Screening of Individuals with Type 2 Diabetes on Anti-Diabetic Agents for Probable Hypoglycaemia Using the Stanford Hypoglycemia Questionnaire (SHQ) in Outpatient Settings: A Cross-Sectional Study from Outpatient Diabetes Care Centres in North India.

Introduction: The study was aimed at identifying the incidence of unreported probable hypoglycaemia in individuals with type 2 diabetes (T2DM) on anti-diabetic medications, using the screening Stanford Hypoglycemia Questionnaire (SHQ) in real-world situations. Methods: It was a multicentre cross-sectional study on consecutive individuals attending 10 diabetes care centres in Lucknow, Uttar Pradesh, India. The inclusion criteria were as follows: known individuals with T2DM, literate, age greater than or equal to 18 years, on at least one anti-diabetic agent for more than a month and not engaged in regular self-monitoring of blood glucose (SMBG). Results: This study was conducted from August 2017 to April 2018, involving 1198 participants. The mean age of the individuals enrolled was 53.45 years (±10.83), with males comprising 55.3% of the population. It was found that 63.6% of patients were on sulphonylurea (SU), 14.5% were on pioglitazone, 92.2% on metformin, 62.3% on Dipeptidyl peptidase (DPP4i) and 12.8% on Sodium-glucose cotransporter (SGLT2i). The mean SHQ score was 1.81 (±1.59). Probable hypoglycaemia was mild in 57.59%, moderate in 14.69% and severe in 1.41%. Those with diabetic neuropathy (P = <0.001), retinopathy (P = <0.001) and nephropathy (P = <0.001) had significantly higher SHQ scores. Insulin or SU use was associated with a significantly higher SHQ score. Concomitant statin use was associated with a lower incidence of mild, moderate and severe hypoglycaemia (P = 0.01). On multivariate analysis, we found that age, sex, systolic blood pressure (SBP), insulin use and fasting blood sugar were the most important factors associated with an increased risk of hypoglycaemia with an R2 cut-off of 0.7. Conclusion: SHQ was discovered to be a simple and cost-effective screening tool for outpatient detection of hypoglycaemia in an Indian setting, and it can add value to management.

Facial Nerve in Parotid Surgery- do Landmarks Differ With Varying Statures?

Aim: To measure the distance of facial nerve from tragal pointer, tympanic plate and digastric muscle, also length of the facial nerve trunk and to establish any variation according to different patient stature. Methodology: Intraoperative measurements were taken using Castroviejo Callipers (20 mm). Height and weight of each was taken and tabulated. Results: The average height was 162 ± 9 cm while the average weight was 58 ± 9 kg. The average length of the extratemporal part of the facial nerve trunk, distance of the facial nerve from the tragal pointer, distance from the outer edge of tympanic plate, distance from the posterior end of the superior border of posterior belly of digastric muscle was 1 ± 0.2 cm, 1 ± 0.1 cm, 0.3 ± 0.2 cm and 0.2 ± 0.1 cm, respectively. Summary: No major difference was found in the landmarks despite varying stature.

Bilateral orthodontic extractions using physics versus conventional forceps among Indian patients.

It is of interest to assess whether or not physics forceps are superior to traditional forceps for the extraction of premolar teeth in orthodontic procedures. Tooth and buccal bone fractures, as well as extraction time, lacerated gingiva, postoperative discomfort, and infection, were all measured in this research of both types of forceps extraction. Twenty individuals who need orthodontic extraction on both jaws were enrolled in the research. One arch's premolars were removed in two appointments, the first using Physics forceps and the second using conventional ones. The subsequent assignment included extraction from the obverse arch. Intraoperative evaluations included assessments of factors such as tooth and buccal bone fractures, surgical time, and gingival lacerations; postoperative assessments of pain and infection were conducted on days 1, 3, and 7. With physics forceps, the average time to remove a patient's mandible was 86.55 seconds, whereas traditional forceps required just 35.70 seconds. Using traditional forceps, the average pain score was 0.865 on day one after surgery, but with physics forceps, it was 3.30. The use of physics forceps resulted in one buccal bone fracture out of twenty premolar extractions. That so, no meaningful statistical change was seen. There was no tooth damage or post-operative infection with either set of forceps, it was found. Each forceps caused a Grade I laceration to the gingiva. The average time required removing a maxillary using physics forceps was 224.05 seconds, whereas the time required doing it with conventional forceps was 141.50 seconds. On a Visual Analogue Scale (VAS), the average first-day pain after surgery using physics forceps was 4.90, whereas using traditional forceps resulted in just 3.15. The difference between using physics forceps and regular forceps was statistically significant by the third postoperative day (2.05 vs 0.75). There was a statistically insignificant increase in the occurrence of buccal bone fracture and tooth fracture while using physics forceps. Both forceps and scissors caused just grade I lacerations, and there was no postoperative infection. These findings suggest that the use of physics forceps, as opposed to conventional forceps, may significantly lengthen the time required to remove orthodontic premolars on both sides of the mouth. Non-significant results were also found for additional criteria such as buccal bone fracture, tooth fracture, gingival laceration, and post-operative discomfort. When it comes to orthodontic premolar extraction, this research found that traditional forceps performed better than modern forceps across a range of measures, including intraoperative time and postoperative discomfort.

Altered white matter integrity in euthymic children with bipolar disorder: A tract-based spatial statistical analysis of diffusion tensor imaging.

Pediatric Bipolar Disorder (BD) is a serious mental illness that affects children and adolescents, characterized by episodes of mania, depression, and mixed episodes. Recent studies have suggested that abnormalities in the white matter (WM) may be a contributing factor. The neuropathogenesis of BD in children is not well-described, and research in this area is limited. Euthymic phase is a period in which clinical symptoms are present but not severe enough to significantly impact mood and daily behavior. In order to better understand the WM changes associated with BD in children, this study utilized Diffusion Tensor Imaging (DTI), to investigate alterations in WM microstructure. 20 confirmed euthymic BD children (aged 7-16) and 20 typically developing children were included in the study. DTI scans were obtained using a 3 T Magnetom Skyra and were analyzed using tract-based spatial statistics (TBSS) to examine changes in fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD). Results showed that compared to the healthy control group, the euthymic BD group exhibited increased FA, AD, RD, and MD values in several brain regions, including the thalamus, precentral corticospinal tract, and superior longitudinal fasciculus. Conversely, decreased values were observed in the body of the corpus callosum and inferior fronto-occipital fasciculus. These findings suggest that alterations in WM microstructure are a hallmark of pediatric bipolar disorder. These findings provide important insights into the brain changes associated with pediatric bipolar disorder and open the door for new avenues of research.

Demystifying the decadal shift in the extent of groundwater in the coastal aquifers of Gujarat, India: A case of reduced extent but increased magnitude of seawater intrusion.

Catastrophic increase in urbanisation and industrialisation along the coastal region leads to increased stress on groundwater reservoirs worldwide. As a growing economy, India faces extreme water crises due to rising water demand and escalating salinisation, specifically in the coastal districts. Therefore, this study shows the implication of a comprehensive modelling approach to assess the spatiotemporal changes in hydrogeochemical processes in the coastal aquifer of the Surat district. Using a multi-model assessment approach, the present study focuses on the decadal evolution in groundwater quality of the coastal aquifers of Surat, Gujarat. Fifty-one groundwater samples were collected for 2008, 2012, and 2018 to assess the spatio-temporal shift in groundwater quality. Piper diagram revealed a shift of hydrogeochemical facies from Mg2+-HCO3- type to Ca2+-Mg2+-Cl- type, indicating the increased salinisation over a decade. The result suggests that rock-water interaction, seawater intrusion mechanism, and anthropogenic activities (intensive agricultural activities and improper waste management) govern the hydrogeochemical processes in the coastal aquifer. A shift of dominance of carbonate weathering to silicate weathering with the dissolution of calcite, dolomite, and gypsum, changing the hydrogeochemistry, was observed over the last decades. This shift leads to the increasing hardness of groundwater. The enrichment of nutrients in groundwater during 2018 (NO3- = 2 to 85 mg. L-1) compared to 2008 (NO3- = 1 to 36 mg.L-1) indicates the increasing imprints of agricultural fertilizer application and human organic waste through sewage contamination on the coastal aquifer. The seawater mixing index model demonstrates that extent of seawater intrusion reduced in 2018 compared to 2012, but the magnitude increased near the coastal talukas (SMI =9.5). The present study helps to understand the increasing anthropogenic activities over a decade leading to increased salinisation and groundwater contamination in the aquifer system. This work can help local stakeholders, water resource managers, and the state government manage the groundwater resources and the future potential threat of aquifer contamination.

Bifrontal-transcranial direct current stimulation as an early augmentation strategy in major depressive disorder: A single-blind randomised controlled trial.

BACKGROUND: Patients with major depressive disorder who have a poor or inconsistent response to antidepressants have been treated using transcranial direct current stimulation (tDCS). Early tDCS augmentation may help with the early amelioration of symptoms. In this study, the efficacy and safety of tDCS as early augmentation therapy in major depressive disorder were evaluated. METHODS: Fifty adults were randomized into two groups and were administered either active tDCS or sham tDCS, along with escitalopram 10 mg/day. A total of 10 tDCS sessions with anodal stimulation at the left dorsolateral prefrontal cortex (DLPFC) and cathode at the right DLPFC were given over two weeks. Assessments were done using Hamilton Depression Rating Scale (HAM-D), Beck's Depression Inventory (BDI), and Hamilton Anxiety Rating Scale (HAM-A) at baseline, two weeks, and four weeks. A tDCS side effect checklist was administered during therapy. RESULTS: A significant reduction in HAM-D, BDI, and HAM-A scores were observed in both groups from baseline to week-4. At week-2, the active group had a significantly greater reduction in HAM-D and BDI scores than the sham group. However, at the end of therapy, both groups were comparable. The active group was 1.12 times more likely to experience any side effect than the sham group, but the intensity ranged from mild to moderate. CONCLUSION: tDCS is an effective and safe strategy for managing depression as an early augmentation strategy, and it produces an early reduction of depressive symptoms and is well tolerated in moderate to severe depressive episodes.

The psychological impact of COVID-19 duty among resident doctors working in a COVID-hospital: A short-term follow-up study.

Background: There is a dearth of longitudinal research that measures the impact of the pandemic on the mental health of resident doctors. Aim: This study aimed to estimate depression, anxiety, stress, burnout, and sleep disturbances (insomnia and nightmares) among resident doctors after COVID-19 duty. The study was a prospective longitudinal study among resident doctors posted in COVID-19 wards in a tertiary hospital in North India. Methods: The participants were assessed at two points of time, two months apart, on a semistructured questionnaire and self-rated scales for depression, anxiety, stress, insomnia, sleep quality, nightmare experience, and burnout. Results: A significant proportion of resident doctors working in a COVID hospital had symptoms of depression (29.6%), anxiety (28.6%), stress (18.1%), insomnia (22%), and burnout (32.4%), even after two months of being off COVID duty. It was seen that these psychological outcomes had a strong positive correlation with each other. Compromised sleep quality and burnout significantly predicted depression, anxiety, stress, and insomnia. Conclusion: The current study has added to the psychiatric aspects of COVID-19 among resident doctors and the changes in these symptoms with time and highlights the need for targeted interventions to decrease these adverse outcomes.

Mental health outcome in hospitalized COVID-19 patients: An observational analysis from North Indian tertiary care hospital.

Aim: The study investigate the severity of perceived stress and wide domains of psychiatric symptoms reported on initial screening in hospitalized patients of COVID-19 with a second aim to determine the role of sociodemographic factors and coping styles in the hospitalized patients of COVID-19. Method: Total 224 patients of COVID-19 infection, hospitalized in various isolation facilities were assessed via web-based self-reported questionnaires on perceived stress scale, brief cope inventory, and DSM-5 crosscutting level-1 questionnaire. Results: Majority of the patients reported moderate level of stress followed by mild and severe. Depression and Anxiety symptoms were most common psychopathologies though the patients have reported greater severity in various domains of psychiatric symptoms. Coping styles explains most of variance (64.8%) of the perceived stress. Similarly total PSS scores, coping styles, COVID-19 status and sociodemographic factors contributed significantly to the variance of all psychiatric symptoms. Conclusion: Factors like female gender, being married, belonging to nuclear families, service class and urban domicile are the significant factors determining higher risk of stress and developing more psychopathologies. Furthermore, coping styles used by the patients have a greater moderating effect on mental health symptoms and their perceived stress which can be a major area for interventions to reduce the mental health morbidities.

Suicide reporting of LGBTQI+ population in India: An analysis of online media reports of the past decade.

BACKGROUND: Imbalanced portrayal of suicide by the media can have adverse public health consequences. We aimed to evaluate the psychosocial context, as well as the quality of media reporting, of suicide among lesbian, gay, bisexual, transgender people, queer and intersex (LGBTQI+) population. METHODS: A cross-sectional study was conducted to evaluate online news reports discussing the suicide of LGBTQI+ persons published between January 2011 and January 2021. Psychosocial factors associated with suicide were extracted from the reports. Quality of suicide reporting was checked against international as well as locally relevant reporting guidelines. RESULTS: A total of 135 suicide reports from five newspapers were analyzed. Multiple psychosocial stressors were reported in 54.5% of the suicides. Social stigma was the most common factor associated with LGBTQI+ suicide. Several breaches of reporting were noted in relation to mentioning the identity (55.6%) and method of suicide (54.3%) in the title of report and inclusion of the deceased's photograph (20.4%). Potentially helpful reporting characteristics, such as including educational information (2.2%), mentioning warning signs (12.6%) and suicide support service details (3.7%), were rarely practiced. Local language news articles displayed more frequent and serious violations compared to English news reports. CONCLUSION: Indian media reporting of suicide among LGBTQI+ persons is poorly adherent to reporting guidelines.

Dysphagia in post Covid-19 Patients- a Prospective Cohort Study.

Never in recent history has mankind been so severely and diversely affected by any disease like the COVID-19 infection. Many post-COVID complications have been mentioned in the literature and other platforms, of which post-COVID Dysphagia is a very distressing complaint. The severity of dysphagia may range from mild discomfort in swallowing to life-threatening aspiration. This paper aims to study post-COVID dysphagia, its various presentations, possible causative factors and diagnosis. Like any other new disease on the block, continuous study and research is the need of the hour, for us to be able to mitigate the damage already inflicted by this pandemic.

Longitudinal outcome of Functional Neurological Disorder in Children and Adolescents in a Tertiary Care centre from Northern India.

FND is common in Indian children and adolescents. Outcome related factors are not well known. With objective to study short-term outcome of FND, prospective, longitudinal, nine months follow-up study of 6-16 years was planned. Socioeconomic, clinical variables, I.Q. and personality traits at baseline and new psychiatric/physical illness, psychosocial factors and comorbidities during follow-up were assessed. Out of 68 children, scholastic (64.7%) and family problems (23.5%) were common psychosocial factors. After nine months,73% achieved remission. Reasons for non-remission were persistence of psychosocial factors and psychiatric comorbidities. A need arises for increasing awareness among general practitioners for early identification and management.

Sensory Processing in Children and Adolescents with Attention Deficit Hyperactivity Disorder.

OBJECTIVE: The aim is to assess the sensory processing difficulties in children and adolescents with ADHD. METHODS: In all, 38 ADHD children of the age group 6-14 years and 34 age- and gender-matched typically developing controls were included in the study. Sensory processing was assessed on Child Sensory Profile-2. The child behavior checklist and Weiss functional impairment rating scale were applied to assess behavioral problems and functional impairments, respectively. RESULTS: A significantly higher sensory processing difficulties were seen in children with ADHD than typically developing controls. There were positive correlations between the scores of Child sensory profile 2 with internalizing (with Sensitivity p = .036, Avoiding p = .001, and Auditory p = .029) and externalizing T scores (with Seeking p = .031, Movement p = .025, and Visual p = .018) of CBCL and also with scores of Weiss functional impairment rating scale (with Seeking p = .001, Sensitivity p = .019, and Registration p = .045). CONCLUSIONS: Sensory problems were common in children with ADHD and add to the functional impairments.

Evaluation of different aesthetic indices for planning orthodontic treatment.

Three aesthetic indices namely aesthetic component of index of orthodontic treatment needs (IOTN -AC), dental aesthetic index (DAI) and dental aesthetics screening index (DESI) were compared in orthodontic treatment. 242 participants (160 female and 82 male) who were interested in orthodontic treatment participated. The individuals' ages ranged from 16-25 years. Three aesthetic indices namely IOTN -AC, DAI and DESI were evaluated for each participant. The overall accuracy of DAI, AC-IOTN and DESI in assessment of dental aesthetics in orthodontic treatment was 62%, 68% and 64% respectively. The Negative predictive value (NPV) was higher than Positive predictive value (PPV) for all indices. The sensitivity was greater than specificity for all indices. It was observed that values of sensitivity, specificity, PPV and NPV were high for AC-IOTN. The findings were significant statistically (p<0.05).

Altered functional connectivity in children with ADHD while performing cognitive control task.

Response inhibition is one of the crucial cognitive domains that exhibit deficit in children with ADHD. To further elucidate it, this study examines the task-based functional-connectivity in children with attention deficit hyperactive disorder (ADHD). We acquired the fMRI data of 16 unmedicated children with ADHD and 16 typically developing (TD) children who performed the flanker task. MVPA and seed-based connectivity analysis was performed to identify the abnormal connectivity pattern across the whole brain. MVPA revealed that six important regions, namely the right IFG, right SMA, bilateral precentral gyrus, left DLPFC, and left cerebellum, had abnormal connectivity in children with ADHD while they performed the cognitive control task. Out of these six regions, four were further used for whole-brain seed-based functional connectivity analyses, which revealed patterns of significantly altered connectivity across multiple regions. Signal intensities changes were also extracted to perform BOLD- reaction time (RT) correlation analysis, that suggest positive correlation between left DLPFC and right IFG. Overall, the results suggest that children with ADHD are unable to endure high cognitive control demand. Our findings highlight the utility of analyzing brain connectivity data in identifying the abnormal connectivity in children with ADHD.

Burden of care and quality of life in caregivers of children and adolescents with autism spectrum disorder.

BACKGROUND: Autism spectrum disorder is a neurodevelopmental disorder which is increasing across the globe. The disorder in children not only creates burden of care in caregivers but also leads to impaired quality of life of families. OBJECTIVE: To study the burden of care and quality of life in caregivers of children and adolescents with ASD. METHODOLOGY: Cross sectional study conducted in Child and Adolescent psychiatry outpatient services at a government centre in north India between September 2014 to August 2015. The sample consisted of 40 caregivers of children with Autism. Mean age of the caregiver's were 34.72 ± 6.32 years. Burden of care and quality of life were measured by Burden Assessment Schedule (BAS) and World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) questionnaire respectively. RESULTS: Mean burden of care on BAS was 71.73 ± 8.62 indicating quite a high degree of burden on the caregivers of ASD. Significantly higher burden was reported by caregivers belonging to low income families and caregivers of children in age group 6-12 years. A positive correlation was observed between severity of autism and burden of care in caregivers. The study also found that as the severity of symptom increases the QoL in caregiver worsens. CONCLUSION: Caregivers of children with ASD suffer from high burden of care and impaired QoL.

Optimizing Airway Surgery in COVID 19 Era.

Otorhinolaryngologists, particularly dealing with airway cases, are subjected to highest risk of COVID 19 aerosolisation, self infection and transmission. Moreover, airway cases, which mostly present as emergency, cannot be deferred. Being a tertiary airway centre and having received a number of airway cases, most of them requiring prompt surgical intervention, our airway surgery and anaesthesiology team had to work in conjunction to adapt and readapt the practice over the past few months, striving to achieve effective airway surgery protocols, to minimize exposure and prevent transmission of COVID 19. To enlist the encountered airway cases during COVID 19 pandemic and to highlight the important inclusions and adaptations in executing the airway surgeries. A retrospective observational study of 7 months duration was carried out. This is a single institutional study, where the sample included the primary as well the referred airway cases. Apart from Tracheotomy, Foreign body bronchus removal, Dilatation of Laryngotracheal Stenosis (LTS) and excision of Recurrent Respiratory Papillomatosis (RRP), we also have had the experience to deal with congenital Laryngo-tracheo-oesophageal Cleft (LTOC) Type III b, Thyroid surgery to relieve tracheal compression and Bilateral Choanal Atresia repair during the last 7 months. Routine 2 weeks follow up of the patients have been favourable, as there has not been any report or clinical features of transmission of COVID 19. As the airway surgeries could be executed with the incorporation of certain change in practice and as the follow up revealed no evidence of transmission, we attempt to contribute to airway best practice guideline for maintaining the safety of patients and health professionals.

Grey and white matter alteration in euthymic children with bipolar disorder: a combined source-based morphometry (SBM) and voxel-based morphometry (VBM) study.

Bipolar disorder (BPD) is a psychiatric condition driving frequent mood swings between periodic extremes of happiness and depression in patients. In this study, a source-based morphometry (SBM) and voxel-based morphometry (VBM) analysis was utilized to measure the differences in the white matter (WM) and grey matter (GM) between euthymic children with BPD and typically developing (TD) children. We adapted both multivariate (SBM) and univariate (VBM) analysis in 20 children with BPD euthymia /remission and compared to the same number of TD age-matched children. The VBM did not reveal any increase in GM and WM voxel values in children with BPD. However, a decrease in the GM voxel values in the bilateral middle frontal and WM voxels in the left hippocampus, left caudate, left orbitofrontal and right inferior parietal cortices was identified. Conversely, SBM analysis in BPD displayed a high GM value in bilateral angular gyrus, bilateral inferior temporal, left supplementary motor area and left middle temporal region, while a low value was observed in left inferior and middle occipital, cerebellum, thalamus, left premotor area and left lingual gyrus. These findings suggested a crucial GM and WM alteration in multiple neural regions in BPD children even during sustained and substantial remission.