Treatment Response of Opium Smoking Hmong Refugees to Methadone Maintenance

Objective: To examine the outcome of methadone maintenance in opium dependent Hmong refugees. Methods: Medical records were searched for Hmong patients in methadone treatment between 01/1995 and 09/1997. Patient\u27s progress was assessed over nine months. Results: 44 Hmong patients were found. Data was available on 40 patients, mean age of 47.7 years, 33 males/7 females. At admission 100% met the DSM-IV criteria for Opium Dependence, 75% Major Depressive Disorder and 68% PTSD. Patients showed marked improvement by having mostly negative urine drug screens, improvement on Addiction Severity Index and 70% being highly successful on outcome criteria modified by Drug Abuse Research Project over 9 months. Conclusions: These findings suggest that opium dependent Hmong patients can show marked improvement while in methadone maintenance program. Prospective controlled studies are warranted

Clinical outcome of tetanus based on dakar tetanus severity score in paediatric intensive care unit of a tertiary care hospital

Objective: To evaluate the validity of  Dakar scoring system in predicting the outcome of tetanus in children of post neonatal age. Method: A prospective single center study conducted at ICU (Intensive Care Unit) of –removed for blind review-- 131 children with diagnosis of tetanus from January 2020 to June 2021 by analyzing demographic and clinical parameters. Results: Mean age of children was 8.11 ± 3.45 years with male predominance 91(69.5%). Major proportion of children were in range of 5-10 years comprising 65(50%). Period of onset of spasm was < 2 days in 92(70%) that correlate well with shorter incubation period (p-value <0.001). Mean duration of ICU stay was (18.81 ± 11.73) days. Only 14(10.7%) received three doses of vaccination but no one received booster dose. In majority of patients trauma due to road traffic accident 86(65.6%) was the predisposing factor followed by ear discharge 31(23.7%) and other causes 14(10.7%). Out of 131 patients 104(79.3%) received mechanical ventilation because of disease severity. Regarding outcome mild cases 2(1.5%), moderate 61(46.6%) and severe were 68(51.9%) according to Dakar scoring system and out of these severe cases 18(13.7%) expired (p-value < 0.001). However, 53(40.4%) discharged, 50(38.1%) shifted out to other wards after stabilization and 10(7.6%) left against medical advice. (p-value 0.001) Conclusion: Dakar scoring system correlates well with disease severity and should be adopted to aid clinical triage and management as with effective and appropriate treatment patients can have good prognosis. However, preventive aspects should be emphasized regarding booster dose of tetanus. Keywords: Tetanus, Outcome, Dakar scoring syste

STUDIJE ISTRAŽIVANJA PODZEMNIH VODA I PRODORA SLANOSTI S POMOĆU ISTRAŽIVANJA ELEKTRIČNOGA OTPORA (ERS), SLUČAJ PODRUČJA WINDER, BELUDŽISTAN, PAKISTAN

The groundwater resources have always been explored for its utilization in domestic and agriculture purposes. In this study, Winder area in Balochistan which is along the coast of Offshore Indus Basin has been explored using electrical resistivity method for deeper understanding of hydrogeological and hydrogeophysical conditions. Schlumberger electrode arrays have been used to acquire vertical electrical sounding data for 23 different sites in this area. The field data were calibrated with theoretical curves during processing using software with graphical interface. The true resistivities, depths, thicknesses, aquifer attributes, soil type and groundwater quality has been extracted from the processed data. Pseudo-sections and geo-electrical lithology sections have been generated for lateral distribution of hydrogeological settings. Furthermore, Dar-zarrouk parameters calculations have been made and 3D surfaces generated at 30m and 60 m depth for transverse resistance (T), longitudinal conductance (S) and anisotropy (λ) plotted for resistivity distribution and coastal salinity intrusion analysis. The soundings results depict five layers mainly composed of silty sand, sandy clay, sand, and sandy gravel and the depth ranges from 0-110m. The interpretation illustrates that freshwater unconfined aquifer are present in the quaternary sand and sandy gravel deposits. The water table is at shallow depth along the river and deeper in northeast and away from Winder river. The resistivity ranges 29-1091 Ωm in layer-3 interpreted as saturated zone. The approximate range of water table is 19-30 m. The higher value of T greater than 10000 shows fresh water and low value 8200 for salinity intrusion in southwest toward sea.Izvori podzemne vode uvijek su se istraživali radi njihove upotrebe u kućne i poljoprivredne svrhe. U ovoj je studiji područje Windera u Beludžistanu, uz obalu priobalnoga bazena Inda, istraženo korištenjem metode električnoga otpora radi dubljega razumijevanja hidrogeoloških i hidrogeofizičkih uvjeta. Nizovi elektroda Schlumberger korišteni su za prikupljanje podataka o vertikalnome električnom sondiranju za 23 različita mjesta u ovome području. Podatci na terenu kalibrirani su teoretskim krivuljama tijekom obrade s pomoću softvera s grafičkim sučeljem. Iz obrađenih podataka izdvojena je stvarna otpornost, dubine, debljine, svojstva vodonosnika, vrsta tla i kvaliteta podzemne vode. Za bočnu raspodjelu hidrogeoloških postavki stvoreni su pseudopresjeci i geoelektrični litološki odsjeci. Nadalje, izrađeni su proračuni Dar-zarroukovih parametara i generirane su 3D površine na dubini od 30 m i 60 m za poprečni otpor (T), uzdužnu vodljivost (S) i anizotropiju (λ). Ti su parametri ucrtani za raspodjelu otpora i analizu upada slane obale. Rezultati sondiranja prikazuju četiri sloja uglavnom sastavljena od muljevitoga pijeska, pjeskovite gline, pijeska i pješčanoga šljunka, a dubina se kreće od 0 do 110 m. Tumačenje ilustrira da su slatkovodni vodonosnici prisutni u kvartarnim pjeskovitim i pjeskovitim naslagama šljunka. Vodeni je sloj na maloj dubini uz rijeku, a dublje na sjeveroistoku i dalje od rijeke Winder. Otpornost se kreće od 29 do 1091 Ωm u sloju 3, što se tumači kao zasićena zona. Približni je domet vodostaja 19 – 30 m. Viša vrijednost T veća od 10000 pokazuje slatku vodu i nisku vrijednost 8200 za prodiranje slanosti na jugozapadu prema moru

Development of a cost-effective CVD prediction model using lifestyle factors. A cohort study in Pakistan

Background: Cardiovascular diseases (CVD) such as hypertension and ischemic heart diseases cause 35 to 40% of deaths every year in Pakistan. Several lifestyle factors such as dietary habits, lack of exercise, mental stress, body habitus (i.e., body mass index, waist), personal habits (smoking, sleep, fitness) and clinical conditions (i.e., diabetes, dyslipidemia and hypertension) have been shown to be strongly associated with the etiology of CVD. Epidemiological studies in Pakistan have shown poor adherence of people to healthy lifestyle and lack of knowledge in adopting healthy alternatives. There are well validated cardiovascular risk estimation tools (QRISK model) that cn predict the probability of future cardiac events. The existing tools are based on laboratory investigations of biochemical test but there is no widely accepted tool available that predicts the CVD risk probability based on lifestyle factors. Aims: Aim of the current study was to develop alternative CVD risk estimation model based on lifestyle factors and physical attributes (without using laboratory investigation) using QRISK model as the gold standard. Study Design: Clinical and lifestyle data of one hundred and sixty subjects were collected to formulate a regression model for predicting CVD risk probability. Methods: Lifestyle factors as independent variables (IV) include BMI, waist circumference, physical activities (stamina, strength, flexibility, posture), smoking, general illnesses, dietary intake, stress and physical characteristics. CVD risk probability of QRISK Intervention computed through clinical variables was used as a dependent variable (DV) in present research. Chronological age was also included in analysis in addition to selected lifestyle factors. Regression analysis, principal component analysis and bivariate correlations were applied to assess the relationship among predictor variables and cardiovascular risk score. Results: Chronological age, waist circumference, BMI and strength showed significant effect on CVD risk probability. The proposed model can be used to calculate CVD risk probability with 72.9% accuracy for the targeted population. Conclusion: The model involves only those features which can be measured without any clinical test. The proposed model is rapid and less costly hence appropriate for use in developing countries like Pakistan

A WORLD PSYCHIATRIC ASSOCIATION INITIATIVE TO INCREASE INTEREST IN PSYCHIATRY AS A CAREER IN QATAR MEDICAL STUDENTS: A PILOT STUDY

Introduction: The World Health Organization identified a chronic shortage of psychiatrists in Low- Middle- and High-Income Countries. In Qatar, the situation is dire with reports there is one psychiatrist per 170,000 people in the population. A one-day, student-led mental-health conference was held in Doha, Qatar under the auspices of the World Psychiatric Association with the aim of increasing interest in psychiatry as a career. Subjects and methods: In this single-arm, pre-post comparison study, a questionnaire assessing interest in psychiatry as a career was administered on participants before and after attending the conference. Demographic information was obtained and response items were on a 5-point Likert scale. Statistical analysis was performed using a two-sample t-test with a significant p-value set at <0.05. Results: The conference was attended by 102 individuals. Fifty-four attendees completed the pre-conference survey (53% response rate) and 36 participants completed the post-conference survey (35% response rate). Data for the 36 matched pre-post responses were included in our analyses. The average age of respondents was 22 years and 81% were female. There was improvement in post-conference results however these changes were not statistically significant. Conclusion: To the best of our knowledge this is the first intervention study on increasing interest in psychiatry as a career carried out in Qatar. It is likely that psychiatry enthusiasts attended the conference and therefore their interest in this medical specialty was already high as corroborated by the favorable pre-conference survey results. This might explain why there was a lack of statistical significance in comparison to post- intervention scores. We recommend that such an event be integrated into the medical school curricula throughout Qatar to include students with low baseline interest in psychiatry. Further research in this area with more robust methodology is urgently needed to help narrow the pervasive treatment gap

Association of genes with phenotype in autism spectrum disorder.

Autism spectrum disorder (ASD) is a genetic heterogeneous neurodevelopmental disorder that is characterized by impairments in social interaction and speech development and is accompanied by stereotypical behaviors such as body rocking, hand flapping, spinning objects, sniffing and restricted behaviors. The considerable significance of the genetics associated with autism has led to the identification of many risk genes for ASD used for the probing of ASD specificity and shared cognitive features over the past few decades. Identification of ASD risk genes helps to unravel various genetic variants and signaling pathways which are involved in ASD. This review highlights the role of ASD risk genes in gene transcription and translation regulation processes, as well as neuronal activity modulation, synaptic plasticity, disrupted key biological signaling pathways, and the novel candidate genes that play a significant role in the pathophysiology of ASD. The current emphasis on autism spectrum disorders has generated new opportunities in the field of neuroscience, and further advancements in the identification of different biomarkers, risk genes, and genetic pathways can help in the early diagnosis and development of new clinical and pharmacological treatments for ASD

Genetics of structural and functional brain changes in autism spectrum disorder.

Autism spectrum disorder (ASD) is a neurological and developmental disorder characterized by social impairment and restricted interactive and communicative behaviors. It may occur as an isolated disorder or in the context of other neurological, psychiatric, developmental, and genetic disorders. Due to rapid developments in genomics and imaging technologies, imaging genetics studies of ASD have evolved in the last few years. Increased risk for ASD diagnosis is found to be related to many specific single-nucleotide polymorphisms, and the study of genetic mechanisms and noninvasive imaging has opened various approaches that can help diagnose ASD at the nascent level. Identifying risk genes related to structural and functional changes in the brain of ASD patients provide a better understanding of the disease's neuropsychiatry and can help identify targets for therapeutic intervention that could be useful for the clinical management of ASD patients.This study was supported by a PI grant from Sidra Medicine (5071012001) to M.H. A.A.B. is supported by Sidra Medicine internal grant (5011041002)

‘We create our own small world’: daily realities of mothers of disabled children in a South African urban settlement

Parents of disabled children face many challenges. Understanding their experiences and acknowledging contextual influences is vital in developing intervention strategies that fit their daily realities. However, studies of parents from a resource-poor context are particularly scarce. This ethnographic study with 30 mothers from a South African township (15 semi-structured interviews and 24 participatory group sessions) unearths how mothers care on their own, in an isolated manner. The complexity of low living standards, being poorly supported by care structures and networks, believing in being the best carer, distrusting others due to a violent context, and resigning towards life shape and are shaped by this solitary care responsibility. For disability inclusive development to be successful, programmes should support mothers by sharing the care responsibility taking into account the isolated nature of mothers’ lives and the impact of poverty. This can provide room for these mothers to increase the well-being of themselves and their children

Simulation and Optimization of Frequency Reuse in OFDMA Networks

Efficient radio resource management is an important aspect when it comes to achieving high bit rates in technologies such as the 3GPP Long Term Evolution (LTE). This thesis aims at understanding existing frequency reuse schemes in OFDMA networks, and to develop an algorithm for frequency allocation for irregular cellular layouts. Previous work done in this field mostly covers schemes for regular cells, whereas in real life cellular layouts are mostly irregular. A comparison of the existing allocation schemes for the users near the boundary of the cells, also known as edge users, with our scheme is presented. Reuse-1, Fractional frequency reuse-3 with random frequency allocation (FFR3-RFA) (for edge users) and our algorithmic frequency allocation (FFR3-AFA) scheme are simulated and compared. FFR3-AFA algorithm assigns a frequency sub-band to a cell by considering the frequency allocations in the neighbor cell edges and the overlap area between those neighboring cells. Static simulations were performed with one user per base station and constant downlink traffic of 100 Kbits/sec, so that all the resources are utilized and there is maximum interference. This way, the difference between the frequency reuse schemes is much more evident. The throughput for our calculation is the ratio of the total successful packets sent in the network and the total packets sent in the network. Small scenarios are considered with different downlink data rates and the results show that FFR3-AFA has better performance than the other two techniques. There is also room for improvement in the algorithm by introducing other factors into the equation other than overlap area, such as user throughput