Barriers and Enablers of Professional Help-Seeking for Common Mental Health Concerns: Perspectives of Distressed Non-Treatment Seeking Young Adults.

Despite a high prevalence of common mental health concerns, especially among young adults, majority of them do not seek professional help. This study explored perceived barriers and enablers of professional help-seeking for common mental health concerns among distressed non-treatment seeking young adults in the urban Indian context. The study utilized an explanatory sequential mixed methods design. A brief survey was conducted with distressed non-treatment seeking young adults (N=37) to assess their current distress level, duration, perceived severity, effect on functioning, self-help methods, past treatment history, inclination to seek help and barriers to professional help-seeking. Semi-structured interviews were conducted with a sub-sample of 10 participants to explore their perceived barriers and potential enablers of professional help-seeking. Quantitative data were analyzed using descriptive statistics and interviews using thematic analysis. The survey revealed significant distress for 75.7% (N=28) of the total sample. Out of these, 25% were either not inclined or had practical constraints to seek help. The mean score for inclination to seek help was highest for partner/friend (4.7). Qualitative findings have been discussed under personal and general barriers and enablers. This is the first study to highlight the complex interplay of barriers and enablers of professional help-seeking among distressed non-treatment seeking young adults in the urban Indian context. There is an urgent need to incorporate the factors that hinder and facilitate professional help-seeking while devising help-seeking interventions to reduce the treatment gap.

Challenges to Mental Wellbeing, Perceived Resources, and Felt Needs During COVID-19 Among College Youth in India.

COVID-19 has significantly impacted the mental health and well-being of college youth across the world. An online survey using checklists and open-ended questions was shared across various institutions in India to capture information about challenges faced, internal and external resources utilized to deal with the stress, existing support systems and suggestions for additional support for maintaining well-being by college youth. Thematic analysis was conducted to understand the emergent themes. Findings suggested that the most challenging aspect of the pandemic was worry about academics, career, and health of loved ones. The most useful self-management strategies to deal with stress were pursuing hobbies, learning new things, spending time with family, sharing concerns and positive self-talks. The students suggested more robust academic as well as mental health support mechanisms at the university level. At the community level students highlighted the need for community based mental health programs and more support from families. This is one of the very first exploratory studies on the potential mental health impact of the pandemic on Indian university students.

Ostial left main coronary artery chronic total occlusion presenting as chronic stable angina

Significant left main coronary artery (LMCA) disease is found in 5–6% of all patients undergoing coronary angiography. It usually presents as acute coronary syndrome and is commonly associated with multi-vessel coronary artery disease (CAD). Complete occlusion of LMCA is a much rarer finding, since these patients usually present as unstable angina, myocardial infarction and cardiogenic shock. We report a case of a young female, who presented with chronic stable angina and had an isolated chronic total occlusion (CTO) of LMCA with no lesions in the other coronary arteries. Aortogram failed to demonstrate the stump of occluded LMCA and demonstrated the filling of the left coronary system from the right coronary artery. Apart from dyslipidemia, she had no other risk factors for CAD. She was extensively evaluated for non-atherosclerotic causes of LMCA CTO including vasculitis. She underwent coronary artery bypass graft successfully without any peri-procedural complications.

Atypical mucocutaneous involvement with Leishmania donovani.

Mucocutaneous leishmaniasis has rarely been reported from India. The usual causative organisms of this infection are Leishmania braziliensis and L. tropica. Another species, L. donovani, which usually causes visceral leishmaniasis, has recently been reported to cause mucocutaneous disease in a few patients from Sri Lanka. We report two patients who had undiagnosed chronic skin lesions for several years. Skin biopsies revealed Leishmania and the species was characterized as L. donovani in both patients. There was considerable improvement in the skin lesions following treatment with liposomal amphotericin B.

Implications of free radicals and antioxidant levels in carcinoma of the breast: a never-ending battle for survival.

BACKGROUND: Under normal circumstances, there is a steady balance between the production of oxygen derived free radicals and their destruction by the cellular antioxidant system inside the human body. However, any imbalance between the levels of these oxidants and antioxidants might cause DNA damage and may lead to cancer development. The aim of this study was to evaluate the level of antioxidants and free radicals in blood and tissue of cancer patients and compare these levels at different TNM stages to derive the possible role of free radicals and antioxidant enzymes in the etiology of breast cancer. MATERIALS AND METHODS: This study includes 30 patients suffering from cancer breast and 20 patients as controls who had benign breast diseases. Circulating lipid peroxide (Malonyldialdehyde [MDA]) levels and activities of the defensive enzymes (Superoxide Dismutase [SOD] and Catalase [CAT]) were estimated in the blood and breast tissue of these patients. RESULTS: Increased levels of free radicals and low levels of antioxidants were observed in malignant tissue. An elevated lipid peroxide concentration was found in the tissue of all the cancer breast patients as evidenced by an increase in the mean MDA level seen with increasing TNM stage of carcinoma breast. Levels of antioxidants SOD and CAT were decreased in cancer patients. CONCLUSION: The results of our study suggest that free radical activity is enhanced in cancer breast patients while the antioxidant defense mechanism is weakened. This activity is enhanced with the increasing severity of cancer as depicted in different TNM stages of breast cancer.

Rosai Dorfman disease--a clinico-pathological presentation.

Rosai Dorfman disease (RDD) or sinus histiocytosis with massive lymphadenopathy (SHML) is a rare disorder that typically manifests as lymphadenopathy and systemic symptoms. The authors report a 45 year old lady who presented with nasal mass and generalised lymphadenopathy. Histopathological examination demonstrated lymphophagocytosis (emperipolesis) consistent with a diagnosis of RDD. The clinical and histologic aspects of the disease are discussed as a rare cause of generalised lymphadenopathy.

Portal hypertension in sarcoid liver disease with hypomelanotic skin involvement.

Portal hypertension due to sarcoid liver disease is a rare entity. We report the case of a 50-year-old female with sarcoid liver disease leading to portal hypertension. The literature on portal hypertension due to hepatic sarcoidosis has been reviewed and the role of steroid therapy discussed.

Demasking of subclinical left ventricular dysfunction in anemic children.

OBJECTIVE: To study subclinical left ventricular dysfunction in anemic children. SETTING: Hospital. SUBJECTS: The study population consisted of 52 cases of anemia (16 mild, 14 moderate, 22 severe) and 20 normal age and height matched children aged between 7-12 years. METHODS: These children were subjected to Echocardiography on Ascuson XP model using 3.5 MHz Transducer during rest and immediately after maximum tolerated exercise on Quniton Model Q-5000 treadmill using modified Naughton protocol. Left ventricular end diastolic dimensions, left ventricular systolic dimension, fractional shortening, left ventricular end diastolic volume, systolic volume, stroke volume and ejection fraction were studied on M-mode echocardiography, and E/A ratio on doppler mode. RESULTS: Significant differences were observed in resting heart rate, gain in heart rate at peak exercise compared to basal values and double product, total exercise duration and metabolic equivalents at peak exercise in controls and anemic subjects. Left ventricular dysfunction was present in all severely anemic subjects after maximum tolerated exercise on treadmill. The only evidence of left ventricular diastolic dysfunction was in form of decreased left ventricular end diastolic volume after exercise in moderate and severely anemic subjects. CONCLUSIONS: Exercise is helpful in demasking subtle left ventricular dysfunctions in anemic subjects that are not detected during rest.

Dielectric relaxation study of glycine and valine in water mixture using picosecond time domain reflectometry.

The complex permittivity of glycine and valine in water mixture for various temperatures and concentrations have been measured as a function of frequency between 10 MHz and 10 GHz using (TDR) time domain reflectometry technique. Dielectric parameters ie. static dielectric constant and relaxation time were obtained from the complex permittivity spectra using nonlinear least square fit method. From the values of relaxation time, thermodynamic parameters were determined.

Dielectric properties of albumin and yolk of avian egg.

The dielectric properties of albumin and yolk of eggs of hen and duck have been investigated using the time domain reflectometry (TDR) technique in the frequency range 10 MHz to 10 GHz at room temperature. The conductivity and pH values were also measured. It has been found that the values of dielectric constant (epsilon s) is lower, while the values of relaxation time tau(ps) are higher than that of pure water possibly due to the bound water present in the yolk and albumin of the avian egg. The dielectric constant for albumin is more than that for yolk of eggs, while reverse is found with the values of relaxation time. Also albumin shows approximately three times higher conductivity than that of yolk. In the case of relatively older (by 2 days) eggs, the dielectric parameters tend to be slightly increased.

Predictors of exclusive breastfeeding in early infancy: operational implications.

OBJECTIVES: To evaluate the independent predictors of exclusive breastfeeding in early infancy. DESIGN: Cross sectional multivariate comparison of different breastfeeding categories. SETTING: Urban teaching hospital Outpatient Department. SUBJECTS: Mothers of 501 children between the age group of 0-6 months were questioned in detail on a standardized pretested proforma about various sociodemographic, parental, infant, feeding related, antenatal and perinatal characteristics likely to affect breastfeeding practices. Mother's height and weight and infant's weight were also recorded. RESULTS: The exclusive breastfeeding, predominant breastfeeding, bottle feeding, ever breastfed and timely first suckling rates were 44.9%, 67.8%, 31.5%, 99.4% and 10.4%, respectively. Amongst the 29 factors subjected to univariate analyses, 16 clinically relevant or significant (p < 0.1) variables were included for multiple logistic regression models. The significant (p < 0.05) positive independent association for exclusive and partial breastfeeding were (OR) infant's present weight (1.45 to 9.64); breastmilk as first feed (1.53 to 2.22); and lower age of child (1.02 to 1.05). Additional important predictors for exclusive breastfeeding versus total top feeding) were (OR) breastfeeding propagation (1.34 and 2.99); less educated mother (1.09 and 1.23); normal vaginal delivery (1.60) and taller mother (1.21). CONCLUSIONS: Breastfeeding propagation plays a key role in promoting exclusive breastfeeding. Other independent negative predictors represent a high risk subset for whom intensive propagation is desirable since these factors by themselves may not be amenable to intervention.

Vertebral compression fracture. An unusual presentation of childhood acute lymphoblastic leukaemia.

Vertebral compression fracture is a rare presenting feature of childhood acute lymphoblastic leukaemia. These cases are often characterized by indicators of good prognosis and show a relatively good treatment outcome.

Alkaptonuria.

A case of alkaptonuria with its various sequelae in the form of ochronosis, ochronotic arthropathy, spondylitis and prostatic calculi is reported. The case is of interest as it presented with hepatocellular failure and hepatitis B surface antigenaemia.