Moderating Effect of C0VID-19 pandemic on the Relationship between Tourists’ Happiness and Intention to Revisit and Overall Image

Abstract This study aims to develop a cross-cultural universal framework, examining two different aspects of tourists’ experience. This paper set out the elements of hedonia (positive emotions) and eudaimonia (meaning and engagement) as tourists’ experience measurable states of tourist happiness. A proposed conceptual model considers tourists’ happiness as an antecedent of tourist behavioural intentions and overall image, moderated by situational animosity (refers to the COVID-19 pandemic in this study) across different countries (USA and China). The integrative model was tested using data generated from a convenient sample of 460 tourists from USA and 440 tourists from China visited to London. Using Structural Equation Modelling (SEM), a powerful multivariate statistical analysis technique, the results statistically confirm that tourists’ happiness influences tourist intention to revisit. Further, the findings substantiate that the COVID-19 pandemic negatively influences the relationship between tourist happiness and revisit intention. Finally, several invariance analyses were performed to examine whether the proposed model can be generalized across different samples (China and USA) and the results support factor structure equivalence (configural invariance), partial loadings equivalence (partial metric invariance) and measurement (scalar) equivalence). Based on these results, discussions and implications for destination marketers, limitations, and suggestions for future research are also provided

Development and validation of an instrument for assessment of professional behaviour during laboratory sessions

Objective: To develop an instrument to assess professional behaviour among medical students, and to determine its validity, reliability, feasibility and acceptability.Methods: This cross-sectional study was conducted at Bahria University Medical and Dental College, Karachi, from July to September 2017, and comprised of medical students in years 1 and 2 of their academic programme. The instrument was developed for the Physiology laboratory sessions using nominal group technique and was tested for validity, reliability, feasibility and acceptability by two assessors through validity and reliability statistics. Data was analysed using SPSS 23.Results: Of the 250 students enrolled, 232(92.8%) had their assessment completed. Applicability of the scale was indicated by exploratory factor analysis. Two factors were isolated which explained 57.65% of the variation. The first factor, comprising of 7 sub-factors, was labelled as \u27practical performance\u27, and the second factor, consisting of 5 sub-factors, as \u27personal interactions\u27. A final 12-item instrument was retained. Cronbach\u27s alpha was determined to be high at 0.863. Intra class correlation was 0.863 for both years 1 and 2 combined.Conclusions: It was possible to develop an instrument for professional behaviour assessment in Physiology laboratory skills session which could indicate valid, reliable, feasible and acceptable results

Self-Congruence and Tourist Happiness: The Mediating Role of Positive Emotions and Meaning

Although a considerable number of earlier studies have empirically investigated the effects of self-congruity on various constructs such as motivation, revisit intention, word-of-mouth, and evaluation of a destination (e.g. Usakli and Baloglu, 2011; Tassiello and Tillotson, 2020; Šegota, Chen and Golja, 2021), the direct and indirect relationship between self-congruity and tourist happiness remain under-investigated in tourism and hospitality settings (Sirgy, 2019). Therefore, to fill this gap in the literature, drawing on marketing, psychology, and tourism literature, the present study aims to investigate the relationship between self-congruity and tourist happiness via the influence of positive emotions (hedonia) and meaning (eudaimonia). The integrative model was tested using data generated from a convenient sample of 460 tourists from USA. Using Structural Equation Modelling (SEM), a powerful multivariate statistical analysis technique, the results statistically confirm that actual and ideal self-congruity influence tourist happiness and the conditions necessary for mediation are supported

Cross talk between serum Kisspeptin-Leptin during assisted reproduction techniques

Background & Objective: Leptin facilitates onset of puberty by impact on hypothalamic Kisspeptin, gonadotropin releasing hormone, follicle stimulating and luteinizing hormone. The link of peripheral Leptin-Kisspeptin in regulating the ovarian and endometrial tissue in relation to adiposity is unknown. Therefore, we wanted to identify Kisspeptin-Leptin association with body mass index (BMI) and success of assisted reproductive treatments (ART) in infertile females.Methods: A cross sectional study was carried from August 2014 till May 2016 after receiving ethical approval at Australian Concept Infertility Medical Centre, and Aga Khan University. The study group comprised of females with an age range of 25-37 year who had duration of unexplained infertility for more than two years. They were grouped as; underweight (/m2), normal weight (18-22.9 kg/m2), overweight 23-24.99 kg/m2 and obese (\u3e25 kg/m2). Kisspeptin and Leptin levels were measured by enzyme linked immune sorbent assay before down regulation of ovaries and initiation of treatment protocol of ART. Failure of procedure was detected by beta human chorionic gonadotropin \u3c25mIU/ml (non-pregnant) whereas females with levels \u3e25mIU/ml and cardiac activity on trans-vaginal scan were declared pregnant.Results: Highest Kisspeptin and Leptin levels were seen in normal weight group (374.80 ± 185.08ng/L; 12.78 ± 6.8 pg/ml) respectively, yet the highest number of clinical pregnancy was observed in overweight group (42%).A strong correlation of Kisspeptin with Leptin (r=0.794, p=0.001) was observed in the overweight females.Conclusion: Leptin-Kisspeptin-fertility link is expressed by maximum number of clinical pregnancies in the female group that showed strongest relationship between serum Leptin and Kisspeptin levels, irrespective of their BMI

Anti-mullerian hormone: Above and beyond conventional ovarian reserve markers

Management of ovarian dysfunctions requires accurate estimation of ovarian reserve (OR). Therefore, reproductive hormones and antral follicle count (AFC) are assessed to indicate OR. Serum anti-Mullerian hormone (AMH) is a unique biomarker that has a critical role in folliculogenesis as well as steroidogenesis within ovaries. Secretion from preantral and early antral follicles renders AMH as the earliest marker to show OR decline. In this review we discuss the dynamics of circulating AMH that remarkably vary with sex and age. As it emerges as a marker of gonadal development and reproductive disorders, here we summarize the role of AMH in female reproductive physiology and provide evidence of higher accuracy in predicting ovarian response to stimulation. Further, we attempt to compile potential clinical applications in children and adults. We propose that AMH evaluation has a potential role in effectively monitoring chemotherapy and pelvic radiation induced ovarian toxicity. Furthermore, AMH guided ovarian stimulation can lead to individualization of therapeutic strategies for infertility treatment. However future research on AMH levels within follicular fluid may pave the way to establish it as a marker of quality besides quantity of the growing follicles

Report: Interactions and conflicts of interests between prescribers and medical sales representatives (MSRs) regarding prescribing and drug promotion practices in Karachi, Pakistan.

Pharmaceutical drug promotion practices are found to have potentially controversial ethical standards. They may compromise on patient's wellbeing especially when it inordinately affects the clinical care and patient's interests by influencing the prescribing behavior of physicians. There is no proper system to keep a watch on the drug marketing and promotion strategies by the pharmaceuticals in Pakistan. A cross sectional study using a specially designed questionnaire and convenience sampling was conducted in Karachi for 6 months targeting prescribers and medical sales representative (MSRs). A total of 600 MSRs and prescribers consented to participate. 66% of MSRs highlighted that prescribers follow ethical prescribing but only (58%) seek evidence base behind promoted drug. This was contradictory to prescribers' response to same, which was 87%. Only (10%) of prescribers acknowledged demanding expensive gifts such as laptops, ACs, furniture and renovation of the clinic which was about 40% according to MSRs. This study offered intricate insights into the MSR and physicians interactions. It highlighted various aspects of these relationships from both MSRs' and prescribers' point of view. Although majority of the physicians negated the notion of expecting expensive favors from the sales representatives, responses by MSRs suggest that anticipation of gifts and incentives exists on part of the physicians. This has the potential to indulge in unethical promotion and irrational prescribing on part of MSRs and prescribers respectively that may further contribute to untoward patient outcomes such as increased treatment costs and adverse drug reactions

Anti mullerian hormone: Ovarian response indicator in young patients receiving long GnRH agonist protocol for ovarian stimulation

Objective: Anti Mullerian hormone (AMH) is gaining place as ovarian marker, chiefly in infertility assistance. We explored its correlation with oocytes retrieval after long GnRH agonist protocol for stimulation, in younger and older infertile population.Methods: This retrospective analysis compiled data of 166 females, receiving ICSI treatment from June 2014 to March 2015. Serum FSH, LH, Estadiol, AMH and antral follicle count were assessed. Outcomes were measured as good (5 to 19 oocytes) and bad responders.Results: Higher discriminatory power of AMH (AUROC; 0.771; p \u3c 0.05) was seen in comparison to FSH (0.692; p \u3c 0.05) and AFC (0.690; p \u3c 0.01). AMH reported strongest association with oocyte retrieved (odds ratio of 15.06). Subgroup analysis reported 68.6 % risk of bad response with AMH levels of less than 1.37ng/ml. This association was observed more significant in young infertile patients \u3c35 year of age (r=0.245; p=0.012) versus older population \u3e35 year (r=0.169; p\u3e0.05).Conclusion: Our study reaffirms that serum AMH correlates well with oocytes retrieved, particularly in females younger than 35 years. We suggest incorporation of AMH in baseline assessment of infertile females, who are falsely advised to postpone interventions based on their age and normal FSH levels

Apport de L’échographie dans le Diagnostic Anténatal du Syndrome de Prune Belly : À Propos d’un Cas et Revue de la Littérature

L’utilisation de l’échographie au premier trimestre de la grossesse et en particulier par voie endovaginale, permet la découverte précoce de mégavessie et donc des syndromes associés. Le syndrome de Prune Belly ou syndrome d’Eagle–Barrett est une malformation complexe rare avec nette prédominance masculine. Il se caractérise par la triade : aplasie ou hypoplasie de la musculature abdominale, dilatations des voies urinaires et cryptorchidie bilatérale. Il s’associe dans 75% des cas, à des atteintes pulmonaires, squelettiques, cardiaques et gastro-intestinales. Nous rapportons le cas d’un syndrome de Prune Belly découvert à 20 semaines d’aménorrhée (SA). À travers ce cas et la lumière d’une revue de la littérature récente, nous soulignerons l’intérêt de l’échographie anténatale dans le dépistage de cette malformation ainsi que les caractéristiques diagnostiques et thérapeutiques de cette entité rare. The use of ultrasound in the first trimester of pregnancy and in particular by the endovaginal way helps in the early discovery of megascessy and associated syndromes. Prune-Belly syndrome or Eagle-Barrett syndrome is a rare complex malformation with marked male predominance. It is characterized by the triad: aplasia or hypoplasia of the abdominal musculature, dilations of the urinary tract, and bilateral cryptorchidism. It is associated in 75% of the cases with pulmonary, skeletal, cardiac, and gastro-intestinal disorders. We report the case of Belly plum syndrome discovered at 20 weeks of amenorrhea (SA). Through this case and in the light of a review of the recent literature, we will highlight the importance of antenatal ultrasound in screening for this malformation as well as the diagnostic and therapeutic features of this rare entity

Influence of Emojis and Emoticons in Enhancing Digital Interpersonal Communication: A Study of WhatsApp Application Users

This research intends to focus on the influence of emojis and emoticons in enhancing digital interpersonal communication of WhatsApp application users. The study is supported in the light of Media Richness Theory and survey method has also conducted as part of quantitative research design. A total of 200 students from different universities of Lahore have been selected to understand the impact of emojis and emoticons in their interpersonal communication on daily basis. The findings show  that emojis and emoticons enhance digital interpersonal communication as it fulfills the criteria of conveying facial expressions, personal emotions and variety of sign languages. Findings of the survey illustrated that an emoji helps in supporting a message's meaning. Sometimes, emojis and emoticons seem more effective and easy to respond on a matter instead of writing long texts. The study also demonstrated that emojis and emoticons also help in understanding other person's mood and the level of interest during digital interpersonal communication

Gastrointestinal and Hepatic manifestations of COVID-19 in patients attending tertiary care hospital

Introduction: To evaluate the frequency of Gastrointestinal (GI) symptoms and elucidate the association of GI symptoms and hepatic injury markers with the severity of COVID-19 and mortality.Methodology: Single-centered observational study recruited 160 confirmed COVID-19 positive patients who were admitted in Medical Unit-1/C1 of Civil hospital Karachi, Pakistan from 21 February to 30 April 2021. Data was ana-lyzed using SPSS version 23.0.Objective: To evaluate the frequency of GI symptoms and elucidate the as-sociation of GI and hepatic abnormalities with the severity of COVID-19 and its mortality.Results: Among 160 patients, 20% presented with digestive symptoms; ab-dominal pain (33.1%), and nausea (33.1%) being the most common. GI symptoms and liver injury markers notably ALT, AST, and GGT were signifi-cantly associated with severity of disease (p value<0.05), ICU admissions (p value<0.01), and poor outcomes (p value<0.01).Conclusion: COVID-19 infected patients presenting with GI symptoms and liver dysfunction have a worse prognosis and needs to be addressed on ur-gent basis to avoid complications and reduce mortality.Key words: Covid-19, Hepatic injury, Gastrointestinal symptoms, Liver dysfunction