Journal of Gandhara Medical and Dental Science

Frequency of Indications for Transthoracic Echocardiography (Tte) in Non-Cardiac Patients in Peshawar, Pakistan

Muhammad Tariq Mehr, Muhammad Ishfaq — Mon, 01 Apr 2024 00:00:00 -0500

OBJECTIVES

This study aimed to find the frequency of indications for Transthoracic echocardiography and its impact on non-cardiac patient management in Peshawar, Pakistan.

METHODOLOGY

A cross-sectional study was conducted in Medical B Ward, Department of Internal Medicine at Hayatabad Medical Complex, Peshawar, Pakistan, over six months from July to 31st December 2020. A non-consecutive probability sampling technique was used. The sample size was calculated using an Openepi calculator, keeping 25.9 % as the frequency of requesting heart failure as an indication of echocardiography, 6.15 % as the confidence limit, and 95 % as a confidence interval.

RESULTS
A total of 195 patients were included in the study. The mean age of the patients was 483 years, with 59% females and 41% males. The major indication for TTE was assessing left ventricular systolic function in 146 (75%) patients and then finding the cause of the observed arrhythmias in 15 (7.5%) patients. A major proportion (95%) of the evaluated patients had no major change in the ongoing management plan following TTE. The working diagnosis in evaluated patients was changed by 12.7%, whereas new management plans were devised in only 4.9% of the cases.

CONCLUSION

Designing a randomized study to fully elaborate on the utility of TTE in patients admitted to acute medical wards while trying to address all confounding variables is an extremely difficult task.

Comparison of the Effectiveness of Rivaroxaban Versus Vitamin K Antagonist in Patients with Lower Limbs Deep Vein Thrombosis

Safi Ullah, Durkho Atif, Aliena Badshah, Muhammad Shadab Aslam Khan4 — Mon, 01 Apr 2024 00:00:00 -0500

OBJECTIVES

To compare the effectiveness of rivaroxaban and vitamin K antagonists in patients with lower limbs deep vein thrombosis.

METHODOLOGY

This quasi-experimental study was conducted in the Department of General Medicine in Khyber Teaching Hospital, Peshawar for six months with a sample size of sixty. Thirty patients were given Rivaroxaban (Group A) and the other thirty patients were given Vitamin K antagonist (Group B). In the Rivaroxaban group, patients had received 15mg twice daily for the first 3 weeks, 20 mg once daily from 3 weeks to 3 months, and followed by 10 mg once daily. In the Vitamin K antagonist group, patients had received a dose of warfarin of 2.5-5mg once daily, with a goal INR between 2-3. Patients were followed up for 3 months, every month and the effectiveness of both drugs was recorded.

RESULTS
Our study shows that in group A (Rivaroxaban), the mean age was 34 years with SD ± 10.77 and in group B (Vitamin K antagonist), the mean age was 36 years with SD ± 11.09. In Group A, 12(40%) patients were males and 18(60%) were females. In Group B, 11(37%) patients were males and 19(63%) were females. Moreover, group A was effective in 27(90%) patients while group B was effective in 25(83%).

CONCLUSION

Rivaroxaban is more effective than vitamin K antagonist in the treatment of lower limbs deep vein thrombosis.

Asymptomatic Bacteriuria in Pregnancy Causes and Incidence

Sadia Ali, Nafeesa Ghani, Ziad Ali, Yamna Ali — Mon, 01 Apr 2024 00:00:00 -0500

OBJECTIVES

This study aims to provide an understanding of asymptomatic bacteriuria in pregnancy by examining its frequency, causative agent, and potential strategies for detection and management.

METHODOLOGY

A cross-sectional study was conducted in the Department of Obstetrics and Gynecology, PGMI Hayatabad Medical Complex, Peshawar, from July to December 2022. The study included 117 antenatal patients with varying gestational periods attending the OPD. Patients with a history of antibiotic therapy, urinary frequency and dysuria, vaginal discharge, renal tract anomalies, and medical disorders were excluded. Demographic details were recorded, and urine samples were collected and cultured. Data was analyzed using SPSS version 22.

RESULTS
The incidence of asymptomatic bacteriuria was 25.5%, among 117 women, with E. coli (53.3%) the most common pathogen responsible for the infection, followed by Klebsiella (36.7%) and staphylococcus (10%).
CONCLUSION
Bacteriuria without causing any symptoms is quite common in pregnancy. Simple measures like screening early in pregnancy can timely detect positive cases and with targeted treatment, both maternal and neonatal morbidity can be curtailed.

Epidemiological and Clinical Characteristics of Cutaneous Leishmaniasis at District Mohmand

Mon, 01 Apr 2024 00:00:00 -0500

OBJECTIVES

This study aims to determine Cutaneous Leishmaniasis’s epidemiological and clinical characteristics (CL) in the Mohmand district.

METHODOLOGY

This descriptive cross-sectional study was conducted at District Headquarters (DHQ) Ghallanai, District Mohmand, involving 360 patients with cutaneous Leishmaniasis. Individuals with coinfections or other skin diseases were intentionally excluded. Data, including gender, age, socio-economic status, size, site, and number of lesions, were recorded. CL was compared among age groups, gender, and socio-economic status using the chi-square test.

\RESULTS
The mean age was 10.72 ± 5.94 years, with 137 (38.06%) females and 223 (61.94%) males. Most patients suffering from CL had a low socio-economic status (n=175, 48.61%), followed by the middle (n=126, 35%). A minority reported a habit of sleeping on the ground (n=43, 11.94%). About 53 (14.72%) had multiple lesions. The location of lesions varied, with 66 (18.33%) on the arm, 229 (63.61%) on the head, neck, and face, and 65 (18.06%) on the leg. The association of the number of lesions (p=0.61), size of the lesion (p=0.47), and location of the lesion (p=0.27) was not statistically significant. Multiple lesions of CL were more common in the low socio-economic group (n=30, 56.6%) than in the middle (n=10, 18.8%) and high-class (n=13, 24.6%) groups, and the results were statistically significant (p=0.019). Most lesions were on the head, neck, and face, with the highest percentage in the low socio-economic group (66.86%). The rate of lesions on the leg was highest in the middle socio-economic group (19.84%), followed by the low (12.57%) and high (30.51%) groups. The differences in location were statistically significant (p=0.032).

CONCLUSION

Cutaneous Leishmaniasis (CL) disproportionately affects children, particularly males and those with lower socio-economic status. We observed a notable link between lesion characteristics and socio-economic status.

Comparative Analysis of Focused Assessment with Sonography for Trauma (Fast) and Computed Tomography (Ct) for Renal Injury Detection in Trauma Patients

Nida Rabbani, Humaira Anjum, Samia Iftikhar — Mon, 01 Apr 2024 00:00:00 -0500

OBJECTIVES

This study aimed to evaluate the diagnostic accuracy of Focused Assessment with Sonography for Trauma (FAST) in detecting renal injuries compared to computed tomography (CT) as the gold standard.

METHODOLOGY

This cross-sectional study was conducted from 2022 to 2023 at the Department of Radiology, Khyber Teaching Hospital, Peshawar. The sample size was 139. The sonographic examination and computed tomography were performed.

RESULTS
The mean age was 38 years ± 13.81. 100(72%) patients were male while 39(28%) were female. FAST had a sensitivity of 85%, specificity of 57.14%, positive predictive value of 97.42%, negative predictive value of 16.66%, and diagnostic accuracy of 83.61%.

CONCLUSION

FAST has reasonable sensitivity, specificity, and accuracy for detecting free fluid in traumatic renal injury patients.

Comprehension of Long-Term Medications in Patient with Type 2 Diabetes Mellitus: A Kap Study

Mon, 01 Apr 2024 00:00:00 -0500

OBJECTIVES

The study aimed to assess the comprehension of long-term medications in patients with Type 2 diabetes mellitus.

METHODOLOGY

A descriptive cross-sectional study was conducted in Khyber Teaching Hospital Peshawar, Pakistan, a region with potentially low literacy rates that could affect health outcomes. After acquiring approval from the Institutional Ethical Review Board, the study utilized an appropriately designed and validated questionnaire to collect data from 305 willing participants. The questionnaire assessed demographic information, comorbid conditions, and comprehension of long-term medications.

RESULTS
The mean age of the patients was 58.52 ± 10.3 years, with a mean HbA1c of 9.15 ± 2.1%. Regarding T2DM treatment, 55.1% used oral anti-diabetic agents, 34.4% used insulin, and 10.2% used both. The complications were diabetic retinopathy (40.7%), chronic kidney disease (28.9%), diabetic foot ulcers (24.9%), cerebrovascular disease (16.7%), and cardiovascular disease (16.6%). Over 50% had T2DM for more than five years. Regarding affordability and access to healthcare, 8.2% couldn't afford medications, 44.9% occasionally missed medicines due to cost, and 74.4% had easy access to healthcare. Comorbidities included hypertension (47.5%) and dyslipidemia (12.8%).

CONCLUSION

Medication comprehension is crucial for T2DM patients’ health outcomes. Tailored interventions can improve glycemic control and reduce complications risk.

Medical Disorders in Pregnancy Among Inpatients at a Tertiary Level Hospital of Peshawar (Khyber Pakhtunkhwa)

Rubina Akhtar, Rukhsana Karim, Nasreen Kishwar, Saba Safdar — Mon, 01 Apr 2024 00:00:00 -0500

OBJECTIVES

This study aimed to determine the prevalence, type, and demographic makeup of pregnancy-related medical conditions among patients receiving treatment in a tertiary care facility.

METHODOLOGY

The Monocentric retrospective impact study was conducted in the Department of Obstetrics and Gynaecology of MTI, Hayatabad Medical Complex Peshawar, from January to December 2022. Case records of all pregnant women (n=1811) with previous or recently developed medical conditions treated during the study period were collected from the records / medical registers, and all the information was recorded in a pre-structured proforma. All women with previous or recently developed medical conditions treated during the study were included. All pregnant women without any medical conditions were excluded. Data was analyzed using simple statistical measures, and the results were presented as frequency percentages. Prior approval from the institution’s ethical committee was obtained to conduct the study.

vRESULTS
Among 6327 antenatal admissions, 1811 (28.62%) women had medical disorders. The most common medical disorder was PIH, reported in 384 (21.20%) of the females, followed by RH incompatibility and Gestational Diabetes Mellitus (GDM) seen in 235 (12.98%) and 205 (11.32%) females, respectively. Other notable medical conditions include UTI in 170 (9.39%), Chronic HTN in 134 (7.40%), iron deficiency anemia in 122 (6.74%), and pre-eclampsia in 100 (5.52%) of women.

CONCLUSION

Pre-existing medical conditions in pregnancy are not uncommon. Early recognition of acute illness and treatment of chronic conditions in pregnancy is of clear benefit and needs to be managed to arrest any adversaries to the mother and fetus.

The Future Career Choices of Pre-Registered House Officers and House Surgeons: a Multicenter Study

Mon, 01 Apr 2024 00:00:00 -0500

OBJECTIVES

This study aimed to determine the future preferences of house officers when choosing a medical speciality.

METHODOLOGY

The cross-sectional study was conducted from January to June 2023 at three teaching hospitals in Abbottabad. 250 participants were selected as the study sample. The data was collected from house officers on a predesigned, self-structured written questionnaire. The data was analyzed using SPSS version 21.

RESULTS
Of 250 individuals, 224 met inclusive criteria; 65% (146) were male and 35% (78) were female. The mean age was 25 years ±1.01. The first preference of the house officer was medicine (44% (100), the second was surgery (31.5%) (70), and the third was obstetrics and gynaecology. Among medicine specialities, only 0.9% (02) opt endocrinology and gastroenterology, while among surgical specialities, 0.4% (01) opt urology and 0.9% (02) opt neurosurgery. 150 individuals (70%) planned residency in the future, among whom 47% (106) set a caveat for residency abroad. The most favourite place abroad was the UK, with 42% (45/106). 180 house officers (80%) are satisfied with their academic abilities.

CONCLUSION

The study revealed that house officers have no awareness of new specialities and are least interested in specialities like endocrinology, gastroenterology, neurosurgery, and urology. In contrast, no influence was noted toward specialities like haematology, public health and community medicine. Most students are satisfied with their medical education but plan to do their residency abroad.

Investigating Post-Menopausal Characteristics and Perceptions of the Menopausal Transition

Saadia Shamsher, Shakeela Wahab, Syeda Sitwat Fatima — Mon, 01 Apr 2024 00:00:00 -0500

OBJECTIVES
This study aimed to investigate the knowledge and perceptions of menopause among post-menopausal women.
METHODOLOGY
A descriptive cross-sectional study was conducted at Hayatabad Medical Complex, Medical, and Teaching Institute Peshawar from March 2022 to March 2023. Participants meeting the inclusion criteria were assessed using a semi-structured proforma covering demographic variables, knowledge, and attitudes toward menopause. Delving into knowledge and perceptions of menopause, the questionnaire probed participants about their awareness of menopause upon cessation of menstrual periods, knowledge of the age of menopause, understanding of menopausal symptoms, whether they perceived menopause as a disease, medical condition, or a natural process, and their opinions on the treatment of menopausal symptoms.
RESULTS
In a survey assessing menopausal characteristics and perceptions, 81% of women experienced natural menopause and 19% underwent surgical menopause. 85% had prior knowledge of menopause, but only 45% knew its typical onset age. 56% held a positive perception of menopause. Hot flashes and mood swings were reported by 55% of women, while 48% experienced insomnia.
CONCLUSION
Many post-menopausal women are not aware of menopausal symptoms. Tailored health education and comprehensive support are necessary to address knowledge disparities and provide holistic care for women in this transition.

Assessment of Patient Satisfaction with the Pre-Operative Anesthetic Evaluation; an Observational Study

Mon, 01 Apr 2024 00:00:00 -0500

OBJECTIVES

This study aimed to determine patient satisfaction with the pre-operative anaesthetist visit.

METHODOLOGY

A cross-sectional study was conducted from March to September 2023. All consecutive elective patients operated under anaesthesia during the study period were interviewed 24 hours after the operation. Data were collected by the Leiden peri-operative patient satisfaction questionnaire (LPPSq) within 24 hours postoperatively. SPSS 26 version was used for data analysis. The chi-square test was used to compare pre-operative visits and patient satisfaction.
RESULTS
230 elective patients were operated upon under anaesthesia during the study period. Among all sections, the Fear and concern factor has the highest Cronbach alpha, 0.942. almost half of the patients aged 26-35 (42.2%) were female (56.3%), Class I in ASA physical status (50.2%), and living in a rural area (64.9%). For occupation, the majority of respondents were unemployed (89.2%). In addition, more than half of the respondents received general anaesthesia (60.6%). The most frequent procedure type was the gynaecology procedure (38%). Regarding an anaesthetist's visit, most respondents received a pre-operative anaesthetist visit (89.6%) and an anaesthetist approach (73.6%). However, the majority didn't receive adequate information, didn’t have a chance to choose the type of anaesthesia, and didn’t have an opportunity to ask a question, with percentages of 68%, 90%, and 95.2%, respectively. A significant and strong association existed between patient satisfaction and pre-operative anaesthetist visits (P<0.000).

CONCLUSION

Patient satisfaction with the pre-operative anaesthetic evaluation was the same compared with the Royal College of Anaesthetists standards. There is an association between pre-operative anaesthetist visits and patient satisfaction. Pre-operative anaesthetic evaluation should be emphasized.

The Factors Impacting Decision-Making for Breast Reconstruction in Women Following Mastectomy: A Cross-Sectional Study

Mon, 01 Apr 2024 00:00:00 -0500

OBJECTIVES

This study aimed to assess the Factors Impacting Decision-Making for Breast Reconstruction in Women Following Mastectomy in Combined Military Hospital, Rawalpindi

METHODOLOGY

This prospective cross-sectional study was conducted at a specialized Breast Clinic in the Combined Military Hospital Rawalpindi from January to June 2023. The sampling technique was non-probability sampling. A total of 56 female patients between the ages of 20-70 years with a histological diagnosis of carcinoma breast and undergoing mastectomy as part of their breast cancer therapy were included in the study. Patients who had metastatic cancer or connective tissue disorder were excluded from the study. After getting informed written consent, data was collected from patients. A semi-structured questionnaire was used as a study tool. Data was presented in the form of tables.

RESULTS
The surgical preference of 56 patients was studied. Only 11(19.6%) patients opted for breast reconstruction. A total of 45(80.4%) patients refused to undergo BR. Several factors affecting the decision not to have BR were identified. They included fear of recurrence in 07 (15.5%) patients, long surgical procedures in 06 (13.3%), lack of concern regarding body image in 11(24.4%), financial issues in 13 (28.8%) patients, unsatisfactory results of breast reconstruction in 8 (17.7%) patients who had lack of trust in plastic surgeon regarding their post reconstruction breast shape.

CONCLUSION

This study laid the conceptual groundwork that factors like fear of recurrence, long surgical procedures, disregard for body image, poverty, and plastic surgeon distrust negatively influence the likelihood of having post-mastectomy breast reconstruction (PMBR).

Methods: From January 2023 to June 2023, this cross-sectional study, carried out at a specialized Breast Clinic in the Combined Military Hospital Rawalpindi, sought to explore surgical preferences for breast reconstruction (BR) among breast carcinoma patients undergoing mastectomy and to identify factors influencing these decisions. 42 patients in all were enrolled, 8 of them selected breast reconstruction while 34 did not. The decision-making process was influenced by a number of issues, such as worry about recurrence, worries about time-consuming surgical procedures, and disregard for body image, financial limitations, and previous unsuccessful reconstructive results.

Results: 28 patients had right-sided disease, 13 had left-sided cancer, and 1 had bilateral involvement, according to disease features. Furthermore, 25 individuals had N0 disease, while 17 had N1 disease, according to nodal staging. Six patients had sentinel lymph node biopsy (SLNB), two underwent axillary lymph node dissection (ALND), five chose upfront surgery, and three underwent neoadjuvant therapy before surgery, demonstrating the range of the surgical methods used.

Conclusion: This study provides insightful information about the complex decision-making process involving breast reconstruction in individuals with breast cancer. The identified characteristics give healthcare professionals a framework on which to build strategies that guarantee patients receive educated and individualized care, thereby improving patient happiness and quality of life in general.

Key words: breast, tumor, surgery, lymph node, reconstruction, aesthetic

Comparison between Outcomes of Open and Arthroscopic Fixation of Tibial Spine Avulsion Fractures

Mon, 01 Apr 2024 00:00:00 -0500

OBJECTIVES

This study aimed to compare the functional outcomes of fragment reduction and to measure the rate of postoperative complications between arthrotomy (ORIF) and arthroscopy(ARIF) pediatric tibial spine avulsion fractures using the Lysholm knee scoring system (limp, pain swelling, climbing stairs) and IKDC subjective knee evaluation form.

METHODS:

This Comparative Study was conducted at the Department of Orthopedic Surgery, Jinnah Hospital Lahore, between 2021-2022. A total of 42 patients who had tibial spine avulsion fracture with follow-up of 6 months were included. Twenty-one patients were treated with ORIF, and 21 were treated with ARIF. Functional outcomes were assessed using the IKDC score and LYSHOLM score (Follow-up rate was 95 %). Radiographic findings of patients were recorded, and a statistical study was done. The level of significance was set at <0.05.

RESULTS: The study revealed that out of 42 Participants, 36(85.71%) males and 6 (14.29 %) females participated in the survey with the age range of 8-16 years with a mean age of 12.02± (2.53) years. Out of 42 Participants, 22 (52.4%) had motor vehicle accidents with type 3(38.1%) and 4(54.8%) modified Meyers and Mckeever fracture classification. At the end of the follow-up period, the mean IKDC score was 90.52 + 1.50 (p = 0.00, CI = 95%). The Lysholm score was 90.676.11 compared to the last follow-up (p=0.20, CI = 95%). Compared to ORIF, only 5(11.9%) patients complained of post-op infection or vascular injury.

CONCLUSION: This study observed better functional outcomes in arthroscopic reduction and immobilization than in open reduction internal fixation. Arthroscopy for TSAF decreases the risk of arthrofibrosis and minimizes morbidities and better management of symptoms. Compared to OIRF, ARIF showed good content validity for the IKDC and Lysholm scales.

Role of Case-Based Discussion as Workplace-Based Assessment Tool in Urology and General Surgery

Shimee Shahzadi, Muhammad Shah, Liaqat Ali, Humera Adeeb, Brekhna Jamil — Mon, 01 Apr 2024 00:00:00 -0500

OBJECTIVES

To determine the effectiveness of case-based discussion in terms of medical record-keeping, clinical reasoning, clinical judgment, and self-reflection in the management of patients.

METHODOLOGY

A multidisciplinary descriptive study was conducted in the Department of Urology Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar, and Department of General Surgery, Hayatabad Medical Complex Peshawar, Pakistan, from January to December 2023. A total number of 20 postgraduate residents, ten from Urology and General Surgery, participated in the study with equal male and female participants. Case-based discussion (CBD) assessments focused on medical record-keeping, clinical Decision-making, clinical judgment, management, follow-up, and reflective writing. The data was collected on structured proforma and was analyzed on SPSS-25.

RESULTS
The total number of study participants was 20, and 410 Case-Based Discussion sessions were conducted. This constitutes an average of 4.8 assessments per week. Most encounters were related to medical clinical decisions and management. The case-based discussion showed significant improvement on the Likert scale of the supervisor’s rating, which extended over four quarters on all major parameters of formative assessment (p 0.001). The multimodal regression test showed significant enhancement in learning parameters on case-based discussions. R2=0.172 F ration=25.141 n=410 (p=0.001). There was no significant difference in the gender of residents as well as training specialty of residents of urology and general surgery (p >0.05).

CONCLUSION

A case-based discussion is an effective tool for formative assessment of Urology and General Surgery postgraduate residents.

COVID 19- Biochemical and Other Mechanisms associated with Neuropathy and Stroke.

Loung V Umedani, Quratulain Javaid — Mon, 01 Apr 2024 00:00:00 -0500

The Coronavirus (SARS-C0V-2) caused COVID 19 disease, commencing from China in December 2019 and soon in 2020 its neurological manifestations were noted. The viral spike (S) protein binding with host cell receptor angiotensin-converting enzyme 2 (ACE2) with assistance of membrane fusion protease (TMPRSS) caused viral entry in host cells. We searched 47 articles using PubMed from January 2021 to January 2023. The initial pooling of virus in nasal mucosa was followed by spread to respiratory and other tissues. This review highlights the neuropathy and stroke mechanisms. The role of receptors, enzymes, proteins and genes in neuropathological mechanisms are highlighted. Vascular endothelial effects, choroid plexus and Blood Brain Barrier disruptions were noted. The epigenetic neuropathological mechanisms need to be explored further to help in designing new therapeutic modalities. The post vaccination neurological manifestations as well as the post COVID effects both need further attention to promptly diagnose and start timely treatment.

Systemic Juvenile idiopathic arthritis in child complicated by amyloidosis with secondary nephrotic syndrome

Syed Sajid Hussain Shah, Bibi Aalia — Mon, 01 Apr 2024 00:00:00 -0500

A 7 years old girl diagnosed as case of juvenile idiopathic arthritis since the age of 1.5 years, generalized onset with systemic presentation is complicated by secondary nephrotic syndrome. Renal biopsy showing amyloidosis. Patient has severe disease course being complicated by sever flare ups of disease symptoms and body swelling. Since onset of disease patient got NSAIDs, methotrexate, steroids, anti TNF inhibitors with no or partial response. After diagnosis with secondary nephrotic syndrome due to secondary amyloidosis patient is started on intravenous tocilizumab. There is improvement of patient symptoms.

Navigating the Storm: Coping with Conflict and Political Change for Mental Health Resilience

Wajiha Qamar — Mon, 01 Apr 2024 00:00:00 -0500

The severe impact of conflicts-which often occur in chaotic and unstable environments-has on mental health, both for people and communities. South-East Asia incurs a disproportionately significant invisible cost to mental health due to persistent political instability, global conflicts, and terrorism.1 These events may induce anxiety and stress, which may culminate in an array of mental health issues, including depression, post-traumatic stress disorder (PTSD), and generalized anxiety disorders. These circumstances are rendered more catastrophic by the continuous threat of violence, displacement, and loss, which makes it challenging for people to retain their resilience in terms of mental health. For example, the prolonged conflict in Kashmir has had a significant impact on people’s mental health in the region.2 Several psychological wounds are the result of sustained violence and uncertainty. Similarly, millions of people in the region have experienced suffering and grief because of terrorism and political unrest.2 Communities impacted by these crises in these areas have a cumulative strain on their mental health.3 The general well-being of these communities is declining due to various factors, including increased stress levels, restricted access to healthcare, and an atmosphere of uncertainty.4 The visible psychological impact on people and their neighbours underscores the importance of acknowledging the broader implications of these crises on mental health.

To develop and maintain mental health resilience amid these challenges, people must learn coping mechanisms.5 Recognizing the seriousness of this issue is crucial, but so is offering those impacted resources and assistance. Numerous therapies and coping mechanisms may be helpful. Teaching individuals about the psychological consequences of political unrest and violence is one of academia’s most essential roles. Academic institutions may reduce stigma, increase awareness, and encourage people to seek assistance by conducting research and implementing educational programmes.6 To assist people and communities in overcoming trauma and developing resilience, mental health practitioners can provide psychosocial interventions like counselling and therapy.7 For those impacted, establishing support systems within communities may be a beneficial resource. These networks may allow people access to mental health experts and a safe atmosphere to discuss their feelings and experiences. Mental health professionals can conduct workshops on resilience building, and these sessions can offer valuable strategies and skills to improve psychological resilience in the face of hardship.8 Access to Services for Mental Health is imperative for governments and non-governmental organizations to guarantee that mental health treatments are easily accessible to individuals who require them.9 This involves encouraging the education and placement of mental health specialists in conflict-affected regions. Understanding and resolving the mental health issues brought on by political unrest and violence are critical tasks for academia. Research in this area is crucial to clarify the intricate relationship between political instability and mental health. Scholars can make the following contributions: Research and Data Analysis: Academic institutions might research to understand better the psychological impacts of political unrest and violence in Pakistan and South-east Asia.10 We can determine patterns and risk factors by gathering information and examining the mental health conditions of impacted groups. Policy Recommendations: Based on their research, academia might advocate policies to facilitate better access to mental health care in places affected by violence.11 When tackling the mental health problem, countries and international organizations can follow these guidelines. Public Awareness Initiatives: To de-stigmatize mental health concerns and motivate people to seek therapy, academia may initiate public awareness initiatives. Advertisements might also inform the public about the distinct symptoms and signs of diseases linked to trauma. Training and Capacity Building: Educational establishments have the potential to provide instruction to mental health professionals who can work in areas of conflict. The training may concentrate on culturally aware methods and the difficulties brought on by trauma associated with conflicts.9

There cannot be denying the relationship between political unrest, global conflicts, and terrorism and the impact they have on mental health. These situations have a profound impact on people and communities, frequently resulting in severe mental health problems. In addition to academia’s active participation, coping methods and treatments can assist in lessening these difficulties and support individuals who require it. Prioritizing mental health as the foundation of resilience is crucial as we address the ongoing conflicts in these areas. To address this critical issue and ensure that people and communities can manage the storm of political transition with their mental health, academic research, community support, and government policy must collaborate.