A study comparing depression, anxiety, and coping styles between high school students attending and not attending coaching class for medical entrance examination.

BACKGROUND: Various kinds of stressors and psychological problems have been reported in the adolescent student population. This study assessed and compared depression, anxiety, and various coping styles among high school students attending coaching classes for medical entrance examination (MEE) and those not. MATERIALS AND METHODS: Systemic random sampling technique was used to recruit 400 high school students with equal number of those attending (Group 1) and those not attending any coaching class for MEE (Group 2). They underwent screening for depression and anxiety through Patient Health Questionnaire-9 and Generalized Anxiety Disorder 7-item. Coping styles were assessed through brief COPE inventory. Screening positive subjects were assessed in detail by a psychiatrist using ICD-10 (International Classification of Diseases 10th Revision), Diagnostic Criteria for Research (DCR). The severity of depression and anxiety was measured through HAM-D and HAM-A, respectively. RESULTS: Depression and anxiety were reported by higher proportion of Group 1 (36%) than Group 2 (22%), χ 2(1) = 9.52; P = 0.002. In both the groups, depressive disorder was the most common, followed by generalised anxiety-disorder and mixed anxiety-depression. The severity of depression (HAM-D score) and anxiety (HAM-A Score) was significantly more Group 1. "Active coping" (χ 2= 4.79 P = 0.02) and "Humor" (χ 2= 30.90, P ≤ 0.01) were more commonly used by healthy students, while "Religious coping" (χ 2= 37.92 P ≤ 0.01) were the most common among those diagnosed with depression/anxiety disorder. CONCLUSION: Higher prevalence of the psychological problems in adolescent school students preparing for MEE highlights the importance of aptitude assessment, career counseling, and school mental health program before their exposure to the competitive academic atmosphere.

Increased concentration of serum gamma-glutamyl transferase in ischemic stroke patients.

BACKGROUND: Stroke is responsible for the largest proportion of neurological disorders causing a significant morbidity. Gamma-glutamyl transferase (GGT) enzyme has an active involvement in atherosclerosis through its role in oxidative and inflammatory mechanisms. Recent evidence suggests that serum GGT is related to the risk and prognosis of cerebrovascular diseases. METHODS: A total of 200 patients (100 with acute ischemic stroke and 100 without stroke) were recruited from various medical wards and medical intensive care unit. Categorical variables were compared between two groups using Chi-squared test and odds ratio (OR). Independent sample t-test was used to see to compare mean GGT level of stroke patients with control. RESULTS: There was no statistical difference with respect to distribution of age groups (χ 2 = 1.25, P = 0.741) and gender (χ 2 = 2.678, P = 0.1018) between cases and controls. Mean age of stroke patients (mean [M] = 61.7, standard deviation [SD] = 13.8) did not differ from controls (M = 62.2, SD = 13.6), P = 0.80. The odds of suffering from diabetes were significantly higher in stroke patients than cases (OR = 2.25, P = 0.005). Independent sample t-test found a significant difference in serum GGT level between cases (M = 57.47, SD = 11.8) and control (M = 41.72, SD = 7.5), P ≤ 0.0001. CONCLUSIONS: Serum GGT was significantly higher in stroke patients than age-sex-matched nonstroke patients. Association remained significant in stroke patients irrespective of age, gender, and other risk factors. Stroke patients with diabetes, hypertension, dyslipidemia, obesity, and smoking had higher level serum GGT level than those without these risk factors. Prospective cohort studies can further explore the potential of GGT as a predictor of acute ischemic stroke.

Comparison of two screening instruments to detect dementia in Indian elderly subjects in a clinical setting.

OBJECTIVE: Cognitive screening in elderly patients receiving treatment for chronic medical conditions in a busy outpatient clinical setting is crucial to detect dementia at an earlier stage. Although Hindi Mini-Mental State Examination (HMSE) is an established screening tool for the geriatric population in India, but cannot be administered with the informant. Our study aims to compare two screening instruments, Informant based - Eight-item Interview to Differentiate Aging and Dementia (AD8) and HMSE among elderly patients attending medical outpatient service (OPD) in a tertiary care hospital. METHOD: A total of 776 subjects aged ≥65 years and receiving treatment from medicine OPD in a tertiary care hospital were screened for dementia using AD8 and HMSE. The clinical diagnosis was established after detailed clinical assessment using ICD-10 criterion. Sensitivity and specificity were calculated for both screening tools and ROC curves were plotted considering ICD-10 diagnosis as the gold standard. RESULTS: Comparison of receiver operating characteristic (ROC) curves showed that HMSE (AUC = 0.77) were better than AD8 (AUC = 0.61) in detecting dementia. Although increasing the cut-off value of AD8 from a recommended score of ≥2 to ≥3 improved sensitivity from 35% to 48.9%, high false-positive rate limited its utility as a cognitive screening tool. CONCLUSION: Although AD8 is easy to use and quickly administered with either patient or informant, it does not seem to be a suitable cognitive screening test for Indian elderly with chronic medical disorders. HMSE at a cut-off score of ≤23 is able to find out dementia among geriatric patients in a busy medical setting.

COVID-19 contact tracing in a tertiary care hospital: A retrospective chart review.

BACKGROUND: Contact tracing is one of the strategies used to control COVID-19 pandemic. It played an important role in the beginning to identify all contacts and minimise the spread of the infection. METHODS: A retrospective chart review was carried out of contact tracing records during the one-month period, starting from the onset of the first lockdown in India. The largest wave of 372 contacts was analysed in detail to find out the association between the result of COVID-19 test and various factors (age, gender, type of contact). RESULTS: A total of 372 contacts (214 males and 158 females) were traced and around 21% contacts were tested positive on COVID-19 RT-PCR test. Chi-square test didn't find the significant difference between COVID-19 test result and proportions of male and female contacts, χ2 (1) 0.033, p = 0.855. Female positive contacts had lower mean age compared to male positive contacts, though not statistically significant, t (75) = - 1.809, p = 0.0745. No difference was found in either median or mean age of contacts with respect to COVID-19 test result. Odds of tested COVID-19 positive among household contacts much higher than community contacts, OR = 24.52, 95% CI 12.45-48.29, p < 0.05. CONCLUSION: No difference was noted in the rate of contracting infection with respect to age and gender of contacts. Type of contact, household or community, significantly affected the probability of becoming infected with the coronavirus. Occupation of primary case was probably responsible for large number of contacts found positive for COVID-19.

A Comparative Study of Yoga with Paroxetine for the Treatment of Premature Ejaculation: A Pilot Study.

CONTEXT: Premature ejaculation (PME) is a common sexual disorder. Drugs used commonly used for its treatment have various side effects and disadvantages. Yoga is being increasingly studied in a variety of medical disorders with positive results. However, its evidence for patients with PME is very limited. AIMS: The aims of this study were to investigate the effect of yoga on ejaculation time in patients with PME and to compare it with paroxetine. SETTINGS AND DESIGN: This was a nonrandomized nonblinded comparative study in a tertiary care center. MATERIALS AND METHODS: Among patients with PME, 40 selected paroxetine and 28 yoga. Intravaginal ejaculation latency time (IELT) was measured in seconds once before and three times after intervention. STATISTICAL ANALYSIS USED: Mean, standard deviation, paired and unpaired t-tests, and repeated measures ANOVA were used for statistical analysis. RESULTS: IELT was significantly increased in both groups - paroxetine (from 29.85 ± 11.9 to 82.19 ± 32.9) and yoga (from 25.88 ± 16.1 to 88697 + 26.9). Although the effect of yoga was slightly delayed in onset, its effect size (η2 = 0.87, P < 0.05) was more than paroxetine (η2 = 0.73, P < 0.05). One-fifth of the patients in the paroxetine group (19.5%) and 8% in the yoga group continued to have the problem of PME at the end of the trial. CONCLUSIONS: Yoga caused improvement in both intravaginal ejaculation latency time and subjective sexual experience with minimal side effect. Therefore, yoga could be an easily accessible economical nonpharmacological treatment option for the patient with PME.

Primary care physician's approach for mental health impact of COVID-19.

As the world struggles to control coronavirus infection with the exhausting capacity of health care systems globally, the role of primary care physician and family physician becomes more important as the first point of contact with the community. Limited availability of mental health services in India requires general practitioners to deal with psychological disorders arising due to infection outbreak and its restrictive control strategies. This article discusses what and how primary physicians can manage the psychological burden of a pandemic, and therefore, reducing the reliance on mental health specialist.

Sexual dysfunction in alcohol-dependent men and its correlation with marital satisfaction in spouses: A hospital-based cross-sectional study.

BACKGROUND: Chronic use of alcohol affects almost every organ system of the body, including male sexual functions. There are only a few Indian studies, which have assessed sexual functions in alcohol-dependent (AD) men and many of them have limitations. This study was aimed to assess sexual functions and marital satisfaction among AD individuals compared to matched controls. SUBJECTS AND METHODS: A cross-sectional descriptive study was carried out on 70 AD men (study group) and an equal number of matched controls and their spouses in the Department of psychiatry of Jawahar Lal Nehru Medical College, Ajmer. Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised, and Severity of Alcohol Dependence Questionnaire (SADQ) were used to assess withdrawal state and severity of alcohol dependence in the AD group. Marital Adjustment Test (MAT) and Arizona Sexual Experience Scale (ASEX) were used in both study and control groups to assess marital satisfaction and various aspects of sexual functioning. RESULTS: More than half of the men (58.6%) with alcohol dependence were found to have sexual dysfunction compared to only one-fifth in the control group (18.5%). The most commonly affected sexual functions were the ability to get and keep erection (70%) and arousal (62.8%). There was a large negative correlation of MAT scores in the AD group with the SADQ, rho (ρ) = -0.68, and sexual dysfunction (ASEX), rho (ρ) = -0.57. However, the duration of alcohol use did not have any significant association with marital satisfaction. CONCLUSIONS: This study showed that participants with AD were more likely to have sexual dysfunction and lower level of marital satisfaction in their spouses. This effect was not because of acute intoxication of alcohol or withdrawal symptoms. We need further research to ascertain whether sexual dysfunction and marital dissatisfaction is a result of alcohol dependence or its reinforcer or both.

Health anxiety among medical students: A comparison between preclinical and clinical years of training.

OBJECTIVE: It is common among medical students to falsely attribute bodily sensations/symptoms and holds a belief of having a medical illness with varying level of conviction. We studied and compared this condition known as "medical student syndrome", a type of hypochondriasis, between preclinical and clinical years students. METHODOLOGY: This research was a descriptive study where a total of 100 students were approached and were asked to complete a short form of health anxiety inventory (SHAI) which has Cronbach's alpha 0.855. No personal identifiers were included in the study questionnaires. All statistical analyses were performed using the SPSS statistical software package (IBM SPSS Statistics Version 23, SPSS Inc., Chicago, IL, USA). RESULTS: The response rate among participants was 88% (42 from preclinical and 48 from clinical years of training). Health-related anxiety (SHAI main section score ≥ 18) was found in 14.77% of students with a higher proportion in preclinical than clinical, 16.66% and 13.04%, respectively. The difference was not significant between the two groups (χ 2 = 0.429 [1], P = 0.766). Students having medical professional in family had lower rate of health-related anxiety, χ 2 (1, n = 88) = 0.228, P = 0.633. The association between family or personal history of psychiatry or medical illness was not significant with SHAI scores. No relation was noted between current health anxiety (SHAI score) and the number of visits to the doctor per year before entering the medical course (χ = 0.174, P = 0.112). CONCLUSION: Every seventh medical student was found to have health-related anxiety. It was not affected by personal and family history of either psychiatric or medical illness.

Clinical profile and mortality among novel influenza A (H1N1) infected patients: 2009-2010 Jodhpur, Rajasthan pandemic.

OBJECTIVES: Influenza causes annual seasonal epidemics around the world. Periodically, a genetically novel strain of influenza circulates worldwide, causing an influenza pandemic. The present study aims to assess the clinical profile, factors determining the response, prognosis of the disease and outcome in H1N1 positive patients during 2009-2010 H1N1 pandemic, so that epidemiology of the disease could be known and high risk groups can be identified. METHODS: Medical records of the H1N1 positive patients, confirmed by RT-PCR method, admitted in ICU/Isolation ward in M.D.M. Hospital, Jodhpur during pandemic of H1N1 influenza (2009-2010) were retrieved and retrospectively studied, the data collected was analysed. RESULTS: During the study period there were 221 H1N1 positive admissions. The age group most affected was 21-40 years in both males (52%) and females (67%). There were 80 deaths; mortality was high in rural population (64%) and pregnant women particularly in third trimester (80%). Common presenting symptoms were Cough, Fever, Breathlessness, Sore throat, Nasal Discharge, Expectoration and Body aches, other less common symptoms were Headache, Vomiting, Diarrhoea and Fatigue. CONCLUSION: Swine flu influenza infection took its heaviest toll in terms of human lives and economy because the young and productive population was mostly affected. Pregnant women and the patients with co-morbid conditions were the susceptible population and thus preventive and therapeutic interventions should be directed to them. Early vaccination of high risk groups and high index of suspicion in the symptomatic patients and chemoprophylaxis accordingly can save many human lives.