEc) and with 58.8 per cent of enteroadherent Esch. coli localised (EAEC-L); EAEC-diffuse (EAEC-D) did not adhere to the human enterocytes. The possibility that EAgg EC and diffuse phenotypes may adhere better to lower small intestine or the large intestine, needs to be investigated.