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An Odd Protocol For An Agent-Based Model Of Hepatitis C Virus Transmission In A Three-Group Structural Heterogeneous Syringe-Sharing Network (M3), Seun Ale, Que Nguyen Dr., John D. Kelleher Prof., Elizabeth Hunter Dr.

Reports

The model described in this ODD is an agent-based model of hepatitis C virus (HCV) transmission among people who inject drugs (PWID). The model incorporates structural heterogeneity through a three-group interaction framework. The syringe-sharing population in the model is divided into core, inner, and outer circle groups representing individuals with high, moderate, and low levels of syringe-sharing interaction intensity, respectively. While the syringe-sharing rate and all epidemiological processes remain identical across agents, the number of daily interaction opportunities differs by agent grouping, capturing variation in structural position within the syringe-sharing network. Interactions are generated dynamically using proximity-based sampling at each …

An Odd Protocol For An Agent-Based Model Of Hepatitis C Virus Transmission With Inter-Group Structural And Behavioural Heterogeneous Syringe-Sharing Networks (M4), Seun Ale, Que Nguyen Dr., John D. Kelleher Prof., Elizabeth Hunter Dr.

Reports

The model described in this ODD is an agent-based model of hepatitis C virus (HCV) transmission among people who inject drugs (PWID). The model incorporates structural heterogeneity through a three-group interaction framework and behavioural heterogeneity through group-specific syringe-sharing rates. The syringe-sharing population in the model is divided into core, inner, and outer circle groups representing individuals with high, moderate, and low levels of syringe-sharing interaction intensity, respectively. In addition to differences in the number of daily interaction opportunities across groups, agents in each group are assigned distinct syringe-sharing probabilities, reflecting variation in risk-taking behaviour across structural groups within the syringe-sharing …

Text Messages To Improve Young Child Diets: Results From A Cluster-Randomized Controlled Trial In Kanchanpur, Nepal, Kenda Cunningham, Sidney Cech, Aman Sen Gupta, Pooja Pandey Rana, Debbie Humphries, Edward A. Frongillo Jr. Ph.D.

Faculty Publications

The objective of this study was to test whether adding a text message campaign about the importance of eating eggs and other nutrition-related behaviours to an on-going package of large-scale, diverse social and behaviour change interventions would improve four types of nutrition-related knowledge and behaviour outcomes: child diets (egg consumption as the primary outcome), maternal diets, maternal nutrition knowledge, and maternal participation in additional interventions. The cluster-randomized controlled trial involved a repeat cross-sectional design, recruiting families with children 12–23 months of age at baseline and endline in one plains district of Nepal. Throughout the 1000-day period, 51 text messages were …

Impact Of Suaahara, An At-Scale Multisectoral Nutrition Programme, On Health Workers’ Maternal And Child Health, And Nutrition Knowledge And Skills In Nepal, Deependra K. Thapa, Edward A. Frongillo Jr. Ph.D., Shalini Suresh, Ramesh P. Adhikari, Bhim Pun, Karuna L. Shakya, Raj Mandal, Subir K. Kole, Kenda Cunningham

Faculty Publications

Suaahara, an at-scale multisectoral nutrition programme in Nepal, aimed to advance knowledge and skills of frontline health workers to improve the quality of nutrition and health services at health facility and community levels. This study assessed the impact of Suaahara interventions on knowledge and skills of health facility workers and Female Community Health Volunteers (FCHVs). The study used a quasi-experimental design in which four Suaahara intervention districts were compared with pair-matched comparison districts. One health facility worker and three FCHVs from each survey cluster were included. Baseline survey consisted of 93 health facility workers (2015) and 118 FCHVs (2012), and …

Evaluation Of Pulse Oximetry Alarm Fatigue And The Impact Of Spo2 Thresholds On Clinical Workflow: A Prospective Observational Study In A Kenyan Neonatal Unit, Bazil Masabo, Augustine Waswa, Jesse Coleman, Morris Ogero, Grace Irimu, Dorothy Chomba, Millicent Parsimei, Cynthia Shitote, Ferdinand Okwaro, William Macharia

Paediatrics and Child Health, East Africa

Introduction: Effective pulse oximetry monitoring in a newborn unit requires clinician action. However, if thresholds are not adapted to each neonate, frequent alarms cause alarm fatigue, which impacts the quality of patient monitoring, staff workload and clinical workflow.

Methods: We conducted an observational study from October 2021 to December 2022 in a Kenyan newborn unit which enrolled neonates through convenience sampling. Data were analysed in R using default thresholds of 85% to 96% for SpO2 and 90 to 200 bpm for PR.

Results: Among the 49 neonates enrolled, median hourly alarms per patient were 12 visual and …

Individual And Household Factors Associated With Tungiasis In A Marginalized Population In Karamoja, Northeastern Uganda, Lynne Elson, Abneel Matharu, Berrick Otieno, Hermann Feldmeier, Charles Waiswa, Amina Abubakar, Jürgen Krücken, Ulrike Fillinger, Francis Mutebi

Institute for Human Development, East Africa

Background Tungiasis is a neglected tropical skin disease caused by adult female fleas which burrow into the skin of people and animals, causing considerable pain and itching. The distribution of the disease is heterogeneous, with Napak district, Karamoja sub-region of northeastern Uganda having the highest disease burden recorded globally. We aimed to determine the factors associated with this high prevalence to inform future intervention strategies.

Methods We conducted a cross-sectional study to identify factors associated with infection of individual children and adults, and a nested case–control study to identify factors for whole households (families). Infected children were identified through mass-screening …

Caregiver Assessment Of Executive Function Deficits Among Hiv-Infected And Hiv-Exposed Uninfected Preschool Children In Kenya, Antipa Sigilai, Moses Nyongesa, Amin Hassan, Janet Thoya, Rachel Odhiambo, K. Katana, Beatrice Kabunda, Grace Bomu, Charles Newton, Amina Abubakar

Institute for Human Development, East Africa

Background: This study examined caregiver assessment of executive functioning (EF) in perinatally HIV-infected (PHIV) and perinatally HIV-exposed but uninfected (PHEU) Kenyan children, and explored the extent to which various biopsychosocial factors influence EF outcomes.

Methods: Children aged 3–5 years that were PHIV (n = 43), PHEU (n = 52), or HIV-unexposed uninfected (HUU, n = 58) and their caregivers were enrolled in this study. EF was measured using the Childhood Executive Functioning Inventory. Caregivers’ common mental disorders (CMDs) and parenting behaviour were evaluated using the Shona Symptoms Questionnaire (SSQ) and a parenting behaviour scale, respectively. We used analyses …

Conditions Affecting The Gi Tract: The Dental Professional’S Role, Sherri M. Lukes, Rdh, Ms, Faadh

The Journal of the Michigan Dental Association

This article explores the critical role dental professionals play in identifying gastrointestinal (GI) conditions through their oral manifestations. It provides an overview of various pathologies, including HPV-induced oropharyngeal cancer, gastroesophageal reflux disease (GERD), and inflammatory bowel diseases like Crohn’s and ulcerative colitis. The author describes specific oral signs, such as dental erosion and aphthous ulcerations, that can serve as early indicators of systemic disease. The piece advocates for an interdisciplinary approach to patient care, emphasizing that dental practitioners are often on the front lines of diagnosing serious systemic health issues.

The Back Page: Helping The Homeless Through The Delonis Oral Health Initiative, Sarah Tomaka, Dds

The Journal of the Michigan Dental Association

This feature story highlights a student-led initiative at the University of Michigan School of Dentistry to provide dental care to Ann Arbor's unhoused population. Through the Delonis Oral Health Initiative, students have partnered with a local shelter to connect over 100 vulnerable patients with essential treatment. The article discusses the profound impact of treating dental pain on an individual's ability to pursue stable housing and a better life. It also showcases how the program provides students with meaningful leadership and community service experience while addressing a critical gap in public health.

Key Predictors Of Postpartum Depression And Anxiety Symptoms Among Mothers In Kilifi, Kenya: A Machine Learning Approach, Faith Benson, Rachel Odhiambo, Willie Brink, Anthony Ngugi, Akbar Waljee, Eileen Weinheimer-Haus, Cheryl Moyer, Ji Zhu, Amina Abubakar

Institute for Human Development, East Africa

Background:

The burden of maternal postpartum depression and anxiety is disproportionately high in sub-Saharan Africa (SSA), yet the use of advanced analytical methods to capture the complex interplay of variables influencing these conditions remains underexplored.

Objective:

To apply machine learning (ML) methods to predict depressive and anxiety symptoms in postpartum mothers and to identify key and actionable predictors.

Methods:

This cross-sectional study included 1,995 biological mothers of singleton infants aged 0–6 months, using survey data collected between March 2023 and March 2024 in Kaloleni and Rabai sub-counties, Kilifi County, Kenya, within the Kaloleni–Rabai Health and Demographic Surveillance …

Results From Jail-Based Substance Use Treatment In Tooele County, Matthew Huntington, Shianne Anderson

Outcomes and Impact Quarterly

This article describes the development and outcomes of a jail-based substance use treatment program in Tooele County, Utah. The program addresses the elevated overdose risk among individuals leaving incarceration through education, peer support, and coordinated reentry planning. Program outcomes include reduced recidivism and improved connection to recovery supports.

Trends In Health-Based Drinking Water Violations For Coliform Bacteria In The United States, Amber Lyon-Colbert, Kshipra Sharma

Public Health Faculty Publications

This research seeks to determine whether health-based drinking water violations for total coliforms have increased since the Revised Total Coliform Bacteria Rule established in 2013 and fully implemented in 2016 by the Environmental Protection Agency under the Safe Drinking Water Act; as well as determine the geographic regions, states and territories in the United States with the highest number of health-based Total Coliform Rule and Revised Total Coliform Rule violations. We obtained data for drinking water violations involving total coliform bacteria from the Safe Drinking Water Information System for 2000-2019 and trend analysis was completed by state, region, water source, …

Impact Of Suaahara, An Integrated Nutrition Programme, On Maternal And Child Nutrition At Scale In Nepal, Edward A. Frongillo Jr. Ph.D., Shalini Suresh, Deependra K. Thapa, Kenda Cunningham, Pooja Pandey Rana, Ramesh P. Adhikari, Subir Kole, Bhim Pun, Indra Kshetri, Debendra P. Adhikari, Rolf Klemm

Faculty Publications

Suaahara was an innovative, complex, multi-sectoral, large-scale, nutrition programme in Nepal to increase exposure to nutrition-related information and services, improve nutrition-related knowledge and practices among pregnant women and mothers of infants and young children, and improve their nutrition. This study evaluated the effectiveness of Suaahara to improve nutrition and nutrition-related practices by comparing changes over 10 years between intervention and comparison districts. The samples of households at baseline in 2012 and endline in 2022 were 2040 and 2480, respectively, from 120 old wards. The impact was estimated using intent-to-treat regression models in which survey year, arm and their interaction were …

Exposure To Suaahara Ii Interventions And Knowledge Of Maternal And Child Nutrition And Health Among Mothers, Grandmothers, And Male Household Heads: An Association Study In Nepal, Shalini Suresh, Edward A. Frongillo Jr. Ph.D., Deependra K. Thapa, Ramesh P. Adhikari, Subir K. Kole, Femila Sapkota, Manisha Laxmi Shrestha, Kristine Garn, Pooja Rana Pandey, Indra Kshetri, Dipak Sharma, Kenda Cunningham

Faculty Publications

Suaahara was a USAID-funded multi-sectoral integrated nutrition program that aimed to improve the nutritional status of children under the age of five and their mothers in Nepal. The program included multiple interventions targeted to mothers and children, as well as other caregivers. Caregiver knowledge of optimal nutrition and health practices among household members is an important driver of healthy child and maternal nutrition behaviors. This study investigates the associations between exposure to Suaahara interventions and knowledge of maternal and child nutrition and health practices among mothers (n =, grandmothers (n =, and male household heads (n =. Linear and logistic …

Apoe And Plasma Ad Biomarkers: The Role Of Genetic Ancestry In Hispanics/Latinos, Caitlin Cheung, Natasha Z Anita, Paola Filigrana, Myriam Fornage, Kevin A Gonzalez, Linda C Gallo, Carmen R Isasi, Robert C Kaplan, Xihao Li, Freddie Márquez, Humberto Parada, Krista M Perreira, Alberto R Ramos, Tatjana Rundek, Wassim Tarraf, Fernando D Testai, Charles Decarli, Hector M González, Tamar Sofer

Faculty, Staff and Student Publications

Background: Apolipoprotein E (APOE) alleles are well-established genetic risk factors for Alzheimer's disease (AD), but their effects on AD biomarkers (amyloid beta [Aβ]42/40, phosphorylated tau [p-tau]181, neurofilament light chain [NfL], and glial fibrillary acidic protein [GFAP]) may vary across populations due to ancestry-, age-, and sex-related differences. We hypothesized that these effects vary across Hispanic/Latino background groups with distinct ancestral admixture.

Methods: We analyzed ε2 and ε4 allele associations with AD biomarkers using survey-weighted linear regression models, adjusting for demographic covariates. Secondary analyses examined genetic analysis group- and ancestry-specific effects.

Results: ε4 was associated with lower Aβ42/40 and higher p-tau181and …

Substance Use Stigma: Examining The Role Of Social Work Education., Eboni Burton

Doctor of Social Work Capstone Projects

This study explored the extent of substance use related stigma among social work students and professionals (i.e., BSW, MSW, PHD and DSW) and its relationship to specialized education/training in substance use and professional practice with people who use drugs (PWUD)/live with a substance use disorder (PWSUD). Stigma was measured using the Opening Minds Provider Attitudes Toward Opioid Use Scale and the Medical Condition Regard Scale. The final sample size was 263. Results indicate that current enrollment in a social work program, post degree or non-curriculum related substance use related training, and personal and professional experience with substance use specifically, mitigate …

Low-Dose Aspirin For Preventing Intrauterine Growth Restriction And Pre-Eclampsia In Sickle Cell Pregnancy, Lydia Pecker, Sophie Lanzkron

Cardeza Foundation for Hematologic Research

No abstract provided.

Does Genetic Testing Influence Outcomes: Early Experience In Melanoma Case Series, Ryan Reyes, George Skenteris, Stella Coker Watson Self Ph.D., Ms, Christine Marie-Gilligan Schammel, Steven D. Trocha

Faculty Publications

Background:

The treatment and prognosis of melanoma have historically been based on histologic stage and Breslow depth; however, due to the increase in surveillance, melanomas are being identified at an earlier stage and lower Breslow depth. Advances in genetic testing, such as Decision Dx®, mean that melanoma diagnostic decisions and prognosis can now be directed by genetics. The purpose of this project was to assess the influence of a Decision Dx® high-grade (Class 2A/B) classification on the treatment of melanoma patients at a regional medical center, particularly those not deemed high risk by conventional classification methods, including Breslow depth and …

J Mich Dent Assoc March 2026

The Journal of the Michigan Dental Association

Each month, the Journal of the Michigan Dental Association delivers news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. It remains the main publication reaching Michigan dentists and is available worldwide through ADA Commons.

The March 2026 (Volume 108, No. 3) issue of the Journal is published in a digital format to provide updates and insights for Michigan's oral health community and MDA members. Print editions occur every other month beginning with January.

This issue includes feature articles on Most-Asked Dental Benefit Questions, an interview with ADA Speaker Dr. Deb Peters, …

News You Need, David Foe

The Journal of the Michigan Dental Association

This comprehensive news section covers a wide range of association updates, including previews of the 2026 Annual Session and the Mission of Mercy volunteer event. It provides critical "Dental Benefit Briefs" regarding claims appeals, CMS rule changes for prior authorization, and code deletions affecting reimbursement. The source also features a Q&A with the new ADA 9th District Trustee and highlights new guidelines for using generative AI in dental journalism. Additionally, it reports on community grants and charitable programs like Livingston District’s "Gold for Food".

Early Insights From A Multi-Centre National Stroke Surveillance Initiative In Tanzania, Sarah Shali Matuja, Azan Nyundo, Emmanuel Assey, Joel Bwelemo, Marieke Dekker, Sarah Urasa, Emanuel Makarius, Peter Kishimbo, Philip Adebayo, Paschal Ruggajo

Internal Medicine, East Africa

Background: Stroke is a leading cause of death and disability globally, with sub-Saharan Africa, bearing the greatest burden. Tanzania has only one active stroke registry, limiting evidence-based care and policy development. We aimed to expand the registry into a multi-centre study across eight major tertiary hospitals to generate baseline data for a national stroke registry.

Methods: From January to August 2024, we analysed de-identified data from adults (≥18 years) admitted with a World Health Organisation defined stroke. Data collected included demographics, risk factors, imaging, and in-hospital mortality. Logistic regression identified predictors of mortality.

Results: A total of 1000 patients were …

Brief Report: Long-Acting Injectable Prep Can Substantially Reduce Hiv Incidence In Los Angeles County: A Simulation Study, Aditya Khanna, Francis Lee, Katrina Schrode, Daniel Sheeler, Anna Hotton, John Schneider, Kayo Fujimoto, Siri Chirumamilla, Ekow Kwa Sey, Nina T Harawa

Faculty, Staff and Student Publications

Background: Although oral pre-exposure prophylaxis (PrEP) has been instrumental in decreasing HIV incidence, its daily dosing regimen poses adherence challenges. Using an agent-based network model informed by empirical data, we simulate the impact of introducing long-acting injectable (LAI) PrEP among young Black men who have sex with men (YBMSM) in Los Angeles County, a group disproportionately affected by HIV.

Setting: Computer simulations using an agent-based network model.

Methods: We modeled HIV transmission among YBMSM over 10 years under scenarios varying the proportion of PrEP users opting for LAI instead of oral medications and adherence levels to LAI retention. The model …

Preferences For Game-Based Elements To Increase Preexposure Prophylaxis And Hiv Prevention Engagement Among Latino Men Who Have Sex With Men: South Florida, 2022, Lacey Despres, Edda Rodriguez, Ross Shegog, Stephanie Diez, Susanne Doblecki-Lewis, Kayo Fujimoto, Suzanne Randolph Cunningham, Mariano Kanamori

Faculty, Staff and Student Publications

We explored gaming elements as a tool to promote engagement in HIV prevention services among Latino men who have sex with men. We conducted thematic content analysis of semistructured interview data that we collected from 12 Latino men who have sex with men (April-August 2022) in South Florida. Themes emerged related to intervention delivery, components, and perceptions. Our findings will guide the development of a game-based intervention to improve preexposure prophylaxis and HIV prevention engagement among Latino men who have sex with men.

Associations Of Moderate-To-Vigorous Physical Activity Timing With Type 2 Diabetes Incidence In Uk Biobank And Prevalent Glycemic Measures In Nhanes, Qiuyu Feng, Gali Albalak, Linjun Ao, Qian Xiao, Heming Wang, Jeroen H P M Van Der Velde, Jessica C Kiefte-De Jong, Martin K Rutter, Charles E Matthews, Joshua R Freeman, Ko Willems Van Dijk, Diana Van Heemst, Raymond Noordam

Faculty, Staff and Student Publications

Objective: We assessed the association between timing of moderate-to-vigorous physical activity (MVPA) with incident type 2 diabetes (T2D) and glycemic measures.

Research design and methods: Regression models were used to assess associations between accelerometer-derived MVPA timing and incident T2D in UK Biobank (UKB) (n = 84,528, prospective), prevalent diabetes, and glycemic measures in the National Health and Nutrition Examination Survey (NHANES) (n = 6,998, cross-sectional).

Results: In UKB, with early morning (0500-0959) MVPA as reference and before adjustment for total MVPA, "variable-timing" MVPA was associated with the lowest incident T2D risk; while after adjustment, afternoon-evening MVPA (1500-2400) showed the lowest …

Hyperpolypharmacy And Readmission Risk Among Medicare Beneficiaries: The Role Of Postdischarge Care, Maria Ukhanova, Linda D Highfield, Trudy M Krause, Gayla M Ferguson, Robert O Morgan

Faculty, Staff and Student Publications

Objectives: Medication reconciliation post discharge may reduce readmission risk in populations with multimorbidity and polypharmacy. We aimed to evaluate the association between hyperpolypharmacy and 30-day readmissions; determine the impact of postdischarge care on 30-day readmissions; and identify interactions among hyperpolypharmacy, postdischarge care, and 30-day readmissions in 2 Medicare populations: individuals 65 years and older and individuals of any age with a qualifying disability.

Study design: Retrospective observational study using the 5% national sample Medicare fee-for-service claims data from 2016 to 2019.

Methods: We used descriptive statistics and generalized estimating equation models adjusted for covariates to assess the relationships among hyperpolypharmacy, …

Intraoperative Blood Pressure Management In Noncardiac Surgery: A Narrative Review Based On Current Evidence, Alexandre Joosten, Michelle S Chew, Emmanuel Futier, Anatole Harrois, Matthias Jacquet-Lagreze, Matthieu Legrand, Antonio Messina, Paul S Myles, Bernd Saugel, Daniel I Sessler, Denise P Veelo, Jean-Luc Fellahi

Faculty, Staff and Student Publications

Purpose: Blood pressure is closely monitored during anaesthesia, yet the optimal intraoperative target remains uncertain. This narrative review synthesizes contemporary observational and randomized evidence and explores emerging strategies for individualized haemodynamic management.

Methods: We reviewed major observational cohort studies, randomized controlled trials (RCTs), consensus statements, and recent technological developments addressing intraoperative hypotension, MAP thresholds, and strategies to prevent perioperative organ injury in adult noncardiac surgery.

Results: Large observational datasets consistently demonstrate graded, duration-dependent associations between intraoperative MAP 60-70 mmHg and postoperative myocardial injury, acute kidney injury, and mortality . These findings have informed international recommendations to avoid MAP below 60-65 …

Breast Cancer Awareness And Preferences For Screening Messaging On Menstrual Hygiene Products In Ghana And Tanzania, Tingting Mo, Elisabeth Msoka, Clement Narh, Blandina Mmbaga, Modesta Mitao, Getrude Mshana, Janeth Kiwia, Huruma Sapheli, Frank Baiden, Miriam Mutebi

General Surgery, East Africa

Background Menstrual hygiene products (MHPs) may offer a high-reach, frequent, long-lasting yet underutilized channel for health education, particularly in low-resource settings. This study aimed to explore women’s breast health awareness (BHA) and their attitudes towards and preferences for BHA messages on MHPs.

Methods Women aged 18–49 years in Ghana and Tanzania (n = 438; 216 Ghana, 222 Tanzania), stratified by age and urban/rural setting, completed a questionnaire assessing socio-demographics, BHA, and preferences for BHA messages with MHP. BHA was assessed with an adapted 31-item Breast Cancer Awareness Measure Tool covering 4 domains: breast cancer signs and symptoms, confidence, skills, and …

A Study Of Awareness Of Antiseptics And Disinfectant Use Among Allied Health Sciences Students And Interns Of A Tertiary Care Hospital, Pooja M, Puneeth A, Sharmi Nm

Digital Journal of Clinical Medicine

Background:

Antiseptics and disinfectants are among the most vital tools in infection prevention and control (IPC), especially in healthcare settings where the risk of hospital-acquired infections (HAIs) remains a significant concern. This study aims to assess the awareness and knowledge of antiseptics and disinfectants among Allied Health Sciences (AHS) students and interns, identify knowledge gaps at different stages of training, and recommend educational interventions.

Methods:

This was a cross-sectional, questionnaire-based study conducted among 1st to 3rd-year AHS students and interns at a tertiary care hospital. Data were collected using a validated questionnaire via a Google form after obtaining approval from …

Morphea With Seronegative Inflammatory Arthritis And Normal Acute Phase Reactants: A Case Report, Balakrishnan Navaneethakrishnan, Mahabaleshwar Mamadapur

Digital Journal of Clinical Medicine

Localised scleroderma, also known as morphea, is an immune-mediated fibrosing disorder that primarily affects the skin and subcutaneous tissues. While traditionally considered purely a cutaneous disease, extracutaneous manifestations (especially inflammatory arthritis) are increasingly being appreciated. The combined presence of morphea and inflammatory arthritis is rare and can be difficult to diagnose, particularly when inflammatory markers and serological testing are non-contributory.

Case Summary : We describe a 41-year-old woman with long-standing biopsy-proven morphea who over 2 years developed chronic, asymmetric inflammatory arthritis of the left wrist and hand small joints. On examination, she had active synovitis with restricted movements of her …

Pseudo-Hallucinations: A Diagnostic Conundrum, Dr Sankram Nayak, Manju Aswath, Vathsalya S. Gowda

Digital Journal of Clinical Medicine

Background:

Pseudohallucinations are vivid, hallucination-like experiences that are internal, recognized as unreal. Distinguishing from true hallucinations remains a diagnostic challenge.

Case-report

33-year-old female with family history of psychosis presented with 10-year duration of delusion of infidelity and auditory experiences, with normal Biopsychosocial functioning. She had multiple psychiatric consultations, diagnosed as paranoid schizophrenia, treated with  various antipsychotics, ECT, current prescription of clozapine(350mg) with clozapine induced seizure.  Reported that her husband was emotionally unavailable. She described the voices in her head which were non-threatening, praising her for having qualities of an ideal-wife.  They were constant companions giving her solace and hence refrained …