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.

Salivary Calcium and Phosphorous in Caries Active Type II Diabetic Patients.

Diabetes mellitus is a metabolic disorder which favours the progression of dental caries and affects the oral health. Studies have revealed that diabetic condition affects salivary electrolytes concentration contributing to demineralization of the teeth. This study was carried out to evaluate the impact of age in diabetes affecting oral health. We wanted to compare calcium and phosphate level in diabetic and non-diabetic patients and its impact on prevalence of dental caries.METHODSA total of 96 patients were examined and divided into groups of age 20-39 yrs. with and without caries and 40-64 yrs. with and without caries. After obtaining their consent, diabetic status was assessed. Patients were divided into diabetic and non-diabetic groups based on diabetic status and inclusion criteria. The groups were further subdivided into with caries and without caries. The dental caries was assessed using Decayed, Missing, Filled Tooth (DMFT) Index.RESULTSCalcium and phosphate ions are significantly reduced in caries active young diabetic patients (4A). In this study it showed that salivary calcium and phosphate ions in type II diabetic patients directly influence the prevalence of caries in young diabetic patients when compare to old patients.CONCLUSIONSThus, within the limitations of the study, impact of calcium and phosphate ions in type II diabetic patients had much more influence on young diabetic patients when compared to old patients.

Thoracodorsal artery perforator flap in immediate breast reconstruction: a series of twenty cases

Background: The management of breast cancer has shown a progressive change, from radical ablative surgery, to breast conserving techniques. Traditionally, the mini latissimus dorsi flap has been used for reconstruction; which is associated with donor site morbidity. Vascular research has now allowed the use of perforator-based flaps for reconstruction, which reduce donor site morbidity.Methods: Twenty thoracodorsal perforator flaps in twenty early breast cancer patients were studied between January 2018 and December 2018. Parameters studied were adequacy of volume, ease and time taken for flap elevation, and final aesthetic outcome.Results: Flap volume was adequate to fill defect. One of twenty cases had flap loss due to venous congestion secondary to pedicle kinking. Average time taken for flap elevation was 70.45 minutes. All patients were satisfied with cosmetic outcome.Conclusions: The TDAP flap is a safe and reliable flap which provides adequate volume for partial breast reconstruction.

Clinical study of reconstruction of devastating defects around the elbow region at a tertiary care hospital

Back ground: Devastating defects are those defects where the major structures like bones, joints, nerves, and blood vessels are exposed. These defects may be due to road traffic accidents, train traffic accidents, post burn scar contracture release raw area etc. Skin grafting or simple flaps may not help in these cases making reconstruction challenge. To study the various flap options for the coverage of the elbow defects and its outcomes. Materials and methods: From the period of 2016 to 2017, all patients with elbow defects that required local or locoregional flaps were chosen for the study. Investigations included plain X-ray of the elbow. Hand held Doppler was done for patients in whom the perforator based flaps were selected for reconstruction. Results: In our study (23 patients) were males and (4 patients) were females. The most common cause was the road traffic accident (18 patients). Two patients were due to a post burn contracture release raw area. One of the patients was due to a work place accidental injury. Six patients were due to train traffic accident and of which 5 patients presented with total amputation (stump raw area). The site of the wound played a major role in determining the flap selection. In our series, most of the patients presented with defects over lateral (6 patients) and posterior lateral (7patients) elbow region. Conclusion: Meticulous planning for their construction of devastating elbow defects is necessary to achieve satisfactory results. The choice between different flaps depends on the nature of the defect, availability of donor tissues and the patient’s needs.

Clinical study of pedicled sternocleidomastoid muscle flap interposition for cervical tracheo oesophageal fistula repair at a tertiary care hospital

Introduction: Tracheo Oesophageal Fistula (TEF) is a major cause of morbidity and mortality necessitating complex clinical evaluation and decision making for optimal management. It is best treated in a specialty tertiary care setting by a multidisciplinary team approach. In acquired nonmalignant causes of airway-oesophageal fistulas, the patients suffer from significant morbidity due to recurrent pulmonary sepsis. These diseases are complex and mandate critical preoperative evaluation for optimal management. Prolonged endotracheal intubation combined with a nasogastric tube may lead to a TEF. This results from pressure necrosis generated by a ventilating cuff in the trachea and a prolonged feeding tube in the esophagus. Aim of the study: To study the results of function preserving pedicled perforator based sternocleidomastoid muscle as an inter position flap after primary repair of cervical tracheaoesophageal fistula. Materials and methods: The study was conducted from the period of one year from 2015-2016 at IRRH and Plastic Surgery Department of Government Stanley Medical College, Chennai. Totally 15 patients were included in the study. Patients with clinical presentation were evaluated, a pre operative P.S. Ganesh Babu, T.M Balakirshnan, Ramadevi. Clinical study of pedicled sternocleidomastoid muscle flap interposition for cervical tracheo oesophageal fistula repair at a tertiary care hospital. IAIM, 2017; 4(9): 105-109. Page 106 investigation like Bronchoscopy, OGD MRI, CECT of the neck was taken. All patients with tracheal oesophageal fistula in the cervical region following corrosive poisoning (organophosphates) on prolonged intubation who under went closure with the pedicled sternocleidomastoid muscle as an interposition flap. Results: All patients diagnosed with Tracheo oesophageal fistula following corrosive poisoning on prolonged intubation were included. (N = 15). The study period was from 2015 to 2016. Patient’s demographic data and clinical course were closely monitored and recorded. All Patients recovered well. Oral feeding started (liquids) on 4th post-operative day after doing gastro Graffin study, and solids on the 10th day. No recurrence in 1 year follows up. Conclusion: In our technique, we maintained the intramuscular cock screw perforators from the transverse cervical artery. This constant anatomy favored us to use sternal head component separate from the clavicular head and interposed them between the repaired trachea and esophagus. Preserving the clavicular head of SCM maintains the form and function of the muscle. The vascularized muscle flap prevents both tracheal and oesophageal strictures and stenosis.

Intercostal drainage tube or intracardiac drainage tube.

Although insertion of chest drain tubes is a common medical practice, there are risks associated with this procedure, especially when inexperienced physicians perform it. Wrong insertion of the tube has been known to cause morbidity and occasional mortality. We report a case where the left ventricle was accidentally punctured leading to near‑exsanguination. This report is to highlight the need for experienced physicians to supervise the procedure and train the younger physician in the safe performance of the procedure.

Wound management and vaccination following animal bite: a study on knowledge and practice among people in an urban area of Pondicherry, India.

Background: Correct wound management and vaccination following animal bite prerequisite for prevention of rabies. Objective: To find out knowledge and practice about the correct wound management and vaccination following animal bite among the individuals in a selected urban area of Pondicherry. Methods: This explorative study was conducted in the field practice area of a tertiary care institution in urban Pondicherry. A total of 156 individuals one each from 156 households were selected and included after obtaining verbal informed consent. Using a pretested semi structured questionnaire, we obtained information on knowledge about wound care following animal bite and vaccination against rabies, and details of animal bite to any household members anytime in the past. Results: Only 19% of the respondents could name “Rabies” as the cause of death following animal bite. All the respondents had known about immediate initiation of anti-rabies vaccine following animal bite and its free availability in government hospitals. However, only one third of the respondents were aware of immediate washing of wound with soap and water following animal bite. The last one year incidence of animal bite was found to be 0.87% (6/682). Majority of the animal bite cases belonged to Class II (58%) and, involved dogs (88%), males (79.2%) and people from low socio-economic status (96%). All the individuals with animal bites had initiated anti-rabies vaccine within 24 hours of bite, however only two third had washed their wound with soap and water immediately following animal bite. About 17% of the animal bite victims had applied oil or turmeric over the wound. Conclusions: Incorrect immediate wound care following animal bite is a concern for prevention of rabies in this area. Health education should be strengthened on certain aspects like disease causation, wound care following animal bite and before coming in contact with a health facility to this population.

Iron-Folic Acid Intake Among Pregnant Women in Anumanthai PHC of Villupuram, Tamil Nadu.

Background: Prevalence of anemia in India is among the highest in the world. Apart from other causes of anemia, iron or folate deficiency is the most common cause, especially during pregnancy. Although, supplementation of diet with iron and folic acid (IFA) tablets has been a part of the Ministry of Health and Family Welfare Program for over three decades, levels of IFA intake during pregnancy remain low. Material and methods: A descriptive study was conducted among 132 postnatal women registered in Anumanthai primary health center (PHC), Villupuram, Tamil Nadu, catering to a population of 56,142 through eight subcenters to explore factors affecting compliance to IFA. One hundred thirty-two postnatal women were interviewed after taking informed consent in local language using a pretested structured proforma. Statistical analysis was done using SPSS Version 16. Results: Majority of the study subjects (134; 98%) were in the age group of 20-29 years. First-trimester registration was 99.4% and 99.3% received at least three antenatal visits at the PHC. Fifty-four (40%) of the study subjects did not consume any IFA tablet at all. Only 31.1% of the study subjects were aware that IFA tablets should be consumed for 100 days. About 25.9% consumed at least above 90 IFA tablets and only 5.9% consumed more than 100 IFA tablets. Nausea and vomiting 85 (63%) and counseling by village health nurse 115 (89%) were reported to be the most common hindering and facilitating factors, respectively. Conclusion: Despite high rates of antenatal visits, the intake of IFA was low.

Use of Insecticide-Treated Bednets in an Urban Coastal Area of Puducherry, India: A Cross-sectional Study.

Use of Insecticide-Treated Bednets (ITNs) has been shown to reduce the incidence of mosquito-borne diseases. However, the impact of ITNs depends on its community acceptance. We studied the ITN usage and factors infl uencing it, following the distribution of one ITN to each family in an urban area of Puducherry. Around 93.6% of the 157 respondents surveyed were aware of mosquito-borne diseases. Coils and vaporizers were used in 91.1% of the families. Around two-fi fths (41.3%) of the 116 families who received the ITNs used it regularly with another 5.1% using it irregularly. Majority of the users (85%) reported reduced mosquito bites and pleasant sleep after use. Small size of ITNs was the most common reason for non-use (46.3%). Families not using normal bed nets at the time of distribution of ITNs were unlikely to use ITNs at present (odds ratio = 5.22, P < 0.001). Therefore, ITN size should be increased and distribution in urban settings should accompany behavior change communication.

Assessment of village water and sanitation committee in a district of Tamil Nadu, India.

A descriptive study was conducted among 75 members of five Village Water and Sanitation Committees (VWSCs) and 15 local residents in Tamil Nadu, India to assess committee's formation and decision making process. There were 64% females and rest were males, all aged between 20 years and 45 years. A total of 50.7% of them passed 12 th standard and 29.3% belonged to self-help groups. Although, all of them were aware about presence of guidelines, none of them knew its contents. About 20% opined that meetings were not being conducted regularly. All members said that they had problems in attending meeting regularly, take decisions if at least 10 (67%) members are present and fund was not adequate for 1 year period. One-third of local residents did not know the committee formation process and none of them aware about guidelines. Formation and decision making process of VWSC should be improved to tackle the sanitation problem.

Determinants of low birth weight: A case control study in a district hospital in Karnataka.

A Case-control study was conducted in District Lady Goschen hospital, Dakshina Kannada district, Southern Karnataka. Subjects were mothers who underwent normal delivery and their neonates. A total of 150 cases and 300 controls were selected. Significant risk factors identified in univariate analysis included pre pregnancy maternal weight (<45 kgs)(OR=6.77), anaemia in pregnancy (Hb<11gm%) (OR=3.11), age less than 20 years (OR=2.96) and maternal height (<145 cms) (OR=2.79). Multiple logistic regression analysis revealed that pre pregnancy maternal weight (<45 kgs)(OR=7.02), anemia in pregnancy (OR=4.37) and maternal age less than 20 years (OR=3.96) were the significant risk factors of low birth weight of term babies. The strategy needs to focus attention on nutrition education to facilitate better weight gain during adolescent period. Discouraging teenage pregnancy is also essential in order to reduce the burden of LBW babies.

Trend of tuberculosis cases under DOTS strategy in Dakshina Kannada district of Karnataka, India: issues and challenges

Tuberculosis remains a worldwide public health problem and India accounts for highest TB burden in the world. The aim of the study was to evaluate the trend and treatment outcome of tuberculosis [TB] cases treated under DOTS strategy at a district level in Karnataka, India. This was a Retrospective record based study conducted in Dakshina Kannada district of Karnataka, during January 2007 to April 2007. Patients registered for treatment in the entire district since its inception in 2003 to 2006 were considered for analysis. Totally, 7620 patients were treated under DOTS strategy. Of these, 3308 cases [43%] were found to be new sputum smear positive for acid-fast bacilli [AFB]. The case notification rate has increased from 55% in 2003 to 85% in 2005. The incidence of new sputum positive TB cases were maximum among productive age group [15-44 years] and was significant [X[2]= 150.08, P=< 0.001]. Males constituted 70% of the total new sputum positive TB cases and the difference seen in males and females was also statistically significant [X[2]= 551.254, P< 0.001]. Defaulter cases have been increasing among new smear positive cases and this was statistically significant [X[2]=4.9, P= 0.03]. The cure rate is declining along with the increasing default rate among new smear positive cases over a period

Prevalence of overweight and obesity among preschool children in semi urban South India.

This study was conducted to ascertain the prevalence of overweight and obesity in 425 pre-school children (2 to 5 years) using the new Child Growth Standards released by the World Health Organization. Overweight and obesity were defined as body mass index (BMI) > 85th and 95th percentiles for that age and sex, respectively. The prevalence of overweight and obesity was 4.5% and 1.4%, respectively.

Congenital cholesteatoma tract presenting as a postaural swelling

The authors report a case of a three-year old boy, who presented with discharge from the site of a previously excised postaural lesion reported to have been an epidermoid cyst. It was found at operation that he had a fistulous connection between the site of the excised lesion and a congenital cholesteatoma sac in the mastoid bone. This case demonstrates the rare occurrence of congenital cholesteatoma eroding through the mastoid bone to the subcutaneous tissues and mimicking an epidermoid cyst. Such a presentation in a child has not previously been reported in the literature. The clinical, radiological, surgical and histological features of this case are discussed