Search results for: Sanaa Riaz

Authors: Almas Hamid, Ghazala Yaqub, Aqsa Riaz

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Qualitative validation was performed to detect the presence of persistent organic pollutants (POPs) in various wastewater samples collected from domestic sources (Askari XI housing society, Bedian road Lahore) industrial sources (PET bottles, pharmaceutical, textile) and a municipal drain (Hudiara drain) in Lahore. In addition wastewater analysis of the selected parameter was carried out. pH for wastewater samples from Askari XI, PET bottles, pharmaceutical, textile and Hudiara drain were 6.9, 6.7, 6.27, 7.18 and 7.9 respectively, within the NEQS Pakistan range that is 6-9. TSS for the respective samples was 194, 241, 254, 140 and 251 mg/L, in effluent for pet bottle industry, pharmaceutical and Hudiara drain and exceeded the NEQS Pakistan. Chemical oxygen demand (COD) for the wastewater samples was 896 mg/L, 166 mg/L, 419 mg/L, 812 mg/L and 610 mg/L respectively, all in excess of NEQS (150 mg/L). Similarly the biological oxygen demand (BOD) values (110.8, 170, 423, 355 and 560 mg/L respectively) were also above NEQS limits (80 mg/L). Chloride (Cl-) content, total dissolved solids (TDS) and temperature were found out to be within the prescribed standard limits. The POPs selected for analysis included five pesticides/insecticides (D. D, Karate, Commando, Finis insect killer, Bifenthrin) and three polycyclic aromatic hydrocarbons (PAHs) (naphthalene, anthracene, phenanthrene). Peak values of standards were compared with that of wastewater samples. The results showed the presence of D.D in all wastewater samples, pesticide Karate was identified in Askari XI and textile industry sample. Pesticide Commando, Finis (insect killer) and Bifenthrin were detected in Askari XI and Hudiara drain wastewater samples. In case of PAHs; naphthalene was identified in all the five wastewater samples whereas anthracene and phenanthrene were detected in samples of Askari XI housing society, PET bottles industry, pharmaceutical industry and textile industry but totally absent in Hudiara drain wastewater. Practical recommendations have been put forth to avoid hazardous impacts of incurred samples.

Keywords: HPLC studies, lahore, physicochemical analysis, wastewater

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Authors: Akbar Nawaz Khan, Abdul Ghaffar, Muhammad Naeem Riaz

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The study was conducted to investigate the phenotypic features, morphometry and production potentialities of indigenous naked neck chicken (NN) of Pakistan under intensive management condition. A total of 35 NN chicks were randomly selected, and the experiment was performed at Poultry and wildlife research section NARC Islamabad for a period of 22 weeks. The predominant plumage color was black and golden while skin color was observed white. The average shank length, leg length, thigh length, keel length, chest breadth, head width, wing space, wing length, body length, body girth, body height and pubic bone width in adult males and females were 69.19 ± 3.34mm, 117.93 ± 4.42mm, 117.93 ± 4.42mm, 90.87 ± 6.53mm, 95.03 ± 4.56mm, 49.77 ± 2.53mm, 30.63 ± 1.50cm, 27.24 ± 2.71cm, 18.88 ± 0.65cm, 17.77 ± 1.01cm, 25.96 ± 0.56cm, 47.81 ± 1.41cm and 35.69 ± 4.09mm respectively. The average age and live body weight of NN chicken at sexual maturity were recorded as 165.85 days and 1269.38 g. While hen-day egg production of NN was recorded as 45%. The present study was aimed to investigate the existence of polymorphism at IGF-I gene in indigenous naked neck chicken through PCR based Restriction Fragment Length Polymorphism. Based on restriction analysis using Hinf I restriction enzyme, three genotypes were detected designated as AA, AC, and CC. Restriction analysis of PCR amplified product showed the presence of DNA fragments of 622, 378, 244 and 191, (genotypes). The PCR-RFLP analysis is easy, cost effective method which permits the easy characterization of IGF-I gene. This showed the investigated IGF-I genes can serve as good molecular markers for marker assisted selection (MAS) concerning growth related traits in chicken.

Keywords: Desi chicken, naked neck, morphology, morphometry, production potential, egg traits, egg geometry, IGF-I, growth, PCR- RFLP, chicken

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Authors: Ishaq Kashif, Muhammad Younas, Muhammad Riaz, Mubarak Ali

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Poor feeding management during pre-weaning period is one of the factors resulting in compromised growth of Beetal kids fattened for meat purpose. The main reason for this anomaly may be less milk offered to kids and non-serious efforts for its management. This study was planned to find the most appropriate protein level suiting the age of the weaning while shifting animals to high input feeding system. Total of 42 Beetal male kids having 30 (±10), 60 (±10) and 90 (±10) days of age were selected with 16 in each age group. They were designated as G30, G60 and G90, respectively. The weights of animals were; 8±2 kg (G30), 12±2 kg (G60) and 16±2 kg (G90), respectively. All animals were weaned by introducing the total mix feed gradually and withdrawing the milk during the adjustment period of two weeks. The pelleted starter ration (total mix feed) with three various dietary protein levels designated as R1 (16% CP), R2 (20% CP) and R3 (26% CP) were introduced. The control group was reared on the fodder (Maize). The starter rations were iso-caloric and were offered for six-week duration. All animals were exposed to treatment using two-factor factorial (3×3) plus control treatment arrangement under completely randomized design. The data were collected on average daily feed intake (ADFI), average daily gain (ADG), gain to intake ratio, Klieber ratio (KR), body measurements and blood metabolites of kids. The data was analyzed using aov function of R-software. The statistical analysis showed that starter feed protein levels and age of weaning had significant interaction for ADG (P < 0.001), KR (P < 0.001), ADFI (P < 0.05) and blood urea nitrogen (P < 0.05) while serum creatinine and feed conversion had non-significant interaction. The trend analysis revealed that ADG had significant quadratic interaction (P < 0.05) within protein levels and age of weaning. It was found that animals weaned at 30 or 60 days, on R2 diet had better ADG (46.8 gm/day and 87.06 gm/day, respectively) weaned at 60 days of age. The animals weaned at 90 days had best ADG (127 gm/day) with R1. It is concluded that animal weaned at 30 or 40 days required 20% CP for better growth performance while animal at 90 days showed better performance with 16% CP.

Keywords: average daily gain, starter protein levels, weaning age, gain to intake ratio

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Authors: I. Upadhyaya, K. Arsi, A. M. Donoghue, C. N. Coon, M. Schlumbohm, M. N. Riaz, M. B. Farnell, A. Upadhyay, A. J. Davis, D. J. Donoghue

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Methionine, a sulfur containing amino acid, is essential for healthy poultry production. Synthetic methionine is commonly used as a supplement in conventional poultry. However, for organic poultry, a natural, cost effective source of methionine that can replace synthetic methionine is unavailable. Invasive Asian carp (AC) are a potential natural methionine source; however, there is no proven technology to utilize this fish methionine. Commercially available rendering is environmentally challenging due to the offensive smell produced during production. We explored extrusion technology as a potential cost effective alternative to fish rendering. We also determined the amino acid composition, digestible amino acids and total metabolizable energy (TMEn) for the extruded AC fish meal. Dry extrusion of AC was carried out by mixing the fish with soybean meal (SBM) in a 1:1 proportion to reduce high moisture in the fishmeal using an Insta Pro Jr. dry extruder followed by drying and grinding of the product. To determine the digestible amino acids and TMEn of the extruded product, a colony of cecectomized Bovans White Roosters was used. Adult roosters (48 weeks of age) were fasted for 30 h and tube fed 35 grams of 3 treatments: (1) extruded AC fish meal, (2) SBM and (3) corn. Excreta from each individual bird was collected for the next 48 h. An additional 10 unfed roosters served as endogenous controls. The gross energy and protein content of the feces from the treatments were determined to calculate the TMEn. Fecal samples and treatment feeds were analyzed for amino acid content and percent digestible amino acid. Results from the analysis suggested that addition of Asian carp increased the methionine content of SBM from 0.63 to 0.83%. Also, the digestibility of amino acid and the TMEn values were greater for the AC meal with SBM than SBM alone. The dry extruded AC meal analysis is indicative that the product can replace SBM alone and enhance natural methionine in a standard poultry ration. The results from feed formulation using different concentrations of the AC fish meal depict a potential diet which can supplement the required methionine content in organic poultry production.

Keywords: Asian carp, extrusion, natural methionine, organic poultry

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Authors: Fatima Khurshid, Noor Ul Ain, Syed Abdul Rehman Kashif, Zainab Riaz, Abdullah Usman Khan, Muhammad Imran

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As the world is moving towards extra-high voltage (EHV) and ultra-high voltage (UHV) power systems, the performance requirements of power transformers are becoming crucial to the system reliability and security. With the transformers being an essential component of a power system, low health index of transformers poses greater risks for safe and reliable operation. Therefore, to meet the rising demands of the power system and transformer performance, researchers are being prompted to provide solutions for enhanced thermal and electrical properties of transformers. This paper proposes an approach to improve the health index of a transformer by using nano-technology in conjunction with bio-degradable oils. Vegetable oils can serve as potential dielectric fluid alternatives to the conventional mineral oils, owing to their numerous inherent benefits; namely, higher fire and flashpoints, and being environment-friendly in nature. Moreover, the addition of nanoparticles in the dielectric fluid further serves to improve the dielectric strength of the insulation medium. In this research, using the finite element method (FEM) in COMSOL Multiphysics environment, and a 2D space dimension, three different oil samples have been modelled, and the electric field distribution is computed for each sample at various electric potentials, i.e., 90 kV, 100 kV, 150 kV, and 200 kV. Furthermore, each sample has been modified with the addition of nanoparticles of different radii (50 nm and 100 nm) and at different interparticle distance (5 mm and 10 mm), considering an instant of time. The nanoparticles used are non-conductive and have been modelled as alumina (Al₂O₃). The geometry has been modelled according to IEC standard 60897, with a standard electrode gap distance of 25 mm. For an input supply voltage of 100 kV, the maximum electric field stresses obtained for the samples of synthetic vegetable oil, olive oil, and mineral oil are 5.08 ×10⁶ V/m, 5.11×10⁶ V/m and 5.62×10⁶ V/m, respectively. It is observed that for the unmodified samples, vegetable oils have a greater dielectric strength as compared to the conventionally used mineral oils because of their higher flash points and higher values of relative permittivity. Also, for the modified samples, the addition of nanoparticles inhibits the streamer propagation inside the dielectric medium and hence, serves to improve the dielectric properties of the medium.

Keywords: dielectric strength, finite element method, health index, nanotechnology, streamer propagation

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Authors: Farina Riaz, Shahab Abdulla, Srinjoy Ganguly, Hajime Suzuki, Ravinesh C. Deo, Susan Hopkins

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Recently, quantum machine learning has received significant attention. For various types of data, including text and images, numerous quantum machine learning (QML) models have been created and are being tested. Images are exceedingly complex data components that demand more processing power. Despite being mature, classical machine learning still has difficulties with big data applications. Furthermore, quantum technology has revolutionized how machine learning is thought of, by employing quantum features to address optimization issues. Since quantum hardware is currently extremely noisy, it is not practicable to run machine learning algorithms on it without risking the production of inaccurate results. To discover the advantages of quantum versus classical approaches, this research has concentrated on colored image data. Deep learning classification models are currently being created on Quantum platforms, but they are still in a very early stage. Black and white benchmark image datasets like MNIST and Fashion MINIST have been used in recent research. MNIST and CIFAR-10 were compared for binary classification, but the comparison showed that MNIST performed more accurately than colored CIFAR-10. This research will evaluate the performance of the QML algorithm on the colored benchmark dataset CIFAR-10 to advance QML's real-time applicability. However, deep learning classification models have not been developed to compare colored images like Quantum Convolutional Neural Network (QCNN) to determine how much it is better to classical. Only a few models, such as quantum variational circuits, take colored images. The methodology adopted in this research is a hybrid approach by using penny lane as a simulator. To process the 10 classes of CIFAR-10, the image data has been translated into grey scale and the 28 × 28-pixel image containing 10,000 test and 50,000 training images were used. The objective of this work is to determine how much the quantum approach can outperform a classical approach for a comprehensive dataset of color images. After pre-processing 50,000 images from a classical computer, the QCNN model adopted a hybrid method and encoded the images into a quantum simulator for feature extraction using quantum gate rotations. The measurements were carried out on the classical computer after the rotations were applied. According to the results, we note that the QCNN approach is ~12% more effective than the traditional classical CNN approaches and it is possible that applying data augmentation may increase the accuracy. This study has demonstrated that quantum machine and deep learning models can be relatively superior to the classical machine learning approaches in terms of their processing speed and accuracy when used to perform classification on colored classes.

Keywords: CIFAR-10, quantum convolutional neural networks, quantum deep learning, quantum machine learning

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Authors: Shagufta Riaz, Ayesha Younus, Munir Ashraf, Tanveer Hussain

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Aesthetic and performance are two most important considerations along with quality, durability, comfort and cost that affect the garment credibility. Fabric drape is perhaps the most important clothing characteristics that distinguishes fabric from the sheet, paper, steel or other film materials. It enables the fabric to mold itself under its own weight into desired and required shape when only part of it is directly sustained. The fabric has the ability to be crumpled charmingly in bent folds of single or double curvature due to its drapeability to produce a smooth flowing i.e. ‘the sinusoidal-type folds of a curtain or skirt’. Drape and seam strength are two parameters that are considered for aesthetic and performance of fabric for both apparel and home textiles. Until recently, no such study have been conducted in which effect of weave designs on drape and seam strength of fabric and garment is inspected. Therefore, the aim of this study was to measure seam strength and drape of fabric and garment objectively by changing weave designs and quality of the fabric. Also, the comparison of 2-D drape and 3-D drape was done to find whether a fabric behaves in same manner or differently when sewn and worn on the body. Four different cotton weave designs were developed and pr-treatment was done. 2-D Drape of the fabric was measured by drapemeter attached with digital camera and a supporting disc to hang the specimen on it. Drape coefficient value (DC %) has negative relation with drape. It is the ratio of draped sample’s projected shadow area to the area of undraped (flat) sample expressed as percentage. Similarly, 3-D drape was measured by hanging the A-line skirts for developed weave designs. BS 3356 standard test method was followed for bending length examination. It is related to the angle that the fabric makes with its horizontal axis. Seam strength was determined by following ASTM test standard. For sewn fabric, stitch density of seam was found by magnifying glass according to standard ASTM test method. In this research study, from the experimentation and evaluation it was investigated that drape and seam strength were significantly affected by change of weave design and quality of fabric (PPI & yarn count). Drapeability increased as the number of interlacement or contact point deceased between warp and weft yarns. As the weight of fabric, bending length, and density of fabric had indirect relationship with drapeability. We had concluded that 2-D drape was higher than 3-D drape even though the garment was made of the same fabric construction. Seam breakage strength decreased with decrease in picks density and yarn count.

Keywords: drape coefficient, fabric, seam strength, weave

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Authors: Shahid Noor, Kazim Najjad, Muhammad Nasir, Irshad Bhutto, Abdul Samad Memon, Khurram Anwar, Tehseen Riaz, Mian Muhammad Hanif, Nauman A. Mallik, Saeed Ahmed, Israr Ahmed, Ali Yasir

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Background: Musculoskeletal pain is the most common complaint presented to the health practitioner. It is well known that untreated or under-treated pain can have a significant negative impact on an individual’s quality of life (QoL). Objectives: This study was conducted across 10 sites in six (6) major cities of Pakistan to evaluate the tolerability, safety, and the clinical response of Nuberol Forte® (Paracetamol 650 mg + Orphenadrine 50 mg) to musculoskeletal pain in routine Pakistani practice and its impact on improving the patient’s QoL. Design & Methods: This NFORT-EFFECT observational, prospective multicenter study was conducted in compliance with Good Clinical Practice guidelines and local regulatory requirements. The study sponsor was "The Searle Company Limited, Pakistan. To maintain the GCP compliances, the sponsor assigned the CRO for the site and data management. Ethical approval was obtained from an independent ethics committee. The IEC reviewed the progress of the study. Written informed consent was obtained from the study participants, and their confidentiality was maintained throughout the study. A total of 399 patients with known prescreened musculoskeletal conditions and pain who attended the study sites were recruited, as per the inclusion/exclusion criteria (clinicaltrials.gov ID# NCT04765787). The recruited patients were then prescribed Paracetamol (650 mg) and Orphenadrine (50 mg) combination (Nuberol Forte®) for 7 to 14 days as per the investigator's discretion based on the pain intensity. After the initial screening (visit 1), a follow-up visit was conducted after 1-2 weeks of the treatment (visit 2). Study Endpoints: The primary objective was to assess the pain management response of Nuberol Forte treatment and the overall safety of the drug. The Visual Analogue Scale (VAS) scale was used to measure pain severity. Secondary to pain, the patients' health-related quality of life (HRQoL) was also assessed using the Muscle, Joint Measure (MJM) scale. The safety was monitored on the first dose by the patients. These assessments were done on each study visit. Results: Out of 399 enrolled patients, 49.4% were males, and 50.6% were females with a mean age of 47.24 ± 14.20 years. Most patients were presented with Knee Osteoarthritis (OA), i.e., 148(38%), followed by backache 70(18.2%). A significant reduction in the mean pain score was observed after the treatment with the combination of Paracetamol and Orphenadrine (p<0.05). Furthermore, an overall improvement in the patient’s QoL was also observed. During the study, only ten patients reported mild adverse events (AEs). Conclusion: The combination of Paracetamol and Orphenadrine (Nuberol Forte®) exhibited effective pain management among patients with musculoskeletal conditions and also improved their QoL.

Keywords: musculoskeletal pain, orphenadrine/paracetamol combination, pain management, quality of life, Pakistani population

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Authors: Mudasir Ahmad Syed, Raashid Ahmd Wani, Mashooq Ahmad Dar, Uneeb Urwat, Riaz Ahmad Shah, Nazir Ahmad Ganai

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Salmonella enterica serovar Typhimurium (Salmonella Typhimurium) is a primary avian pathogen responsible for severe intestinal pathology in younger chickens and economic losses. However, the Salmonella Typhimurium is also able to cause infection in humans, described by typhoid fever and acute gastro-intestinal disease. A study was conducted at days to investigate pathological, histopathological, haemato-biochemical, immunological and expression kinetics of NRAMP (natural resistance associated macrophage protein) gene family (NRAMP1 and NRAMP2) in broiler chickens following experimental infection of Salmonella Typhimurium at 0,1,3,5,7,9,11,13 and 15 days respectively. Infection was developed in birds through oral route at 2×108 CFU/ml. Clinical symptoms appeared 4 days post infection (dpi) and after one-week birds showed progressive weakness, anorexia, diarrhea and lowering of head. On postmortem examination, liver showed congestion, hemorrhage and necrotic foci on surface, while as spleen, lungs and intestines revealed congestion and hemorrhages. Histopathological alterations were principally observed in liver in second week post infection. Changes in liver comprised of congestion, areas of necrosis, reticular endothelial hyperplasia in association with mononuclear cell and heterophilic infiltration. Hematological studies confirm a significant decrease (P<0.05) in RBC count, Hb concentration and PCV. White blood cell count showed significant increase throughout the experimental study. An increase in heterophils was found up to 7dpi and a decreased pattern was observed afterwards. Initial lymphopenia followed by lymphocytosis was found in infected chicks. Biochemical studies showed a significant increase in glucose, AST and ALT concentration and a significant decrease (P<0.05) in total protein and albumin level in the infected group. Immunological studies showed higher titers of IgG in infected group as compared to control group. The real time gene expression of NRAMPI and NRAMP2 genes increased significantly (P<0.05) in infected group as compared to controls. The peak expression of NRAMP1 gene was seen in liver, spleen and caecum of infected birds at 3dpi, 5dpi and 7dpi respectively, while as peak expression of NRAMP2 gene in liver, spleen and caecum of infected chicken was seen at 9dpi, 5dpi and 9dpi respectively. This study has role in diagnostics and prognostics in the poultry industry for the detection of salmonella infections at early stages of poultry development.

Keywords: biochemistry, histopathology, NRAMP, poultry, real time expression, Salmonella Typhimurium

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Authors: Khan Farhan Rafat, Riaz Ahmed

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Renowned offshore organizations are drifting towards collaborative exertion to win and implement international projects for business gains. However, devoid of financial constraints, with the availability of skilled professionals, and despite improved project management practices through state-of-the-art tools and techniques, project delays have become a norm these days. This situation calls for exploring the factor(s) affecting the bonding between project management performance and project success. In the context of the well-known 3M’s of project management (that is, manpower, machinery, and materials), machinery and materials are dependent upon manpower. Because the body of knowledge inveterate on the influence of national culture on men, hence, the realization of the impact on the link between project management performance and project success need to be investigated in detail to arrive at the possible cause(s) of project delays. This research initiative was, therefore, undertaken to fill the research gap. The unit of analysis for the proposed research excretion was the individuals who had worked on skyscraper construction projects. In reverent studies, project management is best described using construction examples. It is due to this reason that the project oriented city of Dubai was chosen to reconnoiter on causes of project delays. A structured questionnaire survey was disseminated online with the courtesy of the Project Management Institute local chapter to carry out the cross-sectional study. The Construction Industry Institute, Austin, of the United States of America along with 23 high-rise builders in Dubai were also contacted by email requesting for their contribution to the study and providing them with the online link to the survey questionnaire. The reliability of the instrument was warranted using Cronbach’s alpha coefficient of 0.70. The appropriateness of sampling adequacy and homogeneity in variance was ensured by keeping Kaiser–Meyer–Olkin (KMO) and Bartlett’s test of sphericity in the range ≥ 0.60 and < 0.05, respectively. Factor analysis was used to verify construct validity. During exploratory factor analysis, all items were loaded using a threshold of 0.4. Four hundred and seventeen respondents, including members from top management, project managers, and project staff, contributed to the study. The link between project management performance and project success was significant at 0.01 level (2-tailed), and 0.05 level (2-tailed) for Pearson’s correlation. Before initiating the moderator analysis test for linearity, multicollinearity, outliers, leverage points and influential cases, test for homoscedasticity and normality were carried out which are prerequisites for conducting moderator review. The moderator analysis, using a macro named PROCESS, was performed to verify the hypothesis that national culture has an influence on the said link. The empirical findings, when compared with Hofstede's results, showed high power distance as the cause of construction project delays in Dubai. The research outcome calls for the project sponsors and top management to reshape their project management strategy and allow for low power distance between management and project personnel for timely completion of projects.

Keywords: causes of construction project delays, construction industry, construction management, power distance

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Authors: Nervana Elbakary, Sami Ouanes, Sadaf Riaz, Oraib Abdallah, Islam Mahran, Noriya Al-Khuzaei, Yassin Eltorki

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Major Depressive Disorder (MDD) requires therapeutic interventions during the initial month after being diagnosed for better disease outcomes. International guidelines recommend a duration of 4–12 weeks for an initial antidepressant (IAD) trial at an optimized dose to get a response. If depressive symptoms persist after this duration, guidelines recommend switching, augmenting, or combining strategies as the next step. Most patients with MDD in the mental health setting have been labeled incorrectly as treatment-resistant where in fact they have not been subjected to an adequate trial of guideline-recommended therapy. Premature discontinuation of IAD due to ineffectiveness can cause unfavorable consequences. Avoiding irrational practices such as subtherapeutic doses of IAD, premature switching between the ADs, and refraining from unjustified polypharmacy can help the disease to go into a remission phase We aimed to determine the prevalence and the patterns of strategies applied after an IAD was changed because of a suboptimal response as a primary outcome. Secondary outcomes included the median survival time on IAD before any change; and the predictors that were associated with IAD change. This was a retrospective cross- sectional study conducted in Mental Health Services in Qatar. A dataset between January 1, 2018, and December 31, 2019, was extracted from the electronic health records. Inclusion and exclusion criteria were defined and applied. The sample size was calculated to be at least 379 patients. Descriptive statistics were reported as frequencies and percentages, in addition, to mean and standard deviation. The median time of IAD to any change strategy was calculated using survival analysis. Associated predictors were examined using two unadjusted and adjusted cox regression models. A total of 487 patients met the inclusion criteria of the study. The average age for participants was 39.1 ± 12.3 years. Patients with first experience MDD episode 255 (52%) constituted a major part of our sample comparing to the relapse group 206(42%). About 431 (88%) of the patients had an occurrence of IAD change to any strategy before end of the study. Almost half of the sample (212 (49%); 95% CI [44–53%]) had their IAD changed less than or equal to 30 days. Switching was consistently more common than combination or augmentation at any timepoint. The median time to IAD change was 43 days with 95% CI [33.2–52.7]. Five independent variables (age, bothersome side effects, un-optimization of the dose before any change, comorbid anxiety, first onset episode) were significantly associated with the likelihood of IAD change in the unadjusted analysis. The factors statistically associated with higher hazard of IAD change in the adjusted analysis were: younger age, un-optimization of the IAD dose before any change, and comorbid anxiety. Because almost half of the patients in this study changed their IAD as early as within the first month, efforts to avoid treatment failure are needed to ensure patient-treatment targets are met. The findings of this study can have direct clinical guidance for health care professionals since an optimized, evidence-based use of AD medication can improve the clinical outcomes of patients with MDD; and also, to identify high-risk factors that could worsen the survival time on IAD such as young age and comorbid anxiety

Keywords: initial antidepressant, dose optimization, major depressive disorder, comorbid anxiety, combination, augmentation, switching, premature discontinuation

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