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The novel Corona virus also known as 2019-nCoV that originated in China in December 2019 has quickly spread all over the world. In absence of specific treatment or vaccine, with no natural immunity, we are forced to rely on old public health measures like Quarantine, Social distancing and Isolation for prevention of spread among community. Although isolated incidents of epidemics have required isolation and quarantine in the past, no pandemic has required social distancing to a national and international scale before. Despite the obvious physical health and economic concerns of this situation, all the above measures bring forth challenges of emotional and psychological nature which can be especially severe in special populations like elderly, young children and adolescents, health care workers, persons with mental illness. Also, certain aspects like death, role of mass media, and ethics also arise during isolation and quarantine. With mass media playing a significant role in drumming up the perceived threat, people may resort to panic behaviours like hoarding essential day to day use items and masks and other medical supplies leading to shortage. Problem of fake news related to COVID 19 lead to Govt. of India launching of AAROGYA SETU app as well as websites to centralise all COVID 19 related information to people of India. Death in isolation deprives family members and friends of opportunity to grieve for near and dear ones lost due infection or due to natural causes. The requirement of isolation and quarantine during this distressing pandemic has paved way for recognising the importance and advantages of telemedicine as a whole which has led to various government bodies including the Government of India to draw primary guidelines for medical practitioners to follow and ensure ethical concerns are addressed.

India being a signatory to Alma-Ata declaration, envisaged ‘Health for all by the year 2000” and hence should look into training undergraduates in psychiatry. Medical students’ attitude towards psychiatry are determined by complex inter lacing variables. Low recruitment is a serious challenge for psychiatry worldwide. Moreover, psychiatry is poorly represented in medical education and undergraduate training in psychiatry and behavioral sciences in most medical colleges in India is unsatisfactory. Keeping these facts in mind, this study was carried out to assess the influence of psychiatry training, including direct patient contact on attitude of medical students towards mental illness. This study was conducted at Department of Psychiatry, Mahatma Gandhi Institute of Medical Science, Sevagram, Wardha, Maharashtra. Second year MBBS students were evaluated with a pre and posttest during their 2 weeks posting in the Psychiatry department. There was some improvement in attitude & knowledge of undergraduate medical students about mental health after two weeks of psychiatry posting. The improvement in male medical students is more than three times of that seen in female medical students, after two weeks of training. The existing M.C.I. recommendations need serious considerations for implementation in each & every Medical College of India. As per the current curriculum, the introduction to psychiatry is in the 1st term during lectures on behavioral sciences following which they not exposed again until the 5th semester when the undergraduate students are required to attend 40 hours lectures parallel to 4 weeks clinical posting culminating with compulsory short note questions worth 20 marks included in paper II of the General Medicine exam. Finally, another two weeks of psychiatry posting is mandatory during internship. Female medical students have shown deterioration in their attitudes & knowledge over more questions than male counterparts. Hence it can be deduced that, males tend to learn better by experience.

Background: Clinical depression can critically incapacitate one and make one question his self-worth and future. Estimates claim that out of the world’s approximately 7.6 billion population, 264 million people suffer from depression. This study was formulated to contribute data and results of the presence of adverse childhood experiences and its tendency to give rise to clinical depression in adulthood. This article presents data of the first forty cases collected for this study. Method: Data was collected in the Psychiatric OPD of in a rural hospital, Wardha. Patients of major depressive disorder on treatment and who were above 18 years of age and willing to participate in the study were included in the study sample. Adverse Childhood Experiences – International Questionnaire, Presumptive Stressful Life Event Scale and Hamilton Depression Rating Scales were applied to the sample size. Results: Among the forty participants 23 (57%) were female and 17 (42.5%) were male. The samples’ age group was either between 30 to 50 years old (55%). Most of the participants were married (67.5%). 52.5% had been exposed to experiencing violence in the household and 52.5% of the participants experienced violence in the community. 20%participants were found to still low to moderate depression. 60% of the total sample population perceived themselves to be withstanding severe stress in the current day-to-day life. Conclusion: This is a preliminary report to an ongoing research project. We can see glimpses of how exposure to stressors during childhood have the ability to impact a person’s mental well-being decades later.

Woman’s mental health, is an important issue and easily one of the most neglected domains, especially so for a woman in her middle age full of physiological and psychological turmoil. Mental health problems occur in higher frequency in women in general. Depression is more common in women as compared to men, women are twice as likely to experience anxiety as men and about 60 % of persons suffering from an OCD or a phobia are women. The greater gender predisposition necessitates an in-depth analysis of the biological and environmental factors of women which cause them to be more predisposed to mental illnesses. A recent report on Women of Tomorrow, reported women in India to be the most stressed female population of the world. Overall, the women of the developing nations were found to be more stressed than their sisters in the developed world. This led us to think about the cultural and environmental influences on the disorders, along with attitudes and perceptions of the society in the mental make-up of a woman. The contributing factors discussed in this article need extensive research to help modulate the implicated factors and in turn amount to primordial prevention. This article emphasizes the priorities to be studied in the context of a woman’s mental health, explores deeper issues and interrelationship of multi factorial determinants.

Patients with structural brain lesions may sometimes present with a variety of psychiatric symptoms for a prolonged period of time without any neurologic symptoms and signs. In such cases the underlying pathology of such clinical picture can be easily misinterpreted to be functional in origin and can delay actual diagnosis as well as alter the prognosis. This report presents a case of elderly gentleman who presented with sudden onset atypical psychiatric manifestations with alteration in mood and behaviour which was diagnosed later on secondary to brain tumour involving both frontal lobes and corpus callosum. Hence we suggest that any atypical psychiatric manifestation in elderly patients warrant a detail evaluation accompanied by neuro-imaging to rule out possible organic cause including tumours. Keywords: Brain Tumour, Neuropsychiatry, Mood and Behavioural disorders

Pseudocyesis or false belief of pregnancy is the emergence of classical manifestations of pregnancy—nausea, breast enlargement and pigmentation, abdominal distention, amenorrhea, and labor pains—in a nonpregnant woman. It is a multifactorial disease and its development is influenced by many different elements such as neuroendocrine, social, psychodynamic, and cultural issues. “Folie-à-deux,” is shared psychotic disorder, describes a syndrome in which delusion is transferred to another person who is more susceptible. Both individuals are closely related or know each other for a long time and typically live together in relative social isolation. In its commonest form, the individual who first develops the delusion (the primary case) is often chronically ill and typically is the dominant member in a close relationship with a more suggestible person (the secondary case) who also develops the delusion. Treatment options should also be kept in mind as antipsychotics themselves can increase prolactin levels and can lead to amenorrhoea and galactorrhea and can further strengthen patient’s belief about her pregnancy. This case highlights that the most important therapeutic step in the treatment of folie-à-deux is separation of the inducer and the induced. Here we describe a case of folie-à-deux of a married couple in which the female had delusional pregnancy while the husband shared and supported her delusion against substantial medical evidence.

Our retrospective cohort study assesses the survival probability and identifies the demographic and clinical predictors of mortality in HIV patients taking antiretroviral therapy using an antiretroviral therapy centre data in Western India. Secondary data on 7532 registered HIV-infected individuals between September 2006 and January 2013 were analysed. The probability of survival at 75 months was 84.9%. Significant indicators of poor chances of survival were greater age, lower occupation class, lower CD4 count, poor functional status; higher stage of disease, lower weight, the presence and type of opportunistic infections, co-trimoxazole therapy and poor adherence to antiretroviral therapy. We thus find that, in addition to pre-ART, antiretroviral therapy clinical status and treatment adherence, socioeconomic status plays an important influence on ultimate survival of HIV patients on antiretroviral therapy.

Research in the eld of periodontology has observed a huge upheaval in the last two decades unveiling newer alterations in techniques, methodologies, and material science. The recent centre of attention in periodontal research is an evidence-based approach which offers a bridge from science to clinical practice. Research inculcates scientic and inductive thinking and it promotes the development of logical habits of thinking and organization. In terms of research methodology, the article aim to inform the reader on topics relating to randomized controlled trials in periodontal research, evidence-based dentistry, calibration of clinical examiners and statistics relevant to periodontal research.

Background: In sub-Saharan Africa, herbal medicine for cancer is dispensed by traditional medicine practitioners (TMPs) to a large extent, who may not have adequate knowledge about the disease and this has been found to contribute to the late presentation of cancer patients to clinics and hospitals leading to poor patient outcomes.Aim: This study will investigate the traditional medicine practitioner's concept of cancer, its care, herbal medicine use, and the patients' perceived benefits (clinical outcomes) in selected districts of Central Uganda.Methods: This study will use a convergent parallel mixed-method design. TMPs claiming to treat cancer, with at least 10 years of experience will be recruited and interviewed about their understanding of cancer as a disease (grounded theory design) and the herbs used in cancer treatment (ethnobotanical survey). We will also conduct a prospective observational study to obtain the data on the perceived clinical outcomes of using herbal medicine. Adult patients (>18years) with a medical diagnosis of cancer signposted by TMPs will be recruited and followed up at baseline, 3, and 6 months. Study outcomes will include a change in the quality of life score, cancer symptoms score, perceived benefits score, and adverse reactions. The researcher will analyze qualitative data using Open, axial, selective coding techniques. We will analyze the quantitative data using descriptive statistics and results presented in frequencies, percentages and measures of central tendency (mean) where applicable. Additional analyzes such as bivariate (paired t-test and one-way repeated measures ANOVA), and multivariate (linear mixed effects model) analysis for the repeated measures data shall be undertaken to analyze the prospective observational data. P- Values of Discussion: This study will aid researchers in further understanding the TMPs' conceptualization of cancer, how that links to the treatment dispensed to their patients, and ultimately the patient-perceived outcomes.

Ethnopharmacological relevance Momordica charantia Linnaeus (Cucurbitaceae) has been extensively used traditionally as food and herbal medicine for type 2 diabetes mellitus in Asia, Brazil, and east Africa. In vitro and in vivo studies suggest its glycemic control potential; however, clinical studies produced conflicting results. Aim of the study To evaluate the efficacy of M. charantia preparations in lowering elevated plasma glucose level in prediabetes and type 2 diabetes mellitus patients. Methods Electronic search of the Cochrane library, PubMed®, CINAHL, and SCOPUS databases was done from 1st January 1960–30th April 2018 without language restriction. Two independent reviewers extracted data and assessed risk of bias of articles. Revman var. 5.3 software was used for data synthesis in meta-analysis. Heterogeneity was assessed using Chi-square and I2 tests. Treatment effect was estimated using mean difference at follow up in outcome measures between M. charantia preparations and placebo or oral hypoglycemic agents control group. The protocol of this study has a registration number PROSPERO CRD42018083653. Results Ten studies of type 2 diabetes mellitus (n = 1045) were included in the meta-analysis. They had 4–16 weeks follow up and overall moderate to high risk of bias. Compared to placebo, M. charantia monoherbal formulation significantly reduces FPG, PPG and HBA1c with mean difference of − 0.72 mmol/L, (95% CI: −1.33, −0.12), I2 = 14%, − 1.43 mmol/L, (95% CI: −2.18, −0.67), I2 = 0, − 0.26%, (95% CI: -0.49, −0.03), I2 = 0 respectively. M. charantia also lowered FPG in prediabetes (mean difference −0.31 mmol/L, n = 52); the evidence was downgraded to low quality because the study had unclear risk of bias and inadequate sample size. No serious adverse effects were reported. Conclusion M. charantia adjunct preparations improved glycemic control in T2DM patients. However, this conclusion is based on low to very low quality evidences for the primary outcomes and sparse data for several safety outcomes, thus, warrant further research. Particularly needed are the researches that focus on standardizing M. charantia formulation and determine its efficacy and safety in clinical trials with adequate sample size, designed with random sequence generation, allocation concealment of intervention and blinding of both research personnel and participants.

Valproate is used for various neurological and psychiatric conditions. It has various adverse effects, mostof which are mild and transient, however, hyperammonaemia in the absence of abnormal liver functionis an uncommon and life-threatening side effect. The exact mechanism for this is unknown, but severalmechanisms have been described for the same. We present a case of 11-year-old male patient belongingto a broken family. Initially he was diagnosed as a case of ADHD with conduct disorder. However due tonon-response to medications, over time, a EEG was done and was found to have generalised epileptiformdischarges, He was maintaining well on Valproate, but had an acute exacerbation of symptoms on beingoff medications for 2 weeks and grandmother restarting Valproate in high dose. Response to the treatmentprovided to the patient was rewarding.

Background. Although herbal medicines are used by patients with cancer in multiple oncology care settings, the magnitude of herbal medicine use in this context remains unclear. The purpose of this review was to establish the prevalence of herbal medicine use among patients with cancer, across various geographical settings and patient characteristics (age and gender categories). Methods. Electronic databases that were searched for data published, from January 2000 to January 2020, were Medline (PubMed), Google Scholar, Embase, and African Index Medicus. Eligible studies reporting prevalence estimates of herbal medicine use amongst cancer patients were pooled using random-effects meta-analyses. Studies were grouped by World Bank region and income groups. Subgroup and meta-regression analyses were performed to explore source of heterogeneity. Results. In total, 155 studies with data for 809,065 participants (53.95% female) met the inclusion criteria. Overall, the pooled prevalence of the use of herbal medicine among patients with cancer was 22% (95% confidence interval (CI): 18%–25%), with the highest prevalence estimates for Africa (40%, 95% CI: 23%–58%) and Asia (28%, 95% CI: 21%–35%). The pooled prevalence estimate was higher across low- and middle-income countries (32%, 95% CI: 23%–42%) and lower across high-income countries (17%, 95% CI: 14%–21%). Higher pooled prevalence estimates were found for adult patients with cancer (22%, 95% CI: 19%–26%) compared with children with cancer (18%, 95% CI: 11%–27%) and for female patients (27%, 95% CI: 19%–35%) compared with males (17%, 95% CI: 1%–47%). Conclusion. Herbal medicine is used by a large percentage of patients with cancer use. The findings of this review highlight the need for herbal medicine to be integrated in cancer care.

Introduction: An important component in the management of schizophrenia is insight. Schizophrenia patients that lack insight have poor clinical outcomes. Chronic patients of chronic schizophrenia lacking insight more often require hospitalisation than those recognising their illness. Poor insight is a good indicator of poor compliance and can predict the prognosis of any psychiatric patient including schizophrenia. Aim: This study was aimed at contrasting the gain in insight after treatment among various sub-groups of patients with schizophrenia. Materials and Methods: A cross-sectional study was conducted at the Acharya Vinobha Bhave Rural Hospital, Wradha, Maharashtra. The sample size was collected for a period of 1 year, during which all the patients admitted to the psychiatry ward were screened, of which 100 eligible patients with schizophrenia were identified using prespecified inclusion and exclusion criteria. Patients of both sexes aged above 18 years and attendants that provided consent were included in the study. The Schedule for Assessment of Insight Scale (SAI) was used to determine the patient’s level of insight. The proportion of patients with distinct socio-demographic characteristics, clinical profile, psychiatric diagnosis and SAI scores were calculated. A paired t-test was used for elaborating the results. The p-value

Objectives Can undergraduate medical students (UGs) adopt a village model to identify mentally ill persons in an adopted village successfully? Materials and Methods UGs during their first year adopt a village, and each student adopts seven families in the villages. During the visit, they look after immunization, tobacco and alcohol abuse, nutrition, hygiene, and sanitation. They help in identifying the health needs (including mental health) of the adopted family. The Indian Psychiatric Survey Schedule containing 15 questions covering most of the psychiatric illnesses were used by UGs to identify mental illness in the community. Persons identified as suffering from mental illness were referred to a consultant psychiatrist for confirmation of diagnosis and further management. Statistical Analysis Calculated by percentage of expected mentally ill persons based on prevalence of mental illness in the rural community and is compared with actual number of patients with mental illness identified by the UGs. True-positive, false-positive, and true predictive values were derived. Results In Umri village, UGs were able to identify 269 persons as true positives and 25 as false positives, whereas in Kurzadi village, UGs were able to identify 221 persons as true positives and 35 as false positives. It suggests UGs were able to identify mental illnesses with a good positive predictive value. In Umri village, out of 294 mentally ill patients, it gave a true positive value of 91.49% and a false positive value of 8.5%, whereas in Kurzadi village, out of the 256 mentally ill patients, it gave a true positive value of 86.3% and a false positive value of 13.67%. Conclusion The ratio of psychiatrists in India is approximately 0.30 per 100,000 population due to which psychiatrists alone cannot cover the mental health problems of India. Therefore, we need a different model to cover mental illness in India, which is discussed in this article.

Marriage can be defined as the state of being united as spouses in a consensual and contractual relationship recognized by law. The general population generally believes marriage to be a solution to mental illnesses. It can be agreed that mental disorders and marital issues have some relation.Parents of patients with psychoses expect that marriage is the solution to the illness and often approach doctors and seek validation about the success of the marriage of their mentally ill child, which is a guarantee no doctor can give in even normal circumstances. Evidence on sexual functioning in patients of psychosis is limited and needs further understanding.Studies show about 60%–70% women of the schizophrenia spectrum and illness to experience sexual difficulties. Based on available information, sexual dysfunction in population with psychosis can be attributed to a variety of psychosocial factors, ranging from the psychotic symptoms in itself to social stigma and institutionalization and also due to the antipsychotic treatment. Despite the decline in sexual activity and quality of life in general, it is very rarely addressed by both the treating doctor and by the patient themselves hence creating a lacuna in the patient’s care and availability of information regarding the illness’ pathophysiology. Patients become noncompliant with medications due to this undesirable effect and hence it requires to be given more attention during treatment.It was also found that paranoid type of schizophrenia patient had lower chances of separation than patients with other types of schizophrenia. The risk of relapse in cases with later age of onset of the disease, lower education, a positive family history of psychosis or a lower income increased more than other populations.

Background: In this report, we describe the epidemiology of SARS-CoV-2 infection, specifically examining how the symptomatic persons drove the transmission in the state of Karnataka, India, during the lockdown phase. Methods: The study included all the cases reported from March 8 to May 31, 2020 in the state. Any person with history of international or domestic travel from high burden states, those presenting with Influenza-like or Severe Acute Respiratory Illness and high-risk contacts of COVID19 cases, who were SARS-CoV-2 RT-PCR positive were included. Detailed analysis based on contact tracing data available from line-list of the state surveillance unit was performed using cluster analysis software package. Findings: Amongst the 3404 COVID-19 positive cases, 3096 (91%) were asymptomatic while 308 (9%) were symptomatic. Majority of the asymptomatic cases were in the age range of 16-50 years while symptomatic cases were between 31-65 years. Most of those affected were males. Cluster analysis of 822 cases indicated that the secondary attack rate, size of the cluster (dispersion) and occurrence of overt clinical illness is significantly higher when the index case in a cluster was symptomatic compared to an asymptomatic. Interpretation: Our findings indicate that both asymptomatic and symptomatic SARS-CoV-2 cases transmit the infection; however, the main driving force behind the spread of infection within the state was significantly higher from symptomatic cases. This has major implications for policies related to testing. Active search for symptomatic cases, subjecting them to testing and treatment should be prioritized for containing the spread of COVID-19. Funding: The study is funded by an Intermediate Fellowship of the Wellcome Trust-DBT India Alliance (Clinical and Public Health Research Fellowship) to Giridhara R Babu, Grant number: IA/CPHI/14/1/501499. Declaration of Interests: GRB and DAJ are employees of Indian Institute of Public Health, Bengaluru, Public Health Foundation of India and their employer had no say in the design of the study or the decision to publish. All other authors are employees of either state government (PD, PKBG) or NIMHANS (Central government). The employers had no role in the design of the study or the decision to publish. The authors declare that they do not have any other financial or non-financial relationships that could present a conflict of interest. Ethics Approval Statement: This is to certify that the study entitled "Epidemiology of SARS-CoV-2 Infection in Karnataka State, South India: Transmission Dynamics of Symptomatic vs. Asymptomatic Infections" was reviewed and approved by the NIMHANS Institutional Ethics Committee (Basic and Neurosciences) in its 24th meeting held on 3rd June 2020 (Ref No. NIMHANS/IEC/2020-21)

BackgroundStudies on several preclinical models of type 2 diabetes mellitus have been conducted to establish the hypoglycemic activity ofMomordica charantiaL. Concerned with appropriateness of these models, we designed a systematic review to establish the efficacy and safety ofM. charantiaL. in preclinical models of type 2 diabetes mellitus.MethodsReview authors will search without language restriction in MEDLINE/PubMed, Web of Science, Embase, Scopus, and CINAHL databases through April 2019. Search filters will be applied to enhance search efficiency. The authors will search for gray literature in Google and Google Scholar, OpenGrey, and ProQuest Dissertations & Theses. Two authors will evaluate full texts, extract data, and asses risk of bias independently. The review will include randomized or non-randomized studies that assessed the efficacy or safety ofM. charantiaL. with vehicle control group. The primary endpoint will be fasting blood glucose level. We will use Egger’s test to assess publication biases. Chi-square test andI2will be used to assess heterogeneity in effect size of the primary outcome. Using RevMan software version 5.3, the authors will perform a meta-analysis of quantitative data.DiscussionThe strength of evidence will be rated as high, moderate, low, or very low using GRADE framework for animal studies. This systematic review will potentially improve research practice by identifying risks of bias and design features that compromise translatability and contribute to evidence-based clinical trial design.Systematic review registrationPROSPERO CRD42019119181

Available data from the Indian studies suggests that the prevalence of psychiatric disorder comes to about 20% while the prevalence of schizophrenia is 0.7/1000–14.2/1000. The chronic course and debilitating effects of schizophrenia combine to create a disease that has tremendous clinical, social, and economic consequences on society. According to data from WHO in 2011, there are 0.301 psychiatrists, 0.166 nurses, and 0.047 psychologists for every 100,000 patients in India. Most people in India are unaware that mental illness is treatable. In India a huge treatment gap still exists for all types of mental health problems: There are plethora of causes that causes a hindrance in seeking treatment, recovery, and prognosis of mentally ill patients in India. Stigma is one of the main factors. Other factors include superstition, poverty, poor accessibility to health-care facilities, and marriage in case of female patients. In this chapter we discuss two cases that throw a light regarding recovery of mentally ill in rural India.

Background Momordica charantia Linnaeus (Cucurbitaceae) has been used traditionally as a nutritious food and as a herbal medicine for type 2 diabetes mellitus. However, human studies that investigated its glycemic control have generated inconsistent findings. Therefore, this systematic review and meta-analysis is aimed at evaluating the safety and efficacy of M. charantia L. preparations in human studies that have investigated its role in glycemic control. Methods This protocol has been prepared according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The review will include randomized clinical trials and non-randomized clinical trials. The included studies will have assessed glycemic control of M. charantia preparations with placebo or standard oral anti-hyperglycemic agents in adult pre-diabetes and/or type 2 diabetes mellitus patients and have at least 4 weeks of follow-up. The primary outcomes of review are fasting blood glucose levels, glycosylated hemoglobin A1c, and post-prandial blood glucose level. Electronic database search for published literatures will be conducted without language restriction in EMBASE, MEDLINE/PubMed, the Cochrane Library, SCOPUS, Web of Sciences, and CINAHL databases. Search for gray literatures and references of the retrieved full-text articles will be conducted in Google, Google Scholar, OpenGrey, ProQuest dissertations & Theses, British Library EThos, and university digital library systems. Two independent reviewers will later evaluate full texts, extract data, and assess risk of bias of eligible articles. Publication biases will be assessed by testing asymmetry of funnel plot using Egger’s or Begg’s tests while heterogeneity will be assessed using Cochran Q test, P value, and I2. Revman software version 5.3 will be used for meta-analysis including subgroup and sensitivity analysis. Discussion This systematic review and meta-analysis will investigate both safety and efficacy of M. charantia preparations in type 2 diabetes mellitus. The review results will be published in a peer-reviewed journal. The results will bring better understanding of clinical outcomes in treatment of type 2 diabetes mellitus patients and highlight gaps for future research. Systematic review registration PROSPERO CRD42018083653. Electronic supplementary material The online version of this article (10.1186/s13643-018-0847-x) contains supplementary material, which is available to authorized users.

BACKGROUND Multifetal gestation is responsible for a disproportionate amount of overall perinatal mortality and morbidity. Multifetal pregnancies have increased due to fertility treatment for assisted reproductive techniques.1 Aims and Objectives To study the maternal and foetal complications in multifetal pregnancy.  To observe the different modes of delivery in multifetal pregnancy.  To study neonatal outcome in multifetal pregnancy. MATERIALS AND METHODS A prospective observational study was carried out at tertiary care centre for one year from June 2016 to June 2017. 30 cases of multifetal pregnancy at or beyond 28 weeks of gestation were enrolled in this study. RESULTS In this study, maximum number of patients having multifetal pregnancy are in 26 -30 year age group. Among these patients 50% were conceived through assisted reproductive techniques and 50% were conceived spontaneously. Maximum (70%) patients are nulliparous. Among these patients, 83% were having DADC twins. Preterm labour is most common complication in this study. 70% patients were delivered by caesarean section and most common indication being precious pregnancy. In this study, there was 1 neonatal death among the twins. CONCLUSION Multifetal gestations have higher maternal and neonatal complications. Preterm delivery and surgical interventions are major complications and has an impact on perinatal outcome.

Background: Worldwide, mental illnesses are on rise. There is an acute shortage of psychiatrists. Young medical graduates find psychiatry specialty a less attractive career option. The present study was conducted to find out attitudinal change of medical graduates to psychiatry specialty after their clinical posting. Methods: The study was carried out in a tertiary medical care centre situated in eastern Maharashtra in a rural setting. The medical graduates undergo rotation which includes clinical posting in psychiatry while they are in second year. One hundred medical students were administered Attitudes Towards Psychiatry-30 (ATP-30) questionnaire at the beginning and the end of two weeks of posting. Results: The response rate was 93% and the mean pre-rotation score on ATP-30 questionnaire was not significantly different as compared with the mean post-rotation score [107 ± 11.7 (SD) vs. 106 ± 12.4 (SD); (p=NS)]. Subgroup analysis revealed a significant decline [56 ± 6.4 vs. 54 ± 6.6 (p< 0.05)] in attitude on 15 positive questions of the questionnaire. Students with urban background [(55.8 ±6.6 vs 58.6 ± 9.3 (p=0.88)] as compared with rural background [58.1 ± 3.2 vs 53.9 ± 6.1 (p=0.03)] had significantly more decline on ATP-30 questionnaire. Conclusions: Overall, there was no change in medical students' attitude following two weeks clinical posting. Based on these findings medical curriculum including duration and frequency of clinical posting in psychiatry during undergraduate training requires change.

The relationship between marriage and mental illness is very complicated, and this issue commonly arises in psychotic illnesses. Psychosis is usually diagnosed at late adolescent and early adulthood. Being a disease of the age at which decision of marriage is taken, the question of whether to marry or not and whether marriage will lead to improvement or deterioration in psychoses is equally faced by patients, their family members, and treating psychiatrists. Mental disorders and problems in marriage are closely linked although there is a controversy about the sequence. In India, marriages are usually arranged by parents and are influenced by a number of factors such as astrological compatibility, caste regulation, geographic proximity, and expectations of dowry. We have worked for two decades in this area. The work summarizes as “Effect of marriage on clinical outcome of persons with bipolar affective disorder: A case–control study.” Married persons had experienced more episodes of illness and for longer duration. Males are more prone for illness than females in both groups (married and never married). Marriage did not influence the severity of illness in persons with bipolar affective disorder. The effects of marriage on women with schizophrenia are as follows: This study concluded that most of the patients and relatives were of the opinion that marriage can cure mental illness. Child birth was found to be a protective factor for decreasing separation in cases. Severity of mental illness was slightly higher in cases than comparison group. It was observed that with increasing severity of illness marital adjustment deteriorates with antagonistic interaction among members.

Background: AUB (abnormal uterine bleeding) is defined as any variation from the normal menstrual cycle including alteration in its frequency, regularity of menses, duration of flow and amount of blood loss. In India, the reported prevalence of AUB is 17.9%. It can occur any time between menarche to menopause. A good clinician tries to recognize and identify the causative factors responsible for the disease, reverse the abnormality and induce or restore the cyclic predictable menses which should have normal volume and duration.Methods: 200 cases of AUB fitting the selection criteria were taken from OPD and gynecology ward between September 2020 to June 2021.Results: AUB was more common in the age group 41-45 years, that is, perimenopausal age group, more in multiparous women and women with previous surgeries on uterus and adnexa. Heavy menstrual bleeding was the most common complaint. Endometrial hyperplasia was the most common finding on ultrasound examination. Medical therapy was beneficial in some patients, rest had to undergo surgical intervention later.Conclusions: Transvaginal sonography is very accurate in assessing the endometrium as well as uterus and adnexa and diagnosing their abnormalities. Medical therapy is the first line of management in most cases. Dilatation and curettage should be used along with hysteroscopy for better results. LNG-IUS gives very good result in suitable cases. Hysterectomy is the final measure if everything else fails. Vaginal hysterectomy is preferred wherever possible.

BackgroundMomordica charantiaL. (Cucurbitaceae) has been used to control hyperglycemia in people with type 2 diabetes mellitus in Asia, South America, and Africa for decades. However, a meta-analysis of clinical trials confirmed very low-quality evidence of its efficacy. To potentially increase the certainty of evidence, we evaluated the effect ofM. charantiaL. in comparison with vehicle on glycemic control in animal models of type 2 diabetes mellitus.MethodsReview authors searched in MEDLINE, Web of Science, Scopus, and CINAHL databases without language restriction through April 2019. Two authors independently evaluated full texts, assessed the risk of bias, and extracted data. We analyzed the influence of study design and evidence of publication bias.ResultsThe review included 66 studies involving 1861 animals. They had a follow up between 7 and 90 days. Majority 29 (43.9%) used Wistar albino rats, and 37 (56.1%) used male animals. Thirty-two (48%) used an aqueous extract of fresh fruits.M. charantiaL. reduced fasting plasma glucose (FPG) and glycosylated hemoglobin A1c in comparison to vehicle control (42 studies, 815 animals; SMD, −6.86 [95% CI; −7.95, −5.77], 3 studies, 59 animals; SMD; −7.76 [95%CI; −12.50, −3.01]) respectively. Magnitude of FPG was large in Wistar albino rat subgroup; SMD; −10.29, [95%CI; −12.55, −8.03]. Publication bias changed FPG to non-significant −2.46 SMD, [95%CI; - 5.10, 0.17]. We downgraded the evidence to moderate quality due to poor methodological quality, high risk of bias, unexplained heterogeneity, suspected publication bias, and lack of standardized dose.ConclusionM. charantiaL. lowers elevated plasma glucose level in type 2 diabetes mellitus animal models. Publication bias and poor methodological quality call for future researches to focus on standardizing dose with chemical markers and provide measures to improve preclinical type 2 diabetes mellitus studies.Systematic review registration CRD42019119181

Background: Substance abuse is one of the most significant global public health issues among youths. Electronic media has become a part of day-to-day life for all. This systematic review is undertaken to comprehensively explore the effect of electronic media on substance abuse among children and adolescents. Methodology: Two review authors independently searched various electronic databases and other sources. Selection Criteria: Randomized control trials that assessed the effect of exposure of electronic media (defined as television, internet, gaming, mobile phones/phones, and radio) among participants in the age range of 5–19 years on substance abuse were included in the review. Data Collection and Analysis: Two reviewers independently extracted data. We used an approach proposed by the Cochrane Collaboration. We used GRADE profiler to assess the overall quality of the evidence. Main Results: We retrieved 6003 studies and found 15 studies that fulfilled our inclusion criteria. Since included studies differed in the type of intervention and reporting of outcomes, we did not undertake meta-analysis and choose to describe studies narratively. Quality of evidence was rated as “very low” due to too little information or too few data to be able to reach any conclusions. Authors' Conclusions: Clinicians, policymakers, and educators to partner with caregivers and youth to support electronic media use that promotes positive outcome in these areas. Registration of Systematic Review: This systematic review has been registered at PROSPERO International prospective register of systematic reviews (Registration number: PROSPERO 2018 CRD42018086935) available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID = 86935 .

Background: The current study was planned to identify the epidemiological factors associated with leptospirosis in South Gujarat region using neighborhood controls. Methods: A total of 100 cases of leptospirosis occurred in South Gujarat region during the year 2012 were selected using simple random sampling. Three neighbors of the selected cases formed the controls ( n = 300). A pretested structured questionnaire was used for data collection and data were analyzed using Epi Info 2007. Results: There was significant association of illiteracy (odds ratio [OR] =1.82, 95% confidence interval [CI] =1.14–2.89), working in waterlogged fields during the reference season (OR = 4.6, 95% CI = 1.6–17.9), swimming/bathing in canals, open air defecation practices, storage of cow dung in or surrounding house, residence in the house made up of cow dung walls, households with access of food to rodents, injuries over hands/foot during the endemic season (OR = 3, 95% CI = 1.8–4.8), and history of skin disease during the endemic season (OR = 4.2, 95% CI = 2–8.5), with leptospirosis. Only 10% of individuals had gumboots for protection. A total of 83 (83%) cases and 240 (80%) controls had taken oral doxycycline chemoprophylaxis ( P > 0.05). Cases had taken chemoprophylaxis for a median 4 weeks (range: 1–8) while controls had taken the same for median 8 weeks (range = 1–8) ( P Conclusions: Although the commonly established factors appear to be associated with leptospirosis, the role of host factors seems to play a more important role in determining susceptibility to leptospirosis in exposed individuals.

Background: Despite more than two decades since recognition of suicides by farmers in India, systematic studies comparing various risk factors are lacking. This is major hurdle for the formulation of strategies for farmers' suicide prevention. Objective: To identify socioeconomic and psychological risk factors and their relative contribution in suicides by farmers. Materials and Methods: A matched case–control psychological autopsy was done on 98 farmers' suicide victims and 98 controls in Central India. Results: Economic problems, psychiatric illness, and stressful life events were found to be important contributors to farmers' suicides. Important economic risk factors were procurement of debt, especially from multiple sources and for nonagricultural reasons and leasing out farms. Psychiatric illness was present significantly in higher proportion among cases than controls. Crop failure, interpersonal problems, medical illness, and marriage of female family member were significant stressful life events. Conclusions: There are socioeconomic and psychological risk factors for suicide by farmers which can be targets of prevention policy.

Always discuss the possibility of pregnancy with women of childbearing age. Try to avoid drugs which are contraindicated in pregnancy in women of reproductive age group. Treatment should be discussed with each woman individually in relation to risk-benefit ratio. Try to avoid all drugs in first trimester. Use an established drug at lowest effective dose. Avoid polypharmacy. Ensure adequate fetal monitoring during pregnancy. Be aware of potential problems with individual drugs around the time of delivery. Inform treating obstetrician of psychotropic use. Monitor the neonate for withdrawal effects after birth.

Aim: To assess the phenomenology and associated beliefs in patients with Dhat syndrome. Methods: A total of 780 male patients aged more than 16 years were recruited from 15 centers spread across the country and were assessed on Dhat Syndrome Questionnaire. Results: The most commonly reported reasons for passage of Dhat were excessive masturbation (55.1%), sexual dreams (47.3%), excessive sexual desire (42.8%) and consumption of high energy foods (36.7%). The most common situation in which participants experienced passage of Dhat were as ‘night falls’ (60.1%) and ‘while passing stools’ (59.5%). The most common consequence due to passage of Dhat was weakness in sexual ability (75.6%). In terms of psychological and somatic symptoms, the common symptoms included bodily weakness (78.2%); feeling tired or having low energy (75.9%); feeling down, depressed, or hopeless (67.9%); and little interest or pleasure in doing things (63.7%). In terms of treatment expectations, about half of the patients (49.1%) expected that energizing medications like vitamins/tonics/tablets were required and more than one-third (38.2%) expected that there was a need for taking energizing injections. Conclusion: Present study shows that Dhat syndrome is a distinct clinical entity seen all over India, with its characteristic features.

Introduction Surat has the highest incidence of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in Gujarat, the main reason being its large migrant population. Mental health in HIV/AIDS has most often been a topic of neglect all over the world. This study attempts to assess the magnitude of depression and the socio-demographic and clinical variables associated with it in HIV-positive patients. Methods A cross-sectional study was conducted in 270 HIV-positive patients using Beck Depression Inventory (BDI; translated and validated in Gujarati and Hindi) along with a questionnaire for eliciting information on socio-demographic and clinical variables. Results The prevalence of depression among HIV-positive patients was 30% with 12.22% having mild depression; 14.07% with moderate depression and 3.7% with severe depression. Bivariate analysis showed that physical pain, physical illness, Cluster of Differentiation 4 (CD4)

Introduction There are limited numbers of studies on Dhat syndrome. Major limitations of the existing literature are heterogeneous assessment methods used to describe the comorbidity and small sample size from isolated centers. Aim To assess comorbidity with a common methodology in patients with Dhat syndrome from multiple centers across India. Methods Using a cross-sectional design, this multicentric study involved assessment of 780 male patients, aged more than 16 years, across 15 study centers. Main Outcome Measures ICD-10 criteria (for evaluation of psychiatric morbidity and sexual dysfunction) Results About one-third (32.8%) of the cases had no comorbidity. One-fifth (20.5%) of the patients had comorbid depressive disorders and another one-fifth (20.5%) had comorbid neurotic, stress-related and somatoform disorders. Half (51.3%) of the study sample had comorbid sexual dysfunction. When various combinations of comorbidities were evaluated, it was seen that more than one-fourth (28.7%) of the patients had only comorbid sexual dysfunction and one-sixth (15.9%) had only comorbid depressive/anxiety disorders. A little more than one-fifth (22.6%) had comorbidity of both sexual dysfunction and depressive/anxiety disorders. Conclusion Comorbid sexual dysfunction is seen in half of the cases of Dhat syndrome, and it is more common than comorbid depressive and anxiety disorders.

Background: Stigma is very common among caregivers of patients with severe mental disorder; however, there is lack of national level data from India. Aim: To assess affiliate stigma and its correlates among caregivers of patients with severe mental disorders. Method: For this, caregivers of patients with schizophrenia ( N = 707), bipolar disorder ( N = 344) and recurrent depressive disorder ( N = 352) were assessed on Stigma scale for Caregivers of People with Mental Illness and General Health Questionnaire. Results: Caregivers of patients with schizophrenia reported significantly higher stigma than patients with bipolar disorder and recurrent depressive disorder. Caregiver of patients with bipolar disorder reported significantly greater stigma than the caregivers of patients with recurrent depressive disorder. Higher caregiver stigma in all the diagnostic groups was associated with higher psychological morbidity in caregivers. Higher stigma in caregivers of schizophrenia was seen when the patient had younger age of onset and longer duration of treatment. In the bipolar disorder group, higher stigma in caregivers was seen when patient had higher residual manic symptoms. Conclusion: This study suggests that caregivers of patients with schizophrenia experience higher stigma than the caregivers of patients with bipolar disorder and recurrent depressive disorder. Higher stigma is associated with higher psychological morbidity in the caregivers. Therefore, the clinicians managing patients with severe mental disorders must focus on stigma and psychological distress among the caregivers and plan intervention strategies to reduce stigma.

This study aimed to evaluate the stigma and its correlates among patients with severe mental disorders. Patients with diagnosis of schizophrenia (N = 707), bipolar disorder (N = 344) and recurrent depressive disorder (N = 352) currently in clinical remission from 14 participating centres were assessed on Internalized Stigma of Mental Illness Scale (ISMIS). Patients with diagnosis of schizophrenia experienced higher level of alienation, sterotype endorsement, discrimination experience and total stigma when compared to patients with bipolar disorder and recurrent depressive disorder. Patients with bipolar disorder experienced higher stigma than those with recurrent depressive disorder in the domain of stigma resistance only. Overall compared to affective disorder groups, higher proportion of patients with schizophrenia reported stigma in all the domains of ISMIS. In general in all the 3 diagnostic groups' stigma was associated with shorter duration of illness, shorter duration of treatment and younger age of onset. To conclude, this study suggests that compared to affective disorder, patients with schizophrenia experience higher self stigma. Higher level of stigma is experienced during the early phase of illness. Stigma intervention programs must focus on patients during the initial phase of illness in order to reduce the negative consequences of stigma.

Physical symptoms in depression are highly prevalent and associated with substantial functional impairment. The prevalence of physical illness in psychiatric patients is higher than that in the general population. Both in developed & developing countries, very little attention is paid to the physical illness of psychiatric patients, which leads to a poorer outcome. Hence we decided to conduct this study and find out the effect of antidepressant treatment on somatic symptoms in depressive disorders. The study was conducted at Sri Venkateshwaraa medical college hospital & research center, Puducherry. Our study sample consisted of 72 consecutive new patients who fulfilled inclusion criteria and had consented to participate in the study. All new patients in the age group 18 to 60 years, who fulfill ICD-10-DCR (Diagnostic criteria for Research) criteria for the Depressive episode (F 32), recurrent depressive disorder (F33), Dysthymia (F 34.1), bipolar affective disorder, current episode depression (F 31.3) were included in our study. MATERIALS AND METHODS: A semi-structured proforma was used to collect socio demographic and clinical data from all the subjects included in the study. Enrolment of cases was done over a period of 6 months. All the subjects were rated on the Hamilton Depression Rating Scale (HDRS-17) to quantify the baseline severity of the depressive symptoms. Screenings for physical symptoms were done for all patients using the Patient Health Questionnaire (PHQ-15). The patients were classified into 4 groups based on physical complaints & co-morbid medical/ surgical diagnosis. HDRS-17 rating was recorded at baseline, 1 month & 6 months for the entire study sample. PHQ-15 scores were recorded at baseline, 1 month & 6 months after initiation of antidepressant treatment for all patients enrolled in the study. RESULTS: The study revealed the prevalence of medically unexplained physical symptoms in depressive disorders in patients attending our psychiatry OPD. The Results depicts the prevalence of physical pain symptoms in patients with depressive disorders. The reduction in HDRS-17 and PHQ15 scores in 1month and 6 months shows the effect of antidepressant treatment in reducing both depressive symptoms and physical symptoms CONCLUSION: This study had been undertaken with intent to study the prevalence of unexplained physical symptoms and physical illnesses among patients with depressive disorders and to analyze the effect of antidepressant treatment on these unexplained physical symptoms.

To provide adequate peri-operative thoracic epidural analgesia, it is important to determine the appropriate initial dosage of local anesthetics. To determine the proper dose, current study evaluated the effect of three different doses of 0.75 % ropivacaine, injected into lower thoracic epidural space, on the spread of analgesic segments and on hemodynamic variables. METHODS: The subjects were 90 patients between 18 to 60 years of age with ASA physical status I and II. Using an epidural catheter placed at site T9 - T10 intervertebral space, 0.75 % ropivacaine was injected as follows: Group A (n = 30, 5 ml), Group B (n = 30, 10 ml) and Group C (n = 30, 15 ml) sensory analgesia, motor blockade and hemodynamic variables were evaluated every 5 min for 25 min after the injection. RESULTS: Number of segments blocked were 5.48, 6.79 and 7.17 at 5th min. in Group A, B, C. respectively. At the end of 25th min, it reached 15.13, 15.50 and 16 segments. In the present study, there was no statistical difference in onset of sensory blockade at 5 th min between three groups. But by 10 th minute, the entire patient had detectable sensory blockade in all three groups. Motor Block onset was quicker and intensity was more in Group B and C as compared to Group A. More number of patients in Group B and Group C had hypotension and bradycardia when compared with Group A. CONCLUSION: To establish proper lower thoracic epidural analgesia with less hemodynamic changes, it is recommended to use 5 ml. of 0.75 % ropivacaine.

The association between the progestin only pill used for treatment of menstrual disorders and cerebral venous sinus thrombosis (CVST) has rarely been reported in the literature. This report describes a case of cerebral venous thrombosis following intake of norethisterone for menorrhagia secondary to polycystic ovary syndrome in a young woman with undiagnosed underlying hyperhomocysteinemia. A 24 year old married woman presented with acute onset of headache, vomiting and right focal seizures. MRI Cerebral venogram and CT Brain revealed thrombosed anterosuperior segment of superior sagittal sinus and haemorrhagic infarct in right frontoparietal region. The risk factors were acquired hyperhomocysteinemia, polycystic ovary syndrome and norethisterone for menorrhagia. The patient was treated with low molecular weight heparin, followed by warfarin, vitamin B 12 , vitamin B 6 and folic acid. She made a total recovery. Although venous thrombosis is usually linked to the ingestion of estrogen, rather than progestogen, this case illustrates that patients who are prescribed progestogen only pills for gynaecological disorders may develop thrombosis, especially if they have predisposing metabolic disorders.

Introduction: In India, tuberculosis is the most common opportunistic infection among HIV positive patients. This study estimates the prevalence of tuberculosis amongst HIV patients in Ahmadabad, Gujarat. Methodology: The present study was conducted at Integrated Counseling and Testing Center for HIV at Sola civil hospital, a public sector tertiary care hospital in Ahmadabad for a twenty month period from January, 2009 to August, 2010. All the patients visiting the center during the study period were screened for HIV. All the patients who were diagnosed HIV positive were subjected for active search of tuberculosis; clinically, radiological as well as by histopathology and laboratory tests. Results: Total 6846 patients were screened for HIV, out of which 167(2.44%) patients were tested HIV positive. Out of 167 HIV positive patients, 22 (13.17%) were diagnosed as cases of tuberculosis. Out of these 22 patients, 18(81.82%) had pulmonary tuberculosis while 4(18.18%) were extra-pulmonary tuberculosis patients. Amongst the four extra-pulmonary tuberculosis cases, one (25.00%) case was of tuberculous meningitis, one (25.00%) was of abdominal tuberculosis and two (50.00%) had tuberculous lymphatic swelling. Conclusion: The prevalence of tuberculosis in HIV positive patients found in this study was 13.17%, which is substantially lower than that reported in previous studies. Appropriate management of these patients requires a strengthened mechanism of cross reference and inter sectoral co-ordination between the two diseases at all levels. SAARC Journal of Tuberculosis, Lung Diseases & HIV/AIDS; 2013; X(1); 13-18 DOI: http://dx.doi.org/10.3126/saarctb.v10i1.8672

Ramsay Hunt Syndrome is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus infection in the geniculate ganglion causes otalgia, auricular vesicles and lower motor neuron facial palsy. A 52-year-old man presented to us with complaints of vesicular eruptions over the right pinna, otalgia and facial weakness i.e. deviation of the angle of mouth to the left side and inability to close the right eye from last 3 days. A diagnosis of Ramsay Hunt Syndrome with grade V facial palsy was made. Intravenous acyclovir and oral steroids were started. Patient showed marked improvement within 10 days. For facial palsy, rehabilitation therapy was also given.

Las anomalías en el origen y patrón de ramificación de la arteria carótida externa (ACE) son comunes. El nivel de la bifurcación de la arteria carótida común (ACC) y las variaciones en el origen / patrón de ramificación de la arteria carótida externa están bien documentados. En el hallazgo de las arterias occipitales y posteriores surgían de un corto tronco común de la ACE en el lado izquierdo. El conocimiento de las variaciones en el origen y curso de las ramas de la ACE son de suma importancia en la cirugía. Los cirujanos deben ser conscientes de la posibilidad de encontrar estas variaciones, ya que pueden conducir a dificultades en la distinción de las ramas de la arteria carótida externa. Este conocimiento es también importante para los radiólogos en la interpretación de las imágenes de las regiones de la cara y el cuello. Anomalies in the origin and branching pattern of the external carotid artery (ECA) are common. The level of the bifurcation of the common carotid artery (CCA) and the variations in the origin/branching pattern of the external carotid artery are well documented. In the present finding occipital and posterior auricular arteries were arising by a short common trunk from ECA on the left side. Knowledge of variations in the origin and course of branches of ECA is of importance in surgery. Surgeons need to be aware of the possibility of encountering such variations, as they may lead to difficulties in differentiating the branches of external carotid artery. This knowledge is also important for radiologists in the image interpretation of the face and neck regions.

Objectives: The present study was undertaken to test the comparative efficacy of chlorpromazine and risperidone in patients of schizophrenia in a tertiary care hospital of Maharashtra. Materials and Methods: About 100 subjects of either sex between 15 and 75 years of age were randomly assigned either chlorpromazine or risperidone. Only those patients were included who met International Classification of Diseases 10 revision criteria by World Health Organization. To avoid bias, the test drugs were coded as A and B. The study coordinator was unaware of the prescribed drugs; however, the prescribing psychiatrist knew about the drug treatment. Results: Both chlorpromazine and risperidone significantly decreased the mean score of positive and general symptoms in patients of schizophrenia. Although chlorpromazine decreased the mean score of negative symptoms, it was not statistically significant. Risperidone reduced the mean score of negative symptoms to a significant extent. The cost (Rs. 3000-4000) of risperidone was more than the cost (Rs. 700-1000) of chlorpromazine per patient per annum. The dropouts were less (25%) in the risperidone group than in the chlorpromazine group (75%). The more purchase of risperidone than of chlorpromazine was observed in our study. Conclusion: The response rates for positive and general symptoms were found to be equal for both chlorpromazine and risperidone. However, risperidone was found to be more effective than chlorpromazine in treating negative symptoms. The dropout rate was less in the risperidone group than in the chlorpromazine group. The compliance was also better in the risperidone group, even though the cost of risperidone was more than that of chlorpromazine.

Context: Children of alcoholics (COAs) are children who have grown up in families in which either one or both parents are alcoholic. The interplay of several factors such as environmental, cognitive, and genetic vulnerability has been linked to the psychopathology among COAs. Aims: To assess psychiatric morbidity in COAs and to compare these children with the children of nonalcoholic parents. Setting and Design: This cross-sectional study was conducted on children of outpatients and inpatients of a tertiary health-care center in Central India, for 18 months. Subjects and Methods: A total of 100 children, fifty children of alcoholic parents and fifty children of nonalcoholic parents between the age groups of 4 and 14 years, were assessed using childhood psychopathology measurement schedule. Statistical Analysis Used: Statistical analysis was done by using descriptive and inferential statistics using Chi-square test and Student's unpaired t-test. SPSS version 22.0, were used for statistical analysis, and P < 0.05 was considered as level of significance. Results: Most of the children were in the age group of 8–11 years. Depression and anxiety were found to be statistically significant (P < 0.05) in COAs than in children of nonalcoholics. Whereas, there was no difference (P > 0.05) for low intelligence and behavioral problems, conduct disorder, psychotic symptoms, special symptoms, physical illness, emotional problems, and somatization. Conclusions: Thus, there is a high need to address the stress to children of persons with substance abuse. Early detection of psychiatric morbidities in such children and appropriate intervention can produce beneficial changes in such children.

Context: Electronic media has become a part of day-to-day life for all, and particularly more so for children and adolescents. Exposure to electronic media may be beneficial as well as harmful. Aim: The aim of the study is to systematically synthesize existing published and non-published empirical evidence on the effect of exposure to electronic media on diet, exercise, and sexual activity. Methodology: Two reviewers independently searched online databases such as MEDLINE, CENTRAL, and EMBASE. We applied no language, date, or publication restrictions. Selection Criteria: We included randomized control trials that assessed the effect of exposure of electronic media on diet, exercise, and sexual activity in participants between 5 and 19 years. Study Selection, Data Extraction: Two reviewers independently screened studies identified in electronic search and independently extracted data and assessed the risk of bias of included studies. Data Analysis: We had planned to use the risk ratio or odds ratio for dichotomous data, and mean difference (MD) or standardized MD for continuous data. However, as included studied differed in types of intervention and reporting of outcomes, we did not undertake meta-analysis. Main Results: All included trials were parallel randomized controlled trials except for one that was a crossover trial. Eight studies reported the effect of electronic media on diet and exercise, two on diet, two on exercise, and one on sexual activity. Quality of evidence was rated as “very low” for all outcomes due to too little information or too few data to be able to reach to any conclusions. Conclusions: There is a little body of evidence that limits conclusions. We need to comprehend as to how to swap undesirable effects of electronic media and make it more desirable. Registration of Systematic Review: This systematic review has been registered at PROSPERO International prospective register of systematic reviews (Registration number: PROSPERO 2018 CRD42018086935) available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=86935 .

SUMMARY Cerebrospinal fluid (CSF) lactate dehydrogenase was determined in 19 control infants without asphyxia (Group I), 24 infants with perinatal asphyxia (Group II), and 26 asphyxiated infants with seizures (Group III). Mean birthweights, gestational ages, CSF glucose, protein and red blood cells, and the âges at which the lumbar punctures were performed were not significantly different among the three groups. Mean CSF lactate dehydrogenase was significantly higher in Group III than in Groups I and II. Isoenzyme patterns indicated that the origin of the CSF lactate dehydrogenase was neuronal tissue, or a plasma transudate from increased permeability of the blood-brain barrier. There were 10 deaths due to anoxic encephalopathy in Group III, but none in Groups I or II. Follow-up of survivors at 10 to 39 months of age revealed neurological sequelae in three infants in Group I, two in Group II and five in Group III. Mean CSF lactate dehydrogenase in those with sequelae had not been significantly different from that of normal survivors; however, the mean was significantly higher in infants who died with anoxic encephalopathy compared with normal infants. These data indicate that CSF lactate dehydrogenase is significantly elevated in infants with fatal anoxic brain damage, and suggest that determinations may be of prognostic value in non-fatal cerebral hypoxia. RESUME La lactate deshydrogenase du liquide cephalo-rachidien chez les nourrissons avec asphyxie perinatale La lactate deshydrogenase du liquide cephalo-rachidien (LCR) a ete determinee chez 19 nourrissons controles sans asphyxie (groupe I), chez 24 nourrissons avec asphyxie perinatale (groupe II) et 26 nourrissons asphyxies avec crises (groupe III). La moyenne des poids de naissance, des âges de gestation, des taux de glucose, proteine et globules rouges dans le LCR et des âges auxquels la ponction lombaire a ete realisee ne differaient pas significativement entre les trois groups. La moyenne de la lactate deshydrogenase du LCR etait significativement plus elevee dans le groupe III que dans les groupes I et II. Les groupements isoenzymatiques indiquaient que l'origine de la lactate deshydrogenase du LCR etait le tissu neuronal ou un transudat plasmatique a partir d'une permeabilite accrue de la barriere cerebromeningee. Ilyaeudixmortsparencephalopathieanoxiquedanslegroupe III, aucunedanslesgroupes I et II. La surveillance des survivants de 10 a 39 mois a reveledessequelles neurologiqueschez trois nourrissons du groupe I, deux du groupe II et cinq du groupe III. Le taux moyen de la lactate deshydrogenase du LCR chez les nourrissons avec sequelles n'etait pas significativement different de celui des survivants normaux. En revanche, la moyenne etait comparativement plus elevee chez les nourrissons decedes par encephalopathies anoxiques que chez les enfants normaux. Ces donnees indiquent que la lactate dehydrogenase du LCR est significativement elevee chez les nourrissons presentant un dommage cerebral anoxique foetal et suggerent que sa determination peut avoir une valeur pronostique dans l'hypoxie cerebrale non fatale. ZUSAMMENFASSUNG Laktatdehydrogenase im Liquor bei Kindern mit perinataler Asphyxie Bei 19 Kontrollkindern ohne Asphyxie (Gruppe I), 24 Kindern mit perinataler Asphyxie (Gruppe II) und 26 Kindern mit Asphyxie und Krampfanfallen (Gruppe III) wurde die Laktatdehydrogenase im Liquor bestimmt. Folgende Parameter waren bei den drei Gruppen etwa gleich: mittleres Geburtsgewicht, Gestationsalter, Liquorzucker, EiweiB und Leukocyten und das Alter, in dem die Lumbalpunktion durchgefuhrt wurde. Der mittlere Wert fiir die Laktatdehydrogenase war bei Gruppe III signifikant hoher als bei den Gruppen I und II. Isoenzymmuster wiesen darauf hin, daB die Laktatdehydrogenase vom Nervengewebe stammt oder von einem Plasmatranssudat aufgrund erhohter Permeabilitat der Blut-Hirn-Schranke. In Gruppe III wurden zehn Todesfalle aufgrund einer anoxischen Encephalopathie verzeichnet, in den Gruppen I und II dagegen keiner. Kontrolluntersuchungen der Uberlebenden im Alter von 10 bis 39 Monaten ergaben bei drei Kindern der Gruppe I, zwei Kindern der Gruppe II und fiinf Kindern der Gruppe III neurologische Folgeer-scheinungen. Der mittlere Wert fiir die Liquorlaktatdehydrogenase bei den Kindern mit Folgeerscheinungen unterschied sich nicht wesentlich von dem der gesunden Uberlebenden, jedoch war er bei Kindern, die an einer anoxischen Encephalopathie starben, signifikant hoher als bei gesunden Kindern. Diese Daten zeigen, daB die Liquorlaktatdehydrogenase bei Kindern mit todlichem anoxischen Hirnschaden signifikant erhoht ist. Somit kann die Bestimmung der Liquorlaktatdehydrogenase fiir eine todliche cerebrale Hypoxie prognostisch von Bedeutung sein. RESUMEN Lactodesidrogenasa en el liquido cefalorraquideo en lactantes con asfixia perinatal La lactodesidrogenasa en el liquido cefalorraquideo (LCR) fue determinada en 19 nifios control sin asfixia (Grupo I), 24 nifios con asfixia perinatal (Grupo II) y 26 lactantes asfixiados con convulsiones (Grupo III). Los pesos de nacimiento promedios, las edades gestacionales, la glucorraquia, la proteinemia y el contagio de celulas rojas en sangre y las edades en las cuales se realizaban las funciones lumbares no eran significativamente diferentes entre los tres grupos. La lactodesidrogenasa del LCR era significativamente mas alta en el Grupo III que en los Grupos I y II. Los esquemas de isoencimas indicaban que el origen de la lactodesidrogenasa del LCR era el tejido neuronal o bien un transurado plasmatico producido por el aumento de la permeabilidad de la barrera hematoencefalica. Hubo 10 muertes debidas a encefalopatia anoxica en el Grupo III pero ninguno en los Grupos I o II. El curso posterior de los supervivientes a los 10 y 39 meses de edad revelaron secuelas neuroldgicas tres nifios de Grupo I, dos en el Grupo II y cinco en el Grupo III. El promedio de lactodesidrogenasa en LCR en aquellos nifios con secuelas no era significativamente diferente de los supervivientes normales; sin embargo el promedio era significativamente mas alto en los lactantes que murieron con encefalopatia noica en comparacion con los lactantes normales. Estos datos indicaban que la lactodesidrogenasa en el LCR esta elevada significativamente en lactantes con anoxia natal y dafio cerebral, y sugiere que las determinaciones pueden ser de valor prondstico en la hipoxia cerebral no fatal.