bluuebunny/crossref_metadata_2025 huggingface dataset:
A realidade epidemiológica do câncer de pele em uma região com alta incidência solar no nordeste brasileiro
Authors: Oliveira José Neto de , Santos Niedja Fernanda Nobre dos , Silva Júnior José Antonio da , Lima Milena Sonely Mendonça Bezerra , Fonseca Álvaro Micael Duarte , Batista Karla Regina Figueirôa , Maia Allyssandra Maria Lima Rodrigues , Nascimento Ellany Gurgel Cosme do
Published: November 2023

Objetivo: avaliar o perfil dos pacientes com câncer de pele atendidos na LMECC. Métodos: estudo descritivo e transversal a partir da análise de prontuários, considerando variáveis  relacionadas às características fenotípicas, profissionais, hábitos de vida, histórico familiar de câncer de pele e tempo de diagnóstico após o aparecimento da lesão. Resultados: Avaliou-se 873 pacientes com câncer de pele na macrorregião de Mossoró-RN. No que tange aos hábitos de vida, a maioria não tinha registro sobre tabagismo, etilismo e a prática de atividade física regular. Houve predomínio do carcinoma basocelular, seguido por espinocelular e o tipo melanoma. Conclusão: É possível destacar a necessidade de atenção às pessoas de pele clara, principalmente n as regiões que possuem maior densidade de trabalhadores  expostos à radiação solar. A educação em saúde é de suma importância sempre fomentar a recomendação para que a população geral.
Efeito da postura prona no manejo de pacientes não intubados com insuficiência respiratória aguda ocasionada pela SARS-CoV-2
Authors: Escorcio Renata , Andrade Luiza Barreto , Guedes Emília Brollo , Mendes Luciane Frizo
Published: November 2023

A pandemia de SARS-CoV-2, mais conhecida como COVID-19, trouxe grandes desafios à equipe multiprofissional no que se refere ao cuidado desses pacientes. Podendo se agravar, essa doença chega a causar a síndrome do desconforto respiratório agudo (SDRA). Algumas condições que influenciam no risco de gravidade da doença são idade avançada, comorbidades e sexo masculino. Estudos relataram que a postura prona é utilizada para tratar insuficiência respiratória aguda hipoxêmica em pacientes com COVID-19 não intubados, atuando através da melhora da troca gasosa. Estudos apontam a necessidade de identificar subpopulações de pacientes com SDRA devido à COVID-19 que podem se beneficiar da postura prona ativa. Objetivo: verificar os efeitos da postura prona ativa e sua relação com gênero, comorbidades, faixa etária, comprometimento pulmonar, escore APACHE e dias de internação na UTI. Método: trata-se de um estudo observacional, transversal e retrospectivo, realizado por meio de análise dos prontuários. Os pacientes foram classificados de acordo com a realização ou não da postura prona ativa durante o período de internação na UTI. Resultado: foi constatado que existe uma diferença significativa entre as distribuições de frequências do gênero nos dois grupos (p=0.019). O grupo que realizou a postura prona ativa foi composto majoritariamente por pacientes do gênero masculino (70%). Existe diferença significativa entre os escores APACHE nos dois grupos (p=0.03). Existe diferença significativa entre o tempo de internação na UTI entre os grupos (p=0.04). Nenhum paciente foi intubado ou a óbito. Conclusão: a postura prona ativa pode ser um procedimento seguro e factível.
Artificial intelligence technology for radiation oncology understaff mitigation and cost-effective treatment planning
Authors: Cassetta Júnior Francisco Roberto , Teixeira Felipe Orsolin
Published: November 2023

Treatment with radiation therapy can be relatively inexpensive and highly effective, reducing the overall cost of healthcare, as well as saving lives of cancer patients. To face the posed challenges of laborious tasks and understaff in radiotherapy, the use of knowledge-based models (artificial Intelligence) to reduce the treatment planning times up to 95% might be a promising solution. One such tool, called RapidPlan (Varian Medical Systems, Palo Alto-CA), could be acquired with an investment of a small fraction of the treatment planning system cost. RapidPlan’s support during treatment planning results in a considerable increase in plan quality while reducing plan variability and elaboration time. The goal of this dissertation was to estimate the break-even point from where the time saved during treatment time would pay the initial investment on RapidPlan. Published data demonstrates that RapidPlan can largely benefit radiation therapy institutions by streamlining the treatment planning process and the break-even point started to be achieved after treating 112 to 2668 patients, depending on the cancer types treated for each group. Therefore, it may be possible to realize a return on investment within a reasonable time frame, while benefiting from gains in efficiency, and possibly mitigating understaffing and lack of experience in treatment planning.
Tendências e diferenciais na ocorrência de cesarianas no Estado de Santa Catarina a partir dos Grupos de Robson
Authors: Silva Pâmela Roberta Rocha da , Machado Karla Pereira , Gonzalez Tatiane Nogueira , Cordeiro Marcos Freitas , Machado Adriana Fiala Kramer , Rausch Bruna Natália , Marmitt Luana Patricia
Published: November 2023

Objetivo: Estudar a ocorrência e identificar tendências na distribuição das cesarianas ocorridas no Estado de Santa Catarina de acordo com os grupos de classificação de Robson, entre 2014 e 2019. Método: Estudo transversal que incluiu todos os registros de microdados de partos e nascimentos do Sistema de Informações sobre Nascidos Vivos do Ministério da Saúde no período supracitado. Foram realizadas análises de tendência temporal da ocorrência de cesarianas em cada um dos 10 grupos de Robson e suas respectivas taxas e contribuições. Essas foram ainda analisadas quanto a distribuição entre as sete macrorregiões de saúde do estado. Resultados: A taxa geral de cesariana foi de 58,3% (IC95%: 58,1; 58,4), variando de 60,5% em 2014 a 57,4% em 2019. Teve destaque a macrorregião da Grande Oeste com a maior taxa geral de cesariana (67,9%). O grupo 5 (mulheres com cesariana prévia) e o grupo 2 (nulíparas com cesariana eletiva) apresentaram as maiores taxas individuais e contribuições para a taxa geral de cesariana. Enquanto o grupo 5 demonstrou tendência ascendente, o grupo 2 reduziu sua contribuição na taxa geral de cesariana no período. Conclusão: Observou-se redução discreta na ocorrência das cesarianas ao longo dos anos. Mulheres dos grupos 2 e 5 representam os principais grupos-alvo para intervenções visando a redução de cesarianas desnecessárias no Estado.
Analisis gaya hidup sehat mahasiswa olahraga
Authors: Rahman Dally
Published: November 2023

Masalah: Gambaran pola hidup sehat yang diterapkan oleh mahasiswa perlu dilakukan analisis, karena gaya hidup sehat merupakan suatu hal yang penting untuk menjamin kesehatan mereka selama menyelesaikan studi di kampus.

Tujuan: Peneliitna ini bertujuan untuk mengetahui gambaran gaya hidup sehat yang diterapkan olahe para mahasiswa olahraga.

Metode: Penelitian ini menggunakan metode deskriptif kuantitatif dengan melibatkan 93 orang mahasiswa sebagai responden. Pengumpulan data dilakukan dengan menggunakan angket pola hidup sehat yang diadopsi dari penelitian sebelumnya. Analisis statistik yang digunakan adalah statistik deskriptif yang akan menggambarkan tentangn rerata, standar deviasi, nilai  maksimal, dan minimal, serta dijelaskan juga persentase tingkat capaian jawaban responden.

Hasil: Hasil Penelitian menunjukkan bahwa persentase jawaban responden telah mencapai 69%, yang artinya gaya hidup sehat para mahasiswa berada pada kategori cukup.

Kesimpulan: Gaya hidup sehat mahasiswa olahraga telah berada pada kategori cukup, sehingga kedepan perlu ditingkatkan lagi agar asupan gizi mereka dapat mencukupi tuntutan aktifitas mereka yang padat di kampus.
Efek metode permainan target terhadap kemampuan shooting olahraga futsal
Authors: Ilmawan Danar , Susianti Evi , Achmad Irfan Zinat
Published: November 2023

Masalah: Rendahnya kemampuan siswa dalam melakukan shooting menjadi permasalahan utama dalam penelitian ini.

Tujuan: penelitian ini bertujuan untuk menguji efek dari penerapan program permainan target dalam meningkatkan kemampuan shooting.

Metode: Penelitian ini menggunakan metode eskperimen dengan group pretest and posttest design. Sampel dalam penelitian ini berasal dari siswa yang mengikuti ekstrakurikuler futsal di MAN 1 Bekasi (n=23). Program permainan target diberikan sebanyak 6 kali pertemuan. Instrumen dalam penelitian ini menggunakan tes shooting selama 15 detik. Analisis data menggunakan IBM SPSS versi 25.0 untuk menguji deskriptif data, normalitas dan paired sample t-test digunakan untuk menguji perbedaan nilai pre-post.

Hasil: Temuan dalam penelitian ini menunjukan bahwa penerapan permainan target selama 6 kali pertemuan secara signifikan dapat meningkatkan kemampuan shooting siswa yang rendah menjadi lebih baik (p≤0.05). Dengan demikian penelitian ini menegaskan bahwa kemampuan shooting dapat meningkat apabila siswa mendapatkan permainan target.

Kesimpulan: Penelitian ini berkontribusi sebagai cara untuk menambah wawasan guru dan pelatih mengenai pentingnya penggunaan permainan target dalam olahraga futsal.
Studi deskripsi dampak corporate learning selama pandemi covid-19 terhadap perilaku gerak
Authors: Jabar Bambang Abdul , Gumilar Agus , Hambali Burhan , Ahma Tasya Aulia R , Ibrahim Charisma Azizah
Published: November 2023

Masalah: Sesi ini Tingkat aktivitas fisik jalan kaki, sedang, kuat, dan total mengalami penurunan selama pandemi COVID-19 di kalangan pelajar di berbagai negara, menurut lima penelitian yang menunjukkan penurunan aktivitas fisik ringan/ringan.

Tujuan: Tujuan dari penelitian ini adalah untuk melihat dampak dari dampak corporate learning selama pandemi covid-19 dan ptmt terhadap perilaku gerak.

Metode: Sesi Penelitian survei deskriptif dengan penyebaran angket perilaku gerak yang berkaitan dengan pengetahuan, keterampilan afektif dan keterampilan telah dibagikan kepada 173 siswa di Kota Bandung.

Hasil: Hasil analisis data berdasarkan analisis proporsional skala positif dan negatif, ditemukan bahwa perlunya promosi gerak fisiologis, psikologis dan motorik agar siswa menjadikan gerak sebagai gaya hidup, aktif bergerak, sehat dan bugar. sepanjang hidup.

Kesimpulan: Penelitian ini menunjukkan perlunya pembelajaran pendidikan jasmani, olahraga dan kesehatan untuk dikembangkan dalam apresiasi gerak untuk kualitas hidup yang lebih baik.
Pengaruh model latihan daya ledak otot tungkai dan keseimbangan terhadap kemampuan jump shot pada atlet klub bolabasket halilintar
Authors: Oktavianus Irfan , Yenes Ronni , Rozi Fakhrul , Irawan Roma , Donie Donie
Published: November 2023

Masalah: Masalah dalam penelitian ini kuranganya kemampuan Jump Shot pada atlet putri klub bolabasket halilintar dalam melakukan Jump Shot yang mengakibatkan Jump Shot yang dilakukan tidak menghasilkan poin. Faktor yang mengakibatkan kurangnya kemampuan Jump Shot, adalah daya ledak otot tungkai dan keseimbangan.

Tujuan: Penelitian ini bertujuan untuk mengetahui Pengaruh model latihan daya ledak otot tungkai dan keseimbangan terhadap kemampuan jump shot pada atlet klub bolabasket halilintar .

Metode: Model latihan yang dapat mengingkatkan daya ledak otot tungkai dan keseimbangan adalah Knee Tuck Jump, Jumping Jack, lompat dengan satu kaki, Squat, Lunges. Penelitian ini merupakan jenis penelitian eksperimen semu. Populasi penelitian adalah atlet klub bolabasket halilintar  berjumlah 10 atlet. Pengambilan sampel menggunakan teknik purposive sampling dengan sampel berjumlah 8 atlet. Teknis analisis data menggunakan uji T. Penelitian ini dilakukan 16 kali pertemuan. Model latihan yang diberikan yaitu Knee Tuck Jump, Jumping Jack, lompat dengan satu kaki, Squad, Lunges. Hipotesis yang diajukan dalam penelitian ini adalah Terdapat pengaruh yang signifikan dari model latihan yang diberikan terhadap kemampuan Jump Shot.

Hasil: Hasil analisis yaitu terdapat pengaruh yang signifikan pada model latihan daya ledak otot tungkai dan keseimbangan terhadap peningkatan kemampuan Jump Shot atlet klub bolabasket halilintar, diperoleh nilai thitung (5,428) > ttabel (1,943).

Kesimpulan: Para pelatih sebaiknya memberikan bentuk Latihan yang dapat meningkatkan daya ledak oto tungkai dan keseimbangan untuk menunjang kemampuan jump shot para atletnya.
THE COMPETING-RISK ANALYSIS OF POST-IPO DELISTINGS
Authors: Chen Jun , Rutherford Ronald , Wang Peiming
Published: November 2023

This paper is working on one IPO panel data to estimate the predicting power of some covariates on future status of IPO firms after going public. These new firms could be delisted due to two major reasons, either acquisition or liquidation. Specifically, our study aims to examine how the possibility of each type of delisting could be determined. There are two main findings in this paper. First, we find that the inclusion of the aftermarket performance in a competing-risk model helps distinguish the impact of those covariates on the two types of delistings. For example, profitability increases the chance of being delisted due to mergers but decreases the chance of being delisted due to bad performance. Second, our evidence indicates that time-varying covariates may impact the delistings in different ways. For instance, profitability appears to affect the voluntary delistings only until last year before delisting. In sum, our paper contributes to the prior literature by shedding light on how voluntary/forced post-IPO delistings are determined.
La Declaración 222 de los Textos de las Pirámides como liturgia “dialógica”
Authors: Bonanno Mariano
Published: November 2023

La variedad de liturgias que conforman los Textos de las Pirámides converge en asegurar el ingreso del faraón en la corporación de los dioses. Los denominados textos sacerdotales, entre los cuales se encuentra la secuencia TP 213-222, constituyen parte del denominado Grupo de Resurrección Ritual, que complementaba la materialidad de la regeneración del difunto (comida y bebida, armas, ropas, estandartes, etc.). En estos textos de resurrección eran los sacerdotes ritualistas los que intermediaban a instancias del faraón, razón por la cual se expresan en tercera persona. El caso particular de TP 222 supone una alternancia entre la segunda y la tercera persona sobre las que el sacerdote oficia la liturgia. Si bien TP 222 es parte de una liturgia mayor, es la única declaración del conjunto en la que se establece esta relación “dialógica” en medio de una introducción sacerdotal preparatoria y un ascenso y unión con el dios sol. Un análisis de esta particular declaración es lo que proponemos en este artículo.
Religião em tempos de espetáculo
Authors: CAMPOS Breno Martins
Published: November 2023

O pressuposto deste ensaio reside na convicção de que o fundamentalismo religioso é um tema acerca do qual as ciências da religião e a teologia não podem se calar. Definições e classificações do fundamentalismo nas variadas formas de sua manifestação são um desafio urgente à produção acadêmica. Como novidade, o objetivo geral desta investigação é compreender o mundo contemporâneo como tempos de espetáculo e a localização do fundamentalismo protestante dentro dele. Na lógica da hegemonia do espetáculo, o fundamentalismo protestante precisa dar visibilidade à sua verdade, pois aquilo que é bom necessariamente aparece. São seus objetivos específicos: (1) apresentar o fundamentalismo protestante como uma metacomunidade constituída em torno de um pensamento único, que precisa ser veiculado para se manter ativo; (2) caracterizar o fundamentalismo protestante como um movimento aderente a uma exposição tão explícita da verdade, que a torna rasa e plana. Na tentativa de alcançar os resultados esperados, propõe-se uma pesquisa bibliográfica e exploratória, cujas obras de referências são partes constitutivas do arquivo do pesquisador, não naquele sentido de repositório, mas na condição de leituras feitas e experiências vividas (vida acadêmica enlaçada com a vida pessoal). Para percorrer os caminhos propostos, faz-se opção por uma pesquisa qualitativa, uma vez que a compreensão do assunto em sua profundidade tem proeminência em relação a seu controle e extensão.
Elasticidad y resistencia de los materiales
Authors: Pedraza Rodríguez Consolación , Martín Romero Alberto
Published: November 2023

La Elasticidad y Ia Resistencia de Materiales son dos disciplinas, íntimamente ligadas, encuadradas dentro de Ia Mecánica de Medios Continuos que, a su vez, forma parte de la Mecánica, entendida ésta como una rama de Ia Física. En un sentido amplio puede decirse que Ia Elasticidad estudia los efectos que las solicitaciones externas provocan sobre un sólido. El estudio de Ia Elasticidad es genérico, en el sentido de que estudia sólidos de forma cualesquiera sometidos a todo tipo de cargas. Este estudio genera un aparato matemático muy complejo que, si bien puede llegar a resolverse con Ia ayuda de complicados programas informáticos, en Ia mayoría de los casos, suele ser inabordable sin esa ayuda. La introducción de ciertas hipótesis simplificativas, de cara a hacer más cómodamente resolubles cierto tipo de problemas muy frecuentes en Ingeniería, da lugar a Ia Resistencia de Materiales. Debe quedar bien entendido que el objeto de estudio de ambas disciplinas es el medio sólido deformable, frente a la Mecánica Racional, Ia otra gran parte de Ia Mecánica, que estudia el comportamiento del sólido rígido.
An increase in animal-related occupational injuries at a veterinary medical center (2008–2022)
Authors: Voss Deidree S. , Boyd Melissa V. , Evanson Jessica F. , Bender Jeff B.
Published: November 2023

OBJECTIVE

To characterize animal-related injuries in veterinary medical center staff at a veterinary medical center.

SAMPLE

706 hospital staff injuries.

METHODS

Deidentified injury reports were submitted to Human Resources from 2008 through 2022. Injury data collected included the injury description, date of injury, occupation, and worker’s compensation claim information. Data were summarized by year, cause of injury, total cost associated with injury, and occupation.

RESULTS

There was an increase in injuries reported in recent years when compared to past years, with the plurality of injuries being bite injuries, specifically occurring on the hand, finger, and wrist area. Bite injuries had a higher average total worker’s compensation cost paid to staff than striking injuries. There were more injuries reported by staff who had less experience working with animals. More injuries occurred during the summer months (June through September). There was not an unusual trend in the reporting of injuries due to COVID-19. Other injuries (eg, needlesticks and falls) were reported from only 2019 to 2022, but constituted a substantial burden for staff.

CLINICAL RELEVANCE

These findings can help stakeholders at teaching hospitals and veterinary clinics to take steps toward creating a safer workplace environment for employees. It is important to identify work hazards and provide proper training and prevention methods to reduce the risk of injuries, especially among less experienced employees. Proper prevention methods will help reduce worker’s compensation costs for the teaching hospital and reduce the number of workdays missed by staff.
Ectopic adrenal tissue in a cat that underwent an ovariohysterectomy
Authors: Knight Kristen , Vogel Helena , Bischoff Matthew , Bajwa Karmenleen
Published: November 2023

OBJECTIVE

To describe the use of ultrasound and adrenal function testing to confirm that excised periovarian tissue is normal ectopic adrenal tissue (EAT).

ANIMAL

A 6-month-old female domestic shorthair cat.

CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES

The cat underwent an ovariohysterectomy procedure, during which abnormal tissue was discovered adjacent to both ovaries. The tissue was removed during the ovariohysterectomy and submitted for histopathology, which was consistent with adrenal gland tissue, initially raising concern for an inadvertent adrenalectomy. Abdominal ultrasound and an adrenal function test were performed that confirmed normal adrenal structure and function; thus, the removed structure was diagnosed as EAT.

TREATMENT AND OUTCOME

The patient continued to recover from the procedure uneventfully at home.

CLINICAL RELEVANCE

Parovarian nodules are an uncommon finding but when observed and biopsied, may be mistaken for physiologic adrenal tissue on the basis of histopathologic features alone without awareness of their existence and clinical context. The use of abdominal ultrasound and ACTH stimulation test offers an affirmative method of differentiating adrenal gland tissue from EAT.
A Decade of Bibliometric Analysis of Biodiversity
Authors: Simion Petruta-Simona , Ciornei Laurentiu , Todirica Ioana Claudia , Petcu Victor , Joita-Pacureanu Maria
Published: November 2023

Bibliometric analysis is a significant method used in scientific research to evaluate extensive and rich areas of specialized research. This study explored biodiversity as the main focus, using bibliometric data from the ScienceDirect and Scopus bases. The analysis found 1115 appearances for the keyword “biodiversity” in the top 10 specialized journals, highlighting journals such as “Biological Conservation” and “Science of The Total Environment”. The clustering of keywords illustrated seven interest groups, highlighting biodiversity, the Romanian context, forestry, climate change and conservation. The time analysis also revealed the thematic evolution of the research, moving from morphology and nitrogen issues to topics such as conservation, climate change and environmental protection. Despite the usefulness of bibliometric analysis, it brings up the limitations and precautions required in the use of bibliometric data, highlighting the importance of a rigorous data cleaning process. It is also stressed that bibliometric analysis is better suited for short-term forecasts than for overly ambitious conclusions about long-term impacts. However, this method is a useful tool for specialized research, facilitating the development of knowledge in various areas of interest.
Retention using braided bonded wires: a 2-year follow-up of the dentition and oral hygiene with predictors of relapse
Authors: Ugrin Silvija Kanizaj , Dzipunova Biljana , Spalj Stjepan
Published: November 2023

Objective

To assess gingival health and predictors of relapse related to braided-wire bonded retainers after the active phase of comprehensive orthodontic treatment.

Materials and methods

Fifty-one subjects were recruited in a prospective study of whom 42 were available for analysis after 2 years of retention (pre-therapeutic ages 11–18 years; 66% female). A rectangular wire retainer (0.027 × 0.011″) was bonded to the mandibular incisors. Little’s index of incisor irregularity; intercanine width; the accumulation of biofilm, calculus and gingivitis; and the incidence of retainer detachment, were recorded. Subjects were examined before orthodontic therapy, upon therapy completion, and after 2 years of retention.

Results

The incidence of retainer detachment over the 2 years was 27%. The post-treatment incidence of irregularity was 17%, and intercanine width reduction was 24%. Calculus accumulation increased significantly during retention (p < 0.001) but not the extent of gingivitis. A multiple logistic regression demonstrated that an increase of mandibular intercanine width by ≥3 mm correspondingly increased the odds of relapse 14.3 times (95% confidence interval [CI], 1.1–196.1; p = 0.046). Patients presenting with retainer failure were 10 times (95% CI 1.6–62.8; p = 0.014) more likely to experience relapse. Subjects who experienced relapse had retainer failure earlier than those without relapse (19 vs. 23 months; p = 0.003). The occurence of relapse was not related to a treatment change in incisor irregularity, the duration of treatment, the age of the patient, gender nor to a change of intercanine width during retention.

Conclusion

Post-treatment changes in the mandibular arch incorporating bonded retainers were not large, but were common. An increase in mandibular incisor irregularity during retention is mostly related to treatment-induced intercanine width expansion. The bonded retainer often detached and increased calculus accumulation.
HOW DOES GRANTING TEACHER AUTONOMY INFLUENCE CLASSROOM INSTRUCTION? LESSONS FROM INDONESIA’S CURRICULUM REFORM IMPLEMENTATION
Authors: Nihayah Risa Wardatun , Dina Wahyu Farrah , Wijayanti Dyana , Asyah Annabel Noor
Published: November 2023

This research seeks to understand how a curriculum reform that emphasizes studentcentered learning influences classroom instruction. The new curriculum is designed by the government of Indonesia to grant autonomy to teachers in re-emphasizing learning according to the student’s needs and local context. Previous studies suggest that teacher autonomy in elaborating curricula and pedagogy is associated with student’s engagement and improvement in learning outcomes. Given the low autonomy of teachers in Indonesia, their responses can inform how we should formulate effective reforms. This research used a case study to investigate how curriculum reform is perceived by middle school teachers and how they translate it into classroom instruction. The data was collected through classroom observations and complemented by semi-structured phone interviews with 20 Math teachers in Jakarta and Central Java from November 2022 to February 2023. To avoid incongruous instruction, this research informs that countries with a long history of low teacher autonomy like Indonesia should not promote a grand education reform design without clear guidelines and adequate support. The reformers need to touch upon teacher’s beliefs about curriculum completion and didactic pedagogy before expecting them to change their teaching practices into active learning and exercise their authority in independently developing curricula.
Ovarian Mature Cystic Teratoma Combined with Mucinous Boderline Tumor-A Case Report with Literature Review
Authors: Wang Lixin , Chen Gang , Jiang Jingui
Published: November 2023

Mature ovarian cystic teratoma with co-existing mucinous borderline tumor is an extremely rare finding in literature. Here, we report a case of bilateral mature cystic teratoma of the ovary with mucinous borderline tumors and intraepithelial carcinoma in a very young, 26-year-old female. The case was diagnosed histologically through immunohistochemical support. The biological behavior of mature ovarian cystic teratoma with mucinous borderline tumor is between those of benign and malignant tumors, having low malignant potential. Since the patient had given birth to a child, a radical operation was performed and no 
tumor recurrence was observed after one year follow-up.
Frequency of Thalassemia and Its Association with Hepatitis C Infection in Local Population of Pakistan
Authors: Khan Ghulam Jilany , Reyaz Nadeem , Baloch Muhammad Bahadur , Cassandra Analisa , Schlicht Susanne
Published: November 2023

Background and Objective: Thalassemia major or βeta-thalassemia is a hereditary blood disorder, necessitating continuous blood transfusions. Frequent blood transfusions often result in the development of hepatitis, hepatocellular carcinoma, acquired immunodeficiency syndrome (AIDS) and many other infectious diseases. Incidence of infection of viral hepatitis in thalassemia patients is majorly associated with infections in the donor population. The objective of this study was to ascertain the frequency of HCV infection in patients with thalassemia in Pakistan.
Methods: This study was conducted from January 2015 to September 2018 in various sections of Punjab and Sindh, Pakistan. A total number of 439 patients were enrolled in this study, samples of blood from the patients were collected and their Anti-HCV antibodies were evaluated by enzyme-linked immunosorbent assay (ELISA); HCV-RNA genome presentation was assessed by HCV-nested-real time-polymerase chain reaction (RT-PCR) for the confirmation.
Results: It was found that major population of the thalassemia patients were male (63%). While the female thalassemia population was almost twice in Sindh province as compared to Punjab. In present study, n = 187 were detected positive among those n = 168 were confirmed by PCR. Only 47% thalassemia patients were found vaccinated against hepatitis B whereas all HCV positive patients were not vaccinated, and (84.96%) thalassemia patients were from the family of first cousin marriage. The patients which are not vaccinated also had significant chance to acquire the viral infection (P < 0.001). Moreover there could be some gender and environmental or geographical factors associated with thalassemia that are yet to be 
explored in detail.
Conclusion: Thalassemia patients carry major risk for acquiring transfusion associated infection
Nuchal Cord and Perinatal Outsome - A Case Control Study
Authors: Najam Saima , Malik Sumaiyya Ejaz , Solangi Hina Shams , Aqeel Shehla , Rizwan Nida , Haider Ali Raza
Published: November 2023

Background and Objective: The nuchal cord means the umbilical cord when it becomes wrapped around the fetal neck by 360 degree. It has been observed that the ultrasound finding of the nuchal cord not only makes the patient more apprehensive but leads to low threshold of the Caesarean section by the managing obstetrician as well. The purpose of this study was to determine the perinatal outcome associated with the cord around the neck in females presenting a hospital setting.
Methods: This case control study was conducted at Dr. Sulaiman al Habib Hospital Riyadh, Saudi Arabia.The data was collected retrospectively with the help of the predesigned proforma for six months and once the selected number of patients with the nuchal cord was enrolled, the total number of the patients was calculated. To create a control group every 12th patient without the nuchal cord was enrolled. Once the control group was formed then the primary and secondary outcomes were compared in both the groups.
Results: It was found that there is significant increase in fetal heart rate abnormalities in the nuchal cord group without increasing the rate of Caesarean section. However, the mean Appearance, Pulse, Grimace, Activity, and Respiration (apgar) score of the neonate in both the groups is not affected. The rate of admission to neonatal intensive care unit (NICU) also did not increase in our study group.
Conclusion: The nuchal cord though found to be associated with fetal heart rate abnormalities but does not increase the rate of Caesarean section. Hence all patients who have nuchal cord should be given trial of labor with continuous cardiotochographic (CTG) monitoring. It is also observed that the apgar score and NICU admission is not affected by the nuchal cord.
Evaluation of the Clinical Efficacy of Vitrification, Warming and Blastocyst Transplantation in Assisted Reproductive Treatment
Authors: Xu Lizhen , Gao Shanshan , Jiang Jingjing , Sun Mei , Sheng Yan , Tang Rong
Published: November 2023

Background and Objective: Advances in cell media have led to embryo transfer from cleavage to blastocyst. The extension of embryo culture to blastocyst stage provides some theoretical advantages and disadvantages that have been controversial. The objective of this study was to evaluate the clinical efficacy of vitrified warm cutting and blastocyst transplantation in Assisted Reproductive Technique (ART) therapy. 
Methods: The study was performed on 2740 women undergoing frozen embryo thawing transfer. Patients' basic clinical information, status of frozen embryo transfer cycle, clinical pregnancy rate, early abortion rate, sex ratio of birth and birth weight were retrospectively analyzed. The main clinical outcomes of the recovery of frozen embryos at cleavage and blastocyst stages were compared. In addition, the clinical outcomes of blastocyst cryopreservation on the 5th, 6th or 7th day after oocyte retrieval according to the date of blastocyst expansion were recorded.
Results: The implantation ratio of cleavage stage embryos was 21.62% compared with 43.52% on D5 (P <0.05). The D5, D6, and D7 implanting rates were statistically different. The pregnancy rates were 57.56%, 51.76% and 35.95% versus 37.79%, and the early abortion was 23.08%, 15.42% and 22.35% versus 34.55% respectively for embryos cryopreserved on D5, D6, D7 and D3. There were significant differences between D5 and D3 rates of ectopic pregnancy and early abortion. The sex ratio, the birth weight and birth defect were not statistically different among four groups.
Conclusion: Blastocyst transfer achieved a higher implantation rate than vitrified cleavage stage embryo and decreased ectopic pregnancy rate. With increased incubation days before expansion blastocyst formed, the implantation rate is reduced and the early abortion rate increases.
Accuracy of Transvaginal Ultrasonography for Diagnosis of Endometriosis Taking Laparoscopy as Gold Standard
Authors: Nighat Sumera , Anwar Zubda , Anwar Azka , Firdaus Taqwa , Saqi Rohma
Published: November 2023

Background and Objective: Endometriosis is a common gynaecological disease with a diverse clinical presentation. Laparoscopy has long been considered the gold standard diagnostic modality for endometriosis but with the evolution of non-invasive, high resolution transvaginal ultrasonography, it is frequently used as the first line diagnostic technique in making a preoperative diagnosis for endometriosis. This study was designed to determine the diagnostic accuracy of transvaginal ultrasonography (TVS) in diagnosis of endometriosis taking laparoscopy as gold standard.
Methods: A total of 118 women of child bearing age who presented with symptoms of pelvic endometriosis in the department of gynecology, Bakhtawar Amin Hospital Multan were included. The study duration was from June 01, 2018 to May 31, 2020. Patients were first investigated on TVS examination to diagnose endometriosis. Afterwards, diagnostic laparoscopy was performed in all patients to confirm the diagnosis of endometriosis. Accuracy of TVS was determined in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
Results: Mean age of the patients was 31.7 ± 7.4 years. Most common presenting complaint was dysmenorrhea in 89 (75.4%) patients followed by dyspareunia in 36 (30.5%), chronic pelvic pain in 30 (25.4%) patients and subfertility in 18 (15.3%) patients. On TVS, endometriosis was diagnosed in 69 (58.5%) patients. While on diagnostic laparoscopy, endometriosis was diagnosed in 75 (63.6%) patients.The sensitivity of TVS in diagnosis of endometriosis was calculated as 82.7%, specificity as 83.7%, PPV as 89.9% and NPV as 73.5%.
Conclusion: TVS appears to be the alternative and safe modality for diagnosis of endometriosis. It can be used as an alternative to diagnostic laparoscopy for the early diagnosis of endometriosis. It has a good sensitivity and specificity for diagnosis of endometriosis.
Myths and Controversies in Assisted Reproductive Techniques: Gynecologist's Perspective
Authors: Nafees Rabia , Khan Haroon Latif , Zareen Humaira , Imran Zoofishan , Sher Shazia Jang
Published: November 2023

Background and Objective: Globally infertility affects between 60 million and 168 million all over the world. Regardless of the fact that Pakistan being currently among the most overpopulated nations of the globe and a populace development pace of around 2%, confronts with the higher pace infertility (21.9%); 3.5%primary and 18.4% secondary. The aim of the study was to assess the understanding of gynecologist of Pakistan regarding Assisted Reproductive Techniques (ART).
Methods: It was a descriptive study, conducted only for gynecologists who attended the “Asia Pacific Initiative on Reproduction” (ASPIRE) conference held in Lahore, Pakistan, from 29th Nov to 1st December2019. Data was collected from the n = 252 gynecologist who were attending the conference.
Results: Out of n = 252 doctors, 82.9% participants considered test tube baby a social norm and acceptable option while 55.6% participants were in the opinion of basically a stigma attached to society. According to 77.8% participants, socially and legally involvement of 3rd party like donor eggs, sperms and gametes cannot justify.
Conclusion: Pakistan, gynecologists are the mainstream dealing with infertility. Apart from general population, there are certain myths and controversies among the gynecologist as well. So that gynecologists’ knowledge and perception is the most important point regarding infertility and ART. 
Primary Granulomatous Inflamatin of Liver A Case Report
Authors: Aslam Shazia , Hameed Sadia , Aslam Sidra
Published: November 2023

Granulomas that consist of focal accumulations of macrophages are commonly found in the liver due to stimulation of the immune system by a number of pathophysiologic agents. Manifestations are variable depending on whether the underlying cause is a systemic disease or a primary hepatic granulomatous reaction. Here we report a case of a 30-year old female who presented with complaint of fever and vomiting. Liver biopsy from focal lesion was suggestive of granulomatous inflammation.
SPARC in Breast Carcinomas: A Critical Review
Authors: Mughal Waqas Arshad , Khalid Sobia , Naseem Nadia , Nagi AH
Published: November 2023

Breast cancer is the second most common cancer in the world according to World Health Organization statistics. Among Asian countries, Pakistan has the highest incidence of breast cancer. The normal breast development is interplay between various hormones and transcription factors. Estrogen receptor, progesterone receptor and human epidermal growth factor are being utilized for the targeted therapy of breast cancers. However, there is further need of research to improve the treatment strategies in this regard. Secreted Protein Acidic and Rich in Cysteine (SPARC) is a new biomarker and therapeutic target in breast cancer as well as other tumor types. It’s a matricellular protein whose main function is to mediate interactions between cells and their extracellular surrounding during morphogenesis, tissue remodeling and angiogenesis. Therefore, SPARC enables tumor cells to interact with stromal cells and the extracellular matrix. Regarding breast carcinoma, SPARC has been identified as an important negative regulator of tumor characteristics associated with poor prognosis.
A Comparison of Human Gut Microbiota and Analysis of Antimicrobial Resistance of E. coli Isolates in Saudi Adults Undergoing Bariatric Surgery
Authors: Aabed Kawther , Moubayed Nadine , Motlak Abrar , Al-Rasheed Al-Anoud , Al-Otaibi Ameerah , Al-Asmri Aisha , Abu-Dusha Hanadi
Published: November 2023

Background and Objective: Human gut harbors a diverse community of more than 100 trillion microbial cells that play an important role in human metabolism, physiology, immune function, and nutrition. Similarly, disruptions to the composition of this population can be linked with gastrointestinal conditions,such as obesity and inflammatory bowel disease. The aim of the present study was to compare the microbial community characteristics among obese, normal-weight and post-gastric bariatric surgerypatients.
Methods: Fifteen healthy adults, who were classified into (1) normal-weight (n=5) (2) obese (n=5) according to their Body mass index (BMI) and (3) post-bariatric surgery (n=5) groups. Gut microbiota from fecal samples were profiled by the streak plate method and theconstituent populationswere identified by biochemical analysis (Vitek2). Finally, specific bacterial strains were identified via molecular techniques, such as Polymerase chain reaction (PCR). Moreover, the antimicrobial sensitivity of E. coli strains isolated from healthy adults was evaluated to determine the pathogenic strains.
Results: The findings revealed that gut microbiota diversity increased following bariatric surgery, whereby84.6% of increased bacteria belonged to Proteobacteria, especially Escherichia coli (member of Gammaproteobacteria). The main bacterial groups in individuals that underwent bariatric surgery were Gemella morbillorum, Citrobacter freundii, Serratia odorifera, Proteus mirabilis, Enterococcus gallinarum, Klebsiella pneumonia, Enterobacter cloacae complex, Pseudomonas aeruginosa and Escherichia coli. The main bacterial groups in the normal-weight group were Citrobacter freundii, Serratia marcescens, Proteus
mirabilis and Escherichia coli. Finally, in obese individuals, Enterobacter cloacae complex, Klebsiella pneumonia, Enterococcus gallinarum and Escherichia coli were the main bacterial groups.Conclusion: These results indicate that inducing changes in the gut microbiota may be a relevant therapeutic approach for obesity and other metabolic defects.
Role of Internal Sphincterotomy as an Adjunct to Open Haemorrhoidectomy for Management of Third- and Fourth Degree Haemorrhoids
Authors: Awan Waseem Sadiq , Ahmed Arslan , Farrukh Raza , Muhammad Yar , Athar Salman , Jehangir Hafiz Muhammad Sajid , Arain Ghulam Mustafa
Published: November 2023

Background and Objective: Post-operative pain and complications are common after open haemorrhoidectomy. Addition of internal sphincterotomy has shown to improve the post-operative outcomes. This study is conducted to compare the outcomes of open haemorrhoidectomy with and without internal sphincterotomy.
Methods: A prospective randomized controlled trial was conducted in the Department of Surgery at Sargodha Medical College/District Headquarter Hospital, Sargodha from February 2016 to December 2017. One hundred and twenty-two patients presenting with third and fourth degree haemorrhoids were divided in two equal groups. In group “A”, haemorrhoidectomy with internal sphincterotomy and in group “B”, haemorrhoidectomy alone was performed. Outcome variables such as pain scores based on Verbal Rating Scales (VRS), hospital stay, complications and wound healing were compared in both groups.
Results: The mean pain scores were less in the internal sphincterotomy group A i.e., 3.3 ± 0.3 while it was 3.6 ± 0.4 in group B at 1st post-op day. The mean duration of hospital stay was less in group A (2.3 ± 0.7 days) and it was 3.4 ± 0.9 days in group B. On the 7th post-operative day, 13 (21.3%) patients in group A and 4 (6.6%) patients in group B had flatus incontinence. Urinary retention was present in 4 (6.6%) cases in group A and 13 (21.3%) in group B. Post-operative bleeding was present in 44 (72.1%) cases of group A and 41 (67.2%) of group B. Constipation was higher in the group B (44.3% vs. 37.7%). Wound healing was better in group A (63.3%). Anal stenosis occurred in 3 (4.9%) patients who were treated with 
haemorrhoidectomy alone.
Conclusion: Addition of internal sphincterotomy improves the outcome of open haemorrhoidectomy in patients of third- and fourth-degree haemorrhoids. It is therefore recommended to carryout internal sphincterotomy when operating on such patients
Mental Health and Chronic Fatigue Syndrome: Is Mental Health the Culprit Behind Your Fatigue?
Authors: Raza Tahira , Chaudhry Muhammad Ashraf , Masu Ahsan , Ahmed Massiha Gulzar , Ahmed Minahil , Amin Bushra
Published: November 2023

Background and Objective: Mental health has proved to affect the physical and emotional aspects of one’s life. Appreciation of its influence on the physical functionality and efficacy of an individual may provide better treatment plans and coping strategies. This study was designed to find out the frequency of depression, anxiety, and stress among medical students at different levels of education, taking gender differences into account and its relation to chronic fatigue syndrome.
Methods: This cross-sectional descriptive study was carried out from October 2017 – March 2018. Standardized questionnaire was given to 270 MBBS students of Combined Military Hospital (CMH) Medical College, Lahore. The sampling method was non probability convenience sampling. The participants gave free consent. The data was analyzed using SPSS version 23.
Results: Out of the 270 candidates, 246 had fatigue. Females scored higher on both questionnaires and showed greater frequency of fatigue and mental health problems like stress [P = 0.004]. Over all mental health traits showed statistically significant association with chronic fatigue (P = 0.001).
Conclusion: Frequency of chronic fatigue among medical students suffering from anxiety, depression and stress is higher as compared to normal students. Female students suffer more from chronic fatigue syndrome, depression, anxiety and stress as compared to males. Strategies to evaluate and rigorously review medical student’s mental problems, and devising appropriate coping mechanisms is essential for their well-being and optimum health.
Stake Holders Opinions of Multiple Mini Interviews (MMI) for Selection of Medical Students in Pakistan.
Authors: Ali Sobia , Hashmi Muhammad Suleman Sadiq , Shoaib Syed Hasan
Published: November 2023

Background and Objective: In 2002 Multiple Mini Interview (MMI) was introduced to assess the noncognitive and/or high cognitive traits. Shalamar Medical and Dental College (SMDC), Lahore encouraged the process of MMI resulting in implementing and piloting the process from 2015. Acceptability is considered as the important aspect to support the validity evidence and since MMI was conducting the very first time in Pakistan for undergraduate admission, it was important to address its acceptability. The objective of this study is to assess the stake holder’s acceptability for Multiple Mini Interviews (MMI) for the selection of medical students.
Methods: This was a cross-sectional study and data was collected at SMDC Lahore, in years 2015 and 2016.  The research sample included candidates who applied for the admission in SMDC and examiners, trained faculty of SMDC involved in process MMI for 2015 and 2016. Acceptability of MMI was determined using post-MMI survey through questionnaire with 5-point Likert scale. Data was analysed using Statistical Package for the Social Sciences (SPSS) 20.0. Demographics were determined. Means, standard deviations and frequencies for each statement of the questionnaire were calculated. Mann-Whitney U-test was applied on the similar statements of the questionnaire among the candidates and examiners for both years separately.
Results: In post-MMI survey most of the statements showed more than 80% acceptability for MMI among stake holders for both 2015 and 2016. Comparison of similar statements among candidates and examiners revealed no significant difference except asked about the time duration (5 minutes) was enough to assess the attributes (P=0.003 & P=0.001) for both years 2015 and 2016 respectively.
Conclusion: Study provided the evidence of stake holders’ (candidates and examiners) acceptability of MMI in medical schools’ admission. It reflected that they are contented with the process
Viable Caesarean Scar Pregnancy: A Case Report
Authors: Najam Saima , Malik Sumaiyya Ejaz , Aqeel Shehla , Rizwan Nida , Haider Ali Raza
Published: November 2023

Ectopic pregnancy is a pregnancy in which blastocyst is implanted at a site other than the endometrium. When it is partially or completely implanted with in the scar it is known as caesarean scar ectopic pregnancy (CSP). It is a very rare form of the ectopic pregnancy and most of the literature available is in the form of case reports and case series. In the succeeding report of a case, a 31 years old gravida-4 para-2 with one miscarriage and one caesarean section presented in emergency department with the amenorrhea of 9 weeks and 5 days. She had moderate abdominal pain and vaginal bleeding. After in-patient evaluation she 
was diagnosed of having viable CSP, necessitating termination of pregnancy. The challenge after the diagnosis was to remove the CSP and retain future fertility without increasing the morbidity. Uterine artery embolization (UAE) followed by the laparotomy and excision of the ectopic pregnancy was carried out to reduce the risk of the hemorrhage. Early and accurate diagnosis is the key and should be followed by individualized prompt treatment in expert hands. A multidisciplinary approach is essential to reduce the overall morbidity and help retaining the future fertility of the patient.