Health-care professionals coping responses to the COVID-19 pandemic in Pakistan.

BACKGROUND: In the initial stage of infectious diseases such as COVID-19 creates a prodigious uncertainty not only in general population but also in health care professionals. This often leads to emotional distress in general public and particularly in health care professionals. OBJECTIVES: During COVID-19 pandemic in Pakistan, the health care professionals experienced unusual stressors. This study aimed to examine the coping responses, optimism, pessimism and psychiatric morbidity of health professionals serving the COVID-19 patients. PARTICIPANTS: Total 87, health care professionals take part in study, whom 36 were physicians and 51 nursing staff. Among these 44 were male, and 43 were female. METHOD: Researchers used cross sectional research design in this study. Physicians and nurses completed self-reported questionnaires. Participants provided demographics data and recorded their responses to self-administered questionnaires. Researchers administered Brief coping orientation to problems experiences (COPE) for assessing the coping strategies, while they assessed psychiatric morbidity through general health questionnaires. Similarly, future expectancy of health care professional was assessed by using life orientation scale. Participants were recruited from quarantine words in two federal government hospitals providing health care services to COVID-19 patients in Pakistan. RESULT: The result showed a significant relationship in optimism and problem focus coping style and avoidance coping style. Moreover, male health professionals score high on optimism as compared to female health professionals. While, avoidance coping style were seen higher in female health professional as compare to male. The result revealed that optimism and psychiatric morbidity were significantly positive in health professionals having problem focus and avoidance coping style.

Maladaptive schema modes as the predictor of post-traumatic stress disorder among trauma survivors.

OBJECTIVE: To study the relationship between dysfunctional schema modes and post-traumatic stress disorder among trauma survivors. METHODS: The cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from March to August 2019, and comprised patients of traumatic brain injury and orthopaedic trauma. Data was collected using Schema Mode Inventory and the Clinician Administered Post-Traumatic Stress Disorder Scale version 5. Data was analysed using SPSS 23. RESULTS: Of the 281 patients, 203(72.2%) were males, 78(27.8%) were females, and 157 (55.9%) were aged 18-40 years. Besides, 137(48.8%) had orthopaedic trauma, 96(34.2%) traumatic brain injuries, and 48(17%) had multiple injuries. Post-traumatic stress disorder symptoms and dysfunctional schema modes were higher in patients with moderate injuries with a mean of 42.14±7.36. Intentionally injured patients 42.70±6.92 and female trauma survivors 42.05±8.26 had more symptoms. CONCLUSIONS: Maladaptive schema mode could lead to post-traumatic stress disorder symptoms among trauma survivors with history of orthopaedic injury, traumatic brain injury and multiple injuries.

Recurrent bilateral frontal lobe lesion with maladaptive schema modes and post-traumatic stress disorder symptoms: a case study.

The frontal lobe is responsible for high-order functioning, such as memory, attention, decision-making, and personality. Lesions in the frontal lobe may lead to different physical and psychological problems. The current study was conducted to examine the emotional, cognitive, and behavioural states and coping strategies of a patient with recurrent bilateral frontal lobe lesion. It also attempted to determine post-traumatic stress disorder (PTSD) symptoms in a patient. This study described the case of an adult with recurrent bilateral frontal lobe tumour. It covered the clinical presentation, administration of Urdu translation of the Schema Mode Inventory (SMI) and Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and analysis of the case. The results of the study showed that the recurrent bilateral frontal lobe brain tumour patient engaged in child mode and had a dysfunctional coping style and a maladaptive punitive parent mode. Furthermore, the patient also had moderate PTSD symptoms.

Psychosocial functioning of the patient with spinal cord and whiplash injury: A case report.

Whiplash is a soft tissue injury of the cervical spine that is generally caused by trauma from a motor vehicle accident or gunshot. It is associated with a wide range of clinical symptoms, including neck pain and stiffness, pain and restricted movement in the upper arms. We report the manifestations of this trauma within the beliefs and psychological functioning based on a comprehensive psychological assessment that include a review of hospital records, clinical examinations, a structured clinical interview, an inventory of psychosocial function, and a post-traumatic maladaptive belief scale. The results show that the patient's traumatic cervical syndrome manifested as moderate impairment in friendships and romantic relationships which reveal severe daily impairment in work, parenting, and self-care activities. The study further suggests that the injury is associated with maladaptive beliefs and significant impairment in psychosocial functioning.

Pesticide-induced oxidative stress and antioxidant responses in tomato (Solanum lycopersicum) seedlings.

Excessive use of pesticides can adversely affect the growth of non-target host plants in different ways. Pesticide-induced stress can affect non-target plants through elevated levels of reactive oxygen species (ROS) responsible for detrimental effects on cell metabolism, biochemical and other physiological activities. In response to oxidative stress, plant activates antioxidant defense system consisting of both enzymatic and non-enzymatic components. In the present investigation, three commonly used pesticides, emamectin benzoate, alpha-cypermethrin and imidacloprid, were assessed for causing oxidative stress in tomato. The oxidative damage induced by these pesticides at five different concentrations i.e. 1/4X, 1/2X, recommended application dose (X), 2X and 4X in the root and shoot tissues of tomato plant/seedlings were evaluated. Following pesticide exposure for 35 days, cell viability, cell injury, total soluble sugar (TSS) and total soluble proteins (TSP) were measured. Antioxidant activities were estimated by measuring activity levels of superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GR) peroxidase (POD), ascorbate peroxidase (APX) and proline. Hydrogen peroxide (H2O2) levels were analysed as ROS, lipid peroxidation was measured in term of thiobarbituric acid reactive substances (TBARS) as membrane damage caused by ROS was also assessed. Analysis of the data revealed that pesticides application at higher concentrations significantly elevated ROS levels and caused membrane damage by the formation of TBARS, increased cell injury and reduced cell viability both in root and shoot tissues compared with non-treated plants. Moreover, a gradual decrease in the levels of TSS and TSP was observed in plants subjected to increasing doses of pesticides. To cope with pesticide-induced oxidative stress, a significant increase in levels of antioxidants was observed in the plants exposed to higher doses of pesticides. Shoot tissues responded more drastically by producing higher levels of antioxidants as compared to root tissues indicating the direct exposure of shoots to foliar application of pesticides. Taken together, these results strongly suggested that the application of pesticides above the recommended dose can provoke the state of oxidative stress and can cause oxidative damages in non-target host plants.

Impact of Supportive Leadership During Covid-19 on Nurses' Well-Being: The Mediating Role of Psychological Capital.

The corona virus disease (Covid-19) has significantly affected the social, physical, and psychological health of workers, specifically the nurses working in the healthcare sectors. Studies have been conducted on the impact of Covid-19 on employees' well-being, organizational structure, and job design; however, limited studies have been conducted focusing on the impact of leadership on employee's well-being during the Covid-19 pandemic. Drawing on job demands resources model and social exchange theory, we examined the impact of supportive leadership on employees' physical, social, and psychological well-being during the Covid-19 pandemic. In addition, we examined the mediating role of psychological capital in examining the relationship between supportive leadership and employees' physical, social, and psychological well-being. Based on three wave time-lagged design, the data were collected from 214 nurses' linear regression analysis and Hayes Process for mediation to test the proposed hypothesis. As hypothesized, supportive leadership predicted employees' physical, social, and psychological well-being. In addition, psychological capital mediated the relationship between supportive leadership and employees' physical, social, and psychological well-being. Implications for research, theory, and practice are discussed.

The relationship between post-traumatic stress disorder and acquired brain injury among civilian patients.

PURPOSE: Patients with acquired brain injury are a vulnerable group in Pakistan with limited psychosocial services available to them. The current study sought to determine the incidence of post-traumatic stress disorder (PTSD) in ABI patients with traumatic and non-traumatic injury. PATIENTS AND METHODS: A cross-sectional research design was used. The assessment of PTSD was carried out by using the Clinician Administered PTSD Scale (CAPS-5). In the study, there were 132 adults older than 18 years who have ABI-either traumatic or non-traumatic. The study was conducted in a public hospital in Islamabad, Pakistan, and the data was collected one-month post brain injury. RESULTS: The results showed that traumatic brain injury (TBI) patients have more PTSD symptoms as compared to non-TBI patients (p = 0.00). Intrusive (p = 0.00) and hyper arousal symptoms (p = 0.04) of PTSD were higher in TBI than in non-TBI patients. There was statically non-significant mean difference in symptoms of PTSD among male and female patients (p = 0.34). The moderately brain injury patients have high PTSD symptoms as compared to mild brain injury patients (p = 0.04). Further, the frequency of severe and extreme PTSD symptoms was high in TBI patient as compared to non TBI patients (p = .05) CONCLUSION: PTSD severity and PTSD symptoms such as intrusive and avoidance symptoms were higher in TBI patients than in non-TBI patients. This study contributed to the literature by assessing the onset of PTSD in patients with acquired brain injury. This study also provided knowledge to plan psychosocial interventions for patients with acquired brain injury having PTSD symptoms.

Estrogen replacement therapy for depression in perimenopausal women.

OBJECTIVE: To determine the effect of a four-week course of oral estrogen therapy on depression in aging women. DESIGN: Quasi experimental. PLACE AND DURATION OF STUDY: The OPD, Bahawal Victoria Hospital, Bahawalpur, from September 2000 to January 2004. PATIENTS AND METHODS: Forty-two depressed women (aged 42-57) who were either perimenopausal (n = 20) or postmenopausal (n = 22) received open label treatment with oral estrogen tablets (1.25 mg/day) for 4 weeks. The Montgomery-Asberg Depression Rating Scale and the Beck Depression Inventory were used to assess depressive symptoms, the Greene Climacteric Scale was used to assess menopause-related symptoms, and the Clinical Global Impression(CGI) was used to assess global clinical improvement in these women at baseline and after treatment. Remission of depression was defined as a score < 10 on the Montgomery-Asberg Depression Rating Scale and a score < or = 2 on the CGI at week 4. RESULTS: The women who completed the study had a median Montgomery-Asberg Depression Rating Scale score of 20 (range = 15-32) at study entry and 11.50 (range = 10-31.0) at week 4 (z = -3.43, p < 0.01). This improvement was consistent with that reported by the women themselves on the Beck Depression Inventory (rs = 0.86, n = 20, p < 0.01). The improvement measured by CGI scores was also significant (p < 0.01). Remission of depression was noted in 5 of the 40 women (after 1 year) who completed the study. Anti-depressant response was not associated with severity or subtypes of depression at study entry or with concomitant improvement in menopause-related symptoms. CONCLUSION: Perimenopausal and postmenopausal women benefit from short-term use of estrogen therapy. Antidepressant effect of estrogen therapy is independent of improvement in menopause-related symptoms.

Effect of pregnancy on diabetic nephropathy and retinopathy.

OBJECTIVE: To determine whether pregnancy worsens renal function in women with diabetic nephropathy and the effect of pregnancy on diabetic retinopathy. DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: The study was conducted in OPD, Bahawal Victoria Hospital, Bahawalpur from September 1997 to June 2003. SUBJECTS AND METHODS: Thirty-five patients (aged 20-36 years ) identified with diabetic nephropathy and moderate to severe renal dysfunction(creatinine [Cr] > 1.4 mg/dl) at pregnancy onset by retrospective chart review. Alterations in glomerular filtration rate (GFR) were estimated. An equal number of non-pregnant premenopausal type I diabetic women with similar degrees of renal dysfunction served as controls for non-pregnant rate of decline of renal function and potential contributing factors. Student's t-test and repeated measures analysis of variance were analyzed. RESULTS: Mean serum Cr rose from 1.8 mg/dl prepregnancy to 2.5 mg/dl in the third trimester. Renal function was stable in 27%, showed transient worsening in pregnancy in 27%, and demonstrated a permanent decline in 45%. Proteinuria increased in pregnancy in 79%. Exacerbation of hypertension or pre-eclampsia occurred in 73% and 71% of these showed acceleration of disease during the pregnancy. All the patients had diabetic retinopathy, though proliferative retinopathy was diagnosed and treated in only 54.5.% prepregnancy. The retinopathy progressed, requiring laser therapy, in 45.4%. Macular edema was noted in 6 of the patients. Other diabetic complications included peripheral and autonomic neuropathy in 8 patients. CONCLUSION: Pregnancy induced progression is seen in the decline of renal functions. Patients with diabetic nephropathy were found to have a > 40% chance of accelerated progression of their disease as a result of pregnancy. Forty-five percent of the patients had permanent decline in GFR in association with pregnancy.