Disorder Of Public Health Importance Research Articles

An overview of sickle cell disease from the socio-demographic triangle - a Nigerian single-institution retrospective study.

IntroductionSickle cell disease (SCD) is a hereditary red blood cell disorder of public health importance globally with Nigeria the epicenter zone in Africa. There is a paucity of knowledge on how hemoglobin variants, personal characteristics, and environment (socio-demographic triangle) interact to influence SCD propagation. A clinical overview of these epidemiologic parameters may proffer strategies for controlling the SCD disease burden. The objective of this study was to examine the prevalence patterns of SCD, including other associated epidemiologic and hematological (i.e., hemoglobin concentration, ABO blood groups) parameters from laboratory data.Methodsthis was a retrospective cross-sectional study of 138 newly diagnosed SCD patients in the laboratory unit of the department of haematology using routine alkaline cellulose acetate hemoglobin electrophoresis technique from 2013 to 2014. Demographic and other relevant data were obtained from case notes and laboratory records at the presentation. The agent-host-environment variables were used in the construction of the epidemiological triad chain of transmission.Resultsa total of 138 (1.63%) newly diagnosed SCD patients aged 7 months to 41 years made up of 39% (0.63% SCD prevalence) adults and 61% (1% SCD prevalence) pediatric age-groups were seen out of 8457 consecutive patients screened within the study period. About 98.55% and 1.45% were homozygous sickle-hemoglobin (SS) and heterozygous sickle-hemoglobin C (SC) variants, respectively. The pediatric department (CHER+CHOP) recorded the highest proportion of SCD (65%). In contrast, the public health department had the least proportion (1%). There was a statistically significant difference in the gender status and the months of SCD diagnosis (p=0.0147). The month of April had the highest proportion of SCD. A majority (66.7%) of the SCD had moderate grade anemia.Conclusionthe study revealed a gender disparity in the months of SCD diagnosis. However, there was no statistical difference in the pediatric and adult SCD prevalence patterns.

Variations and characteristics of the various clinical phenotypes in a cohort of Nigerian sickle cell patients

ABSTRACT Background Sickle cell anaemia affects about 4 million people across the globe, making it an inherited disorder of public health importance. Red cell lysis consequent upon haemoglobin crystallization and repeated sickling leads to anaemia and a baseline strain on haemopoiesis. Vaso-occlusion and haemolysis underlies majority of the chronic complications of sickle cell. We evaluated the clinical and laboratory features observed across the various clinical phenotypes in adult sickle cell disease patients. Methods Steady state data collected prospectively in a cohort of adult sickle cell disease patients as out-patients between July 2010 and July 2020. The information included epidemiological, clinical and laboratory data. Results About 270 patients were captured in this study (165 males and 105 females). Their ages ranged from 16 to 55 years, with a median age of 25 years. Sixty-eight had leg ulcers, 43 of the males had priapism (erectile dysfunction in 8), 42 had AVN, 31 had nephropathy, 23 had osteomyelitis, 15 had osteoarthritis, 12 had cholelithiasis, 10 had stroke or other neurological impairment, 5 had pulmonary hypertension, while 23 had other complications. Frequency of crisis ranged from 0 to >10/year median of 2. Of the 219 recorded, 148 of the patients had been transfused in the past, while 71 had not. Conclusion The prevalence of SLU, AVN, priapism, nephropathy and the other complications of SCD show some variations from other studies. This variation in the clinical parameters across different clinical phenotypes indicates an interplay between age, genetic and environmental factors.

A cross-sectional study on ante-natal depression in a tertiary health care hospital in Navi Mumbai

Background: Depression is a common source of disability among women. Antenatal depression has been often overlooked and under diagnosed, throughout the world especially in the developing countries like India. This study was conducted to assess the mental health status of pregnant women attending the antenatal clinic in a tertiary health care hospital.Methods: A cross-sectional study was conducted over a period of three months among randomly selected pregnant women attending the antenatal clinic of a tertiary hospital. A total of 170 pregnant women formed the study subject. Data was collected using a pre-designed, pre-tested, semi-structured questionnaire and analysis was done using SPSS version 20.0.Results: Among the study population, the prevalence of depression was found to be 20.6%. Depression was significantly associated with the socio-economic status and education of the study subjects. Women with family discord were significantly more depressed than those with no discord. Unplanned pregnancy and preference of male child very significant factors for depression. Multiparity and bad obstetric history also showed a higher level of depression which was statistically significant.Conclusions: There is a significant prevalence of antenatal depression which needs screening and appropriate management. Maternal health policies must integrate maternal depression as a disorder of Public Health importance and interventions should target the pregnant women as early as possible.

Prospective study to evaluate the efficacy of fluoxetine in comparison with amitriptyline in patients with depression

Background: Mental disorders are common in medical practice and may present either as a primary disorder or as a comorbid condition. They are a group of disorders characterized by altered regulation of mood, behavior and affect. Depressive disorder ranks top among the mental disorders. Depression is a disorder of public health importance, in terms of its prevalence, morbidity, mortality and economic burden. Methods: Study was carried out in the outpatient department of psychiatry, Government Rajaji Hospital, Madurai, after obtaining clearance from Institutional ethical committee, written informed consent was obtained from all the patients. Eighty newly diagnosed patients suffering from depression, attending psychiatric outpatient department were selected after satisfying inclusion and exclusion criteria. They were divided into two groups with 40 patients in each group. Group I received amitriptyline (25- 150 mg /day) and group II received fluoxetine (20- 40 mg /day). Efficacy was assessed by measuring the reductions in the total HAM D-Scores (Hamilton depression rating scale) at the end of the study from baseline scores. Results: The efficacy of two antidepressants was compared and it was found that the incidence of depression was higher among the 20 – 40 years age groups in both the study groups. Females were more in number as compared to males in both the study groups. The efficacy of fluoxetine is comparable to that of Amitriptyline both were equally efficacious in the treatment of depression. Conclusions: Depression is a disorder of major public health importance, in terms of its prevalence, morbidity, mortality and economic burden. The prevalence of depression is more in women than men. Fluoxetine and amitriptyline were equally efficacious in the treatment of depression.

A cross sectional study on mental health status of pregnant women at urban health centre of Bangalore, India

Background: Depressive disorders are a common source of disability among women. In addition to the economic and human costs of maternal depression, children of depressed mothers are at risk for health, developmental, and behavioural problems. Community-based epidemiological data on antenatal depression from developing countries is scarce.Methods: A cross sectional study was carried out for a period of 4 months in urban health centre in Bangalore. Simple random sampling technique was used to select 250 pregnant women attending antenatal clinic. Information on socio-demographic variables, obstetric variables and mental health status was collected based on preformed proforma. Data was analysed using Statistical Programme for the social science (SPSS) version 16.0.Results: Amongst the study population, prevalence of depressive disorder was 24.8%.The depression was significantly increasing with advancing pregnancy. Socio economic status and depression was associated statistically significant (p=0.024). Educational status of women was associated with depression (p=0.053).women with history of abortion had more depression as compared to those who did not have abortions was statistically significant (p=0.02).Conclusions: Depressive symptoms occur commonly during 2nd and 3rd trimester of pregnancy, drawing attention to a need to screen for depression during antenatal care. Maternal health policies, a priority in developing countries, must integrate maternal depression as a disorder of public health importance. Interventions should target women in the early antenatal period.

Subacute sclerosing panencephalitis presenting with hypersexual behavior.

Sir, Subacute sclerosing panencephalitis (SSPE) is a rare progressive demyelinating disease of the central nervous system associated with a chronic infection of brain tissue with measles virus. The disease is commonly seen in children and young adults. It is characterized by progressive intellectual deterioration, focal and/or generalized seizures, myoclonus, ataxia, and visual disturbances.[1] The presentation varies according to the age of the patient, and the diagnosis is often delayed in adults due to the atypical presentation. The hypersexual disorder is classically defined in persons aged above 18 years and is characterized by the recurrent and intense sexual urge irrespective of the situation persisting beyond 6 months.[2] The disease is usually associated with significant psychiatric ailments and also with central nervous disorders such as stroke, brain injury, and medications. SSPE presenting with hypersexual behavior is uncommon and is rarely reported in the literature. We retrospectively reviewed the data pertaining to four patients of SSPE treated at our hospital between 2012 and 2014. The diagnosis of SSPE is based on the Dyken's criteria.[3] SSPE is diagnosed, if the patient meets any three of the following five criteria: (a) Progressive intellectual deterioration with signs of myoclonus; (b) characteristic electroencephalographic (EEG) pattern; (c) elevated cerebrospinal fluid (CSF) globulin levels; (d) elevated CSF measles antibody titers; and (e) brain biopsy suggestive of measles. The demographic profile and investigation findings of all the patients are summarized in the Table 1.Table 1: Clinical details of all the four patientsBriefly, all our patients are young adults of both sexes and hail from poor socioeconomic strata of the society. All the patients presented with classical behavioral abnormalities, scholastic regression, and a couple of them presented with the hypersexual syndrome. All the patients showed a characteristic EEG pattern of periodic lateralized epileptiform discharge sequences neuroimaging revealed nonspecific white matter hyperintensities in few patients. The paired serum and CSF samples for measles ELISA IgG were positive in all the patients confirming the diagnosis of SSPE. The patients were treated with intrathecal interferon, Isoprinosine, and antipsychotic drugs including risperidone. Sodium valproate was used to control the myoclonus and seizure activity. One patient had a persistent worsening illness with recurrent seizures and succumbed to his illness at the end of 1-year of observation. Behavioral abnormalities improved in the remaining three patients, and they are under regular follow-up. In India, SSPE is still a common neurodegenerative disorder despite an increase in the measles vaccination. The diagnosis and treatment are usually delayed due to the varying presentation of the disease. Our data revealed that three patients were receiving psychiatric treatment for more than a year prior to the proper diagnosis. Poor scholastic performance and cognitive regression are important clues to the underlying diagnosis of SSPE and EEG is often diagnostic in these cases.[4] The clinical presentation of adult onset differs from childhood onset as, personality changes and ophthalmic manifestations are common presenting features and survival with treatment have been better in certain series.[5] Our data had patients from the second and third decades of life, and none of the patients had ophthalmic manifestations. Hypersexual behavior leads to social stigma and is often underreported by the patients. The same has been linked with a variety of neuropsychiatric disorders including obsessive-compulsive disorder, bipolar disorder, drugs such as dopaminergic agonists and other disorders including stroke and brain injury. The prevalence of SSPE is common among lower socioeconomic strata, large family size, and rural areas due to overcrowding. The measles virus is transmitted by respiratory secretions via aerosol exposure and also through direct contact with larger droplets.[1] A variety of metabolic disorders leads to dementia in young including Wilson's disease, hypothyroidism, B12 deficiency, etc. Our patients were investigated for these conditions and the negative screen resulted in the psychiatric diagnosis. It is essential for all the practitioners to look for myoclonus and also investigate for the rare causes of dementia such as SSPE and prion diseases. The therapy of SSPE involves the use of isoprinosine and an immunomodulator like interferon. The response to therapy depends on the clinical stage of SSPE at which the treatment was started. SSPE staging is done as per the modified Jabbour's classification and patients with stage 1 disease respond remarkably to the therapy whereas, stage 2 disease progresses invariably resulting in fatal outcomes in 2–5 years. To conclude, SSPE is a devastating disorder of public health importance in the developing countries. A high index of suspicion for SSPE is required during the evaluation of young adults with myoclonus, behavioral changes, and scholastic regression. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Calcium-dependent intracellular signal pathways in primary cultured adipocytes and ANK3 gene variation in patients with bipolar disorder and healthy controls.

Bipolar disorder (BD) is a chronic psychiatric disorder of public health importance affecting >1% of the Swedish population. Despite progress, patients still suffer from chronic mood switches with potential severe consequences. Thus, early detection, diagnosis and initiation of correct treatment are critical. Cultured adipocytes from 35 patients with BD and 38 healthy controls were analysed using signal pathway reporter assays, that is, protein kinase C (PKC), protein kinase A (PKA), mitogen-activated protein kinases (extracellular signal-regulated kinase (ERK) and c-Jun N-terminal kinase (JNK)), Myc, Wnt and p53. The levels of activated target transcriptional factors were measured in adipocytes before and after stimulation with lithium and escitalopram. Variations were analysed in the loci of 25 different single-nucleotide polymorphisms (SNPs). Activation of intracellular signals in several pathways analysed were significantly higher in patients than in healthy controls upon drug stimulation, especially with escitalopram stimulation of PKC, JNK and Myc, as well as lithium-stimulated PKC, whereas no meaningful difference was observed before stimulation. Univariate analyses of contingency tables for 80 categorical SNP results versus diagnoses showed a significant link with the ANK3 gene (rs10761482; likelihood ratio χ2=4.63; P=0.031). In a multivariate ordinal logistic fit for diagnosis, a backward stepwise procedure selected ANK3 as the remaining significant predictor. Comparison of the escitalopram-stimulated PKC activity and the ANK3 genotype showed them to add their share of the diagnostic variance, with no interaction (15% of variance explained, P<0.002). The study is cross-sectional with no longitudinal follow-up. Cohorts are relatively small with no medication-free patients, and there are no ‘ill patient' controls. It takes 3 to 4 weeks of culture to expand adipocytes that may change epigenetic profiles but remove the possibility of medication effects. Abnormalities in the reactivity of intracellular signal pathways to stimulation and the ANK3 genotype may be associated with pathogenesis of BD. Algorithms using biological patterns such as pathway reactivity together with structural genetic SNP data may provide opportunities for earlier detection and effective treatment of BD.

Carotenoids in yellow‐ and red‐fleshed papaya (Carica papaya L)

AbstractVitamin A deficiency is a disorder of public health importance in Sri Lanka. A recent national survey revealed that 36% of preschool children in Sri Lanka have vitamin A deficiency (serum retinol &lt;0.2 µg ml−1). In view of its well‐established association with child morbidity and mortality, this is a reason for concern. One of the main fruits which has been recommended for prevention of vitamin A deficiency in Sri Lanka is papaya (Carica papaya L). In this study the carotenoid profiles of yellow‐ and red‐fleshed papaya were analysed by medium‐pressure liquid chromatography (MPLC) and UV‐vis spectrophotometry. A section of yellow‐fleshed papaya showed small carotenoid globules dispersed all over the cell, whereas in red‐fleshed papaya the carotenoids were accumulated in one large globule. The major carotenoids of yellow‐fleshed papaya were the provitamin A carotenoids β‐carotene (1.4 ± 0.4 µg g−1 dry weight (DW)) and β‐cryptoxanthin (15.4 ± 3.3 µg g−1 DW) and the non‐provitamin A carotenoid ζ‐carotene (15.1 ± 3.4 µg g−1 DW), corresponding theoretically to 1516 ± 342 µg kg−1 DW mean retinol equivalent (RE). Red‐fleshed papaya contained the provitamin A carotenoids β‐carotene (7.0 ± 0.7 µg g−1 DW), β‐cryptoxanthin (16.9 ± 2.9 µg g−1 DW) and β‐carotene‐5,6‐epoxide (2.9 ± 0.6 µg g−1 DW), and the non‐provitamin A carotenoids lycopene (11.5 ± 1.8 µg g−1 DW) and ζ‐carotene (9.9 ± 1.1 µg g−1 DW), corresponding theoretically to 2815 ± 305 µg kg−1 DW mean RE. Thus the carotenoid profile and organisation of carotenoids in the cell differ in the two varieties of papaya. This study demonstrates that carotenoids can be successfully separated, identified and quantified using the novel technique of MPLC. Copyright © 2003 Society of Chemical Industry

Therapy of spontaneous ringworm in cats with orally administered griseofulvin.

Ringworm in cats is a common dermatological disorder of public health importance. Investigations in this country 3,7 and other parts of the world 5,6 have disclosed that Microsporum canis is the principal cause of this condition in cats. In a recent survey 3 of ringworm of animals in the United States, this fungus has been found to be responsible for approximately 98% of the feline cases studied. Such infections are frequently transmitted to human contacts, and infected cats constitute the principal source of this agent for man. M. canis is also an important cause of dermatophytosis in dogs, pet monkeys, and horses, 3 and such lower-animal hosts are also frequently involved in the transmission of the disease to humans. Although it has been conclusively established that the relatively common M. canis ringworm in man represents spread from cats and other animals, to date no attempts have been made in this