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There is no multi-country/multi-language study testing a-priori multivariable associations between non-modifiable/modifiable factors and validated wellbeing/multidimensional mental health outcomes before/during the COVID-19 pandemic. Moreover, studies during COVID-19 pandemic generally do not report on representative/weighted non-probability samples. The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) is a multi-country/multi-language survey conducting multivariable/LASSO-regularized regression models and network analyses to identify modifiable/non-modifiable factors associated with wellbeing (WHO-5)/composite psychopathology (P-score) change. It enrolled general population-representative/weighted-non-probability samples (26/04/2020-19/06/2022). Participants included 121,066 adults (age=42±15.9 years, females=64 %, representative sample=29 %) WHO-5/P-score worsened (SMD=0.53/SMD=0.74), especially initially during the pandemic. We identified 15 modifiable/nine non-modifiable risk and 13 modifiable/three non-modifiable protective factors for WHO-5, 16 modifiable/11 non-modifiable risk and 10 modifiable/six non-modifiable protective factors for P-score. The 12 shared risk/protective factors with highest centrality (network-analysis) were, for non-modifiable factors, country income, ethnicity, age, gender, education, mental disorder history, COVID-19-related restrictions, urbanicity, physical disorder history, household room numbers and green space, and socioeconomic status. For modifiable factors, we identified medications, learning, internet, pet-ownership, working and religion as coping strategies, plus pre-pandemic levels of stress, fear, TV, social media or reading time, and COVID-19 information. In multivariable models, for WHO-5, additional non-modifiable factors with |B|>1 were income loss, COVID-19 deaths. For modifiable factors we identified pre-pandemic levels of social functioning, hobbies, frustration and loneliness, and social interactions as coping strategy. For P-scores, additional non-modifiable/modifiable factors were income loss, pre-pandemic infection fear, and social interactions as coping strategy. COH-FIT identified vulnerable sub-populations and actionable individual/environmental factors to protect well-being/mental health during crisis times. Results inform public health policies, and clinical practice., Competing Interests: Conflict of interest Conflict of interest statements of all authors are detailed in eTable 12., (Copyright © 2024. Published by Elsevier B.V.)

International studies measuring wellbeing/multidimensional mental health before/ during the COVID-19 pandemic, including representative samples for >2 years, identifying risk groups and coping strategies are lacking. COH-FIT is an online, international, anonymous survey measuring changes in well-being (WHO-5) and a composite psychopathology P-score, and their associations with COVID-19 deaths/restrictions, 12 a-priori defined risk individual/cumulative factors, and coping strategies during COVID-19 pandemic (26/04/2020-26/06/2022) in 30 languages (representative, weighted non-representative, adults). T-test, χ 2 , penalized cubic splines, linear regression, correlation analyses were conducted. Analyzing 121,066/142,364 initiated surveys, WHO-5/P-score worsened intra-pandemic by 11.1±21.1/13.2±17.9 points (effect size d=0.50/0.60) (comparable results in representative/weighted non-probability samples). Persons with WHO-5 scores indicative of depression screening (<50, 13% to 32%) and major depression (<29, 3% to 12%) significantly increased. WHO-5 worsened from those with mental disorders, female sex, COVID-19-related loss, low-income country location, physical disorders, healthcare worker occupations, large city location, COVID-19 infection, unemployment, first-generation immigration, to age=18-29 with a cumulative effect. Similar findings emerged for P-score. Changes were significantly but minimally related to COVID-19 deaths, returning to near-pre-pandemic values after >2 years. The most subjectively effective coping strategies were exercise and walking, internet use, social contacts. Identified risk groups, coping strategies and outcome trajectories can inform global public health strategies., Competing Interests: Declaration of competing interest Conflict of interest statements of all authors are detailed in eTable 8., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The nervous system is critical for intestinal homeostasis and function, but questions remain regarding its impact on gut immune defense. By screening the major neurotransmitters of C. elegans, we found that γ-aminobutyric acid (GABA) deficiency enhanced susceptibility to pathogenic Pseudomonas aeruginosa PA14 infection. GABAergic signaling between enteric neurons and intestinal smooth muscle promoted gut defense in a PMK-1/p38-dependent, but IIS/DAF-16- and DBL-1/TGF-β-independent, pathway. Transcriptomic profiling revealed that the neuropeptide, FLP-6, acted downstream of enteric GABAergic signaling. Further data determined that FLP-6 was expressed and secreted by intestinal smooth muscle cells and functioned as a paracrine molecule on the intestinal epithelium. FLP-6 suppressed the transcription factors ZIP-10 and KLF-1 that worked in parallel and converged to the PMK-1/p38 pathway in the intestinal epithelia for innate immunity and gut defense. Collectively, these findings uncover an enteric neuron-muscle-epithelium axis that may be evolutionarily conserved in higher organisms., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2023 Elsevier Inc. All rights reserved.)

In this study, we investigate what happens to entropy in the presence of electrokinetic phenomena. It is speculated that the microchannel has an asymmetrical and slanted configuration. The presence of fluid friction, mixed convection, Joule heating, presence and absence of homogeneity, and a magnetic field are modelled mathematically. It is also emphasized that the diffusion factors of the autocatalyst and the reactants are equal. The governing flow equations are linearized using the Debye-Huckel and lubrication assumptions. The resulting nonlinear couple differential equations are solved using the program's integrated numerical solver, Mathematica. We take a graphical look at the results of homogeneous and heterogeneous reactions and talk about what we see. It has been demonstrated that homogeneous and heterogeneous reaction parameters affect concentration distribution f in different ways. The Eyring-Powell fluid parameters B1 and B2 display an opposite relation with the velocity, temperature, entropy generation number, and Bejan number. The mass Grashof number, the Joule heating parameter, and the viscous dissipation parameter all contribute to the overall increase in fluid temperature and entropy.

Background: The Collaborative Outcome study on Health and Functioning during Infection Times (COH-FIT; www.coh-fit.com) is an anonymous and global online survey measuring health and functioning during the COVID-19 pandemic. The aim of this study was to test concurrently the validity of COH-FIT items and the internal validity of the co-primary outcome, a composite psychopathology "P-score"., Methods: The COH-FIT survey has been translated into 30 languages (two blind forward-translations, consensus, one independent English back-translation, final harmonization). To measure mental health, 1-4 items ("COH-FIT items") were extracted from validated questionnaires (e.g. Patient Health Questionnaire 9). COH-FIT items measured anxiety, depressive, post-traumatic, obsessive-compulsive, bipolar and psychotic symptoms, as well as stress, sleep and concentration. COH-FIT Items which correlated r ≥ 0.5 with validated companion questionnaires, were initially retained. A P-score factor structure was then identified from these items using exploratory factor analysis (EFA) and confirmatory factor analyses (CFA) on data split into training and validation sets. Consistency of results across languages, gender and age was assessed., Results: From >150,000 adult responses by May 6th, 2022, a subset of 22,456 completed both COH-FIT items and validated questionnaires. Concurrent validity was consistently demonstrated across different languages for COH-FIT items. CFA confirmed EFA results of five first-order factors (anxiety, depression, post-traumatic, psychotic, psychophysiologic symptoms) and revealed a single second-order factor P-score, with high internal reliability (ω = 0.95). Factor structure was consistent across age and sex., Conclusions: COH-FIT is a valid instrument to globally measure mental health during infection times. The P-score is a valid measure of multidimensional mental health., Competing Interests: Conflict of interest Conflict of interest statements of all authors are detailed in Supplementary Table 7., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: . High-quality comprehensive data on short-/long-term physical/mental health effects of the COVID-19 pandemic are needed., Methods: . The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) is an international, multi-language (n=30) project involving >230 investigators from 49 countries/territories/regions, endorsed by national/international professional associations. COH-FIT is a multi-wave, on-line anonymous, cross-sectional survey [wave 1: 04/2020 until the end of the pandemic, 12 months waves 2/3 starting 6/24 months threreafter] for adults, adolescents (14-17), and children (6-13), utilizing non-probability/snowball and representative sampling. COH-FIT aims to identify non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to improve social/health outcomes in the general population/vulnerable subgrous during/after COVID-19. In adults, co-primary outcomes are change from pre-COVID-19 to intra-COVID-19 in well-being (WHO-5) and a composite psychopathology P-Score. Key secondary outcomes are a P-extended score, global mental and physical health. Secondary outcomes include health-service utilization/functioning, treatment adherence, functioning, symptoms/behaviors/emotions, substance use, violence, among others., Results: . Starting 04/26/2020, up to 14/07/2021 >151,000 people from 155 countries/territories/regions and six continents have participated. Representative samples of ≥1,000 adults have been collected in 15 countries. Overall, 43.0% had prior physical disorders, 16.3% had prior mental disorders, 26.5% were health care workers, 8.2% were aged ≥65 years, 19.3% were exposed to someone infected with COVID-19, 76.1% had been in quarantine, and 2.1% had been COVID 19-positive., Limitations: . Cross-sectional survey, preponderance of non-representative participants., Conclusions: . Results from COH-FIT will comprehensively quantify the impact of COVID-19, seeking to identify high-risk groups in need for acute and long-term intervention, and inform evidence-based health policies/strategies during this/future pandemics., (Copyright © 2021. Published by Elsevier B.V.)

Background: The COVID-19 pandemic has altered daily routines and family functioning, led to closing schools, and dramatically limited social interactions worldwide. Measuring its impact on mental health of vulnerable children and adolescents is crucial., Methods: The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT - www.coh-fit.com) is an on-line anonymous survey, available in 30 languages, involving >230 investigators from 49 countries supported by national/international professional associations. COH-FIT has thee waves (until the pandemic is declared over by the WHO, and 6-18 months plus 24-36 months after its end). In addition to adults, COH-FIT also includes adolescents (age 14-17 years), and children (age 6-13 years), recruited via non-probability/snowball and representative sampling and assessed via self-rating and parental rating. Non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to promote health and prevent mental and physical illness in children and adolescents will be generated by COH-FIT. Co-primary outcomes are changes in well-being (WHO-5) and a composite psychopathology P-Score. Multiple behavioral, family, coping strategy and service utilization factors are also assessed, including functioning and quality of life., Results: Up to June 2021, over 13,000 children and adolescents from 59 countries have participated in the COH-FIT project, with representative samples from eleven countries., Limitations: Cross-sectional and anonymous design., Conclusions: Evidence generated by COH-FIT will provide an international estimate of the COVID-19 effect on children's, adolescents' and families', mental and physical health, well-being, functioning and quality of life, informing the formulation of present and future evidence-based interventions and policies to minimize adverse effects of the present and future pandemics on youth., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Innate immunity is the first line of host defense against pathogen infection in metazoans. However, the molecular mechanisms of the complex immune regulatory network are not fully understood. Based on a transcriptome profiling of the nematode Caenorhabditis elegans , we found that a bZIP transcription factor ZIP-11 was up-regulated upon Pseudomonas aeruginosa PA14 infection. The tissue specific RNAi knock-down and rescue data revealed that ZIP-11 acts in intestine to promote host resistance against P. aeruginosa PA14 infection. We further showed that intestinal ZIP-11 regulates innate immune response through constituting a feedback loop with the conserved PMK-1/p38 mitogen-activated protein signaling pathway. Intriguingly, ZIP-11 interacts with a CCAAT/enhancer-binding protein, CEBP-2, to mediate the transcriptional response to P. aeruginosa PA14 infection independently of PMK-1/p38 pathway. In addition, human homolog ATF4 can functionally substitute for ZIP-11 in innate immune regulation of C. elegans . Our findings indicate that the ZIP-11/ATF4 genetic program activates local innate immune response through conserved PMK-1/p38 and CEBP-2/C/EBPγ immune signals in C. elegans , raising the possibility that a similar process may occur in other organisms., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Zheng, Aihemaiti, Liu, Afridi, Yang, Zhang, Xu, Chen and Tu.)

GABAergic neurotransmission constitutes a major inhibitory signaling mechanism that plays crucial roles in central nervous system physiology and immune cell immunomodulation. However, its roles in innate immunity remain unclear. Here, we report that deficiency in the GABAergic neuromuscular junctions (NMJs) of Caenorhabditis elegans results in enhanced resistance to pathogens, whereas pathogen infection enhances the strength of GABAergic transmission. GABAergic synapses control innate immunity in a manner dependent on the FOXO/DAF-16 but not the p38/PMK-1 pathway. Our data reveal that the insulin-like peptide INS-31 level was dramatically decreased in the GABAergic NMJ GABA A R-deficient unc-49 mutant compared with wild-type animals. C. elegans with ins-31 knockdown or loss of function exhibited enhanced resistance to Pseudomonas aeruginosa PA14 exposure. INS-31 may act downstream of GABAergic NMJs and in body wall muscle to control intestinal innate immunity in a cell-nonautonomous manner. Our results reveal a signaling axis of synapse-muscular insulin-intestinal innate immunity in vivo., Competing Interests: The authors declare no competing interest.

Objective: To determine the pattern of presentations and characteristics of patients at a psychiatric emergency services facility., Methods: The cross-sectional study was conducted in November 2016 at the Department of Psychiatry and Behavioural Sciences, Jinnah Postgraduate Medical Centre, Karachi, and comprised all patients presenting to the departmental emergency services. Data was documented on a pre designed semi-structured proforma, and analysed using SPSS 22., Results: Of the 316 cases, 162(51.3%) were males and 154(48.7%) were females. The overall mean age was 30.78+/- 13.09 years (range: 8-80 years). Psychiatric emergencies comprised suicidal attempt, excitement, violence, altered sensorium, altered/ inappropriate behaviour and extrapyramidal symptoms / acute dystonia together constituting for 123(38.9%) of the total presentations, while there were 20(6.33%) cases of hysterical fits and 6(1.89%) with acute anxiety symptoms. Overall, 56(17.7%) subjects were found to have no psychiatric diagnosis, and 46(81.5%) of these were referred cases., Conclusions: Non-emergency visits constituted high percentage of emergency presentation.

In a humanitarian crisis, healthcare workers are on the frontline in providing their services. Despite being crisis management personnel, healthcare workers may get exposed to occupational stress due to unprecedented circumstances, challenges in delivery of high-quality care, lack of resources, and most importantly for being at high risk to suffer from the impact of the situation itself. Therefore, it is imperative to maintain the mental health of healthcare workers on a regular basis and more so during a pandemic like COVID-19. For addressing the occupational stress in healthcare workers, a Cognitive Behaviour Therapy (CBT) based intervention is suggested, also supported by a Cochrane review, which can build/ improve/ enhance resilience, needed to shield individuals against the development of psychopathology, at the public health level in humanitarian crises. In addition to developing resilience, which will be helpful in combating anxiety, depression, somatization, and incapacitation, CBT will also help in dealing with the social isolation which has been part and parcel of COVID-19 and similar pandemic situations., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Psychiatry.)

Background  Escitalopram is widely used for the management of the major depressive disorder and generalized anxiety disorder, but there is no to very limited data available regarding efficacy and safety in Pakistani patients. This study was conducted to evaluate the efficacy and safety of escitalopram oral drops to manage the major depressive disorder and generalized anxiety disorder in a local cluster within Pakistan. Methods This prospective multicenter observational study was conducted in the department of psychiatry from August 2018 - August 2019. Eighty-five patients meeting the selection criteria were included in the study. Adolescent, adult, and geriatric patients of either gender with generalized anxiety disorder having Hamilton Anxiety Rating Scale (HAM-A) rate ≥ 10 and major depressive disorder having Montgomery-Asberg Depression Rating Scale (MADRS) rate ≥ 7 or patients with co-morbid generalized anxiety disorder (GAD), major depressive disorder (MDD) were selected for the study. We are reporting patients' improvement from baseline, response rate, and remission rate. Data analysis is performed by using SPSS version 21 (IBM Inc, Armonk, USA). Results Among enrolled patients, 42 were adolescents, 22 were adults, and 21 were geriatric. The mean age of an adolescent, adult, and geriatric patients was 14.92 ± 2.04, 44.54 ± 12.08, and 64.61 ± 3.16 years, respectively. Among enrolled patients, the mean change in a total score of HAM-A for anxiety and MADRS for depression were -10.04 ± 4.32 and -17.67 ± 14.42, respectively. At the end of the study, the remission rate and response rate for depression were 82 % and 75%, respectively. Similarly, the remission rate and the response for anxiety were 76% and 81%, respectively. Mean HAM-A and MADRS scores were significantly improved for adolescent, adult, and geriatric patients. Adverse events were reported in eight (9.41%) patients with six having gastrointestinal (GI) disturbance and two having to worsen anxiety. All reported adverse events were of mild severity.  Conclusion  Escitalopram oral drops are found effective and tolerable in reducing both anxiety and depression over the duration of study in all age groups, including adolescents, adults, and geriatrics., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2020, Afridi et al.)

Nanoparticles as biomedicine has made a crucial role in health biotechnology. Different transition metals in various forms playing role in nanotechnological advances and biological applications. Silver as one of the nontoxic, safe inorganic antibacterial agents and can serve as replacement of antibiotics. Present research is based on biogenic synthesis of silver nanoparticles (Ag-NPs) as potential antibiotics from fungal metabolites of Penicillium oxalicum. We used different analytical techniques X-ray diffraction (XRD) and scanning electron microscopy (SEM) for characterization of biosynthesized silver nanoparticles. Furthermore, the antibacterial activity of biosynthesized silver nanoparticles was checked against Staphylococcus aureus, S. dysenteriae, and Salmonella typhi by using well diffusion method and UV visible spectrophotometer. Maximum zone of inhibition recorded against S. aureus, Shigella dysenteriae was 17.5 ± 0.5 mm (mm) for both species and 18.3 ± 0.60 mm for Salmonella typhi. The biosynthesized silver nanoparticles of P. oxalicum showed excellent antibacterial activity. It was concluded from our results that biosynthesized silver nanoparticles have significant potential and might be useful for a wide range of biological applications such as bactericidal agent against resistant bacteria, preventing infections, healing wounds, and anti-inflammation., (© 2019 Wiley Periodicals, Inc.)

Gender Dysphoria is a condition with a strong and persistent incongruence between one's experienced and assigned gender. The magnitude of disturbance is enormous, ranging from social isolation, rejection, segregation and exclusion from the society to some severe mental health problems such as anxiety, depression, self-harm and death. The condition been recognized across wide range of cultures around the world; however the degree of its expression and tolerance varies. Art has long been used as a medium for expression as well as a tool for therapy. In this paper, the researcher has used the medium to highlight the challenges associated with Gender Dysphoria., (Copyright © 2019. Published by Elsevier B.V.)

In this article, the entropy generation characteristics of a laminar unsteady MHD boundary layer flow are analysed numerically for an incompressible, electrically conducting and dissipative fluid. The Ohmic heating and energy dissipation effects are added to the energy equation. The modelled dimensional transport equations are altered into dimensionless self-similar partial differential equations (PDEs) through suitable transformations. The reduced momentum and energy equations are then worked out numerically by employing a new hybrid method called the Gear-Generalized Differential Quadrature Method (GGDQM). The obtained numerical results are incorporated in the calculation of the Bejan number and dimensionless entropy generation. Quantities of physical interest, like velocity, temperature, shear stress and heat transfer rate, are illustrated graphically as well as in tabular form. Impacts of involved parameters are examined and discussed thoroughly in this investigation. Exact and GGDQM solutions are compared for special cases of initial unsteady flow and final steady state flow. Furthermore, a good harmony is observed between the results of GGDQM and those given previously by the Spectral Relaxation Method (SRM), Spectral Quasilinearization Method (SQLM) and Spectral Perturbation Method (SPM).

The primary objective of the present work is to study the effects of heat transfer and entropy production in a nanofluid flow over a curved surface. The influences of Lorentz force and magnetic heating caused by the applied uniform magnetic field and energy dissipation by virtue of frictional heating are considered in the problem formulation. The effects of variable thermal conductivity are also encountered in the present model. The dimensional governing equations are reduced to dimensionless form by introducing the similarity transformations. The dimensionless equations are solved numerically by using the Chebyshev⁻Gauss⁻Lobatto spectral method (CGLSM). The rate of increase/increase in the local Nusselt number and skin friction coefficient are estimated by using a linear regression model. The expression for dimensionless entropy production is computed by employing the solutions obtained from dimensionless momentum and energy equations. Various graphs are plotted in order to examine the effects of physical flow parameters on velocity, temperature, and entropy production. The increase in skin friction coefficient with magnetic parameter is high for nanofluid containing copper nanoparticles as compared to silver nanoparticles. The analysis reveals that velocity, temperature, and entropy generation decrease with the rising value of dimensionless radius of curvature. Comparative analysis also reveals that the entropy generation during the flow of nanofluid containing copper nanoparticles is greater than that of containing silver nanoparticles.

The effects of variable thermal conductivity on heat transfer and entropy generation in a flow over a curved surface are investigated in the present study. In addition, the effects of energy dissipation and Ohmic heating are also incorporated in the modelling of the energy equation. Appropriate transformations are used to develop the self-similar equations from the governing equations of momentum and energy. The resulting self-similar equations are then solved by the Generalized Differential Quadrature Method (GDQM). For the validation and precision of the developed numerical solution, the resulting equations are also solved numerically using the Runge-Kutta-Fehlberg method (RKFM). An excellent agreement is found between the numerical results of the two methods. To examine the impacts of emerging physical parameters on velocity, temperature distribution and entropy generation, the numerical results are plotted against the various values of physical flow parameters and discussed physically in detail.

The present research work explores the effects of suction/injection and viscous dissipation on entropy generation in the boundary layer flow of a hybrid nanofluid (Cu-Al 2 O 3 -H 2 O) over a nonlinear radially stretching porous disk. The energy dissipation function is added in the energy equation in order to incorporate the effects of viscous dissipation. The Tiwari and Das model is used in this work. The flow, heat transfer, and entropy generation analysis have been performed using a modified form of the Maxwell Garnett (MG) and Brinkman nanofluid model for effective thermal conductivity and dynamic viscosity, respectively. Suitable transformations are utilized to obtain a set of self-similar ordinary differential equations. Numerical solutions are obtained using shooting and bvp4c Matlab solver. The comparison of solutions shows excellent agreement. To examine the effects of principal flow parameters like suction/injection, the Eckert number, and solid volume fraction, different graphs are plotted and discussed. It is concluded that entropy generation inside the boundary layer of a hybrid nanofluid is high compared to a convectional nanofluid.

In this article, we investigated entropy generation and heat transfer analysis in a viscous flow induced by a horizontally moving Riga plate in the presence of strong suction. The viscosity and thermal conductivity of the fluid are taken to be temperature dependent. The frictional heating function and non-linear radiation terms are also incorporated in the entropy generation and energy equation. The partial differential equations which model the flow are converted into dimensionless form by using proper transformations. Further, the dimensionless equations are reduced by imposing the conditions of strong suction. Numerical solutions are obtained using MATLAB boundary value solver bvp4c and used to evaluate the entropy generation number. The influences of physical flow parameters arise in the mathematical modeling are demonstrated through various graphs. The analysis reveals that velocity decays whereas entropy generation increases with rising values of variable viscosity parameter. Furthermore, entropy generation decays with increasing variable thermal conductivity parameter.

Objective: To find out the prevalence of Migraine among patients of Depressive Disorder., Methods: A descriptive cross sectional study, conducted at Department of Psychiatry and Behavioral Sciences, JPMC, Karachi from 1 st January 2014 to 30 th June 2014. Total 272 patients were enrolled in the study. Depressive disorder was diagnosed as per ICD-10 criteria and Migraine headache as ICHD-2 criteria for diagnosis., Results: A total of 272 patients with mean age of 31.85 ± 8.7 were enrolled. Out of 272 cases 64% were females; Out of total cases 86.4% were married. Migraine with aura was seen among 6.6% and migraine without aura was present among 26.1%. Migraine was linked more with females and married and of those having severe Depressive disorder., Conclusion: Migraine headache is common among depressed people, particularly females and having severe depression, so it ought to be remembered that while looking for Depressive disorder or headache the other condition must be remembered.

Objective: To determine the frequency of co-morbid common primary headaches among depressed patients., Methods: This study was conducted at the Jinnah Postgraduate Medical Centre, Karachi, from July to December 2014, and comprised depressed patients. Diagnosis of depressive disorder was based on diagnostic criteria of International Classification of Diseases (10th version). For the diagnosis of common primary headaches, International Classification of Headache Disorders (2nd edition) criteria were applied. SPSS 17 was used for data analysis., Results: Of the 331 participants, 129(39%) were males and 202(61%) were females. The overall mean age was 31.40±8.6 years (range: 18-50 years). Besides, 208(62.83%) participants had no headache and 123(37.16%) had common primary headaches. Of the latter, 18(5.4%) had migraine with aura, 49(14.8%) had migraine without aura and 56(16.9%) had tension-type headache. Common primary headaches were more common in females and among those having severe depressive disorder., Conclusions: The primary headache was common among outpatients with depressive disorder, predominantly tension-type headache and migraine without aura.

Objective: To determine the frequency of different motivating factors to quit opioid use., Methods: The descriptive, cross-sectional study was conducted at the Department of Psychiatry and Behavioural Sciences, Jinnah Postgraduate Medical Centre, Karachi, from August 2012 to February 2013, and comprised opioid users. Demographic data was collected through a semi-structured questionnaire whereas motivational factor was assessed through a self-designed proforma. A motivational factor questionnaire was developed after a pilot study. In this questionnaire, different intrinsic and extrinsic factors were categorised into four types, i.e. biological, psychological, social and religious factors. SPSS 17 was used for data analysis., Results: Of the 157 participants, 148(94.3%) were males and 9(5.7%) were females. The overall mean age was 31.83±8.99 years (range: 14-57 years). The mean age of onset of using opioids was 25.79±7.17 years (range: 13-40 years). The mean duration of using opioids was 5.29±3.72 years (range: 1-20 years). Besides, 141(90%) patients were under the age of 45 years. Strong social factors included feeling of inability to care for family among 122(77.7%) participants, embarrassment in society 107(68.2%), and family pressure by parents/ spouse/ children 94(59.9%)., Conclusions: Family and social factors were found to be the main source of motivation for a person to quit substance abuse.

It is well documented that depression increases the risk of cardiovascular disease (CVD). Women of age 55 and younger with depression are more likely to have CVD. The present study aims to investigate CVD risk in depressed women of reproductive age (RA) and menopausal age (MA). Adult women of RA and MA were divided in to two groups; healthy and depressed. Women were screened for depression (ICD-10 criteria) at outpatients department of local psychiatric hospital. Fasting serum cortisol, estradiol and lipid profile levels were determined. Data was analyzed using two-way ANOVA followed by Newman's Keuls q-test. Total cholesterol (TC), low-density lipoproteins (LDL) and triglycerides (TGs) were raised in MA women however high density lipoprotein (HDL) and estradiol were lower as compared to RA women. Depressed RA women showed increased TC, LDL and HDL but decreased estradiol as compared to healthy women of similar age group. MA depressed women showed increased TC and LDL but decreased HDL and estradiol as compared to healthy controls. We found that MA depressed women had low HDL and estradiol as compared to RA depressed women. Circulating cortisol levels were increased in both depressed RA and MA women compared to respective healthy controls. Low HDL/LDL ratio was found in both healthy and depressed MA women when compared with respective RA women. A significant negative correlation of estradiol and cortisol was found in depressed RA women. It is concluded that low HDL/LDL ratio and hypercortisolemia in both healthy and depressed MA women make them more vulnerable to CVD.

Objective: To study the prevalence and pattern of self-medication among adult males and females in Karachi, Pakistan., Methods: This cross-sectional community- based survey was carried out at five randomly selected towns of Karachi (Defence, Gulshan-e-Iqbal, North Nazimabad, Malir, Orangi town) over a period of 3 months (October, November & December 2012). A sample size of 500 adult cases (250 males & 250 females), with systemic random selection from different towns of Karachi were inducted in this study. The city was divided in 5 zones and one town from each zone was selected by systemic randomization. First available male and female from each randomly selected house were included in the study. After consent and confidentiality assurance they were interviewed on semi-structured Performa designed for this purpose. Results were analyzed and tabulated through SPSS v14.0., Result: The prevalence of self-medication in males and females in Karachi is found to be 84.8% (males 88.4% and females 81.2%). The most frequent symptoms for which self-medication used were headache (32.7%), fever (23.3%) and the medicines used were painkillers (28.8%), fever reducer medicines (19.8%). The most common reason 33.3% was previous experience with similar symptom., Conclusion: Self-medication is highly prevalent (84.8%) in Karachi. It was frequently used for headache followed by fever. Predominantly painkillers, fever reducer and cough syrups were used in the form of tablets and syrups. Main source of medicines for males were friends and for females were relatives.

Objective: To determine the frequency of cognitive impairment and its predictors in patients, who underwent first time coronary artery bypass graft surgery (CABGS)., Study Design: An observational study., Place and Duration of Study: The National Institute of Cardiovascular Diseases (NICVD), Karachi, from December 2008 to December 2009., Methodology: Study included patients > 18 years, who underwent first-time elective CABGS. Emergency CABGS, with additional cardiac procedures, myocardial infarction (MI) within one month and known psychiatric illness were excluded. Patients were evaluated for their socio-demographic profile, medical history, intra-operative, anesthetic and surgical techniques and postoperative complications/therapy in ICU. Cognitive functioning, before the surgery, at discharge, 6 weeks and 6 months post-CABG was evaluated by McNair's and MMSE scales. HDRS was added to see if depression was a confounding factor for cognitive decline., Results: One hundred and thirty four patients were followed-up at discharge, 74 at 6 weeks and 73 at 6 months. There were 113 (84.3%) males and 21 (15.7%) females, with mean age of 53.7 ± 8.36 years. Prevalence of cognitive disturbance at baseline was 44.8%, which increased to 54.5% at discharge, and improvement was seen at 6 months, it was 39.7%. Older age, female gender, higher bleeding episodes, and high post-surgery creatinine level were more frequently associated with cognitive decline., Conclusion: Postoperative cognitive deficit was common and remained persistent at short-term. Older age, females and high postoperative creatinine were identified as its important predictors. There was high frequency of acute depression before surgery with significant reduction over time.

The family of evolutionary or genetic algorithms is used in various fields of bioinformatics. Genetic algorithms (GAs) can be used for simultaneous comparison of a large pool of DNA or protein sequences. This article explains how the GA is used in combination with other methods like the progressive multiple sequence alignment strategy to get an optimal multiple sequence alignment (MSA). Optimal MSA get much importance in the field of bioinformatics and some other related disciplines. Evolutionary algorithms evolve and improve their performance. In this optimisation, the initial pair-wise alignment is achieved through a progressive method and then a good objective function is used to select and align more alignments and profiles. Child and subpopulation initialisation is based upon changes in the probability of similarity or the distance matrix of the alignment population. In this genetic algorithm, optimisation of mutation, crossover and migration in the population of candidate solution reflect events of natural organic evolution.

Background: Age-adjusted incidence of prostate cancer in Pakistan is 5.3 per 100,000 which is relatively low as compared to other Asian countries, but increasing numbers of cases are being reported. Data on risk factors associated with prostate cancer risk among Pakistani men are sparse. The objective of this study was to identify lifestyle factors associated with the risk of prostate cancer in Pakistani men., Methods: An unmatched case-control study was conducted in Lahore from February to October 2011. The study enrolled 195 histologically confirmed cases of adenocarcinoma of prostate from Shaukat Khanum Memorial Hospital and Institute of Nuclear Medicine and Oncology Lahore (INMOL) and Lady Reading Hospital. Peshawar, using purposive sampling technique. A total of 390 hospital controls were selected using convenient sampling technique from different teaching hospitals of Lahore after screening with prostate specific antigen levels. A semi-structured interview form was used to collect data through face-to-face interviews. Odds ratio was used as a measure of strength of association and was calculated using unconditional logistic regression., Results: Farmers were found to be at higher odds of prostate cancer (OR 19.76; 95% CI 5.51-70.80; p < 0.001). No significant association was found with marital status, ethnic background, religious affiliation and consanguineous marriages. Level of physical activity was inversely associated with prostate cancer risk (OR 0.05; 95% CI 0.01-0.26; p < 0.001). Positive association was found with increased red meat consumption (OR 11.82; 95% CI 2.88-48.54; p = 0.001) and dairy products intake (11.76; 95% CI 4.23-32.67; p < 0.001)., Conclusion: Red meat consumption, higher dairy products intake and working as farmers are strongly associated with increased odds of prostate cancer among Pakistani men.

Objective: To assess and compare cognitive disturbances among newly diagnosed depressed and healthy control cases on the McNair and Kahn auto-evaluation scale., Study Design: Comparative, cross-sectional study., Place and Duration of Study: Out-patients Department of Psychiatry, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from February to May, 2007., Methodology: All consecutive new cases reporting at the out patient department were screened for depressive illness. They were matched with healthy-controls aged between 18-40 years. Clinical assessment was carried out on the basis of detailed history, physical examination, mental state examination by psychiatrists. For diagnostic purpose, application of ICD-10 followed by administration of Scale for Cognitive Difficulties., Results: Sixty subjects, 30 depressed patients (20 females and 10 males) and 30 healthy-controls (18 females and 12 males) were assessed. The age of cases with depressive disorder ranged 18-38 years. It was found that 63.3% (65% females and 60% males) depressed patients had cognitive difficulties compared to 3.3% of healthy-controls (p < 0.001). Proportions were compared using chi-square test with significance at p < 0.05., Conclusion: Depression is not merely an emotional (mood) disorder but has an impact on cognition domain as well. Attention/concentration was the most common domain of cognition affected, followed by memory disturbance among the drug-naïve depressed patients.

Objective: To assess gastrointestinal symptoms among depressed patients presenting in an outpatient psychiatric clinic., Methods: All consecutive and consenting cases of depressive disorder presenting to the clinic from Jan' 02 to Dec' 05 were inducted in the study. A descriptive study was carried out in a clinical setting at the Neuro-Spinal Medical Institute, Karachi, Pakistan. The assessment was based on detailed history, physical examination, mental state examination and filling of semi structured proforma designed for this purpose. For diagnostic purpose WHO classification ICD-10 criteria was used., Results: A total of 1165 (Male: 56%, Female: 43.2%) patients were assessed. The age ranged from 6 to 90 years for male and 5 to 80 for females with p-value of 0.001. Majority were married. Their educational status revealed that 20.4% of males and 45.1% females were illiterate. The most frequently reported gastrointestinal symptom was decreased appetite (67.7%) followed by constipation (57.7%) and diarrhoea (42.3%). Other reported symptoms included abdominal pain, vomiting, gas, indigestion and nausea in order of frequency. In males 13.7% and 12.7% females had suffered for > 10 years before seeking psychiatric consultation. Surprisingly, about 26.3% of the patients had previously pursued alternative modes of treatment (homeopathic, faith healers and hakeems)., Conclusion: Somatic symptoms manifesting as gastrointestinal symptoms are common in patients with depressive disorder. Awareness about such an association is essential and will be useful for primary care physicians and gastroenterologists for establishing early diagnosis and management, thus avoiding unnecessary investigations in patients with poor resources.

Objective: To determine clinical manifestations of depressive disorder among cases below 18 years., Design: Cross-sectional study., Place and Duration of Study: Carried out at NMI (Neurospinal Medical Institute), Karachi, over a period of 3 years (October 2001 to 2004)., Patients and Methods: Four hundred consecutive cases, below the age of 18 years, were evaluated. One hundred cases were inducted in this study based on detailed history and interview by psychiatrists. The diagnostic criteria of ICD-10 (International classification of diseases in its tenth revision) of WHO was used. Results based on clinical features were tabulated and analysed with SPSS-10. Fisher s exact test/Chi-square test were used for comparison between male and female cases., Results: A total number of 400 consecutive cases, below the age of 18, who approached for psychiatric consultation, were evaluated. After applying the ICD-10 diagnostic criteria, a 100 (25%) of them were found to be suffering from depressive disorder. Among them, 54 were girls and 46 boys, giving a male to female ratio of 1:1.32 and statistically insignificant gender difference. Instead of mood disturbance, the most frequent presenting complaints included pain (55%), insomnia (33%), fear (16%), weakness (14%) and aggression (13%)., Conclusion: Depression is a common psychiatric disorder among the pediatrics and adolescents. The clinical presentation was usually found to be atypical.

Objective: To determine the gender based response to fluoxetine HCl medication in relation to tryptophan metabolism in depressed patients., Design: A comparative, analytical study., Place and Duration of Study: Clinical Biochemistry and Psychopharmacology Research Unit, Department of Biochemistry, University of Karachi during the year 2002 to 2003., Subjects and Methods: Sixteen adults depressed patients who were not having any other major comorbidity were selected from the outpatients department of local psychiatric clinic for the study. They were subjected to a semi-structured interview for associated clinical characteristics and diagnosis of depression according to ICD-10 criteria. A control group of normal health male and female individuals was identified for comparison with the depressed group. All the depressed patients were treated with fluoxetine hydrochloride (Prozac 20 mg/day) for four weeks. Healthy individual's data was compared with the depressed group and evaluated for gender based response to fluoxetine HCl medication., Results: Significant decreases were found in total tryptophan concentrations (33 %, p<0.01,56%, p<0.01) in depressed male and female patients respectively, in contrast, serum cortisol levels were increased by 68% and 98% in male and female depressed patients respectively as compared to healthy controls. Significant increases (23%, p<0.05) in albumin levels were found in females only. Four weeks treatment of male and female depressed group by Fluoxetine HCL (Prozac) 20 mg/kg/day, increased serum total tryptophan concentrations significantly by 32% (p<0.05) in males and by 83% (p<0.01) in females. Serum-free tryptophan concentrations were increased by 22% (p<0.05) in males only. In contrast serum cortisol concentrations were decreased by 31% (p<0.01) and 45.35% (p<0.01) in males and females respectively., Conclusion: Increases in tryptophan and decreases in cortisol concentrations were greater in females which may contribute to better response of the drug in females.

Objective: To determine the level of Anxiety, Depression and Stress among the Husbands of Obstetric Cases., Subjects and Methods: This hospital-based prospective study was conducted at Karachi, during the year 1998. A semi-structured proforma along with Hospital Anxiety Depression Scale (HAD) and Life Events Scale were administered to the consenting spouses of obstetric cases., Results: Only 23% of lower socio-economic group husbands accompanied their wives to the hospital compared to 70% of the higher socio-economic group. Out of the 56% of husbands of 82 consecutive obstetric cases interviewed, 13% of those whose wives were NVD showed anxiety and depression as compared to 25% of those with Cesarean Section (C/S). Life Events Scale showed 50% of lower socio-economic group having stress compared to only 10% in higher socio-economic group., Conclusion: Contrary to the West, where majority of the Obstetric cases are accompanied by their spouses, in our study only 23% of the cases had their husbands present within the obstetric facility. There is a need of such a study, based on a larger sample in order to address this critical period/issue, considering the concept of 'paternity leaves'. Surprisingly, majority of husbands did not have Anxiety or Depression during the Obstetric period (a critical period needing appropriate attention) of their wives.

'Insight', which is an indication of patient's understanding about his/her illness, needs particularly sensitive measures for its assessment. A questionnaire regarding insight, and brief psychosocial profile of the patients was applied to 103 cases. The cases were categorized according to the diagnosis and initial understanding of mental illness and 'insight' by the patients in our culture. The study did not support the popular belief that neurotics have and psychotics do not have insight.