Dengue and scrub typhus co-infection in children: Experience of a teaching hospital in an endemic area.

Background: Dengue fever and scrub typhus are considered an endemic disease in the Indian subcontinent. The epidemiology and clinical presentations are complex and vary each year. Objective: The objective of this study was to estimate the prevalence of coinfection with scrub typhus in children diagnosed with dengue fever. Methods: A retrospective hospital-based, cross-sectional study was done in the Department of Pediatrics of a teaching hospital in Puducherry. All children (0-14 years) who had enzyme-linked immunosorbent assay (ELISA) reported scrub typhus among those diagnosed with dengue fever (NS1Ag or immunoglobulin M ELISA positivity) during 2012-2016. Medical records with incomplete data were excluded from the study. Odds ratio was calculated to find out the association of coinfections. An independent t-test was used to find out the statistical significance. P < 0.05 was considered statistically significant. Results: Atypical features of dengue were present in 250/318 (78.6%) children. Coinfections were seen in 62/318 (19.4%) children. Scrub typhus was the most common (n = 51/62, 82.2%). The chance of scrub typhus in a dengue serology-positive child is significant when the symptoms are atypical or protracted (OR- 2.6, P = 0.033). Conclusion: High index of suspicion should be present in endemic dengue and scrub typhus coinfection.

Supplementing research ethics training in psychiatry residents: A five-tier approach.

BACKGROUND: Ethics training is a key step in the research supervision of psychiatry trainees and there is need for a structured educational module. METHODS: We developed a new research ethics training module for psychiatry residents - The Five-Tier Approach. Twenty-five first year psychiatry residents of an academic psychiatric training centre in India participated in this multi-session workshop. Module 1 included the completion of NIH online certification course for research ethics training. Module 2 was a one-hour interactive group discussion on ethical principles in research. Module 3 was a two-hour session consisting of case-based group discussion of nine selected research vignettes. Module 4 involved preparation of an informed consent form. Module 5 was a mock ethics committee role-played by seven students while the larger group observed using a Fish Bowl technique and provided feedback. Assessments were done during the third and final modules. RESULTS: During the third module, understanding regarding certain areas - autonomy, benefits and justice was found to be inadequate. In the final step, all ethical aspects were covered by the students. DISCUSSION: This five-tier approach seems like a superior tool for research ethics training in academic institutions, especially in Southeast Asia, where the student-teacher ratios are generally very high.

A Voxel Based Morphometry Study of Brain Gray Matter Volumes in Juvenile Obsessive Compulsive Disorder.

INTRODUCTION: Adult patients with Obsessive Compulsive Disorder (OCD) have been shown to have gray matter (GM) volume differences from healthy controls in multiple regions - the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), medial frontal gyri (MFG), striatum, thalamus, and superior parietal lobule. However, there is paucity of data with regard to juvenile OCD. Hence, we examined GM volume differences between juvenile OCD patients and matched healthy controls using voxel based morphometry (VBM) with the above apriori regions of interest. METHOD: Fifteen right handed juvenile patients with OCD and age- sex- handedness- matched healthy controls were recruited after administering the Mini International Neuropsychiatric Interview-KID and the Children's Yale-Brown Obsessive Compulsive Scale, and scanned using a 3 Tesla magnetic resonance imaging scanner. VBM methodology was followed. RESULTS: In comparison with healthy controls, patients had significantly smaller GM volumes in left ACC. YBOCS total score (current) showed significant negative correlation with GM volumes in bilateral OFC, and left superior parietal lobule. CONCLUSION: These findings while reiterating the important role of the orbito-fronto-striatal circuitry, also implicate in the parietal lobe - especially the superior parietal lobule as an important structure involved in the pathogenesis of OCD.

INTRODUCTION: Les patients adultes souffrant du trouble obsessionnel-compulsif (TOC) ont révélé des différences de volume de matière grise (MG) d'avec des sujets témoins en santé dans de multiples régions ­ le cortex orbitofrontal (COF), le cortex cingulaire antérieur (CCA), le gyrus frontal moyen (GFM), le striatum, le thalamus, et le lobule pariétal supérieur. Cependant, il y a pénurie de données à l'égard du TOC juvénile. Nous avons donc examiné les différences de volume de MG entre les patients du TOC juvéniles et des sujets témoins appariés en santé à l'aide de la morphométrie voxel à voxel (VBM) dans les régions d'intérêt mentionnées ci-dessus. MÉTHODE: Quinze patients juvéniles droitiers souffrant du TOC et des sujets témoins en santé appariés selon l'âge, le sexe, et la manualité ont été recrutés après l'administration de la Mini International Neuropsychiatric Interview-KID et la Children's Yale-Brown Obsessive Compulsive Scale (YBOCS). Les images ont été obtenues à l'aide d'un scanner d'imagerie de résonance magnétique 3 Tesla, selon la technologie VBM. RÉSULTATS: Comparativement aux témoins en santé, les patients avaient des volumes de MG significativement plus petits dans le CCA gauche. Le score total (actuel) d'YBOCS indiquait une corrélation négative significative avec les volumes de MG dans le COF bilatéral, et le lobule pariétal supérieur gauche. CONCLUSION: Ces résultats réitèrent le rôle important de la circuiterie orbito-fronto-striatale, mais ils impliquent aussi que le lobe pariétal, en particulier le lobule pariétal supérieur, est une importante structure participant à la pathogenèse du TOC.

Repetitive transcranial magnetic stimulation not beneficial in severe choreiform movements of Huntington disease.

Repetitive transcranial magnetic stimulation (rTMS) has been used therapeutically for reducing choreiform movements in patients with Huntington disease. There have been case studies reporting improvement in choreiform movements with administration of low-frequency rTMS lasting for a brief period. We report a case series where application of 7 consecutive sessions of bilateral low-frequency rTMS over the scalp area corresponding to supplementary motor area in patients with severe Huntington chorea did not reduce the intensity of choreiform movements even transiently. Hence, the proposed role of rTMS in reducing intensity of choreiform movements by altering neuronal plasticity may not hold true in severe cases.

White matter abnormalities in children and adolescents with obsessive-compulsive disorder: a diffusion tensor imaging study.

BACKGROUND: There is paucity of data on white matter (WM) abnormalities in juvenile obsessive-compulsive disorder (OCD). This study aimed to identify WM microstructure changes in juvenile OCD. METHODS: Fifteen children and adolescents with OCD and 15 matched healthy controls underwent diffusion tensor imaging using a 3 Tesla (Achieva, Best, The Netherlands) magnetic resonance imaging scanner. Voxelwise analyses were conducted on data processed through tract-based spatial statistics (TBSS). RESULTS: Patients significantly differed from controls in axial as well as radial diffusivities, but not in fractional anisotropy. Patients demonstrated significantly increased axial diffusivity in corpus callosum (genu, body, and splenium), right and left superior longitudinal fasciculi, left inferior longitudinal fasciculus, right and left cingulum, bilateral anterior thalamic radiations, bilateral anterior limb of internal capsule, left posterior limb of the internal capsule, and middle cerebellar peduncle. In addition, significantly increased radial diffusivity was seen in patients in genu of the corpus, right and left superior longitudinal fasciculi, left inferior longitudinal fasciculus, right and left uncinate fasciculi, bilateral anterior thalamic radiation, bilateral inferior fronto-occipital fasciculus, left posterior limb of internal capsule, right superior cerebellar peduncle, middle cerebellar peduncle, and right inferior cerebellar peduncle. CONCLUSIONS: Our findings suggest involvement of multiple WM tracts in juvenile OCD. In addition to the widely proposed hypothesis of orbitofrontal-striato-thalamo-cortical circuitry deficits in the development of OCD, our findings suggest involvement of additional brain regions, possibly parietal cortex, lateral prefrontal cortex, and limbic system. The widespread differences in WM among cases and controls also points to the possibility of underlying myelination changes.