Augmenting mental health literacy of troops in a large military station: A novel approach.

Background: Mental health literacy (MHL) helps in acknowledging the symptoms at an early stage, thus promoting prompt management of negative stress behaviors. Despite the central thrust towards augmentation of MHL of troops, there is a paucity of available literature on the subject matter, especially in the Indian context. Current research explores the efficacy of a standardized Information Education and Communication (IEC) module for the promotion of MHL among troops. Materials and Methods: 1200 soldiers posted in a large military station underwent a psycho-educational module about stress and related mental health conditions in an open-label experimental study. Data was collected using a simple demographic tool and a specially constructed Armed Forces Medical College (AFMC) mental health awareness questionnaire. The same sample was studied before the IEC activity, immediately after the IEC activity, and again after six months. Results: Community-based psycho-educational module helped in improvement in MHL and the gains were stable at six months. Conclusions: Well-standardized and structured module was found to be an effective strategy for improving MHL. The authors consider this study as seminal for bringing objectivity to mental health promotional programs in the Armed Forces.

Prevalence of Vitamin B12 deficiency in elderly population (>60 years) presenting with dementia to outpatient department.

BACKGROUND: Vitamin B12 deficiency is an easily treatable cause of reversible dementia. It is likely to be more common in Indian population due to traditionally vegetarian culture. This study was conducted to estimate the prevalence of Vitamin B12 deficiency in elderly patients (>60 years) with dementia attending outpatient department. METHODS: This study was conducted in two phases. The first phase was a cross sectional observational study to estimate the prevalence of Vitamin B12 deficiency in the elderly population with dementia. The second phase was a pilot study done in subjects with Vitamin B12 deficiency to assess the change in cognition following Vitamin B12 supplementation. RESULTS: Out of 2920 study eligible subjects, 200 were diagnosed as dementia with Mini Mental Status Examination (MMSE) score of ≤ 24. Vitamin B12 deficiency was seen in 7.5% of patients. Vitamin B12 deficiency was associated with shorter and more severe dementia. Macrocytosis was more common in Vitamin B12 deficiency (p value < 0.001) where as vegetarian diet did not show significant correlation (p value 0.69). There was significant improvement in the median MMSE score in the intervention group with increase in MMSE by 2 points at 6-8 weeks and 3 points at 12 weeks (p value 0.009 and 0.003 by Mann Whitney test). CONCLUSION: Prevalence of Vitamin B12 deficiency in dementia was 7.5%. It was associated with macrocytosis, shorter duration and more severe dementia. There was a significant improvement in median MMSE score at 6 weeks and 12 weeks following Vitamin B12 supplementation.

Susceptibility of cadets and recruits to chickenpox: A seroprevalence study.

BACKGROUND: Regular outbreaks of chickenpox are reported among cadets and recruits in the army undergoing training, resulting in morbidity and loss in terms of training days. Vaccination policy in the army mandates that all cadets and recruits be vaccinated against chickenpox on joining the training centers. However, 100% vaccination of trainees is not achieved. Hence, seroprevalence data among cadets and recruits were collected with the aim to assess the need for vaccination against chickenpox. METHODS: The data were collected from cadets and recruits undergoing training in military training centers by simple random sampling. Blood samples were collected from all study participants for IgG enzyme-linked immunosorbent assay for varicella zoster. A structured questionnaire was also used to collect information from all participants. RESULTS: A total of 2041 cadets and recruits between the ages of 19-29 years were studied of which 96.1% were males. Of all participants, 49.9% were seropositive showing varicella zoster virus (VZV) IgG antibody in the serum, and 29.1% study participants gave positive history of having had varicella in the past. The sensitivity of definite positive history of varicella when compared with presence of VZV IgG antibodies was found to be 55.50% while specificity was found to be 97.17%. CONCLUSION: A very large majority of cadets and recruits that joined the army are susceptible to chickenpox. Hence, the risk of repeated chickenpox outbreaks in these training centers remains very high. As the sensitivity of history of past infection of chickenpox is relatively low, it cannot be used as a tool to determine the susceptibility of the trainees to the infection.

Vaccination status and COVID-19 related mortality: A hospital based cross sectional study.

BACKGROUND: Efficacy of vaccines studied in clinical trial settings are likely to be different from their effectiveness in a real-world scenario. Indian Armed Forces launched its vaccine drive against COVID-19 on 16 Jan 2021. This study evaluated the effect of vaccination on mortality amongst hospitalized COVID patients. METHODS: A cross sectional study was done on all admitted moderate to severe COVID-19 patients at a designated COVID hospital in New Delhi. The primary outcome assessed the association of being fully vaccinated with mortality. Unadjusted odds ratios (OR) (with 95% CI) was performed for each predictor. Logistic regression was used for multivariable analysis and adjusted odds ratios obtained. RESULTS: The 1168 patients included in the study had a male preponderance with a mean age of 54.6 (± 17.51) years. A total of 266 (23%) patients were partially vaccinated with COVISHIELD® and 184 (16%) were fully vaccinated. Overall, 518 (44.3%) patients had comorbidities and 332 (28.4%) died. Among those fully vaccinated, there was 12.5% (23/184) mortality while it was 31.45 % (309/984) among the unvaccinated (OR 0.3, 95% CI 0.2 to 0.5, p<0.0001). In a logistic regression model, complete vaccination status and younger age were found to be associated with survival. CONCLUSIONS: Vaccination with two doses of COVISHIELD® was associated with lower odds of mortality among hospitalized patients with moderate to severe COVID.

Hair transplantation by follicular unit extraction for male androgenetic alopecia: A retrospective observational study from two centers.

BACKGROUND: Follicular unit extraction (FUE) is the most popular method of hair transplantation in today's world. Hair transplantation in androgenetic alopecia (AGA) in males can restore the frontal hairline and provide hair density in alopecic areas to the satisfaction of most patients. METHODS: Consecutive male patients of AGA who underwent hair transplantation by FUE method in two centers between the period of January 2016 and June 2017 have been included in this study based on inclusion and exclusion criteria. Photographic images, trichoscopy and Likert's scale were used to assess patient's improvement in hair density after the transplantation procedure. Statistical methods using SPSS software was used to analyze the results. Institutional ethical clearance and patients' written consent for procedure and images was obtained. The study was an observational retrospective study using data and images from records for which consent and ethical clearance was obtained from patients and the institution. RESULTS: Average number of follicular units transplanted in patients was 1290 (improvement in hair density: of 30.61 follicular units/sq cm). There was a statistically significant difference in improvement in hair density in patients younger than 33 years and in patients with Norwood classification below stage 4a. Forty-nine patients were satisfied with the results after assessment by the Likert scale. CONCLUSION: Hair transplantation by follicular extraction method provides good hair cover in AGA in males. This modern dermatosurgical technique with its many innovations is a very helpful technique to improve quality of life in male pattern baldness.

Scientific literacy and the medical student: A cross-sectional study.

Background: Problem-solving, critical thinking, communication skills and the ability to interpret data are four core components of scientific literacy, which any student must acquire during the educational process. This is of specific relevance to the medical profession as doctors need to be 'scientific' in their approach. The nine domains of scientific literacy are further grouped under two major abilities: understanding methods of enquiry that lead to scientific knowledge and the ability to organize, analyse and interpret quantitative data and scientific information. Methods: We included all first-year medical students within the first 2 months of admission in four medical colleges of India. We used the Test of Scientific Literacy Skills, a self- administered questionnaire, which is a validated and standardized tool for evaluating scientific literacy among students. Results: A total of 525 medical students participated in our study over 3 years-335 were males and the majority of students (73.5%) had joined medical college from schools affiliated with the Central Board of School Education system. The presence of scientific literacy skills across the study sample was low. Conclusion: The relative lack of scientific literacy uncovered by our study needs to be addressed by medical colleges, using innovative student-centred approaches and incorporating social media literacy. Reforms are urgently required in the school education system, which serves as a feeder to the medical education system.

Mini-Simple Limbal Epithelial Transplantation Versus Conjunctival Autograft Fixation With Fibrin Glue After Pterygium Excision: A Randomized Controlled Trial.

PURPOSE: To compare the outcomes between mini-simple limbal epithelial transplantation (mini-SLET) and conjunctival autograft (CAG) fixation with fibrin glue after excision of pterygium. METHODS: Ninety-two eyes with primary nasal pterygium were prospectively randomized into a CAG control arm and a mini-SLET study arm. Follow-up examinations were set at the first and third day, at weeks 1, 2, and 4, and at the third and sixth month after surgery. The primary outcome measure was the recurrence rate at 1, 3, and 6 months after surgery, whereas the secondary outcome measures were the intraoperative time, postoperative symptoms, and other complications. RESULTS: Eighty-two eyes completed the 6-month follow-up interval. Of the 42 eyes that underwent CAG, 4 (9.5%) exhibited recurrences, whereas only 1 of the 40 eyes (2.5%) treated with mini-SLET had recurrence (P = 0.358). The time taken for surgery in the study group (21.4 minutes) was greater as compared to the control group (15.1 minutes) (P < 0.001). The postoperative median symptom (foreign body sensation, lacrimation, pain, and irritation) score in the CAG group was significantly more for all symptoms on day 1 and day 3; however, on day 7, it was significantly more for pain and irritation only. Except dellen formation (1 in each group), both groups exhibited different other complications, although less in the study group. CONCLUSIONS: The study group exhibited a positive trend of less recurrence with reduced postoperative symptoms and other complications. More similar studies are required in future to validate the results.

Trigeminal neuralgia: When does neurovascular contact turn into a conflict?

BACKGROUND: The most common cause for trigeminal neuralgia is contact of the trigeminal nerve with an offending vessel which is also observed routinely in many asymptomatic patients. Therefore, the aim of this study was to determine when an asymptomatic Neuro Vascular Contact (NVC) turned into a neurovascular conflict and made the patient symptomatic. METHODS: All patients who underwent Magnetic Resonance Imaging (MRI) brain with clinical diagnosis of trigeminal neuralgia formed the study group and all cases of sensorineural hearing loss formed the control group. RESULTS: Out of 51 cases of trigeminal neuralgia 27 were males and 24 were females. The neurovascular contact was seen in 41 (80.4%) cases and 17 (28.3%) controls. Change in caliber of trigeminal nerve was seen in 27 (52.9%) cases and only in 01 (1.66%) control. Arterial imprint on nerve was seen in 26 (50.9%) cases and 01 (1.66%) control. Distortion of the course of nerve was seen in 12 (23.5%) cases and 01 (1.66%) control. Superior cerebellar artery was commonest vessel seen in contact with nerve on affected side in 25 (61%) cases. CONCLUSION: Demonstrating neurovascular contact alone is not enough for diagnosis of conflict as it is also present in some asymptomatic individuals, therefore it is important to identify thinning of nerve, arterial imprint or grooving and distortion in course of nerve, as these are more reliable signs of a conflict between the vessel and the nerve, and these cases are best treated surgically by Micro Vascular Decompression (MVD).

Bacterial colonization of peripheral intravenous cannulas in a tertiary care hospital: A cross sectional observational study.

BACKGROUND: The use of intravenous (IV) cannulas is an integral part of patient care in hospitals. These intravenous cannulas are a potential route for microorganisms to enter the blood stream resulting in a variety of local or systemic infections. Studies showing the actual prevalence of colonization of peripheral IV cannulas and its role in BSI are lacking. Hence, this study was aimed to estimate the prevalence of colonization of the injection ports of peripheral IV cannulas. METHODS: This cross sectional study was conducted on patients admitted in ICU and wards in an 800 bedded tertiary care hospital. Swabs were taken from lumens of peripheral IV cannulas and cultured. Patient demographic data and practices followed for maintenance of IV line were noted. RESULTS: A total of 196 injection port samples were taken, out of which 11 tested positive for microbial growth (5.61%). Staphylococcus aureus was the predominant organism contributing 64% of the microbial growth. A significant association was seen between presence of local signs, old age and positive cultures. Flushing IV cannula every 6 h was associated with negative cultures. CONCLUSION: Peripheral IV cannulation has significant potential for microbial contamination and is largely ignored. Most of the risk factors associated with growth of microorganisms in the injection ports of peripheral intravenous cannulas (which has a potential to cause catheter-related blood stream infections) can be prevented by improving protocols for management. To prevent infection from occurring, practitioners should be educated and trained about the care and management of IV.

Bronchial artery embolization in treatment of hemoptysis: Treatment efficacy and complications at a tertiary care chest centre.

BACKGROUND: Hemoptysis is one of the most alarming condition to both the patients suffering from it and the treating physicians. It is caused due to varied etiologies. One of the emergent and at times life-saving treatment option is by minimally invasive interventional radiological technique of Bronchial Atery Embolization (BAE). The authors aimed to carry out a retrospective analysis of short term efficacy and safety of all patients treated by this technique at a tertiary care thoracic centre. METHODS: A total of 52 patients were included in the study who had a median follow up of 35 days. All these patients were referred for hemoptysis, intractable hemoptysis not controlled by conservative management or massive hemoptysis. An analysis of the underlying etiology, immediate and short term outcomes and complications was made. RESULTS: The study showed Tuberculosis and its sequel (bronchiectasis and chronic fibrotic changes) as the commonest etiology (65%). The BAE showed high short term efficacy (92%) in stopping the hemoptysis with a relatively low complication rate especially of major complications such as spinal cord ischemia (1.9%). The study strengthens the limited Indian data available on the subject and based on its outcome, BAE should be tried in all patients presenting with uncontrollable or massive hemoptysis not getting relief by conservative management alone. CONCLUSION: BAE is a very effective procedure with very less complications for management of massive or uncontrollable hemoptysis.

A study of therapy targeted EGFR/ALK mutations in Indian patients with lung adenocarcinoma: A clinical and epidemiological study.

BACKGROUND: Established predictive biomarkers for Non-Small Cell Lung Carcinoma (NSCLC) include sensitizing Epidermal Growth Factor Receptor (EGFR) mutations and Anaplastic Lymphoma Kinase (ALK) fusion oncogene. The primary aim of the study is to ascertain the prevalence of EGFR mutation and ALK gene rearrangement in patients of lung adenocarcinoma in Indian population and the second objective is to impress upon the importance of adequate processing of limited tissue samples. METHODS: Histopathologically confirmed cases of lung adenocarcinoma, whose tumour had been tested for both EGFR and ALK gene mutations, were included in this study. The EGFR mutations were analyzed using PCR and Gene Sequencing. ALK fusion oncogene was found by Fluorescence In Situ Hybridization (FISH) technique using kit of Vysis LSI ALK Dual colour Break Apart Rearrangement probe. RESULTS: A total of 152 cases of lung adenocarcinoma were included. Out of which, 92 (60.5%) were male and 60 (39.5%) were female. After exclusion of 17 cases due to unsatisfactory result, EGFR mutations were found positive in 35.5% cases (48/135). ALK gene rearrangement was found in 7.6% (10/131) after excluding 21 cases with unsatisfactory result. CONCLUSION: EGFR mutations and ALK gene rearrangement was found to be mutually exclusive. Incidence of EGFR mutations (35.5%) is much higher in Indian population than in Caucasians (13%) and is close to the incidence in East Asian countries. The 7.6% incidence of ALK fusion oncogene in Indian patients establishes the importance of molecular studies to give maximum benefit of targeted therapy to the patients.

Zoonotic surveillance for rickettsiae in rodents and mapping of vectors of rickettsial diseases in India: A multi-centric study.

BACKGROUND: The global resurgence of rickettsial diseases and their potential to impact the fitness of military personnel and inflict widespread casualties amongst civil populations has emerged as a major cause of public health concern. Absence of surveillance system, lack of awareness amongst medical fraternity to rickettsial activity along with the difficulty in diagnosis because of their protean clinical manifestations are reasons for the outbreaks of these diseases. OBJECTIVES: To determine rickettsial activity amongst rodents and study vector diversity, abundance and their distribution to enable mapping of rickettsial hotspots. METHODS: Zoonotic surveillance was undertaken in six selected study areas in India - Jammu, Akhnoor, Rajouri-Poonch, Udhampur-Nagrota, Dehradun and Pune. Weil-Felix test was used for rickettsial sero-surveillance amongst rodents and standard identification keys were used for mapping vector diversity and database preparation. RESULTS: Serological findings revealed positivity to all the three rickettsial antigens (OXK, OX19 and OX2) in Jammu, OX19 in Dehradun and OXK and OX2 positivity in Udhampur-Nagrota belt. The vector database records presence of 16 species of trombiculid mites from three important genera - Leptotrombidium, Schoengastiella and Gahrliepia with ticks from five genera and 8 species of fleas from four genera. Mite fauna of study sites has been enriched with addition of new records of mite species (five mite species at Pune, two at Akhnoor with one mite species each at Jammu and Dehradun). CONCLUSION: The study reveals rickettsial activity amongst rodents at Jammu, Dehradun and Udhampur-Nagrota belt. The results correlate well with the presence of vectors of scrub and tick typhus and corroborate the occurrence of outbreaks of these diseases in the respective areas.