Post-traumatic stress and depression following a landslide linked to the 2018 floods in Kerala, India: Relevance of screening

There is scant information on early manifestation of trauma due to catastrophic natural events and its relation with stress-related disorders. The specific objective of this study was to estimate and compare the prevalence of post-traumatic stress and depression on day 3 (D3) and week 6 (W6) following the 2018 flood in Kerala, India. In a cross-sectional study, symptoms of post-traumatic stress and depression were studied at D3 using primary care Post-Traumatic Stress Disorder screen for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (PC-PTSD-5), and then at W6 using PC-PTSD-5, Screening Questionnaire for Disaster Mental Health, PTSD Checklist for DSM-5 (PCL-5), and Becks Depression Inventory. Majority (70 percent) were screen positive at D3 (n = 20) compared with 30 percent at W6 (n = 50), with a decreased frequency of all symptoms. Being PC-PTSD-5 screen positive at W6 was significantly associated with the presence of threat to life, physical injury, and death of relatives or neighbors. According to PCL-5, at W6, 46 percent had possible PTSD. Except damage to property, other disaster related or sociodemographic variables were not associated with the risk of having PTSD. Positive predictive value of PC-PTSD-5 (D3) for PTSD (PCL-5) at W6 was 64.3 percent. Depression and possibility of PTSD were significantly associated. A considerable proportion of victims continued to have post-traumatic stress and depression although the -frequency decreased over time. A simple screening measure may help to identify victims with possible PTSD.

Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin

BACKGROUND:

A set of enduring conditions have been reported in the literature involving persistent sexual dysfunction after discontinuation of serotonin reuptake inhibiting antidepressants, 5 alpha-reductase inhibitors and isotretinoin.

OBJECTIVE:

To develop diagnostic criteria for post-SSRI sexual dysfunction (PSSD), persistent genital arousal disorder (PGAD) following serotonin reuptake inhibitors, post-finasteride syndrome (PFS) and post-retinoid sexual dysfunction (PRSD).

METHODS:

The original draft was designed using data from two published case series (Hogan et al., 2014 and Healy et al., 2018), which represent the largest public collections of data on these enduring conditions. It was further developed with the involvement of a multidisciplinary panel of experts.

RESULTS:

A set of criteria were agreed upon for each of the above conditions. Features of PSSD, PFS and PRSD commonly include decreased genital and orgasmic sensation, decreased sexual desire and erectile dysfunction. Ancillary non-sexual symptoms vary depending on the specific condition but can include emotional blunting and cognitive impairment. PGAD presents with an almost mirror image of unwanted sensations of genital arousal or irritability in the absence of sexual desire. A new term, post-SSRI asexuality, is introduced to describe a dampening of sexual interest and pleasure resulting from a pre-natal or pre-teen exposure to a serotonin reuptake inhibitor.

CONCLUSIONS:

These criteria will help in both clinical and research settings. As with all criteria, they will likely need modification in the light of developments.

Prevalence of child abuse in Kerala, India: An ICAST-CH based survey

BACKGROUND

Child abuse is a major concern in India with frequent reports of extreme maltreatment and fatalities. A dearth of robust and methodologically sound studies has resulted in ambiguity regarding the extent of child abuse in the general population.

OBJECTIVES

To estimate the one-year and lifelong prevalence of exposure to violence, physical abuse, emotional abuse, sexual abuse, and neglect using a validated instrument-the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool - Child, Home Version (ICAST-CH).

PARTICIPANTS AND SETTING

Adolescents (n = 6957) attending randomly selected schools in one city in Kerala, India.

METHODS

Cross-sectional survey using self-report instrument.

RESULTS

The one-year prevalence of any abuse was 89.9% (95% CI: 89.1-90.7) suggesting that child maltreatment was widespread. Physical and emotional abuses were also very common. Although sexual abuse was least common, a considerable proportion of adolescents reported it; one-year prevalence of sexual abuse was 16.7% and lifetime prevalence was 19.9%. Boys reported more abuse than girls across all the categories of abuse (including sexual abuse). Abuse was more frequent in the higher age groups and classes at school. Abuse was also more frequent in nuclear families and families that reported alcohol use. Children who reported an abusive experience usually faced more than one category of abuse; abuse in one category was significantly associated with abuse in other categories.

CONCLUSIONS

Abuse of children is alarmingly common. There is an urgent need for improving the awareness surrounding this issue as it is a major public health challenge faced by the country. The priority should be on setting up easily accessible support services for children.

Prevalence of child abuse in school environment in Kerala, India: An ICAST-CI based survey

Very few studies focus on childhood abuse in developing countries and only a small fraction of such studies explicitly deal with abuse in a school environment. The purpose of this study was to estimate the prevalence of sexual, physical, and emotional abuse in a school environment in a developing country. Abuse history was collected using the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool - Children's Institutional Version (ICAST-CI). Demographic variables were also collected. Student supportive measures were provided both during and after the survey. 6682 school attending adolescents in Thrissur, Kerala participated in this cross sectional self report study. One year and lifetime prevalence of physical (75.5%, 78.5%), emotional (84.5%, 85.7%) and sexual (21.0%, 23.8%) abuse was high. Abuse was considered to be present even if an individual item from these three categories was reported. Most abuse was reported as occurring 'sometimes' rather than 'many times'. More males than females reported being victims of abuse; figures for one-year prevalence were: physical abuse (83.4% vs. 61.7%), emotional abuse (89.5% vs. 75.7%), and sexual abuse (29.5% vs. 6.2%). Various factors significantly increase the likelihood of abuse-male gender, low socioeconomic status, regular use of alcohol and drugs by family member at home, and having other difficulties at school. Children tended to report abuse less frequently if they liked attending school and if they always felt safe at school. The results highlight the urgent need to address the issue of abuse in the school environment and minimize its impact.

Bioavailability studies on fast release formulations of indomethacin

Indomethacin-nicotinamide solid dispersions were prepared by fusion method. Drug-carrier interaction in the liquid and solid states were studied using phase solubility data and differential scanning colorimetry (DSC). DSC revealed the formation of an eutectic mixture of indomethacin and nicotinamide. Tablets and capsules, formulated from the solid dispersions showed significantly better dissolution and enhanced absorption rate in human volunteers, compared to commercial capsule of indomethacin.

In vitro and in vivo characterization of scleral implants of indomethacin

Scleral implants of indomethacin with sodium alginate as carrier were fabricated and evaluated for various physico-chemical properties such as uniformity of thickness, weight, drug content, surface pH, percent dissolution and water up-take capacity (swelling index). The effect of drug particle size, polymer concentration, drug loading, plasticizer concentration, and effects of physical reinforcement (freeze-thawing for 3 and 6 cycles) and chemical cross-linking with calcium chloride, on the in vitro drug release characteristics were evaluated. Selected batches of the implants were subjected to pharmacodynamic studies, after scleral placement, in uveitis induced (intravitreal injection of Bovine Serum Albumin (BSA)-50 micrograms/ml) rabbit eyes. The release of indomethacin from the prepared implants followed predominantly matrix diffusion kinetics. Swelling and moisture absorption/loss studies correlated well with the in vitro release studies. The pharmacodynamic studies showed a marked improvement in the various clinical parameters (congestion, keratitis, flare, clot, aqueous cells and synechias), in the implanted eye when compared to the control eye in the rabbits.

Novel therapeutic approaches for uveitis and retinitis

A virtual increase in the number of patients undergoing immunosuppressant therapy and those suffering from AIDS has created a unique class of population suffering from virulent uveitis and retinopathies. A very common pathogen implicated in retinopathy in such patients is the cytomegalovirus (CMV).