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2006| May | Volume 60 | Issue 5
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Autism: A review for family physicians
May 2006, 60(5):205-215
Autism is a complex neurodevelopmental disorder characterized by qualitative impairments in social interaction and communication, with restricted, repetitive, stereotyped patterns of behavior, interests and activities. These behaviors manifest along a wide spectrum and commence before 36 months of age. Diagnosis of autism is made by ascertaining whether the child's specific behaviors meet the Diagnostic and Statistical Manual of Mental Disorders-IV-Revised criteria. Its etiology is still unclear but recent studies suggest that genetics plays a major role in conferring susceptibility. Recent neuroimaging research studies indicate that autism may be caused by atypical functioning in the central nervous system, particularly in the limbic system: amygdala and hippocampus. In a third of autistic children, loss of language and/or social skills occurs during the second year of life, usually between 15 and 21 months of age. Comorbidity with mental retardation, epilepsy, disruptive behaviors and learning difficulty is not uncommon. Although there is currently no known cure for autism there is evidence to suggest that early intervention therapy can improve functioning of autistic children. Judicious use of psychotropic drugs is necessary to manage associated aggression, hyperactivity, self-mutilation, temper tantrums; but drugs are not a substitute for behavioral and educational interventions. The family physician can play an important role in detecting autism early, coordinating its assessment and treatment, counseling the parents and classroom teacher, and monitoring the child's progress on a long term basis.
Preliminary screening of osteoporosis and osteopenia in urban women from Jammu using calcaneal QUS
Sudhaa Sharma, Vishal R Tandon, Annil Mahajan, Avinash Kour, Dinesh Kumar
May 2006, 60(5):183-189
Osteoporosis is a major public health problem, associated with substantial morbidity and socio-economic burden. An early detection can help in reducing the fracture rates and overall socio-economic burden in such patients.
The present study was carried out to screen the bone status (osteopenia and osteoporosis) above the age of 25 years in urban women population in this region.
MATERIALS AND METHODS:
A hospital based study was carried out in 158 women by calculating T-scores utilizing calcaneal QUS as diagnostic tool.
The result suggested that a substantial female population had oesteopenia and osteoporosis after the age of 45 years. The incidence of osteoporosis was (20.25%) and osteopenia (36.79%) with maximum number of both osteoporosis and osteopenic women recorded in the age group of (55-64 years). After the age of 65 years, there was an almost 100% incidence of either osteopenia or osteoporosis, indicating that it increases with age and in postmenopausal period, thereby suggesting lack of estrogenic activity might be responsible for this increasing trend. Religion, caste and diet had an influence on the outcome of osteopenic and osteoporosis score in present study, but still it has to be substantiated by conducting larger randomized clinical trials in future.
A substantial female population was screened for osteoporosis and osteopenia using calcaneal QUS method utilizing same WHO T score criteria that otherwise shall remain undiagnosed and face the complications and menace of osteoporosis.
Influence of years since menopause on bone mineral metabolism in South Indian women
Suresh M, Dhananjaya M Naidu
May 2006, 60(5):190-198
Although an increase of bone turnover has been documented at the time of menopause, the subsequent abnormalities of bone resorption and formation in the elder women have not been investigated.
To assess bone turnover among different YSM (years since menopause) groups of postmenopausal women.
SETTINGS AND DESIGN:
A case control study in a tertiary care hospital.
MATERIALS AND METHODS:
Forty-seven premenopausal (control) women and 257 postmenopausal women were included in this study. Based on YSM, the postmenopausal women were divided into four groups namely, 1-5 YSM (n=82), 6-10 YSM (n=77), 11-15 YSM (n=58) and >15 YSM (n=40). The levels of calcium, phosphorus, total alkaline phosphatase, FSH, LH, estradiol, intact-paratharmone and 25-hydroxy vitamin D in serum and urine levels of calcium, phosphorus and bone resorption marker calcium/creatinine(Ca/Cre) ratios were analyzed in all subjects.
STATISTICAL ANALYSIS USED:
One way ANOVA followed by Duncan's multiple range test.
Significantly increased levels of FSH (P<0.001) and declined levels of urine calcium (P=0.015) and Ca/Cre ratios (P=0.006) were observed in >15 YSM group over 1-5 and 6-10 YSM groups. An inverse correlation was observed between serum FSH levels and urine Ca/Cre ratios (r = -0.655, P<0.001) in >15 YSM group. Comparable deficient estradiol levels were observed in all YSM groups.
The risk of bone resorption is greater in early years than late years of menopause. The decreased bone resorption risk in late postmenopausal women might be due to increased FSH levels. However, further studies are required to explore this finding.
Chronic mania: An unexpectidly long episode?
Jatinder Mohan Chawla, Yatan Pal Singh Balhara, Indra Mohan, Rajesh Sagar
May 2006, 60(5):199-201
Mood disorders (unipolar and bipolar disorders) are one of the most distressing and disabling disorders known to man kind. Mood disorders may present as either a depressive phase or manic phase. Chronic mania by definition means presence of manic symptoms in excess of 2 yrs without remission. Chronic mania differs in its psychopathological presentation from the acute mania. Chronic mania also poses a diagnostic and management challenge. Along with the poor response to the treatment these patients are also likely to suffer from severe impairment in the social, familial, interpersonal and occupational functioning. These disturbances may add to the chronicity of the condition. This case underlines the significance of keeping possibility of chronic mania which has been overlooked in the recent literature.
LETTER TO EDITOR
Acute renal failure following multiple honeybee stings
Sanjay Vikrant, Ramesh Kumar Patial
May 2006, 60(5):202-204
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