Objective: This case report highlights Wilson's disease, a rare genetic disorder involving the liver and brain presenting clinically with psychiatric symptoms as the first manifestation. Method: We present two cases of Wilson’s disease who had the typical symptoms of Schizophrenia and Bipolar mood disorder (mania) respectively. Results: Wilson disease first presentation of psychiatric diagnosis may obscure the diagnosis who later on turned out to be suffering from Wilson’s disease. Conclusion: Although such patients are more commonly seen in neurological and hepatological settings, mental health professionals must keep in mind a high level of suspicion, once first presentations may be of psychiatric nature.

A cross-sectional study was conducted with the aim to explore the present status of birth preparedness and complication readiness in rural area of West Bengal and determine the possible factor(s) influencing their knowledge and practice regarding this concern. Thirty villages with homogenous characteristics were identified by cluster sampling methods from a rural block (Bhatar, Burdwan district, West Bengal) of India on April 2013 to November 2013. From every cluster 7 mothers who had delivered baby within the last year and were available first, interviewed consecutively using a guided questionnaire adapted from JHPIEGO Maternal and Neonatal Health Programme survey tools. Multivariate logistic regression was applied in analysis to predict how much the independent variables influenced the birth preparedness of mothers. 62.4% mothers were found to be well prepared. Trained birth attendants and health facilities were identified before delivery in 81.9% and 78.1% cases respectively. Mode of transportation for complication management or delivery was pre-decided by about 60% of family. Only 35.7% family saved money for the same purpose. Logistic regression revealed that well preparedness increased 11 times with every new pregnancy, but it did not depend on caste and education status of the mothers. The overall birth preparedness status of the rural mothers is poor and they acquire more knowledge regarding birth preparedness from their self experience rather than from existing health system. ​
Parturition ; Rural Population ; India

p style=text-align: justify;strongOBJECTIVES:/strong To assess effects of type 3 thyroplasty on outcomes of voice quality in puberphonia.METHODS:br /Design:/strong Prospective cohortbr /strongSetting:/strong Tertiary Referral Hospitalbr /strongParticipants:/strong Six patients with puberphonia who failed voice therapy, aged 16-25 years, who consulted at the ENT Outpatient department between September 2010 and September 2012, underwent type 3 thyroplasty.Pre-operative and 6-month post-operative voice analysis by voice recordings, Voice Handicap Index (VHI), GRBAS score and real time acoustic analysis (perturbation) using Dr Speech software (University version 4.0, Voice Tech Corporation, USA [Tiger Electronics] with habitual fundamental frequency (FO), jitter % and shimmer % as parameters were performed.Results: Mean pre-operative VHI and GRBAS scores were 53 and 75.67, respectively, whereas post-operative scores were 29 and 25.00, respectively. (P-value for VHI was 0.004 and that of GRBAS was 0.00). On acoustic analysis, mean pre-operative habitual fundamental frequency (FO), jitter % and shimmer % was 245.82 Hz, 0.21 and 2.34, respectively, whereas post-operative mean was 140.78 Hz (P=0.00), 0.19 (P=0.04) and 1.52 (P=0.00), respectively.Conclusion: The mainstay of treatment of puberphonia is voice therapy. Thyroplasty provides a suitable management option in those cases who fail to respond by voice therapy./p
Human ; Male ; Adult ; Young Adult ; Adolescent ; Laryngoplasty ; Surgical Procedures, Operative ; Voice Quality ; treatment

INTRODUCTIONThe introduction of highly active antiretroviral therapy (HAART) for the treatment of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) has led to the reduction of mortality and the improvement of the quality of life of people living with HIV/AIDS (PLWHA). The present study was conducted to determine the pattern of adherence to HAART among PLWHA, and to assess the factor(s) affecting nonadherence, if any.

METHODSThis study was a hospital-based analytical, cross-sectional epidemiological study conducted between July and October 2011. A total of 370 adult HIV-positive patients registered in the Antiretroviral Therapy Centre of Burdwan Medical College and Hospital, West Bengal, India, were included. Nonadherence was defined as missing at least a single dose of medicine within the last four days. Data was analysed using the Statistical Package for the Social Sciences version 19.0 (IBM Corp, Armonk, NY, USA).

RESULTSA total of 87.6% of patients were found to be adherent to HAART. Principal causes of nonadherence were forgetting to take medicine (70.2%), being away from home (65.2%), and busyness with other things (64.7%). Multivariate logistic regression analysis revealed that nonadherence was significantly associated with a positive family history of HIV/AIDS (odds ratio [OR] 16; 95% confidence interval [CI] 2.2-114.3; p = 0.01), occurrence of side effects with HAART (OR 9.81; 95% CI 1.9-51.7; p = 0.01) and employment (OR 5.93; 95% CI 1.5-23.2; p = 0.01).

CONCLUSIONAlthough overall adherence was high, the factors that affect nonadherence can be addressed with proper counselling and motivation of patients and their family members. Adherence to HAART could delay the progression of this lethal disease and minimise the risk of developing drug resistance.

Acquired Immunodeficiency Syndrome ; drug therapy ; Adolescent ; Adult ; Antiretroviral Therapy, Highly Active ; methods ; Cross-Sectional Studies ; Drug Resistance ; Female ; HIV Infections ; drug therapy ; Humans ; India ; Male ; Medication Adherence ; Middle Aged ; Odds Ratio ; Quality of Life ; Risk Factors ; Surveys and Questionnaires ; Tertiary Care Centers ; Young Adult

Introduction: Vitamin D deficiency and frequent infections are the two common worldwide phenomenon among elderly. Recent studies have demonstrated that vitamin D regulates the expression of specific endogenous antimicrobial peptides like cathelicidin LL-37 of macrophages and neutrophils, which is active against a broad spectrum of infectious agents. Therefore, the objective of the present study was to determine the level of cathelicidin LL-37 in macrophages of elderly women (classified according to serum 25(OH)D level) after exposure to Vibrio cholera infection and to find out the effect of 1,25(OH)2D added in vitro. Methods: This study was conducted among 40 randomly selected rural elderly women aged between 60 to 70 years of age. Their vitamin D status was assessed by the estimation of serum 25(OH)D and classified into three groups viz. sufficient (14 members), insufficient (13 members), and deficient (13 members). Later, their peripheral blood mononuclear cells (PBMC) were isolated and cultured from fresh blood. 1,25(OH)2D supplementation was given selectively at a dose of 10 ×10-8 M for 72 hours in the culture media; then exposed to infection and screened according to the objectives of this study. Results: Macrophages in all groups, except vitamin D deficient group, responded significantly in terms of LL-37 release during exposure to Vibrio cholera infection. Considering in vitro 1,25(OH)2D, supplementation responded significantly (p<0.05) in all three groups. Conclusion: Vitamin D can be used as a prophylaxis to enhance cathelicidin LL-37 release for all three groups as in the present study.

OBJECTIVE: To report the first case of primary bilateral antro-choanal polyps in the elderly age group.

METHODS:
Design: Case report
Setting: Tertiary Government Hospital
Patient: One
Result: A 60-year-old, non-allergic female with progressive bilateral nasal obstruction was subsequently diagnosed with bilateral antro-choanal polyps. Endoscopic sinus surgery was performed and the patient remained asymptomatic on one year follow-up.

Conclusion: Antro-choanal polyps can occur bilaterally in the elderly age group. To the best of our knowledge, this is the first reported case of primary bilateral antro-choanal polyps in an elderly female.

Human ; Female ; Middle Aged ; Polyps-diagnosis ; Nasal Obstruction ; General Surgery