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There is definite evidence for the involvement of retina in Parkinson's disease (PD). However, a specific pattern has not been clear due to the cross-sectional nature of the majority of the previous studies.The aim of this work was to study the pattern of changes in the retinal layers in patients with PD on longitudinal follow-up.Twelve patients with PD (23 eyes) were evaluated at baseline with complete history, clinical examination, Unified Parkinson's Disease Rating Scale (UPDRS) motor part, visual acuity, and retinal imaging with spectral-domain Optical Coherence Tomography. After a mean duration of 3.7 ± 0.46 years, patients were re-evaluated.The Central Macular Thickness (CMT) of the right eye was found to be significantly thicker during the follow-up (P = 0.002). The outer retinal layer in the temporal quadrant at 0.5 centimeters from the fovea of the left eye was found to be significantly thinner (P = 0.001).The serial evaluation of the retinal layers in patients with PD suggests a progressive loss of thickness of the outer retinal layer. The involvement of non-dopaminergic mechanisms, especially glutamatergic pathways, may be responsible for these changes.

Risk estimates of depression and anxiety disorders in primary care patients was studied in 7017 patients from 71 primary health centres in Kerala, India. When compared to those without, patients with a single chronic medical illness had approximately 3-4-fold higher rates of depression and anxiety disorders; this increases to 6-fold when the number of medical illnesses is two or more. Patients with hypertension, diabetes, epilepsy, tuberculosis, asthma, and arthritis had higher odds of depression after controlling for socio-demographic variables and co-occurring medical illnesses. The findings were replicated for anxiety disorders except for tuberculosis. Findings highlight the need for integrated interventions.

Cognitive behaviour therapy (CBT) is an effective treatment for depression. However, culture can influence engagement and treatment efficacy of CBT. Several attempts have been made in Asian countries to develop a culturally adapted CBT for depression. However, research in the Indian context documenting the views on cultural influence of CBT is limited. The present study is an attempt to explore the views of patients and therapists in India by following an evidence-based approach that focuses on three areas for adaptation: (1) awareness of relevant cultural issues and preparation for therapy; (2) assessment and engagement; and (3) adjustments in therapy techniques. Semi-structured interviews with three consultant clinical psychologists/therapists, a focused group discussion with six clinical psychologists, and two patients undergoing CBT for depression were conducted. The data were analysed using a thematic framework analysis by identifying emerging themes and categories. The results highlight therapists’ experiences, problems faced, and recommendations in all three areas of adaptation. The findings highlight the need for adaptation with understanding and acknowledging the culture differences and clinical presentation. Culturally sensitive assessment and formulation with minor adaptation in clinical practice was recommended. Therapists emphasised the use of proverbs, local stories and simplified terminologies in therapy. The findings will aid in providing culturally sensitive treatment to patients with depression in India. Key learning aims (1) To understand the views of Indian patients and therapists based on their experience of CBT. (2) To understand the need for cultural adaptation of CBT in India. (3) To understand the adaptations by therapists while using CBT in clinical practice. (4) To gain perspective on how CBT can be culturally adapted to meet the needs of the Indian population.

Objective To survey the prevalence of retrospectively recalled clinically significant symptoms of attention deficit hyperactivity disorder (ADHD) in childhood and determine the association of ADHD symptoms in childhood with current academic achievement and psychopathological outcomes among college students in the state of Kerala, India. Methods A self-administered questionnaire was distributed to 5784 students from 58 colleges selected by cluster random sampling. The Barkley Adult ADHD Rating Scale-IV was used for recollection of childhood ADHD symptoms; a total score of ≥60 (indicating the 99 percentile) was taken as the cut-off for clinically significant ADHD symptoms in childhood. The Alcohol, Smoking and Substance Involvement Screening Test was used to assess lifetime use of alcohol and tobacco. The Kessler Psychological Distress Scale was used to assess non-specific psychological distress. Lifetime suicidality and exposure to sexual abuse were assessed by asking relevant questions. Students who recalled having clinically significant ADHD symptoms in childhood were compared with those who did not. Results Of 5784 students, 639 (11.5%) did not complete the questionnaire. Of the remaining 5145 students, 1750 (34.8%) were men and 3395 (65.2%) were women, with a mean age of 19.4 years. 143 (2.8%) students reported clinically significant ADHD symptoms in childhood. Childhood ADHD symptoms were significantly more common in men and in those living in urban areas. In the bivariate analysis, those with clinically significant ADHD symptoms in childhood had significantly higher odds of poorer academic performance, alcohol use, tobacco use, psychological distress, suicidal thoughts, suicidal attempts, and contact and non-contact sexual abuse, after adjusting for sex and residence. Conclusions Clinical evaluation and appropriate management may be warranted for adults who retrospectively recall clinically significant ADHD symptoms in childhood.

GNE myopathy is a rare, predominantly distal myopathy, involving mainly the lower limbs and presenting with gait disturbances. In this cross-sectional study gait evaluation of 23 (14 men) genetically confirmed GNE myopathy patients was done using Instrumented walkway analysis (GAITRite®) along with video gait capture. We recorded the topographical pattern of muscles involvement in lower limbs and correlated Functional Ambulation Profile-FAP and Medical Research council-MRC grading of lower limb scores with duration of illness. Early foot flat, foot drop gait with wider out-toed stance and higher perturbations with increased pressure at heel and decreased arm swing were noted. Muscle topography showed predominant weakness in ankle dorsi-flexors, flexor hallucis longus, extensor hallucis longus, hip adductors and knee flexors with stark sparing of quadriceps and relative sparing of hip- abductors, extensors, flexors and ankle plantar-flexors. Gait parameters in women were significantly more affected than men (p 0.05) for the same duration of illness. FAP score and MRC grading of lower limb scores correlated significantly with duration of illness (p 0.05). We observed that ankle dorsiflexors were affected earliest with sparing of quadriceps muscles in these patients.

The health-related quality of life (HRQoL) is an important endpoint in modern clinical practice with improved survival of pediatric posterior fossa malignant brain tumors (PFMBTs). We evaluated the effect of environmental and psychosocial milieu on QoL and cognitive functioning (CF) of Indian children with PFMBT.In a cross-sectional study, 47 children18 years of age with medulloblastoma or anaplastic ependymoma were evaluated ≥6 months after completion of adjuvant therapy. All clinical and socioeconomic details, educational status of child and family members, socioeconomic status, environmental factors affecting QoL were documented. Children underwent HRQoL evaluation using Pediatric quality of life Inventory (PedsQL) questionnaire and neuropsychological evaluation.The median age of the cohort at presentation was 7 years (1-18) and median duration of evaluation after adjuvant therapy was 16 months. In 47 families, 72.34% had low monthly income and 76.6% of mothers took formal education. QoL scores were above median values. Parents reported scores highlighted that Lansky performance score (P = 0.001) and maternal education (P = 0.043) significantly influenced the cognitive component of QoL. Twenty-seven children had below-average IQ. Young age at presentation (P = 0.020), maternal education (P = 0.032), high socioeconomic status (P = 0.001) influenced the IQ score. Even though the majority of children (57.44%) had below-average IQ, they had a score of more than 50 on the cognitive functioning scale. A total of 72.5% of the eligible children in our cohort went back to school following therapy, though often with a delay of one academic year.Overall cognitive functioning scores of these children are good, but they are not representative of actual neurocognitive tasks based performance or IQ scores. Children should remain under regular follow-up with a neurocognitive assessment and psychological counseling at regular intervals.

Patients with Parkinson's disease (PD) commonly use complementary and alternative medications. Yoga is a mind-body intervention that is being increasingly explored as a tool in the therapeutic armamentarium of PD.To critically evaluate the studies and summarize the utility of Yoga in PD.We performed a systematic literature search in the Medline and Cochrane databases and included randomized controlled trials (RCT) of Yoga in PD. The studies were evaluated for internal validity and the relevant data were extracted.A total of seven studies were included in the analysis. We collated the data on the changes in motor function, gait and balance parameters, anxiety, depression and quality of life scores observed after intervention (Yoga) in patients with PD and highlighted the limitations of these studies.Anxiety, depression, and balance issues in PD may benefit from Yoga. Yoga has potential as an add-on therapy in PD.

Introduction and aims There is a paucity of studies on the harms experienced by college students from India due to others' drinking, despite their increased risk. We studied the prevalence and correlates of harm from others' drinking among college students in the state of Kerala, India. Design and methods A total of 5784 students from 58 colleges completed a self-administered questionnaire, which included the World Health Organization-Thai Health Harm to Others from Drinking Master Protocol and other structured instruments to assess correlates. The frequencies of various harms were determined and a mixed effect multivariable negative binomial regression model was used to identify the factors responsible for harms. Results Of the 4487 valid responses, 68.3% were females. The mean age of the sample was 19.5 years. Harm from others' drinking was reported by 68.7% of respondents. Among various harm domains, psychological harm was reported by 65.7%, physical by 15.2%, financial by 20.9%, and property harm by 5.0%. Strangers were the most common perpetrators. Being male and having a part-time job increased harms. Increasing age, urban residence, and staying in a hostel were correlated with psychological-but not physical-harm. Subjects who reported harm had higher odds of reporting alcohol use and psychological distress. 'Any harm' or psychological harm was associated with suicidal thoughts; only physical harm was correlated with suicidal attempts. Discussion and conclusions The high prevalence of harms from others' drinking and its negative correlates underscore the need for colleges to focus on second-hand effects in programs for tackling alcohol use.

Objective P300 is an event-related potential, being explored as an objective tool to assess cognition. This study aimed to investigate the characteristics of auditory and visual P300 in patients with TLE having unilateral HS using electroencephalography (EEG) and to study its correlation with cognition. Methods This is a cross-sectional case-control study, where P300 characteristics in thirty patients with unilateral hippocampal sclerosis with refractory epilepsy were compared with fifteen age-, gender-, and years of education-matched healthy controls (M: F-10:5, mean age-28 ± 4.76 years). Among patients, 15 belonged to the right HS group (M: F-9:6, age at onset-12.92 ± 10.22 years, duration of epilepsy-16.67 ± 9.38 years) and 15 to the left HS group (M: F-8:7, age at onset-10.62 ± 7.18 years, duration of epilepsy-15.53 ± 10.14 years). All subjects underwent EEG-based auditory and visual oddball tasks and cognitive assessment. The P300 latencies (in milliseconds) as well as amplitudes (in microvolts) were predicted in EEG and were correlated with cognitive scores. Source localization of P300 was performed with the CLARA algorithm. Results The auditory P300 latencies in controls, right HS, and left HS were 323.93 ± 40.28, 351.06 ± 47.23, and 328.80 ± 36.03, respectively (p = 0.18) and its amplitudes were 2.3040 ± 1.46, 2.77 ± 1.19, and 2.68 ± 1.78, respectively (p = 0.48). Visual P300 latencies in controls, right HS, and left HS were 365.87 ± 47.37, 359.67 ± 64.45, and 376.00 ± 60.06, respectively (p = 0.51) and its amplitudes were 3.93 ± 2.28, 2.09 ± 1.45, and 3.56 ± 1.74, respectively (p = 0.014). Further, when compared to the control group the cognitive scores were lower in the patient group (p Significance In comparison to the controls, patients with right HS recorded lesser amplitude on visual P300 and lower scores on cognitive tests. P300 and cognitive parameters exhibited varied relationship. P300 could be a complementary objective tool to assess cognition in patients with TLE.

The need to enhance mental health in primary care settings for infants and toddlers is increasingly becoming apparent. However, the lack of trained healthcare personnel and culturally appropriate measures makes it a challenge in low- and middle-income countries. A needs-based assessment of the extent of the problems in toddlers will help address the lacunae in providing mental health services.A needs-based assessment was carried out of a community sample of 9,287 mothers with toddlers aged between 13 and 25 months in Kerala, India. This assessment was conducted by junior public health nurses using an indigenously developed checklist titled 'Screening checklist for Behavioural, Emotional and Rhythm-related disturbances in Toddlers' (S-BERT).According to the mothers surveyed, 30.4% of toddlers had concerning or distress causing behaviours. Three factors, namely behavioural, rhythm-related and emotional disturbances, were deemed significant when the item response theory was used to examine the factor structure of S-BERT.This study suggests that behaviours that cause distress to mothers of toddlers are common, if queried specifically. Given the constraints in health resources as the cultural factors in operation, use of indigenous tools and principles of collaborative stepped care may be the way forward.Propósito: La necesidad de mejorar la salud mental en lugares de atención primaria para infantes y niños pequeñitos es cada vez más aparente. Sin embargo, la falta de un personal entrenado de cuidado de salud y medidas culturalmente apropiadas la convierte en un reto en países de bajos y medianos recursos económicos. Una evaluación, con base en las necesidades, de la extensión de los problemas en los niños pequeñitos ayudará a llenar el vacío de proveer servicios de salud mental. Métodos: Una evaluación con base en las necesidades se efectuó en un grupo muestra comunitario de 9,287 madres con niños pequeñitos de edad entre los 13 y 25 meses en Kerala, India. Esta evaluación la llevó a cabo por un grupo de nuevas enfermeras de salud pública usando una lista de verificación desarrollada localmente y conocida como “Lista para verificar la examinación de trastornos en el comportamiento, la emoción y relacionados con el ritmo en niños pequeñitos” (S-BERT). Resultados: De acuerdo con las madres de la encuesta, 30.4% de los niños pequeñitos presentaban preocupaciones o angustias que causaban el comportamiento. Tres factores, a saber, del comportamiento, relacionados con el ritmo y trastornos emocionales, fueron considerados significativos cuando se usó la Teoría de Respuesta a los Asuntos para examinar el factor estructura de S-BERT. Conclusión: Este estudio sugiere que los comportamientos que causan la angustia a las madres de niños pequeñitos son comunes, si se consultan específicamente. Dadas las limitaciones en cuanto a los recursos de salud como los factores culturales operativos, el uso de herramientas locales y principios de cuidados escalonadamente colaborativos pudiera ser el camino a seguir.But: Le besoin d'améliorer la santé mentale dans des contextes de soin primaire pour les bébés et les jeunes enfants devient de plus en plus apparent. Cependant le manque de personnel de soin de santé formé et le manque de mesures culturellement appropriées en font un véritable défi dans les pays à revenu faible ou intermédiaire. Une évaluation de l’étendue des problèmes chez les jeunes enfants, basée sur le besoin, aidera à s'attaquer aux lacunes en offrant des services de santé mentale. Méthodes: Une évaluation basée sur les besoins a été faite chez un échantillon communautaire de 9287 mères avec des petits enfants âgés de 13 à 25 mois à Kerala en Inde. Cette évaluation a été faite par de jeunes infirmières et infirmiers de santé publique utilisant une checklist développée sur place intitulée “Checklist de dépistage de troubles comportementaux, émotionnels et du rythme chez les petits enfants” (S-BERT). Résultats: Selon les mères qui ont été sondées, 30,4 des petits enfants avaient des comportements inquiétants ou des comportements de détresse. Trois facteurs, soit les perturbations comportementales, liées au rythme et émotionnelles, ont été estimées être importants lors que la Théorie Item Response a été utilisée afin d'examiner la structure de facteur de la S-BERT. Conclusion: Cette étude suggère que les comportements qui causent de la détresse aux mères de petits enfants sont communs, s'ils se trouvent spécialement dans les questions. Compte tenu des contraintes des ressources de santé en tant que facteurs culturels de l'opération l'utilisation d'outils développés sur place et les principes de soins élaborés de manière collaborative peuvent s'avérer être la meilleure manière d'aller vers l'avant.Verhaltens-, emotionale und rhythmische Störungen bei Kleinkindern - vorläufige Ergebnisse einer gemeindenahen Studie in Kerala, Indien Ziel: Die Notwendigkeit, psychische Gesundheit in der Grundversorgung von Säuglingen und Kleinkindern zu verbessern, wird immer deutlicher. Aufgrund des Mangels an geschultem Fachpersonal und kulturell angepassten Maßnahmen stellt dies jedoch in Ländern mit niedrigem und mittlerem Einkommen eine Herausforderung dar. Eine am Bedarf orientierte Beurteilung des Ausmaßes der Probleme bei Kleinkindern wird dazu beitragen, die Lücken in der psychischen Gesundheitsversorgung zu schließen. Methoden: In Kerala, Indien, wurde an einer Community-Stichprobe von 9287 Müttern mit Kleinkindern im Alter zwischen 13 und 25 Monaten eine Bedarfsanalyse durchgeführt. Die Beurteilung wurde von Junior-Pflegekräften des öffentlichen Gesundheitswesens unter Verwendung einer eigens entwickelten Checkliste mit dem Titel „Screening-Checkliste für Verhaltens-, emotionale und rhythmische Störungen bei Kleinkindern“ (S-BERT) durchgeführt. Ergebnisse: Laut den befragten Müttern zeigten 30,4% der Kleinkinder besorgniserregende oder belastende Verhaltensweisen. Um die Faktorstruktur von S-BERT zu untersuchen, wurde die Item-Response-Theorie verwendet. Drei Faktoren, nämlich Verhaltens-, Rhythmus- und emotionale Störungen, wurden als signifikant erachtet. Schlussfolgerung: Diese Studie legt nahe, dass von Müttern als belastend erlebte kleinkindliche Verhaltensweisen häufig sind, wenn gezielt danach gefragt wird. Angesichts der eingeschränkten Gesundheitsressourcen und kulturelle Faktoren könnten der Einsatz einheimischer Instrumente und das Prinzip der kollaborativen Stufenpflege eine Lösung sein.幼児の行動と情緒とリズムに関連する問題 インドのケーララ州 (Kerala) における地域密着研究の先行報告 目的:乳幼児のプライマリーケアにおいて精神保健を強化する必要性がますます 明らかになっている。しかし、訓練された精神保健従事者と文化的適合性の高い 手法の欠如が、中または低所得国での精神保健の充実を困難にしている。ニーズ に基づく幼児の問題の範囲を測定するアセスメントが、精神保健サービス提供の 切れ目への対応に役立つ可能性がある。 方法:インド、ケーララ州において、生後1歳1か月～2歳1か月の幼児とそのお母 さんの9287組の地域サンプルに対し、ニーズに基づく評価を行った。この評価は、 ｢幼児の行動と情緒とリズムに関連する問題のスクリーニング調査票 (S-BERT) ｣ と名付けた独自に開発された方法を用い、準公衆衛生保健師により実施された。 結果:調査を受けた母親達によると、幼児の30.4％に気になる、もしくは苦痛に 関連する行動があった。項目応答理論を用いてS-BERTの構成項目を検討したとこ ろ、3項目、すなわち、行動の問題、生活リズム関連問題、情緒的な問題が重要 とみなされた。 結論 本研究では、具体的に質問した場合には、幼児の母親に苦痛をもたらす行 動は共通していることが示唆された。運営における文化的要因としての保健資源 の限界を考えると、独自に開発されたツールの使用と協働による段階的医療の方 針によって前進できる可能性がある。.研究目的:在婴幼儿初级保健机构中加强心理健康的需求日益明显。然而, 由于缺乏训练有素的保健人员以及文化上的适当措施, 这在中低收入国家是一个挑战。对幼儿问题的严重程度进行基于需求的评估将有助于解决提供心理健康服务方面的不足。 研究方法:对印度喀拉拉邦的一个社区样本进行了基于需求的评估, 样本为拥有13-25个月龄幼儿的9287名母亲。这项评估是由初级公共卫生护士使用一份自主开发的题为“幼儿行为、情绪和节律相关障碍筛查清单” (S-BERT) 的检查表进行的。 研究结果:根据受访母亲的调查, 30.4%的幼儿有使其担忧或引起痛苦的行为。运用项目反应理论考察S-BERT的因子结构时, 发现行为、节律相关和情绪障碍三个因素是显著的。 研究结论:这项研究表明, 如果确切询问的话, 给幼儿母亲带来痛苦的行为是常见的。鉴于卫生资源方面的制约来自现行的文化因素, 运用本土工具和协作分级护理原则可能是前进的方向。.الاضطرابات السلوكية والعاطفية المرتبطة بالإيقاع عند الرضع - نتائج أولية من دراسة مجتمعية في كيرالا، الهند، الغرض من الدراسة: أصبحت الحاجة إلى تعزيز الصحة النفسية في أماكن الرعاية الأولية للرضع والأطفال الصغار واضحة بشكل متزايد. غير أن الافتقار إلى موظفي الرعاية الصحية المدربين والمقاييس الملائمة ثقافياً يجعلان من ذلك تحدياً في البلدان المنخفضة والمتوسطة الدخل. وسيساعد تقييم مدى المشاكل التي تواجه الأطفال الصغار على أساس الاحتياجات في معالجة الثغرات في تقديم خدمات الصحة النفسية. منهج الدراسة: تم إجراء تقييم قائم على الاحتياجات لعينة مجتمعية من 9287 أم مع أطفال صغار تتراوح أعمارهم بين 13-25 شهرا في ولاية كيرالا، الهند. وقد أجرى هذا التقييم ممرضات الصحة العامة المبتدئات باستخدام قائمة مرجعية محلية بعنوان "قائمة فحص الاضطرابات السلوكية والعاطفية المرتبطة بالإيقاع عند الأطفال الصغار (BERT-S). النتائج: وفقا للأمهات الذين شملهم الاستطلاع، كان 30.4 % من الأطفال الصغار لديهم سلوكيات مقلقة أو مسببة للضيق. وكان هناك ثلاثة عوامل اعتبرت هامة وفقا لنظرية استجابة العنصر: الاضطرابات السلوكية، الاضطرابات المرتبطة بالإيقاع، والاضطرابات العاطفية. الخلاصة: تشير هذه الدراسة إلى أن السلوكيات التي تسبب الضيق لأمهات الرضع شائعة، إذا تم الاستفسار عنها على وجه التحديد. ونظراً للقيود التي تواجه الموارد الصحية وخاصة في ضوء العوامل الثقافية، فإن استخدام الأدوات المحلية ومبادئ الرعاية التعاونية قد تكون هي الوسيلة الأمثل.

Objectives To study the effect of monthly pulses of intravenous methylprednisolone (IVMP) on seizure and global outcomes in children with epileptic encephalopathy (EE). Methods This retrospective study was undertaken in a tertiary care epilepsy center in India. Consecutive patients with EE who had received IVMP as adjunctive therapy for a minimum of 3 months and had at least one pre-and post-steroid EEG each, were identified and a structured questionnaire was used to collect information including outcomes at 3 months post-steroid course completion and beyond, as available. Results Ninety-seven patients (M:F=71:26) fulfilling the inclusion criteria with a mean age at onset of seizures being 20.52 ± 25.69 months were included. Commonest seizure types were myoclonic (66%); Lennaux-Gastaut and West Syndromes accounted for 57 % and 24 % patients respectively. The etiology was unknown in 52 %. All children were on a combination of standard anti-seizure drugs. The duration of IVMP pulse therapy was 7.72 ± 6.25 months. One-fourth (26 %) patients experienced minor adverse events. Greater than 50 % seizure burden reduction was seen in 66 % patients at 3 months with seizure-freedom in 25 %. A total of 45 (46 %) patients became seizure-free in the cohort eventually with continuation of steroids beyond 3 months. Children with idiopathic EEs, normal neuroimaging, myoclonic jerks, and West syndrome showed the best response. The presence of burst-suppression and generalized paroxysmal fast activity (GPFA) predicted inadequate response. Conclusions Adjunct pulse doses of IVMP are safe, well-tolerated, and effective in reducing seizures and improving global outcomes in children with idiopathic EEs, West syndrome, normal neuroimaging, and myoclonic jerks. Seizure freedom might be delayed in a subset of these patients, hence duration of therapy beyond 3 months may be warranted.

Mental health issues among health care workers (HCWs) in treatment settings during COVID-19 remains understudied in India. This study examines its prevalence and correlates among HCWs in Karnataka State, India. HCWs who attended a workshop to improve mental health well-being during COVID-19 completed an anonymous online questionnaire. In addition to socio-demographics, domains assessed include occupational characteristics, COVID-19 related concerns, anxiety/depression, substance use, suicidality, lifestyle and family functioning. Of the 3083 HCWs who completed the survey (response rate-51.4 %), anxiety disorder and depression was highest among those with frontline COVID-19 responsibilities (anxiety disorder-26.6 %, depression-23.8 %). Prevalence was significantly higher among those with clinical responsibilities compared to those with supportive responsibilities (anxiety disorder: 23.9 % vs 15.5 %), (depression: 20.0 % vs 14.2 %). In the backward step-wise logistic regression analysis, HCWs with anxiety disorder were more likely to be doctors/nurses/hospital assistants, older, female, unmarried, without a leisure activity, report increased alcohol use and suicidal thoughts after pandemic onset, and having a history of receiving mental health interventions. Participants with depression additionally had family distress and hardly ever exercised. To conclude, mental health issues are common among HCWs in India. Interventions need to ensure that HCWs are protected from mental health consequences of working in COVID-19 treatment settings.

Estimates of child sexual abuse (CSA) during adolescence may undercount exposure and retrospective recollection in adulthood may be prone to recall bias. Thus, a more accurate and CSA may be possible if the question is examined in a large sample of 18 years old. This study examined the prevalence and psychosocial correlates of CSA among college-going 18 years olds. This is a cross-sectional survey of college students. 1424 students from 58 colleges selected by cluster random sampling completed a self-administered questionnaire incorporating standardized instruments. Prevalence rates were calculated. Chi-square test was used to compare categorical variables and binary logistic regression analysis was used to examine the correlates of CSA. CSA was reported by 13.2% and significantly more common among males compared to females (18.4% vs. 10.4%

Objectives We analyzed changes in sleep profile and architecture of patients with drug-resistant TLE-HS using three validated sleep questionnaires- Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), NIMHANS Comprehensive Sleep Disorders, and polysomnography (PSG). We studied the effect of epilepsy surgery in a subset of patients. Methods In this prospective observational cohort study, sleep profile of 40 patients with drug-resistant TLE-HS was compared to 40 healthy matched controls. Sleep architecture of 22 patients was studied by overnight PSG and compared to 22 matched controls. Sleep profile was reassessed in 20 patients after a minimum period of three months after epilepsy surgery. Results The mean PSQI was higher among patients compared to controls(P=0.0004) while mean ESS showed no difference. NCSDQ showed fewer patients feeling refreshed after a night's sleep compared to controls (p=0.006). PSG revealed a higher time in bed (p=0.0001), longer total sleep time (p=0.006) and more time spent in NREM stage 1 (p=0.001) and stage 2 (p=0.005) while spending less time in stage 3 (p=0.039) among TLE patients. Sleep efficiency was worse in patients on ≥3 ASMs compared to those on 2 ASMs (p-0.044). There was no change in mean ESS (p=0.48) or PSQI (p=0.105) after surgery. Conclusions Patients with drug-resistant TLE-HS have an altered sleep profile and architecture. Patients on ≥3 ASMs have a lower sleep efficiency. Reassessment at short intervals after epilepsy surgery did not reveal significant changes in sleep profile.

Purpose Magnetoencephalography (MEG) was used to record and localize the sources of the epileptiform discharges, in absence epilepsy, at three different time intervals to infer the sources of involvement during generation and propagation. Methods Twenty patients with absence epilepsy (M:F = 1:1; age: 10.2 ± 3.4 years), which included 12 patients with childhood absence epilepsy (CAE) and 8 patients with juvenile absence epilepsy (JAE), were recruited in this prospective MEG based study. MEG epileptiform discharges were divided into three sub-groups based on the duration viz., 1 s (very short),>1–9.9 s (short) and ≥10 s (long) and the discharges of each group were averaged independently in each patient. MEG source analysis was performed on these averaged discharges, of each of the subgroups, at the onset, during middle and offset. Results The source locations obtained, in lobar and gyri levels, were compared across these three groups of varying duration of discharges and in the CAE and JAE subjects. It was observed that the most frequent location of sources from the sublobar, limbic and frontal lobes in all the discharge groups at different time intervals. Also, it was noted that there were only subtle and variable degree of the differences of source localization of epileptic discharges among CAE and JAE subgroups. Conclusion The study provided novel findings regarding origin and propagation of sources of epileptiform discharges in patients with childhood and juvenile absence epilepsies. Such analysis further improves the understanding of network involvement of subcortical and cortical regions in these patients.

Apneas occurring during sleep may precipitate autonomic instability in epilepsy patients making them susceptible to sudden death (SUDEP). Literature on heart rate variability (HRV) during apnea among patients with temporal lobe epilepsy (TLE) is sparse. The aim of this study was to characterize the HRV during the peri-apneic period in patients with TLE and compare with HRV of matched healthy individuals during the overnight polysomnographic (PSG) recording. Further, the role of carbamazepine (CBZ) in modulating peri-apneic HRV in the above cohort was also assessed. Twenty patients diagnosed to have TLE (drug naive (n = 10) or on CBZ monotherapy (n = 10)) were compared with ten healthy controls. In both patients and controls, the time domain, frequency domain, and non-linear HRV indices were analyzed for 2 min before and after apnea/hypopnea termination and compared using paired t test (p ≤ 0.05). Additionally, the changes in HRV parameters in the peri-apnea/hypopnea period were compared between the three groups using one-way ANOVA followed by post hoc comparison (p ≤ 0.05). The three study groups were age (p = 0.21) and gender (p = 0.27) matched. In controls (M/F = 5:5; mean age 24.3 ± 5.0 years), there were significant changes in standard deviation of RR interval (SDNN), low frequency (LF) component and long-term HRV (SD2) parameters in the peri-apnea/hypopneic period. Conversely, in drug-naive TLE (M/F = 6:4; mean age: 22.8 ± 4.1 years), all the HRV parameters, including non-linear measures were comparable in the pre- and post-apneic period. On the other hand, patients on CBZ (M/F = 6:4; mean age 20.5 ± 4.8 years) showed significant changes in low-frequency nu (LFnu) and high-frequency nu (HFnu) components in the peri-apnea/hypopneic period. Comparison of the changes in HRV parameters in the peri-apnea/hypopnea period in patients with TLE and controls showed significantly lower changes in drug-naive TLE patients in SDNN, LF, and SD2 as compared to controls. This study showed that there was a lack of apnea-mediated HRV changes in patients with drug-naive TLE. This might suggest a possible alteration in reflex baroreceptor activation in patients with TLE, predisposing them to SUDEP, and this may be worsened with CBZ.

Objective The purpose of this study is to localize the sources of epileptiform discharges (EDs), in juvenile myoclonic epilepsy (JME) using Magnetoencephalography (MEG), at three different time instances and analyze the propagation of EDs, from onset to offset, for inferring the cortical and subcortical region of involvement. Methods Twenty patients (age 23.5±6.3years old) with JME were recruited in this prospective study. MEG source analysis was performed on the independently collected EDs of each patient. The distributed source model was employed for source localization using low resolution electromagnetic brain tomography (LORETA). In each EDs, the onset (leading edge of the spike from baseline), peak and offset (trailing edge of the spike), with time window of 8ms, were subjected for source localization in order to study the propagation of the EDs. The obtained source location coordinates, from each individual MRI, were transformed in Talairach space and the distribution of region of source involvement was analysed. Results The frequency pattern of lobar distribution at onset, peak and offset respectively suggest that discharges most commonly localized at onset from sublobar region, at peak from frontal lobe and at offset from the sublobar region. It was observed that the maximum involvement of sources from the sublobar, limbic and frontal lobes at different time instances. It indicates that the restricted cortical-subcortical involvement during the generation and propagation of EDs in JME. Significance This MEG study supported the cortical-subcortical region of involvement and provided further insights in our understanding the network involvement in generation and propagation of EDs in JME.

Aims To study the at-risk rate for Autism Spectrum Disorders (ASD) on a parent-report questionnaire in toddlers between the ages of 16–24 months. Materials and methods 6237 toddlers from Kerala, India selected by cluster random sampling were surveyed by community nurses using the Modified Checklist for Autism in Toddlers − Revised (M-CHAT-R) translated to Malayalam and culturally adapted. Results 5.5% toddlers were at risk on M-CHAT-R and 2.7% on “Best Seven”. Conclusions M-CHAT-R and its “Best Seven” could be viable community level screening instruments, albeit with further cultural adaptation for a primarily non-English speaking population in India.

Background: Tobacco use is a major public health concern in India. Its use in young people is linked to increased severity, longer duration, and reduced efforts to seek treatment for tobacco use. A significant proportion of young people are enrolled in colleges, and early prevention during this period has better effectiveness. There is preliminary evidence that prevalence may vary across courses even among students of the same sociocultural background. Hence, we compared the prevalence and correlates of tobacco use among college students enrolled in five common streams of collegiate education (medical, nursing, engineering, arts/science and others, law/fisheries) in Kerala, India. Methods: 5784 college students from 58 colleges (medical, nursing, engineering, arts, and law and fisheries) selected by cluster random sampling in the district of Ernakulum, Kerala, completed a self-administered questionnaire incorporating standardized instruments. R software was used for analyses. Lifetime prevalence and severity of tobacco use were determined. Sociodemographic variables of tobacco users and nonusers enrolled in various courses were compared using chi-square test and two-way ANOVA. Furthermore, for each course, factors influencing tobacco use were identified using multivariable logistic regression analysis. Results: The mean age of the sample was 19.5 ± 1.9 years, with the majority being female (65.3%). Lifetime prevalence of tobacco use varied from 0.5% in nursing students, 4.2% in medical students, 8.2% in students of arts and science, 12.5% in engineering students, and 22.8% among other students (law/fisheries). Approximately two-thirds of all tobacco users across courses showed signs of nicotine dependence. Dependent users also showed variance with none in nursing, 2.6% among medicine, 1.6% among arts and science, 1.9% among engineering, and 6.3% among others. Male gender and alcohol use were consistently associated with tobacco use across courses, whereas other examined psychosocial correlates showed variance. Conclusions: To conclude, it appears that among college students, course-level characteristics may influence risk of tobacco use. This has public health importance as it suggests that interventions need to be tailored bearing this in mind. Future research needs to examine campus-level characteristics that may explain variance.

Purpose To assess the role of P300 in patients with temporal lobe epilepsy (TLE) with unilateral hippocampal sclerosis (HS) using magnetoencephalography (MEG) based auditory and visual oddball tasks, and to assess its correlation with neuropsychological tests. Methods Thirty-patients (M:F-17:13, onset-11.77 ± 8.75 years, duration-16.10 ± 9.61 years) with TLE-HS (Left:15, Right:15) and fifteen-healthy age, gender and years of education matched controls (M:F-10:5, age-28.13 ± 4.76 years) underwent auditory and visual oddball tasks in MEG and cognition assessment using Indian Council of Medical Research (ICMR)-cognitive test battery. Independent component analysis (ICA) was applied to the magnetic evoked field responses for the detection of the P300 component. Source localization of P300 was performed with Classical LORETA Analysis Recursively Applied (CLARA). The latency and amplitude of P300 were estimated and subsequently correlated with cognitive scores. Results The visual P300 amplitude in the TLE group was lower when compared to the control group. In subgroup comparison (controls vs. right HS vs. left HS), visual P300 amplitudes were lower in the right HS group compared to both left HS and control groups (p-value = 0.014). On the other hand, no significant difference for auditory P300 latency or amplitude was noted between patients and controls as well as between subgroups. A negative correlation found between the MEG visual P300 amplitude and Indian Trial Making Test (TMT)-B duration in the patient group. Conclusion Patients with TLE-HS have decreased visual-P300 amplitude. A significant correlation found between visual P300 amplitude and cognitive tests of visuospatial attention and working memory. Overall, MEG based visual P300 amplitude can be further explored with large sample size studies to establish as a complementary objective test for cognitive assessment in TLE.

Fifteen adult cases of uncemented total hip replacement were assessed clinically (by Harris Hip Score) and radiologically by serial radiographs and CT scan. In the postoperative Harris Hip Score the neck of femur groups and the arthritic hip groups had comparable results and uncemented total hip replacement gives acceptable results in otherwise disabling condition of hip. Prospective evaluation of fifteen patients in the age group of 18 years to 60 years with good general condition and no septic foci underwent uncemented total hip replacement for various indications during June 2013 to March 2015. The periodic evaluations were done clinically and radiologically and CT scans at regular intervals. Among the fourteen patients with fifteen hip replacements (one bilateral) the overall improvement in average Harris Hip Score was from 29.9 preoperatively to 91.4 postoperatively and in one case we observed detoriation in Harris Hip Score by loosening but it still gave fair result. In this study clinical assessment correlated well with radiographic appearance and CT scan. There were no evidences of osteointergration in any case possibly because of short duration of study. The postoperative Harris Hip Score has significant (p

Purpose The peri-ictal autonomic disturbances have been studied as predictors of seizure outcome and as markers of seizure onset. We studied the changes in heart rate (HR), HRV, oxygen saturation and blood pressure (BP) in the peri-ictal period in patients with drug-resistant localization-related epilepsy. Methodology Ninety one subjects undergoing video-EEG monitoring, underwent continuous HR, SpO 2 , BP and Lead II ECG monitoring. The changes during the preictal, ictal and postictal periods were analyzed for 57 seizures in 42 patients with artifact-free recordings and correlated with VEEG ictal onset and MRI characteristics. Results Ictal tachycardia was noted in 15 (26.3%) seizures, of which, 60% had temporal lobe onset. HR increased by an average of 20.1% from pre-ictal to ictal phases (p=0.04). Ictal bradycardia was noted in one event with right temporal seizure onset. Heart rate variability (HRV) analysis of the preictal, ictal and postictal phases showed an increase in the sympathetic and decrease in parasympathetic activity during the ictus with relatively preserved total power. Ictal oxygen desaturation (84.1%±3.5%) was noticed in 10 (17.5%) seizures. Ictal hypertension was observed in 15 (26.3%); ictal hypotension was noted in 5 (8.7%) seizures. Both the systolic BP and diastolic BPs increased from the pre-ictal to ictal phase (p=0.01). Conclusions Peri-ictal dysautonomia can present in variable patterns and can be measured and compared over different modalities such as BP, HR and HRV. Though degree of tachycardia and increase in BP were higher during extratemporal onset of seizures, a fall in variability was noted in seizures of temporal lobe origin. Oxygen desaturation is not an uncommon event during the peri-ictal period in localization related epilepsy.

To study the genesis and propagation patterns of periodic complexes (PCs) associated with myoclonic jerks in sub-acute sclerosing pan-encephalitis (SSPE) using magnetoencephalography (MEG) and electroencephalography (EEG). Simultaneous recording of MEG (306 channels) and EEG (64 channels) in five patients of SSPE (M:F = 3:2; age 10.8 ± 3.2 years; symptom-duration 6.2 ± 10 months) was carried out using Elekta Neuromag(®) TRIUX™ system. Qualitative analysis of 80-160 PCs per patient was performed. Ten isomorphic classical PCs with significant field topography per patient were analysed at the 'onset' and at 'earliest significant peak' of the burst using discrete and distributed source imaging methods. MEG background was asymmetrical in 2 and slow in 3 patients. Complexes were periodic (3) or quasi-periodic (2), occurring every 4-16 s and varied in morphology among patients. Mean source localization at onset of bursts using discrete and distributed source imaging in magnetic source imaging (MSI) was in thalami and or insula (50 and 50 %, respectively) and in electric source imaging (ESI) was also in thalami and or insula (38 and 46 %, respectively). Mean source localization at the earliest rising phase of peak in MSI was in peri-central gyrus (49 and 42 %) and in ESI it was in frontal cortex (52 and 56 %). Further analysis revealed that PCs were generated in thalami and or insula and thereafter propagated to anterolateral surface of the cortices (viz. sensori-motor cortex and frontal cortex) to same side as that of the onset. This novel MEG-EEG based case series of PCs provides newer insights for understanding the plausible generators of myoclonus in SSPE and patterns of their propagation.

Introduction and Aims Concern around potentially increasing alcohol use among young people has been growing in public discourse in India. However, there are few published studies on this issue. We studied the prevalence, patterns and correlates of alcohol use among adolescents in Ernakulam, Kerala State, India. Design and Methods A total of 7560 students in the age group 12–19 years from 73 schools completed a self-administered questionnaire incorporating standardised instruments to assess alcohol use. Results The overall prevalence of lifetime alcohol among adolescents use was 15% (23.2% among boys and 6.5% among girls) with prevalence increasing with age, and 25.3% of drinkers reported hazardous alcohol use. The mean age at onset of alcohol use was 13.6 years. Initiation of alcohol use typically preceded use of tobacco and illicit drugs. Most students reported initiation into alcohol use by family members in the context of family celebrations. The prevalence of alcohol use was higher among students from urban areas and those with a part-time job. Lower use was seen among Muslims. Lifetime alcohol use was associated with significantly higher tobacco and illicit drug use, suicidal thoughts, attention deficit hyperactivity disorder symptom-scores, history of non-contact sexual abuse and with poor academic performance. Discussion and Conclusions Alcohol use among adolescents in India deserves greater attention than it has previously received, marked as it is by an early onset and associated with a range of negative mental health problems. [ Jaisoorya T S, Beena K V, Beena M, Ellangovan K, Jose D C, Thennarasu K, Benegal V. Prevalence and correlates of alcohol use among adolescents attending school in Kerala, India. Drug Alcohol Rev 2016;35:523–529]

BACKGROUND AND PURPOSE: Re-emergent tremor (ReT) is the tremor that reappears after a variable period of latency while maintaining posture. Little is known about the mechanisms that contribute to the origin of this silent period (SP). Our aim was to compare the imaging characteristics of patients with and without ReT and find the structural correlate of SP if any. MATERIALS AND METHODS: Fifteen patients with ReT (Group 1) and eighteen patients without ReT (patients with rest tremor and postural tremor, but no latency) were evaluated clinically, electrophysiologically, with diffusion tensor imaging (DTI) and voxel-based morphometry (VBM). DTI parameters of different regions of interest were analyzed and compared with that of 37 healthy age- and gender-matched controls. RESULTS: No statistically significant difference was observed between the two groups in terms of age, duration of disease, levodopa equivalent dose, or severity of the disease. However, in the left supplementary motor area (SMA), there was a significant reduction of fractional anisotropy and an increase of radial diffusivity and mean diffusivity in patients with ReT (Group 1) as compared to patients without ReT (Group 2) and healthy controls. The results of the VBM analysis were not significant. CONCLUSION: The presence of abnormality of SMA suggests that patients with ReT have a different pathophysiological mechanism as compared to patients without ReT. This is a novel finding implicating a possible contribution of the frontal lobe to the genesis of SP in ReT. ReT could be a distinct clinical entity within the tremor dominant subtype.

Bipolar disorder is a chronic psychiatric condition characterized by episodes of elevated/irritable and depressed moods resulting in the loss of more disability-adjusted life years (DALYs) than other major conditions. The neurocognitive impairments in these patients interfere with sustained goal-directed performance and achievement even during the euthymic phase of the illness. Methodology The study aimed to explore the neurocognitive profile of patients in their euthymic phase. We matched 30 patients diagnosed with Bipolar Affective Disorder (BD) in the age range of 20–40 years with 30 healthy controls (with no axis I or II diagnosis, assessed on MINI) matched on age, gender, and education. The neurocognitive profile was assessed using NIMHANS Neuropsychology Battery. Results Euthymic phase patients with bipolar disorder had statistically significant low scores on the speed of processing information as compared to healthy controls. Although impaired in BD group, no statistically significant difference was found between the two groups on executive functions and memory. Conclusion The findings of the study suggest that cognitive retraining aimed at ameliorating these deficits can be a used as an essential intervention in rehabilitation programs to successfully reintegrate patients with the bipolar affective disorder into the society. The research also indicates that despite the symptomatic recovery between the episodes, impairments in the speed of processing information continue to disrupt performance in patients with Bipolar Disorder.

Understanding the burden and pattern of mental disorders as well as mapping the existing resources for delivery of mental health services in India, has been a felt need over decades. Recognizing this necessity, the Ministry of Health and Family Welfare, Government of India, commissioned the National Mental Health Survey (NMHS) in the year 2014-15. The NMHS aimed to estimate the prevalence and burden of mental health disorders in India and identify current treatment gaps, existing patterns of health-care seeking, service utilization patterns, along with an understanding of the impact and disability due to these disorders. This paper describes the design, steps and the methodology adopted for phase 1 of the NMHS conducted in India. The NMHS phase 1 covered a representative population of 39,532 from 12 states across 6 regions of India, namely, the states of Punjab and Uttar Pradesh (North); Tamil Nadu and Kerala (South); Jharkhand and West Bengal (East); Rajasthan and Gujarat (West); Madhya Pradesh and Chhattisgarh (Central) and Assam and Manipur (North East). The NMHS of India (2015-16) is a unique representative survey which adopted a uniform and standardized methodology which sought to overcome limitations of previous surveys. It employed a multi-stage, stratified, random cluster sampling technique, with random selection of clusters based on Probability Proportionate to Size. It was expected that the findings from the NMHS 2015-16 would reveal the burden of mental disorders, the magnitude of the treatment gap, existing challenges and prevailing barriers in the mental-health delivery systems in the country at a single point in time. It is hoped that the results of NMHS will provide the evidence to strengthen and implement mental health policies and programs in the near future and provide the rationale to enhance investment in mental health care in India. It is also hoped that the NMHS will provide a framework for conducting similar population based surveys on mental health and other public health problems in low and middle-income countries.

Objectives: There is scarce data on the prevalence of OCD among adolescents in India. This study reports point prevalence of OCD among school students (age 12–18 years) in the Kerala state of India and examines its association with ADHD, psychological distress, tobacco/alcohol abuse, suicide risk and history of sexual abuse. Method: 7560 students of 73 schools were self-administered the OCD subsection of Clinical Interview Schedule–Revised, the Composite International Diagnostic Interview (CIDI) for obsessive compulsive symptoms and other relevant instruments to identify OCD and related clinical measures. A diagnosis of ICD-10 OCD was derived through the CIS-R algorithm which required duration of at least 2 weeks and at least a thought/behavior to be resisted along with a cut-off score for severity and impairment. Results: In the sample, 50.3% were males with a mean age of 15.2 years (range of 12–18 years). The response rate was 97.3% (7380 valid responses). 0.8% (n = 61) fulfilled criteria for OCD with a male predominance (1.1 vs. 0.5%, p = 0.005). Prevalence was higher among Muslims and increased with age. Taboo thoughts (62.3%) and mental rituals (45.9%) were the commonest symptoms. Those with OCD had significantly higher suicidal thoughts (59 vs. 16.3%, p

Although the relationship between sleep and migraine has been widely reported, studies on sleep microstructure are few. The aim was to study and compare microstructural polysomnographic characteristics in patients of “migraine without aura” (MOA) with controls. Twenty-five patients of MOA and 25 age- and gender-matched healthy controls were subjected to overnight polysomnography. Microstructural sleep analysis, including arousal and cyclic alternating pattern (CAP) analysis was performed. Arousals and CAP parameters were compared between the two groups using the Mann-Whitney U test (p ≤ 0.05). The overall arousal index (p = 0.528) and that during non-rapid eye movement (NREM) sleep (p = 0.503) were comparable between the two groups. However, the arousal index was lower in migraineurs during rapid eye movement (REM) sleep (p = 0.001). The overall CAP rate (p = 0.020) as well as the number of CAP cycles and sequences (p = 0.032) was lower among migraineurs. The total phase A duration (p

Summary Background Anesthetic-induced suppression of cortical electrical activity is a major concern during epilepsy surgery. Dexmedetomidine (Dex) has been recently evaluated in a few small series for its effect on the electrocorticographic spikes intra-operatively. Methods In this prospective study, electrocorticogram (ECoG) was monitored during dexmedetomidine infusion in 34 patients (M:F=23:11, age=29.2±10.9 years; duration of epilepsy=15.3±8.9 years) undergoing anterior temporal lobe resection with amygdalo-hippocampectomy for drug-resistant mesial temporal lobe epilepsy (Right: 18, Left: 16). Anesthesia was induced with thiopental/propofol and maintained with oxygen-N 2 O-isoflurane. ECoG was recorded for 5min after the end tidal MAC of N 2 O and isoflurane were decreased to zero; anesthesia was maintained with O 2 :Air=50:50, vecuronium and fentanyl. ECoG was recorded using a 4-contact strip electrode for: (a) 5min prior to dexmedetomidine (PreDEX), (b) 5min during dexmedetomidine infusion (DEX; 1μg/kg) and (c) 5min after stopping dexmedetomidine (PostDEX). Results The ECoG spikes were manually counted in all the channels. The mean spike rate in the 2 channels with maximum spikes (MAX CH A and MAX CH B) was normalized to a 3-min duration. RM-ANOVA and post hoc comparison of three phases were used to compare the spike rates. The mean spike rate during Dex phase was higher compared to preDEX (MAX CH B: p =0.007 and MAX CH A: p =0.079) and PostDEX (MAX CH B: p =0.17, MAX CH A: p =0.79) phases. The spike rate increased in 67.6% patients, while 11.8% patients showed ≤25% reduction and 20.6% patients showed >25% reduction in spike frequency. Conclusion Dexmedetomidine is useful during intra-operative ECoG recording in epilepsy surgery as it enhances or does not alter spike rate in most of the cases, without any major adverse effects.

Background: Dexmedetomidine, a predominant alpha-2-adrenergic agonist has been used in anesthetic practice to provide good sedation. The drug is being recently used in neuroanesthesia during awake surgery for brain tumors and in functional neurosurgery. Materials and Methods: This prospective study analyzed the hemodynamic effects of dexmedetomidine infusion during electrocorticography in patients undergoing surgery for mesial temporal sclerosis. Dexmedetomidine infusion was administered during intra-operative electrocorticography recording, 15 minutes after the end tidal MAC of N 2 O and isoflurane were decreased to zero. Anesthesia was maintained with O 2 :air mixture = 50:50, vecuronium and fentanyl. Heart rate (HR), mean arterial pressure (MAP) and end tidal carbon dioxide (ETCO 2) were recorded across at induction, 2 min prior to dexmedetomidine (PreDEX), 5 min during dexmedetomidine infusion (DEX; 1 μg/kg), 5 min after stopping dexmedetomidine and 10 minutes after stopping dexmedetomidine. Results: Forty patients with mesial temporal sclerosis (M: F = 27:13, mean age = 28.15 ± 10.9 years; duration of epilepsy = 12.0 ± 7.9 years) underwent anterior temporal lobe resection with amygdalohippocampectomy for drug-resistant epilepsy. Infusion of dexmedetomidine caused a transient fall in HR in 87.5% of patients and an increase in MAP in 62.5% of patients, which showed a tendency to revert back towards PreDEX values within 10 min after stopping the infusion. Sixty-five percent of the patients showed ≤25% reduction and 10% of them showed >25% reduction in HR. 47.5% of the patients showed ≤25% increase and 15% of them showed >25% increase in MAP. These changes were over a narrow range and within physiological limits. Conclusion: The infusion of dexmedetomidine for a short period causes reduction of HR and increase in MAP in patients, however the variations are within acceptable range.

Objectives: To study the prevalence of chronic perinatal pain among mothers who had infants between the ages of 13–25 months in the State of Kerala, India and to report its correlates in the socio-...

This study describes the prevalence and correlates of alcohol use among college students in Ernakulam, Kerala State, India. A total of 5784 students from 58 colleges selected by stratified random sampling completed a questionnaire incorporating standardized instruments. The prevalence of lifetime alcohol use was 21.4% with a male predominance. Among users, low-risk, hazardous, and dependent use were 80.2%, 18.3% and 0.9% respectively. Initiation was mostly with friends (45.3%). Both low-risk and high-risk alcohol users (hazardous and dependent users), in comparison to abstainers, had higher odds of being older, non-Muslim, having a part-time job, using other substances, and exposure to sexual abuse. Students who reported low-risk use also had an urban background, more severe psychological distress and suicidal thoughts, while high-risk users had attention deficit hyperactivity disorder (ADHD) symptoms. Students who reported high-risk use compared to low-risk users had higher odds of having a part-time job, tobacco use, and ADHD symptoms. Alcohol use among college students is common, with both low- and high-risk drinking associated with significant morbidity. This study highlights the need to promote public health policies to target and prevent all patterns of alcohol use among young people.

Byline: Manoj. Sharma, Girish. Rao, Vivek. Benegal, K. Thennarasu, Divya. Thomas Background: Technology use has shown an impact of users' lifestyle. The use has been attributed to psychosocial reasons. This usage manifests as excessive to addictive use of technology. There is a need to explore its addictive potential on large sample study as well as its association with psychosocial variables. It is one of its kind study on wider age group. The present work assessed the magnitude, burden, and sociodemographic correlates of technology addiction in an urban community. Materials and Methods: A total of 2755 individuals (1392 males and 1363 females) in the age group of 18–65 years were approached for screening internet addiction and mobile overuse, using house-to-house survey methodology. Results: The survey indicated the presence of addiction for 1.3% for internet (2% males and 0.6% females) and mobile phone overuse (4.1%–2.5% males and 1.5% females). It was more common among males. Significant differences were observed in relation to family status for internet and mobile phone use more commonly among single/nuclear families. Technology addictions were found to be more common among single families and lesser in nuclear and joint families. Mobile phone users had psychiatric distress in comparison to users with internet addiction. The study showed negative correlation of age, years of marriage, and numbers of family members with internet addiction and mobile overuse. Conclusions: It has implication for raising awareness about addictive potential of technology and its impact on one's lifestyle. Introduction Uncertainty and instability are frequently the norm in today's life. This unpredictability leads to an increased level of discomfort and distress among people as they try to accomplish their day-to-day objectives and achieve their professional goals. It has further contributed to the use of technological devices such as internet, video game, online chatting, exercise, sex, shopping, and gambling to manage day-to-day activities as well as their mood states. Technology addiction (also called process addiction or “nonsubstance-related addiction.”) is a recurring compulsion by an individual to engage in some specific activity, despite harmful consequences, as deemed by the user himself/herself to his/her individual health, mental state, or social life.[sup][1] About 1.5 million people, i.e., 3% of the German population, were believed to be at risk of internet addiction.[sup][2] The rate of problematic internet use in Italian adolescents was 5.4%[sup][3] and 18.3% in pathological internet users among British.[sup][4] Among teenagers aged 13–18 years, 10.2% used the internet moderately and 6% was severely addicted to internet,[sup][5] 5% were compulsive buyers in the U.S.,[sup][6] 8% reported lifetime internet gambling, 3.6% reported weekly online gambling,[sup][7] 70% of all adult content traffic occurs during the 9-to-5 working day timing, and the adult sites were the fourth most visited category while at work,[sup][8],[9] while 5% of the workforce struggles with problems related to sexual compulsivity. Among them, 80% were male.[sup][10] Nearly 20% of men and 12% of women reported using the internet at work for sexual pursuits.[sup][11] The prevalence of internet use at workplace reported to be as low as 1% and as high as 39%.[sup][12] Mood disorders (72%), anxiety disorders (38%), and substance abuse (40%) were most frequently observed in patients with sexual addictions.[sup][13] In Indian context, 5% of youth in the age group of 18–25 years have addictive use of social networking sites and 24% have problematic usage of internet.[sup][14],[15] There is a need to assess the magnitude of technology addiction on a large sample with wider age group in Indian context. Since it was the first of its kind work in India, the present study had focused on the assessment of magnitude and sociodemographic correlates of technology addiction in an urban community. …

There are limited data on the prevalence and correlates of psychological distress among adolescents in India. This study assessed psychological distress among adolescents who attended school in Kerala, India.A total of 7560 students from 73 schools, aged 12 to 19 years completed a self-administered questionnaire that included Kessler Psychological Distress Scale and other standardised instruments to assess various domains.Mild psychological distress was reported by 10.5%, moderate distress by 5.4%, and severe distress by 4.9% of students. Older age, not living with both parents, and urban residence were significantly associated with psychological distress (p0.05). Students who experienced psychological distress had a higher risk of reporting academic failure, alcohol and tobacco use, suicidality, and sexual abuse. Increasing severity of psychological distress was associated with higher odds of these correlates.Psychological distress is common among adolescents and its correlates with negative outcomes suggest the need for early recognition and treatment.

[b]Background: [/b]The present study aims at comparing the cognitive profile of creative artists and non-creative participants. We assessed creativity correlates by taking a sample of professionally creative artists unlike those previous studies conducted with college students or which employed biographical data from eminent creators who form a rare and extreme group on the continuum of creativity.[b]Material/ Methods: [/b]A matched control design with cross sectional assessment was used for the study. The study sample comprised two groups – Creative group (CR) and matched Non-creative group (NC) with 30 participants each. All participants were in the age range of 20-40 years and had a minimum average intelligence (IQ score >90). Screening measures included the Edinburgh Handedness Inventory, Raven’s Standard Progressive Matrices and the Creativity Achievement Questionnaire used to select pro C creative individuals for the creative group. NIMHANS Neuropsychological Battery (Rao et al, 2004) was used to assess the comprehensive cognitive profile (domains of speed and attention; executive functions; learning & memory) of the participants. The Battery comprises globally recognized neuropsychological tests which have been standardized for the Indian population.[b]Results: [/b]It was found that CR group had statistically significant higher scores on focused attention, category fluency, design fluency (both free and fixed), visuo-spatial working memory (medium effect size), set shifting ability, response inhibition and verbal memory. A significant positive correlation was found between intelligence, mental speed, focused attention, category fluency, design fluency (both free & fixed), set shifting, response inhibition, verbal memory and all components of creativity.[b]Conclusions:[/b]The present study elucidates the functions associated with creativity. It was possible to identify creative individuals, one to one matching across both the groups, thereby controlling the influence of age, gender and education; using a standardized and comprehensive battery to assess cognitive functions and statistical rigor in analyzing the data.

MRI is a useful method for discriminating low- and high-grade glioma using perfusion MRI and susceptibility-weighted imaging (SWI). The purpose of this study is to evaluate the usefulness of T1-perfusion MRI and SWI in discriminating among grade II, III, and IV gliomas. T1-perfusion MRI was used to measure relative cerebral blood volume (rCBV) in 129 patients with glioma (70 grade IV, 33 grade III, and 26 grade II tumors). SWI was also used to measure the intratumoral susceptibility signal intensity (ITSS) scores for each tumor in these patients. rCBV and ITSS values were compared to seek differences between grade II vs. grade III, grade III vs. grade IV, and grade III+II vs. grade IV tumors. Significant differences in rCBV values of the three grades of the tumors were noted and pairwise comparisons showed significantly higher rCBV values in grade IV tumors as compared to grade III tumors, and similarly increased rCBV was seen in the grade III tumors as compared to grade II tumors (p

Aims To study the prevalence and correlates of psychological distress among college students in Kerala, India. Material and methods 5784 students across 58 colleges were self-administered Kessler’s Psychological Distress Scale (K10) and other standardized instruments. Results The prevalence of psychological distress was 34.8% (Mild-17.3%; Moderate-9.2%; Severe-8.3%) with a female predominance. Students with psychological distress were more likely to report academic failures, substance use, suicidality, sexual abuse and symptoms of attention deficit hyperactivity disorder. Students with severe distress had higher morbidity. Conclusions Psychological distress is common among college students and its association with negative correlates suggests the need for early interventions.

Executive functions (EFs) are essential and important for achieving success in children's everyday lives and play a fundamental role in children's cognitive, academic, social, emotional and behavioral functioning. A cross-sectional study was carried out to develop age- and sex-specific norms for EFs using the Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P) among 2- to 5-year-olds from urban Bangalore, India. In addition, the association between EFs and anthropometric measures, a marker of nutritional status, is also examined. Primary caregivers of 412 children, equally distributed by age and sex, participated. Raw scores for each domain and indices were converted to standard t-scores and percentiles were computed. A t-score at or above 63 corresponding to the 90th percentile was considered as the cutoff for executive dysfunction in this sample. The prevalence of executive dysfunction is 10% based on the Global Executive Composite score of the BRIEF-P. The cutoff score for identifying executive dysfunction using existing United States (US) norms is higher compared to the cutoff score obtained in the current study. Therefore, using US norms for Indian children could result in the prevalence of executive dysfunction been underestimated. Multiple linear regression analysis revealed that stunted and underweight children have significantly elevated EF scores after adjusting for age, sex and socioeconomic status (SES; p .01). A greater understanding of EFs in preschool children is important for the early identification of executive dysfunction and implementing interventions to improve their future prospects. This study also shows that undernourished children are more likely to have executive dysfunction.

Background: Gambling has been portrayed in many anecdotes in the culture of India as an addiction associated with psychosocial dysfunctions. The present study assessed pathological gambling and other behavioral addictions as a comorbid condition in an urban Indian community. Materials and Methods: A total of 3250 individuals were approached to report on gambling behavior and other behavioral addictions using a door-to-door survey approach and 2755 participated in the study. The Lie–Bet Tool for gambling, Behavioral Addiction Screening Checklist, and Internet Addiction Test were administered. Results: Of those surveyed in the age group of 18–50 years, 1.2% reported pathological gambling along with the presence of eating, mobile phone, or television addiction. Only 0.3% of the participants reported the need to change gambling behaviors. Conclusions: These findings have implications for screening and intervention for the management of behavioral addictions that are comorbid with gambling.

Internet use has increased access to online sexually explicit material. We explored the use of pornography in a community sample.In a house-to-house survey, 2525 individuals (1239 men; 1286 women) in the age group of 18-40 years were administered a schedule which included a screening tool for pornographic addiction along with a General Health Questionnaire.Around 8.3% (229; 152 men [10.9%]; 77 women [5.6%]; p0.001) acknowledged the use of pornography. It was more common among single and single parenting group samples. Pornographic addiction was 0.2% (5/2525; 0.3% men; 0.1% women). Sex had a significant association with age and pornography addiction.Our study documents the use of pornography in India. It suggests the need for in-depth studies.

Objective: To study role of ankle foot orthosis (AFO) in improving locomotion and functional recovery after stroke. Setting: Neurological Rehabilitation Department of a university research tertiary hospital. Patients and Methods: AFO and activity based rehabilitation. Main Outcome Measures: Distance (meters) covered during the 6-minute walk test (6MWT) and speed (meter/second) during the 10-meter walk test. Functional abilities assessed using Functional Independence Measure (FIM®). Results: Twenty-six patients (21 male) with stroke (mean duration 196.7 days, range 45–360 days) and mean age of 41.6 years (range 18–65 years, standard deviation [SD] 12.5) were included. Fourteen had right hemiplegia. The mean length of stay in the unit was 26.5 days (range 18–45 days, SD 5.5). All patients had equinus deformity with spastic foot drop and were provided with AFO. Walking endurance with 6MWT was 90 m on admission (without AFO). At discharge, it improved to 174 m with AFO and 121 m without AFOs (P < 0.001-with and without AFO at discharge). Walking speed improved from 0.4 m/s (admission) to 0.51 m/s with AFO, P = 0.004 and 0.45 m/s without AFO, P = 0.015) at discharge. Nine patients (34.6%) had clinically important difference-minimal clinically important difference (>0.16 m/s speed gain; >50 m endurance gain) at discharge. The mean FIM® score on admission was 84.3 ± 18.6. At discharge FIM® improved to 101.9 ± 13.7 (P < 0.001). Conclusions: Use of AFOs improve gait parameters significantly in only one-third stroke patients in the study when combined with activity-based inpatient-rehabilitation.