Zul Merali

Ottawa University · Faculties of Social Sciences and Medicine

Background Alzheimer’s disease is a neurodegenerative disease that affects patients’ ability to perform activities of daily living thus requiring assistance from their loved ones. The progressive nature of the disease unravels new and continuous challenges for the caregivers posing a huge burden on caregiving. However, there is little research in S...

Background Population growth and an increase in the number of Africans who survive to old age puts them at a higher risk of developing neurodegenerative diseases such as dementia and Alzheimer’s. Little research has been conducted on community knowledge and perceptions of dementia in rural settings in Kenya. Method Community health volunteers, hea...

Background The Global Dementia Action Plan 2017‐2025 specifies key targets, with an emphasis on building research infrastructure and capability across the Global South. However, to date, only 0.1% of total research in Africa constitutes dementia research, the lowest volume of all LMIC regions. Several biomarker and risk models of the preclinical an...

Background With a shortage of mental health specialists and a significant rural population in Pakistan, leveraging community-based healthcare workers becomes crucial to address mental health needs. Equipping the healthcare workers with digital tools such as mobile applications have the potential to increase access to mental health support in low-re...

Background Health-related Quality of life (HRQoL) assessment is essential for optimizing patient care, treatment adjustments, and medical decision-making, particularly in post-Myocardial Infarction (MI) patients, but limited data exists on HRQOL post-MI from Pakistan. This study aimed to assess HRQoL and its determinants in the Pakistani population...

Background There is limited evidence that interventions for improving mental well-being can be integrated sustainably into primary health care in Pakistan. We aimed to pilot ‘mPareshan digital intervention’ locally, adapted from WHO mhGAP and delivered by trained and supervised women lay workers to learn if it was feasible and possibly effective in...

Background The risk of dementia, including the most common form, Alzheimer's disease, is forecasted to increase in low- and middle-income countries due to longer lifespans and the rising prevalence of non-communicable diseases. However, little research has been conducted on the knowledge and perceptions about dementia in rural communities in Kenya...

Background In low- and middle-income countries (LMICs), four out of five people with mental illness do not receive specialized treatment. Utilizing non-specialist frontline workers to deliver basic mental health services at the community level therefore needs to be explored. Aims This study assessed improvement in knowledge and skills of frontline...

Dementia prevention in Africa is critically underexplored, despite the continent's high prevalence of modifiable risk factors. With a predominantly young and middle‐aged population, Africa presents a prime opportunity to implement evidence‐based strategies that could significantly reduce future dementia cases and mitigate its economic impact. The m...

Optimal brain health is essential to smoothing major global skill-intensive economic transitions, such as the bioeconomy, green, care economy and digital transitions. Good brain health is vital to socio-economic sustainability, productivity and well-being. The care transition focuses on recognizing and investing in care services and care work as es...

Diagnosing Alzheimer's disease (AD) poses significant challenges to health care, often resulting in delayed or inadequate patient care. The clinical integration of blood‐based biomarkers (BBMs) for AD holds promise in enabling early detection of pathology and timely intervention. However, several critical considerations, such as the lack of consist...

Blood‐based biomarkers (BBM) for Alzheimer's disease (AD) are being increasingly used in clinical practice to support an AD diagnosis. In contrast to traditional diagnostic modalities, such as amyloid positron emission tomography and cerebrospinal fluid biomarkers, BBMs offer a more accessible and lower cost alternative for AD biomarker testing. Th...

Community engagement (CE) has increasingly been recognized as a critical element for successful health promotion and intervention programs. However, the term CE has been used to mean different things in different settings. In this article, we explore how CE has been conceptualized in the field of mental and brain health in Kilifi County, Kenya. We...

Background With a shortage of mental health specialists and a significant rural population in Pakistan, leveraging community-based healthcare workers becomes crucial to address mental health needs. Equipping the healthcare workers with digital tools such as mobile applications have the potential to increase access to mental health support in low-re...

Background: The increasing emergencies and humanitarian challenges have worsened the mental health condition of women in the Eastern Mediterranean Region. Aim: To assess the prevalence, determinants and interventions to address mental health among women in fragile and humanitarian settings in the Eastern Mediterranean Region. Methods: Using th...

Background: Quality of life (QoL) assessment is essential for optimizing patient care, treatment adjustments, and medical decision-making, particularly in post-Myocardial Infarction (MI) patients, but limited data exists on QOL post MI from Pakistan. This study aimed to assess Quality of Life (QoL and its determinants in the Pakistani population. M...

Background Multimodal interventions targeting modifiable disease‐associated risk factors may support large‐scale population brain health. The landmark Finnish‐Geriatric‐Intervention‐Study‐to‐Prevent‐Cognitive‐Impairment‐and‐Disability(FINGER) demonstrated improvements in cognition and health outcomes 2‐years post‐intervention. Researchers now seek...

BACKGROUND There is a dearth of specialized mental health workforce in low- and middle-income countries. In the presence of huge treatment gaps, the feasibility of utilizing frontline community workers to promote mental well-being needs to be explored. OBJECTIVE To assess the feasibility, acceptability, and usefulness of an app-based counselling i...

Background There is a dearth of specialized mental health workforce in low- and middle-income countries. Use of mobile technology by frontline community health workers (CHWs) is gaining momentum in Pakistan and needs to be explored as an alternate strategy to improve mental well-being. Objective The aim of this study is to assess the feasibility,...

Objective This study proposes to identify and validate weighted sensor stream signatures that predict near-term risk of a major depressive episode and future mood among healthcare workers in Kenya. Approach The study will deploy a mobile application (app) platform and use novel data science analytic approaches (Artificial Intelligence and Machine...

The technical advisory group of the World Health Organization (Geneva, Switzerland) has suggested person-centered and community-based mental health services in response to the long-term and far-reaching mental health impacts of the COVID-19 pandemic. Task shifting is a pragmatic approach to tackle the mental health treatment gap in low- and middle-...

Mental illnesses can impact anyone. However, those who suffer from mental ill health can face stigma contributing to a barrier in help-seeking behaviour. The Brain and Mind Institute, at the Aga Khan University (BMI AKU) aims to create a small ‘army’ of mental health ambassadors for mental health awareness, identification, and referral for those in...

Background: Interventions targeting combined sexual and reproductive health, Human Immunodeficiency Virus (HIV) management and mental health care in sub-Saharan Africa (SSA) are few. There is a need to address common determinants of poor mental, psychosocial and sexual and reproductive health and rights (SRHR) through multimodal and multipronged i...

Objective: This study proposes to identify and validate weighted sensor stream signatures that predict near-term risk of a major depressive episode and future mood among healthcare workers in Kenya. Approach: The study will deploy a mobile app platform and use novel data science analytic approaches (Artificial Intelligence and Machine Learning) to...

Background Adolescent parenthood can be associated with a range of adverse outcomes for young mothers such as depression, substance abuse, and posttraumatic stress disorder. Identification of depression and understanding risk factors among pregnant adolescents is important for development of appropriate interventions and programs focused on adolesc...

In South Africa, men were traditionally eligible to receive government pensions at 65 years. However, that eligibility criterion was changed in 2008 to allow men to receive a pension payout at 60 years. This study is designed to quantify the impact of the 2008 pension reform on mental health outcomes (depression and traumatic stress) and deaths amo...

It is now widely acknowledged that low- and middle-income countries in Africa are among global hotspots for high vulnerability to climate change, despite making comparatively low contributions to this phenomenon. Climate change has been shown to affect mental health as a result of disruption of social and economic structures that populations depend...

The first aim of the present review is to provide an in-depth description of the cannabinoids and their known effects at various neuronal receptors. It reveals that cannabinoids are highly diverse, and recent work has highlighted that their effects on the central nervous system (CNS) are surprisingly more complex than previously recognized. Cannabi...

A novel botanical dietary supplement, formulated as a chewable tablet containing a defined mixture of Souroubea spp. vine and Platanus spp. Bark, was tested as a canine anxiolytic for thunderstorm noise-induced stress (noise aversion). The tablet contained five highly stable triterpenes and delivered 10 mg of the active ingredient betulinic acid (B...

Background: Souroubea sympetala Gilg. is a neotropical vine native to Central America, investigated as part of a targeted study of the plant family Marcgraviaceae. Our previous research showed that extract of S. sympetala leaf and small branch extract had anxiolytic effects in animals and acts as an agonist for the GABAA receptor at the benzodiazep...

Background: Δ9-Tetrahydrocannabinol (THC, a CB1 receptor agonist) and Cannabidiol (CBD, a non-competitive antagonist of endogenous CB1 and CB2 ligands) are two primary components of Cannabis species, and may modulate fear learning in mammals. The CB1 receptor is widely distributed throughout the cortex and some limbic regions typically associated w...

Background: Δ9-Tetrahydrocannabinol (THC, a CB1 receptor agonist) and Cannabidiol (CBD, a non-competitive antagonist of endogenous CB1 and CB2 ligands) are two primary components of Cannabis species, and may modulate fear learning in mammals. The CB1 receptor is widely distributed throughout the cortex and some limbic regions typically associated w...

Background: Abnormalities in heart rate during sleep linked to impaired neuro-cardiac modulation may provide new information about physiological sleep signatures of depression. This study assessed the validity of an algorithm using patterns of heart rate changes during sleep to discriminate between individuals with depression and healthy controls....

Context: Depressive symptoms are highly prevalent and cause substantive morbidities and loss of functioning among employees. Depression may be prevented at its early stages. However, there is a paucity of information regarding indicated preventive interventions for depression among employees. The objective of this review is to examine the effectiv...

A new anti-anxiety dietary supplement was developed for the animal health market, by combining 2 triterpene containing botanicals, Souroubea sympetala (Marcgraviaceae) with Platanus occidentalis (Platanaceae) A validated method for a quality control of the botanical blend was achieved using HPLC-APCI-MS. The method resulted in the detection and qua...

Selective serotonin (5-HT) reuptake inhibitors (SSRIs) are first-line antidepressants but require several weeks to elicit their actions. Chronic SSRI treatment induces desensitization of 5-HT1A autoreceptors to enhance 5-HT neurotransmission. Mice (both sexes) with gene deletion of 5-HT1A autoreceptors in adult 5-HT neurons (1AcKO) were tested for...

The juvenile period is marked by a reorganization and growth of important brain regions including structures associating with reward seeking behaviors such as the nucleus accumbens (NA) and prefrontal cortex (PFC). These changes are impacted by stressors during the juvenile period and may lead to a predisposition to stress induced psychopathology a...

The 5-HT1A autoreceptor mediates feedback inhibition of serotonin (5-HT) neurons, and is implicated in major depression. The human 5-HT1A gene (HTR1A) rs6295 risk allele prevents Deaf1 binding to HTR1A, resulting in increased 5-HT1A autoreceptor transcription. Since chronic stress alters HTR1A methylation and expression, we addressed whether recrui...

Ethnopharmacological relevance: The Maya have traditionally used copal, Protium copal, as incense during ceremonies since pre-Columbian times. Anecdotally, copal (when burned as incense), is thought to elicit mentally uplifting and calming effects. The main objective of this study was to determine whether the incense elicits anxiolytic-like behavi...

Background: Gastrin Releasing Peptide (GRP) may play a role in fear learning. The GRP Receptor is expressed in the basolateral amygdala and hippocampus, and central administration of GRP mediates fear learning. The effects of GRP on reconsolidation, however, have been minimally explored. Reconsolidation, the process by which formed memories are re...

Freud-1/Cc2d1a represses the gene transcription of serotonin-1A (5-HT1A) autoreceptors, which negatively regulate 5-HT tone. To test the role of Freud-1 in vivo , we generated mice with adulthood conditional knock-out of Freud-1 in 5-HT neurons ( cF1ko ). In cF1ko mice, 5-HT1A autoreceptor protein, binding and hypothermia response were increased, w...

As part of our ongoing research into botanical therapies for anxiety disorders, the neotropical vine Souroubea sympetala was chosen for study as a phytochemical discovery strategy focusing on rare Central American plant families. When orally administered to male Sprague-Dawley rats, the crude plant extract, its ethyl acetate fraction, supercritical...

Appreciable evidence suggests that perturbations within the gut microbiome and the immune system may play a key role in the pathogenesis of depression stemming from earlier stressful experiences. In the present investigation we examined whether microbial changes in cecum contents were associated with social avoidance behaviors, a feature of depress...

In adult rats, access to a palatable diet can buffer against the effects of stressors. Approximately 10% of all adolescents are repeatedly victimized by their peers raising the possibility that palatable food consumption may be relevant to this developmental window. This study assessed the long-term impact of juvenile social defeat exposure on anxi...

Rhodiola rosea is a plant with adaptogenic qualities used by Inuit populations of Nunavik, Quebec (Canada) for general mental and physical rejuvenation. Previous studies have demonstrated that the Canadian populations of R. rosea significantly attenuate the expression of learned fear and anxiety-like behaviors in rodent models. In order to further...

Background: Major depression is a prevalent mental disorder and imposes considerable burden on health and productivity. Men are not immune to major depression, yet they often delay seeking help because of perceived stigma and gender norms. E-mental health programs hold potential for early prevention of major depression. However, we have little kno...

One in 3 of us will experience mental illness in our lifetime, and yet the current treatments as well as the development of new strategies haven’t been overly encouraging.1 In economically developed countries mental illness exerts an enormous social and economic toll; in Canada, for instance, more than 500 000 people will not go to work daily owing...

Cognitive behavioral group therapy (CBGT) has been reported to be more effective than a mindfulness-based stress reduction program (MBSR) in reducing symptoms of social anxiety disorder (SAD). The present study determined whether CBGT and MBSR differentially affected subjective anxiety and physiological response to a stressful speaking task. The sa...

Ethnopharmacological relevance: The medicinal plant, Piper amalago L. (Piperaceae), is used traditionally by Q'eqchi' Maya healers for the treatment of "susto,"a culture-bound syndrome. Previous research suggests that susto symptoms may be a manifestation of anxiety. The objectives were to characterize the effect of ethanolic extract of P. amalago...

The intranasal route of drug administration has gained increased popularity as it is thought to allow large molecules, such as peptide hormones, more direct access to the brain, while limiting systemic exposure. Several studies have investigated the effects of intranasal oxytocin administration in humans as this peptide is associated with prosocial...

Considerable evidence supports the view that depressive illness and suicidal behaviour stem from perturbations of neuroplasticity. Presently, we assessed whether depressed individuals who died by suicide displayed brain region-specific changes in brain derived neurotrophic factor (BDNF) and whether such effects varied by gender. Using postmortem sa...

Objectives: The polyphenol resveratrol has shown regulatory effects on hippocampal neurogenesis, which according to the neurovascular niche hypothesis, is likely to involve stimulation of angiogenesis. In rodents, global cerebral ischemia leads to selective CA1 neuronal damage, spatial memory impairments, lasting changes in corticosterone (CORT) s...

Stressful events have been implicated in the evolution of mood disorders. In addition to brain neurotransmitters and growth factors, the view has been offered that these disorders might be provoked by the activation of the inflammatory immune system as well as by de novo changes of inflammatory cytokines within the brain. The present review describ...

The prevalence of anxiety disorders is rising rapidly in today’s society, impacted greatly by recent times of civil unrest and war throughout the world. Many of the currently prescribed drug therapies for anxiety disorders are associated with aversive side-effects and lose efficacy with repeated administration. Ethnobotanical research has shown tha...

Social relationships are tightly linked to health and well-being. Recent work suggests that social relationships can even serve vital emotion regulation functions by minimizing threat-related neural activity. But relationship distress remains a significant public health problem in North America and elsewhere. A promising approach to helping couples...

The mode of action of the anxiolytic medicinal plant Souroubea sympetala was investigated to test the hypothesis that extracts and the active principle act at the pharmacologically important GABAA–benzodiazepine (GABAA–BZD) receptor. Leaf extracts prepared by ethyl acetate extraction or supercritical extraction, previously determined to have 5.54 m...

Background: Investigations in healthy outbred rat strains have shown a potential role for brain-derived neurotrophic factor (BDNF) and the hypothalamic-pituitary-adrenal (HPA) axis in the antidepressant and memory side effects of electroconvulsive therapy (ECT, or ECS in animals). The Wistar-Kyoto (WKY) rat strain is used as a genetic model of dep...

Stressor experiences during the juvenile period may increase vulnerability to anxiety and depressive-like symptoms in adulthood. Stressors may also promote palatable feeding, possibly reflecting a form of self-medication. The current study investigated the short- and long-term consequences of a stressor applied during the juvenile period on anxiety...

The prevalence of anxiety disorders is rising rapidly in today’s society, impacted greatly by recent times of civil unrest and war throughout the world. Many of the currently prescribed drug therapies for anxiety disorders are associated with aversive side-effects and lose efficacy with repeated administration. Ethtnobotanical research has shown th...