Sex distribution in clinical trials of radiologic contrast agents: A 27-year review.

PURPOSE: Clinical trials play a pivotal role in assessing the safety and efficacy of medical therapies. Addressing sex distribution among enrollees in clinical trials of radiologic contrast agents is essential for ensuring the generalizability of trial outcomes. Previous research has highlighted the influence of demographic factors, particularly sex, on treatment responses, emphasizing the need for equitable representation in clinical trials. Our study aim was to determine the sex distribution of enrollees in clinical trials of radiologic contrast agents. METHODS: Our retrospective study included a total of 65 clinical trials conducted between 1990 and 2017 identified on clinicaltrials.gov after a comprehensive review including searching individually for all FDA approved contrast agents. Data collected included the year of FDA approval, the number of participants, sex distribution, trial location, trial phase, and study type. Inter-rater validation ensured data accuracy. RESULTS: Our analysis revealed fluctuations in sex distribution of trial enrollees. Enrollment of males exceeded females in most years, with a shift towards a more equitable representation in recent trials. Trials conducted in the United States had a higher rate of enrollment by females. Phase I trials had the most balanced representation, whereas Phase IV trials had the highest sex disparity. CONCLUSION: Across all trials, females made up 47.3 % of enrollees [3316 out of 7016 total enrollees]. Enrollment of males exceeded females in 44 of the 65 trials studied, females outnumbered males in 19 trials, and enrollment was equal between the sexes in 2 trials. While the sex distribution observed across all trials represents an equitable representation of enrollees, the wide variance of sex distribution at the level of individual trials has the potential to limit the generalizability of results.

Gender Differences in Academic Rank, Leadership, and Awards Among NIH Grant Recipients in Diagnostic Radiology.

Objective: Females have been traditionally underrepresented in academia across multiple medical specialties, including radiology. The present study investigated primary investigators (PIs) who received National Institutes of Health (NIH) radiology funding between 2016 and 2019 to establish if there was a correlation between NIH grants, gender, academic rank, first and second tier leadership positions, geographic location, and professional awards. Materials and Methods: Funding information was obtained from the NIH Research Portfolio Online Reporting Tools Expenditure and Results (RePORTER) website for 2016-2019. Information for each PI was obtained from academic institutional websites, LinkedIn, and Doximity. Mann-Whitney U tests and chi-square analyses were performed to compare and determine associations between gender and the stated variables of interest. Results: Of the 805 radiology PIs included in this study, 78% were male. There was a significant association of gender with the attainment of the highest academic rank (p = 0.026), with females occupied more of the assistant professor ranks (M:F = 1:1.5) and less of the professor ranks (F:M = 1:1.2). Between genders, there was no significant difference in first and second tier leadership positions (p = 0.497, p = 0.116), and postgraduate honors and awards (p = 0.149). The greatest proportion of grants was awarded in the setting of sole male PIs (55%) and the least proportion of grants were awarded when the contact PI and other project leader were female (1%). Conclusion: Despite having similar academic credentials, including number of leadership positions and postgraduate honors and awards, female radiology PIs who have received NIH grants continue to be underrepresented in higher academic ranks.

Predicting Multimorbidity Using Saudi Health Indicators (Sharik) Nationwide Data: Statistical and Machine Learning Approach.

The Saudi population is at high risk of multimorbidity. The risk of these morbidities can be reduced by identifying common modifiable behavioural risk factors. This study uses statistical and machine learning methods to predict factors for multimorbidity in the Saudi population. Data from 23,098 Saudi residents were extracted from the "Sharik" Health Indicators Surveillance System 2021. Participants were asked about their demographics and health indicators. Binary logistic models were used to determine predictors of multimorbidity. A backpropagation neural network model was further run using the predictors from the logistic regression model. Accuracy measures were checked using training, validation, and testing data. Females and smokers had the highest likelihood of experiencing multimorbidity. Age and fruit consumption also played a significant role in predicting multimorbidity. Regarding model accuracy, both logistic regression and backpropagation algorithms yielded comparable outcomes. The backpropagation method (accuracy 80.7%) was more accurate than the logistic regression model (77%). Machine learning algorithms can be used to predict multimorbidity among adults, particularly in the Middle East region. Different testing methods later validated the common predicting factors identified in this study. These factors are helpful and can be translated by policymakers to consider improvements in the public health domain.

Equity, diversity & inclusion in academic radiology: An elusive dream.

BACKGROUND: Disparities in sex and race/ethnicity continue to persist in the academic radiology. This study addresses the sex/racial underrepresentation and evolution in the academic radiology. PURPOSE: To evaluate academic radiology temporal trends disparities by analyzing sex and race/ethnicity diversity in academic degree and tenure status. MATERIALS AND METHODS: A retrospective cross-sectional analysis conducted using American Association of Medical College database between 2007 and 2018. Trends in academic degree, tenure status, race/ethnicity, and sex assessed with linear regression analysis and Poisson regression model for annual percent change with statistical significance of p < 0.05. RESULTS: Out of 107,213 radiologists 72%, n = 76,893 males and 64%, n = 68,738 white faculty with 1277 males and 872 females. White MD-degree radiologists constitute 67.2%, Asian (20.9%), Black (2.5%), Hispanic (3.2%), multiple (3.4%), unknown (1.8%) and "other" (1%) races with a similar PhD/other doctoral and dual-degree. White faculty recruitment trend (n2007 = 955, n2018 = 703) and representation (-0.82% per year; 95% CI, -1.00 to -0.63; p < 0.0001) decreased, while Asian URM decreased respectively (n2007 = 152, n2018 = 205) (0.68% per year; 95% CI, 0.58 to 0.77; p < 0.0001). Females were underrepresented in all categories. CONCLUSION: URM and females are underrepresented in academic radiology. Academic degree types and tenure track may contribute to White and male academic radiologists overrepresentation.

Impact of the COVID-19 pandemic on physical therapy practice in Saudi Arabia.

PURPOSE: The new Coronavirus (COVID-19) pandemic has caused significant impact on the medical sector worldwide, including physical therapy (PT). The purpose of this study was to investigate the impact of the COVID-19 pandemic on the PT services, and the associated psychological distress endured by PT practitioners in Saudi Arabia. METHODS: A cross-sectional study was conducted to survey on-duty PT practitioners using a web-based questionnaire. Licensed PT practitioners working in Saudi Arabia (n = 265) participated and completed all the survey questions. The questionnaire comprised 30 questions covering the sociodemographic data and the outcome measures, which included the impact of the pandemic on the PT practice, use of telerehabilitation, administrative response during the pandemic, and PT practitioners' anxiety measured by the General Anxiety Disorder-7 scale. RESULTS: During the lockdown, disruptive impact on the PT practice was reported by most of the participants (80%). The majority of PT clinics/departments were either partially (43.8%) or completely (31.3%) shutdown, and therapists treated patients less than usual. Around 30% of participants reported using a telerehabilitation approach during the pandemic to communicate with patients, and about 33% received online courses and webinars to adapt the PT practice in response to the pandemic. About 21% of participants endured moderate to severe levels of anxiety, which was more pronounced among females. CONCLUSION: The COVID-19 pandemic significantly impacted the PT services in Saudi Arabia. Consequently, the number of patients treated was reduced, and therapists suffered notable psychological stress. Furthermore, although implemented, adaptive administrative measures were inadequate. Physical therapy practitioners and administrative authorities are encouraged to prioritize training and implementation of telerehabilitation as a likely prospective approach of PT practice.

Teleworking Survey in Saudi Arabia: Reliability and Validity of Arabic Version of the Questionnaire.

OBJECTIVES: This study aimed to adapt the survey questionnaire designed by Moens et al. (2021) and determine the validity and reliability of the Arabic version of the survey in a sample of the Saudi population experiencing teleworking. METHODS: The questionnaire includes 2 sections. The first consists of 13 items measuring the impact of extended telework during the coronavirus disease 2019 (COVID-19) crisis. The second section includes 6 items measuring the impact of the COVID-19 crisis on self-view of telework and digital meetings. The survey instrument was translated based on the guidelines for the cultural adaptation of self-administrated measures. RESULTS: The reliability of the questionnaire responses was measured by Cronbach's alpha. The construct validity was checked through exploratory factor analysis followed by confirmatory factor analysis (CFA) to further assess the factor structure. CFA revealed that the model had excellent fit (root mean square error of approximation, 0.00; comparative fit index, 1.0; Tucker-Lewis index, 1; standardized root mean squared residual, 0.0). CONCLUSIONS: The Arabic version of the teleworking questionnaire had high reliability and good validity in assessing experiences and perceptions toward teleworking. While the validated survey examined perceptions and experiences during COVID-19, its use can be extended to capture experiences and perceptions during different crises.

Gender Differences Among Academic Radiation Oncology National Institutes of Health (NIH) Funding Recipients.

Purpose The purpose of our study was to evaluate National Institutes of Health (NIH) funding recipients between 2016 and 2019 to determine if there was an association between gender, research productivity, academic rank, leadership positions, and post-graduate awards. Materials and Methods The NIH Research Portfolio Online Reporting Tools Expenditure and Results (RePORTER) website was used to retrieve data for grants in Radiation Oncology from 2016-2019. Demographics and profiles of awardees were retrieved from institutional websites, LinkedIn, and Doximity. Publication metrics were collected through the Scopus database. Mann-Whitney U tests and chi-square analyses were performed to compare and determine associations between gender and other variables.  Results Three hundred and forty radiation oncology principal investigators (PIs) were included in this study, of whom 76% were men. Of the 776 total NIH grants awarded, 62% of the grants had a sole male PI and 1% had two or more PIs in which the contact PI and co-PI were women. Between the genders of PIs in this sample, there was no significant difference in highest academic rank, leadership positions (i.e., chair, director, founder, president, and other), and post-graduate honors and awards. Total publications, years of active research, h-index, and m-index were higher amongst men in the professor category but were largely similar between genders in the associate and assistant professor categories. Conclusions The results demonstrate that most NIH grants in radiation oncology were awarded to men. Strategies that increase women in radiation oncology (RO), as well as those that increase NIH grants amongst women may also increase the prevalence of women in senior academic ranks and leadership positions.

Gender and Racial Profile of the Academic Pediatric Faculty Workforce in the United States.

Background Equity, diversity, and inclusion remain a challenge in the healthcare workforce. This study explored the current gender and racial/ethnic trends in academic pediatric positions across the United States. Methodology The pediatric faculty self-reported data by the American Association of Medical Colleges (AAMC) Faculty Roster from 2007 to 2020 were analyzed. The races were classified as White (non-Hispanic), Asian, Hispanic, Black (non-Hispanic), Multiple races (including both non-Hispanic and Hispanic), Others, and Unknown. Gender was categorized as male and female. Results The results showed that Asian, Black (non-Hispanic), and Hispanic academic pediatricians increased in full professor, associate professor, and assistant professor positions and decreased in instructor positions from 2007 to 2020. Black (non-Hispanic) academic pediatricians relatively decreased 5.5% in chairperson positions. Women increased in full professor, associate professor, instructor, and chairperson positions; however, relatively decreased 1.8% in assistant professor positions. Men and White (non-Hispanic) academic pediatricians relatively decreased 10.5% and 16%, respectively, in all academic ranks. Women, Asian, Black (non-Hispanic), Hispanic, and Other races were underrepresented in tenured, on-track (tenure-eligible), and not-on-track (tenure-eligible) positions. Conclusions Women and underrepresented minorities in medicine (URiM) physicians continue to remain significantly underrepresented in academic pediatric faculty positions and tenured track positions. There is a dire need to adapt multifaceted strategies to increase the engagement of women and URiM in academic pediatrics.

Serum biomarkers for the prediction and diagnosis of preeclampsia: A meta-analysis.

OBJECTIVE: Preeclampsia is a major risk factor for maternal and foetal mortality and morbidity. There have been tremendous efforts to identify serum biomarkers which can reliably predict the occurrence of preeclampsia. The study aims to assess the biomarkers that have the greatest utility in the diagnosis of preeclampsia. METHODS: A systematic search was performed on the PubMed literature database, and chain references were retrieved. Original research articles composed of case controls, cohorts, randomised control trials, and cross-sectional studies were included. The recorded variables included each study's design, type, year, and location; the value (mean ± standard deviation) of the markers in the patients and the pregnant controls; and the p-value, unit of measurement, and the sample size of each study. The results were interpreted based on the standardised mean difference (SMD) values. RESULTS: A total of 398 studies were retrieved from the PubMed database. After further analysis, 89 studies were selected for this review. An additional 47 studies were included based on chain referencing. Later, 136 full-text articles were reviewed in detail and their data were entered. Finally, 25 studies, in which 13 serum biomarkers were assessed, were selected for this meta-analysis. The levels of the angiogenic markers fms-like tyrosine kinase (sFlt), sFlt/placental growth factor (PlGF), and endoglin were significantly higher in patients with preeclampsia than in the pregnant controls. The levels of PlGF and the lipid biomarkers high density lipoprotein (HDL) and adiponectin were significantly lower, while the levels of triglycerides, apolipoprotein B (APO-B), and leptin were elevated in the preeclamptic patients compared to the pregnant controls (p < 0.05). CONCLUSION: In our study, the values of the serum biomarkers sFlt, PlGF, sFlt/PlGF, HDL, adiponectin, leptin, triglycerides, and APO-B differed significantly between preeclampsia patients and the pregnant controls. These findings demand advanced evaluation of biomarkers to enhance diagnostic screening for preeclampsia.

The State of Diversity in Academic Plastic Surgery Faculty across North America.

BACKGROUND: Gender and racial disparity is prevalent in all surgical subspecialties with women and racial groups historically underrepresented in academic plastic surgery. This study evaluated gender and racial profiles of academic plastic surgery faculty in North America and correlated both with research productivity and its effect on academic ranks of faculty in plastic surgery. METHODS: In this cross-sectional study, we compiled a list of accredited medical schools that offer plastic surgery training for residency. Data were collected on demographics, academic rank, and research output using the Doximity, LinkedIn, and Scopus databases. Data analyses were performed with a Mann-Whitney U test and a Kruskal-Wallis test. RESULTS: Women who were black, indigenous, and/or other color occupied only 6.25% of plastic surgery faculty leadership positions in North America. There are more women and underrepresented minorities in leadership positions in Canada, when compared with the USA, relative to each country's demographic. In both countries, women and underrepresented minority plastic surgeons had fewer publications, citations, and years of active research. Interestingly, having women in leadership positions was associated with a higher number of women faculty members. CONCLUSIONS: Gender and racial disparity exist in academic plastic surgery in North America. Several changes are required in order for women and underrepresented minorities in medicine to have an equal chance at career advancement. Better representation and diverse leadership have the potential to bring about equity, diversity, and inclusion in academic plastic surgery.

Ultrasonic Synthesis and Biomedical Application of Mn0.5Zn0.5ErxYxFe2-2xO4 Nanoparticles.

In the present study, biocompatible manganese nanoparticles have been linked with zinc and iron molecules to prepare different derivatives of Mn0.5Zn0.5ErxYxFe2-2xO4 NPs (x = 0.02, 0.04, 0.06, 0.08, 0.10), using an ultrasonication approach. The structure, surface morphology, and chemical compositions of Mn0.5Zn0.5ErxYxFe2-2xO4 NPs were elucidated by X-ray diffractometer (XRD), High-resolution transmission electron microscopy (HR-TEM), scanning electron microscope (SEM), and Energy Dispersive X-Ray Analysis (EDX) techniques. The bioactivity of Mn0.5Zn0.5ErxYxFe2-2xO4 NPs on normal (HEK-293) and (HCT-116) colon cancer cell line was evaluated. The Mn0.5Zn0.5ErxYxFe2-2xO4 NPs treatment post 48 h resulted in a significant reduction in cells (via MTT assay, having an IC50 value between 0.88 µg/mL and 2.40 µg/mL). The specificity of Mn0.5Zn0.5ErxYxFe2-2xO4 NPs were studied by treating them on normal cells line (HEK-293). The results showed that Mn0.5Zn0.5ErxYxFe2-2xO4 NPs did not incur any effect on HEK-293, which suggests that Mn0.5Zn0.5ErxYxFe2-2xO4 NPs selectively targeted the colon cancerous cells. Using Candida albicans, antifungal activity was also studied by evaluating minimum inhibitory/fungicidal concentration (MIC/MFC) and the effect of nanomaterial on the germ tube formation, which exhibited that NPs significantly inhibited the growth and germ tube formation. The obtained results hold the potential to design nanoparticles that lead to efficient bioactivity.

Screen time and Sleep Quality among College and University Students of Karachi / Tempo de tela e qualidade do sono entre estudantes universitários de Karachi

Objectives: To assess the relationship between screen times and sleep quality of the age group 17-24. Methodology: This is a cross-sectional study. The study was conducted on students of Colleges and universities in Gulshan-e-Iqbal Town Karachi. A total of 600 undergraduate students were approached in colleges and universities of Gulshan Town, Karachi. The sampling technique was Multi Staged sampling. The research instrument comprised of 3 parts i) Demographic profile, ii) Sleep quality measures and iii) Screen time usage measures. Results: The mean total hour of sleep was 6.7 ± 1.5. The Mean Cumulative score of the components of the questionnaire was 7.47 ± 3.56, while 174 (29%) have Normal Sleep quality and 426 (71%) have poor sleep according to the questionnaire. The odds ratio suggests there were 4.23 times higher chances of poor sleep quality in students whose screen time was more than 2 hours on weekdays as compared to other students. (OR: 4.23, 95% CI: 2.66-6.72). The odds ratio suggests there were 24.15 times higher chances of poor sleep quality in students whose screen time was more than 2 hours on weekends as compared to other students (OR: 24.15, 95% CI: 11.192-52.11). Conclusion: As, negative impacts were determined within sleep quality, and increased screen watching of multiple versions of the devices (screen time), influencing the commended level of screen watching among university and college students (age 17-24) is an affair of public health.

Objetivos: Avaliar a relação entre o tempo de tela e a qualidade do sono de estudantes universitarios na faixa etária de 17 a 24 anos. Metodologia: Este é um estudo transversal. O estudo foi realizado em estudantes de faculdades e universidades em Gulshan-e-Iqbal Town Karachi. Um total de 600 alunos de graduação foram abordados nessas instituicoes. A técnica de amostragem foi a amostragem Multi Staged. O instrumento de pesquisa compreendeu 3 partes i) Perfil demográfico, ii) Medidas de qualidade do sono e iii) Medidas de uso do tempo de tela. Resultados: A média de horas totais de sono foi de 6,7 ± 1,5. A pontuação média cumulativa dos componentes do questionário foi de 7,47 ± 3,56, sendo 174 (29%) com qualidade de sono normal e 426 (71%) com sono ruim, de acordo com o questionário. O odds ratio sugere que houve 4,23 vezes mais chances de má qualidade do sono em alunos cujo tempo de tela era superior a 2 horas durante a semana, em comparação com outros alunos (OR: 4,23, IC 95%: 2,66-6,72). O odds ratio sugere que houve 24,15 vezes mais chances de má qualidade do sono em alunos cujo tempo de tela era superior a 2 horas nos finais de semana em comparação com outros alunos (OR: 24,15, IC 95%: 11,192-52,11). Conclusão: Como os impactos negativos foram determinados na qualidade do sono e aumento da visualização da tela de várias versões dos dispositivos (tempo de tela), influenciar o nível recomendado de visualização da tela entre universitários e estudantes universitários (idade 17-24) é uma questão de saúde pública.

Manuscript Writing and Publication Workshop: An Invoking Pilot Study on Enhancing Cognitive Research Capabilities in Health Sciences Institutes of Pakistan.

Background With an upsurge in research in developing countries, researchers from allied sciences need to augment their skills for disseminating research work worldwide. Training workshop is one of the quick interventions which can enhance writing skills and ease research publication. Objective We designed this research to explore the perception of the faculty of different higher education institutes (HEIs) regarding manuscript writing and to assess the impact of these workshops in the improvement of cognitive capabilities of preliminary researchers in Pakistan. Methodology We conducted workshops in HEIs of Sindh, Pakistan. Contents of the workshop covered algorithm of writing manuscript and related descriptions, choice of quality journals, correspondence with the editor, and dealing with rejection. The knowledge of the participants was assessed by 15 items pre and post evaluation tests. McNamar's test assessed the significance of the change in knowledge. Kruskal Wallis test was performed to check the difference in the opinion of workshop quality among different institutes. Results A significant improvement was observed in participants' knowledge on the readers' prospects (P=0.001), the algorithm of writing (P<0.001), interpretations of results (P<0.001), and selection quality journal for publication (P <0.001). The agreement with the workshop's quality based on need, knowledge, and content was above average. Conclusion The participants' response regarding the effectiveness of manuscript writing for publication workshop was overwhelmingly positive, and there was a significant impact on the knowledge of the participants. There is a need for research training that will help for better capacity building in different HEIs of Pakistan.

Impact of wellness indicators on intellectual dimensions of medical teachers of Karachi: Findings from cross sectional study.

OBJECTIVE: To measure impact of social, spiritual, occupational, physical, financial and emotional wellness on intellectual wellness of medical teachers. METHODS: The cross-sectional study was conducted at 8 medical universities in the Sindh province of Pakistan from January 2012 to December 2014, and comprised faculty members. Using a self-administered questionnaire, teachers' responses on physical, emotional, social, spiritual, intellectual, occupational and financial spokes of the wellness wheel that were graded on a 4-point Likert scale. Generalised linear models were executed to find the best predictive scores for intellectual wellness. RESULTS: Out of 300 subjects approached, 261(87%) returned the questionnaire fully completed. Of them, 86(33%) were males and 175(67%) were females. Occupational wellness followed by spiritual, financial and emotional wellness depicted significantly high correlation with IW (p<0.05). Adjusted analysis revealed significant effects of spiritual, financial and occupational wellness (p<0.05). Findings of Models 1 and 2 suggested that holding the effect of other wellness subscales, intellectual wellness increased up to 0.485 score and 0.245 score due to occupational and spiritual wellness (p<0.05) respectively, while financial wellness was not significant (p>0.05). In the final model, occupational wellness effect increased to 0.504 score and spiritual wellness effect projected to 0.273 score for intellectual wellness (p<0.05). CONCLUSIONS: Amongst all the spokes of the wellness wheel, occupational, financial, social, emotional and spiritual wellness improved mental capabilities of medical teachers to overcome the challenges for acquiring intellectual wellness. However, wellness at workplace played the major role in enhancing intellectual proficiencies.

Aortic Valve Replacement in Bioprosthetic Failure: Insights From The Society of Thoracic Surgeons National Database.

BACKGROUND: This study was conducted to determine the current nationwide trends and outcomes of reoperative surgical aortic valve replacement (SAVR) performed for a degenerated bioprosthesis. METHODS: Data from The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were used. All patients who underwent isolated reoperative SAVR for a degenerated aortic bioprosthesis between January 2012 and December 2016 were included. Patients who had other concomitant cardiac surgery procedures or active endocarditis were excluded. Changes during this period were tracked with trend analyses. RESULTS: The number of patients undergoing SAVR for bioprosthetic failure increased substantially between 2012 and 2014 (782 in 2012 to 844 in 2013 and to 900 in 2014; relative change, +7.25%); this trend reversed significantly between 2015 and 2016 (decreased to 873 in 2015 and to 840 in 2016; relative change, -3.4%; P = .005). Patients were older in 2012-2014 (65.80 ± 13.52 years) compared with 2015-2016 (64.45 ± 12.91 years; P = .001). Mean STS-predicted mortality risk score decreased from 4.55% in 2012-2014 to 4.25% in 2015-2016 (P = .001). There was no difference in postoperative stroke (1.80% vs 1.80%, P = .87), renal failure requiring dialysis (2.7% vs 2.8%, P = .69), or operative mortality (3.5% vs 4.0%, P = .36) after reoperative SAVR in 2012-2014 and 2015-2016, respectively. CONCLUSIONS: The number of patients undergoing SAVR for a degenerated bioprosthesis is decreasing in the United States, particularly among older and high-risk patients. These trends may reflect the adoption of valve-in-valve transcatheter aortic valve replacement for a degenerated bioprosthesis after its United States Food and Drug Administration approval in 2015.

Effect of diabetic counseling based on conversation map as compared to routine counseling on diabetes management self-efficacy and diabetic distress among patients with diabetes in Pakistan: a randomized controlled trial (study protocol).

BACKGROUND: Novel interactive and pictorial health education tool named Diabetes Conversation Map (DCM) might be effective for the improvement of diabetes management self-efficacy (DMSE) and diabetes distress (DD) among diabetic patients in lower middle-income setting. This study protocol will assess the effectiveness of DCM as compared to routine care (RC) to improve DMSE, decrease DD and glycated hemoglobin (HbA1c) among patients with type 2 diabetes (T2DM). METHODS: This will be two arms randomized controlled trial, conducted at national institute of diabetes and endocrinology (NIDE) in Karachi, Pakistan. A sample of 120 T2DM patients of age 30-60 years with suboptimal diabetes control will be screened through eligibility criteria and DD screening tool. Patients who fulfill the eligibility criteria and have diabetes distress will be randomized into interventional and control arm. The intervention arm will receive four education sessions (40 min each) using DCM for 4 weeks duration of enrollment. Controlled arm will receive RC. DMSE and DD will be measured using the validated Likert tools at baseline and after 3 months of enrollment. Latest results of HbA1c will be retrieved from the respective medical record files at baseline and 3 months. Change in DMSE, DD scores and HbA1c levels within groups (pre-post) and between the groups after 3 months of enrollment will be compared. Multivariable linear regression will be conducted to adjust for any potential confounders. DISCUSSION: In a study in UK, 70% of the patients with diabetes reported DCM had helped them in controlling their diabetes and recommended this method to teach other patients with diabetes also. In China, a study found that patients with diabetes who received DCM based education had significantly lower DD and significantly higher diabetes empowerment score after six months of the intervention as compared to the traditional counselling. A cross sectional study conducted in Pakistan also demonstrated that teaching based on DCM was useful in improving the knowledge, attitude and practices of patients with T2DM. Besides, no other study has evaluated the effectiveness of these novel tools for DMSE and diabetes distress DD in well-designed, sufficiently powered clinical trials. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03747471 . Date of registration: Nov 20. 2018. Version and Date of Protocol: Version 1, IRB Approval date 28 June 2018.

Effect of Sociodemographic Variables and Other Factors on the Usage of Different Doses of Aspirin in Postmyocardial Infarction Patients: A Cross-sectional Study.

BACKGROUND: Aspirin (acetylsalicylic acid) is commonly prescribed to patients with a history of myocardial infarction (MI) or occlusive vascular events (e.g., stroke). Due to the complications associated with failure to follow aspirin usage guidelines, determining predictors of aspirin noncompliance in these patient populations is of clinical value and may help prevent poor outcomes. METHODS: This cross-sectional study of all patients with a previously diagnosed MI was conducted over a period of 3 months from May 2015 to July 2015 at a government-based hospital in Karachi, Pakistan. Patients were administered a questionnaire that comprised two parts. Part A was designed to measure sociodemographic data including age, gender, and marital status. Part B determined whether the patient was counseled on aspirin significance, and dosage recommendation, and was participating in cardiac rehabilitation therapy. RESULTS: A total of 456 patients included in the study. Of them, 298 (66.7%) were males. The average age was 59 (standard deviation 11) years. The outcome from univariate logistic regression revealed that with 1 year increase of age, the usage of low dose of aspirin was significantly decreased by 2%. Patients with higher education attributed a significantly different effect on the usage of aspirin. Marital status divulged no significant association with the use of different doses of aspirin. The role of rehabilitation had no effect when adjusted for age and level of education. CONCLUSION: Post-MI patients with higher education level and undergoing rehabilitative therapy are more likely to take low-dose aspirin as compared to those who failed to have these attributes. There is a need for carrying out further work to confirm these findings and expand our recommendations, particularly the sensitive issue regarding adequate doctor counseling among these high-risk patients.

Risk factors of hospitalization among chronic kidney disease patients in tertiary care hospitals - A single-center experience.

Chronic kidney disease (CKD) affects health and life of patients. They confront anemia, hypertension, infections and cardiovascular disease. Due to these health issues, they are at risk of repeated hospitalizations. The risk factors which propel them to hospitalize are important to know, and by controlling these factors, we can impede preventable hospitalization. This case-control study included 1050 adult CKD patients, conducted in two tertiary care hospitals of Karachi. Variables included were age, gender, ethnicity, area of residence, marital status, education smoking status, comorbids, blood pressure, type of angioaccess, hemodialysis (HD) status, stage of CKD, activity level, and laboratory parameters. Two predicted models using multivariable logistic regression analysis were established to evaluate the effect of factors leading toward hospitalization. Patients with ischemic heart disease had 3.56 [95% confidence interval (CI): 2.14-5.9] times higher rate of admission. The nonactive and moderately active patients were admitted 3.8 and 2.26 times more respectively as compared to the active patients (P <0.001). Patients with HD venous catheter were admitted 33.43 (95% CI: 12.45-89.81) times more than patients without any angioaccess. All laboratory parameters had highly significant effect on admission (P <0.001), odds ratio for low albumin, low hemoglobin, and high total leukocyte count were 6.87(95% CI: 4.45-10.6), 4.2 (95% CI: 2.73-6.57) and 7.9 (95% CI: 4.93-12.66) respectively. In conclusion, cardiovascular disease was observed as the most important risk factor of hospitalization for CKD patients. The other plausible risk factors were late referral to nephrologist, low activity level anemia, and hypoalbuminemia.

Embryo quality in intracytoplasmic sperm injection: A quasi experimental design in Pakistan.

OBJECTIVE: To assess the role of good-quality embryos in acquiring pregnancy after intracytoplasmic sperm injection and to predict factors required for development of embryos. METHODS: The quasi-experimental study was conducted from June 2010 to August 2012 at Islamabad Clinic Serving Infertile Couples and comprised infertile females who received long-term gonadotropin agonist protocol for intracytoplasmic sperm injection. Basal estradiol and antral follicle count was measured at baseline, while estradiol, progesterone and interleukin levels with pre-ovulatory follicle count were evaluated on the ovulation induction day. Follicular output rate was measured as ratio of pre-ovulatory follicle count to antral follicle count. The quality of embryos was graded as good, fair and poor on the third day after the injection. Linear regression was employed to determine unadjusted and adjusted estimate of effect of different factors on good-quality embryo. RESULTS: There were282 subjects with a mean age of 32.1±4.7 years (range: 23-41 years). There was an inverse correlation of body mass index with good-quality embryo (r=-0.131). In adjusted analyses, basal estradiol and progesterone on the ovulation induction day showed negative effect (95% confidence interval: -1.42 - -1.01), while estradiol and interleukin measured positive effect on quality of embryo (p<0.05). Follicular output rate was highly positively correlated with good quality embryo (p<0.05).. CONCLUSIONS: Females with low body mass index produced good-quality embryos. A high follicular output rate with production of estradiol and interleukin complemented good-quality embryos.

Comparison of undergraduate educational environment in medical and nursing program using the DREEM tool.

INTRODUCTION: Educational environment (EE) in a health educational institute can bring about an enduring impact on the students' motivation, knowledge, critical thinking along with their social life. Therefore, identifying strengths and the need for change in the education environment is vital for the enhancement of the students' learning. OBJECTIVE: This study aimed to compare the perceptions of nursing and medical students about their EE in a private university, Karachi Pakistan. METHODOLOGY: Data from two cross-sectional studies of 884 students from both medical and nursing schools of Aga Khan University was acquired and analyzed. EE was measured by a well-known inventory i.e. 'Dundee' Reading Educational Environment Measure (DREEM). The scores were constructed using standardized guidelines. Mann-Whitney U test and two way ANOVA were used in statistical analysis. RESULTS: With 84.1% average response rate, the mean + SD DREEM score was measured as 126 ±â€¯20.3. Nursing students regarded more positive perception about their EE (127.3 ±â€¯19.3) as compared to medical students (124.6 ±â€¯21.3) and was found to be statistically significant (P = 0.027). Medical students scored higher in the domain of Perception of Atmosphere (PoA); whereas, nursing students scored higher in Academic Self Perception (ASP). Both of the groups have rated lower scores on the domain of Perception of Teaching (PoT). CONCLUSION: Both medical and nursing students appreciated the EE pertaining to Perception of Learning (PoA), Academic Self- Perception (ASP), Perception of learning (PoL) and Social Self-perception (SSP). The study showed that nursing students' perception on their EE was relatively more satisfactory than medical students. However, both medical and nursing students identified areas of improvement in the domain of Perception of Teaching (PoT). This finding indicates dire need to devise innovative teaching strategies both for medical & nursing education.