Study of clinical profile of patients of bipolar mood disorder with and without substance abuse and clinical course variables in the substance abusing bipolar group in one of the tertiary care centre of North India

Background: Bipolar disorder is the sixth leading cause of disability worldwide and has a lifetime prevalence of about 3% in general population. In patients with bipolar disorder there was 58 % lifetime prevalence of co-occurring alcohol abuse and a 38 % lifetime prevalence of co-occurring other substance abuse. Substance abuse interferes with treatment and management approaches of the bipolar disorder.Methods: A cross sectional observational study of 120 male patients divided in substance abusing (60) and non-substance abusing groups (60) with bipolar disorder according to DSM-V, who met the Inclusion criteria . A written informed consent was obtained from the patients and/ or their family members. Patient’s information was recorded on the socio-demographic and clinical profile sheet .Thereafter, YMRS or HAM-D scales were applied as per the phase of the illness.Results: Most of the patients were between 15-25 years in SAB group and 35-50 years in NSAB group, educated, semiskilled and married. Tobacco abuse was the commonest followed by cannabis and alcohol abuse. The mean duration of hospital stay in SAB group was 41.40 days and in NSAB group was 43.20 days. Dysphoric mania, aggressive behavior and suicidal attempts were more in SAB group. Mean total YMRS score of SAB group was greater than NSAB group.Conclusions: Maximum patients had onset of substance abuse before the onset of affective symptoms. Manic symptomatology was more severe in substance abusing group.

Description of clinical factors for suicide attempts in a tertiary care hospital of northern part of India

Background: Suicide is the result of an act deliberately initiated and performed by a person in the full knowledge or expectation of its fatal outcome. Suicide attempts are a significant public health problem. The present study aimed to explore the variousclinical characteristics of suicideattempters in a tertiary care hospital of Shimla, Himachal Pradesh, a northern state of India.Methods: We conducted a descriptive study among patients with attempted suicide to the department of Psychiatry, Indira Gandhi Medical College (IGMC) Shimla. A structured, self-designed interview schedule and short-form revised Eyseneck personality questionnaire-Hindi (EPQRS-H) was used for data collection. Data was analyzed using Epi info software v 7.2.0.Results: There were total 77 participants in the study out of which 44 (57.1%) were females. Mean age (Standard deviation) of participants was 30.8 years (9.9 years). Relationship problems were the most common (48.1%) recent life event followed by health events (28.6%). Depression was found to be the most common diagnosis (62.3%). Pesticide consumption was the method of attempting suicide in 72.7% of females compared to 66.7% of males.Conclusions: Recent major life events especially relationship problems may lead to majority of suicide attempts. There is urgent need to focus on patients suffering from depression by health personnel as well as family members. The sale of the pesticides should be regulated to keep in check the misuse of the same.

A report on the indoor residual spraying (IRS) in the control of Phlebotomus argentipes, the vector of visceral leishmaniasis in Bihar (India): an initiative towards total elimination targeting 2015 (Series-1).

Background & objectives: Visceral leishmaniasis, commonly known as kala-azar is endemic in Bihar state, India. Current vector control programme in Bihar focuses mainly on spraying the sandfly infested dwellings with DDT. The Government of India in collaboration with WHO has fixed the target 2015 for total elimination of kala-azar. The present study was carried out to see the impact of DDT and improved IEC in the containment of vector density vis-à-vis disease transmission. Methods: Before the start of the spraying operations training was imparted to all the medical and paramedical personnel regarding the methods of spraying operations. Pre- and post-sandfly density was monitored in four selected districts. Incidences of kala-azar cases were compared for pre- and post-spray periods. Social acceptability and perceptions of households was collected through questionnaires from 500 randomly selected households in the study districts. Results: House index in three study districts reduced considerably during post-spray when compared to pre-spray. Kala-azar incidence in many districts was reduced after the DDT spray. Either partial or complete refusal was reported in 14.4%, while 35% were not satisfied with the suspension concentration and coverage; and 46.6% were found satisfied with the spraying procedure. Interpretation & conclusion: Strengthening the IEC activities to sensitise the community, proper training of health personnel, monitoring of spray, good surveillance, proper treatment of cases and two rounds of DDT spray with good coverage in the endemic districts up to three years are essential to achieve the desired total elimination of kala-azar in Bihar state.

Dual culture method to determine the relationship of gut bacteria of sandfly (Phlebotomus argentipes) with promastigotes of Leishmania donovani.

A simple dual culture agar plating technique has been developed and evaluated for its efficiency in determining the relationship of gut bacteria of sandfly with Leishmania donovani promastigotes. There are about twenty morphologically distinct bacterial colonies have been isolated from the gut homogenate of Phlebotomus argentipes. In dual culture method, each bacterial isolate was inoculated in one half of the plate and the promastigotes of Leishmania was inculcated in the other half by streaking. After incubation, the type of association was determined based on the presence or absence of promastigotes colonies. The reliability of this method was compared with broth dilution method in 96 well plate.

Vector control in leishmaniasis.

Indoor residual spraying is a simple and cost effective method of controlling endophilic vectors and DDT remains the insecticide of choice for the control of leishmaniasis. However resistance to insecticide is likely to become more widespread in the population especially in those areas in which insecticide has been used for years. In this context use of slow release emulsified suspension (SRES) may be the best substitute. In this review spraying frequencies of DDT and new schedule of spray have been discussed. Role of biological control and environment management in the control of leishmaniasis has been emphasized. Allethrin (coil) 0.1 and 1.6 per cent prallethrin (liquid) have been found to be effective repellents against Phlebotomus argentipes, the vector of Indian kalaazar. Insecticide impregnated bednets is another area which requires further research on priority basis for the control of leishmaniasis. Role of satellite remote sensing for early prediction of disease by identifying the sandflygenic conditions cannot be undermined. In future synthetic pheromons can be exploited in the control of leishmaniasis.

A pilot study on the status of lymphatic filariasis in a rural community of Bihar.

A pilot study of lymphatic filariasis was conducted in two contiguous villages of Patna district in Bihar situated at the side of the river Ganges, known to be endemic for lymphatic filariasis, to study present status of transmission parameters of filariasis. Of the 1872 persons examined, 8.4% were found asymptomatic but microfilaraemic. Morbidity pattern due to filarial infection showed an increase with advancement of age and significantly high in males as compared to female (p < 0.001). Acute and chronic filarial disease was observed as 0.5% and 9% respectively. Microfilaria was found in 10% of acute and 11.2% of chronic filarial cases. The Mf rate was found to be 9.9% in males and 9.0% in females respectively. The parasite species was identified as W. bancrofti. The vector fauna surveyed show highest prevalence of vector species of Cx. quinquefasciatus (43%) in both domestic as well as predomestic area in the community. Other species like Cx. vishnui and Ma. uniformis were also seen. Each household and predomestic area was searched for mosquito fauna at night. The infection rate in vectors was found to be 14% and infectivity rate (L3) was 8%. The filariasis cases detected in the study were treated with 12 days course of DEC 6 mg/kg body weight.

Acute haematogenous osteomyelitis in children. Retrospective review of 57 cases

Background: To review and share our experience about the management and complications of acute haematogenous Osteomyelitis at our hospital. Methods: 57 children with confirmed diagnosis ofacute haematogenous Osteomyelitis; hospitalised in Rustaq hospital; Oman between March 1998 and April 2005 were retrospectively reviewed. Results: The prevalence of age; sex; bone affected;type of organism isolated and complications were established. Elevated ESR; CRP along with Ultrasonographic changes seen in soft tissues are the most valuable supportive investigations. It wasobserved that early decompression of the bone /soft tissue under cover of combinations of antibiotics led to resolution of disease in majority of patients.. Conclusion: Surgery should be performed withminimal damage of the covering periosteum and soft tissue. Antibiotics should be continued for a period of 6-8 weeks according to sensitivity. Clinician should always keep in mind gram negativeand fastidious organisms in negative cultures for antibiotic selection

Morphological variations in Phlebotomus argentipes (Diptera: Psychodidae) Annandale and Brunetti.

Morphological variations were observed in Phlebotomus argentipes, the vector for visceral leishmaniasis reported from the endemic states of Bihar, West Bengal and Uttar Pradesh. The taxonomic features distinguishing vector and nonvector species of P. argentipes were relative length of ascoid and antennal segment IV. Three morphotypes were characterized as <0.4, = 0.4 and >0.4 respectively. Other characteristics of wing width, wing length, eye, style, antennal segment III, IV, V was found statistically significant (p<0.05) and eleven other morphological measurements were not significant. This study suggests three different morphotypes of P. argentipes in these three endemic states. The genetic and reproductive isolation among such morphotypes will establish the variability in further studies.