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Transcatheter sinus venosus defect (SVD) closure with covered stents is emerging as an alternative to surgery. An adequate anchor zone in the superior vena cava is mandatory for the stability of the covered stent to prevent caudal embolization. There is a potential risk of innominate vein occlusion by the fabric of the covered stent in patients with a very short superior caval vein. Three among a total of 105 patients who underwent SVD closure at our institution developed innominate vein occlusion. Predisposing anatomical factors, identification and management of occluded innominate vein, and follow-up outcomes are discussed., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Annals of Pediatric Cardiology.)

Background: Device closure of multiple atrial septal defects (MASDs) is frequently done using a single centrally deployed septal or cribriform occluder, but multiple devices are needed for large defects separated more than 6 mm. There is a concern about complications while using multiple devices, especially in children., Methods: Patients who received multiple devices for closure of MASD were grouped according to their age and analyzed for procedural techniques, immediate and late complications. MASDs closed by a single device were not included. Balloon sizing was done when echocardiographic images were suboptimal before simultaneous device deployment through two venous accesses or sequential deployment through one access. Duration and number of antiplatelet drugs and residual flows were analyzed on follow-up., Results: Twenty-five patients received multiple devices. Balloon interrogation was performed in 16/18 adults but only in 2/7 children. Device size was 2-5 mm larger than echocardiographic defect size or equal to balloon waist. There were no procedural failures; 7/25 showed small postprocedural residual flows. Complications including embolization in one, arrhythmia in one, and cobra deformity in two were managed successfully. On a median follow-up of 5.5 years (1-12 years), residual flows disappeared in 4/7 and there were no major late complications., Conclusions: Use of multiple devices for closing MASD is feasible with good technical success. Echocardiography and balloon interrogation are the keys for success. Simultaneous deployment is often needed and sequential delivery is feasible rarely if the defects are far apart. Minor residual leaks are common but improve on follow-up. There are no significant new complications on long-term follow-up., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Annals of Pediatric Cardiology.)

Objectives: The objective of this study is to analyze the antiproliferative activity of Acacia nilotica (L.) leaf ethanolic extract against cancer KB cells and to determine the mode of cancer cytotoxicity., Materials and Methods: In this study, high-performance liquid chromatography and liquid chromatography-mass spectrometry analysis were done to confirm the presence of ethyl gallate as a major bioactive phenolic in the leaf ethanolic extract of A. nilotica, further dose-dependent (0-120 μg/mL) antiproliferative effect was investigated in human carcinoma cell line KB. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, reactive oxygen species, mitochondrial membrane potential loss, DNA damage, and apoptosis were evaluated., Results: A. nilotica leaf ethanolic extract (ANLEE) showed effective concentration (EC 50 ) of 40 μg/mL. Interference of growth was significantly (P < 0.05) high in KB cells treated with ANLEE when compared to untreated control, but less when compared to the reference drug paclitaxel. In addition, the in vivo acute toxicity study demonstrated the safe limit of administration of 2000 mg/kg body weight ANLEE by the histological analysis in rats. The results from the present study indicate that mitochondria and DNA of KB cells are severely affected leading to apoptosis., Conclusions: ANLEE is a prospective source for cancer therapy and therefore should be highlighted to explore on its wide range of safety in rats and efficacy against human carcinoma cell line KB., Competing Interests: None

Background: Common mental disorders, such as mood, anxiety, and substance use disorders, are significant contributors to disability globally, including India. Available research is, however, limited by methodological issues and heterogeneities., Aim: The present paper focuses on the 12-month prevalence and 12-month treatment for anxiety, mood, and substance use disorders in India., Materials and Methods: As part of the World Health Organization World Mental Health (WMH) Survey Initiative, in India, the study was conducted at eleven sites. However, the current study focuses on the household sample of 24,371 adults (≥18 years) of eight districts of different states, covering rural and urban areas. Respondents were interviewed face-to-face using the WMH Composite International Diagnostic Interview after translation and country-specific adaptations. Diagnoses were generated as per the International Classification of Diseases, 10 th edition, Diagnostic Criteria for Research., Results: Nearly 49.3% of the sample included males. The 12-month prevalence of common mental disorders was 5.52% - anxiety disorders (3.41%), mood disorders (1.44%), and substance use disorders (1.18%). Females had a relatively higher prevalence of anxiety and mood disorders, and lower prevalence of substance use disorders than males. The 12-month treatment for people with common mental disorders was 5.09% (range 1.66%-11.55% for individual disorders). The survey revealed a huge treatment gap of 95%, with only 5 out of 100 individuals with common mental disorders receiving any treatment over the past year., Conclusion: The survey provides valuable data to understand the mental health needs and treatment gaps in the Indian population. Despite the 12-month prevalence study being restricted to selected mental disorders, these estimates are likely to be conservative due to under-reporting or inadequate detection due to cultural factors., Competing Interests: There are no conflicts of interest.

Background: Clozapine has been shown to be superior to chlorpromazine in improving the positive and negative symptoms of schizophrenia. However, technical experience with clozapine in Indian patients has not been documented., Aim: To assess the improvement in psychopathology of treatment-resistant schizophrenia with clozapine therapy and to study the relationship between sociodemographic and various psychopathology variables among patients with treatment-resistant schizophrenia., Methods: Twenty-two patients with treatment-resistant schizophrenia were evaluated using the Positive and Negative Syndrome Scale (PANSS) for schizophrenia, Calgary Depression Scale, Global Assessment of Functioning (GAF) Scale and Abnormal Involuntary Movement Scale (AIMS). These scales were used to determine the level of psychopathology, depression, overall functioning and severity of abnormal involuntary movements in the patients. The patients were admitted to the hospital for a short time to initiate clozapine therapy. At discharge, patients were stabilized on 300-400 mg/day of clozapine. The patients were re-evaluated after 20 months., Results: The study group showed better global functioning after clozapine therapy. The therapy was well-tolerated though moderate side-effects were seen. Suicidal thoughts declined with clozapine therapy. There was a significant reduction in the negative symptom and general psychopathology scores of PANSS., Conclusion: Clozapine has therapeutic efficacy in some but not all treatment-resistant patients with schizophrenia.

A male patient with homosexual obsession in obsessive compulsive disorder shows a better outcome following a combination of pharmacotherapy and psychotherapy. This case report emphasizes the importance of combination therapy in obsessive compulsive disorder with abnormal sexual impulses and behavior.

The aim of the study was to determine the prevalence of psychiatric and personality disorders in survivors following their first suicide attempt. Three hundred and fortyone survivors who received treatment from the various medical wards of a general hospital participated in the study. ICDIO psychiatric disorders were diagnosed in 47.2% of the cases. The most common diagnosis was depressive episode (31 %). Only 7 % qualified for a diagnosis of personality disorder. A significant proportion of patients (52..8%) did not suffer from any identifiable ICD- 10 psychiatric disorder.

25 inpatients with schizophrenia were examined to explore the relationship between insight and psychopathology and illness severity over a four-week period. The average degree of insight improved irrespective of the type of recovery. There was no consistent relationship between the changes in insight and changes in psychopathology. The severity of mental illness and awareness of mental disorder showed a semi-independent pattern of association. It is concluded that insight operates to some extent independent of psychopathology and severity of illness.

Families caring for a member with a chronic severe mental illness like schizophrenia have to cope with a lot of burden and distress. The coping styles used by these families and their relationship to burden has not been studied in Indian families. This study aims to identify the coping styles adopted by the relatives of schizophrenic patients. 44 patients with schizophrenia and 44 relatives from an outpatient psychiatric clinic were assessed. Resignation, an emotion-focussed coping strategy, was found to be more commonly employed by the relatives, than other strategies. Majority of the relatives failed to maintain social contacts. Levels of burden and negative symptoms correlated significantly with the resignation strategy. Analysis of the coping strategies of the relatives is essential before clinical interventions with families are planned to improve the coping skills of the carers.

This paper highlights the characteristics of 800 alcohol-dependent patients treated at a drug de-addiction centre, over a period of 5 years. The mean score on SADD (severity of alcohol dependence data) questionnaire was 23.95, which indicates a severe level of dependence. Followup analysis of 607 cases showed that 379 (62.4%) patients had not utilised the follow-up services beyond one month. Discussion focuses on retaining patients in follow-up.

Epidemiology and the study of subtypes of delusional disorders is a poorly researched area. This study tries to fill this lacuna and provides the evidence contrary to the accepted fact that the persecutory type is the most common subtype of persistent delusional disorder (paranoia). Out of 4234 patients who attended psychiatry outpatient department during the year 1994-1997, 45 patients received the ICD-10 diagnosis of persistent delusional disorder. Charts of these patients were used for the study. The prevalence of delusional disorder and delusional parasitosis were around 1% and 0.5% respectively making delusional parasitosis the most common sub-type in our setting. Patients with delusional parasitosis had significantly lesser education compared to the patients with persecutory or jealous delusions. These observations are explained on the basis of cultural practices and linguistic competence.

This case report of Turner's syndrome with mania highlights an extremely rare combination of two disorders. The implications of X linkage in bipolar disorder is discussed.

With introduction of the concept of alcohol dependence syndrome, scales specifically to measure dependence were developed and used in clinical and research settings. 12 questions from The Severity of Alcohol Dependence Data Questionnaire were translated into the Iccal language and was administered to 70 patients referred to the deaddiction centre. The translated version showed good evidence of internal validity, criterion validity and external validity.