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.

Obstructive Lung Disease as a Complication in Tuberculosis Survivors: Fate of Tuberculosis

Background: Successful treatment of TB confirming the bacteriological clearance from involved site or completion of chemotherapy does not assess structural and functional effects on the involved organ. This study has been conducted to assess the post tubercular sequelae in cured pulmonary tuberculosis patients. Methods: It was an observational hospital based study conducted on about 120 patients attending or being admitted in the department of Pulmonary Medicine after fulfilling the inclusion criteria India to assess the post tubercular sequelae by using spirometry. Results: Out of 120 patients, 20 patients were excluded from the study as they could not perform the test at all. Hence a total of 100 patients were finally enrolled in the study. The prevalence of pulmonary impairment was only 32% with predominant lung function abnormality being obstructive pattern. Conclusion: Out of 120 patients, 20 patients were excluded fromthe study as they could not perform the test at all. Hence a total of 100 patients were finally enrolled in the study. The prevalence of pulmonary impairment was only 32% with predominant lung function abnormality being obstructive pattern.

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.

Prospective study of radiation related adverse events and its management in cancer patient at tertiary care teaching hospital

Background: Radiation therapy is associated with certain adverse events which may cause significant discomfort to patient and may affect patient’s life. The objective of the study was to assess radiation related adverse events in the patients who are on radiation therapy and to prevent and manage these adverse events.Methods: A prospective observational study was conducted on 193 patients receiving radiotherapy in Oncology Department at Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab. One fraction (2 Gray) dose had been given to patients daily for five days in a week and monitor. The collected data was analyzed by applying IBM SPSS v21.Results: The clinical results observed in 193 consecutive patients with follow-up of 7 weeks and graded according to RTOG Acute Radiation Morbidity Scoring Criteria. Majority of events were reported in age group of 41-60 years followed by 61-80 years, 20-40 years. Epidermal, mucosal, Genitourinary and Lower G.I. reactions are graded. The reactions managed by providing symptomatic treatment.Conclusions: Radiation related adverse events have been found frequently in patients with radiotherapy and chemo-radiotherapy both. As the number of doses increase with time the grade of reactions also increases. Appropriate follow-up and management of these events reduces patient burden of treatment.

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.

Comparison of the Oswestry Disability Index and Magnetic Resonance Imaging Findings in Lumbar Canal Stenosis: An Observational Study

STUDY DESIGN: Cross-sectional study. PURPOSE: The aim of the study was to determine relationship between the degrees of radiologically demonstrated anatomical lumbar canal stenosis using magnetic resonance imaging (MRI) and its correlation with the patient's disability level, using the Oswestry Disability Index (ODI). OVERVIEW OF LITERATURE: The relationship between the imaging studies and clinical symptoms has been uncertain in patients suffering from symptomatic lumbar canal stenosis. There is a limited number of studies which correlates the degree of stenosis with simple reproducible scoring methods. METHODS: Fifty patients were selected from 350 patients who fulfilled the inclusion criteria. The patients answered the national-language translated form of ODI. The ratio of disability was interpreted, and the patients were grouped accordingly. They were subjected to MRI; and the anteroposterior diameters of the lumbar intervertebral disc spaces and the thecal sac cross sectional area were measured. Comparison was performed between the subdivisions of the degree of lumbar canal stenosis, based on the following: anteroposterior diameter (three groups: normal, relative stenosis and absolute stenosis); subdivisions of the degree of central canal stenosis, based on the thecal sac cross-sectional area, measured on axial views (three groups: normal, moderately stenotic and severely stenotic); and the ODI outcome, which was also presented in 20 percentiles. RESULTS: No significant correlation was established between the radiologically depicted anatomical lumbar stenosis and the Oswestry Disability scores. CONCLUSIONS: Magnetic resonance imaging alone should not be considered in isolation when assessing and treating patients diagnosed with lumbar canal stenosis.

Micronutrients and superoxide dismutase in postmenopausal women with chronic periodontitis: a pilot interventional study

PURPOSE: The study was aimed at investigating changes in periodontal parameters and superoxide dismutase activity triggered by root surface debridement with and without micronutrient supplementation in postmenopausal women. METHODS: Forty-three postmenopausal chronic periodontitis patients were divided into two groups: group 1 (n=22) were provided periodontal treatment in the form of scaling and root planing (SRP) and group 2 (n=21) patients received SRP along with systemic administration of micronutrient antioxidants. Patients in both groups were subjected to root surface debridement. Group 2 patients also received adjunctive micronutrient antioxidant supplementation. Serum and salivary superoxide dismutase (SOD) activity along with periodontal parameters were recorded at baseline and 3 months after therapy. RESULTS: Salivary and serum SOD values significantly (P<0.05) improved with periodontal treatment. Improvement in systemic enzymatic antioxidant status along with reduction in gingival inflammation and bleeding on probing (%) sites was significantly greater in group 2 as compared to group 1. CONCLUSIONS: Adjunctive micronutrient supplements reduce periodontal inflammation and improve the status of systemic enzymatic antioxidants in postmenopausal women.

Concurrent Low Dose Carboplatin with Radiotherapy Versus Radiotherapy alone in Management of Locally Advanced Head and Neck Cancer Patients.

A prospective study was performed to evaluate the efficacy and safety of concurrent chemotherapy with single agent low dose Carboplatin and radiotherapy on survival, functional and quality of life outcomes in locally advanced head and neck cancer patients. Material and Methods : Sixty inoperable, previously untreated locally advanced head and neck cancer patients were planned to be treated with radical radiotherapy 66 Gy with concurrent single agent chemotherapy with low dose Carboplatin 150 mg IV weekly up to 6.3 weeks (Group A) and conventional radical radiotherapy alone (Group B). Results : After completion of therapy in Group A complete response was observed in 19/30 (63%) patient and in control group B in 10/30 (33%).Grade II mucosal toxicities were observed in 40% of cases and 33 % of cases in study and control group respectively. Conclusion : Concomitant single agent chemo radiotherapy with low dose Carboplatin could be a better choice in advanced stage of Head and Neck carcinoma in terms of survival, acceptable toxicities together with enhanced response and quality of life.

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.

Non-familial paediatric colorectal cancers - an 18 years’ experience.

Background: Primary gastrointestinal malignancies constitute only 1% of all paediatric neoplasms. Aim: The aim of this study was to describe our 18 years’ experience with non-familial paediatric colorectal malignancies, outlining pertinent features of diagnosis, treatment and outcome. Methods: 9 patients of non-familial paediatric colorectal malignancies were admitted in PGIMS, Rohtak, Haryana between 1990 and 2008. After the initial surgical management, the advanced cases underwent chemotherapy and radiation therapy where required and were followed up. Results: There were six male and three female patients (age range: 7 to 16 years). Three tumours arose in the rectum, three in the sigmoid colon, one each in the splenic flexure and appendix, and there was one case of diffuse colonic polyposis. All cases presented with obstruction and rectal bleeding. Two cases of sigmoid carcinoma were unresectable and expired 4 months post-surgery. The rest responded to radical resection. Three patients required palliative radiation therapy. Due to the advanced stage, chemotherapy was given to all the carcinoma patients. One patient had local recurrence after 5 months and another developed distant metastasis. The rest are on follow-up and clinically and radiologically disease free. Conclusion: Paediatric colorectal malignancy is a rare entity, usually diagnosed in the later stages, culminating in advanced disease. A majority of cases undergo radical resection due to the advanced stage of presentation. Advanced stages may also require chemotherapy and radiation therapy.

Conversion to hijrah (EUNUCH) is it need based or a crime.

Young boys were allegedly kidnapped and kept under illegal custody for months together. After demoralization had set in due to prolonged confinement, surgery was done on their private parts and female hormones were given to the persons. The converted person were made to wear female garments and performed in groups as a female dancers and earned money while in captivity. After a few years the person approached the police that this heinous crime had been done against their will.

Detection of anti-Proteus antibodies in sera of patients with rheumatoid arthritis.

This study was carried out to determine increased level of antibodies to certain bacteria in rheumatoid arthritis (RA) patients. Fifty RA patients and 25 each of those suffering from osteoarthritis (OA) and healthy controls were tested for antibodies to somatic ('O) and flagellar ('H') antigens of Proteus mirabilis, Escherichia coli, and for antibodies to 'O' antigen of Klebsiella pneumoniae by standard tube agglutination method. Anti-Proteus antibodies against 'O' and 'H' antigens could be demonstrated in 70% and 64% RA cases respectively, and were statistically significant. Antibodies could be demonstrated against E. coli 'O' and 'H' antigens in 86% and 92% RA cases respectively, and were statistically significant. Against K. pneumoniae 'O' antigen, no antibody could be demonstrated in any of RA and OA cases, and healthy controls. Of the 50 RA patients, 30 had raised CRP levels. Antibodies against P. mirabilis and E. coli antigens appeared to be independent from CRP. Thus a specific elevation in the immune response to P. mirabilis and E. coli has been demonstrated in patients with RA from India.