An individualised psychosocial intervention program for persons with MND/ALS and their families in low resource settings

OBJECTIVE

To develop individualised psychosocial intervention program for people with MND and their families in India.

METHODS

People with MND and healthcare staff were constructively involved in co-designing the intervention program in four phases adapted from the MRC framework: 1. A detailed need assessment phase where 30 participants shared their perceptions of psychosocial needs 2. Developing the intervention module (synthesis of narrative review, identified needs); 3. Feasibility testing of the intervention program among seven participants; 4. Feedback from participants on the feasibility (acceptance, practicality adaptation). The study adopted an exploratory research design.

RESULTS

Intervention program of nine sessions, addressing psychosocial challenges through the different stages of progression of the illness and ways to handle the challenges, specific to the low resource settings, was developed and was found to be feasible. People with MND and families who participated in the feasibility study shared the perceived benefit through feedback interviews.

CONCLUSION

MND has changing needs and challenges. Intervention programme was found to be feasible to be implemented among larger group to establish efficacy.

Potential for Increased Epilepsy Awareness: Impact of Health Education Program in Schools for Teachers and Children

Background  Epilepsy, although a common disorder, yet is highly stigmatized. Under this condition, children with epilepsy are more vulnerable to stigmatization, social isolation, lack of support, and psychological and emotional problems. Thus, there is an immediate need of literature focusing on intervention studies to change the attitudes of school teachers and children.

Methods  The study was conducted with the objectives to evaluate knowledge, attitude, and practices (KAP) about epilepsy among school teachers and children; provide educational training program to teachers; and check the efficacy of training program imparted by teacher and trainer.

Results  Repeated measure of analysis of variance shows that knowledge ( F = 1,134.875, p < 0.001), attitude ( F = 2,429.909, p < 0.001), and practice ( F = 2,205.122, p < 0.001) are significantly different between pre- and posttests indicated by Pillai’s trace test. Similarly, from the Pillai’s test, knowledge ( F = 49.317, p < 0.001), attitude ( F = 125.304, p < 0.001), and practice ( F = 178.697, p < 0.001) are significantly different among teachers, trainer imparting training to children, and teachers imparting training to children. It is seen that KAP scores significantly differ between two time points and across the three groups. Among all the groups, teachers imparting training to children had high level of practice.

Conclusion  Inclusion of health education programs in the textbooks and health education schemes for teachers and school children are crucial ways to bring a change in their attitude, behavior, and practices toward epilepsy.

Potential for Increased Epilepsy Awareness: Impact of Health Education Program in School on Teachers and Children

Background Although epilepsy is a common disorder, it is highly stigmatized. Not only public but even teachers are not free from stigmatization and cultural barriers. Under this condition, children with epilepsy are more vulnerable for stigmatization, social isolation, lack of support, and psychological and emotional problems. At the same time, there is an immediate need of literature focusing on intervention studies to change the attitudes of school teachers and children.

Materials and Methods The study was conducted with the objectives to evaluate knowledge, attitude, and practices about epilepsy among school teachers and children; provide educational training program to teachers; and check the efficacy of training program imparted by teacher and trainer.

Results Repeated measure of analysis of variance shows that knowledge (F = 1134.875, p < 0.001), attitude (F = 2429.909, p < 0.001), and practice (F = 2205.122, p < 0.001) are significantly different between pre- and posttest indicated by Pillai’s trace test. Similarly, from the Pillai’s test knowledge (F = 49.317, p < 0.001), attitude (F = 125.304, p < 0.001) and practice (F = 178.697, p < 0.001) are significantly different among the teachers, trainer imparted training group of children, and teachers imparted training group of children groups. It is seen that knowledge, attitude, and practice scores significantly differ between two time points and across three groups. Among all the groups, teachers imparted training group children had high level of practice.

Conclusion Inclusion of health education programs in the textbooks and health education schemes for teachers and school children is a crucial way to bring a change in their attitude, behavior, and practices.

Caregiver burden and quality of life of patients with amyotrophic lateral sclerosis in India

AIM

Amyotrophic lateral sclerosis (ALS) or motor neuron disease (MND) is a progressive degenerative disorder that can have significant debilitating impact. Few studies have explored living with ALS in the developing countries. The study aims to understand the relationship between functionality, quality of life, and caregiver burden in ALS in the sociocultural scenario in India.

METHODS

A cross-sectional descriptive study was performed among 30 persons with ALS and their caregivers (men = 19; women = 11) receiving treatment from a national quaternary referral care center for Neurological disorders in Southern India. All patients were diagnosed as Definite ALS according to El Escorial Criteria. The mean age at onset of illness was 51.6 years and mean duration of illness at presenting to hospital was 11 months. The caregivers were spouses, offspring, or siblings. Variables were assessed with ALS Functional Rating Scale Revised (ALSFRS- R), ALS Specific Quality of Life Scale (ALSSQOL-R) with the patients and Zarit Burden Interview (ZBI) with the caregiver.

RESULTS

Functionality and quality of life negatively correlated with caregiver burden. Caregiver burden was negatively associated with "negative emotional state" and "interaction of the patient with family and environment", sub domains in ALSQOL scale. No significant association was noted between caregiver burden and intimacy, religiosity as well as physical symptoms domains of quality of life.

CONCLUSION

ALS patients and caregivers would benefit from structured care plan that is sensitive to the impact of the illness on the specific domains of quality of life as well as the deterioration in the neurological functioning.

Comparison of Post-Liver Transplantation Outcomes in Portopulmonary Hypertension and Pulmonary Venous Hypertension: A Single-Center Experience

BACKGROUND

In potential liver transplant candidates, pulmonary vascular diseases, including portopulmonary hypertension (PoPH) and pulmonary venous hypertension (PVH), can be associated with high morbidity and mortality. Although there are clear guidelines regarding management and transplant listing criteria for patients with PoPH, the listing criteria for PVH are not well defined.

OBJECTIVE

The aim of this study was to describe and compare the perioperative and postoperative morbidity and mortality associated with PoPH and PVH in patients undergoing liver transplantation.

METHODS

We conducted a retrospective observational study of all patients referred for liver transplantation to our center between 2005 and 2015 who underwent a right heart catheterization (RHC) for screening for pulmonary hypertension as suggested by initial echocardiography. Based on the RHC data, the patients were grouped into no pulmonary hypertension (No PH), PoPH, and PVH categories. In patients who underwent liver transplantation, we recorded vital status intraoperatively and at 30 days and 1-year post-transplant, and we recorded the incidence of postoperative cardiopulmonary and renal complications.

RESULTS

Of the 134 patients who underwent RHC as part of the initial transplant evaluation, 50 patients were successfully transplanted. There was 1 intraoperative death in the PoPH group. No significant difference in mortality was noted between the No PH, PoPH, and PVH groups intraoperatively and 30 days after liver transplantation. At 1 year, the survival rates were 100%, 69.2%, and 94.1% in the No PH, PoPH, and PVH groups, respectively. With respect to cardiopulmonary and renal complications, no statistically significant difference was noted among the groups, though there was a trend toward increased post-transplant reversible pulmonary complications in the PVH group.

CONCLUSION

Our findings suggest that the post-transplant outcomes of patients with PoPH and PVH are similar. In light of the growing recognition of diastolic dysfunction and cirrhotic cardiomyopathy in decompensated cirrhotic patients at the time of transplant, the issue of pulmonary hypertension related to PVH will gain increasing importance as we assess these patients for transplantation. Therefore, future studies are needed to define evidence based guidelines to determine candidacy for liver transplantation in the context of PVH.

Psychosocial challenges in family caregiving with children suffering from Duchenne muscular dystrophy

Families of children with Duchenne muscular dystrophy (DMD) go through significant challenges in dealing with the condition. Few studies have looked into the situation, especially in the sociocultural scenario that is unique to India. The authors' aim was to identify the psychosocial challenges for caregivers of children with DMD. A cross-sectional descriptive study was perfomed among the caregivers of 60 children with DMD who were attending the neuromuscular disorders clinic of a national tertiary referral center for neurological disorders. The knowledge and attitude, psychosocial needs, burden, and coping patterns were assessed in an interview. The findings showed that parents of children with DMD tended to have inadequate understanding of the disease but had a positive attitude, had a moderate family burden, and tended to rely more on religion, focus on and venting of emotions, and instrumental and emotional social support for coping. Caregivers of children with DMD would benefit from psychosocial intervention to address their understanding of and attitude toward the disease, as well as burden of dealing with it, and to help them develop their coping skills and meet their children's and their own needs.

Prospective analysis of short course chemotherapy in female genital tuberculosis

Short course chemotherapy with 2SHRZ/7HR of 9 months duration was given in 41 proven cases of female genital tuberculosis. Thirty-two (78%) patients completed 9 months of therapy. Twenty-five (61%) were pronounced cured. Short course chemotherapy appears to be quite effective in patients of genital tract tuberculosis.

Bioremediation of oil sludge-contaminated soil

Bioremediation has become an important method for the restoration of oil-polluted environments by the use of indigenous or selected microbial flora. Several factors such as aeration, use of inorganic nutrients or fertilizers and the type of microbial species play a major role in the remediation of oil-contaminated sites. Experiments were undertaken for bioremediation of oil sludge-contaminated soil in the presence of a bacterial consortium, inorganic nutrients, compost and a bulking agent (wheat bran). Experiments were conducted in glass troughs for the 90-day period. Bulked soil showed more rapid degradation of oil compared to all other amendments. During the experimental period, wheat bran-amended soil showed 76% hydrocarbon removal compared to 66% in the case of inorganic nutrients-amended soil. A corresponding increase in the number of bacterial populations was also noticed. Addition of the bacterial consortium in different amendments significantly enhanced the removal of oil from the petroleum sludge from different treatment units.

Long-term use of clobazam in the management of intractable epilepsy : a prospective study

Clobazam, a 1-5 benzodiazepine, was used as add-on in the management of intractable epilepsy prospectively from 1993-1996. Forty patients who satisfied the defined inclusion and exclusion criteria with minimum one year follow-up were included. Therewere 25 male and 15 female patients, which included 15 children (37.5 ) and 25 adults (62.5 ). They had epilepsy for a mean period of 145.3 ? 106.9 months. Majority had uncontrolled complex partial seizures with or without secondary generalization. 55had single type of epilepsy and 45 had multiple type of seizures. Clobazam (Frisium) was added as an adjuvant in the dose of 5-30 mg. Patients were followed regularly to evaluate its efficacy and toxic effects. Follow up ranged from 12-66 months with amean of 27.2 ? 13 months. Twelve patients (30) were totally free from seizure, 16 (40) had more than 75 reduction in frequency and 6 (15) had no effect. Tolerance was seen in 7 ( 17.5) patients. This could be managed by increasing the dosage in a step-wise manner. Three female patients complained of increase in weight which has not been reported in the literature so far. We could reduce the dose of other antiepileptics in all and stopped one AED in 8 patients. Clobazam is recently introduced in the Indian market and relatively very economical compared to other newer antiepileptic drugs and effective as first line add-on drug in the management of refractory epilepsy in both adults and children.

Audit in maternal and child health

Audit in medicine is a well tried means of assessing the quality of practice by using acceptable measures of outcome. Audit in maternal and child health has been limited to fatal outcomes such as maternal and perinatal deaths. The outcome of audit is of interest to the providers, the health authorities and the consumers. The utility of audit lies in effective use of data to improve quality of service. Quality control of instruments and education of junior staff are some other benefits of audit. The limitations of manpower, money, means, fear of litigation and above all dislike of clinicians for handling data are hurdles in the way of effective audit. The concept of 'Standard Primipara' and 'Total Fetal Wastage' are likely to add new dimension to perinatal audit.

Secondary abdominal pregnancy

Advanced abdominal pregnancy is a rare event with a high fetal and maternal morbidity and mortality. We present 3 cases of abdominal pregnancy seen at our hospital. The perinatal mortality was 100% with no maternal deaths. Literature has been reviewed and management of abdominal pregnancy is discussed. Awareness of this condition and its clinical features is important in preventing abdominal pregnancy related morbidity, mortality. Careful clinical examination coupled with investigatory aids like X-rays and ultrasound will clinch the diagnosis. Most of the patients require early laparotomy following diagnosis and the morbidity and mortality are high particularly for the fetus.

Two cases of gas gangrene complicating uterine rupture and fetal death at term

Two patients with obstructed labor and uterine rupture complicated by clostridial septicemia are reported. The diagnosis was apparent clinically. The importance of early diagnosis and prompt treatment are emphasized. The place of hysterectomy, which should be individualized is discussed. All efforts should be directed towards prophylaxis in high risk cases.

Internal iliac artery ligation in obstetrics and gynecology. Ten years experience

Twenty-two cases of bilateral internal iliac artery ligation done in the Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India over a period of 10 years (1981-1990) were studied. Various indications and complications were analysed. Internal iliac artery ligation is a life-saving procedure in pelvic hemorrhage. Complications are infrequents.

A review of fallopian tube carcinoma over 20 years (1971-90) in Pondicherry

Nine cases of tubal carcinoma were found in a period of 20 years in JIPMER Hospital among approximately 9,000 gynaecological malignancies. Most patients were diagnosed as malignant ovarian tumour, but two cases presented unusually, one as Meig's syndrome and another as acute hemoperitoneum. This often stressed symptom of amber discharge or hydrops tubae profluens could not be elicited in any patient. All the patients underwent surgical treatment and radiotherapy or chemotherapy. The period of follow up ranged from two months to four and half years.

Endometriosis in abdominal scars--review of 27 cases

Twenty-seven cases of endometriosis in abdominal scars seen over a 10-year period have been reviewed. Multiparous women within the age group of 25-35 years were affected more frequently. Hysterotomy for termination of midterm pregnancy was the most common surgical procedure done prior to the occurrence of scar endometriosis. Associated pelvic endometriosis was present in 25.9% of the cases. Treatment of choice is complete surgical excision. Progestogen therapy appears to be less effective. Good technique and proper care during surgery may help in preventing this complication.

Intussusception: a rare complication following abdominal hysterectomy

A 35-year-old parous woman was treated with abdominal hysterectomy for uterine myomata. The patient developed intussusception in the immediate postoperative period and was managed by laparotomy and manual reduction. The difficulties in diagnosis and management of this rare complication are discussed.

Postcoital vesico-vaginal fistula following surgery for cancer cervix

A 25-year-old parous woman was treated with radical hysterectomy for cancer of the cervix. Six months later she developed a vesico-vaginal fistula following coitus. The fistula was repaired and vaginal reconstruction performed. Sexual dysfunction and the need for vaginal reconstruction are discussed.

Genital amebiasis

Five cases of amebiasis of the genital tract involving the cervix, vulva and penis are described. All presented as an ulcerating mass and were clinically suspected to have a tumor. In two cases the amebiasis co-existed with a carcinoma, an association which is extremely rare. The spouse of a patient with penile amebiasis was found to have amebiasis of the cervix suggesting a sexually transmitted mode of infection. The need for histopathological confirmation of all suspected genital malignancies is emphasised due to the striking resemblance of genital amebiasis to a carcinoma. The co-existence of amebiasis with carcinoma is of interest and suggests a possible etiological relationship.