Infectious causes of acute encephalitis syndrome hospitalizations in Central India, 2018-20.

BACKGROUND: We enhanced surveillance of hospitalizations of all ages for acute encephalitis syndrome (AES) along with infectious aetiologies, including the Japanese encephalitis virus (JEV). METHODS: From October 2018 to September 2020, we screened neurological patients for AES in all age groups in Maharashtra and Telangana States. AES cases were enrolled at study hospitals along with other referrals and sampled with cerebrospinal fluid, acute and convalescent sera. We tested specimens for non-viral aetiologies viz. leptospirosis, typhoid, scrub typhus, malaria and acute bacterial meningitis, along with viruses - JEV, Dengue virus (DENV), Chikungunya virus (CHIKV), Chandipura virus (CHPV) and Herpes simplex virus (HSV). RESULTS: Among 4977 neurological hospitalizations at three study site hospitals over two years period, 857 (17.2%) were AES. However, only 287 (33.5%) AES cases were eligible. Among 278 (96.9%) enrolled AES cases, infectious aetiologies were identified in 115 (41.4%) cases, including non-viral in 17 (6.1%) cases - leptospirosis (8), scrub-typhus (3) and typhoid (6); and viral in 98 (35.3%) cases - JEV (58, 20.9%), HSV (22, 7.9%), DENV (15, 5.4%) and CHPV (3, 1.1%). JEV confirmation was significantly higher in enrolled cases than referred cases (10.2%) (p < 0.05). However, the contribution of JEV in AES cases was similar in both children and adults. JE was reported year-round and from adjacent non-endemic districts. CONCLUSIONS: The Japanese encephalitis virus continues to be the leading cause of acute encephalitis syndrome in central India despite vaccination among children. Surveillance needs to be strengthened along with advanced diagnostic testing for assessing the impact of vaccination.

Psychiatric morbidity in geriatric population in old age homes and community: a comparative study.

BACKGROUND: The phenomenon of population ageing is already a major social and health problem in the developed countries. The elderly have their problems of disease and disability due the increasing age and changing social circumstances and the need for social support forms an important aspect of geriatric healthcare. AIM: To comparatively study the prevalence and pattern of psychiatric disorders in geriatric population in old age homes with those living with the families; and its association with the sociodemographic variables. MATERIALS AND METHODS: Brief Psychiatric Rating Scale was used to screen the study population for psychotic and non-psychotic symptoms. Mini Mental Status Examination was used to assess the cognitive decline and the Psychiatric diagnosis was made according to International classification of diseases 10(th) Revision Diagnostic criteria. SPSS-16 was used for statistical analysis. RESULTS: Psychiatric disorders were more prevalent in individuals aged >80 years, in females, and illiterates. Mood disorders were the most common Psychiatric disorders. Individuals in old age homes had less prevalence of Psychiatric illness than those living in the community. CONCLUSION: The overall prevalence of Psychiatric disorders was less in the geriatric population in old age homes because of the better availability of care, being engaged in regular activities as per the schedule, group works, etc. This study reflects the importance of delivery of care for better life in geriatric population.

Genital self mutilation in alcohol withdrawal state complicated with delirium.

Genital self mutilation is a rare and a severe form of self-injurious behavior usually described in psychotic disorders, with delusions and hallucinations. It has been ascribed to sexual conflicts, Body image distortions, Internalized aggression, and suicidal intent. This phenomenon has been described in schizophrenia, affective psychosis, alcohol intoxication, and personality disorders. The present case genital self mutilation in a case of alcohol withdrawal state complicated by delirium is reported.