Search results for: Saima Sadaf

Authors: Sadaf H. Khan, Jyoti Kumar

Abstract:

Sick Building Syndrome (SBS) is a situation in which inhabitants of a building develop illness symptoms or get infected with a chronic disease as a result of the building in which they reside or work. Certain symptoms tend to get more severe as an individual spends more time in the building; however, they generally improve with time or even disappear when they leave that space. Though ‘Design of Built-Spaces’ is a crucial factor in regulating these symptoms but it still needs to be identified further as to what specific design features of a ‘Built-Space’ trigger sick building syndrome (SBS). Much of the research work present to date is focused on the physiological or physical sickness caused due to inappropriate built-space design. In this paper, the psychological aspects of sick building syndrome (SBS) will be investigated across the adult population, more specifically graduate students in India trying to settle in back to their previous physical work environments, i.e., campus, classrooms, hostels, after a very long hold which lasted more than a year due to lockdowns during Covid-19 crisis all over the world. The study will follow an analytical approach and the data will be collected through self-reported online surveys. The purpose of this study is to enquire causal agents, diagnosable symptoms and remedial design of built spaces which can enhance the productive level of built environments and better facilitate the inhabitants by improving their psychological wellbeing, which is the most uprising concern. The fact that SBS symptoms can be studied only within the initial few weeks as an occupant starts interacting with a built-environment and leaves as the occupant leaves that space or zone, the post-lockdown incoming of students back to their respective campuses provides an opportunity to clearly draw multiple conclusions of the relationship that exist between the Design of Built-Spaces and Psychological Sickness Syndrome associated with it. The study will be one of a kind approach for understanding and formulating methods to improve psychological wellbeing within a built-setting by better identifying factors associated with these psychological symptoms, including anxiety, mental fatigue, reduced attention span and reduced memory span as refined symptoms of SBS discussed in 1987 by Molhave within his study.

Keywords: built-environment psychology, built-space design, healthcare architecture, psychological wellbeing

Procedia PDF Downloads 137

Authors: Saima Ali, Liaqat Ali, Nasir Orakzai

Abstract:

Background: Hydronephrosis is the most common abnormal finding in the urinary tract on prenatal screening with Ultrasonography. The prenatal hydronephrosis is a diagnostic dilemma in differentiating between obstructive variant versus physiologic hydronephrosis. The assessment and prompt diagnosis of prenatal hydronephrosis is important because of the fact that untreated obstructive hydronephrosis usually leads to recurrent UTI, Urosepsis, deterioration of renal functions, non-functioning kidneys, and even end-stage renal disease. Objectives: To determine the etiology and outcome of postnatal treatment of children with prenatal hydronephrosis in two teaching hospitals of Khyber Pakhtunkhwa (KPK) Methods: It is a multicentric descriptive study that was conducted in department of Paediatrics in Kuwait teaching hospital Peshawar and Department of Urology in Institute of Kidney Diseases Hayatabad Medical Complex Peshawar from January 2008 till December 2010. Total numbers of 64 neonates were included in the study with the mean follow-up of 14.5 months. All the diagnostic data in prenatal, postnatal data, and operative and non-operative data were collected on structured Proforma and was analyzed on SPSS version 17. Results: Out of 64 patients, 39 (60.9 %) were male while 25 were female. 52 patients had unilateral while 12 patients had bilateral hydronephrosis. Based upon prenatal USG in term of AP diameter, 37 (57 %) patients had mild hydronephrosis (5-10 mm AP diameter), 14 patients had moderate hydronephrosis (10-15 mm AP diameter) while 13 patients had gross hydronephrosis (More than 15mm). Regarding etiology, 44(76 %) patients were labeled as physiologic hydronephrosis, 11 patients (9.3%) with PUJ obstruction, 5 patients with Vesicoureteric reflux (VUR) and 4 patients with posterior urethral valves. Surgery was performed in total of 15 (23.4%) patients that included open Pyeloplasty in 11 patients, Vesicostomy followed by posterior valve fulguration in 4 patients. All the patients of VUR treated medically. The severity in the grade of prenatal hydronephrosis is significantly associated with the need for definitive urological surgery p < 0.005. Ancillary procedures like percutaneous nephrostomy (PCN) were inserted 7 patients. Conclusions: Prenatal hydronephrosis is a common ailment associated with significant morbidity. Physiological Hydronephrosis and VUR can be successfully treated with medical treatment. However obstructive PUJ obstructions and posterior urethral valves require surgical correction with a good success rate.

Keywords: prenatal hydronephrosis, Pelviureteric Junction (PUJ) Obstruction, vesicoureteric reflux, posterior urethral valve, renography

Procedia PDF Downloads 221

Authors: Poornima Gupta, Sadaf Siraj

Abstract:

The study examined the organizational causes of organizational stress in women executives and entrepreneurs in India. This was done so that mediation strategies could be developed to combat the organizational stress experienced by them, in order to retain the female employees as well as attract quality talent. The data for this research was collected through the self- administered survey, from the women executives across various industries working at different levels in management. The research design of the study was descriptive and cross-sectional. It was carried out through a self-administered questionnaire filled in by the women executives and entrepreneurs in the NCR region. Multistage sampling involving stratified random sampling was employed. A total of 1000 questionnaires were distributed out of which 450 were returned and after cleaning the data 404 were fit to be considered for analyses. The overall findings of the study suggested that there were various job-related factors that induce stress. Fourteen factors were identified which were a major cause of stress among the working women by applying Factor analysis. The study also assessed the demographic factors which influence the stress in women executives across various industries. The findings show that the women, no doubt, were stressed by organizational factors. The mean stress score was 153 (out of a possible score of 196) indicating high stress. There appeared to be an inverse relationship between the marital status, age, education, work experience, and stress. Married women were less stressed compared to single women employees. Similarly, female employees 29 years or younger experienced more stress at work. Women having education up to 12th standard or less were more stressed compared to graduates and post graduates. Women who had spent more than two years in the same organization perceived more stress compared to their counterparts. Family size and income, interestingly, had no significant impact on stress. The study also established that the level of stress experienced by women across industries differs considerably. Banking sector emerged as the industry where the women experienced the most stress followed by Entrepreneurs, Medical, BPO, Advertising, Government, Academics, and Manufacturing, in that order. The results contribute to the better understanding of the personal and economic factors surrounding job stress and working women. It concludes that the organizations need to be sensitive to the women’s needs. Organizations are traditionally designed around men with the rules made by the men for the men. Involvement of women in top positions, decision making, would make them feel more useful and less stressed. The invisible glass ceiling causes more stress than realized among women. Less distinction between the men and women colleagues in terms of giving responsibilities, involvement in decision making, framing policies, etc. would go a long way to reduce stress in women.

Keywords: women, stress, gender in management, women in management

Procedia PDF Downloads 230

Authors: Komal Khan, Hafsa Zaneb, Saima Masood, Muhammad Younus, Sanan Raza

Abstract:

Cigarette smoke induces many physiological and pathological changes in respiratory tract like goblet cell hyperplasia and regional distention of airspaces. It is also associated with elevation of inflammatory profiles in different airway compartments. As probiotics are generally known to promote mucosal tolerance, it was postulated that prophylactic use of probiotics can be helpful in reduction of respiratory damage induced by cigarette smoke exposure. Twenty-four adult mice were randomly divided into three groups (cigarette-smoke (CS) group, cigarette-smoke+ Lactobacillus (CS+ P) group, control (Cn) group), each having 8 mice. They were exposed to cigarette smoke for 28 days (6 cigarettes/ day for 6 days/week). Wright-Giemsa staining of bronchoalveolar lavage fluid (BALF) was performed in three mice per group. Tissue samples of trachea and lungs of 7 mice from each group were processed by paraffin embedding technique for haematoxylin & eosin (H & E) and alcian blue- periodic acid-Schiff (AB-PAS) staining. Then trachea (goblet cell number, ratio and loss of cilia) and lungs (airspace distention) were studied. The results showed that the number of goblet cells was increased in CS group as a result of defensive mechanism of the respiratory system against irritating substances. This study also revealed that the cells of CS group having acidic glycoprotein were found to be higher in quantity as compared to those containing neutral glycoprotein. However, CS + P group showed a decrease in goblet cell index due to enhanced immunity by prophylactically used probiotics. Moreover, H & E stained tracheas showed significant loss of cilia in CS group due to propelling of mucous but little loss in CS + P group because of having good protective tracheal epithelium. In lungs, protection of airspaces was also much more evident in CS+ P group as compared to CS group having distended airspaces, especially at 150um distance from terminal bronchiole. In addition, a comprehensive analysis of inflammatory cells population of BALF showed neutrophilia and eosinophilia was significantly reduced in CS+ P group. This study proved that probiotics are found to be useful for reduction of changes in micro-architecture of the respiratory system. Thus, dietary supplementation of probiotic as prophylactic measure can be useful in achieving immunomodulatory effects.

Keywords: cigarette smoke, probiotics, goblet cells, airspace enlargement, BALF

Procedia PDF Downloads 321

Authors: Saima Shaikh, Andre Brown, Wallace Enegbuma

Abstract:

Earthquakes strike both developed and developing countries, causing tremendous damage and the loss of lives of millions of people, mainly due to the collapsing of buildings, particularly in poorer countries. Despite the socio-economic and technological restrictions, the poorer countries have adopted proven and established housing-strengthening techniques from affluent countries. Rural communities are aware of the earthquake-strengthening mechanisms for improving housing resilience, but owing to socio-economic and technological constraints, the seismic guidelines are rarely implemented, resulting in informal construction practice. Unregistered skilled laborers make substantial contributions to the informal construction sector, particularly in rural areas where knowledge is scarce. Laborers employ their local expertise in house construction; however, owing to a lack of seismic expertise in safe building procedures, the authorities' regulated seismic norms are not applied. From the perspective of seismic knowledge transformation in safe buildings practices, the study focuses on the feasibility of seismic guidelines implementation. The study firstly employs a literature review of massive-scale reconstruction after the 2005 earthquake in rural Pakistan. The 2005-earthquake damaged over 400,000 homes, killed 70,000 people and displaced 2.8 million people. The research subsequently corroborated the pragmatic approach using questionnaire field survey among the rural people in 2005-earthquake affected areas. Using the literature and the questionnaire survey, the research analyzing people's perspectives on technical acceptability, financial restrictions, and socioeconomic viability and examines the effectiveness of seismic knowledge transfer in safe buildings practices. The findings support the creation of a knowledge transfer framework in disaster mitigation and recovery planning, assisting rural communities and builders in minimising losses and improving response and recovery, as well as improving housing resilience and lowering vulnerabilities. Finally, certain conclusions are obtained in order to continue the resilience research. The research can be further applied in rural areas of developing countries having similar construction practices.

Keywords: earthquakes, knowledge transfer, resilience, informal construction practices

Procedia PDF Downloads 136

Authors: Kamran Jawed, Anu Jose Mattam, Zia Fatma, Saima Wajid, Malik Z. Abdin, Syed Shams Yazdani

Abstract:

Worldwide demand of natural and sustainable fuels and chemicals have encouraged researchers to develop microbial platform for synthesis of short chain fatty acids as they are useful precursors to replace petroleum-based fuels and chemicals. In this study, we evaluated the role of fatty acid synthesis and β-oxidation cycle of Escherichia coli to produce butyric acid, a 4-carbon short chain fatty acid, with the help of three thioesterases, i.e., TesAT from Anaerococcus tetradius, TesBF from Bryantella formatexigens and TesBT from Bacteroides thetaiotaomicron. We found that E. coli strain transformed with gene for TesBT and grown in presence of 8 g/L glucose produced maximum butyric acid titer at 1.46 g/L, followed by that of TesBF at 0.85 g/L and TesAT at 0.12 g/L, indicating that these thioesterases were efficiently converting short chain fatty acyl-ACP intermediate of fatty acid synthesis pathway into the corresponding acid. The titer of butyric acid varied significantly depending upon the plasmid copy number and strain genotype. Deletion of genes for fatty acyl-CoA synthetase and acyl-CoA dehydrogenase, which are involved in initiating the fatty acid degradation cycle, and overexpression of FadR, which is a dual transcriptional regulator and exerts negative control over fatty acid degradation pathway, reduced up to 30% of butyric acid titer. This observation suggested that β-oxidation pathway is working synergistically with fatty acid synthesis pathway in production of butyric acid. Moreover, accelerating the fatty acid elongation cycle by overexpressing acetyl-CoA carboxyltransferase (Acc) and 3-hydroxy-acyl-ACP dehydratase (FabZ) or by deleting FabR, the transcription suppressor of elongation, did not improve the butyric acid titer, rather favored the long chain fatty acid production. Finally, a balance between cell growth and butyric acid production was achieved with the use of phosphorous limited growth medium and 14.3 g/L butyric acid, and 17.5 g/L total free fatty acids (FFAs) titer was achieved during fed-batch cultivation. We have engineered an E. coli strain which utilizes the intermediate of both fatty acid synthesis and degradation pathway, i.e. butyryl-ACP and -CoA, to produce butyric acid from glucose. The strategy used in this study resulted in highest reported titers of butyric acid and FFAs in engineered E. coli.

Keywords: butenoic acid, butyric acid, Escherichia coli, fed-batch fermentation, short chain fatty acids, thioesterase

Procedia PDF Downloads 344

Authors: Sadaf Salek

Abstract:

Introduction: Cats are susceptible to various health conditions, and one such ailment that can affect their oral health is epulis in their lips. Epulis refers to a benign tumor or growth that can develop in different areas of a cat's mouth, including the lips. While epulis is not life-threatening, it can still cause discomfort and affect a cat's overall quality of life. This essay aims to delve into the causes, symptoms, and treatment options for epulis in cat's lips, shedding light on this lesser-known oral condition. Causes: Epulis in a cat's lips can have several causes. Firstly, genetic predisposition plays a significant role, with certain breeds being more prone to developing these growths. Secondly, chronic irritation to the mouth, such as from dental diseases or foreign objects, can also contribute to the development of epulis. Lastly, hormonal imbalances, specifically an excess of estrogen, have been associated with the occurrence of these tumors in cats. Understanding these causes can help cat owners take preventive measures to reduce the risk of epulis in their feline companions. Symptoms: Identifying the symptoms of epulis in a cat's lips is vital for early intervention and effective treatment. The most common symptoms include swelling, redness, and the presence of a visible growth or lump on the lip. Cats with epulis may also exhibit drooling, difficulty eating, and a reluctance to groom themselves. Any change in eating habits or oral behavior should not be overlooked and prompt a visit to the veterinarian for a thorough examination. Treatment ptions: When it comes to treating epulis in a cat's lips, various options are available, depending on the size, location, and characteristics of the growth. The primary treatment involves surgical removal of the tumor. This procedure should be performed by a qualified veterinarian, ensuring complete excision of the mass while preserving as much healthy tissue as possible. In some cases, radiation therapy may be necessary, especially if the tumor is large or aggressive. Additionally, a veterinarian may recommend oral hygiene care and regular dental cleaning to prevent further growths and maintain the cat's oral health. Prevention and Care: Preventing epulis in a cat's lips is not always possible, especially if genetic factors are involved. However, certain preventive measures can minimize the risk of these growths. Maintaining good oral hygiene through regular brushing and the use of appropriate dental products can help prevent chronic irritation and dental diseases. Routine veterinary check-ups should also include thorough oral examinations to detect any abnormal growths or changes in the mouth at an early stage. Pet owners should be observant and seek veterinary care promptly for any signs of discomfort or changes in eating habits. Conclusion: Epulis in a cat's lips is a condition that requires attention and proper treatment. Understanding the causes, identifying symptoms, and exploring treatment options are of utmost importance to help improve a cat's oral health and overall well-being.

Keywords: fibroma, cat, lip, epulis

Procedia PDF Downloads 17

Authors: Kalsoom Shaikh, Ghulam Sarwar Gachal, Saima Memon

Abstract:

Our study aimed to assess diversity and habitats of amphibian fauna in Sindh province as amphibians are among most vulnerable animals and the risk of their extinction is increasing in many parts of world mainly due to habitat degradation. Present study consisted of field surveys and laboratory analytical work; field surveys were carried out to confirm amphibian diversity and collection of water samples from their habitats, whereas laboratory work was conducted for identification of species and analysis of water quality of habitats through physico-chemical parameters. For identification of amphibian species, morphology was thoroughly examined using taxonomic key, whereas water quality was assessed via physico-chemical parameters including pH, electric conductivity (EC), total dissolved solids (TDS), total hardness (T. Hard), total alkalinity (T. Alk), chloride (Cl), carbon dioxide (CO₂), sulfate (SO₄), phosphate (PO₄), nitrite (NO₂) and nitrate (NO₃) using material and methods of analytical grade. pH value was analyzed using pH meter, whereas levels of EC and TDS were recorded using conductivity meter and TDS meter, respectively. Other parameters with exception of non-metallic parameters (SO₄, PO₄, NO₂, and NO₃) were analyzed through distinct titration methods. Concentration of non-metallic parameters was evaluated using ultra-violet spectrophotometer. This study revealed existence of four amphibian species including Hoplobatrachus tigerinus, Euphlyctis cyanophlyctis, Allopa hazarensis belonging to Family Ranidae and Bufo stomaticus (Family Bufonidae) randomly distributed in district Ghotki, Jamshoro, Kashmor, Larkana, Matiari and Shikarpur in Sindh. Assessment of aquatic habitats in different areas found value of parameters as followed: Habitats in district Ghoki (pH: 7.8 ± 0.3, EC: 2165.3 ± 712.6, TDS: 1507.0 ± 413.1, T-Hard: 416.4 ± 67.5, T. Alk: 393.4 ± 78.4, Cl: 362.4 ± 70.1, CO₂: 21.1 ± 3.5, SO₄: 429.3 ± 100.1, PO₄: 487.5 ± 122.5, NO₂: 13.7 ± 1.0, NO₃: 14.7 ± 2.5), district Jamshoro habitats (pH: 8.1 ± 0.4, EC: 2403.8 ± 55.4, TDS: 1697.2 ± 77.0, T. Hard: 548.7 ± 43.2, T. Alk: 294.4 ± 29.0, Cl: 454.7 ± 50.8 CO₂: 16.9 ± 2.4, SO₄: 713.0 ± 49.3, PO₄: 826.2 ± 53.0, NO₂: 15.2 ± 3.4, NO₃: 21.6 ± 3.7), habitats in Kashmor district (pH: 8.0 ± 0.5, EC: 2450.3 ± 610.9, TDS: 1745.3 ± 440.9, T. Hard: 624.6 ± 305.8, T. Alk: 445.7 ± 120.5, Cl: 448.9 ± 128.8, CO₂: 18.9 ± 4.5, SO₄: 619.8 ± 205.8, PO₄: 474.1 ± 94.2, NO₂: 15.2 ± 3.1, NO₃ 14.3 ± 2.6), district Larkana habitats (pH: 8.4 ± 0.4, EC: 2555.8 ± 70.3, TDS: 1784.4 ± 36.9, T. Hard: 623.0 ± 42.5, T. Alk: 329.6 ± 36.7, Cl: 614.3 ± 89.5, CO₂: 17.6 ± 1.2, SO₄: 845.1 ± 67.6, PO₄: 895.0 ± 61.4, NO₂: 13.6 ± 3.8, NO₃: 23.1 ± 2.8), district Matiari habitats (pH: 8.0 ± 0.4 EC: 2492.3 ± 928.1, TDS: 430.0 ± 161.3, T. Hard: 396.7 ± 183.3, T. Alk: 388.1 ± 97.4, Cl: 551.6 ± 73.4, CO₂: 15.8 ± 2.9, SO₄: 576.5 ± 200.0, PO₄: 434.7 ± 100.6, NO₂: 15.8 ± 2.9, NO₃: 15.2 ± 3.0) and habitats in Shikarpur district (pH: 8.1 ± 0.6, EC: 2191.7 ± 765.1, TDS: 1764.9 ± 409.2, T. Hard: 431.9 ± 68.4,T. Alk: 350.3 ± 44.3, Cl: 381.5 ± 29.5, CO₂: 18.0 ± 4.0, SO₄: 518.8 ± 97.9, PO₄: 493.6 ± 64.6, NO₂: 14.0 ± 0.8, NO₃: 16.1 ± 2.8). Values of physico-chemical parameters were found higher than permissible level of Environmental Protectiona Agency (EPA). Monthly variation in concentration of physico-chemical parameters was also prominently recorded at all the study locals. This study discovered poor diversity of amphibian fauna and condition of their habitats was also observed as pitiable. This study established base line information that may be used in execution of an effective management plan and future monitoring of amphibian diversity and their habitats in Sindh.

Keywords: amphibians, diversity, habitats, Pakistan, Sindh

Procedia PDF Downloads 127

Authors: Shomaila Sadaf, Margarethe Olbertz-Siitonen

Abstract:

This study looks at identity and othering in discourses around sensitive issues in social media. More specifically, the study explores the multimodal resources and narratives through which the other is formed, and identities are ascribed in online spaces. As an integral part of social life, media spaces have become an important site for negotiating and ascribing identities. In line with recent research, identity is seen hereas constructions of belonging which go hand in hand with processes of in- and out-group formations that in some cases may lead to othering. Previous findings underline that identities are neither fixed nor limited but rather contextual, intersectional, and interactively achieved. The goal of this study is to explore and develop an understanding of how people co-construct the ‘other’ and ascribe certain identities in social media using multiple modes. In the beginning of the year 2018, the British government decided to include relationships, sexual orientation, and sex education into the curriculum of state funded primary schools. However, the addition of information related to LGBTQ+in the curriculum has been met with resistance, particularly from religious parents.For example, the British Muslim community has voiced their concerns and protested against the actions taken by the British government. YouTube has been used by news companies to air video stories covering the protest and narratives of the protestors along with the position ofschool officials. The analysis centers on a YouTube video dealing with the protest ofa local group of parents against the addition of information about LGBTQ+ in the curriculum in the UK. The video was posted in 2019. By the time of this study, the videos had approximately 169,000 views andaround 6000 comments. In deference to multimodal nature of YouTube videos, this study utilizes multimodal discourse analysis as a method of choice. The study is still ongoing and therefore has not yet yielded any final results. However, the initial analysis indicates a hierarchy of ascribing identities in the data. Drawing on multimodal resources, the media works with social categorizations throughout the documentary, presenting and classifying involved conflicting parties in the light of their own visible and audible identifications. The protesters can be seen to construct a strong group identity as Muslim parents (e.g., clothing and reference to shared values). While the video appears to be designed as a documentary that puts forward facts, the media does not seem to succeed in taking a neutral position consistently throughout the video. At times, the use of images, soundsand language contributes to the formation of “us” vs. “them”, where the audience is implicitly encouraged to pick a side. Only towards the end of the documentary this problematic opposition is addressed and critically reflected through an expert interview that is – interestingly – visually located outside the previously presented ‘battlefield’. This study contributes to the growing understanding of the discursive construction of the ‘other’ in social media. Videos available online are a rich source for examining how the different social actors ascribe multiple identities and form the other.

Keywords: identity, multimodal discourse analysis, othering, youtube

Procedia PDF Downloads 86

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

Abstract:

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

Procedia PDF Downloads 106