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Objectives: Despite the inclusion of hoarding disorder (HD) in the DSM-5, there is little epidemiological data on hoarding from low and middle-income countries. This study, the first from India, examines the prevalence and correlates of HD among primary care patients in the state of Kerala, India. Methods: To assess correlates, the Hoarding Rating Scale-Interview (HRS-I) and other structured instruments were administered to 7,555 subjects selected by stratified random sampling from 71 primary health centers. Results: The prevalence of HD was 1.02% (95%CI 0.8-1.3). Those with HD were more likely to be older and live alone. In the binary logistic regression analysis, after controlling for significant sociodemographic variables, subjects with HD had a higher odds of reporting chronic illness, depression, anxiety disorder, alcohol abuse, and tobacco dependence. Subjects with HD had significantly higher disability scores than unaffected individuals. Conclusion: Although HD is not uncommon in India, this disorder is rarely reported in specialty settings in India, which suggests that awareness and detection should be improved, considering the co-occurring negative correlates and disability among affected individuals.

Arteriovenous malformation (AVM) is defined as a convolute of abnormally connected arteries and veins, where the capillary bed is missing. Intracranial cerebral AVMs are 20 times more common than extracerebral. Focal lingual artery AVMs, especially at carotid bifurcation are rarely reported in the literature. Magnetic resonance imaging, angiography, digital subtraction angiography are the current modalities of diagnosis. Surgical resection can be an effective treatment for vascular malformation; however, the potential for large volume blood loss poses a challenge. In addition, the inability to identify the surgical margins of the nidus can result in recurrence. Present case was diagnosed based on radiological imaging as lingual AVM at the bifurcation of carotid artery. The paper discusses the case of a AVM of the tongue in a 23-year-old female patient at the level of carotid bifurcation. The paper further discusses the various imaging modalities used to diagnose the condition and review the latest literature on the current management concepts. Utmost care needs to be exercised when AVMs are suspected. Radiological investigations are must to know the location and extent of the lesion before attempting surgical intervention like biopsy or excision, which poses life-threatening complications like massive hemorrhage and damage to vital structures.

Objectives: To study the prevalence of chronic perinatal pain among mothers who had infants between the ages of 13–25 months in the State of Kerala, India and to report its correlates in the socio-...

Objectives To study the prevalence and clinical correlates of insomnia among a sample of primary care attendees, in the state of Kerala, India. Design Cross-sectional survey. Setting Primary care. Participants 7017 adult patients [18–60 years] attending 71 primary health centers selected by cluster random sampling. Measurements Patients were assessed for insomnia using the Insomnia Severity Index. In addition to self-reported socio-demographic and chronic medical illness details, structured instruments were used to assess for mental disorders, disability and life satisfaction. Results Subclinical insomnia and clinical insomnia were reported by 17.7% and 4.7% subjects, respectively. Subjects with subclinical and clinical insomnia when compared to those without insomnia had higher odds of having older age, female gender, urban background, lower education, chronic medical and mental disorders, greater disability and poor life satisfaction. Subjects with clinical insomnia when compared to the subclinical group had higher odds of having older age, urban background, lower education, mental disorders and greater disability. Among mental disorders, depressive disorder was correlated with both clinical and subclinical insomnia. Conclusions Clinical and subclinical insomnia is common among primary care attendees and both are associated with significant morbidity. This study highlights that it is a major public health concern, albeit neglected, which needs to be dealt as a priority.

Background: Laryngopharyngeal reflux is known to be associated with multiple disease of the upper aero digestive tract and can cause serious injury to the mucosa long term.Methods: Patients diagnosed with chronic tonsillitis and indicated for surgery were evaluated for laryngopharyngeal reflux using reflux symptom index score. When score greater than 13 was suggestive of laryngopharyngeal reflux (LPR) and counselled for 24 hours ambulatory dual probe pH monitoring. When the reflux event was 7 or more were diagnosed having LPR. Patients were divided into two groups Group A patients with chronic tonsillitis and without LPR and Group B patients with chronic tonsillitis and LPR. Postoperatively there slough percentage was calculated as 25%, 50%, 75%, 100% on the postoperative day (POD) 7, 14 and 21. Slough clearance rates were calculated as 100- slough percentage. Results: There were 40 patients in Group A and 40 patients in Group B. The slough clearance rates of Group A were 46.3, 73.8 and 96.9 on post-operative days 7, 14, 21 respectively. The slough clearance rates of Group B were 30.1, 57.6, 90.1 on POD 7, 14, 21 respectively. The p values comparing slough clearance rates showed 0.00, 0.002, 0.013 on POD 7, 14, 21 which was statistically significant. Group B with laryngopharyngeal reflux had delayed healing than Group A.Conclusions: Laryngopharyngeal reflux seems to adversely affect healing and complication following tonsillectomy due to lowering of slough clearance rates. Hence we recommend the need for assessment and treatment pre/post operatively of laryngopharyngeal reflux disease in adult patients undergoing tonsillectomy.

Background: Laryngopharyngeal reflux disease is an under diagnosed condition due to unavailability of the diagnostic tool that is dual probe pH monitoring and is on the rise in adult population according to El Serag by 4% every year since 1976.Methods: Adult patients coming to the outpatient department between April 2017 to April 2018 were evaluated using reflux symptom index score (RSI). Score greater than 13 were suggestive of laryngopharyngeal reflux and patients underwent 24 hours ambulatory dual probe pH monitoring. 7 or more reflux events in study period were diagnostic of laryngopharygeal reflux. Results: 3000 adult patients were screened for RSI and 1756 (58.3%) had scored greater than 13. Among these patients 893 patients had 7 or more reflux events in pH monitoring. We found a prevalence of 29.76% in our study population.Conclusions: Prevalence laryngopharyngeal reflux disease needs to assess periodically at regular intervals to create more awareness of the disease and patient education thus preventing from causing chronic illnesses.

Aim:To assess the role of red cell distribution width as a marker to predict tumor burden in gallbladder cancer (GBC).Methods:One hundred and twenty-eight patients with newly diagnosed GBC were included in the study. Peripheral blood samples were obtained, and red cell distribution width (RDW) was assessed. Tumor markers and other biochemical parameters were also recorded.Statistical Analysis: Quantitative variables were summarized using mean and standard deviation or median and interquartile range based on the normality of the distribution. The association of RDW with stage of tumor was analyzed using Chi-square test. All statistical tests were interpreted for significance using a cutoff value of P< 0.05.Results:RDW showed a positive correlation with total bilirubin, total leukocyte count, and erythrocyte sedimentation rate (P< 0.002), but not with platelet count (P< 0.643). RDW showed a significant correlation with tumor markers CA 19-9 (P< 0.003), carcinoembryonic antigen (P< 0.003), and CA 125 (P< 0.002). In Stage IVB, there were significantly more patients with high RDW (78%) than normal RDW (21.8%). However, the results were not statistically significant (P< 0.073).Conclusion:In the present study, we have utilized RDW for correlation with tumor markers in carcinoma gallbladder and as a predictor of stage. We demonstrated higher levels of RDW with advanced stages of GBC. Overall, the study suggested that RDW may be utilized as a surrogate biomarker to predict tumor burden and disease in patients with GBC.

Answers on p 110. A previously healthy 47 year old driver presented with a six week history of headache, vomiting, tiredness, and unsteadiness of feet. Examination revealed marked pallor, the pulse was regular at 97 beats/min, blood pressure was raised at 180/116 mm Hg, and the minimental test score was 6/10. The cranial nerves were normal, as was his power in all four limbs. Bulk and tone were normal, but all the deep tendon reflexes were brisk. Sensation were …