Epidemiological Insights from 1,652 Patients with Spinal Tuberculosis Managed at a Single Center: A Retrospective Review of 5-Year Data

Methods@#Hospital records of spinal tuberculosis patients treated at a single center over a period of 5 years were retrospectively reviewed. A diagnosis of spinal tuberculosis was based on standard clinical, radiological, microbiological, and histopathological evidence. Patients were treated in accordance with the “middle-path” regimen; surgery was reserved for selective indications. @*Results@#A total of 1,652 patients were included. Their median age was 32.4 years, with 53% being male. Axial pain (98%) was the most common presenting symptom; 19% of patients had neurological deficit. Lumbar spine (37%) was the most common site of involvement, with a paradiscal pattern (82%) of involvement predominating. Multi-level involvement was seen in 19% of patients; skip lesions were noted in 2.8%. Transpedicular biopsy was performed in 667 patients; at least one tissue test was diagnostic of tuberculosis in 65% of patients. Forty-four patients had drug resistance to rifampicin. Surgery was required in 10.5% of patients. The “middle-path” regimen was associated with high compliance and significant improvements in pain (Visual Analog Scale score) and function (36-Item Short Form Health Survey). @*Conclusions@#Our findings confirm the widespread prevalence of spinal tuberculosis and describe various epidemiological characteristics of a large sample of spinal tuberculosis patients. Adoption of the “middle-path” regimen is associated with high compliance and favorable outcomes in spinal tuberculosis.

Adapting the stepped care approach for providing comprehensive mental health services in rural India: Tapping the untapped potential

Recent National Mental Health Survey (2015-16) reported a prevalence of 13.7% for any mental disorders excluding tobacco use disorders in India. Translating it into real numbers, nearly 150 million people need active mental health interventions, disproportionately more in rural areas. Major challenges in delivering comprehensive mental health services in rural India are: a) lack of a well-defined strategy; and b) lack of trained mental health manpower. To fill this gap, the global mental health community has increasingly realized the importance of Community Health Workers (CHWs) and role of stepped care approach in mental health service delivery. We propose a model of stepped care approach to fulfil the need of rural India, utilizing the existing health system components for improving mental health knowledge, reducing social stigma for mental disorders, screening for priority mental disorders at community level, ensuring compliance to treatment, timely follow-up, and community-based rehabilitation by mobilising community support for diagnosed cases. This stepped care approach will integrate mental health into Ayushman Bharat’s Health and Wellness Centres (HWCs) for the provision of comprehensive primary health care. Integration of new age technologies such as telepsychiatry, e-health, and mHealth into the proposed model will make it feasible and costefficient for inaccessible parts of the country.

Neurological manifestations in organophosphorous toxicity.

Organophosphorous compounds are one of the efficient methods available for pest control. Because of its easy availability, the various preparations of organophosphorpus compounds cause significant morbidity and mortality to the human lives. In addition to producing pesticide related illness and death, Organophosphorous compounds produces different neurological manifestations as a sequelae to its toxicity. Four such neurological syndromes are discussed with their salient clinical features.

Congenital immunodeficiency disorder.

A 17 year old girl, a 9th standard student with history of recurrent pneumonia and soft tissue "cold abscesses" since neonatal period, presented with fever and cough with yellowish expectoration of 2 months duration. Her clinical and radiological finding along with elevated serum IgE level were consistent with the diagnosis of hyper immunoglobulin E syndrome or Job's syndrome.

Epidemiology of poisoning fatalities in Manipal.

A twelve year retrospective review of poisoning fatalities was undertaken in the tertiary care referral hospital of Kasturba Medical College, Manipal, South India. Of the 1917 cases of forensic autopsies conducted, 372 cases (79.4%) were due to poisoning deaths. There was an increasing trend observed in the number of poisoning deaths from the period 1993-94 to 1999-2000, followed by a declining trend during 2003-04. Ninety two percent of the fatalities were due to self-poisoning, with 77% due to pesticide consumption. Majority of the cases occurred in the rural areas during winter season. Many of the decedents were men (73.1%) in their 3rd decade of life. Suggestions are being offered on the basis of this study for the control of pesticide poisoning.

Victimologic study of snakebite envenomation.

Snakebite is of grave concern in most parts of India. Being a tropical country with an extensive coastline, India is home to a variety of snakes both poisonous and non-poisonous. This is a retrospective research study conducted at Kasturba Hospital, Manipal, which is a tertiary care teaching hospital situated in Coastal Karnataka, South India. During a three-year period starting from 1st January 2001 to 31st December 2003, one hundred and twenty six cases of snakebites that were admitted at Kasturba Hospital, Manipal were studied. The commonest age group affected was 21-30 years with a male preponderance (66.7%). The victims were agriculturists in 54 cases. Most of the bites occurred during summer. Bites occurred when the victim was outdoors in 72.2% of the cases. Lower limb was commonly involved. Double fang mark was seen in 47.6% of the cases. Non-poisonous snakebite was seen in 38.1% of the cases. One hundred and twenty patients survived, and 6 persons died, representing a mortality of 4.8%.

Suicide - the magnitude of the problem.

Suicide is the second commonest manner of unnatural death flanked by accident and homicide. Suicide is by no means a simple issue, for it hinges on a spectrum of ethical, legal, sociological and psychological problems and it is yet to be offered an unequivocal and satisfactory answer to all the questions raised by this perplexing phenomenon. In an attempt to analyse the magnitude of the problem of suicide, this paper provides a comprehensive data encompassing the prevailing scenario of suicide, investigation of suicide as viewed by different workers and the importance of differentiation between accident, homicide and suicide The presentation is concluded by emphasizing the advantages of psychological autopsy in suicide investigation.

Profile of methyl parathion poisoning in Manipal, India.

The main objective of this study was to collect data with regard to the pattern of acute methyl parathion poisoning in this part of the world. One hundred and fifty three patients with organophosphate poisoning presented to Kasturba Hospital, Manipal between January 2001 and December 2002, out of which 58 cases (37.9%) were due to methyl parathion exposure. The commonest reason for poisoning was suicide (98.2%). A significant proportion of victims were male (72.4%), many in the 21–30 years age group (43.1%). In 77.5% of the cases, the poisoning incident occurred during daytime. Manifestations were predominantly muscarinic in nature, and the median value of serum pseudocholinesterase at admission was 2407.5 IU/L. Respiratory failure was the commonest complication (41.2%). 25.8% of the cases ended in death, and 40% of these succumbed within 24 hours of exposure.

Intermediate syndrome in organophosphorous poisoning.

One hundred and fifty three cases of Organophosphorous poisoning cases presented to Kasturba Hospital, Manipal, India during a 2 year period ( 2001- 2002), out of which 45 cases (29.4%) had features of Intermediate Syndrome. Largest number of victims were in the age group of 21-30 years (37.7%). Males predominated (71.1%). Methyl Parathion was the commonest compound (57.7%). Respiratory muscle weakness was the most common manifestation seen (84.4%). Mortality was 22.3%.

Correlation between postmortem diagnosis and survival time in poisoning deaths.

Every deaths resulting from poisoning has to be investigated to establish cause of death. Difficulties in clinical diagnosis of poisoning cases is well known because many a time they present with non specific symptoms and signs or the features may simulate natural disease process. Same with Forensic Pathologist as many times postmortem findings are nonspecific. Some poisons are retained in the body for long time after deaths while others may be rapidly destroyed during metabolic activity. This study was undertaken to find out effect of survival time on the postmortem findings, and on chemical analysis of body tissue and body fluids in poisoning deaths. In majorities of cases death was due to insecticides. Toxicological report showed positive for poison in 70% of cases. Kerosene smell, which is present in Organophosphorus poisoning, is present maximum upto three days. Chemical analysis report showed positive in 94% of cases in first three days. There after chance of detection of poison in routine viscera decreases upto 50%. Suggestions have been made for postmortem diagnosis in poisoning victims.

Para suicide: An approach to the profile of victims.

Suicide is the second commonest manner of unnatural death flanked by accident and homicide. Unlike suicide which terminates the human life forever, its counterpart, ‘Para suicide’ paralysis the human life either temporarily or permanently. Para suicide could not be taken as a lighter entity in the modern times, for it may prove as equally dangerous as suicide itself and sometimes perhaps more than that. The present study is an analysis of the spectrum of Para suicide in the terms of various sociodemographic / epidemiological features. The study presents the profile of suicide attempters, who reported / were brought to the Kasturba Hospital, Manipal, Coastal Karnataka, South India, over a span of twelve months with an alleged history of attempted suicide. The study sample comprised of 52 subjects who survived the attempt of suicide. Men (56%) considered as more vulnerable than women. Urbanites (80%) outnumbered the rural dwellers (20%). Thirty six percent of the attempters were in their third decade of life. Fifty six percent of the victims had had their education up to the Secondary School. Manual laborers (23%) were most vulnerable when compared to the skilled laborers and professionals (4% each). Ninety four percent of the subjects were the followers of Hindu religion. Married individuals (52%) and those from lower middle class sector (70%) attempted suicide more often. Presentation is concluded by the suggestion of probable preventive measures.

Serum nitrate levels as an index of endothelial function in pre-eclamsia and normal pregnancy.

The study was conducted in St. John's Medical College Hospital and Department of Physiology, with the aim of studying the serum nitrate levels in pre-eclampsia and normal pregnancy. The total number of subjects studied in various groups were 159, control (n = 55), first trimester (n = 13), second trimester normal (n = 42), second trimester pre-eclampsia/PET (n = 5), third trimester normal (n = 32), third trimester pre-eclampsia/PET (n = 12). The serum nitrate was measured by one step enzymatic assay using Nitrate reductase from Aspergillus species. The nitrate levels in the third trimester pre-eclamptic group was found to be significant lower (P = 0.02), as compared to normal subjects, however the renal functions were normal in all the subjects.