Socio-demographic profile and mode of attempt of suicide among suicide attempters in Kashmir: a hospital-based study

Background: Suicide is an important and serious public health problem. It is one of the major emergencies in psychiatry. This study was carried out to assess the socio-demographic profile and mode of attempt of suicide among suicidal attempters attending emergency.Methods: This study was a cross sectional, observational study conducted at Institute of Mental Health and Neurosciences-Kashmir, an associated hospital of Government Medical College Srinagar, among the suicide patients attending the outpatient service and inpatient services fulfilling inclusion and exclusion criteria over a period of one and a half year. Each patient was informed about the purpose of interview; his/her consent was obtained in a simple and easily understandable unambiguous language.Results: A total of 221 cases who had been admitted following unsuccessful suicide attempts to the emergency and psychiatry department were taken up for the study. Out of which 161 (72.9%) were females and 60 (27.1%) were males, the mean age was 24.61±8.9 years. Lower middle and upper lower classes occupied an equal percentage of 34.4% of the suicide attempters, while 24% belonged to upper middle class and only 5.9% belonged to lower class .The least no. of cases (1.4%) were from the upper classes. The most common mode adopted was poisoning whereas the least common mode was self- immolation. Poisoning and self-mutilation were proportionally high in females as compared to males with a significant p value.Conclusions: There should be a robust system in place which takes care of future management and follow up of this group of population.

Socio demographic, clinical and side effect profile of electroconvulsive therapy use among psychiatric inpatients: a cross sectional study from South East Asia - Kashmir

Background:Electroconvulsive Therapy (ECT) is a neuromodulative technique, which is effective but underutilized for treatment of psychiatric disorders. The aim of the study was to investigate socio demographic, clinical and side effect profile of electroconvulsive therapy use among psychiatric inpatients.  Methods:A cross sectional study was performed for a period of 1 year in postgraduate department of psychiatry (Institute of mental health and neurosciences Kashmir - center of excellence). Patients of pharmacotherapy resistant psychiatric disorders attending the hospital during this period were taken in study. The data was recorded in a specially designed proforma which documented the socio-demographic variables including age, sex, residence, occupation, socioeconomic status was recorded. Chi-square, Fisher exact, and t tests were used to note the statistically significant association.Results:The mean age of the study sample was 39.6 (±11.76) years. Maximum number of patients were in the age group 41-50 years i.e. 16 (28.6%), followed by 31-40 years i.e. 15 (26.8%). The mean number of ECT’s received was 8.22 (±2.073). About 29 (51.8%) patients reported body aches, 24 (42.9%) patients reported forgetfulness, 9 (16%) patients reported headache and only 1 (2%) patient reported agitation.Conclusion:The results indicate that electroconvulsive therapy is used in all psychiatric disorder with fewer side effects in pharmacotherapy resistant psychiatric disorders.

Quality of life and wellbeing in patients receiving electroconvulsive therapy: a study from Kashmir

Background: Electroconvulsive therapy (ECT) is an effective neurostimulative treatment in psychiatric disorders and is widely used throughout the world except few countries. Studies regarding quality of life and well-being in patients receiving electroconvulsive therapy have not been undertaken in our country. Objective of current study was to study the quality of life and well-being in patients receiving Electroconvulsive therapy. Methods: 50 patients who have been prescribed pharmacological drugs form the control group and 50 patients already on psychotropic medication who were prescribed electroconvulsive therapy form the case group were taken up for study. Detailed evaluations were carried out clinically and by measurement of Well-being index. Pre-treatment evaluation was carried out one day before Electroconvulsive therapy, and post treatment was carried out at 3 and 7 week. Data were evaluated by means of chi square and Repeat ANOVA, Post hoc Bonferroni correction for within group comparisons applicable. Results: Mean wellbeing index for study group is 14 which is slightly higher than control (11) (p>0.001.) Well-being index of study group is much higher than that of control group at 3 and 7 week post treatment (p>0.001). Conclusions: Sustained effect on quality of life remains in depression up to 7 weeks and in mania it responds rapidly wanes off within 7 weeks. Electroconvulsive therapy improves the quality of life in psychiatric patients.

Pathological Studies on Lung Abscesses in Sheep Slaughtered in Kashmir Valley, India

The present study was conducted in Kashmir valley of India to investigate the prevalence and pathology of lung abscesses in sheep, slaughtered in different organized abattoirs. These abattoirs were visited between January 2010 to February 2011 and a total of 1455 lungs were examined. Out of these 18.9% lungs had abscesses, with higher incidence in young sheep (60%) than in adult ones (40%). Grossly, abscesses were observed in one or more lung lobes and were either single or multiple. In majority of lungs, abscess sizes varied from pea to walnut size, but in some cases large abscesses were also observed. Histopathologically, abscesses were characterized by a central caseo-necrotic core surrounded by pyogenic membrane with infiltration of polymorphonuclear cells and few mononuclear cells and macrophages. Most of the abscesses revealed presence of Gram positive bacterial infection where as chronic abscesses indicated both Gram positive and Gram negative bacterial infection. Fibrous tissue proliferation around the pyogenic membrane of the chronic abscesses was noticed. Disruption and disorientation of elastin fibres was also a prominent feature. Increased concentration of both acid and neutral mucopolysaccharides was observed in and around the lesion. Purulent material of abscesses revealed marked metachromasia. The study revealed that lung abscesses in domestic sheep are highly prevalent in Kashmir valley. Thus, there is a need to introduce appropriate control measures of diseases affecting the lungs to minimize the incidence of lung affections and hence reduce the ensuing economic losses

Insulin Resistance and Polycystic ovary Syndrome: A Review

Polycystic Ovary Syndrome (PCOS) is the most common, yet complex, endocrine disorder affecting women in their reproductive years and is a leading cause of infertility. This disease appears to be multifactorial and polygenic in nature involving multisystem dysfunction, namely reproduction, endocrine and metabolic. Hyperandrogenism and insulin resistance appear to be central cause to the pathophysiology of the disease. The glucose and insulin metabolism pathways have been studied and debated to understand whether Insulin Resistance is due to a defect in insulin action or a primary defect in β-cell function or decreased hepatic clearance of insulin, or a combination of all these factors. Numerous studies have demonstrated that obese, normal weight and thin women with PCOS have a form of insulin resistance that is unique and intrinsic to the disorder. Moreover obese women with PCOS possess an additional burden of insulin resistance resulting from their excess adiposity. Hyperinsulinemia leads to increase in androgen production directly by acting as a co-gonadotropin, augmenting Luteinizing Hormone activity within the ovary, and indirectly by increasing serum LH pulse amplitude. Whereas Androgens may in turn contribute at least partially to the insulin resistance state linked with PCOS.  In this review, we will briefly study the role of insulin resistance in polycystic ovary syndrome. Keywords: Polycystic ovary syndrome, insulin resistance, Hyperandrogenism

Psychosocial and medical factors affecting treatment compliance in patients attending psychiatric hospital: a study from Kashmir

Background: Compliance with medication is decisive for treatment of the psychiatric disorders and is necessary for determining the outcome and prognoses of psychiatric patients. While the causes of poor compliance are multifactorial, the psychiatrist should be aware of such factors and may be able to implement interventions to address those factors. The objective of study was to find out the various medical and social reasons affecting treatment Compliance among patients suffering from psychiatric disorders.Methods: A Cross-Sectional study from 2011 to 2012 was conducted in IMHANS (Institute of Mental Health and Neurosciences) Srinagar (J&K), a questionnaire was designed, and the questionnaire included questions on socio-demographic variables, psychiatric illnesses, and Medical and psycho-social affecting treatment compliance. A systematic selection method for choosing the respondents was opted, questionnaire was administered on 200 (n=200) patients who attended the Outpatient department during the period. Simple random sampling method was applied for selection of respondents, the first time visitors to OPD were exclude along with repetition of respondents.Results: Out of 200 respondents studied in the study 41.5 % were males and 58.5% were females. Maximum number of patients (31.5%) studied were in the age group below the 30 years. 3.5% of respondents were in the age group above 70 years. Out of total 200 respondents in the study 74 % of the respondents are in compliance with recommended medicine whereas non-compliance was found in the 26% of studied population. Complications (13.46%) ascending out by usage of psychiatric medicine can be attributed as one of the major case of treatment non-compliance in psychiatric patients, among the psychiatric patients. Accessibility of psychiatric medicine and Financial constrain was also one of the reasons behind the medicine non-compliance (7.69%). Patients with no insight to psychiatric disease also include a good percentage of (5.76 %) of medicine non- compliance.  Conclusions: Non-compliance is a dominant factor which causes possibly causes readmission in psychiatric wards. Compliance in psychiatric patients in general could be enhanced and improved by adequate intervention via patient counselling and patient medicinal care and education

Drug safety and Pharmacovigilance: An overview

Adverse drug reactions (ADRs) have a major impact on public health, reducing patient’s quality of life and imposing a considerable financial burden on the health care systems at a time when many health care systems are under considerable financial strain. All healthcare providers have roles to play in maintaining a balance between a medicine's benefits and risks. Once a drug is available to the public, making a determination about its safety is the shared responsibility of all who are part of the prescribing process, including patients. The role of healthcare professionals is vital in recording and reporting suspected ADRs in order that regulatory agencies are alerted of emerging safety concerns and thereby facilitating timely and appropriate action. Pharmacovigilance is an important exercise for monitoring of drug related issues after marketed in “real world setting”. Pharmacovigilance and all drug related issues are important for everyone whose life is being impacted any way by medical interventions. The evolution of Pharmacovigilance in recent years has growing importance as a science critical to effective clinical practice and public health science. The national Pharmacovigilance centers have become a significant influence on the drug regulatory authorities, at a time when drug safety concerns have become increasingly important in public health and clinical practice. This paper unfolds the basics of drug safety and other important aspects of Pharmacovigilance. Keywords: Adverse drug reactions, Pharmacovigilance, Drug regulation

External fixation of “intertrochanteric” fractures

In developing countries, due to limited availability of modern anesthesia and overcrowding of the hospitals with patients who need surgery, high-risk patients with “intertrochanteric” fractures remain unsuita ble for open reduction and internal fixation

Prevalence and pattern of electroencephalographic changes associated with clozapine treatment: a cross-sectional study

Abstract Background Clozapine is a second-generation antipsychotic which is known to have superior efficacy as compared to other antipsychotics. It is particularly used in treatment-resistant schizophrenia (10–30%). However, its use is limited due to the serious side effect of inducing seizures which can occur at all doses. The purpose of our study was to analyse patients taking clozapine for any electroencephalographic (EEG) abnormalities. We undertook a cross-sectional study on 107 patients with a different diagnosis taking clozapine who visited the outdoor treatment facility of a tertiary care psychiatric diseases hospital in Kashmir. A 32-channel digital EEG was obtained and evaluated visually for any abnormalities in these patients. The data was tabulated and analysed using SPSS 23.0. Results EEG abnormalities were reported in 60.75% of patients receiving clozapine out of which slow waves and epileptiform activities were present in 48.60% and 30.84% of patients, respectively. Background slowing was often in the delta and theta ranges. Our study showed that there was a statistically significant relationship between the dose of clozapine and EEG abnormalities. Clinical seizure occurred in only one patient receiving clozapine 450 mg/day and was a smoker who had recently stopped smoking. Conclusions EEG abnormalities occur frequently in clozapine-treated patients specifically those taking higher doses of clozapine. This calls for utilising EEG as a useful clinical investigation in these patients along with clinical monitoring of seizures especially in those taking higher doses of clozapine in order to hint towards early signs of clozapine toxicity. Caution needs to be taken in patients who are smokers and show a pattern of change in their smoking habits. Moreover, EEG abnormalities though frequently associated with clozapine are not reliable predictors of seizures. Therefore, anticonvulsants may not be routinely indicated in patients on clozapine even in the presence of epileptiform discharges