Clinic In India Research Articles

P3-S1.20 Aetiology of urethral discharge syndrome and its association with sexual practices among males attending STI clinics in India

BackgroundStudies to validate the aetiology of urethral discharge (UD) syndrome are limited in India. The objectives of the study were to determine etiological agents of UD syndrome among males attending...

Indian Diabetes Risk Score Helps to Distinguish Type 2 from Non-Type 2 Diabetes Mellitus (GDRC-3)

The aim of this study was to investigate whether the Indian Diabetes Risk Score (IDRS) could assist in classifying type 2 diabetes mellitus (T2DM) and non-T2DM among patients attending clinics in India. Patient records from 2006 through 2009 were taken from the clinical database of a tertiary care diabetes hospital in Chennai, Southern India. A total of 8747 patients with diabetes, diagnosed by a physician either as type 1 diabetes mellitus (T1DM), T2DM, or other types were included for analysis. The IDRS, based on age, abdominal obesity, family history of diabetes, and physical activity, was calculated for each patient at first visit to our clinic. Receiver operating characteristic (ROC) curves were generated to obtain optimal IDRS cut points for predicting T2DM and non-T2DM. Of the 8747 patient records analyzed, 204 (2.3%) were classified as non-T2DM and 8543 (97.7%) as T2DM. In ROC analysis, an IDRS ≥60 [area under the curve (AUC), 0.894; sensitivity, 83.8%; specificity, 81.0%] was predictive of T2DM, while an IDRS <60 (AUC, 0.882; sensitivity, 79.9%; specificity, 83.8%) was predictive of non-T2DM. The IDRS, a simple, cost-effective risk score, can assist in classifying T2DM versus non-T2DM among clinic patients in India.

Accusations of Illiteracy and the Medicine of the Organ

The bodily organ features prominently in the public representation of medical clinics in India. Interviews with clinic directors offer a rationale: the clinic's public is assumed to be illiterate. Pedagogies of the body as an order of parts appear frequently across a range of media: these often bear a formal similarity to pedagogies of language in a post-colonial context. This similarity is here framed as a shared metonymic order, a framing used to offer some context for the notable accusation by clinicians, at points over India's modern history, that "illiterates confuse their organs." In offering a different and "metaphoric" reading of this confusion of parts, the essay suggests why popular debate on markets in human kidneys for transplant draws extensively on the experience of persons with the sterilization camps of the Indian Emergency and then turns to the recent trend of reporting on the deaths of political leaders as being due to "multi-organ failure."

Surveillance of adverse drug reactions at two multidisciplinary hospitals and an outpatient specialty clinic in India

Abstract Context Adverse drug reaction (ADR) reporting is under-developed in India, with only two of six national reporting centres currently functioning. Objective To introduce an ADR monitoring programme at two hospitals and an outpatient skin specialty clinic in South India and to evaluate the programme. Design An ADR monitoring programme was introduced in three participating centres and ADRs were documented and analysed over a period of six months. All unplanned admissions, all inpatients of the two participating hospitals and all outpatients of the skin specialty clinic were included in the study. A clinical pharmacist (the investigator) interviewed all patients on admission to identify suspected ADRs. For inpatients and clinic outpatients, suspected ADRs were documented by the treating doctor. A panel of four judges, including the investigator and the physician treating the patient with the suspected ADR, assessed the cases. Confirmed ADRs were then classified and categorised. Key findings In total, 152 ADRs were documented. The percentage of patients with a reported ADR at each of the three centres was 3.5, 3.7 and 2.3. The gender of patients with reported ADRs was 53.9 per cent male and 46.1 per cent female. Most of the patients had a type “A” reaction (110, 72.4 per cent). Using Naranjo's probability scale, 25.7 per cent of ADRs were categorised as “probable” and 74.3 per cent as “possible.” Of the ADRs reported in the two hospitals, 31.1 per cent related to unplanned medication-related hospital admissions and 68.9 per cent occurred during the hospital stay. Antibiotics (32.2 per cent), psychotropic drugs, steroids and non-steroidal anti-inflammatory drugs (11.8 per cent each) were the most common drugs that caused ADRs. General medicine (37.5 per cent) and dermatology (35.5 per cent) departments accounted for the highest number of ADRs. Pruritic rash (36.7 per cent) was the most common ADR reported at the skin clinic while pruritic rash, gastritis and diarrhoea (10.7 per cent each) and akathisia and hypoglycaemia (7.8 per cent) were the most common ADRs reported in the hospitals. Conclusion This is the first study to evaluate an ADR reporting programme in India. Introduction of the ADR monitoring programme improved health care practitioners' awareness of the importance of pharmacovigilance. Occurrence of ADRs seemed to be similar to those reported in the developed world, with the exception of the proportion of severe ADRs (25 per cent), which was higher than reported elsewhere in published studies.

Prevalence and risk factors for inappropriate drug use among older people: results from an Indian public outpatient setting

Objectives To determine the prevalence and risk factors associated with prescribing of inappropriate drugs using Modified Beers' criteria 2003, in older patients consulting medical specialists at a Geriatric Outpatient Clinic in India. Methods This was a prospective interventional study with 1081 participants aged 60 years or over, of both sexes. Key findings The average number of medications was 6.32±0.08. Only 117 patients were prescribed at least one inappropriate drug (10.8%). Out of these, 112 received only one inappropriate drug while five patients received two. Therefore, there were 122 cases of inappropriate drug use (IDU; 11.28%). The two most commonly used inappropriate drugs were short-acting benzodiazepines and amitriptyline. According to the first list of the Beers' criteria, 112 instances of IDU were found, with only 10 instances of IDU from the second list. Logistic regression analysis showed that age over 70 years, multiple diagnoses, polypharmacy and a longer duration of treatment were risk factors for IDU. Conclusions The assessment of IDU among older outpatients from an Indian public hospital has shown a lower prevalence of IDU compared with other countries. The findings of this study illustrate the need to bring the finer issues concerned with geriatric pharmacotherapy to the attention of physicians, since the physicians involved in this study accepted the recommendations made by the investigator.

Clinician-Patient Communication in a Glaucoma Clinic in India

We compiled data from nonparticipant observations of clinician-patient communication in clinical interactions in a tertiary care eye hospital in India. Applying elements of the French philosopher Michel Foucault's concept of power and knowledge, we deconstructed the structuring and moderating influences on the expert/nonexpert dyad. We found that clinicians enforce their "disciplining power" through varying degrees of communicativeness to bring about compliance in the patient. Clinicians appear to classify the patient as "participant" or "deviant" based on the patient's "internalization" of instructions, and then communicate in predictable ways with the patient. Patients can also wield power, communicating it by understanding and following or not understanding and not clarifying/verifying instructions in the clinic, and thereafter failing to comply with the clinician's advice. We suggest that clinicians need to hone their communication skills both to optimally utilize interactions in the clinic and to encourage patient compliance, thereby making possible better treatment outcomes.

Understanding women's experiences with medical abortion: In-depth interviews with women in two Indian clinics

We explored women's perspectives on using medical abortion, including their reasons for selecting the method, their experiences with it and their thoughts regarding demedicalisation of part or all of the process. Sixty-three women from two urban clinics in India were interviewed within four weeks of abortion completion using a semi-structured in-depth interview guide. While women appreciated the non-invasiveness of medical abortion, other factors influencing method selection were family support and distance from the facility. The degree of medicalisation that women wanted or felt was necessary also depended on the way expectations were set by their providers. Confirmation of abortion completion was a source of anxiety for many women and led to unnecessary interventions in a few cases. Ultimately, experiences depended more on women's expectations about the method, and on the level of emotional and logistic support they received rather than on inherent characteristics of the method. These findings emphasise the circumstances under which women make reproductive choices and underscore the need to tailor service delivery to meet women's needs. Women-centred counselling and care that takes into consideration individual circumstances are needed.

Group intervention for carers of geriatric patients: experiences from a clinic in India

Sixty per cent of the global elderly population live in low-and middle-income countries, and this proportion was expected to rise to 70% by 2010 (International Institute of Ageing, 2001; Ferri et al, 2005). The 2001 Indian census found over 70 million people aged 60 years or more (considered senior citizens according to the Indian National Policy on Older Persons). Most of those senior citizens live with younger family members and are dependent on them for financial and social support. Hence, any physiological and psychological changes in the older family members affect the younger supportive members as well.

Dr TC Anand Kumar (1936–2010)

Dr TC Anand Kumar, one of the founding editors of Reproductive BioMedicine Online and an emeritus member of the journal’s current Editorial Board, passed away on 26 January, 2010. A reproductive biologist of international repute, he will always be remembered for his diverse contributions to the field ranging from the role of the neuro-endocrine system in reproduction to developing the means of administering hormones via the nasal route and spear-heading the team that produced India’s first scientifically documented in-vitro fertilized baby at the ICMR’s Institute for Research in Reproduction and the KEM Hospital, Mumbai in 1986. After his retirement as the Director of the Institute for Research in Reproduction, Mumbai, India, he founded the Hope Infertility Clinic in Bangalore in 1991 where many of the first generation of assisted reproductive specialists in the country were trained and started their careers in this field. A graduate from Bangalore, he attained his doctorate from the University of Rajasthan and then went on to Birmingham, UK to pursue his studies. Despite several job opportunities provided to him in UK, he was committed by a national spirit and returned to India to participate in the growth of science in the young nation. It was then that he started the electron microscopy laboratory at the All India Institute Medical Sciences in 1970 which is still functional today. He served at the premier All India Institute of Medical Sciences from 1969 to 1982 where he was committed to teaching medical students and also started the neuro-endocrine research laboratory. He founded the Indian Society for the Study of Reproduction and Fertility in 1988 comprising scientists, public executives, programme managers and clinicians from the field of reproductive science which is a very active and flourishing Society today. He continued sharing his wisdom and experience with the younger generation of scientists by serving as an advisor on many committees in the World Health Organization, Department of Science and Technology, Council of Scientific and Industrial Research (Government of India), Department of Biotechnology (Government of India) and the Indian Council of Medical Research until September 2009. His work was recognized by his peers and he received the Shanti Swaroop Bhatnagar Award, the highest scientific award in the country, as well as the Sanjay Gandhi National Award, and was a Fellow of the prestigious Indian Academy of Science, the National Academy of Medical Science (India) and Fellow of Gonville and Caius College, Cambridge, UK. The visionary in Dr Anand Kumar was equally concerned about the welfare of his patients seeking treatment with newer reproductive technologies. It was never fathomed that the field of assisted reproductive technology would grow in India to the extent that it exists today. When the first scientifically documented IVF baby was born, he was always questioned whether an over-populated country needed test-tube babies. With this modality of treatment gaining acceptance and hundreds of clinics operating in India, he took a lead in formulating National Guidelines for Accreditation, Supervision and Regulation of ART Clinics in India. His Proposal for National Guidelines in Medically Assisted Reproductive Techniques (MART) was published in RBMOnline in March 2001 (see http://www.rbmonline.com/Article/103). A man who stood for truth had the greatness to give away his fame and glory of being the pioneer of India’s first IVF baby when he discovered all the hand-written notes of Dr Subhas Mukerjee. Dr Mukerjee from Kolkata had claimed to have created an IVF baby in 1979 (the second in the world) but his claims were neither substantiated nor recognized by scientists or the authorities, leading to the man ending his life prematurely. Dr Anand Kumar had the courage to research his predecessors’ findings and scientifically present it to the world giving Dr Mukerjee his due place in medical history (Anand Kumar TC, Curr. Sci. 72:526–531;1997). Such generosity and honesty is a very rare and precious attribute. Dr Anand Kumar’s love for science and the search for the truth will always be remembered. His students who are now highly placed all over the world will always cherish their mentor. He is survived by his wife Karpagam, son Vijay who lives in Cambridge, UK, daughter Ambika and three grand-children.

Liquid medication dosing errors: a pre-post time series in India

AbstractObjectiveTo evaluate the influence of pharmacist intervention on the level of parental dosing measurement errors and paediatrician dosage prescribing in a clinic in India.Setting and study designThe study was conducted at Srujan Hospital for Sick Children, India. It used a time series design with two groups of patients. Group 1 involved 175 children prescribed paracetamol and assigned to usual care. Following an educational intervention for the hospital paediatricians, including feedback on dosages prescribed for Group 1 and promotion of a dosing chart, 162 patients were recruited to the intervention group (Group 2). Parents in Group 1 received paracetamol suspension and verbal instructions from hospital staff (standard care). Parents in Group 2 were provided with a syringe with a line marking the prescribed dose and its use was demonstrated to them by the pharmacist. Data on the dosages prescribed and measurement accuracy by parents were obtained for both groups.Main outcome measuresMeasurement of correct dosages by parents, and prescribing of appropriate dosages by paediatricians.ResultsIn Group 1, 85 of 175 parents (48.6%) measured the correct dose (±0.5 ml) and paediatricians prescribed appropriate dosages in 67 of 175 cases (38.2%). In Group 2, 160 of 162 parents (98.7%) measured the correct dose and paediatricians prescribed appropriate dosages in 160 of 162 cases (98.7%), showing statistically significant improvements in both indicators (P &amp;lt; 0.001). When the impact of prescribing and dosing correctness was combined on an individual patient basis, 76 of 175 (43.4%) were appropriate in Group 1, and 160 of 162 (98.7%) were appropriate in Group 2. There was a statistically significant improvement (P &amp;lt; 0.001) in appropriate dosing outcome between the two groups.ConclusionPharmacist intervention through patient education, including the use of a syringe, significantly improved parents' dosing accuracy. Pharmacists' feedback resulted in a reduction in physicians' prescribing errors in a country where pharmacist involvement is currently minimal.

P01-115 - Analysis & follow up study of 120 teen agers those were presented with examination phobia in a clinic in India

IntroductionPhobias &amp; fearfulness shortly before examination are a common presenting feature in a section of teen aged students, ausing a stress in their own aswellas in their anxious parents. On a longitudinal evaluation of such 120 cases in a remote district clinic in the age group of 15-23 with a median age of 18 years will show their varied underlying morbidity ultimately.ObjectivesIs it a normal phenomenon or much sressed those may shows some psychological disorders is ascertained here.AimsHere is a search for their such varient stress prior to examination &amp; an attempt to identify their etiology so that some remedy is seen.Methods120 cases in those age group who complained of phobia 1-90 days before exam in the rural clinic in Midnapore 126k.m away from capital city of Kolkata &amp; stayed for a follow up for 24 months were analysed. They constite 72 female &amp; 48 males. They were followed up at 2 monthly interval &amp; their pshychological assesment was done by psychologist. Their final diagonosis at the end of 2 year were tabulised asper criteria of ICD-10.ResultsMild mental retardation &amp; lower side IQ&lt; 80 were found in majority of cases (Apprxm.25%).Acute anxiety disorder was next (15%), followed by generalised anxiety disorders (10%),obsessive compulsive disorder is also revealed in about 5% cases, more in females. Other less common disorders were depressive disorders, conduct &amp; personality disorders, &amp; other bevavioral disorders. No pshycotic ilness like schizophrenia was revealed.ConclusionsAnxiety Disorders in varient &amp; obscured form may be a common presenting feature of teenagers as examination phobia in first &amp; may yields to therapy with family.

Cytotoxic effects of ultra-diluted remedies on breast cancer cells

The use of ultra-diluted natural products in the management of disease and treatment of cancer has generated a lot of interest and controversy. We conducted an in vitro study to determine if products prescribed by a clinic in India have any effect on breast cancer cell lines. We studied four ultra-diluted remedies (Carcinosin, Phytolacca, Conium and Thuja) against two human breast adenocarcinoma cell lines (MCF-7 and MDA-MB-231) and a cell line derived from immortalized normal human mammary epithelial cells (HMLE). The remedies exerted preferential cytotoxic effects against the two breast cancer cell lines, causing cell cycle delay/arrest and apoptosis. These effects were accompanied by altered expression of the cell cycle regulatory proteins, including downregulation of phosphorylated Rb and upregulation of the CDK inhibitor p27, which were likely responsible for the cell cycle delay/arrest as well as induction of the apoptotic cascade that manifested in the activation of caspase 7 and cleavage of PARP in the treated cells. The findings demonstrate biological activity of these natural products when presented at ultra-diluted doses. Further in-depth studies with additional cell lines and animal models are warranted to explore the clinical applicability of these agents.

Malaria: Patterns of relapse and resistance

Malaria constitutes persistent threat to the human health and remains a distinct cause of morbidity and mortality, 40% of the world population is at risk of exposure to this menace in 100 countries (WHO, 2001). Present data represents the registered cases of malaria in the hospitals and clinics in India. Plasmodium vivax and Plasmodium falciparum infections were recorded 63.86%, 66.06%, 62.58% and 36.13%, 33.93%, 37.41%, respectively, amongst individuals with symptoms of intermittent high fever for three days. Maximum transmission with highest slide positivity rates (SPR) 61.76% and 50.14% was periodically and strategically observed during September and October while lowest yearly transmission slide positivity rates (SPR) (19.60–24.07%) was estimated in the months of March and April. Average relapse rates (ARR) in P. vivax was recorded 17.1%. Short term relapses were more recurring than the long term in the ratio of 4:1. Eighty-eight patients who were administered with total of 1500mg chloroquine and 75mg primaquine through divided doses also showed relapse rate of 4.5%. Patients suffering from falciparum malaria showed resistance against chloroquine in 10.6% cases after getting 1500mg chloroquine based on divided doses (i.e. 600mg on day 1 and 300mg after 8h and followed by 300mg daily for 2 days.)

Clinical presentation of mania compared with depression: data from a geriatric clinic in India

This retrospective chart review evaluated a comparison of the clinical profiles of older outpatients having mania and those with unipolar depression. The charts of elderly outpatients with mania and unipolar depression in tertiary care settings were reviewed and relevant information incorporated regarding clinical presentation, past and family history of affective disorder, treatment history and previous psychiatric and neurological history. Charts for 30 patients with mania (23 men and 7 women with mean (+/-SD) age of 68.5(+/- 5.75 years) and 92 with depression (47 men and 45 women with mean (+/-SD) age of 68.18 (+/-6.0 years) were evaluated. Fifteen patients (50%) with manic episodes had psychotic symptoms in the form of delusions and hallucinations while only 33 (35.8%) depressed patients had psychotic symptoms. One-third of manic patients received mood stabilizers at index visit. More than half (n = 16; 53.3%) of the patients in the mania group were prescribed antipsychotic medications. On cognitive functions, patients with manic episodes scored poorly compared with those with depression. These findings suggest that mania in the elderly is a severe form of affective disorder with respect to psychotic and cognitive symptoms. Conclusions from this study are limited due to its retrospective design. Further studies in this area are warranted.

Clinical characteristics of patients with ankylosing spondylitis in India

This study focuses on describing full spectrum of clinical, laboratory, and radiological characterization of ankylosing spondylitis (AS) patients in India. Data on 70 consecutive AS patients, seen at the rheumatology clinic in India, was prospectively obtained using investigator-administered questionnaires. Diagnosis was made according to the modified New York criteria. The core set of variables selected by Assessment in AS International society were obtained. The differences in clinical characteristics based on presence or absence of peripheral arthritis, gender, and juvenile (JOAS) vs. adult onset AS (AOAS) were evaluated. The male/female ratio was 5:1. The mean age of onset of symptoms and diagnosis were 23.6 and 32.5 years, respectively. Females had similar spinal indices and radiological damage as male counterpart. However, they had more common extra-articular manifestations and root joint involvement. The majority of patients consisted of AOAS (78.5%) and was clinically similar to JOAS. One or more peripheral joints were involved in 65.7% of patients, affecting predominantly the lower extremity (90.6%, knee 47.1%, and ankle 35.7%) in asymmetrical pattern (78%). Patients with peripheral arthritis had higher erythrocyte sedimentation rate, more frequent enthesitis, root joint, and whole spine involvement, suggesting more aggressive disease. Most common site of enthesitis was chondro-sternal junction (30%) and Achilles tendonitis (24.3%). The root joints frequently involved extra-axial joints. Uveitis was the most common extra-articular manifestation (25.7%). The predominant initial symptom was typical inflammatory low back pain (87.1%). Assessment in ankylosing spondylitis indices showed a moderately severe disease activity and damage with following values: mean Bath Ankylosing Spondylitis Disease Activity Index, 3.2 (+/-1.8); mean Bath Ankylosing Spondylitis Functional Index, 2.3 (+/-2.0); and mean Bath Ankylosing Spondylitis Metrology Index, 3.15 (+/-2.3). Majority of the patients had bilateral sacroiliitis (grades 2-4) on radiographs (87.1%). In conclusion, the features of AS in Indian patients were broadly similar to other part of world, with the exception of increased frequency of peripheral arthritis.

Lessons from patients with hemoptysis attending a chest clinic in India

OBJECTIVE:To evaluate the various etiologies of hemoptysis.MATERIALS AND METHODS:Four hundred and seventy-six consecutive patients of hemoptysis who were admitted to the Department of Pulmonary Medicine between January 1996 and December 2002 were included in this study. Hemoptysis was categorized as mild (< 100 ml/day), moderate (100–400 ml/day), and massive (>400 ml/day). We also categorized the patients according to the primary etiology of the hemoptysis.RESULTS:Of the 476 patients with hemoptysis included in this study, 352 were males and 124 were females. Pulmonary tuberculosis was the leading cause of hemoptysis. There were 377 (79.2%) patients in the pulmonary tuberculosis group, 25 (5.7%) in the neoplasm group, 19 (4.0%) in the chronic bronchitis group, 18 (3.8%) in the bronchiectasis group, and 35 (7.3%) patients with hemoptysis due to other causes. About one-third of the patients with hemoptysis had been misdiagnosed by the referring doctor as having active pulmonary tuberculosis.CONCLUSION:Although pulmonary tuberculosis is the most important cause of hemoptysis in India, it may also occur due to a variety of other causes. Awareness should be increased among general physicians about the various etiologies of hemoptysis in pulmonary tuberculosis patients.

Clinical practice with antidementia and antipsychotic drugs: Audit from a geriatric clinic in India.

Background:Dementia is one of the most disabling disorders afflicting the elderly, with a staggering emotional and economic impact. Antidementia agents have been used for delaying cognitive decline. Antipsychotics are commonly prescribed for behavioral symptoms associated with dementia.Objectives:To explore the use of anti-dementing agents and antipsychotics used in patients with a diagnosis of dementiaMaterials and Methods:A retrospective chart review method; geriatric clinic of tertiary care setting.Results:The study sample included 51 consecutive patients with a diagnosis of dementia. The commonest subtype of dementia that was diagnosed was Alzheimer's disease (45%), followed by Frontotemporal dementia (25%).The commonest antidementia drug that was used was donepezil, which alone was prescribed in 27 patients (52%). The commonest antipsychotic used was quetiapine, which was used in 24 patients (47%).Conclusions:The study found donepezil to be the most commonly prescribed antidementia drug and quetiapine to be the most commonly used antipsychotic in a tertiary care geriatric clinic, in a developing country. There is a need to study the cost-effectiveness of antidementia and antipsychotic drugs in patients with dementia, in developing countries.

Diagnosis delay in patients with ankylosing spondylitis: factors and outcomes—an Indian perspective

This study focuses on the causes and consequences of delay in diagnosis of ankylosing spondylitis (AS). Seventy consecutive patients presenting at a rheumatology clinic in India were studied. Mean (+/-S.D) delay in diagnosis was 6.9 (+/-5.2) years. The main cause of delay was incorrect diagnosis as non-specific back pain (19/54, 35.1%), degenerative disc disease (14/54, 25.9%), rheumatoid arthritis (11/54, 20.37%), and tuberculosis of spine (9/54, 16.6%) in that order, for which the patient received prolonged treatment. Absence of extra-articular manifestations and juvenile age also significantly correlated with diagnostic delay. Delay in diagnosis resulted in significantly worse disease activity index (BASDAI), functional index (BASFI), and damage index (BASMI). Most incorrect initial diagnoses were made by orthopedicians (75.9%), followed by general physician (50%), and rheumatologist (12%). Continuing medical education workshops with a focus on clinical diagnosis of inflammatory back pain may help in early diagnosis of AS.

Profile of Adult Patients Attending a Marriage and Sex Clinic in India

Sexual disorders, which are usually influenced by multiple factors, are very prevalent across the globe but there are few studies which provide the pattern of help-seeking behavior in the Indian population. The study aims to present the pattern of sexual dysfunction in the patients attending a marriage and sex clinic from 1979 to 2005. Details are obtained from the records of the patients who attended the clinic. In accordance with the change in diagnostic classification, the data are presented: ICD-IX (for period 1979-1992) and ICD-X (for period 1993-2005). Out of a total of 1,242 patients, 566 patients attended the clinic during 1979 to 1992, and 676 patients during 1993 to 2005. More than half of the clinic population during the period was aged 20-29 years. Premature ejaculation is the most common complaint and the most commonly diagnosed clinical entity, followed by male erectile problems and culturally induced sexual behaviors such as dhat syndrome. Being more educated, married and from an urban background promotes help-seeking in tertiary care clinics but these findings may be due to selection bias. Sexual activity continues to be strongly influenced by culturally held beliefs. This influence is more troublesome for young and unmarried persons who have not changed over the period.

P24 Suboptimal utilization of the services of the allied health professionals (AHPS) in rheumatology clinics in India

P24 Suboptimal utilization of the services of the allied health professionals (AHPS) in rheumatology clinics in India