bluuebunny/crossref_metadata_2025 huggingface dataset:
STRATEGIC PLANNING FOR A LUBRICANT MANUFACTURING COMPANY Using SWOT Analysis, QSPM model (one of the Top companies of Iranian Oil, Gas and Petrochemical Products Exporters' Association)
Authors: Saghaei Maryam , Fazayeli Leila , Shojaee Mohammad Reza
Published: October 2021

Increase in competition in local and global markets, market globalization, customers’ limitations considering the producers, lack of exclusive conditions and improvement in complete competition condition governance, rapid changes in technology, swift innovations in products have led to a complication in organizations so that preserving and improving organization situation would be impossible without a daily consideration and reacting to the environmental variable. Strategic management process provides a close estimation of environmental changes and more preparation to react toward changes and organization internal/external pressures. Applying a specific strategy based on long-term goals could result in an optimal usage of organization internal resources for taking the environmental opportunities and overcoming the threats. Using the SWOT analysis and QSPM models, the present paper tries to methodize an appropriate strategy for a lubricant manufacturing company..After completing the checklists provided to assess the strength points, weak points, opportunities, and threats, the weight and importance of each factor was defined by the company managers and they were interviewed for final conclusions. Based on the acquired data, EFE and IFE matrixes were calculated and the results were analyzed on diagrams. The results showed that the company was placed in the region of diversity strategies. These results were also confirmed by QSPM matrix. The strategy of participate in fairs to present staff and product for costumers gained the highest score and therefore, became the top priority.
Knowledge Management: FROM THEORY TO PRACTICE
Authors: Nazari Kamran , Emami Mostafa
Published: October 2021

Knowledge management is a process that helps organizations to find important information, select, organize and publish them; and it’s a proficiency that will be necessary for actions like solving problems, dynamic learning, decision making. Knowledge management can improve a wide range of organization performance properties by enabling company to more intelligent performance, but it’s not enough alone; because knowledge management to be useful needs undertaking staff to organization and their job, that accept the knowledge management process with spirit and heart and perform it (Wiig, 1999:14).Knowledge management is the leveraging of collective wisdom to increase responsiveness and innovation. It is important that you discern from this definition three critical points. This definition implies that three criteria must be met before information can be considered knowledge. » Knowledge is connected. It exists in a collection (collective wisdom) of multiple experiences and perspectives Knowledge management is a catalyst. It is an action – leveraging. Knowledge is always relevant to environmental conditions, and stimulates action in response to these conditions. Information that does not precipitate action of some kind is not knowledge. In the words of Peter Drucker, ‘‘Knowledge for the most part exists only in application.’’ » Knowledge is applicable in un-encountered environments. Information becomes knowledge when it is used to address novel situations for which no direct precedent exists. Information that is merely ‘‘plugged in’’ to a previously encountered model is not knowledge and lacks innovation.
Türkiye'de Tamamlayıcı Sağlık Sigortaları Prim Üretimi ve Özel Sağlık Sigortaları Sistemine Katkıları Açısından Değerlendirilmesi
Authors: BAŞOĞLU Burçin
Published: October 2021

Türkiye’de Tamamlayıcı Sağlık Sigortaları Prim Üretimi Ve Özel Sağlık Sigortaları Sistemine Katkıları Açısından Değerlendirilmesi
Sosyal Bilimler / Araştırma

Burçin Başoğlu *

ÖZ
Özel Sağlık Sigortası, poliçe sahibinin hastalıklar ve kazalar sonucu meydana gelen sağlık giderlerinin karşılanması için hazırlanan isteğe bağlı sağlık sigortası ürünüdür. Bu çalışmada; son yıllarda Özel Sağlık Sigortaları literatürüne giren Tamamlayıcı Sağlık Sigortaları hakkında genel bilgiler verildikten sonra Tamamlayıcı Sağlık Sigortalarının Özel Sağlık Sigortacılığı Tüm Sağlık Branşları Toplam Prim Üretimine adet ve prim üretimi bazında katkıları değerlendirilmiştir. Tamamlayıcı Sağlık Sigortaları, Genel Sağlık Sigortaları tarafından teminat altına alınmayan ya da teminat altına alındığı halde fark ücreti ödenmesini gerektiren sağlık hizmetlerinin, Özel Sağlık Sigortaları aracılığı ile sigorta kapsamına alınması ve ilave ücret ödemeden sağlık hizmetlerinden yararlanılmasını sağlayan sigorta türüdür. Bu çalışmayla Tamamlayıcı Sağlık Sigortaları ve diğer sigortacılık sistemlerinin kavramsal çerçeveleri açıklanmış ve bu uygulamaların benzer ve faklı yönleri ortaya konulmuştur. Daha sonra Tamamlayıcı Sağlık Sigortalarının yapısı, kapsamı, amacı, teminatları ve uygulama nedenleri anlatılmıştır. Türkiye’deki Tamamlayıcı Sağlık Sigortaları güncel verilerine dayanılarak sektördeki son durumu ortaya konulmaya çalışılmıştır.
Çalışmanın amacı; Türkiye’de Tamamlayıcı Sağlık Sigortaları prim üretiminin, Özel Sağlık Sigortaları prim üretimi içerisindeki payının değerlendirmesini yapmaktır. Bu amaçla 2015-30.09.2020 Tarihleri İtibarı ile Tamamlayıcı Sağlık Sigortaları prim üretimi ve Özel Sağlık Sigortaları prim üretimi verileri Türkiye Sigorta Birliği internet sitesinden temin edilerek oransal analizi ve değerlendirmesi yapılmıştır. Değerlendirme neticesinde; Tamamlayıcı Sağlık Sigortalarının Özel Sağlık Sigortaları prim üretimine genel olarak her yıl artan oranda katkı sağladığı gözlenmiştir.

Anahtar Kelimeler; Özel Sağlık Sigortası, Tamamlayıcı Sağlık Sigortası, Prim Üretimi, Kamu Sağlık Harcamaları, Kayıt Dışı Sağlık Harcamaları.
SUGGESTION FOR AN OPTIMAL MODEL FOR E.coli, S. aureus AND C. albicans PRESERVATION AT A STORAGE TEMPERATURE IN THE RANGE OF 4°C TO -20°C
Authors:   Department of Microbiology and Virology, Faculty of Medicine, Medical University – Varna, Bulgaria., Ermenlieva Neli , Georgieva Emilia ,   TRS Medical laboratory assistant, Medical College, Medical University-Varna, Bulgaria., Tsankova Gabriela ,   Department of Microbiology and Virology, Faculty of Medicine, Medical University – Varna, Bulgaria., Todorova Tatina ,   Department of Microbiology and Virology, Faculty of Medicine, Medical University – Varna, Bulgaria., Mihaylova Silvia ,   TRS Assistant Pharmacist, Medical College, Medical University of Varna, Bulgaria.
Published: October 2021

The low temperature in the storage processes can vary in the range of +4°C to -80°C and even lower, using liquid nitrogen. Depending on this, the time for which we expect the microbial culture to remain viable also changes. Agar slant culture, covered with oil, stab culture, saline suspension, glycerol and DMSO preservation, drying on silica gel, drying on soil, sterile water, lyophilization, cryopreservation, etc. are methods employed for the preservation of microorganisms. However, the choice of method to be used depends on the type of microorganism, the purpose of storage, and duration of preservation. The aim of the study is to compare storage techniques using semisolid agar and cultivation at 4°C and using BHI broth with glycerol and cultivation at -20°C. These are two commonly used and accessible methods for bacteria and yeast preservation. After performing the storage procedure for a total of 18 strains of S. aureus, E. coli and C. albicans, we re-cultivated them after two and six months of preservation. From the obtained results, we can conclude that the storage of bacteria at 4°C on semisolid agar for up to 8 weeks is successful, in C. albicans, one of the tested six strains did not survive. After 6 months, another strain of the yeasts did not show growth, as well as one of the sixth E. coli strains. Storing microbes at -20°C with a cryoprotectant has proven to be a more successful method. This was an expected result, and other authors commented that lower storage temperatures provide longer life for microorganisms.
Studi Eksperimental Beton Mutu Tinggi Dengan Agregat Batok Kelapa Dan Terak Baja
Authors: Tikupadang Anisa , Parung Herman , Kusuma Benny
Published: October 2021

Steel slag is a waste from the steel smelting industry. Along with the increasing demand for steel, it can also cause steel waste to increase. Coconut shell is a solid waste from the rest of coconut processing. This study aims to obtain the compressive strength, split tensile strength, flexural strength, and modulus of elasticity with coarse aggregate substituted for steel slag and coconut shell, with a concrete quality of f'c 45 MPa. The results of this study that the compressive strength of concrete obtained, 100% crushed stone aggregate increased 5.213% and coconut shell substitution and steel slag increased 1.650%. The value of the split tensile strength of concrete, 100% crushed stone is 9.312% and the substitution of coconut shells and steel slag is 9.073 of the compressive strength. The value of flexural strength, 100% crushed stone is 0.827√(f'c) and the substitution of coconut shell and steel slag is 0.752 f'c from the compressive strength. The modulus of elasticity of concrete, 100% crushed stone is 24845,351 MPa and substitution of coconut shells and steel slag is 20674,005 MPa.
T2* relaxometry maps of the uterus – Future prospectives with oncology implications
Authors:   “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania, Radiology and Medical Imaging, County Emergency Hospital Radiology Department, Cluj-Napoca, Romania, Pintican Roxana M , Kerekes Reka David ,   Radiology and Medical Imaging, County Emergency Hospital Radiology Department, Clinicilor Str. 3-5, 400009, Cluj-Napoca, Romania, Bura Vlad ,   Radiology and Medical Imaging, County Emergency Hospital Radiology Department, Clinicilor Str. 3-5, 400009, Cluj-Napoca, Romania, Stamatian Florin ,   “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania, Chief of the Obstetrics and Gynecology Department, County Emergency Hospital, Clinicilor Str. 3-5, 400009 ,Cluj-Napoca, Romania, Kovacs Tunde ,   Obstetrics and Gynecology Department at IMOGEN Research Center, County Emergency Hospital, L. Pasteur Str., 400349, Cluj-Napoca, Romania, Morar Iris ,   Physicist, IMOGEN Research Center, County Emergency Hospital, L. Pasteur Str., 400349, Cluj-Napoca, Romania, Nagy Viorica ,   “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania; “Ion Chiricuta” Oncology Institute, Republicii Str 34-36, 400015, Cluj-Napoca, Romania, Fechete Radu ,   professor at Technic University, Physics and Chemistry Department, G Baritiu Str. 25, 400027, Cluj-Napoca, Romania, Chiorean Angelica ,   Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Radiology, Cluj-Napoca, Romania
Published: October 2021

T2* relaxometry mapping has found diverse applications in neuroradiology but was insufficiently evaluated in pelvis MRI. Further, staging of the uterine-related cancers may be sometimes a cumbersome. Our aim is to present the T2* relaxometry maps respectively relaxometry and proton density values in patients with endometrial and cervical cancer, together with their postoperative outcomes. Three patients with uterine-related cancers underwent a 3T pelvic MRI examination. The protocol included a large field-of-view (FOV = 28 cm), a short (TE=30 ms) and a long (TE = 200 ms) echo time sequences. T2* maps were obtained by the means of post-processing methods. Parametric maps showed same Relaxation Time (RT) between endometrial cancer and adjacent metastatic lymphadenopathy, respectively different RT between endometrial and cervical cancer. In conclusion, we presented the T2* relaxometry values of endometrial and cervical cancer, and discuss their possible implications in FIGO staging and patient management. Keywords: T2 relaxometry; T2 mapping; MRI; Endometrial cancer; Cervical cancer; FIGO staging.
The role of bedside ultrasound during tracheal intubation procedure
Authors:   PICU, Universitary Ramón y Cajal Hospital, Madrid, Spain, Martínez José Luis Vázquez , Moreno Rocío Tapia ,   PICU, Universitary Ramón y Cajal Hospital, Madrid, Spain, Pérez-Caballero Macarrón César ,   PICU, Universitary Ramón y Cajal Hospital, Madrid, Spain, Pérez Ana Coca ,   PICU, Universitary Ramón y Cajal Hospital, Madrid, Spain, Porras María Sánchez ,   PICU, Universitary Ramón y Cajal Hospital, Madrid, Spain, Toledo Diana Folgado ,   PICU, Universitary Ramón y Cajal Hospital, Madrid, Spain
Published: October 2021

Tracheal intubation in complex settings (i.e. difficult airway, hemodynamic instability) means a challenging procedure [1]. It must be performed very quickly, being obviously essential to confirm the adequate positioning of the tube tip as soon as possible. Capnography is the most recommended tool in spite proper evaluation also includes clinical exam and X-ray, which implies some delay [2]. When capnography is not available and/ or misleading readings are present, bedside ultrasound can be extremely useful. The T.R.U.E. (Tracheal Rapid Ultrasound Exam) protocol consists on performing transverse bedside upper airway ultrasonography, by placing a linear transducer over the suprasternal notch [3]. At this level, tracheal and oesophagus are easily identified. In case of unnoticed oesophageal intubation, a gas art fact emerges in the oesophagus lumen. To definitively confirm the optimal tracheal tube position, regardless the absence of oesophageal gas artifact, left lung sliding must be checked in order to rule in/out a selective bronchial intubation.
Peripheral facial nerve palsy as a presenting symptom of COVID-19 infection: A case report
Authors:   Associated Professor in Neurology, Toxoplasmosis Research Centre, Immuno genetics Research Centre, Clinical Research Development Unit of Bou-Ali Sina Hospital, Mazandarn University of Medical Science, Sari, Iran, Karimia Narges , Sharifi-Razavi Athena ,   Assistant Professor in Neurology, Clinical Research Development Unit of Bou-Ali Sina Hospital, Mazandarn University of Medical Science, Sari, Iran
Published: October 2021

New corona virus named as COVID-19 can presented not only by respiratory symptoms, but also with other organs involvement such as gastrointestinal, cardiac, renal and neurological symptoms. We reported a patient who presented with peripheral facial nerve palsy and evaluations revealed COVID-19 infection. We suggest from this case, that COVID-19 infection may be a potential cause of facial paralysis and during this terrible pandemic, neurologists will need to be vigilant for the any neurological manifestation or neurological complications of covid-19.
Manipulative Capacity in the application of the Comparison mechanism
Authors: Yeribekyan Benik
Published: October 2021

The article presents some theoretical justifications and some features of the origin of the comparison mechanism.
Some areas of the practical application of the comparison mechanism were also presented, and the main manipulative intentions were analyzed. The theoretical part considers and analyzes the problems and features of the development of a comparison mechanism. In particular, the Adler theory is analyzed. The author substantiates the fact that the basis of the comparison mechanism originates in early childhood. In this process, a particular role and significance is the fact of comparison with siblings. The theory of object relations is also considered a theoretical basis, especially regarding the psychological structure of the narcissistic personality. In this context, the psychoanalytic approach is regarded as a profound basis for forming a psychological comparison mechanism and later becomes a stable behavioural pattern. The correlation between the emergence of the psychological comparison mechanism and the influence of the individual's environment is also theoretically justified. The formed behavioural pattern becomes the basis for subsequent manipulations in the field of social psychology. In particular, the concept of a reference group is when an individual compares himself with members of his group and groups of opponents. In this case, using this mechanism, you can build the foundations of national identity and, as an additional tactic using the mechanism of depreciation. In marketing, a manipulative comparison mechanism is used to influence the self-image. In this case, a particular consumer is identified with this image by comparing himself to the advertising image. In the political and marketing spheres, manipulative use of the comparison mechanism can be found very often. The phenomenon of manipulation in this context concerns the concept of intention. The main manipulative intention is the desire to devalue. In politics, devaluation is often used, and in marketing, dominance is used. In the context of the latter, appropriate language is used.
The manipulative use of the comparison mechanism is considered in the example of the discursive practices of representatives of individual political elites. In the political sphere, in using the comparison mechanism, the intention of devaluation, narcissistic comparison is mainly used. This process can particularly be seen when comparing the speech of the President of Georgia with the statement of the President of Ukraine. Using the example of President Zelensky's statement, one can see the use of a symbolic image, which provides even greater power of manipulative influence on one's audience. In marketing and advertising, the comparison mechanism is combined with the demonstration of the advantages of your own product compared to others.
Current State of Agro-Tourism and Development Preconditions in Armenia
Authors: Vardanyan Narine , Gharakhanyan Gayane , Ghalamdaryan Anzhela , Mryan Anna
Published: October 2021

Agrotourism is developing very fast worldwide, and Armenia is not left out of those rates of development. There are serious preconditions for the development of agro-tourism in Armenia. This study aims to reveal the current state of agro-tourism, outlining the development preconditions in Armenia, particularly the role of PR in the development of this field. To collect the necessary information, we used the methods of expert and in-depth interviews, document analysis and viewing.
The studied data refer to gastro-houses, house-studios, adventure tourism and other interesting directions of agro-tourism, which were spread in the Republic of Armenia until the first half of 2020 and were in different regions, in particular: Gegharkunik, Vayots Dzor, Shirak, Lori, Kotayk, Tavush, Aragatsotn, Ararat.
The results of the research allow us to conclude that:
• Agro-tourism has prospects for development in Armenia;
• Agro-tourism can contribute to the development of different villages and communities in the Republic of Armenia;
• Planning PR campaigns is a necessary precondition for development;
• The lack of a common tourism platform in the Republic of Armenia hinders the development.
• The expansion of packages offering rural tourism by Armenian tour operators will contribute to development.
• It is possible to create a network of guest houses, which will include only the ones that are engaged in agro-tourism.
Vodun Continuum in Black America: Communication with the Dead and the Invisible World in Jesmyn Ward’s Sing Unburied Sing
Authors: Azon Senakpon Adelphe Fortune
Published: October 2021

The spread of Western rationalism through armed conquest, with the global dominance of Judeo-Christian and Islamic creeds, has almost obliterated the existence of the alternative ontological perceptions rooted in the dominated people’s cultures. This essay studies how Ward’s Sing Unburied Sing reaches back to African ancestral beliefs, vodun practices and rituals, and brings to life characters who strive to counteract exclusion with the conception of the world as a Whole, a continuum whose survival is premised on the respect of, and fusional union with, each element of that Whole. This conception partakes in the search for meaning to existence in a society that has erected individualism and the exclusion of black people into creed. The paper uses the theoretical approach of vodun ontology and, in an Afrocentric perspective, reads through Ward’s novel this cultural trait thriving centuries after the enslaved people’s departure from Africa. It purports to voice African traditional values and to celebrate cultural difference.
SAFETY AND RELIABILITY OF CARBON-PEEK PLATE FOR THE TREATMENT OF DISTAL RADIUS FRACTURES: A REVIEW OF THE LITERATURE
Authors: Saracco Michela , Fulchignoni Camillo , Velluto Calogero , Rocchi Lorenzo
Published: October 2021

Introduction

Distal radius fractures are one of the most common injuries. Open reduction and internal fixation (ORIF) are the most diffused between surgical treatments. Carbon-fiber reinforced (CFR) polyetheretherketone (PEEK) plates have been proposed to prevent effects linked to stainless steel or titanium alloy traditional plates, such as radio-opacity, mismatch of bone-plate elasticity modulus, corrosion, limited fatigue life, osseointegration.

Objective

This review aims to evaluate the actual safety and reliability of CFR- PEEK plates to treat distal radius fractures.

Methods

Electronic databases PubMed, Google Scholars, and Cochrane Library were searched in December 2020. Eligible studies were published in peer-reviewed journals. Three authors independently selected relevant articles and discussed those. Searching identified 13 titles and abstracts, 11 manuscripts were considered eligible for the full-text analysis. Of these 11 papers, 7 studies were included in our review.

Results

215 patients were analyzed in this systematic review. The mean age of enrolled patients was 52,8 years. 34% were males and 66% were females. Fractures were classified according to AO/ASIF classification system. We reported 12 cases of complications specific to this device, such as intraoperative plate and screws rupture, erosive flexor tendons synovitis, and loosening.

Conclusion

CFR-PEEK distal radius plates are potentially an alternative to traditional ones. But we believe that the use of this device does not entail a significant advantage in the treatment of distal radius fractures, as safe and low-cost traditional devices are available. Further comparative studies are needed to demonstrate the superiority of carbon devices.
Knowledge, Attitude and Practice (Kap) on Occupational Noise Exposure among Ambulance Drivers at Hospitals in Klang Valley, Malaysia
Authors: Zaki Mohamad Zulkhairil Mohd , Rahman Haliza Abdul , Bakar Azrin Shah Abu
Published: October 2021

There has been a great concern of occupational noise-included hearing loss (NIHL) among health care workers. Prior research revealed that ambulance drivers are at high risk of noise on hearing. The aim of this study is to assess the level of noise emitted from the ambulance siren and knowledge, attitude and practice (KAP) on occupational noise exposure. A cross-sectional study in Klang Valley, Malaysia was conducted from February 2019 to March 2019 among 82 ambulance drivers. Data was collect using a self-administered questionnaire consisting sociodemographic, 13 questions for knowledge, 13 questions on attitude and 13 on the practice toward occupational noise exposure. In addition, a Solo 01dB Sound Level Meter was used to measure the level of noise emitted from the siren of the ambulance. Data was analysis by using SPSS version 22. Average noise level (Laeq) was 88.9 db (A) which can be considered as high than permissible exposure limit specified in Factories and Machinery (Noise Exposure) Regulations 1989. The KAP on occupational noise exposure among respondents were moderate. In addition, there was a significant difference between knowledge and attitude on occupational noise (p=0.002, r=-0.339). Improved of KAP is recommended through conducting training and seminars on occupational noise frequently to ensure high level of KAP among ambulance drivers. Besides, engineering controls such as installing noise barrier were advised to be implemented and enforcement of law should be taken seriously to minimize and void hearing related problems in the near future.
Subacute thyroid and SARS-CoV-2 relationship
Authors: Sariakçali Bariş , Duman Gülhan
Published: October 2021

Background: This study aims to research the relationship of subacute thyroiditis with SARS-CoV-2. The prevailing risks of predisposition to certain diseases or organ dysfunctions even after surviving the disease are discussed more frequently each day. Aim: Could SARS-CoV-2 be considered as a triggering factor in patients diagnosed with subacute thyroiditis? Investigating the relationship between subacute thyroiditis and SARS-CoV-2. Methods: Thirty-three patients diagnosed with subacute thyroiditis between 01.11.2020 and 01.04.2020 were included in the study. Patients who tested positive for SARS-CoV-2 throughout the examinations performed at the time of the diagnosis for subacute thyroiditis and patients who were previously diagnosed with Covid-19, who tested positive for SARS-CoV-2, and subsequently diagnosed with subacute thyroiditis within 30 days have been included in the study. Clinical evaluation of the patient, thyroid hormone values, CRP values, sedimentation levels, and thyroid ultrasonography images were considered to diagnose subacute thyroiditis; patients whose results were compatible with subacute thyroiditis were diagnosed with subacute thyroiditis, and they were included in the study. Results: It was found that 5 (15%) of the 33 patients included in the study had Covid-19 disease before the diagnosis of subacute thyroiditis and were isolated for the SARS-CoV-2 virus. Conclusion: The SARS-CoV-2 virus can be considered a triggering factor for subacute thyroiditis. We believe that researching this relationship on a broader patient population will bring more clarity to the subject. Although encountered in only one of our cases, the Coronavirus vaccine and SAT relationship may shed light on future studies. Keywords: Subacute thyroiditis, SARS-CoV-2, COVID-19
Effects of Aerobics Versus Core Stability Exercises for the Management of Primary Dysmenorrhea
Authors: Khan Nighat Nasrullah , Riaz Saima , Khan Rehan Ramzan , Mannan Hira , Ghafoor Sobia , Khalid Hayatullah
Published: October 2021

Objective: To compare the effects of aerobics and core stability exercises for the management of primary dysmenorrhea. Methodology: The study design was quasi-experimental, conducted in Yahya gym, Lahore, from February 2019 to July 2019. The sampling technique employed was non-probability convenient sampling with a sample size of 42 females within 18-30 years who had primary dysmenorrhea. The subjects were assigned into two groups. Group A was treated with aerobic exercises, while Group B was treated with core stability exercises with eight weeks workout plan and the results of three menstrual cycles were recorded. Stretching maneuvers were added as a standard treatment to both groups. Data were collected after 12 weeks and recorded for three menstrual cycles. Numeric Pain Rating Scale (NPRS) was used to measure pain intensity. Data were analyzed using IBM SPSS v.25. Results: Mean age of group A vs. group B participants was 25.23 ±2.64 vs. 21.38±3.41 years respectively. Mean BMI score of group A participants was 21.38±2.14 while for group B participants mean BMI score was 21.65±1.99 Kg/m2. Conclusion: This study concludes that both aerobic exercises and core stability exercises are effective to reduce the intensity of pain in primary dysmenorrhea. However aerobic exercises showed relatively better results in term of mean difference of NPRS score across both groups. Keywords: Menstruation, Primary dysmenorrhea, Exercise, Pain.
Effectiveness of Muscle Energy Technique Versus Strain Counter Strain Technique on Trigger Points of Quadratus Lumborum among Low Back Pain Patients
Authors: Tubassam Sadaf , Riaz Saima , Khan Rehan Ramzan , Ghafoor Sobia , Rashid Sajid , Zahra Anfal
Published: October 2021

Objective: To determine the effectivness of muscle energy technique versus strain counter strain techniques on trigger points of quadratus lumborum among patients with low back pain. Methodology: A quasi-experimental trial was conducted on 40 patients who had low back pain due to trigger points in Sialkot medical complex hospital, Sialkot. The participants were divided into group A (MET) and group B (SCS). Group A was treated with muscle energy techniques and moist heat therapy, while Group B was treated with strain counter strain technique and moist heat therapy for two weeks. Numeric pain rating scale and Modified Oswestry Disability Questionnaire were used. Data was analyzed on SPSS 21. Results: The mean score of the Oswestry Disability Index (ODI) was 53.10±7.35 and 56.60 ± 7.89 at the start of treatment in group A (MET) and group B (SCS), respectively. The final ODI score for group A (MET) and group B (SCS) was 22.25± 5.87 and 37.70± 7.87, respectively. The mean value of pain intensity on the Numerical Pain Rating Scale (NPRS) was 7.30±1.25 vs. 7.85±1.26 at the start of treatment in Group A (MET) and Group B (SCS), respectively. The post-treatment NPRS score was 3.20 ±1.16 vs. 4.55±1.20 for Group A (MET) and Group B (SCS), respectively. Conclusion: According to the findings of this study, both METS and SCS significantly improved pain and functional disability in patients with low back pain caused by trigger points in the quadratus lumborum. However, in terms of mean difference, METS are more effective than SCS. Keywords: Strain counter strain, METS, Trigger points, Quadratus lumborum, Low back pain
Frequency of Isolation and Antibiotic Susceptibility of Micro-Organisms Causing Urinary Tract Infections in Children
Authors: Pervaiz Saima , Ikram Sadia , Errum Anila , Iqbal Sahar , Cheema Sara Massood , Javed Nida , Shamim Saba
Published: October 2021

Objective: To determine the frequency of urinary tract infections and the spectrum of microorganisms causing UTI and their antibiotics susceptibility pattern in children age between 1 month and 12 years. Patients and Methods: In this cross-sectional study, 131 patients of suspected UTI, from the department of pediatric medicine were included, from June-2020 to Nov-2020. 5 milliliters of urine sample were collected and sent to the hospital laboratory for determination of UTI. If UTI was confirmed, samples were further processed to determine the pattern of organisms causing UTI and their antibiotic spectrum. Results: Mean age of the patients included in this study was 6.07±256 years. There were 75 (57.25%) male patients, and 56 (42.75%) female patients. Urinary tract infections were diagnosed in 30 (22.90%) patients. E. coli diagnosed in 14 (46.67%) patients. Resistant strains were diagnosed in 3 (10%) patients. Regarding antibiotic sensitivity, 3rd generation cephalosporins and carbapenems were sensitive to many organisms. Conclusion: E. coli is the predominant uropathogen causing UTIs in children. Third generation cephalosporins are optimal initial choice for management of UTI in children. Keywords: urinary tract infections, causating micro-organisms, antibiotic sensitivity
Quantitative analysis of Protective Role of salivary protein on demineralization of enamel
Authors: Rathore Asadullah , Alam Anwar , Riaz Marryam , Arshad Asma , Javed Maria , Fayyaz Fariha , Chaudhry Sana
Published: October 2021

Objective: The aim of this study was to analyze the effect of salivary proteins (statherin and histatin-1) on demineralized enamel surface and to study changes in texture, magnitude and direction of crystallites and changes in prismatic structure of enamel respectively. Material & Methods: Synchrotron x-ray diffraction technique to determine the variation in degree of crystal orientation (texture). Incisors were demineralized and sectioned to 300-500 microns, rinsed with salivary protein solutions of statherin and histatin separately and in combination with short and full-lengths. A beam spot size of 20μm × 20μm was used to obtain 2D diffraction patterns to distinguish orientation of crystallites. Results: The contour maps as well as the SEM analysis present similar surface properties of the sample treated with STN-21 and the controlled PBS sample. Therefore, STN-21 was found potent in preventing demineralization and restoring surface enamel texture followed by STN-21+HTN-21 and STN43+HTN38. HTN-21 and HTN-38 showed similar demineralization pattern as the controlled demineralized sample. Conclusion: Ranking of demineralization among samples was found to be controlled demineralized > HTN-21 = HTN-38 > STN-43+HTN-38 > STN-21+HTN-21 > STN-21. Developing STN-21 as a therapeutic against dental caries and erosion. Keywords: Enamel, Demineralization, salivary proteins.
Complications of Laproscopic Cholecystectomy in Patients of Acute Cholecystitis
Authors: Rehman Haseena , Lalley Gul , Sharif Gul , Shafi Asim , Mehmood Asif , Khan Mohammad Shoaib
Published: October 2021

Objective: To determine the complications of laparoscopic cholecystectomy in patients of acute cholecystitis. Study Design: Prospective study. Place & Duration: Department of Surgery, Lady Reading Hospital, Peshawar for duration of six months from January 2020 to June 2020. Methods: Total 120 patients of both genders with ages 20 to 60 years were included in this study. Patients’ detailed demographics were recorded after taking written consent. Patients with history of abdominal surgery were excluded. All the patients underwent laparoscopic cholecystectomy for gall bladder diseases. Post-operative pain was analyzed by VAS. Complications were recorded at 5th postoperative day. Data was analyzed by SPSS 24.0. Results: Out of 120 patients 30 (25%) patients were males and 75% patients were females. Most of the patients 50 (41.67%) were in the age group 31 to 40 years followed by 37 (30.83%) patients were ages between 41 to 50 years. 70 (58.33%) patients had surgical size port incision was 5mm and 50 (41.67%) patients had 10mm. Mean pain score was 2.24+1.1 at 5th postoperative day. Wound infection was found in 10 (8.33%). Port site hernia was found in 12 (10%). Conclusion: Laparoscopic cholecystectomy is safe and effective treatment procedure with no major complications. Keywords: Laparoscopic Cholecystectomy, Acute Cholecystitis, Wound Infection, Port Site Hernia, Pain
Comparing the Effectiveness of Carvedilol and Propranolol to Prevent Reoccurrence of Esophageal Variceal Bleeding in Patients with Liver Cirrhosis.
Authors: Khurshid Liaqat , Khan Asadullah , Hassan Salim , Khan Adil Naseer
Published: October 2021

Objective: To compare the efficacy of carvedilol and propranolol to prevent reoccurrence of esophageal variceal bleeding in patients with liver cirrhosis. Study Design: Place and Duration: Department of Gastroenterology and Hepatology, Ayub Teaching Hospital, Abbottabad, Pakistan for six months duration from 15th November 2020 to 15th May 2021. Methods: Total one hundred and forty patients of ages between 18-65 years were presented in this study. Patients detailed demographics age, sex, body mass index and Child-Turcotte-Pugh (CTP) class were recorded after taking written informed consent. Patients were equally (n=70) divided into two groups. Group A had 70 patients and received carvedilol while group B had 70 patients and received propranolol for 6 months. Reoccurrence ofesophageal variceal bleeding in cirrhotic patients among both groups were observed at 2nd, 4th and 6th months and patients pulse rate, arterial pressure and portal vein flow were recorded at these time points. Complete data was analyzed by SPSS 26.0 version. Results: Mean age of the patients in group A was 40.38 ± 5.87 years with mean BMI 28.09 ± 7.33 kg/m2 and in group B mean age was 39.43 ± 12.69 years with mean BMI 27.53 ± 8.84 kg/m2. In group A 45 (64.3%) patients were males and 25 (35.7%) were female patients while in group B 50 (71.43%) were male patients and 20 (28.7%) patients were females. We found that there was no statistically significant difference observed among both groups regarding these demographic variables. Reoccurrence of bleeding observed in group A was significantly lower (among 20 (28.6%) cases) as compared to group B (among 36 (51.43%) cases). Pulse rate, mean arterial pressure and portal vein flow was found lower in the carvedilol group as compared to propanol group with p value < 0.05 upon follow up at2,4 and 6 months. Conclusion: We found in this study that the drug carvedilol was more effective and safe to prevent reoccurrence of esophageal variceal bleeding in cirrhotic patients as compared to propanol. Keywords: Cirrhotic patients, Carvedilol, Propanol, Portal vein flow, Mean arterial pressure
ICU Stay in Patients with Low Ejection Fraction Undergoing Cardiac Revascularization: Comparison of On-Pump Versus Off-Pump Coronary Artery Bypass Grafting
Authors: Bilal Muhammad , Fawad Ahmad , Anwar Shah Syed Mumtaz
Published: October 2021

Background: Coronary artery bypass graft (CABG) surgery can result in serious complications for the patients. It is being currently performed with cardiopulmonary bypass with cardiac arrest in 80% of the cases across the world. There have debate in the past regarding the cardiac revascularization via CABG approaches. Aim: The aim of this study is to study the difference in the patient’s ICU stay who have low ejection fraction and are undergoing cardiac revascularization between off pump and on pump coronary artery bypass grafting. Methodology: A sample size of 60 patients has been taken in the study with 30 patients' in the on-pump surgery group and 30 patients' in the off-pump surgery group. The data has been collected from department of Cardiac Srugery AFIC/NIHD, Rawalpindi. Results and Conclusion: The study concludes that the on-pump CABG patients tend to have shorter ICU stay than the off-pump CABG patients who have low ejection fraction and are undergoing cardiac revascularization. Therefore, on-pump treatment is recommended in the study. Keywords: Off pump, on pump, coronary artery bypass grafting, ICU stay, low ejection fraction, cardiac revascularization
Early Decompressive Craniectomy: A Life Saving Option in Closed Head Trauma
Authors: Jalal Malik Liaqat Ali , Rehman Atta Ur , Farooq Muhammad Shaukat , Hussain Wajahat
Published: October 2021

Aim: To determine outcome and factors associated with outcome among patients with closed head injury who underwent decompressive craniectomy. Methodology: Cross sectional analytical study conducted in Neurosurgery Department of teaching hospital Dera Ghazi Khan from January, 2021 to June, 2021. Total 105 patients fulfilling the inclusion criteria were enrolled in the study. Approval of ethical review committee was obtained. All the patients with closed head injury which underwent decompressive craniectomy were included. Socio demographic profile, mode of injury, Glasgow Coma Scale (GCS) at admission time, pupillary reaction and timing from hospital admission to surgery, duration of surgery, length of hospital stay and occurrence of CSF leakage was noted. SPSS version 22 was used for data entry and analysis. Results: Head injury was more common in males. 43.8% cases admitted with GCS score between 3-8 and with head injury by road traffic accident. Leakage of CSF was recorded in 13.3% patients. Mortality was recorded in 18.1% patients. GCS at time of admission, time elapsed between admission and surgery and duration of surgery was significantly associated with the outcome. Conclusion: Early decompressive craniectomy significantly reduce death rate in patients with closed head injury. Keywords: Craniectomy, Outcome, Glasgow coma scale
Prevalence and Risk Factors of Acute Diarrhea in Children Under Five Years of Age in Urban Slums of Bahawalpur
Authors: Abbas Huda , Hussain Wajahat , Masood Hamad , Javed Zunaira , Zaidi Arif Ahmed , Aziz Asia
Published: October 2021

Aim: To find out the prevalence and risk factors of acute diarrhea in children between six months to five years of age. Methodology: It is cross-sectional analytical study conducted in urban slums of Bahawalpur from January to December 2019. Approval from institutional ethical review committee was obtained. Sample size was 324 with 95% level of confidence, 5% margin of error and 31.1% expected population proportion. Tibba Badar sher and Bhatta # 2,3 were two slum areas of Bahawalpur city selected by simple random method. In two slum areas, 324 children aged six months to five years were selected by systematic random sampling on household basis in proportionate way i.e. 271 from Tibba Badar Sher and 53 from Bhatta No. 2,3. Data was collected by using structured questionnaire and for data analysis SPSS version 22 was used. Results: Prevalence of diarrhea in children under 5 years of age, living in urban slums was 38.9%. Diarrhea was more common in children whose mothers were working women and mothers not practiced hand washing before feeding child. Conclusion: Diarrhea was common in children whose mothers were not washing their hands before feeding and also among children not vaccinated against measles and rotavirus. Key words: Diarrhea, Rota virus, Hand washing, Vaccination
Effect of Brain Training Game on Mild Cognitive Impairment (MCI) in Older Adults
Authors: Arshad Hafsah , Anwar Kinza , Khattak Hafsah Gul , Amjad Imran , Majeed Yaser
Published: October 2021

Aim: To determine effects of Kinect- based games on neurocognitive functions in older adults with mild cognitive impairment. Methodology: A quasi experimental pre-post trail was conducted on 18 mild cognitive impairment (MCI) older adults. The subjects were recruited to access cognitive impairment through purposive sampling technique. The inclusion criteria were elderly aged ≥ 50 years, both genders, able to read and write, whereas older adults with severe cognitive impairments, neurological disorders and un controlled comorbidities were excluded. Brain training was provided for 30 minutes with 5-minute warm-up time and 5-minute cool-down time for 6 weeks. Blind assessor measured readings at baseline and after six weeks. The outcome measures were Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MOCA), Trail making test A & B and verbal fluency test (Semantic &Phonemic). The data was analyzed at baseline and after six weeks of intervention Results: Significant improvements were observed in post-test measurements (p <0.05) in MMSE, MoCA, TMT A & B and verbal fluency (Semantic &Phonemic) tests after 6 weeks of treatment. Conclusion: Kinect-based virtual reality games are beneficial in improving cognitive abilities of older adults with mild cognitive impairment. Keywords: Cognitive training, Mild cognitive impairment, Montreal Cognitive Assessment
Antimicrobial Resistance in Carbapenem resistance Pseudomonas
Authors: Tahir Sonia , Chaudhary Saadia , Naeem Tahir
Published: October 2021

Aim: To figure out the antimicrobial sensitivity effect of multidrug resistant Pseudomonas aeruginosa obtained from several type of clinical specimens. Study setting: Department of Microbiology and Resource laboratory, University of Health Sciences Lahore. Methods: A sum total of 53 isolates of multi-resistant Pseudomonas aeruginosa were selected from Jinnah hospital Lahore during the period of 1st January 2016 to 2nd February 2017. Nutrient agar slants were used for the transportation of resistant strains. In accordance with the CLSI manuals re-confirmation and processing of the strains were accomplished. The sub culturing and incubation was done on culture media such as MacConkey and blood agar at room temperature for 1 day. Standard confirmation of isolates under went by the graded morphological, cultural and biochemical techniques. In order to achieve this, Gram staining, culture media such as blood, oxidase test, motility test were executed. Results: The resistance pattern of Pseudomonas aeruginosa against antibiotics was as follows: Meropenem 53(100%), 51(96%) to piperacillin–tazobactam, 49(92%) to ceftazidime, 43(81%) to amikacin, 41(77%) showed resistance to aztreonam, 48(91%) to quinolones as shown in figure. Almost all the Pseudomonas aeruginosa were resistant to aztreonam except for 23% (n=12 isolates). Colistin was predominant as the major strength of treatment for Pseudomonas aeruginosa with sensitivity of 48(91%). Keywords: Disk-diffusion, Carbapenem, McFarland.
Psoriasis: Age related diagnosis and the impact on quality of life
Authors: Ansari Muhammad Asif , Kalhoro H. Bashir Ahmed , Ahmed Sh Shakeel , Pirzado M. Suleman , Mughal Hira , Gurgez Karim Bukhsh
Published: October 2021

Background: Psoriasis is a chronic inflammatory disorder with proliferative dermatological and systemic manifestations involving multiple organs. Its etiology and pathogenesis is closely related with genetic and environmental factors. The current study was designed to assess the relationship of age at the diagnosis of psoriasis and its impact on their quality of life. The findings thus obtained might help to take appropriate therapeutic and psychological measures together with patients’ counselling to minimize any adverse consequences. Aim: To determine the age of diagnosis of psoriasis and its impact on the quality of life with age quartiles in psoriasis patients. Setting: This cross sectional study was carried out in Dermatology out patients department (OPD) affiliated with Liaquat University Hospital (LUH), Hyderabad from December 2019 to June 2020. Methodology: Total 141 diagnosed cases of psoriasis vulgaris were included in the study. The final data in the form of DLQI SCORE, PASI SCORE in each quartile of age of all patients was collected and findings were noted down in the predesigned proforma. Results: The average age of the patients included in the study was 37.53±12.12 years. There were 103 (73%) males and 38 females (27%) who consented to be the part of the study. Quality of life among 17 (12.06%) patients had little impact, 42 (29.79%) had moderate effect, 77 (54.61%) patients had severe effect and 5 (3.55%) had extreme effect. There is significant effect with respect to age quartiles at diagnosis of psoriasis (p=0.005). Significant effect on quality of life was observed in 1st and 2nd quartile while moderate effect appeared to impact the patients in 3rd quartile of age. Conclusion: Psoriasis is more than just a skin disorder and has a very large effect on patients’ quality of life with noticeable effects having potential to impact their personalities, daily routine activities and even relationships with people around them. Depending upon the severity of the disorder, it could affect quality of life without any discrimination of age, gender, duration and married life of patients. The more it is on the exposed parts, the more it affects their quality of life. Keywords: Psoriasis, Quality of life, DLQI score, PASI score.