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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.

Background: Alcohol use among college students is a major public health priority owing to its high prevalence and numerous negative outcomes. Most interventions targeting alcohol use among college students consider them as a homogenous entity. There is preliminary evidence from high-income countries that patterns of alcohol use differ across academic streams. This remains unstudied in India. Aims: To compare the prevalence and correlates of alcohol use among students enrolled in various collegiate educational streams (medical, nursing, engineering, arts and science, and others [law/fisheries]) in the state of Kerala, India. Settings and Design: This is a cross-sectional survey conducted among college students. Materials and Methods: 5784 students completed a self-administered questionnaire assessing alcohol use and its correlates in the psycho-social domains. Statiscal Analysis: Lifetime prevalence and severity of alcohol use was determined across examined academic streams. A multivariable logistic regression analysis was done separately for each course, to identify factors influencing alcohol use. Results: The lifetime prevalence of alcohol use varied between 10.6% among nursing students to 41.7% among students pursuing “other” stream (law/fisheries). Students pursuing medicine and nursing had a relatively lower proportion of hazardous users. Consistently across all academic streams, being male and using tobacco increased the risk, while those from the Muslim community had a lower risk of alcohol use. Other examined psychosocial correlates showed varying relationship across courses. Conclusion: The prevalence and psychosocial correlates of alcohol use vary among students pursuing various academic streams. This finding has public health importance as the incorporation of course level characteristics in intervention programs will improve effectiveness.

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.

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.

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: The objective of this study was to correlation between heart rate variability (HRV) and bladder sensations during filling and voiding phase of urodynamic study (UDS) in patients with myelopathy. Materials and Methods: Myelopathy patients (traumatic and nontraumatic) within 6 months of illness were included in the study. Demographic data, etiopathological diagnosis, and urinary complaints were noted. UDS was performed and simultaneous HRV calculated at each event of filling and voiding phase by recording and calculating standard deviation of normal-to-normal (NN) interval (SDNN), root mean square of successive differences, total power (TP), average heart rate, high frequency (HF), low-frequency (LF) ratio, and data analyzed. Results: The study included 30 patients (23 males) with a mean age of 31.2 years (range 18–60 years, standard deviation 11.6). The mean of LF in normalized units showed an increase from 43.6 ± 14.1 at baseline to 48.9 ± 17.4 at strong desire to void (SDV) and at urgency to 44.1 ± 14.5. HF at baseline 40.4 ± 14.1 reduced to 36.4 ± 12.8 at SDV and rose at urgency to 41.2 ± 13.2. LF/HF at baseline was 1.3 ± 0.8, which increased to 1.6 ± 1.1 at SDV and reduced at urgency to 1.2 ± 0.6. Significant change in mean value was seen in TP (P = 0.01) and SDNN (P = 0.009) at first desire to void. Significant positive trend was seen in TP (P = 0.048) and SDNN (P = 0.042) during filling. Conclusion: Comparison of HRV measures failed to show significant rise in sympathetic or parasympathetic component in myelopathy patients during UDS and requires more critical evaluation.

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.

ObjectivesThe study examined the prevalence, sociodemographic, and clinical correlates of chronic pain among primary care patients in the state of Kerala, India. It also examined the patterns and relationships of chronic physical and mental health conditions with chronic pain.MethodsThis study is a cross-sectional survey conducted among 7165 adult patients selected randomly by a multi-stage stratified design from 71 primary health centers. The questionnaires administered included Chronic pain screening questionnaire, self-reported Chronic physical health condition checklist, Patient Health Questionnaire-SADS, The Alcohol Use Disorders Identification Test, Fagerström Test for Nicotine Dependence, WHO Disability Assessment Schedule and WHOQOL- BREF for Quality/Satisfaction with Life. The prevalence and comorbid patterns of chronic pain were determined. Logistic regression analysis and generalized linear mixed-effects model was employed to examine the relationship of chronic pain to socio-demographic variables and examined physical and mental health conditions.ResultsA total of 1831 (27%) patients reported chronic pain. Among those with chronic pain, 28.3% reported no co-occurring chronic mental or physical illness, 35.3% reported one, and 36.3% reported multi-morbidity. In the multivariate analysis, patients with chronic pain when compared to those without had higher odds of being older, female, having lower education, not living with their family, greater disability, and poor satisfaction with life. Chronic pain was independently associated with both medical (hypertension, diabetes mellitus, tuberculosis, arthritis, and other medical illnesses) and mental health conditions (depressive disorders, anxiety disorders, and tobacco dependence). It showed a varying strength of association and additive effect with increasing number of co-occurring physical and mental illnesses.ConclusionsChronic pain is a common condition among primary care attendees associated with significant burden of medical and mental health comorbidity. The findings highlight the need to incorporate treatment models that will ensure appropriate management to improve outcomes within the resource constraints.

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.

Background: Studies of alcohol use among college students in India have reported a male preponderance, but a recent large study suggested that alcohol use is increasing in young females. This increase in use among the young females is of concern as they experience poorer outcomes and a higher risk for addiction. Hence, we aimed to examine the gender-specific correlates of alcohol use among college students in the district of Ernakulum, Kerala. Methods: From 58 colleges, 5,784 students completed a self-administered questionnaire that assessed use of alcohol, use of tobacco and illicit drugs, psychological distress, suicidality, symptoms of attention deficit hyperactivity disorder, and history of sexual abuse. Results: Of the questionnaires, 342 had incomplete responses and had to be discarded, and the rest (n = 5,442, 94.1%) were analyzed. lifetime alcohol use was reported by 39% males and 12.6% females. In the multivariable logistic regression analysis using a full model, male students using alcohol compared to male non-users were older, non-Muslim, had poor academic performance, and used other substances. Female users, compared to female non-users, were non-Muslim, had urban residence, used tobacco, and had higher psychological distress, higher suicidal thoughts, and higher lifetime exposure to sexual abuse. Conclusion: Gender-specific differences extend across sociodemographic and psychological domains. Incorporation of these may improve the effectiveness of public health strategies addressing alcohol use.

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 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.

Objectives: To study the effects of cognitive retraining and inpatient rehabilitation to study the effects of cognitive retraining and inpatient rehabilitation in patients with acquired brain injury (ABI). Design and Setting: This was a prospective follow-up study in a neurological rehabilitation department of quaternary research hospital. Patients and Methods: Thirty patients with ABI, mean age 36.43 years (standard deviation [SD] 12.6, range 18–60), mean duration of illness 77.87 days (SD 91.78, range 21–300 days) with cognitive, physical, and motor-sensory deficits underwent inpatient rehabilitation for minimum of 14 sessions over a period of 3 weeks. Nineteen patients (63%) reported in the follow-up of minimum 3 months after discharge. Type of ABI, cognitive status (using Montreal Cognitive assessment scale [MoCA] and cognitive Functional Independence Measure [Cog FIM]®), and functional status (motor FIM®) were noted at admission, discharge, and follow-up and scores were compared. Results: Patients received inpatient rehabilitation addressing cognitive and functional impairments. Baseline MoCA, motor FIM, and Cog FIM scores were 15.27 (SD = 7.2, range 3–30), 31.57 (SD = 15.6, range 12–63), and 23.47 (SD = 9.7, range 5–35), respectively. All the parameters improved significantly at the time of discharge (MoCA = 19.6 ± 7.4 range 3–30, motor FIM® = 61.33 ± 18.7 range 12–89, Cog FIM® =27.23 – 8.10 range 9–35). Patients were discharged with home-based programs. Nineteen patients reported in follow-up and observed to have maintained cognition on MoCA (18.8 ± 6.8 range 6–27), significantly improved (P < 0.01) on Cog FIM® (28.0 ± 7.7 range 14–35) and motor FIM® =72.89 ± 16.2 range 40–96) as compare to discharge scores. Conclusions: Cognitive and functional outcomes improve significantly with dedicated and specialized inpatient rehabilitation in ABI patients, which is sustainable over a period.

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.

Context: There are scarce data on the prevalence of adult obsessive-compulsive disorder (OCD) in India. Aims: The aim was to study the point prevalence of OCD and subthreshold OCD and its psychosocial correlates among college students in the district of Ernakulam, Kerala, India. Settings and Design: A cross-sectional survey of 5784 students of the age range of 18–25 years from 58 colleges was conducted. Materials and Methods: Students were self-administered the OCD subsection of the Clinical Interview Schedule-Revised, the Composite International Diagnostic Interview for obsessive-compulsive symptoms (OCSs), and other relevant instruments to identify OCD, subthreshold OCD, and related clinical measures. Statistical Analysis: The point prevalence of OCD and subthreshold OCD was determined. Categorical variables were compared using Chi-square/Fisher's exact tests as necessary. Differences between means were compared using the ANOVA. Results: The point prevalence of OCD was 3.3% (males = 3.5%; females = 3.2%). 8.5% students (males = 9.9%; females = 7.7%) fulfilled criteria of subthreshold OCD. Taboo thoughts (67.1%) and mental rituals (57.4%) were the most common symptoms in OCD subjects. Compared to those without obsessive-compulsive symptoms (OCSs), those with OCD and subthreshold OCD were more likely to have lifetime tobacco and alcohol use, psychological distress, suicidality, sexual abuse, and higher attention-deficit/hyperactivity disorder symptom scores. Subjects with subthreshold OCD were comparable to those with OCD except that OCD subjects had higher psychological distress scores and academic failures. Conclusions: OCD and subthreshold OCD are not uncommon in the community, both being associated with significant comorbidity. Hence, it is imperative that both are identified and treated in the community because of associated morbidity.

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.

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.

Background: Radiosurgery is an alternative to surgical resection of arteriovenous malformation (AVM). Very few studies have addressed the concern of radiation injury to the brain and its attendant adverse effects on cognitive function. Materials and Methods: This prospective study included all patients who underwent gamma knife radiosurgery (GKRS) at our institute for cerebral AVM between 2006 and December 2008 (n = 34). All patients underwent neuropsychological evaluation before the procedure. Neuropsychological evaluation was repeated in eighteen patients 2 years following GKRS. Clinical outcome, AVM obliteration, and factors influencing outcome were analyzed in these eighteen patients. Results: Before GKRS, more than 50% had significant impairment of neuropsychological functions compared to normal population norms. 66.6% achieved the excellent radiosurgical outcome. At 2 years follow-up, patients showed varied improvement in neuropsychological function in various categories. Pretherapeutic median value for percentage perseverative responses was 26.5 and at follow-up, it reduced to 18.2 (P = 0.039). Set shifting improved in 11 patients (61.1%), remained same in 5 patients (27.7%), and deteriorated in two patients (11.1%). Patients with a higher Spetzler-Martin grade AVM demonstrated a significantly more favorable shift in follow-up test values for set shifting function (P = 0.021). Patients with postradiation imaging changes had lesser tendency to improve in neuropsychological performance at follow-up. Conclusions: GKRS has no clinically harmful effect on cognitive and neuropsychological functioning in patients with brain AVM. On the contrary, there is an improvement in majority of patients at 2 years following radiosurgery when nidus is obliterated.

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.