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Microplastics (MPs), with a diameter of less than 5 mm, include polymers such as polystyrene, polypropylene, and polyethylene. The MPs occur in different morphologies including fragments, beads, fibers, and films that are swallowed by fresh water and land-based animals and enter their food chain, where they produce hazardous effects such as uterine toxicity, infertility, and neurotoxicity. The aim of this review is to explore the effects of polystyrene MPs (PS-MPs) on the female reproductive system and understand the mechanisms by which they produce reproductive toxicity. Several studies suggested that the exposure to PS-MPs increased the probability of larger ovaries with fewer follicles, decreased the number of embryos produced, and decreased the number of pregnancies in female mice. It also changed sex hormone levels and caused oxidative stress, which could have an impact on fertility and reproduction. Exposure to PS-MPs caused the death of granulosa cells through apoptosis and pyroptosis via activation of the NLRP3/caspase pathway and disruption of the Wnt-signaling pathway. Activation of TL4/NOX2 caused the uterine fibrosis resulting in endometrium thinning. The PS-MPs had a negative impact on ovarian capacity, oocyte maturation, and oocyte quality. Furthermore, the PS-MPs disrupted the hypothalamus-pituitary–gonadal axis in marine animals, resulting in a decrease in hatching rate and offspring body size, causing trans-generational effects. It also reduced fecundity and produced germ-line apoptosis. The main focus of this review was to explore the different mechanisms and pathways through which PS-MPs adversely impact the female reproductive system.

Background A multidisciplinary approach is widely recommended for the effective management of chronic kidney disease (CKD), with the objective of improving both clinical and psychosocial outcomes. However, resource constraints and increasing demands on healthcare systems have emphasized the necessity for alternative models of care, such as nurse-led interventions. These interventions possess the potential to address critical challenges in CKD management by providing accessible, patient-centered care across diverse healthcare settings. Objective This systematic review and meta-analysis aims to compare the effects of nurse-led care with routine care in CKD management to determine its efficacy across diverse cultural backgrounds. Methods Following PRISMA guidelines, a comprehensive search was conducted on PubMed, EMBASE, Scopus, and Cochrane databases, supplemented by manual searches and clinical trial registries. Inclusion criteria were randomized controlled trials (RCTs) involving nurse-led care for CKD patients aged 18 or older. Data extraction focused on study and baseline characteristics, and outcomes related to quality of life (symptoms/problems associated with kidney disease, sleep, energy/fatigue, patient satisfaction, overall health, depression, physical functioning, emotional well-being, role-physical, burden of kidney disease), depression, eGFR, and blood pressure. Statistical analysis used RevMan and STATA software, with results reported as standardized mean differences, along with their confidence intervals. Results The analysis included 10 RCTs with a total of 964 participants. Nurse-led care significantly improved symptoms/problems associated with kidney disease, sleep quality, pain, energy/fatigue, overall health, and depression. However, no significant improvements were observed in the burden of kidney disease, physical functioning, role-physical, patient satisfaction and emotional well-being. Variability in outcomes related to depression highlights potential heterogeneity among studies. While some trials reported enhanced hospitalization rates and treatment adherence, others showed inconsistent findings, suggesting a need for more rigorous research. Conclusion Nurse-led care provides notable benefits in managing certain aspects of CKD, including symptom control, sleep disturbances, energy levels, and overall health. However, its limited impact on kidney function and other clinical outcomes underscores the necessity for developing robust, standardized nurse-led care models and conducting long-term studies to evaluate their comprehensive efficacy.

In Pakistan effective border control measures and school closures were implemented after declaration of COVID-19 pandemic. Public awareness campaigns were started to educate public including adolescents. This study aims to assess adolescent’s knowledge, attitudes and preventive practices during pandemic in Pakistan. A cross-sectional study was conducted among 328 individuals from October 2021 to February 2022 among school going adolescents aged 10–19 years in Pakistan. An online questionnaire was administered using online platforms. The questionnaire included sections on socio-demographic information, knowledge, attitudes, preventive practices, vaccine practice and information on new COVID-19 variants. Data was analyzed using multiple linear regression method. Among these individuals, mean knowledge scores were 9.64 (3.53), mean attitude score were 4.12 (1.77) and mean preventive practice score were 17 (6.83). Older adolescents exhibited better adherence to preventive measures and support to travel bans and adherence to SOPs during lock down. Multiple linear regression revealed that higher knowledge (β = 0.22, p = 0.03) and positive attitudes (β = 0.92, p < 0.001) were significantly associated with better preventive practices. This indicated that adolescents living in Pakistan have moderate knowledge about COVID-19 pandemic, with positive attitudes towards preventive measures taken by the government. However, there is a need for targeted educational interventions to enhance understanding and adherence to preventive measures among adolescents to better manage the pandemic in near future.

Poor adherence is one of the biggest obstacles in therapeutic control of high blood pressure. The objectives of this study were (i) to measure adherence to antihypertensive therapy in a representative sample of the hypertensive Pakistani population and (ii) to investigate the factors associated with adherence in the studied population. A cross-sectional study was conducted on a simple random sample of 460 patients at the Aga Khan University Hospital (AKUH) and National Institute of Cardiovascular Diseases, Karachi, from September 2005-May 2006. Adherence was assessed using the Morisky Medication Adherence Scale (MMAS), with scores ranging from 0 (non-adherent) to 4 (adherent). In addition to MMAS, patient self-reports about the number of pills taken over a prescribed period were used to estimate adherence as a percentage. AKU Anxiety and Depression Scale (AKU-ADS) was incorporated to find any association between depression and adherence. At a cut-off value of 80%, 77% of the cases were adherent. Upon univariate analyses, increasing age, better awareness and increasing number of pills prescribed significantly improved adherence, while depression showed no association. Significant associations, upon multivariate analyses, included number of drugs that a patient was taking (P<0.02) and whether he/she was taking medication regularly or only for symptomatic relief (P<0.00001). Similar to what has been reported worldwide, younger age, poor awareness, and symptomatic treatment adversely affected adherence to antihypertensive medication in our population. In contrast, monotherapy reduced adherence, whereas psychosocial factors such as depression showed no association. These findings may be used to identify the subset of population at risk of low adherence who should be targeted for interventions to achieve better blood pressure control and hence prevent complications.

Stress among medical students induced by academic pressures is on the rise among the student population in Pakistan and other parts of the world. Our study examined the relationship between two different systems employed to assess academic performance and the levels of stress among students at two different medical schools in Karachi, Pakistan. A sample consisting of 387 medical students enrolled in pre-clinical years was taken from two universities, one employing the semester examination system with grade point average (GPA) scores (a tiered system) and the other employing an annual examination system with only pass/fail grading. A pre-designed, self-administered questionnaire was distributed. Test anxiety levels were assessed by The Westside Test Anxiety Scale (WTAS). Overall stress was evaluated using the Perceived Stress Scale (PSS). There were 82 males and 301 females while four did not respond to the gender question. The mean age of the entire cohort was 19.7±1.0 years. A total of 98 participants were from the pass/fail assessment system while 289 were from the GPA system. There was a higher proportion of females in the GPA system (85% vs. 59%; p<0.01). Students in the pass/fail assessment system had a lower score on the WTAS (2.4±0.8 vs. 2.8±0.7; p=0.01) and the PSS (17.0±6.7 vs. 20.3±6.8; p<0.01), indicating lower levels of test anxiety and overall stress than in students enrolled in the GPA assessment system. More students in the pass/fail system were satisfied with their performance than those in the GPA system. Based on the present study, we suggest governing bodies to revise and employ a uniform assessment system for all the medical colleges to improve student academic performance and at the same time reduce stress levels. Our results indicate that the pass/fail assessment system accomplishes these objectives.

Introduction Stress among medical students induced by academic pressures is on the rise among the student population in Pakistan and other parts of the world. Our study examined the relationship between two different systems employed to assess academic performance and the levels of stress among students at two different medical schools in Karachi, Pakistan. Methods A sample consisting of 387 medical students enrolled in pre-clinical years was taken from two universities, one employing the semester examination system with grade point average (GPA) scores (a tiered system) and the other employing an annual examination system with only pass/fail grading. A pre-designed, self-administered questionnaire was distributed. Test anxiety levels were assessed by The Westside Test Anxiety Scale (WTAS). Overall stress was evaluated using the Perceived Stress Scale (PSS). Results There were 82 males and 301 females while four did not respond to the gender question. The mean age of the entire cohort was 19.7±1.0 years. A total of 98 participants were from the pass/fail assessment system while 289 were from the GPA system. There was a higher proportion of females in the GPA system (85% vs. 59%; p<0.01). Students in the pass/fail assessment system had a lower score on the WTAS (2.4±0.8 vs. 2.8±0.7; p=0.01) and the PSS (17.0±6.7 vs. 20.3±6.8; p<0.01), indicating lower levels of test anxiety and overall stress than in students enrolled in the GPA assessment system. More students in the pass/fail system were satisfied with their performance than those in the GPA system. Conclusion Based on the present study, we suggest governing bodies to revise and employ a uniform assessment system for all the medical colleges to improve student academic performance and at the same time reduce stress levels. Our results indicate that the pass/fail assessment system accomplishes these objectives.