bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical case of papulo-pustular rosacea
Authors: Evseeva Anna L. , Ryabova Vera V. , Koshkin Sergei V.
Published: November 2021

The article presents a clinical case of papulopustular rosacea from our own practice. First of all, the patient's anamnesis is extremely interesting: family history (his brother has episodes of reddening of the face), the onset of rosacea against the background of a stressful situation, the presence of gastric diseases, the connection with nutritional factors. One of the first mentions of rosacea belongs to Avicenna, who in his writings described the clinical picture of rhinophyma ("badschenan", later renamed "abedsamen"). The pineal nose, dotted with "serpentine" vessels, has traditionally been associated with excessive drinking. Currently, the role of alcohol as an etiological factor is not paramount, but its aggravating effect has been proven.
Despite the typical picture of rosacea, our patient has been receiving therapy for seborrheic dermatitis and other diseases several times over the course of several years. Probably, the specialists had doubts about the possible diagnosis of rosacea in a male patient under the age of 30.
Modern possibilities of a supporting therapy and correction of post-inflammatory skin changes in patients with acne
Authors: Tlish Marina M. , Shavilova Marina E.
Published: November 2021

Background. Acne has a net detrimental effect on the quality of life of patients, which is due not only to long-term treatment and predominance of dermatosis on the face, but also due to substantial risk of development of enduring post-inflammatory skin changes. The main part of treatment methods for post-acne marks is currently aimed at correction of already formed rash, and not at prevention of its development. In this respect, studies aimed at development of new methods for prevention and treatment of post-inflammatory skin changes in acne are particularly topical.
Aim. To evaluate clinical efficiency and tolerability of Postacnetin gel at prevention and correction of significant post-inflammatory skin changes in patients with severe forms of acne vulgaris.
Methods. 60 patients with severe forms of acne were under observation and were prescribed isotretinoin and topical medications in accordance with the Federal Guidelines of Treatment. Depending on the planned supporting therapy, the patients were divided into main and control groups of 30 people. Patients of the control group used only adapalene cream after the end of the course of systemic treatment with isotretinoin. Patients of the main group were additionally prescribed Postacnetin gel 2 months before reaching the cumulated dose of isotretinoin, and were also recommended to use it within 4 months after termination of isotretinoin therapy alongside with the use of adapalene cream. The effect of Postacnetin gel on post-inflammatory skin changes was assessed over time by counting post-acne elements, mexametry data and results of assessment of cicatrical changes according to the scale of G. Goodmann et al. Tolerability of the therapy was studied by means of monitoring of adverse reactions and calculation of the dermatology life quality index (DLQI).
Results. By the end of application of the systemic medication, persistent erythema developed less often in patients of the main group, and pigmentation and scars were clinically less severe according to the data of the mexametry and the scale of G. Goodman et al. Subsequent dynamic observation of patients of the main group revealed more significant regression of post-inflammatory changes in them. Thus, dark spots were less common in these patients in the 2nd and 4th months in comparison with the control group, and according to mexametry data, they were less severe. They also had lower severity of scars and level of the total index of the quantitative scale of G. Goodman et al. According to the results of monitoring of side effects and DLQI, both treatment regimens were well tolerated.
Conclusion. The use of Postacnetin gel in the complex therapy of patients with severe forms of acne vulgaris is an effective method for prevention and correction of persistent post-inflammatory skin changes and is well tolerated by patients.
Avaliação da influência de comorbidades cardiometabólicas sobre a evolução clínica da covid-19 em pacientes com lúpus eritematoso sistêmico no Amazonas
Authors: Franco Andrezza Mendes , Neto Sebastião Barreto Falcão , Brito Camile Smith de Oliveira , Souza Rosana Barros de , Ribeiro Sandra Lúcia Euzébio
Published: November 2021

Objetivo: Avaliar a influência de comorbidades cardiometabólicas sobre a evolução da Doença de Coronavírus de 2019 (COVID-19) nos portadores de Lúpus Eritematoso Sistêmico (LES) no Amazonas. Métodos: Estudo prospectivo, observacional e descritivo, constituinte do projeto guarda-chuva REUMACOV BRASIL. Avaliou-se as fichas dos pacientes com LES do projeto REUMACOV no Amazonas e coletados dados sociodemográficos, presença de comorbidades e evolução clínica da COVID-19. Resultados: Amostra com 137 pacientes com LES, sendo 76 com COVID-19 (grupo Caso) e 61 saudáveis (grupo Controle).  Havia comorbidades em 56,4% do Caso e 43,6% do Controle, as principais foram Hipertensão Arterial e Obesidade. O principal achado laboratorial foi a elevação de marcadores inflamatórios no Caso, especialmente naqueles com doenças associadas. Maiores taxas de hospitalizações, óbitos e limitações pós-COVID-19 ocorreram nos com comorbidades, mesmo sem relevância estatística. Além disso, o período sintomático foi maior nesse grupo. Conclusão: A influência das comorbidades sobre o prognóstico de pacientes com LES e COVID-19 foi pequena, pois embora dados tenham mostrado que esse grupo foi mais suscetível a quadros preocupantes, estatisticamente ele se mostrou semelhante ao grupo sem comorbidades.
Respectful maternity care in the achievement of universal health coverage
Authors: ANSARI HUMAIRA , YERAVDEKAR RAJIV
Published: November 2021

The attainment of universal health coverage (UHC) is incomplete without achieving respectful maternity care (RMC). While planning for UHC, the need and importance of RMC should be considered. In India, the government has started a health scheme on UHC, namely the Ayushman Bharat Scheme. RMC being an important component of UHC, if not achieved, will result in failure to achieve UHC in the true sense.
Temporal Changes in Seismic Anisotropy as a New Eruption Forecasting Tool
Authors:   , Gerst Alexander
Published: November 2021

The orientation of crustal anisotropy changed by ~80 degrees in association with the 1995/96 eruption of Mt. Ruapehu volcano, New Zealand. This change occurred with a confidence level of more than 99.9%, and affects an area with a radius of at least 5 km around the summit. It provides the basis for a new monitoring technique and possibly for future mid-term eruption forecasting at volcanoes. Three deployments of seismometers were conducted on Mt. Ruapehu in 1994, 1998 and 2002. The fast anisotropic direction was measured by a semi-automatic algorithm, using the method of shear wave splitting. Prior to the eruption, a strong trend for the fast anisotropic direction was found to be around NW-SE, which is approximately perpendicular to the regional main stress direction. This deployment was followed by a moderate phreatomagmatic eruption in 1995/96, which ejected material with an overall volume of around 0.02-0.05 km3. Splitting results from a deployment after the eruption (1998) suggested that the fast anisotropic direction for deep earthquakes (>55 km) has changed by around 80 degrees, becoming parallel to the regional stress field. Shallow earthquakes (<35 km) also show this behaviour, but with more scatter of the fast directions. Another deployment (2002) covered the exact station locations of both the 1994 and the 1998 deployments and indicates further changes. Fast directions of deep events remain rotated by 80 degrees compared to the pre-eruption direction, whereas a realignment of the shallow events towards the pre-eruption direction is observed. The interpretation is that prior to the eruption, a pressurised magma dike system overprinted the regional stress field, generating a local stress field and therefore altering the fast anisotropic direction via preferred crack alignment. Numerical modelling suggests that the stress drop during the eruption was sufficient to change the local stress direction back to the regional trend, which was then observed in the 1998 experiment. A refilling and pressurising magma dike system is responsible for the newly observed realignment of the fast directions for the shallow events, but is not yet strong enough to rotate the deeper events with their longer delay times and lower frequencies. These effects provide a new method for volcano monitoring at Mt. Ruapehu and possibly at other volcanoes on Earth. They might, after further work, serve as a tool for eruption forecasting at Mt. Ruapehu or elsewhere. It is therefore proposed that changes in anisotropy around other volcanoes be investigated.
A Treat to Xerotes: An Emerging Trend
Authors: Zainab Heena , Hugar Deepa , Sultana Ameena , Muchandi Aditya C , Mahveen Syeda Madiha
Published: November 2021

Xerostomia or dry mouth refers to a condition in which the function of salivary gland to secrete saliva is not enough to keep the mouth wet. Systemic diseases, local factors and various drugs are believed to be the causes. A sticky, dry or burning sensation in the mouth, altered taste or intolerance for spicy, salty or sour foods and cracked lips are believed to be the signs of xerostomia. So, the patients of xerostomia require distinctive care for upkeeping the oral health condition and, it is our obligation to treat such condition which involves multidisciplinary approach. Different approaches used nowadays are sugar free chewing gums, artificial saliva, sucking sugarless candies which provide symptomatic relief but recurrence is probable when treatment ends and drugs like direct acting cholinergic agonists can promote salivation but has various side effects alongside. So, to overcome such limitations,neuroelectrostimulatory devices were introduced in today's world as recent advancements in the management of xerostomia. This review aimed to describe theseneuroelectrostimulatory devices.
Ein Runenfund aus der ersten Hälfte des 6. Jahrhunderts von Záluží u Čelákovic, Bezirk Prag-Ost
Authors: Korený Rastislav
Published: November 2021

In 2008, a silver fitting from grave 39/XXXV at the cemetery in Záluží u Čelákovic was subjected to analysis. In addition to the finding that it was a fitting from a wooden bowl, of which only tiny fragments have survived, a visual inspection of the object revealed that there was a suspicious group of scratches on its surface, the form of which resembled ancient Germanic runes. The aim of the contribution is not only to publish them, but also to draw attention to a so-far unknown group of monuments.
Effect of ondansetron application on neural tube development in 48-hour chick embryos
Authors: Yildizhan Serhat , Koca Tulay , Vurmaz Ayhan
Published: November 2021

The study aims to show that ondansetron, which is used safely in pregnant women, can cause serious side effects. Neural tube defects are among the most common congenital malformations of the central nervous system. It is known that genetic predisposition, environmental factors, and some drugs play an important role in the development of neural tube defects. Ondansetron is a selective 5-hydroxytryptamine-3 receptor antagonist used in the treatment of cancer, nausea, and vomiting during pregnancy and after anesthesia. In the literature studies, it was not found that developmental anomalies were observed. Seventy-five free specific pathogen eggs were incubated for 32 hours and divided into five groups of 15 eggs each, including a control group. Ondansetron was administered to these five groups by sub-blastoderm route in 4 different doses with a Hamilton microinjector. At 48 hours of incubation, the embryos were dissected and examined morphologically and histopathologically. At the end of the study, a significant dose-dependent decrease was observed in crown-rump lengths, somite numbers, and mean the number of silver-dyed nucleolar regulatory regions (AgNOR) and total AgNOR / nuclear area ratios. Statistically significant differences were observed between the experimental groups in terms of neural tube closure (p <0.05). Ondansetron has been shown to affect neuronal development and vertebral growth in chicken embryos depending on increasing doses.
The link between cord blood IL-1β, TLR4, PGE2 and TAC values with neonatal diseases
Authors: Gurel Selcuk , Karadag Gurel Aynur
Published: November 2021

Premature birth is an important cause of neonatal mortality and neonatal morbidity. Most premature births are known to be induced by cytokines released for different reasons. Inadequate congenital immune response in premature infants may contribute to increased susceptibility to infection. The aim of the study is to determine the IL-1β, TLR4, PGE2, and TAC profiles in cord blood with characteristics specific to pregnancy and the correlation with neonatal complications caused by premature birth. The study included 26 neonates, 11 girls and 15 boys, born from 24-42 weeks of gestation. Of these, 13 were term and 13 were preterm . For IL-β, PG-E2, TLR4 and TAC levels, 1 mL of cord blood sample was taken from preterm and term neonates. Data related to demographic data, clinical status of patients and outcomes were obtained from electronic medical records and files. Cytokine values obtained from premature neonates were statistically high in terms of TLR4, IL1 and PGE2 compared to term infants. The TRL4 and IL1 values for premature infants with necrotizing enterocolitis and retinopathy of prematurity were lower compared to those without NEC and ROP. In spite of negative correlations between TAC and the other three cytokines, a statistically significant correlation was not identified. TLR4, IL1 and PGE2 were negatively correlated with weight and gestational week, contrarily TAC measurements were positively correlated with weight and gestational week. Measurements of cytokine concentrations in cord blood are among important biomarkers showing degree of inflammation and may assist in predicting neonatal complications and play an effective role in development of specific treatments.
Linguostylistic and linguopoetic analysis of E. E. Cummings’ i carry your heart with me (i carry your heart with me)
Authors: Morozova Halyna
Published: November 2021

Article deals with linguostylistic and linguopoetic analyses, which emerged in the middle of the previous century and were developed by the world’s leading linguists. Linguostylistics and linguopoetics are interdependent branches of linguistics. The first one consists of three levels: semiotic, metasemiotic and metametasemiotic. At first literary text is examined at phonetic, lexical and grammatical levels, where each word is considered as an independent part of speech. The second level analyses each language unit in combination with others. At this point attention is drawn to metaphors and other figurative expressions. Metametasemiotic level is also known as linguopoetic analysis of the literary text. It is a vertical analysis, which identifies main tools for creating the aesthetic effect of poetry on reader.

E.E. Cummings is an American poet, essayist, and playwright. His poetry is known for the frequent use of graphic, lexical and grammatical deviations, as well as phonetic and lexical parallelism. In this article the author offers an outline of linguopoetic and linguostylistic analyses of E.E. Cummings’ poem i carry your heart with me (i carry it in according to the described system at semiotic and metasemiotic levels.

The results of linguostylistic analysis describe elements that draw readers’ attention. Hence, the main tools the author uses at semiotic level are decapitalization, assonance and alliteration, which create rhythm in the poem. Enjambment compensates for the lack of punctuation. Metasemiotic analysis singles out metaphors based on the comparison of the you-character with symbolic images of the sky, heart, tree and others. Linguopoetic analysis outlines elements that draw readers’ attention and bring forth aesthetic function of the poem.
Old age representations in Constanze Dennig’s dystopia “Exstasy Rave”
Authors: Gaidash Anna , Kadubovska Svitlana
Published: November 2021

The paper tackles the representations of old age in Constanze Dennig's dystopia "Exstasy Rave". Modern theatrical tendencies and the role of drama as a mouthpiece of social ideas, in particular in matters of aging and old age, are related; ageist stereotypes in the text of Constanze Dennig are analyzed; problem-semantic aspects of corporeality are studied; the possibilities of author's remodeling of discriminatory stereotypes of old age are inferred. The challenges presented by the Austrian woman playwright in her drama allow us to attribute her work to the post-dramatic theater, which in Lehmann's sense is able to help restore the social continuum and support society's internal unity. Through the mouths of the protagonists and the nonverbal plane, Dennig's drama becomes a means of communication in society. The analyzed age stereotypes of the play reveal the author's reflection on the social challenges of modern Western society, including the attitude to the third age and the aging process. In the dystopia, old age is perceived as a physical and moral decline and a burden on society. In the future, discriminatory practices against the older generation are not only verbal, but also physical (forced euthanasia). There are manifestations of self-stereotyping by the aged dramatis personae themselves. Carefully read problem-semantic aspects of corporeality in a dramatic text are a segment of ageist discourse, sometimes with a political color. Yet, the woman playwright offers mechanisms for remodeling the ageist consciousness by means of the female characters (Eva, Michaela). Dennig constructs a sharply negative vision of the potential consequences of the ageist attitude towards the elderly because she observes their roots in the socio-economic and moral-ethical issues of today. Thus, old age is a litmus test for the social morality of Europeans, who set an example to the younger generation with their attitude to old age.
The impact of Risk Identification on IT Project Delivery in Qatar Public Sector
Authors: Oshi Mutaz , Abushanab Emad
Published: November 2021

Unmanaged project risks can jeopardize the project's success and outcome. To assist project managers in overcoming or reducing the impact of project risk, several risk management models and standards have been established. This study is aimed to assess the impact of identified IT project risk factors on project delivery (satisfaction) in Qatar’s public sector. A questionnaire consisting of identified risk factors was developed by reviewing related literature. Data were collected from the target sample and analyzed using SPSS and SmartPLS. The results demonstrated the impact of each of the nine identified risk factors with the dependent variable project delivery (satisfaction). The hypotheses analysis showed five hypotheses H1, H2, H5, H6, and H8 supporting the literature with a positive impact on project delivery (satisfaction). Those factors are namely, the Stakeholders, Business Process, Organizational, Technical, and Schedule with significant P-values of 0.030, 0.002, 0.028, 0.023, and 0.001, respectively. The other four hypotheses H3, H4, H7, and H9 are inconsistent with the literature, with (insignificant) high P-values resulting in a negative impact on project delivery (satisfaction). Those factors are namely, Project Management, Human resources, Budget, and External with P-values 0.164, 0.605, 0.096, 0.225, respectively. The researcher recommends that project management professionals consider the five identified risk factors with a positive impact as the most critical IT risk factors; the research findings serve as a foundation and guideline to help the project management community avoid project pitfalls commonly associated with poor risk management and project failure.
Effective Smart Contracts for Supply Chain Contracts
Authors: Aejas Bajeela , Bouras Abdelaziz
Published: November 2021

Blockchain is in its way of revolutionizing different sectors with its decentralized peer-to-peer networking. Smart contracts are the piece of software that have written rules to be executed automatically to update the state of the block chain in a systematic way. One of the main use of Smart contract is in Supply Chain management. Supply Chain management deals with lot of legal contracts at a time. Contracts are agreements between two or more parties that define the duties and obligations for execution of any kind of activities. In this research, we are trying to automate the supply chain related contracts by identifying the important entities such as contract type, start date, end date etc., by using Natural Language Processing methods, then convert the contract to smart contract. This provides an efficient template for creation of smart contracts from natural language contracts and thereby offer best smart contract template for a given type of contract in Supply Chain.
Machine Learning Approach to predict Metro Ridership based on Land Use Densities
Authors: Alkhereibi Aya Hasan , Wakjira Tadesse , kucukvar Murat , Qidwai Uvais , Muley Deepti , Siam Abdalla
Published: November 2021

Predicting metro ridership is an essential requirement for efficient metro operation and management. The dependence of metro ridership on the land use densities entails a need for an accurate predictive model. To this end, the current study is aimed to develop a novel machine learning (ML) based model to predict the metro station ridership utilizing the land use densities near metro stations. The ridership data was obtained from Qatar Rail, and the land use data were obtained from the Ministry of Municipality and Environment in Qatar. The land use densities in the catchment area of 800 m around the metro stations have been considered in this study. The non-linear relationship between the metro ridership and land use densities has been captured through different ensemble ML models including random forests, extremely randomized trees, and gradient tree boosting. Results showed that the ML models, once meticulously optimized and trained are capable of producing an accurate prediction for metro ridership. Among the ML models, gradient tree boosting showed the highest prediction capability. The authors concluded that the proposed prediction model can be utilized by both urban and transport planners in their processes to plan the land use around metro stations, predict the transit demand from those plans, and ultimately achieve the optimal use of the transit system i.e., Transit-Oriented Developments.
The Gravity of Distance: Evidence from a Trade Embargo
Authors: Al-Malk Afnan , Maystadt Jean-Francois , Zanardi Maurizio
Published: November 2021

On June 5, 2017, an airspace blockade was imposed on the State of Qatar by four of its neighbors: Saudi Arabia, Bahrain, United Arab Emirates, and Egypt. We study the exogenous increase in air transportation costs with non-blockading countries to examine the effect of increased travel distance on bilateral trade. Based on a gravity model estimated with a Poisson pseudo-maximum likelihood, we find a distance elasticity of trade between -0.3 and -0.5. Our findings revise downwards cross-sectional estimates of the distance elasticity of trade and confirm more recent estimates exploiting similar time-varying shocks to distance.
Qatar’s Labor Law changes and Workers’ Welfare: Attitudes & Perceptions for a Sustainable Future
Authors: Diop Abdoulaye , Kien Le Trung , AL Khelaifi Buthaina , Al Qassass Haneen , Bader Lina , El-Maghraby Engi , Mustafa Semsia Al-Ali
Published: November 2021

From September 22 2020 to January 19 2021, the Social and Economic Survey Research Institute (SESRI) at Qatar University surveyed 2,760 individuals, including Qatari nationals, higher-income and lower-income expatriates about Qatar’s recent Labor Law changes. The survey is based on a nationally representative sample interviewed by telephone in nine different languages. The survey shows that both Qataris and resident expatriates have a mostly positive perception of the recent Labor Law changes and their impact on Qatar’s economy and the working and living conditions of expatriates. However, the findings also indicate that public awareness surrounding the new legislative reforms remains low.
A Comparative UG Near-peer Mentoring Model for Motivating School Students towards Innovations during E-STEM Education: A Case Study of Qatar
Authors: Santhosh Malavika Elaveetil , Bhadra Jolly , Saad Azza , Magdy Rana , Alkhair Shahad , Ali Ruba , Ehalwary Enas , Al-Thani Noora
Published: November 2021

The importance of online education and online learning has gained colossal importance during the present era. Despite online education being the savior during the current pandemic, its implementation was/has been quite puzzling. This article describes a novel approach to the execution of an E-STEM (online- Science, technology, engineering, mathematics) course for school students by integrating the near-peer mentoring approach. Wherein, the undergraduate (UG) students were the near-peer mentors, who had mentored/guided the school students (middle school & high school). Even though the E-STEM course was developed & presented by the STEM professionals, it was the near peer-mentors who were responsible for the constant motivation & assessment of the school students. The paper displays several roles of the UG mentors, predominantly aiding the students’ motivation and also their assessment via a triangulation assessment approach: with the UG mentors being responsible for the indirect and embedded assessment of the students. The STEM course was efficaciously conducted for 56 students of high school and middle school students, involving 16 undergraduate near-peer mentors. Various E-tools and student-feedback mechanisms were used to implement the E-STEM course in a student-centered manner. Thereby, to reveal the success of the model, the student’s feedback, pre-post questionnaires, and text message transcripts were investigated. The constructive roles of undergraduate mentors, in aiding the school students towards their active engagement, and STEM innovations, during E-learning, have been validated. A clear comparison had been made between the behavioral aspect of the high school students and middle school students with the UG mentor. Therefore, unlike many studies that had shown the success of the near-peer mentoring model, our article addresses the underlying process, that contributes to the success with a distinct comparison between the two (prior mentioned aspect).
Comparison of peripheral blood smear examination with automated haematology analyzer for diagnosing different types of anemia.
Authors: Asghar Rabiah , Tariq Javera , Naeem Nabeela , Zafar Anila , Qureshi Khadija , Majeed Shameela
Published: November 2021

Objective: This study aims to determine diagnostic accuracy of peripheral blood smear and automated haematology analyzer and to determine frequency of different types of anemia diagnosed by peripheral blood smear and automated hematology analyzer. Study Design: Cross Sectional study. Setting: Department of Pathology, Rawal Institute of Health Sciences, Islamabad. Period: November 2015 to April 2016. Material & Methods: Sample size of 149 suspected anemia patients was calculated using WHO calculator with 95% confidence interval. Research approval was taken from hospital ethical board. Patients were approached through non probability consecutive sampling method. Both peripheral blood smear examination and automated haematology analysis of each sample was performed. Diagnostic accuracy and frequency of anemia types was measured. Data analysis was done with the help of SPSS version 25. Chi-square and fissure exact test and ROC curve analysis was applied and significant (p<0.05) results were reported. Results: Total 149 patients were included in study. There were 42(28.2%) male and 107(71.8%) female.  Mean age of patients was 35.1±2.1SD. Peripheral blood smear and automated haematology analyzer showed sensitivity (68% vs 92%), specificity (59% vs 88%), PPV (72% vs 92%), NPV (55% vs 88%) and diagnostic accuracy (64% vs 91) respectively. Most common type of anemia diagnosed with peripheral blood smear was microcytic hypochromic anemia with raised RDW 36.7% followed by normocytic normochromic anemia with raised RDW 13.3% and macrocytic anemia (p=0.001) while in automated haematology analyzer microc ytic hypochromic anemia with raised RDW54.4% followed by normochromic normocytic anemoia with normal RDW 11.1% (p=0.000). Conclusion: Automated haematyology analyzer had high diagnostic accuracy for diagnosis of anemia.  Microcytic hypochromic anemia and normocytic normochromic are most common anemias diagnosed by peripheral blood smear and automated hematology analyzer and peripheral blood smear cannot be completely replaced by automated haemolytic analyzer. However, if both methods are used simultaneously, more accurate results can be obtained.
Frequency of peripheral neuropathy in newly diagnosed cases of type II diabetes mellitus.
Authors: Yar Altaf Ahmad , Javed Munaza , Shahzad Muzamul , Iqbal Javed , Aslam Muhammad Imran , Khan Zafar Ahmad
Published: November 2021

Objective: The aim of this study is to determine the frequency of peripheral neuropathy in newly diagnosed cases of type II diabetes mellitus. Study Design: Cross Sectional Study. Setting: Department of Medicine at Avicenna Medical & Dental College, Lahore. Period: 1st February 2020 to 31st July 2020. Material & Methods: One hundred and twenty newly diagnosed patients of type 2 diabetes mellitus were enrolled in this study. Patients detailed demographically recorded after getting written consent. Patients were diagnosed for the duration of 4-weeks and calculated fasting blood sugar (FBS) of ≥126mg/dl, and Random Blood Sugar (RBS) of ≥200 mg/dl or HbA1c ≤6.5. Results: Seventy (58.3%) were males and rest 50 (41.7%) were females with mean age 37.15±10.91 years. Mean body mass index of the patients was 22.48±3.66 kg/m2. Forty two (35%) patients had symptoms of peripheral neuropathy while that patient’s who did not have any symptom was 78 (65%). Same symptoms were observed within 4-weeks and we noticed that 23 (19.2%) patients showed peripheral neuropathy and rest 97 (80.8%) patients did not have any symptoms. Conclusion: The frequency of peripheral neuropathy is higher in early stages of type II diabetes mellitus and its frequency can be reduced to diagnose within a month.
Histopathological spectrum and outcome of surgery for salivary gland tumors presented in tertiary care hospital of Pakistan.
Authors: Ammar Ahmed Siddique , Khalid Rizwan , Naqi Syed Asghar , Khattak Shehrbano , Inayat Farwa , Asghar Sohail
Published: November 2021

Objective: This study is aimed to know the histopathological spectrum and outcome of surgery for salivary gland tumors presented in a tertiary care hospital of Pakistan. Study Design: Retrospective study. Setting: Tertiary Care Hospital of Pakistan. Period: July 2018 to June 2020. Material & Methods: After approval from Institutional Review Board. Total 73 patients were selected with preoperative diagnosis of salivary gland tumors with consecutive non probability sampling. All surgical procedures were done by specialist general surgeons who had experience of more than 10 years of head and neck surgery. Results: Male to female ratio was 2:1 with mean age of patients was 46 years. Among males 29 (59.1%) were benign salivary gland tumors while 20 (40.81%) were malignant salivary gland tumors. Among females 13 (54.16%) were benign and 11 (45.83%) were malignant salivary gland tumors Most common benign tumor was pleomorphic adenoma 32 (43.8%) while mucoepidermoid carcinoma was most common malignant tumor 17 (23.28%). Only 9 (12.32%) patients experienced nerve paresis. Conclusion: Male preponderance, a relatively younger age at presentation and single predominant benign tumor (pleomorphic adenoma) were the significant findings. Majority of them were found in parotid gland and found to be benign in nature. Majority of them were found in parotid gland and found to be benign in nature. Although fine needle aspiration cytology and magnetic resonance imaging provide some useful information about the nature of tumor but most of them will acquire a surgical excision in order to find the definitive diagnosis.
Intravenous analgesia versus thoracic epidural catheterization in moderately severe pancreatitis: A randomized controlled trial in a tertiary care health facility.
Authors: Khadija Ghulam , Syed Waqas Hasan , Ullah Sana , Aziz Munazzah , Nawaz Sumaira , Zareen Abeera , Changeez Mehwish , Malik Sara , Tariq Maham , Khan Jahangir Sarwar
Published: November 2021

Objective: In this study we evaluated the two most commonly used methods for pain relief in acute pancreatitis i.e. epidural analgesia and I/V analgesia and compared the results. Study Design: Randomized Controlled Clinical Trial. Setting: Surgical Unit-1 of Holy Family Hospital, Rawalpindi. Period: June 2019 to June 2020. Material & Methods: Patients presenting with acute pancreatitis with moderate severity were divided into groups A and B. In group A patients, epidural catheter was passed at T9-T10 level epidural space and they received 0.125% Bupivacaine injection every 4 hours, while group B patients received combination analgesia in the form of IV tramadol 100mg TDS and IV Toradol 30mg BD. Pain was assessed by using visual analog scale (VAS) at 12 hour intervals. Rescue analgesia, in the form of IV paracetamol 1g given in the case of >7 VAS score was also recorded. Results: Total 100 patients were included according to the inclusion criteria of the study. Patients were randomly divided into two groups; Group A (Epidural) and group B (intravenous). Mean age (years) in the study was 42.39+11.21 whereas there were 37 male and 63 female patients who were included in the study. In our study, mean pain score in group A was 3.16+1.23 which was significantly lower than group B (5.42+1.01), p-value < 0.0001. There was a single mortality in the study. 6 patient’s required ventilatory support due to respiratory complications, 5 in group B and 1 in group A. Conclusion: Epidural analgesia is superior to I/V analgesics in pain management of moderately severe pancreatitis and it also reduces respiratory morbidity in these patients.
Haemophilus influenzae infection among children with acute bacterial meningitis.
Authors: Muhammad Shahzad Maqsood  , Hussain Safdar , Asim Khurshid
Published: November 2021

Objective: To determine the frequency of haemophilus influenzae infection in children less than 5 years with acute bacterial meningitis (ABM). Study Design: Descriptive Cross Sectional study. Setting: Department of Pediatric Medicine, The Children’s Hospital and Institute of Child Health, Multan. Period: October 2019 to March 2020. Material & Methods: A total of 165 children aged 5 – 60 months of either gender having acute bacterial meningitis with duration of < 2 weeks were enrolled. Cerebrospinal fluid (CSF) of each child was sent for microbiological analysis. Results: There were 106 (64.2 %) boys and 59 (35.8 %) girls. Mean age was 2.72 ± 1.07 years. Most cases, 112 (67.9 %) belonged to urban areas.  Maternal literacy was positive in 65 (39.4%) cases while 59 (35.8%) were fully vaccinated. Mean disease duration was 56.25 ± 15.36 hours and 112 (67.9%) had duration of illness more than 36 hours. Frequency of Haemophilus Influenzae was noted in 35 (21.2%) cases. Conclusion: Frequency of Haemophilus Influenzae was high among children with acute bacterial meningitis. Early diagnosis and appropriate management might help reducing prolonged hospitalization and disease morbidity related to Haemophilus Influenza.
Intraventricular meningiomas: A case series and literature review.
Authors: Urooj Fatimah Siddiqui  , Muhammad Faiq Ali  , Muhammad Asim Khan Rehmani  , Atiq Ahmed Khan  , Sheeraz  , Ramesh Kumar  , Imran
Published: November 2021

Objective: Intraventricular meningiomas (IVMs) are rare type of meningiomas. Majority of IVMs are located in lateral ventricles. Study Design: Case Series. Setting: Civil Hospital Karachi. Period: January 2013 to January 2018. Material & Methods: 15 patients were assessed with histologically verified IVMs, clinical features, radiological findings, surgical approaches, outcome and literature review. Results: The most common presentations included raised intracranial pressure (66.7%), visual deficits (40%), cognitive changes and dysphasia. All lesions arose in the lateral ventricles. Preoperative diagnosis was confirmed on MRI. Excision was performed using the posterior parietal and parieto-temporal approach for lateral ventricle tumors. Total excision was done in 13 out of 15 patients and two patients with residual tumor underwent stereotactic radiosurgery. Biopsy report showed WHO grade-I lesion in all cases. Postoperative complications included CSF leakage, transient hemiparesis and dysphasia. Glasgow Outcome Score of 5 was found in majority of cases (87%) on follow-up. Conclusion: These results depict that IVMs can be excised completely with minimum postoperative morbidity. However, resection requires planning to avoid eloquent cortical damage.
The incidence of myocarditis in patients with COVID-19 and in-hospital mortality.
Authors: Muhammad Zahid Ali  , Irfan Younus  , Sohail Yousuf  , Muhammad Javed  , Khalil Iqbal  , Faiza Altaf
Published: November 2021

Objective: To determine the Incidence of myocarditis in patients with COVID-19 and in-hospital mortality. Study Design: Observational Cohort study. Setting: Aziz Bhatti Shaheed Teaching Hospital, Nawaz Sharif Medical College, Gujrat. Period: 15 to 30 March 2020. Material & Methods: Patients with positive PCR results for COVID-19 were included in this study after informed consent; patients with prior history of any cardiovascular, pulmonary or other co-morbidity were excluded while patients having history of hypertension, diabetes or smoking were included in the study. All the patients remain admitted for 14 days. Patients were evaluated clinically, by ECG, troponins and echocardiographically for diagnosis of myocarditis. Patients were managed conservatively. Incidence of myocarditis and in-hospital mortality was noted. Successful treatment towards hospital discharge was relief of clinical symptoms, a-febrile, clear chest X-Ray and at least two consecutive negative PCR for covid-19. P-value <0.05 was considered as significant. Data was analyzed with SPSS -23. Results: Out of fifty five, 5(9%) patients were diabetics and 4 were hypertensive. Five (9%) developed mild pneumonia which recovered conservatively and three (5.4%) patients developed myocarditis. One (1.8%) patient expired having myocarditis. Duration of follow up was only during hospital stay. So our in-hospital mortality was 1.8%, p value was calculated as significant < 0.05. Conclusion: Myocarditis is a known but less common complication of COVID-19. Cardiac injury is more in those with previously having cardiovascular or other co-morbidities. In healthy and immunocompetent population its incidence is quite low.
Irritable bowel syndrome among medical students and its association with anxiety.
Authors: Sehrish Shafique  , Naveed Faraz  , Hina Wasti  , Ambreen Surti
Published: November 2021

Objective: To find out the frequency of Bowel Syndrome (IBS) among medical students according to ROME 111 criteria. To find out the frequency of common subtypes of IBS among the IBS positive medical students. To observe the association between anxiety, depression, and irritable bowel syndrome according to HAD scale. Study Design: Cross Sectional study. Setting: Medical Students of BUMDC. Period: September to November 2020. Material & Methods: The study was conducted among the medical students at a private medical college in Karachi. Ethical approval taken. After taking consent questionnaires were given. The total students with irritable bowel syndrome were presented by their frequencies, then finding were analyzed using ROME 111 and HAD scale. Results: A total of 370 students were included after considering inclusion and exclusion criteria. Out of which 152 students (41%) were found to have irritable bowel syndrome according to ROME 111 criteria. The most common IBS subtypes seen in our study was IBS –D (diarrhea) 80. Among those students diagnosed with IBS, anxiety was positive in 100 students while depression was seen in 5 students according to HAD scale. Conclusion: This study concludes that medical students are more prone to develop IBS which is aggravated by stress related anxiety for having extensive curriculum and pressure from the peers of having good score in exam among intellectual section of the society which is not an easy task to cope up.
Surgical repair of Vesico-Vaginal: Vaginal route versus abdominal route.
Authors: Abdul Qayoom Khuro  , Illahi Bux Brohi  , Muhammad Shahid Bhatti
Published: November 2021

Objective: To determine outcomes and complications of vesico-vaginal fistula repair via vaginal and abdominal route. Study Design: Cross Sectional study. Setting: Department of Urology and Kidney Transplantation, Pir Abdul Qadir Institute of Medical Sciences Gambat. Period: January 2020 to December 2020. Material & Methods: Patients having vesicovaginal fistula irrespective of age and fulfilling our inclusion criteria were included in the study using non-probability consecutive sampling technique. Patients having very large fistula, fistula involving neck of urinary bladder, failure of previous operation, patients with malignancy or co-morbidities were excluded from the study. Vaginal and abdominal approaches were used for fistula repair depending upon the level of fistula. Those operated via vaginal route were kept in trans-vaginal group and those operated via abdominal route were assigned trans-abdominal group. Results: Total 35 cases were studied having age 16-45 years with mean age of 32.6 ± 4.2 years. Transvaginal fistula repair was done in 37.1% and transabdominal repair was done in 62.8% cases. Most common cause of VVF was previous gynecological surgery in 77% cases. Success rate was 100% in transvaginal fistula repair as compared to 95.4% success rate achieved in transabdominal repair of fistula. Conclusion: Trans abdominal and transvaginal route both are good approaches but Transvaginal route of fistula repair is associated with high success rate than transabdominal route with minimum complications and better outcomes but it needs expert surgeon.
Management of retrosternal goitres: A 4 year institutional review in a tertiary hospital.
Authors: Ihsan Ullah  , Sanaullah Khan  , Nazish Izhar Khan  , Azam Jan  , Mohammad Ahmad Arsalan Khan  , Muhammad Khizar Hayat
Published: November 2021

Objective: To account for the characteristic presentations, pathology and the post-operative complications of surgical treatment of retrosternal goitre. Study Design: Retrospective Descriptive study. Setting: Department of Otorhinolaryngology at Rehman Medical Institute, Peshawar. Period: July 2016 and December 2019. Material & Methods: All patients that underwent thyroidectomy during the study period were included in the study. The thyroid gland that did not have retrosternal extensions were excluded. Retrospective chart records of all these patients were analysed. Data obtained from the charts was recorded on Statistical package for social services version 23.0 and analysed for descriptive statistics. Results: 67 patients with goiters were at the tertiary care center of Peshawar, females (77.6%) and males (22.4%). 6 (8.9%) were retrosternal. The most common symptoms were neck swelling (83.3%) followed by shortness of breath (66.7%). Post-operative hypocalcaemia was the most common complication among retrosternal thyroidectomy patients (66.7%). Only one patient needed sternotomy. Conclusion: All patients with retrosternal goitre should be offered surgery. The post-operative complications are low and resolve uneventfully.
Clinical and epidemiological characteristics of pediatric and adolescent patients of COVID-19, an experience of a Divisional Corona Center, Bahawalpur from South Punjab, Pakistan.
Authors: Ali Hammad  , Muhammad Naeem  , Hafiz Muhammad Anwar  , Ameer Ahmad
Published: November 2021

Objective: To assess various clinical and epidemiological characteristics of pediatric and adolescent patients of COVID-19 of Bahawalpur division, to improve their outcome and management. Study design: Descriptive Cohort study. Setting: Department of Pediatrics, Civil Hospital Bahawalpur. Period: 1st March to 30th July 2020.  Material & Methods: Data of patients was recovered from hospital record. Data of variables like age, gender, rural or urban living area, symptomatology and need for hospitalization was collected from hospital record. Results: Out of total 516 diagnosed COVID-19 patients, 5.4% patients were of age less than 20 years, 32% from birth to 5 years, 20% from 6 to 10 years of age, 21.4% were 11 to 15 years of age, 28.5% were 16 to 20 years age group. 57.1% were male and 42.8% were female. 42.8% were asymptomatic, 32% patient had respiratory symptoms, 25% had Gastro-intestinal symptoms. 64.2% belonged to urban territory of living, 35.7% belonged to rural. 81.2% patients fall in mild category and 18.7% in moderate. Mortality was Null. Hospitalization was needed in 53.5%, while 46.5% were home quarantined. Mean duration of hospital stay was 14+1 days. Conclusion: Pediatric and adolescent patients have mild to moderate disease severity leading to better outcome of the disease.
Outcomes of arthroscopic Bankart repair (ABR) for anterior shoulder instability using two knotless suture anchors fixation.
Authors: Sana Ullah  , Waqas Haleem  , Muhammad Waqar  , Zeeshan Khan  , Israr Ahmad  , Muhammad Arif Khan
Published: November 2021

Objectives: The purpose of this study is to evaluate the short term outcomes of isolated Arthroscopic Bankart Repair (ABR) using knotless suture anchor technique, in young and middle aged patients with post traumatic Anterior Shoulder Instability (ASI). Study Design: Prospective Observational Study. Setting: Sports Units of Hayatabad Medical Complex, Peshawar. Period: January 2018 to December 2020. Material & Methods: 32 patients were included in this study, all of them were male, and who had traumatic anterior shoulder dislocation and underwent Arthroscopic Bankart Repair (ABR), with at least 2 years follow-up and minimum of 4 months of physiotherapy postoperatively. Sample size was calculated through non-probability consecutive sampling technique. Recurrent instability, postoperative glenohumeral osteoarthritis, post-surgical complications and subjective scores (Simple Shoulder Test [SST], American Shoulder and Elbow Surgeon [ASES] and Rowe scores) were evaluated. Results: Among the 32 participants, five patients (15.6%) experienced at least one episode of redislocation, eight patients (25%) had moderate to severe glenohumeral-osteoarthritis. The overall satisfaction rate was 76% with ASES, SST and Rowe scores of 82%, 9% and 79% respectively. One patient (3.12%) had wound infection. Conclusion: Isolated Arthroscopic Bankart Repair (ABR) using knotless suture anchor fixation  for anterior shoulder instability followed by physiotherapy has excellent short term outcome in term of low post-surgical complication rate, high patient satisfaction, ability to joint work back and improved subjective scores, although high rate of postoperative glenohum eral osteoarthritis is disappointing necessitating further studies on the matter.