bluuebunny/crossref_metadata_2025 huggingface dataset:
TECHNIQUES OF CREATING THE ABSURD IN YU. MORITS’ AND A. GIVARGIZOV’S POEMS FOR CHILDREN
Authors:   Russian State University for the Humanities, Leonova Ekaterina Yu.
Published: August 2021

The purpose of the work is to reveal the principles of the functioning of the absurdity, where it is characterized as a category of text, which is based on the reduction to absurdity (reductio ad absurdum). The article studies the methods of creating the absurd in poems for children by Y. Moritz (“Bouquet of cats”, “Bureau of burnt things”, “Lemon Malinovich Compress”, “Laughing confusion”, «Wonderful deeds») and A. Givargizov (“Notes of a hunter’s dog”, “No unauthorized entry”, “Uncustomarily”). It also distinguishes between the levels of text organization, at which absurdity is created by two poets. For Y. Moritz, a play is going at the basic level of the object organization of the text (subsystem of episodes), for A. Givargizov, it goes at the external level of the object organization (subsystem of internal vision frames) and at that of compositional speech forms. The article also analyzes the figurative system of poems, which makes it possible to determine the materiality and visuality of Y. Moritz’ and A. Givargizov’ poems as the key features of their poetry. One of the main features of the poetics of the absurd in Y. Moritz’s poems is the activation of materialized phenomena and objects, as a result of what the poems acquire a rich plot and cinematic quality
MAIN PROBLEMS OF COMMERCIALIZATION OF INTELLECTUAL PROPERTY FACILITIES IN KAZAKHSTAN
Authors: Kulembaeva Anargul' , Ksembaeva Al'mira , Sartova Rysty , Kushenova Mayra , Nurbaeva Gul'mira
Published: August 2021

Commercialization allows customers to have a wider range of products and allows companies to generate more revenue, improve efficiency, and reduce costs. In the article, the authors characterize the main problems of commercialization of intellectual property objects, as well as the conditions that ensure the effectiveness of this process. The rights to commercialize intellectual property objects come from a commercial organization, and the owner retains the rights throughout his life as a legal leverage over competitors. Intellectual property rights broadly include patents, trade secrets, know-how, property data, registered designs, copyrights and trademarks, among others. The study revealed the experience of developed countries, which showed the importance and high efficiency of the commercialization of intellectual property objects. The authors identified the main directions of improving the process of commercialization of intellectual property objects.
Environmental audit in Russia: organization and methodology
Authors: Savin Aleksandr , Savin Ilya
Published: August 2021

The article deals with the concept of environmental audit, the legal basis for its regulation, as well as the development and organization of environmental audit in the modern Russian economy.
The place of sheep breeding in the formation of meat resources and the development of the regional economy
Authors: Valiev Ayrat , Khafizov Dafik
Published: August 2021

The economic importance of the sheep breeding industry in the development of the agrarian economy of Russia is due to the types of product assortment obtained in this industry for the formation of food security and for industry. The advantages of sheep breeding in the use of natural forage lands for sheep grazing in Russia are analyzed. The role of sheep products in the food supply of the country is revealed. The place of sheep breeding in the development of the economy of the regions, the level of specialization in the sheep breeding industry in the regions of the country is investigated, the expediency of expanding the regions of sheep keeping, increasing the efficiency of using the potential of the industry, the growth of economic indicators in agriculture, increasing the production of sheep products in rural farmsteads and farms is revealed, the role of consumer cooperation in the development of sheep breeding in small forms of management, increasing employment in rural areas is revealed.
STABILITY OF THE NATIONAL CURRENCY AS A FACTOR IN ENSURING THE ECONOMIC SECURITY OF THE STATE
Authors: Minakov Andrey , Egorova Elena
Published: August 2021

At the present stage, the question of the stability of the national currency is beginning to take on particular relevance. Since its fluctuations have a certain impact on the financial market and, at the same time, on other sectors of the economy, since money itself is the only meter of the value of goods and services, the national currency becomes an important factor in the development of the national economy and its economic security. And given the current instability, the study of this issue will identify effective public policies that will be based on ensuring the country's economic security through the stability of the national currency, since without the elaboration of measures to ensure the sustainability of the national monetary unit it is impossible to achieve macroeconomic stability of the country. The main purpose of the article is to identify the impact of changes in the national currency on the economic development of the country in order to develop directions regarding the stabilization of the exchange rate, in order to minimize threats to economic security. Research methods: The work uses the dialectical-materialistic method of knowledge and general scientific, special and private-scientific methods based on it. In particular, the work uses logical, comparative, methods of analysis (namely statistical, etc.), synthesis. Results of the study: The article examines the main approaches to understanding the main factors influencing the formation of the national currency of its exchange rate, as well as the effects of changes in the exchange rate on the development of the state's economy and ensuring its economic security, analysis of statistical data of changes in the country's national currency. The conclusion is made about the existing problems and possible directions of solution. Applied value of the material: The article is of practical value as part of the search for directions to ensure the economic security of the state.
ENVIRONMENTAL RISK MANAGEMENT IN THE CHEMICAL INDUSTRY
Authors: Bank Sergey , Vakulenko Vladimir
Published: August 2021

In the process of development of the chemical industry, due to the inclusion of new processes and innovative developments, often the environmental interests of society become of paramount importance, since recently the problems of environmental pollution have been increasingly exacerbated, therefore the main trend in solving this problem is a clear statement of the problem of management environmental risks of the chemical industry. This policy should be implemented within the framework of the environmental management system, which includes the stages of planning, organizing and implementing environmental activities.
Do methods of hospital pre-alerts influence the on-scene times for acute pre-hospital stroke patients? A retrospective observational study
Authors: Gunn Jacob
Published: August 2021

Introduction:Stroke is one of the leading causes of death and disability worldwide. The ambulance service is often the first medical service to reach an acute stroke patient, and due to the time-critical nature of stroke, a time-critical assessment and rapid transport to a hyper acute stroke unit are essential. As stroke services have been centralised, different hospitals have implemented different pre-alert admission policies that may affect the on-scene time of the attending ambulance crew. The aim of this study is to investigate if the different pre-alert admission policies affect time on scene.Method:The current study is a retrospective quantitative observational study using data routinely collected by North East Ambulance Service NHS Foundation Trust. The time on scene was divided into two variables; group one was a telephone pre-alert in which a telephone discussion with the receiving hospital is required before they accept admission of the patient. Group two was a radio-style pre-alert in which the attending clinician makes an autonomous decision on the receiving hospital and alerts them via a short radio message of the incoming patient. These times were then compared to identify if there was any difference between them.Results:Data on 927 patients over a three-month period, from October to December 2019, who had received the full stroke bundle of care, were within the thrombolysis window and recorded as a stroke by the attending clinician, were split into the variable groups and reported on. The mean time on scene for a telephone call pre-alert was 33 minutes and 19 seconds, with a standard deviation of 13 minutes and 8 seconds. The mean on-scene time for a radio pre-alert was 28 minutes and 24 seconds, with a standard deviation of 11 minutes and 51 seconds.Conclusion:A pre-alert given via radio instead of via telephone is shown to have a mean time saving of 4 minutes and 55 seconds, representing an important decrease in time which could be beneficial to patients.
CONCEPT AND RATIONALE OF EVOLUTIONARY BARLEY BREEDING UNDER CLIMATE CHANGE IN JORDAN
Authors: Al‐Hajaj Nawal , Kafawin Omar
Published: August 2021

In this study, we reviewed the climate changing and the impact on crop production, and evolutionary breeding as adaptation key to crop resilience. The increasing climate change impact on the agriculture system has renewed interest to the broadest possible germplasm base for a resilient and sustainable food system. Heterogeneous populations developed through evolutionary plant breeding could be the ideal solution to reduce the effects of environment variability on cereal crop planted under low-input conditions.The study assessed the genetic basis of adaptation of a barley population which evolved in different rainfed locations and years in Jordan without any human selection as suggests model of plant breeding strategy to improve food security, nutrition, income and resilience of smallholder farmers in the dryland regions in the climate change scenarios. The study suggests that the breeder can shift the undesirable traits in evolutionary populations by practicing individual selection for specific adaptations, or individual selection from populations showing wide adaptations and high stability. On the other hand, the breeder can overcome the undesirable traits by keeping the highest variations within the population by seed sieving to remove small seed and plant mowing for tallest head.
CONCEPTUAL MODEL DEPICTING RISK FACTORS INFLUENZING CLOUD DATA SECURITY
Authors: Nair Remya , Meenakumari J.
Published: August 2021

Cloud Platform has the data stored in a remote server and accessed with the help of services provided by cloud service providers. The primary objective is to provide data security due to the confidentiality of data transmitted to the remote server, over an unmonitored and multi-tenancy channel (internet). The major components of cloud platform are application, service, runtime cloud, storage and infrastructure. This is a conceptual paper trying to explain the risk factors to be deemed in a cloud environment. The benefits include scalability, availability, reliability, flexibility, increased collaboration, competitive edge, sustainability, reduced proportional cost. Risk factors influencing the data security and Integrity are identified up to three level of sub-constructs.. All the risk factors including hackers, mishandling of passwords, risk of data accessed from public /unmonitored sources, security in communication channels, intentional and unintentional data security threats created due to human interference are included in the scope of this paper. In this paper, the identification of sub factors of cloud data security risk components is achieved. The futuristics scope of this paper is to identify early risk prediction and mitigation strategies to all the identified risk factors related to data security by implementing SEM methodology.
HOW TO RANK TOURIST DESTINATIONS: A LITERATURE REVIEW
Authors: Bagchi Sraboni , Uddin K. M. Sharf
Published: August 2021

Tourism is the most prominent service industry and one of the world's fastest-growing businesses. One of the most immediate issues in the tourist business is assessing and evaluating tourism destinations. Due to the wide variety of variations across tourism sites, comparing them is a challenging process. This study focuses on various Multi-Criteria Decision-Making methods which can be used for assessing and ranking tourist destinations. Although we discovered a number of MCDM techniques for evaluating tourism destinations, they are not extensively employed. So far, the major reasons have been recognized as a lack of knowledge of the procedures, a lack of understanding of their implications, difficulties collecting data, a lack of interest, etc. The purpose of this review article is to give an overview of several MCDM approaches and their implications for ranking tourism destinations. Based on a review of relevant works of literature, this paper describes the phases, strengths, and limits of several MCDM approaches that will be beneficial in deciding which method to employ for evaluating tourism destinations.
LEADERSHIP AND DECISION MAKING IN CASES OF UNCERTAINTY AND RISK - THE CASE OF THE EMERGING CORONAVIRUS (COVID-19) CRISIS
Authors: Malkawi Prof. Dr. Nazem , MOHAILAN Dr. “MOHAMMADHAIDER“ , MALKAWI Dr.Ahmad , MALKAWI DR. REHMEH
Published: August 2021

Motivation/Background: The purpose of this paper is to shed light on leadership and decision-making in situations of uncertainty and risk-the case of the emerging coronavirus (COVID-19) crisis, as well as to give a systematic framework as a guide for leaders to deal with the COVID-19 and other sudden crises.
Method: This paper is based on theoretical analytical methodology, were questions of the study are built, and then data were collected from previous research about study concepts. This helps in extracting lessons and principles that help researchers to answer study questions and build a methodological the framework.
Results: The current COVID-19 crisis is a global sudden crisis that differs from previous crises in terms of its strength, effects, and speed, it strucks all health, economic, social and psychological aspects of life. It causes a challenge of supply chains pose to governments and organizations, accelerated transformation to virtual work, and brought cultural change at all levels. All this forced leaders to take quick and bold decisions in the absence of complete information and lack of transparency.
Conclusions: The originality of this study stems from studying the new COVID-19 crisis that suddenly struck the world and confused the most powerful countries and institutions, as leaders stood unable to deal with this crisis and its destructive effects in various aspects of life. Research on dealing with this crisis is still incomplete and subject to modification and change. Therefore, studying this and coming up with a systematic framework increases originality and novelty of this study.
Competência em Informação no papel social do tutor a distância
Authors: Tamião de Souza Jéssica Gabriela , Cavalcante Luciane de Fátima Backman
Published: August 2021

O presente artigo analisa a Competência em Informação (CoInfo) no contexto da Educação a Distância (EAD), por meio da prática profissional do tutor a distância. Reflete sobre os aspectos sociais da prática do profissional tutor, embasado teoricamente nos sete pilares de Bruce (1999), sobretudo em seu último pilar que aborda a utilização da CoInfo em benefício do próximo. Os dados foram coletados por meio de pesquisa semiestruturada com tutores a distância, em uma instituição de ensino, de uma cidade do interior do Estado do Paraná. Os resultados evidenciam que, embora os tutores apresentem habilidades informacionais, as práticsa da CoInfo e, sobretudo, do pensamento crítico não são institucionalizados em seu local de trabalho.
“E então veio a pandemia...”
Authors: Figueiredo Talita , Alexandre Borges Ana Lucia
Published: August 2021

Tecnologias de Informação e Comunicação (TICs) providas pelos grandes conglomerados digitais que dominam uma paisagem aqui denominada capitalismo de plataforma passaram a configurar o ambiente de salas de aula digitais em 2020, quando a pandemia do coronavírus confinou no ensino remoto quase 1,5 bilhão de estudantes no mundo. Neste artigo, abordamos como diferentes níveis de desigualdade digital impactaram parcela relevante da população. Em nosso percurso teórico-metodológico, valemo-nos do conceito de regime de informação como chave para compreender o ambiente político, econômico e social em que essas mudanças se inserem. Em seguida, usamos pesquisas de fonte secundária para traçar um panorama da desigualdade digital no país. Por fim, propomos a competência crítica em informação como ferramenta para reconhecer e questionar o regime de informação vigente e, assim, abrir caminho para o exercício de uma cidadania ativa empenhada em mitigar a desigualdade digital, por meio de uma práxis transformadora.
Existe diversidade de letramento digital sem reflexão crítica sobre a leitura?
Authors: Silva Saldanha Gustavo , Salomão Amanda
Published: August 2021

This paper furthers the discussion that intersects the works of Paulo Freire and Nicolas Roubakine, within the sphere of the epistemology of Information Science, on the role of reading as a tool for acquiring knowledge and developing critical awareness. The theoretical concepts employed in this research are founded on Roubakine's approach to reading, who saw it as a means to socialize knowledge among socially oppressed groups, and complemented by the perception that reading involves reading the world itself. Ultimately, the knowledge acquired through these reading experiences could be used to increase readers' awareness of their environments and create opportunities to resist and oppose the inequalities that are perpetuated in current information regimes.
Analysis of Lifestyle, Advertising Effectiveness, and Instant Coffee Consumption among Peri-Urban Farmers
Authors: Djamaludin Moh. Djemdjem , Silmie Dewi Mutia
Published: August 2021

Coffee consumption is increasing because many types of coffee are circulating, such as instant coffee among the public. The instant coffee studied in this study is the Iwan Fals edition of instant coffee. This study aimed to analyse the lifestyle and effectiveness of instant coffee advertising on instant coffee consumption among peri-urban farmers in Bogor Regency. This study used a cross-sectional study design located in Cibungbulang District, Bogor Regency. The location was chosen purposive because it is a peri-urban area that has more than 20% of agricultural land. A total of 100 respondents in this study were selected using a purposive sampling method with the criteria of a farmer and in the last 12 months consuming and viewing Iwan Fals edition coffee advertisements. The results of this study found that the maker's lifestyle is the most (32%) owned by the respondents. The effectiveness of instant coffee advertising in this study is included in the effective category (3.54). The results showed a relationship between gender, believing lifestyle, trying hard lifestyle with instant coffee consumption. The influence test results found an influence of male gender and lifestyle beliefs on instant coffee consumption. In general, respondents are classified as effective in consuming coffee because of their lifestyle and increase energy.
Atriplex canescens (Pursh) Nutt. una especie multifuncional de las zonas semiáridas de Norteamérica: una revisión
Authors: Castillo Quroz David , Gutiérrez Lara Ramón , Avila Flores Diana Yemilet , Castillo Reyes Francisco , Sáenz Ceja Jesús Eduardo
Published: August 2021

Atriplex canescens es una especie nativa ampliamente distribuida en las zonas semiáridas de Norteamérica, desde el norte de México hasta el oeste de Estados Unidos de América. La presente revisión de la información publicada sobre esta especie durante los últimos 25 años pretende mostrar su taxonomía, distribución geográfica, hábitat, usos actuales y potenciales, así como las amenazas para su hábitat. Los resultados evidenciaron que el uso más amplio de A. canescens es el forrajero, en la alimentación de ganado bovino, caprino y ovino. También, destacó su empleo en la rehabilitación de suelos degradados, la captura de carbono, la prevención de la erosión y la fitorremediación de suelos contaminados por desechos industriales. Además, tiene un amplio potencial en el campo biotecnológico, como control biológico, biocombustible y fuente de genes tolerantes a la sequía y salinidad; asimismo, el consumo de flores, frutos, hojas y raíces de A. canescens ha sido muy importante para las comunidades indígenas. Sin embargo, a pesar de su amplia distribución enfrenta algunas amenazas, como el cambio de uso de suelo, la competencia con especies invasoras y la reducción de la conectividad entre poblaciones naturales. En síntesis, A. canescens es un taxón con una gran diversidad de usos, por lo que es necesario generar conocimiento para su manejo sustentable y conservación.
Crecimiento e incremento en biomasa y carbono de Pinus teocote Schltdl. et Cham. y Pinus oocarpa Schiede., Guerrero, México
Authors: Rios Camey Juan Manuel , Aguirre Calderón Oscar Alberto , Treviño-Garza Eduardo Javier , Jiménez-Pérez Javier , Alanís-Rodríguez Eduardo , De Los Santos-Posadas Héctor Manuel
Published: August 2021

La modelización del crecimiento en biomasa es una de las técnicas más importantes para conocer el stock de carbono en cualquier intervalo de desarrollo en una planta, y permite tomar decisiones de manejo forestal para fines de mitigación del cambio climático. El objetivo de este estudio fue ajustar modelos de crecimiento para cuantificar incrementos en biomasa (B) y captura de carbono (C) en bosques maduros de Pinus teocote y Pinus oocarpa, en la región de la montaña del estado de Guerrero. Se derribaron 24 árboles por especie, y mediante la técnica de análisis troncales se ajustaron cinco modelos de crecimiento, posteriormente se determinaron los puntos de inflexión del incremento corriente anual (ICA), incremento medio anual (IMA) y el turno técnico. El modelo de Weibull presentó los mejores ajustes para determinar el crecimiento en biomasa aérea (B); la ecuación resultante en P. teocote fue , R2adj = 0.73, REMC = 184.2 kg y  = 125 kg. En P. oocarpa la ecuación de crecimiento fue , R2adj = 0.88 REMC = 155.9 y  =108.2 kg. El análisis del crecimiento proyectado hasta el turno técnico en B (107 y 126 años) produciría incrementos de 2.81 t ha-1 año-1 de B en P. teocote y 3.64 t ha-1 en Pinus oocarpa. Los modelos de crecimiento son confiables y eficientes para estimar biomasa e inferir la captura de carbono con base en la técnica de análisis troncal en bosques maduros de P. teocote y P. oocarpa en la región estudiada.
HIGH VAGINAL SWABS;
Authors: SULEHRI MUHAMMAD ANWAR , QASIM ALTAF PERVEZ
Published: August 2021

Objectives: To study the road traffic accident (RTA) fatalities in Faisalabad, in relation to vulnerability of victims, their sociodemographic characteristics and to identify the risk factors of fatal RTAs. Study Design: A descriptive retrospective study. Setting: PostMortem Unit, Allied Hospital, Punjab Medical College (PMC) Faisalabad. Period: From January to December, 2006. Materials & Methods:Eighty-five dead bodies of fatal RTAs brought for Medico legal autopsies, to Allied Hospital, (PMC) Faisalabad, during calendar year 2006 wereincluded in study for Post Mortem Examination. Results: In this study maximum cases of road traffic accident were among males (91%), male tofemale ratio was approximately 9:1. Maximum incidence of RTA was in the age range of 21 to 50 years comprising 55.29% and commonest agegroup involved was 21-30 years accounted for (21.18%). Most common victims were pedestrians 41.18% followed by motorcyclists 29.41%and cyclists 16.47%. Incidence was more common in the pedestrian. Conclusions: Road traffic accident is the leading cause of deaths anddisabilities worldwide and it is needed to prevent them. Road traffic crashes are predictable and therefore preventable. In order to combat theproblem, there is a need for close coordination and collaboration, using a holistic and integrated approach, across many sectors and manydisciplines.
KETOPROFEN;
Authors: Zafar Farya , Ali Huma , Naqvi Ghazala Raza , Khan Sohail , Qureshi Muhammad Saquib , Sharif Huma
Published: August 2021

Ketoprofen is effectively useful in managing arthritis, rheumatoid arthritis,osteoarthritis and ankylosing spondylitis. This article covers the pharmacological uses,toxicology, contraindications, food – drug, drug-drug interactions and associated side effects ofKetoprofen that have been reported in literature in earlier years.
EFFECT OF PROPRANOLOL;
Authors: Abrar Hina , Naqvi S.N.H. , Ahmed Muhammad Rashid , Basharat Ali Asma , Younus Nadia , Perveen Rehana , Yasin Hina
Published: August 2021

Tuberculosis is the disease required long term treatment. Rifampicin is the majorelement of antiTB therapy if resistance is not documented. Potential of antitubercular dugsto produced hepatoxicity is very high and among all antiTB agents rifampicin (RIF) inducedhepatoxicity stands on top. Rifampicin is the major element of antiTB therapy if resistance is notdocumented. But its hepatotoxic effects are the main hurdle to continue with this therapy. In thisstudy RIF were administered to the rabbit alone or in combination of propranolol to evaluate thehepatotoxic effects of RIF and reduction of hepatotoxicity by propranolol. Histological evaluationof liver tissue on higher magnification, its micrometric analysis and SEM (scanning electronmicroscopy) of liver were used to estimate the effects of this combination. Micrometry revealedthat number of viable hepatocytes, their diameter and nuclear diameter were altered. SEMmicrograph showed distorted and swollen hepatic cords. All of these changes successfullyturned to normal by combined administration of propranolol. Propranolol successfully improvesthe hepatic architecture proved by both qualitative and quantitative microscopy.
CHOLECYSTECTOMY;
Authors: Ahmed Bashir , Raza Hamid , - Kamlaish
Published: August 2021

Objectives: The aim of our study which is to compare total intravenousanesthesia with target controlled infusion using the drugs Propofol and remifenatnil with thetechniques of volatile induction maintenance anesthesia using sevoflurane and sufentanil inpatients undergoing laparoscopic cholecystectomy procedure, at a tertiary care hospital inKarachi, Pakistan. Study Design: The type of study is a randomized control trial, conductedfor a period of 8 months Period: from June 2015 to January 2016 Setting: at a tertiary carehospital in Karachi Pakistan. Method: The patient population consisted of n=100 patientsbelonging to the ASA class I and II and undergoing laparoscopic cholecystectomy procedure atour institute. The patients were divided into two groups group A consisted of all those patientswho underwent total intravenous anesthesia and group B consisted of patients who underwentvolatile induction maintenance anesthesia. Appropriate blinding measures were taken for thosewho were involved in the post-operative care of the patients, and the patients themselves. Duringthe procedure routine monitoring was done, data was recorded in a pre-designed proforma.Patients were analyzed in the post-operative period for side effects and pain levels. Statisticalanalysis was done using SPSS version 23, a p value of less than 0.05 was considered to bestatistically significant. Results: The patient population consisted of n= 100 patients dividedinto two groups. No statistically significant difference was found between the demographicvariables of the patients of both groups (age, weight, baseline values of blood pressure, heartrate, time duration of surgery and anesthesia). The time for the loss of corneal reflex was longerin the group A (109 +/- 90) as compared to group B (45 +/- 10) having a p value of less than0.001. However the time for opening of the eyes and the duration of post anesthesia care unitwas shorter in group A (420 +/- 130 seconds for eye opening and 45 +/- 15 min for PACU) andin group B (484 +/- 116 seconds for eye opening and 53 +/- 25 mins for PACU) having p valuesof 0.006 (eye opening) and 0.017 (PACU) respectively. In group A n= 44 (88%) of the patientsrequired rescue analgesia, and in group B n= 36 (72%) of the patients required it, having a pvalue of 0.013 respectively. The need for the use of ephedrine and atropine in the pre and portoperative period was similar in both the groups. Conclusion: According to the results of ourstudy we found that each method of anesthesia has its own advantages and disadvantagesand the anesthetist present should weigh the risks and benefits for each patient individually,and use the most beneficial method of administration of anesthesia in the patient undergoinglaparoscopic cholecystectomy procedure, accordingly.
CELIAC DISEASE;
Authors: Erkus Edip , Zahid Kocak Mehmet , Aktas Gulali , Savli Haluk
Published: August 2021

Celiac Disease (CD) is an autoimmune disorder based on immune response togluten in genetically predisposed subjects. Five subtypes of CD has been described; classicaldisease, atypical disease, silent disease, latent disease, potential disease. Literature consistsat least five different definition of latent CD. We aimed to present a unique latent CD case inan elderly woman, who referred with anemia, hypoalbuminemia and vitamin D deficiency. Sheresponded well to initiation of gluten free diet.
APPENDICULAR DISEASES;
Authors: Ali Khan Amjad , Asghar Abdul Shaheed , Ishaq Muhammad , Akhund Israr Ahmed
Published: August 2021

Acute appendicitis is a common cause of acute surgical abdomen and manyappendectomies are performed daily. All disease processes involving appendix will present asacute appendicitis. Clinically diagnosed acute appendicitis is treated by urgent appendectomy.As most of the removed appendices will reveal acute suppurative inflammation, therefore,appendectomy specimens are not usually submitted for histopathological examination unlessthe surgeon notices advanced disease or grossly recognizable abnormalities. Objectives: Thepurpose of this study is; 1, to explore the spectrum of diseases affecting the appendix in thecommunity; 2, to find the age and gender association of appendicular diseases; and 3, to seeif all the surgically removed appendices should be submitted for histopathological examinationas a routine procedure. Study Design: Retrospective study. Setting: Charsada TeachingHospital affiliated with Jinnah Medical College Peshawar. Period: January 2013 to January2016. Methods: The histology slides and diagnoses of all the retrieved cases were reviewedwith regards to morphology, patient’s age, gender and presence or absence of any associateddisease. Results: Nine disease entities were identified affecting the appendix, which from mostto least common were acute suppurative appendicitis, lymphoid hyperplasia, fecalith, fibrousluminal obliteration, oxyuriasis, carcinoid tumor, submucosal fibrosis, acquired diverticulosis,and inflammatory mucocele. The first three commonest diseases were most frequent in thesecond decade of life; fibrous luminal obliteration in the fourth decade, carcinoid tumors inthe third decade, and oxyuriasis in the first decade. Moreover, acute suppurative appendicitis,fecalith, oxyuriasis, and submucosal fibrosis were more frequent in males; whereas, lymphoidhyperplasia and fibrous luminal obliteration were more common in females. Conclusions:Acute suppurative appendicitis was the most common histological diagnosis. Acute suppurativeappendicitis, fecalith, oxyuriasis, and submucosal fibrosis were more common in males;whereas, lymphoid hyperplasia and fibrous luminal atresia were more common in females.Acute suppurative appendicitis, lymphoid hyperplasia, and fecalith were most common in thesecond decade of life. In view of the nine different histological disease entities identified in thisstudy under one clinical diagnosis of acute appendicitis, it is highly recommended to submit allappendectomy specimens for histopathological examination.
HELICOBACTER PYLORI INFECTION;
Authors: Tabassum Tahira , Imtiaz Ayesha , Sharif Aamir , Akram Muhammad
Published: August 2021

Objectives: To estimate the prevalence of Helicobacter pylori infection inpopulation of Sargodha and determination of possible risk factors. Design: Descriptive study.Place and Duration: University medical complex & Research Center, Sargodha Medical College,Sargodha from 01.01.2017 to 31.03.2017. Material and Methods: The study was conductedamong 486 clinically suspected individuals of Sargodha, Punjab, Pakistan. Data was obtainedby questionnaire and H. pylori antibodies were detected by H. pylori ‘One Step Test Device’based on immune-chromatographic technique. Results: A total of 486 individuals participatedin the study of which 327 (67.28%) were positive for H. pylori infection. The prevalence was66.97% in males and 33.2% in females (p = 0.00) and increased with increasing age (p =0.000). In the study, significant association was found between age groups, education levels,food habits, monthly income with H. pylori infection with p values 0.000, 0.000, 0.001, 0.041respectively while no significant association was seen for source of drinking water (p =0.321).Conclusion: The results of present study showed the prevalence of H. pylori in reported areaand confirmed that it is higher in developing countries. It is concluded that prevalence ofinfection with this bacterium can be minimized by increasing the hygenicity, improving the livingstandards and, of course, by educating the nation.
NORMAL CORONARY ANGIOGRAM;
Authors: Asghar Naeem , Ilyas M. Faiq , Nazim Muhammad
Published: August 2021

Objectives: To observe the clinical characteristics of patients having normalcoronary angiogram following an abnormal stress test or presented with chest pain indicatingcoronary angiogram. Study Design: A single center retrospective, descriptive study. Period:Coronary angiograms done from September 2015 to September 2016 were retrievedand reviewed for normal coronary arteries. Setting: Khatum-un-Nabyeen Heart Center.Methodology: Clinical profile of the patients having normal coronary angiogram was retrievedfrom hospital record. Results: Out of 900 angiograms reviewed, 81(9%) were having normalcoronary arteries. Mean age was 43±10 years. Females were 64.1%. Clinical characteristicof study group was as follows: smokers 32.09%, family history of premature coronary arterydisease 51.8%, hyperlipidemia 60.4% and hypertension 19.7%. Diabetes was present onlyin 20.9%. Among females: 19.2% were current users of oral contraceptives pills and 13.4%were post menopausal. Mean BMI was 25.4±4. Conclusion: Normal coronary angiogram isinfrequent observation in cardiac catheterization laboratories and mostly found in youngerto middle aged females. Family history of coronary artery disease and hyperlideimaare verycommon in such patients.
CHRONIC RENAL FAILURE;
Authors: Memon Noor Un Nisa , Kumar Santosh , Das Bhagwan
Published: August 2021

Objectives: To compare thyroid hormone levels in apparently healthy individualsand un-dialyzed chronic renal failure patients in local population. Study Design: Crosssectional,descriptive, observational study. Setting: OPD patients in BMSI Biomedical ScienceInstitute of Medical Jinnah Medical Karachi. Period: June 2010 to December 2010 in BMSIJPMC, Karachi. Methods: Ninety individuals including 30 healthy control and 60 patients ofchronic renal failure were included in this study. Individuals were grouped based on severity ofdiseases (stages) as healthy (control) group and the diseased group. Patients with un-dialyzedCRF on conservative management, GFR < 60 ml/mint/1.73m2, age between 20 to 60 years inboth sexes were included in this study. Patients already taking thyroxine or antithyroid drugs,history of thyroid surgery and neck radiation and patients on maintenance haemodialysis wereexcluded. Measurement of thyroid hormone levels were done through Radio Imune Assay (RIA)method and GFR by Cock Craft Gualt formula. Results: Serum FT3 significantly low in patientswith CRF of stage III 1.27±0.12, stage IV 1.04±0.09 vs 2.80±0.09 in controls, p=0.001. TSHwas significantly high in patients of CRF as compared to control 4.41±0.87 and 3.3±0.34 vs1.97±0.16, P=0.001. No significant difference was seen in serum FT4 levels. Conclusion: Inlocal population thyroid hormone level of FT3 declines with the severity of Glomerular FiltrationRate as compare to healthy individuals. However, TSH level increases with this severity as alsoreported in other countries. Additionally, FT3 level is helpful for early detection and preventionof complications. Local population need awareness to prevent CRF by reporting to hospitalbefore stage 3.
OSTEOARTHRITIS;
Authors: Ghaznavi Samina , Kidwai Aneela Altaf , Bashir Farhat , Alam Mahfooz
Published: August 2021

Objectives: To determine the pattern of symptomatic and radiographicosteoarthritis in the urban population of Karachi. Data Source: Outpatient clinics. Design ofStudy: Cross sectional observational. Setting: Liaquat National Hospital, Karachi. Period:August 2015 till July 2016. Materials and Methods: Symptomatic patients belonging to bothgenders, aged ≥ 30 years, having clinical and radiographic osteoarthritis involving knee, hip,spine, hand, foot and shoulder were included. Diagnosis of knee osteoarthritis was based onAmerican College of Rheumatology criteria, whereas the diagnosis of other joint areas wasbased on clinical and radiographic features. Patients were categorized as having monofocal ormultifocal osteoarthritis. The results were interpreted as frequencies and percentages. Results:Of the total 215 patients, 137 (63.7%) were females and 78 (36.27%) were males with meanage of 52.2 ± 9.3 years. Monofocal and multifocal osteoarthritis was found in 151 (70.23%) and64 (31.2%) patients respectively. Knee osteoarthritis (92.7%) was the most frequent monofocalpresentation. Of 64 patients with multifocal osteoarthritis, knee and hip joint were involved in28 (43.75%) and knee and hand osteoarthritis was found in 13 (20.3%) patients. Seven patients(10.9%) had osteoarthritis of three or more joints. Overall bilateral knee osteoarthritis wasfound in 158 (77.45%) patients. Conclusion: Bilateral symptomatic and radiographic kneeosteoarthritis was the most common presentation. Comparatively less proportion of patientshad osteoarthritis of three or more joints.
INTERTROCHANTERIC FRACTURES;
Authors: Shah Faaiz Ali , Alam Waqar , Ali Mian Amjad
Published: August 2021

Objectives: To determine the frequency of lag screw cut out in intertrochantericfractures fixed with dynamic hip screw and to identify the possible contributing factors for screwcut out. Study Design: Descriptive case series. Place and Duration of the Study: Orthopaedic& Traumatology Unit”A” Lady. Reading Hospital Peshawar from January 2014 to January 2017.Material and Methods: Patients of either gender or age with intertrochanteric fractures fulfillingthe inclusion and exclusion criteria were fixed with dynamic hip screw (DHS). Post operativelyfracture reduction, position of screw in head of femur and tip apex distance were calculatedon anterio posterior and lateral radiographs. All the patients were reviewed fortnightly for twomonth and then monthly for six months for lag screw cut out on radiographs. Results: Total 110patients mean age 72(range 22 to 98 years) years were fixed with dynamic hip screw. Lag screwcut out was noted in 12(10.9%) patients with 4(33.3%) male and 8(66.6%) female patients.The mean age was 62 years. Right side was involved in two (16.6%) patients while left in ten(83.3%) patients. Radiographically fracture reduction was poor in most (50%, n=6)) patients.The mean tip apex distance (TAD) was 32mm (range 24 to 40 mm). Majority (75%, n=9) ofcut out screw were in superior portion of the head of femur. Four (33.3%) patients had screwcut out at 8th week postoperatively while eight (66.6%) patients had screw cut out at 12th week.Conclusion: Lag screw cut out wasthe most common mechanical complication after fixation ofintertrochanteric fractures and all of the cut out patients were elderly with inadequately reducedfracture, superiorly placed lag screw and longer tip apex distance.
CATARACT SURGERY;
Authors: Memon Zulfiqar Ahmed , Zafar Omar , Farooq Arsalan , Memon Shabnam , Hassan Najam ul , Shah M. Tahir
Published: August 2021

Objectives: To determine the efficacy of topical nepafenac 0.1% eye dropsas compared toprednisolone acetate 1% eye drops in the management of postoperativeinflammation after cataract surgery. Study Design: Randomized controlled clinical study.Place and Duration of study: Pakistan air force hospital Rafiqui from Oct 2016 to Feb 2017.Patients and methods: Two hundred and forty eight eyes were randomly divided in two equalgroups. Patients received nepafenac 0.1% or prednisolone acetate 1% as single drop 8 hourlybeginning 1 day preoperatively, continued till 2 weeks post-operatively. Efficacy of the drugwill be considered if there is no anterior chamber reaction along with no aqueous flare after 2weeks of treatment. Results: 85.5% of cases resolved with topical nepafenac 0.1%as comparedto 88.7% that were cured with prednisolone acetate 1%. Pearson chi square test indicates thatthere is no statistical significant difference (p= 0.449) between the efficacy of two modes oftreatment. Conclusion: Nepafenac 0.1% eye drops are as effective as prednisolone acetate 1%in the prevention of postoperative inflammation with cataract surgery.
FOLIC ACID;
Authors: Yasmin Haleema , Bhutta Shireen , - Hasina
Published: August 2021

Objectives: The objective of our study was to assess the effectiveness offolic acid in optimizing the red blood cells folate levels and to observe the frequency of folateresistance among Pakistani female patients. Setting: Outpatient Department of Obstetrics &Gynaecology, Jinnah Post graduate Medical Centre (JPMC), Karachi. Period: January–July2016. Methodology: Participants fulfilling the inclusion criteria were included after informedconsent. Detail history and physical examination was done in each participant. All studyparticipants received 5mg (400 μg) folic acid as a daily supplement for 24 weeks. Red bloodcell folate concentrations were measured at baseline and after 24 weeks of therapy. Pairedsample t-test was used to find out significant difference between folate levels. Results: A totalof 44 women (23 pregnant while 21 non pregnant) were included in the study. Mean age of theparticipants was 27.6 ± 5.9years and mean BMI was 23.9 ± 4.1kg/m2 respectively. The meanvalues of Red blood cells folate at baseline and at 24 weeks were 623.6 ± 406.6 and 861.9 ±432.4respectively. Paired sample t-test results showed that there was no significant difference.Thirty-two (70.4%) women showed an increase in RBC folate status while 13 (29.6%) womenhad steady or decreased levels of folate after taking folic acid for 24 weekswhich may be dueto RBS enzyme methylenetetrahydrofolate reductase (MTHFR) deficiency. Conclusion: Simplefolic acid supplementation is not very helpful in improving folate status in female Pakistanipatients. Resistant to improvement may be due to MTHFR deficiency in our study subjects.
ORAL HEALTH;
Authors: Mirani Shahid Ali , Ali Shah Syed Yousif , Sahito Muhammad Ameen
Published: August 2021

Objectives: This study was carried out to evaluate the dental students’perception about condition of their gums and teeth and prevalence of dental caries. StudyDesign: Descriptive cross sectional study. Setting: Liaquat University of Medical and HealthSciences. Period: July 2011 to December 2011. Material and Method: The sample size was200 students comprising of both male and female. Clinical Oral examination was performedwith the help of mouth mirror and explorer in dental chair. The perception of dental studentsabout condition of their gums and teeth was obtained through questionnaire. Results: Theresults revealed that 25 % of students in present study had dental decay. The mean DMFT scorewas 0.625. Moreover, the mean DMFT score for male and female students was 0.658 and 0.576respectively. The results about distribution of DMFT components indicated that the decayed(D) teeth were in greatest number followed by filled (F) and missed (M) teeth. Conclusion:There was statistically no significant association between dental caries and gender. Moreover,prevalence of dental caries was significantly different between those who perceived their gumsand teeth condition excellent and good compared to the students who perceived their gumsand teeth condition as poor.
PARA UMBILICAL HERNIAS
Authors: Kalim Muhammad , Khan Saeed , Ali Asad , Ullah Rafi , Khan Mazhar
Published: August 2021

Background: Para-umbilical hernias are the common hernias among ventralabdominal hernias constituting about 85% of the overall abdominal wall hernias. Due to theirhigh risk of complications, adult paraumbilical hernias needs surgical repair. Objectives: Tocompare effectiveness of mesh versus mayo’s repair of para umbilical hernias in terms of postoperativepain. Study Design: Randomized controlled trial. Setting: Surgical Department,Hayatabad Medical Complex, Peshawar. Period: 12 months. Materials and Methods: A totalof 162 patients with paraumblical hernia were repaired. They were equally divided into 2 groupswith mesh repair (group A) and Mayo’s repair (Group B). The intervention effectiveness of meshversus mayo’s repair of para umbilical hernias was measured in terms of post-operative painby Visual Analogue Scale at the end of 3rd month. Data was analyzed by using SPSS version17. Chi Square Test was used p Value < 0.05 was significant. All the results were presentedin the form of tables and charts. Results: Mean age in (Mesh repair) was 30 years ± 2.1SDwhereas mean age in (Mayos repair) was 28 years ± 1.71SD. In Group A (Mesh repair), 73(90%)patients had mild pain (VAS 0-3), 8(10%) patients had moderate pain (VAS 4-6). In Group B(Mayos repair), 63(78%) patients had mild pain (VAS 0-3), 16(20%) patients had moderate painscore (VAS 4-6), 2(2%) patients had severe pain score (VAS 7-10). Mesh repair was effective in73(90%) patients whereas Mayos repair was effective in 63 (78%) patients. Conclusion: Meshrepair is more effective in terms of post-operative pain than Mayos repair.
LUMBAR DISC HERNIATION
Authors: Amir Sohail , Qadir Maimoona
Published: August 2021

Objectives: To determine Demographic characteristic and etiology of patientspresenting with lumbar disc herniation. Study Design: Descriptive cross sectional study.Setting: Department of Neurosurgery, Naseer Teaching Hospital Peshawar. Period: September2013 to February 2015. Material and Methods: We evaluated two hundred and eleven patients.All patients with either gender and age who presented through outpatient department, withclinically and radiological diagnosed lumbar disc prolapsed were included in the study.Patient profile like name, age, sex, occupation like driver, barber, carpenter, labourer, officeworker and those with systemic diseases were documented on predesigned Proforma. MRILumbosacral spine done in all patients. Data was analyzed using SPSS version 20.02015.Results: 211 patients were recruited in this study. Out of which 145(69%) were male and66(31%) were female. In our study 97(46%) were in age ranges of 31-40 years, followed by63(30%) in 21-30years, followed by 29(14%) in age group. Long route drivers on bad roadshad common disc herniation 66(31%) followed by labour (moderate to heavy weight lifting)42(20%), carpenters 27(13%), barbers 23(11%) and office workers 19(9%). Conclusion: Middleage working male was more prone to develop Lumbar disc herniation, more commonly at L4-l5and L5-S1 level. Long distance driver, labourer, carpenter, barber and office worker have strongassociation with lumbar disc herniation.