| A year on: The changes we introduced and the common mistakes encountered Shahul Ameen, Samir Kumar Praharaj, Vikas Menon Indian Journal of Psychological Medicine 2019 41(1):1-5 | |||||||||||||||||||||||||
| A critical look at the methodology of epidemiological studies Sandeep Grover, Samir Kumar Praharaj Indian Journal of Psychological Medicine 2019 41(1):6-8 | |||||||||||||||||||||||||
| Predominant polarity in bipolar affective disorder: A scoping review of its relationship with clinical variables and its implications Arghya Pal Indian Journal of Psychological Medicine 2019 41(1):9-17 Background: Bipolar affective disorder (BPAD) is an episodic psychiatric disorder that is associated with considerable morbidity. Psychiatrists have found it difficult to treat the disorder owing to the variety of presentation and variety of challenges in clinical decision-making. To guide the clinicians, the concept of predominant polarity (PP) in BPAD has become important. This review was conducted to understand the definition, epidemiology, relationship with sociodemographic and clinical parameters, and implications of PP in BPAD. Methodology: The review was conducted after selecting 17 original research studies from PubMed using appropriate search terms. Results: There is no consensus definition of PP. Epidemiological data showed varied results, although most common PP demonstrated in most studies was depressive polarity. The relation between sociodemographic and clinical parameters also lacked uniformity, although certain patterns could be identified in their relationships. The implications of PP in diagnostics, treatment, and classificatory system are discussed. Conclusion: PP in BPAD conveys clinically important information that aids a clinician in decision-making. Further studies are required so that we can understand the neurobiological underpinning of the concept. | |||||||||||||||||||||||||
| Expressed emotion research in India: A narrative review Anvar Sadath, Ram Kumar, Magnus Karlsson Indian Journal of Psychological Medicine 2019 41(1):18-26 Background: Expressed emotion (EE) is detrimental to patients with schizophrenia, mood disorders, eating disorders and many other psychiatric and neurological disorders. However, majority of the EE literature is generated from the west, and the results of those studies may have limited application in Indian setting. Hence, we conducted this review with the main aim of understanding EE research in India and its potential role in the course and outcome of psychiatric disorders and other chronic illnesses. Methods: Using keywords, we performed searches of electronic databases (PubMed, IndMed, PsychInfo, Science-Direct and Google Scholar) and internet sources and a manual search in the bibliography of the retrieved articles to identify potential original research articles on EE in India. Results: As per the selection criteria, 19 reports of 16 studies were included and reviewed. The sample size of the EE studies ranged from 20 to 200, and majority of the studies were conducted in psychosis/schizophrenia, followed by obsessive compulsive disorder and epilepsy. Although high EE was found in most of the studies, the impact of EE on illness outcome is not well explored and only two studies examined the relationship between EE and relapse. Discussion and Conclusion: There is a dearth of studies on EE, especially its relationship with relapse or clinical outcomes in the Indian context. We recommend more studies in these areas which may be helpful for clinical decisions and advancement of context knowledge in EE. | |||||||||||||||||||||||||
| Mental disorders in ethnic community: A prevalence study from thakali community of Nepal Devavrat Joshi, Pawan Sharma, Ananta P Adhikari, Praveen Bhattarai, Mohan R Shrestha, Basudev Karki Indian Journal of Psychological Medicine 2019 41(1):27-31 Introduction: Mental disorders are common and major source of disability around the world. Though Nepal lacks national data on the prevalence of mental disorders, many studies have been conducted in specific groups of people. The Thakali community is one of the indigenous communities of Nepal. We aim to look at the prevalence of mental disorders in this group. Materials and Methods: This is a cross-sectional study with multiphasic sampling conducted in the Thakali community in six distinct geographical regions of Nepal. The first stage was a household survey done by field researchers using screening questionnaires to detect a probable diagnosis of mental disorders. The second stage was detailed clinical assessment and diagnosis (ICD-10) by two independent psychiatrists. Results: Among the 917 participants, after the first phase, a probable diagnosis (as per the screening questionnaire) was found to be 12.5%. After the psychiatrists' assessment and addition of already diagnosed cases, the prevalence was 6.1%. In both the cases, prevalence of alcohol use disorder was comparatively higher (34.8% and 31.9%, respectively). Conclusion: Despite many shortcomings, this study has provided an estimate of the prevalence and pattern of mental disorders among an indigenous Nepalese community. We emphasize the need of validation of tools for Nepal and estimation of prevalence at the national level. | |||||||||||||||||||||||||
| Prevalence of depression in an urban geriatric population in Marathwada region of Western India Mamta S Rathod, Jagannath V Dixit, Akhil D Goel, Vikas Yadav Indian Journal of Psychological Medicine 2019 41(1):32-37 Background: Depression is a common problem in the elderly but is often undetected and ignored as a medical problem, leading to poor quality of life. This community-based study was conducted to know the burden and risk factors of depression among the elderly. Subjects and Methods: The survey was done in 2015 in Maharashtra, India as a part of an initiative addressing community mental health needs of the elderly. Total 400 elderly, aged 60 years and above, were selected through a house-to-house survey, using probability proportional to size method, and interviewed for depression using Major Depression Inventory Scale (MDI Scale), and other potential risk factors using a pretested questionnaire. Results: A total of 16.75% elderly had depression. Increasing age (Spearman's rho = 0.112, P = 0.026), illiteracy (OR = 2.23; 95% confidence interval, CI 1.22–4.07), lack of sleep (OR = 2.97; 95% CI 1.73–5.09), and leisure time spending alone (OR = 0.57, 95% CI 0.34–0.98) were found to be associated with depression. However, on multivariate analysis, only sleep duration <6 h was found to be associated [AOR = 2.6; 95% CI 1.4–4.6]. Conclusions: There is a considerable burden of depression in the elderly, reemphasizing the need for regular screening for this disorder and its risk factors. | |||||||||||||||||||||||||
| Prevalence and correlates of current alcohol use among bhutanese adults: A nationally representative survey data analysis Kinley Wangdi, Tshering Jamtsho Indian Journal of Psychological Medicine 2019 41(1):38-45 Background: Alcohol-related ailments are among the 10 leading causes of morbidity and mortality in Bhutan. The objectives of this article were to determine the prevalence and explore the correlates of current alcohol use among Bhutanese adults. Materials and Methods: This is a retrospective study of secondary data from the National Health Survey 2012 of Bhutan. The outcome variable of interest was current alcohol use. The questionnaire was developed following the World Health Organization (WHO) STEPwise approach to Surveillance (STEPS) of noncommunicable diseases. Univariate and multivariate logistic regression was performed to identify the correlates of current alcohol use. The prevalence of current alcohol use was 30.9%. The correlates of current alcohol use were male sex [adjusted odds ratio (AOR) = 1.85; 95% confidence interval (CI) 1.47–2.36], widowhood (AOR = 2.92, 95% CI, 1.22–6.99), and chewing betel quid >20 times per week (AOR = 2.07, 95% CI, 1.08–4.03). Primary (AOR = 0.67, 95% CI, 0.50–0.91), high (AOR = 0.52, 95% CI, 0.38–0.71), and university (AOR = 0.46, 95% CI, 0.29–0.73) educated participants were less likely to be current alcohol users when compared with those who had no education. Compared with unskilled workers, services and sales workers were less likely to use alcohol regularly (AOR = 0.64, 95% CI, 0.49–0.82). Homemade alcohol Ara was the most common drink. Conclusion: The national prevalence of current alcohol use in Bhutan is higher than the national average in the WHO South-East Asia Region. Prevention should target the correlates and limit the availability of locally home-brewed Ara. | |||||||||||||||||||||||||
| Factors associated with depression among school-going adolescent girls in a District of Northern India: A cross-sectional study Mukesh Shukla, Siraj Ahmad, Jai Vir Singh, Nirpal Kaur Shukla, Ram Shukla Indian Journal of Psychological Medicine 2019 41(1):46-53 Context: Depression among adolescents, especially among girls, is a rising public health problem worldwide. It has been associated with a profound negative impact on their physical, social, and mental well-being. Aim of the Study: To ascertain the factors associated with depression among school-going adolescent girls in district Barabanki of Uttar Pradesh. Settings and Design: School-based cross-sectional study. Subject and Methods: The study was conducted among 2187 school-going adolescent girls (10–19 years) in Barabanki district from September 2016 to September 2017 using multistage sampling. Sociodemographic characteristics such as age, residence, family background, and socioeconomic status were assessed through direct interview of the adolescent girl, with its reconfirmation from school records. Eleven-item Kutcher Adolescent Depression Scale was used for assessment of depression. Statistical Analysis Used: Probability (P) was calculated to test for statistical significance at 5% level of statistical significance. Association between risk factors and depression was determined using bivariate analysis followed by multivariate logistic regression. Results: The prevalence of depression was found to be 39.7%. Multiple logistic regression revealed that depression was significantly higher among those residing in rural areas [odds ratio (OR) 3.32; P < 0.001], those in early and mid-adolescent age group (OR 2.51; P < 0.001), those studying in private schools (OR 3.22; P < 0.001), and those with Hindi as the medium of instruction (OR12.50; P < 0.001). Depression was also found to be significantly higher among those whose mothers were educated up to primary (OR 3.19; P < 0.01) or up to intercollege (OR 1.59; P < 0.001) when compared with illiterate mothers. Similarly, depression was found to be more common among those girls whose fathers were educated up to intercollege (OR 1.29; P < 0.05) or were graduate and above (OR 1.58; P < 0.001). Conclusion: A significant proportion of school-going adolescent girls were suffering from depression, which reflects the need for reinforcement and strengthening of school-based mental health screening programs. Parents, teachers, and community health workers should work as a team to deal with the problem in a more effective way. | |||||||||||||||||||||||||
| Magnitude of mental morbidity and its correlates with special reference to household food insecurity among adult slum dwellers of Bankura, India: A cross-sectional survey Sanjay K Saha, Parthapratim Pradhan, Dibakar Haldar, Baisakhi Maji, Widhi Agarwal, Gautam N Sarkar Indian Journal of Psychological Medicine 2019 41(1):54-60 Background: Mental disorders cause considerable morbidity and disability, and there is ample evidence that mental disorders are positively associated with household food insecurity. Methods: A cross-sectional survey was conducted for a period of 2 months at Bakultala slum of Bankura town involving 152 people of ≥18 and ≤60 years of age selected using simple random sampling technique to estimate the prevalence of mental disorders and to find out its correlates. Information pertaining to socio-demographics and household food security (HHFS) and “ potential psychiatric case” were collected through a house to house interview of the head of the household, using predesigned questionnaire, Bengali version of self-reporting questionnaire, and 6-item household food security scale (HFSS). Results: In total, 45% of the study participants belonged to food unsecured households. Overall, 21% of the respondents were identified as “potential psychiatric case,” which was found to be associated with higher age, illiteracy, divorcee female, and people living in households without food security. Conclusion: Study results reflecting high prevalence (21%) of “potential psychiatric case” with various correlates such as age, sex, education, marital status, and HHFS among the slum dweller of Bankura town may be helpful in formulating policies for combating mental health morbidities. | |||||||||||||||||||||||||
| Stressful life events and relapse in bipolar affective disorder: A cross-sectional study from a tertiary care center of Southern India Sivin P Sam, A Nisha, P Joseph Varghese Indian Journal of Psychological Medicine 2019 41(1):61-67 Background: Bipolar affective disorder (BAD) is a severe mental illness which results in serious lifelong struggles and challenges. The full impact of stressful life events (SLEs) on the course of BAD is poorly understood. Materials and Methods: A cross-sectional study was conducted on 128 consecutive patients with BAD currently admitted with a relapse. Our objectives were (1) to estimate the proportion, type, and timing of preonset SLEs in relapsed BAD patients and (2) to study the association between SLEs and selected clinical variables in this group. Semi-structured proforma, Young Mania Rating Scale, Hamilton Rating Scale for Depression, Presumptive Stressful Life Events Scale, and Brief Psychiatric Rating Scale were used. Statistical analysis was done using R software for Windows. Results: About 69.5% (89/128) of patients reported preonset SLEs – among which 50 (56.2%) had mania and 39 (43.8%) had depression. Conflict with in-laws and financial problems were the commonly reported SLEs. The mean duration between SLEs and the relapse was 19.73 ± 4.8 days. BPRS score was significantly high in subjects with preonset SLEs (P = 0.022). No significant association was detected between SLEs and the type of episode during relapse (P = 0.402). Conclusion: This study emphasizes the significance of SLEs in the relapse and longitudinal course of BAD. Understanding the association of SLEs and relapse in BAD will help in predicting further relapses and developing newer pharmacological and nonpharmacological measures targeting this aspect, thereby maximizing both symptom reduction and quality of life in patients with BAD.
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Cancer Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Παρασκευή 4 Ιανουαρίου 2019
Psychological Medicine
Plastic Surgery
| EDITORIAL | ||
| The plagiarism | p. 1 | |
| Cenk Demirdover DOI:10.4103/1300-6878.249406 | ||
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| REVIEW ARTICLE |  | |
| A general evaluation of stem cell studies and human cloning from the ethical, faith, and legal perspective | p. 3 | |
| Cemal Alper Kemaloglu, Fatih Birtek DOI:10.4103/tjps.tjps_46_18 Stem cell and cloning studies bear promising potential in the field of regenerative medicine with their exciting and innovative features. The wide range of applications of these cellular treatments and their permanent repairing qualities foretell that a completely different scientific paradigm is emerging for the future. However, satisfactory insight has not yet been developed with respect to the moral status and legal aspects of these studies. Furthermore, their potentially untoward side effects are not understood well enough to compare with the benefits they provide for human life. In general, attempts are made to place the subject in a pattern composed of the sanctity of life, the unique characteristics of being an individual, the boundaries drawn by beliefs, and the basic principles of law. This article will discuss the benefits of stem cell and cloning studies as well as their undeveloped medical, ethical, religious, and legal aspects. | ||
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| ORIGINAL ARTICLES | | |
  | Inferior gluteal artery perforator flap for closure of sacral defects after pilonidal sinus surgery | p. 9 |
| Zulfikar Ulas Bali, Anvar Ahmedov, Burak Ozkan, Mustafa Mazican, Yavuz Kececi DOI:10.4103/tjps.tjps_36_18 Introduction: The aim of the current study was to introduce the use of the inferior gluteal artery perforator flap (IGAPF) as a new alternative surgical technique for closure of sacral defects after pilonidal sinus surgery. Patients and Methods: Inferior gluteal artery perforators were used on 15 male patients operated in the plastic and reconstructive surgery department of our tertiary care centers between March 2014 and May 2017. Age, size of the defect, duration of follow-up, complications, and recurrence rate were assessed. Results: The average age was 30.2 (range: 17–54) years, and the mean duration of follow-up was 8.2 (range: 7–16) months. No recurrence was detected within the follow-up period, and the only remarkable complication reported was total flap necrosis attributed to venous congestion in one patient. The mean size of the defects after excision was 21.6 cm2. Conclusion: Our preliminary results imply that IGAPF can be a safe and effective alternative for closure of large defects after pilonidal sinus surgery. Further controlled trials on larger series are warranted to establish the advantages and disadvantages of this alternative technique. | ||
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 | Complicated fingertip defects: Clinical approach to their reconstruction and the flaps that can be used in emergency settings | p. 14 |
| Ozay Ozkaya Mutlu, Ozlem Colak, Ahmet Dilber, Derya Bingol, Onur Egemen DOI:10.4103/tjps.tjps_43_18 Aim: Numerous flaps have been described for the reconstruction of complicated defects of the fingertip. The aim of this study was to evaluate our experience on flaps that can be used in emergency settings, and analyze the outcomes of these procedures. Materials and Methods: A retrospective analysis of 81 patients, who presented to the emergency unit with complicated fingertip defects between 2009 and 2014 and in whom replantation was deemed unsuitable due to various reasons including crush or avulsion type of injury mechanism, absence of the amputated part, or unrepairable vascular injury in the amputate, was carried out. Results: Eighty-nine flaps were performed in 81 patients. The defects were repaired with V-Y advancement flaps in 57% (45 patients – 51 fingers) of the defects, kite flap in 15% (13 patients – 13 fingers), cross-finger flap in 12% (11 patients – 11 fingers), Kutler flap in 6% (4 patients – 5 fingers), digital artery perforator flap in 6% (4 patients – 5 fingers), and thenar flap in 4% (4 patients – 4 fingers) of the injuries. One patient operated with the digital artery perforator flap, and one other operated with the kite flap, developed partial flap necroses. There were no other complications. Conclusion: Functional and esthetic restoration of soft tissues in the fingers is possible with the use of appropriate flaps and meticulous surgical technique. | ||
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 | Epidemiological and localization characteristics of non-melanoma skin cancers: Retrospective analysis of 400 cases | p. 19 |
| Siddika Findik, Orkun Uyanik, Mahmut Altuntas, Zeynep Altuntas DOI:10.4103/tjps.tjps_45_18 Aim: In this study, it was aimed to investigate the epidemiological and localization characteristics of the patients diagnosed with nonmelanocytic skin cancer (NMSC). Materials and Methods: Histopathologic results of patients diagnosed with NMSC in the Pathology Department of Necmettin Erbakan University, Meram School of Medicine, between 2007 and 2017 were retrospectively reviewed. The age, sex, tumor type, and localization of the patients were investigated. Results: A totals of 400 patients diagnosed with NMSC were identified. 220 of the patients were male (55%) and 180 were female (45%). The male to female ratio was 220/180 (1.22). The age range was 10–105-year-old and the mean age was 67.8. Basal cell carcinoma (BCC) was found in 263 patients (65%), squamous cell carcinoma (SCC) in 114 patients (28%) and baso SCC (BSCC) in 12 patients (3%). BCC and SCC were observed together in 9 patients. BCC was most commonly detected in the nasal region with (31%) 82 patients (50%). SHC was most commonly detected in the lower lip region with 26 patients (22%). The localization of the BSCC was most common in the nasal region with 6 patients (%50). The rate of BCC/SCC in the nasal region was 82/11. The BCC/SCC ratio in the extremity region was 4/14. Conclusion: In our region, the most frequent histopathologic diagnosis was found BCC in patients prediagnosed with NMSC, and most cases were seen in male patients. In cases of BCC a BSCC, the most common tumor localization was nose area while it was lower lip area in SCC cases. In addition, BCC and BSCC were not detected in the lower lip. | ||
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 | A retrospective analysis of tandoor burn injuries in Eastern Anatolia | p. 23 |
| Nese Kurt Ozkaya, Safak Aktar, Said Algan, Huseyin Akkaya DOI:10.4103/tjps.tjps_47_18 Aims: This study was to determine the severity of the tandoor burns in a city in Eastern Anatolia and to attract attention for the prevention of tandoor burns. Subjects and Methods: A retrospective evaluation was made of the registration data of burns hospitalized. A record was made of patient variables including burn type, age, gender, socioeconomic status, and amputation site and level. Statistical Analysis Used: Descriptive statistics were used to summarize the data, and results were reported as number and percentage. Categorical variables were evaluated with the Chi-square test. P < 0.05 was considered statistically significant. Results: To emphasize the importance of tandoor burns, the data were classified as tandoor (8.8%) and other types of burns (91.2%). Tandoor burns were the fourth-most common cause of burn. While the rate of amputation in other burn types was 1.26%, the amputation rate was 9.09% in tandoor burns. In the 0–3 years of age group, the percentage of tandoor burns was significantly higher. In respect of tandoor burns, more amputations were performed on children than on adults. Conclusions: Tandoor is used in many places in the world for various purposes (as sociocultural habits, cooking, and warming, especially in low-socioeconomic areas). Increasing protective measures in the use of tandoor may be useful for reducing the amputations due to tandoor burns and its possible long lifetime consequences. Because, unfortunately, tandoor burns are a significant cause of amputations in children-foot amputations in particular. | ||
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| CASE REPORTS | | |
 | An unusual dog bite in an infant with penetrating brain injury and scalp loss | p. 30 |
| Sheerin Shah, Hanish Bansal, Rajinder K Mittal, Ashwani K Chaudhary, Sanjeev Uppal, Ramneesh Garg, Soheb Rafique, Jagminder Singh DOI:10.4103/tjps.tjps_52_18 The spectrum of bites varies from superficial scraches till deep avulsion of tissues. Children especially infants , because of inherent inability to defense against dogs , are more liable to get their bites. We report an interesting case of dog bite in a 5 months old infant. | ||
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 | A progressed case of Stewart–Treves syndrome in a patient with chronic idiopathic lymphedema in the lower extremity | p. 33 |
| Mehmet Ozdemir, Muhammed Sulaiman Sultany, Ercan Celikkaleli, Burhan Ozalp DOI:10.4103/tjps.tjps_58_18 Angiosarcomas are uncommon malignant tumors that arise from vascular endothelial cells with poor prognosis. Stewart–Treves syndrome (STS) is a type of cutaneous angiosarcoma that develops in chronic lymphedema. Although the majority of lymphangiosarcomas arise from areas of lymphedema as a consequence of lymph node dissection in radical mastectomy, it has also occurred in other causes of lymphedema. In the pathophysiology of lymphangiosarcoma, impairment of the local immune response and induced angiogenesis are emphasized. A 69-year-old male patient with a previous diagnosis of chronic lymphedema in his left lower limb presented with STS and widespread metastases. The patient refused the treatment for lymphedema and ignored the lesion due to its innocuous appearance. In addition, during the presentation, he had Stage 4 disease and, therefore, he was not a candidate for curative operative treatment. Early tumor resection or limb amputation has the best outcomes in the treatment. | ||
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 | Recalcitrant desmoid tumor of the abdominal wall: A reconstructive dilemma | p. 36 |
| Prakash Chandra Kala, Ranjit Kumar Sahu, Ramkaran Choudhary, Ashok Puranik DOI:10.4103/tjps.tjps_64_18 Desmoid tumors are slow-growing benign tumors. These tumors infiltrate surrounding tissues but not malignant and associated with women of fertile age, especially during and after pregnancy. We report a young male patient with a recurrent desmoid tumor of the anterior abdominal wall who underwent resection four times earlier. The patient had a history of four-time operation over the same site for the same disease. Preoperative evaluation included thorough clinical examination with abdominal ultrasound. The histology revealed a desmoid tumor. Primary surgical resection and immediate reconstruction of abdominal defect were performed. | ||
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| LETTER TO THE EDITOR | | |
| Role of tumor-infiltrating lymphocytes in melanoma | p. 39 | |
| Yasemin Benderli Cihan DOI:10.4103/tjps.tjps_49_18 | ||
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