Indian Academy of Pediatrics Consensus Guidelines on Prevention and Management of Suicidal Behavior in Adolescents

Justification: Suicide is an important cause of adolescent mortality and morbidity in India. As pediatricians are often the first point of contact for adolescents and their families in the healthcare system, they need guidelines to screen, assess, manage and prevent adolescent suicidal behavior to ensure survival, health and mental well-being of this vulnerable population. Objectives: To formulate guidelines to aid pediatricians for prevention and management of adolescent suicidal behavior. Process: Indian Academy of Pediatrics, in association with Adolescent Health Academy, formed a multidisciplinary committee of subject experts in June, 2019 to formulate guidelines for adolescent suicide prevention and management. After a review of current scientific literature and preparation of draft guidelines, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by refining of draft guidelines, and discussions over e-mail where suggestions were incorporated and the final document was approved. Guidelines: Pediatricians should screen for mental distress, mental disorders and suicidal and para-suicidal (non-suicidal self-injury) behavior during adolescent health visits. Those with suicidal behavior should be referred to a psychiatrist after providing emergency healthcare, risk assessment, immediate counselling and formulation of a safety plan. Pediatricians should partner with the community and policymakers for primary and secondary prevention of adolescent suicide.

Effectiveness of Foot Reflex Therapy in Post-Operative Pain among Patients Subjected to Major Abdominal Surgery

Most patients experience post–operative pain and it is unavoidable. It is the duty of the nurses to ensure that patients' pain is assessed and managed effectively when they are at the hospital. Foot reflex therapy is one effective way nurses can adopt to manage the patient with pain after surgery. We wanted to evaluate the effectiveness of foot reflex therapy on post-operative pain in patients who are subjected to major abdominal surgery. METHODSThis is a descriptive randomized control study that was conducted at Sri Ramachandra Medical College and Hospital, among 360 patients who underwent major abdominal surgery. They were equally divided into two groups as control and study groups and the results were analyzed statistically. RESULTSMajority of the patients in the study group showed a positive effect on pain control during 4th and 5th [ (Mean: 1.27 with SD: 1.12) (Mean: 0.03with SD: 0.32) at p < 0.001] post-operative day following foot reflex therapy. CONCLUSIONSThe existing pain and the post-operative pain can be managed by nurses, patients, their care takers or families together, whenever appropriate, in a multidisciplinary manner. Foot reflex therapy is one such alternative complementary therapy which the nurses can adopt to implement the techniques independently.

The Effect of Yogic Practices and Siddha Treatments for Lumbar Spondylosis: A Case Report

Lumbar spondylosis is the degeneration of the spinal column from any cause. In the more narrow sense, it refers to spinal osteoarthritis. Yoga is an art and science of healthy living. It is one part of the Siddha system. It develops into a separate field and treating diseases. As per yogic scriptures, the practice of yoga leads to the union of individual consciousness with that of the Universal Consciousness. This is a case of lumbar spondylosis treated with yoga asana and Siddha medicine in an OP set up. The patient was given Siddha medicine in the form of internal oral and topical application. The present case report showed promotive effects of Siddha and yogic intervention on lumbar spondylosis.

Sonographic Evaluation of Spectrum of Breast Diseases-A Study in a Tertiary Care Hospital of Southern Tamil Nadu

Background:Breast carcinoma has become one of the leading causes of death among women. Early clinical detection of breast carcinoma through screening has led to the detection of the tumor at a relatively earlier clinical stage, which definitely reduced the mortality. Breast ultrasonography (US) has gained widespread acceptance as a diagnostic tool for the evaluation of human breast disease and the ultrasound guided fine needle aspiration biopsy (FNAB) as the preferred method of tissue sampling. The present study aims to observe the diagnostic accuracy of US, in the assessment of breast masses compared to pathologic findings. Methods: This analytical, retrospective study was conducted on 246 patients that were referred for US scan in a tertiary care hospital of southern Tamilnadu, between January to December 2017. 110 breast masses from 246 patients were evaluated with US & US guided FNAB. BI-RADS US criteria combined with pathological findings were correlated in differentiation between benign and malignant masses. Sensitivity, Specificity & Accuracy were derived for US. Results:In our study the Sensitivity, Specificity, Positive predictive value (PPV) & Negative predictive value (NPV) of US, in detecting malignant breast nodule, was found to be 94%, 97.67%, 98.43% and 91.30% respectively. The overall accuracy of US in detection of benign & malignant breast nodule was found to be 95.45%. Conclusions: BI-RADS criteria combined with US guided FNAB, well correlated with pathological findings, increases the rate of detection of Breast cancer and reduces the number of unnecessary surgical & radiological procedures and the overall cost of medical care

Utility of CD200 expression and CD20 antibody binding capacity in differentiating chronic lymphocytic leukemia from other chronic lymphoproliferative disorders

Background: Chronic lymphoproliferative disorders (CLPDs) are heterogeneous group of disorders with variable clinical presentations and outcomes. Therefore, accurate classification is crucial for treatment planning. At present, flow cytometry immunophenotyping (FCM-IPT) is a useful tool for diagnosing these diseases. However, overlapping immunophenotypes do exist. Recently, differential expression of CD200 and variation in number of CD20 antibody bound per cell (ABC) in different CLPDs has been reported. Materials and Methods: Seventy-seven CLPD cases were analyzed by FCM-IPT for CD200 expression, and Quantibrite bead was used to calculate CD20 ABC. Results: Variability in CD200 expression can help in the differentiation of chronic lymphocytic leukemia (CLL) and hairy cell leukemia (HCL) from other CLPDs. CD200 was brightly expressed in 100% CLL cases, having homogenous bright (2+) intensity. On the contrary, CD200 was uniformly negative in all Mantle cell lymphoma cases except 1, in which the intensity was dim, and the mean fluorescence intensity was significantly lower than CLL. Furthermore, all HCL cases showed bright expression of CD200, thereby making it useful in differentiation from other CLPD with villous lymphocytes. Evaluation of CD20 ABC showed that it differs among various CLPD and was significantly lowest in CLL and highest in HCL both on peripheral blood and bone marrow samples. Conclusion: Our results support the fact that CD200 can be added to routine CLPD panel as it is useful in subcategorizing them. However, inclusion of CD20 ABC to routine panel does not seem plausible but may be done for difficult diagnostic cases or where anti-CD20 therapy is planned.