Barriers and Challenges to Mental Health Care in Pakistan

World Health Organization (WHO) defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (1). Despite being a global health-related burden, and a major cause of morbidity worldwide including Pakistan, mental health diseases are an overlooked entity in our country. In Pakistan, we have seen a rapid improvement in the treatment of conditions related to physical health over the course of years, but mental health issues are still being given limited priority. Pakistan is the 6th most populated country in the world with a current estimated population of 210 million and a growth rate of 2% per year (2). It is a developing country that faces several health challenges when dealing with communicable as well as non-communicable diseases including mental health problems

Stress, Anxiety and Depression in students of a private medical school in Karachi, Pakistan

Objective: To determine frequency of stress, anxiety and depression and their coping mechanisms in undergraduate students of a private sector university. Methods: A cross sectional study was conducted at Aga Khan University recruiting students from Medical School, School of Nursing & Midwifery, and Dental Hygiene program who had attended at least six months on campus from October 2016 until August 2017. The “Aga Khan University Anxiety and Depression Scale” and “Student-Life Stress Inventory” scales were used to assess depression and anxiety, and stressors. Results: A total of 283 students participated in this study and all of them scored higher than the cutoff on both scales labeling them as highly stressed. Students from dental hygiene program reported more stressors as compared to MBBS (p\u3c0.001) and SONAM (p=0.002). Factors identified as stressors included pressure to pass exam, meeting family’s expectations of good academic performance, and missing home. Conclusion: Stress, anxiety and depression are found to be highly prevalent among undergraduate students in medical setting in Karachi. Awareness, recognition, and timely management may reduce stress among the students and improve their performance and quality of life

Recent Progress in the Use of Capacitive Deionization and Microbial Desalination Cell for Water Treatment - A Critical Review

The increasing depletion of water resources is a severe obstacle to the sustainable development. Finding new ways to provide clean water is one of the many collaborative activities that will be obligatory to resolve this worldwide issue. In this regard, among various methods, electrochemical methods have been used for water treatment. For instance, capacitive deionization (CDI) and microbial desalination cells (MDCs) are capable technologies that can overcome the aforementioned issue. In this regard, current study examines recent advancements in MDC and CDI technologies along with the ongoing research in this field. Moreover, it discusses different configurations of these technologies constructed in the past with different materials and methods to present a better understanding of systems’ efficiencies, along with their contribution towards research and development. It further presents the unexplored prospects of MDCs and CDI for future work

Burden of Depression Among Survivors of Ischemic Stroke of Southern Punjab

Background; Depression is one of the most frequent neuropsychiatric disturbances after ischemic stroke. The frequency of depression in stroke patients has varied widely in different populations. Post stroke depression is an important factor limiting recovery and rehabilitation in acute stroke patients. This study was done to ascertain frequency of depression among patients with ischemic stroke in our local population. Objective; To assess the frequency of depression in patients with ischemic stroke in Pakistan. Material and Methods; Consecutive 150 patients fulfilling inclusion criteria was enrolled and this descriptive study was conducted at department of Psychiatry and Neurology OPD, Nishtar Hospital, Multan using non – probability convenient sampling technique. All patients were assessed by single psychiatrist on PHQ-9 scale, for Depression. Results; Of these 150 study cases, 94 (62.7 %) were male patients while 56 (37.3 %) were female patients. Mean age of our study cases was 54.69 ± 7.18 years (with minimum age of our study cases was 44 years while maximum age was 71 years). Of these 150 study cases, 71 (47.3 %) belonged to rural areas and 79 (52.7 %) belonged to urban areas. Monthly family income up to Rs. 50000 was noted in 89 (59.3%) while more than Rs. 50000 was noted in 61 (40.7%). Of these 150 study cases, 83 (55.3%) were illiterate and 67 (44.7%) were literate. Of these 150 study cases, site of lesion in basal ganglia was 61 (40.7%), subcortical in 56 (37.3%) and cortical in 33 (22.0%) and Depression was noted in 77 (51.3%). Conclusion; Very high frequency of depression was observed in our study among patients having ischemic stroke. Depression was significantly associated with gender, occupation, educational level, prolonged duration of illness and site of lesion. Clinicians treating stroke patients should anticipate depressive symptoms and diagnose them to treat them in early stages. Keywords; Ischemic stroke, depression, frequency. DOI: 10.7176/JMPB/69-01 Publication date:March 31st 202

Psychological Morbidity in patients with Idiopathic Hirsutism presenting for Laser Treatment at a Tertiary Care Hospital

Objective: The objective of our study was to determine the frequency of depression, anxiety, and stress in females presenting for laser treatment of hirsutism at a dermatology clinic. Materials and Methods: This was a cross-sectional descriptive study. 152 female participants of all ages presenting for laser treatment of hirsutism to the dermatology department –removed for blind review--from June 2019 to Dec 2019, were included using a consecutive convenient sampling technique. Patients having an FG (Ferriman and Gallwey) score of 8 or more, were included whereas those having any underlying cause (as assessed by history and examination and laboratory investigations where required) for both hirsutism and psychological disorder were excluded. The participants were given an Urdu version of the DASS 21 (depression, anxiety, and stress scale) to complete. Results: The participants had a mean age of 30.22 (SD = 9.17). The prevalence of depression, anxiety, and stress in the sample was found to be 13.2%, 23.7%, and 17.8%, respectively. Mean depression, anxiety, and stress scores on DASS 21 were 4.43(SD=4.87, Cut-off= 10), 4.34(SD=5.12, Cut-off= 8), and 8.21(SD=6.26, Cut-off=15), respectively, indicating that the scores were within the normal range. Anxiety was the most common illness in the sample and both depression and stress showed a decline with advancing age up till 45years of age. No statistically significant association was found between the severity of hirsutism and depression, stress, and anxiety scores. Conclusion: Psychological morbidity was found to be lower in patients of idiopathic hirsutism presenting for laser treatment. The long-term efficacy of laser treatment needs further evaluation in future research

Antibiotic Resistance Pattern of Salmonella Species in Children in a Tertiary Care Hospital

Objective: To determine the recent antibiotic resistance patterns of Salmonella species in children in a tertiary care hospital. Materials and Methods: This descriptive cross-sectional study was conducted in the Department of Pediatrics of Akbar Niazi Teaching Hospital, Bhara Kahu, from 18th March 2020 to 31st January 2021. A total of one hundred and seventy-eight (n=178) patients of either gender having age between 1 month to 12 years who had signs and symptoms of enteric fever and positive blood culture report of Salmonella species were enrolled in this study through non-probability, consecutive sampling. The demographic characteristics of patients along with the antibiotic sensitivity pattern of the Salmonella species were recorded on the predesigned proforma and analyzed through SPSS version 25. Results: Out of the total of 178 patients, reports of blood cultures of 164(92.1%) patients showed Salmonella Typhi while those of 14(7.9%) patients showed Salmonella Paratyphi. Out of the total of 178 Salmonella cases, 11(6.2%) were extensively drug-resistant and 58(32.6%) were multidrug-resistant. All XDR cases were of Salmonella Typhi. Out of 14 Salmonella Paratyphi, 2(14%) were MDR but no XDR Salmonella Paratyphi was found.  Nalidixic acid had the highest resistance (96.4%) followed by sulphamethoxazole (65.5%). Azithromycin had the least resistance (0%) followed by imipenem (1.8%), piperacillin-tazobatam (1.9%), and meropenem (2%). Resistance of ceftriaxone was 20.8% and that of ciprofloxacin was 28.2%. Conclusion: No resistance of Salmonella species against azithromycin was found in our study. The presence of XDR typhoid fever cases and the rising resistance of Salmonella species to ceftriaxone and carbapenems are very alarming. To prevent this resistance, we should reserve carbapenems for complicated cases of resistant typhoid fever only. Minocycline and pipercillin-tazobactam are two other good cost-effective drugs in resistance to typhoid fever

Synthesis and in silico study of 2-furyl(4-{4-[(substituted)sulfonyl]benzyl}-1-piperazinyl)methanone derivatives as suitable therapeutic agents

In the study presented here, a new series of 2-furyl(4-{4-[(substituted)sulfonyl]benzyl}-1-piperazinyl)methanone derivatives was targeted. The synthesis was initiated by the treatment of different secondary amines (1a-h) with 4-bromomethylbenzenesulfonyl chloride (2) to obtain various 1-{[4-(bromomethyl)phenyl]sulfonyl}amines (3a-h). 2-Furyl(1-piperazinyl)methanone (2-furoyl-1-piperazine; 4) was then dissolved in acetonitrile, with the addition of K2CO3, and the mixture was refluxed for activation. This activated molecule was further treated with equi-molar amounts of 3a-h to form targeted 2-furyl(4-{4-[(substituted)sulfonyl]benzyl}-1-piperazinyl)methanone derivatives (5a-h) in the same reaction set up. The structure confirmation of all the synthesized compounds was carried out by EI-MS, IR and 1H-NMR spectral analysis. The compounds showed good enzyme inhibitory activity. Compound 5h showed excellent inhibitory effect against acetyl- and butyrylcholinesterase with respective IC50 values of 2.91±0.001 and 4.35±0.004 μM, compared to eserine, a reference standard with IC50 values of 0.04±0.0001 and 0.85±0.001 μM, respectively, against these enzymes. All synthesized molecules were active against almost all Gram-positive and Gram-negative bacterial strains tested. The cytotoxicity of the molecules was also checked to determine their utility as possible therapeutic agents