PREVALENCE AND RISK FACTORS OF NON–ALCOHOLIC FATTY LIVER DISEASE IN LEAN INDIVIDUALS: A HOSPITAL BASED STUDY.

Introduction: According to epidemiological studies, NAFLD affects 9% to 53% of India's general population, with a higher frequency among those who are overweight or obese, those who have diabetes, or those who have prediabetes. There is emerging evidence of NAFLD occurring in lean or normal weight individuals. Studies show that between 5 and 34% of lean people have NAFLD. The highest prevalence rates, which were above 30%, were seen in India. Furthermore, Asian men who are slender, healthy, and active have insulin resistance prevalence that is three to four times higher than that of men in the rest of the world. Aim: To access the prevalence and risk factors of NAFLD among lean individuals attending Gauhati Medical College & Hospital with diagnosed Fatty Liver Disease. Materials and methods: A Hospital based Cross sectional study was done. The Gastroenterology department was used to choose the study participants using a purposive sampling method. The sample was made up of all patients with fatty liver disease who visited the gastroenterology outpatient department. The study found that the prevalence of NAFLD in lean individuals is Result: 16.9%. Females are at higher risk (P=0.0313 OR: 0.08316) of developing NAFLD in lean patients. Diabetes (P=0.0260 OR: 3.667) and Hypertension (P=0.0149 OR: 4.189) are significant risk factors. Altered bilirubin levels (P=0.0035 OR: 5.829), lipid profile (P=0.0013 OR: 7.367) and AST/ALT (P=0.0166 OR: 4.321) levels is also associated with NAFLD in lean individuals. NAFLD affects 16.9% of lean Conclusion: people with a BMI under 23. Among the lean population, women have a higher chance of getting NAFLD than men. In the study population, important risk factors for NAFLD include diabetes and hypertension. Patients with NAFLD (BMI <23) are more likely to have abnormal lipid profiles, AST/ALT values and bilirubin levels than non-NAFLD fatty liver patients with BMI <23.

Association of Dietary and Physical Activity Patterns and Hypertension in Western Rajasthan, 2022

Introduction: Hypertension (HTN) is a modifiable risk factor for coronary artery disease, heart failure, cerebrovascular disease and chronic renal failure. HTN affects about 1 billion people globally; by 2025, up to 1.58 billion adults worldwide are likely to suffer from complications of HTN. This study was done to know the diet and physical activity patterns and HTN among the population of three districts of Western Rajasthan. Objectives: To study the dietary and physical activity patterns among the population of Western Rajasthan. and to compare key findings among three districts Pali, Jodhpur and Barmer so that lifestyle changes can be recommended. Methods: A case-control study was done among attendees of NCD clinics of tertiary-level centers in Pali, Barmer and Jodhpur. Hospital Controls were matched to age (± 5 years) and gender Considering the prevalence of HTN to be 20%*, the proportion of exposure in the general population as 0.2, odds ratio to be 2.2, power =80%, alpha=5% sample size is estimated to be 102 cases & 102 controls (from each district). Results: Overall being married (OR= 3.3), having diabetes Cardiac disease (OR= 2.6), excessive salt consumption (OR= 2.7), moderate physical exercise less than 30 minutes (OR=1.9), using oil other than vegetable oil(OR=1.8) , Age >?60 years (OR =1.4) were the key risk factors. It was found that high BMI (BMI>27), consumption of non-vegetable oils (12.7%) was highest in Jodhpur, lack of moderate exercise for at least 30 minutes (81%), lack of sports activity (92%) was highest in Pali, least number of days/week of fruits and vegetables consumption (~1.64 days) was seen in Barmer. Conclusions: Change in quantity of salt consumption and incorporation of moderate physical exercise for >30 minutes was most followed in control of HTN among the attendees of NCD Clinics from the multiple advise given.

A Narrative Review on Priorities of Mental Health Issues among Transgenders: “So Near, Yet so Far”

In recent years there is a rapid rise in coming out of sexual and gender minority adults to their family members and society. Unfortunately, studies on unmet health needs of transgenders with a special focus to mental health is under-researched in India. The current paper aimed to explore about the mental health of transgenders and a literature search was done using PubMed, Google Scholar, and Scopus databases for the following medical subject headings (MeSH) key terms “transgender”, “mental Health”, “social stigma”, “LGBT”, “gender dysphoria”, “genderqueer”, “intersex”, “MSM”, “hijra”, “gay”, “lesbian”, “bisexual”, and “homosexual”. Transgender individuals were found to show high rates of mental health concerns. The most common mental health problems that we have shown in this review article are depression, obsessive-compulsive disorders, generalized anxiety disorders, suicidal attempts and bipolar disorders. Transgender people are at more risk for mental health problems than their heterogenous counterparts. The intervention program to eliminate or reduce these problems needs to be planned carefully, considering all the determinants

Challenges of Second-hand Smoke: Are We Asking the Right Questions?

Second-hand tobacco smoke as defined by WHO is the smoke emitted by a smoker or released from a burnt cigarette or any tobacco product. It is highly prevalent all over the globe but its serious health implications are often neglected by the public and the scientific community alike. Second-hand smoke has everlasting impact on all the body’s major organs, especially among the vulnerable population of children, pregnant ladies, people with chronic diseases and senior citizens. Although India started its war against this menace earlier than other counties, all its efforts remain bootless as its approach and implementation have a wide range of lacunae. This review aims to give a big picture of second-hand smoke, highlighting its pathophysiological changes in the body, socioeconomic impact, various strategies, and the gap that prevents these strategies from finding a favorable result in India. It becomes all the more important to reduce its impact owing to the increase in prevalence among youth reducing their vitality, derailing the society and the nation. It is recommended that the health authorities approach this health problem with utmost seriousness as a laid-back approach could welcome this silent killer’s known and unknown repercussions

Pattern of Psychiatric Emergencies in Children and Adolescents at a Tertiary Care Centre After Onset of COVID-19 Pandemic

Objective: To assess changes in profile of psychiatric emergencies in children and adolescents (aged <19 year) during the coronavirus disease 2019 (COVID-19) pandemic compared to pre-pandemic period. Methods: The psychiatric emergency records were analyzed for the period of April, 2019 – September, 2021 to assess the pattern and profile of mental health emergencies in children and adolescents in the period before and after the onset of the pandemic lockdown (i.e., 23 March, 2020). Results: 379 consecutive child and adolescent psychiatric emergencies were identified, of which 219 were seen after the onset of pandemic. Commonest reason for referral in the pandemic group was attempted self-harm (44.3%). The ICD-10 neurotic, stress-related and somatoform disorders constituted the commonest diagnostic category, similar to pre-pandemic period. A significantly higher proportion (44% vs 28%) of children was prescribed benzodiazepines in the pandemic period, compared to the pre-pandemic period. Conclusion: The average monthly psychiatric emergencies in children and adolescents showed no increase during the pandemic period. Self-harm was the commonest cause of psychiatric referral in emergency services mental health crisis in the younger population.

Treatment effects and lip profile changes following premolars extraction treatment vs fixed functional treatment in Class II division 1 malocclusion: A randomized controlled clinical trial

ABSTRACT Objective: The objective of this two-arm parallel randomized controlled trial was to evaluate the treatment effects and lip profile changes in skeletal Class II patients subjected to premolars extraction treatment versus fixed functional treatment. Methods: Forty six subjects fulfilling inclusion criteria were randomly distributed into Group PE (mean age 13.03±1.78 years) and Group FF (mean age 12.80±1.67 years) (n=23 each). Group PE was managed by therapeutic extraction of maxillary first premolars and mandibular second premolars, followed by mini-implant-supported space closure; and Group FF, by fixed functional appliance therapy. Skeletal, dental, and soft-tissue changes were analyzed using pre and post-treatment lateral cephalograms. Data obtained from this open label study was subjected to blind statistical analysis. Results: Extraction treatment resulted in greater increase of nasolabial angle (NLA: 3.1 [95% CI 2.08, 4.19], p<0.001), significant improvement of upper lip (UL-E line: -2.91 [95% CI -3.54, -2.28], p<0.001, UL-S line: -2.50 [95% CI -2.76, -2.24], p<0.001, UL-SnPog': -2.32 [95% CI -2.90, -1.74], p<0.01) and lower lip position (LL-E line: -0.68 [95% CI -1.36, 0.00], p<0.01, LL-S line: -0.55 [95% CI -1.11, 0.02], p<0.01, and LL-SnPog': -0.64 [95% CI -1.20, -0.07], p<0.01), lip thickness (UL thickness: 2.27 [95% CI 1.79, 2.75], p<0.001; LL thickness: 0.41 [95% CI -0.16, 0.97], p<0.01), upper lip strain (UL strain: -2.68 [95% CI -3.32, -2.04], p<0.001) and soft tissue profile (N'-Sn-Pog': 2.68 [95% CI 1.87, 3.50], p<0.01). No significant difference was observed between the groups regarding skeletal changes in the maxilla and mandible, growth pattern, overjet, overbite, interincisal angle and soft tissue chin position (p>0.05). Premolar extraction treatment demonstrated significant intrusion-retraction of maxillary incisors, better maintenance of maxillary incisor inclination, and significant mandibular molar protraction; whereas functional treatment resulted in retrusive and intrusive effect on maxillary molars, marked proclination of mandibular anterior teeth, and significant extrusion of mandibular molars. Both treatment modalities had similar treatment duration. Implant failure was seen in 7.9% of cases, whereas failure of fixed functional appliance was observed in 9.09% of cases. Conclusions: Premolar extraction therapy is a better treatment modality, compared to fixed functional appliance therapy for Class II patients with moderate skeletal discrepancy, increased overjet, protruded maxillary incisors and protruded lips, as it produces better dentoalveolar response and permits greater improvement of the soft tissue profile and lip relationship.

RESUMO Objetivo: O objetivo desse estudo randomizado controlado paralelo de dois braços foi avaliar os efeitos do tratamento e as mudanças no perfil labial em pacientes esqueléticos Classe II submetidos a tratamento com extração de pré-molares (EP) versus tratamento funcional fixo (FF). Métodos: Quarenta e seis indivíduos que preencheram os critérios de inclusão foram distribuídos aleatoriamente em Grupo EP (idade média 13,03±1,78 anos) e Grupo FF (idade média 12,80±1,67 anos) (n=23 cada). O grupo EP foi tratado com extração dos primeiros pré-molares superiores e segundos pré-molares inferiores, seguida de fechamento do espaço com ancoragem em mini-implantes; e o Grupo FF, com tratamento usando aparelhos funcionais fixos. As alterações esqueléticas, dentárias e de tecidos moles foram analisadas usando cefalogramas laterais pré e pós-tratamento. Os dados obtidos desse estudo aberto foram submetidos a análise estatística cega. Resultados: O tratamento com extrações resultou em maior aumento do ângulo nasolabial (ANL: 3,1 [IC 95% 2,08, 4,19], p<0,001), melhora significativa do lábio superior (Ls-Linha E: -2,91 [IC 95% -3,54, -2,28], p<0,001, Ls-Linha S: -2,50 [IC 95% -2,76, -2,24], p<0,001, Ls-SnPog': -2,32 [IC 95% -2,90, -1,74], p<0,01) e posição do lábio inferior (Li-Linha E: -0,68 [IC 95% -1,36, 0,00], p<0,01, Li-Linha S: -0,55 [IC 95% -1,11, 0,02], p<0,01, e Li-SnPog': -0,64 [IC 95% -1,20, -0,07], p<0,01), espessura dos lábios (espessura Ls: 2,27 [IC 95% 1,79, 2,75], p<0,001; espessura Li: 0,41 [IC 95% -0,16, 0,97], p<0,01), tensão do lábio superior (tensão Ls: -2,68 [IC 95% -3,32, -2,04], p<0,001) e perfil de tecidos moles (N'-Sn-Pog': 2,68 [IC 95% 1,87, 3,50], p<0,01). Nenhuma diferença significativa foi observada entre os grupos quanto às alterações esqueléticas na maxila e mandíbula, padrão de crescimento, sobressaliência, sobremordida, ângulo interincisal e posição dos tecidos moles do mento (p>0,05). O tratamento com extração de pré-molares demonstrou significativa intrusão-retração dos incisivos superiores, melhor manutenção da inclinação dos incisivos superiores e protração significativa dos molares inferiores; enquanto o tratamento funcional resultou em efeito retrusivo e intrusivo nos molares superiores, proclinação acentuada dos dentes anteriores inferiores e extrusão significativa dos molares inferiores. Ambas as modalidades de tratamento tiveram duração de tratamento semelhante. A falha do mini-implante foi observada em 7,9% dos casos, enquanto a falha do aparelho funcional fixo foi observada em 9,09% dos casos. Conclusões: O tratamento com extração de pré-molares é uma modalidade de tratamento melhor do que os aparelhos funcionais fixos para pacientes Classe II com discrepância esquelética moderada, sobressaliência aumentada, incisivos superiores protruídos e lábios protruídos, pois produz melhor resposta dentoalveolar e permite maior melhora do perfil dos tecidos moles e relacionamento labial.

Laron syndrome: A tale of two siblings / Journal of the ASEAN Federation of Endocrine Societies

@#Primary growth hormone (GH) resistance or growth hormone insensitivity syndrome, also called Laron syndrome, is a hereditary disease caused by mutations in the GH receptor or in the post-receptor signaling pathway. This disorder is characterized by postnatal growth failure resembling GH deficiency. Differentiating the two conditions is necessary. We present the cases of two siblings, a 16-year-old female and a 9-year-old male, born from a consanguineous union. Both had normal birth weights with subsequent severe short stature and delayed teeth eruption, with no features suggestive of any systemic illness. Serum insulin-like growth factor 1 (IGF1) and insulin-like growth factor binding protein 3 (IGFBP3) were both low. Suspecting GH deficiency, provocative testing with clonidine was done revealing peak growth hormone >40 ng/mL in both patients. In view of low IGF1 and IGFBP3 and high GH on stimulation, IGF1 generation test was done for both siblings, with values supporting the diagnosis of GH insensitivity or Laron syndrome.

Performance of Fast-Acting Aspart Insulin as Compared to Aspart Insulin in Insulin Pump for Managing Type 1 Diabetes Mellitus: A Meta-Analysis

Background@#No meta-analysis has analysed efficacy and safety of fast-acting aspart insulin (FIAsp) with insulin pump in type 1 diabetes mellitus (T1DM). @*Methods@#Electronic databases were searched for randomised controlled trials (RCTs) involving T1DM patients on insulin pump receiving FIAsp in intervention arm, and placebo/active comparator insulin in control arm. Primary outcome was to evaluate changes in 1- and 2-hour post-prandial glucose (1hPPG and 2hPPG). Secondary outcomes were to evaluate alterations in percentage time with blood glucose <3.9 mmol/L (hypoglycaemia), time in range (TIR) blood glucose 3.9 to 10 mmol/L, insulin requirements and adverse events. @*Results@#Data from four RCTs involving 640 patients was analysed. FIAsp use in insulin pump was associated with significantly greater lowering of 1hPPG (mean difference [MD], –1.35 mmol/L; 95% confidence interval [CI], –1.72 to –0.98; P<0.01; I2=63%) and 2hPPG (MD, –1.19 mmol/L; 95% CI, –1.38 to –1.00; P<0.01; I2=0%) as compared to controls. TIR was comparable among groups (MD, 1.06%; 95% CI, –3.84 to 5.96; P=0.67; I2=70%). Duration of blood glucose <3.9 mmol/L was lower in FIAsp group, approaching significance (MD, –0.91%; 95% CI, –1.84 to 0.03; P=0.06; I2=0%). Total hypoglycaemic episodes (risk ratio [RR], 1.35; 95% CI, 0.55 to 3.31; P=0.51; I2=0%), severe hypoglycaemia (RR, 2.26; 95% CI, 0.77 to 6.66; P=0.14), infusion site reactions (RR, 1.35; 95% CI, 0.63 to 2.93; P=0.77; I2=0%), and treatment-emergent adverse events (RR, 1.13; 95% CI, 0.80 to 1.60; P=0.50; I2=0%) were comparable. @*Conclusion@#FIAsp use in insulin pump is associated with better post-prandial glycaemic control with no increased hypoglycaemia or glycaemic variability.

Swyer syndrome presenting as dysgerminoma: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#Complete gonadal dysgenesis with 46,XY karyotype is a clinical condition characterized by the absence of testicular tissue but typical Mullerian structures in a phenotypically female individual. The condition presents as primary amenorrhoea or delayed puberty. Eventually, malignant neoplasms may arise. We report a case of a 16-year-old patient with Swyer syndrome presenting with primary amenorrhoea and with previous diagnosis four years earlier of a malignant dysgerminoma in the right ovary.

A comparative analysis of surgical outcome in uveitic and non-uveitic steroid–induced glaucoma in children

Purpose: To compare outcomes of surgical management of uveitic glaucoma (UG) and steroid?induced glaucoma (SIG) in children in terms of intraocular pressure (IOP) control, visual acuity, and associations for failure. Methods: This was a retrospective case–control study of consecutive UG (cases) and non?uveitic SIG (controls) in children <18 years of age who underwent surgery between January 2005 and December 2017. Results: Primary trabeculectomy with mitomycin C (MMC) was performed in 12 cases (mean age: 9.2 ± 4.3 years) and 40 controls (mean age: 10.4 ± 3.7 years) (P = 0.33). Primary phaco?trabeculectomy with MMC was performed in 11 cases (mean age: 11.4 ± 4.7 years) and 16 controls (mean age: 10.4 ± 3.4 years) (P = 0.57). IOP control (P = 0.26), visual acuity (P = 0.97), number of glaucoma medications (P = 0.06), and survival rates (49% cases vs. 68% controls at 5 years; P = 0.22) were similar between the two groups following trabeculectomy. Survival rates in the phaco?trabeculectomy group at 5 years were 68% cases vs. 69% controls (P = 0.71). IOP was higher (P = 0.008) and visual acuity was worse (P = 0.02) in cases at the last visit. Associations for failure (univariate analysis) were younger age (OR: 6.29, 95% CL: 1.43, 27.67; P = 0.03) and male gender (OR: 4.79, 95% CL: 1.09, 20.97; P = 0.04). On multivariate analysis, younger age (OR: 11.985, 95% CL: 1.071, 134.153; P = 0.04) remained significant. Preoperative number of uveitic attacks was protective on univariate (OR: 0.75, 95% CL: 0.48, 1.15; P = 0.1) and multivariate analyses (OR: 0.49, 95% CL: 0.24, 0.09; P = 0.04). Conclusion: Outcomes of trabeculectomy between cases and controls were similar in our series. However, phaco?trabeculectomy in pediatric uveitic eye group fared worse than eyes with SIG.

Prevalence of Hepatitis B and Hepatitis C Virus Infection in Patients with Advanced Renal Failure: A Tertiary Care Centre Study from North Indian Population

Abstract: Viral hepatitis (Hepatitis B Virus (HBV) & Hepatitis C Virus (HCV)) related liver disease is a leading cause of morbidity and mortality especially in the patients with advanced renal failure who are treated with dialysis, and this is due to high number of blood transfusion sessions and/or cross contamination from the dialysis circuits. Aims & Objectives: This study aimed to determine the prevalence of HBV and HCV infections in patients with advanced renal failure (ARF). Materials & Methods: A cross-sectional study was done in joint collaboration of Department of Nephrology and Department of Gastroenterology, KGMU, Lucknow, from June 2018 to June 2020 among, CRF patients. Clinical data such as age, gender, duration of dialysis; number of transfusions, Serum sample was collected from each patient. Serological markers for HBV and HCV were determined with ELISA by using commercial diagnostic kits. HCV-RNA and HBV-DNA were determined quantitatively by polymerase chain reaction (PCR) assay. Results: A total 934 patients with advanced renal failure attended the nephrology OPD. Out of 934 patients, 65 (6.96%) patients screened positive for HBV/HCV infection. The results of this study also showed that the prevalence of viral hepatitis infection in the haemodialysis (HD) and without HD patients is 8.25% and 6.3% respectively. Conclusion: It has been found that viral infections, particularly HBV and HCV infections are common in advanced renal failure patients who are on HD.

Estimation of Elder Abuse and its Associated factors in a Rural Area of Gujarat:A community based cross sectional study

Introduction: The Indian population experiencing rapid ageing. By 2050, elderly would be 19.5% of the total population. The increasing elderly in society brings with new social problems having tremendous health impact. Elder abuse is a serious but neglected social problem that has adverse consequence on health. Objective: To measure the prevalence of elder abuse and to determine associated factors of elder abuse. Method: A community based cross sectional study was conducted among elderly population aged 60 years and above in the Piparia village of Vadodara district. A sample of 126 study participants were interviewed to collect data on prevalence of abuse and associated factors leading to abuse. Descriptive and inferential statistics were applied to draw conclusion from collected data. Prevalence of elder abuse was foundResults: to be 28.57%. Emotional abuse was the commonest type of abuse reported. Socio economic status, family type, Tobacco use (Smoke and smokeless) were found to be significantly associated with elder abuse. Conclusion: Elder abuse is prevalent in rural Gujarat. Further evidence is needed to assess the magnitude of the problem and the type of intervention necessary to resolve it.

Orthostatic Hypotension and its Relationship with HbA1c Levels in Patients with Diabetes Mellitus

Introduction: For the diagnosis of diabetes mellitus, various tests are available such as FBS (Fasting blood sugar), PPBS ( Post Prandial Blood Sugar), Oral Glucose Tolerance Test, Random Plasma Glucose Test, HBA1c, etc, of which HBA1c is considered to be the most standard test.1,2 As diabetes mellitus can be asymptomatic initially, it can lead to important complications such as neuropathy, nephropathy, retinopathy, cardiovascular diseases, etc if not detected early.3 Postural blood pressure measurement which diagnoses orthostatic hypotension is a cheap, easy and useful tool to predict HBA1c level even in asymptomatic diabetic patients. Methods: This is a randomized cross-sectional study of 100 diabetic patients attending Medicine OPD or admitted in our tertiary care hospital of South Gujarat. Pretested proforma was used to collect data after taking informed consent. Investigations including blood pressure measured with a standard Sphygmomanometer at the end of 3 min after standing and HBA1c as mentioned in the proforma was carried out. Final analysis has been done with Open EPI and SPSS software. Results: 33% of patients of our study population were found with abnormal orthostatic hypotension. Our data shows orthostatic hypotension is directly associated with high HbA1c, longer duration of DM, and higher value of BMI. No correlation was found between age and gender. Conclusion: Among diabetic patients, high HbA1c, prolong duration of DM and high BMI were associated with abnormal orthostatic hypotension, which can be alarming sign of complications of diabetes mellitus.

A study of clinical and treatment profile of tuberculosis patients attending DOTS centre at Primary Health Centre

Introduction: Tuberculosis (TB) is an age-old disease killing significant number of humans over history and one of the major cause of morbidity and mortality, especially in developing and underdeveloped countries. It killed 1.4 million people annually worldwide in the year 2019. India had 2.69 million cases in 2019, according to TB report 2020. Despite the presence of the programme for it's control, TB continues to threaten the population due to emergence of more and more resistance cases challenging it's elimination. This study reflects the annual burden of tuberculosis in an area served by a Primary Health Centre in Urban Delhi and the treatment outcomes. The records of the patients attendingMethods: the DOTS centre was obtained from the treatment register at Primary Health Centre, Palam, Delhi. The records of patients visiting between April 2020 to March 2021 were included. Data analysis was done on Statistical Package for the Social Sciences (SPSS) version 22 and appropriate statistical tests were applied. The total number ofResults & Conclusion: tuberculosis patients registered from April 2020 to March 2021 were 260. Out of these 260 patients, 155 (59.6%) were pulmonary and 105 (40.4%) were extra-pulmonary. A total of 175 (67.3%) were microscopically confirmed and 85 (32.7%) were clinically/radiologically diagnosed.

ASSESSMENT OF DEPRESSION AMONG ELDERLY PERSONS RESIDING IN CHHATTISGARH

India's “National Policy on older persons” classifies 60 years and above as aged who will constitute 10% of the total population by 2021. It is estimated that depression affects approximately 350 million people worldwide. An increasing geriatric population is associated with rising prevalence of chronic non-communicable diseases; therefore, the magnitude of depression is also expected to grow. Keeping the above background in mind, the present study will be conducted among elderly to determine the prevalence of depression. A cross sectional study was carried among 685 elderly people selected by Cluster Sampling and contacted through house to house survey in urban, rural and tribal areas of Chhattisgarh using a pre designed structured questionnaire i.e. Geriatric depression scale. It was found that 11.8% subjects were having depression, 25.1% were suggestive of depression and 63.1% subjects were not having any depressive symptoms. It is concluded that depression is prevalent among elderly persons residing in tribal area therefore it needs to be identified at an early stage, so that proper interventions can be started at the primary care level to ensure healthy ageing.

Cingulum bundle integrity in schizophrenia with auditory verbal hallucinations: A diffusion tensor imaging tractographic study

Background & objectives: Cingulum bundle (CB) is frequently implicated in schizophrenia; however, its role in specific symptoms of schizophrenia such as auditory verbal hallucinations (AVHs) is less explored. Few studies have reported association between reduced integrity of CB and severity of AVH. Using a symptom-based approach, this diffusion tensor imaging (DTI) tractographic study was aimed to assess and compare the integrity of CB in schizophrenia with AVH, schizophrenia without AVH and healthy controls. Methods: A total of 92 right-handed adult individuals (aged 18-50 yr) were recruited across three study groups. Those with Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) diagnosis of schizophrenia with AVH (group I; n=30) were compared to those with DSM-5 schizophrenia without lifetime AVH (group II; n=32) and healthy controls (group III; n=30; screened using Mini International Neuropsychiatric Interview version-7.0.0. and negative family history). Clinical assessments (groups I and II) included scale for assessment of positive symptoms, scale for assessment of negative symptoms, clinical global impression-schizophrenia and psychotic symptom rating scale. All participants underwent DTI, and quantitative tract-based measurements of fractional anisotropy (FA) were obtained for images using DTI studio version-3.0. Results: All groups were comparable for age, gender, education and severity of illness. Group I had significantly lower FA values in the cingulate gyrus (CG) part of the left CB compared to groups II and III. No significant difference was found between groups II and III. Interpretation & conclusions: The findings of this study suggest that the disruption in the left CB appears to be specific for AVH-positive schizophrenia. The finding is, however, preliminary subject to replication in future studies. Further investigations are needed to understand its relevance in the context of AVH-positive schizophrenia.

A Study of Anthropometric Profile in Children with Congenital Heart Disease

Background: Congenital heart disease (CHD) is commonly associated with protein energy malnutrition (PEM) and failure to thrive in children. Children with congenital heart diseases are commonly malnourished irrespective of CHD. The aim of the study is to assess the effect of CHD on growth and to identify the areas of growth affected with reference to different anthropometric measurements. Materials and Method: A case control observational study was carried out in children aged 0-12 years old with CHD in the Department of Pediatrics, Kota. All patients underwent an anthropometric evaluation (weight, height/length, head circumference, mid-arm circumference) and growth charts (NCHS and WHO) were used accordingly. Results: We had total of 40 patients, 30 (75%) had acyanotic congenital malformation, while 10 (25%) had cyanotic cardiac malformation. Majority, 17(77%) out of 22 cases above 5 years with CHD were underweight. Left to right shunt children with acyanotic malformation were tended to have acute malnutrition and stunting was more severe in children with cyanotic defects, with 100% of them affected. Conclusion: A significantly higher number of children (82%) were underweight and 86% were stunted among children with congenital heart disease. In conclusion it can be stated that children with congenital heart disease have highly measurable significant growth retardation (P<0.05) by student t test.

Non-traumatic myositis ossificans

Myositis ossificans (MO) is a benign, ossifying lesion that usually affects the skeletal muscle. The rare non-traumatic form of MO can cause diagnostic dilemma and management issues. These lesions, however, have similar radiology and histopathological characteristics described in the more frequently encountered traumatic forms. Depending on the stage of the lesion, the inherent feature of myositis ossificans varies, and so does the management of the lesion. We describe a non-traumatic MO occurring in latissimus dorsi of a young girl and discuss the review of literature on this rare subtype.

Metastatic gallbladder carcinoma presenting as an ovarian mass

Metastatic gallbladder carcinoma to the ovaries is occasional but a recognized entity. It can mimic, clinical and morphologically, a primary ovarian tumor, challenging the diagnosis. We present the case of a patient with a lump in the hypogastrium extending into the right iliac fossa and was found to have abdominopelvic cystic lesion with enhancing solid components and multiple sub-centimetric and ill-defined abdominal lymph nodes. Also, subpleural and parenchymal nodules in the lungs were present. She subsequently underwent a laparotomy. Cholecystectomy was also done due to pre-existing symptomatic biliary lithiasis. The histologic report described the ovarian involvement as metastases from a gallbladder carcinoma. The presentation of ovarian metastases can challenge the diagnosis. Hence, careful evaluation of the digestive tract and judicious use of immunohistochemistry should be considered in patients presenting with ovarian masses.