Behavioral Risk Factors of HBV Infection and its Association with HBs Ag Positivity among Residents of Kaza Sub- division of District Lahaul & Spiti in Himachal Pradesh

Background: Chronic viral hepatitis is a major global public health problem, an important cause of morbidity and mortality. We conducted this study to evaluate the behavioral risk factors of HBV infection and its association with HBsAg positivity among residents of Kaza sub-division of district Lahaul & Spiti in Himachal Pradesh. Material & Methods: The study was carried out by the Gastroenterology, Community Medicine, and Microbiology Department at Indira Gandhi Medical College Shimla at Kaza, a subdivision of Lahaul & Spiti. The cluster sampling technique was used to get the desired sample size of 4000. Forty clusters were chosen using a probability proportionate to size sampling method, and 100 research participants were added to each cluster using a simple random sampling method. The data was gathered using a pre-tested interview plan. A blood sample of 5ml from each study participant was obtained, and its HBsAg content was examined. Results: In our study, 2.7% of the interviewed respondents’ parents were positive for hepatitis B and 3.7% reported one positive family member. Injectable drug use was reported by 1.6 (68/4231). Among these users 8.8% (6/68) shared needles with other IDUs in last 12 months and 35.3% (24/68) used a common container to draw up drug solution. Sexual intercourse was reported to be experienced by 15.5 (655/4231) and 12.2% either did not disclose or were children. Out of those who ever experienced sexual/penetrative intercourse 38.3% (251/655) had reported it with someone else other than a spouse. Majority of these had two partners other than a spouse (30.3%; 76/251). Around 30% (195/655) reported of using a condom in their last intercourse. Body piercings or a tattoo from someone who doesn’t sterilize his or her equipment, including local treatment from lamas, was prevalent among 16.3% of the population (689/4231). Acupuncture was taken as a remedy for any medical condition by 9% of participants. Regression analysis also revealed that one infected family member emerged as an independent factor associated with HBsAg positive test after adjusting for confounders. Conclusion: Our study provided much important information concerning hepatitis B risk factors in this tribal group. Health education about behavioral risk factors among this tribal population should be the main intervention that might help limit the spread of these blood-borne infections.

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.

Groundnut as the commonest foreign body of tracheobronchial tree in winter in Northern India. An analysis of fourteen cases.

In Northern India, in an institution like ours which receives quite a number of patients from surrounding rural areas, we found groundnut as the most common foreign body of tracheobronchial tree in children particularly in winter months of October to January. This article attempts to address the potential hazard of groundnut inhalation in children. In Northern India, in an institution like ours which receives quite a number of patients from surrounding rural areas, we found groundnut as the most common foreign body of tracheobronchial tree in children particularly in winter months of October to January. This article attempts to address the potential hazard of groundnut inhalation in children.

Paraganglionoma of extrahepatic biliary tract causing obstructive jaundice.

We report a young woman with paraganglionoma arising from the extrahepatic bile duct presenting with acute obstructive jaundice. The patient underwent excision of the gall bladder and extrahepatic bile duct with the tumor, and Roux-en-Y hepaticojejunostomy. She is asymptomatic 9 months later, with normal biochemical investigations and imaging.

Wegener's granulomatosis: a case with laryngeal involvement.

A patient of Wegener's granulomatosis (WG) with laryngeal involvement and respiratory difficulty has been described. Direct laryngoscopic biopsy led to the diagnosis of Wegener's granulomatosis. The patient underwent a tracheostomy and was subsequently treated with cyclophosphamide and corticosteroids to which he responded.

von Hippel Lindau syndrome presenting as obstructive jaundice with involvement of pancreas in two siblings.

Von Hippel Lindau disease is rare autosomal dominant disorder. In our patient's family, 4 out of 7 siblings had manifestations of the disease; 3 of those affected had pancreatic lesions with obstructive jaundice in 2 siblings caused by pancreatic cysts is reported for the first time.

Effect of adeno-tonsillectomy on hearing threshold and middle ear pressure.

Out of 50 children (100 ears) undergoing adeno-tonsillectomy, 34 ears had hearing threshold 20-50 dB (20 dB is normal) and 32 ears showed negative middle ear pressure of 100 to 400 mmH2O (100 mmH2O is normal). Post-operatively only 7 ears had hearing threshold of 20-30 dB and negative middle ear pressure of 100 to 200 mmH2O. Thus adenoidectomy improves eustachian tube functions.

Course of severe ulcerative colitis in northern India.

Thirty patients with severe ulcerative colitis were studied prospectively. Sixty percent (18/30) of severe ulcerative colitis were in remission after mean duration of 9.2 days (range 2-20 days) of intensive intravenous therapy without major side effects of steroids. Factors predicting poor response to medical therapy on admission are: stool frequency > or = 9 per day, pulse rate > or = 120/minute, temperature > or = 38 degrees C, Albumin < or = 2 gm, mucosal tags on plain x-ray abdomen and pancolitis.

Nasal mucociliary clearance & mucus pH in patients with diabetes mellitus.

Nasal mucociliary clearance (NMC) time and nasal mucus pH were studied in 50 patients suffering from diabetes mellitus and in a group of 50 healthy non-smokers and non-alcoholic controls. NMC time and pH values were found to be significantly increased in diabetics (NMC = 18.02 +/- 5.08 and pH = 7.96 +/- 0.75) as compared to controls (NMC = 7.49 +/- 1.06 and pH 6.43 +/- 0.67). The increase in NMC and pH was much more in patients having insulin dependent diabetes mellitus (IDDM) (NMC - 20.87 +/- 4.71 and pH -8.38 +/- 0.56) than in non-insulin dependent diabetes mellitus (NIDDM) (NMC - 15.16 +/- 3.67 and pH -7.53 +/- 0.687) and also when the duration of disease was more than 10 yr (NMC - 22.36 +/- 4.36 and pH -8.47 +/- 0.607). This impairment was attributed to osmotic diuresis with loss of water and electrolytes from all parts of the body and also small vessel abnormalities encountered in diabetes.

Tuberculosis of middle ear cleft.

Three cases of tuberculosis of middle ear cleft who presented with ear discharge, postaurale swelling post-aural fistula and facial nerve palsy in one case are reported. Audiometry showed conductive deafness in two cases and sensorineural deafness in one case. Roentgenograms revealed bony erosion of the mastoid bone in two cases and coalescence of mastoid air cells in one case. Modified radical mastoidectomy was done in all the three cases and histopathology of tissue removed on operation revealed tuberculosis. All the symptoms except facial nerve palsy improved and post-aural wound healed completely with anti-tubercular therapy. Early recognition and specific therapy may avoid these complications like fistula formation, facial nerve palsy and deafness and may well reduce the need for surgical procedure.