Objective
To present the International Parkinson and Movement Disorder Society (MDS) Clinical Diagnostic Criteria for Parkinson9s disease.
Background
Although several diagnostic criteria for Parkinson9s disease have been proposed, none have been officially adopted by an official Parkinson society. Moreover, the commonest-used criteria, the UK brain bank, were created more than 25 years ago. In recognition of the lack of standard criteria, the MDS initiated a task force to design new diagnostic criteria for clinical Parkinson9s disease.
Methods/Results
The MDS-PD Criteria are intended for use in clinical research, but may also be used to guide clinical diagnosis. The benchmark is expert clinical diagnosis; the criteria aim to systematize the diagnostic process, to make it reproducible across centers and applicable by clinicians with less expertise. Although motor abnormalities remain central, there is increasing recognition of non-motor manifestations; these are incorporated into both the current criteria and particularly into separate criteria for prodromal PD. Similar to previous criteria, the MDS-PD Criteria retain motor parkinsonism as the core disease feature, defined as bradykinesia plus rest tremor and/or rigidity. Explicit instructions for defining these cardinal features are included. After documentation of parkinsonism, determination of PD as the cause of parkinsonism relies upon three categories of diagnostic features; absolute exclusion criteria (which rule out PD), red flags (which must be counterbalanced by additional supportive criteria to allow diagnosis of PD), and supportive criteria (positive features that increase confidence of PD diagnosis). Two levels of certainty are delineated: Clinically-established PD (maximizing specificity at the expense of reduced sensitivity), and Probable PD (which balances sensitivity and specificity).
Conclusion
The MDS criteria retain elements proven valuable in previous criteria and omit aspects that are no longer justified, thereby encapsulating diagnosis according to current knowledge. As understanding of PD expands, criteria will need continuous revision to accommodate these advances. Disclosure: Dr. Postuma has received personal compensation for activities with Roche Diagnostics Corporation and Biotie Therapies. Dr. Berg has received research support from Michael J. Fox Foundation, the Bundesministerium fur Bildung und Forschung (BMBF), the German Parkinson Association and Novartis GmbH.

MDS Clinical Diagnostic Criteria for Parkinson's Disease (S19.001)

https://www.mdpi.com/2076-393X/9/2/128/pdf

Medical Students and SARS-CoV-2 Vaccination: Attitude and Behaviors

Objective: The main objective of the present study was to explore the frequency of Depression, anxiety and stress among university students in Sialkot, Pakistan.
Method: Survey research method was used to collect data from three universities of Sialkot by using simple random sampling technique from 500 university students. The study was conducted at GC Women University, Sialkot in total duration of five months from February 2019 to June 2019. A demographic sheet and DASS-21 (Depression, Anxiety Stress Scale) were used to measure the level of depression, anxiety and stress. Data was scored according to the standard scoring procedure for each subscale and for further analysis frequency distribution method was applied through statistical package for social sciences (SPSS. 21).
Results: The means of Depression, Anxiety and stress are M=15.08, M=18.24 and M=19.02 respectively. The frequency of depression, anxiety and stress among university students was found 75%, 88.4% and 84.4% respectively. The findings of the study showed the prevalence of Depression within the range of normal (25%), mild (16%), moderate (35.8%), severe (14.6%) and extremely severe (8.6%). The prevalence of anxiety was found to be in the range of normal (11.6%), mild (4.4%), moderate (19.4%), severe (17.8%) and extremely severe (46.8%). Stress was normal (15.6%), mild (33.8%), moderate (35.4%), severe (13.2%) and extremely severe (2.8%).
Conclusion: It is concluded that symptoms of anxiety and stress are more prevalent with moderate to extremely severe range than depression in the current sample. These findings suggest urgent need of some preventive measures and interventions to improve the mental health of students.
doi: https://doi.org/10.12669/pjms.36.5.1873
How to cite this:Asif S, Mudassar A, Shahzad TZ, Raouf M, Pervaiz T. Frequency of depression, anxiety and stress among university students. Pak J Med Sci. 2020;36(5):971-976. doi: https://doi.org/10.12669/pjms.36.5.1873
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

/pdf/frequency-of-depression-anxiety-and-stress-among-university-2jbkmp4gda.pdf

Frequency of depression, anxiety and stress among university students.

In December 2019, an outbreak of the novel coronavirus pneumonia infection occurred in Wuhan City, Hubei Province, China, and it has received substantial attention globally. Few studies have investigated the psychological stress of students in Health University during the COVID-19 outbreak, and almost no work has attended to the influencing factors that may cause their psychological stress risk. This cross-sectional, survey-based, region-stratified study collected demographic data and mental measurement from 2,498 medical students and 1,177 non-medical students in 31 provinces from March 5, 2020, to March 10, 2020, in China. The psychological stress was measured using the Chinese Perceived Stress Scales (CPSS) under a self-design questionnaire. Sociodemographic, major characteristics, and knowledge of the novel coronavirus pneumonia were also identified as potential influencing factors of stress. The study revealed that medical students are suffering from more stress than non-medical students almost in all provinces of China. Four influencing factors including level of familiarity with the novel coronavirus, family income, major of students, and status of the intern student can be significantly related to students' stress in the medical group by using the univariate and multivariate analysis. Further analysis showed that students with low stress had a greater number of positive psychological emotions and a lower number of negative psychological emotions than with medical students with high stress. In addition, high stress caused low enthusiasm for learning in these medical students and lead to little/no willingness to do professional medical work in the future. In conclusion, we need to increase the level of our knowledge related to the novel coronavirus pneumonia to reduce stress and strongly focus on the special populations in medical students with certain features, such as intern students, clinical nursing students, and low-income families, to improve their learning attitudes and establish positive professional mental outlooks.

/pdf/effect-of-the-novel-coronavirus-pneumonia-pandemic-on-1515zzvg35.pdf

Effect of the Novel Coronavirus Pneumonia Pandemic on Medical Students’ Psychological Stress and Its Influencing Factors

The aim of this study was to assess the association between cigarette smoking and health-related quality of life (HRQoL) among students in two different universities, and the potential mediating effect of depression. Participants were students who came for mandatory check-ups at Student Health Care Centers in two Universities in Serbia, differing by socio-politically and economically environments. Students completed socio-demographic questionnaire, Beck Depression Inventory (BDI) and the SF-36 questionnaire for assessment of HRQoL. In both populations, after adjustment for socio-demographic, behavioral and health factors, smoking was associated with poorer Mental Composite Score (MCS) and Physical Composite Score (PCS) (Belgrade 1,624 students: MCS β = 3.38, 95% confidence interval [CI] 1.31, 5.44, PCS β = 1.01, 95% CI -0.50, 2.52; Kosovska Mitrovica 514 students: MCS β = 5.06, 95% CI 1.74, 8.37, PCS β = 3.29, 95% CI 0.75, 5.83). After additional adjustment for BDI score, the observed associations were lost (Belgrade: MCS β = 1.12, 95% CI -0.57, 2.80, PCS β = -0.40, 95% CI -1.71, 0.92; Kosovska Mitrovica: MCS β = 0.77, 95% CI -2.06, 3.60, PCS β = 0.56, 95% CI -1.75, 2.87). Higher BDI score was associated with poorer PCS and MCS across all quintiles. The association of smoking with impairment of HRQoL among university students in two different settings was mediated by higher levels of depressive symptoms. These findings highlight the need for further research on the interaction between smoking, mental health and quality of life, with implications for prevention, diagnosis and treatment.

/pdf/tobacco-smoking-and-health-related-quality-of-life-among-36pujauo8v.pdf

Tobacco smoking and health-related quality of life among university students: Mediating effect of depression.

Introduction

The overall environment of the medical school is often considered very stressful. It projects negative effects not only on the academic performances of medical students but also deteriorate their physical health and psychosocial wellbeing. The aim of this study was to determine the frequency of depression, stress, and anxiety among final year medical students.

Methods

This observational study was conducted in public and private medical colleges in February 2019. The instrument utilized in this study was Depression, Anxiety, and Stress Scale (DASS-21). Factors predisposing to depression, stress, and anxiety were also recorded. Data were entered and analyzed using SPSS v. 21.

Results

The mean scores of depression, anxiety, and stress were 18.00 ± 11.5, 19.15 ± 11.2, and 20.92 ± 11.2, respectively. The mean score of anxiety and stress was higher in private college students, while that of depression was higher in public college students. Overall, 57.6% of the students suffered from moderate to extremely severe depression, 74% of the students suffered from moderate to extremely severe anxiety, and 57.7% students had moderate to extremely severe stress. The common reasons to high stress and anxiety included the pressure of passing exams, the pressure of living up to family’s expectations, fear of stepping into the real world of medicine, and dissatisfaction with the administration.

Conclusion

The incidence of psychological illnesses including anxiety, stress, and depression is high among the medical students of Pakistan. Reasons predisposing the students to these illnesses must be efficiently tackled.

Depression, Anxiety, and Stress Among Final-year Medical Students

Introduction Undergraduate medical research is very important not only for scientific learning but also for career progress. However, there are barriers, especially in developing countries, that restrict undergraduate research. This study aims to evaluate the barriers experienced by medical students in conducting research at undergraduate level. Methods It was an observational, cross-sectional survey conducted with 687 clinical students of two public medical universities of Pakistan. A self-structured questionnaire consisting of seven items was administered to assess the barriers in conducting research at undergraduate level. Data was processed and analysed through SPSS v 22.0 (IBM Corp., Armonk, NY, USA). Results Lack of knowledge as a barrier was identified by 90.68% (n = 623) students. The second most common barrier identified by the students was lack of time (88.79%; n = 610), followed by lack of mentoring as the third most common barrier (85.74%; n = 572). Sub-group analysis showed that lack of knowledge, lack of mentoring, limited data base access, lack of time, and lack of finances were more crucial barriers for female gender (p < 0.05). Only lack of interest was a crucial barrier for male gender (p < 0.05). Conclusion A number of barriers need to be addressed in order to enhance students' participation in clinical research such as lack of interest, funding, and poor availability of research mentors and access to scientific databases to improve participation in clinical research. Substantial amendments in the medical undergraduate curriculum are needed.

Barriers Experienced by Medical Students in Conducting Research at Undergraduate Level.

Background
The emergence of monkeypox has presented a new challenge for health agencies around the globe. There is significant increase in the number of cases that too in non-endemic countries with more than 18000 cases reported worldwide.


Objective
The present study was conducted to assess knowledge and awareness regarding monkeypox among dental professionals.


Materials and Method
The present cross-sectional study among 410 subjects who were residing in a northern state of the country. Informed consent was obtained from all the subjects. Study sample was selected on the basis of Systematic random sampling methodology. A self-designed close-ended questionnaire written in English and verified by experts was utilized for the study. The questionnaire was delivered personally to study subjects to collect the required information. Chi-square test and ANOVA were used for statistical analysis.


Results
One-fourth (24.8%) of the subjects never heard about monkeypox disease. Negative response was given by 44.8% of subjects regarding resemblance of monkeypox with small pox. Only 31.2% of subjects had knowledge regarding oral manifestations of the disease. High knowledge scores were reported by only 28% of subjects. Higher knowledge levels were significantly related to education level and working profile of study subjects. Online media (Internet) was preferred as the main source to obtain more information by 42.2 of subjects.


Conclusion
There was low level of knowledge regarding monkeypox among study subjects. There is an urgent need for dental professionals to keep themselves updated with recent knowledge on new emerging infectious diseases.

http://wydawnictwa.pzh.gov.pl/roczniki_pzh/pobierz-artykul?id=1452

Identifying monkeypox: do dental professionals have adequate knowledge and awareness?

Background and objective Parkinson's disease (PD) is a common neurodegenerative disorder. There are various manifestations of PD. Among them, motor dysfunction has been studied in many research studies; however, few studies are available related to the dermatological manifestations of PD. This study was conducted with the aim to shed light on various skin conditions that occur in PD. Methods This cross-sectional study was conducted at a tertiary care hospital in Pakistan for a period of nine months; 107 patients with PD were included after obtaining informed consent. A self-administrated questionnaire was used to record demographic data and dermatological findings. Results Among the various dermatological manifestations, patients with PD most commonly presented with seborrheic dermatitis (46.7%) and rosacea (10.2%). Other manifestations included bullous pemphigoid (7.4%) and melanoma (4.6%). Conclusion The study revealed several dermatological manifestations of PD, which usually get overlooked by neurologists. Through this study, we want to emphasize that PD, apart from all the motor signs and symptoms, can also present as skin problems, and hence, a multi-disciplinary approach should be taken while managing PD.

Dermatological Manifestations of Parkinson's Disease: Clues for Diagnosis.

The research focuses on polyherbal antidiabetic extracts from various plants that are utilized in the management of type 2 diabetes mellitus at various doses. Ayurvedic treatment is widely accepted throughout due to their efficacy, safety, less price, ubiquity, and acceptance. Polyherbal medicines, contain glycosides, alkaloids, flavonoids, and other compounds that have unique mode of action to treat diabetes, have long been used across the world. This study was carried out to investigate the hypoglycemic effects and antihyperglycemic activity of polyherbal (PH) extract in streptozotocin (STZ)-induced diabetic rats. Along with this, the antioxidant and antihyperlipidemic activity of Polyherbal extract (PH) were also studied. Further, polyherbal tablets were formulated and evaluated. Polyherbal extract (hydroalcoholic) was tested for the hypoglycemic activity for 4 h in normoglycemic rats, oral glucose tolerance test (OGTT) (2 h), and antihyperglycemic activity (28 days) in non-diabetic and STZ-induced diabetic rats. Further, antihyperlipidemic and antioxidant activity were also studied along with histopathology and pre & post-compression tablet data. The effective antidiabetic activity was observed for PH I (400 mg/kg followed 200 mg/kg). OGTT has shown that PH I (200 mg/kg) extract is having a better glucose utilization capacity. The data also propose that PH I (400 mg/kg followed 200 mg/kg) exhibit significant and consistent hypoglycemic activity. Our findings explain that polyherbal extract in variant doses has antihyperlipidemic and antioxidant activity, which is manifested by decreasing total cholesterol, triglyceride, LDL, VLDL and MDA level. The extract also increased the HDL, SOD and reduced glutathione level in various treatment groups. The data propose that the combined extract showed a consistent and ameliorated hepatic and renal function, in the treatment groups. Polyherbal extract PH I (400 mg/kg) have manifested the most effective improvements in diabetic complications. All the pre & post-compression tablet data were within limits. The above results propose that this Polyherbal extract may be a potential source for the development of the new antidiabetic drug. The proposed activity of the polyherbal extract is supported by various biochemical and histopathologic analyses. By examining its safety and in vivo efficacy, the combination of ayurvedic components will give us a novel glimmer of hope for the lifestyle illness. 

Raj Kumari

Papers

Depression, Anxiety, and Stress Among Final-year Medical Students

Barriers Experienced by Medical Students in Conducting Research at Undergraduate Level.

Identifying monkeypox: do dental professionals have adequate knowledge and awareness?

Dermatological Manifestations of Parkinson's Disease: Clues for Diagnosis.

In-vivo Evaluation and Formulation Development of Polyherbal Extract in Streptozotocin-Induced Diabetic Rat