Increase in Teachers\u27 Knowledge About ADHD After a Week-Long Training Program A Pilot Study

Objectives: ADHD affects 3% to 5% of school-age children. Clinical and community based epidemiological studies in Pakistan have shown a high prevalence of ADHD among school going children. A thorough review of literature shows that no studies of teachers\u27 training programs regarding ADHD have been published in Pakistani research literature. The aim of the present study is the development and evaluation of an ADHD training program for teachers. Methods: A teachers\u27 training program for ADHD was designed and a pilot run in 3 schools of Karachi, Pakistan. Teachers knowledge regarding signs and symptoms of ADHD was tested before and after the workshop and then again after 6 months using an ADHD knowledge questionnaire. Results: Forty-nine teachers, all of them women, completed the questionnaires before and after the training program, and 35 of them filled it out at the 6-month interval. Mean scores of these tests were compared using a paired t test. The authors found the difference of mean score of 1.48 +/- 2.95, and this was statistically significant (p \u3c .005). Conclusion: The authors conclude that the workshop improved the knowledge of the school teachers regarding ADHD symptomatology, and it remained significant even after 6 months of training

Carotid cavernous fistula in a patient with coronary artery disease

Carotid cavernous fistulas are abnormal communications between the carotid and cavernous vasculature, with potential for serious neurological and ocular sequelae. There is considerable literature on the neuro-radiological management of carotico-cavernous fistula depending upon their flow status. The coronary artery bypass grafting (CABG) for coronary artery disease (CAD) is a well established method of revascularization. However, the association of carotid cavernous fistula in presence of CAD is an infrequent occurrence. We present a case of coronary artery disease scheduled for bypass surgery, developed spontaneous bilateral carotid cavernous fistulas, highlighting a unique aspect of association between coronary and carotid disease

Association of depression with treatment outcomes in Type 2 Diabetes Mellitus: A cross-sectional study from Karachi, Pakistan

Background: To assess the associations of depression with glycemic control and compliance to self-care activities in adult Patients with Type 2 Diabetes Mellitus. Methods: This cross-sectional study was conducted at a tertiary-care hospital in Karachi (Aga Khan University Hospital). Equal numbers of depressed and non-depressed Patients were consecutively recruited from the diabetic clinic. Information on demographic and clinical characteristics was collected in face-to-face interviews and from medical records. Hospital Anxiety Depression Scale (HADS) was used to measure depression. Associations of depressed status (HADS \u3e= 8) with poor glycemic control (Hemoglobin A1c level \u3e= 7%) and compliance to self-care activities were assessed by logistic regression analyses. Results: A total of 286 Patients were included in this study with a male-female ratio of 1.2:1. Mean age was 52 years and in 64.7% of them, the duration of diabetes was more than 3 years. Depressed Patients were more likely to be female (adjusted odds ratio [OR] = 1.88, 95% confidence interval [95% CI] = 1.07-3.31), had a family history of diabetes (OR = 2.64, 95% CI = 1.26-5.55), and poor glycemic control (OR = 5.57, 95% CI = 2.88-10.76) compared with non-depressed Patients. Depression was also associated with low compliance to self-care activities such as taking dose as advised (OR = 0.32, 95% CI = 0.14-0.73), dietary restrictions (OR = 0.45, 95% CI = 0.26-0.79) and foot care (OR = 0.38, 95% CI = 0.18-0.83). Conclusions: Adult Patients with Type 2 Diabetes who have depression were more likely to have poor glycemic control and lower compliance to self-care activities, and they might need particular attention during follow-up visits

Vitamin B12 Supplementation in Trea ting Major Depressive Disorder: A Randomized Controlled Trial

Recent literature has identified links between vitamin B12 deficiency and depression. We compared the clinical response of SSRI-monotherapy with that of B12-augmentation in a sample of depressed patients with low normal B12 levels who responded inadequately to the first trial with the SSRIs. Methods: Patients with depression and low normal B12 levels were randomized to a control arm (antidepressant only) or treatment arm (antidepressants and injectable vitamin B12 supplementation). Results: A total of 199 depressed patients were screened. Out of 73 patients with low normal B12 levels 34 (47%) were randomized to the treatment group while 39 (53%) were randomized to the control arm. At three months follow up 100% of the treatment group showed at least a 20% reduction in HAM-D score, while only 69% in the control arm showed at least a 20% reduction in HAM-D score (p\u3c0.001). The findings remained significant after adjusting for baseline HAM-D score (p=0.001). Conclusion: Vitamin B12 supplementation with antidepressants significantly improved depressive symptoms in our cohort

Comparison of Urdu version of Strengths and Difficulties Questionnaire (SDQ) and the Child Behaviour Check List (CBCL) amongst primary school children in Karachi

OBJECTIVE: To compare CBCL (Child Behaviour Check Llist) Urdu, with the validated Urdu version of Strengths and Difficulties Questionnaire (SDQ) used as gold standard among school children in Karachi, Pakistan, and to develop local cutoffs for CBCL using SDQ as a gold standard. STUDY DESIGN: A cross-sectional study. PLACE AND DURATION OF STUDY: Schools of Karachi metropolitan area from January to December 2006. METHODOLOGY: The Strengths and Difficulties Questionnaire (SDQ) and Child Behaviour Check List (CBCL) was completed by parents of 5-11 years old primary school children in Karachi. Appropriate cutoff points for total problem, internalizing and externalizing scales were obtained for CBCL. RESULTS: A total of 556 parents filled out both the SDQ Urdu version as well as CBCL. Scores from the parent rated total SDQ scores were highly correlated with the total CBCL scores (r=0.589). The local cutoffs derived for CBCL were considerably lower than USA norms. Slightly higher cutoff for males was found as compared to females for the total CBCL scores. CONCLUSION: Like the original English version, the Urdu version of CBCL and SDQ are both equally valid assessment tools to be used for both clinical and research purpose in Pakistani settings, where Urdu is widely spoken and understood

Design and Implementation of a Virtual Team Collaboration System

This paper analyzes a newly developed virtual team collaboration site and compares this application with the currently in use team collaboration tool created using a Google site. Various tests that are essential for a web service to function properly are performed to compare the applications. The tests are aimed to find any issues with the applications and identify if Teamboard ODU, the newly developed application, can perform better than the Google site. We test for speed, performance, usability, functionality and also explore the methodology used to develop the application. These test results allow us to make an informed assumption about the effectiveness of Teamboard ODU and help us understand whether this can be a replacement for the Google site. The study hypothesizes that Teamboard ODU performs better in terms of the HTTP transaction, site availability and load time. It also has functionalities comparable to the Google site. Future enhancement and maintenance can also be performed if needed. Several scenarios are developed to test the hypotheses, and the results will be used to compare the two sites and identify whether Teamboard ODU can be an effective replacement

Sino-US strategic rivalry and regional security dynamics in the South China Sea

The South China Sea is a crucial region that has become a focal point of territorial disputes and geopolitical tensions between China and its neighbouring countries, resulting in complex security dynamics. Against this backdrop, the US has sought to counter China\u27s assertiveness in the region, resulting in a strategic rivalry that has far-reaching implications for regional security. The study\u27s theoretical framework is based on Neo-realism, which posits that state behaviour in the international system is driven by self-interest and the desire for power and security. The concepts of offensive realism and balance of power play a supportive role in the research. The researcher adopted a qualitative method to carry out this study. Drawing on existing literature and analysis, this study explores the emerging China-US rivalry and key drivers behind their rivalry in the South China Sea, including economic and military factors, as well as broader geopolitical considerations. China has concentrated on developing its military capabilities and increasing its influence in the region through diplomatic, military, and economic means. Furthermore, this strategic rivalry affected the regional security dynamics that led to the militarisation of the SCS, an arms race, alliances, instability, and heightened regional tensions

Arteriovenous malformation with associated multiple flow-related distal anterior cerebral artery aneurysms: A case report with poor outcomes

Background: Low-grade arteriovenous malformations (AVMs) associated with multiple flow-related distal anterior cerebral artery (DACA) aneurysms are rare occurrences. Here, we present a case of a frontal AVM with three associated DACA aneurysms arising from a single feeder.Case description: A 36-year-old male presented to us in the ER with acute-onset dysphasia and altered mental status. Head computed tomography and angiogram showed a spontaneous intracerebral hemorrhage with intraventricular extension and revealed a Spetzler Martin Grade II AVM, being fed by two feeders, with the major feeder from the DACA bearing three flow-related aneurysms. As the patient awaited digital subtraction angiography, his Glasgow Coma Scale dropped and he underwent emergency embolization with Onyx. This was followed by external ventricular drainage. The patient\u27s neurological status did not improve, and he died following a complicated clinical course.Conclusion: Multiple DACA aneurysms are a case of both clinical and anatomical rarity and to avoid complications in the clinical course, one must be judicious about the time spent between symptom onset and embolization