Background Little is known about the impact of the coronavirus disease 2019 pandemic on children with attention-deficit hyperkinetic disorder (ADHD). This study aimed to assess the impact of lockdown on children with the ADHD, and their families. Additionally, feasibility of carrying out “text message-based” intervention was evaluated. Methods An online survey was performed to evaluate the impact of lockdown on children with ADHD and their family members. Additionally, a “text message”-based intervention was performed over 2 weeks. Along with the text-based intervention, we also provided reading materials and an option of telephonic consultation. Results Of the 80 parents who initially consented to participate, 48 filled the baseline survey, and 41 agreed to receive intervention. Out of 41, 29 filled satisfaction survey. During the lockdown period, there was worsening of symptoms of ADHD in the form of increase (slight or marked) in the activity level (50.1%), irritability (45.8%), and disturbing or disruptive behavior (47.7%) in children. In terms of behavior of family members, there was marked/slight increase in irritability (37.5%), and shouting at the child (43.8%), verbal abuse (25%), and punishing the child (27.1%). Additionally, there was an increase in the praising (67.6%) and spending time with the child (72.9%). Text-based messages on a scale of 0 to 10 were rated as 5.79 for the content, 5.76 for the usefulness, and 6 for satisfaction. Conclusion Lockdown resulted in worsening of symptoms among children of ADHD and it had impact on the interaction pattern of the children and parents. A “text message”-based intervention is a feasible and possibly acceptable option to deal with the behavioral problem of the children and adolescents with ADHD.

CD3TCRαβ and CD19 cell-depleted haploidentical or mMUD HSCT is a practical and viable alternative for children with a range of PIDs.

Gender is a critical determinant of mental health and mental illness. The patterns of psychological distress and psychiatric disorder among women are different from those seen among men. Women have a higher mean level of internalizing disorders while men show a higher mean level of externalizing disorders. Gender differences occur particularly in the rates of common mental disorders wherein women predominate. Differences between genders have been reported in the age of onset of symptoms, clinical features, frequency of psychotic symptoms, course, social adjustment, and long-term outcome of severe mental disorders. Women who abuse alcohol or drugs are more likely to attribute their drinking to a traumatic event or a stressor and are more likely to have been sexually or physically abused than other women. Girls from nuclear families and women married at a very young age are at a higher risk for attempted suicide and self-harm. Social factors and gender specific factors determine the prevalence and course of mental disorders in female sufferers. Low attendance in hospital settings is partly explained by the lack of availability of resources for women. Around two-thirds of married women in India were victims of domestic violence. Concerted efforts at social, political, economic, and legal levels can bring change in the lives of Indian women and contribute to the improvement of the mental health of these women.

We examined tolerance mechanisms in patients receiving HLA-mismatched combined kidney and bone marrow transplantation (CKBMT) that led to transient chimerism under a previously-published non-myeloablative conditioning regimen (Immune Tolerance Network study ITN036). Polychromatic flow cytometry (FCM) and high throughput sequencing of TCRβ hypervariable regions of DNA from peripheral blood T regulatory cells (Tregs) and CD4 non-Tregs revealed marked early enrichment of regulatory T cells (CD3+CD4+CD25highCD127lowFoxp3+) in blood that resulted from peripheral proliferation (Ki67+), possibly new thymic emigration (CD31+) and, in one tolerant subject, conversion from non-Tregs. Among recovering conventional T cells, central memory CD4+ and CD8+ cells predominated. A large fraction of the T cell clones detected in post-transplant biopsy specimens by TCR sequencing were detected in the peripheral blood and were not donor-reactive. Our results suggest that enrichment of Tregs by new thymic emigration and lymphopenia-driven peripheral proliferation in the early post-transplant period may contribute to tolerance following CKBMT. Furthermore, most conventional T cell clones detected in immunologically quiescent post-transplant biopsies appear to be circulating cells in the microvasculature rather than infiltrating T cells.

Despite the high prevalence and potentially disabling consequences of mental disorders, specialized mental health services are extremely deficient, leading to the so-called ‘Mental Health Gap’. Moreover, the services are concentrated in the urban areas, further worsening the rural-urban and tertiary primary care divide. Strengthening of and expanding the existing human resources and infrastructure, and integrating mental health into primary care appear to be the two major solutions. However, both the strategies are riddled with logistic difficulties and have a long gestation period. In such a scenario, telepsychiatry or e-mental health, defined as the use of information and communication technology to provide or support psychiatric services across distances, appears to be a promising answer. Due to its enormous potential, a review of the existing literature becomes imperative. An extensive search of literature was carried out and has been presented to delineate the modes of communication, acceptability and satisfaction, reliability, outcomes, cost-effectiveness, and legal and ethical challenges related to telepsychiatry. Telepsychiatry has been applied for direct patient care (diagnosis and management), consultation, and training, education, and research purposes. Both real-time, live interaction (synchronous) and store–forward (asynchronous) types of technologies have been used for these purposes. A growing amount of literature shows that training, supervision, and consultation by specialists to primary care physicians through telepsychiatry has several advantages. In this background, we have further focused on the models of telepsychiatry best suited for India, considering that mental health care can be integrated into primary care and taken to the doorstep of patients in the community.

No abstract

Background: Depression is a common mental disorder seen across all age groups, including children and adolescents. Depression is often associated with significant disability in children and adolescents. Aim: This review aims to evaluate the Indian research on depression in children and adolescents. Results: Available data suggest that the point prevalence of depression/affective disorders ranges from 1.2% to 21% in the clinic-based studies; 3%–68% in school-based studies and 0.1%–6.94% in community studies. There has been only one incidence study from India which estimated the incidence to be 1.6%. With respect to the risk factors for depression, studies have reported various education-related difficulties, relationship issues with parents or at home, family-related issues, economic difficulties, and other factors. A limited number of studies have evaluated the symptom profile, and the commonly reported symptoms include depressed mood, diminished interest in play activities, concentration difficulties, behavior problems in the form of anger and aggression, pessimism, decreased appetite, decreased sleep, anhedonia, and somatic symptoms. None of the studies from India has evaluated the efficacy/effectiveness of various antidepressants in children and adolescents with depression. Conclusion: There is a wide variation in the point prevalence reported across different studies, which is mainly due to methodological differences across studies. Limited data are available with respect to symptom profile and factors associated with depression in children and adolescents.

Sickle cell disease is a potentially debilitating hemoglobinopathy associated with early mortality. The only established curative therapy is hematopoietic cell transplantation (HCT) with a matched sibling donor. The National Institutes of Health nonmyeloablative regimen of alemtuzumab/300 cGy total body irradiation and prolonged sirolimus exposure for graft-versus-host disease (GVHD) prophylaxis was administered to 16 children and adolescents. Infused products were unmanipulated granulocyte colony stimulating factor mobilized peripheral blood stem cells. All patients achieved mixed donor-recipient engraftment with no cases of secondary graft failure to date. Two patients have donor myeloid chimerism in the range of 30% to 40%. No sickling crises post-HCT have been observed. Event-free and overall survival rates are 100% with median follow-up of 19.5 months. No cases of GVHD have been observed. Sirolimus weaning was possible in all but one eligible patient to date. Ongoing followup and a larger prospective clinical trial are required to determine the long-term safety and efficacy of this regimen in children.