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Introduction: There are three independent variables used in clinical practice to evaluate patients suffering from alcohol use disorder (AUD); these are Alcohol Use Disorders Identification Test (AUDIT), liver function tests (LFTs), and imaging findings on ultrasound of the abdomen. There is limited literature about the association of imaging findings with LFT and AUDIT scores in cases of AUD. Objective: The study was conducted to determine the association of ultrasound abdomen findings with LFTs and AUDIT scores in patients with AUD. Methods: This study was conducted using data from 439 patients of AUD (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) treated in the psychiatry department of a tertiary care hospital. The data hence obtained were subjected to statistical analysis. The ordinal data sets were compared using the Chi-square test, and P < 0.05 was taken as statistically significant. Results: The ultrasonography (USG) findings of hepatic/portal system changes in patients of AUD show a significant association with the corresponding changes in AUDIT scores, serum bilirubin, and aspartate transaminase (AST) levels. The ultrasound findings were also significantly associated with total years of drinking and average drinking (in g) per day in the last 3 years. The USG findings did not show a significant statistical association between ALT (alanine transaminase) and serum gamma-glutamyl transferase levels. Conclusion: In patients with alcohol use disorder, USG abdomen findings correlate with the severity of dependence as indicated by years of drinking, average alcohol consumption per day for the last 3 years, AUDIT score (last 1 year), and markers of liver injury (serum bilirubin and AST). Combined use of clinical severity indicators (e.g., AUDIT), lab parameters, and USG abdomen can help in the early diagnosis of ALD.

Introduction Cervical lymphadenopathy is a relatively common clinical presentation that can have varied causes including reactive, inflammatory, tubercular, or neoplastic etiologies. Sonography is most often the first line of investigation used in clinical practice to characterize the enlarged nodes with respect to their location, number, size, and morphological imaging characteristics and determine the differential etiological possibilities. Materials and Methods The present study was conducted involving 434 patients who presented over a period of 3 years to radiology departments of three multispecialty hospitals for the evaluation of cervical swellings. The study aimed to establish the correlation between the ultrasound and Doppler parameters used in clinical practice and the final histological diagnosis in cases of tubercular cervical lymphadenitis. Results Overall, a female predisposition was observed in the proportion of patients who presented with cervical lymphadenopathy. A similar increased female percentage was also observed in cases finally detected to have tubercular pathology. The highest diagnostic indices were obtained for two ultrasound parameters of “matted nodes” and “caseous necrosis with posterior acoustic enhancement.” Although other features such as hypoechoic nodes, Doppler findings of peripheral vascularity, and high resistive index (RI)/pulsatility index (PI) values demonstrated high sensitivity, they showed poor specificity, positive predictive values, and low accuracy. Conclusion In ultrasound scans for suspected cases of tubercular cervical lymphadenitis, the maximum weightage should be given to “matted nodes” and “caseous necrosis with posterior acoustic enhancement” parameters to differentiate the tubercular etiology from other potential causes. These parameters demonstrate high sensitivity, specificity, positive predictive value, and accuracy. Hence, they can be relied upon to start timely anti-tubercular treatment and follow-up with patients on a clinical-radiological basis. This can supplement waiting for suboptimal cytology reports that are difficult to arrive at, specifically in tubercular cervical lymphadenitis cases. The same applies as well to biopsy specimens that are hard to obtain from cervical nodes with associated potential grave complications.

Introduction: Saphenofemoral junction (SFJ) incompetence is the most commonly attributed etiological factor in varicose veins of lower limbs with a consequent increase in the caliber of the great saphenous vein (GSV). This study aimed to assess GSV diameter to determine its cutoff diameter value for predicting reflux at the SFJ, in cases of varicose veins. Methods: This hospital-based prospective study was conducted on 156 patients (245 diseased limbs) over a period of 2 years, involving patients referred from the outpatient department for evaluation of varicose veins or those being evaluated as a part of preoperative assessment. Results: The cutoff value of GSV diameter to detect SFJ incompetence was determined at 5.4 mm with best sensitivity of 74.3%, specificity of 78.5%, and accuracy of 75.1%. Conclusion: GSV diameter assessment is of immense clinical importance as it can help the treating physician to filter out the false-negative cases solely being diagnosed based on reflux at SFJ, especially those with an absence of obvious clinical signs.

Introduction: Benign prostatic hyperplasia is a common condition in elderly men and is a major cause of bladder outflow obstruction. Various parameters are used in clinical practice, to be able to assess the severity of the enlarged prostate and its direct effect on the quality of life of the patient in terms of evaluation of lower urinary tract symptoms (LUTSs). These are the International Prostate Symptom Score (IPSS); urodynamic studies such as uroflowmetry, measurement of postvoid residual urine (PVRU), prostatic volume (PV), intravesical prostatic protrusion, and digital rectal examination. Out of these, sonographic measurement of prostate volume and postvoid residual urine is the most widely used and readily available noninvasive methods. The present hospital-based study aims to establish an association between the PV, PVRU, and clinical symptom scores derived as per IPSS. Methods: This prospective, hospital-based study was done over a sample group of 748 symptomatic males with LUTS, referred from outpatient departments over a period of 2 years, for the assessment of PV and postvoid residual urine. The ordinal data sets were compared using the Chi-square test and a P < 0.05 was taken as statistically significant. Results: The Chi-square statistics for the association of prostate volume with IPSS were 13.1678. P value was = 0.01. The Chi-square statistics for the association between PVRU and IPSS scores were 1.613. P value was = 0.80645. Conclusion: The results derived from the data establish that the statistical association between prostate volume and IPSS scores is weakly significant and association between PVRU and IPSS scores is not statistically significant at all.

Objectives: Primary objective of the study was to determine the association between the TI-RADS system of thyroid lesion evaluation on ultrasound and the cytological findings of thyroid lesions by FNAC (graded as per the Bethesda system). The secondary objective was to study the outcome of high TI-RADS and high Bethesda grades in terms of malignant potential determined by histopathological examination. Materials and Methods: A multi-centric retrospective hospital-based study was done for all patients who underwent sonography for evaluation of thyroid lesions and subsequently fine needle aspiration cytology (FNAC) from 2018 to 2021 at two hospitals in two different states of India. Clinical and radiological data were obtained from hospital records. The data hence obtained was subjected to statistical analysis. The outcome of high-grade TIRADS and Bethesda scores in terms of malignant potential (confirmed by histopathology) was also evaluated. Results: A total of 249 patients fulfilled the inclusion criteria. 129 patients (51.8%) were in 36-55 year age group with female predominance. The majority of cases in the study belonged to TI-RADS 3 category (33.73%) on sonography and Bethesda Grade III (28.91%) after cytological analysis. Out of 72 Bethesda grade III cases, 59 (81.9%) had TI-RADS 3 score. Similarly, out of 67 Bethesda Grade IV cases, 55 (82%) had TI-RADS 4 scores showing maximum concordance. The accuracy of TIRADS 4 and 5 lesions and Bethesda grade 4-6 lesions in detecting malignancy confirmed on HPE was 67.9 and 73.6%. Discussion: Our study done on 249 patients from varying demographic profiles showed that the correlation between sonography and cytological findings of thyroid lesions was statistically significant. Both diagnostic modalities helped to correctly determine the severity of the lesions, and malignant potential and enabled grading into clinically relevant groups that decided the further management as per laid down guidelines. Conclusion: The concurrent use of ACR-TIRADS on sonography coupled with the Bethesda system of cytological evaluation for thyroid nodules is clinically appropriate in ascertaining the RoM (Risk of malignancy) in a thyroid nodule.

Alcohol withdrawal delirium is a medical emergency with mortality rates of 20–50% without treatment. Benzodiazepines (BZDs) (gamma-aminobutyric acid receptor agonists) are the mainstay of treatment. Alcohol withdrawal delirium is associated with sympathetic hyper-activity and marked agitation, which in severe cases respond poorly to BZDs alone. Very high doses of BZDs pose risk of respiratory depression and further complications such as aspiration pneumonia which can worsen the treatment outcome. Dexmedetomidine is a selective Alpha-2 adrenergic agonist which has been approved by US Food and Drug Administration for short-term sedation of intubated and mechanically ventilated adult patients in intensive care unit settings and for sedation of non-intubated patients during invasive procedures. Its unique sedative, sympatholytic, and respiratory sparing properties can supplement and can reduce the dose requirement of BZDs while managing such cases. We present three cases of severe alcohol withdrawal delirium [delirium tremens (DT)] who responded poorly to initial BZD treatment but responded well to adjunctive dexmedetomidine infusion. Dexmedetomidine is a pragmatic adjunct to BZDs in severe delirium tremens.

Introduction: Cholesteatoma has been described as an accumulation of desquamated keratin debris in a pocket of squamous epithelium over a matrix within the middle ear cleft. A prospective study was carried out to establish a correlation between preoperative high-resolution computed tomography (HRCT) temporal bone findings with intraoperative findings in cases of cholesteatoma. Methods: Fifty patients of chronic otitis media, active squamous type, i.e. clinically suspected cholesteatoma, scheduled to undergo tympanomastoid exploration were selected. The positive and negative findings of the scan were documented as per the parameters to be analyzed. The important intraoperative surgical findings were then analyzed with preoperative HRCT findings. Results: Agreement between surgical and HRCT findings ranged from 86% (facial canal erosion) to 100% (external bony canal involvement). HRCT had higher detection rate as compared to surgery for scutum erosion (40% vs. 36%), tegmen erosion (6% vs. 4%), facial canal erosion (28% vs. 14%), lateral semicircular canal erosion (6% vs. 2%), incus erosion (78% vs. 64%), sinus tympani involvement (14% vs. 4%), attic involvement (44% vs. 42%), mastoid involvement (88% vs. 80%), and aditus widening (54% vs. 44%). The higher detection of scutum erosion, tegmen erosion, facial canal erosion, lateral semicircular canal erosion, and incus erosion is probably due to partial volume averaging. Conclusion: The findings of the present study showed that HRCT is an essential and indispensable tool for preoperative evaluation of cholesteatoma. It was highly sensitive and adequately specific for a significant number of findings. These findings are pivotal in planning the surgery and preparing for necessary anticipatory reconstructive procedures.

Objective: Mesenteric lymphadenitis reflects the mesenteric lymph node (MLN) response to an underlying infection of uncertain etiology, usually viral. In children, enlarged MLNs are common findings detected during abdominal ultrasound, whether done for nonspecific pain abdomen or for unrelated clinical presentations. This study was conducted to determine the significance of mesenteric lymphadenopathy in asymptomatic children as compared to those with symptoms of acute abdominal pain or chronic abdominal pain (CAP). Methodology: A prospective hospital-based study was conducted among 72 children aged between 2 and 15 years. These children were referred from the outpatient/pediatric ward department for 1 year, for evaluation by abdominal ultrasonography. Children were grouped into three categories based on their clinical presentations as asymptomatic (controls), those with CAP, and those with acute abdomen. The sonographic findings were tabulated against each, with accounting of parameters such as size, number of enlarged nodes, and site of nodes. Pearson's Chi-square test was used to analyze ordinal variables between groups. About 95% confidence interval was selected with a P = 0.05 taken as statistically significant. Results: Significant enlarged MLNs were comparable in prevalence in all groups. The incidence of significant mesenteric lymphadenopathy in the CAP group was even less than in the control group. The Chi-square statistic was 2.5612. The P = 0.633718. The result is not statistically significant at P < 0.05. This indicates that MLNs on ultrasonography have no significant association with the clinical presentation in children. Conclusion: Our study indicates that reporting of enlarged mesenteric nodes on transabdominal sonography in children is not statistically significant with the clinical symptomatology.

Splenic infarction without splenic vessel thrombosis is an infrequent presentation in clinical practice. The case discussed here is a 45-year-old male with a history of alcohol abuse, who presented to the hospital with pain abdomen epicentered in the left upper quadrant. On evaluation, the patient was found to be having portal hypertension complicated with alcoholic hepatitis, acute necrotizing pancreatitis, gastric, and paraesophageal varices. The presence of splenic infarction without concomitant splenic vessel thrombosis in this patient merits a discussion of relevant investigations and their findings thereof.

Inhalant abuse is common in adolescents and young people. However, awareness about its harmful effects is low, and the potential to cause dependence remains a cause of concern. Inhalant abuse is often associated with underlying novelty-seeking traits, which can also predict propensity for other substances of abuse. Inhalants are cheap, freely available, and legal to possess and escape detection in vulnerable groups. There is a need to spread awareness about the harmful effects of inhalants and devise effective primary and relapse prevention strategies.

Background: More Indians have access to mobile phones than toilets. Concerns have been raised for addictive potential of Internet. There are few Indian studies on the prevalence of Internet addiction (IA) among adolescents. The present study aimed to assess the prevalence of IA among adolescents and its association with sociodemographic variables in a cantonment school. Methodology: It was a cross-sectional study among students of the age group of 10–19 years in Western Maharashtra. Sociodemographic data were collected using a self-administered questionnaire. Young's IA test was used to diagnose IA. Statistical analysis was done using Chi-square test and odds ratio. Results: A total of 1325 students participated in the study. Among these, 2.5% had scores above 69 (addicted). Among those with scores > 69, 85% were boys, average daily Internet use was 5.3 h in last 1 year. Use for academics, online gaming, and social media were the most common reasons for current use among the study sample. Risk factors included watching pornography, online gaming, use of Internet due to loneliness or boredom, use in Internet café, permanent login status, accessing Internet > 4 h daily, and consumption of tobacco or alcohol by any of the parents. The possible protective factors included using Internet only for academics, restricting Internet use to < 2 h, and having a playground nearby and playing there. Conclusion: In our study, prevalence of IA is around 2.5%. The possible risk and protective factors can be targets of intervention and further study.

Background: A gap exists from evidence-based medicine (EBM) to clinical practice and there is a felt need to bridge this. Critical appraisal of scientific articles during Journal club by postgraduate (PG) residents will help them to understand and apply the scientific evidence into best clinical practice. Hence, a new module of critical appraisal of journal articles was used for Psychiatry Residents in a Medical College and its impact was assessed. Materials and Methods: Nine psychiatry PG residents from three academic batches participated in the study after informed consent and Institutional ethical committee clearance. They were trained in the Colorado Psychiatry EBM Examination Test module. Subsequently, three consecutive journal article presentations of them were assessed under seven Subtests of the module. Results: There was gradual increase in the assessment scores of all PG residents with each journal article presentation. They also expressed satisfaction of the assessment method and felt confident of applying the principles of critical appraisal in their clinical practice in future. Conclusion: This study evaluated the impact of a new module of critical appraisal of journal article by psychiatry PG residents. It was found to be acceptable by residents and improved their competency to apply literature-based EBM into their clinical practice. It is recommended for further multicentric evaluation on a larger sample.

Drone operations have added a new chapter to modern warfare. They may not guarantee immediate territorial gains but can significantly influence ideological and political alignment of the adversary at a cost which is much lower than conventional war. However, drone operators, which include remote pilots, intelligence coordinators, and other support staff, may face important psychological issues which may affect their mental health and operational efficiency. We conducted a nonsystematic narrative review of the articles dealing with the issue and found that drone operators and support staff have higher chances of suffering from emotional disengagement, Post Traumatic Stress Syndrome (PTSD), emotional exhaustion, and burnout. The scope of the article does not cover the psychological effect on the targeted populations or political and ethical issues dealing with drone warfare.

Background: Understanding the prevalence of a psychiatric disorder among children is essential for formulating sound public health policy. Aim: This study is aimed to estimate the prevalence of depression in urban school-going adolescents and its association with age, sex, and birth order. Materials and Methods: A total of 500 participants in the age group 12–16 years from a working-class community, studying in an urban school, were selected for the study. The children with a score greater than or equal to 19 on the CDI scale were taken for the second phase, and diagnosis of depression was confirmed by a psychiatric consultant through a clinical interview. In clinically diagnosed cases, all help was rendered, including follow-up. Results: The prevalence of clinical depression among school-going children of age group 12–16 years was 8.4%. There was no significant gender difference in the prevalence of clinical depression. Significantly, more children had clinical depression in the age group of 14–16 years than in the 12–14 years of age group. Depressive symptoms were more among children with first birth order. Conclusions: These results show that depression is common in school going urban adolescents in India and highlight the need for screening school-age children for depression so that early intervention can be provided.

Background: Traditionally medical education involves classroom teaching, small group discussions and bed-side clinics. These have become difficult to conduct in times of the COVID-19 pandemic. Video-conferencing software and apps provide pragmatic alternatives for medical education in this scenario. However, the apps are not designed specifically for medical education. In this background, we aimed to review available video-conferencing freeware (platforms/apps) for their suitability in imparting post-graduate medical education. Methodology: Software and apps were searched on Android and iOS platforms. Freeware were selected based on pre-defined criteria. They were evaluated for features supporting post-graduate medical education like participant numbers, time limit, user comfort and security features. Results: Our search yielded 118 video conferencing software and apps. Of these, 07 free apps met the initial inclusion and exclusion criteria. 'Say Namaste' was included post-hoc. Most apps allowed adequate numbers of participants and were comfortable for users. Only two apps had end-to-end encryption. Conclusion: Video-conferencing freeware can serve as a viable alternative for some aspects of medical teaching. Provision of certain additional features would make these apps more effective for post-graduate medical education.

Alcohol withdrawal delirium (delirium tremens [DT]) is a medical emergency. Gamma-aminobutyric acid type A agonists (benzodiazepines [BZDs]) are the mainstay of treatment. Resistant alcohol withdrawal requires adjunctive medications along with BZDs and supportive care. DT is associated with significant autonomic dysfunction (sympathetic hyperactivity). Dexmedetomidine is a selective a2-adrenergic receptor agonist which reduces sympathetic over-activity and agitation in delirious patients. We present a case of alcohol withdrawal delirium (DT) who responded well to adjunctive dexmedetomidine infusion resulting in reduced sympathetic activity and reduced dose requirement of BZDs.

Introduction: At the population level, screening and brief intervention (BI) is the most cost-effective method to reduce the burden of disease due to hazardous alcohol use. In delivering BI at individual level, trained workforce as well as time is a limiting factor. Hence, a study was conducted to assess the outcome of a “modified brief intervention” program delivered at workplace in a group setting for the participants identified with hazardous alcohol use pattern, as a secondary prevention measure. Materials and Methods: Study was a pre- and post-intervention study without a control group. Following an educational lecture, conducted by a mental health team including a psychiatrist, participants were screened using the WHO ASSIST questionnaire, V3.0 version. Those screened positive for hazardous alcohol use were given “modified brief intervention” in a group setting at their workplace which consisted of two semi-structured sessions of 1-h duration each. The sessions were spaced in a month. First session was based on motivation enhancement measures along with gathering of current alcohol use details and second session focused on relapse prevention. Three months later, the outcomes were assessed using a semistructured questionnaire and ASSIST was reapplied. The analysis was done using the R-commander from R-software. Results: No significant difficulty was experienced in conducting the interventions. Fifty (55.6%) participants stayed alcohol abstinent following second session and another 22 (24.44%) had reduced both the quantity and frequency of use. Paired t-tests revealed statistically significant reduction in all secondary outcome parameters (ASSIST scores, usual dose in one sitting, maximum dose, and number of days of use in month). Eighty (88.89%) participants reported the program to be effective. Only 3 months of observation is a limitation. Conclusion: The study provides an efficient secondary prevention model to reduce hazardous drinking at the population level needing less workforce, cost, and time.

Cognitive impairment in cases of high-altitude cerebral edema is a less researched area of neuropsychiatry. Usually, it presents with depressive symptoms and can sway the treatment on the lines of organic depressive disorder and pseudodementia. We report one such case of which presented with depressive symptoms with cognitive dysfunction. The diagnosis was later revised to organic amnesic syndrome. His cognitive deficits improved with the use of cognitive retraining, especially with the use of mobile-based applications.