Psychiatric Co-Morbidities in Couples With Infertility At A Tertiary Care Hospital

Background: Infertility is more prevalent nowadays and affects both males and females. It is an extremely challenging and unpredictable situation with social, interpersonal, and financial consequences. Therefore, it affects psychological health and quality of life of the couple. We assessed psychiatric morbidity and quality of life among couples and the relationship of duration of infertility with psychological burden, along with comparison between primary and secondary infertility. Methodology: 75 couples attending a tertiary care hospital in the age range of 18-45 years fulfilling the criteria for infertility and consenting for the study were interviewed and DASS 21 and WHO-QOL BREF was applied to analyze depression, anxiety, stress, and quality of life. Patients with previous psychiatric illness, intellectual disability was excluded. Results: The mean age of males and females was 29.6 years with 75% couples of primary infertility and 25% of secondary infertility. Females showed a higher range of psychiatric morbidity than males with 56% females and 12.2% males had depression, 56% females and 18.1% males had anxiety, 88% females and 66.7% were stressed. The data was clinically significant for anxiety in males and for stress in both males and females. QOL had scores on the lower side with non-significant association between primary and secondary infertility. Conclusions: Infertility has an impact on psychological health, and it affects females more than males. It also impairs QOL of the couple and hence there is need for an integrated approach to reach favorable outcomes.

Snake Bite Victim Treatment Outcome In Tertiary Care Setting In Kumaon Region Of Uttarakhand

Background: Kumaon region of Uttarakhand has a wide array of snakes. According to national health profile 2016 report on state wise cases and death due to snake bite was 167 and 1 respectively in Uttarakhand 2015 (Jan- December).This led to enquire this statistical disparity in spite of high prevalence of snake bite cases. Aim: To asses treatment outcome of Snake bite victim in tertiary care setting. Material And methods: Outcome was assessed in terms of clinical status at the time of discharge and duration of hospitalization. Results: Dose range of anti snake venom (ASV) for all snake bite victim was 10 -20 vials. 86.36%% case recovered and 13.6% died. Conclusion:Timely appropriate dose of anti snake venom administration has led to better outcome for which transportation of snake bite victim to appropriate health facility with in golden hour is imperative.

Sale and Consumption on Smokeless Tobacco in Jammu and Kashmir, India: Attitude and Views of Jammu Adult Population

Background: Concerned over increasing cases of mouth cancer in the state, the Jammu and Kashmir Government hasbanned the smokeless tobacco (ST) products like gutkha and also increased the taxes in other tobacco-related products.Despite legislation, the effectiveness of this step is a matter of concern. The gutka users are able to get their regular supplyand shopkeepers are still seen selling gutka pouches.Objective: The objective of this study was to assess the attitude and views of Jammu adult population toward the sale andconsumption on ST by Jammu and Kashmir Government.Materials and Methods: A cross-sectional survey was carried out among the general adult population of Jammu city. 400respondents completed a questionnaire on tobacco use, knowledge of existence of law, health warning, cost increase, andhazards related to ST.Results: Half of the current users (51.6%) surveyed compared to the past users (61.4%) and non-users (69.7%) had knowledgeabout laws on gutka products. Significantly higher percentage of the current users (52.1%) and past users (57.9%) indicatedthat the actions against tobacco products would be slightly effective (P < 0.05). 52.5–68.4% of respondents were aware ofhealth warning signs printed on the tobacco packet. 59.1% of the current users reported easy availability of gutka. The pastusers (54.4%) reported an increase in black marketing of ST gutka.Conclusion: The sale and consumption ban and increased taxes by the government are an effective measure for the improvementof health and reduce consumption. They demonstrate that there is a need for greater public education and the policy has beenlagging behind to curb the black market sale.

Study on emerging risk factors of acute myocardial infarction patients in Kumaon region of Uttarakhand, India

Background: Cardiovascular disease is a major global health problem reaching epidemic proportions. Along with the developed nations, underdeveloped and developing countries are now facing this burden. Keeping this in mind various emerging risk factors in patients with documented evidence of acute myocardial infarction attending a tertiary care hospital in the Kumaon region of Uttarakhand were studied.Methods: This study is a prospective study done in the department of Medicine, Sushila Tiwari Government Hospital, Haldwani over a period of 2 years. Patients were enrolled from the Medical Emergency/ OPD who had documented evidence of Acute Myocardial Infarction. Informed consent was taken from each study subject.Results: The mean age was 54.27 years (SD- 13.062). Among the risk factors, high triglyceride is significantly higher in younger patients as compare to older patients. Lipid profile distribution when they compare to any addiction, it has been found in the study that LDL is significantly higher in those who were having any addiction. Hypertension was significantly higher in patients who smoke (p=0.04). The major contributing risk factor was any addiction (smoking, alcohol, tobacco consumption in any form) followed by dyslipidemia.Conclusions: The challenge is to develop appropriate strategies to prevent coronary artery diseases and promote healthy lifestyles.

A Study on Assessment of Family Burden, Quality of Life and Mental Health in Caregivers of Patients with Schizophrenia

Background: Caregivers of patient with schizophrenia face a lot of burden which hampers their quality of life as well as mental health. This study was conducted to evaluate perceived burden of care, quality of life, and mental health in caregivers of schizophrenia patients and to explore the correlation between above parameters and total duration of illness of the patient with schizophrenia.  Methods: The study was conducted at a tertiary care center. Participants were 99 caregivers of the patient with schizophrenia that were screened to ascertain whether they met the selection criteria. Perceived burden was scored by Family burden scale which is a semi structured interview schedule. Quality of life scale (WHO QoL-BREF Hindi version), was used to assess Quality of life. Modified Mini International Neuropsychiatric Interview was used to examine mental health of caregivers. Results: In the present study, total duration of schizophrenia showed statistically significant negative correlation with quality of life of caregiver. In the study, though the correlation between perceived family burden and total duration of schizophrenia was positive but it was not statistically significant. The burden also had statistically significant negative correlation with socioeconomic status and quality of life of the caregiver. The caregivers with high likelihood of mental illness scored significantly higher burden than other two groups. Conclusions: Caregivers of persons with schizophrenia do perceive burden, on account of which and along with lower socioeconomic status they experience poor quality of life and compromised mental health.

Aetiological Spectrum of Acute Renal Failure in Kumaon Region of Uttarakhand.

Background: Acute renal failure (ARF) or acute kidney injury (AKI) is a clinical condition in which rapid decline in glomerular filtration rate over an hour to days. It is an important clinical condition and common cause of mortality in hospitalized patients. Aims: To analyze the aetiological spectrum and outcome of ARF in Kumaon region of Uttarakhand and to compare data with that of other parts of country. Settings and Design: Hospital based observational analytic study. Methods: This study was conducted on patients admitted to Government Medical College & associated Dr. Susheela Tiwari Memorial Hospital Haldwani from November 2011 to October 2012 with ARF irrespective of the cause. ARF was defined according to AKIN criteria. Statistical analysis used: Statistical analysis of data was performed using SPSS V.20.0 (Windows). All data was summarized and expressed as mean ± SD or as percentages as appropriate. The chi square test was used to analyze categorical variables while the student T-test used to analyze normally distributed data. Statistical significance was accepted at p<0.05. Results: Out of 100 patients, 77% had community acquired ARF and 23% had hospital acquired ARF. Medical causes were leading contributors (68%), while surgical causes in 20% and obstetrical causes in 12% of patients. 36% patients required hemodialysis. The overall mortality was 21%, and highest mortality was found in celphos poisoning group (100%). Conclusion: ARF is still common in the community and is associated with high mortality. Aetiologies like acute gastroenteritis, septicaemia, snakebite and malaria were the leading cause of ARF in our study.

Atypical presentation of visceral leishmaniasis (kala-azar) from non-endemic area.

Leishmaniasis is a major public health problem in various part of world; it has also emerged in new geographic areas and host populations. Visceral infection can remain subclinical or become symptomatic, with an acute, subacute or chronic course. Kala-azar, or visceral leishmaniasis (VL), presents as fever, pancytopenia and hypergammaglobulinaemia. The presence of splenomegaly is characteristic of VL. It may be absent in immunocompromised patients, who may present atypically. Absence of splenomegaly is rare in immunocompetent patients, though it may occur in the early stages. Atypical presentations can be challenging to the clinician. This paper presents an atypical presentation of kala-azar, with multiorgan failure in the absence of splenomegaly or fever.

Primary meningococcal polyarthritis in a young man.

We report a rare occurrence of primary meningococcal polyarthritis in a 19-year-old man. The fluid in the elbow joint showed Gram-negative diplococci but the culture was sterile. The diagnosis was confirmed by polymerase chain reaction targeting crgA gene of Neisseria meningitidis.

Imaging in adult patients with acute febrile encephalopathy: What is better computerized tomography or magnetic resonance imaging.

Context: Imaging techniques are commonly used by emergency physicians in a febrile comatose patient. Their utility requires judicious use of the available resources. In this study, we have compared the efficacy of cranial imaging techniques in adult patients with acute febrile encephalopathy. Materials and Methods: This prospective observational study enrolled 101 patients presenting to the emergency with fever of less than 15 days duration and altered sensorium. All the patients were subjected to routine investigations, detailed cerebrospinal fluid analysis, computerized tomograms (noncontrast followed by contrast enhanced), and magnetic resonance imaging of the brain. Final diagnosis was reached after considering the clinical, biochemical findings, imaging results, and response to therapy. The positive yield of radiological investigations was compared against the final diagnosis. Results: The patients were divided into three groups. Forty-eight had evidence of meningoencephalitis, 22 patients had pyogenic meningitis, and 20 were combined together in other group. In 12 patients, a definitive diagnosis could not be made. Only 37% patients were detected to have abnormal computerized tomograms and the most common abnormality was diffuse edema, which failed to point to an etiological diagnosis. Magnetic resonance imaging was abnormal in 62.75% cases and was able to suggest an etiological diagnosis in 100% cases of cerebral venous thrombosis, tubercular meningitis, 95% cases of meningoencephalitis, and 45% patients with meningitis. Conclusions: We can conclude that magnetic resonance imaging provides better information than computerized tomography in adult patients with acute febrile encephalopathy.

Clinico-Radiological Correlation in Childhood Hypopituitarism.

Non-tumor etiology constitutes a major group of childhood hypopituitarism. Magnetic resonance imaging has enormously complimented hormonal assessment in these patients. We describe clinico-radiological correlates in thirtyone children (23 boys), aged 1-17 years with a peak GH (growth hormone) levels <7 ng/mL after pharmacological stimuli. Hypoplastic pituitary gland was the most frequent abnormality in children with isolated growth hormone deficiency (IGHD) as compared to stalk abnormalities in children with multiple pituitary hormone deficiencies. MRI tetrad (hypoplastic/absent pituitary, hypoplastic stalk, absent/ ectopic posterior pituitary bright spot and empty sella) was more prevalent in IGHD. MRI abnormalities correlated with the severity of growth hormone deficiency.

Hypertrophic pachymeningitis: varied manifestations of a single disease entity.

Hypertrophic pachymeningitis is a unique clinical entity characterised by fibrosis and thickening of the duramater with resulting neurological dysfunction. Three cases of this entity are described. Presenting features were headaches and cranial neuropathies in two patients and predominantly cerebellar dysfunction in the third. One of the patients also had evidence of spinal involvement. Lower cranial nerves were chiefly involved in two patients whereas optic nerve was the predominantly affected nerve in one. Except for the presence of rheumatoid arthritis in one of the patients, we could not document clinical or biochemical evidence of any predisposing infective, inflammatory or infiltrative condition in the other two. All three patients had characteristic changes on imaging suggestive of thickened and enhancing duramater. Although variable steroid responsiveness was seen in all the three patients, tendency towards steroid dependence was evident. The clinical presentations, causes, radiological features, management options and differential diagnosis of this unique clinical syndrome have been discussed.