The Atypical Antipsychotics as a New Generation Class of Antidepressants in Clinical Practice Olumuyiwa John Fasipe, Oluwatosin Beatrice Ibiyemi-Fasipe Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(6):484-489 This study was designed to announce and discuss the atypical antipsychotics as a new generation class of antidepressants that had bring forth significant improvement and positive outcome to the management of patients with depressive disorders in clinical practice. Furthermore, there is opportunity for antidepressant activity to arise through a novel mechanism of action as in the case of atypical antipsychotics. In addition, this article further justifies the current pharmacological standpoint of view with respect to repurposing of the atypical antipsychotics as emerging antidepressant agents for the treatment of depressive disorders in clinical practice. From the psychopharmacological point of view, an atypical antipsychotic is efficacious as a sole monotherapy or adjunct-augmenting pharmacotherapeutic agent for the treatment of patients having anxious depression disorders (that is, either major depressive disorder [MDD] or bipolar depression or schizoaffective/psychotic depression with anxiety disorder component). The atypical antipsychotics appear to be more consistently effective in the treatment of bipolar depression and also do not increase the risk of inducing mania or increasing the frequency of bipolar cycling. In fact, patients with depressive disorders tend to even respond far better and become clinically more stable (undergo remission faster) on an atypical antipsychotic alone as monotherapy compared to the other old conventional antidepressant agents, such as tricyclic antidepressant, selective serotonin reuptake inhibitor (SSRI), or serotonin–norepinephrine reuptake inhibitor (SNRI) alone. This is one of the main reasons behind the Food Drug Administration (FDA) approval of a fixed-dose combination of an SSRI with the atypical antipsychotics such as fluoxetine and olanzapine. A fixed-dose combination of an SSRI with the atypical antipsychotics such as fluoxetine and olanzapine has received the FDA approval for the pharmacotherapy of MDD, acute bipolar depression, and schizoaffective (psychotic) depression. Furthermore, a fixed-dose combination of sertraline and aripiprazole is currently undergoing clinical trial investigation for the same indications.

Retrospective review of presentation of newly diagnosed children with diabetes mellitus in a Nigerian rural setting Umar Isa Umar, Isyaku Lawal Muhammed, Ibrahim Aliyu Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(6):490-494 Background: Diabetes mellitus (DM) is the common endpoint of a variety of disorders of insulin production and/or insulin action resulting in hyperglycemia with associated abnormalities of carbohydrate, fat, and protein metabolism. Presentation with diabetic ketoacidosis (DKA) may be associated with significant morbidity and mortality in the pediatric population. Objective: The objective of this study was to examine the pattern of presentation of newly diagnosed children with DM in a rural setting. Design: It was a retrospective study of case files of newly diagnosed children with DM. Patients and Methods: It was a retrospective review of case files of children younger than 18 years with diagnosis of DM, over a 2-year period (from November 1, 2015, to October 31, 2017) at Federal Medical Centre Nguru, Yobe State, North-Eastern Nigeria. Results: A total of 3289 patients were seen during the study period, of which 6 were diagnosed with DM, giving a case prevalence rate of 1.8/1000. The mean age at presentation was 11.1 (±0.8) years, and there were four males and two females among the patients. All of the patients presented in DKA, and other prevalent presenting features were polyuria (6, 100%), polydipsia (6, 100%), dehydration (6, 100%), weight loss (100%), fever (83.3%), and weakness (4, 66.7%). Two of the six patients with DKA died from cerebral edema, and one had acute kidney injury during admission. Conclusion: Presentation with DKA is common in this setting despite the glaring symptoms of DM, such as polyuria, polydipsia, and weight loss. This highlights the need for intensified efforts in education of health workers and the populace at large for quick recognition, presentation, and prompt diagnosis for optimal management of childhood DM.

Prevalence of stress and its relation to different precipitating factors among urban females of reproductive age group in Burdwan, India Arunima Chaudhuri, Manjushree Ray Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(6):495-502 Background: Women in emerging economic and social markets are more stressed than those in developed countries. Aims: We aimed to study the prevalence of stress and its relation to different precipitating factors among urban females of reproductive age group. Materials and Methods: This descriptive cross-sectional study was conducted in a tertiary care center of West Bengal after taking institutional ethical clearance and informed consent of the participants. A sample of 7500 women was selected after proper randomization using an online randomizer. On the first appointment, history of the participants was carefully taken, pulse and blood pressure were recorded, and body mass index (BMI) and waist/hip (W/H) ratio were measured. Parameters assessed were Presumptive Stressful Life Events Scale (PSLES) scores and Perceived Stress Scale (PSS) scores. Results: Among 7500 participants, 3245 (43.27%) had mild-to-moderate stress and 4255 (56.73%) had severe stress. Mean ± standard deviation value of PSLES score of participants recruited for the study was 237.99 ± 79.45, and PSS score was 23.76 ± 5.24; there was a positive correlation between PSLES scores and PSS scores with r = 0.8. There was no significant difference in age between the two groups (22.8 ± 3.22 vs. 22.64 ± 3.15; P= 0.26). There was a significant difference in PSLES scores between the two groups (312.93 ± 27.19 vs. 162.99 ± 25.63; P < 0.001). There was a significant difference in values of PSS scores, BMI, W/H ratio, and pulse rate between the two groups. Marital conflicts, family conflict, and conflict with laws were the highest percentages of problems reported by these groups of participants as cause of stress. Conclusions: We observed that 100% of our participants were stressed, and family conflict, marital conflict, problems with in-laws, and abuse by husbands were some of the main contributors of stress in the population studied. Stress levels are increasing in females and require early intervention. To address gender disparities in mental health, multiple actions need to be implemented at various levels. In particular, national mental health policies must be developed that are based on an explicit analysis of gender disparities in risk and outcome.

Investigation of a cancer cluster in an industrial area of North India Vijay Kumar Barwal, Shishupal Singh Thakur, Sanjay Kumar, Salig Ram Mazta, Anmol Gupta, Ankit Chaudhary Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(6):503-507 Introduction: Cancer clusters always get a lot of attention in the media. It is an aggregation of relatively unexpected high number of cancer cases. People become concerned that a cancer cluster exists in a certain community and that it is caused by some type of carcinogen that is being released into the environment. We investigated a similar concern regarding suspected clustering of cancer cases in an industrial area of a district in North India. Materials and Methods: A retrospective cohort study was carried out from March 1, 2016, to May 31, 2016 taking the whole study area population as exposed. House-to-house search of cancer cases was undertaken retrospectively from the year 2011 onward. The total population of the cohort (denominator) was taken from the census of India 2011 data. Age-adjusted standardized rates were calculated. Results: A total of 53 cancer patients were identified. A maximum number of cases were of the lip and oropharynx (15.1%), followed by the lung (13.2%) and esophagus. The yearly incidence of cancer for both sexes ranged from 87.2 to 90.9/lakh population. The 5-year period prevalence for both sexes was 207.4/lakh population. Conclusion: This panic occurred due to a list of cancer cases given to the health department by the residents and public representatives of the area. As these were just figures without a denominator, it gave a false impression of a high number of cancer cases. However, on conducting this study, we found the age-adjusted cancer incidence to be similar or even lower than the Global Cancer Incidence, Mortality and Prevalence, and Indian Council for Medical Research figures for India. Hence, we ruled out a true cancer cluster.

Knowledge, attitude and practices of health care workers in biomedical waste management in a newly opened tertiary care hospital Sunite A Ganju, Lata R Chandel, Anupama Sharma, Rajinder Singh, Nisha Kumari, Aman Bhatia Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(6):508-510 Background: Biomedical waste management (BMWM) and adoption of standard work precautions are core strategies in infection control. For effective implementation of infection control practices, capacity building of various stakeholders in BMWM is essential. This study evaluates the impact of training on BMWM and infection control practices in cleaning personnel and technical staff. Methods: Two categories of health-care workers were trained on infection control management and BMWM. A pre- and posttest was administered in both groups. Results: On posttest evaluation, the knowledge showed significant improvement. This could be assessed as a modification of attitude and practices during handling of BMW shown on audit done on routine rounds of hospital conducted by the infection control committee. Conclusion: We recommend that evaluation of training is critical for effective implementation of trainings.

Blood pressure trends in idiopathic steroid-sensitive childhood nephrotic syndrome: A prospective observational study Moumita Samanta, Madhumita Nandi, Srirupa Bhattacharya, Abhisek Naskar, Mrinal Kanti Das Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(6):511-515 Background: It has been observed that blood pressure (BP) tends to rise in children with idiopathic nephrotic syndrome (NS) in the acute stage, during attack or relapse, and may reverse back to normal with time. However, there is a lacuna of knowledge regarding the actual trend of BP in these children when they are in medication-free period. The study was conducted to analyze the trend of BP in these children as persistent hypertension (HTN) is an important determinant of future cardiovascular morbidity. Materials and Methods: This was a prospective observational study over 6-month duration in children with diagnosis of idiopathic childhood NS wherein BP recordings were followed up and HTN was managed with medications if required. The secondary causes of HTN and steroid-resistant, steroid-dependent, and frequently relapsing NS were excluded. Results: At initial presentation, 36.4% of children had elevated BP of which 9.0% needed antihypertensive drugs. The corresponding values at remission were 66.6% and 15.15% with a declining trend seen in follow-up. Antihypertensive medications had to be given to 22 (33.33%) children for a mean duration of 30.5 ± 21.8 (range: 7–105) days. There was a significant relation between nadir of serum albumin at the time of attack and number of days to go into remission with incidence of HTN (<0.05). Conclusions: Meticulous tracking of BP is essential in children with idiopathic NS as elevated BP, although to a milder degree, is noted in a significant percentage of these children.

Uncommon tumor with rare variant: Cystic struma ovarii – A case report with review of literature Veer Karuna, Priya Gupta, Nidhi Verma, Amod Kumar Saroj Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(6):516-520 Struma ovarii is a very unusual and rare type of monodermal teratoma presenting as a solid pelvic mass. Struma ovarii concurrently occurring with cystic variant is rarely reported. To the best of our knowledge, only 4–5 cases of cystic struma ovarii have been reported in the past two decades. In exceptionally rare cases, it can be malignant. We present an ovarian teratoma which was grossly partially solid and partially cystic filled with mucoid content, causing the diagnosis of struma ovarii to be unnoted. There may be the source of many diagnostic problems if the microscopic examination showed flattened cystic wall with entrapped minimal thyroid follicles in counterpoint to struma ovarii resulting in confusion with other cystic ovarian tumors. No other component of mature teratoma was found in the present case. Presence of a few thyroid follicles and flattened epithelial lining needs extensive sampling and immunohistochemical staining for thyroglobulin and thyroid transcription factor-1 to establish an exact diagnosis. The aim of this literature is to delimitate cystic struma ovarii rarity and for the diagnostic dispute encountered.

Clear cell hidradenoma: Report of three cases Rashmi B Aderao, Uddhao S Zambare, Swagata A Tambe, Chitra S Nayak Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(6):521-523 Clear cell hidradenoma is a benign eccrine gland tumour with rare incidence of malignant transformation. It is more commonly seen in adult females in the second to fifth decades. Head and face are the most common sites. On histopathology, tumour shows periodic acid–Schiff-positive clear cells and polyhedral cells. Recurrence rate is low if the lesion is completely excised. Here, we report three cases of clear cell hidradenoma presenting as a solitary nodule on the neck, scalp, and chest.