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Abstract Background The EvalUation of goal-diRected activities to prOmote well-beIng and heAlth (EUROIA) scale is a novel patient-reported measure that was administered to individuals with chronic heart failure (CHF). It assesses goal-directed activities that are self-reported as being personally meaningful and commonly utilized to optimize health-related quality of life (HRQL). Our aim was to evaluate psychometric properties of the EUROIA, and to determine if it accounted for novel variance in its association with clinical outcomes. Methods This study was a secondary analysis of the CHF-CePPORT trial, which enrolled 231 CHF patients: median age = 59.5 years, 23% women. Baseline assessments included: EUROIA, Kansas City Cardiomyopathy Questionnaire–Overall Summary (KCCQ-OS), Patient Health Questionnaire–9 for depression (PHQ-9), and the Generalized Anxiety Disorder–7 (GAD-7). 12-month outcomes included health status (composite index of incident hospitalization or emergency department, ED, visit) and mental health (PHQ-9 and GAD-7). Results Exploratory Principal Axis Factoring identified four EUROIA factors with satisfactory internal reliability: i.e., activities promoting eudaimonic well-being (McDondald’s ω = 0.79), social affiliation (⍺=0.69), self-affirmation (⍺=0.73), and fulfillment of social roles/responsibilities (Spearman-Brown coefficient = 0.66). Multivariable logistic regression indicated that not only was the EUROIA inversely associated with incidence of 12-month hospitalization/ED visits independent of the KCCQ-OS (Odds Ratio, OR = 0.95, 95% Confidence Interval, CI, 0.91, 0.98), but it was also associated with 12-month PHQ-9 (OR = 0.91, 95% CI, 0.86, 0.97), and GAD-7 (OR = 0.94, 95% CI, 0.90, 0.99) whereas the KCCQ-OS was not. Conclusion The EUROIA provides a preliminary taxonomy of goal-directed activities that promote HRQL among CHF patients independently from a current gold standard state-based measure. Clinical trial registration NCT01864369; https://classic.clinicaltrials.gov/ct2/show/NCT01864369 .

Objective: To compare the ultrasonographic findings of splenic dimension in healthy pregnant and non-pregnant women. Methods: This analytical cross-sectional study was conducted at University Ultrasound Clinic, Lahore from August 2022 to February 2023. A total of 200 females (100 non-pregnant and 100 pregnant) were examined. Mindray and Toshiba Ultrasound Machines were used to perform the ultrasonography. The measurements of splenic length, width, and thickness were recorded. The length of the spleen was measured in a longitudinal view. The width of the spleen was measured in a transverse view. The anteroposterior diameter (thickness) of the spleen was also measured. Results: The overall mean age was 29.0 ± 7.8 years. The mean difference of splenic width, thickness, and volume were significantly higher in pregnant women as compared to non-pregnant women i.e., 5.58 ± 1.44 cm vs. 5.15 ± 1.42 cm (p-value 0.033), 6.37 ± 2.56 cm vs. 4.46 ± 1.10 cm (p-value

Abstract Background Cross-cultural competence is widely regarded to play an important role in being able to deliver appropriate and effective health care to patients with different backgrounds, race, gender orientation and cultural beliefs. This study aims to assess how medical students feel about their comfort, knowledge, and skill level in handling a diverse patient population using a validated questionnaire. Methods This study was carried out over a period of three weeks from July 5th to July 26th of 2021, in the Aga Khan University Hospital, Karachi, Pakistan. All medical students who fulfilled the eligibility criteria and gave informed consent were included in the study. A modified version of the Harvard cross-cultural care survey was used to assess the medical students’ comfort, knowledge and skill level in a variety of circumstances related to patients with different backgrounds and cultures. Descriptive statistical analysis of the questionnaire items was carried out. We reported frequencies and percentages for gender and year of study. For the questionnaire items, we reported mean, assuming that our Likert scale had equivariant intervals. Furthermore, multivariate analysis between demographics and themes was carried out. A p-value of

Introduction Heart failure (HF) symptoms improve through self-care, for which adherence remains low among patients despite the provision of education for these behaviours by clinical teams. Open Access Digital Community Promoting Self-Care, Peer Support and Health Literacy (ODYSSEE–vCHAT) combines automated digital counselling with social network support to improve mortality and morbidity, engagement with self–care materials, and health-related quality of life.Methods and analysis Use of ODYSSEE-vCHAT via Internet-connected personal computer by 162 HF patients will be compared with a control condition over 22 months. The primary outcome is a composite index score of all-cause mortality, all-cause emergency department visits, and HF-related hospitalisation at trial completion. Secondary outcomes include individual components of the composite index, engagement with self-care materials, and patient-reported measures of physical and psychosocial well-being, disease management, health literacy, and substance use. Patients are recruited from tertiary care hospitals in Toronto, Canada and randomised on a 1:1 ratio to both arms of the trial. Online assessments occur at baseline (t=0), months 4, 8 and 12, and trial completion. Ordinal logistic regression analyses and generalised linear models will evaluate primary and secondary outcomes.Ethics and dissemination The trial has been approved by the research ethics boards at the University Health Network (20-5960), Sunnybrook Hospital (5117), and Mount Sinai Hospital (21-022-E). Informed consent of eligible patients occurs in person or online. Findings will be shared with key stakeholders and the public. Results will allow for the preparation of a Canada-wide phase III trial to evaluate the efficacy of ODYSSEE-vCHAT in improving clinical outcomes and raising the standard of outpatient care.Trial registration number NCT04966104

BACKGROUND & OBJECTIVE: Dental hygiene reflects the overall health and impacts the quality of life. The present study was designed to assess knowledge, attitude, and practices regarding oral hygiene among medical and dental undergraduate students and to compare the oral hygiene habits among male and female students METHODOLOGY: A cross-sectional study was conducted among medical and dental students of Bahria University Medical and Dental College, Karachi (BUMDC) from December 2018 to January 2019. Ethical approval was taken from the ERC committee of Bahria University Medical and Dental College (ERC/2/2018). Students (n= 332) of MBBS and BDS from first to final year were enrolled by non-probability convenience sampling technique. A self-structured questionnaire was used to obtain data. Percentages were determined for each response. The Chi-Square test was used to check the association of oral hygiene outcomes with respect to gender. RESULTS: The study comprised 332 male and female students, out of which 189 (56.9%) were dental and 143(43.1%) were medical. The majority of students (71.4%) were female. The mean age of participants was 20.8± 1.3 years, 44.6% used toothbrushes, 33.7% used toothbrush and floss, and 21.4% used toothbrush and miswak, 61.4% of respondents have brushed their teeth twice a day, 5.1% of respondents were reported bad smell from their teeth, 58.1% were complaining sore jaws. Dental hygiene was significantly associated with gender (p≤ 0.05). Females have better practices and a positive attitude toward oral hygiene. CONCLUSION: Female students had better oral hygiene knowledge and practices with more positive attitude as compared to male counterparts.

Objective: To compare the ultrasonographic findings of splenic dimension in healthy pregnant and non-pregnant women. Methods: This analytical cross-sectional study was conducted at University Ultrasound Clinic, Lahore from August 2022 to February 2023. A total of 200 females (100 non-pregnant and 100 pregnant) were examined. Mindray and Toshiba Ultrasound Machines were used to perform the ultrasonography. The measurements of splenic length, width, and thickness were recorded. The length of the spleen was measured in a longitudinal view. The width of the spleen was measured in a transverse view. The anteroposterior diameter (thickness) of the spleen was also measured. Results: The overall mean age was 29.0 ± 7.8 years. The mean difference of splenic width, thickness, and volume were significantly higher in pregnant women as compared to non-pregnant women i.e., 5.58 ± 1.44 cm vs. 5.15 ± 1.42 cm (p-value 0.033), 6.37 ± 2.56 cm vs. 4.46 ± 1.10 cm (p-value <0.001), and 178.2 ± 97.90 cm2 vs. 118.8 ± 47.57 cm2 (p-value <0.001) respectively. A significant difference of splenic width (p-value <0.001) and thickness (p-value <0.001) were observed with respect to gestational age of the individuals. Moreover, mean difference of splenic width was significantly increased in age group 15-30 years as compared to 31-51 years i.e., 5.68 ± 2.25 cm vs. 4.94 ± 2.00 cm (p-value 0.022) respectively. Conclusion: In pregnancy, the splenic thickness and splenic volume is seen to be increased when compared to non-pregnant women. [ABSTRACT FROM AUTHOR]

This paper explores the politics of fetishism in J. M. Coetzee’s Disgrace. It contends that the characters in Coetzee’s novel appear to consciously suspend the danger that is often associated with strangers. They willingly interact with those in their neighborhoods and consciously suppress the warnings of mishaps or misfortune that such strange encounters may entail. This study is a textual analysis of the selected text to examine all the encounters, specifically those between Lucy and the natives, as well as those of Bev Shaw with David Lurie. In the post-colonial period, such abnormal behavior notably reveals a distinct feature of fetishism among the colonizer and the colonized, as it does in Coetzee’s characters. In order to achieve this objective, Coetzee’s novel is the primary text, while Sara Ahmed’s concepts of “Stranger Fetishism” and “Encounters” serve as a theoretical framework for this investigation. The objective of this research is to analyze the ambiguities of characters in the novel, such as Lucy’s passive response to her rape and Bev’s ironic behavior with David. Eventually, the discussion leads to the unfolding of their personal intents, which are deliberately kept undercover to satisfy their personal interests. This research intervenes in the current scholarship on postcolonial studies by bringing fresh reading perspectives on Coetzee’s text.

Background: Even though organ transplants save thousands of lives globally, there exists a wide mismatch between an increasing demand for organ transplants and limited number of organ donors. The aim of the study was to assess the reasons and inspect differences between donors and non-donors in both students of medical and non-medical universities. Methods: A cross-sectional study was conducted over a period of 6 months (May 2018-March 2021). Sample of 400 participants enrolled from three medical colleges, two business/social sciences institutions and one engineering university of Karachi. Categorical variables were compared using the Chi-squared test. Continuous variables were compared using a student t-test. Variables with a univariate p-value ≤ 0.10 were included in multiple logistic regression models. Adjusted odds ratio (OR) with 95% confidence interval were reported. Results: With a very high response rate 383(96%) for knowledge about organ donation, a subdued response 201(52.3%) for willingness to donate. Most common source of knowledge regarding organ donation was social media 249(65%), followed by university 207(54%), family/friends 184(48%) and television 172(45%). Multiple logistic regression model identified being comfortable discussing organ donation as a positive predictor of willingness to donate (OR: 2.71, p=0.005), and the belief that organ donation disfigures the body as a negative predictor (OR: 0.40, p

Background: Deficiency of silent information regulator 1 (SIRT1) can trigger inflammation, mitochondrial malfunctioning, and apoptosis through the hypothalamic-pituitary-ovarian axis, producing poor quality oocytes, leading to infertility. Normal vitamin D (VD) levels promote SIRT1 activity required for optimal fertility, and low levels of either may result in fertility problems owing to cell-membrane de-stabilization, increased autophagy, DNA damage leading to increased reactive oxygen species and mitochondrial dysfunction. Therefore, in this study, we want to estimate the levels of VD, SIRT1 and antioxidants (MnSOD; manganese superoxide dismutase, GR; glutathione reductase, visfatin) and oxidants (adrenaline & cortisol) in individuals living with infertility and explore the association of VD with SIRT1 expression (levels), antioxidants, and oxidants contributing to infertility in women. The significance of this study is that it highlights the importance of maintaining optimal levels of VD for reproductive health in females., Methods: This cross-sectional study included 342 (135 infertile and 207 fertile) female subjects. Serum levels of MnSOD, SIRT1, visfatin, GR, VD, adrenaline, and cortisol were analyzed by ELISA and were compared in fertile and infertile samples using the Mann Whitney U test., Results: There were significantly high levels of VD, SIRT1, GR, MnSOD and visfatin in fertile female participants. However, mean adrenaline and cortisol levels were higher in infertile samples with a significant negative correlation with VD. A significant negative correlation of VD with MnSOD, SIRT1, visfatin and GR was observed (p <0.01). In VD subset groups, MnSOD levels were significantly high in VD sufficient groups however, adrenaline and cortisol levels were significantly high in groups suffering from VD deficiency., Conclusions: Deficiency of VD is associated with a decrease in SIRT1 and other antioxidants, which may deter natural reproductive functions leading to infertility. Further studies are required to determine the cause-effect relationship of VD deficiency on conception and interpretation of the involved mechanism., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Alam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)