Dostoevskii and the Human: reading the post-Siberian novels through existential phenomenology

Readers often intuit that Dostoevskii’s fiction is capable of revealing something fundamental about the human condition. This thesis provides a path to understanding how Dostoevskii’s mature fictional works encode some of the author’s key insights into human existence in literary form. These insights are represented in particularly intense, epiphanic experiences undergone by Dostoevskii’s characters during their narrative journeys. Characters appear to come into primordial contact with a variety of existentialia — necessary conditions for human experience — during epiphanies. In brief, I read the major post-Siberian novels as works of literary existential phenomenology. I make use of Heidegger’s existential phenomenological methodology in Being and Time to provide a framework for exploring and structuring Dostoevskii’s own form of religiously inclined, literary existentialism

Community-based Crisis Response: Evidence from Sierra Leone’s Ebola Outbreak

Postmortems on the recent Ebola outbreak in West Africa suggest that effective community engagement helped slow transmission by encouraging people to come forward and be tested. We evaluate the impact of Community Care Centers: a new crisis response model designed to allay fears about western medical care and, thus, encourage early reporting, isolation, and treatment. We employ new panel data on reported Ebola cases and a difference-in-difference design and find that Community Care Centers dramatically increased reporting, potentially reducing the spread of Ebola. Our results highlight how community-based efforts to increase confidence in health systems can be critical for crisis management

Relationship of Social Progress Index (SPI) with Gross Domestic Product (GDP PPP per capita): The moderating role of Corruption Perception Index (CPI)

This study investigated the impact of social progress on economic development in 119 countries, while taking their individual corruption perception into consideration. Simple linear regression was use on the secondary data for 119 countries and 5 continents while the SPSS PROCESS macro was used to test the moderating effect of corruption perception. As hypothesized, a positive relationship of the social progress index (SPI) with gross domestic product (GDP) PPP per capita was observe. This means that countries, which fulfill basic human needs, foundations of wellbeing and foster availability of opportunities have enhanced economic development. Moreover, the moderating role of corruption perception between the relationship of social progress and economic development was confirmed; thus indicating that countries with better corruption perception rating possess a stronger relationship of SPI and GDP (PPP) per capita and vice versa. When checked for continents, moderation results showed that the continents that have higher values of corruption perception index (CPI) are more socially and economically developed

Gender Differences in Risk Factors, Mortality, and Length of Stay of Patients Discharged From a Pakistani Stroke Unit: A Comparative Cross-Sectional Study

BACKGROUND: Differences between women and men in relation to stroke are increasingly being recognized. There is a scarcity of data on gender-based differences in stroke risk factors and outcomes from Pakistan. METHODS: We enrolled 231 consecutive patients diagnosed with acute stroke. All patients received care along a standardized stroke pathway in a single stroke unit. We analyzed demographic and medical factors, NIHSS scores, and outcomes. RESULTS: Of 213 consecutive hospitalized patients, 135 patients were men and 76 were women. The male to female ratio was 1.84. The mean age of males was 62.3913.56, as compared to females 61.15911.60 years. Hypertension, smoking, and dyslipidemia were more commonly found in men whereas ischemic heart disease, atrial fibrillation, and history of prior stroke were more frequently encountered in women. However, after adjustment for age and gender smoking in men (P.059) and atrial fibrillation (P.054) and prior stroke (P.017) in women, these were found to be independent predictors of stroke. Diabetes was equally distributed between the two genders. Women were more likely to be dependent prestroke (P.524), have more severe strokes (P.142), and more likely to have a longer hospital stay (P.942). In-hospital mortality was higher in women than in men (6.7% vs 5%; P.524) and they had poorer discharge modified Rankin Scale scores (mRS 5; 8.5% vs 5%; P.775); however, these differences were not statistically significant. CONCLUSION: There appear to be gender-based differences in the risk factor profile and perhaps outcome in Pakistani patients despite standardized care in a dedicated stroke unit

Association Between Diabetic Control And Anti-Diabetic Medication Adherence Using 8-Point Morisky Medication Adherence Scale In Local Population Of Khyber Pakhtunkhwa

Abstract: Background: Drug adherence to medications in diabetes is very necessary for strict glycemic control. Many factors in diabetics are associated with low adherence to drugs resulting in complications. Methods: This research was conducted as an observational study with cross-sectional study design. It was scheduled between July 2022 to December 2022 in medical outpatient department of Combined Military Hospital, Peshawar Results: 115 individuals were inducted over a period of 6 months from medical OPD ex Combined Military Hospital Peshawar. Five patients failed to follow-up with research team resulting in a total of 110 participants included in results. Average age across the study sample was 50.25 ± 11.97 years with 58 (52.73%) males and 52 (47.27%) females. Most participant in our study sample were educated up to matriculation with BMI <25kg/m2. Average duration of diabetes across the sample was 6.1 ± 3.69 years. In treatment options, 53 (48.18%) individuals were only managed with oral therapy, 16 (14.55%) on insulin only while 41 (37.27%) were prescribed with both oral hypoglycemic drugs and insulin. Most common comorbid across study population was hypertension, seen in 59 (53.94%) diabetic patients, followed by cataract in 41 (37.47%) and IHD in 33 (30%) patients.  In all 110 individuals, only 29 (26.36%) individuals had good glycemic control i.e., HbA1c <7% with average glycosylated hemoglobin percentage measuring 8.29% ± 1.59%. As per MMAS-8 score, 25 (22.73%) patients reported good adherence, 31 (28.18%) patients reported fair adherence while rest 54 (49.09%) were found to have bad adherence. Average MMAS-8 score was 5.17. Conclusion: There is a correlation between medication adherence as measured by MMAS-8 score with control of diabetes as measured by HbA1c score in the range of 1.824% across the range of MMAS-8 score from 0-8. Sleep quality, BMI and multiple comorbid conditions were also linked with raised HbA1c. Key words: Drug adherence, Morisky Medication Adherence Scale, Diabetes, Non-diabetes, diabetic medication

Restless legs syndrome in patients with type 2 diabetes mellitus

Objective: To determine the frequency of restless legs syndrome (RLS) and its associated factors in patients with type 2 diabetes mellitus. Design and Methods: It was single centered, cross-sectional study done with convenient sampling. The study population comprised 174 subjects (120 diabetics and 54 non-diabetics). Participants were recruited from the Diabetes clinic of Jinnah Medical College Hospital, Karachi. The relevant clinical and laboratory parameters were obtained by clinical history and chart review. Multivariable logistic regression was done to identify the factors of RLS among diabetics. Results: Using the International RLS Study Group (IRLSSG) criteria, RLS was identified only in 67(55.8%) subjects from the diabetic group. The mean age of RLS subjects was 56±8 years as compared to 46±8 years in the non-RLS subjects. Forty percent (26/67) of the diabetic/RLS+ subjects had diabetes for \u3e10 years and had significantly deranged glycemic indices. Periodic limb movements during sleep (PLMS) as reported by the bed partner or close family member were reported by 32(26.7%) of the diabetic subjects only; of which 21(65.6%) subjects had RLS. Sleep disturbances were more frequent among patients with RLS as compared to non-RLS (61.2% versus 21.5%). According to Semmes-Weinstein filament test, 61% of diabetics and 67% of diabetic/RLS subjects had peripheral neuropathy. Interestingly, none of our subjects who were diagnosed as RLS was ever asked by their physician for symptoms of RLS prior to this study. Conclusion: RLS is a common problem among patients with type 2 diabetes mellitus and is associated with increasing age, peripheral neuropathy and impaired day time functioning. Poor recognition by physicians result in delayed diagnosis

Comparison Of Quality Of Sleep Between Diabetic And Non-Diabetic Population Using Pittsburgh Sleep Quality Index

Background: Sleep is an essential event that effects quality of life and hormonal balance in human body. The association between sleep and diabetes is bi-directional. Methods: This study was conducted with a case control design in the Department of Medicine of Combined Military Hospital Peshawar between June 2022 to November 2022. Results: . Mean age of study population was 51.1±12.94 years with 46% females and 54% males. Majority population was educated up to matriculation with BMI in normal (18.5-24.9 kg/m2) range. There was no statistical difference in demographic data amongst diabetic and control group . Avg HbA1c was 8.546% ± 1.57% in the diabetic group and 5.712% ± 0.49% in control group. As per PSQI questionnaire 47 (47%) participants were good sleeper across the study population, which included 17 out 50 (34%) individuals in the diabetic and 30 out of 50 (60%) in control group. This equated to statistically significant difference amongst two group with a p value 0.007. A statistically significant difference (p = 0.001) was also seen in PSQI score between diabetic and control groups (9.40 ± 5.82 vs 5.98 ± 4.85 respectively). Diabetics had 2.9 times odds (95% confidence interval 1.29-6.57, p = 0.01) of having bad quality sleep as compared to controls. In the diabetic group majority were males educated up to matriculate having medium adherence treated with both oral hypoglycemic drugs and insulin having 3 or more comorbid condition with hypertension being most prevalent single comorbid disease. Conclusion: By strict glycemic control in diabetics we can imove their quality of sleep Interventions to improve sleep hygiene can be suggested to patients by diabetes educators as part of diabetes self-management education programs

The impact of disease control measures on the spread of COVID-19 in the province of Sindh, Pakistan

The province of Sindh reported the first COVID-19 case in Pakistan on 26(th) February 2020. The Government of Sindh has employed numerous control measures to limit its spread. However, for low-and middle-income countries such as Pakistan, the management protocols for controlling a pandemic are not always as definitive as they would be in other developed nations. Given the dire socio-economic conditions of Sindh, continuation of province-wise lockdowns may inadvertently cause a potential economic breakdown. By using a data driven SEIR modelling framework, this paper describes the evolution of the epidemic projections because of government control measures. The data from reported COVID-19 prevalence and google mobility is used to parameterize the model at different time points. These time points correspond to the government’s call for advice on the prerequisite actions required to curtail the spread of COVID-19 in Sindh. Our model predicted the epidemic peak to occur by 18(th) June 2020 with approximately 3500 reported cases at that peak, this projection correlated with the actual recorded peak during the first wave of the disease in Sindh. The impact of the governmental control actions and religious ceremonies on the epidemic profile during this first wave of COVID-19 are clearly reflected in the model outcomes through variations in the epidemic peaks. We also report these variations by displaying the trajectory of the epidemics had the control measures been guided differently; the epidemic peak may have occurred as early as the end of May 2020 with approximately 5000 reported cases per day had there been no control measures and as late as August 2020 with only around 2000 cases at the peak had the lockdown continued, nearly flattening the epidemic curve