Study protocol of DIVERGE, the first genetic epidemiological study of major depressive disorder in Pakistan.

INTRODUCTION: Globally, 80% of the burdenof major depressive disorder (MDD) pertains to low- and middle-income countries. Research into genetic and environmental risk factors has the potential to uncover disease mechanisms that may contribute to better diagnosis and treatment of mental illness, yet has so far been largely limited to participants with European ancestry from high-income countries. The DIVERGE study was established to help overcome this gap and investigate genetic and environmental risk factors for MDD in Pakistan. METHODS: DIVERGE aims to enrol 9000 cases and 4000 controls in hospitals across the country. Here, we provide the rationale for DIVERGE, describe the study protocol and characterise the sample using data from the first 500 cases. Exploratory data analysis is performed to describe demographics, socioeconomic status, environmental risk factors, family history of mental illness and psychopathology. RESULTS AND DISCUSSION: Many participants had severe depression with 74% of patients who experienced multiple depressive episodes. It was a common practice to seek help for mental health struggles from faith healers and religious leaders. Socioeconomic variables reflected the local context with a large proportion of women not having access to any education and the majority of participants reporting no savings. CONCLUSION: DIVERGE is a carefully designed case-control study of MDD in Pakistan that captures diverse risk factors. As the largest genetic study in Pakistan, DIVERGE helps address the severe underrepresentation of people from South Asian countries in genetic as well as psychiatric research.

Novel chitosan/guar gum/PVA hydrogel: Preparation, characterization and antimicrobial activity evaluation.

A series of chitosan/poly(vinyl alcohol)/guar gum (CS/PVA/GG) blends were prepared. The synthesis was carried out using different combinations of CS and GG, while keeping PVA constant by casting solution method. The effect of formaldehyde as a crosslinking agent was also evaluated. The blends were characterized by scanning electron microscopy (SEM), Fourier Transform Infra-red (FTIR) and X-ray powder diffraction (XRD). Additionally, the swelling ratio along with antimicrobial activity was also studied. SEM exhibited the phenomenon that surface morphology was mostly affected by blend ratios and cross-linker. The XRD shows the crystalline structure of blends. The FTIR confirmed the strong intermolecular bonding between polymers. Swelling exhibits that cross-linking affects the hydrophilicity of blends and swelling was excellent for S4 blend. The prepared blends showed promising antimicrobial activity against P. multocida, S. aureus, E. coli, and B. subtilis bacterial agents. The data concludes that GG, CS and PVA ternary blends could possibly be used for the biomedical applications.