Gossypiboma larynx: a rare cause of post-tracheostomy stridor-case report and review of literature.

BACKGROUND: Gossypiboma, a retained surgical sponge with a foreign body reaction, is an unusual but serious complication seen in open abdominal surgeries. It is exceptionally rare following head and neck surgeries. Here, we present a case of Gossypiboma of the upper airway following tracheostomy. CASE PRESENTATION: A 32-year-old male presented with stridor and difficulty breathing one-month post-tracheostomy after a severe head injury following a road traffic accident. A neck radiograph was unremarkable, and a computed tomography (CT) scan of the neck showed a well-defined homogenous curvilinear membrane extending from the hypopharynx to the upper trachea. Bronchoscopic evaluation of the larynx and upper trachea revealed a retained surgical sponge, which was retrieved. The patient's breathing improved drastically post intervention. CONCLUSION: Gossypiboma may go undetected in radiographs and may also present atypically as a homogenous membrane on a CT scan of the neck. Though rare, retained surgical items can have profound medicolegal and professional consequences on physicians. Hence, a strong clinical suspicion and vigilance for gossypiboma is necessary for patients presenting with respiratory distress post-tracheostomy.

A qualitative study on psychopathology of dhat syndrome in men: Implications for classification of disorders.

BACKGROUND: Dhat syndrome is regarded by many as a culture bound syndrome of the Indian sub-continent. However the nosological status, conceptual understanding of the condition as well as the diagnostic guidelines are all mired in controversy. AIMS: The current study aims to study the psychopathology of Dhat syndrome in men by using a qualitative approach and to arrive at an operational definition for diagnosing Dhat syndrome. METHOD: The qualitative approach consisted of five Focus Group Discussions (FGD) and five Key Individual Interviews (KII) with participants, consisting of patients as well as doctors - both allopathic as well as traditional. RESULTS: Detailed analysis revealed valuable data regarding the symptoms, causes, treatment measures, socio-cultural context, psychiatric co-morbidity, nature of the disorder and various other phenomenological dimensions. Ideas for future nosological positioning were also specifically looked for. Operational definition and diagnostic guidelines were also arrived at based on the analysis as well as on previous literature. CONCLUSION: Although lot of agreement existed among various stakeholders about symptoms and presentation, they varied significantly in their opinion on nature of the condition and treatment. Suggestions for ICD 11 have been made.

Secondary mania following cancer chemotherapy with capecitabine.

Mania-like states occurring due to neurological, metabolic or toxic conditions, without a primary mood disorder have been reported in scientific literature as secondary mania. A major clinical problem in such situations often stems from the difficulty to understand if the mood disturbance is indeed secondary to an organic cause or a coincidental primary mood disorder. Chemotherapy regimens have been associated with multiple psychiatric complications, including psychosis, mania and anxiety. Capecitabine is implicated to be associated with encephalopathy whose clinical presentation often mimics that of psychosis. However, presentations with mania have not been reported until with the capecitabine and oxaliplatin combination chemotherapy regimen. In this report, we describe a case of secondary mania in a patient suffering from carcinoma colon on treatment with chemotherapy regimen of capecitabine and oxaliplatin.

Pathways to Care of Alcohol -Dependent Patients: An Exploratory Study From a Tertiary Care Substance Use Disorder Treatment Center.

BACKGROUND: No study from India has examined pathways to care in alcohol using population systematically. OBJECTIVES: The present study aimed to understand the pathways to care among alcohol-dependent individuals seeking help at a tertiary care center. PATIENTS AND METHODS: It was a cross-sectional, observational study. A total of 58 subjects diagnosed with alcohol- dependence syndrome as per DSM-IV-TR were included in the study. Pathways to care were assessed using the world health organization encounter form. RESULTS: For 56.9% of the subjects, first point of contact was with a tertiary care addiction psychiatrist. Traditional healers were consulted by about 5.2% of the patients seeking help for the first time. The mean duration of main problems due to alcohol use was 5.82 ± 4.95 years. The first contact tended to be at place nearer to the patient's residence while further contacts tended to be farther away. Family, friends and neighbours together constituted the single largest group suggesting patients to seek care. CONCLUSIONS: There is a long time lag between the onset of alcohol use related problems and the first help seeking attempt. Of those who do decide to seek help, the proportion of those obtaining specialist help is higher than commonly believed.

A study on phenomenology of Dhat syndrome in men in a general medical setting.

BACKGROUND: "Dhat syndrome" is believed to be a culture-bound syndrome of the Indian subcontinent. Although many studies have been performed, many have methodological limitations and there is a lack of agreement in many areas. AIMS: The aim is to study the phenomenology of "Dhat syndrome" in men and to explore the possibility of subtypes within this entity. SETTINGS AND DESIGN: It is a cross-sectional descriptive study conducted at a sex and marriage counseling clinic of a tertiary care teaching hospital in Northern India. MATERIALS AND METHODS: An operational definition and assessment instrument for "Dhat syndrome" was developed after taking all concerned stakeholders into account and review of literature. It was applied on 100 patients along with socio-demographic profile, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Mini International Neuropsychiatric Interview, and Postgraduate Institute Neuroticism Scale. STATISTICAL ANALYSIS: For statistical analysis, descriptive statistics, group comparisons, and Pearson's product moment correlations were carried out. Factor analysis and cluster analysis were done to determine the factor structure and subtypes of "Dhat syndrome." RESULTS: A diagnostic and assessment instrument for "Dhat syndrome" has been developed and the phenomenology in 100 patients has been described. Both the health beliefs scale and associated symptoms scale demonstrated a three-factor structure. The patients with "Dhat syndrome" could be categorized into three clusters based on severity. CONCLUSIONS: There appears to be a significant agreement among various stakeholders on the phenomenology of "Dhat syndrome" although some differences exist. "Dhat syndrome" could be subtyped into three clusters based on severity.

Perceptions Related to Pharmacological Treatment of Opioid Dependence Among Individuals Seeking Treatment at a Tertiary Care Center in Northern India: A Descriptive Study.

BACKGROUND: Perceptions of individuals with opioid dependence regarding medications used for long-term management of the condition have been explored only by a handful of studies. Interestingly, no study had compared the perceptions regarding buprenorphine, buprenorphine-naloxone, and oral naltrexone in the opioid-dependent subjects from the same setting. OBJECTIVES: The present study aimed to examine the perceptions related to treatment of opioid dependence with buprenorphine, buprenorphine-naloxone, and oral naltrexone among individuals seeking help at a tertiary care center. METHODS: This was a cross-sectional, observational study with consecutive sampling. Sociodemographic data, Drug Abuse Monitoring System questionnaire, perceptions questionnaire, clinical interview to elicit drug use history, treatment history and details of prior abstinence attempts were completed. RESULTS: Eighty-five subjects were recruited in the study. Fear of becoming dependent (35.3%) was the most common harm reported while withdrawal control (82.4%) was the most common benefit reported with buprenorphine preparations. Precipitated withdrawals (21.2%) were the most common harm reported and prevention of relapse (53%) was the most common benefit reported with oral naltrexone. While patients who believed that buprenorphine or naltrexone were harmful reported durations of treatment that were much shorter than those who did not so believe, there was no statistically significant difference in the actual duration and period of abstinence (p = .34; p = .62). Sociodemographic profile, perceptions related to dosing, nature of medication, expectations from treatment, and duration of illness were also described.

Rare Form of Dyskinetic Movements Associated with Alcohol Withdrawal.

Movement disorders are known to occur during alcohol withdrawal. Tremor, choreoathetosis, transient parkinsonism, myoclonus and dystonia have been previously described. The present report describes involuntary 'fluttering' movements of fingers developing during alcohol withdrawal reminiscent of a rare form of tardive dyskinesia. Such a presentation has not been described earlier.

Psychiatric classification: Current debate and future directions.

Classification of health related conditions can be a complex task. This is particularly so in case of psychiatric disorders. The present paper reviews the fundamentals of psychiatric classification, including its basis, history, methods of evaluation, the journey so far and future directions. The various criticisms of current classificatory systems and possible solutions are discussed. Special reference to the research domain criteria (RDoC) approach has been made and implications discussed.

Colposcopy - a novel diagnostic technique for oral mucosal lesions.

The incidence of premalignant lesions and oral cancers is steadily increasing globally. In spite of advancement in early detection, there is increased mortality and morbidity related to oral cancers. The diagnosis of a dysplastic premalignant lesion of the oral mucosa cannot be based solely on clinical findings. Therefore histologic evaluation of a representative biopsy specimen is necessary. Therefore, the selection for a biopsy site is highly significant. In this article, we present a current review of the colposcope and oral application of the colposcopy technique and its use as an adjunct in the early diagnosis of premalignant and malignant lesions of the oral mucosa. We stress upon the fact that colposcopy (direct oral microscopy) of oral mucosal lesions helps in selecting more representative sites for biopsy than routine clinical examination alone. Because of its precision, versatility, ease of use, and being a non-invasive technique, colposcopy might prove to be a useful step toward continuing to learn and improve the care for our patients.

Teratogenicity with olanzapine.

Olanzapine, a 2(nd) generation antipsychotic, is in use in the clinical practice for nearly a decade and a half now. It is classified as a category C drug with very few reports of its toxic effects on the fetus. In general, the risk benefit analysis warrants its use in pregnancy. We report a case of microcephaly and anopthalmos associated with the use of olanzapine in pregnancy. Although a causal role cannot be unequivocally proven, it calls for larger studies to explore this issue.