Association of bullying experiences with depressive symptoms and psychosocial functioning among school going children and adolescents.

ObjectivesWe examined the association of bullying experiences with depressive symptoms and psychosocial functioning among children and adolescents in rural Pakistan. A total of 452 school-going children in Nawabshah, Pakistan were conveniently interviewed to assess rates of bullying experiences and severity of depressive symptoms. Depressive symptoms were assessed using the Patient Health Questionnaire for Adolescents.ResultsExperience of victimization was reported by 130 (28.8%) and perpetration by (146, 32.3%). A total of 162 (35.80%) reported mild depressive symptoms, 88 (19.50%) moderate, 33 (7.30%) moderately severe and 19 (4.20%) severe depressive symptoms. Age was not associated with patterns of bullying other than pure bully perpetration (.12, P = .024). Both victims and perpetrators of bullying experienced adverse emotional and social consequences. Bully-perpetrators exhibited the greater severity of depressive symptoms due to distress in psychosocial functioning

Economic costs of perinatal depression and anxiety in a lower middle income country: Pakistan.

BackgroundWomen's mental health during the perinatal period is a major public health problem in Pakistan. Many challenges and competing priorities prevent progress to address the large treatment gap. Aim To quantify the long-term impacts of untreated perinatal depression and anxiety in economic terms, thus highlighting its overall burden based on country-specific evidence.MethodsCost estimates were generated for a hypothetical cohort of women giving birth in 2017, and their children. Women and children experiencing adverse events linked to perinatal mental health problems were modelled over 40 years. Costs assigned to adverse events included were those linked to losses in quantity and quality-of-life, productivity, and healthcare-related expenditure. Present values were derived using a discount rate of 3 %. Data were taken from published cohort studies, as well as from sources of population, economic and health indicators.ResultsThe total costs were $16.5 billion for the cohort and$2680 per woman giving birth. The by far largest proportion referred to quality-of-life losses ($15.8 billion). Productivity losses and out-of-pocket expenditure made up only a small proportion of the costs, due to low wages and market prices. When the costs of maternal suicide were included, total costs increased to$16.6 billion.LimitationsImportant evidence gaps prevented the inclusion of all cost consequences linked to perinatal mental health problems.ConclusionsTotal national costs are much higher compared with those in other, higher middle-income countries, reflecting the excessive disease burden. This study is an important first step to inform resource allocations

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Mutational analysis and clinical investigations of medically diagnosed GSD 1a patients from Pakistan.

Glycogen storage disease type I (GSD I) is a rare autosomal recessive inborn error of carbohydrate metabolism caused by the defects of glucose-6-phosphatase complex (G6PC). Disease causing variants in the G6PC gene, located on chromosome 17q21 result in glycogen storage disease type Ia (GSD Ia). Age of onset of GSD Ia ranges from 0.5 to 25 years with presenting features including hemorrhage, hepatic, physical and blood related abnormalities. The overall goal of proposed study was clinical and genetic characterization of GSD Ia cases from Pakistani population. This study included forty GSD Ia cases presenting with heterogeneous clinical profile including hypoglycemia, hepatomegaly, lactic acidosis i.e., pH less than 7.2, hyperuricemia, seizures, epistaxis, hypertriglyceridemia (more than180 mg/dl) and sometimes short stature. All coding exons and intron-exon boundaries of G6PC gene were screened to identify pathogenic variant in 20 patients based on availability of DNA samples and willingness to participate in molecular analysis. Pathogenic variant analysis was done using PCR-Sanger sequencing method and pathogenic effect predictions for identified variants were carried out using PROVEAN, MutationTaster, Polyphen 2, HOPE, Varsome, CADD, DANN, SIFT and HSF software. Overall, 21 variants were detected including 8 novel disease causing variants i.e., G6PC (NM_000151.4):c.71A>C (p.Gln24Pro), c.109G>C(p.Ala37Pro), c.133G>C(p.Val45Leu), c.49_50insT c.205G>A(p.Asp69Asn), c.244C>A(p.Gln82Lys) c.322A>C(p.Thr108Pro) and c.322A>C(p.Cys284Tyr) in the screened regions of G6PC gene. Out of 13 identified polymorphisms, 3 were identified in heterozygous condition while 10 were found in homozygous condition. This study revealed clinical presentation of GSD Ia cases from Pakistan and identification of novel disease-causing sequence variants in coding region and intron-exon boundaries of G6PC gene

Exploring clusters of defense styles, psychiatric symptoms and academic achievements among medical students: a cross-sectional study in Pakistan.

ObjectiveThe clusters of participants with a homogeneous psychological make-up can be identified using sophisticated machine learning techniques such as the two-step clustering algorithm. It can also help us to identify the synergistic and additive effects of a range of psychometric variables. The identification of synergistic effect of this clustering of defense mechanism has significant practical implications as they share a certain variance. This study aims to identify the clusters of ego defenses and their relationship with academic performance and mental health outcome in medical students.ResultsThe high achievers scored higher on mature and neurotic defense styles and lower on immature than their counter parts. A higher proportion of medical students in high achievers group had normal scores on depressive symptoms than low achievers. While a majority among low achievers suffered from severe anxiety levels than high achievers group. High achievers scored higher on sublimation, humor, anticipation, suppression, pseudo-altruism, idealization, reaction formation, autistic fantasy, denial, and rationalization

SNC_Net: Skin Cancer Detection by Integrating Handcrafted and Deep Learning-Based Features Using Dermoscopy Images

The medical sciences are facing a major problem with the auto-detection of disease due to the fast growth in population density. Intelligent systems assist medical professionals in early disease detection and also help to provide consistent treatment that reduces the mortality rate. Skin cancer is considered to be the deadliest and most severe kind of cancer. Medical professionals utilize dermoscopy images to make a manual diagnosis of skin cancer. This method is labor-intensive and time-consuming and demands a considerable level of expertise. Automated detection methods are necessary for the early detection of skin cancer. The occurrence of hair and air bubbles in dermoscopic images affects the diagnosis of skin cancer. This research aims to classify eight different types of skin cancer, namely actinic keratosis (AKs), dermatofibroma (DFa), melanoma (MELa), basal cell carcinoma (BCCa), squamous cell carcinoma (SCCa), melanocytic nevus (MNi), vascular lesion (VASn), and benign keratosis (BKs). In this study, we propose SNC_Net, which integrates features derived from dermoscopic images through deep learning (DL) models and handcrafted (HC) feature extraction methods with the aim of improving the performance of the classifier. A convolutional neural network (CNN) is employed for classification. Dermoscopy images from the publicly accessible ISIC 2019 dataset for skin cancer detection is utilized to train and validate the model. The performance of the proposed model is compared with four baseline models, namely EfficientNetB0 (B1), MobileNetV2 (B2), DenseNet-121 (B3), and ResNet-101 (B4), and six state-of-the-art (SOTA) classifiers. With an accuracy of 97.81%, a precision of 98.31%, a recall of 97.89%, and an F1 score of 98.10%, the proposed model outperformed the SOTA classifiers as well as the four baseline models. Moreover, an Ablation study is also performed on the proposed method to validate its performance. The proposed method therefore assists dermatologists and other medical professionals in early skin cancer detection

Bioremediation of Synthetic and Industrial Effluents by Aspergillus niger Isolated from Contaminated Soil Following a Sequential Strategy

The present study aimed to assess and compare the ability to remediate synthetic textile and industrial wastewaters by Fenton treatment, a biological system and sequential treatments using Aspergillus niger (A. niger). All studied treatments were found to be effective in decolorization of the effluents under study. Fenton treatment followed by A. niger showed excellent potential for the maximum decolorization of the synthetic and industrial effluents under study. The effectiveness of sequential treatment was evaluated by water quality parameters such as total organic carbon (TOC), Biological Oxygen Demand (BOD5) and Chemical Oxygen Demand (COD) before and after each treatment. The results indicated that A. niger is an effective candidate for detoxification of textile wastewaters

Electro-Oxidation of Metal Oxide-Fabricated Graphitic Carbon Nitride for Hydrogen Production via Water Splitting

Hydrogen is a great sourcez of energy due to having zero emission of carbon-based contents. It is found primarily in water, which is abundant and renewable. For electrochemical splitting of water molecules, it is necessary to use catalytic materials that minimize energy consumption. As a famous carbon material, graphitic carbon nitride, with its excellent physicochemical properties and diversified functionalities, presents great potential in electrocatalytic sensing. In the present work, graphitic carbon nitride-fabricated metal tungstate nanocomposites are synthesized by the hydrothermal method to study their applications in catalysis, electrochemical sensing, and water splitting for hydrogen production. Nanocomposites using different metals, such as cobalt, manganese, strontium, tin, and nickel, were used as a precursor are synthesized via the hydrothermal process. The synthesized materials (g-C3N4/NiWO4, g-C3N4/MnWO4, g-C3N4/CoWO4, g-C3N4/SnWO4, g-C3N4/SrWO4) were characterized using different techniques, such as FTIR and XRD. The presence of a functional groups between the metal and tungstate groups was confirmed by the FTIR spectra. All the nanocomposites show a tungstate peak at 600 cm−1, while the vibrational absorption bands for metals appear in the range of 400–600 cm−1. X-ray diffraction (XRD) shows that the characteristic peaks matched with the JCPDS in the literature, which confirmed the successful formation of all nanocomposites. The electrochemical active surface area is calculated by taking cyclic voltammograms of the potassium–ferrocyanide redox couple. Among the entire series of metal tungstate, the g-C3N4/NiWO4 has a large surface area owing to the high conductive properties towards water oxidation. In order to study the electrocatalytic activity of the as-synthesized materials, electrochemical water splitting is performed by cyclic voltammetry in alkaline medium. All the synthesized materials proved to be efficient catalysts with enhanced conductive properties towards water oxidation. Among the entire series, g-C3N4-NiWO4 is a very efficient electrocatalyst owing to its higher active surface area and conductive activity. The order of electrocatalytic sensing of the different composites is: g-C3N4-NiWO4 > g-C3N4-SrWO4 > g-C3N4-CoWO4 > g-C3N4-SnWO4 > g-C3N4-MnWO4. Studies on electrochemically synthesized electrocatalysts revealed their catalytic activity, indicating their potential as electrode materials for direct hydrogen evolution for power generation

Economic costs of perinatal depression and anxiety in a lower-middle income country: Pakistan

Background: Women’s mental health during the perinatal period is a major public health problem in Pakistan. Many challenges and competing priorities prevent progress to address the large treatment gap. Aim: To quantify the long-term impacts of untreated perinatal depression and anxiety in economic terms, thus highlighting its overall burden based on country-specific evidence. Methods: Cost estimates were generated for a hypothetical cohort of women giving birth in 2017, and their children. Women and children experiencing adverse events linked to perinatal mental health problems were modelled over 40 years. Costs assigned to adverse events included were those linked to losses in quantity and quality-of-life, productivity, and healthcare-related expenditure. Present values were derived using a discount rate of 3%. Data were taken from published cohort studies, as well as from sources of population, economic and health indicators. Results: The total costs were $16.5 billion for the cohort and$2,680 per woman giving birth. The by far largest proportion referred to quality-of-life losses ($15.8 billion). Productivity losses and out-of-pocket expenditure made up only a small proportion of the costs, due to low wages and market prices. When the costs of maternal suicide were included, total costs increased to$16.6 billion. Limitations: Important evidence gaps prevented the inclusion of all cost consequences linked to perinatal mental health problems. Conclusions: Total national costs are much higher compared with those in other, higher middle-income countries, reflecting the excessive disease burden. This study is an important first step to inform resource allocations