Mental Health Programme in India: Has the tide really turned?

Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have seen rapid strides with several initiatives, including (i) expansion of DMHPs to 90 per cent of the total districts of the country, (ii) the National Mental Health Policy and (iii) strengthening the Mental Health Legislation by way of providing explicit provisions for rights of persons with mental illnesses. Among others, factors responsible for this accelerated growth include the easily accessible digital technology as well as judicial activism. Federal and State cooperation is another notable feature of this expansion. In this review, the authors summarize the available information on the evolution of implementation and research aspects related to India’s NMHP over the years and provide a case for the positive turn of events witnessed in the recent years. However, the authors caution that these are still baby steps and much more remains to be done.

A rare case of giant mucinous cystadenocarcinoma of the right ovary with metastatic deposits and Brenner tumor in the left ovary

Ovarian cancer is the second most common gynecological malignancy. Mucinous tumor accounts for 3% of ovarian tumors and is a challenging task for a surgical pathologist. Association of Brenner tumor, a subtype of epithelial malignancy is a rare entity reported in the literature. Herein, we report a unique case of a 57-years old post-menopausal woman who presented with progressive abdominal distention for 3 years and constipation for 1 year. Clinically, it was suspected as a case of complex ovarian cyst and the patient underwent staging laparotomy. Intraoperatively, a giant mucinous cystadenocarcinoma of the right ovary with deposits in the pouch of Douglas, omentum, umbilical, and the sub-umbilical region was found along with a benign Brenner tumor of the left ovary.

Study of socio-demographic profile and causes of street vending in urban area, Aurangabad, Maharashtra

Background: Street vending as a profession has been in existence in India since times immemorial. Poverty and lack of gainful employment in the rural areas and in the smaller towns drive large numbers of people to the city. Thus the present study is conducted to study socio-demographic profile, causes, addiction, morbidity pattern among street vendors. The objective of the present study is to study socio-demographic profile of street vendors, causes of street vending, addiction among street vendors, health problems faced by street vendors.Methods: The study was conducted in Shahagunj, where urban health training centre of Government Medical College Aurangabad is situated, for period of 2 months duration. All street vendors in the Shahagunj were included in the study. The purpose of study was explained to them. The survey was carried out with predesigned pretested questionnaire. The question related to socio-demographic characteristics, causes of street vending, addiction of smoking were asked.Results: About (29.6%) vendors belongs to age group 30-39, male participants are more in number, illiterate or educated up to primary school. Most of the vendors belongs to nuclear family, 71.25% vendors are migrated from other cities to seek employment, 73.6% vendors works with no holiday in a week. Vendors are addicted of tobacco chewing (27%), pan (6%) and cigarette (6%). Causes to become in informal sector are unable to fulfill requirement of formal sector 54%, only source of income 44% avoid tax is 2%. About 30% vendors are having health issues; maximum was musculoskeletal morbidities contributing 8.8%.Conclusions: Unable to fulfill requirement of formal sector and no other source of income are the major causes to be in the street vending.

Study of tobacco and alcohol consumption among students of a medical college in a city of Maharashtra

Background: Over the years, substance use has increased drastically in every section of the society. Tobacco and alcohol consumption in medical fraternity is quite common. The objectives of the study were to find out the prevalence of tobacco and alcohol consumption in medical students and to find out various reasons to start these habits.Methods: It was a cross-sectional study conducted in Government Medical College, Aurangabad during September to November 2018. Study was conducted amongst undergraduate MBBS students. Taking prevalence as 47%, allowable error 10% and 10% non-respondents the sample size comes as 85. By lottery method, third year medical students were selected randomly for the study. Completed data from 120 students were included in the study. Pre-designed semi-structured self-administered questionnaire was used for data collection. Trial version of SPSS software was used for statistical analysis.Results: In the present study, overall prevalence of substance use among undergraduate MBBS students was found to be 52.5% out of which 61.6% were males and 29.4% were females. Peer pressure was the main reason of continuing the habit (93.2%). 66% of these substance users showed willingness to quit the habit.Conclusions: High prevalence of tobacco and alcohol consumption was observed among undergraduate medical students

Colon targeted tablets of Albendazole with enhanced solubility by Complexation and Micellar Solubilization

Albendazole (AZ) is a drug used for the treatment of gastrointestinal nematode infections. Phase solubility study was performed to investigate the optimized ratio of AZ: β-cyclodextrin (β-CD) solid dispersion (SD). Increase in the solubility of optimized AZ: β-CD SD was further enhanced by addition sodium lauryl sulfate (SLS) in different ratios was studied. Matrix tablets of the optimized ratio of AZ: β-CD SD with SLS and various proportions (10%, 15%, and 20%) of guar gum (GG). xanthan gum (XG) and pectin (PT) were prepared by non-aqueous wet granulation with PVP K30. Standard calibration curve for AZ was performed in three buffers like 0.1 N HCl, pH 6.8 phosphate buffer solution (PBS) and pH 7.4 PBS and absorbance were measured at 295 nm. Tablets were evaluated for various physical characteristics such as thickness, hardness, and drug content uniformity. The matrix tablets were subjected to in vitro drug release studies in 0.1 N HCl (2 h), pH 6.8 PBS (3 h) and pH 7.4 PBS (19 h) with and without rat caecal content medium. Formulation F9 shows 70.65% and 95.62% of AZ in with and without rat caecal content media respectively is selected as optimized one. Optimized formulation F9 passed the test for stability up to 3 months as per ICH guidelines.

A study of prevalence of hypertension and socio-demographic factors in urban slum, Maharashtra

Background: Hypertension is the commonest cardiovascular disorder, posting a major public health problem of the world and especially to population in socio-economic and epidemiological transition. Around 7.5 million deaths or 12.8% of the total of all annual deaths worldwide occur due to high blood pressure. It is predicted to be increased to 1.56 billion adults with hypertension in 2025. In India there is 24-30% of prevalence of hypertension in urban areas and 12-14% in rural areas. The objectives of the study were to find out the prevalence of hypertension in study population of 18 years and above and to study some socio-demographic factors affecting hypertension.Methods: A community based cross sectional study was carried out in urban slum area, under urban field practice area of a Govt. Medical College & hospital. Sample size of 360 participants of age more than 18 yrs residing in study area taken. Data collected by using systematic random sampling by house to house visit. A semi-structured & pretested questionnaire used to interview the patients after obtaining their consent. The data was analyzed using SPSS version 23. Appropriate statistical tests were applied.Results: The overall prevalence of hypertension was 30.5%. Out of 360 subjects, 47 (13%) found elevated hypertensive. Out of 110 hypertensive population nearly 53 (48%) were in older age group, nearly 60 (55%) were illiterate and 53 (48%) were unskilled workers out of 110 was found statistically significant (p<0.05).Conclusions: Prevalence of hypertension found to be 30.5%. Some socio-demographic factors like age, sex, education, occupation were statistically significant (p<0.05).

Protective effect of metformin against tuberculosis infections in diabetic patients: an observational study of south Indian tertiary healthcare facility

ABSTRACT Background: World Health Organization estimated that people with diabetes (DM) are at 2-3 times higher risk for tuberculosis (TB). Studies have shown that DM not only increases the risk of active TB, but also puts co-affected persons at increased risk of poor outcomes. Objectives: To determine the protective effect of metformin against TB in DM patients and also, to investigate the relationship between poor glycemic control and TB. Methods: A case-control study was conducted over 8 months, where cases and controls were selected based on the inclusion and exclusion criteria of the study. The diabetics diagnosed with TB were selected as study group (SG = 152) and without TB were as control group (CG = 299). Exposure status of metformin in both groups were analyzed. Results: The mean (SD) age of both CG and SG were 55.54 ± 11.82 and 52.80 ± 11.75, respectively. Majority of the subjects in the study were males. The mean hospital stay of SG and CG were 7 days and 6 days, respectively. Poor glycemic control (HbA1c > 8) observed in SG (51.7%) vs CG (31.4%). HbA1c value <7 is associated protective factor for TB occurrence [OR = 0.52 (95% CI 0.29-0.93)]. The protective effect of metformin against TB was 3.9-fold in diabetics (OR = 0.256, 0.16-0.40). Conclusion: Poor glycemic control among diabetics is a risk factor for TB occurrence. The result shows metformin use is a protective agent against TB infection in diabetics. Hence, incorporation of metformin into standard clinical care would offer a therapeutic option for the prevention of TB.

Ketamine and levobupivacaine versus levobupivacaine alone for post operative analgesia and side effects in lower abdominal surgeries in children A comparative study

Background: Different additive drugs such as opioids, epinephrine, clonidine, and neostigmine have been used along with local anaesthetics to improve the duration and quality of analgesia. Few studies have demonstrated the increase of efficacy in various aspects after combining dexmedetomidine and ropivacaine and dexmedetomidine to caudal bupivacaine in pediatric major abdominal cancer surgeries. Objectives: The present study was designed to compare the duration of postoperative analgesia and the incidence of any side effects of single-dose caudal levobupivacaine with ketamine versus levobupivacaine alone in childrens undergoing lower abdominal surgeries. Materials and methods: A total of 50 pediatric patients, 2–4 years of age, were included in the study. They were divided into two groups: group A (n = 25) received levobupivacaine, whereas group B (n = 25) received ketamine with levobupivacaine. Postoperative duration of analgesia and postoperative complications were recorded in all the childrens. Mohan K, Mohana Rupa L. Ketamine and levobupivacaine versus levobupivacaine alone for post operative analgesia and side effects in lower abdominal surgeries in children – A comparative study. IAIM, 2016; 3(10): 70-73. Page 71 Results: The duration of postoperative analgesia was longer in group B than in group A, which was statistically significant. Few postoperative complications were recorded in group B. Conclusion: Combination of ketamine with levobupivacaine by caudal epidural administration produced an additive analgesic effect with few side effects when compare to levobupivacaine alone.

Role of MRI in post traumatic posterior urethral distraction defects in comparison to RGU/ MCUG

Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty.

Study on Integration of Renewable Technologies into Power Systems.

Renewable energy resources, which are becoming integrated into electric power systems around the world, connect to existing transmission grids at a range of voltage levels. The changes brought about by these new power sources are certain to have a significant impact on system performance and efficiency and to necessitate advances in the planning and operation of electric grids. Certainly there are challenges in developing renewable generation technologies, such as reducing the capital costs and improving energy efficiencies of the various types of renewable resources, such as wind, solar PV, solar thermal, and wave. Breakthroughs are also needed in large-scale energy storage technologies. To seamlessly integrate renewable resources in the grid research and development must address challenges that high penetration levels will have in power system planning and operation, and in grid connection. Finally, the existing workforce and the students going into power and energy engineering careers need to be educated so that they can envision and develop the new approaches and technologies to maintain grid reliability and economy. The challenges of integrating high penetrations of renewable energy technologies into the grid are less well recognized in part because they require interdisciplinary research in such areas as power systems analysis, communications, power electronics, economics, operations research, and industrial organization.

Portulaca oleracea inhibit vincristine induced peripheral neuropathy: involvement of ATP-sensitive K+ channels.

Background: The Portulaca oleracea belonging to portulacaceae family. It is a herbaceous plant widely distributed throughout the world and used in traditional medicine for many ailments. The present study was to evaluate the antinociceptive action of petroleum ether extract of P. oleracea in vincristine induced peripheral neuropathic pain and the possible mechanisms involved. Methods: Peripheral neuropathy was induced in rats by administration of vincristine sulfate (50 μg/kg i.p.) for 10 consecutive days. The cold tail hyperalgesia was assessed by cold water tail immersion test. To identify the possible mechanisms involved in the antinociceptive action of petroleum ether extract of P. oleracea, acetic acid writhing method was employed. Mice were pretreated with naloxone, glibenclamide before petroleum ether extract treatment to identify the involvement of opioid and potassium channels, respectively. Results: The administration of petroleum ether extract of P. oleracea (100 and 200 mg/kg p.o.) for 10 days significantly attenuated vincristine-induced cold hyperalgesia. Pre-treatment with glibenclamide reversed the antinociceptive effect of P. oleracea, but the naloxone pre-treatment did not reverse the antinociceptive activity of P. oleracea. Conclusion: The results of the present study reveal the antinociceptive effect of P. oleracea in vincristine induced peripheral neuropathy and involving ATP-sensitive potassium channels pathway.

Co-circulation of dengue virus serotypes with chikungunya virus in Madhya Pradesh, central India.

Background: Dengue and chikungunya present with very similar signs and symptoms in the initial stage of illness and so it is difficult to distinguish them clinically. Both are transmitted by Aedes aegypti and Aedes albopictus mosquitoes. This study was conducted with the aim to explore the co-circulation of dengue and chikungunya viruses in central India. Materials and methods: Samples from suspected dengue cases were subjected to dengue immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) and dengue-negative samples were tested with chikungunya-specific IgM ELISA. The samples collected in acute phase of illness were tested by nested reverse transcription polymerase chain reaction (nRT-PCR). Chikungunya virus (CHIKV) sequences were analysed to determine their genotype. Results: Of 138 samples screened for dengue, 21 (15.2%) were positive, and of 119 samples screened for chikungunya, 13 (10.9%) were positive. Dengue viruses 1 and 4 were found co-circulating with chikungunya virus in Jabalpur, central India. The chikungunya virus detected belonged to the East Central South African genotype. Conclusion: Accurate and timely diagnosis would help in patient management and use of resources. It is advocated to simultaneously test samples for these two diseases in endemic areas. This will also aid in understanding the epidemiology of chikungunya.

First case series of emerging Rickettsial neonatal sepsis identified by polymerase chain reaction-based deoxyribonucleic acid sequencing.

Purpose: To detect and identify the aetiological agent in the peripheral blood from the cases of neonatal sepsis. Materials and Methods: Four neonates from geographically different regions of South India presented with signs of neonatal sepsis and all the routine clinical and laboratory investigations were performed. Blood culture by Bac T Alert 3D was negative. To establish the aetiology, polymerase chain reaction (PCR) for eubacterial genome and subsequent amplifi cation with Gram positive and Gram negative primers were performed followed by deoxyribonucleic acid (DNA) sequencing. Results: PCR for the detection of eubacterial genome was positive in all the four neonates and further amplifi cation with designed Gram positive and Gram negative primers revealed the presence of Gram negative bacteria. The amplicons were identifi ed as Orientia tsutsugamushi in three neonates and Coxiella burnetti in the other neonate. Multalin analysis was done to further characterise the strain variation among the three strains. Conclusion: PCR-based DNA sequencing is a rapid and reliable diagnostic tool to identify the aetiological agents of neonatal sepsis. This is the fi rst case series of emerging Rickettsial neonatal sepsis in India.

Extrapulmonary multidrug resistant tuberculosis presenting as chest wall abscess - A rare case report.

Summary: Even though the prevalence of pulmonary drug resistant tuberculosis is showing an increasing trend globally, only a few case reports of extrapulmonary tuberculosis caused by drug resistant mycobacteria have been documented over the last decade. Extrapulmonary tuberculosis is not infrequent and may cause considerable morbidity and mortality. Tuberculous abscess over chest wall is commonly due to the spread from an adjacent affected lymph node group. Multidrug resistance poses a great challenge to the physicians in managing such a condition and significantly affects the prognosis. Here we report a rare presentation of multidrug resistant tuberculosis as anterior chest wall abscess in a young male.

Perceptions about training and knowledge of HIV/AIDS ethics among health care providers at teaching hospitals of a medical college in Karnataka, India.

A cross sectional study was conducted to evaluate perceptions of HIV/AIDS ethics among health care professionals at three associate hospitals of Kasturba Medical College Mangalore. A total of 144 health care professionals were included, of which 106 (73.6%) were doctors and 38 (26.4%) were nurses. Only 52.8% of doctors and 56.6% of nurses agreed that they had received adequate training related to HIV data confidentiality. 85.8% of doctors and 76.3% of nurses perceived that they need additional training in HIV policies & procedures. With respect to rights of HIV-positive clients 92.5% of doctors and 84.2% of nurses felt the need for further training. 69% of doctors and 52.6% of nurses agreed that confidentiality could be breached in case of subpoena or other judicial processes. Only 68.4% nurses agreed that it is an offence to intentionally disclose HIV/AIDS confidential information to anyone who is not legally authorised.

Pretreatment of Albino Rats with Methanolic Fruit Extract of Randia Dumetorum (L.) Protects against Alcohol Induced Liver Damage

Alcohol abuse and its medical and social consequences are a major health problem in many areas of the world. The present study was conducted to evaluate the protective effect of methanolic fruit extract of Randia dumetorum (L.) on alcohol-induced liver damage in rats. Rats were divided into five different groups (n=6), group I served as a control, group II received ethanol (3 ml/100 g/day p.o.), group III served as standard group and received silymarin (50 mg/kg p.o.), group IV and V served as extract treatment groups and received 50 & 100 mg/kg methanolic extract of R. dumetorum. All the treatment protocols followed 30 days and after rats were sacrificed blood and liver were used for biochemical and histological studies, respectively. The activities serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglyceride (TG), direct bilirubin (DB), total bilirubin (TB) and lipid peroxidation were statistically increased in rats exposed to alcohol while total protein and glutathione decreased compared to control rats. Treatment with R. dumetorum significantly decreased the elevated levels of ALT, AST, TG, DB, TB and lipid peroxidation compared to the group exposed to alcohol only. R. dumetorum significantly resulted in increased levels of total protein and reduced glutathione compared to the group that received alcohol only. Histology of the liver section of the animals treated with R. dumetorum improved the hepatotoxicity caused by alcohol. Hence the study concluded that R. dumetorum has potential hepatoprotective activity.

Evaluation of Integrated Counselling and Testing Centres (ICTC) for HIV in a District of India

ICTCs provide a critical entry point for prevention, care and support for both people affected by HIV/AIDS and general population. The study was conducted with the objective of evaluating ICTCs in terms of infrastructure and staffing, services provided, level of utilization and quality of counselling. The structure and process evaluation of 13 ICTCs under National AIDS control programme III (NACP III) was carried out in a Coastal District of South India. The evaluation was carried out using UNAIDS Tools between July and September of 2010. Twelve out of 13 ICTCs (92%) had adequate infrastructure and staff. Most of the general clients (75%) attending ICTCs were provider initiated and 84.5% of antenatal women in the district attended pre-test counselling and also underwent HIV testing. Twenty six pre-test counselling sessions and 12 post test sero-positive counselling sessions were observed. Pre-test counselling content assessment revealed that only 57.4% of sessions address all the issues whereas, 79% of post-test sessions addressed most of the issues during counselling. Counsellors’ skills assessment information gathering and information giving were found to be poorly done. It was found that post test counselling sessions were not conducted for clients with HIV negative report. The aspects of ICTCs such as services provided at the centers, utilization of services by the clients, infrastructure and staffing pattern were found to be adequate. Counselling forms the vital component of the ICTC needed improvement and post test counselling should be mandatory to all the clients.

Medical insurance: promoting unethical practices?.

We appreciate the authors of your illustrative and interesting articles on health care insurance in India for their lucid handling of issues in the medical insurance sector. While the health insurance sector in India is still at a nascent stage and has to meet enormous challenges, insurance policies must be transparent and standardized, and made clear to both patients and medical practitioners.

A study on visual outcomes after cataract surgery with intraocular lens implants at the rural health training center, Paithan, Maharashtra.

A study was conducted to assess the visual outcomes of patients after cataract surgery with intraocular lens implants with reference to visual acuity (VA) and visual function (VF) and to assess patient satisfaction with surgical outcome. The retrospective study was carried out using operation theatre records at the Rural Health Training Centre (RHTC), Paithan, during 2007. Out of 819 cataract surgery patients operated in 2007 a total of 50 were selected randomly. Door-to-door visits were paid by investigator and multipurpose worker to previously operated patients for VA examination and to fill predesigned questionnaire. Statistical analysis was done by using SPSS 17.0 Version; 50% patients had VA in fair vision range of <6/18-6/60 and 52% showed the VF in the range of 76-100. Of the 32 satisfied patients, majority were in the age group 70-79 years. The patients with good visual outcomes achieved after surgery would act as pamphlets for the community.