Identification of anuran species diversity of the Panna Tiger Reserve, Central India, using an integrated approach

We present a comprehensive inventory of amphibians from Panna Tiger Reserve in Madhya Pradesh based on morphological, molecular and bioacoustic data. Representatives of 15 anuran species were collected, corresponding to roughly four fifths of the known amphibian species of Madhya Pradesh. The main results of this study are: (1) Description of advertisement calls of eleven species, including the first-time description of advertisement calls of Sphaerotheca pashchima. (2) Identification of cryptic species using acoustic and molecular techniques. (3) Five new significant range extensions and new state records. (4) Description of geographical variation in call properties in three anuran species. This study also provides morphological descriptions with ecological and natural history notes for each species that may be useful in management planning for amphibian conservation in Panna Tiger Reserve.

Changes in bacterial profile during amebiasis: demonstration of anaerobic bacteria in ALA pus samples

Little is known about the changes in gut resident flora during amebic colitis and amebic liver abscess (ALA) caused by Entamoeba histolytica infection. Fecal samples from ALA patients, from healthy E. histolytica negative and positive (asymptomatic) individuals, and from pre- and post-metronidazole-treated healthy volunteers and pus samples from ALA patients were tested for the presence of various bacterial genera using 16S rRNA-based primers. Statistically significant reduction in Lactobacillus due to E. histolytica infection was observed in asymptomatic individuals and ALA patients. On the other hand, reduction in Bacteroides, Bifidobacterium, and Clostridium in the same samples was due to metronidazole treatment. Two anaerobic genera, viz. Bacteroides and Peptostreptococcus, were detected in ALA pus samples, and this observation is unprecedented. In addition, PCR revealed metronidazole resistance genes in fecal and pus samples of metronidazole-treated individuals. Re-examination of the ameba-bacterium relationship in amebiasis is suggested.

Issues related to disability in India: a focus group study

BACKGROUND

Systematic research into disability has been scarce, especially from India, even though an estimated 5% of the population may have significant disability due to physical disorders. Depression as a common psychiatric disorder affects about 3%-5% of the population. Thus, the impact of disability related to physical, mental and substance use disorders is enormous and it influences resource allocation and policy planning.

METHODS

The issues relating to disability were addressed through a qualitative multicentered study. Focus groups were conducted at three sites in Chennai, Bangalore and Delhi on three themes: (i) parity, stigmatization and social participation; (ii) current practices and needs; and (iii) the General Disability Model as proposed by the World Health Organization. The focus groups were homogeneous and included members from six categories of participants: individuals with physical disability, individuals with mental disability, individuals with alcohol/drug-related disability, family members of mentally disabled persons, family members of physically disabled persons and health professionals. In all, 118 groups were conducted with a mean (SD) group size of 8.6 (1.6).

RESULTS

Patients with mental and alcohol/drug-related disability were more discriminated against than those with physical disability. Awareness regarding the existing laws and social programmes was uniformly poor across the three centres. Stigmatization was a major reason for under-utilization of the meagre resources available. There was poor awareness of the Disability Act, 1996. The consumers felt more comfortable with the earlier terms of 'handicap' and 'impairment'.

CONCLUSIONS

The study has implications for policy planning, clinical decision-making and social behaviour. Awareness of the laws, facilities and programmes needs to be increased, especially regarding the Disability Act, 1996 among consumers as well as health professionals. More disability-friendly facilities are required.

Integration of mental health care into primary care. Demonstration cost-outcome study in India and Pakistan

BACKGROUND

Targeting resources on cost-effective care strategies is important for the global mental health burden.

AIMS

To demonstrate cost-outcome methods in the evaluation of mental health care programmes in low-income countries.

METHOD

Four rural populations were screened for psychiatric morbidity. Individuals with a diagnosed common mental disorder were invited to seek treatment, and assessed prospectively on symptoms, disability, quality of life and resource use.

RESULTS

Between 12% and 39% of the four screened populations had a diagnosable common mental disorder. In three of the four localities there were improvements over time in symptoms, disability and quality of life, while total economic costs were reduced.

CONCLUSION

Economic analysis of mental health care in low-income countries is feasible and practicable. Our assessment of the cost-effectiveness of integrating mental health into primary care was confounded by the naturalistic study design and the low proportion of subjects using government primary health care services.

Rural psychiatry in developing countries

During the last two decades several initiatives have been taken to improve psychiatric services in low-income rural areas in developing countries. They have included the formulation of national mental health programs and establishment of pilot programs for integration of mental health care with primary health care in India, Iran, and other countries in Asia, Africa, and South America. The psychiatrist has multiple roles to play in meeting the many challenges of providing mental health care in rural areas in developing countries.

Transesophageal echocardiography for the detection of left atrial thrombus

We performed transesophageal two-dimensional echocardiography (TEE) and compared its results with those of transthoracic echocardiography (TTE) in a series of 120 patients with rheumatic mitral stenosis (MS). The patients were selected from a pool of 2000 patients of rheumatic heart disease assessed earlier by clinical examination and TTE. The selection criteria for TEE included one or more of the following: 1. Atrial fibrillation, 2. Embolic episode, 3. Before closed mitral valvotomy or balloon mitral valvuloplasty, 4. Large left atrium (LA) and 5. Evidence of clot or spontaneous echo-contrast in LA. The aim was to study the usefulness of TEE as compared to TTE in the detection of thrombus in LA. LA thrombus was imaged in 34/120 TEE studies as compared to 21/120 TTE studies. In 12/13 patients in whom TTE failed, the clot was present in the left atrial appendage (LAA). In the remaining one patient, poor echo window for TTE was responsible. In 2/6 patients with embolic episode, neither TTE nor TEE could document the presence of clot in LA. The procedure of TEE was well tolerated and there were no complications. We conclude that TEE is a safe and valuable adjunct to TTE with better diagnostic ability for the detection of LA thrombus and should be performed in all patients with MS in whom a clot in LA is suspected or needs to be excluded.

Genetic loadings in schizophrenia: a dermatoglyphic study

Finger and palmar dermatoglyphics of 120 male and 120 female schizophrenics with and without a family history of schizophrenia in first-degree relatives were studied in the northwestern part of India. Patients were selected according to specific diagnostic criteria. Significant dermatoglyphic differences were observed for fingerprint patterns, total finger ridge counts and 'atd' angle between the schizophrenics with and those without a positive family history of schizophrenia, suggesting a strong "genetic loading" (i.e., hereditary factors) in familial cases of schizophrenia. Dermatoglyphic features of isolated schizophrenics also significantly differed from those of controls, thus indicating the involvement of genetic factors in the etiology of schizophrenia.

An incidence study of schizophrenia in India

Under a WHO collaborative study, the Chandigarh center monitored two geographically defined populations over a 2-year period. Using helping-agency-coverage and other methods along with a set of specified criteria, 268 first-onset potentially schizophrenic cases were actively identified. Of these, 232 cases could be assessed in detail which included 209 schizophrenics as per specified ICD-9 or Catego criteria. The annual incidence rates obtained were 4.4 and 3.8 per 10,000 for rural and urban areas, respectively. The rural cohort had a higher incidence for each of the three diagnostic definitions. In the urban cohort, sex and diagnostic definition did not affect the incidence. In the rural cohort, females had a lower incidence for Catego S+ and a higher incidence for other diagnostic definitions.

Climate and admissions for mania in the tropics

Seasonality of admissions for mania has been commonly reported. Most reports are from temperature zones. We analyzed admissions for mania covering a 9 year period and looked for any seasonal trends using existing methods. No seasonal variation was found. The hospital lies in the tropical zone with a relatively constant climate. This may influence the seasonal pattern of relapses in affective disorder.

Seasonal relapses in affective disorder in the Tropics: a prospective follow-up of 12 patients

Seasonal relapses of affective disorder are known. We report 12 patients who had season-linked relapses during a prospective follow-up period of 4 years. There were both winter and summer relapses of mania and depression. The centre is in the tropical zone, with lesser variation of sunshine and temperature than in more extreme latitudes. This may inference the pattern of relapse in affective disorder. Differences in relapses between tropical and temperate zones need to be investigated.

A double-blind evaluation of alprazolam and imipramine in the treatment of major depression

This report describes the results of a multicentre collaborative study comparing the safety and efficacy of alprazolam with imipramine in patients suffering from major depressive disorder. Two hundred and eight patients diagnosed as major depression as per DSM-III criteria were randomly allocated to alprazolam (N= 105) or imipramine (N = 103) in a double-blind fashion. Detailed assessments were carried out for a period of six weeks. Results revealed that alprazolam was as effective as imipramine as an antidepressant. Side effects were less frequently reported with alprazolam.

Training of primary health care medical officers in mental health care. Errors in clinical judgment before and after training

This investigation examined the nature and frequency of errors in clinical judgment that were displayed by primary health care medical officers before and after short-term training in mental health care. Thirty-nine medical officers who underwent inservice training for 2 weeks were evaluated using standardized case vignettes. Before the training, doctors displayed a sizable percentage of major and minor errors, which dropped significantly following training. Errors were not unique to psychiatric presentations alone, but occurred with respect to vignettes representing physical disorders as well. The results on the whole demonstrate a satisfactory gain in clinical skills of medical officers following the training and highlight the need for continuation of a program of this nature.

Association of acute colonic pseudo-obstruction (Ogilvie's syndrome) with herpes zoster

Ogilvie's syndrome, or acute pseudo-obstruction of the colon is characterized by massive distension of the colon in the absence of organic distal obstruction. The syndrome is associated with various unrelated and, most often, extra-abdominal causes. An association between Ogilvie's syndrome and herpes zoster has been reported only once, by Ceccese et al. in 1985. We present a second such case. This patient did not show evidence of any active illness other than the involvement of the T10 dermatome by herpes zoster. The patient's symptoms of colonic obstruction subsided with resolution of the zosteriform rash.

Comparison of urban and rural respondents' experience and opinion of ethical issues in medical care

Ninety-four urban and 54 rural respondents who had undergone hospitalisation in the previous three years were interviewed using a semistructured interview schedule to ascertain their experiences and opinion regarding ethical issues. The interview focussed particularly on patients' satisfaction and expectations about information provided by medical professionals on various aspects of their illness. Results revealed that both the groups were satisfied with the amount of information they had received during their hospitalisation. Rural respondents were comparatively less satisfied with the information they received regarding complications of illness, possible side effects/complications of treatment, and nature of investigations. A higher proportion of urban respondents required information about other available treatment options and possible outcome of illness if left untreated. A higher number of urban respondents felt that provision of information about illness may have harmful consequences to the patient, and more frequently reported that receiving information was the patient's right. These results suggest that although both urban and rural respondents were sensitive to ethical issues, the response of urban respondents from developing countries is more akin to that of their counterparts in the developed countries.

Multiple synchronous primary intra-abdominal neoplasms

Multiple synchronous primary intra-abdominal neoplasms involving more than one organ system are rare, particularly if the appendix is involved. We report a patient with synchronous primary lesions in the colon, appendix, and the kidney. We also discuss the incidence of this entity with respect to sex and age, the organs most often involved in instances of multiple primary lesions, and review the criteria for differentiation of synchronous versus metachronous lesions.

Standardisation of multiple-choice questionnaire for evaluating medical officers' training in psychiatry

This study reports the standardisation of a multiple choice questionnaire (MCQ) for evaluating the training of primary care physicians in psychiatry. An item pool of 104 multiple-choice questions of the 'single best response' type was written. This item pool along with an 'MCQ assessment sheet' was mailed to 90 psychiatrists with a request to evaluate the questionnaire. Twenty five psychiatrists responded to the enquiry, of which 22 gave their detailed comments regarding the MCQ. Based on the responses that were received, 14 items were discarded, 77 items were modified and 13 items accepted without any modification. The final pool of 90 items was split into two comparable sets, one for pre-training assessment and the other for post-training assessment. The questionnaire was administered to a group of 32 medical officers and was found to be sensitive in detecting gains in knowledge following training.

Lithium carbonate in the treatment of manic depressive psychosis in children

The authors present their experience of prophylactic lithium therapy in seven children diagnosed as manic depressive psychosis, bipolar type, according to International Classification of Diseases, 9th revision. The authors demonstrate the effectiveness of lithium as a therapeutic and prophylactic agent for manic depressive illness in children. Side-effects are not a problem if serum lithium levels are maintained between 0.6-1.2 mEq/L. Renal functions have remained un-impaired even after three years of lithium therapy in four children.

The WHO collaborative study on strategies for extending mental health care, IV: A training approach to enhancing the availability of mental health manpower in a developing country

Part of the WHO collaborative study is the training of general health workers to provide mental health services. The authors describe the training program used in Raipur Rani, chandigarh, India, to train medical ancillaries (called peripheral health workers). Training methods used were based on evaluation of 1) Workers' existing knowledge of and attitudes toward mental health problems, 2) existing training materials, 3) the need for new training materials, and 4) the support and supervision workers needed to carry out their duties. Use of the workers has greatly increased the availability of mental health services.

The WHO collaborative study on strategies for extending mental health care, II: The development of new research methods

Teams in seven developing countries under sponsorship of the World Health Organization have been carrying out collaborative operational research on providing mental health care through primary health care services. New techniques of identifying mental disorders in children and adults have been developed and tested. Methods of assessing the skills and attitudes of health workers toward mental health work and of gauging community attitudes toward mental illness have also been developed. Results have been directly applied in planning better mental health care. The authors conclude that cross-cultural collaborative research is effective in improving mental health care for those in greatest need.

Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries

A semi-structured interview for assessing the knowledge and attitude of health workers concerning mental health problems was applied in seven developing country areas within the context of a World Health Organization coordinated collaborative study. The results indicate a lack of basic mental health training associated with a failure to recognize mental health problems, restricted knowledge concerning psychotropic drug therapy, and an inability to visualize practical forms of mental health care which could be introduced at primary care level. The results were used to design appropriate training programs, and the observations will be repeated to assess the effectiveness of training.

The burden of mental illness on the family. Results of observations in four developing countries. A report from the WHO Collaborative Study on Strategies for Extending Mental Health Care

As part of the WHO Collaborative Study on Strategies for Extending Mental Health Care 259 families in four developing countries (Colombia, India, Sudan and the Philippines) were screened with regard to the social burden caused by mental illness of one of its members. Levels of subsistence, previous illness, financial burden, personal relations and social acceptance were studied. The social burden was greatest in the urban areas.

Dermatolglyphic studies in schizophrenia : a review

Dermatoglyphic studies Carried out in Schizophrenia have been evaluated and critically examined. Methodological errors existing in the previous studies have been pointed out and some guidelines for methodological refinements suggested and a dermatoglyphic corsensus index for diagnosis has been evolved. The heterogeneous nature of schizophrenia, being a group of syndromes, has been unanimously accepted, therefore, each category should be studied separately. Further scope of this potentially fruitful area has been discussed.

A follow up study of hysteria

The present study undertook to examine the outcome of a group of cases who were diagnosed as hysteria, six or more years ago in a general hospital psychiatric unit and correlate various clinical factors with good or bad outcome. Of the 81 cases selected for the study, 57 (67%) could be located and followed up after a gap of 6-8 years. Majority of the cases (74%) had either no symptoms or symptoms less than before at the time of the follow up. In only 3 cases, there was evidence of an underlying organic illness which seemed to have been missed at the initial assessment. A new sub-classification of hysteria with glossary of terms used for this study is presented for future research work.

Childhood mental disorders in primary health care: results of observations in four developing countries. A report from the WHO collaborative Study on Strategies for Extending Mental Health Care

To ascertain the frequency of mental disorders in Sudan, Philippines, India, and Columbia, 925 children attending primary health care facilities were studied. Rates of between 12% and 29% were found in the four study areas. The range of mental disorders diagnosed was similar to the encountered in industrialized countries. The research procedure involved a two-stage screening in which a ten-item "reporting questionnaire" constituted the first stage. The study has shown that mental disorders are common among children attending primary health care facilities in four developing countries and that accompanying adults (usually the mothers) readily recognize and report common psychologic and behavioral symptoms when these are solicited by means of a simple set of questions. Despite this, the primary health workers themselves recognized only between 10% and 22% of the cases of mental disorder. The result have been used to design appropriate brief training courses in childhood mental disorders for primary health workers in the countries participating in the study.

A model for rural psychiatric services-raipur rani experience

During the last five years efforts have been directed to understand the needs of the mentally ill persons residing in the rural areas. An outcome of our work involving 60,000 people living in a geographically defined area in Ambala District of Haryana has resulted in a realistic model for wider application in the country. The project work has led to the development of a number of research instruments and data regarding the prevalence of mental illness in the rural areas. A method for identifying mentally ill and to study the community attitudes has also been developed. The preparation of the Manual and simple training programmes has been a significant contribution. Knowledge regarding the practical problems of supervision and support of peripheral health workers in carrying out mental health work has been gained. The formation of the Mental Health Association by the village leaders has enhanced the community awareness and involvement in the ongoing programme of care.It is hoped that the experiences and the results of the above research work would act as a stimulant for similar experiments and further refining of the needed expertise and data for making mental health care a reality at the primary health care in the near future.

Stability of serum lithium levels-usefulness and relevance in Indian conditions

Two groups of patients on regular lithium therapy were studied to find out the stability in values of serum lithium over a period of time. Serum samples of one group was stored at -4°C while that of other group at room temperature. These samples were subsequently analysed over a period of eight days and subjected to statistical analysis. It was seen that values on the first day did not differ significantly from values of subsequent days. Implications of this findings are discussed in Indian conditions as lithium estimation facilities are available only at a few centres.

Manic-depressive psychosis and schizophrenia: a dermatoglyphic study

The study analysed qualitative and quantitative dermatoglyphic features in schizophrenia and manic-depressive psychosis. Differences were found which support the view that these two psychoses are genetically distinct. A possible field for further study is discussed.

Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries

1624 patients who were attending primary health facilities in 4 developing countries were examined to determine how many were suffering from mental disorder. Using stringent criteria to establish the presence of psychiatric morbidity, 225 cases were found, indicating an overall frequency of 13.9%. The great majority of cases were suffering from neurotic illnesses and for most the presenting complaint was of a physical symptom, such as headache, abdominal pain, cough or weakness. The health workers following their normal procedure correctly detected one third of the psychiatric cases.