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Nicola Luigi Bragazzi,1– 4 Hicham Khabbache,5 Khalid Ouazizi,6 Driss Ait Ali,6 Hanane El Ghouat,6 Laila El Alami,6 Hisham Atwan,7 Ruba Tuma,8– 10 Nomy Dickman,10 Raymond Farah,10,11 Rola Khamisy-Farah9,10 1Human Nutrition Unit (HNU), Department of Food and Drugs University of Parma, Parma, Italy; 2Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada; 3Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; 4United Nations Educational, Scientific and Cultural Organization (UNESCO) Chair, Health Anthropology Biosphere and Healing Systems, University of Genoa, Genoa, Italy; 5Director of the UNESCO Chair “Lifelong Learning Observatory” (UNESCO/UMSBA), Fez, Morocco; 6Department of Psychology, Faculty of Arts and Human Sciences Fès-Saïss, Sidi Mohamed Ben Abdellah University, Fez, Morocco; 7Department of Internal Medicine, Kaplan Medical Centre, Hebrew University, Rehovot, Israel; 8Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Galilee, Israel; 9Clalit Health Services, Akko, Israel; 10Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; 11Department of Internal Medicine B, Ziv Medical Center, Safed, IsraelCorrespondence: Nicola Luigi Bragazzi, Human Nutrition Unit (HNU), Department of Food and Drugs University of Parma, Via Volturno 39, Parma, 43125, Italy, Tel +39 0521 903121, Email nicolaluigi.bragazzi@unipr.itPurpose: Sex and Gender-Based Medicine (SGBM) addresses the influence of sex and gender on health and healthcare, emphasizing personalized care. Integrating SGBM into medical education is challenging. This study examines the implementation of an SGBM course in an Israeli university during the first year of the medical school.Methods: The course integrated lectures, group work, online gender studies resources, workshops, teacher training, and essential literature. The curriculum spanned pre-clinical and clinical aspects, featuring seven 90-minute sessions. Surveys assessed course structure, content, and lecturers using a 5-point Likert scale and qualitative feedback. Quantitative analysis involved descriptive statistics, and thematic analysis was used for qualitative data.Results: Of the 84 students surveyed, 35 (41.7%) responded to the first part, and 30 (35.7%) to the second. The SGBM course received high satisfaction with an average score of 3.63, surpassing other first-year courses (average 3.21). Students appreciated the supportive academic atmosphere (mean score 4.20) and diverse teaching methods (mean score 4.03), while the development of feminist thinking was less appreciated (average score 3.49). Lecturers received high ratings (average score 4.33). Qualitative feedback highlighted the value of group work, the significance of the subject matter, and the helpfulness of supplementary videos. Students requested more content on contemporary issues like gender transition and patient perspectives. The feminist medicine aspect was contentious, with students seeking better gender balance and scientific evidence.Conclusion: Introducing SGBM into the first-year curriculum yielded positive results with high student satisfaction for content and lecturers. An expanded course module is planned, to be assessed at the end of the next academic year.Keywords: sex- and gender-based medicine, medical education, medical training, curriculum integration

Abstract Background Treatment cost and high prevalence of Poly Cystic Ovarian Syndrome (PCOS) is a very challenging issue globally. Due to this reason; current study was conducted to determine pharmaco-economy of conventional and non-conventional treatments for the management of PCOS. Methods Prospective Cross-Sectional study was conducted in the metropolitan city of Karachi from January – December 2019. Primary data of 200 PCOS patients were collected from different hospitals and clinics. An instrument was used to collect data pertaining to the direct and indirect cost associated with the disease management. Collected data was analyzed by the tools for cost analysis and software called Statistical Package of Social Sciences (SPSS) – 22. Results In Cost Minimization Analysis (CMA); Allopathic treatment [Mean cost/month: PKR:4479.32 ± 350.95 (USD:27.46 ± 2.15)], Herbal treatment [Mean cost/month: PKR:1527.78 ± 78.15 (USD:9.37 ± 0.48)], Combination treatment [Mean cost/month: PKR:2803.09 ± 654.22 (USD:17.18 ± 4.01)], and Homoeopathic treatment [Mean cost/month: PKR:976.95 ± 46.19 (USD:5.99 ± 0.28)]. Incremental cost/month for Allopathic treatment is 358%, Herbal treatment is 56%, Combination treatment is 187%. In Cost Effectiveness Analysis (CEA); Allopathic treatment (Incremental cost-effectiveness ratio/month: 1334.24), Herbal treatment (Incremental cost-effectiveness ratio/month: 936.41), Combination treatment (Incremental cost-effectiveness ratio/month: 1017.09). Due to lowest cost of Homeopathic treatment, cost of Homeopathic treatment was considered as a threshold value. In-direct cost/month of Allopathic treatment is PKR:593.33 ± 24.00 (USD:3.64 ± 0.15), Herbal treatment is PKR:307.84 ± 26.69 (USD:1.89 ± 0.16), Combination treatment is PKR:409.09 ± 45.63 (USD:2.51 ± 0.28) and Homoeopathic treatment is PKR:300.00 ± 26.39 (USD:1.84 ± 0.16). Conclusion The most cost-effective is treatment is Homeopathic; Herbal treatment is second most cost-effective option for the treatment of PCOS. Lowest direct and indirect costs and short treatment duration collaboratively lessen the %incremental cost per year and incremental cost effectiveness ratio per year.

Health-care workers are on the front line of the COVID-19 pandemic. In this occupational group, infection is of great concern due to the risk of nosocomial spread of the disease and significant reduction in the number of employees, it also endanger patient safety and compromise the capacities of health care workers. This is a cross-sectional study conducted among healthcare workers of university hospital of Farhat Hached Sousse who were affected by COVID 19 during September 1, 2020 to February 28, 2021. Data collection was carried out using an anonymous questionnaire about socio-professional and medical characteristics. Severity level of the SARS-CoV-2 infection was assessed according to the criteria of the National Authority for Health Assessment and Accreditation guideline (INEAS). Of the 555 healthcare workers with COVID-19, 477 participated. The factors associated with residual symptoms of COVID- 19 were: age (p=0.002), female gender (p=0.001), marital status (p=0.015), cardiovascular (p=0.001), endocrine (p=0.002) comorbidities, obesity (p=0.004), work position (p=10-3), professional work seniority (p=0.022), duration of confinement (p=10-3) and hospitalization (p=0.037).The use of antibiotics(p=10-3), anticoagulants (p=0.010) and corticosteroids (p=0.004) were significantly associated with the persistence of symptoms. After binary logistic regression, the factors associated with persistent symptoms were female gender, para-medical category, antibiotic and corticosteroid use. Long-term follow-up of HCWs with COVID-19 is recommended to understand and treat persistent symptoms after recovery. Protective equipment should be provided as well as vaccination for prevention and management.

Background: Inferior Vena Cava (IVC) filters have become an advantageous treatment modality for patients with venous thromboembolism. As the use of these filters continues to grow, it is imperative for providers to appropriately educate patients in a comprehensive yet understandable manner. Likewise, generative artificial intelligence models are a growing tool in patient education, but there is little understanding of the readability of these tools on IVC filters. Methods: This study aimed to determine the Flesch Reading Ease (FRE), Flesch–Kincaid, and Gunning Fog readability of IVC Filter patient educational materials generated by these artificial intelligence models. Results: The ChatGPT cohort had the highest mean Gunning Fog score at 17.76 ± 1.62 and the lowest at 11.58 ± 1.55 among the Copilot cohort. The difference between groups for Flesch Reading Ease scores (p = 8.70408 × 10−8) was found to be statistically significant albeit with priori power found to be low at 0.392. Conclusions: The results of this study indicate that the answers generated by the Microsoft Copilot cohort offers a greater degree of readability compared to ChatGPT cohort regarding IVC filters. Nevertheless, the mean Flesch–Kincaid readability for both cohorts does not meet the recommended U.S. grade reading levels.

Abstract Background Spinal muscular atrophy (SMA) is a group of motor neuron diseases. In 95% of SMA patients, the telomeric copy of the SMN gene (SMN1) is homozygously deleted. Due to the autosomal recessive pattern of SMA inheritance, individuals with a family history of SMA are at risk of being carriers. A total of 622 individuals from SMA families, including parents, siblings, and first, second, and third-degree relatives, were recruited to the neuro-genetic clinic of Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. SMA cases and suspected carriers were referred to the genetic laboratory. Pregnant women underwent amniocentesis and chorionic villi sampling at 12–14 gestational weeks. RFLP-PCR and real-time PCR were performed for symptomatic and asymptomatic individuals (possible carriers), respectively. RFLP and real-time PCR were performed for amniotic fluid and chorionic villi samples. Results The study enrolled 622 subjects from SMA-affected families, including 159 fetuses and 463 non-fetuses. Two samples were missing. A total of 268 individuals (43.2%) were healthy (wild type), 187 individuals (30.1%) were heterozygous for exon deletion of SMN1, and 143 individuals (23%) were homozygous for exon deletion of SMN1. Four individuals (0.6%) showed three copies of the SMN1 gene. Conclusion The frequency of carriers with two SMN1 copies on a single chromosome (cis) was estimated at 2.9% (18/622), and the total rate of carriers was approximately 21.8%. Considering the high rate of SMA carriers in this study, genetic counseling and definitive prenatal diagnosis are of utmost importance for reducing the psychosocial burden of the SMA disease among Iranian families.

Background: Following COVID-19 vaccination, some women suffered from menstrual cycle disturbances. This studyaimed to investigate menstrual cycle disturbances after COVID-19 vaccination in women of reproductive age.Materials and Methods: This cross-sectional study was performed on 407 vaccinated women in the vaccinationcenter of Imam Hossein Hospital (Tehran, Iran) between October 2021 and October 2022. They were interviewedbased on a research-made checklist which consisted of two areas of questions about the baseline characteristics of participantsand menstrual cycle characteristics to explore menstrual characteristics following COVID-19 vaccination.Results: The prevalence of menstrual disturbances was higher after the third dose (38.3%) compared with the second(27.9%) and first (17.7%) doses (P

Objectives: Computed tomography CT scan is a medical device used in diagnosis; however, the radiation of CT will affect the human body such as blood components. Materials and Methods: In this study, the blood component of diabetic patients will examine the effect of CT radiation on blood components by withdrawing samples of 2 cc from diabetes patients’ blood before and after a CT scan on the body for patients who are exposed to the head, chest, and abdomen. Results: There were no significant statistical differences were between blood counts (WBC, RBC, and Hg) before and after the CT scan for the head, chest, and abdomen. Conclusions: The main conclusion of the current study is that, depending on the results, the CT scan is safe for patients.

Background: Breast cancer can cause significant emotional and psychological challenges for women and their families. The stress and anxiety associated with a cancer diagnosis can pave the way for the development of a variety of psychological disorders. This study investigated the potential mediating role of physical health in the association between distress tolerance and metaemotional awareness in women diagnosed with breast cancer.Methods: This study employed a descriptive correlational design, enrolling a convenience sample of women diagnosed with breast cancer who were receiving treatment at the hematology department of Shafa Hospital in Ahvaz City, Iran, between March and August 2023. A sample of 207 patients was selected using convenience sampling method. Distress Tolerance Scale, Meta-Emotion Scale, and Physical Health Questionnaire were used to collect data. The hypothesized model was assessed using structural equation modeling (SEM) with maximum likelihood estimation. Data analysis was performed using the SPSS version 27 and Amos version 25.Results: The results showed a significant correlation between physical health and distress tolerance in women with breast cancer (P

Background: The zygomatic region stands out as the most prominent facial portion, and zygomatic complex fractures (ZMC) are the second most prevalent facial fractures in the lateral mid-face area. This study investigated the associations between fractures in the ZMC and injuries to the infraorbital nerve at a tertiary care hospital. Methods: This cross-sectional study was conducted among 72 patients from September 2021 to March 2022, at the Oral and Maxillofacial Surgery Department, Jinnah Post Graduate Medical Centre, Karachi. Patients aged between 16 to 65 years, recently diagnosed with zygomatic bone fractures, were included in the study through consecutive non-probability sampling. Comprehensive patient histories, including demographic information, gender, age and residential status, obesity, and the identification of infraorbital nerve injuries diagnosed through clinical examinations and radiographic assessments. SPSS vr20 was used and the Chi-Square test was utilized to explore associations between categorical variables. Results: Among the 72 cases, 45(62.5%) were male, while 27(37.5%) were females. The average age was 37.43 ± 11.04 years, with ages ranging from 16 to 65 years. Within this cohort, 47(65.3%) individuals were residents of urban areas, whereas 25(34.7%) hailed from rural regions. Notably, positive infraorbital nerve injuries were detected in 54 patients (p=0.02), constituting 75.0% of the total injuries. Among those with ZMC fractures, 25(34.7%) (p=0.02) also had infraorbital injuries, while 20(27.8%) (p=0.03) did not exhibited such injuries. Conclusion: our study highlights a noteworthy correlation between ZMC fractures and infraorbital injuries. These results underscore the reciprocal relevance of assessing infraorbital injuries in ZMC fracture cases and vice versa, enhancing the comprehensive understanding and management of such injuries in clinical practice.

Randa I Farah,1 Izzat Ahmad Alawwa,1 Dana Q Khateeb,2 Bayan E Hwidi,2 Karam Mohannad Albdour,2 Odai Ghassan Bani Monia,2 Rand Nizam Assaf,2 Abdulrahman Ali Aldabaibah,2 Gaith Iyad Jamil Alsaket,2 Mohammad Ali Alshrouf2 1Nephrology Division, Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan; 2School of Medicine, University of Jordan, Amman, JordanCorrespondence: Randa I Farah, Nephrology Division, Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan, Tel +962 799386016, Email r.farah@ju.edu.joBackground: The adherence to antihypertensive therapy plays a significant role in determining the clinical outcomes of hypertension. We aim to evaluate the level of adherence to antihypertensive medications among patients and to assess the effect of different sociodemographic factors on the level of adherence using the Hill-Bone scale for indirect assessment.Methodology: In this cross-sectional study, we utilized a validated, face-to-face interview questionnaire to collect data on sociodemographic characteristics, participants’ attitudes, and disease knowledge. The Hill-Bone questionnaire was employed to assess treatment adherence. The statistical analysis was conducted using SPSS version 28.0, where mean, standard deviation, and range were utilized for variability analysis.Results: A total of 390 patients were included in this study. The sample comprised 56.9% of females and 56.4% of participants aged 60 years or older. Approximately 80% of participants were currently married, and 46.7% had a higher education level. The average Hill-Bone CHBPTS score was 21.23± 4.95 and indicated good adherence in 63.8% of participants. The findings showed that several factors were significantly associated with higher adherence rates, including older age (COR = 3.41, 95% CI = 1.10– 10.54, p = 0.03), higher educational level (COR = 1.72, 95% CI = 1.05– 2.83, p = 0.03), regular blood pressure monitoring (COR = 1.90, 95% CI = 1.10– 3.30, p = 0.03), and knowledge about their medications (COR = 2.12, 95% CI = 1.14– 3.94, p = 0.02).Conclusion: The medication adherence within our population falls below the desired level. Enhanced counselling and further research are necessary to identify additional factors influencing adherence and develop effective strategies for promoting adherence to antihypertensive medications.Keywords: elderly patients, hypertension, hill-bone scale, medication adherence, socioeconomic factors

Ubah Mumin Ali Osman,1 Selim Turfan,1 Mohamed Farah Yusuf Mohamud1– 4 1Emergency Department, Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia; 2Somalia Society for Emergency Medicine (SOSEM), Mogadishu, Somalia; 3Tayo Institute for Health, Research, and Development, Mogadishu, Somalia; 4Faculty of Medicine, Mogadishu University, Mogadishu, SomaliaCorrespondence: Mohamed Farah Yusuf Mohamud, Emergency Department, Mogadishu Somali Turkey Training and Research Hospital, Hawa-Abdi Street, Hodan District, Mogadishu, Somalia, Tel +252615591689, Email m.qadar59@gmail.comAbstract: Honeybee bites are a common public health hazard, the incidence of which is gradually increasing. A bee sting incident involving more than fifty stings is categorized as massive envenomation. The clinical manifestations of honey bee stings can range from localized symptoms to severe allergic and systemic reactions.This case study presents a 60-year-old male who experienced multi-organ failure following a severe bee sting incident. According to our research, this is the first documented instance in Somalia of multi-organ failure resulting from a sting by a giant honey bee. The case highlights the potential severity of bee stings, which, while often considered minor, can lead to serious medical complications. Interestingly, despite the patient suffering numerous stings and receiving a substantial amount of venom, an immediate anaphylactic reaction did not occur. Instead, a delayed severe response leading to multi-organ failure emerged within 48 hours of the incident.Keywwords: Honey bee, multi-organ failure, acute kidney injury, acute liver injury, pancreatitis, pulmonary odema

Objective(s): Interpersonal and social rhythm therapy (IPSRT) is a type of psychotherapy that was initially designed to improve the mood and prevent the relapse of people with bipolar disorder, and for this purpose, understanding and working with biological and social rhythms and training interpersonal skills It is focused. The present study was conducted with the aim of investigating the effectiveness of IPSRT in combination with motivational interviewing (MI) on reducing the symptoms of major depression with anxiety distress, which is one of the most common and debilitating mental disorders. Methods: In this study, IPSRT was combined with MI in the form of a single-case study design with multiple baselines. The subjects included 2 people (one male and one female) with low vision suffering from major depressive disorder with anxiety distress who were selected by the purpose-based accessible sampling method in September 2022 from among the members of the Mashhad welfare student WhatsApp group. After the stability of the research variables in the baseline, the subjects underwent 12 weekly 1-hour therapy sessions with a follow-up period of 2, 1, and 3 months. Beck's depression and anxiety questionnaires were used to evaluate changes in baseline, treatment and follow-up. Data analysis was done with the help of stable change index, effect size, improvement percentage and visual analysis of the graph. Results: The results showed that this treatment has made clinically and statistically significant changes (P

Summary: Background: It is unknown if early COVID-19 monoclonal antibody (mAb) therapy can reduce risk of Long COVID. The mAbs amubarvimab/romlusevimab were previously demonstrated to reduce risk of hospitalization/death by 79%. This study assessed the impact of amubarvimab/romlusevimab on late outcomes, including Long COVID. Methods: Non-hospitalized high-risk adults within 10 days of COVID-19 symptom onset enrolled in a randomized, double-blind, placebo-controlled phase 2/3 trial of amubarvimab/romlusevimab for COVID-19 treatment. Late symptoms, assessed using a participant-completed symptom diary, were a pre-specified exploratory endpoint. The primary outcome for this analysis was the composite of Long COVID by participant self-report (presence of COVID-19 symptoms as recorded in the diary at week 36) or hospitalization or death by week 36. Inverse probability weighting (IPW) was used to address incomplete outcome ascertainment, giving weighted risk ratios (wRR) comparing amubarvimab/romlusevimab to placebo. Findings: Participants received amubarvimab/romlusevimab (n = 390) or placebo (n = 390) between January and July 2021. Median age was 49 years, 52% were female, 18% Black/African American, 49% Hispanic/Latino, and 9% COVID-19-vaccinated at entry. At week 36, 103 (13%) had incomplete outcome ascertainment, and 66 (17%) on amubarvimab/romlusevimab and 92 (24%) on placebo met the primary outcome (wRR = 0.70, 95% confidence interval (CI) 0.53–0.93). The difference was driven by fewer hospitalizations/deaths with amubarvimab/romlusevimab (4%) than placebo (13%). Among 652 participants with available diary responses, 53 (16%) on amubarvimab/romlusevimab and 44 (14%) on placebo reported presence of Long COVID. Interpretation: Amubarvimab/romlusevimab treatment, while highly effective in preventing hospitalizations/deaths, did not reduce risk of Long COVID. Additional interventions are needed to prevent Long COVID. Funding: National Institute of Allergy and Infectious Diseases of the National Institutes of Health. Amubarvimab and romlusevimab supplied by Brii Biosciences.

ABSTRACT Background Limited research concerning existing inequities in mental health care and support services in the United Kingdom captures perceptions and lived experiences of the significantly underrepresented Muslim population. Methods Underpinned by social constructivist theory, we used consultation to facilitate public and patient involvement and engagement (PPIE) to identify inequities in mental health care and support experienced by Muslims from minoritised ethnic communities living in deprived areas in Liverpool, UK. The rationale was to (a) better inform standards and policies in healthcare and (b) provide a psychologically safe space to members of the Muslim community to share perceptions and experiences of mental health care and support services. To ensure trustworthiness of the data, member checking was adopted. This paper describes the procedure to achieving this consultation, including our recruitment strategy, data collection and analysis as well as key findings. Findings Twenty‐seven consultees attended the women's consultation and eight consultees attended the men's consultation. Consultees were from Yemeni, Somali, Sudanese, Egyptian, Algerian, Pakistani and Moroccan communities and share the Islamic faith. Four key interlinked themes were identified from consultees' narratives: (1) broken cycle of trust; (2) an overmedicalised model of care; (3) community mental health prevention initiatives; and (4) culturally conscious training and education. Conclusions The Muslim population has identified numerous barriers to accessing mental health support and there is a need to resource activities that would aid deeper understanding of mental health support needs through continuous and meaningful community initiatives. This would afford mental health practitioners and organisations opportunities for developing realistic anti‐racism strategies, effectively adopting social prescription, strengthening partnerships and collaborations aimed at supporting delivery of evidence‐based mental health care provisions to tackle mental health inequities. Patient and Public Involvement This paper reports on the involvement and engagement of Muslims from minoritised ethnic communities living in the Liverpool city region.

Standard treatment for acute skin inflammatory conditions comes with unwanted side effects. Traditionally, Lawsonia inermis has been used to treat skin-related ailments, with lawsone as the main active phytochemical is predicted to inhibit a skin pro inflammatory cytokine, IL-1α. This study is aimed to evaluate the anti- inflammatory effect of lawsone in acute ethanol-induced skin inflammatory condition in vitro, by targeting IL-1α in silico. Basically, the IC50 of lawsone on human epidermoid carcinoma cell line (A431) was obtained by using MTT proliferation assay, followed by acute low dose ethanol-induced inflammatory skin condition on A431 cells to determine cell viability. Next, molecular docking study was done by utilizing Autodock Vina software, and further analyzed by ProteinsPlus and PyMol softwares. Meaningful interaction that exist in the binding of lawsone to IL-1α was determined by molecular docking results comparison with two other compounds (kirenol and curcumin diglucoside). In vitro study showed the IC50 of lawsone in low cytotoxicity level at 150 µM. Skin anti-inflammatory assay indicated that lawsone has highly significant (p

Background: Prediabetes is a metabolic condition characterized by blood sugar levels higher than normal but below the diabetic range. The onset of microvascular complications may set in this phase, hence intervening during the prediabetic stage becomes crucial in halting the progression to irreversible diabetes. We compared blood sugar levels between lifestyle modification and metformin medication and identified which option is better for managing prediabetes. Methods: A quasi-experimental study was done from January to October 2023 recruiting 150 prediabetic adults coming to Sikander Abad clinic through convenience sampling including 18 to 65 years of age while obese adults, those who had hypoglycemia within the past 3 months, and GDM women were excluded. Patients were divided into two groups and given a choice to choose pharmacotherapy (Metformin) or non-pharmacological measures (lifestyle modification). A thorough history and examination were done on all patients and Fasting Blood Sugar was done initially and after 3 months. SPSS version 21 was used. Independent and paired sample T-tests were used and chi-square was computed to see associations with the demographic factors. P-value

Objective: Pregnancies are typically affected by anemia with an increased risk of adverse outcomes for both maternal and neonatal. The purpose of the present study was to determine the frequencies of iron deficiency anemia in pregnancies, and its maternal and perinatal outcomes. Methodology: This cross-sectional study was conducted on 104 pregnant women in the Department of Obstetrics and Gynecology, Fatima Hospital Baqai Medical University from January 2019 to January 2021. All pregnant women with iron deficiency anemia attending Fatima hospital at any trimester were enrolled. Patients were categorized into anemic (Hb 10 g/dL) patients based on their Hb levels. Postpartum hemorrhage (PPH), placental abnormalities, sepsis (infection), and preeclampsia were different maternal outcomes. Low birth weight (LBW), prematurity, stillbirth, Small for gestational age (SGA), and intrauterine growth restriction (IUGR) were different fetal outcomes. SPSS version 27 was used for data analysis. Results: The overall mean age was 26.76±5.9 years. The mean Hb level was 8.76± 1.2 g/dL. Of the total 104, the frequency of anemic and non-anemic pregnant women was 93.3% (n=97) and 6.7% (n=7) respectively. The mean parity of pregnant women was 5 (±3). Out of 104, the frequency of mild, moderate, and severe anemia was 52.9% (n=55), 38.4% (n=40), and 8.7% (n=9) respectively. Of the 97 anemic pregnant women, the frequency of various maternal outcomes such as postpartum hemorrhage (PPH), placental abnormalities, pre-eclampsia, and infection or sepsis was 29 (29.9%), 8 (8.2%), 58 (59.8%), and 2 (2.1%) respectively. Conclusion: Iron deficiency anemia in the third trimester of pregnancy is associated with adverse maternal and neonatal

IntroductionThe COVID-19 pandemic encouraged the shift toward technology-based learning globally, impacting education systems profoundly. In response to this emerging need, the Eastern Mediterranean Public Health Network (EMPHNET) adapted its Public Health Empowerment Program-Basic Field Epidemiology (PHEP-BFE) to a Blended Learning Model. This study evaluates the Blended PHEP-BFE program in Iraq, Egypt, and Lebanon, focusing on participant reactions and learning outcomes.MethodsA descriptive evaluation was conducted, aligned with the first two levels of Kirkpatrick's model. Online questionnaires were administered to participants and facilitators through EMPHNET's Learning Management System (LMS). Qualitative and quantitative data were analyzed to assess program effectiveness, satisfaction, and challenges.ResultsA total of 138 PHEP-BFE participants (119 (86.2%) males and 19 (13.8%) females) from Iraq (n = 61), Egypt (n = 66), and Lebanon (n = 11) responded to the questionnaire. The majority of the participants (96.4%) reported that they were satisfied with PHEP-BFE. Notably, 77.5% of participants rated the blended learning program as very good or excellent, 18.1% rated it good, and 3.6% found it average, with a minimal 0.7% expressing dissatisfaction. The majority of participants agreed that the blended PHEP-BFE enhanced their capacity to conduct, review and monitor surveillance data (95.7%), perform descriptive data analysis (94.2%), effectively communicate information with agency staff and the local community (95.7%), write summaries of surveillance findings or outbreak investigations (95.7%), use MS Excel to enter, analyze, and display public health surveillance data (91.3%), prepare and administer an oral presentation for fieldwork (94.9%), and increase their knowledge of fundamental field epidemiology (94.9%). The participants responded positively to the program's content, training duration, learning platform, facilitators and mentors, and fieldwork.ConclusionThe study showcases the success of the blended PHEP-BFE in diverse contexts, emphasizing positive participant reactions and improved competencies. The evaluation underscores the program's success in advancing public health training in the EMR. Blended learning models prove promising for future FETP initiatives, contributing valuable insights to public health workforce development. Positive outcomes and identified challenges, provide a roadmap for continuous improvement.

Summary: Background: Research in healthy young adults shows that characteristic patterns of brain activity define individual “brain-fingerprints” that are unique to each person. However, variability in these brain-fingerprints increases in individuals with neurological conditions, challenging the clinical relevance and potential impact of the approach. Our study shows that brain-fingerprints derived from neurophysiological brain activity are associated with pathophysiological and clinical traits of individual patients with Parkinson’s disease (PD). Methods: We created brain-fingerprints from task-free brain activity recorded through magnetoencephalography in 79 PD patients and compared them with those from two independent samples of age-matched healthy controls (N = 424 total). We decomposed brain activity into arrhythmic and rhythmic components, defining distinct brain-fingerprints for each type from recording durations of up to 4 min and as short as 30 s. Findings: The arrhythmic spectral components of cortical activity in patients with Parkinson’s disease are more variable over short periods, challenging the definition of a reliable brain-fingerprint. However, by isolating the rhythmic components of cortical activity, we derived brain-fingerprints that distinguished between patients and healthy controls with about 90% accuracy. The most prominent cortical features of the resulting Parkinson’s brain-fingerprint are mapped to polyrhythmic activity in unimodal sensorimotor regions. Leveraging these features, we also demonstrate that Parkinson’s symptom laterality can be decoded directly from cortical neurophysiological activity. Furthermore, our study reveals that the cortical topography of the Parkinson’s brain-fingerprint aligns with that of neurotransmitter systems affected by the disease’s pathophysiology. Interpretation: The increased moment-to-moment variability of arrhythmic brain-fingerprints challenges patient differentiation and explains previously published results. We outline patient-specific rhythmic brain signaling features that provide insights into both the neurophysiological signature and symptom laterality of Parkinson’s disease. Thus, the proposed definition of a rhythmic brain-fingerprint of Parkinson’s disease may contribute to novel, refined approaches to patient stratification. Symmetrically, we discuss how rhythmic brain-fingerprints may contribute to the improved identification and testing of therapeutic neurostimulation targets. Funding: Data collection and sharing for this project was provided by the Quebec Parkinson Network (QPN), the Pre-symptomatic Evaluation of Novel or Experimental Treatments for Alzheimer’s Disease (PREVENT-AD; release 6.0) program, the Cambridge Centre for Aging Neuroscience (Cam-CAN), and the Open MEG Archives (OMEGA). The QPN is funded by a grant from Fonds de Recherche du Québec - Santé (FRQS). PREVENT-AD was launched in 2011 as a $13.5 million, 7-year public-private partnership using funds provided by McGill University, the FRQS, an unrestricted research grant from Pfizer Canada, the Levesque Foundation, the Douglas Hospital Research Centre and Foundation, the Government of Canada, and the Canada Fund for Innovation. The Brainstorm project is supported by funding to SB from the NIH (R01-EB026299-05). Further funding to SB for this study included a Discovery grant from the Natural Sciences and Engineering Research Council of Canada of Canada (436355-13), and the CIHR Canada research Chair in Neural Dynamics of Brain Systems (CRC-2017-00311).

Summary: Background: Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment. Methods: This study was conducted over two stages (January 2022–July 2023). The first phase involved a survey to MASCC-MSG members (January 2022–May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023–May 2023). Consensus was defined as agreement on a parameter by >80% of respondents. Findings: Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus). Interpretation: These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice. Funding: No funding was received.

Diabetes According to WHO (2016) is a serious chronic disease that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. The high cost of treating DM patients is reaching USD 1,500 to 9,000 in developing countries. The difference in costs for oral antidiabetics and the high cost analysis method. This study aims to determine the minimum cost between metformin 500 mg and acarbose 100 mg drugs in Sultan Suriansyah Banjarmasin in adult patients. This research was conducted using a cross-sectional design based on medical records and detail of patient costs in January-December 2022. The number of sample in this study were 39 patients. The statistic analysis used in study is the Mann-Whitney test and the Independent T-Test. The result of the analysis of cost minimization based on the average total cost of therapy are Rp 419,560 for metformin 500ng and Rp 680,922 for acarbose 100 mg with a probability value > 0.05 for the cost of co morbidities which means that there is no significant difference between the two drugs. Probability value < 0.05 for antidiabetic oral drug costs, lab costs and total therapy costs which means the there is a significant difference between the two drugs. Conclusion in this study is aral antidiabetic therapy for minimal diabetes mellitus is metformin compared to acarbose.

Abstract Background Public health programs are charged with implementing evidence-based interventions to support public health improvement; however, to achieve long-term population-based benefits, these interventions must be sustained. Empirical evidence suggests that program sustainability can be improved through training and technical assistance, but few resources are available to support public health programs in building capacity for sustainability. Methods This study sought to build capacity for sustainability among state tobacco control programs through a multiyear, group-randomized trial that developed, tested, and evaluated a novel Program Sustainability Action Planning Model and Training Curricula. Using Kolb’s experiential learning theory, we developed this action-oriented training model to address the program-related domains proven to impact capacity for sustainability as outlined in the Program Sustainability Framework. We evaluated the intervention using a longitudinal mixed-effects model using Program Sustainability Assessment (PSAT) scores from three time points. The main predictors in our model included group (control vs intervention) and type of dosage (active and passive). Covariates included state-level American Lung Association Score (proxy for tobacco control policy environment) and percent of CDC-recommended funding (proxy for program resources). Results Twenty-three of the 24 state tobacco control programs were included in the analyses: 11 received the training intervention and 12 were control. Results of the longitudinal mixed-effects linear regression model, where the annual PSAT score was the outcome, showed that states in the intervention condition reported significantly higher PSAT scores. The effects of CDC-recommended funding and American Lung Association smoke-free scores (proxy for policy environment) were small but statistically significant. Conclusion This study found that the Program Sustainability Action Planning Model and Training Curricula was effective in building capacity for sustainability. The training was most beneficial for programs that had made less policy progress than others, implying that tailored training may be most appropriate for programs possibly struggling to make progress. Finally, while funding had a small, statistically significant effect on our model, it virtually made no difference for the average program in our study. This suggests that other factors may be more or equally important as the level of funding a program receives. Trial registration. ClinicalTrials.gov, NCT03598114. Registered on July 26, 2018.

Background: Women with uterine fibroids (UFs) experience many clinical manifestations that affect their quality oflife (QOL). The Uterine Fibroid Symptom and Health-related Quality of Life (UFS-QOL) questionnaire is an Englishinstrument specifically designed to assess fibroid-related symptoms and their impact on QOL. This study aims toinvestigate the reliability and validity of the Persian version of the UFS-QOL questionnaire in Iranian women with UF.Materials and Methods: In this psychometric study, women with UFs who presented to Imam Hossein Hospital(Tehran, Iran) between August 2022 and January 2023 were enrolled in this study. A forward-backward approachwas applied to translate the UFS-QOL questionnaire into Persian. The reliability of the UFS-QOL questionnaire wasassessed by internal consistency and test-retest correlation. Confirmatory factor analysis (CFA) was used to assessconvergent validity between items and subscales of the UFS-QOL questionnaire. Pearson’s correlation coefficient wasused to assess convergence validity between subscales of the UFS-QOL and the World Health Organization Qualityof Life Brief Version 26 questionnaire (WHOQOL-BREF-26).Results: Overall, we assessed 226 women with UFs. All subscales of the UFS-QOL questionnaire had acceptableinternal consistency (Cronbach’s alpha>0.7). Test-retest analysis indicated significant positive correlations betweentwo measurements of all subscales of the UFS-QOL questionnaire: symptom severity (P

Abstract Background The minimum acceptable diet is the proportion of children aged 6–23 months who consumed the minimum meal frequency and minimum dietary diversity during the previous day or night. The minimum acceptable diet assesses both micronutrient adequacy and the quantity of food consumed during the previous day or night. Inappropriate infant and young child feeding practices during this period result in significant threats to child health through impaired cognitive development. Therefore, this study aims to assess the minimum acceptable diet and associated factors among children aged 6–23 months in Jig-Jiga, Somali region, Eastern Ethiopia. Methods A community-based, cross-sectional study was conducted in Jig-Jiga town. A systematic random sampling technique was used to select 536 children aged 6–23 months with their mothers. Data were collected using a pre-tested, structured questionnaire. The data were entered into Epi-data 3.1. The data were cleaned and analyzed using SPSS v20. Bi-variable and multivariable logistic regression analyses were done, and model fitness was checked and tested by the Hosmer-Lemeshow goodness of fit test. The results of the adjusted odds ratio with 95% confidence intervals and P

Summary: Background: Individual immune responses to SARS-CoV-2 are well-studied, while the combined effect of these responses on population-level immune dynamics remains poorly understood. Given the key role of population immunity on pathogen transmission, delineation of the factors that drive population immune evolution has critical public health implications. Methods: We enrolled individuals 5 years and older selected using a multistage cluster survey approach in the Northwest and Southeast of the Dominican Republic. Paired blood samples were collected mid-pandemic (Aug 2021) and late pandemic (Nov 2022). We measured serum pan-immunoglobulin antibodies against the SARS-CoV-2 spike protein. Generalized Additive Models (GAMs) and random forest models were used to analyze the relationship between changes in antibody levels and various predictor variables. Principal component analysis and partial dependence plots further explored the relationships between predictors and antibody changes. Findings: We found a transformation in the distribution of antibody levels from an irregular to a normalized single peak Gaussian distribution that was driven by titre-dependent boosting. This led to the convergence of antibody levels around a common immune setpoint, irrespective of baseline titres and vaccination profile. Interpretation: Our results suggest that titre-dependent kinetics driven by widespread transmission direct the evolution of population immunity in a consistent manner. These findings have implications for targeted vaccination strategies and improved modeling of future transmission, providing a preliminary blueprint for understanding population immune dynamics that could guide public health and vaccine policy for SARS-CoV-2 and potentially other pathogens. Funding: The study was primarily funded by the Centers for Disease Control and Prevention grant U01GH002238 (EN). Salary support was provided by Wellcome Trust grant 206250/Z/17/Z (AK) and the Australian National Health and Medical Research Council Investigator grant APP1158469 (CLL).

Key Clinical Message The case highlights an unusual presentation where sleep issues preceded psychotic symptoms, implying link between disrupted sleep and psychosis onset. Earlier symptoms were viewed as depression but may have signaled psychosis exacerbated by insomnia. Abstract Sleep disorders, prevalent yet frequently overlooked in individuals with psychotic disorders, have significant associations with the onset and severity of psychosis. Here we describe the case of a patient who first presented with insomnia, but whose condition improved with the use of risperidone and was diagnosed with first‐episode psychosis. Multiple studies emphasize the critical relationship between sleep disturbances and psychosis, particularly in the lead‐up to first‐episode psychosis. Structural abnormalities in the brain, notably the thalamus, combined with neurotransmitter imbalances involving dopamine and acetylcholine, seem pivotal in this interrelation. The connection between dopamine, sleep disturbances, and psychosis, specifically the role of D2 dopamine receptors, highlights a potential pathway bridging sleep irregularities with psychosis. The study underscores the need for further research to delineate the relationship between sleep disturbances and psychosis and to assess the efficacy of various therapeutic interventions targeting both conditions.

Postpartum cardiomyopathy is a type of heart failure that occurs during late pregnancy or early postpartum without clear causes. It poses significant health risks. Recognition and management are crucial for better outcomes. We describe a case of a 23-year-old Ugandan woman who developed heart failure symptoms 1 month after giving birth. Physical examination revealed signs of congestive heart failure. Chest X-ray showed cardiomegaly, leading to a diagnosis of postpartum cardiomyopathy based on clinical criteria. Treatment involved diuretics, beta-blockers, angiotensin receptor blockers, SGLT2 inhibitors, and bromocriptine. This case underscores the importance of considering postpartum cardiomyopathy in the postpartum period. Prompt diagnosis and comprehensive management through a multidisciplinary approach can improve patient outcomes. Further research is needed to deepen our understanding of this condition.

Background: Sex education is based on addressing the issues relating to human sexuality or other sexual activity includes reproductive health, emotional relations, reproductive rights and responsibilities, abstinence, consent and birth control. Youngsters, a vulnerable age group, experiment and engage in risky activities such as seeking information from adult themed content and pornography sources. Since, no study has addressed this subject thus; our study aims to see if there is an association between watching of pornography and lack of sex education among youngsters in Pakistan. Methods: The sample 151 at 95% confidence level consisted of both male and female participants (ages of 16-24 years). The data collection tool used in this study was an online questionnaire. Chi square was used to develop an association between lack of sex education and watching of adult themed content. All tests were significant when p

Background: To understand severity and complications of diabetes mellitus and to analyze effects of drugs, it is necessary to create diabetic animal model. There are different doses of streptozotocin to induce diabetes mellitus in rats that may be associated with mortality or may be insufficient for induction of DM. The objective of our study was to optimize the dose of streptozotocin to create a diabetic animal model with sustained hyperglycemia and to document the toxic dose at which there may be high mortality rate. Methods: This experimental animal study was conducted at animal house, faculty of pharmacy Ziauddin University Karachi in April 2019. The sample size included 30 albino wistar rats divided into five Groups A, B, C, D and E “with 6 rats each group”. Group A was the control, while streptozotocin at different concentrations was administered intraperitoneally in Group B, C, D and E respectively. Blood sample was drawn from lateral tail vein of animals and hyperglycemic profile was checked on 2nd, 4th, 6th, 8th and 10th day. Results: When compared to control Group A, hyperglycemic profile (blood glucose level >180) was achieved in Group B, C, D and E after 48 hours. High mortality rate was observed in Group E followed by Group D. Group C had persistent hyperglycemia while Group B had reversible hyperglycemic profile. Conclusion: Intraperitoneal dose of streptozotocin 60 mg/kg created diabetic animal model with persistent hyperglycemia. However, dose above increased the mortality rate and below failed to create diabetic animal model.

ABSTRACT BACKGROUND: Treating patients with multi-morbidities have always been more difficult when compared to patients with no co-morbid conditions. Hence data from this study will empower us in exhibiting effective plans in the management of multi-morbidities with sepsis in our region. Objective: To determine the association of multi-morbidities with sepsis in adult patients admitted in a tertiary care hospital. Materials and Method: This is a case-control study conducted in the Medicine Wards and Intensive Care Unit of a tertiary care hospital in Karachi during the period of May 2018 to October 2018. Results: In this study, 52 patients were enrolled. The mean age of patients was 59.35 ± 6.17. Socioeconomic Status showed significant association (p-value 0.034). The Mean SOFA Score was 2.13 ± 1.86. The Odds of having cancer [OR: 3.10 (0.10 - 80.1), p-value 0.50] and other multimorbidities like rheumatoid arthritis [OR: 3.30 (0.30 - 33.6), p-value 0.32] in cases of sepsis respectively were more than in controls but the data was not statistically significant. The Mean Length of Hospital Stay was 4.71 ± 2.08. Conclusion: An association of multimorbidities in patients with sepsis could not be determined and requires to be researched further.

ABSTRACT Background: Antenatal care is an essential pillar of safe motherhood. The aim is to give optimal care to the mother so that she can endure the nine months of pregnancy without any complications. A proper exercise plan further helps in achieving appropriate care. The aim of the study is to determine the role of physical therapy in antenatal care as perceivedbytheclients. Methods: It was a was cross sectional study and females in their nine months of pregnancy aged between 18 to 40 years were inducted in the study. A total of 375 participants were selected through purposive sampling technique. Data entry was done on SPSS version 20 and frequencies and percentages were taken as descriptive statistics for categorical variables. ‘ Results: There were 375 patients among which 81.9% were housewives, 15.5% were working women while 2.7 % were students. 83.7% of the women were aware of physical therapy out of which 95.2% women agreed that physiotherapy has positive role in antenatal care yet only 42% actually attended physiotherapy sessions and 36% were currently following exercise programme. Conclusion: The perception and knowledge of women regarding physical therapy (exercise) during pregnancy is reasonable but a small numberof subjects exercise during pregnancy. Key Words: Pregnant Females, Antenatal Care, Physical Therapy.

With the onset of the COVID-19 outbreak, a limited healthcare force catered to an ever-increasing number of COVID-19 patients on top of non-COVID-19 patients. Over two years after the pandemic, it is evident that medical practice must adapt to COVID-19 to ensure the provision of undeterred, quality medical care. This review intends to re-evaluate the Tonsillectomy protocols that we employed during COVID-19 and explore ways in which we might improve the safety of this frequently performed surgery even after the pandemic. A decrease in the frequency of tonsillitis was observed as lockdown and strict social distancing protocols were followed. Thus, it is concluded that tonsillectomies may be deferred unless urgent and in the best interest of the patient and medical workforce. However, when surgery is necessary, new mitigation strategies, like preoperative COVID-19 screening, minimizing intra-operative staff, widespread use of personal protective equipment (PPE), negative pressure operating rooms, and reducing postoperative hospital stay need to be incorporated into the safety protocols of airway surgeries and minimize aerosolization such as using SES (smoke evacuation system) during surgery and TORS (trans-oral robotic surgery). This narrative review covers an extensive literature review of papers on PubMed, Google Scholar and Medline that highlight the impact of the Pandemic on the surgical practice in patients of recurrent tonsillitis since December 2019. Keywords: Tonsillitis; Tonsillectomy; COVID-19; SARS-COV-2; Health Policy; Surgical Policy.

Background: Morbidly adherent placenta (MAP) is one of the most dreaded antenatal complications leading to massive hemorrhage, immense blood transfusion, hysterectomy, intensive care unit admission, mechanical ventilation, multi-organ failure and maternal mortality. The study aimed to determine the maternal outcome in terms of complications, interventions, and mortality in patients with MAP in a tertiary care hospital. Methods: During the study period of one year (2020-2021) a total of 68 patients with MAP were studied. Demographic profiles including age, parity, gestational age and history of previous cesarean sections were recorded. Other complications and interventions were also noted. Data was analyzed by using SPSS version 23 and a t-test was applied for comparison between the two groups. p-value 0.05). Peripartum hysterectomy was performed in 48.5% of patients. The complications noted were bladder injury 17.6%, ICU admission 45.5% and maternal mortality 4.4%. Conclusion: Morbidly adherent placenta (MAP) was found directly related to cesarean section (p>0.05). Appropriate measures should be taken to reduce the primary scars to reduce the incidence of repeat scars and ultimately MAP related severe maternal outcomes. Keywords: Morbidly Adherent Placenta (MAP); Caesarean Section; Placenta Previa.

Background: Nausea and vomiting are frequently witnessed for pregnant women who undergo C-sections under spinal anesthesia. The objective of this study was to determine the effectiveness of Ondansetron and Dexamethasone on nausea and vomiting in patients undergoing spinal anesthesia for cesarean section. Methods: This was an experimental study conducted in the Department of Anesthesia and Department of Obstetrics and Gynecology, Hamdard University Hospital, from April 15, 2021-August 15, 2021. Pregnant women (n=93) with the age >18-0.05). Post-operative 11(22.0%) cases reported nausea and 1.0(2.0%) cases of vomiting in the dexamethasone group with significant difference (p=0.001), however, participants of the Ondansetron group did not report any symptom. Conclusion: Ondansetron 4mg/kg dose decreased the propensity of nausea and vomiting after cesarean section. However, dexamethasone 8mg/kg seemed to be effective in controlling postoperative vomiting only. Keywords: Nausea; Vomiting; Ondansetron; Dexamethasone; Spinal Anesthesia.

Background: Gout is the most prevailing type of inflammatory arthropathy and its incidence has risen in recent decades. As previously no such research was found through an extensive literature survey, the current study aimed to evaluate gout patients residing in Lahore, Pakistan. Methods: To conduct this cross-sectional study, n=203 responses were obtained by a simple and objective-oriented questionnaire devised for the collection of data. Dependent variables association was measured by the Pearson Chi-square. A p-value

Background: Cognitive behavior therapy is an important treatment for various psychiatric and psychological problems. Different psychotherapeutic treatments are used for improvement in patients. The study aimed to compare Clozapine and Fluoxetine with Choline on the progress of cognition and cognitive behavior in rats. Methods: This experimental study was conducted in the pharmacology department of Karachi University on locally bred male albino rats (n=24). These were divided into four treatment groups (Saline, Fluoxetine, Clozapine, and Choline) and measured the output at the 1st, 3rd, 5th, and 7th weeks. Familiar and Novel object recognition test and Passive avoidance test was used to observe learning and memory as well as the mechanism of cognition. One way-ANOVA and post-hoc analysis was done between groups. The p-value 0.05) in the Novel and Familiar Object Recognition test. However, at week three it was highest for Fluoxetine (58.15±3.35) compared to Choline, Clozapine and Saline for the novel object. However, in Familiar objects, it was found highest for Clozapine (58.88±3.05) (p

Background: Coronary Artery Disease (CAD) is a complex interaction of genetic and multifactorial environmental factors. This study was conducted to evaluate the association of blood groups with the severity of coronary artery lesions in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Methods: This descriptive cross-sectional study was conducted at a tertiary cardiac care center in Karachi, Pakistan. Consecutive adult patients of either gender diagnosed with ST-segment elevation myocardial infarction (STEMI) undergone primary PCI during the study period of November 2020 to February 2021 were included. Based on blood grouping patients were stratified into two groups, non-O and O. comparative analysis of clinical and angiographic findings was performed and Chi-square test was used with p-value ≤ 0.05 was considered statistically significant. Results: A total of 398 patients were included in this study out of which 296(74.4%) were males (mean age: 57.15±10.95 years) and 102(25.6%) females. Type O blood group distribution was 107(26.9%) and non-O blood groups were 291(73.1%). The non-O blood group included A=110(27.6%), AB=43(10.8%), and B=138(34.7%). Significant results in type O and non-O group were seen among single vessel diseases (41.1%, 29.6%) (p=0.029) and circumflex artery as culprit (16.8%,9.6%) (p=0.046), whereas in post-procedure complication no significant results were found (p=0.554) with in-hospital mortality rate (p=0.642). Conclusion: Blood group type O was found to be associated with single-vessel coronary artery diseases. However, no association of blood groups was observed with lesion complexity, post-procedure complications and mortality. Keywords: Ischemic Heart Diseases; Coronary Artery Diseases; Myocardial Infarction; Blood Group.

Background: Parental stress is the major factor that increases a risk of unwillingly placing children with disabilities. The aim of our study is to assess the frequency of depression amongst parents of children with intellectual disability. Methods: This was a cross sectional study conducted for 10 months in various hospitals and rehabilitation centers in Karachi, Pakistan. Participants were inducted using purposive sampling technique. Parents of intellectually challenged children up to 18 years of age were included and a self-administered questionnaire was utilized for data collection both in English and Urdu. PHQ 8 was used to assess the severity of depression amongst parents. For all purposes, p-value of

ABSTRACT Temporomandibular joint (TMJ), is a synovial joint, involves two bones particularly mandible and temporal bone. Since TMJ involve muscles of mastication and jaw movement therefore, its disorders damages surrounding tissues and minimizes its function. The etiology of TMJ disorders is complex and multifactorial including genetic, traumatic, inflammatory, degenerative and idiopathic disorders as well as behavioral factors (parafunctional habits). Generally females are more affected because of increased level of estrogen hormone affecting bone and cartilage; moreover, emotional factors (anxiety, stress and depression) are also higher in females compared to males. Genetic disorders of TMJ include many genes, which contribute in bone formation and inflammation mediation. This article is focused on etiology of temporomandibular joint disorders and involvement of certain genes and other predisposing factors leading to pathophysiology of its development. Information regarding TMJ disorders was retrieved through PubMed, Medline and other authentic search engines available in the University, information was collected through reviews, research, and epidemiological studies published up to 2016. This review article concludes urgent management is sought in 1-2% young children, 5% teenagers and 5-12% adults. In order to avoid any iatrogenic injury it is mandatory to do prior extensive and detailed physical examination of TMJ.

Background: Injury is a significant issue of public health, a major global burden and first aid training programs incorporated as part of school curriculum will have a considerable impact on public health, and this will in turn reduce out of hospital cardiac arrests. The study aimed to determine the immediate First aid knowledge and long term retention of its knowledge (after three months) of the students (13-18 years), participating in a volunteer program in Karachi. Methods: This study was conducted in a tertiary care hospital, delivering First aid training to 143 participants by Basic life support (BLS) trained staff in a tertiary care hospital. The design consisted of a pre-test, post-test and follows up assessments, carried out via questionnaire and hands-on assessment. SPSS was used for statistical analysis. ANOVA and Friedman test was applied to evaluate the dependent variable’s improvement in knowledge between pre, post and follow up tests. Results: From 143 participants, 41.5 %, 63.8 % and 61 % satisfactory results were seen in the pre-test, post-test and follow up assessments, respectively. In Pre-test, males scored 18.75 % and the females scored 8.42%, whereas, in the post-test, the scores were 75.7% and 64.58% respectively. Similarly, in follow up evaluations results obtained were 62.1% and 45.8% respectively. Hands-on scores were 88.4% in males and 95.8 % in females. Conclusion: The level of first aid knowledge was unquestionably less satisfactory in the pre-test evaluations compared to post-test and follows up assessments. Due to its effectiveness, it should be incorporated as part of the school curriculum. Keywords: Adolescents; Knowledge; Cardiopulmonary Resuscitation.

Background: The association between health and nutrition are eminent. Quality nutrition is acknowledged as one of the most important determinants of optimal development, good health, and wellbeing. Therefore, the study aimed to determine the knowledge, attitudes, and practices amongst adolescents regarding nutrition. Methods: It was a cross-sectional study conducted between 2016 to 2017 in Karachi. The sample size was 384; the purposive sampling technique was applied with a target population of adolescents between 14 and 19 years of age. Informed consent was taken before the questionnaire submission. Data were collected via self-administered questionnaires from students of various schools in Karachi. The Chi square test was applied for associations and a p-value of

Pregnancy complicated complete heart block is a high-risk situation. Maternal complete heart block (CHB), which manifests for the first time during pregnancy and peurperium, poses a challenge to treating physicians. Pace maker insertion is recommended early in case the patient is symptomatic or has a prolonged Q-T Interval or left atrial enlargement on ECG. We are reporting a case of a pregnant woman G 2 para1+0 with 31 weeks of pregnancy complete heart block. She presented complains of sudden onset of localized epigastric pain which was accompanied with shortness of breath and non-projectile vomiting. Apart from these symptoms, she did not feel any palpitation. She was conscious and oriented with a pulse rate 44 bpm and BP 151/71mmHg. ECG confirmed the diagnosis of complete heart block. A permanent pacemaker was placed. She delivered at 37 weeks of gestation with an alive & healthy baby by caesarean section due to ruptured membranes. When a multidisciplinary approach is used, both maternal and neonatal outcomes are good. KEY WORDS Pacemaker, Complete Heart Block (CHB), Q-T Interval.

ABSTRACT Background: Pressure ulcers, although being very common, are still a neglectedfield of study in Pakistan. They can esult in debilitating complications if not treated early and properly. Proper medical care along with prompt physiotherapy is the idealistic choice in managing pressure ulcers Objectives: Assess the awareness among doctors about the role of physiotherapyin managementof pressure ulcers. Methods: Thecrosssectional survey involved 200 doctors selected by convenience sampling from government and private hospitals of Karachi. Doctors were interviewed through a structured questionnaire and p value

Background: Continuing professional education (CPE) or continuous education (CE) is the means by which people maintain their knowledge and skills related to their profession. Mandatory continuing education is a major factor in relicensure that is being licensed to practice for a specific period with the license either getting renewed at the end of that period or forfeited. This study is designed to assess the awareness regarding importance of continuing professional education as a requirement for re-licensing among General Dental Practitioners and Specialists and to identify the role of governing bodies for endorsing re-licensure procedure on the basis of CME Methods: Cross sectional study was conducted among 450 dentists practicing in Karachi (July 2013 to Dec 2013), divided in to two groups ;General Dental Practitioners (n=350)and Consultant Specialists(n=100). Simple Random sampling technique was applied thorough lottery from available list of Dentists and Consultants. Data was collected through a self administered questionnaire. SPSS version 20 was used for analysis and Chi –square test to assess associations of categorical variables. P value less than 0.05 was considered as significant. Results: Majority participants n= 250 (55.6%) were aware about re -certification and re-licensing and n= 292 (64.9%)knew the difference between the two. Only n=153 (34%) were of the view that re -certification and re-licensing should be made mandatory in Pakistan. Conclusion: The awareness of CME & re-certification is high among our professionals Key Words: Re-certification, Re-licensing, Continuous Medical Education.

Background: Liver biopsy so far, is the mainstay of diagnosing hepatic fibrosis. Activated HSCs express certain mesenchymal markers, of which Smooth Muscle Actin is a well-known marker. This study aims to appreciate expression of Alpha Smooth Muscle Actin in hepatic stellate cells of CHC cases and to find out the frequency of α-SMA positive HSCs in perisinusoidal, periportal and pericentral regions of liver. Methods: Liver biopsies of sixty Chronic Hepatitis C cases were immmunostained using anti α-SMA antibody. To assess immunoexpression, semi quantitative scoring was done in three areas in each sample; pericentral, periportal and perisinusoidal area. Results: Immunoexpression of α-SMA was observed in all area with strongest staining on HSCs of perisinusoidal area. Conclusion: α-SMA can represent a useful marker for early hepatic stellate cells activation in our population and can help target patients requiring aggressive therapy. KEY WORDS: α-SMA, CHC, liver fibrosis, Hepatic Stellate Cells.

In Pakistan, tobacco consumption is at an all-time high with the tobacco industry witnessing a boom. According to the Pakistan Tobacco Company, production and sale has taken a sharp leap from Rs.1,000 million rupees to Rs.1,750 million in 2008. The youth remain particularly vulnerable as massive antismoking ad campaigns have failed to drill in the health hazards. The aim of this study is to assess the attitude, perception and practices of youth regarding cigarette smoking. Comparative cross-sectional study was conducted in Ziauddin University and Bahria University. Sample was taken from all years of teaching. Data was collected through self-administered structured questionnaire that was developed in English. It comprised of questions pertaining to their year of study, smoking history, and perception and practices regarding smoking. A total of 450 students were surveyed, medicine (n=260) and engineering (n=190). One-fourth of the survey sample admitted to have tried to smoke at least once in their lifetime (p=0.001), and at least 20% medical students (n=53) and 35% of engineering students (n=66) surveyed had smoked a cigarette (p=0.001). While students studying medicine were better aware of the risks associated with smoking and tobacco consumption, however compared to engineering students their overall knowledge of the health risks was unsatisfactory. A significant number of medical students were unable to list and hence effectively counsel about long and short term health benefits. Peer pressure and media played a large role in students picking up the habit. KEY WORDS: Pakistan/Epidemiology, Smoking, Karachi, Mechanism Medical Students.

Background: The role of vitamin D, a steroid hormone that exerts most of its biological activities by binding to the vitamin D receptor, in health and disease is far from understood and the literature is full of contradictory findings. Still, evidence that vitamin D is capable of modulating several features of cancer exist. Objective: To correlate changes in breast tissue with low serum levels of Vitamin D(Vit D) in females during their reproductive years. Methods: This study was conducted in the department of Anatomy, Ziauddin Medical College, Karachi and data collected from the department of surgery, Patel Hospital, Karachi in patients undergoing biopsy of the breast lump, between February 2012 and February 2013. 90 patients with diagnosis of breast lump, between 25-40 years of age, with parity varying from 1-5 were divided into 2 groups, those with serum Vit D levels in the normal Range(group A) and those having marked deficiency of serum Vit D levels(group B). Detailed histological study of the biopsy specimen was conducted in all the patients. Results: Patients who had a marked deficiency of serum vitamin D levels, had more proliferation of stromal connective tissue in group B whereas in group A patients, minimal proliferation of connective tissue was observed in H and E stained slides under the light microscope. Conclusion: It seems clear that Breast Cancer prevention includes maintaining adequate Vitamin D levels by using oral vitamin D supplementation and with prudent exposure to sunlight. Key Words: Breast Lump, Vitamin D, H and E Stain, Serum 25(OH) D, VDR, MAARS Protein.

Background: Thyroid gland volume (TGV) is highly variable as it is greatly influenced by age, gender, anthropometric measurements and geographical location. It has become essential for every population to determine reference range of their normal thyroid gland volume (TGV) in healthy individuals. This in turn will help the population in grading of goiter and will guide in large scale iodine monitoring programs. Objective: To determine TGV in a subset of Karachi population and to determine its association with age and gender. Methods: A cross-sectional study employing 421 volunteers aged 21 years and above went through the ultrasound (US) examination of their thyroid gland (TG) after being confirmed euthyroid by their serum thyroid stimulating hormones (TSH) evaluation. Results: TGV in the study was found to be 6.26 ± 2.89 ml. Males had significantly higher TGV 6.78 ± 2.88 ml as compared to females 5.7 ± 2.79 ml (P=0.00). Volume of right lobe was significantly greater than that of left lobe (P=0.00) in both the genders. TGV increased significantly with age till 60 years (P

Background: Osteporosis is increasingly observed as a major public health concern as it leads to poor quality of life, pain and often disability for those effected. Especially in the developing countries, its prevalence in alarming in the face of poor awareness and management. Objective: To assess the risk factors for osteoporosis in females coming to a tertiary care hospital of Karachi. Methods: This was hospital based case control study conducted in a private tertiary healthcare facility of Karachi. It was carried out in 2012. 57 cases and 60 controls were selected through WHO Sample size calculator. Matching among cases and controls was based on gender, socioeconomic status and age group. Data was collected through questionnaire based personal interviews. Data entry and analysis was done using Epi Info. Association between categorical variables was found using chi square. Odds ratio was calculated for finding association between different risk factors and osteoporosis. The study was cleared through the Ethical review board. Results: One hundred and seventeen cases and controls were taken in this study with the age range of 45+ years (mean age 56.8 ± 11.8). Statistically significant difference was found in under 50 age group where cases were only n=8 (14%) as compared to controls n=25(42%). Parsi ethnicity showed strong association with osteoporosis (OR 2.23). Strong association was observed between smoking and osteoporosis with an Odds Ratio of 4.0. Strong association was observed with Rheumatoid arthritis (OR 2.8, CI at 95% 1.2-6.3) and Calcium deficiency (OR 2.2, CI at 95% 1.1-4.7). Conclusion: The study revealed specific to Parsi ethnicity, family history, smoking, rheumatoid arthritis and Vitamin D deficiency were found to be potent risk factors. Therefore as reaffirmed from our study also, risk factors except from the non modifiable ones should be tackled well in advance through health education and interventions. Key Words: Osteoporosis, Rheumatoid Arthritis, Bone Density

Background: Motivation and job satisfaction ultimately effect work performance of an individual. There are various factors which influence the work motivation and knowledge of these factors can help in improving the work performance. Objective: To assess the different factors that are associated with work motivation among nurses working in private and public tertiary care hospitals of Karachi. Methods: This descriptive, cross-sectional study was carried out among nurses for duration of 3 months in 2013. Total 240 nurses from two tertiary care hospitals of Karachi were selected by convenience sampling. A pretested and self-administered questionnaire was used to assess factors associated with work motivation. Data was analyzed using SPSS version 20.0. Results: Of total 240 study participants, 48.8% (117) nurses were in favor of financial incentives that motivate them most. Salary structure and appraisal system both showed significant difference (p-value= 0.000) between nurses from public and private hospitals while the most content place to work was reported government hospitals by 43.4% (104) nurses. Work motivation mean score revealed significant difference (p-value =0.003) among nurses from different working areas of hospital. Factors associated with job satisfaction showed significant difference (p value = 0.000) among nurses from private and public sector hospitals. Conclusion: Financial incentives were found to be the most important motivating factor for nurses that improve their performance. It was also concluded that public sector hospitals along with so many factors of satisfaction are the most content place of working that motivate them most. Key Words: Motivation, Nurses motivation, Tertiary care hospital, factors of motivation.