Medical Journal of Dr. D.Y. Patil Vidyapeeth

Sleep that knits up the Ravel'd sleave of care…Nature's second course…the Bard said it all Amitav Banerjee Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):187-188

Sleep assessment in psychiatry - To be awake to every possibility Suprakash Chaudhury, Adnan Kadiani Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):189-192

Chronic insomnia: A review Suprakash Chaudhury, Rakesh Kumar Singh, Dolly Kumari, Chetan Diwan, Swaleha Mujawar, Daniel Saldanha Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):193-201 Chronic insomnia is a fairly common condition affecting one-fourth of the clinical population. It has been variously defined and is related to a large number of conditions. A thorough assessment of the patient presenting with chronic insomnia is of vital importance for the treatment. Treatment consists of modifying sleep habits to reduce autonomic and cognitive factors and education about healthier sleep practice. Drug treatment should be reserved for the short-term alleviation of insomnia. Appropriate treatment of chronic insomnia improves the quality of life. The prevention of insomnia consists of a balance of rest, recreational exercise in combination with stress management and a healthy diet.

Framing a De novo curriculum on sleep disorders for an Indian medical graduate using Kern's model Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):202-206 The six-step Kern's model is used to develop a de novo curriculum and link the same to the health-care needs of the general population. The available estimated data from India suggest that the incidence of sleep disorders has increased in all the age groups. Considering the shortage of specialists dealing with sleep hygiene, at present, most of the patients either do not avail health care or are handled by some subspecialists. It is a fact that the current undergraduate curriculum offered to a medical student in India is not holistic and does not incorporate skills to identify and manage sleep disorders in all 4 years of the undergraduate course. In short, there is limited scope for an Indian medical graduate (IMG) to get sensitized about sleep medicine and thus is not competent to identify, evaluate, treat, and prevent sleep disorders. Thus, Kern's model was employed to develop a curriculum on sleep disorders which can be used for the benefit of an IMG.

Screening for sleep disorders and their medical and psychiatric comorbidities Nikhil Sanjay Mankar, Sharmishtha S Deshpande Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):207-210 Background: Sleep disorders are common in medical out-patients. They are seldom addressed despite being known to worsen overall health of patients. Detailed evaluation to differentiate these into primary sleep disorders, psychiatric and medical co-morbidity or both can be done by a liaison Psychiatrist. Managing these is necessary for providing good quality recovery for the patient. Method: Cross-sectional survey of 148 randomly selected medical out-patients in a tertiary care hospital was carried out to assess various sleep disorders. Pittsburgh sleep quality index was used for assessment. They were assessed by qualified psychiatrist to establish Psychiatric diagnosis by clinical interview as per ICD-10 classification. Co-occurrence of these with chronic medical problems as diagnosed by clinician was documented. Results: Sleep disorders were common in medical out-patients (48.64%). Commonest among them was difficulty initiating sleep and reduced duration. A significant number screened to have sleep disorders, also had psychiatric co-morbidities (63.8%), Depressive disorders being the commonest (52.1%). Chronic medical illnesses were present in 50 (33.8%) of the all patients assessed for having sleep disorders. Co-occurrence of medical and psychiatric co-morbidities was not statistically significant. Conclusion: Considering high prevalence, patients should be routinely assessed for various sleep problems by Physician and referred to Psychiatrist for management as many of them also have psychiatric co-morbidities. Physician and Psychiatrist liaison is important in managing complex medical and psychiatric co-morbidities associated with sleep disorders.

Sleep disturbance and its effect on work performance of staffs following shifting duties: A cross-sectional study in a medical college and hospital of Tripura Kaushik Nag, Anjan Datta, Nabarun Karmakar, Tamal Chakraborty, Partha Bhattacharjee Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):211-216 Introduction: Sleep disturbance among night-shift workers results in serious adverse effects on their health affecting almost all the systems of the body. Recently, the World Health Organization has also identified night-shift work as being carcinogenic to human. Objective: The main objective is to study the prevalence of sleep disturbance and its effect on work performance of health-care staff working in shifts in a Medical College Hospital of Tripura. Materials and Methods: An institution-based cross-sectional study was conducted in February 2018, among 135 staffs working in shifts, including resident doctors, intern doctors, nursing staffs, security guards, technicians, ward boys, and ward girls of the Tripura Medical College and DR. BRAM Teaching Hospital. Systematic random sampling was used to collect the required samples with a predesigned and pretested interview schedule designed based on the Pittsburgh Sleep Quality Index. Data entry and analysis were done in the Statistical Package for the Social Sciences software version 16.0 (SPSS Inc. SPSS for Windows, Chicago, Illinois, USA). Data were represented in percentages in tables and charts, and the Chi-square test was applied to find out the statistical association. Results: Of the total 135 participants, the majority (28.9%) were interns and nursing staffs and paramedical students (26.7%). The prevalence of sleep disturbance was 54% among the participants, and it was significantly higher among those residing in hostel and quarter as compared to their own home (P = 0.003). Sleep disturbance was also found to be significantly decreasing their performance at work (P < 0.001). Conclusion: This study showed the high prevalence of sleep disturbance among shift workers, which significantly hampered their work performance in this institute. To find the measures to prevent sleep disturbance among staffs having a shifting duty, further research work can be done based on the findings of the study.

A study on thyroid profile and prolactin level in hypothyroid females of a rural population of a developing country Samarjit Koner, Arunima Chaudhuri, Abhijit Biswas, Debasis Adhya, Rajarshi Ray Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):217-224 Background: In patients with primary hypothyroidism, there are increased levels of thyrotropin-releasing hormone (TRH) which can cause rise of prolactin (PRL) levels and these patients may have galactorrhea. Aims: Considering the clinical importance of hyperprolactinemia in ovulation disorders, sterility, and menstruation disorders, the present study was conducted to observe the prevalence of hyperprolactinemia and related galactorrhea in newly diagnosed hypothyroid females and correlate serum PRL level with thyroid-stimulating hormone (TSH) in hypothyroid females in a rural population of East India. Materials and Methods: This pilot study was conducted in Burdwan Medical College on 200 newly diagnosed female hypothyroid participants after taking institutional ethical clearance and informed consent of the participants. Age and gender-matched 100 controls were taken. Serum TSH, serum free thyroxine (fT4), and serum PRL levels were assessed. A questionnaire was designed for the evaluation of hypothyroidism symptoms for all the participants. These symptoms were galactorrhea, dryness of skin, feeling cold, hair loss, weakness, weight gain, constipation, loss of libido, and menstrual abnormalities. A total number of hyperprolactinemic patients were 42; out of them, 30 females were clinical and 12 were subclinical hypothyroid patients. One hundred and fifty-eight patients had normal PRL level. Results: Significant difference was found between clinical and subclinical hypothyroid females for body mass index (BMI) (P = 0.002), TSH (P < 0.0001), fT4 (P < 0.0001), and PRL (P = 0.002). The prevalence of hyperprolactinemia was 21% in hypothyroid females, 23.07% in clinical or overt hypothyroid females, and 17.14% in subclinical hypothyroid females. The prevalence of galactorrhea is 1% in all hypothyroid females and 1.53% in clinical hypothyroid females. A significant positive correlation was found between TSH and PRL in hypothyroid patients. Conclusions: Incidence of hyperprolactinemia is found to be notable in hypothyroid females including clinical and subclinical hypothyroidism, and hypothyroid females show positive correlation between TSH and PRL levels. Hence, PRL levels need to be assessed in all hypothyroid females.

Hyperprolactinemia and hypothyroidism Viroj Wiwanitkit Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):225-226

Neurological soft signs in positive and negative subtypes of schizophrenia Spandana Devabhaktuni, Daniel Saldanha, Suprakash Chaudhury, Samiksha Sahu Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):227-232 Background: Schizophrenia, a heterogeneous clinical syndrome, has fascinated researchers since times immemorial. An increasing number of studies have implicated multiple brain regions, variations in the localization, and severity of brain impairments in schizophrenic patients that could ultimately lead to unraveling the etiopathogenesis of schizophrenia. A direct, easily administered, and inexpensive way of investigating brain dysfunction in schizophrenia is the study of neurological soft signs (NSS). Aim: To document the presence of NSS in positive and negative subtypes of schizophrenia and compare them with normal controls. Materials and Methods: The study was conducted on 52 schizophrenic patients diagnosed according to the International Classification of Diseases 10 Diagnostic Criteria for Research and 52 normal controls matched for age and education. All the patients gave written informed consent. NSS were assessed using Neurological Evaluation Scale (NES). Results: The prevalence of NSS in this study was estimated to be 77%. Statistically significant correlations were observed between the negative symptom subscale of Positive and Negative Syndrome Scale and the NES scores among the patients with schizophrenia. Conclusions: The comparison of the mean NES scores among cases and controls in this study reveals a very highly significant difference between the two groups studied. This suggests that NSS are highly prevalent among patients with schizophrenia.

Handwashing practices among caregivers of children Ibrahim Aliyu, Abdulsalam Mohammed, Bashir Mariat Zubayr, Godpower Chinedu Michael, Bukar Alhaji Grema, Umar Isah Umar, Mahmud Jahun Gambo, Halima Umar Ibrahim Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(3):233-238 Introduction: Handwashing has been proven to reduce the risk of acquiring infection; this is why every 15th October is being set aside as Global Handwashing Day, which aims at improving global awareness on the importance of handwashing. Materials and Methods: The study was cross-sectional, parents/caregivers were consecutively recruited over 8 months, and pretested questionnaire was administered by the researchers and trained assistants. Results: There were 102 (32%) males and 217 (68%) females with a male-to-female ratio of 1:2.1. A total of 279 (87.5%) respondents reported that they were aware of the moments of hand hygiene. Their relations (38.3%) were the most common source of information on hand hygiene. However, soap and water (72.4%) were the predominant items used for handwashing. Furthermore, 317 (99.1%) respondents were incorrect on the steps of handwashing technique. All respondents (100%) reported washing their hands after using the restroom. However, their educational and social status had no significant relationship with their ability to mention the steps in handwashing and the critical moments in hand hygiene, respectively, (educational status: ‡Fisher's exact = 0.440; P = 1.00, and $Fisher's exact = 3.308; P = 0.282, respectively) and (social class: ‡‡Fisher's exact = 0.756; P = 1.00 and $$Fisher's exact = 1.232; P = 1.00, respectively). However, there were statistically significant relation with adhering to the principles of handwashing (educational status: †χ2 = 7.835; df = 2; P = 0.019) and (social class: ††χ2 = 7.952; df = 2; P = 0.019), respectively. Conclusion: Majority of the respondents wash their hands especially after soiling with dirt; and water and soap were mostly used; however, the technique of handwashing was poorly understood by caregivers and this was shown to be less influenced by their educational or social status.