Depression is one of the most frequently diagnosed psychiatric illnesses, which remains a big cause of mortality and morbidity among all groups of population. 1 Things are not different in our part of the world as depression remains a common mental health illness in our population. 2 If untreated, it may lead to serious consequences including severe depression with psychotic illness, physical problems and even suicide. [3][4][5] Transgender is a broad term which includes the people with all types of gender identity disorder. ICD-11 coins a new term for this group of people, i.e. gender incongruence. In United States of America, 390/100,000 individuals are believed to be transgenders. 6 Census of 2017 has shown that more than 10,000 transgender subjects exist in Pakistan. They suffer from various health issues including the HIV, drug dependence, and various mental health problems. 7,8 Previous research highlights the presence of depression and suicide ideation among the transgender population. Depression, suicide and other mental health indices are very high among the transgender population as compared to controls even in a developed country like USA. 9 Another study showed suicide attempt rate as 32-50% among the transgender population of our neighboring country India. This was also coupled with increased rate of depression among the target population. 10 Oswalt et al. concluded in a large study that all mental health illnesses including schizophrenia are found more among the transgender as compared to heterosexual controls. 11 Depression and suicidal ideation, if remain unaddressed for long, may result in poor life quality and even leading to death. 12 Suicidality and depression have some common biological pathways, which explain one of the bases of their comorbidity. Role of genetics, alteration in the hypothalamic-pituitary-adrenal (HPA) axis, dysregulation of serotonin metabolism and receptors and neuroimmunological basis are some of the factors which contribute in development of both depression and suicidality. 13 In addition to the biological factors, depression also leads to suicidal ideation and suicidality by psychological and social pathways. 14 Ideas of self harm are also part of diagnostic criteria for depression in

Prevalence of depressive symptoms was high among recruits. Special attention should be paid to recruits from low socioeconomic background and those who lack social support and who worry about the future.

Around 10-15% of the general population face sleep problems of one kind or another, making them a common healthcare problem in all parts of the world. 1 Various types of sleep problems include bad quality of sleep, sleep apnea and insomnia, which can be part of various physical problems including pregnancy, 2 chronic renal failure, 3 malignancies, 4 and various mental health problems, 5 etc.Head and neck tumours are aggressive tumours that account for approximately 3% of all the diagnosed cases of malignancies. 6 Whole physiology of human body is disturbed in one way or another when a patient is having a deadly disease like cancer. Sleep, appetite and sexual function are altered invariably in patients suffering from cancer. 7 Disturbed sleep quality among the patients of head and neck tumours have been reported globally. in a study done in Netherlands, 56% of the patients of head and neck tumours had disturbed sleep. 8 Another similar study showed that insomnia was among the top four complains reported by the patients of head and neck tumours. 9 Literature reported by Faiz et al. revealed that daytime fatigue, sleepiness and sleep-related breathing disorders were common in patients with tumours in the head and neck region. 10 Sleep related problems, if persist for long, have a direct effect on mental health and overall quality of life of a patient who is already suffering from a devastating illness. 9,11 Many studies done in the past have shown a strong relationship between sleep and other mental health problems. Shuman et al. concluded that depression was present among 49% of the patients of head and neck tumours and patients with depression significantly reported more sleep problems as compared to patients who were not depressed. 12 Another recent study revealed that there was a significant and powerful correlation between mental health with sleep quality of pulmonology patients. 13 A study done in USA among the patients of advanced cancer concluded that increasing depression was positively correlated to worse subjective sleep quality. 14 Physical effects of head and neck tumours may contribute to the poor sleep quality among the patients but chronic nature of disease and other disease-related factors may prone the individuals towards various mental health disorders, which can affect the sleep quality and overall

Objective: To see the effect of application of Vancomycin powder directly into the subgaleal space in reducing the postoperative surgical site infections.Materials and Methods: All the patients who underwent consecutive elective craniotomies from April 2017 to May 2018 Dept of Neurosurgery, szabmu, PIMS, Islamabad. The control group received the standard routine prophylaxis according to the hospital protocols, whereas the treatment group, in addition to the standard prophylaxis, received Vancomycin powder in the surgical wound in addition to the standard routine prophylaxis. Results: 182 patients were enrolled in the study, 91 allocated to each the control and treatment group (Vancomycin). Six patients were lost to follow up. There were 90 patients in the control group and 86 patients in the treatment (Vancomycin) group. Both the groups were almost statistically similar. In the control group, 34.09% (n = 60) were male and 17.04% (n = 30) were female. In the treatment group, 29.54% (n = 52) were male and 19.31% (n = 34) were female. The overall rate of surgical site infection (SSI) was 3.97% (7 out of 176 cases). A statistically significant difference found in infection rate between the treatment group, 0% (0 out of 86 cases) and the control group, 7.77% (7 out of 90 cases) with the p value of 0.002. Conclusions: The use of topical Vancomycin powder in surgical wounds may significantly reduce the incidence of infection in patients undergoing elective craniotomies. It is a promising means of preventing devastating and harmful postoperative wound infections.

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