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Aabiya Arif,1 Yeny Chavarria,2 Mohammad Aadil Qamar,1 Sameer Saleem Tebha,3 Mehwish Butt,3 Khulud Qamar,4 Abubakr Yosufi5 1Medical School, Ziauddin University, Karachi, Sindh, Pakistan; 2Department of Neurology, University of California, Irvine, CA, USA; 3Department of Neurosurgery and Neurology, Jinnah Medical and Dental College, Karachi, Sindh, Pakistan; 4Department of Medicine, Dow Medical College, Karachi, Sindh, Pakistan; 5Medical School, Kabul University of Medical Sciences, Kabul, AfghanistanCorrespondence: Abubakr Yosufi, Dean’s Office, Kabul University of Medical Sciences, Kabul, Afghanistan, Tel +93-74-7236767, Email abubakr.educational@gmail.comBackground: New-onset refractory status epilepticus (NORSE) has been reported in the scientific literature as a phenomenon associated with the COVID-19 infection. Given the resurgence of the newer variants of COVID-19 added with its multi-system manifestations, this project was conducted to study the clinical picture of NORSE secondary to COVID-19 infection.Methods: Three electronic databases were searched using an extensive search strategy from November 2019 to December 2021. Patients reporting NORSE secondary to COVID-19 were included in this review. The status epilepticus severity score (STESS) was calculated by the study authors for individual patients. Statistical analysis was performed using SPSS version 26 with a p-value < 0.05 as statistically significant.Results: After screening, 12 patients were included in this study with a mean age of 61.6 ± 19.0-year olds. The most common type of status epilepticus reported in our study population was non-convulsive status epilepticus (NCSE) (7 out of 12 patients, 58.3%). The linear regression model revealed that STESS scores were significantly influenced by patients’ age (p = 0.004) and intra-hospital occurrence (IHO) of status epilepticus (p = 0.026). Overall, 8 patients (66.7%) were discharged without complications.Conclusion: Given the observed association of STESS with the aging population and IHO of status epilepticus, special attention is due to the caretakers of this population, while further studies are needed to further build upon this review.Keywords: new-onset refractory status epilepticus, COVID-19, status epilepticus severity score, status epilepticus, NORSE, FIRES

Background: Today, media literacy and reflective thinking are emphasized as an important preventive strategy against drug abuse. Therefore, the present study aimed to explore how spiritual health mediates the relationship between media literacy and reflective thinking in lowering addiction risk among female students.Methods: In a descriptive-correlational study, 315 female students were selected using convenience sampling techniques at the University of Zanjan, Iran, from April 2021 to November 2021. They were asked to complete the Media Literacy Questionnaire (MLQ), Reflective Thinking Questionnaire (RTQ), Addiction Risk Assessment (ARA), and Spiritual Health Scale (SHS). The data was then analyzed using SEM conducted by SPSS Amos version 24.Results: Preliminary findings indicated a significant negative correlation between addiction risk and both media literacy (r=-0.33, P=0.001) and spiritual health (r=-0.36, P=0.001), with reflective thinking acting as a critical factor in enhancing media literacy’s protective effect. Spiritual health was regarded as a mediating variable in this study. The results demonstrated that spiritual health effectively mediated the relationship between media literacy and reflective thinking, affecting addiction risk among female students (P=0.001).Conclusions: This study revealed a significant negative correlation between addiction risk and both media literacy and spiritual health, where reflective thinking plays a crucial role in enhancing the protective effect of media literacy on addiction risk, with spiritual health acting as a mediating variable.

Background: Drug abuse among students is a widespread issue that can have negative consequences on their psychological well-being and academic performance. Objectives: This study aims to investigate the mediating role of spiritual intelligence in the relationship between media literacy and tendency to addiction in nursing students in 2022. Methods: The research involved 139 undergraduate nursing students from Zanjan and Abhar School of Nursing and employed non-random quota sampling. Data were collected using questionnaires assessing addiction tendency, media literacy, and spiritual intelligence. The analysis, conducted in SPSS 24, included Pearson's correlation coefficient and regression analysis following Baron and Kenny's mediation method. Results: The results revealed significant negative correlations between addiction tendency and both media literacy (r=-0.33) and spiritual intelligence (r= -0.36). Mediation analysis demonstrated that spiritual intelligence played a significant mediating role in the relationship between media literacy and addiction tendency. The path from media literacy to spiritual intelligence was significant (β= 0.28), as was the path from spiritual intelligence to addiction (β= -0.36). Furthermore, the total effect of media literacy on addiction (β= -0.16) and the direct effect of media literacy on addiction with the inclusion of spiritual intelligence in the model (β= -0.21) were both significant, confirming the mediating role of spiritual intelligence. Conclusion: this study underscores the mediating role of spiritual intelligence in the relationship between media literacy and addiction among nursing students. These findings emphasize the importance of incorporating media literacy and spiritual intelligence into nursing education to potentially reduce the risk of addiction among students.

Background & Objective: Every society tries to improve its educational systems to educate students to face their problems in daily life easily. Therefore, it is essential to provide optimal learning conditions and situations in the learning process to achieve the best results. The study aimed to investigate the mediating role of self-regulation learning strategies in the relationship of mindfulness and responsibility with interpersonal relationships and social acceptance in general practitioner students. Materials & Methods: This cross-sectional study was conducted from January to August 2022. Based on structural equation modeling methodology, 384 medical students of Zanjan University of Medical Science participated in this study by simple random sampling. The questionnaires used included Baer's Mindfulness, Responsibility, Interpersonal Communication Skills, Crown's Social Acceptance, and Self-Regulated Learning Strategies questionnaire. The questionnaire was made electronically using the native Porsline system. Standard equation modeling was used by SPSS (version 24) and Lisrel (version 8.8) software packages to analyze the data with a 95% confidence interval. Results: The findings demonstrated that mindfulness directly affects interpersonal relationships (P=0.03, β=0.31). The direct effect of mindfulness on social acceptance revealed a positive and statistically significant effect of P=0.04, β =0.28. With a standard beta of 0.33, the results indicated a direct and significant impact of accountability on interpersonal relationships (P=0.03). The results also suggested that the direct effect of responsibility on social acceptance was positive and statistically significant (P=0.01, β=0.45). Conclusion: According to the findings of the model analysis, responsibility, and mindfulness directly affected interpersonal relationships and social acceptance while simultaneously fostering solidarity. Furthermore, the indirect path of responsibility on social acceptance was significant; that is, self-regulation was able to serve as a mediator between responsibility and social acceptance, and the final model could explain, on average, 50% of the distribution of "interpersonal relations and acceptance" in the student population. Therefore, it is suggested to pay attention to such factors as self-regulation and interpersonal skills in the education of students.

سابقه و هدف: پیشرفت تحصیلی پیامدی رفتاری است که اهمیت زیادی برای دانش‌آموزان دارد و شاخصی مهم برای ارزیابی نظام‌های آموزشی در نظر گرفته می‌شود که شناسایی عوامل مؤثر بر آن ضروری است. ازاین‌رو، پژوهش حاضر با هدف تعیین رابطۀ هوش معنوی و وجدان تحصیلی با عملکرد تحصیلی و تعیین نقش واسطه‌ای سرسختی تحصیلی در دانش‌آموزان پایۀ نهم شهر زنجان انجام گرفته است. روش کار: مطالعۀ حاضر توصیفی از نوع همبستگی است. جامعۀ آماری تمامی دانش‌آموزان پسر پایۀ نهم ناحیۀ دو شهر زنجان در سال تحصیلی 98-1397 بود. حجم نمونه بر اساس جدول مورگان 317 نفر تعیین شد و شرکت‌کنندگان به‌روش نمونه‌گیری خوشه‌ای چندمرحله‌ای وارد مطالعه شدند. داده‌ها با استفاده از پرسش‌نامۀ وجدان تحصیلی مک ایلروی و بانتیگ، پرسش‌نامۀ سرسختی تحصیلی بنیشک و همکاران و پرسش‌نامۀ هوش معنوی کینگ جمع‌آوری شد. همچنین برای بررسی عملکرد تحصیلی از معدل کل دانش‌آموزان و جهت تجزیه‌وتحلیل داده‌ها از آزمون‌های همبستگی پیرسون و آزمون رگرسیون گام‌به‌گام و برای تعیین نقش میانجی از روش بارون و کنی استفاده شد. در این پژوهش همۀ موارد اخلاقی رعایت شده است و مؤلفان تضاد منافعی گزارش نکرده‌اند. یافته‌ها: نتایج نشان داد که بین وجدان تحصیلی با پیشرفت تحصیلی (05/0P

Purpose: Sarcopenia or age-associated muscle decline is common in patients with chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) is an effective tool in reducing COPD phenotype, but its effects on sarcopenia and functional capacity are poorly known. We aimed to assess the restorative potential of PR on skeletal muscle and physical capacity in COPD patients. Methods: We investigated the male COPD patients, 56–71 years old (n = 55), through clinical examination, laboratory investigation, and spirometry. All patients were evaluated at two time points, 1 year apart before and following the PR. Reduced handgrip strength (HGS), appendicular skeletal mass index (ASMI), and gait speed were considered the clinical indexes of Sarcopenia. Enzyme-linked immunosorbent assay were used to measure the circulating markers of inflammation (C-reactive protein [CRP]) and oxidative stress (8-isoprostanes). Results: At baseline, the COPD patients had low HGS and gait speed and elevated CRP and 8-isoprostanes levels. According to four internationally recognized criteria, these patients also had a high incidence of Sarcopenia. One year of PR partially restored the HGS, gait speed, CRP, and 8-isoprostanes levels (all P < 0.05). However, the ASMI values were insignificantly restored following PR. PR also reduced the incidence of sarcopenia in COPD patients. Among various criteria for sarcopenia, the international working group on sarcopenia yielded the highest incidence of sarcopenia in COPD patients. Conclusion: Altogether, our data show the therapeutic potential of PR in skeletal muscle, physical performance, and systemic health in patients with COPD.

Background: The study startup process for interventional clinical trials is a complex process that involves the efforts of many different teams. Each team is responsible for their startup checklist in which they verify that the necessary tasks are done before a study can move on to the next team. This regulatory process provides quality assurance and is vital for ensuring patient safety [10]. However, without having this startup process centralized and optimized, study approval can take longer than necessary as time is lost when it passes through many different hands. Objective: This manuscript highlights the process and the systems that were developed at The University of Kansas Comprehensive Cancer Center regarding the study startup process. To facilitate this process the regulatory management, site development, cancer center administration, and the Biostatistics & Informatics Shared Resources (BISR) teams came together to build a platform aimed at streamlining the startup process and providing a transparent view of where a study is in the startup process. Process: Ensuring the guidelines are clearly articulated for the review criteria of each of the three review boards, i.e., Disease Working Group (DWG), Executive Resourcing Committee (ERC), and Protocol Review and Monitoring Committee (PRMC) along with a system that can track every step and its history throughout the review process. Results: Well-defined processes and tracking methodologies have allowed the operations teams to track each study closely and ensure the 90-day and 120-day deadlines are met, this allows the operational team to dynamically prioritize their work daily. It also provides Principal investigators a transparent view of where their study stands within the study startup process and allows them to prepare for the next steps accordingly. Conclusion/future work: The current process and technology deployment has been a significant improvement to expedite the review process and minimize study startup delays. There are still a few opportunities to fine-tune the study startup process; an example of which includes automatically informing the operational managers or the study teams to act upon deadlines regarding study review rather than the current manual communication process which involves them looking it up in the system which can add delays.

Abstract Although messenger RNA (mRNA) vaccines have established efficacy for prevention of severe SARS-CoV2 infection in the general population, their effectiveness in patients with malignancy, especially those on anti-neoplastic therapies, remains an area of open research. In order to better understand the risk of developing breakthrough SARS-CoV-2 infection and the outcomes associated with breakthrough infection for cancer patients, individual patient data from a curated outcomes database at the University of Kansas were retrospectively reviewed to determine the rate of breakthrough infection during an 8-month period encompassing the height of the delta variant surge. Although the rate of breakthrough infection in cancer patients after two doses of an mRNA vaccine remained low at 1.1%, hospitalization and death rates were 27 and 5%, respectively. Patients with hematologic malignancies, especially multiple myeloma, and those on anti-neoplastic therapy at the time of vaccination were found to be at higher risk for developing breakthrough infection.

Background: Even though vitamin A (Vit A) is one of the essential vitamins required for bone growth and development, it is still uncertain whether its effect on bone mineral density (BMD) is beneficial or harmful. Aim: To assess Vit A's effect and its derivatives on BMD and the risk of developing osteoporosis. Data sources: PubMed, Cochrane Library, Science Direct, Embase, and Google Scholar were searched in February 2019 and updated in November 2020. Methods: Conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Results: A total of 13 studies were included in this report out of 9,124 citations. Five of them were cross-sectional studies, and nine were cohort studies. Three out of five cross-sectional studies showed an increase in BMD, while two showed a decrease in BMD. Four out of eight cohort studies found an increase in BMD; two studies found no association between vitamin A level and BMD; one showed an inverse U-shape association of vitamin A with BMD, suggesting that both the increase or decrease levels of vitamin A affect BMD, while only one study showed a decrease in BMD. Conclusion: Although most of the included studies showed a favorable effect of Vit A on BMD, Vit A's role or its derivatives on BMD change remains unclear.

The purpose of present study was to examine the structural relationship between perceived transformational teaching and critical thinking mediated by motivational beliefs (self-efficacy, intrinsic interest and test anxiety) among university students. The population in this study was all of the undergraduate students of Psychology of Islamic Azad University, Karaj Branch, Iran, in 2019-2020 academic year. From this population 384 students were selected using random stratified sampling method. The research instruments were Transformational Teaching Questionnaire (TTQ), The California Critical Thinking Disposition (CCTD) questionnaire and Motivated Strategies for Learning Questionnaire (MSLQ). The proposed model of the relationships between variables was tested using path analysis. According to results, proposed model had an acceptable fitness regarding fitness indices. In general, the results showed that perceived transformational teaching are effective both directly and indirectly through self-efficacy, intrinsic interest and test anxiety with critical thinking disposition.

There are some traditions in Sunni and Shi’ite sources on the 7th verse of Surah al-Ra’d that are notable in terms of numerous different perspectives in this regard while there has been no comparative research on this subject yet. To this aim, the present study uses descriptive analysis to deal with the comparative study of the existing evidences in Sunni and Shi’ite traditions in the first 5 Hijri centuries. In this regard, only the traditions that introduce Imam Ali (PBUH) and then the following Imams as the guide after the Prophet Muhammad (PBUH) are in agreement with the stylistics of the verse, Qur’anic terminology, and comprehensiveness. However, those Sunni traditions that introduce merely Prophet Muhammad and Imam Ali as the guides are true for those given ages. © Rezaii Haftadar, H; Zahedi Far, S; Kouhi, Q. (2020) The Comparative Analysis of Sunni and Shi’ite Traditions in the First 5 Hijri Centuries about the Qur’anic Verse “But Thou Art Truly a Warner, and to Every People a Guide". Biannual Journal of Comparative Exegetical Researches, 6 (11) 115-139. Doi: 10.22091/ptt.2020.4110.1522

For downloading the full-text of this article please click here. Background and Objective: Mismanagement of emotional impulses and reduced commitment to the religious duty of prayers as well as the increased relationship between male and female students are considered as the important issues in academic environments in recent years. The present study was an attempt to investigate the relationship of emotional intelligence and commitment to prayers with sexual desire in single students of Miyaneh Universities. Methods: The statistical population included all single B.A. students in Payame Noor University and Islamic Azad University in Miyaneh, out of which a sample of 140 university students was selected using accessible sampling method. Data were collected using Petrides and Farnhaym’s Emotional Intelligence Questionnaire, Panahi’s Prayer Adherence Questionnaire, and Multidimensional Sexuality Questionnaire (MSQ). The data were analyzed by using Pearson correlation and multivariate regression. In this study, all the ethical considerations have been observed and no conflict of interest was reported by the authors. Results: Based on the results among the components emotional intelligence, only emotion control had a negative and significant correlation with sexual desire (r=-0.236, P

Background: Today, the borderline personality disorder has become highly prevalent among adolescents. Its relationship with the incidence of self-harm behaviors has augmented its importance. Thus, in the present article, we aimed to answer the question of what the relationship is of emotional abuse, borderline personality, and self-harm behavior with the mediating role of object relation in female adolescents. Methods: This cross-sectional study was performed on 285 female students in Qazvin, Iran in the academic year of 2020-2021. Seven female middle schools were randomly chosen for sample collection. Child Trauma Questionnaire (CTQ) Scale, Object Relations Inventory, Leichsenring Borderline Personality Disorder Questionnaire, and Klonsky & Glenn Self-injurious Behavior Questionnaire were used to collect data from the participants. Finally, the data were entered into SPSS software version 25, and Pearson correlation coefficient and multiple regression were utilized to analyze them. Results: The findings indicated the bivariate correlation of emotional abuse, object relations, and borderline personality with self-harm (r=-0.10, P=0.04, r=-0.47, P=0.001, and r=-0.47, P=0.001, respectively). Standardized coefficients of effects, object relations (β=0.47, P=0.001), borderline syndrome (β=0.28, P=0.003), and emotional abuse (β=-0.10, P=0.046) showed the most significant effects. The mediating role of object relations in this study was also confirmed. Conclusion: Our results revealed a relationship between borderline personality disorder and self-harm behavior in female adolescents. Object relations can also greatly eliminate the effect of borderline personality disorder on self-harm.

Background: Academic performance, as a behavioral consequence, is of great importance for students and is considered as significant indicator for evaluating educational systems and identifying the factors affecting them. This led us to study the relationship of academic consciences and academic performance with the mediating role of academic hardiness in ninth grade students in Zanjan. Methods: As the statistical population, we selected all the ninth-grade male students of district 1 of education department of Zanjan, Iran in 2018-2019. The present research was conducted as a descriptive correlational study. The statistical sample comprised 295 of these students. Data were collected using McIlroy and Banting Academic Conscience Questionnaire and Academic Hardiness Questionnaire of Benishkak and colleagues. Additionally, total academic grade point average (GPA) of the students was utilized to assess academic performance. The data were analyzed by Pearson correlation and stepwise regression tests. To determine the mediating role of academic hardiness, Baron and Kenny method was also used. Results: The correlation of the variable of academic conscience with the academic performance equaled r=0.255, P=0.042, effort control equaled r=0.131, P=0.047, emotion control equaled r=0.181, P=0.045, challenge ability was r=0.161, P=0.045, and hardiness was r=0.195, P=0.044; these results were statistically significant. This study also revealed that in the relationship between academic conscience and academic performance, academic hardiness has a mediating role. Conclusion: Academic conscience, by affecting academic hardiness, can contribute to students’ academic performance.

Background: Prediction of tumor shrinkage and pattern of treatment response following neoadjuvant endocrine therapy (NET) for estrogen receptor positive (ER+), Her2 negative (Her2–) breast cancers have had limited assessment. We examined if ultrasound (US) and Ki–67 could predict the pathologic response to treatment with NET and how the pattern of response may impact surgical planning. Methods: A total of 103 postmenopausal women with ER+, HER2– breast cancer enrolled on the FELINE trial had Ki–67 obtained at baseline, day 14, and surgical pathology. A total of 70 patients had an US at baseline and at the end of treatment (EOT). A total of 48 patients had residual tumor bed cellularity (RTBC) assessed. The US response was defined as complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). CR or PR on imaging and ≤70% residual tumor bed cellularity (RTBC) defined a contracted response pattern. Results: A decrease in Ki–67 at day 14 was not predictive of EOT US response or RTBC. A contracted response pattern was identified in one patient with CR and in sixteen patients (33%) with PR on US. Although 26 patients (54%) had SD on imaging, 22 (85%) had RTBC ≤70%, suggesting a non-contracted response pattern of the tumor bed. The remaining four (15%) with SD and five with PD had no response. Conclusion: Ki–67 does not predict a change in tumor size or RTBC. NET does not uniformly result in a contracted response pattern of the tumor bed. Caution should be taken when using NET for the purpose of downstaging tumor size or converting borderline mastectomy/lumpectomy patients.

Background: Recurrence in substance abusers is high, but alexithymia, impulsivity and emotional intelligence can play a role in predicting it.Aims: The purpose of this study was to investigate the role of alexithymia, impulsivity and emotional intelligence in predicting recurrence of substance abuse disorder. Method: Descriptive-correlational research method and among those who referred to addiction treatment centers, 120 were selected by purposeful. For information gathering, we used the predicted scales Wright at al( 2001, Toronto Alexithymia Scale-20 (FTAS-20) (1994), Barratt Impulsiveness Scale-11 (BIS-11) (2004), and Bradbury and Graves' emotional intelligence(2005) . Data were analyzed using Pearson correlation and regression. Results: The results showed that there is a significant positive relationship between alexithymia, difficulty in identifying feelings, total score of impulsivity and the dimensions of motor impulsivity and cognitive impulsivity with relapse. There was a significant negative relationship between the impulsiveness of non-planning , emotional intelligence and dimensions with self-awareness, self-management, social awareness and relationship management of emotional intelligence components and recurrence of drug use (p

Background and Objectives: The tendency to use drugs is a growing phenomenon, which is linearly increasing from early adolescence to early adulthood. This study aimed to determine the relationship between religious orientation and addiction potential with the mediatory roles of social support and self-efficacy among male adolescents in Zanjan Rood, Iran. Methods: This descriptive and correlational study was conducted among all male high-school students of Zanjan Rood in the academic year of 2015-2016. In total, 181 subjects were selected based on single-stage cluster sampling. Data collection was carried out using Religious Orientation Scale by Allport, Philips Social Support Questionnaire, Sherer General Self-Efficacy Scale, and Addiction potential Scale (APS). In addition, data analysis was performed through structural equation modeling and path analysis by using SPSS version 20 and LISREL. Results: In this research, the components of internal and external religious orientation, social support (family, friends, acquaintances, and total support), and self-efficacy had a significant impact on addiction potential of the participants. Moreover, social support and self-efficacy had a mediatory role in the relationship between religious orientation and addiction potential among adolescents. Evaluation of direct paths demonstrated that while the path of internal religion orientation had the highest effect on addiction potential (B=0.68, P

Background and Objective: Today, the prevalence of academic procrastination among students is increasing and various factors are correlated with it. Therefore, this study was conducted to determine the relationship between cognitive emotion regulation and educational skills with academic procrastination in students of the Faculty of Health and Paramedical of Zanjan University of Medical Sciences. Materials and Methods: The research method was descriptive-correlational and the statistical population was all undergraduate students of Zanjan School of Public Health that 168 subjects (103 females, 65 males) were selected by stratified random sampling. Data were collected using standard questionnaires of Gravinsky Cognitive Censorship Management, Pulse Study and Criticism, and Solomon and Rhistlebum academic procrastination. Data were analyzed by using Pearson correlation and multiple regression tests. Results: Normal distribution of variables was confirmed regarding to the significance level above 0.05 of Smirnov's Kolmogorov test. The results showed that there was a significant positive correlation between rumination (components of emotion regulation) and academic procrastination (P

Abstract Background and Objectives: Quality of working life (QWL) is an important issue and examination of the spects that can affect it causes promotion of individual and organizational productivity. This study was conducted to investigate correlation between health correlates and the QWL in the emloyees of the Islamic Azad University, Lahijan Branch. Methods: This descriptive-correlational study with regression analysis was conducted on 130 nonteaching employees of the Islamic Azad University, Lahijan Branch selected by convenience sampling with reference to the number of the studied variables (spiritual, physical, mental, social, and environmental health). The participants filled out demographic, health-promoting behaviors, and QWL questionnaires. Data were analyzed by SPSS using descriptive and inferential statistical tests especially multivariate regression. Results: Among health components, physical health (r=0.55) and mental health (r=0.50) had the highest correlation with total QWL score. The amount of explained variance in criterion variable (QWL) by the regression model was 40%. Table of coefficients demonstrated that the scores for mental health and spiritual health had greater contribution in the model than other health aspects. Physical health, psychological health, spiritual health, and environmental health explained 29%, 45%, 37%, and 21% variance in QWL, respectively. Conclusion: The findings of this study demonstrated positive correlation between health aspects and QWL. Because the university employees spend a great deal of time at work and the quality of their work affects the entire organization, this finding can be useful to guide policy-makers and health experts in developing preventive and intervention programs in the future for promotion of the employees' health and organization.

Background and Objectives: Metabolic control and observance of dietary therapy in adolescents with type I diabetes is weaker compared to other patients—the fact which might lead to physical, mental, and social changes in such adolescents in this period of their life. Hence, adolescences are more subject to complications of diabetes. This study, accordingly, was conducted to examine the relationship of religious orientation and physician-patient relations in prediction of treatment in adolescents with type 1 diabetes. Methods: In a cross-sectional design, a number of 101 female and male adolescents with type 1 diabetes were selected. Data was collected via Alport Religious Orientation Questionnaire, patient-doctor relationship questionnaire (PDRQ-9) by Vanderfeltzer et al., and General Adherence Scale (GAS-5). Data analysis was performed using Pearson correlation test and Simultaneous and Stepwise Multiple Regression. Results: Mean of participants’ age was 17.5±2.5, and adherence to treatment was 16.7±2.9. Adherence to treatment had a significant and negative correlation with external religious orientation (p=0.002, r=-0.3), while it did not have a significant correlation with internal religious orientation. Also, it had a significant positive correlation with physician-patient relation (p=0.01, r=0.24). In stepwise regression, ability of prediction of adherence to treatment by external religious orientation was 30%. Internal religious orientation and physician-patient relation had no significant share in prediction of adherence to treatment. Conclusion: According to the results of this research, external religious orientation has the most powerful correlation with adherence to treatment so that there was a reduction in patients’ adherence to treatment as external religious orientation increased. Afterwards, physician-patient relation had a correlation with adherence to treatment so that an increase in physician-patient relation would result in an increase in adherence to treatment. Keywords: Medication Adherence, Orientation, Physician-Patient Relations, Religious, Type 1 Diabetes Mellitus.

Abstract Introduction Gitelman syndrome is an inherited autosomal recessive renal salt-wasting disorder. It presents with variable clinical symptoms including muscle weakness and fatigue, and the diagnosis is based on metabolic alkalosis, hypokalemia, hypomagnesemia and hypocalciuria. It is usually diagnosed incidentally in early adulthood. There are rare cases of Gitelman syndrome presenting in early childhood; however, to the best of our knowledge it has not previously been associated with delayed puberty. Case presentation A 17-year-old South Asian man with recurrent episodes of generalized muscle weakness, fatigue and cramps from the age of two years was admitted for further workup. Before the age of 12 years, the episodes had been mild, but they then got progressively worse. Other symptoms include polyuria, polydipsia, nocturia, paresthesia and occasional watery diarrhea. He also had a history of short stature, poor weight gain and delayed developmental landmarks. His family history was unremarkable except for the consanguineous marriage of his parents. An examination revealed a thin and lean man with blood pressure of 95/60mmHg. His height and weight were below the third percentile and his sexual development was at Tanner Stage II. Laboratory work revealed serum sodium of 124mmol/L, potassium 2.4mmol/L, calcium 6.5mmol/L and magnesium of 1.2mg/dL. His testosterone level was low (0.85ng/mL, normal for his age 2.67 to 10.12ng/mL) with normal levels of luteinizing hormone and follicle-stimulating hormone. The sex hormone findings were attributed to delayed puberty. A 24-hour urinary analysis revealed decreased excretion of calcium (25.9mg/24 hours). Based on the findings of hypokalemic metabolic alkalosis without hypertension, severe hypomagnesemia and hypocalciuria, a diagnosis of Gitelman syndrome was made. Treatment was started with oral supplementation of potassium, magnesium and calcium along with spironolactone and liberal salt intake. Conclusion Diagnosis of Gitelman syndrome is usually made incidentally during adolescence or early adulthood based on clinical and biochemical findings. We report that Gitelman syndrome can present during the early childhood years. If undiagnosed and untreated, it can lead to growth retardation and delayed puberty.

Objective: To explore the potential adverse effects of prolonged inhalation of mosquito coil smoke on the testicular histomorphology and serum testosterone levels in rats., Study Design: An experimental study. Place and Duration of the Study: Department of Anatomy, Army Medical College, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan, from January to December 2020., Methodology: This study was carried out on 20 male Sprague-Dawley rats, divided into control Group A (n = 10) and experimental Group B (n = 10). Rats in Group B were exposed to mosquito coil smoke (allethrin-based) for 4 hours / day for 12 weeks. After 12 weeks of exposure, serum testosterone levels and testicular morphology (seminiferous tubule diameter, germinal epithelium height, and testicular capsule thickness) were compared between the groups., Results: Rats exposed to mosquito coil smoke showed significantly reduced serum testosterone levels (p <0.001) along with testicular histological disruption in terms of significantly dilated seminiferous tubules (p <0.001), reduced germinal epithelial height (p <0.001), and thickened testicular capsule (p <0.001), as compared to the control group., Conclusion: Prolonged inhalation of allethrin-based mosquito coil smoke reduced serum testosterone levels and caused testicular histological disruption in the exposed group of rats., Key Words: Allethrin, Germinal epithelium, Mosquito coil, Seminiferous tubules, Testicular capsule, Testosterone, Testis.

Background and Aims: Since 1990, global child and infant mortality rates have typically stabilized or decreased due to improved healthcare, vaccination rollouts, and international funding. However, Afghanistan continues to face the highest child and infant mortality rates globally, with 43 deaths per 1000 live births. This study aims to examine the factors contributing to this high mortality rate and propose interventions to address the issue., Methods: A comprehensive literature search was conducted using databases such as Google Scholar and PubMed, focusing on articles published in English within the last 10 years (2013-2023). The search terms included "Child mortality," "Infant mortality," "SIDS," "COVID-19," and "Afghanistan." Original studies, systematic reviews, case studies, and reports meeting the inclusion criteria were selected for analysis. Additional sources from organizations such as UNICEF, the World Bank Group, WHO, and EMRO were also reviewed., Results: The study findings reveal significant challenges contributing to Afghanistan's high infant and child mortality rates. These challenges include birth defects, preterm birth, malnutrition, sudden infant death syndrome (SIDS), traumatic injuries, fatal infections, infanticide, and abuse. The ongoing conflict, insecurity, and humanitarian crises further exacerbate the situation, leading to increased child casualties. Despite efforts by international agencies like UNICEF to provide vaccines and maternal education, the infant mortality rate remains high., Conclusion: In conclusion, Afghanistan's child and infant mortality rates are of significant concern, and it is imperative that action be taken to reduce the incidence of child and infant mortality rates., (© 2024 The Author(s). Health Science Reports published by Wiley Periodicals LLC.)

Objective: To determine the preventive effect of coenzyme Q10 (CoQ10) on the testicular histology of rats exposed chronically to mosquito coil smoke., Study Design: Experimental study. Place and Duration of the Study: Department of Anatomy, Army Medical College/National University of Medical Sciences, Rawalpindi, Pakistan, from January to December 2020., Methodology: Thirty male Sprague Dawley rats were divided into three groups of 10 rats each. Group A was the healthy control. Group B rats were exposed to allethrin-based mosquito coil smoke for 12 weeks (4 hours/day). Group C rats received coenzyme Q10 (CoQ10, 10mg/kg/day) through oral gavage, in addition to 12 weeks of mosquito coil smoke exposure (4 hours/day). At the end of the study, testicular histology was compared among three groups including the germinal epithelium height, seminiferous tubule diameter, and testicular capsule thickness, while adjusting for the body weight variations among rats., Results: The rats in Group B, exposed only to mosquito coil smoke showed testicular disruption, characterised by dilated seminiferous tubules (p <0.001), reduced germinal epithelial height (p <0.001), and thickened testicular capsule (p <0.007), as compared to the control group rats. However, the germinal epithelium height (p = 0.73) and testicular capsule thickness (p = 0.31) of rats receiving CoQ10 in addition to mosquito coil smoke inhalation were not significantly different from the control group., Conclusion: Prolonged inhalation of allethrin-based mosquito coil smoke can cause testicular disruption among rats. The oral CoQ10 administration can effectively prevent the histomorphological adverse effects on the testis among rats exposed to mosquito coil smoke., Key Words: Allethrin, Coenzyme Q10, Germinal epithelium, Mosquito coil, Seminiferous tubules, Testicular capsule.

Background/aim: Probiotics are live microbial supplements that improve the microbial balance in the host animal when administered in adequate amounts. They play an important role in relieving symptoms of many diseases associated with gastrointestinal tract, for example, in necrotizing enterocolitis (NEC), antibiotic-associated diarrhea, relapsing Clostridium difficile colitis, Helicobacter pylori infections, and inflammatory bowel disease (IBD). In this narrative review, the authors aim to evaluate the role of different probiotic formulations in treating gastrointestinal diseases in pediatric population aged 18 years or younger and highlight the main considerations for selecting probiotic formulations for use in this population., Methodology: The authors searched PubMed and Clinicaltrials.gov from inception to 24th July 2022, without any restrictions. Using an iterative process, the authors subsequently added papers through hand-searching citations contained within retrieved articles and relevant systematic reviews and meta-analyses., Results: The effectiveness of single-organism and composite probiotics in treating gastrointestinal disorders in pediatric patients aged 18 or under were analyzed and compared in this study. A total of 39 studies were reviewed and categorized based on positive and negative outcomes, and compared with a placebo, resulting in 25 studies for single-organism and 14 studies for composite probiotics. Gastrointestinal disorders studied included NEC, acute gastroenteritis (AGE), Acute Diarrhea, Ulcerative Colitis (UC), and others. The results show that probiotics are effective in treating various gastrointestinal disorders in children under 18, with single-organism probiotics demonstrating significant positive outcomes in most studies, and composite probiotics showing positive outcomes in all studies analyzed, with a low incidence of negative outcomes for both types., Conclusion: This study concludes that single-organism and composite probiotics are effective complementary therapies for treating gastrointestinal disorders in the pediatric population. Hence, healthcare professionals should consider using probiotics in standard treatment regimens, and educating guardians can enhance the benefits of probiotic therapy. Further research is recommended to identify the optimal strains and dosages for specific conditions and demographics. The integration of probiotics in clinical practice and ongoing research can contribute to reducing the incidence and severity of gastrointestinal disorders in pediatric patients., Competing Interests: The author(s) declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To determine the ameliorative effects of prolotherapy on monosodium iodoacetate (MIA) induced and histomorphological changes in the articular cartilage of tibial condyles at rat knee joint., Study Design: An experimental study. Place and Duration of the Study: Department of Anatomy, Army Medical College Rawalpindi, NUMS, Rawalpindi, from August to November 2021., Methodology: Thirty adult male Sprague Dawley rats were divided into three groups, each having 10 rats. Group A was control. Group B was injected with single dose of 1mg MIA intraarticularly in the right knee to induce osteoarthritic changes. Group C was injected with single dose of 1mg MIA intraarticularly, in right knee was followed by 0.1ml Prolotherapy (3ml of 25% dextrose, 2ml of 2% xylocaine, 1ml of injection neurobion, and 1ml of injection methecobal) as intra articular injection at week 2, 6 and 10 in right knee. Rats were sacrificed after one month of the last dose of Prolotherapy. Articular cartilage was collected for gross and histological examination and compared among the groups., Results: Articular cartilage belonging to control group A was normal. While group B showed statistically significant deterioration in gross appearance (p = 0.001**), reduction in number of chondrocytes (p = 0.005*) and thickness of articular cartilage (p = 0.001**) in comparison to group A. In group C due to prolotherapy statistically significant improvement in gross appearance (p = 0.034*), increase in number of chondrocytes (p = 0.003*), and thickness of articular cartilage (p = 0.001**) was observed as compared to group B., Conclusion: Prolotherapy significantly ameliorates histomorphology of tibial articular cartilage against MIA induced osteoarthritic changes in rat knee joint., Key Words: Articular cartilage, Knee joint, Monosodium iodoacetate, Osteoarthritis, Prolotherapy.

Objective: To evaluate the histomorphological response of alpha-tocopherol co-administration with carboplatin chemotherapy., Study Design: A laboratory-based experimental study. Place and Duration of the Study: Anatomy Department, Army Medical College / National University of Medical Sciences (NUMS), Rawalpindi, Pakistan, from January to December 2021., Methodology: Thirty adult Sprague-Dawley rats were divided into three groups of ten rats each. Control group A received normal diet and water, experimental group B was administered single injection of carboplatin 2.5 mg/Kg intraperitoneally; and experimental group C along with carboplatin injection also received alpha-tocopherol 62.7 mg/Kg daily. At the end of 12 weeks, the euthanasia of animals was done and kidneys were dissected out. Right-sided kidneys were stained with Haematoxylin and Eosin. Micrometry was done to measure the diameters of renal cortical tubules and renal corpuscles., Results: The proximal and distal tubular and luminal diameter and transvertical diameter of renal corpuscle were increased in group B as compared to control group A. In group C, the proximal and distal tubular diameters were 5.175 ± 0.39 µm and 3.88 ± 0.364 µm, respectively; proximal and distal luminal diameters were 2.67 ± 0.35 µm and 1.64 ± 0.24 µm, respectively and transvertical diameter of renal corpuscle was 12.16 ± 0.870 µm. These values were less than experimental group B and closer to that of control group A., Conclusion: Renal microscopic parameters showed improvement in the group administered with alpha-tocopherol. Therefore, alpha-tocopherol has ameliorative effects on carboplatin-induced renal damage., Key Words: Alpha-tocopherol, Carboplatin, Renal corpuscle, Tubules.

Background and Aims: South Asian countries, including Pakistan, Afghanistan, India, and Bangladesh, have a high prevalence of pulmonary and extra-pulmonary tuberculosis (EPTB). This prevalence is influenced by various risk factors such as ethnicity, nutrition, socioeconomic disparities, high out-of-pocket healthcare expenses, and specific Mycobacterium Tuberculosis (TB) lineages. The COVID-19 pandemic has likely hindered access to healthcare and led to under-reporting of EPTB cases nationally and internationally. This rapid review aimed to summarize the literature on the prevalence and disease outcomes of EPTB in the mentioned countries, compare the situations across countries, and provide recommendations for future action., Methods: The review utilized PubMed and Google Scholar databases to search for literature on EPTB in South Asian countries. The search string included keywords related to different forms of EPTB and the countries of interest while excluding pulmonary tuberculosis., Results: The results showed that both TB, including drug-resistant TB, and EPTB are prevalent and burdensome in South Asia. In Pakistan, pleural TB was the most commonly reported form of EPTB, followed by lymph node TB, abdominal TB, osteoarticular TB, Central Nervous System TB, and miliary TB. In India, lymph node TB(LNTB) was more common among EPTB cases. Bangladesh reported a high prevalence of EPTB involving lymph node, pleura, and abdomen, while Afghanistan had a higher prevalence of forms such as LNTB and tuberculous meningitis., Conclusion: In conclusion, the prevalence of EPTB in Pakistan, Afghanistan, India, and Bangladesh is alarmingly high and negatively impacts population health. Effective measures are needed for treatment and management of this condition, along with addressing current and future challenges. Strengthening the evidence base through surveillance and research is crucial to understand the patterns and significant factors related to EPTB, requiring investment in these areas., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

The renal system manifestations of coronavirus disease-2019 have been documented extensively; however, scientific literature remains scarce regarding collapsing glomerulopathy hence the need for this investigation., Methods: A comprehensive review was conducted covering a timeline from 1 January 2020 to 5 February 2022 without any restrictions. The data extraction was conducted independently, and articles were assessed for the risk of bias. Data analysis was conducted using Comprehensive Meta-Analysis version 3.3.070 and RevMan version 5.4 for pooled proportions and risk ratio (RR) between dialysis-dependent and independent treatment groups with a P -value less than 0.05 considered significant., Results: A total of 38 studies were included in this review, including 74 (65.9%) males. The mean age was 54.2 years old. The most common symptoms reported were related to the respiratory system (59.6%, 95% CI: 50.4-68.2%) and hematuria (34.2%, 95% CI: 26.1-43.4). Antibiotics (25.9%, 95% CI: 12.9-45.3%) was the commonest management used. Proteinuria was the most reported laboratory finding at 89.5% (95% CI: 82.4-93.9%), while the commonest microscopic finding was acute tubular injury (77.2%, 95% CI: 68.6-84.0%). An increased risk of the presence of symptoms ( P= 0.005) and microscopic findings ( P= 0.0003) related to collapsing glomerulopathy in dialysis-dependent group was noted with increased management ( P= 0.01) used in this group for coronavirus disease-2019 infection., Conclusion: The findings of this study portray the prognostic value of the variables (symptoms and microscopic findings, etc.) reported in the analysis. Hence this study serves as a foundation for future investigations that minimize the study's limitations to provide a more robust conclusion., Competing Interests: There are no conflicts of interest., (© 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Vaccine hesitancy (VH) is prevalent in conflict zones due to a lack of essential resources and knowledge, thereby escalating the coronavirus disease of 2019 (COVID-19) cases in these territories. This has resulted in a higher incidence of cases from exposure to a single COVID-19 positive case and further burdens the health care system of conflict zones which are already on the brink of collapsing., Aim: This narrative review aims to determine VH to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in five conflict zones that include Somalia, Yemen, Palestine, Syria, and Afghanistan., Methodology: A Boolean search was carried out in MEDLINE-PubMed from inception till 6 June 2022. The search was performed by using the following keywords: "(SARS-CoV-2 OR covid OR covid 19) AND (vaccine hesitancy OR covid vaccine acceptance OR intention to vaccinate) AND (Syria OR Yemen OR Palestine OR Afghanistan OR Somalia"). The full text of all relevant articles in English along with their supplementary material was extracted., Results: All the included studies reported at least 30% or more increase in vaccine hesitancy among conflict settings. VH was mostly due to a lack of available resources, lack of appropriate knowledge, and believing misleading rumors about the vaccine., Discussion: Considering the massive amount of reluctance among people residing in conflict zones, the need to take effective measures against VH is undoubtedly apparent. This can be accomplished by carrying out mass vaccinations by the governments and proper health education through raising the public awareness regarding vaccines, thereby eliminating rumors that exacerbate the fear of adverse effects., Conclusion: The approach described in this article to combat VH can be implemented to increase vaccination rates and significantly alleviate R 0 across the globe., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Siddiqui, Priya, Adnan, Abbas, Qamar, Islam, Rahmat, Essar and Farahat.)

Healthcare workers (HCWs) have faced an increased amount of mental health struggles amidst the COVID-19 pandemic. However, those in conflict-based settings with fragile healthcare systems meet additional challenges. This study reviews violence, conflict and mental health among HCWs in five countries: Syria, Palestine, Yemen, Afghanistan and Lebanon. Our study reports that HCWs are targeted by violence, bombings, mistreatment and different forms of abuse, including verbal and physical. With the additional burdens of the pandemic including prolonged working hours, limited resources and insufficient humanitarian aid, the healthcare workers fall victim to increased levels of burnout and mental illnesses. The situation leads to dire consequences on their personal lives and professional development, compelling them to quit their job or country all together. Although healthcare workers remain resilient in these conflict-based settings, immediate interventions are required to prevent violence against them and cater to their rapidly declining mental health., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Objectives: Vaccine hesitancy remains a global issue, especially within poverty-stricken countries where there's an interplay of financial and non-financial barriers. This narrative review aims to understand attitudes and behaviors toward COVID-19 vaccination in four South Asian countries and make context-specific recommendations to vaccine program drivers and decision-makers., Methods: A search was conducted using PubMed and Science Direct, and CINHAL from January 2020 up to May 2022 restricted to the English language for terms: "Afghanistan" OR "Pakistan" OR "India" OR "Bangladesh" in combination with "COVID-19 vaccine" and other related terms. All articles were initially included, and those with relevance were included in the synthesis of this paper., Results: A narrative review was performed for this study. Our narrative review included a total of eighteen studies with a sample size ( n = 223-5,237) averaging about 1,325 participants per study conducted. The studies included revealed public hesitancy to receive the COVID-19 vaccine ranging from 6.3 to 56.2% with an average of 31.63% across all eighteen studies. Several reasons were linked to this observation in these four South Asian countries, and the predominant ones included: Insufficient information provided to the general public about the side effects of the vaccines, concerns regarding vaccine safety, and skepticism of vaccine efficacy., Conclusion: Vaccine hesitancy is a global problem within the context of COVID-19, and issues regarding equity, misinformation, and poverty in South Asian countries makes it difficult to meet goals for herd immunity. Policymakers and governments should aim toward financial and non-financial incentives to drive the public toward vaccination., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ennab, Qasba, Uday, Priya, Qamar, Nawaz, Islam and Zary.)

The global water crisis is expected to worsen if urgent action is not taken in making sustainable amends. This applies to Pakistan as the entire country suffers massively from poor water sanitation. Waterborne diseases are rising exponentially attributed to rise in microbial infestations, trace elements and drug toxicity in many water bodies of Pakistan. Treatment and prevention strategies must be implemented through national authorities and at the individual level. Awareness on use of clean water must be emphasized and proper administration on water management policies should be implemented. Immediate and active sustainability for water resources can ensure a safer future for Pakistan., Competing Interests: None declared., (© 2022 The Authors.)

Afghan children have suffered for decades because of chronic socioeconomic health crises. The current state of Afghanistan has deprived the basic human needs of children. The lack of freedom leaves their voices unheard, causing detrimental effects on their mental health. Mental illnesses such as post-traumatic stress disorder, anxiety, and depression are prevalent in Afghanistan, causing severe negative outcomes among children. Promotion of mental health services, psychological training, awareness campaigns, acceptance of Afghan refugees, and initiatives to support re-connecting with loved ones, are among the many recommended measures needed to manage this alarming situation. This requires an immediate action plan from government and public health officials to mitigate this impending catastrophe., (© The Author(s) 2022.)

With over seven pandemics and four million reported cases, Cholera remains of the most prevalent acute watery diarrheal diseases in the world to date. As in other developing countries, Iraq once again combats Cholera - and its past encounter in 2015, where the death toll reached 1500, highlights the importance of quickly addressing the current outbreak. The war-torn state of the nation, malnourished public, lack of sanitation and hygiene, mass displacement and global warming all contribute to the prevalence of Cholera in Iraq. Along with the current efforts, additional strategies are recommended for managing cholera cases, such as awareness campaigns, monitoring the safety of water bodies, and food inspection., Competing Interests: None declared., (© 2022 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Pakistan has not benefited significantly from telemedicine, despite the promise that it could overcome many of the barriers impeding maternal healthcare delivery in emerging markets. Due to a lack of a regulatory framework and a lack of government interest, new companies in Pakistan have a hard time establishing healthcare projects that will be cost-effective and innovative. A review of telemedicine adoption in the past and present for improving maternal healthcare standards is presented in this article. Furthermore, a discussion of the challenges associated with digital health adoption is provided, as well as possible and feasible policies for making the use of digital health in maternal health more effective., Competing Interests: None declared., (© 2022 The Authors.)

Type III von Willebrand disease is present in the Punjab province of Pakistan along with other inherited bleeding disorders like hemophilia. Cousin marriages are very common in Pakistan so genetic studies help to establish protocols for screening, especially at the antenatal level. Factors behind the phenotypic variation of the severity of bleeding in type III vWD are largely unknown. The study was conducted to determine Mutations/genetic alterations in type III von Willebrand disease and also to determine the association of different mutations, methylation status, ITGA2B/B3 mutations and alloimmunization with the severity of type III vWD. After informed consent and detailed history of the patients, routine tests and DNA extraction from blood, mutational analysis was performed by Next Generation Sequencing on Ion Torrent PGM. DNA methylation status was also checked with the help of PCR. In our cohort, 55 cases were detected with pathogenic mutations. A total of 27 different mutations were identified in 55 solved cases; 16 (59.2%) were novel. The mean bleeding score in truncating mutations and essential splice site mutations was relatively higher than weak and strong missense mutations. The mean bleeding score showed insignificant variation for different DNA methylation statuses of the VWF gene at the cg23551979 CpG site. Mutations in exons 7,10, 25, 28, 31, 43, and intron 41 splice site account for 75% of the mutations.

Public health remains a major concern in Pakistan, with communicable diseases including HIV/AIDS, hepatitis B, and C, and tuberculosis the leading cause of morbidity and mortality. Several factors contribute to the country's high risk of infectious disease epidemics, including overcrowded cities, unclean drinking water, inadequate sanitation, poor socioeconomic conditions, and low vaccination coverage. Due to the absence of a comprehensive surveillance strategy and mechanism, it has been difficult to manage infectious disease outbreaks effectively. The article offers insights into the various challenges faced by public and private healthcare sectors to control the spread of communicable diseases and proposes solutions to prevent crippling of the overburdened healthcare system on a national scale., Competing Interests: None., (© 2022 The Authors.)

The objectives of this study were to guide students on reflective essay writing, evaluate their understanding and explore the immediate impact of a well-designed session on learning of students. A 1.5-hour learning session was designed following Gagne's nine events of instruction and conducted on final year MBBS students to guide them on reflective practice and its significance. The session was evaluated by a self-designed, structured questionnaire given as a pre-test and post-test. Of 158 students, self-scoring of reflective essay, by hand raising method, revealed that nearly 60% students were critical reflectors, 30% were reflectors and 10% were non-reflectors. Five out of nine questions showed a significant effect (p <0.001) in two-tailed t-test. This learning session led to a significant improvement in understanding of students regarding role of reflective practice in modifying their future behaviour, and its role in making them a better professional. Key Words: Learning, Reflections, Satisfaction, Feedback, Written, Educational assessment, Medical students.

Afghanistan's humanitarian crisis has severely impacted the mental health of frontline workers. With the introduction of the Taliban government, ongoing civil unrest, and other forms of violent attacks, healthcare workers (HCWs) continue to provide patient care despite minimal resources. A severe contraction in the economy, poor supply of medications, political turmoil, and insufficient humanitarian aid have added to pre-existing problems. High levels of insecurity and instability as well as decades of traumatic experiences have contributed to increasing mental health challenges amongst frontline workers. Despite the scarcity of mental health services, HCWs continue to persevere with their service to the community. However, inadequate interventions may have serious implications for HCWs bearing the brunt of multiple traumas. Thus, governmental and international involvement is needed to address both the economic and psychological needs of HCWs in Afghanistan., (© The Author(s) 2022.)