bluuebunny/crossref_metadata_2025 huggingface dataset:
Legal Regulation and Health Risks: Analyzing “Tukang Gigi” in The Context of Service Accessibility
Authors: Alfarizi Mohammad Hanaan , Prasasti Annisa Widya , Genovés Manuel Beltrán
Published: July 2024

Introduction: Access to dental services is a challenge for lower to middle-income individuals. Tukang gigi, an alternative to dentists, offers more affordable oral health care. Governed by Ministry of Health Regulation No. 39 of 2014, tukang gigi's authority is limited to acrylic dentures. However, evidence shows unauthorized practices, posing health risks like misdiagnosis and complications. This not only jeopardizes patient health but also undermines the credibility of the dental health profession, eroding public trust.Purposes of the Research: The aim of the research is to find out the legality of dental practices that exceed their authority with a policy approach to the community's need for cheap access to healthMethods of the Research: The research employs a literature study method, specifically normative legal research, focusing on legal norms in laws and regulations. Following a systematic process of collecting, reading, recording, and analyzing library data, the study adopts a doctrinal legal research approach. The emphasis is on elaborating and explaining collected data related to the main research topics.Results of the Research: The current law limits tukang gigi to making and installing detachable dentures that meet health standards. However, tukang gigi often put braces, remove tartar, and color braces outside their allowed scope. Therefore, tukang gigi are not accountable for their activities, leaving consumers or service users vulnerable to malpractice. Despite benefiting from dental artisan work, consumers are ignorant of legal protections when these practitioners breach government rules. Tukang gigi often break the law owing to a lack of information or compliance, so they are at risk without legal protection. In contrast to Spain, where denturists cannot practice dentistry. Only dentists and dental technicians are legally recognized in Spain. This is because dentistry skill requires strict requirements. Dental professionals monitor actions closely to reduce misconduct. Dental care is affordable.
Comparison of the Legal Regulation of Adultery as Social Control in Society: A Comparison Between Indonesia, Malaysia, Brunei Darussalam, and Turkey
Authors: Lestiawati Ida , Maisa Maisa , Manan Abdul
Published: July 2024

Introduction: Differences in adultery regulations in various countries in the world can be different, one of which is due to the ideology adopted by each country. Regulations related to adultery actually have relevance to state ideology and the values held and lived by society, including religious values.Purpose of the Research: This research aims to analyze and compare adultery regulations based on the values and ideology that apply in a country by comparing adultery regulations between Indonesia, Malaysia, Brunei Darussalam, and Turkey.Method of Research: This research is normative legal research by prioritizing historical, conceptual, legislative and comparative approaches.Results of Research: The results of the research confirm that the development of adultery regulations in Indonesia has not been substantively facilitated since it was regulated in the WvSNI and even passed into the Criminal Code in 1946. This is because what is regulated in the Criminal Code as an official translation of Dutch criminal law is only an overspel that if translated into Indonesian is closer to the act of infidelity and not adultery. The regulation of adultery in the new national criminal law is officially regulated in the New Criminal Code, especially in Article 411 of the New Criminal Code, which is actually in accordance with the meaning of the offense of adultery in accordance with the values and culture of Indonesian society. Differences in the regulation of adultery in each country, especially countries with a majority Muslim population. This is a necessity because differences in adultery regulations in each country depend on the ideology adopted by each country. However, in general, in societies where the majority are Muslim, adultery is classified as a disgraceful act that deserves criminal sanctions as applied in Indonesia, Malaysia and Brunei Darussalam, whereas Turkey, even though the majority of the population is Muslim, is based on a secularist view, only regulating adultery within the realm of law. private.
Kautilya’s Ideas for Diplomacy and its reflection in India’s Foreign Policy
Authors: Bhattacharya Sanchaly
Published: July 2024

Kautilya (also known as Chanakya), was India’s political strategic thinker and philosopher of the 4th century B.C., during Chandragupta Maurya’s reign. While, Arthashastra received wider recognition across the world for his state-building theories, in terms of Kautilya’s contribution to the strategic thought in realpolitik, Kautilya’s work has long been neglected not only by Western scholars but even sometimes by the Indian intellectual community. India, for a long, was recognized as the land of spirituality with a lack of rationality, and the discovery of Arthashastra made those perceptions irrelevant. While, there are other factors such as technological developments with nuclear deterrence and factors of globalization in cross-border trade and commerce, India’s foreign policy outlook has considered the realm of international affairs based on Arthashastra, which will be deciphered in this paper. Stressing the notion of ‘state’ and a comparative analysis of Kautilya’s state with that of the Western scholars and the current interpretation of ‘state’, the article will delve deeper into the doctrine of elements of the state, and their role in dealing with foreign policy. Analyzing the concept of ‘Vijigishu’ or central kingdom propagates in Kautilya’s ‘Mandala theory, and what is ‘enemy’ in foreign relations, the article will try to understand how the classic scripture is still relevant in India’s foreign policy choices. Contextually, the article will put appropriate examples to establish the fact that Kautilya’s Arthashastra has significantly influenced the decision-making in Indian diplomacy.
The bacterial profile and antibiotic susceptibility in skin and soft tissue infections at tertiary care hospital of Quetta, Pakistan
Authors: Aman Bibi Sazain , Taj Muhammad Kamran , Taj Imran , Azam Saima , Khan Sakina , Rashid Rozina
Published: July 2024

Objective: To determine the bacterial profile and antibiotic susceptibility in skin and soft tissue infections among patients in a tertiary care setting.
Method: The cross-sectional cohort study was conducted at the Centre for Advanced Studies in Vaccinology and Biotechnology, University of Balochistan, Quetta, Pakistan, from June 2021 to May 2022, and comprised bacteria-infected skin samples that were collected from the Bolan Medical Complex Hospital, Quetta, and the Sandeman Provincial Hospital, Quetta. The swab samples were immediately cultured, and positive samples were evaluated for biochemical tests, antibiotic susceptibility test and polymerase chain reaction. Data was analysed using SPSS 22.
Results: Of the 800 samples, 598(74.7%) tested positive for pathogenic bacteria. Staphylococcus aureus accounted for 316(39.5%) infections, followed by clostridium perfringens 18.96(2.37%), escherichia coli 120(15.12%), pseudomonas aeruginosa 98(12.25%) and klebsiella pneumoniae 44(5.5%). Among all the infected samples, 380(47.5%) belonged to males, 218(27.25%) to patients aged 5-20 years, 448(56%) to the uneducated subjects, and 462(57.87%) to patients having lower socioeconomic status. Pseudomonas aeruginosa showed the highest level of resistance against all antibiotics.
Conclusion: Regular surveillance and proper use of antibiotics should be encouraged in hospitals to limit the spread of antibiotic resistance against pathogenic bacteria.
Key Words: Antibiotics, Bacteria, Surveillance, Frequency, Skin.
Clinical learning evaluation among undergraduate physical therapy students during rotations in teaching hospitals of Sialkot and Lahore
Authors: Arif Gulafshan , Saleem Zunaira , Asif Rimsha , Yousaf Qandeel
Published: July 2024

Objective: To evaluate the clinical learning environment among undergraduate physical therapy students.
Method: The descriptive, cross-sectional study was conducted from January 23 to May 25, 2023, after approval from the ethics review committee of Imran Idrees Institute of Rehabilitation Sciences, Sialkot, Pakistan, and comprised undergraduate physical therapy students of either gender aged 19-26 years in their 3rd to 5th academic year studying in different institutions in Lahore and Sialkot. Data was collected using the clinical learning evaluation questionnaire. Data was analysed using SPSS 22.
Results: Of the 295 students, 269(91.2%) were females and 26(8.8%) were males. The overall mean age was 22.03±1.14 years. There were 210(71.2%) students enrolled in the semester system, while 85(28.8%) were part of the annual system. The overall mean score was 71.05±10.20. Supervision (76.02±11.80) and motivation (80.21± 11.71) were the most satisfying part of clinical learning identified by the students.
Conclusion: The clinical learning environment demonstrated high satisfaction levels in supervision and motivation domains, while improvements were needed in the areas of cases, authenticity and organisation of doctor-patient encounters.
Key Words: Environment, Learning, Motivation, Physical therapy, Students, Supervision, Undergraduate.
Diphtheria's disturbing comeback: an alarming resurgence in Pakistan
Authors: Khan Wajiha Fatima , Khan Yusra , Alam Safa , Rahim Shazia , Malik Farheen
Published: July 2024

Dear Respected Editor,
Diphtheria, caused by Corynebacterium diphtheria, affects the throat and nasopharynx. Transmission occurs through airborne respiratory droplets, secretions, or direct contact. Toxigenic strains produce diphtheria toxin (DT) that causes local inflammation and necrosis of the pharynx, forming a characteristic gray and leathery pseudo membrane. Symptoms are fever, a sore throat, a swollen neck, and dysphagia. It can even lead to serious complications like pseudomembranous pharyngitis, myocarditis, and arrhythmias. Before the development of the toxoid vaccine for diphtheria, millions of people perished from the severe respiratory distress produced by the disease. [1] In the days before vaccinations, diphtheria was the leading cause of death in children [2]
In 1980, Pakistan reported 14,328 cases of diphtheria with an incidence rate of 177.7. [3] Strong public health efforts reduced cases of diphtheria from thousands to hundreds within 15 years. Pakistan’s launch of the Expanded Programme of Immunization (EPI) in 1978 significantly reduced diphtheria cases. From thousands in 1980, reported cases dropped to just 93 during 1995-2000 and a mere 9 during 2014-2015 [3].
Southeast Asia has borne the brunt of global diphtheria cases in the past decade, with Pakistan reporting the highest number (821 cases in 2018) [1, 3]. The disease recently resurfaced, tragically causing 45 deaths among children and teenagers in 2022 [1]. In November 2022, flood-affected areas in Sindh, Punjab, and Khyber Pakhtunkhwa further reported around 70 suspected cases [1]. A concerning 50% increase in diphtheria cases in 2023 prompted the NIH to issue an outbreak advisory, urging vigilance and strong preventive measures by both the public and officials [4]. The significant population growth in Pakistan, exacerbated by a lack of family planning, wealth inequality and COVID-19 outbreak affecting the immunization coverage has led to the spread of diphtheria in recent years. [5]
Thus, to combat the rising diphtheria infection in Pakistan, we would like to make some recommendations:

High quality, accessible vaccines: Ensure high-quality vaccine availability in rural and urban areas, with 10-year booster shots for sustained immunity [1, 3].
Large-scale vaccination: Implement WHO/UNICEF-recommended strategies for large-scale vaccination coverage in Pakistan [1, 3].
Rural awareness campaigns: Address vaccine hesitancy through targeted awareness programs in rural areas, highlighting benefits and dispelling misconceptions [1, 3].
Increased healthcare funding: Allocate increased budget for healthcare (NHSRC) to support vaccine production, storage, and distribution [4].
Strict antibiotic adherence: Implement daily patient checklist to ensure complete antibiotic courses, preventing recurrence [4].
Anatomical variations of sphenoid sinus in terms of volume and protrusions of optic nerve/internal carotid artery in a subgroup of Pakistani population
Authors: Aijaz Asma , Talat Samreen  , Shazia Fehmi  , Afsheen Khan  , Hira Ahmed  , Nadeem Baig
Published: July 2024

Objectives: To compare the volume of sphenoid sinus with protrusions of optic nerve and internal carotid artery in both males and females.
Method: The cross-sectional study was conducted from October 2020 to February 2021 at the Radiology Department of Dow University of Health Sciences, Karachi, and comprised males and females aged 20-60 years having no sphenoid sinus bony abnormality. Sphenoid volume and optic nerve and internal carotid artery protrusions were examined in the computed tomography scans of the paranasal sinus. Based on the protrusions, the scan findings were split into four groups: Group 1 had no protrusion, Group 2 had optic nerve protrusion, Group 3 had internal carotid artery protrusion, and Group 4 had protrusions of both the optic nerve and the internal carotid artery. Data was analysed using GraphPad Prism 9.
Results: Of the 300 subjects, 171(57%) were males and 129(43%) were females. The overall mean age was 39.27±10.9 years. There were 147(49%) subjects in group 4, followed by 72(24%) in group 3, 42(14%) in group 2 and 39(13%) in group 1. Statistically significant difference was observed between sphenoid volume across the study groups for both male and female subjects (p<0.001).
Conclusion: There was significant relationship between internal carotid artery and optic nerve protrusions and sphenoid volume.
Key Words: Sphenoid sinus, Optic nerve, Internal carotid artery, Computed tomography.
Psychogenic impact of child labour in Pakistan
Authors: Ishaque Abdul Thawwab , Rizvie Abdul Raheem , Mohamed Imtiyas Muhammed Ifham
Published: July 2024

Madam,
Child labour is a pressing global issue, with millions of children affected by its consequences. Currently, millions of children worldwide are trapped in various forms of labour, disrupting their education and robbing them of a proper childhood. Child labour in Pakistan is alarmingly on the rise, with over 3.3 million children trapped in its grasp.1 Approximately 12.5 million children are ensnared in various labour activities, perpetuating a cycle of poverty and denying them their right to education and a proper childhood.2 Shockingly, predictions from the World Economic Forum indicate this number could escalate to 16 million by fiscal year-end.2 A study conducted in three urban squatters of Karachi ., found that behavioural problems afflict 9.8% of working children in Pakistan, with peer and conduct issues being the most prevalent.3 Compounding the concern, Pakistan’s sole National Child Labor Survey in 1996 raises significant doubts about data reliability and comprehensiveness.1
Pakistan’s attempts to combat child labour, including the Convention on the Rights of the Child (CRC) initiated almost three decades ago, have fallen short due to a lack of an established public coordinated child protection case management and referral system, aligned with international standards.4 Legal frameworks and enforcement mechanisms which prohibit child labour such as The Employment of Children Act-1991 exist in Pakistan.5 But they lack the potency needed to effectively curb this pervasive problem due to the persistence of child labour attributed to socioeconomic factors, restricted educational access, and insufficient social support systems.
To effectively address this crisis on a long-term basis, a multi-pronged strategy is essential. Strengthening and rigorously enforcing child labour laws is paramount to shielding children from violence and exploitation. A comprehensive legislation incorporating a child protection case management system and referral mechanism is imperative, ensuring children’s rights, quality education, and safeguarding against exploitation. Focused interventions must enhance education access in underserved communities, providing viable alternatives to child labour. Raising awareness among parents, communities, and employers about the enduring harm of child labour is vital. Collaborative endeavours involving governmental bodies, NGOs, and international partners are pivotal for successful implementation and sustainability. An urgent need exists for an updated national child labour survey, reflecting the current socio-economic context to inform future decisions. In summary, urgent action is needed to address Pakistan's child labour's psychological toll. A multifaceted strategical approach can pave the way for a brighter future for every child.
Olfactory neuroblastoma: a rare sinonasal malignancy
Authors: Uppal Athar Adnan , Zaman Saira , Shahbaz Ayesha , Iram Sadia
Published: July 2024

Olfactory neuroblastoma is a rare malignant tumour arising from the olfactory nerve and extending into the nasal cavity. In this case report, the case of a 42-year-old male is presented. The patient had a two-month history of progressive nasal blockage and episodes of epistaxis. No complaint of anosmia or facial pain was reported. All the necessary examinations were performed. Upon investigation, the CT scan and MRI showed a polypoid mass involving the right maxillary sinus, eroding the medial wall and expanding into the osteo-meatal complex. The diagnosis of olfactory neuroblastoma was confirmed through histopathological examination and further validated by immunohistochemistry as it was positive for synaptophysin, chromogranin, gamma enolase, and neurofilament. On staging, the tumour was Kadish B. The mass was excised by lateral rhinotomy. The patient was kept on radiotherapy and was free from recurrence upon follow-up 10 months later.
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Outbreak of Acute Conjunctivitis in Karachi: A perfect ground for misuse of topical Antibiotics
Authors: Arooba Iqbal  , Shanza Khan
Published: July 2024

Dear Sir/Madam,
The metropolitan city of Karachi is facing an outbreak of acute conjunctivitis, a highly contagious eye infection known as 'pink eye'.1 About 80% of all cases of acute conjunctivitis are viral, human Adenoviruses being the most common agent. Patients usually present with acute onset of redness, discomfort, photophobia and watery discharge, often involving both eyes. Transmission is through direct contact with the ocular discharge of infected individuals.2
Tests like viral culture and PCR assays are not routinely employed due to limited accessibility and the diagnosis is primarily clinical. Treatment is mainly supportive: cold water application, lubricating eye drops and hygiene maintenance is recommended. Formal treatment guidelines are currently unavailable and no antiviral drug has been approved.2 This letter aims to draw your attention to the inappropriate use of topical antibiotics during the current epidemic of acute conjunctivitis.
Self-medication, including OTC antibiotics use, is a ide spread practice in developing countries like Pakistan, where the prevalence is 95.5%.3 This is because of the easy accessibility of medicines, especially antibiotics used without prescription for many, including the common pink eye. In the UK, chloramphenicol eye drops use for acute conjunctivitis increased by 47.8% from 2005 to 2007.4 This has substantially increased antibiotic resistance in ocular flora; a significant increase in ocular MRSA from 30% in 2000 to 42% in 2005 was reported.5 Moreover, antibiotic drops available at local pharmacies are usually in combination with steroids which is not recommended due to exacerbation of potential herpetic conjunctivitis. In addition, increased antibiotic prescriptions by general practitioners have also contributed to this growing problem. This has added unnecessarily to the total health care finance; millions of dollars are spent every year on acute conjunctivitis in the USA.2
The most appropriate way to manage and prevent VC is patient education, including reassurance that it is a self-limiting disease and counselling regarding precautionary measures. On the national level, public service messages on television, Tele-ophthalmological services and distribution of pamphlets in hospitals, especially during the outbreak season, can help prevent its transmission and subsequent overuse of OTC antibiotics. Guidelines should be set for general practitioners to minimise antibiotic prescriptions and consider quick diagnosis by point-of-care test such as AdenoPlus. Around $ 340 million could be saved, and 1 million cases of antibiotic treatment could be avoided by using this test.2 Finally, thorough ophthalmologic examinations can help exclude other causes.
Cultivating academic success and inclusion: rethinking education for children with ADHD in Pakistan
Authors: Abbas Syeda Qaima , Akhtar Ahmad
Published: July 2024

To the Editor,
In Pakistan, 2.49% of children have ADHD, with a boy-to-girl ratio of 3:1(1). However, the challenge is exacerbated by a prevailing stigma surrounding mental health issues, which often compels potential individuals to shy away from seeking professional help. This predicament not only burdens these young minds but also gives rise to various complications as they transition into adulthood. (2)
While some training sessions for teachers and parents have been conducted to address ADHD in Pakistan, the extent of these efforts remains limited. (3, 4) The merits of such initiatives are undeniable, as they empower caregivers to understand and adapt their behaviours to support affected individuals better. Moreover, educational institutions have an invaluable opportunity to evolve their teaching methodologies to cater to the unique mental constitution of children with ADHD.
Once teachers are enlightened about the cognitive dynamics of their students, they can craft strategies to help these individuals maximise their academic potential. Guided by recommendations from the Attention Deficit Disorder Association (ADDA) (5), classroom settings can be tailored to assist atypical students facing academic challenges (refer to Table 1). Other practical suggestions include extending task submission deadlines for concerned students and rewarding those who meet them on time with extra credit. Similarly, allocating extra time during tests acknowledges the extra effort required by this population to accomplish tasks that come more easily to typical children.
In this pursuit of curriculum adjustments, teachers must forge positive relationships with students dealing with ADHD. Creating an inclusive, nonjudgmental environment where students can freely express themselves without fear of criticism or reprimand is paramount.
In summary, embracing innovative teaching methods that promote the inclusion of students with ADHD alongside their typical peers can yield profound benefits for their cognitive development, academic achievements, and social well-being. Providing these essential tools and fostering an inclusive learning environment empowers this young generation to navigate future challenges and lead fulfilling, independent lives.
The association between age of onset of obesity and the rising risk of hypertension a cause of concern for young adults
Authors: Badar Khan Waniya , Abu Bakar Bhura Shumaila
Published: July 2024

Dear Editor,
Living a sedentary lifestyle can lead to being overweight or obese in young adults. These conditions are characterized by excessive fat accumulation, which can threaten health. A body mass index (BMI) of over 30 indicates obesity and is linked to comorbidities such as Type 2 Diabetes Mellitus and Hypertension. Obesity accounts for around 65 78% of cases of primary hypertension, and the mechanisms behind this include sympathetic nervous system overactivation, stimulation of the renin-angiotensin aldosterone system, changes in adipose-derived cytokines, insulin resistance, and renal changes (1).
In 2016, 39% of adults aged 18 or older were overweight or obese worldwide. In most high-income countries, almost two-thirds of adults are overweight or obese. In South Asia and Sub-Saharan Africa, approximately 20% of adults have a BMI greater than 25 (2). A recent study in China suggests that overweight or obese participants with an onset age of less than 38 years had a higher risk of hypertension than those who were not overweight or obese (3). According to the latest population-based National Health Survey of Pakistan (NHSP), nearly 18.9% of Pakistanis over the age of 15 were hypertensive, with a higher prevalence in urban populations than in rural areas where men were more affected than women (4). Studies have shown that with these increased early age of onset of hypertension more young adults have become prone to late life cardiovascular diseases like myocardial infarction and ischemic or haemorrhagic strokes and hypertension end organ damage as young people tend to overlook health consequences related to hypertension as there is less awareness regarding these in such an age group as compared to middle aged and elderly. New evidence suggests that the rate of hypertension treatment and control vary with age making it more important for earlier detection (5).
Tackling the root causes, such as high-calorie food intake, sedentary lifestyle, work stress, and lack of access to healthier food options, is necessary to overcome this severe issue. Introducing physical activities in universities for at least an hour a day can keep people active and relieve students of various stressors. Food cafeterias should offer healthier food options and reduce the high-calorie fast food availability. Seminars can help increase awareness of health-related issues with obesity, encouraging students and teachers to adopt a better lifestyle.
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Role of leadership behaviours in mitigating physician burnout in Pakistan
Authors: Moeen ud Din Khawaja , Asif Muhammad Ahsan , Iqbal Minahil
Published: July 2024

Dear Sir / Madam.
Respectable Editor, Physician burnout is the reality of the modern-day world that influence the quality of patient care, physician turnover, and long-term patient satisfaction. Several components become a part of this unfortunate phenomenon which includes emotional exhaustion and decreased level of productivity. These features lead to a sense of negativity and depersonalization from the reality which in turn results in the overall reduced sense of personal accomplishments and efficacy. For the most part these constituents effect the working environment in the hospital settings in way that leads to deleterious impact on work healthcare output.1
Worldwide physician burnout has reached global epidemic levels, with recent studies conducted in local hospital settings in Pakistan showing a prevalence of high burnout in 13.5% and moderate level of burnout in 62.2% among the physicians. An eye opening data of 33% doctors desired to quit their jobs.2 Current scenarios after the post-pandemic era and now the hazardous economic destabilization of Pakistan is playing a role of catalyst for the dissatisfaction, mental and physical anguish among the physicians hence leading to an increased burnout.
In relation to this matter, the most important factor playing a significant role in amelioration of this grim situation is the role of leadership staff. A recent study has identified that the leadership behaviour ratings of physicians’ supervisors are negatively associated with burnout and are positively linked with a sense of professional fulfilment. In the same study, they have rightly pointed out that physicians are more likely to depart from a place where they are not acknowledged enough.3 Another similar study conducted by James et al. using the Full Range of Leadership Model (FRLM) has successfully reported that transformational leadership behaviours that include idealized influence, and individualized consideration cultivate a sense of higher-order values, purpose, and individualized development to achieve performance that is beyond expected from the usual scenarios.4 Keeping that in mind, the present distressing burnout situation calls for an emergent need to take immediate appropriate actions to mitigate the prevalent situation with involved and supportive leadership qualities like the provision of comprehensive support groups, a humane number of working hours, improved salary packages, de-stressing activities like sports on department level etc. to ameliorate the mental health of physicians and enhance their overall productivity.5
To conclude, physician burnout is reparable with minimum efforts in the form of improved supervision and management qualities of the leadership staff.
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Thermal Influence on the Heart: The Impact of Hot Weather on Cardiovascular Conditions
Authors: Ayesha Imran Butt  , Azhar Muhammad Junaid
Published: July 2024

Dear Editor,
We are cognisant of the fact that cardiovascular diseases (CVDs) have a considerable impact on public healthcare systems. Cardiovascular disorders rank as the primary global reason of fatality, claiming an estimated 17.9 million lives in 2019, which equates to 32% of all global fatalities. The majority of these deaths, around 85 percent, result from heart attacks and strokes. Low- and middle-income countries tolerate the brunt of heart-related fatalities, accounting for over three quarters of all deaths attributed to these conditions. Additionally, out of the 17 million premature deaths caused by noncommunicable diseases in 2019, CVDs were responsible for 38 percent.1 The prevailing cardiovascular risk factors encompass increasing age, hypertension (commonly referred to as a double-edged sword), diabetes mellitus, tobacco use, obesity, dyslipidaemia, and stress.1,2 A sedentary lifestyle together with poor eating habits have also led to an increased rate of CVS-related illnesses.1
Often overlooked as a risk factor, experiencing high temperatures significantly adds to the increased occurrence of cardiovascular diseases. Multiple studies support the connection between extreme temperatures and heightened cardiovascular risks.2-5 Being exposed to higher temperatures can lead to intravascular volume depletion, haemoconcentration, a hypercoagulable state, electrolyte imbalance, and raised sympathetic activity, placing substantial stress on the heart, especially in individuals with pre-existing cardiovascular disease.3
To investigate cardiovascular mortality associations with extremes of temperatures, Barrak Alahmad et al. assembled daily counts of specific cardiovascular causes of death from 567 cities across 5 continents in overlapping periods ranging from 1979 to 2019, and the city-specific daily ambient temperatures were noted. The findings indicated that higher temperature extremes (99th percentile for heat and 1st percentile for cold) were linked to an increased probability of mortality from various cardiovascular conditions, including ischaemic heart disease, stroke, and heart failure.4 In a case-crossover study conducted using the England and Wales MINAP database, involving 24,861 participants (hospital admissions for myocardial infarction) during the warmest months (June to August) from 2003 to 2009, it was found that each 1-degree Celsius increase in temperature beyond the established threshold of 20 °C temporarily increased the risk of heart attack by 1.9 percent.5
The cardiovascular-related illness and fatalities are quite prevalent in Pakistan. Pakistan due to her geographical location, usually encounters summer temperatures ranging from 45 to 55 degrees Celsius across most areas of the country.
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The 6E approach to a healthy life
Authors: Sanjay Kalra  , Madhur Verma  , Nitin Kapoor
Published: July 2024

us to focus on promotion of health and prevention ofdisease. Simple public health messaging is required toinform and motivate the public to follow evidence-basedinterventions which can help prevent metabolic illnessesand their complications. We present a catchy 6E frameworkwhich enjoins individuals to Eat well, Exercise well,Eliminate unhealthy behaviours/habits, Ensure adequateEntertainment, relaxation and sleep, practice Emotionalcontrol, and Eschew/avoid extremes. This message can beused at individual, family as well as public health levels, tospread awareness about healthy behaviours and lifestyle.Keywords: Diabetes, metabolic syndrome, obesity,prediabetes, prevention, primary care, primaryprevention
Super selective intra-arterial cerebral infusion (SSIACI) for newly diagnosed and recurrent glioblastoma
Authors: Syed Sarmad Bukhari  , Noman Ahmed  , Muhammad Shahzad Shamim
Published: July 2024

Chemotherapy with various modalities is the standard of care in the management of newly diagnosed and recurrent glioblastoma. Current guidelines recommend intravenous administration of systemic chemotherapy. However, the blood brain barrier (BBB) restricts ionized molecules larger than 180 Da (Daltons) while most chemotherapeutic agents are between 200-1200 Da (TMZ [194 Da]). The doses administered are restricted by their systemic toxicity. Super selective intra-arterial cerebral infusion (SSIACI) can administer a localized regular or higher dose of chemotherapy that circumvents the systemic circulation. This is accompanied by disruption of the BBB (BBBd) which can be achieved in a number of ways (IV mannitol, MRIgFUS and bradykinins etc). With super selective catheterization, the drug’s volume of distribution (Vd) is restricted to a targetted area. Additionally, following drug delivery, flow may be arrested to prevent drug washout with blood flow.1
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Patient-reported outcomes for immediate breast reconstruction with mastectomy among breast cancer patients in Pakistan
Authors: Sidra Afzal  , Muhammad Asad Parvaiz  , Nida Javed  , Muhammad Abu Bakar
Published: July 2024

Objective: To evaluate the effect of immediate breast reconstruction with mastectomy in the local population.
Method: The quasi-experimental, control study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised patient data from April 2017 to December 2020, of breast cancer patients who underwent mastectomy with or without immediate breast reconstruction. Those who underwent mastectomy were labelled as control group A, while patients with immediate breast reconstruction were labelled as intervention group B. Data was analysed using SPSS 20.
Results: Of the 66 patients, 33(50%) were in each of the 2 groups. Group B had significantly more patients aged <40 years than group A (p=0.01), more patients with graduate-level education (p=0.04), and more patients who were either unmarried or divorced (p=0.05) than group A. Group B patients had higher mean scores for satisfaction with breasts (p=0.001) and psychosocial wellbeing (p=0.001) than those in in group A. Mean scores for adverse effects of radiotherapy were significantly higher in group B than in group A (p=0.04).
Conclusion: Better health-related outcomes were reported by patients who underwent immediate breast reconstruction with mastectomy.
Key Words: Immediate breast reconstruction, IBR, Quality of life, Mastectomy, Psychosocial wellbeing.
The role of breathing techniques in the management of asthma: a systematic review
Authors: Zafar Syeda Nabiha , Maliha Khalid  , Ayesha Jamil  , Sara Khawar Butt  , Aneeqa Manzoor  , Mishal Nadeem
Published: July 2024

Objective: To determine the effectiveness of breathing techniques in the management of asthma.
Method: The systematic review was conducted from July 2021 to August 2022, and comprised search on PubMed, Google Scholar, and MEDLINE databases using the population-intervention-control-outcomes format and Boolean operators. Relevant randomised controlled trials published in the English language in the preceding 10 years were included. The last literature search was done on January 15, 2022. To evaluate the bias in studies, the Cochrane risk of bias tool was used. PEDro scale was used to assess the quality of the trials analysed.
Results: Of the 250 studies initially identified, 11(4.4%) random controlled trials were analysed in detail. The quality of methodology was high, and the studies reported significant improvement with the use of breathing techniques in symptoms of asthma and quality of life along with a decrease in the use of bronchodilators.
Conclusion: Literature supported the use of breathing techniques in the management of asthma.
Key Words: Asthma, Breathing technique, Physiotherapy, Quality of life, Symptoms of asthma.
Needle breakage as an unusual complication of intravenous therapy: a case report
Authors: Liu YanQun , Xu HeXing , Fang LongYun , Wen Ji , Cui HuZhe , Qin XiangZheng
Published: July 2024

Residual intravenous foreign bodies following hand trauma are relatively rare; only a few previous reports of this situation are available. It has been reported that foreign bodies often migrate to the heart and atrium dextrum. Herein, we report a recent case of needle breakage in the dorsal vein of the hand that was removed with lignification using an intraoperative C-arm fluoroscopy machine and tape tourniquet to avoid proximal movement during removal. The mandate should be to remove within the capacity allowed so that rare cases and terrible complications can be avoided.
The case was seen at The Yanji City, Jilin Province, China at the Yanbian University Hospital emergency at February 20, 2023.
Keywords: Complications, Needle breakage, Foreign body, Intravenous therapy, Case report.
Syringoma. Why is it so difficult for a dermatologist to make a clinical diagnosis?
Authors: Glebova Larisa I. ,   Yevdokimov Moscow State University of Medicine and Dentistry, Zadionchenko Ekaterina V. , Radionova Ekaterina E. , Murashova Yulia A. ,   Yevdokimov Moscow State University of Medicine and Dentistry,   Korolenko Hospital – branch of Moscow Research and Practical Center of Dermatology and Cosmetology,   Korolenko Hospital – branch of Moscow Research and Practical Center of Dermatology and Cosmetology
Published: July 2024

Syringoma is a fairly rare benign neoplasm of the dermal appendages of the sweat glands. Basically, rashes are typical for middle-aged women. Linear and eruptive skin rashes have been described. The article traces the anamnesis of the disease in a woman who for a long time in different cities of Russia could not be correctly put diagnose.
Neurological masks of the onset of insulin-requiring diabetes in a comorbid patient in the practice of a general practitioner
Authors: Lebedeva Marina V. ,   Sechenov First Moscow State Medical University (Sechenov University), Beketov Vladimir D. ,   Sechenov First Moscow State Medical University (Sechenov University)
Published: July 2024

A clinical observation of the onset of pancreatogenic diabetes mellitus with neurological manifestations is presented. Difficulties in glycemic control, the importance of self-monitoring of glycemic indicators by the patient are shown. Pathological substantiation of the high risk of hypoglycemic conditions in patients with pankeatogenic diabetes mellitus is given.
Rheumatoid nodules in the lungs: difficulties of diagnosis and therapy
Authors: Sarapulova nastasia V. ,   Ural State Medical University, Teplyakova Olga V. , Shai Semyon E. ,   Medical Association "New Hospital",   Ural State Medical University,   Ural State Medical University
Published: July 2024

Rheumatoid arthritis (RA) is the most common systemic connective tissue disease and typically presents pulmonary involvement, which can be of various types. Rheumatoid nodules (RN) of the lungs are one of the most common such lesions and can be potentially dangerous for the development of complications such as pneumothorax. In addition, RN often requires differential diagnosis with other diseases represented by focal formations in the lungs. The article presents two clinical cases related to the development and complication of RN. The first case describes the development of recurrent pneumothorax in a patient with a long history of RA and risk factors for the development of lung disease. The second case is a atypical variant of the onset of RA with simultaneous involvement of the joints and the formation of nodules in the lungs. The results of RN visualization are demonstrated. The presented data are discussed.
Screening Sebagai Upaya Perlindungan Hukum Bagi Investor Saham Syariah di Indonesia
Authors: Abdul Hafiz  , Abdul Mujib
Published: July 2024

One of the interesting things in Islamic stocks is the existence of a screening system that indirectly shows the cautious attitude of the authorities and institutions that oversee the performance of Islamic stocks in the capital market. This screening is carried out to ensure that Islamic stocks remain on the right track. The screening process is carried out twice a year aimed at ensuring that stocks that have entered the sharia category continue to perform in accordance with sharia principles or have gone out of the sharia channel. The method used in this study is a qualitative research method using a descriptive qualitative approach. Shares that are no longer sharia from DES can no longer be transacted. Legal protection provided by OJK as the capital market regulator in Indonesia is by providing two options to investors: First: Immediately sell the shares owned to the issuer that issued the shares as stated in POJK no. 17 / POJK.04 / 2015. Second: If the investor does not want to sell the shares, then the investor can open a new account for conventional shares in order to transact again with the shares. This option is not mentioned in POJK no. 17/POJK.04/2015, but OJK still provides legal protection in the form of a way out so that the shares owned can be transacted in conventional stock accounts so that investors do not experience losses.
Analisis Faktor yang Mempengaruhi Kinerja Keuangan UMKM Tahun 2023: Studi Kasus pada Pelaku UMKM di Kecamatan Banjarsari, Kota Surakarta
Authors: Riska Febriyanti  , Susilaningtyas B.Kurniawati  , Syahriar Abdullah
Published: July 2024

This study aims to determine the influence of : (1) Capital, (2) Human Resources, (3) Partnership on the financial performance of MSMEs in Banjarsari District, Surakarta City. The method used in this study is a quantitative method with data analysis techniques using multiple linear regression. This study used probability sampling method, which is a simple random sampling technique. The sample of this study was 100 respondents who were MSME actors in Banjarsari District who were randomly invited. This study used primary data obtained through questionnaires that had been taken directly with Likert scale. The results of this study in T and F tests show that the variables of capital, human resources and partnerships affect the financial performance of MSMEs. The results of the R2 coefficient test have an Ajusted R Square value of 44.6% and the remaining 55.4% is influenced by variables outside this study.
Determinasi Brand Image, Kualitas Layanan dan Digital Banking Terhadap Loyalitas Nasabah Dimediasi Kepuasan Nasabah BSI KCP Malang Soetta
Authors: Asyarotul Istnaini  , Fani Firmansyah
Published: July 2024

The purpose of this research is to determine the influence of Brand Image, Service Quality, and Digital Banking variables on Customer Loyalty through Customer Satisfaction at BSI KCP Malang Soetta. This research uses a quantitative approach. The technique used is non-probability sampling which was taken using a purposive sampling technique. The population in this research is Bank Syariah Indonesia customers. The number of samples in this research was 200 customers. Hypothesis testing in this research uses the Smart PLS 3 test tool. The data used is the result of a questionnaire that has been distributed to BSI KCP Malang Soetta customers. The results of this research show that the brand image variable does not affect customer loyalty. The service quality variable influences customer loyalty. The digital banking variable affects customer loyalty. The customer satisfaction variable influences the customer loyalty variable. The customer satisfaction variable is not able to mediate brand image with customer loyalty. The customer satisfaction variable can mediate the service quality variable with the customer loyalty variable. The customer satisfaction variable can mediate the digital banking variable with the customer loyalty variable.
Redesigning A Hybrid Work Scheme To Improve Employee Performance At Pt Bhineka Rahsa Nusantara, Bandung City
Authors: Lathifah Dinar , Nirmalasari Healthy , Sukoco Iwan
Published: July 2024

The significant increase in the hybrid work scheme trend post-Covid-19 pandemic has become a major concern for many companies, including PT Bhineka Rahsa Nusantara. Challenges arise when not all companies have proper management in responding to this work arrangement trend. Therefore, this research aims to assist PT Bhineka Rahsa Nusantara, a startup company in the FMCG industry in Indonesia, in analyzing, evaluating, and redesigning the hybrid work policy. The research method used is qualitative research, which will delve deeper into the components of the hybrid work scheme such as working hours, work flexibility, work environment, and information technology. This research is continued through 4 stages of designing the hybrid work scheme, namely mapping, layering, profiling, and transforming, which ultimately formulated into a policy strategy. Data collection techniques include interviews with internal and external company stakeholders, participatory observation, and documentation studies from primary and secondary sources. The results of this research present analysis, evaluation, and proposals for redesigning the hybrid work scheme based on the perspectives of policy makers, policy managers, and policy recipients that have been adjusted to various applicable regulations. The resulting scheme design consists of policy proposals and documented steps.
Seberapa Efektivitas Aplikasi SiAKU Terhadap Laporan Keuangan Koperasi Desa Wisata Candirejo: Studi Kasus Pada Koperasi Desa Wisata Candirejo
Authors: Rizka Yunifia Putri  , Widhian Hardiyanti
Published: July 2024

This study aims to examine the difference in how effective and efficient the application is in managing the financial statements of the Candirejo Tourism Village Cooperative, before and after using through the Financial Administration Information System (SiAKU) application. Through the Si AKU application, experts provide comprehensive updates and settings to make it easier for Candirejo city tourists to help record visit packages. Candirejo tourism village is a tourism located in Candirejo Village, Borobudur District, Magelang Regency, Central Java Province. This study used quantitative procedures with data collection strategies through convenience surveys to obtain satisfaction fulfillment scores. This study uses quantitative methods that explain the differences between variables. This study used a sample of 10 respondents from employees of the Candirejo Tourism Village Cooperative through the interview method and the Paired T-Test stage with an alpha of 5%. The results of this test show that there are differences between effectiveness and efficient variables in managing the time of making financial statements at the Candirejo Tourism Village Cooperative.