HIV-Associated Rheumatic Diseases: A Narrative Review.

ABSTRACT: Human immunodeficiency virus (HIV) is widely prevalent among the world population. Although, historically, it has been linked to opportunistic infections in keeping with immunodeficiency and immune dysregulation, it has also been associated with a wide variety of autoimmune manifestations. With the introduction of highly active antiretroviral therapy and subsequent restoration of immunity, there have been multiple immune-mediated diseases that have resurfaced in the HIV population. Our review highlights autoimmune diseases in association with HIV and its targeted therapies in detail.

Validating Interactions of Pathogenic Proteins of Staphylococcus aureus and E. coli with Phytochemicals of Ziziphus jujube and Acacia nilotica.

This study focused on the assessment of the antimicrobial resistance of Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) isolated from bovine mastitis milk samples and the revealing anti-mastitis potential of phytocompounds of Ziziphus jujube and Acacia nilotica through molecular docking analysis. The mastitis milk samples were collected from various dairy farms for the isolation of the bacteria (S. aureus and E. coli) and their response to antibiotics. Ethanolic extracts of both plants were prepared. Their antibacterial activity was evaluated, and they were processed for phytochemical analysis after which, molecular docking analysis with pathogenic proteins of the bacteria was carried out. Parametric and non-parametric statistical analyses were performed to reach the conclusions of this study. The findings of the study revealed a higher drug resistance (≥40%) of E. coli against ampicillin, amikacin, and vancomycin, while S. aureus exhibited the highest resistance to ampicillin, erythromycin, and ciprofloxacin. The ethanolic extracts of the Ziziphus jujube and Acacia nilotica plants produced a ZOI between 18 and 23 mm against multidrug-resistant S. aureus and E. coli. Gas chromatography-mass spectrophotometry (GC-MS) was used to explore 15 phytocompounds from Ziziphus jujube and 18 phytocompounds from Acacia nilotica. The molecular docking analysis of 2cyclopenten-1-one,3,4,4 trimethyl and Bis (2ethylhexyl) phthalate of Ziziphus jujube showed a binding affinity of -4.8 kcal/mol and -5.3 kcal/mol and -5.9 kcal/mol and -7.1 kcal/mol against the DNA Gyrase and toxic shock syndrome toxin-1 proteins of S. aureus and E. coli, respectively. The suberic acid monomethyl ester of Acacia nilotica showed a binding affinity of -5.9 kcal/mol and -5 kcal/mol against the outer membrane protein A and Topoisomerase IV protein of E. coli and -5.1 kcal/mol and -5.8 kcal/mol against the toxic shock syndrome toxin-1 and Enterotoxin B proteins of S. aureus. Similarly, 2,2,4-trimethyl-1,3-pentanediol di-iso-butyrate showed a binding affinity of -6.5 kcal/mol and -5.3 kcal/mol against the outer membrane protein A and Topoisomerase IV of E. coli and -5.2 kcal/mol and -5.9 kcal/mol against the toxic shock syndrome toxin-1 and Enterotoxin B proteins of S. aureus, respectively. The study concluded that there was an increasing trend for the antimicrobial resistance of S. aureus and E. coli, while the Ziziphus jujube and Acacia nilotica plant extracts expressed significant affinity to tackle this resistance; hence, this calls for the development of novel evidence-based therapeutics.

Work-Family Conflict and Suicidal Ideation Among Physicians of Pakistan: The Moderating Role of Perceived Life Satisfaction.

Recent studies have shown an increased level of suicidal behavior among physicians, not only in Pakistan but all over the world. In this cross-sectional study, 622 physicians, aged 32-55 years, participated from 50 private and public hospitals located in the seven cities of the Punjab province of Pakistan. Three standardized tools were used to assess suicidal ideation, perceived life satisfaction and work-family conflict of the participants. Results showed work-family conflict as positive whereas life satisfaction was shown to be a negative predictor of suicidal ideation among the physicians. Furthermore, findings suggested that, as a moderator, percieved life satisfaction holds a significant role in decreasing the levels of work-family conflict and suicidal ideation among the physicians. Therefore, it is recommendable to incoroporate a perceived life satisfaction enhancement program into the training of physicians so that suicidal ideation may be prevented and treated effectively.

Bordetella bronchiseptica infections in patients with HIV/AIDS: A case report and review of the literature.

RATIONALE: Bordetella bronchiseptica is a common cause of upper respiratory tract infections in domesticated dogs and cats and a rare zoonotic pathogen in immunocompromised humans. With increasing numbers of people acquiring pets and spending time with them in confined spaces due to COVID-19 lockdowns, it is important to be aware of adverse health consequences brought about by this interaction. We present a case of B bronchiseptica pneumonia in a patient with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and review key characteristics of an additional 30 cases of B bronchiseptica infections in 29 patients with HIV/AIDS that were identified by literature review. PATIENT CONCERNS: A 61-year-old male with HIV/AIDS who was not on antiretroviral therapy and had advanced immunosuppression with a CD4+ T-lymphocyte count of 3 cells/µL sought medical attention for multiple somatic issues including subjective fevers, shortness of breath, and intermittent chest pain. DIAGNOSIS: Computed tomography of the chest identified bilateral nodular opacities in the lower lobes with scattered areas of ground glass opacities. B bronchiseptica was identified in sputum culture by mass spectrometry followed by supplementary biochemical testing. INTERVENTIONS: Empiric broad-spectrum antibiotics were initiated and changed to levofloxacin after susceptibility testing was completed. OUTCOMES: The patient was discharged after symptomatic improvement with levofloxacin. LESSONS: Pneumonia with interstitial infiltrates in the setting of advanced CD4 lymphocyte depletion is the most common clinical syndrome caused by B bronchiseptica in patients with HIV/AIDS, and may be accompanied by sepsis. Advanced immune suppression, as well as chronic medical conditions, for example, alcoholism, diabetes, and renal failure that compromise host defenses are also commonly found in cases of B bronchiseptica infection in patients who do not have HIV infection. Reported animal contact among patients was not universal. Isolates were susceptible to aminoglycosides, carbapenems, fluoroquinolones, but typically resistant to most cephalosporins.

Management of anxiety among pregnant women with serious medical conditions: A multicentre study.

OBJECTIVE: To examine the effectiveness of relaxation training on anxiety level of pregnant women with serious medical complications. METHODS: The ex-post facto study was conducted from January to August 2018 at Allied and City hospitals in Jallalpur Jattan,Gujrat, Pakistan, and comprised pregnant women with serious medical conditions. Their medical symptoms were confirmed by a medical chart. Data was collected using the anxiety subscale of the Depression, Anxiety and Stress Scale 21, and those with high levels of anxiety were retained. These women attended 60-minute relaxation training twice a week for 8 weeks. Data was analysed using SPSS 21. RESULTS: Of the 126 women initially assessed, 50(39.5%) were shortlisted for detailed anxiety evaluation. Of them, 30(60%) were included, and after 3(10%) dropouts, the study was completed by 27(90%) women. There was significant difference in overall pre- and post-intervention mean values of anxiety (p=0.001). CONCLUSIONS: Relaxation training was found to have a significant effect in terms of reducing anxiety without the use of medications among pregnant women with serious medical conditions.

Postpartum depression and suicidal ideation in new mothers with hearing loss: Perceived social support as a moderator, a multicentre study.

OBJECTIVES: To explore postpartum depression as a predictor of suicidal ideation and to find if perceived social support had a moderator effect in this scenario among new mothers with hearing loss. METHODS: The descriptive cross-sectional study was conducted from March to September 2018 in Lahore, Islamabad, Rawalpindi, Gujrat, Gujranwala, Jhelum and Sialkot Cities of Pakistan. New mothers with hearing loss (HL) and those without hearing loss were recruited from maternity clinics 2 to 6 weeks after the delivery. Standardised tools were used to measure postpartum depression, perceived social support and suicidal ideation among the subjects. Data was analysed using SPSS 21. RESULTS: Of the 547subjects, 272(49.7%) were those with hearing loss and 275(50.3%) were without hearing loss. Odd ratio showed that mothers with hearing loss were 1.97 times more likely to exhibit postpartum depression compared to those without hearing loss, whereas participants with HL were 1.08 times more likely to be at risk of having suicidal behaviours compared to those without hearing loss. On the other hand, those without hearing loss were 0.97 times higher on social support. Postpartum depression was a positive predictor (p<0.001) whereas perceived social support negatively (p<0.001) predicted the suicidal ideation of new mothers with hearing loss. The interaction of postpartum depression and perceived social support negatively affected (<0.001) suicidal behaviour. CONCLUSIONS: Perceived social support appeared to lower the probability of postpartum depression and suicidal ideation among mothers with hearing loss.

Development and Validation of Religious Tolerance Scale for Youth.

The objective of the present research was to develop and validate an indigenous scale of religious tolerance for young adults, based on Van der Walt (2014) model of religious tolerance. The two independent studies were conducted in this regard. In the first study, a pool of 81 items was generated and after qualitative analysis and pilot study, 53 items were retained for exploratory factor analysis. Using the data from the sample of (N = 500) students, the items were then subjected to principal component analysis using varimax rotation method. A factor solution based on 25 items and 7 well-structured factors was obtained. Afterward, a similar sample of (N = 282) students was obtained for confirmatory factor analysis that confirmed the factor structure of the scale with 23 items. In the second study, validation of the scale was determined by examining its convergent and discriminant validity with the original religious tolerance questionnaire and balanced dogmatism sale, respectively. The results of the study uphold religious tolerance scale as a promising indigenous psychometric measure for religious tolerance.

Suicidal Behavior Among the Youth With and Without Sensory Impairment: Prevalence and Comparison.

This comparative survey was conducted to explore the prevalence of suicidal behavior among the youth without sensory impairment (n = 595) as well as youth with sensory impairment: visual impairment (n = 537) and hearing impairment (n = 535). Suicidal behavior of the participants were assessed by the Urdu form of Suicidal Behavior Questionnaire. Findings indicated the higher prevalence of overall suicidal behavior among the participants with visual impairment (38%) as compared with the participants with (32%) and the youth (13%) without sensory impairment. Odds ratios further confirmed these results by showing the participants with visual impairment higher on suicidal behavior. Moreover access to counseling, monthly income of the parents, and severity level of disability appeared to be positive predictors of suicidal behavior among the participants. Thus, results showed that all of the three groups are at the risk of having suicidal behavior and, therefore, careful measures are required to be taken at prevention and intervention levels.

Nurses in double trouble: Antecedents of job burnout in nursing profession.

OBJECTIVE: To understand the most prominent factors contributing to job burnout in the nursing profession. METHODS: Mixed method design was used in this study. In the qualitative part of the study, a focus group discussion approach was used to determine the major factors contributing in nurses' job burnout. The quantitative part was conducted by using a questionnaire based on the theme generated in the qualitative part along with other demographic information. The data was collected from 93 nurses with 90.3% response rate. RESULTS: The proposed logistic regression model was able to correctly classify the 96% job burnout cases using factors mutually agreed in the focus group discussion. All the factors are significantly contributing to job burnout. However, the unfavourable work environment contributes more to job burnout as compared to the unfavourable support from family. CONCLUSION: unfavourable support of work environment and unfavourable support from family are the main contributors in the job burnout of nurses. Therefore, an equal improvements in both areas should be made on the priority basis to retain the happy nurses to deliver excellent healthcare services.

Vitamin D and bone metabolism in breast cancer patients in Karachi, Pakistan.

Breast cancer is one of the common types of malignancy worldwide and in Pakistan. The heterogeneous disease itself and its complex treatment leads to various bone-affecting complications that make breast cancer patients more vulnerable to bone fractures. Vitamin D deficiency among these women worsens the condition and promotes breast cancer growth. Thus, the purpose of the study was to assess serum levels of 25-hydroxyvitamin D (25OHD) and bone markers in women suffering from breast cancer. Serum levels of 25OHD, alkaline phosphatase (ALP), bone specific ALP, calcium (Ca), phosphorus (P), magnesium (Mg), albumin (Alb) and beta carboxyl terminal collagen crosslink (ß-CTx) were analyzed in 201 histological diagnosed patient volunteers from breast cancer clinic. Vitamin D insufficiency was present among the total study population and deficiency was particularly observed among women with metastases. These patients had significantly increased serum levels of ß-CTx and bone specific ALP when compared with the non-metastatic group. No significant difference was observed in other biochemical parameters. A weak correlation between serum levels of 25OHD and ß-CTx was observed. Therefore, monitoring of serum levels of 25OHD and bone markers at the time of diagnosis and during the course of treatment will endeavor a better overall health status.

Assessing Nutritional Status Of Critically Ill Patients Using Serum Prealbumin Levels.

BACKGROUND: Malnutrition in hospitalized patients, contributes to poor outcomes. Biomarker serum prealbumin, can prevent the complications by commencement of nutritional support to improve clinical outcomes. This study was designed to assess the association between low serum prealbumin level (<18 mg/dl), with length of stay and all cause intensive care unit mortality. METHODS: This cross-sectional study was conducted from July 2016 to July 2017 at Aga Khan University Hospital Karachi Pakistan. All consecutive patients, aged between 18 to 70 years, admitted in medical or surgical intensive care unit were included. Demographic, clinical history and blood samples for analysing serum prealbumin were obtained on first day of admission. Patients were categorized into two groups based on their serum prealbumin level (taking <18 mg/dl as low). RESULTS: A total of 139 patients were included in this study; 95 (68.3%) were male. Median (Q3-Q1) prealbumin level of 12.3 mg/dl (18.8-8.7) was observed with low prealbumin level (<18 mg/dl) in 100 (71.9%) patients. All-cause mortality was observed in 26 (26.0%) patients, mortality rate was significantly higher in patients with low prealbumin level (26.0% vs. 17.9%), p-value =0.31). Hospital and intensive care unit length of stay were statistically insignificantly different between the two groups with p-values of 0.27 and 0.44 respectively. CONCLUSIONS: We did not find association of low serum prealbumin with length of stay and mortality. Further research is warranted for the assessment of prealbumin as independent predictor of ICU mortality.

Burden of care and Suicidal Ideation among Mothers of Children with Autism Spectrum Disorder: Perceived Social Support as a Moderator.

OBJECTIVE: To examine the moderation effect of perceived social support between burden of care and suicidal ideation among mothers of children suffering from Autism Spectrum Disorder.. METHODS: The descriptive cross-sectional study was conducted from September 2017 to February 2018 in the Pakistani cities of Islamabad Lahore, Gujrat, Gujranwala, Jhelum and Sialkot, and comprised of mothers of Autism Spectrum Disorder children aged 7-12 years who were selected conveniently from the special schools in their respective cities. Standardized tools were used to assess the burden of care, perceived social support and suicidal ideation among the participants. SPSS 21 was used for data analysis. RESULTS: Of the 373 mothers approached, 356(95.4%) responded, but the study was completed by 339(95.2%) of them. There was positive relationship (p<0.01) between burden of care and suicidal ideation, and whereas results showed negative relationship among perceived social support, burden of care (p<0.001) and suicidal ideation (p<0.001). The burden of care positively (p<0.001) and perceived social support negatively (p<0.002) affected suicidal ideation. Perceived social support moderated the burden of care-suicidal ideation relationship (p<0.001) among the mothers.. CONCLUSIONS: Social support provided by the significant others lowered the burden of care and suicidal ideation among mothers of children with Autism Spectrum Disorder.

Coping mechanisms as predictors of suicidal ideation among the medical students of Pakistan.

OBJECTIVE: To identify the coping mechanisms as positive and negative predictors of suicidal ideation among medical students. METHODS: This cross-sectional analytical study was conducted from January to October 2017, and comprised students aged 19-25 years selected from 3 public-sector medical colleges located in Gujrat and Lahore, both in the Punjab province of Pakistan. Multilevel mixed methods sampling was used. Two standardised scales were used to assess the suicidal ideation and coping mechanisms of the participants. RESULTS: Of the 1200 subjects, 640(53%) were males and 560(47%) were females. Besides, 390(32%) subjects hailed from Gujrat and 810(68%) from Lahore. Self-distraction (p<0.05)), active coping (p<0.0001), use of emotional support (p<0.05), use of instrumental support (p<0.001) positive reframing (p<0.0001), planning (p<0.001), humour (p>0.05), acceptance (p<0.001) and religion (p<0.0001) were negative predictors of suicidal ideation whereas denial (p<0.0001), substance use (p<0.05), venting (p>0.05) and self-blame (p<0.0001) were positive predictors of suicidal ideation. CONCLUSIONS: A psycho-educational programme must be introduced for medical students to enable them to adopt the right coping strategies in order to handle stressful situations.

Factor Structure of Urdu Version of the Flourishing Scale.

Background: A great deal of research has been carried out on the assessment of the eudaimonic perspective of psychological well-being and the hedonic perspective of subjective well-being. The Flourishing Scale (FS) has been extensively used in research and practice, as it assesses the fundamental aspects of social psychological functioning. Nevertheless, the psychometric properties of Urdu versions of eudaimonic measures, such as the FS, have not yet been ascertained. The translation and validation of the FS in the Urdu language was not available, and hence this study was planned with the aim to validate the Urdu version of the FS. Methods: We assessed the psychometric properties of the FS in a sample of adults aged 18 years and above in Pakistan (N = 130) using exploratory factor analysis based on principal component analysis with varimax rotation and confirmatory factor analysis. Results: The exploratory factor analysis confirmed the unidimensional nature of the 8-item FS. We assessed that the Urdu version of the FS showed a high internal consistency reliability (α = 0.914) with a significant intraclass correlation coefficient (ICC), p < 0.001). In our study, the Kaiser-Mayer-Olkin value was 0.915 with a chi-square test value (χ2) of 637.687, and Bartlett's test of sphericity was significant (df = 28, p < 0.001). The intraclass correlation coefficients (ICCs) at test-retest for all domains were statistically significant (p < 0.001) and showed excellent agreement for all the items. The revised confirmatory factor analysis revealed a good-fit model, but with item 8-"People respect me"-removed due to its lower factor loading. Conclusions: The findings suggest that the FS is a psychometrically sound instrument for assessing social psychological functioning among adults in Pakistan. Therefore, the validated Urdu version of the FS may be used in future studies of well-being in clinical psychology and positive psychology.

Social exclusion, mental health and suicidal ideation among adults with hearing loss: protective and risk factors.

OBJECTIVE: To investigate social exclusion, mental health and demographic characteristics as risk and protective factors of suicidal ideation among adults with hearing loss. . METHODS: This analytical, cross-sectional study was conducted in Lahore, Pakistan, from June 2016 to January 2017, and comprised people with hearing loss. Multistage proportionate stratified sampling procedure was used. Mental Health Inventory, Social Exclusion Scale and Suicidal Ideation Attributes Scale were administered to the participants. RESULTS: Of the 415 subjects, 246(59.3%) were males and 169(40.8%) females. Suicidal ideation was significantly and positively related to social exclusion (p<0.001), psychological distress (p<0.001), age (p<0.001)) and severity of hearing loss (p<0.05), whereas a significant negative relationship of suicidal ideation (p<0.05) was observed with psychological well-being. Hierarchical regression analysis indicated social exclusion (p<0.001), psychological distress (p<0.001), age (p<0.001), severity of hearing loss (p<0.001) and gender (p<0.001) as significant positive predictors (risk factors), whereas psychological well-being (p<0.05)) was a significant negative predictor (protective factor) of suicidal ideation. CONCLUSIONS: Social exclusion, psychological distress, severity of hearing loss and age were risk factors, whereas psychological well-being was a protective factor regarding suicidal ideation.

Prevalence and Predictors of Non-Suicidal Self-Injury among Children with Autism Spectrum Disorder.

OBJECTIVES: To find the prevalence as well as to identify the predictors as protective and risk factors of Non-Suicidal Self-Injury (NSSI) among children with autism spectrum disorder (ASD). METHODS: In this analytical cross sectional survey 83 children with ASD age range from 8 to 18 years were selected through convenient sampling technique from five special schools of Lahore city. The Urdu form of a standardized tool was used to assess NSSI. RESULTS: Statistical analysis indicated overall point prevalence of NSSI was 33%. Moreover banging/self-beating (47%), scratching (38), pinching (35%), picking scabs (33%), self-biting (32%), pulling hair (30%) and rubbing skin (19%) emerged as common forms of challenging behavior. Further regression analysis showed that age B(1.68*, P<.05), gender B(3.72, P<.001) and severity level of ASD B(1.85***, p<.0001) as risk factors/positive predictors of NSSI. However early intervention (-0.66***, P<.0001) and involvement of parents in counselling (-2.66*, P<.05) emerged as protective factors/negative predictors of NSSI among children with ASD. CONCLUSION: Non-suicidal self-injury is a serious challenge among children with ASD. Early intervention, counselling and parental involvement in managing the children with ASD will not only prevent but reduce the challenging behaviors.

Non-suicidal self-injury among children with hearing loss and intellectual disability.

OBJECTIVE: To find the prevalence and to identify the predictors of non-suicidal self-injury among school-going children.. METHODS: This cross-sectional study was conducted at the University of Gujrat, Gujrat Pakistan, from September 2015 to October 2016, and comprised children with intellectual disability and hearing loss. Participants were recruited from schools for special children located in Gujranwala, Jhelum and Gujrat. Multistage stratified sampling technique was used. RESULTS: Of the 325 children, 178(50.4%) had intellectual disability and 175(49.6%) had hearing loss. Findings indicated that the prevalence of self-injurious behaviour was higher in children with intellectual disability 48(27%) compared to their counterparts with hearing loss 3(2%). Neural network, when administered on whole data set, indicated type of disability 0.474(100%), education/training 0.99(20.9%) and access of counselling 0.114(24%) as important predictors of non-suicidal self-injury in both groups. On the other hand, the degree of disability (hearing loss 0.42[100%]; intellectual disability 0.32[100%]), education/ training (hearing loss 0.18[43%]; intellectual disability 0.27[84.5%]) and access of counselling (hearing loss 0.175[41.8%]; intellectual disability 0.256[78.7%]) were important predictors of non-suicidal self-injury among the participants, when neural network was run on the split files on the basis of disability. CONCLUSIONS: The prevalence of non-suicidal self-injury among children with intellectual disability was higher as compared to those with hearing loss.

Coping strategies, mental health and HIV status: Predictors of suicidal behaviour among PWIDs.

OBJECTIVE: To understand suicidal behaviour among people who inject drugs. METHODS: This correlational, cross-sectional study was conducted in two Pakistani cities of Gujrat and Jhelum from October 2015 to March 2016, and comprised male injecting-drug users aged18-60 years. Multistage systematic random sampling method was used. Urdu-translated versions of the brief cope inventory, mental health status scale and suicidal behaviour questionnaire (revised) were administered. SPSS 16 was used for data analysis. RESULTS: Of the 200 participants, 83(41.5%) were aged 26-32 years. The prevalence of human immunodeficiency virus was in 94(47%) cases. Suicidal behaviour was positively associated with psychological distress and human immunodeficiency virus status (p<0.05), whereas it was negatively associated with mental health, psychological well-being and coping strategies (p<0.05). Regression analysis showed mental health index and psychological well-being were negative predictors, whereas psychological distress and human immunodeficiency virus status were positive predictors of suicidal behaviour among the participants (p<0.05). CONCLUSIONS: The level of stress led people who inject drugs towards suicidal behaviour. However, the level of stress varied according to the severity of human immunodeficiency virus and poor mental health.

Bullying victimization: A risk factor of health problems among adolescents with hearing impairment.

OBJECTIVE: To find bullying victimisation as a predictor of physical and psychological health problems among school-going children with hearing impairment. METHODS: The co-relational cross-sectional study was conducted in Gujrat district of Pakistan's Punjab province from August 2014 to January 2015, and comprised adolescents with hearing impairment. The subjects were selected through multi-stage stratified proportionate sampling from the local schools. Two standardised instruments were administered to assess the relationship between bullying and health problems. Multidimensional Peer Victimisation Scale was used for measuring bullying behaviour, while the Health Questionnaire was used to assess physical and psychological health problems. Both scales were translated into Urdu using lexicon equivalence method of translation. RESULTS: Of the 286 subjects, 183(64%) were boys. A significant positive relationship was found between the four components of bullying and health problems (p<0.05 each). Boys experienced more physical victimisation than girls (p<0.05), but there was no significant difference between girls and boys in social manipulation (p>0.05). CONCLUSIONS: Children with hearing impairment experienced bullying just like those without such an impairment. Bullying needs to be considered a significant public health issue and should be dealt with effectively.

Major depression in Jalal Pur Jattan, district Gujrat, Pakistan: Prevalence and gender differences.

OBJECTIVE: To assess the prevalence of depression along gender lines in the general population. METHODS: Using multistage stratified proportionate sampling, the cross-sectional study was conducted in four Union Councils of Jalal Pur Jattan in Gujrat, Pakistan from November 2011 to November 2012. From each stratum, two samples were taken: adults and adolescents. Then each sample was divided into adult males and adult females (20-45 years); adolescent boys and adolescent girls (13-19 years). The questionnaire was developed on the basis of diagnostic criteria given in the revised version of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. RESULTS: Of the total population of 28,259, 1117(3.6%) were approached for the study. Of them, 1110(99.3%) people participated. Overall, 173(15%) were found to be vulnerable to psychological problems whereas 59 (5.31%) were found as vulnerable cases to depression. However, the diagnosis of major depression was handed to 38(3.4%) respondents. Of these 38 subjects, 7(18.42%) persons were suffering from mild; 22(57.89%) from moderate, and 9(23.68%) from severe symptoms. Further, 30(78.9%) of these subjects were women. CONCLUSIONS: Major depression was prevailing in the community of Jalal Pur Jattan in almost the same ratio as in other places around the globe, and, therefore, the inhabitants need psychiatric services.