Sexual dysfunction among men in secondary care in southern India: Nature, prevalence, clinical features and explanatory models.

Background. Sexual dysfunction, common in general medical practice, is under-recognized and inadequately managed resulting in significant morbidity and reduction in quality of life. We examined the nature, prevalence, clinical features and explanatory models of illness among men with sexual dysfunction in a general healthcare setting. Methods. We recruited 270 consecutive men attending a general health clinic. Participants were evaluated using a structured interview. The International Index of Erectile Function-5, the Chinese Index of Premature Ejaculation-5, Short Explanatory Model Interview and the Revised Clinical Interview Schedule were used to assess sexual dysfunction, explanatory models and psychiatric morbidity. Results. Premature ejaculation and erectile dysfunction were reported by 43.0% and 47.8% of men, respectively. The most common perceived causes were loss of semen due to masturbation and nocturnal emission. Popular treatments were herbal remedies and resources used were traditional healers. The factors associated with erectile dysfunction were diabetes mellitus, financial stress, past history of psychiatric treatment and common mental disorders such as depression and anxiety; those associated with premature ejaculation were common mental disorders, older age and financial debt. Sexual dysfunctions and concerns were under-diagnosed by physicians when compared to the research interview. Conclusion. There is a need to recognize sexual problems and effectively manage them in general medical settings. The need for sex education in schools and through the mass media, to remove sexual misconceptions, cannot be under-emphasized.

Perceptions about anxiety, depression and somatization in general medical settings: A qualitative study.

Background. The recognition rates of anxiety and depression in general medical settings, despite the significant prevalence of such presentations, are low. Psychiatrists argue that the recognition and management of these conditions by physicians is less than optimal in primary care and general practice. We did this study to gain insights into physicians’ perspectives on anxiety, depression and somatization, the conceptual models they employ and the practical problems they face in managing such patients in general medical settings. Methods. Focus group discussions (FGDs) were conducted with family and primary care physicians. The FGDs for physicians were tape recorded and transcribed, verbatim. The views of psychiatrists working in liaison clinics were also ascertained. Results. Family and primary physicians admitted to a high prevalence of patients who present with medically unexplained symptoms. They noted the co-occurrence of psychosocial stress. All physicians working in general medical settings admitted to difficulty in separating anxiety, depression and somatic presentations because of milder, less distinct syndromes and overlapping symptoms. They argued that it was difficult to use the current three-category division and that a more complex classification would be time-consuming and impractical in primary care. Conclusion. Psychiatric classifications for use in primary care should consider the different context and employ physicians’ perspectives rather than push specialist concepts and criteria.

Poverty, social stress & mental health.

While there is increasing evidence of an association between poor mental health and the experience of poverty and deprivation, the relationship is complex. We discuss the epidemiological data on mental illness among the different socio-economic groups, look at the cause -effect debate on poverty and mental illness and the nature of mental distress and disorders related to poverty. Issues related to individual versus area-based poverty, relative poverty and the impact of poverty on woman's and child mental health are presented. This review also addresses factors associated with poverty and the difficulties in the measurement of mental health and illness and levels/impact of poverty.

Portable lead analyzer to locate source of lead.

OBJECTIVE: To investigate the sources of lead in the environment in children with elevated blood, with the help of a Field Portable X-Ray Fluorescence Analyzer. METHODS: One hundred and seven school children were chosen for this study on a random basis, from Mangalore and Karnataka. Their blood lead was analyzed. Of the cases analyzed, 10 students whose blood lead level was more than 40 microg/dl were investigated using a field portable X-Ray Fluorescence Analyzer. This is the first time such a device has been available for this purpose in India. RESULTS: The 'likely' source of lead exposure could be determined in eight cases which was from the immediate environment of the children like 'lead-based' paint on surfaces in the house, on playground and other exterior equipment; lead storage batteries, contaminated dust and soil and other lead-containing substances. CONCLUSION: The use of an X-Ray Fluorescence Analyser appeared to be useful in determining the source of lead.

Explanatory models and common mental disorders among patients with unexplained somatic symptoms attending a primary care facility in Tamil Nadu.

BACKGROUND: Patients with unexplained somatic symptoms are commonly seen in primary care. We assessed the explanatory models and common mental disorders in patients with unexplained somatic symptoms attending a primary care facility in a rural area of south India. METHODS: One hundred consecutive patients diagnosed to have unexplained somatic symptoms attending a primary care facility were examined. The Tamil version of the Revised Clinical Interview Schedule was used to assess common mental disorders and the Tamil version of the Short Explanatory Model Interview was used to assess their explanatory models. RESULTS: Ninety-eight patients thought that their problem was serious. Sixty-nine, 41 and 40 claimed that it affected their work, family and social lives, respectively. Forty-two of the patients believed in black magic. Forty-four patients satisfied the ICD-10 PC criteria for common mental disorders. Depression was the commonest diagnosis (63.6%). Patients with psychiatric diagnoses admitted to emotional problems (chi2 = 46.9; p < 0.001), and felt that their problems affected their family (chi2 = 38.5; p < 0.001), social life (chi2 = 28.6; p < 0.001) and work (chi2 = 34.4; p < 0.001). More patients who satisfied criteria for psychiatric diagnosis felt that their problems were moderate or very serious (chi2 = 21.5; p < 0.001) and they feared they might become disabled or die (chi2 = 12.2; p < 0.001). Psychiatric syndromes were significantly associated with belief in black magic (chi2 = 7.01; p < 0.01). These associations remained statstically significant after adjusting for age, gender, literacy and socioeconomic indices using logistic regression. CONCLUSION: The majority of patients held strong beliefs regarding the physical nature of their complaints, believed In the serious nature of the problem and feared disability or death. There is a need to elicit specific explanatory models regarding the nature of illness in patients who present with somatic symptoms without organic causes. Understanding the patient's perspectives is a prerequisite for providing the necessary treatment and to dispel fears.

'Wine Glass' appearance: a unique MRI observation in a case of primary lateral sclerosis.

Magnetic resonance images (MRI) in a patient with primary lateral sclerosis is described. T2WI, MRI of brain showed characteristic hyperintensities of the corticospinal tracts bilaterally, extending from the internal capsule to the brain stem - producing a 'wine glass' appearance on coronal sections, which has not been described so far to the best of our knowledge. Differential diagnosis of this interesting 'wine glass' appearance on MRI along with a review of the MR-signal abnormalities in motor neuron disease is discussed.

Herbal formulations as pharmacotherapeutic agents.

Herbal medicines are popular as remedies for diseases by vast majority of world's population. Polyherbal preparations are products from medicinal plants. These are considered as safe since they are natural products. Herbal formulations which have reached widespread acceptability as therapeutic agents in India include noortropics, antidiabetics, hepatoprotective agents and lipid lowering agents. Pharmacological effects of many plants have been studied in various laboratories in India. However, there are many limitations regarding safety and efficacy of these preparations. Knowledge about active principles of herbal preparations are not well defined, information on toxicity and adverse effects of these formulations are lacking. Information regarding pharmacokinetics and bioavailability is not available. Packet inserts providing details regarding safety, and warning are not required for sale of these which are available as over the counter preparations. The risk of untested and unregulated remedies should be known to the lay public. Selection of plant material based on quality, standardisation of methods of preparation, enforcement of regulation regarding appropriate labels, are measures which will improve the quality and acceptability of herbal preparations as therapeutic agents. Documentation of research publications in journals and availability of information on website, are other measures to assist research in this field.

Initial experience with in-vitro fertilization technology in the English-speaking Caribbean

This audit documents the first experience with in-vitro Fertilization technology in the English-speaking Caribbean. From 1996 to 2000, 121 cycles have been performed in 99 couples utilizing these techniques. After ovarian stimulation, 1,103 oocytes were retrieved (average 9.1) and of these, 65 fertilized normally, with embryo transfer possible in 111 cycles. Twenty-one pregnancies were recorded (21.2 per patient and 18.9 per embryo transfer) and the live birth rate per patient was 12.1. The trend was for the success rate to be better in patients under age 36 years.

An expert system for the diagnosis of epilepsy: results of a clinical trial.

BACKGROUND: Artificial intelligence is an area where computer systems are used to solve real-life problems that require expert human intelligence. Expert systems serve as an effective alternative to supplement the dearth of human experts in a narrow domain of applications. We developed an expert system named SEIZ using DIAGNOS (an expert system shell for diagnostic applications) for the diagnosis and management of epilepsy. METHODS: A clinical trial was done to test the reliability of SEIZ. The clinical and demographic data from the medical records of 50 patients with epilepsy who attended an epilepsy clinic were provided to the expert system. The system-generated diagnosis was compared with the clinical diagnosis. RESULTS: The seizure types and epileptic syndromes for the 50 patients included generalized -tonic-clonic seizure (14), absence (4), complex partial seizure (18), simple partial seizure (4), juvenile myoclonic epilepsy (5) and other epileptic syndromes (3). There were two cases of hysterical conversion reaction. There was concordance in the diagnosis between the expert system and clinician in 47 cases (94%). The overall sensitivity was 94% and the specificity was 100% for absence, generalized tonic-clonic seizures, simple partial seizures and juvenile myoclonic epilepsy; 94% for complex partial seizures and 98% for hysterical conversion reaction. CONCLUSION: This expert system could generate reliable diagnoses for patients with epilepsy. Such a system may be useful for a doctor in a remote or peripheral area where an expert on epilepsy is not available.

'Face of the giant panda' sign in Wilson's disease: revisited.

We report a patient, with Wilson's disease, who showed the characteristic radiological sign known as 'Face of the giant panda sign' on magnetic resonance imaging (MRI) of the brain.

Characterization of gait parameters in patients with Charcot-Marie-Tooth disease.

The gait of five patients with Charcot-Marie-Tooth(CMT) disease was analyzed using light-emitting diodes and a force plate. The flexion-extension motions of the hips, knees, and ankles, as well as their moments (vector sums of forces acting at the joints) in the flexion-extension and abduction-adduction planes, were quantified. The gait of the CMT patients showed abnormalities consistent with both distal weakness (ankle dorsi- and plantar-flexors) and weakness of the hip abductor muscles. The latter weakness appeared to produce asymmetric hip moments and truncal instability in the mediolateral plane during ambulation. However, the extent to which the gait was abnormal appeared not to be exclusively related to the severity of the sensorimotor conduction deficits in the peripheral nerves. In the four patients for whom nerve conduction velocity studies were available, decrease in the lower-extremity distal conduction velocities and evoked motor amplitude potentials did not correlate with the severity and extent of the gait abnormalities.

A simplified procedure for rapid screening of vibrios for cholera toxin production.

Conventional methods for the detection of cholera toxin (CT) production by vibrios are not readily available to most laboratories. A modification is described here of a simplified method standardised earlier and based on the degradation of nicotinamide adenine dinucleotide (NAD) by CT; this is simple and can be carried out in small laboratories also. It is also easy to perform, and gives reproducible results.

Effects of intranasal challenge with group A beta haemolytic streptococcus M type 49 in Swiss albino mice.

Mice are susceptible to natural infections with streptococci and therefore can serve as suitable animal models to study experimental streptococcal infections. In an earlier study, we had shown the development of pharyngeal colonization, antibody response and histopathological changes in the heart following intranasal (IN) challenge with a rheumatogenic serotype of group A beta haemolytic streptococcus, the M type 18. To determine if nonpharyngitis associated serotypes can also elicit similar responses, 30 Swiss albino mice were challenged intranasally with 2 x 10(7) colony forming units of a skin associated serotype of group A beta haemolytic streptococcus, the M type 49. Pharyngeal colonization varied from 64% (n = 30) in the first week to 69% (n = 16) during the fourth week after IN challenge. Eleven (36.7%) of the 30 animals studied showed antibody response to DNase B (ADNB) with peak titers varying from 150 to 1200 units. Wide variations were seen in ADNB titers in individual mice. Histopathological evidence for cardiac lesions were seen in three animals. The changes were mild and varied from mild to chronic endocardial inflammation to calcification. The study shows that Swiss albino mice are also susceptible to IN challenge with skin associated strains of GABHS and therefore can serve as useful models to study the effects of experimental infection with diverse serotypes of GABHS.

Effect of elevated glucose on contractile and relaxant response of aortic strips in Indian bonnet monkey (Macaca radiata radiata).

Vascular contractile response to phenylephrine and potassium chloride were examined in strips of isolated thoracic aorta from non-diabetic monkeys with and without intact endothelium exposed to glucose (5.5 mM; control) and (11 mM; high) concentration. Acetylcholine causes relaxation in isolated aortic strips with intact endothelial cells while it causes contraction in aortic strips with damaged endothelial cells. In preparations with intact and damaged endothelium, there was a significant increase in the maximal contractile response to potassium chloride when added cumulatively, on exposure to elevated glucose (11 mM) concentration as compared to control. It was also observed that relaxant response to acetylcholine and sodium nitroprusside in control (5.5 mM) and high glucose (44 mM) concentration. Endothelium-dependent relaxation to acetylcholine decreased significantly in the presence of 44 mM glucose. In preparation without endothelium, contraction caused by acetylcholine increased in the presence of glucose (44 mM). Direct smooth muscle relaxation to sodium nitroprusside remained unchanged in aortic strips with and without endothelium. Relaxation response to sodium nitroprusside decreased in strips with damaged endothelium on exposure to high glucose when compared to control glucose.

Pharyngeal colonisation, ADNB response and development of cardiac lesions in mice following intranasal inoculation with group A beta haemolytic streptococcus M type 18.

Swiss albino mice from a randomly bred colony were inoculated intranasally with 1.6, 2 or 2.4 x 10(7) colony forming units of a mid-logarithmic phase culture of group A beta haemolytic streptococcus M type 18 for 3 days, 6 days or once a week respectively for three weeks. Pharyngeal colonisation could be observed in 67 (59.8%) of 112 mice on 4th day after inoculation and 14 (38%) of the 37 mice on 21st day. Out of 27 mice tested for determination of antibodies to deoxyribonuclease B at regular intervals for 98 days, 15 (55.5%) showed responses, with maximum titers varying from 50 units to 4800 units in individual mice. Histopathological evidence for cardiac lesions were seen in five (3.03%) of the 165 animals studied. These included one case of severe endocarditis, two cases of endocarditis with valvular lesions and one case with non-specific lymphocyte infiltration in the heart. One other animal showed subendocardial oval nodular aggregates. Although the cellular nature of these lesions were not determined, this study shows that Swiss albino mice can serve as suitable animal models to study experimental streptococcal infections. However these are preliminary observations and are to be confirmed and revalidated by further controlled experiments.

Mitochondrial myopathies--a clinicopathological study.

Mitochondrial myopathies are heterogeneous group of clinical disorders that can affect multiple systems besides skeletal muscles. The mitochondrial abnormalities in the skeletal muscles are morphologically identified by the presence of characteristic Ragged-red fibers (RRF) in the cryostat sections of the muscle stained with modified Gomori's trichrome stain. In this retrospective study, clinical and histopathological features in six patients with mitochondrial myopathies have been analysed. The utility of histochemical methods in confirming the diagnosis of mitochondrial myopathy has been emphasised.