bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Utility of Bladder Cancer Biomarkers
Authors: Krabbe Laura-Maria , Gakis Georgios , Lotan Yair
Published: January 2021

Each year, there are an estimated 550 000 diagnoses of bladder cancer worldwide, and almost 200 000 deaths from bladder cancer. The need for frequent follow-up, including invasive procedures like cystoscopy, repetitive procedures like transurethral resection of bladder tumors and intravesical instillation therapy in non-muscle invasive stages, as well as systemic treatment with or without radical local treatment in advanced stages, makes bladder cancer one of the most expensive cancers to treat. Prognostic and predictive biomarkers have the potential to fundamentally change bladder cancer treatment algorithms, which may result in improved patient comfort and oncological outcomes and may also decrease the socioeconomic burden of the disease. Intense research has resulted in the recent approval by the U. S. Food and Drug Administration of the first agent for this disease that targets a specific mutation (fibroblast-growth factor receptor). Yet, many areas of bladder cancer diagnosis and treatment have remained unchanged for decades, and this is only in part due to their therapeutic success. In order to integrate biomarkers into clinical practice patterns, specific considerations for the different disease stages and settings should be kept in mind. Especially in the setting of screening, work-up of hematuria, as well as surveillance of patients with non-muscle invasive bladder cancer, (urine-)biomarkers may prove useful. They must, however, demonstrate a high enough sensitivity to pick up a cancer diagnosis or recurrence, allow easy handling (preferably a point-of-care setting) and adequate cost–benefit relationships, while also providing additional information to a full work-up. A biomarker to identify patients with muscle invasive bladder cancer who are in need of—and likely to respond to—neoadjuvant therapy would be very useful. In later disease, early detection of recurrence or progression, as well as biomarkers guiding treatment decisions between the available systemic agents, will be paramount for improved patient care.
APLICABILIDADE DO CÓDIGO DE DEFESA DO CONSUMIDOR NAS LICITAÇÕES E CONTRATAÇÕES POR EMPRESAS PÚBLICAS
Authors: Silva Wilzemberge
Published: January 2021

O objetivo deste artigo é a análise da aplicabilidade do Código de Defesa do Consumidor nas licitações e contratações realizadas por empresas públicas, sob a ótica da Constituição Federal, em especial seu art. 173, §1º, II, do referido dispositivo infraconstitucional ora citado e da Lei Federal 13.303/2016, outrora denominada como “Lei das Estatais”. Analisaremos se as empresas públicas podem inserir em seus instrumentos convocatórios as cláusulas que versem sobre o seu direito como consumidor final, se há alguma ofensa ao princípio do interesse público sobre o interesse privado com esta aplicação e se obedece aos princípios da legalidade e da vinculação ao instrumento convocatório.
EFEITOS DO TREINAMENTO FÍSICO EM PACIENTES PÓS-TRANSPLANTE CARDÍACO: REVISÃO DE LITERATURA
Authors: Amaral Denise , Figueiredo Thaina
Published: January 2021

O Transplante Cardíaco (TC) é a última terapia para pacientes com Insuficiência Cardíaca (IC) refratária. Todavia, após o TC, estes apresentam alterações orgânicas que os tornam intolerantes ao exercício e com baixo condicionamento físico. Este trabalho visa abordar os efeitos dos diferentes tipos de treinamento físico em pacientes pós-transplante cardíaco. O estudo foi realizado através de revisão da literatura, utilizando as bases de dados PubMed e SciELO no período de novembro de 2019 a maio de 2020. Foram encontrados 28 artigos. Após a leitura prévia dos títulos e resumos foram excluídos 24 artigos por não se enquadrarem nos critérios de inclusão deste estudo. Ao total foram revisados 4 artigos. Após o TC o paciente apresenta baixo condicionamento físico e intolerância à atividade devido às alterações fisiológicas de sua doença de base. Diante disto, a atuação da fisioterapia deve se dar de forma precoce para o restabelecimento das funções hemodimnâmicas, estruturais e fisioclínicas do transplantado, promovendo, com isso, o seu retorno à vida ativa e produtiva. Após análise dos artigos foi possível observar resultados satisfatórios em relação à qualidade de vida, tolerância ao exercício, aumento de VO2 Com o treino aplicado (aeróbico e/ou resistido) nos portadores de TC.
EFICÁCIA DO EXERCÍCIO RESISTIDO INTRADIALÍTICO EM PACIENTES COM INSUFICIÊNCIA RENAL CRÔNICA: REVISÃO DE LITERATURA
Authors: Temoteo Ana Kelly , Costa Tania
Published: January 2021

A Doença Renal Crônica é definida como uma perda lenta, progressiva e irreversível das funções renais; uma condição na qual os rins não apresentam mais funcionalidade por resultado da destruição dos néfrons, resultando na incapacidade do organismo manter o equilíbrio metabólico e hidroeletrolítico renal. O objetivo deste trabalho visa analisar a eficácia do exercício resistido intradialítico em pacientes com Doença Renal Crônica. O estudo foi realizado através de uma revisão da literatura, utilizando as bases de dados PubMed, Scielo e Lilacs no período de março a maio de 2020. Pacientes com DRC em tratamento hemodialítico apresentam algumas complicações relacionadas à doença. A atuação da fisioterapia promove, para esses indivíduos, mudanças significativas na prevenção e retardo dessas complicações. Após análise, foi possível evidenciar resultados satisfatórios como mudanças significativas no condicionamento físico, aspectos psicológicos e prevenção de complicações relacionadas à doença.
FATORES QUE DIFICULTAM O TRABALHO DO PROFESSOR EM UMA SALA DE RECURSOS MULTIFUNCIONAIS
Authors: Pereira Dayane , Tavares Hilda , Silva Fabiana
Published: January 2021

As salas de recursos multifuncionais e o serviço ofertado neste espaço são conquistas dentre tantas alcançadas para a educação especial. A proposta desse serviço abrange o apoio aos professores de sala de aula regular e a promoção de aprendizagens aos educandos com necessidades especiais. Esta pesquisa teve como objetivo identificar as dificuldades encontradas pelo professor atuante nesse ambiente, sendo possível verificar pontos negativos que dificultam esse trabalho. Percebeu-se que o processo inclusivo está longe do idealizado e que existem aspectos negativos como a falta de profissionais capacitados, defasagem de material pedagógico e o pouco contato entre o professor da sala de recursos multifuncionais e o da sala regular. Esses aspectos dificultam o trabalho do professor, interferindo no serviço prestado nesse espaço.
LIDERANÇA: ESTILOS E INFLUÊNCIAS NA PRODUTIVIDADE DAS ORGANIZAÇÕES
Authors: Paes Alana , Silva Alexsandro , Dutra João , Campelo Arandi
Published: January 2021

O objeto de estudo deste artigo consiste nas análises dos estilos de liderança aplicadas no dia a dia das organizações. O estudo teve como objetivo identificar pontos negativos e positivos em cargos de liderança e como isso reflete diretamente nos liderados, a partir das definições estabelecidas por Chiavenato (2005). A pesquisa, de caráter bibliográfica, teve como fonte livros e artigos publicados na internet, em torno do tema central do artigo. O estudo revelou que os líderes utilizam as três formas de liderança para gerir suas equipes. A liderança autocrata, que geralmente não é muito eficaz; a liderança democrática, que tem os pontos positivos, mas requer muita habilidade do líder em conduzir a sua equipe; e a liderança liberal. O estudo revela como as atitudes e cada decisão tomada pelo líder afeta diretamente a conduta dos liderados, nos mostrando que no ambiente de trabalho a falta de um líder acarreta consequências que podem afetar o resultado de um setor ou de toda a empresa.
Anais do Workshop Conexão PlanScie: prevenção ao suicídio na pós-graduação
Authors:   Thaís Ramos Fraga Alves
Published: January 2021

Aqui você irá encontrar as temáticas que introduziram e guiaram as discussões durante o Workshop Conexão PlanScie: Prevenção ao Suicídio na Pós-Graduação [Setembro Amarelo], realizado no período de 31 de agosto de 2020 à 05 de setembro de 2020, através da plataforma Zoom e com certificação de 20 horas. O nosso objetivo é criar uma experiência digital para todas as comunidades científicas do Brasil, a fim de trazer discussões e sensibilidade ao público de discentes, docentes e gestão responsável pela formação do ensino superior. Além de, fomentar conexões para novas propostas de estratégias voltadas para a prevenção do suicídio na pós-graduação
Formulación de hamburguesa gourmet precocida-congelada, usando carne caprina, perejil (Petroselinum crispum) y albahaca (Ocimum basilicum)
Authors: Diaz Torres Raul , Prias Mogro Leila Agueda
Published: January 2021

Recientemente se ha visto una creciente demanda de productos cárnicos saludables. Numerosos ingredientes han sido usados para reformular productos cárnicos y promover la presencia de compuestos beneficiosos para la salud. El objetivo de este trabajo fue desarrollar una formulación de hamburguesa a base de carne de ganado caprino, empleando saborizantes naturales con propiedades antioxidantes. Se utilizó un diseño factorial 32 para definir 9 formulaciones de hamburguesa basadas en carne caprina, con diferentes adiciones de perejil (Petroselinum crispum) y albahaca (Ocimum basilicum), comparando sus indicadores de calidad con los establecidos en las normativas ecuatorianas. Se evaluó la composición química de los productos, su calidad higiénica, y el Índice de Calidad Sensorial (ICS) obtenido a partir de la aplicación de una escala hedónica por atributos a 80 consumidores potenciales del producto, así como su índice de costo. Los resultados fueron procesados mediante el paquete estadístico SPSS. La carne utilizada fue Tipo I, de acuerdo a las normativas ecuatorianas. Todas las formulaciones corresponden con la categoría “Me gusta” aunque la formulación 2 (1,5 % de perejil y 2,5 % de albahaca) presentó los mayores valores en todos los atributos, especialmente en cuanto a olor y consistencia. Las muestras cumplen con los requisitos microbiológicos establecidos según las normativas ecuatorianas, con valores de aerobios mesófilos, presencia de Escherichia coli y Staphylococcus aureus, inferiores a los permisibles y ausencia de Salmonella, con un índice de costo de 9,57 dólares/kg. Se obtuvo un producto aceptable para el consumidor, inocuo y de alto valor nutricional
On the edge of sense: nonsense and paradox in Edward Lear’s and Qorpo Santo’s selected works
Authors: Marques Granato Fernanda , Bastazin Vera
Published: January 2021

In this article, we delineate the relationship between nonsense, opposition and paradox in selected excerpts of the works of Edward Lear (1812-1888) and Qorpo Santo (1829-1883), considering nonsense and paradox in the light of the theories proposed mainly by Gilles Deleuze and Charles Ogden and secondarily by  Jean Jacques Lecercle, Wim Tigges and Ferdinand Saussure. This article seeks to understand the relationship between sense and nonsense in relation to the way these theorists articulate the productive tension that exists between other kinds of binary relationships. Research carried out about the relationship between nonsense theories and the binary opposites delineated by pairs and more precisely about Edward Lear and Qorpo Santo has been extremely scarce, and this article seeks to contribute to the related literary scholarship.
A progenitora obstinada: apontamentos sobre a representação da maternidade Igbo na prosa de Buchi Emecheta e Chimamanda Ngozi Adichie
Authors: Moraes Farias Rodolfo , Riambau Pinheiro Vanessa
Published: January 2021

Este trabalho se propõe a analisar aspectos da representação da maternidade igbo em duas narrativas de escritoras nigerianas, o romance As alegrias da maternidade (1979), de Buchi Emecheta, e o conto A historiadora obstinada (2009), de Chimamanda Ngozi Adichie, avaliando como a experiência materna das protagonistas reflete os desejos e objetivos comuns que as une (ou aparta) enquanto mulheres de um mesmo grupo étnico. Almejamos ainda sopesar as representações femininas que escapam à idealização da mãe perfeita, aferindo como estas “outras” ajudam a reforçar o rigoroso padrão de comportamento a todas imposto, relegando-as à busca de um parâmetro ou protótipo de conduta que muitas vezes obsta sua autorrealização pessoal. Contamos, para tal, com o auxílio de teóricas como Umeh (1996), Stratton (1994), Robolin (2013), Christian (1994) e Segato (2012), entre outras.
Re-politicizing Mental Illness: Reflections on Boredom and Depression in American Post-postmodern Fiction
Authors: Pirnajmuddin Hossein , Khodambashi Kaveh , Abbasi Pyeaam
Published: January 2021

Figurations of psychological problems, mental illness, boredom, depression, addiction and medication abound in post-postmodern fiction. David Foster Wallace's Infinite Jest and The Pale King and Jonathan Franzen's The Corrections are cases in point. Apparently, what these works share in common are the material and psycho-biological explanations that they hint at or provide for the various mental problems and disorders experienced by the characters. These pertain to the specific socio-economic and cultural mode characterizing the contemporary scene. Drawing on the insights provided by Franco Berardi the present article tries to shed light on the significance of such figurations. Keywords: Davis Foster Wallace; Jonathan Franzen; Franco Berardi; boredom; depression.
Unveiling the Contemporary in Virginia Woolf
Authors: Fagundes Patricia
Published: January 2021

This article aims to discuss Virginia Woolf’s critical appraisal of the contemporariness of her contemporaries’ production, focusing on her 1923 essay “How It Strikes a Contemporary”. To that end, it contextualizes the publication of The Common Reader – First Series (1925) so as to problematize its conversational quality as a philosophical principle inherent to Woolf’s oeuvre (Pinho 2020). A comparison is also drawn between Woolf’s “How It Strikes a Contemporary” and Giorgio Agamben’s “What Is the Contemporary?” (2009) in order to shed light on the intersections between contemporary philosophy and the philosophical questions we find in Woolf’s writing.
Describing Pain in Mary Raftery's Documentary Play No Escape
Authors: Pastore Natália Elisa , Fernandes Alinne , Bastos Beatriz Kopschitz
Published: January 2021

Documentary theatre is a genre in which real sources and events are used and edited to become the form of dramatic texts and performances. The personal experiences narrated in No Escape (2010), a documentary play by Mary Raftery, have shocked many people, due to the play’s multiple graphic descriptions of child abuse which took place in industrial schools and orphanages in Ireland. This article analyses how pain is presented in No Escape, by contrasting the language used, in their respective lines in the play, by authorities, victims, and representatives of the institutions. Pain, as a physical and psychological sensation, is a subject that still needs to be examined further in discussing the history of Ireland, to provide scholars and society with an opportunity to reflect upon this subject – and, perhaps, achieve healing.
A representação do sujeito diaspórico em O livro dos negros, de Lawrence Hill
Authors: Carreira Shirley de Souza Gomes
Published: January 2021

As neonarrativas de escravidão surgiram no cenário literário norte-americano com a publicação de Jubilee, de Margaret Walker (1966), porém só tiveram efetivo reconhecimento nos anos oitenta, com o lançamento de Beloved, de Toni Morrison (1987). Concebidas como “romances contemporâneos que assumem a forma, as convenções e a voz narrativa em primeira pessoa das narrativas de escravos produzidas antes da Guerra Civil” (RUSHDY, 1997), foram, aos poucos, se distanciando desse modelo e hoje podem ser consideradas transnacionais e globais, bem como dialógicas, polifônicas e transgenéricas, segundo Judith Misrahi-Barak (2014). Nessa perspectiva e com o suporte teórico dos Estudos Culturais e do conceito pós-moderno de metaficção historiográfica, este trabalho propõe a análise da representação do sujeito diaspórico em O livro dos negros, do canadense Lawrence Hill (2014), que tem por temática a trajetória de escravos durante a vigência do sistema escravagista. Ao deslocar a voz narrativa para o oprimido, Hill desafia o discurso da História, escovando-a a contrapelo.
Antecipação, complexidade narrativa e o melodrama paternal em This is Us
Authors: Amaral Carolina Oliveira do , Baltar Mariana
Published: January 2021

Este artigo pretende apontar reconfigurações na matriz do melodrama através de um estudo de caso da série This is us (2016 - ). Partindo da análise da obra, observamos como as tradições do melodrama maternal são atualizadas no que propomos definir como melodrama paternal, construindo uma imagem de masculinidade que recupera noções de cuidado e sensibilidade, restituindo valores familiares. Apontamos também como esta série de sucesso se apresenta como inovadora através do uso intenso do controle temporal em uma narrativa não linear que, também neste ponto, acaba por atualizar outro elemento estético fundamental do melodrama: a antecipação.
Female Negotiations of Affect in Domestic and Public Space in the Television Series The Handmaid’s Tale
Authors: Der-Ohannesian Nadia
Published: January 2021

The screen adaptation of the 1985 novel The Handmaid’s Tale, by Margaret Atwood, converges with the current global turn to the right. Across different geographies and variables, there have been attempts at reinforcing the control of women’s reproductive capacity, crucial to the reproduction of capitalism, and resistance by networks of feminist movements. Such tensions bear resemblance with the concerns represented in the television show. Within the affective turn, in the present study, I examine the gaze as a gendered bodily practice of control over women as well as a practice of resistance under the guise of affect, friendship and desire, in private and public space.
O Mundo de Oz de L. Frank Baum: conto de fadas modernizado, utopia norte-americana ou alta fantasia avant la lettre?
Authors: Matangrano Bruno Anselmi
Published: January 2021

Na introdução de O Maravilhoso Mágico de Oz (1900), L. Frank Baum declara sua intenção de inaugurar um novo tipo de conto de fadas, ao mesmo tempo mais moderno e mais americano. O resultado de seu projeto se traduz pela criação de um universo complexo, que se expande ao longo de treze sequências e obras derivadas, alcançando imenso sucesso midiático. Desde então, muito se especula sobre o gênero ou modo narrativo ao qual a série de Oz se enquadra, pois, embora Baum a aponte como um conto de fadas, e, portanto, associado ao maravilhoso, logo sua obra foi lida como uma utopia norte-americana e como uma precursora da fantasia. A partir desse contexto e de tais questionamentos, o presente estudo propõe uma leitura do universo criado por Baum buscando elementos dessas três categorias para entender seu lugar no cânone da fantasia, ao mesmo tempo em que procura entender a importância do uso de mapas na construção de mundos secundários, elemento que ao longo do século XX se popularizou em obras dessa vertente.
STRATEGI PEMASARAN UNTUK MENINGKATKAN KEUNGGULAN KOMPETITIF PADA PT. TELKOM PONTIANAK
Authors: Fadli Mochammad Faisal
Published: January 2021

ABSTRACT This study is to determine how marketing strategies to increase competitive advantage at PT. Telkom Pontianak. The number of respondents was 18 respondents. The instrument used for data collection was in the form of a Likert scale questionnaire This study uses a descriptive method in the form of a questionnaire, which is an information collection technique that allows the analysis to study attitudes, behaviors, and characteristics, some of the main people in the organization who can be influenced by the proposed system or by the existing system. Based on data analysis, agree that price, product, promotion and distribution are factors that affect the level of marketing strategy. Constraints faced by PT. Telkom Pontianak In Improving Marketing Strategy, namely Collaboration, Target Achievement, and Environmental conditions. Efforts Made By PT. Telkom Pontianak In Facing Marketing Constraints is Recognizing Customers, Promoting, and Choose a strategic location Key word: Marketing Strategy ABSTRAKPenelitian ini bertujuan untuk mengetahui bagaimana strategi pemasaran untuk meningkatkan keunggulan bersaing pada PT. Telkom Pontianak. Jumlah responden sebanyak 18 responden. Instrumen yang digunakan untuk pengumpulan data berupa angket skala likert Penelitian ini menggunakan metode deskriptif berupa kuesioner yaitu suatu teknik pengumpulan informasi yang memungkinkan analisis untuk mempelajari sikap, perilaku, dan karakteristik, beberapa orang utama dalam organisasi yang dapat dipengaruhi oleh sistem yang diusulkan atau oleh sistem yang ada. Berdasarkan analisis data disepakati bahwa harga, produk, promosi dan distribusi merupakan faktor-faktor yang mempengaruhi tingkat strategi pemasaran. Kendala yang dihadapi PT. Telkom Pontianak Dalam Meningkatkan Strategi Pemasaran yaitu Kolaborasi, Pencapaian Target, dan Kondisi Lingkungan. Upaya Yang Dilakukan PT. Telkom Pontianak Dalam Menghadapi Kendala Pemasaran adalah Mengenali Pelanggan, Mempromosikan, dan Memilih Lokasi yang StrategisKata kunci : strategi pemasaran
Study on Efficiency of the Sewage Treatment Plant at College Campus (Karnataka) for Sustainable Artificial Recharge Designed model: A Case study
Authors:   International Center for Applied science, MAHE Manipal, Karnataka, India., M R Dhanraj , A Ganesha ,   International Center for Applied science, MAHE Manipal, Karnataka, India.
Published: January 2021

The aim of this study is to evaluate the quality of sewage generated from 7000 KLD Sewage Treatment Plant (STP) located at Manipal Institute of Technology, Manipal Karnataka which is based on the Activated Sludge Technology. The study of sewage quality of this plant is essential as most of the treated effluent discharged into a stream during monsoon and remaining season used for a Gardening purpose. Water samples were collected from the outlet and analyzed for the major waste-water quality parameters, such as pH, Biochemical Oxygen Demand (BOD) and residual chlorine. The overall quality of sewage of 7000 KLD Sewage treatment plants will be evaluated by collecting samples. The results of these evaluations also determine whether the effluent discharged into the water body is under limits given by Karnataka state pollution control board (KSPCB) & BIS standards.
DETERMINATION OF REFERENCE INTERVAL OF LIVER FUNCTION TESTS DURING PREGNANCY IN URBAN AREA OF DISTRICT RAWALPINDI PAKISTAN
Authors: Younas Alveena , Gilani Mehwish , Ain Qurat ul , Asif Naveed , Aamir Muhammad , Ali Asif
Published: January 2021

Objective: To determine the reference Interval of liver function tests during uncomplicated pregnancy inpopulation of Rawalpindi and assess their correlation over first and second trimesters of pregnancy.

Study Design: Cross sectional study.

Place and Duration of Study: Department of Chemical Pathology & Endocrinology Armed Forces Institute ofPathology Rawalpindi from Feb 2017 to Jun 2018.

Methodology: Seven hundred and fifty four pregnant women with uncomplicated, single intrauterine pregnancy were recruited from Rawalpindi. Thirteen patients with known history of Diabetes Mellitus, hypertension, liver disease, renal disorders and those on anti-epileptics, non-steroidal anti-inflammatory drugs and steroids were excluded from the study. Blood sample was taken from each subject to analyze serum bilirubin, albumin, total alkaline phosphates and alanine aminotransferase on random access discrete auto analyser, ADVIA 1800 Chemistry system manufactured in Japan for Siemens Healthcare Diagnostics Inc. Data for serum bilirubin, albumin, ALP and ALT were expressed as mean ± standard deviation. As the reference data followed the Gaussian distribution, therefore the 2.5th and 97.5th percentiles were estimated by values approximately 2SD on each side of mean.

Results: After analysis of serum samples of 754 subjects, the reference intervals for bilirubin, albumin, ALP andALT during first trimester were; bilirubin 3-9 µmol/l, albumin 31-45 g/L, ALP 122-224 U/l and ALT 3-35 U/l, while of second trimester were: bilirubin 2- 7µmol/l, albumin 28-45 g/L, ALP131-300U/l and ALT 1-33U/l.

Conclusion: First and second trimester wise reference values of Liver Function Tests have been determined inpregnancy in this study. This would not only........
CARDIOVASCULAR RESPONSE TO LARYNGOSCOPY VERSUS FIBER-OPTIC BRONCHOSCOPE DURING OROTRACHEAL INTUBATION IN PATIENTS UNDERGOING ELECTIVE SURGERY
Authors: Ali Moazzam , Khawar Maliha , Nazneen Maryam , Nazneen Zaqawat
Published: January 2021

Objective: To compare the hemodynamic response between flexible fiber optic bronchoscope (FOB) andMacintosh laryngoscope during orotracheal intubation. The secondary objective was to calculate the timerequired for intubation between these two techniques

Study Design: Quasi experimental study.

Place and Duration of Study: Department of Anesthesia, Frontier Corps Hospital Quetta, from Oct 2016 to Apr2017.

Methodology: Eighty patients fulfilling the inclusion/exclusion criteria were included in this study and weredivided randomly into two groups. Group L was intubated with Macintosh laryngoscope (control group) whereas group F was intubated with Fiber optic bronchoscope. Mean arterial pressure and heart rate was recorded as baseline, pre-intubation and then every 01 minute for 03 minutes. Changes in heart rate and mean arterial pressure were recorded in the proforma by another anesthetist who was blinded to the procedure performed.

Results: The mean age in group L was 41.23 ± 8.37 years and in group F was 40.73 ± 9.77 years. The mean weight in group L was 69.63 ± 8.92 kg and in group F was 70.6 ± 9.20 kg. In group L, male to female ratio was 26:14 whereas in group F it was 28:12. Mean heart rate and mean arterial pressure did not show significant change over time between groups. Time required for intubation was significantly less (22.45 ± 4.12 secs) in laryngoscopy group versus Fiber-Optic Bronchoscope group (44.68 ± 5.88 secs).

Conclusion: In conclusion we can say that our study demonstrated that using laryngoscope or Fiber-OpticBronchoscope for orotracheal..........
COMPARISON OF PROKINETIC ACTIVITY OF RANITIDINE AND NEOSTIGMINE ALONE AND IN COMBINATION- AN IN VITRO STUDY
Authors: Butt Aroosa Ishtiaq , Khan Asma , Mazhar Wardha , Khan Qamar uz Zaman , Maqsood Imrana
Published: January 2021

Objective: To explore the prokinetic effect of Ranitidine, to compare it with the prokinetic effect of Neostigmineand to observe the potentiating prokinetic effect of Ranitidine and Neostigmine in combination.

Study Design: Randomised controlled trial (experimental study).

Place and Duration of Study: Multi disciplinary centre, Army Medical College, Rawalpindi, from Jan to Dec 2015.

Methodology: Experiments were performed on three groups of rabbits (n=6) and Cumulative dose responsecurves were plotted using isolated duodenal tissue on power lab (USA). In the first two groups of experiments,cumulative concentrations of Neostigmine and Ranitidine were studied separately with neostigmine acting as acontrol and in the third group the potentiating effect of a fixed dose of ranitidine on neostigmine was evaluated.

Results: Neostigmine’s response was taken as 100 percent and Ranitidine’s response when compared to it came out to be 197 percent. The dose response curve of Neostigmine was shifted to the left and upwards in the presence of Ranitidine. The percent response with Neostigmine alone was taken as 100 percent and increased to 212 percent when the tissue was pre-treated with Ranitidine.

Conclusion: Our study has indicated that Ranitidine has marked prokinetic effect which is found to be greaterthan Neostigmine. It is also inferred that Ranitidine can potentiate the prokinetic effect of Neostigmine.
ANALYSIS OF FACTORS ASSOCIATED WITH DELAYED GASTRIC EMPTYING AFTER WHIPPLE’S PROCEDURE
Authors: Yasin Talha , Wattoo Nasir Mehmud , Butt Qasim , Safdar Kamran , Asif Muhammad
Published: January 2021

Objective: To assess the frequency and analyze associated factors of delayed gastric emptying among the patients undergoing Whipple’s procedure at surgical unit of a tertiary care centre in Pakistan.

Study Design: Cross sectional study.

Place and Duration of Study: Pak Emirates Military Hospital and Combined Military Hospital Rawalpindi,Pakistan, Apr 2018 to Mar 2019.

Methodology: A prospective study was conducted on 80 patients of both the genders who underwent Whipple’s procedure at the surgical unit of abovementioned hospitals. Delayed gastric emptying was diagnosed based on the criteria as defined by the International Study Group of Pancreatic Surgery by the consultant surgeons involved. Factors studied in our analysis included age, gender, smoking, presence of co morbidities, peroperative blood transfusion, sepsis, operative time and BMI.

Results: Out of 80 patients included in the final analysis, 61 (76.25%) were male and 19 (23.75%) were female.Mean age of patients included in our study was 46.31 ± 6.711 years. Thirty six (45%) patients had delayed gastricemptying while 44 (55%) did not meet the criteria as mentioned above. With binary logistic regression we foundthat presence of sepsis and high BMI had a strong relationship (p-value <0.05) with delayed gastric emptyingafter the Whipple’s procedure.

Conclusion: Delayed gastric emptying is a fairly common phenomenon among the patients undergoingWhipple’s procedure. High BMI and post-operative sepsis constitute the group which is at the highest risk ofdeveloping this post-operative complication in our study.
PREVALENCE OF OBESITY IN AFFLUENT SCHOOL CHILDREN IN MULTAN
Authors: Junaid Muhammad , Jalil Jawad , Noor Misbah , Arouj Kehkashan , Qamar Khadija
Published: January 2021

Objective: The objective of this study was to determine the prevalence of obesity in affluent school children in Multan.

Study design:  Cross sectional study

Place and Duration of study: Three private schools of Multan selected at random; willing to participate in the study. The study was carried out from 15 May 2015 to 15 November 2015.

Results: In our study, 37.58% (n=62) children were between 5-7 years and 62.42% (n=103) were between 8-10 years of age, mean +SD was calculated as 7.79+1.47 years, 73.94% (n=122) were males and 26.06% (n=43) were females. Mean values of basic characteristics of the patients were calculated as 2.14+1.21 as birth order, 33.18+8.25(kg) for weight, 130.15+8.81(cm) and 1.30+0.08(m) for height and 19.40+3.26 (kg/m^2) for BMI. Prevalence of obesity in affluent school children in Multan was calculated as 43.03% (n=71).

Conclusion: We concluded that the prevalence of obesity in affluent school children in Multan is very higher. Low physical activity and sedentary lifestyle are potential risk factors for obesity in children which may be modified and persistence of obesity may be avoided.
IMMUNOHISTOCHEMICAL EXPRESSION OF P53 IN INVASIVE DUCTAL CARCINOMA OF BREAST IN PAKISTANI WOMEN
Authors: Khan Umair Aslam Shahzad , Khadim Muhammad Tahir , Ali Syed Salman , Wajid Muhammad Imran Khan , Bajwa Akhter Ali , Anjum Saba
Published: January 2021

Objective: To determine the frequency of immunohistochemical expression of p53 in invasive ductal carcinoma of breast in Pakistani women.

Study Design: Descriptive, cross-sectional study.

Place and Duration of Study: Department of Histopathology, Combined Military Hospital, Lahore, from Jul 2015 to Jan 2016.

Methodology: This study involved 80 histopathological samples of invasive ductal carcinoma breast which weretested for p53 expression. Sample size with 80 cases was calculated using 95% confidence level and 10% marginof error while expected percentage of p53 expression will be 71.67%. Specimens were selected by non-probability, consecutive sampling. All specimens of newly diagnosed cases of invasive ducal carcinoma at CMH Lahore on histopathological examination of female patients aged between 15-80 years. IHC application of p53 was done as per technique mentioned in the manual given by the DAKO.

Results: Patient age was calculated which was between 25 years and 80 years while mean age was 50.76 ± 11.80years. Majority of the patients were aged between 25-50 years (n=44, 55.0%). In 54 (67.5%) patients lymph nodes were positive for tumor metastasis. Majority 64 (80%) of the tumors were Grade-II followed by Grade-III in 15 (18.7%) patients. The size of the tumor ranged from 0.2 cm to 14 cm with a mean of 4.16 ± 2.59 cm. p53 expression was positive in 38 (47.5%) patients. The expression of p53 was higher in patients who have positive lymph nodes (59.3% vs. 23.1%; p=0.002). However, expression of p53 was not so significant for age (p=0.079), tumor size (p=0.414)......................
COMPARISON OF FREQUENCY OF CESAREAN SECTION IN ELECTIVE INDUCTION OF LABOUR AT 40 +0 AND 41 +0 WEEKS OF GESTATION
Authors: Saeed Saira , Murtaza Badar , Nasim Zulekha , Raziq Sohail
Published: January 2021

Objective: To compare the frequency of cesarean section in elective induction of labour at 40 weeks and 41weeks of gestation.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Department of Gynecology & Obstetrics, Sialkot, from July to Dec 2017.

Methodology: The pregnant females at full-term were divided in 2 groups. All patients aged 20-35 years andparity less than 5 with singleton alive pregnancy and vertex presentation at 40+0 weeks gestation were placedin group A and all singleton alive pregnancies with vertex presentation at 41+0 weeks in group B. Group A wasinduced at 40+0 weeks and group B was induced at 41+0 weeks of gestation. Induction of labour was performed and fetal heart rate monitoring was conducted every 15 minutes. Augmentation was completed and frequency of cesarean section recorded in both groups.

Results: In this study a total of 100 patients were included. The mean age of the patients was 27.33 ± 4.87 years(range 20-35 years) with mean age of 26.54 ± 4.66 and 28.12 ± 4.99 years in group A and group B respectively.The cesarean section was performed in 20 (20%) patients, with 14 (28%) in group A and 6 (12%) in group B.Statistically significant difference of cesarean section was noted in both groups (p-value=0.046).

Conclusion: There was a significantly lower rate of cesarean section in elective induction of labour at 41weeks as compared to 40 weeks of gestation.
HIGH BCR-ABL1 GENE PERCENTAGE AT TIME OF PRESENTATION: A TOOL TO PREDICT FAILURE IN ACHIEVING EARLY MOLECULAR RESPONSE IN CHRONIC MYELOID LEUKEMIA (CML): A TERTIARY CARE CENTER EXPERIENCE
Authors: Khan Amjad , Ahmed Riaz , Fatimah Sarah , Nadeem Muhammad , Iqbal Shama , Gilani Sayed Tanveer Abbas , Amjad Huma
Published: January 2021

Objective: To determine the relationship of baseline quantitative BCR ABL1 gene percentage and therapeutic response i.e. Early Molecular Response (EMR) at 3 months with first generation Tyrosine kinase inhibitors (Imatinib) in patients with Chronic Myeloid Leukemia (CML) in chronic phase (CP).

Study Design: Prospective observational study.

Place and Duration of Study: Combined Military Hospital, Rawalpindi, Pakistan, and Armed Forces Institute of Pathology Rawalpindi, Pakistan from Oct 2017 to Oct 2019.

Methodology: One hundred and seventy patients, 18 years of age or older with newly diagnosed Chronic Myeloid Leukemia (CML) in chronic phase (CP) with quantitative baseline BCR-ABL (IS) transcript were included in the study. All enrolled patients were placed on Imatinib therapy (400 mg/day) and Reverse transcription polymerase chain reaction (RT-PCR) for BCR ABL transcript was repeated at 3 months to document EMR (BCR-ABL (IS) <10%). Patients who were in accelerated/blast phase, or already taking any Tyrosine Kinase Inhibitors (TKI) or chemotherapy were excluded from the study.

Results: In our study 101 (59.4%) patients achieved early molecular response. Out of these 80 (70.8%) patients with BCR-ABL<50% at baseline value showed early molecular response. However, only 21 (36.8%) with BCRABL >50% at baseline achieved early molecular response (p-value <0.001).

Conclusion: A significant number of patients achieved early molecular response with Imatinib therapy that had BCR ABL below 50%, however those with baseline BCR ABL >50%, the rate of EMR was comparatively lower.
PATTERN OF FOREIGN BODIES AERO DIGESTIVETRACT – A SINGLE CENTRE STUDY
Authors: Raza Maqbool , Rafique Atif , Khattak Shahid Farooq , Majeed Farhan , Azam Khalid , Farid Ghulam
Published: January 2021

Objective: To find out the pattern of foreign bodies inhaled or ingested in a series of patients.

Study Design: Case series.

Place and Duration of Study: Ear, Nose and Throat (ENT) department, Pak Emirates Military Hospital (PEMH)Rawalpindi, Jan 2016 to Dec 2016.

Methodology: A total of 46 cases of foreign body upper aero digestive tract who presented in the ENTDepartment, PEMH Rawalpindi in 2016 were included in this study. Twenty eight cases were of foreign bodyesophagus and 18 were of foreign body airway. The age, gender, duration of foreign body lodgment, types offoreign body’s physical signs and symptoms were recorded. Relevant radiographic studies were performed.

Results: Out of 46 patients of foreign body aero digestive tract 33 were males and 13 were females. The overallfrequency of foreign bodies’ upper aero digestive tract was 46 (0.14%) with 28 (0.08%) being foreign bodiesesophagus and 18 (0.06%) foreign bodies airway. In 50% cases of bronchial foreign bodies were in age group 0-3 years. The most frequent foreign body in the esophagus was coin in 13(46.4%) followed by chicken bone 5 (17.8%) and fish bone 3 (10.7%). Peanuts, peas, and beans were predominant component of the airway foreign bodies constituting 6 (33.3%), 3 (16.6%) and 3 (16.6%) respective of the total. Most frequent sites of impaction of the foreign body were cervical esophagus 16 (34%), right main bronchus 11 (23.9%) and left main bronchus 3 (6.5%).

Conclusion: Foreign body aero digestive tract is an uncommon but potentially life..........
POSTPARTUM DEPRESSION: ASSESSMENT OF CULTURAL RISK FACTORS
Authors: Tarar Amina Hanif , Ijaz Mohammad Mohsin , Tarar Muhammad Ali , Batool Munazza
Published: January 2021

Objective: To explore the cultural risk factors influencing the Postpartum Depression of first-born infants’mothers.

Study Design: Correlational survey.

Place and Duration of Study: Jannat Maternity Home, Dera Ghazi Khan, Pakistan, from Jan to Nov 2019.

Methodology: A sample of 101 first-born infants’ mothers with ages ranging from 18 to 26 years was selectedthrough purposive sampling. Edinburgh Post-Partum Depression Scale and Oslo Social Support Scale were used.

Results: Results suggested significantly lower mean scores for Postpartum Depression of mothers having a firstborn baby boy (M=5.98, SD=2.44) and higher for those having a girl (M=18.33, SD=4.62). Multi-factorial analysis of variance indicated a significant main effect of Social Support and Family System on Postpartum Depression levels of first-born infants’ mothers, explaining 44% and 11% variance respectively. Further, Post-Hoc analysis revealed higher levels of Postpartum Depression for mothers having poor Social Support (M=17.30, SD=6.15) as compared to those having moderate (M=9.68, SD=6.27) and strong Social Support (M=6.26, SD=2.30). Moreover, pair wise-comparisons demonstrated higher levels of Postpartum Depression for first-born infants’ mothers belonging to nuclear families (M=17.61, SD=7.09) as compared to joint ones (M=9.60, SD=5.70).

Conclusion: The study establishes that first-born infants’ gender, degree of social support, and nature of familyhave a profound effect on the Postpartum Depression levels of mothers. These findings will extend the understanding of cultural risk factors influencing first-born infants’ mother’s mental health.
MEAN SERUM FERRITIN LEVELS IN TYPE-2 DIABETES MELLITUS IN PAKISTANI POPULATION
Authors: Ali Kamran , Raza Qasim , Maka Tarique Ahmed
Published: January 2021

Objective: To evaluate the mean serum ferritin in type-2 diabetic patients.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Medicine, Combined Military Hospital, Peshawar, from Sep 2014 to Feb 2015.

Methodology: A total of one hundred patients with type-2 diabetes mellitus fulfilling inclusion criteria were selected. Blood sample was collected from all patients by the clean-catch technique after they received standardized verbal instructions. Blood samples were seen by classified pathologist in the laboratory.

Results: Mean age of patients was 55.51 ± 5.40 years with 60% male gender predominating the overall sample of diabetics. Mean serum ferritin was 219 ± 70.67 ng/ml and mean HbA1c was 7.24 ± 0.61%. Stratification with regard to age and gender was also carried out.

Conclusion: Serum ferritin levels were observed raised in type-2 diabetics, suggestive of possible role in the pathogenesis of type-2 diabetes mellitus. We recommend further research work over its pathogenesis so that the guidelines for its control may be formulated.
SHORT AND LONG TERM FOLLOW UP RESULTS OF (THE VERSATILE) GASTROCNEMIUS MUSCLE FLAP
Authors: Ali Ghazanfar , Hameed Shahid , Majid Abdul , Ahmad Rao Saud , Butt Ahsan Masood , Javed Rana Hassan
Published: January 2021

Objective: To see the long and short term outcome of the Gastrocnemius muscle flap for coverage of soft tissue defects of knee and proximal Tibia.

Study Design: Case series.

Place and Duration of Study: Surgery Department of Combined Military Hospital Bahawalpur, from Dec 2014 to Oct 2017.

Methodology: A total of 33 patients were enrolled for the study through consecutive sampling. Data was processed using SPSS-17. All patients were followed up at first and second week (early morbidity), and then at 06 months (late morbidity) from operation. During early follow up, they were examined for Hematoma at donor site, wound Infection, sural nerve injury, partial skin graft loss and Partial Flap Necrosis. In late follow up patients were examined for reduced Knee mobility and Gastrocnemius muscle contractions.

Results: The studied 33 patients consisted of 30 (90.90%) men and 3 (9.09%) women. The mean age was 35 years (range: 16 to 64) years. Hematoma was commonest complication. It occurred in 6.06%. Wound infection, partial loss of flap, partial loss of skin graft and wound infection occurred in 3.03% patients. Late follow up revealed reduced knee mobility in 9.09% patients (n=3) and bothersome contraction of gastrocnemius muscle in same number of patients.

Conclusion: The gastrocnemius flap is reliable, versatile, and very useful for provision of supple soft tissue coverage for defects around the knee and the upper leg.
OPTIMIZING CLINICAL APPROACH TO THE FORM OF DELIVERY DURING PREGNANCY IN PATIENTS WITH CARDIAC DISEASE; A REVIEW OF THE EFFECTS OF PRACTICE CHANGE BY CONCURRING TO INTERNATIONAL GUIDELINES
Authors: Khalil Adiba Akhtar , Akhtar Khurram
Published: January 2021

Objective: To assess if adherence to international guidelines for pregnant cardiac patients’ mode of delivery is achievable with available local resources.

Study Design: Prospective quasi experimental descriptive study.

Place and Duration of Study: All Pregnant patients with cardiac disease reporting to Armed Forces Institute of Cardiac Disease/National Institute of Heart Disease (AFIC/NIHD) who were admitted for and were delivered from Oct 2009 to Sep 2011 were included in the study.

Methodology: International guidelines and recommendations for mode of delivery for cardiac patients with pregnancy were followed for patients. Caesarean sections were reserved only for obstetrical reasons and absolute cardiac indications. The patients with first trimester miscarriage were not included. Data was collected on a personal computer Microsoft excel sheet. Frequency was calculated from the data entered. The reduction in caesarean section rate and increase in vaginal delivery rate as per guidelines without an increase in maternal mortality, was the main outcome.

Results: Total of 221 patients were delivered in the 2 year period between October 2009 to September 2011 at AFIC/NIHD. The caesarean section rate the year before 2008-2009 had been 48.6%. After the change in practice by concurring to international guidelines, the caesarean section rate for the 2 year period dropped to 26.7%. The hospital maternal deaths were 5. This was slightly better to the year 2008-2009 which had 3 maternal deaths.

Conclusion: It’s possible to adhere to international recommendations and protocols for pregnant cardiac patients and achieve internationally comparable outcome in terms of mode of delivery without increasing current institutional maternal mortality rate with local hospital resources.
EFFECT OF PREANALYTICAL VARIABLES ON SERUM THYROID STIMULATING HORMONE ANALYSIS BY CHEMILUMINESCENCE METHOD
Authors: Rehman Ambreen , Asif Naveed , Malik Saima Shakeel , Sheikh Waqas , . Quratulain , Khadim Muhammad Tahir
Published: January 2021

Objective: To identify effect of pre-analytical variables on serum thyroid stimulating hormone.

Study Design: Cross sectional study.

Place and Duration of Study: Armed Forces Institute of Pathology (AFIP) Rawalpindi, Department of Chemical Pathology & Endocrinology, from Mar 2018 to Aug 2018.

Methodology: Hundred subjects with ages ranging from 18 to 34 years, irrespective of gender, were randomly selected for this study. Five milliliters venous blood sample was collected from each subject in a serum separator and divided into two aliquots. First aliquot was centrifuged and analyzed immediately for TSH, while second aliquot was stored for 24 hours and was then analyzed. TSH was measured by third generation assay usingchemiluminescence technique on ADVIA Centaur® XP. Serum TSH levels were also analyzed twice daily; in the morning (0800 to 0900 hours) and afternoon (1400 to 1600 hours). Data was analyzed using SPSS version 24. Frequency and percentages were calculated for qualitative variables like gender and pre-analytical variables. Test of significance Mann-Whitney U-test was applied and p-value <0.05 was taken as significant.

Results: Mean age of subjects was 23 ± 3.4 years. Change in circadian rhythm was observed in 17 (28%) males and 14 (36%) females. Statistically significant association was found between morning and evening TSH levels, while no change was observed in TSH level by early and late centrifugation of samples.

Conclusion: TSH levels vary significantly between blood samples collected at different timings of the day from the same person. TSH is resistant to degradation, immunologically stable, and reasonably insensitive to potential problems associated with routine specimen handling, when measured by immunoassay technique. Therefore, it is helpful in large epidemiological studies and small size laboratory, which require long transportation time and storage.
MULTI-SEPTATE GALLBLADDER, A RARE ANOMALY!
Authors: Zahid Uzma , Rasikh Alia , Qureshi Pervez Saleem
Published: January 2021

Multiseptate Gallbladder (MSG) is a congenital problem with varing clinical presentation. Its prevelance in peadriatic age group is much less as compared to adults, especially in females, making it a rare condition. Symptoms may be mild or severe, or patient may be completely asymptomatic, with incidental sonographic diagnosis. Exclusion of other associated conditions is also required. Its correct diagnosis is important, so that the patient can be observed for complications including possibility of carcinoma in rare instances. We report here a case of a female child, diagnosed as having Multiseptate gallbladder, at Hearts International Hospital, Rawalpindi, Pakistan . She is being regularly followed in opd.