Sunil Goyal

Study of prevalence of depression in adolescent students of a public school.

Background: Three to nine per cent of teenagers meet the criteria for depression at any one time, and at the end of adolescence, as many as 20% of teenagers report a lifetime prevalence of depression. Usual care by primary care physicians fails to recognize 30-50% of depressed patients. Materials and Methods: Cross-sectional one-time observational study using simple screening instruments for detecting early symptoms of depression in adolescents. Two psychological instruments were used: GHQ-12 and BDI. Also socio-demographic data (e.g. academic performance, marital harmony of parents, bullying in school, etc) was collected in a separate semi-structured performa. Statistical analysis was done with Fisher’s Exact Test using SPSS17. Results: 15.2% of school-going adolescents were found to be having evidence of distress (GHQ-12 score e14); 18.4% were depressed (BDI score e12); 5.6% students were detected to have positive scores on both the instruments. Certain factors like parental fights, beating at home and inability to cope up with studies were found to be significantly (P < 0.05) associated with higher GHQ-12 scores, indicating evidence of distress. Economic difficulty, physical punishment at school, teasing at school and parental fights were significantly (P < 0.05) associated with higher BDI scores, indicating depression. Conclusion: The study highlights the common but ignored problem of depression in adolescence. We recommend that teachers and parents be made aware of this problem with the help of school counselors so that the depressed adolescent can be identified and helped rather than suffer silently.

An Epidemiological Study of Dementia under the Aegis of Mental Health Program, Maharashtra, Pune Chapter

Background: There has been an exponential growth in the number of elderly population in India. This study aims to determine the prevalence of dementia in an urban center of Pune and to evaluate the corresponding socio-demographic correlates along with psychiatric morbidity in the study sample. Materials and Methods: The study population in Pune and Kirkee cantonments was selected based on 2001 census data. The number of people over 65 years numbered 6721 and 2145 of them were randomly selected for a door-to-door survey. They were initially administered household questionnaire and then subjected to a screening tool. Each participant underwent a brief mental state examination and data was collected on the basis of a structured proforma. Patients underwent a detailed cognitive profile using subtests from CSI-D (community screening instrument – dementia), which included a Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) word list, word fluency and delayed recall. Information pertaining to socio-demographic factors in participants and caregivers, caregiver-burden and behavioral and psychological symptoms in participants too were collected from the questionnaire. Radio imaging investigation was also carried out to quantify the deficit. Statistical Package for the Social Sciences (SPSS) software was used to compute the results. Results: Findings revealed that prevalence of dementia in the sample population of elderly aged above 65 years was 4.1%. Socio-demographic factors which conferred a statistically higher risk for dementia were identified to be older age, low socio-economic status, low level of education, presence of family history, whereas, marriage was found to be protective. Burden of care was associated with caring for elderly with dementia with increasing severity of dementia. Patients with dementia performed poorly on cognitive test battery. Social network had a protective effect in respect with severity of dementia. On magnetic resonance imaging (MRI) majority of cases of Alzheimer’s Dementia (AD) and Vascular Dementia (VaD) were noted to have both gray and white matter involvement. Conclusion: Poor awareness is a key public-health problem. Society plays an important role in the ageing process. The withdrawal of the elderly from the previous societal roles,reduction in all types of interactions i.e. shift of attention from outer world to the inner world, reduction in the power and prestige of the elderly enhance aging process. Aging in Indian culture though a disability is much stressful today in Indian culture as in others.

Psychosocial correlates of human immunodeficiency virus infected patients

Background: Reactions of people to a diagnosis of HIV and its effect on well-being vary greatly. There is paucity of Indian studies in this area. Aim: To assess the level of anxiety, depression and quality of life in HIV seropositive individuals. Materials and Methods: It was a descriptive cross-sectional study with a sample size of 50 seropositive individuals. They were assessed using a specially prepared proforma containing several questions pertaining to their demographic profile, details of HIV status and high-risk behavior, questions on family support and discrimination. In addition, all subjects were evaluated with WHO well-being index, General Health Questionnaire (GHQ), and Hospital Anxiety, and Depression Scale. Results: Anxiety was noted in 54% of the individuals whereas only 30% suffered from depression. GHQ showed psychological morbidity in 44% individuals. WHO well-being index noted poor psychological well-being in 46% of individuals. Conclusion: The high level of anxiety and depression in HIV seropositive subjects reiterates the importance of psychological counseling in HIV afflicted individuals in conjunction with suitable pharmacotherapy.

Does cerebellar flocculus size affect subjective outcomes in pediatric auditory brainstem implantation

OBJECTIVES The objectives of study was to 1) Describe relevant surgical anatomy in defining and accessing the lateral recess for placement of electrode, 2) Propose a working classification for grades of Flocculus; 3) To determine if different grades of cerebellar flocculus effects placement of ABI electrode and subjective outcomes in implantees. METHODS Our study was a prospective study, and comprised of cohort of 12 patients who underwent ABI surgery via retrosigmoid approach between 1 Jan 2012 to 31 Dec 2014. All children with congenital profound sensorineural hearing loss with either absent cochlea or cochlear nerve were included in the study. Relevant anatomy was noted. We also noted down the difficulty encountered during the placement of ABI electrode. Auditory perception and speech intelligibility was scored post operatively for 1 year. RESULTS Cerebellar flocculus was divided into 4 grades depending on the morphology of cerebellar flocculus. It was noted that Grade 3 & 4 flocculus (Group B) had difficult ABI electrode placement in comparison to Grade 1 & 2 flocculus (Group A). The subjective outcomes of Group A was better than Group B. However the p value was not statistically significant. CONCLUSION Cerebellar flocculus can be graded depending on morphology and size. Flocculus of higher grades can make the placement of ABI electrodes difficult and adversely effects the postoperative subjective outcomes.

Takayasu arteritis in pregnancy

In 1908, Mikito Takayasu, a Japanese ophthalmologist, reported the case of a 21-year-old woman with retinal arteriovenous anastomoses, syncope, and absent upper extremity pulses.1 Takayasu arteritis (TA), also known as occlusive thromboaortopathy, is a primary systemic vasculitis of unknown etiology, predominantly affecting women2 during their reproductive years (female to male ratio is 4:1). It has variable geographical distribution with the greatest prevalence in Asians, especially Japan, and the Orient. Optimal management for pregnant patients with this disease has not yet been established. Due to the manifold cardiovascular complications that can occur in the course of the disease, management of pregnancies in TA patients is a challenge for the obstetrician, the rheumatologist and the cardiologist.

Translabyrinthine approach to internal auditory meatus: A retrospective study

Background Ear and the lateral skull base surgery is challenging and yet fascinating for a Neuro-otologist. A thorough knowledge of the complex anatomy is indispensable for the surgeon in order to provide the best possible care. Methods The aim of the study was to highlight the present day indications for translabyrinthine approach to IAM from a Neuro-otologist perspective. Results There were a total of 7 patients who underwent Translabyrinthine approach at our centre. In the present study we have reported cases of Vestibular Schwannoma, Facial nerve schwannoma, Cholesteatoma involving the IAM, Menieres disease with refractory vertigo which were managed via translabyrinthine approach. We also encountered, probably the first reported case, tuberculoma of the IAM which was clinical suspected to be vestibular schwannoma. Conclusion The article presents different clinical situations where this approach can be suitably utilized and has been dealt with via a retrospective study encountered at our centre.

Audit of Bilateral Simultaneous Cochlear Implantation in Pediatric Population: South Indian Study

Objective To conduct a medical audit of bilateral simultaneous cochlear implantation (CI) in patients with severe prelingual sensorineural hearing loss (SNHL). Methods A medical audit of a tertiary care ear, nose, and throat center in Southern India was conducted on data collected from January 2007 to December 2014. All cochlear implantees <6 years of age with severe bilateral SNHL who underwent bilateral simultaneous CI were included in the present study. The exclusion criteria were children >6 years, sequential bilateral CI, revision cases, abnormal or malformed cochlea, and children with global developmental delay in milestones. Subjective outcome scores used were Category of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR). Results The CAP and SIR results showed that 20% of implantees achieved peak scores of 7 and 5, respectively. Mean CAP and SIR scores at 12 months were 5.4 and 3.1, respectively. Conclusion The present study supports the claim that bilateral CI in severe prelingual bilateral SNHL is better than unilateral and recommends that bilateral CI should be the standard of care in children.

Outcomes of Cochlear Implantation in Auditory Neuropathy Spectrum Disorder and the Role of Cortical Auditory Evoked Potentials in Benefit Evaluation

Objective To compare the outcomes of cochlear implantation (CI) in children with auditory neuropathy spectrum disorder (ANSD) and age-matched controls with profound sensorineural hearing loss, using categories of auditory performance (CAP), speech intelligibility rate (SIR), meaningful auditory integration scale (MAIS), and meaningful use of speech scale (MUSS), and to determine the role of Cortical Auditory Evoked Potentials (CAEP) in benefit evaluation after CI. Methods Ten patients (8 males and two females) with ANSD who underwent CI were included in the study. Auditory and speech scores were compared between baseline and after 12 months of habilitation in children with ANSD. Post CI speech scores in children with ANSD were compared with the control group (age-matched children with profound sensorineural hearing loss) at 12 months of habilitation. P1 latency of CAEP has a good correlation with auditory and speech scores in children with ANSD in the study group. Results Significant benefits were seen in children with ANSD who underwent CI compared to the baseline CAP and SIR scores and one year after habilitation. There is no statistically significant difference in outcomes between the two groups with CI (ANSD and profound sensorineural hearing loss) (p-value: CAP=1.00, SIR=0.84, MAIS=0.33, MUSS=0.08). Speech perception in noise test (SPIN) scores in children with ANSD were 63% and 80% with 0 dB signal noise ratio (SNR) and +10dB SNR, respectively. P1 wave of CAEP has a good correlation with the subjective outcomes. Conclusion CI in children with ANSD has showed benefits comparable to children with profound sensorineural hearing loss. CAEP is a useful tool in objectively assessing cortical maturity in children with ANSD following CI.

COCHLEAR IMPLANTATION IN PATIENTS WITH RENAL DYSFUNCTION

Background: Cochlear implantation is a safe surgery for restoration of hearing in severe to profound cochlear hearing loss candidates. Patients with congenital cochlear hearing loss may at times have renal anomalies. Renal dysfunction can contribute to sensorineural hearing loss, and it can affect cochlear implantation in a variety of ways, from minor intraoperative issues to major life-threatening complications. Our study aimed to determine the prevalence of renal association encountered in cochlear implantees over a period of 15 years (Jan 2000–Dec 2014) at our centre; secondly to classify these renal associations, as this has an effect on management; and finally to suggest a protocol for perioperative management of cochlear implantees with renal comorbidity. Material and methods: This is a retrospective study of 1000 consecutive patients who underwent cochlear implantation at the Madras ENT Research Foundation (Chennai) over the period Jan 2000–Dec 2014. All cochlear implantees with bilateral severe to profound cochlear hearing loss and associated renal associations were included. The data for our study were collected from nephrologist referral forms and medical records. The paper gives a nephrologist’s perspective on perioperative care to be given during cochlear implantation. Relevant literature is reviewed. Results: Overall prevalence of renal disease was 6 out of 1000 implantees (0.6%) in our series. We classify the associated renal associations in cochlear implant candidates into 4 categories, and appropriate management for them is described. Conclusions: A protocol for evaluating renal associations as they affect cochlear implantation has been designed, and the optimal management of these issues has been discussed.

Changes in response characteristics of cortical auditory evoked potentials in bilateral cochlear implantees

Background: Cochlear implants (CIs) represents the most successful intervention to restore hearing in profoundly hearing impaired children and adults. An objective measures such as cortical auditory evoked potentials (CAEPs) would provide more insights to the auditory process involved in post implantation. Aim of the study was to profile the change in response characteristics of CAEPs in simultaneous binaural cochlear implantees. Objective was to measure change in latency and amplitude in monoaural and binaural condition for speech stimulus with change in intensities. Methods: Ours study is an observational retrospective study done at a tertiary ENT referral centre in south India, between Jan 2014 to Dec 2015. Out of total 15 patients with bilateral cochlear implantation, 7 consecutive bilateral simultaneous cochlear implantees with chronological age between 2-6 years were included in the study. Only pre-lingual congenital hearing loss children with no syndromic associations and normal cochlear anatomy were included while, peri-lingual, post-lingual children and children with sequential bilateral implantation were excluded from the study. Results: Amplitude of P1 was higher for binaural stimulation compared to monoaural stimulation. Latency of P1 was smaller for binaural compared to monoaural stimulus. In monaural stimulation the latency of P1 was smaller in right ear compared to left ear. However the difference between the right ear, left ear and binaural conditions were not statistically significant. Ours is a preliminary study and more bilateral implantees will be included in future studies to give more power to the study. Conclusions: We suggest that CAEPs can be used as a useful objective tool for assessment of post CI outcome.