Informed consent in psychiatry outpatients

Background & objectives: Comprehension and process of consent are important for persons with mental illness as they may not be impaired in considering research participation. The American Psychiatric Association developed a detailed Cultural Formulation Interview (CFI). The present study was a part of field testing of CFI, aimed to standardize cultural information affecting the patients' management in India. This paper describes the process and conclusions from the consent-seeking process of this study. Methods: The purpose and procedures about field trial of the CFI were introduced and the patient and caregiver were requested for participation. Consent process was carried out step by step, by reading out the consent form to the first new patient of the day in the psychiatry outpatients department of a tertiary care hospital in north India, inviting questions followed by the 'comprehension' questions. The entire process was audiotaped without any personal identifiers. The process was repeated if not comprehended. Results: A total of 67 patients consented, 11 refused and majority were educated more than secondary school. Some concerns shown by the patients and caregivers included risk of participation, loss or benefits of participation, privacy, etc. All types of mentally ill patients participated in the study. Interpretation & conclusions: Translations of consent forms used simple words, consonant with understanding of the potential participants. Patients' belief that participating in this long process would improve their care, and serve humanity, influenced their decision to participate. Except for intoxication and severe psychosis, patients could understand and comprehend issues around consent. Main issues were confidentiality and culture. Our experience in the psychiatry OPD refutes the commonly held belief that mentally ill persons lack comprehension and ability to consent.

Status of Female Adolescents Living at Rajshahi Slum in Bangladesh.

Objective: To avoid the social consequences of unplanned pregnancy, transmission of STIs and HIV/AIDS, adolescents need to be awaked of their reproductive health. That is why; the study is aimed to know the present status of adolescents in terms of socio-demographic and menstrual management status living in slum areas of Rajshahi City Corporation (RCC), Bangladesh. Materials and methods: The data for this study were collected purposively in 2012 from 200 girls aged 10-19 who were slum living at RCC using a pre-designed questionnaire. The purpose and importance of this study were explained to the respondents before participating in this study. Results and discussion: The result showed that 64% of the respondents were in the group of 18-19 years. Around 9.5% of the adolescents had never gone to school. The maintenance of hygiene during menstruation is a vital aspect of adolescent reproductive health. But the result showed that about 94% of the respondents answered that they do not know the underlying reasons for what menstruation occurred. Only 5% of the respondents maintained some form of hygiene measurements (pad or clean cloth) during the onset of their menstruation. The result also indicated that 24.5% of the respondents felt physical illnesses during their menstruation. Conclusion: The authority should commit to ensuring that the needs, challenges, aspirations, vulnerabilities and rights of adolescents, especially for girls, are fully considered in this new development agenda. Keeping this in mind, adolescent friendly health services should be ensured by arranging special hours or special days for them, orienting and providing training to healthcare providers on how to counsel adolescents.

Study On Harmful Effects Of Opium On Liver And Lungs In Chronic Opium Addicts Of Western Rajasthan.

Background: Today opium dependence is widely prevalent in certain states of India, especially Rajasthan, Punjab, Haryana, Madhya Pradesh (MP) etc. In rural areas of western Rajasthan crude opium is consumed with a social acceptance by a notable proportion (8.0%) of adult male population. Later on they become addicted to it. Objective: to observe the changes in some liver and lung function parameters in opium addicted subjects of Barmer city of Western Rajasthan. Methods:The present study was conducted in district hospital of Barmer, Rajasthan. Total fifty (50) adult male subjects with age ranged from 30 to 50 years were participated in this study. Among them 25 were opium addicted and were considered as study group (Group B) and another 25 apparently healthy adult male of same age group were designated as control group (Group A). Opium addicts were consuming about 5–11 gm/day opium for >2 years. Then liver function tests were evaluated by estimating serum aspartate amino transferase (AST), alanine amino transferase (ALT), alkaline phosphatase and lung function tests by measuring FVC, FEV1 , FEV1/FVC% , PEF, FEF 25-75% of both the groups. Results: In this study AST, ALT and alkaline phosphatase levels were found significantly (p<.05) higher in group B as compared to those of group A. Again, FVC, FEV1, FEV1/ FVC were significantly (p<.05) lower in group B as compared to those of group A. PEF (L/sec) and FEF25-75% were also significantly (p<0.001) lower in group B as compared to those of group A. Conclusion: it is concluded that chronic long term use of opium, increases the risk of hepatic and pulmonary damage.

Vernal keratoconjunctivitis: modes of presentation in Nepalese population.

OBJECTIVE: To determine pattern of clinical presentation in Vernal Keratoconjunctivitis (VKC) in our context. METHODS: Thirty-four VKC patients were included in this study. RESULTS: The study revealed prepubertal onset with male preponderance and most frequently encountered symptom in the study among VKC cases was itching (100%) followed by redness of eyes and discharge (76.5% each) and the commonest sign was tarsal papillae (100%) followed by conjunctival hyperemia (91%) in 68 eyes of 34 cases of VKC. CONCLUSION: The clinical presentation of VKC cases in our country is very much similar to the findings of other parts of the world.

Gastric teratoma in infants--a report of two cases.

Gastric teratoma is an exceeding rare lesion seen most often in male infants. Two cases of gastric teratoma, the first in a three and half month male, and the second in a one year old male child are reported. In the first case, the tumour was more solid, while in the second case it was a solid-cystic mass. These two cases represent the additions to the few, limited, known gastric teratomas reported in the world literature.

Patterns of immunoglobulins in the serum of leprosy patients.

There have been considerable variations in the levels of immunoglobulins in the serum of leprosy patients which needed elucidation. An attempt has been made in this direction to find out the levels of IgG, IgM and IgA in the serum samples of 145 cases of various grades of leprosy. The patients were selected in the age group of 11 to 60 years and have received treatment with DDS from a period ranging from 6 months to 5 years. A constant increase in the levels of immunoglobulins has been noted and the effect of treatment over variation in the levels has been discussed.