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Abstract Introduction The ongoing training process and medical curriculum of the medical profession are crucial for equipping them with necessary knowledge and skills, but it can also be challenging to balance the demands of a busy learning schedule, making this period stressful. This study has been aimed to determining the attitude towards suicide and their help-seeking behavior among medical undergraduates in the union territory of Jammu and Kashmir (J&K). Methodology Across medical colleges of the J&K region, an online survey was conducted among 275 medical undergraduates using Attitude Towards Suicide Scale-20 and General Help-Seeking Behavior Questionnaire. An independent sample t-test and one-way ANOVA were carried out for statistical analysis in SPSS 25.0. Result The mean age of the participants was 22.05 years, including 116 male and 159 female students. Psychiatry posting was attended by 31.3% (N = 86) students. Students showed greater acceptability over suicide is preventable, and it is a cry for help. For personal and emotional problems, subjects preferred seeking help from informal sources, while for suicidal ideations, they exhibited inclination towards formal sources. Conclusion Findings of the result should be utilized in preventing negative mental health consequences and in planning assistance to them. Medical students within the institution should receive counselling services from the psychiatry department in a non-stigmatizing manner.

Abstract Introduction Obsessions are recurrent ego-dystonic thoughts, images, or urges followed by compulsion to reduce them. The phenomenology of obsessive–compulsive disorder (OCD) along with comorbidities is essential for understanding treatment response. This study aimed to assess phenomenology, impairment, and psychiatric co-morbidity associated with OCD in children and adolescents. Methodology A cross-sectional study was done among 36 patients suffering from OCD. Socio-demographic and clinical details were collected with the application of Children’s Yale-Brown Obsessive Compulsive Scale for severity of illness, Children’s Global Assessment Scale for impairment assessment, and Kiddie-Sads-Present and Lifetime Version for comorbidity. Result Thirty-six patients, comprising 20 male and 16 female subjects, with a mean age ± SD of 11 ± 3.4 years and a mean duration of illness of 12.30 months, were included in the study. A positive family history was noted in 30.6% of subjects. Mean C-YBOCS score was 24.44 (moderate to severe OCD) and the mean C-GAS score was 47.86, with 55.6% of subjects suffering from other comorbidities. Fear of contamination with washing and cleaning was among the most common themes in the population. Data was analyzed and presented as mean ± SD, frequencies, and percentages. Conclusion Considering the increased prevalence of OCD in children and adolescent populations, a thorough symptom evaluation and any co-morbidities related to OCD should be considered by clinicians.

Solid pseudopapillary neoplasm of the pancreas is rarely encountered in clinical practice. It is a tumor with a good prognosis and overall curative rates. It primarily affects young females in their twenties. It has characteristic imaging appearances, but a definite diagnosis requires histopathological examination. The treatment goal of solid pseudopapillary neoplasm is almost always curative and aims for complete resection of the mass. Here, we present 2 cases of this rare neoplasm. The first case was managed by laparoscopic distal pancreatectomy, while the second underwent a Whipple procedure for pancreatic head involvement.

Multiple studies have been done in the past to understand the relationship between seizure and psychosis, still no conclusive point has been found yet. The mechanism behind the relationship is unknown. Seizures may cause brain damage, increasing the chance of schizophrenia and psychosis, or the two illnesses may share etiological elements. We present a case of a 45-year-old male with a prior history of viral meningoencephalitis, axonal motor polyneuropathy, encephalopathy, and well-controlled generalized tonic–clonic seizures. However, the patient presented to us with a new onset of behavioral disturbances in the form of severe aggression, disinhibition, homicidality, and suicidality during treatment with multiple antiepileptics drugs but with no response to multiple antipsychotics. This patient had an adequate response to clozapine and modified electroconvulsive therapy. No such case has been reported in literature, till date. During the phase of forced normalization, the patient may experience behavioral issues following the management of their seizures with antiepileptic medications and the normalization of their electroencephalography. Any unusual behavior observed in epilepsy patients following the initiation of therapy and seizure control should alert clinicians to the likelihood of this condition.

This study investigated the effects of mindfulness training on alleviating fear of the COVID-19 epidemic among international students in China during the academic year 2020. The training group participants (N = 41) and the control group participants (N = 44) were surveyed pre-and post-training with the two English questionnaires: The Five-Facet Mindfulness Questionnaire (FFMQ) and the fear of the COVID-19 scale (FCV–19S). The results showed that, regarding the relationship between the two main variables in the study, mindfulness is related negatively to the COVID-19 epidemic. Moreover, compared to the control group, results showed that individuals in the training group demonstrated significant improvements in mindfulness levels and decreased Fear of COVID-19. Thus, findings suggest that a short online mindfulness meditation training may reduce fear of the COVID-19 epidemic.

This study investigates the effectiveness of Apple’s privacy labels, introduced in iOS 14, in promoting transparency around app data collection practices with respect to the GDPR. Specifically, we address two key research questions: (1) What special categories of personal data, as regulated by the GDPR, are collected and used by apps, and for which purposes? (2) What disparities exist between app-stated permissions and the apparent unnecessary data gathering across various categories in the iOS App Store? By analyzing a comprehensive dataset of 541,662 iOS apps, we identify common practices related to prevalent use of sensitive and special categories of personal data, revealing widespread instances of unnecessary data collection, misuse, and potential GDPR violations. Furthermore, our analysis uncovers significant inconsistencies between the permissions stated by apps and the actual data they gather, highlighting a critical gap in user privacy protection within the iOS ecosystem. These findings underscore the need for stricter regulatory oversight of app stores and the necessity of effective privacy notices to build accountability and trust and ensure transparency. This study offers actionable insights for regulators, app developers, and users towards creating secure and transparent digital ecosystems.

Error control coding improves reliability and efficiency of wireless communication systems. This research delves into the latest advancements in error control coding schemes for wireless communication systems, with a specific focus on their application within the domain of Low Power Wide Area Networks (LPWANs) such as Narrowband Internet of Things (NB-IoT) systems, LoRa energy-efficient hardware design, random access control systems, and wireless sensor networks. In the context of LPWANs, particularly NB-IoT systems, we investigate the adaptive coding and modulation (ACM) in NB-IoT systems, which adapts coding rates and modulation techniques to changing channel circumstances. Comprehensive analysis of the literature review shows that the proposed approaches are more energy efficient and less error-prone than fixed coding and modulation schemes. Using Cell Design Methodology (CDM), Single Error Correction (SEC) codes are optimized for energy efficiency. Power and energy efficiency have improved in standard CMOS and CDM logic systems. This impacts IoT devices, memory storage, and security systems. Next, Forward Error Correction (FEC) is examined for ALOHA-based random-access control systems wherein packet loss rate and spectral efficiency metrics are mathematically calculated. FEC is beneficial, especially when time and frequency synchronization diverge. Monte Carlo simulations studied in the literature shows that FEC improves satellite communication systems. This review establishes benefits of FEC, notably in satellite communications systems. In addition, Wireless Sensor Networks (WSNs) error control techniques and network reliability and performance are examined along with Convolutional, Turbo, Low density parity check codes(LDPC), and Polar error correction coding (ECC) methods. We learn about their benefits, drawbacks, and implementation challenges by assessing their efficacy, efficiency, and applicability in wireless sensor networks (WSN) applications. This study further highlights advancements of energy-efficient error control coding when, integrated into network designs alongwith the trade-offs between efficacy and intricacy to help improve wireless communication networks. Finally, this study summarizes current error control coding approaches for wireless communication systems. We provide insights into improving reliability, energy conservation, and efficacy by examining ACM, CDM, FEC, and error correction coding (ECC) across varied domains including LPWAN and IoT technologies with earnest hope to facilitate researchers, engineers, and professionals working in the field of error control coding in wireless communication.

Link reliability and enhanced coverage are the primitive concerns of Low-Power Wide-Area Networks (LPWANs) for suitability to critical Internet of Things (IoT) applications. Reliability is limited by the destructive multipath propagation, data rate and sensitivity, that ultimately limits the coverage range. LoRa by far is the predominant LPWAN operating on unlicensed spectrum. Despite its robust Chirp Spread Spectrum (CSS) modulation, there is a severe degradation in its error performance particularly in hostile propagation environments, and an excessive reduction in coverage. Rotating Polarization Wave (RPW) is a potential LPWAN recently emerged to achieve a highly reliable IoT and Machine-to-Machine (M2M) communication. This is the first paper to provide comprehensive error performance comparison between LoRa and RPW. Okumura-Hata model is used for median path loss calculation. Shadowing and fast fading margins of RPW and LoRa are estimated. Effective gain of RPW is computed from error performance. Results have shown that LoRa offers a sensitivity of 23 dB higher than RPW under AWGN conditions. However, under fading conditions, RPW exhibits a sensitivity of 15 dB higher than LoRa. At a reference distance of 100 m, the maximum received signal strength of RPW is −39 dBm, which is 29 dB above LoRa. The maximum coverage distance attained by RPW is 15 km, which is 1.5 times of LoRa.

Abstract Background Literatures revealed syndrome of inappropriate antidiuretic hormone (SIADH) as the most common mechanism of hyponatremia in COVID-19. However, it is important to rule out other etiologies of hyponatremia. Methods This is a case series, retrospective study. Four patients were reviewed from the Mesaieed Hospital, Hamad Medical Corporation, Qatar. The patients were admitted during the second wave of pandemic because of mild to moderate COVID pneumonia. The patients received medications according to the protocol; after few days of treatment, their blood laboratory results showed hyponatremia; as compared to the initial readings, hyponatremia workup excluded SIADH. History revealed that the patients were drinking large amounts of water, around 4–5 L/day, due of certain reasons: one patient had dysgeusia, and the other three patients thought that excessive drinking of water is beneficial for COVID-19 infection. Results The hyponatremia level was less than 135 mmol/L, other laboratory tests excluded SIADH, and the provisional diagnosis was dilutional hyponatremia. Male/female ratio was 3/1, age from 29- to 45-year-old patients with no associated comorbidities. Fluid restriction up to 1.5 L/day showed dramatic improvement of their sodium blood level. The patients are discharged in a stable condition. Conclusions In COVID-19 patients, hyponatremia not only is secondary to SIADH but can also be due to other etiologies. Hyponatremia can be induced by excessive water drinking and considered an extremely rare reported cases.

Background: Personality disorders (PDs) comprise deeply ingrained and enduring behavioral patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations. Our aim was to study sociodemographic profile and parental attitudes in patients with PDs and their comparison with healthy controls. Materials and Methods: It was an observational case–control study conducted in Department of Psychiatry, Government Medical College, Srinagar, J and K, India. A total of 41 cases and 163 controls were selected. Patients were diagnosed using Diagnostic and Statistical Manual-5 (DSM-5) criteria. Childhood Trauma Questionnaire was used for parental attitudes. Results: The mean age of patients and controls was 22.41 (standard deviation [SD] = 4.14) and 22.52 (SD = 4.15), respectively. Majority of the participants were females, single, were from nuclear families, and belonged to upper-middle socioeconomic class. Most of the patients were borderline PD (BPD), followed by histrionic PD. The frequency and inappropriateness of punishment by parents was more in patients than controls. Conclusion: A positive correlation was seen between PDs and inappropriate parental attitudes and rearing styles. Therefore, it is required to have a better understanding of PDs and to help parents to develop skills to handle their children with utmost care in distress.

Abstract Background Clozapine is an atypical second-generation antipsychotic belonging to the family of dibenzodiazepines. There is lack of literature on clozapine from this part of the world. So, our aim was to study the socio demographic, clinical and side effect profile of patients on clozapine in Kashmir. Results The mean age of the study group was 32.6 ± 8.9 years with majority being males (78.4%), unmarried (78.4%), unemployed (77.2%), and belonging to nuclear families (77.2%). Almost half of them resided in urban localities (51.1%) and studied upto middle school (55.7%). Around three- fourth (75%) of the patients had diagnosis of treatment-resistant schizophrenia. The mean dose of clozapine was 338.92 ± 158.11 mgs. Sedation (76.1%), hypersalivation (69.5%), constipation (46.6%), and weight gain (34.1%) were most common side effects noted in patients. 4.5% cases developed seizures while on clozapine. 2.3% patients developed agranulocytosis while 4.5% patients developed neutropenia on clozapine. The neutropenia was more pronounced in patients of schizophrenia with suicidal tendencies with doses of more than 400 mg. Conclusions We have used clozapine in a wide range of indications. Our patients seem to tolerate and respond to higher doses of clozapine and the prevalence of blood dyscrasias in our study sample was much higher than the rest of India.

Purpose – This empirical paper aims to examine the impact of interest rate (IR) and political instability (POLINS) on Palestine's domestic private investment. Design/methodology/approach – A set of econometric techniques of time series data are adopted to meet the study objectives. They include regression analysis, unit root tests, cointegration test, ARDL & Bound tests, VAR test and Granger causality test. Findings – The study's primary results complement the neoclassical approach, which states that the IR is negatively associated with domestic private investment. The empirical results reveal that there is no long-run relationship. Also, there is no causality between domestic investment and lending rates. Accordingly, these findings alert policymakers to draw a series of steps to minimize the IR at a minimum to stimulate investment for improved economic growth and development. Practical implications – There is still no national currency in Palestine. The Palestinian Monetary Authority (PMA) is advised to set an appropriate ratio of the IR for the currencies-in-circulation in Palestine for boosting investment and economic development. Originality/value – This paper provides new background information to both policymakers and researchers on the main determinants of investment in Palestine using econometric analysis. Accordingly, this critical issue is required to be examined in Palestine for stimulating investment.

Abstract Background In Palestine, type 2 diabetes mellitus (T2DM) is a rapidly growing health concern. This study evaluated knowledge, attitude, and practice of patients with T2DM with regard to their disease. The study also investigated association and correlation between knowledge, attitude, and practice with sociodemographic and clinical characteristics of the patients. Predictors of higher knowledge, positive attitude, and good practice were also identified. Methods This cross-sectional study was conducted in primary healthcare facilities frequently visited by patients with T2DM across the West Bank of Palestine in the period of October 2018 to January 2019. An interviewer administered questionnaire was used to determine knowledge, attitude and practice of patients with T2DM with regard to their disease. Results Out of 300 patients invited, 220 (73.3%) patients responded. In this study, the median age was 57.0 years (51.0, 65.0), the median time elapsed since diagnosis with T2DM was 7.0 years (4.0, 14.0), the median fasting blood glucose was 150.0 mg/dL (128.8, 180.0), the median postprandial glucose was 230.0 mg/dL (200.0, 270.0), the median HbA1c was 7.8% (7.0, 8.53), and the median BMI was 28.8 kg/m2 (25.5, 33.1). The median knowledge score was 6.0/13.0 (4.5/13.0, 7.5/13.0), the median attitude score was 3.0/4.0 (2.0/4.0, 4.0/4.0), and the median practice score was 3.0 (1.0/5.0, 4.0/5.0). Having university education was strongly associated with having higher knowledge scores (p-value = 0.001). Additionally, having attended an educational program on diabetes was moderately associated with higher practice scores (p-value = 0.026). Conclusions Findings of this study highlighted the need for appropriately designed interventions to increase knowledge about T2DM among patients with low educational level. Well-designed educational programs might promote healthy practice among patients with T2DM. Future studies are still needed to assess if such interventions could be effective in improving health outcomes and quality of life of patients with T2DM in Palestine.

Background: Although lithium is known to cause thyroid dysfunction and increased thyroid gland volume, clinical examination and biochemical assessment are fundamental to thyroid workup of patients on lithium treatment. We aimed to determine the thyroid gland volume and the thyroid hormone levels of patients who have been receiving lithium treatment for affective disorders in comparison to voluntary healthy controls. Materials and Methods: This was a cross-sectional, hospital-based observational study, performed in 43 patients on long-term lithium treatment for bipolar disorder, major depressive disorder, and schizoaffective disorder. Patients with documented continuous and adequate serum lithium levels for more than or equal to 6 months recruited consecutively underwent ultrasonographic examination of the thyroid gland. Ultrasonographic examinations were also done in all gender- and age-matched healthy controls. All cases and controls underwent biochemical thyroid function tests. Results: There were no statistically significant differences in gender (P = 0.198; χ2 = 1.654) of cases and controls. Most of the cases were married; maximum number of them unemployed and belonged to the lower socioeconomic status. Total thyroid volume was significantly greater in the lithium-treated group than the control group (9.40 ± 1.41 vs. 4.79 ± 0.45). Clinical inspection and palpation only detected goiter in six (n = 6, 13.95%) of patients on lithium and none among controls. The mean triiodothyronine (T3), mean thyroxine (T4), and mean scores for thyroid-stimulating hormone were significantly increased in patients receiving lithium therapy as compared to controls. Conclusion: It would seem wise from a clinical point of view to include ultrasonographic examination of the thyroid gland as part of the standard thyroid workup before initiating lithium treatment.

Background: Although lithium is known to cause thyroid dysfunction and increased thyroid gland volume, clinical examination and biochemical assessment are fundamental to thyroid workup of patients on lithium treatment. We aimed to determine thyroid gland volume and the Thyroid hormone levels of patients who have been receiving lithium treatment for affective disorders in comparison to voluntary healthy controls. Methods: This was a cross-sectional, hospital-based observational study which was performed in 43 patients on long-term lithium treatment for bipolar disorder, major depressive and schizoaffective disorders. Patients with documented continuous and adequate serum lithium levels for more than or equal to 6 months recruited consecutively underwent the ultrasonographic examination of the thyroid gland. Ultrasonographic examinations were also done in all gender- and age-matched healthy controls. All cases and controls underwent biochemical thyroid function tests. Results: There were no statistically significant differences in gender (P = 0.198; Chi-square = 1.654) of cases and controls. Most of the cases were married, maximum number of them unemployed and belonged to the lower socioeconomic status. Total thyroid volume was significantly greater in the lithium-treated group than the controls (9.40 ± 1.41 vs. 4.79 ± 0.45). Clinical inspection and palpation only detected goiter in six (n = 6, 13.95%) of patients on lithium and none among controls. The mean triiodothyronine, mean thyroxine, and mean scores for thyroid-stimulating hormone were significantly increased in patients receiving lithium therapy as compared to controls. Conclusion: It would seem wise from a clinical point of view to include ultrasonographic examination of the thyroid gland as part of the standard thyroid workup before initiating lithium treatment.

Background: Menopausal transition (MT) is the period of irregular menstrual activity which directly precedes menopause and is characterized by widely fluctuating hormone levels and reproductive, metabolic, and psychological disturbances. We aimed to study the prevalence of psychiatric comorbidity among ambulatory women in MT. Materials and Methods: One hundred consecutive ambulatory women in MT were assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria by means of the Mini-International Neuropsychiatric Interview, English version 5.0.0. The diagnosis of MT was made according to the Stages of Reproductive Aging Workshop. Results: About 28% of the cases had major depressive disorder (MDD), 14% had anxiety disorders, and 7% had anxiety with depression. A statistically significant difference in psychiatric comorbidity was found between the age groups of 45–50 years and 51–55 years. There was a statistically significant difference between onset of menarche and psychiatric comorbidity. Women in the late MT had statistically significant sleep disturbances. Conclusion: A high prevalence of mental disorders was observed which included MDD and other anxiety disorders. The results suggested that screening and appropriate management for psychiatric disorders should be part of the routine evaluation that would help in early recognition of symptoms and reduction in discomfort of these symptoms.

This research provides an analysis and evaluation of consumer purchasing behavior using green electronic marketing of vehicles diversification into new markets, focusing on Electrical Vehicles (Ev) and Hybrid Vehicles (Hv). The world has been making remarkable efforts to make everything green and cleaner by the help of the advanced technology, including transportation. The technology especially the E marketing, social media, etc. focuses on orienting people to believe that hybrid and electrical vehicles generate less pollution, will save money and reduce dependence on natural sources of fuel. This research aims to inspect the relationship between Stimuli Factors, Electrical Vehicles’ (Ev) and Hybrid Vehicles’ (Hv) Consumers and Response Purchase Decisions (S-O-R), in addition to inspect the moderation effects of Psychological Inputs on S-O-R relationship in Vehicle industry of Jordan. The current research used quantitative method to gather accessible data from the sample of the study. Variables used in this study include HVs & EVs consumers, Stimuli factors (marketing inputs, external environment) and positive psychological inputs and response purchase decisions. Partial Least Squares (PLS) approach as a statistical method was used to analyze the data. Results indicate that all the relations had a positive significant, except the interactional relationship be-tween Stimuli factors which includes marketing inputs, external environment, and positive psychological inputs, affect response purchase decisions. In other words, the mediation (HVs & EVs consumers) shows valuable change for the prediction of response purchase decisions while, moderated effect of psychological inputs did not make change.

Cyproheptadine hydrochloride(CH)- and dexamethasone-induced obsessive-compulsive symptomatology with suicide is extremely rare. We describe the case of a 20-year-old lean male who developed obsessive-compulsive symptoms and suicidality within a week of the use of CH and dexamethasone. There was complete resolution of symptoms after stopping the offending agent. Ashort trial of selective serotonin reuptake inhibitor was given for the rapid improvement of symptoms.

Background: Personality disorders (PDs) comprise deeply ingrained and enduring behavioral patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations. We aimed to study sociodemographic profile, birth risk factors, and social support in PDs in Kashmir. Materials and Methods: It was an observational study conducted in the Department of Psychiatry, Government Medical College, Srinagar. There were forty one subjects in both the groups-cases and controls. Structured Clinical Interview developed II (SCID II); Oslo 3-item Social Support scale and the Childhood Trauma Questionnaire were used for assessing pattern, social support, and birth risk factors in personality disorders. Results: Mean age of patients and controls was 22.41 ± 4.14 and 22.52 ± 4.15 years, respectively. Majority of the participants were females in both the groups. Most of the cases and controls were single and from nuclear families. Maximum number of patients and healthy controls fitted into the upper-middle socioeconomic class. About 70.73% of cases had good social support while 29.27% of cases had minimal social support. About 99.4% of controls had good and only 1 (0.6%) had minimal social support. Majority of our patients had a borderline PD (35) followed by histrionic PD (3). Other forms of PD seen were avoidant/anxious PD in one patient. Birth complications were seen in 9.76% of cases and none of the controls, therefore, were statistically significant. Conclusion: Most of the cases were borderline, unmarried, from nuclear families belonging to upper-middle socioeconomic class with good social support.

As SARS-CoV-2 continues to spread across the globe and significantly impacts health-care systems and strains resources, identifying prognostic factors to predict clinical outcome remains essential. We conducted a retrospective cohort study to further explore the prognostic value of serum hypoalbuminemia and other factors in hospitalized COVID-19 patients. The primary endpoint was defined as the risk of in-hospital mortality. 300 patients were included in the analysis, with 56% being male and a mean (±SD) age of 61.5 ± 15.3 years. The mean (±SD) albumin was 2.86 ± 0.5 g/dL. Our analysis showed that patients with in-hospital mortality had lower albumin levels than patients without in-hospital mortality (2.6 ± 0.49 vs. 2.9 ± 0.48 g/dL, respectively, with P value =

Background: Frontline healthcare workers (FHCWs) are at an increased risk of contracting COVID-19. We aimed to assess the stress and psychological impact of the COVID-19 pandemic among FHCWs. Methods: This was an exploratory hospital-based study. A semistructured e-questionnaire was developed and shared through emails, WhatsApp groups, Facebook, and Twitter. The study instruments used were stress questionnaire and the impact of event scale—revised. Results: We received 133 valid responses. A total of 81 (61.4%) of the respondents were single, 74 (55.6) were male, 70 (52.6%) were between 20 and 29 years of age, and 91 (68.4%) were from urban background. A total of 83 (62.4%) of respondents were doctors and 28 (21.1%) were registered nurses. A total of 36 (27.1%) were posted in emergency and 34 (25.6%) were in the in-patient department. Feeling sad and pessimistic, feeling of being avoided by others, the burden of change in the quality of work, and worrying whether the family will be cared for in their absence were significantly more in nurses as compared to the doctors. Stress due to burden in an increase in the quantity of work was seen more in FHCWs working in the swab collection center as compared to those working in the in-patient department, emergency, or theaters. Severe psychological impact was seen in 81 (60.9%) of FHCWs. The psychological impact was significantly more in males and in those who were married. It was also significantly related to the place of posting. Conclusion: More than half of the FHCWs had a severe psychological impact owing to COVID-19. The psychological impact was more in males and those who were married, and it was related to the place of posting of the FHCWs. Nurses had significantly higher stress as compared to doctors.

BackgroundCoronavirus disease-19 (COVID-19) has not only spawned a lot of stigma and discrimination towards its survivors but also to their corpses. We aimed to assess the magnitude and correlates of stigma in these survivors, on return to their communities.MethodsThis was a cross-sectional, hospital-based, exploratory study conducted by the postgraduate department of psychiatry, in collaboration with the postgraduate department of chest medicine, Govt. medical college, Srinagar. The study was performed among COVID-19 survivors, who attended the outpatient department after their discharge from the hospital. Socio-demographic characteristics were recorded through semi-structured proforma. Stigma was measured by the stigma questionnaire. Data was analyzed using descriptive statistics and regression analysis.ResultsA total of 91 survivors consented to participate in the study. Almost half (46.2%) of them were in the age group of 30-49 years and close to two-thirds (68.1%) were males. About three-fourths (74.7%) were from the urban background. The mean time from hospital discharge to study entry was 11.7±5.1 [Range(R) = 7-21] days. 98% of survivors provided at least one stigma endorsing response and the total mean stigma score was 28.5±7.1[R = 6-39]. The mean stigma sub-scores were highest for enacted stigma (7.6±1.8) [R = 2-9] and externalized stigma (15.0±4.1) [R = 1-20]. Enacted stigma was significantly high in males as compared to females. Enacted stigma and internalized stigma were both associated with education. Enacted stigma, externalized stigma, disclosure concerns, and total stigma was significantly associated with the occupation. Being unemployed and time since discharge were identified as independent predictors of total stigma.ConclusionOur study results showed high levels of enacted and externalized stigma among COVID-19 survivors. Enacted stigma was more among males and in those who were highly educated. Survivor centered and community-driven anti-stigma programs are the need of the hour to promote the recovery and community re-integration of these survivors.

[This corrects the article DOI: 10.1371/journal.pone.0240152.].

BACKGROUND: Vaccine hesitancy is seen, globally, as a major factor that will determine future coronavirus disease-19 (COVID-19) spread and its effective management. This study aimed to identify COVID-19 vaccine perception, acceptance, confidence, hesitancy, and barriers among the general population. MATERIALS AND METHODS: This was an online survey which was developed and shared through social media platforms among the general population of Kashmir. The survey captured demographic data and used a validated hesitancy measurement tool. We analyzed the data using descriptive statistics and multivariable logistic regression using Stata 15 (Stata Corp. 2017. Stata Statistical Software: Release 15. College Station, TX, USA: Stata Corp LLC). RESULTS: A total of 835 responses were received. Most participants were males, with females compromising of 19.5% participants. 65.1% of participants were in the age group of 30–50, whereas 19.2% were below 30 years of age. 52.70% of respondents were willing to take the vaccine when available, while 32.5% of respondents were unsure about their decision of inoculation. The most cited reason for willingness to get vaccinated was an understanding of the disease and vaccination. 41.70% felt that the vaccines developed against COVID-19 have not been fully tested; therefore, concerns around the safety and its longer-term side effects were the reasons cited. Public health messaging should be tailored to address these concerns. CONCLUSIONS: Vaccine hesitancy is a global threat undermining the control of preventable infections. The government should take proactive steps to address the factors that may potentially impact the benefits expected from the introduction of a COVID-19 vaccine in the union territory.

Background and Aims: Globus is the physical sensation of a lump in the throat presenting as difficulty in swallowing. Since there is a paucity of literature regarding the psychiatric comorbidity in globus, we aimed to study the psychiatric comorbidities in these patients visiting a tertiary care center in Kashmir. Materials and Methods: It was a noncontrolled, noninterventional, cross-sectional, hospital-based study carried out from August 2014 to July 2015 among the patients with a diagnosis of globus. Patients were selected from the outpatient unit, visiting the Institute of Mental Health and Neurosciences Kashmir. About 51 patients with globus who fulfilled the inclusion criteria and gave written informed consent were selected as study cases. For diagnosing psychiatric comorbidities, we used the Mini-International Neuropsychiatric Interview. Results: The mean age of our cases was 39.58 years. Females outnumbered males in cases by a ratio of 3:1 approximately. Psychiatric disorders were seen in 70.588% of globus patients. Major psychiatric disorders seen in our patients were major depressive episode (23.53%) and generalized anxiety disorders (11.76%). Conclusions: Majority of patients with globus who present to a tertiary care center have comorbid psychiatric disorders. We need to screen these patients for such comorbidities and develop a holistic approach for better outcome in such cases.

BACKGROUND: The coronavirus disease-19 (COVID-19) emerged from China and rapidly spread to many other countries all over the world. This study aimed to assess the prevalence of anxiety, depression, posttraumatic stress disorder, and obsessive–compulsive (OC) symptoms among COVID-19 survivors after their discharge from the COVID-19 treatment center. MATERIALS AND METHODS: This was a cross-sectional, hospital-based study performed among 119 COVID-19 survivors. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression. Posttraumatic Stress Disorder (PTSD)-Checklist (PCL) and Brief OC Scale were used to measure PTSD and OC symptoms. Data were analyzed by descriptive and inferential statistics using the SPSS (IBM Corp. Released 2015 version 23.0). RESULTS: The mean anxiety, depression, and PTSD scores were, 7.12 ± 0.68, 8.08 ± 0.22, and 19.78 ± 0.88, respectively. Based on cutoff scores, the prevalence of anxiety, depression, and PTSD among COVID-19 survivors was n = 53, 44.54%; n = 73, 61.34%; and n = 30, 25.21%, respectively. Older COVID-19 survivors (≥50 years) were more likely to show symptoms of depression and anxiety (P < 0.001) compared to younger ones. Furthermore, COVID-19 survivors who were ≥50 years of age experienced a greater level of PTSD compared to younger ones; similar trends were seen in those experiencing OC symptoms. In the present study, n = 98 (82.4%) were obsessed with fears of contamination and an equal number had compulsive handwashing. CONCLUSION: Anxiety, depression, PTSD, and OC symptoms are common among the COVID-19 survivors and that underscores the need to diagnose and manage mental health morbidities among these survivors long after their recovery from COVID-19.

With growing interest in Industry 4.0, machine-to-machine communication (M2M) will become the key enabler for low-power wide area networks (LPWANs) in connecting machines and sensor nodes distributed across a distance in the industrial environment. The choice of modulation and diversity techniques, and the selection of spectrum (licensed/unlicensed) will impact and influence the requirements of wireless M2M systems. Link reliability is one of the most important requirements for LPWAN deployment in industrial scenarios. Rotating Polarization Wave (RPW) system has been recently proposed as an LPWAN solution for reliable M2M communication in high clutter environment and it deploys BPSK modulation with polarization diversity (PD). This paper proposes a new multi-level Rotating Polarization Phase-Shift Keying (RP-MPSK) modulation to provide high data rate and energy efficiency. A novel quaternion model for RPW system (Q-RPW) is also proposed to reduce the complexity in modeling, simulation, and implementation. Results using Q-RPW model show that RP-MPSK modulation offers a high diversity gain over BPSK with second-order diversity. Bit error rate (BER) performance of RP-MPSK modulation compared against other LPWAN modulation like MPSK, FSK and QAM has shown high reliability and substantial improvement in SNR. To overcome the degradation in error performance caused by the proposed higher-order modulation, sampling rates are recommended based on BER performance. BER performance of RP-MPSK under multipath and interference conditions is also investigated.

The present study demonstrated a sustainable and cost-effective approach to depolymerize/oxidize softwood (SW) and hardwood (HW) kraft lignins using concentrated hydrogen peroxide at temperatures ranging from 25 to 35 °C, in the absence of catalysts or organic solvents. The degree of lignin depolymerization could be simply controlled by reaction time, and no further separation process was needed at the completion of the treatment. The obtained depolymerized lignin products were comprehensively characterized by GPC–UV, FTIR, 31P-NMR, TGA, Py-GC/MS and elemental analysis. The weight-average molecular weights (Mw) of the depolymerized lignins obtained from SW or HW lignin at a lignin/H2O2 mass ratio of 1:1 after treatment for 120 h at room temperature (≈25 °C) were approximately 1420 Da. The contents of carboxylic acid groups in the obtained depolymerized lignins were found to significantly increase compared with those of the untreated raw lignins. Moreover, the depolymerized lignin products had lower thermal decomposition temperatures than those of the raw lignins, as expected, owing to the greatly reduced Mw. These findings represent a novel solution to lignin depolymerization for the production of chemicals that can be utilized as a bio-substitute for petroleum-based polyols in polyurethane production.

Background: Many therapeutic options have been evaluated and tried for seasonal affective disorder (SAD) including bright light therapy (BLT), anti-depressants, beta-blockers and psychotherapy, but the data supporting use of mood-stabilizing agents is just handful in spite of this condition being understood most frequently to be associated with bipolar affective disorder II (BPAD II). So we planned to study role of Lamotrigine (Mood stabilizing agent) in SAD. Materials and Methods: 30 patients of SAD who were prescribed lamotrigine in addition to antidepressant medications for a minimum of 8 weeks and were assessed for severity using HAM-D were selected retrospectively from the hospital records for this study. HAM-D scores at 2, 4 and 8 weeks were compared to baseline scores. Statistics Analysis: Single tailed t-test was used to study the difference of means to assess the therapeutic response and pre/post analysis of change. Statistical significance was set at P < 0.05. Results: Though no significant difference was seen in HAM-D Scores at 2 weeks of treatment compared to baseline, but results were statistically significant at 4 and 8 weeks of treatment with lamotrigine augmentation of antidepressant medications. Conclusion: We conclude that lamotrigine augmentation was found to be effective treatment strategy for managing winter depression phase of Seasonal Affective Disorder.

Background: Polycystic ovary syndrome (PCOS) is one of the common endocrine disorders and is associated with reproductive, metabolic, and psychological disturbances affecting one in five women of reproductive age group. Objective: To investigate the prevalence of psychiatric disorders among women in ambulatory treatment with a diagnosis of PCOS. Materials and Methods: One hundred and ten patients of PCOS were evaluated using Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria by means of Mini International Neuropsychiatric Interview, English version 5.0.0. Diagnosis of PCOS was confirmed according to the National Institute of Health/National Institute of Child Health and Human Development, 1990 consensus conference criteria. Forty subjects without PCOS who were matched for age and body mass index were taken as a comparison group. Results: About 23% of cases had major depressive disorder as compared to 7.5% of controls, 1.8% had dysthymia, 15.45% had panic disorder compared to 5% of controls, 6.36% had obsessive compulsive disorder compared to 2.5% of controls, 8% cases had suicidality, 2.72% of cases were bipolar affective disorder, and 15.45% had generalized anxiety disorder (GAD). Conclusion: A high prevalence of mental disorders was observed, especially major depression, panic disorder, and GAD in patients with PCOS in our study. The results suggest that screening and appropriate management for psychiatric disorders should be part of the routine evaluation of these patients.

İbn Haldun modern anlamda bir şehir plancısından ziyade bir tarih felsefecisi ve sosyolog olarak bilinir. Ancak o, Mukaddime’de medeniyet anlayışının bir parçası olarak, şehir ortamının planlanmasına ilişkin bazı prensipler üzerine değerlendirmeye değer düşünceler serdetmiştir. Altı asır önce yazılmış olmasına rağmen, okumalarımız onun şehir planlamasına ilişkin fikirlerinin oldukça modern bir tat taşıdığını ve bunların güncel şehirleşmeyle ilgili konularda hala geçerli olduğunu göstermektedir. O, döngüsel süreçlere inanmaktadır ki şehirler ve kentsel gelişim de benzer bir sürece tabiidir. Onun gözlemlerinden aktararak kendi zamanının kültürünü, yaşam biçimlerini, yapılarını, ve şehirlerin problemlerini tasvir etmiştir. Şehirdeki insanın mutluluğu, şehrin fiziki gelişimi, çevre ve sürdürülebilirliği de dahil olmak üzere konunun neredeyse bütün veçhelerine değinmiştir. Şehir planlaması konusunda İbn Haldun’dan ne öğrenebiliriz? Şehirlerimizin günümüzde karşılaştığı güncel meselelerle onun irfanını ve prensiplerini nasıl bağdaştırabiliriz? Bu makale aynı zamanda İbn Haldun tarafından ortaya konulan şehir planlamasına ilişkin ilkeleri tartışmakta ve bunların güncele dönük yorumunu değerlendirmeye çalışmaktadır.

Ibn Khaldun is better known as a philosopher of history and a sociologist rather that an urban or city planner (in a modern sense of the term). However, as part of his civilization discourse, Ibn Khadun has advanced some worth noting thoughts on the principles related to planning of urban environment in his Muqaddima. Although it was written over six centuries ago, our reading shows that his ideas on urban planning carry very much of modern flavor and therefore still relevant to the contemporary urban issues. He believes in the cyclical process where cities and urban development undergo a very much similar procedure. From his own observation, he portrayed the cultures, life styles, forms, structures and problems of cities in his time. He touched upon almost every facet, including human well being, physical development as well as environment and sustainability of the cities. In the context of urban planning, what can we learn from Ibn Khaldun? How can we relate his knowledge and principles to address current issues confronting our cities today? This paper also studies the principles of urban planning as put forward by Ibn Khaldun and tries to evaluate its interpretation in the context of contemporary city planning.

The present research work aimed at hydrolytic treatment of kraft black liquor (KBL) at 200–300 °C for the production of low-molecular-weight depolymerized kraft lignin (DKL). Various process conditions such as reaction temperature, reaction time, initial kraft lignin (KL) substrate concentration, presence of a catalyst (NaOH), capping agent (phenol) or co-solvent (methanol) were evaluated. The research demonstrated effective depolymerization of KL in KBL at 250–300 °C with NaOH as a catalyst at a NaOH/lignin ratio of about 0.3 (w/w) using diluted KBL (with 9 wt. % KL). Treatment of the diluted KBL at 250 °C for 2 h with 5% addition of methanol co-solvent produced DKL with a weight-average molecular weight (Mw) of 2340 Da, at approx. 45 wt. % yield, and a solid residue at a yield of ≤1 wt. %. A longer reaction time favored the process by reducing the Mw of the DKL products. Adding a capping agent (phenol) helped reduce repolymerization/condensation reactions thereby reducing the Mw of the DKL products, enhancing DKL yield and increasing the hydroxyl group content of the lignin. For the treatment of diluted KBL (with 9 wt. % KL) at 250 °C for 2 h, with 5% addition of methanol co-solvent in the presence of NaOH/lignin ≈ 0.3 (w/w), followed by acidification to recover the DKL, the overall mass balances for C, Na and S were measured to be approx. 74%, 90% and 77%, respectively. These results represent an important step towards developing a cost-effective approach for valorization of KBL for chemicals.

Suicide and attempted suicide is an important health issue and the number of people who die of suicide exceeds that of conflicts. Kashmir has been suffering from a low intensity war since last 20 years in which thousands have been killed or injured. There has been phenomenal increase in cases of psychological disorders along with suicide and and suicide attempters. Suicide in a conflict zone is viewed with indifference due to focus on the physical part of trauma. Difficulties faced by the suicidal patient and his attendants are seldom highlighted. 1408 patients who reported to emergency room for suicide attempt from 2000 to 2008 were taken for the study. All the patients underwent the hospital protocol for poisoning management. Patients were subjected to detailed psychiatric evaluation and questions were specifically asked about the difficulties encountered during management. Most of the cases were females with 92.11% belonging to the Muslim religion. 76.20% cases were from a rural background. 32.5% had been referred because of the lack of specific antidotes. Forty-three percent required arrangement of transportation by their own family members. Fifty-seven percent had been stopped for security checks along the way. Seventy-three percent felt that the attitude of the staff hostile. Twenty-three percent of patients had to share a bed. Almost all patients were questioned by security agencies within the hospital. More than 68% patient reported hostility amongst their neighbors. Suicidal poisoning is a significant health problem in Kashmir and management of these cases is fraught with difficulties across the spectrum of health care. Educating the doctors at primary care about first aid, improvement in community services followed by long term resolution of the conflict would go some way in alleviating the difficulties faced by a suicidal patient and his family in a conflict zone.