Hepatic and splenic venous access are specialised techniques used to perform diagnostic and interventional procedures in the cardiac catheterisation laboratory. Bleeding events are the most commonly reported complication following hepatic or splenic venous access. The VASCADE Vascular Closure System (Cardiva Medical Inc. Santa Barbara, CA) is an approved device for closure of femoral vascular access tracts in patients ≥18 years of age. We report our experience using VASCADE to close the hepatic or splenic venous access site in the cardiac catheterisation laboratory.

This is a single centre retrospective review of all patients who had percutaneous hepatic or splenic venous access obtained in the cardiac catheterisation laboratory from March 1, 2022 through October 30, 2023 and underwent tract closure with VASCADE.

Ten patients (six male) underwent 16 procedures (median age and weight 3.5 years and 12.5 kg) with 15 hepatic and two splenic veins accessed. Successful closure of the access tracts with VASCADE was performed in all patients. There were no major adverse events related to closure of the access sites with VASCADE.

VASCADE can be used following transhepatic and trans-splenic venous access in the cardiac catheterisation laboratory to safely close the access tract and potentially reduce the risk of post-procedural bleeding complications. Further evaluation in a larger cohort of patients is needed to ensure VASCADE is safe for use and provides adequate haemostasis following hepatic or splenic venous access, particularly in children.

The concept of digital psychiatry, encompassing technologies such as mental health apps, Virtual Reality (VR), Artificial Intelligence (AI), and telepsychiatry, emerges as a potential solution to bridge the existing gaps in the mental health system of Pakistan. However, one of the major barriers to the implementation of these technologies is hesitancy to adopt digital tools by psychiatrists.

This study aims to explore the current understanding of digital psychiatry, the barriers faced by psychiatrists in its’ widespread implementation, and their willingness to adopt these services in clinical practice.

This cross-sectional study surveyed psychiatrists’ knowledge, attitudes, and practices on digital psychiatry from 39 public hospitals across Pakistan using an online validated questionnaire from January to July 2023. Participants included psychiatry residents, fellows, and consultants practicing in Pakistan. Responses were analyzed with Raosoft software, Quirkos, and SPSS 26 using thematic analysis and correlation.

A total of 200 participants responded to the questionnaire, primarily in the age range of 20-30 years (56%). The gender distribution was 55% male (N = 111) and 45% female (N = 89). Among the professional roles, 23% were consultants, 7% were registrars, 54% were psychiatry residents, and 17% were medical officers. Respondents came from both rural (N = 148, 74%) and urban (N = 52, 26%) practice settings. Regarding telepsychiatry, 46% strongly agreed that they are familiar with telepsychiatry, while 58% agreed that telepsychiatry can save time and money. Additionally, 22% strongly agreed that it’s a viable approach for patient care. Concerning perspectives on Artificial Intelligence (AI) in digital psychiatry readiness, only 40% of participants had received AI training. However, 55% expressed interest in collaborating with international centers on AI-related projects. In terms of mental health apps, 62% of respondents reported limited familiarity with them. Nevertheless, 65% believed that these apps could potentially save time and money for psychiatric health systems. Lastly, concerning Virtual Reality (VR) in psychiatric care, 57% of participants were familiar with VR technology, but only 43% were acquainted with its applications in psychiatry. Notably, 71% did not view VR as a viable replacement for in-person psychiatric management.

This is the first study conducted on understanding digital psychiatry in Pakistan’s healthcare system, which revealed multiple challenges to digital health competency among psychiatrists. This emphasizes on the need for formal training and funding towards resources to overcome obstacles in utilizing mental health technologies.

None Declared

After the introduction of proposal regarding cannabidiol for the treatment of some psychiatric disorders including anxiety, there is confusion if cannabidiol use is associated with the provocation of anxiety symptoms or it can be safely used for the treatment. In nonmedical terms, (Cannabidiol) Cannabis is referred to as Marijuana and has been considered a potential substance of abuse for ages, that raises few questions for its use as a treating agent. It is an interesting area to be explored.

Our aim is to find out the implications of Cannabidiol use. We look forward to knowing the mechanism behind cannabidiol being a potential treatment strategy for anxiety.

A literature search was conducted using the search terms [anxiety] OR [cannabis] OR[ Marijuana] OR [cannabidiol] OR [tetrahydrocannabinol] OR [phytocannabinoids] OR [panic] OR [generalized anxiety] OR [social anxiety] OR [psycholgic distress] OR[psychosis] OR [depression]. The overall search produced 230 results. We included 30 studies relevant to the subject in this review.

Results revealed that anxiety is highly prevalent in individuals with a history of cannabidiol use in comparison to non-users. Symptoms of stress are more pronounced with more frequent cannabidiol use. Chronic users present with more severe symptoms like palpitations and the constant restlessness that are difficult to be managed. The potential role of Cannabinoids in reducing the conditioning of fear can be considered one of the reasons for investigations being done on it. Cannabidiol (Cb1) receptor plays a potential role in producing anxiolytic effects. The side effects of first-line drugs like distorted body shape due to weight gain, sexual health concerns and resistance along with frequent relapses, available for managing anxiety disorders are one of the reasons to consider alternative substances. Though, human testings are still underway, animal models are used currently for experimentation purposes and show positive anxiolytic effects of cannabidiol.

There is increased need to investigate necessary chemical and physiologic changes that are produced within the body in response to cannabidiol use. More investigations should be done on human subjects along with animal studies. Proper guidelines should be shared with practicing physicians so that new and pretested ways are open for the treatment of resistant cases with proper implications of knowledge in clinical settings so that there is minimal chance of abuse of potentially addictive chemicals.

Keywords: Cannabis, Cannabidiol, anxiety, treatment, provocation.

None Declared

Bipolar disorder (BD) is a source of marked disability, morbidity, and premature death. There is a paucity of research on personalized psychosocial interventions for BD, especially in lowresource settings. A previously published pilot randomized controlled trial (RCT) of a Culturally adapted PsychoEducation (CaPE) intervention for BD in Pakistan reported higher patient satisfaction, enhanced medication adherence, knowledge and attitudes towards BD, and improvement in mood symptom scores and health-related quality of life measures compared to treatment-as-usual (TAU).

This protocol describes a larger multicentre RCT to confirm the clinical and cost-effectiveness of CaPE in Pakistan.

A multicentre individual, parallel arm, RCT of CaPE in 300Pakistani adults with BD. Participants over the age of 18, with adiagnosis of bipolar I and II and who are currently euthymic, will berecruited from seven sites including Karachi, Lahore, Multan, Rawalpindi,Peshawar, Hyderabad and Quetta. Time to recurrence will be the primaryoutcome assessed using Longitudinal Interval Follow-up Evaluation(LIFE). Secondary measures will include mood symptomatology, qualityof life and functioning, adherence to psychotropic medications, andknowledge and attitudes towards BD.

Full ethics approval has been received from National Bioethics Committee (NBC) of Pakistan and Centre for Addiction and Mental Health (CAMH), Toronto, Canada. The study has completed sixty-five screening across the seven centres, of which forty-eight participants have been randomised.

A successful trial will lead to rapid implementation of CaPE in clinical practice, not only in Pakistan, but also in other low-resource settings including those in high-income countries, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority patients with BD.

None Declared

Epilepsy is a neurologic condition characterized by spontaneous jerky body movements. It is a chronic morbid condition mostly diagnosed during childhood. Patients are maintained on long-term medications to prevent recurrent seizures that can damage the brain. Medications used for the management of epilepsy have several side effects and require proper monitoring. Patients with epilepsy are at increased risk of psychiatric comorbidities.

Our aim is to find factors responsible for causing suicidality in patients with epilepsy.

A review was conducted using Pubmed database with the search terms [epilepsy] OR [neurological conditions] OR [suicide] OR [suidical attempt] OR [suicidal ideation] OR [depression] OR [psychiatric diseases] OR [mood disorders] OR [anxiety] OR [sleeplessness] which yielded around 800 articles. The number was later reduced to be centered around the main area of interest and produced around 40 articles.

Results show that many contributing factors play an unavoidable role in promoting suicidal ideation that can lead to suicidal attempts in epilepsy. The stigma associated with epilepsy leads to social isolation, lack of opportunities, financial constraints, and impact on close relationships which can be the reasons for depression. According to the review, the foremost contributing factor is the underlying social, emotional, and economic condition of epilepsy patients. Depression and anxiety are the most prevalent psychiatric comorbidities in epileptic patients. Epileptic patients who develop psychiatric ailments show decreased adherence to medications that further worsen the problem.

Though, this area in neurology has started getting attention for further research and guidelines. But efforts are still inadequate for this to be put into clinical practice. More desperate actions needed to be taken for proper diagnosis and management of suicidal ideations by proper use of assessment tools so that timely actions are planned. This is a highly demanding area due to the impact of depressive symptoms on the prognosis of the chronic neurologic condition.

Keywords: Suicidality; Epilepsy; neurology.

None Declared

Depression is the leading cause of disability worldwide and low and middle-income countries (LMICs) carry over 80% of this disease burden. Attempts have been made to address depression in LMICs, with improvements in the home environment and maternal knowledge. However paternal depression is a neglected and under-researched area. Since maternal depression is associated with depression in fathers there is a need for partner inclusive parenting programs to address parental mental health and improve child outcomes.

To evaluate the clinical and cost effectiveness of partner inclusive Learning through play plus (LTP+) intervention in reducing depression in fathers and mothers.

To evaluate the effectiveness of LTP + intervention in improving child outcomes.

To conduct process evaluation and identify challenges in transition to scale up of the intervention across Karachi, Pakistan from the perspective of fathers, mothers, and other stakeholders.

This is a cluster randomised controlled (cRCT) trial of partner inclusive group parenting program called (Learning Through Play (LTP+) across 18 towns in the city of Karachi. Over 5000 parents (fathers and partners) will participate in the study with a capacity building component of training 4000 Community Health Workers across Pakistan.

This large cRCT will confirm the clinical and cost-effectiveness of LTP+ in reducing depression in parents and improving child outcomes along with the barriers and facilitators to implement the LTP+ group parenting program and the possibilities to roll out the innovation at national level through engagement with policy makers.

Addressing depression in parents is hugely important because of its adverse effects both for child and parents. This low-cost group parenting program will help in scaling up the innovation across health services in Pakistan and other LMICs.

None Declared

Contact heat is commonly used in experimental research to evoke brain activity, most frequently acquired with electroencephalography (EEG). Although magnetoencephalography (MEG) improves spatial resolution, using some contact heat stimulators with MEG can present methodological challenges. This systematic review assesses studies that utilise contact heat in MEG, their findings and possible directions for further research.

Eight electronic databases were searched for relevant studies, in addition to the selected papers' reference lists, citations and ConnectedPapers maps. Best practice recommendations for systematic reviews were followed. Papers met inclusion criteria if they used MEG to record brain activity in conjunction with contact heat, regardless of stimulator equipment or paradigm.

Of 646 search results, seven studies met the inclusion criteria. Studies demonstrated effective electromagnetic artefact removal from MEG data, the ability to elicit affective anticipation and differences in deep brain stimulation responders. We identify contact heat stimulus parameters that should be reported in publications to ensure comparisons between data outcomes are consistent.

Contact heat is a viable alternative to laser or electrical stimulation in experimental research, and methods exist to successfully mitigate any electromagnetic noise generated by PATHWAY CHEPS equipment – though there is a dearth of literature exploring the post-stimulus time window.

Globally, governments have enforced protective measures of social distancing to prevent COVID-19 spread. The lifestyles of public have essentially transformed due to these actions. This study evaluates the effects of COVID-19 on connections and behavior/life adaptations.

Changes in life style and behavior in COVID-19-Pandemic

We conducted a global cross-sectional study via survey on phone apps and social media platforms in population aged ≥ 16, including questions regarding demographic data and lifestyle changes. We also searched databases APA PsycNet, PubMed, PsycINFO, and Medline; reviewed 40 articles and included 3 in this review, a cross-sectional online survey1, a planned questionnaire2, and a study on 600 adolescents, age 10-19 in Palestine3

Our survey data showed total of 1002 responses, 31.7% decreased sleep, 42.1% increased appetite, 70.6% bulk-buying, and 50.2% weight gain. 43.1% less socialization than before, 78.7% increased screen time, 53.5% excessive hand washing/wiping surfaces, 45% reported social distancing facilitated in overpowering the fear of contracting infection, 29.4% negative impact on relationships, 80.7% noticed changes in behavior including shaking hands/hugging/speaking with a mask on, 49.5% adopted new hobbies, 34.9% showed increase in meditation. The literature review revealed that since COVID-19, there is an increase in screen time, weight, appetite, sleep, and a decrease in physical activity1-3, and greater adherence to the Mediterranean diet in younger population2

COVID-19 induced quarantine has caused increased screen time, appetite, weight gain, adoption of new hobbies, bulk-buying, hand washing, meditation, reduced sleep, and negatively impacted interaction/relationships. COVID-19 pandemic is ongoing and our data needs further assessment in more population studies.

No significant relationships.

Psychological distress and suicide are known to be associated with exposure to traumatic life events. No literature is available on prevalence of suicidal ideation in the aftermath of terrorist attacks in Pakistan.

To study suicidal ideation and desire for death in trauma exposed population in Pakistan.

To estimate the prevalence of suicidal ideation and desire for death one year after exposure to extreme trauma in a well-defined and accessible group in Pakistan.

Subjects were examined 1 year after exposure to a bomb blast in Islamabad, Pakistan. A semi-structured interview schedule and Beck Scale for Suicidal Ideation were used to assess a group of female University students. Assessment record of 50 consecutive study participants were evaluated to estimate point prevalence of suicidal ideation and desire for death in the study population.

All subjects were enroled in full time university education at the time of assessment. 17 subjects (34%) presented with weak desire for death whilst 5 subjects (10%) presented with moderate to severe desire for death. 15 Subjects (30%) presented with active suicidal ideation at the time of assessment. However, ony 3 subjects (6%) presented with moderate to severe suicidal ideation. The subjects presenting with suicidal ideation described family ties, religious beliefs, fear of irreversible injury as protective factors against their suicidal thoughts. Only 2 subjects (4%) had engaged in some degree of planning towards committing suicide.

This study provides the first structured estimate of prevalence of suicidal ideation in trauma exposed population of Pakistan.