Shailja Sharma

Cognitive impairment among persons of rural background living with human immunodeficiency virus infection on antiretroviral therapy: A study from a tertiary care centre of North India

Journal of Neurosciences in Rural Practice ¦ Volume 7 ¦ Supplement 1 ¦ December 2016 NF1 is a common, genetically transmitted neurodevelopmental disorder with a high potential cause of subcortical focal brain lesions. Neurologic problems in NF1 vary and include malignant brain tumors, cognitive and attention deficits, headaches, and seizures.[1] Previous reports have estimated that seizures occur in approximately 4%–7% of individuals with NF1.[3] AHC is a rare clinical picture that can manifest before the age of 4 years and presents dystonic movements and nystagmus as well as progressive intellectual and motor impairment. These episodes can last from a few minutes to some days. Most cases are sporadic. Its incidence is reported to be around one in 1 million children.[4] In addition, half of the children with AHC may have epilepsy, and these seizures are usually quite distinct from AHC attacks in their manifestations although they may occur simultaneously.[4] If an EEG is recorded during the seizure, it usually shows an appropriate abnormality, but between seizures the EEG is normal. We detected normal ictal EEG during her attack. In addition, her former repeat EEG was also normal.

Malnutrition as a cause of mental retardation: A population-based study from Sub-Himalayan India

Background: Mental retardation is one of the most common disabilities of childhood. The research on childhood malnutrition and its relationship with cognitive functioning suggests that malnutrition alone does not cause mental retardation. Objective: To identify the relation between malnutrition and cognition among children from a Sub-Himalayan state in North India. Materials and Methods: A two-phase cross-sectional study was conducted in the rural, urban, and slum area of district Kangra. A 30-cluster sampling technique was used to screen a population of children 1–10 years of age from five randomly selected panchayats (village government units) of district Kangra. The screening was based on a modified version of the ten questions screen, adapted to the local population. In the first phase, a door-to-door survey was done to identify suspects of mental retardation. In the second phase, the children found positive in the first phase were called for clinical examination to confirm mental retardation. Anthropometric assessment of all study children was done by measuring weight and height. The nutritional assessment was done by categorizing them according to Waterlow classification for malnutrition. Results: Out of the total 5300 children, 1.7% were diagnosed as mentally retarded. No positive association was reported with different types of malnutrition and mental retardation. A weakly positive association existed between nutritional status and mental retardation (correlation coefficient-0.04). Children who were both wasted and stunted had the highest risk (odds ratio, 95% confidence interval - 5.57, 2.29–10.36) of mental retardation as compared to normal. Conclusion: Malnutrition may be one of the causes but certainly not the only cause of mental retardation. Other causes may be contributing more significantly toward it.

Prevalence of mental retardation in urban and rural populations of the goiter zone in Northwest India

Background: The existence of an endemic goiter belt along the southern slopes of the Himalayas has been known for a long time. Prevalence of neonatal hypothyroidism is high and there has been little work on the prevalence of mental retardation in this part of India. Objective: The study was conducted with the aim to know the prevalence of mental retardation in the urban and rural populations of Himachal Pradesh, India and to generate a hypothesis on the differential distribution (geographical) of mental retardation. Methods: This cross-sectional study was conducted in the rural and urban areas of the district of Kangra, Himachal Pradesh, India among children of 1-10 years of age. In the first phase, the children in the age group of 1-10 years were screened for mental retardation using the Ten Questions Screen, whereas in the second phase the suspects were evaluated clinically. Results: The prevalence of mental retardation was found to be 1.71% in the study population with higher prevalence (3.3%) in the 73-120 months age group. The prevalence was higher among the males in all study populations [rural: 1.9%, urban (nonslum): 1.6%, and urban slum: 7.14%). The prevalence was similar among the urban (nonslum) (1.75%) and rural (1.11%) populations, whereas it was higher (4%) in the urban slum population. A prevalence of 2% was seen in families from the lower middle class and 1.8% among families from the lower class in the rural population, whereas a prevalence of 2% was seen among lower middle class families of urban (nonslum) areas. Conclusion: The prevalence of mental retardation was higher in our study than in other parts of the country. The study concludes with the hypothesis that the prevalence of mental retardation is differentially distributed geographically with socioeconomic factors being important predictors.

Socio demography of mental retardation: A community-based study from a goitre zone in rural sub-Himalayan India

Introduction: Mental retardation is one of the most common disabilities of childhood which can be prevented by timely identification of the causative agent and an adequate management accordingly. District Kangra lies in the sub-Himalayan belt and forms a part of the 2400 km long goitre belt along the southern slopes of the Himalayas. Objective: To study the prevalence of mental retardation among children (1–10) years of age. Materials and Methods: A two-phase cross-sectional study was conducted in the rural area of district Kangra. A 30-cluster sampling technique was used to screen a population of children 1–10 years of age from five randomly selected panchayats (village government units) of district Kangra. The screening was based on a modified version of the ten questions screen, adapted to the local population. In the first phase a door to door survey was done to identify suspects of mental retardation. In the second phase, the children found positive in the first phase were called for examination by the pediatrician to confirm mental retardation. Results: A total of 2420 children were screened in the first phase of which 95 tested positive. About 52 of these children were found to be mentally retarded in the second phase giving a prevalence of 2.15%. The 69% of these children belonged to the lower middle class and 28.3% belonged to middle class families using the Uday Parekh scale for assessment of the socio-economic status. Conclusion: Prevalence of mental retardation is high in district Kangra of Himachal Pradesh in comparison to other states of India. This could be attributed to the good primary health care in Himachal Pradesh where institutional deliveries are about 70%. This may have led to better survival of children with congenital disorders and those that suffer perinatal trauma.

Predictors of Tobacco Use among Youth in India: GATS 2009-2010 Survey.

BACKGROUND Tobacco use among youth in India is an increasingly rising burden. It is affected by various socio-demographic factors, which form predictors of use. Focus on these predictors can help policy makers in curbing the major morbidity and mortality due to tobacco among youth. OBJECTIVE To study the various socio- demographic variables associated with tobacco use among youth in India. MATERIALS AND METHODS The study was a secondary analysis of data from the Global Adult Tobacco Survey, India 2009-10, in the age group of 15-24 years. Predictors of smoking and smokeless tobacco were analysed using data on occupation, education, and other sociodemographic factors place of living. Epi Info used for conducting the analysis. RESULTS The total population interviewed in GATS India -2010 was 69,926. Of these the youth population between 15- 24. The total number of tobacco users (smokers and smokeless) was 2,969 (22.%). There were 11 (3.05%) dual users. Smokeless form of tobacco (15.1%) was used more than smoked form among youth. Males and urban youth preferred smoked form of tobacco over smokeless form. Smoking among youth had an inverse relation with increasing education level. Majority of smokeless form of tobacco users and dual users belonged to poor economic classes. CONCLUSIONS This productive age group is more susceptible to tobacco addiction, especially smokeless tobacco. Rural youth, students, female sex and poor socio-economic strata prefer smokeless whereas urban, male and lesser educated youth preferred smoked form of tobacco. Efforts should be directed towards discouraging tobacco use initiation among the young population in India.

Utility of Consensus Statement in Assessment of Obesity: A Study among Undergraduate Medical Students from Rural Northwest India.

Introduction: In India, obesity is emerging as an important health problem particularly in the urban areas, paradoxically coexisting with under nutrition. Almost 30-65% of adult Indians are either overweight or obese or have abdominal obesity. Materials and Methods: A cross-sectional study design was used to assess the prevalence of obesity among undergraduate medical using consensus statement for obesity in India. Results: The results of the body mass index (BMI) calculations show 26 females and 4 males (29.79% of total students) with a BMI of <18 kg/m2 as underweight, whereas 13 boys and 4 girls (15.54% of total students) as obese with a BMI of 25 kg/m2 and above. A total of 18 boys and 6 girls (21.26% of total students) were overweight with a BMI between 23 and 24.9 kg/m2. Discussion: It is estimated that by application of these guidelines, additional 10-15% of Indian population would be labeled as obese or overweight. We see this very clearly in our study, where we see an increase of 14.53% of students classified as obese and 5.93% students as overweight on using the guidelines of the consensus statement.

Inequality in the immunization schedules of different states of the same Country: Are we aware?

With Universal Immunization Programme in India incorporating newer vaccines, the immunization schedule has been changing rapidly, varying from one state to another. The number of diseases being protected against has increased from 6 to 14 in the past few years. The immunization schedules of the states of Delhi, Himachal Pradesh, and Haryana were compared among themselves and also with the schedule recommended by the Indian Academy of Pediatrics. Variations were observed. The migrants, service providers, and those users switching between private and public sector many a time are affected due to this variation among the immunization schedules.