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Background: Stressful situations are often linked with poor health and lifestyle behaviors (e.g., unhealthy diet, limited physical activity, poor sleep quality etc.). Subsequent to the nationwide lockdown in Pakistan due to COVID-19 pandemic, medical students experienced substantial lifestyle changes along with academic stresses. The goal of this study was to measure the impact that the COVID-19 lockdown had on lifestyle like sleep, physical activity and nutrition, substance abuse, dealing with finances, spirituality and family life, with respect to a sample of Pakistani medical students. Methods: This cross- sectional online study involving 1100 medical students (68.7% females) from five medical colleges in Pakistan, used self-administered questionnaire to evaluate the impact of pandemic related restrictions on lifestyle of medical students in Pakistan from August- September 2020. Parameters such as physical activity, sleep, nutrition, smoking and substance abuse, family life, finances, internet use and spirituality were studied. Results: Fifty-nine percent of medical students reported a significant effect of lockdown on their physical activity. Only 5.8% people clearly followed or adhered to a routine during the pandemic. About 54.6% students have found that physical activity and exercise significantly reduced their anxiety. More than half of respondents reported increase in screen time, weight gain and poor sleep with 3.1% of students stating an increased use of sleeping pills to fall asleep Another 18.3% students had an increased worry regarding COVID19 based on the information they received on internet. No significant increase in substance uses and alcohol use or family conflicts among students post pandemic was noted. Conclusion: Our findings underscore that COVID-19 pandemic has led to undesired changes in health and lifestyle habits of medical students, which may, to some extent, be responsible for higher negative impact. Hence it is important for medical colleges to start awareness campaigns to tackle challenges for medical students physical and emotional well-being. doi: https://doi.org/10.12669/pjms.38.7.6031 How to cite this:Tahir SM, Imran N, Haider II, Mustafa AB, Aqeeb-ur-Rehman, Azeem MW, et al. A study to evaluate the impact of COVID-19 on Lifestyle of Medical students. Pak J Med Sci. 2022;38(7):1730-1737. doi: https://doi.org/10.12669/pjms.38.7.6031 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Since the start of January 2019, COVID-19 has caused unparalleled disruption to all aspects of life globally, including the delivery of medical education. Each university and institution have a different approach on how medicine, as a course, is taught and delivered, however, generally there is a consensus that in the earlier years, more emphasis should be given to the acquisition of theoretical and scientific knowledge, including anatomy and physiology. In the later years, medical students are then expected to apply their theoretical knowledge in a practical setting by attending various placements and interacting with patients and other healthcare professionals. The duality of this approach results in doctors who are both competent in their knowledge of the basic sciences whilst being good clinicians with sound practical and inter-personal skills. Covid-19 causes an unprecedented interruption to all students, however with courses such as Medicine, whereby a practical element is crucial, the adaptation to deliver the course effectively is more of a challenge. Clinical rotations were cancelled during the start of the pandemic due to concerns about the students and their families contracting the virus and also for the protection of the vulnerable patients in hospitals. In this manuscript we have explored the adaptations made in order to deliver medical education and evaluate the effectiveness of these methods. We will also be discussing the implications and limitations of these methods. doi: https://doi.org/10.12669/pjms.38.1.5269 How to cite this:Karim Z, Javed A, Azeem MW. The effects of Covid-19 on Medical Education. Pak J Med Sci. 2022;38(1):320-322. doi: https://doi.org/10.12669/pjms.38.1.5269 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Food security is a serious issue in developing countries like Pakistan because of ever-increasing population. To feed the hunger population, safe and nutritious vegetables are growing concern as they are being polluted by heavy metals. The present study was conducted to investigate the concentration of heavy metals such as cadmium (Cd), chromium (Cr), lead (Pb), nickel (Ni), iron (Fe), manganese (Mn), and zinc (Zn) in highly consumed vegetable collected from peri-urban markets of Rawalpindi and Multan region. Health risk associated with the consumption of these vegetables in term of estimated daily intake of metals (EDIM) and health risk index (HRI) was also evaluated among local consumers. Results showed that mean values of cadmium (Cd), and lead (Pb) in all vegetable samples from both region were exceeding the respective MAL set by FAO/WHO. Estimated daily intake of heavy metals was found below than the permissible limit. EDIM showed following decreasing trend Fe > Zn > Mn > Ni > Pb > Cr and Cd, respectively. The health risk index (HRI) for all heavy metals were less than the threshold level (1), indicating no significant threat to the local population through the consumption of these vegetables.

Iron deficiency has become a common nutritional problem of developing countries, especially in children. This study approached to tackle the issue of iron deficiency by inexpensive fortified food such as chewing gums, which is commonly consumed by children. In this study, iron-fortified chewing gums were prepared by adding ferrous sulfate (FeSO4) and sodium iron EDTA (NaFeEDTA) 30 mg/100 g. An efficacy trial was conducted to determine the impact of iron-fortified chewing gums on the blood profile and iron status of school-going children (n = 300). Results showed maximum increase in blood profile and iron status that is, serum ferritin (10.43%), hemoglobin (3.22%), hematocrit (3.42%), red blood cells (3.05%), mean cell volume (1.55%), mean cell hemoglobin (5.43%), total white blood cells count (9.09%), and platelets count (4.40%) as compared with control whereas decrease in mean cell hemoglobin concentration (1.90%) and neutrophils (3.33%) was also observed. The study concluded that FeSO4 and NaFeEDTA (1:1) fortification of chewing gums is an appropriate approach for mitigating iron deficiency among the target population.

Background & Objective: The Coronavirus disease 2019 (COVID-19) pandemic has caused widespread psychological distress. The aims of the study were a) to assess mental health symptoms experienced by expatriate hospital staff and b) to determine the impact of staff wellbeing interventions specific to pandemic related stress. Methods: The study was conducted from June 2020 until August 2020. A 16-question survey was disseminated online via Survey Monkey to assess the mental health needs of hospital staff during the pandemic. Based on results, a virtual, tiered mental health support model was developed, and staff feedback was collected. Results: Almost 46.2% of respondents (N: 1001) reported at least one mental health symptom in the initial survey. The most common symptoms were anxiety, low mood and feelings of isolation. Being single and in poor health status were predictors of developing mental health symptoms (P

Background & Objective: Child & adolescent mental health needs to be considered as an integral component of overall health, however significant gaps exist in service provision especially inpatient services in Pakistan. The paper presents the characteristics of admitted youths and response to treatment in Pakistan’s first dedicated child & adolescent psychiatry inpatient unit in Lahore over a period of first seven years. The aim of this study was to better understand the various characteristics of children and youth admitted to this inpatient unit and response to treatment over a seven years’ period since the inception of the unit. Methods: Inpatient medical records of children & adolescents admitted to dedicated Child & Adolescent Inpatient Unit at King Edward Medical University, Lahore were reviewed. Data was extracted regarding referral patterns, sociodemographic factors and diagnosis for the first seven years, from 2012 to 2019. Patients’ scores on Strengths and Difficulties Questionnaire and Clinical Global Impressions Scales administered during intake were also reviewed. Results: Six hundred and thirty-four (634) patients, 56% (355) being females were admitted to the unit during seven years with mean age of 12.3±2.3. Mean duration of admission was 15.60±6.3 days. Most predominant ICD-10 Axis-I psychiatric diagnosis were neurotic, stress related and somatoform disorders (262); mood disorders (78); schizophrenia, schizotypal & delusional disorders (77) and behavioral and emotional disorders with onset usually occurring in childhood and adolescence (44). One hundred and fifty-nine (25%) children had comorbid diagnosis of intellectual disability on Axis-III. Strengths and difficulties questionnaire scores were in abnormal range for significant proportion (>50 %) of patients. CGI mean scores showed marked improvement at discharge. Conclusion: Neurotic, stress related and somatoform disorders are the most common diagnosis in youth needing inpatient treatment in Pakistani setup. Study results indicate that there is a clear need for specialized inpatient child and adolescent services such as ours in low- & middle-income countries. doi: https://doi.org/10.12669/pjms.37.2.2611 How to cite this:Imran N, Bodla ZH, Asif A, Shoukat R, Azeem MW. Pakistan’s First Child & Adolescent Psychiatry Inpatient Unit: Characteristics of admitted patients and response to treatment over a 7-year period. Pak J Med Sci. 2021;37(2):305-311. doi: https://doi.org/10.12669/pjms.37.2.2611 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Depleting petroleum resources coupled with the environmental consequences of fossil fuel combustion have led to the search for renewable alternatives, such as biodiesel. In this study, sunflower (Helianthus annus), mustard (Brassica compestres) and pearl millet (Pennisetum americanum) seed oils were converted into biodiesel (fatty acid methyl esters) by acid-, base- and lipase-catalyzed transesterification, and the resultant fuel properties were determined. The methyl esters displayed superior iodine values (102–139), low densities, and a high cetane number (CN). The highest yield of biodiesel was obtained from mustard seed oil, which provided cloud (CP) and pour (PP) points of −3.5 and 5 °C, respectively, and a CN of 53. The sunflower seed oil methyl esters had a density of 0.81–0.86 kg/L at 16 °C, CP of 2 °C, PP of −8 °C, and a CN of 47. The pearl millet seed oil methyl esters yielded a density 0.87–0.89 kg/L, CP and PP of 4 °C and −5 °C, respectively, and a CN of 46. The major fatty acids identified in the sunflower, mustard, and pearl millet seed oils were linolenic (49.2%), oleic acid (82.2%), and linoleic acid (73.9%), respectively. The present study reports biodiesel with ideal values of CP and PP, to extend the use of biodiesel at the commercial level.

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.

Obsessive-compulsive disorder (OCD) can be found in about 4% of the general population and is characterized by various compulsions and obsessions that interfere with the person's quality of life from a mild to severe degree. The following discussion reflects on current concepts in this condition, including its epidemiology and etiologic underpinnings (behavioral, neurological, immunological, gastroenterological, as well as genetic). The interplay of PANS and PANDAS are included in this review. In addition, the core concepts of OCD diagnosis, differential diagnosis, and co-morbidities are considered. It is stressed that the quality of life for persons with pediatric OCD as well as for family members can be quite limited and challenged. Thus, principles of management are presented as a guide to improve the quality of life for these persons as much as possible.

Sources of data This article is based on key recent published literature including international guidelines and relevant reviews and meta-analyses. Authors have also supplemented this material with their own clinical experience. Areas of agreement There is an agreement that autism spectrum disorder (ASD) have a strong hereditary component. There is also a consensus that the reported prevalence estimates have increased in the last 5 years. There is strong support for using the broader spectrum disorder conceptualization of the DSM-5. Areas of controversy Higher public awareness of ASD has generated several controversial theories of causation. We review a number of environmental risk factors receiving media attention including: vaccines, mercury, heavy metal exposure and Selective Serotonin Uptake Inhibitors (SSRIs). Popular yet controversial treatment interventions are discussed. Early diagnostic screening tools are also addressed. Growing points There is increasing scientific interest in identifying biomarkers of autism with potential for early diagnosis, prognostic indicators and predictive treatment responses. We review evidence from genetics, neuroimaging and eye tracking as candidate biomarkers. Area timely for developing research Family studies point to a strong hereditary component in the aetiology of autism. However these studies have not established 100% concordance rates, suggesting a role for environmental factors. The gene-environment interplay has not received enough attention in scientific research. This represents an important new avenue for research in ASD.

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.

Objective: To measure the knowledge of healthcare professionals about increasingly prevalent Autism Spectrum Disorder (ASD) along with perceptions around its management and prognosis and comparison across various specialties. Methods: This Cross sectional survey based comparative analysis took place at Maternity and Children Hospital and King Faisal Hospital Makkah from December 2017 to May 2018. The validated self-administered “Knowledge about childhood autism among health workers” questionnaire was used along with additional questions regarding perceptions about ASD. The mean and mean percent scores were calculated. Chi squared test and ANOVA were applied to find the association between quantitative and qualitative variables respectively. Results: Out of 162 participants, 153 returned the questionnaire and 147 were included in final analysis. Physicians constituted 81.6% (120) of participants. The mean score for participants was 9.80(S.E.M ±0.32) where non-physicians yielded higher mean score (11.2±4.41) as compared to physicians (9.6±3.28) (p=0.113). Psychiatrists had highest score of 16/19 while general physicians had lowest (6/19). Participants with more years of experience had higher mean scores (p-value = 0.01). About 72.10% (106) of participants opted for medication as a treatment option. Nearly 38.1% (56) of participants were skeptical about improvement of ASD with early interventions. Conclusion: There is a lack of knowledge about ASD amongst healthcare professionals in Saudi Arabia. Experienced professionals working with ASD children can be utilized to deliver targeted trainings nationwide.

Objective: To measure the knowledge of healthcare professionals about increasingly prevalent Autism Spectrum Disorder (ASD) along with perceptions around its management and prognosis and comparison across various specialties. Methods: This Cross sectional survey based comparative analysis took place at Maternity and Children Hospital and King Faisal Hospital Makkah from December 2017 to May 2018. The validated self-administered “Knowledge about childhood autism among health workers” questionnaire was used along with additional questions regarding perceptions about ASD. The mean and mean percent scores were calculated. Chi squared test and ANOVA were applied to find the association between quantitative and qualitative variables respectively. Results: Out of 162 participants, 153 returned the questionnaire and 147 were included in final analysis. Physicians constituted 81.6% (120) of participants. The mean score for participants was 9.80(S.E.M ±0.32) where non-physicians yielded higher mean score (11.2±4.41) as compared to physicians (9.6±3.28) (p=0.113). Psychiatrists had highest score of 16/19 while general physicians had lowest (6/19). Participants with more years of experience had higher mean scores (p-value = 0.01). About 72.10% (106) of participants opted for medication as a treatment option. Nearly 38.1% (56) of participants were skeptical about improvement of ASD with early interventions. Conclusion: There is a lack of knowledge about ASD amongst healthcare professionals in Saudi Arabia. Experienced professionals working with ASD children can be utilized to deliver targeted trainings nationwide. doi: https://doi.org/10.12669/pjms.35.4.605 How to cite this:Hayat AA, Meny AH, Salahuddin N, Alnemary FM, Ahuja KR, Azeem MW. Assessment of knowledge about childhood autism spectrum disorder among healthcare workers in Makkah- Saudi Arabia. Pak J Med Sci. 2019;35(4):951-957. doi: https://doi.org/10.12669/pjms.35.4.605 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Mental health disorders are a burgeoning global public health challenge, and disproportionately affect the poor. Low- and middle-income countries (LMICs) bear 80 % of the mental health disease burden. Stigma associated with mental health results in delayed help seeking, reduced access to health services, suboptimal treatment, poor outcomes and an increased risk of individuals' human rights violations. Moreover, widespread co-occurrence of physical comorbidities such as noncommunicable diseases with mental health disorders makes the treatment of both conditions challenging and worsens prognosis. This paper explores various aspects of stigma towards mental health with a focus on LMICs and assesses measures to increase help-seeking and access to and uptake of mental health services. Stigma impacts persons living with mental illness, their families and caregivers and healthcare professionals (mental health professionals, non-psychiatric specialists and general practitioners) imparting mental health care. Cultural, socio-economic and religious factors determine various aspects of mental health in LMICs, ranging from perceptions of health and illness, health seeking behavior, attitudes of the individuals and health practitioners and mental health systems. Addressing stigma requires comprehensive and inclusive mental health policies and legislations; sustainable and culturally-adapted awareness programs; capacity building of mental health workforce through task-shifting and interprofessional approaches; and improved access to mental health services by integration with primary healthcare and utilizing existing pathways of care. Future strategies targeting stigma reduction must consider the enormous physical comorbidity burden associated with mental health, prioritize workplace interventions and importantly, address the deterioration of population mental health from the COVID-19 pandemic.

The present study was aimed to assess the antioxidant activity of ethanolic sugarcane leaf extractfor the stabilisation of sunflower, (SFO), soybean and (SBO) canola oils (CO) at ambient temperature.SFO, SBO and CO were added with 600 ppm sugarcane leaf extract, filled in transparent PET bottles,stored at ambient temperature for 180 days, sampled at 0, 60, 120 and 180 days for the assessment ofoxidative stability. Total phenolic content in sugarcane leaf extract (SLE) was 724.3 (mg GAE/100g).2,2,diphenyl- 2 picrylhydrazyl free radical scavenging activity of SLE was 76% as compared to 88% inbutylated hydroxyl toluene. C18:1 and C18:2 in fresh, 6 months stored controls and SLE supplementedSFO were 46.12%, 42.59%, 44.91% and 47.15%, 40.29, 43.13%, respectively. C18:2 and C18:3 in freshand 180 days stored control and SLE supplemented SBO were 51.19%, 45.61%, 48.97% and 6.19%, 3.37%and 5.67%, respectively. Similar trend was also recorded in canola oil. Induction period of supplementedvegetable oil was higher than the un-supplemented samples (P

Background This study assessed anxiety and depression levels among parents of children with intellectual disability (ID) and analyzed their coping strategies. Methods One hundred parents of children with ID were recruited through child psychiatry outpatient services in a tertiary care setting in Lahore, Pakistan. A structured questionnaire including sociodemographic details, the Agha Khan University Anxiety Depression Scale, the Family Stress and Coping Questionnaire, Brief COPE questionnaire, and Support questionnaire were used for data collection. Results The mean age of parents was 35 years, and the majority of parents (86%) in the study were females. Seventy percent of the parents had significant levels of anxiety and depression. Parents mostly used emotion-based coping to deal with their anxiety and depression; self-distraction, behavioral disengagement, and venting were the main coping strategies used. Conclusions The study showed family stressors, various coping strategies, and support sources in depressed parents who are taking care of their intellectually disabled children. Based on these results, effective culturally sensitive intervention programs can be designed to educate parents and help them effectively cope with stress.

Delayed brain development in perinatally HIV-infected children may affect the functional brain activity and subsequently cognitive function. The current study evaluated the functional brain activity in HIV-infected children by quantifying the amplitude of low frequency fluctuations (ALFF) and functional connectivity (FC). Additionally, correlation of ALFF and FC with cognitive measures was performed. Twenty-six HIV-infected children and 20 control children underwent neuropsychological (NP) assessment and resting-state functional magnetic resonance imaging (rs-fMRI). ALFF and FC maps were generated and group differences were analyzed using two-sample t-test. Furthermore, ALFF and FC showing significant group differences were correlated with NP scores using Pearson's correlation. Significantly lower ALFF in the left middle temporal gyrus, precentral and post central gyrus was observed in HIV-infected children compared to controls. FC was significantly reduced in the right inferior parietal, vermis, middle temporal and left postcentral regions, and significantly increased in the right precuneus, superior parietal and left middle frontal regions in HIV-infected children as compared to control. HIV-infected children showed significantly lower NP scores in various domains including closure, exclusion, memory, verbal meaning, quantity and hidden figure than controls. These waning cognitive functions were significantly associated with changes in ALFF and FC in HIV-infected children. The findings suggest that abnormal ALFF and FC may responsible for cognitive deficits in HIV-infected children. ALFF and FC in association with cognitive evaluation may provide a clinical biomarker to evaluate functional brain activity and to plan neurocognitive intervention in HIV-infected children undergoing standard treatment., Highlights • Resting-state fMRI and cognitive assessment were performed in HIV-infected children. • HIV-infected children showed abnormal spontaneous neural activity (SNA) and functional connectivity (FC). • Lower cognitive scores were significantly associated with SNA and FC in HIV-infected children. • HIV infection may have significant impact on neurodevelopment and cognitive performance.

Aims and methodTo assess adolescents' perceptions of their psychiatric illness and the role of various demographic factors in a Pakistani setting. Adolescents with various psychiatric diagnoses were interviewed using a structured questionnaire including the Illness Perceptions Questionnaire–Revised (IPQ-R).ResultsFifty-two adolescents with various psychiatric illnesses were interviewed; their mean age was 12.7 years and the majority (67%) were female. Males had significantly higher scores on timeline and emotional representation (PClinical implicationsDespite the importance of early intervention in psychiatric problems, engaging youth in the treatment process in Pakistan remains difficult. Better understanding of how adolescents perceive their psychiatric difficulties may play a significant role in developing culturally sensitive interventions and better utilisation of services.

N-acetylcysteine (NAC) is a well-known antidote for acetaminophen toxicity and is easily available over the counter. It has antioxidant and anti-inflammatory properties and an established tolerance and safety profile. Owing to its neuroprotective effects, its clinical use has recently expanded to include the treatment of different psychiatric and non-psychiatric disorders. Although a number of randomized controlled trials have documented the clinical evidence for NAC, there are no reviews that summarize the evidence. The present scoping review summarizes the study designs, the patient characteristics, the evidence and the limitations in randomized controlled trials designed to explore the efficacy of NAC for psychiatric conditions in the pediatric population.

BackgroundIn poor urban Pakistan, private GP clinics lack adequate services to promote early child development (ECD) care. A clinic-based contextualised ECD intervention was developed for quarterly tool-assisted counselling of mothers.AimTo explore the experience and implementation of ECD intervention by the private care providers and clients, for further adaptation for scaling of quality ECD care, at primary level private healthcare facilities in Pakistan.Design & settingA mixed methods approach using quantitative records review and qualitative interviews at poor urban clinics in Rawalpindi and Lahore, Pakistan.MethodQuantitative data from study-specific records were reviewed for 1242 mother–child pairs registered in the intervention. A total of 18 semi-structured interviews with clinic staff, mothers, and research staff were conducted at four clinics. The interviews were audiorecorded and transcribed verbatim.ResultsDistrict Health Office (DHO) support allowed transparent and effective selection and training of clinic providers. Public endorsement of ECD care at private clinics and the addition of community advocates promoted ECD care uptake. Clinic settings were found feasible for clinic assistants, and acceptable to mothers, for counselling sessions. Mothers found ECD counselling methods more engaging compared to the usual care provided.ConclusionIn poor urban settings where public health care is scarce, minimal programme investment on staff training and provision of minor equipment can engage private clinics effectively in delivering ECD care.

This study tries to calculate value at risk at Asian emerging stock markets of daily, weekly and monthly stock returns by calculating its log returns. This study also ranks equity markets on the basis on Sharpe ratio and risk adjusted returns. This process helps investors to gauge these stock markets on various risk levels present in these market to make a good decision of investment for wealth maximization. This study uses 10 year financial data from 2004 to 2014 of daily weekly and monthly data frequency. Value at risk is calculate of all data frequencies at 1 and 5 percent level of significance. Results are different in short, medium and relatively long run cases of each stock market. However, collectively, Pakistan, Indian and Malaysian markets perform better at a given level of risk and return.

OBJECTIVE: Association between Intellectual disability (ID) and psychiatric disorders in children & adolescents is well established but there is a paucity of published studies from Pakistan on this topic. The main aim of the study was to assess the frequency of ICD-10 psychiatric diagnosis in the hospital outpatient sample of children with ID in Lahore, Pakistan as well as to find out which challenging behaviors, caregivers find difficult to manage in this setup. METHODS: Socio-demographic information was collected, Wechsler Intelligence Scale for Children-Revised & ICD-10 diagnostic criteria was used to assess children (age range 6 - 16 years) with suspected ID along with identification of behaviors found to be difficult to manage by caregivers. RESULTS: 150 children were assessed with mean age of 10.7 years (males 70 %). Majority (72%) had mild ID while 18.7% and 9.3% had moderate and severe ID respectively. Thirty percent of children met the criteria for any psychiatric diagnosis, the most common being Oppositional Defiant Disorder (14%) and Hyperkinetic Disorders (10%). Verbal and physical aggression, school difficulties, socialization problems, inappropriate behaviors (e.g. disinhibition), sleep & feeding difficulties were the significant areas identified by the caregivers as a cause of major concern. CONCLUSIONS: Significantly high prevalence of ICD-10 psychiatric diagnosis in children with ID was found in Lahore, Pakistan. Support services for these children should be responsive not only to the needs of the child, but also to the needs of the family. Language: en

article i nfo Keywords: Epilepsy Seizures ADHD Stimulant Methylphenidate Amphetamine Pharmacotherapy Comorbidity To retrospectively examine response to stimulant treatment in patients with epilepsy and ADHD symptoms as predicted by seizure freedom for six months, use of methylphenidate (MPH) versus amphetamine (AMP) preparations, cognitive level, and medical records were searched for patients under the age of 18 with epilepsy and ADHD symptoms treated with MPH or AMP (n = 36, age = 10.4 ± 3.5; male = 67%). "Responders" had a CGI-improvement score of ≤2 and did not stop medication because of adverse effects. "Worsened" patients discontinued medication because of agitation/emotional lability. Seizure freedom did not predict treatment response. Lower cognitive level was associated with increased rate of worsening (p = 0.048). No patients who were seizure-free at the start of the medication trial experienced an increase in seizures. Of the patients having seizures at the start of trial, one patient on MPH and two patients on AMP had increased seizures during the trial. Seizures returned to baseline frequency or less after stimulant discontinuation or anticon- vulsant adjustment. Methylphenidate was associated with a higher response rate, with 12 of 19 given MPH (0.62 ± 0.28 mg/kg/day) compared with 4 of 17 given AMP (0.37 ± 0.26 mg/kg/day) responding (p = 0.03). Methylphenidate treatment and higher cognitive level were associated with improved treatment outcome, while seizure freedom had no clear effect. Confidence in these findings is limited by the study's small, open-label, and uncontrolled design.

Studies have shown an association between parental distress and caretaking of children with developmental cognitive delays. There is little data in developing countries, such as Pakistan, concerning the impact of raising children with intellectual disability upon the quality of parent functioning and risk for psychopathology.To assess the level of psychopathology i.e. anxiety, depression and both anxiety and depression together among parents of children with intellectual disability (ID).This was a cross-sectional study conducted at a tertiary care hospital in Pakistan. The study was approved by the Institutional Research Committee. Participants were 198 parents (99 fathers/99 mothers) of 100 children with the diagnosis of ID. Informed consents were obtained. The parents were assessed for anxiety and depression using DSM IV criteria.Significantly high proportion of mothers (89%) had anxiety, depression, or both anxiety and depression together as compared to fathers (77%) (p-value0.05). Among mothers, 35% met criteria for anxiety, 40% for depression and 13% for both anxiety and depression. Among fathers 42% had anxiety, 31% depression and 3% both anxiety and depression. There was a significant association between gender of parent and individual psychiatric diagnosis of anxiety, depression and anxiety and depression together (p-value0.05). A significant association was also found between mother's anxiety, depression or both and degree of ID of their children (p-value0.05).1) Significantly high proportion of parents of children with ID has psychiatric diagnosis of anxiety, depression or both; 2) the psychiatric diagnosis of anxiety, depression and anxiety and depression together is associated with gender of parent; and, 3) the diagnosis of anxiety, depression or both in mothers was associated with severity of ID in their children.Des études ont montré une association entre la détresse parentale et la garde d’enfants souffrant de retards de développement cognitif. Dans les pays en développement, comme le Pakistan, il existe peu de données au sujet des répercussions d’élever des enfants souffrant de déficience intellectuelle sur la qualité du fonctionnement des parents et le risque de psychopathologie.Évaluer le niveau de psychopathologie, c.-à-d., l’anxiété, la dépression et l’anxiété et la dépression à la fois chez les parents d’enfants souffrant de déficience intellectuelle (DI).Cette étude intersectorielle a été menée à un hôpital de soins tertiaires du Pakistan. Elle a été approuvée par le comité de recherche institutionnelle. Les participants étaient 198 parents (99 pères/99 mères) de 100 enfants ayant reçu un diagnostic de DI. Des consentements éclairés ont été obtenus. Les critères de l’anxiété et de la dépression du DSM-IV ont servi à évaluer ces troubles chez les parents.Une proportion significativement élevée des mères (89%) souffrait d’anxiété, de dépression ou d’anxiété et de dépression à la fois comparé aux pères (77%) (valeur1) Une proportion significativement élevée des parents d’enfants souffrant de DI a un diagnostic psychiatrique d’anxiété, de dépression, ou des deux à la fois; 2) le diagnostic psychiatrique d’anxiété, de dépression, ou des deux à la fois est associé au sexe du parent; et 3) le diagnostic d’anxiété, de dépression, ou des deux à la fois chez les mères était associé à la gravité de la DI de leurs enfants.

Background The diagnosis and treatment of Autism in Pakistan occurs in multiple settings and is provided by variety of health professionals. Unfortunately, knowledge and awareness about Autism is low among Pakistani healthcare professionals & the presence of inaccurate and outdated beliefs regarding this disorder may compromise early detection and timely referral for interventions. The study assessed the baseline knowledge and misconceptions regarding autism among healthcare professionals in Pakistan which can impact future awareness campaigns. Methods Physicians (psychiatrists, pediatricians, neurologists and family physicians) and non-physicians (psychologists and speech therapists) participated in this study. Knowledge of DSM-IV TR criteria for Autistic Disorder, beliefs about social, emotional, cognitive, treatment and prognosis of the disorder were assessed. Demographic information regarding the participants of the survey was also gathered. Results Two hundred and forty seven respondents (154 Physicians & 93 Non-physicians) participated in the study. Mean age of respondents was 33.2 years (S.D 11.63) with 53% being females. Reasonably accurate familiarity with the DSM IV-TR diagnostic criteria of Autistic Disorder was observed. However, within the professional groups, differences were found regarding the utilization of the DSM-IV-TR criteria when diagnosing Autistic Disorder. Non-Physicians were comparatively more likely to correctly identify diagnostic features of autism compared with Physicians (P-value Conclusion Results suggests that current professionals in the field have an unbalanced understanding of autism due to presence of several misconceptions regarding many of the salient features of autism including developmental, cognitive and emotional features. The study has clinical implications and calls for continued education for healthcare professionals across disciplines with regards to Autism in Pakistan.

Background Studies have shown higher rate of various psychiatric disorders among individuals with substance abuse / dependence. There is little data in developing countries, such as Pakistan, on prevalence of psychiatric co-morbidity in this population and impact on treatment. Objective To assess the psychiatric co-morbidity among individuals with substance dependence and to determine its demographic associations in patients with substance dependence in Pakistan. Method This was a descriptive study conducted at a tertiary care hospital in Pakistan. Participants were 588 individuals with substance dependence admitted to a tertiary care hospital in Pakistan, mainly in male inpatient substance dependence unit. The patients were assessed for psychiatric co-morbidity using DSM IV criteria. Informed consent was obtained. The study was approved by the Institutional Research Committee. The results were obtained by using chi square test on SPSS 17. Results Out of 588, 200 patients (34%) were found co-morbid with other psychiatric disorders along with substance dependence. Reason of first substance use and history of previous substance dependence were observed to be significantly associated with co-morbid psychiatric disorders, x2 (48, n = 549) = 112.396, p Conclusion 1. There was high rate of psychiatric co-morbidity among individuals with substance dependence in this sample. 2. Depression, personality disorders and anxiety disorders were the major co-morbid diagnosis among this population.