Comparative study of clinical profile and presumptive stressful life events in patients of psychogenic non epileptic seizure and epileptic seizure: a cross sectional study.

Background: Psychogenic Non Epileptic Seizure (PNES) is one of the most common conditions to be mistaken for epilepsy. No clinical feature is pathognomic of PNES, but some help in distinguishing it from epileptic seizure. Role of psychologically stressful events has been considered central to the pathogenesis of PNES and used in differentiating it from epileptic seizure. The purpose of present study was to compare the clinical profile and number of stressful life events in the two patient groups in Indian population. Methods: 50 new patients of epileptic seizure and PNES each, aged 16 to 60 visiting the psychiatric and neurology OPD were selected. Detailed history and physical examination was carried out to exclude any medical illness. Diagnosis was made based on clinical history given by an eye witness and EEG recording. Brain imaging (CT/MRI) was conducted, to rule out any secondary causes of seizure. General health questionnaire 12, and presumptive stressful life event scale was applied on all patients. SPSS 19 was used for data analysis. Chi square was used for categorical data and Man Whitney U test for continuous data. Results: There were significantly more females in the PNES group (P = 0.001) and significantly more illiterate (P = 0.004) .There were no significant difference with regard to the age of onset, marital status. Also there was no statistically significant difference between the two group with regard to number of stressful life event (P = 0.330). Conclusion: Stressful life event should not bias a clinician towards making a diagnosis of PNES.

Neuro-psychiatric profile of university students attending psychiatry outpatient department of a tertiary care centre

Background: Mental health problems are on the rise in young population because of multiple sources of stress and pressure to excel in the competitive environment, especially depression, substance use disorders and suicide in developing countries. Aims: To assess neuro-psychiatric profile of university students attending psychiatry OPD of a tertiary care centre. Method: All the university students who attended psychiatry OPD were assessed for Neuro-psychiatric problems using DSM-IV TR criteria for psychiatric/behavioural problems and Harrison’s principles of internal medicine criteria for Neurological problems. Results: The common diagnoses were depression 63(19.3%), tension headache 40(12.3%) anxiety disorder NOS 38(11.7%), dhat syndrome 34(10.4%), obsessive compulsive disorder 29(8.9%), migraine 28(8.6%), conversion disorder 14(4.3%), primary insomnia 11(3.4%), schizophrenia 7(2.1%), mania 6(1.8%), seizure disorder 6(1.8%), generalised anxiety disorder 6(1.8%), substance use disorder 5(1.5%). Conclusion: This study gives us an insight into the mental health of university students

Conservative management of flail chest.

A total of 100 cases of flail chest were studied to find out the efficiency of the anti-lung contusion regimen containing a diuretic, a steroid and an enzyme preparation for some 10 days, along with pad and strapping. There were 80 males and 20 females. Majority (71%) of patients were between 16 and 45 years. Road side accident was the commonest cause, present in 65% cases followed by bull horn injuries (25%), fall from a height (8%) and gun shot injuries to chest (2%). Associated intrathoracic and extrathoracic injuries were recorded in 45% and 30% cases respectively and they were treated according to their merits. There were 11 deaths with an overall success rate of 89%.

A new role of bronchofibrescope in the removal of unusual intrapleural foreign bodies.

Successful removal of unusual intrapleural foreign bodies (surgical blades) by means of a bronchofibrescope (BFS) passed through the thoracostomy tube tract is reported. The potential role for the use of the fibreoptic bronchoscope for this purpose is emphasized.

Tooth in the bronchus--an unusual foreign body and presentation.

Tooth in right bronchus in a 60-year-old man who presented with recurrent episodes of chest infection, dyspnoea and haemoptysis is a rare clinical entity. The patient was cured after successful bronchoscopic removal of the tooth.

Bilateral simultaneous pneumothorax--a study of 25 cases.

Twenty-five cases of bilateral simultaneous pneumothorax were studied. In children it was mostly postpneumonic, whereas in adults it was tuberculous or traumatic. Prompt intercostal drainage on both the sides supported by antibiotics and/or anti-tubercular drugs, and respiratory physiotherapy was curative on most occasions. The association of bronchopleural fistula or septicaemia worsens the prognosis.

Corrosive pyloric stenosis--a report of two cases.

Two unusual cases of post corrosive pyloric stenosis in adults are reported. Both the cases were diagnosed clinically and confirmed by barium meal examination. Patients were discharged following anterior gastrojejunostomy. Follow-up examination did not reveal any problem. However, both of them are undergoing regular dilatation for the associated oesophageal stricture.

Penetrating chest trauma: a review of 150 cases.

Penetrating injuries of the chest with emphasis on the policy of selective management in 150 cases, 145 males and 5 females, with age ranging from 5-60 years were reviewed. Chest pain and breathlessness were the commonest presenting features. Haemorrhagic shock and haemoptysis were noted in 30% and 20% cases respectively. Fire arms injury was the leading cause of chest trauma, being present in 80 (53.33%) cases. Except for 6 (3 cases had superficial stab wounds and 3 died on way to operation theatre), all patients (144) needed surgical intervention (tube thoracostomy drainage in 110 and major operation in 34 patients). There were 7 deaths in this study; massive haemorrhage was the cause of death in 4 and septic shock in 3 cases. An overall success rate of 95.34% was observed in this series.

Tracheostomy tube: an unusual foreign body in trachea

A rare case of aspiration of the vertical flange of the tracheostomy tube into the trachea, is reported. The literature on the subject is briefly reviewed