bluuebunny/crossref_metadata_2025 huggingface dataset:
Cultura ambiental y uso de residuos sólidos en la comunidad educativa de la institución etnoeducativa Pedro Romero del distrito de Cartagena, Bolívar
Authors: Castillo Pacheco Zaida Yanira , Chacón Sánchez Anyela Marcela
Published: October 2022

En la Institución Etnoeducativa Pedro Romero confluyen estudiantes de estratos 0, 1 y 2 de barrios populares de la ciudad de Cartagena, personas vulnerables, de escasos recursos y de bajo nivel académico, en su gran mayoría. Actualmente, la institución cuenta con un Proyecto Ambiental Escolar (PRAE) en el que se consignan diversas estrategias pedagógicas que conllevan a la sensibilización de los estudiantes en temas ambientales. El presente proyecto de investigación está encaminado a analizar la cultura ambiental y el manejo de residuos sólidos de docentes, directivos docentes, padres de familia y estudiantes de los grados décimo y once de la Institución Etnoeducativa Pedro Romero, utilizando el método mixto, con instrumentos cuantitativos y cualitativos. se concluye que se necesita contar con el compromiso de la institución educativa y de las instituciones encargadas de los temas ambientales para generar un conocimiento práctico mediante experiencias significativas y por medio de la transversalización en todas las áreas.
Sistema de comercialización de las pequeñas empresas agropecuarias de la ciudad de Pilar, año 2022
Authors: Monges Gómez Federico Daniel , Domínguez Alarcón Lucas Daniel
Published: October 2022

El presente trabajo se enmarca dentro de los estudios no experimentales, de tipo descriptivo, con métodos de estudio cualitativo y cuantitativo. Lo que permitió llegar a la conclusión que el crecimiento de la comercialización de un año con respecto al otro se mantiene y existe un pequeño aumento. El gasto operativo se ha incrementado, el volumen de venta es en general muy bueno, siendo productos de primera necesidad y el costo aún es accesible para la población, aunque exista una competencia bastante fuerte de los microempresarios mayoristas, para los minoristas y sobre todo para los estrategas que realizan el acto de la comercialización y entrega de puerta en puerta, el cual es un servicio que gusta a la comunidad, por ende, va en incremento en la población pilarense, lo que nos expresa que el hecho da resultados favorables tanto en relación con lo planificado como con el período anterior. Uno de los aspectos negativos de la comercialización de los productos agropecuarios, es que no siempre se mantiene la calidad de los mismos, por lo tanto, solo a veces existe correlación entre calidad y precio de los productos.
O EXERCÍCIO FÍSICO NA GRAVIDEZ: UMA REVISÃO SISTEMÁTICA DA LITERATURA
Authors: Alves Daniela Maria Bicho , Pacheco Raquel Sofia Guerreiro , Frias Ana Maria Aguiar
Published: October 2022

A gravidez é uma condição única para cada mulher, podendo ser acompanhada de alguns desconfortos inerentes. A prática de exercício físico traz inúmeros benefícios conhecidos nas variadas dimensões do ser biopsicossocial para o individuo. Durante a gravidez é uma prática que suscita ainda alguma renitência associada ao desconhecido e/ou receio. O objetivo deste estudo foi avaliar se a prática de exercício é uma intervenção segura e benéfica para o bem-estar da grávida, através de uma revisão sobre estudos relativos à influência do exercício físico na gravidez. Foi realizada pesquisa em três bases de dados científicas, MEDLINE Complete, CINAHL Complete e Cochrane Central Register of Controlled Trials, por três autores de forma independente. Aplicados os critérios de inclusão e exclusão, elegeram-se 6 estudos para inclusão na presente revisão. Vários benefícios relativos à prática de exercício foram evidenciados, tanto a nível físico para a grávida e feto, como a nível psicológico, sendo reportado o bem-estar como a condição mais relevante e transversal a todos os estudos. O exercício físico adequado à gravidez consiste numa prática segura com efeitos benéficos para a grávida. Benefícios anatomofisiológicos, mas sobretudo a nível do bem-estar geral, sentimentos e qualidade do sono foram descritos, exercendo estes últimos grande influência a nível psicológico e atuando de forma preventiva a várias desordens psicológicas. Comprovou-se a importância que a educação para a saúde tem na adesão à prática de exercício pela grávida, assumindo-se a necessidade de criação de estratégias que visem a atuação do profissional neste âmbito.
INFLUÊNCIA DA SUPLEMENTAÇÃO DE ÁCIDO FÓLICO AO NÍVEL DA DÍADE MÃE/FILHO: UMA REVISÃO INTEGRATIVA
Authors: Ildefonso Helena Alexandra da Silva , Domingos Raquel Filipa Fernandes , Frias Ana Maria Aguiar
Published: October 2022

As evidências apontam para a importância de uma nutrição adequada na prevenção de desequilíbrios nutricionais antes e durante a gravidez, nomeadamente, ao nível da suplementação de ácido fólico. A sua ausência, deficiência ou até mesmo excesso pode desencadear alterações/malformações ao nível fetal e materno. Objetivo: Analisar a influência da suplementação de ácido fólico ao nível materno e no desenvolvimento do embrião/feto. Metodologia: Recorreu-se a uma Revisão Integrativa da Literatura, nas bases de dados National Library of Medicine - Pubmed, CINAHL Complete, Medline Complete e Nursing & Allied Health Collection: Comprehensive Edition (EBSCOHost web), utilizando como auxiliar de construção a metodologia PICO. Resultados: Da literatura analisada pôde aferir-se o efeito preventivo que o ácido fólico exerce na mulher, desde a fase pré concecional até ao nascimento do filho, na redução do risco de pré-eclâmpsia e hipertensão gestacional, mas também de patologias associadas ao desenvolvimento físico e neuropsicológico da criança, como defeitos ao nível do tubo neural, transtornos do espectro do autismo, entre outros. Conclusão: A suplementação com ácido fólico numa fase precoce, assim como a prática de uma correta nutrição, potenciam o desenvolvimento de uma gestação de sucesso, levando à redução da morbilidade e mortalidade materno-fetal. A aposta na otimização da atuação dos profissionais de saúde, numa perspetiva preventiva/interventiva na área pré-concecional/saúde materna poderão trazer inúmeros benefícios para a díade.
MEDIDAS DE CONFORTO E PROMOÇÃO DE BEM-ESTAR NA GRÁVIDA E NO FETO: UMA REVISÃO INTEGRATIVA DA LITERATURA
Authors: Sequeira Vanda Isabel Cerejo , Polainas VeraVera Lúcia Gordo , Frias Ana Maria Aguiar , Barros Maria da Luz Ferreira
Published: October 2022

O objetivo principal foi verificar a eficácia das intervenções não farmacológicas holísticas que aliviam os desconfortos durante a gravidez. Realizou-se uma revisãoiIntegrativa da literatura, através da metodologia PICOT, formulando a questão de investigação “Quais as intervenções não farmacológicas holísticas, seguras para a gravidez, na redução dos desconfortos?”, com recurso aos motores de busca EBSCOhost, PubMed, SciELO e Google Académico. Os artigos selecionados foram publicados entre 2008 e 2021. Ao utilizar os Descritores MeSH – Comfort, Pregnancy, Patient Comfort; Pregnancy Complications; Discomfort; Care; Welfare - surgiram 186 artigos. Após leitura dos títulos, foram excluídos 124 artigos por serem repetidos ou apresentarem títulos irrelevantes, fincando com 62 artigos. Posteriormente, após leitura do título e resumo dos artigos, foram selecionados 13 artigos. Por último, após a leitura integral e aplicando os critérios de inclusão obtivemos 6 artigos para análise profunda e detalhada. Com esta revisão evidenciou-se que as grávidas, na sua grande maioria, revelam aspetos positivos com a prática das distintas medidas não farmacológicas holísticas, quer nos desconfortos sentidos e/ou na satisfação pelos momentos proporcionados, identificando benefícios e aconselhando a sua prática a outras grávidas.
A IMAGEM CORPORAL E A AUTOESTIMA COMO DETERMINANTES NA ACEITAÇÃO DAS MUDANÇAS
FÍSICAS NA GRAVIDEZ: UMA REVISÃO NARRATIVA
Authors: Peixeiro Ana Raquel Moreno , Pereira Joana Filipa Gonçalves , Frias Ana Maria Aguiar , Barros Maria da Luz
Published: October 2022

Durante a gravidez é colocada à prova a imagem corporal que a mulher tem sobre si mesma, assim como a sua autoestima, que pode ser perturbada ou fortalecida durante este período. A Gravidez é um período em que ocorrem mudanças fisiológicas importantes, pois a mulher vê o seu corpo sofrer marcadas alterações, existindo necessidade de ajuste a essa nova realidade. O objetivo deste artigo é demonstrar de que forma a imagem corporal e a autoestima da grávida determinam a aceitação das mudanças fisiológicas da gravidez. O método utilizado foi uma revisão bibliográfica de estudos publicados nas plataformas eletrónicas Scientific Eletronic Library Online (SciELO), Nacional Library of Medicine (PubMed), Web of Science Core Collection – Clarivate, Google Académico, nos meses entre outubro e dezembro de 2021. Os artigos selecionados encontram-se entre 2008 e 2020 nos idiomas português e inglês. Os resultados dos artigos analisados demonstram que a satisfação corporal e a autoestima da grávida diminuem consoante a evolução da gravidez, notando que grávidas com atitudes negativas em relação às alterações corporais têm maior propensão ao desenvolvimento de depressão e distúrbios alimentares. Concluímos que a imagem corporal está diretamente relacionada com a autoestima e que ambas são determinantes na aceitação, pela grávida, das mudanças inerentes à gravidez.
COMPORTAMENTOS ADITIVOS E GRAVIDEZ: ÁLCOOL, TABACO E OUTRAS DROGAS
Authors: Cordeiro Cátia Alexandra Martins , Sapata Patrícia Sofia Henriques , Franco Sara Filipa Garrido Coração , Espanhol Sónia Rodrigues , Bugalho Olga Cristina Nobre , Frias Ana Maria Aguiar
Published: October 2022

Os primeiros 1000 dias de vida de um bebé, desde a conceção até aos dois anos, são um período de desenvolvimento crítico, altura em que ocorrem a maioria das falhas de crescimento, sendo o período gestacional o mais crítico. Objetivo: Pesquisar quais os efeitos negativos do uso de substâncias aditivas lícitas e ilícitas na grávida e no feto/recém-nascido. Métodos: Revisão da literatura com pesquisa bibliográfica nas bases de dados: NCBI (PubMed), EBSCO Host, BMC e SciELO. Resultados: O consumo de álcool na gravidez pode levar a abortos espontâneos, defeitos congénitos e problemas de desenvolvimento do feto, restrição de crescimento intrauterino ou morte fetal. O tabagismo traz riscos para a mulher como aborto, gravidez ectópica, descolamento prematuro de placenta, rutura das membranas e placenta prévia, e riscos para o feto como alterações no desenvolvimento neurológico e comportamento, prematuridade e baixo peso ao nascer. A droga, no decorrer da gravidez, provoca vasoconstrição, aborto espontâneo, deslocamento prematuro da placenta, parto pré-termo, e restrição do crescimento intrauterino. Conclusão: A adoção de estilos de vida saudáveis é importante para uma vivência saudável da gravidez. A cessação precoce do consumo de substâncias apresenta resultados positivos na evolução da gravidez, na saúde materno-fetal e no parto. A gravidez é um momento de eleição para o abandono de substâncias psicotrópicas, estando a mulher mais motivada e recetiva às intervenções dos profissionais de saúde
O PAPEL DO PSICÓLOGO COMO FIGURA DE PROTEÇÃO E GARANTIA DE DIREITOS DAS MULHERES DURANTE O PRÉ-NATAL
Authors: Camargo Natália Ferreira
Published: October 2022

Este artigo teve como objetivo realizar uma revisão narrativa sobre alguns conceitos analíticos que podem contribuir para o aumento de cesáreas e violência obstétrica. Após a revisão dos conceitos de instinto e arquétipo, constatou-se que são interpretados de forma errônea gerando um mito de que as mulheres não devem buscar informações sobre o período gestacional, pois ser mãe está em sua natureza. Quando, a teoria de Jung nos mostra o oposto, existe um instinto de reflexão, que impulsiona o ser humano a buscar informações. Consideram-se necessárias mudanças quanto aos profissionais que acompanham a gestante durante o pré-natal. A figura de um psicólogo que repasse informações pertinentes a esse período pode ser fundamental na proteção da mulher e garantia de seus direitos.
Heat Transfer Enhancement in Stirling Engines Using Fins with Different Configurations and Air Flow
Authors: Abdelrahman Gomma  , Abdullah Alsit  , Sharul Sham Dol
Published: October 2022

The Stirling engine, in comparison to other classical engines, is an external enclosed heat engine cycle with extraordinary theoretical efficiency and minimal emissions. However, when combined with a minor heat source, the productivity of the Stirling engine suffers. Thus, this study emphasizes research on improving engine performance using heat transfer. A simulation was done using CFD analysis in ANSYS Fluent to enhance heat transfer using different types of fins, air blowers, and roughness. κ-ω SST model was used as the turbulence model to capture the heat transfer behavior near and away from the surface. All runs showed a higher heat transfer rate per unit area than the no finned case. Increasing the number of fins reduces the heat transfer by 10 %, Applying this solution would cost more since more material is needed to decrease the gap between fins. When doubling the length of the fin, the heat transfer of the circular design was reduced by 1%, the pinned design by 5%, and the squared design by 30%. The addition of fins reduced the flow of heat to the cold end and kept the temperature near the cold end below 100°C. Increasing the roughness resulted in a small increase in heat flow. Comparing the laminar flow to the transitional flow, the transitional flow increases the heat transfer by 1000%.
Numerical Investigation of the Hypersonic Inlet under Throttling with Heat Source
Authors: Nurfathin Zahrolayali  , Mohd Rashdan Saad  , Azam Che Idris  , Mohd Rosdzimin Abdul Rahman
Published: October 2022

The influence of using a heat source to manage the shock wave boundary layer interactions (SWBLI) at the hypersonic inlet under throttling were studied numerically. This hypersonic inlet was created for a fluid flow Mach number of 5. The throttling was induced by a plug placed near the intake isolator's outlet. The study's parameters included the heat source power and size. The intake performance indicators were the total pressure recovery and the flow distortion. The position of the heat source was determined by studying the interplay of the shock waves from the compression ramp. The results demonstrated the existence of the shock waves at the heat source, and its influences on the SWBLI inside the isolator. This behaviour, led to an increase in the total pressure recovery and reduction of the flow distortion.
Assessing the correlation between caffeine consumption and its effect on the academic performance of medical students of Shifa College of Medicine, Islamabad, Pakistan: A Cross-Sectional Study
Authors: Tahir Dawood , Rehman Ibad Ur , Zahra Tatheer
Published: October 2022

Background: 

To assess the correlation between caffeine consumption and its effect on the academic performance of medical students of Shifa College of Medicine, Islamabad, Pakistan.

Methods: 

A descriptive cross-sectional study was conducted in Shifa College of Medicine and its affiliated hospital for about three months from 10th June, 2019 till 15th August 2019. Second-year medical students actively took part in it. We used convenient sampling; a total of 101 students eagerly participated in it. We used a detailed self-administered questionnaire in which simplified questions with four to five options were given. Participants marked their responses to the provided options. A correlation was noticed between their Locomotive System and Gastrointestinal System modular exam scores with the questionnaire response. Data were analyzed by SPSS version 23. 

Results: 

Out of 101 participants, 51.5% were males, and 48.5% were females. About 77.2% of participants were consuming caffeine in any form, while 22.8% never consumed caffeine. Those who consumed moderate (200-400 mg) caffeine in any way performed better in the Locomotive System Module with a mean score of 71.88%. Simultaneously, those who consumed a lot more than 400 mg of caffeine scored better in the Gastrointestinal Tract Module with a mean score of 76.50%. 

Conclusion: 

By conducting this study, we identified that caffeine consumption is surprisingly high in medical students. The correlation between caffeine consumption and its effect on medical students’ performance is not significant.

 

Key Words: Academic performance, Caffeine consumption, Medical students. (Source: MeSH-NLM).
Assessment of Emotional Intelligence Levels among Students of a Public Medical College of Pakistan amidst the Crisis of Covid-19 Pandemic
Authors: Ali Umaira , Ansar Shahroz , Sabir Syed Arshad
Published: October 2022

ABSTRACT                             

Purpose                

Aim of the study was to determine the standards of emotional intelligence among students of Rawalpindi Medical University, Rawalpindi.                           

Method                

A cross-sectional study, employing the use of a self-made online questionnaire, was carried out among the students of Rawalpindi Medical University’s 1st year to final year MBBS. Convenience sampling was used to collect data, which was subsequently entered into Statistical Package for the Social Sciences (SPSS) version.25 for analysis.

Results                  

The average value of emotional intelligence was calculated to be 54.34% ±13.89 SD; mean values for emotional awareness, emotional management and social awareness were found to be 65.15% ±12.6 SD, 51.12% ±12.12 SD and 48.4% ±17.39 SD respectively.                

Conclusion                            

The emotional intelligence of the students amidst the Corona virus pandemic had a noticeably lower value compared to the values determined previously in other studies in the absence of such pandemic. This result points towards the role of pandemic-induced stress in the apparent decrease of emotional intelligence.
A Descriptive Study on Patterns of Traumatic Spinal Injuries in a Tertiary Care Hospital Rawalpindi
Authors: Mehmood Fraz , Shahzad Yasir , Shah M. Motsim , Akhtar Nadeem , Hashmi Fatima , Badar Danish
Published: October 2022

Introduction: Spinal injuries are one of the most debilitating injuries if not fatal and affect every dimension of patients' lives i.e. early mortality and late complications. Lifelong disability due to spinal cord injury is very common even if the patient survives early death. The current study was aimed to investigate the frequency, management, mortality, the pattern of spinal injuries and to recommend plans for better patient management based on assessment.Material and Methods: The study was descriptive, cross-sectional, and was conducted at the Neurosurgery Department of Rawalpindi Medical University and Allied Hospitals for the duration of October 2018 to January 2019. All cases of traumatic spinal injuries were included and variables noted were gender, age, mode of Injury, presenting motor power in limbs, ASIA score, diagnosis, management, outcome, and deaths.Results: In the sample size of 84 patients, the mean age was 37.1 years, the mechanism of injury due to falls was most common at 73%, the lumbar region was found to be the most common area involved. Male patients outnumbered females in the study. 14% of the patients could not survive due to the injury, 15% received cervical traction, 4% received cervical traction and anterior cervical plating, and 43% of patients underwent Transpedicular Screw Fixation, the total number of patients who expired was 25%.Conclusion: Patterns of traumatic spinal injuries are changing, shifting from road traffic accidents to falls being the primary cause nowadays, with prolonged hospital stay periods, disability for life, and high-cost treatments putting a huge burden on our already exhausted health resources. Efforts should be made to make a national registry for traumatic spinal injuries presented to the emergency department and guidelines should be established regarding occupational hazards. Awareness should be given to the general population regarding hazards at home regarding falls.
Case-Control Study on Fetal Outcomes in Isolated Oligohydramnios in Third Trimester
Authors: Iqbal Iram , Asghar Sajida , Nisa Khairun , Rashid Fouzia , Quredhi Kashif Khurshid , Riaz Ramish
Published: October 2022

Background: Oligohydramnios is defined as a condition with low volume of amniotic fluid relative to gestational age. Long-term oligohydramnios can result in pulmonary hypoplasia, intra uterine growth retardation, Potter’s syndrome, club hand & foot and dislocation of hip. This study was conducted to assess feto-maternal outcome in isolated oligohydramnios and factors associated with poor outcome.

Methodology: This case-control study was conducted from January to December 2020 in the Gynecology & Obstetrics and Radiology departments of HBS General Hospital, Islamabad. Total 300 patients with isolated oligohydramnios fulfilling the criterion were included. For cases, patients with singleton intrauterine pregnancy with AFI <5, of any age or parity with gestational age of more than 34 weeks were included. 300 controls were also taken. Patients with increased amount of amniotic fluid, diabetics, hypertensive and cardiac patients were excluded. Patient were followed up till delivery. Mode of delivery was checked out. Fetal APGAR score at 1 minute and at 5 minutes were observed. New born weight and  NICU admissions were recorded. Data was  analyzed via SPSS v26.

Results: Forty six percent (n=138) patients underwent caesarean section while fifty four percent (n=162) had normal vaginal delivery. Significant association (OR=1.85, P<0.001) was found between caesarean section in mothers with oligohydramnios compared to controls. Thirty eight percent (n=114) of neonates among cases had low APGAR score. Significant association (OR=3.29, P<0.001) was found between low APGAR score and mothers with oligohydramnios compare3d to controls. Thirty percent (n=90) required NICU  admission. There were 6 still births. Mother’s with oligohydramnios have double risk of still birth and NICU admission compared to women with normal fluid levels.

Conclusion: Neonate born with mothers having oligohydramnios have low birth weight, lower APGAR scores and high rate of NICU admissions. Delivery at 37-39 weeks in oligohydramnios is associated with higher rate of still births.
Frequency of Carpal Tunnel Syndrome and Related Functional Status in Computer Operators
Authors: Yasmeen Samreen , Ishaque Farhan , Ali Syeda Maliha , Irshad Saleha , Qura Ummul , Syed Tasfia
Published: October 2022

Objective:

To find out the frequency of Carpal Tunnel Syndrome (CTS) and associated functional limitations in computer operators.

 

Materials &Methods:

This cross-sectional study was conducted in the premises of DUHS, Ojha campus, Karachi. The duration of study is from 1st Dec 2019 to 29th February 2020.Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to evaluate the frequency of CTS in computer users, total sample size taken was 95, data was collected in the premises of DUHS, Ojha campus including both males and females employs between age group of 25 to 50 years that were working on the current job for more than 2 years, members that were <25 or >50 years were excluded from the study.

Results:

The study indicated possible association of Symptom severity and functional limitations with respect to age. The frequency of CTS symptoms with moderate to severe severity was 17.9% and 35.8% respectively whereas 46.3% reported mild symptoms. According to functional status scale 55.8% had mild functional limitations whereas moderate to severe difficulty in performing day to day activities was found 21.1% and 23.0% respectively.

 

Conclusion:

This study survey indicated that computer using is associated with the development of CTS symptoms. It also results in the increasing the severity of the symptoms, causing prominent functional limitations that interferes with proper working of employs.

 

Keywords: carpal tunnel syndrome, frequency, computer users, functional limitations.
Assessment of Olfactory Fossa Depth based on Keros Classification using Computerised tomography (Ct) in Age Groups of Both Genders
Authors: Lakhani Mubina , Raza Iffat , Khan Rosheena Nabeel , Mohiuddin Maria , Adnan Naushin , Hassan Nuzhat
Published: October 2022

Objective: Keros classification based assessment of olfactory fossa depth in different age groups of both genders using computerized tomography (CT)

Methodology: Cross sectional study done at Ziauddin university, Clifton, Karachi. Sample size was 270 adults including 160 males & 110 females. The assessment of depth of Olfactory fossa was carried out by measuring the height of lateral lamella of cribriform plate on CT images.

Result: Olfactory fossa of 270 patients from both sides of both genders were classified according to Keros classification. We found Type II to be the most frequent on both sides in both genders. No significant difference in olfactory fossa depth was found when compared in different age groups.

Conclusion: The present study shows that vast majority of the population comes under Keros type II & type III thus emphasizing the need of pre-operative radiological assessment. Association of right & left olfactory fossa depth in different age groups was found to be insignificant.
Complications of Measles in Malnourished Children, a Descriptive Cross-Sectional Study at a Tertiary Care Hospital Rawalpindi
Authors: Asghar Rai Muhammad , Sharif Muddassar , Khan Isfand Yar , Syed Abid Hussain , Ashraf Rai Rijjal , Hussain Muhammad
Published: October 2022

Objective: To determine the frequency of common complications of measles in malnourished children.

Materials and Methods: This study was conducted in the Department of Pediatrics Benazir Bhutto Hospital, Rawalpindi from January 2018 to December 2018. Through a Descriptive Cross-Sectional Study Design, a total of 110 cases of measles with malnutrition presenting to the Paediatrics Department were selected and observations were recorded on follow up.

Results: The mean age was 2.7 years (SD±1.2) of which 61% (n=67) were male and 39% (n =43) were female patients. 35.5% (n=39) presented with grade I, 24.5% (n=27) in grade II and 40% (n= 44) in grade III malnutrition. On follow up, pneumonia was observed in 39.1%, diarrhea in 36.4%, otitis media in 10% and encephalitis in 8.1% of children. The most frequent complications were observed in grade II and grade III malnourished children and children of younger age groups.

Conclusion: Measles and malnutrition are still calamity in our population as once together, the complications of each other are more prevalent and preventive projects must be designed with full efficacy against both these conditions.
Frequency of Causes of Female Infertility Diagnosed Through Laparoscopy in Females Presenting in a Tertiary Care Hospital
Authors: Saif Mahwish , Mustafa Sadia , Butt Binyamin
Published: October 2022

OBJECTIVE To report the frequency of causes of female infertility by laparoscopy in females presenting in a tertiary care hospital MATERIALS & METHODS Study design: Cross sectional study Setting: Department of Obstetrics & Gynecology, Shalimar Hospital, Lahore Duration of study: July 01, 2020, till July 31, 2021 DATA COLLECTION PROCEDURE: A total of 370 females fulfilling selection criteria were selected from operation theatre of Department of Obstetrics and Gynecology, Shalimar Hospital Lahore. Informed consent was obtained from each case. Demographic information (name, age, BMI, duration of marriage, type of infertility, and parity) will also be noted. Then females underwent laparoscopy under general anesthesia by researchers. On laparoscopy, the pelvis was inspected, including uterus, fallopian tubes, round ligaments, uterovesical pouch, uterosacral ligaments, and Pouch of Douglas. The tubes were inspected for any abnormality in their length and shape and patency was checked by retrograde dye test. Both ovaries were examined regarding their size, shape, thickness of peripheral follicles, evidence of ovulation and their relationship with fimbrial end of the tubes. Peritubal, periovarian and omental adhesions, tubo-ovarian masses, endometriotic deposits, fibroid, presence of fluid in the Pouch of Douglas or any other pathology, if present was noted. Data was entered and analyzed in SPSS version 21.0. RESULTS: The mean age of our cases was 33.93 ± 5.81 years with minimum and maximum ages of 18 and 45 years. According to the etiology of infertility, 5(1.4%) cases had unexplained infertility, 140(37.8%) cases had tubal infertility, 60(16.2%) cases had polycystic ovaries, 41(11.1%) cases had Peritubal and peri-ovarian adhesion, 71(19.2%) cases had endometriosis, 38(10.3%) females had fibroids and 20(5.4%) cases had an ovarian cyst. CONCLUSION: We conclude that on diagnostic laparoscopy the frequency of causes of female infertility was found to be tubal infertility (37.8%), followed by endometriosis (19.2%), polycystic ovaries (16.2%), Peri-tubal and peri-ovarian adhesion (11.1%), fibroids (10.3%), ovarian cyst (5.4%), unexplained infertility (1.4%).
Verrucous Squamous Cell Cancer of the Esophagus: A Case Report
Authors: Mushtaq Sumera , Gondal Ghulam Murtaza , Fatima Kiran , Hussain Tassawar
Published: October 2022

Verrucous Cancer of the esophagus is basically a type of squamous cell carcinoma and is associated with a chronic inflammatory process in the lower esophagus usually secondary to gastro-esophageal reflux disease (GERD). Mostly it is a local disease process but sometimes it can invade distant structures also. We report a case is a 62-year-old female patient who presented with marked weight loss, anorexia, and difficulty to take solid food. On Upper GI endoscopy there was a warty appearing irregular mass at the mid to distal esophagus. Superficial multiple biopsies were taken but turned negative for malignancy and re-endoscopy after a few days with deep multiple biopsies revealed the diagnosis of verrucous carcinoma on histopathology. The patient was having multiple co-morbid conditions like hypertension, diabetes mellitus, and early nephropathy along with infiltration of malignancy in surrounding structures on CT scan chest. Therefore a decision was taken to place an esophageal stent by upper GI endoscopy followed by chemotherapy and radiotherapy by the oncology department. Patient symptoms were much relieved after 4 months of chemotherapy and radiotherapy and the patient is still on regular follow-up in medical OPD. Chronic inflammation due to gastritis and esophagitis is the main risk factor for verrucous carcinoma of the esophagus. Although surgery is the treatment of the choice for the local and early disease but as in our case disease was already spread palliative stenting followed by chemo-radiation is the best possible option that can be offered.
The Conundrum of Medical Writing
Authors: Sial Shagufta Saeed
Published: October 2022

Writing is an art. Medical writing is an amalgamation of art with science. Not all medical writers have the inherent capability to pen down their work. For some it is a source of contentment, happiness, and authorization whereas it’s a hard nut to crack for others, requiring additional efforts to accomplish this uphill task.

Future medical writers confront many challenges before they embark upon this worthwhile endeavour. Some may not realize its importance; others simply enter into the world of bewilderment as to how to start. Yet others are well versed with the subject but just cannot pen it down and the majority cannot squeeze their time in because of their hectic daily routines. In order to counter these challenges, one has to overcome the conundrum of medical writing.

Why to Write?

Medical writing is an essential feature of evidence-based medicine and is mandatory for progress in the medical profession. Apart from religious, international, national, institutional, and professional gains, the honor, regard, and respect a medical writer earns in the scientific world is priceless. High research scores, h-indices, portfolios, citations, and references quoted by other researchers and writers elevate you to unfathomable heights. Your work creates an opportunity for others to get benefit from the work done and the medical knowledge grows in a stepladder fashion. Ultimately the main aim i.e.  Benefit humanity also fulfilling the divine requirement for a Muslim medical writer.

This qualm of writers' hesitancy can have devastating effects on the professional career of a writer. Age limit constraints, fear of losing an opportunity to appear in examinations on time, poor prospects for gaining senior posts and promotions, etc. can be detrimental to the psychosocial well-being too. This initiates the unfortunate vicious circle causing further delay or even abandonment of work. This state of affairs could be demoralizing for a doctor who is otherwise humane, hardworking, conscientious, and has been courteous to patients. Even his research could be an extraordinary work but he is unable to put it down in black and white. The medical writers have to trounce over this perplexing situation by getting acquainted with the essence of writing.

The significance of Medical writing cannot be undermined as it forms the basis of development, evolution, and progress in the medical field. It is the only preservable way of transferring knowledge to others. The importance of gaining knowledge and preserving it is very well depicted and stressed in Islam.

The first Divine word “IQRA” and the second revelation related to “THE PEN” is ample evidence. Numerous   Hadiths stress gaining knowledge and preserving it. I quote one Hadith “TAQYID Al ILM”, {define, preserve and record knowledge by ‘writing it down}’.1
Seeing COVID-19 through a Health care professional’s eye
Authors: Yaqoob Eesha , Javed Saad , Rehman Adeela , Fayaz Mudassar , Babar Maryam Salma , Nasir Ayesha
Published: October 2022

Background: The world is in a state of war. The health care professionals are the front line soldiers who are fighting this war against COVID-19. The modification in human behavior to a specific stimulus (say the Corona epidemic) is the single most important determinant of the fate of that stimulus.  On 26th February 2020, Pakistan reported its first corona positive cases. Till Mid-March, the number raised to a significantly critical level. As the outbreak was unexpected in Pakistan, the situation created chaos and panic among the public as well as among health care workers. The current study analyzed COVID-19 thorough a healthcare professional's eye. There has been no previous study according to the PubMed database. Using the keywords, "Coronavirus, Health care professionals, Pakistan, COVID-19", for any sort of previous cases reported or literature reported relating to coronavirus, our team could not find any article, case report or publication of any sort. So this study is the first from Pakistan

Methods: In this cross-sectional study, a self-administrated online questionnaire was circulated through emails and social media to the whole country. The questionnaire comprised of assessing knowledge about the cause and symptoms of COVID-19. A total of 146 responses were scrutinized to include in the survey, in the time period of 1 week (March 23-30, 2020). The participants belonged to private and government institutions from all provinces of Pakistan. Results: The mean values of all items depicted that all health care professionals were well aware of the knowledge, symptoms and transmissibility of COVID-19.

Conclusion:  The study concluded that the healthcare professionals were fully aware of the transmission of COVID-19 and its symptoms. However, it is recommended that the government should provide full support to health care professionals, who are at the front line.  

 

Key words: COVID-19, Health care professionals, Transmissibility, Pakistan
Hypomagnesaemia in Acute Exacerbation Chronic Obstructive Airway Disease; Association with Anthonisen’s Levels of Exacerbation
Authors: Aziz Javaira , Amir Muhammad , Akbar Abrar , Aziz Sadia , Shams Nadia , Meraj Lubna
Published: October 2022

Background: COPD is major public health issue causing morbidity and mortality. Lower serum magnesium levels are seen in patients with acute exacerbations compared to stable COPD patients. This study aims at identifying hypomagnesemia as predictor of COPD exacerbations that may help reduce the burden of readmissions and mortality.

Material and Methods: The Descriptive cross-sectional study was conducted DHQ Hospital Rawalpindi from 16 July 2016 to 15 Jan 2017 after the ethical approval and informed consent. The indoor adult (> 18 years) diagnosed cases of COPD exacerbation were included by consecutive sampling. Patients with malignancy, pregnancy and receiving magnesium supplements were excluded.  Demographic details documented and after complete clinical evaluation, serum Magnesium levels of were assessed. Serum Magnesium < 1.80 mg/dl labeled hypomagnesaemia.  Data was analyzed by SPSS with significant p< 0.05.

Results: Amongst 176 patients; there were 93(52.8%) males and 83(47.2%) females. Mean age was 56+7 years. Mean duration of COPD was 6.56 + 5.24 years (2-10 years).  Mean height in the study was 181 +12 cm and mean weight was 56.06 + 7.08 kg. The mean serum magnesium level was 1.5 + .49mg/dl. Low serum magnesium (<1.8 mg/dl) observed in 103(58.5%), gender wasn’t associated with hypomagnesaemia (p=0.294). Hypomagnesaemia in accordance to types of Anthonisen’s criteria was observed in 19(44.2%) with Type I, 37(57.8%) with Type II and 47(68.1%) with Type III COPD exacerbation. Hypomagnesaemia had significant association with Anthinosen’s levels of exacerbation (p=0.043). The mean age in patients with hypomagnesaemia was 56.61+6.78 Vs.  55.30+7.47 in patients without hypomagnesaemia (p=0.228).

Conclusion: The study concludes mean serum magnesium levels are significantly lower in patients with acute exacerbation of COPD (58.5%), particularly in type II and III. Magnesium levels should be performed in all COPD exacerbations irrespective of gender and age. Replacement of magnesium may be helpful in alleviating symptoms and reducing frequency of exacerbations.
H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in Dyspeptic Patients
Authors: Farooq Shafaq , Aslam Muhammad , Arif Muhammad , Farooq Umar , Akhtar Nasim , Meraj Lubna
Published: October 2022

Introduction: There are several invasive and non-invasive techniques used to diagnose H. pylori infection, each having its own advantages and disadvantages. Invasive methods require biopsy samples from stomach and duodenum and can be tested by various methods such as histology, Rapid urease test (RUT), microbiological culture and Polymerase chain reaction (PCR) whereas non-invasive tests include stool antigen test, serology and Urea breath test

Objectives: To determine the diagnostic accuracy of H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in dyspeptic Patients (18-65 years).

Materials & Methods: Descriptive, cross-sectional study was conducting during 30th April 2019 to 30th October 2019 in Gastroenterology Unit, Holy Family Hospital, Rawalpindi. A total of 85 patients irrespective of gender having age 18-65 years having symptoms of dyspepsia were included. Patients having gall stones, celiac disease, pancreatic disease, Diabetes Mellitus, thyroid disease and any other patients on PPI or H2 receptors. Patients with history of alcoholism, diagnosed cases of H. Pylori infection or treatment history of H Pylori. Patients diagnosed for pancreatitis, cholecystitis, Hepatitis B or C Virus positive cases of Chronic Liver Diseases, HIV, malignancy or Ischemic Heart Disease or being pregnant were excluded. H. Pylori on Fecal Antigen Detection and endoscopic biopsy were noted.

Results: Fecal Antigen Detection found that 42 were True Positive and 04 were False Positive. Among 39, Fecal Antigen negative patients, 04 (False Negative) had H. Pylori on endoscopic biopsy whereas 35 (True Negative) had no H. Pylori involvement on endoscopic biopsy (p=0.0001). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in dyspeptic Patients was 91.30%, 89.74%, 91.30%, 89.74% and 90.59% respectively.

Conclusion: This study concluded that diagnostic accuracy of H. Pylori Fecal Antigen Detection in dyspeptic Patients is quite high.

Keywords: helicobacter pylori, Fecal Antigen Detection, endoscopic biopsy.
Is GeneXpert MTB/RIF assay reliable for the diagnosis of pleural tuberculosis?
Authors: Shafiq Muhammad Mudassir , Nadeem Muhammad , Zaidi Gul Afshan , Arshad Naveed , Khan Muzammil , Niazi Zainab
Published: October 2022

Introduction: Tuberculosis is the most common cause of infectious diseases related mortality globally. Tuberculous pleural effusion is a common presentation of extra pulmonary tuberculosis and a diagnostic challenge most of the time. The rapid diagnosis of tuberculous pleural effusion is essential for early treatment. GeneXpert is a new tool for rapid diagnosis but the ability to correctly diagnose of GeneXpert is a vital concern in the diagnosis of extra pulmonary tuberculosis.

Objective: To determine the accurate ability of diagnosing the pleural fluid GeneXpert MTB/RIF assessment in the suspected pleural tuberculosis patients considering as gold standard to the pleural biopsy.

Methods: This study was a validational cross sectional survey and it was conducted in pulmonology department of Pakistan Institute of Medical Sciences, Islamabad from 1st July to 31st December 2018 after approval of IRB. Participants with suspected pathology ≥ 18 year with exudative pleural effusion were included in the study. By implementing the process of standard technique, closed needle pleural biopsy was executed by means of ABRAM’S needle. The collected samples of patients were sent to the pathology department of Pakistan Institute of Medical Sciences for histopathology. Pleural fluid was referred to National Institute of Health Islamabad for GeneXpert MTB/RIF assessment on the alike day and reports were assembled. All findings were entered in a structured Proforma. Data was entered in SPSS version 20 and analyzed.

Results: Total 180 patients were included; 65.6% patients were male. When the sensitivity of pleural fluid GeneXpert MTB/RIF examination was calculated it was 10.4% whereas, the calculated specificity was 72.8%. While +ve predictive value of GeneXpert was 22.2% and -ve predictive value was 52.1%. Likelihood ratio was 8.25 and ROC curve also showed similar values. 

Conclusion: The sensitivity of pleural fluid GeneXpert MTB/RIF assay is very low and specificity is moderate for diagnosis of pleural tuberculosis when compared with pleural biopsy.
Translation and Psychometric properties of Children Behavior Questionnaire-Very short form: Gender differences on Temperament
Authors: Syeda Shamama, Aqsa Shakeel Syeda Shamama, Aqsa Shakeel
Published: October 2022

Objective: 1- To translate Children’s Behavior Questionnaire-very short (CBQ) form in Urdu language and to establish its psychometric properties. 2- To study gender differences on subscales of CBQ.

Material and Methods: The study was conducted with 279 mothers (working and non-working) and their children (3-7 years) in Rawalpindi, Pakistan. CBQ-very short form was translated into Urdu language as per standard procedure1. Translated scale was given to mothers and available fathers to rate their children on temperament. To establish cross language validation 13 mothers were given both original English CBQ-very short form and translated version with the gap of two months. To study gender differences on three dimensions of temperament between boys and girls (boys = 138, girls = 141) one way ANOVA was run.

Results: Results indicated high Cronbach’s alpha reliability α = .80 (total) and .61to .81 for its subscales, high to satisfactory cross language validation (test retest reliability) r =.64* to .86** (p < .05 & .01), and high inter-rater reliability between fathers and mothers r = .38* to .82** (p < .05 & .01). The item total correlations of subscales were also satisfactory.  Finding showed that Urdu version of CBQ is highly reliable and valid to be used with Pakistani Children (3-8 years). In addition we found significant gender differences on effortful control, girls being high on effortful control as compared to boys.

Conclusion: The study revealed CBQ-very short form- Urdu version as reliable and consistent measure of children’s temperament (3-7years) in Pakistani culture. Findings also support earlier evidence that girls show higher score on effortful control as compared to their counterparts.

Key Words: CBQ, Temperament, gender differences, Urdu version.
Differential Leukocyte and Platelet Counts as Early Diagnostic Indicators in Acute Dengue Infection
Authors: Alishba Naeem, Maryam Zahra, Sehar Khaliq Alishba Naeem, Maryam Zahra, Sehar Khaliq
Published: October 2022

Background: Dengue is an epidemic in Pakistan. Proper monitoring of dengue cases is necessary for its early diagnosis and prevention especially in developing countries with limited resources. Our study aims to use some hematological parameters as Early Diagnostic Indicators in Acute Dengue Infection which can help in reducing mortality and morbidity.

Methods: Dengue NS1 Antigen test was used to identify 119 Dengue Patients over the months of August-October, 2019. Hematological data from such patients was collected and analysed.

Results:  In our study thrombocytopenia was prominent with sensitivity based on gender distribution being 86% for males and 76% for females. According to age, distribution thrombocytopenia had a sensitivity of up to 81% in the younger age group and 80% in the older age group.

The other prominent findings in younger age groups were lymphopenia, neutropenia, and monocytopenia with a sensitivity of 55%, 43%, and 24% respectively. Lymphopenia and neutropenia had similar sensitivity across the two genders, whereas monocytopenia had higher sensitivity among females of 27% as opposed to males of 12%.

Eosinopenia did not differ as much among the two age groups i.e. 18% in young and 19% in older patients and across the two genders i.e. 56% in males and 60% in females.

The sensitivity of lymphocytosis in older patients is 21% which was also significant.

Conclusions:  The Differential Leukocyte Count and Platelets Count can help as an early indicators of acute dengue infection in resource limited areas. This can help in early diagnosis and prompt treatment thus reducing complications.

 

Keywords: Acute dengue, differential leukocyte count, platelets count, thrombocytopenia, neutropenia
Emergency Presentation of Abdominal Pain with Unusual Etiology
Authors: Naeem Abdul , Aziz Maria , Mir Alia , Sial Hamid , Shafiq Muhammad Mudassir , Arshad Iram
Published: October 2022

Abdominal pain has vast differentials and routine etiologies are diagnosed easily. Difficulty arises with uncommon presentation. This is a case of 28 years old lady presenting to emergency department of Holy Family Hospital, Rawalpindi with worsening abdominal pain, vomiting and loose stools over 2 weeks. Routine examination and workup did not help to find any cause. Ultrasound abdomen suspected matted gut loops with enlarged lymph nodes. CECT abdomen confirmed a non-differentiating tissue collection in right iliac fossa. Later diagnosis of complicated gossybioma (retained gauze surrounded by fibrotic tissue with entero-enteric fistula and fecolith in appendix) was confirmed by laparoscopy that was surgically removed. Conclusion: Gossybioma is infrequent but avoidable complication that needs to be considered by surgeon meticulously especially by swab counting, avoiding staff change over during procedure and consideration in follow up visit.