The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.

The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.

About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15–20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.

The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

Medical-education is associated with high overall stress and it is important to identify relevant factors.

The study was aimed to discern the differences in perceived stress among the students of public and private medical colleges of Pakistan and to identify factors subservient to any hypothesized difference.

This cross-sectional study was conducted at different private and public medical colleges of Pakistan using validated tools: PSS-14 (Perceived Stress Scale) to find out the levels of stress faced by each sector and MSSQ (Medical Student Stressor Questionnaire) to determine the factors associated with increased stress.

Total of 424 medical students from various public and private medical colleges of Pakistan (212 each) filled the questionnaires. The mean score +/- SD of PSS-14 was 36.17 ± 6.096 for the public sector and 36.29 ±5.732 for the private sector. Hence, there was no difference between the two comparative means of PSS score, t(422)=-0.213,p=0.831.The results for both sectors were classified as high perceived stress (27-40 score is high perceived stress). Out of 40 individual stress-causing factors in MSSQ, the students from private-sector scored higher as compared to public-sector: Quota System in examination t(422)=-3.951,p=0.000, stress caused by lack of time for friends and family t(422)=-3.225,p=0.001, stress caused by Tests/Examination t(422)=-2.131,p=0.034, stress caused by the parental wish for them to study medicine t(422)=-2.346,p=0.019 and stress caused by fear of getting poor marks t(422)=-2.183,p=0.030.

There exists no overall difference in the perceived-stress among the medical students of public and private medical colleges despite private-sectors having significantly more operational financial resources.

No significant relationships.

Superior semi-circular canal dehiscence syndrome is a disorder characterised by auditory and vestibular symptoms that can significantly impact quality of life, and yet it has no disease-specific quality of life instrument.

Thirty-six patients who underwent transmastoid superior semicircular canal resurfacing and plugging were included from an initial cohort of 60 surgically managed patients. A sub-cohort of 19 consecutive patients completed validated symptom and quality of life questionnaires before and after surgery. Of the 36 patients, 31 participated in a telephone semi-structured interview post-operatively.

Following surgery, there was a statistically significant improvement in autophony index score (p = 0.02), symptom severity score (p < 0.001) and sound hypersensitivity (p = 0.01). Thematic analysis of telephone interviews suggested three main symptom themes: auditory hypersensitivity, dysequilibrium, headache and concentration difficulties. Dysequilibrium was found to persist post-operatively.

Surgery improves overall symptoms and quality of life. However, important symptom themes may be overlooked using the outcome measures that are currently available. A unified disease-specific outcome measure is urgently required to better understand the impact of symptoms and measure treatment effects.

This cross-sectional study investigated vestibular function outcomes after cochlear implantation in patients with inner-ear anomalies.

Twenty-two patients with bilateral symmetric inner-ear anomalies and 28 patients with normal inner ears were included. All were congenitally or progressively deaf persons implanted unilaterally during the previous 15 years. Vestibular system function was assessed by vestibular-evoked myogenic potential and bithermal caloric tests.

The vestibular-evoked myogenic potential abnormality rate in implanted ears with an inner-ear anomaly was 81.8 per cent, compared with 39.3 per cent in implanted ears with normal anatomy. In the non-implanted sides, the rate was 45.5 per cent (10 out of 22 cases) in the inner-ear anomaly patients compared with 17.9 per cent in patients with normal inner-ear structure. The respective abnormal caloric test rates in inner-ear anomaly versus normal anatomy patients were 81.8 per cent and 17.9 per cent (implanted ears), 77.3 per cent and 14.3 per cent (non-implanted sides).

Inner-ear anomaly and implantation were both associated with more vestibular-evoked myogenic potential abnormalities; when occurring together, these factors showed a synergistic effect. Caloric test abnormality is mainly dependent on the presence of an inner-ear anomaly, but implantation is not associated with caloric abnormality.

This study aimed to report the changes made to ENT placements across the UK in response to the pandemic and their impact on student experience.

A questionnaire eliciting how ENT placements were provided before and after coronavirus disease 2019 was disseminated amongst Student and Foundation Doctors in Otolaryngology representatives.

Thirty-eight respondents from 27 medical schools across the UK completed the survey (response rate of 90 per cent). Twenty-nine of the 38 respondents (76 per cent) reported a change in ENT placements in response to the pandemic. Six of the 38 students (16 per cent) remained satisfied with their ENT placements, as compared to 12 students prior to the pandemic (32 per cent).

There is considerable variability in how medical schools responded to the pandemic. Most medical schools placed students into smaller groups, with less direct contact in the hospital. These changes resulted in lower student satisfaction. The increased emphasis on e-learning underscores the need for high quality e-learning materials to promote learning throughout the pandemic and in the future.

The coronavirus disease 2019 pandemic has greatly disrupted routine ENT services. Subsequently, universities have chosen to either augment or suspend clinical placements.

This study aimed to elicit patients’ perspectives toward various approaches to clinical placements in ENT during the coronavirus disease 2019 pandemic.

Cross-sectional questionnaires were given to patients attending the ENT department for routine out-patient care. Responses were measured using a five-point Likert scale. Seventy-nine patients completed the survey.

Ninety-five per cent of respondents felt the coronavirus disease 2019 pandemic had not reduced their comfort in interacting with medical students. Most participants reported being comfortable with students participating directly or remotely in their care, and with students having access to their anonymised data. Twenty-five per cent of participants stated that they are uncomfortable with consultations being recorded and shared for medical education purposes.

A number of approaches to clinical placements remain acceptable to patients. Educational leads should continue to offer placements in ENT that can incorporate direct or remote observation of consultations.

The existing provision of ENT teaching in the undergraduate curriculum is deemed inadequate by medical students, general practitioners and ENT surgeons alike. This study aims to explore the perceptions of a variety of stakeholders on how undergraduate ENT provision can be optimised.

This study involved semi-structured interviews with seven participants (two medical students, two general practitioners, two ENT surgeons and a curriculum developer). Inductive thematic analysis was used to identify key themes that emerged from the interviews.

The four emergent themes were evaluation of current ENT provision, barriers to learning and teaching, alternate means of delivery of ENT education, and professional identity development. A number of barriers to learning and teaching in the clinical environment were identified including student-related, teacher-related and environmental factors.

The existing ENT provision should be re-considered to help students achieve a basic level of competence in managing common ENT conditions. This can be achieved by ENT teaching in additional contexts including general practice, e-learning and simulation workshops.

Using a cross sectional study design 1366/1401 women in their 3rd trimester of pregnancy were screened for depression using the Self-Rating Questionnaire (SRQ) and the Edinburgh Postnatal Depression Scale (EPDS). These instruments are validated, available in Urdu and have been used in the pre and postnatal period in Pakistan. The life events checklist was used to measure social stress and the Brief Disability Questionnaire (BDQ) for disability.

342 women scored ≥ 12 on the EPDS giving an estimated AND prevalence of 25.6 %. The EPDS and SRQ scores showed a high positive correlation. A significantly higher percentage of depressed women experienced problems in marital relations, work, finances, housing and domestic violence. Depressed women had higher disability scores. 32% of the depressed and 14% of non depressed were unable to perform usual daily activities. 35% of depressed women stayed in bed due to illness as compared to only 16 % of non-depressed.

This study confirms a high prevalence of AND in less educated women, experiencing a large number of social difficulties.

Tobacco smoking is one of the major preventable causes of premature death and disease in the world. Adolescents are amongst the most vulnerable group of individuals in society and are highly susceptible to cigarette smoking. Sixth Formers being the most senior members of the school act as role models to younger pupils and could influence smoking behaviour.

In a cross sectional and comparative study we aimed to determine the differences in smoking prevalence and patterns between Sixth Form students in Pakistan (a developing country) and the United Kingdom (a developed country).

A self-administered questionnaire, adapted from the WHO questionnaire, about tobacco smoking for health professionals was distributed amongst the students. The responses were anonymised to encourage truthful answers; there was no pressure to respond.

Of the 235 participants in the UK, 38 (16%) were regular smokers. Of the 297 participants in Pakistan, 20 (7%) of participants were regular smokers. In both countries there was a significant difference between the genders, with males being more likely to smoke. In Pakistan it was identified that the main reason for smoking was due to peer pressure, where as in the UK it was for recreational and social purposes.

The prevalence of smoking was higher in UK compared to Pakistan. There was a significant difference in the smoking behaviour patterns in the two countries.

Many time people get addicted to a drug like opiods when prescribed for some medical purpose. Neurobiological models of addiction has proposed cellular adaptation as mechanism of drug addiction. Excessive release of dopamine in NA due to drug intake produces euphoric sensation leading to pathological learning. Repeated use of drug increase glutametergic drive from prefrontal to NA cause compulsive seeking of drug in drug addicts. Is it possible to prevent medically induced addiction.

Pub med search was made by using key words, addiction model, dopamine, glutamate, anticraving medicine, oxidative stress.

Different antiglutametergic medication like ketamine, mementine, accomprosate modulate glutamatic excitation to prevent addiction. Natural medicine like N acetyle cystine and oxytocin have protective role . Typical antipsychotic can block surge of dopamine in NA.

When addictive drug has to be used inevitably for medical purpose it should be combined with other drugs to prevent development of addiction. First euphoria related to dopamine release in NA can be blocked by use of low dose typical antipsychotic or dopamine partial antagonist . NMDA is molecular target of various addictive drugs. Memtentine, ketamine or accomprosate can minimize effects of glutametergic plasticity. N accetyle cystine can restore glutamatergic pathway by its system of cystine- glutamate antiporter. It is source of glutathione largest anti oxidant system of body. Intranasal oxytocin can prevent addiction through its action on stress, learning, memory and intimacy. Intranasal oxytocin can be delivered directly to the brain.

Different strategies can be used to prevent medically induced addiction.

The author has not supplied his declaration of competing interest.

Postnatal depression is known to cause disability and suffering in women and negative consequences both for their infants and their families, with huge costs globally. Several studies from low and middle income countries (LAMIC) have demonstrated that effectively delivered psychological interventions are cost effective for improving maternal and child health, but access to these interventions is limited in both the low and high income countries.

The objective of the study is to develop and test a mobile phone-based intervention (TechMotherCare), which will include components of cognitive behavioural therapy (CBT) and child development related psychoeducation.

The aim of the study is to examine the feasibility and acceptability of the TechMotherCare intervention.

A total of 36 participants will be recruited from health centers in Karachi, Pakistan for this 2-arm randomized pilot study. The TechMotherCare App intervention will be based on principles of CBT and learning-through-play (LTP) a parenting intervention and will assess the real-time depressive symptoms of participants and respond, using intelligent real time therapy (iRTT) dependent on symptoms reported by participants.

Outcome assessments will be completed after 3 months (end of intervention). In-depth qualitative interviews will also be conducted with participants pre- and post-intervention. The trial is ongoing and we will present both the qualitative and quantitative results.

The results of this pilot trial will inform the design of a larger randomised controlled trial using a mobile based technology platform to address the huge treatment gap in LAMICs.

The authors have not supplied their declaration of competing interest.