Disorders In India Research Articles

Incidence of parathyroid disorders in Indian adult male population: A 25-year follow-up study.

Detailed information on the epidemiology of parathyroid disorders in India is lacking. Most of the available data pertain to primary hyperparathyroidism (PHPT) rather than the overall burden of parathyroid disorders. We studied the incidence of parathyroid disorders in a cohort of service personnel followed for a long duration. The data for this retrospective, descriptive epidemiological study were derived from the electronic medical records (EMR) of health care personnel enrolled between 1990 and 2015. Subjects were recruited between the ages of 17 and 20years in good health, and the data pertaining to parathyroid disorders were derived from the EMR. We calculated the incidence rates per person-years of parathyroid disorders using appropriate statistical methods. Our analysis includes 51217 participants (median age 33, range 17-54years) with a mean follow-up of 12.5years. Yearly evaluation of the data gave cumulative follow-up duration of 613925 person-years. PHPT was diagnosed in 37 patients and hypoparathyroidism in 16 patients, giving incidence rates of 6 and 2.6 per 100000 person-years, respectively. Only one patient was diagnosed with pseudohypoparathyroidism (0.16 per 100000 person-years). Of the 37 patients with PHPT, 16 (43%) developed postsurgical hypoparathyroidism. Our cohort had a low incidence of PHPT when compared to Western populations. Long-term epidemiological studies are essential to identify the demographic trends of metabolic bone disorders in India.

Cultural aspects of anxiety disorders in India

Cultural factors have influenced the presentation, diagnoses, and treatment of anxiety disorders in India for several centuries. This review covers the antecedents, prevalence, phenomenology, and treatment modalities of anxiety disorders in the Indian cultural context. It covers the history of the depiction of anxiety in India and the concept of culture in the classification of anxiety disorders, and examines the cultural factors influencing anxiety disorders in India. We review the prevalence and phenomenology of various disorders, such as generalized anxiety disorder, panic disorder, social anxiety, and phobic disorder, as well as culture-specific syndromes such as dhat and koro in India. Finally, the review examines the wide range of therapeutic modalities practiced in India, such as faith healing, psychotherapy, ayurveda, psychopharmacology, Unani medicine, homeopathy, yoga, meditation, and mindfulness. We conclude by emphasizing the significance of cultural factors in making relevant diagnoses and offering effective and holistic treatments to individuals with anxiety disorders.

Primary Immunodeficiency Disorders in India-A Situational Review.

Primary immunodeficiency disorders (PIDs) are a group of genetic defects characterized by abnormalities of one or more components of the immune system. While there have been several advances in diagnosis, management, and research in the field of PIDs, they continue to remain underdiagnosed, especially in the less affluent countries. Despite several limitations and challenges, India has advanced significantly in the field of PIDs in the last few years. In this review, we highlight the progress in the field of PIDs in India over the last 25 years, the difficulties faced by clinicians across the country, the current state of PIDs in India and the future prospects.

Prevalence of Mental Disorders in India and Other South Asian Countries

Prevalence of Mental Disorders in India and Other South Asian Countries

Age and gender-specific reference intervals for lysosomal enzymes in dried blood spot samples: A study in Indian population

ObjectivesThe study aimed to establish age and gender-specific reference values for the activities of lysosomal enzymes (acid α-galactosidase [GLA], acid β-glucocerebrosidase [GBA], acid α-glucosidase [GAA], acid sphingomyelinase [ASM] and galactocerebrosidase [GALC]) in dried blood spots (DBS) of Indian population. Design and methodsA total of 3797 healthy Indian subjects (1456 females and 2341 males) aged from 2days to 60years were selected for the study. Activities of 5 lysosomal enzymes were determined by tandem mass spectrometry, for newborns (<30days), infants (>1month–1year), children (>1–5years) and (>5–18years) and adults (>18years).Variations in enzyme activities based on age and gender were studied. The reference interval was defined as the central 95% range, and was determined based on age and gender. ResultsHighly significant differences in activities were observed for GAA (p=0.001), GLA (p<0.0001), GBA (p<0.0001), ASM (p<0.0001) and GALC (p<0.0001), between different age groups. Comparison of activities between genders showed significant difference for ASM in children aged 1–5years (p=0.03) with higher activity in females, and for GLA in children aged 5–18years (p=0.004) where the activity was higher in males. Reference intervals decreased with age for all enzymes, except GAA. The ranges of GLA and GALC were higher in females, whereas GBA was higher in males. ConclusionThe study establishes age and gender-specific reference values for the screening and identification of lysosomal storage disorders in Indian population. Our data may facilitate establishment of mass screening programs for these disorders in India.

Genetic variations in the Dravidian population of South West coast of India: Implications in designing case-control studies.

Background & objectives:Indian data have been largely missing from genome-wide databases that provide information on genetic variations in different populations. This hinders association studies for complex disorders in India. This study was aimed to determine whether the complex genetic structure and endogamy among Indians could potentially influence the design of case-control studies for autoimmune disorders in the south Indian population.Methods:A total of 12 single nucleotide variations (SNVs) related to genes associated with autoimmune disorders were genotyped in 370 healthy individuals belonging to six different caste groups in southern India. Allele frequencies were estimated; genetic divergence and phylogenetic relationship within the various caste groups and other HapMap populations were ascertained.Results:Allele frequencies for all genotyped SNVs did not vary significantly among the different groups studied. Wright's FST was 0.001 per cent among study population and 0.38 per cent when compared with Gujarati in Houston (GIH) population on HapMap data. The analysis of molecular variance results showed a 97 per cent variation attributable to differences within the study population and <1 per cent variation due to differences between castes. Phylogenetic analysis showed a separation of Dravidian population from other HapMap populations and particularly from GIH population.Interpretation & conclusions:Despite the complex genetic origins of the Indian population, our study indicated a low level of genetic differentiation among Dravidian language-speaking people of south India. Case-control studies of association among Dravidians of south India may not require stratification based on language and caste.

Past, present, and future of iodine deficiency disorders in India: Need to look outside the blinkers.

Iodine deficiency disorders (IDDs) have been recognized as one of the major nutritional disorders throughout the world affecting 200 million people who are at risk and another 71 million suffering from goiter and other IDDs. These groups of disorders can affect every stage of life, but most vulnerable age group is between 6 and 12 years and these disorders together constitute the single largest preventable cause of brain damage leading to learning disabilities and psychomotor impairment. The existence of endemic goiter in an extensive belt along the southern slopes of the Himalayas, Alps, and Andes has long been described, but consistently high prevalence of IDDs outside the endemic zones and failure to attain goals set by the National Iodine Deficiency Disorder Control Program questions the strategy and achievements till date. Therefore, the present article is an attempt to critically examine the program since inception in India.

A review of Indian research on co-occurring cannabis use disorders& psychiatric disorders.

Background & objectives:Cannabis is a widely used illicit drug and its use is often associated with co-occurring psychiatric disorders. This systematic review was aimed to provide information on the published Indian studies on co-occurring cannabis use disorders and psychiatric disorders.Methods:An electronic search of available Indian literature using relevant search terms was carried out in May 2015 and 52 articles in English language published from India were included in the current review.Results:Studies on cannabis and associated psychotic disorders (n=16) chiefly described acute episodes with predominant positive symptoms, following cannabis use. Some studies (n=6) observed an overall increased prevalence of all psychiatric disorders and symptoms owing to cannabis use, while others (n=14) elaborated on high rates of substance use in those with psychiatric disorders. The effect of cannabis use on cognitive function was the focus of some of the Indian studies (n=7). All these studies barring one had all male subjects, and a single study described the service delivery model for those with dual diagnosis disorders in India. Most of the research used cross-sectional observational design and focussed on treatment-seeking population.Interpretation & conclusions:A review of Indian literature on cannabis use and its association with psychiatric disorders indicates a high co-prevalence of psychotic disorders, especially in vulnerable individuals as well as high rates of co-occurrence of other psychiatric comorbidities. However, there is limited focus on exploring the aetiological association between cannabis use and psychiatric disorders; understanding the neurobiology of this association and management-related issues.

Incidence of Endocrine Disorders in Indian Adult Male Population.

Background:The comprehensive epidemiology of endocrine disorders is lacking from our country. Most of the available data pertain to the prevalence of diabetes and thyroid disorders only. We studied the incidence of endocrine disorders in a cohort of service personnel followed for a long duration.Materials and Methods:The data for this descriptive epidemiologic study were derived from the electronic medical records of the male service personnel enrolled between 1990 and 2015. They were recruited between the ages of 17 and 20 years in good health, and their morbidity data were derived from the medical records. We calculated the incidence rates as per person-years (py) using appropriate statistical methods.Results:Our analysis includes 51,217 participants (median: age 33 years, range: 17–54) with a mean follow-up of 12.5 years. Yearly evaluation of the data gave a cumulative follow-up duration of 613,925 py. The incidence of diabetes, obesity, and dyslipidemia was 0.41, 0.23, and 0.12 per 1000 py, respectively. The incidence of thyroid, parathyroid, pituitary, adrenal, and metabolic bone disorders was 3.9, 8.6, 1.6, 0.81, and 0.97 per 100,000 py, respectively.Conclusion:Our cohort had lower incidence rates of endocrine disorders when compared with the Western population. Long-term epidemiological studies are essential to identify the demographic trends of the endocrine disorders in India.

Assessment of Cognitive Deficits in Obstructive Sleep Apnea with Paper-Based Tests and Choice Reaction Time in Indian Population

Obstructive sleep apnea (OSA) is a disease characterized by intermittent hypoxemia and sleep fragmentation. Studies conducted previously to assess cognitive functions in OSA have shown variable results. OSA is one of the increasingly common disorders in India. OSA typically shows 'tip of iceberg' phenomenon, i.e. very few diagnosed cases even with high prevalence. Thus, in a country with one of the highest number of road traffic accidents and occupational accidents, it becomes even more important to assess all OSA patients for cognitive functions especially with choice reaction time which is a very good indicator of real life situations such as vehicular driving and demanding occupational task. Thus, we compared cognitive functions in 30 cases of OSA with 30 age, sex and education matched control using standardized paper based tests and choice reaction time. We found choice reaction time to be severely affected in OSA. Amongst various domains of cognition, attention and executive functions were significantly affected in OSA. Also, there was decline in psychomotor abilities and memory.

Legal Provisions, Educational Services and Health Care Across the Lifespan for Autism Spectrum Disorders in India.

India is estimated to have over 10 million persons with autism. Rising awareness of autism in India over last decade with ready access to information has led to an increase in prevalence and earlier diagnosis, the creation of services and some policy initiatives. However, there remains a gaping chasm between policy and implementation. The reach and quality of services continues sketchy and uneven, especially in the area of education. The present review discusses existing legal provisions for children and adults with autism in India. It also discusses Governmental efforts and lacunae in existing health care facilities and education services in India. While there are examples of good practice and stories of hope, strong policy initiatives have to support grassroots action to improve the condition of persons with autism in India.

Prevalence of thyroid dysfunction: Experience of a tertiary care centre in Kerala

Background: There is limited data regarding the prevalence of thyroid disorders in India, and this is the first study to assess their prevalence in northern Kerala. Methods: All subjects who underwent blood sampling for estimation of thy-roid function tests (TFTs) on their initial visit to the EMS Memorial Cooperative Hospital and Research Centre, Perin-thalmanna (2009-2013) were included in the study. Results: The study population included 8179 subjects (Males: 3205, females: 4974), of ages from 1-94 (Mean-41.95) years of age. The overall prevalence rate of thyroid function abnormalities was 15.73%; more in females (16.91 %) than males (13.90%). The subclinical hypothyroidism (SCH) was the commonest thyroid abnormality (7.15 %) followed by overt hypothyroidism (4.2%), hyperthyroidism (2.77 %) and subclinical hyperthyroidism (SH) (1.6 %). The prevalence rate of hypothyroidism in different age groups was 2.81 % in 1-19, 3.53 % in 20-45 and 5.36 % in those ≥ 46 years respectively. The prevalence rate of SCH was highest (8.05 %) in the age group of 20-45 years followed by 6.74 % in ≥ 46 and 4.19 % in 1-19 years. Conclusions: The thyroid function abnormalities are common and the prevalence is higher in females than males. The prevalence rates of thyroid function disorders were 9.76%, 17.50 % and 15.05 % in age groups of 1-19, 20-45 and ≥ 46 years respectively. The SCH was the commonest abnormality, followed by overt hypothyroidism, hyperthyroidism and SH; first 3 conditions were more common in females than males, whereas last was common in males.

Prevalence of thalassemia and hemoglobinopathy in eastern India: A 10-year high-performance liquid chromatography study of 119,336 cases.

Background:Hereditary hemoglobin (Hb) disorders are the most commonly encountered single gene disorders in India. Proper timely identification of these disorders is of paramount importance to prevent thalassemia major and clinically severe hemoglobinopathy as well as for epidemiologic purposes.Aims:Our aim was to determine the prevalence of thalassemia and hemoglobinopathy in patients of a tertiary care hospital of West Bengal, India.Materials and Methods:This prospective study was conducted on 119,336 cases over a period of 10 years. After taking clinical history and familial history, complete hemogram report was obtained by an automated cell counter. High-performance liquid chromatography (HPLC) was performed on the samples with Bio-Rad Variant using beta thalassemia short program. Confirmatory tests were performed whenever required.Results:A normal Hb pattern was observed in 104,804 (87.83%) cases and abnormalities were detected in 14,532 (12.17%) patients. β (beta) thalassemia trait was the commonest abnormality found in 5,488 (4.60%) patients. HbE trait was found in 3,604 (3.02%) patients, β thalassemia major/intermedia in 1,981 (1.66%) cases, and Eβ thalassemia in 1,384 (1.16 %) cases. Other variants detected included HbE disease, sickle-cell disease, sickle β thalassemia, HbD-Punjab trait, HbQ-India trait, α-thal trait, double heterozygous state of HbS and HbE, double heterozygous state of HbS and HbD, HbJ-Meerut, hereditary persistence of fetal hemoglobin (HPFH), HbH, delta β-thal trait, and Hb Lepore.Conclusion:In view of the high prevalence of hemoglobinopathy in this region, a routine premarital screening program is needed for the identification and prevention of high-risk marriages and thus, prevention of the psychosocial trauma of bearing a transfusion-dependent child for life.

Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India.

BackgroundThe large treatment gap for mental disorders in India underlines the need for integration of mental health in primary care.AimsTo operationalise the delivery of the World Health Organization Mental Health Gap Action Plan interventions for priority mental disorders and to design an integrated mental healthcare plan (MHCP) comprising packages of care for primary healthcare in one district.MethodMixed methods were used including theory of change workshops, qualitative research to develop the MHCP and piloting of specific packages of care in a single facility.ResultsThe MHCP comprises three enabling packages: programme management, capacity building and community mobilisation; and four service delivery packages: awareness for mental disorders, identification, treatment and recovery. Challenges were encountered in training primary care workers to improve identification and treatment.ConclusionsThere are a number of challenges to integrating mental health into primary care, which can be addressed through the injection of new resources and collaborative care models.

Relapsing optic neuritis and isolated transverse myelitis are the predominant clinical phenotypes for patients with antibodies to myelin oligodendrocyte glycoprotein in India.

BackgroundClinical phenotypes of patients with antibodies to myelin oligodendrocyte glycoprotein (anti-MOG+) are unknown in India.ObjectivesRetrospectively to characterise anti-MOG+ patients with inflammatory central nervous system disorders in India.MethodA total of 87 patients with non-multiple sclerosis demyelinating disorders (excluding acute disseminated encephalomyelitis) who were seronegative for anti-aquaporin 4 antibody were retrospectively analysed using a cell-based assay for anti-MOG+ status.ResultsTwenty-five patients were anti-MOG+ in this cohort. They represented 28.7% (25/87) of patients who tested negative for anti-AQP4+. Sixty-four per cent (16/25) of anti-MOG+ patients were men and had a relapsing course. Patients with recurrent optic neuritis and those with a single attack of acute longitudinally extensive transverse myelitis were the most common phenotypes.ConclusionRelapsing optic neuritis was the most common phenotype, contrasting with a lower risk of relapses in transverse myelitis.

Assessment of knowledge, attitude and practices of dental practitioners regarding temporomandibular joint disorders in India

Background: Temporomandibular joint disorders (TMDs) are one of the major causes of chronic orofacial pain affecting 28-86% of the population. The diagnosis of TMDs is challenging to a considerable number of practitioners and is influenced by their knowledge, attitude and experience. Aim: This study aimed at assessing the knowledge, attitude and practices regarding TMDs among TMD experts and general dental practitioners (GDPs) in India. Materials and Methods: A total of 200 dental practitioners (32 TMD experts and 168 GDPs) across India, registered under the Dental Council of India, were included in the survey. A questionnaire consisting of 21 issues with regard to TMDs was designed from relevant standard textbooks. The questionnaire was pretested for validation and distributed personally or through the web designed program. The knowledge and attitude scores of both the groups were assessed and compared. The therapeutic modalities practiced by the groups were also noted. Results: A significant difference was found in the knowledge scores and attitude between TMD experts and GDPs. A significant correlation was found between attitude score and years of experience in both the groups. Both TMD experts and GDPs expressed little confidence in the management of TMDs. About 75% of GDPs expressed concern over an inadequate number of TMD experts. Conclusion: Need for continued updating of knowledge, panel discussions, and revisions of the curriculum in graduate schools was realized.

The burden attributable to headache disorders in India: estimates from a community-based study in Karnataka State.

BackgroundHeadache disorders are common worldwide, causing pain and disability. India appears to have a very high prevalence of migraine, and of other headache disorders in line with global averages. Our objective was to estimate the burdens attributable to these disorders in order to inform health policy.MethodsIn a door-to-door survey, biologically unrelated adults (18–65 years) were randomly sampled from urban and rural areas of Bangalore and interviewed by trained researchers. The validated structured questionnaire enquired into several aspects of burden.ResultsOf 2,329 participants (non-participation rate 7.4 %), 1,488 (63.9 %; 621 male, 867 female) reported headache in the preceding year. Symptom burden was high. Migraine (1-year prevalence 25.2 %) occurred on average on 28 days/year but, in 38.0 % of cases (ie, 9.6 % of adults), on ≥3 days/month (≥10 % of days). All causes of headache on ≥15 days/month (prevalence 3.0 %) occurred on a mean of 245 days/year. Both these and migraine were rated severe in intensity.Participants with headache lost 4.3 % of productive time; those with migraine lost 5.8 % (equating to 1.5 % from the adult population). Lost paid worktime accounted for 40 % of this, probably detracting directly from GDP.We estimated population-level disability attributable to migraine using the disability weight from GBD2010 for the ictal state (0.433). Mean disability per person with migraine was 1.8 %, reducing the functional capacity of the entire adult population by 0.46 %.Fewer than one quarter of participants with headache had engaged with health-care services for headache in the last year. Actual expenditure on headache care was greatest among those with headache on ≥15 days/month (especially probable medication-overuse headache), but otherwise not high. Expressed willingness to pay for effective treatment for headache was higher, signalling dissatisfaction with current treatments.ConclusionsIn Karnataka State, southern India, prevalent headache disorders, especially migraine, give rise to commensurately heavy burdens. Limited access to health care fails to alleviate these. Structured headache services, with their basis in primary care, are the most efficient, effective, affordable and equitable solution. They could be implemented within the health-care infrastructure of India and are likely to be cost-saving. This solution requires political will, itself dependent on awareness.

Long-Term Outcomes in Children Diagnosed with Autism Spectrum Disorders in India

We investigated long-term outcomes in children with diagnosis of autism spectrum disorders based on Childhood Autism Rating Scale (CARS score). Information about outcomes such as speech, friendships and activities of daily living (ADLs) was collected through telephone-based interviews. Gilliam Autism Rating Scale-2 and Vineland Social Maturity Scale were used to assess level of functioning at follow-up. Parents of 80 [67 males, mean age 12 (3) years] children participated in the interview, 23 attended follow-up assessment. Sixty-four (80%) were verbal, 34 (42.5%) had need-based speech, 20 (25%) had friends and 37 (46%) had achieved age-appropriate ADLs. Median total follow-up period was 10 years. Lower disease severity, parent participation and higher maternal education were associated with better outcomes.

A magazine study of eating disorders in India: a puzzling failure?

An attempt was made to study the extent of the problem of eating disorder in Indian women using the method of placing a notice in a women's magazine and on Facebook and referring respondents to questions on a website. The method was based upon a study conducted in the UK by Fairburn and Cooper over 30 years ago. In the UK study there were many respondents. In our study there were few. The reasons for this difference are not clear.

A Novel Screening and Diagnostic Tool for Child and Adolescent Psychiatric Disorders for Telepsychiatry.

Background:A diagnostic tool designed as part of a telepsychiatry application for diagnosis and management of child and adolescent psychiatric disorders in India was developed considering the paucity of trained child psychiatrists and mental health professionals in India.Materials and Methods:The diagnostic tool consisted of screening and 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) criteria-based diagnostic algorithms for 18 psychiatric disorders seen in childhood and adolescence. Accuracy of diagnoses and feasibility of use of the tool was examined by comparing it with detailed semi-structured clinical evaluations by a qualified psychiatrist with 50 psychiatric patients (children and adolescents).Statistical Analysis:Descriptive analyses and paired t-tests were conducted to compare the mean number of diagnosis generated by the two interviews. Sensitivity, specificity, positive and negative predictive values were computed for the screening and the diagnostic sub-modules of the tool, compared to the clinical diagnoses. Kappa coefficients were computed to assess agreement between the diagnoses generated by the diagnostic sub-module and the clinical diagnoses.Results:The screening sub-module had high sensitivity, high specificity and negative predictive values for all disorders. For the diagnostic sub-module, there was moderate (kappa-0.4–0.6) to substantial agreement (kappa > 0.6) for all the disorders, (except psychosis) and high sensitivity (barring a few disorders) and specificity for almost all the disorders. Positive predictive values were found to be acceptable to high for most disorders, with consistently high negative predictive values.Conclusion:The new tool was found to be comprehensive, reasonably short and feasible. Results showed acceptable level of accuracy in diagnosis generated by the tool.