A Controlled Study to Analyze Psychological Aspects and Psychiatric Morbidity Amongst People who Attempt Suicide.

Background : Suicide is a complex, multidimensional phenomenon. Attempted suicide has a bearing on future attempts/completion, a correlation with psychosocial factors and psychiatric disorders and these factors have an effect on suicide prevention. Aim : To compare people who attempt suicide and controls in regard to psychosocial aspects and psychiatric morbidity and to find out the factors leading to attempted suicide. Methods : Consecutive 40 cases of attempted suicide and 40 controls of either sex between 16-35 years of age studied till tenth standard referred to the department of Psychiatry from various super speciality departments in Sir Ganga Ram Hospital were recruited in the study over a period of 18 months after ensuring their medical stability and after obtaining their consent. The subjects were assessed using semistructured proforma covering socio-demographic and clinical characteristics of patient and his/her illness and by using the following tools : Cattelle’s 16 personality factors test(16 PF), Frustration test, Family relationship inventory, Presumptive Stressful life event scale, Beck’s depression inventory, Beck’s suicidal intent scale, Smith’s lethality of suicide attempt scale, MINI-plus and Kuppuswamy’s Socio-economic Status Scale. Results : The study showed female preponderance amongst attempters and 67.5% came from a nuclear family background (p=0.000). 25% of the suicide attempters had made an earlier past suicide attempt and 15% had a family history of attempted or completed suicide (p=0.011). Benzodiazepine overdose was the most common method (37.5%) of attempting suicide followed by organophosphorus poisoning (30%).For attempters, mean scores for frustration, and acceptance and concentration variables on family relationship inventory were statistically significant (p=0.000).Psychiatric disorders were present in 65% of the attempted suicide cases and results were statistically significant for undesirable life events in the past and lifetime in attempters.Conclusions : The present study revealed that lack of family cohesion and relationship/marital problems with more undesirable life events in the past and lifetime are important factors for attempted suicide. High levels of frustration, low family acceptance and high family concentration are predictors of attempting suicide later.

Outcome predictors for non-invasive positive pressure ventilation in acute respiratory failure.

BACKGROUND: Noninvasive positive pressure ventilation (NIPPV) has emerged as a significant advancement in the management of acute respiratory failure. OBJECTIVE: To identify factors, based on clinical and laboratory parameters, for predicting the outcome of NIPPV in patients with acute respiratory failure. MATERIALS AND METHODS: Fifty patients were included in the study. Inclusion criteria were RR>30 breaths/ min, PaO2<60mmHg, PaO2/FiO2<300, pCO2< or = 45mmHg and signs of increased work of breathing. Baseline clinical parameters and arterial blood gas (ABG) were recorded before initiating NIPPV. Clinical parameters including heart rate, respiratory rate, oxygen saturation and ABG was revaluated at 1, 4, 12, 24 hrs after initiation of NIPPV. Change in these parameters and need for intubation was evaluated. RESULTS: Of the 50 patients, 37 (74%) showed clinical and ABG improvement. Out of 13 (26%) patients who failed to respond, 7 (52%) needed endotracheal intubation within 1 hr. There was significant improvement in clinical and ABG parameters within 1st hr in success group and these parameters continues to improve even after 4 hrs of NIPPV treatment (p<0.05). Failure group had higher baseline heart rate than success group (p<0.05). CONCLUSION: Determination of baseline clinical factors such as heart rate and respiratory rate, available at the time of initiation and after a short period, can predict the likelihood of success or failure of NIPPV. As a result, delay in intubation can be avoided which itself is associated with significant mortality.

Percutaneous tracheostomy.

The purpose of this review is to discuss the various techniques of percutaneous tracheostomy and to assess their safety and efficacy profile, indications and contraindications, early and late complications. Literature was reviewed from Medline and MD Consult databases. Early techniques by Sheldon, toye and Schachner have been abandoned due to their high complication rates. Percutaneous dilational tracheostomy using the Ciaglia kit (Wiliam Cook Europe Bjaeverskov) and a Griggs kit (Portex PDT kit, POrtex, Hythe, Kent, UK) has been used most often. Griggs guide Wire Dilator Forceps kit (SIMS, Portex, Hythe, Kent, UK) is the next most common in use but its long-term studies are few. Fantoni (TLT set, Mallinckrodt Medical) and PercuTwist device (Riisch, Kernen, Germany) are two new techniques currently under study. Percutaneous dilational tracheostomy and conventional surgical tracheostomy are still competing methods to provide an airway for intensive care patient requiring assisted ventilation. Review of literature shows that percutaneous tracheostomy is safe, cost-effective and compares favourably with the open surgical tracheostomy. Many intensive care units now use the percutaneous tracheostomy as a procedure of choice. Percutaneous tracheostomy has a learning curve and requires appropriate case selection and meticulous attention to the technique by all those who want to use this method.

Involvement of nitric oxide (NO) in hypoglycaemic activity of tolbutamide.

The study was conducted to find the involvement of Nitric Oxide (NO) using L-arginine, a NO precursor and NG-methyl L-arginine a nitric oxide synthase inhibitor on tolbutamide activity in normal rabbits. L-arginine (25-300 mg/kg, body weight, oral) produced transient and dose dependent hypoglycaemia. When combined with tolbutamide (40 mg/kg, oral) it produced early and prolonged action. The effect of tolbutamide was blocked by NG-methyl L-arginine (5 mg/kg, body weight, oral). The results confirm the involvement of NO in tolbutamide activity and the possibility of using L-arginine as a supplement to antidiabetic drugs in blood glucose control.

Carcinoid tumour: laser therapy.

A 31-year-old female, pregnant (I trimester), presented with symptoms and signs of bronchial asthma. Chest roentgenogram and computerized tomography of the chest revealed right mid and lower zone opacity (collapse). Bronchoscopic examination revealed intrabronchial growth in the right middle and lower lobe bronchus. Biopsy and histopathological examination confirmed carcinoid tumour. These symptoms and signs disappeared after laser therapy. The lesion, however, recurred two years later.

A case of pre-leukaemia masquerading as haemolytic anaemia due to multi-enzymopathy of the red cell.

A 19 year old woman presented as a case of haemolytic anaemia due to multi-enzyme deficiency of the erythrocyte. After a transient improvement with folic acid therapy, she developed acute myeloblastic leukaemia. This is the second reported case of a myelodysplastic syndrome presenting with a haemolytic picture and subsequently developing an acute myeloblastic leukaemia.