bluuebunny/crossref_metadata_2025 huggingface dataset:
Video Assistant Referee in soccer: A Scoping Review
Authors: Leilane da Silva Magna , Barbosa Filho  Valter Cordeiro , de Lima e Silva  Leandro , Moreira Nunes  Rodolfo de Alkmim , Preciado  Maria , Vieira de Andrade Barreira  Daniel Bruno , Gomes Campaniço  Jorge Manuel
Published: September 2023

The Video Assistant Referee (VAR) is a technology that is changing the behavior of referees, players, managers, and fans in soccer. This scoping review mapped the studies on the use of VAR in soccer. An electronic database searching was performed in November 2020 using Medline/PubMed, Scopus, and Web of Science. Studies that analyzed field referees or video assistants and addressed professional field soccer were eligible. Studies’ characteristics were extracted and summarized. An initial search found 346 potentially relevant titles; six of them followed all eligibility criteria, providing information on VAR in high-performance men’s soccer competitions held in 18 countries. There was a multiplicity of variables analyzed in the primary studies, mainly quantitative approaches of the VAR effects on game parameters, as follows: Decision-making process (n=4), game time (n=3); goals (n=5); offside (n=4); yellow and red card application (n=3); fouls (n=2); penalties (n=3); and VAR incidents (n=2). In general, primary studies have indicated that VAR can significantly enhance the accuracy of referees' decision-making, as well as having had a positive influence on the game's outcome. However, some negative aspects have been observed, such as a reduction in effective playing time and limited training for referees. Studies on VAR in soccer are still in their initial stages, and research priorities were highlighted to help future research and practice on VAR in soccer.
Keywords: Sport, Soccer, Football, Decision Making, "Video-Assisted Techniques and Procedures"
Pedagogical Content Knowledge in the Physical Education Field. A systematic review of the literature 2011-2022
Authors: Montoya Noelva Eliana
Published: September 2023

Teaching of Physical Education, knowledge about what to teach, who to teach and how to teach must be considered; within the framework of these aspects, Pedagogical Content Knowledge arises, considered as an amalgamation between content and pedagogy. This study analysed the scientific production in the Scopus, Web of Science and Science Direct databases, regarding the development of Pedagogical Content Knowledge in the Physical Education Field, between 2011 and 2022 and was done systematically. Articles were included in English and Spanish, for a total of 32 articles. The results show that there was a peak of publications in the year 2020; the country in which more studies have been carried out is the United States; regarding the level of research, the vast majority are of an explanatory nature. The studies were classified into three categories: Pedagogical Content Knowledge in school Physical Education, in School Sports and in training programs for physical education teachers. It could be concluded that there is a need for Common Content Knowledge and Specialized Content Knowledge to be better taught in teacher education programs as they are a fundamental basis for Pedagogical Content Knowledge. Likewise, since this construct is dynamic and changing, it should also be considered in the professional development phase, since field experience and the relationships established in the field provide new knowledge and formative experiences.
Keywords: Pedagogical content knowledge, physical education, teacher training, school sports, literature review.
Pengaruh Konten Kreator Tiktok @Sikibor Halilibor Terhadap Sikap Dan Perilaku Generasi Z
Authors: Nisa Aden , P Sendi Dwi Harya , Adelia P Yuna
Published: September 2023

Pada zaman sekarang perkembangan teknologi sudah semakin mempelihatkan eksistensinya. Salah satunya yaitu adanya teknologi komunikasi penggunaan internet hingga munculmya media sosial. Namun perlu diketahui, penggunaan media sosial yang dilakukan secara terus-menerus pastinya akan menimbulkan efek positif atau negatif. Penelitian ini bertujuan untuk mengetahui seberapa pengaruh konten creator @sikibor halilibor terhadap sikap dan perilaku generasi z. Penelitian ini menggunakan metode kuantitatif dengan subjek penelitian mahasiswa Universitas Tidar Angkatan 2020. Hasil penelitian ini berdasarkan Uji koefisien determinasi (R²) yaitu terdapat pengaruh konten media terhadap sikap sebesar 11,8%   dan   pengaruh   konten   media   terhadap  perilaku sebesar 24,7.
Konstruksi Sosial Pasangan Nikah Muda dalam Mengasuh Anak di Jakarta Selatan
Authors: Rianti Adisa Cahya , Nurhadi Robi , Fitriana Devi
Published: September 2023

Dalam kehidupan pernikahan atau rumah tangga anak merupakan anugerah dan karunia yang diberikan oleh Tuhan guna melengkapi kebahagiaan orang tua. Hingga saat ini, masih kita temui pasangan-pasangan yang menikah di usia muda. Banyak dari mereka yang sebenarnya belum siap untuk memiliki anak, sehingga memungkinkan mereka untuk memberikan pola asuh yang tidak tepat. Tujuan penelitian ini adalah untuk mengetahui dan memahami kenyataan atau realita yang dihadapi oleh pasangan nikah muda dalam mengasuh anak di Jakarta Selatan. Penelitian ini merupakan penelitian dengan metode kualitatif dengan menggunakan teknik analisis interaktif meliputi reduksi data, penyajian data sampai menarik kesimpulan. Hasil penelitian menunjukkan bahwa (1) konstruksi sosial pasangan nikah muda dalam mengasuh anak di Jakarta Selatan terbilang cukup baik (2) Namun tidak ada kesiapan yang dimiliki pasangan untuk mengasuh anak (3) pasangan nikah muda di Jakarta Selatan berusaha untuk memperbaiki cara mengasuh anak mereka dengan belajar ilmu pengasuhan atau parenting.Kata Kunci: Konstruksi Sosial, Pasangan Nikah Muda, Mengasuh Anak
Boekbespreking: Law of Delict by Scott
Authors: Neethling J , Potgieter JM
Published: September 2023

None
Vitamin A deficiency, a potential threat to sight in transplant recipients
Authors: Fatema Ali Lanewala
Published: September 2023

Vitamin A (Vit A or Retinol) is an essential nutrient for proper human body functioning including embryogenesis, vision, cell proliferation and differentiation, immune regulation, and glucose and lipid metabolism. It is mainly acquired through diet rich in Retinol or Retinyl esters; or its precursors like carotenoids, Provitamin A, and beta carotene.1,2
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Idiopathic scrotal calcinosis – a case report
Authors: Khan Muhammad Mehraiz , Mirza Zeeshan Rashid , Cheema Faisal Ehsan , Rafia Shahzad
Published: September 2023

Idiopathic scrotal calcinosis is formation of calcium deposits in the dermal layers of the scrotum. It results in the formation of single or multiple nodular calcifications that vary in size and number. First reported in 1883, this condition is common in the third decade of life. The presenting complaints range from disfigurement to itching, leading to decreased quality of life. The diagnosis is usually made on a clinical basis and can be confirmed by the histopathology of the excised nodules.  Surgical removal of the nodules is the generally recommended treatment. The surgery aims to eradicate the nodules leaving the scrotal skin enough for scrotoplasty.
We present a case of idiopathic scrotal calcinosis in a 37 years old male who came for radiological examination.
Keywords: Calcinosis, scrotum, calcium, pruritus.
Prophylactic use of Levofloxacin during induction of acute lymphoblastic leukaemia in children—experience from Pakistan
Authors: Rehman Palwasha , Shaukat Zunaira , Saeed Haleema , Raza Aun , Anjum Sadia , Muhammad Wali Rabia
Published: September 2023

To assess whether prophylactic use of Levofloxacin would reduce the number of febrile neutropenia episodes during the induction phase, a single-centre, case-control study was carried out. Data was collected prospectively of patients who received Levofloxacin prophylaxis during the induction chemotherapy from September 2019 till October 2020. The cases were compared with historical controls who did not receive antibiotics prophylaxis. A total of 121 patients were enrolled, among which 61 patients were cases, whereas 60 patients were controls. The patients who received Levofloxacin prophylaxis had lower rate of febrile neutropenia episodes than patients who did not receive any prophylaxis (P 0.01) (odds ratio [OR] :0.23, CI 95percent). No significant difference in induction mortality was seen between the two groups (p 0.14). Levofloxacin prophylaxis reduced the rate of febrile neutropenia episodes among patients, but it did not affect the infection related mortality.
Keywords: Antibiotic Prophylaxis, Acute Lymphoblastic Leukaemia, Children.
Effect of urinary kidney injury molecule-1 levels on short-term prognosis of chronic heart failure
Authors: Geng Like , Dang Qun , Lv Guo , Wang Luzhao , He Sanjun
Published: September 2023

Objective: To explore the influential elements of urinary kidney injury molecule-1 levels in chronic heart failure, and to judge its ability to predict 90-day rehospitalisation.
Method: The cross-sectional case-control study was conducted from November 2020 to April 2021, at Hanzhong Central Hospital, China, and comprised adult patients having chronic heart failure with normal renal function in group A and healthy subjects in control group B. Patients in group A received anti-heart failure therapy for 1 week in hospital and were followed up for 90 days after discharge. Blood pressure (BP), kidney injury molecule-1, creatinine and serum pro-B-type natriuretic peptide levels were evaluated at baseline and 1 week after treatment in group A, while the samples were collected only at baseline in the control group B. Data was analysed using SPSS 22.
Results: Of the 102 subjects, 68(66.6percent) were in group A; 44(64.7percent) males and 24(35.3percent) females with mean age 62.38±9.51 years. The remaining 34(33.3percent) subjects were in group B; 21(61.7percent) males and 13(38.2percent) females with mean age vs. 58.82±8.11 years. The urinary kidney injury molecule-1 level in group A was essentially on the increase compared to group B (p 0.05). After 1 week of treatment, the kidney injury molecule-1 level decreased compared to the baseline value in group A (p 0.05). Diastolic blood pressure and pro-B-type natriuretic peptide were the determinants of urinary kidney injury molecule-1 level, and urinary kidney injury molecule-1 level before discharge was significantly associated with rehospitalisation within 90 days (p 0.05).
Conclusion: Urinary kidney injury molecule-1 level before discharge was a significant predictor of rehospitalisation within 90 days, and diastolic blood pressure and pro-B-type natriuretic peptide levels were the influencing factors of urinary kidney injury molecule-1. Also, urinary kidney injury molecule-1 levels were significantly raised in chronic heart failure.
Key Words: Chronic heart failure, KIM-1, Rehospitalisation.
Naegleria Fowleri - Prevention is the best cure
Authors: Muhammad Musab Niazi
Published: September 2023

Respected Editor,
With the temperatures rising every summer and the quality of water deteriorating in Pakistan and specially Karachi the ‘brain-eating amoeba’ Naegleria fowleri was on rise during this summer too. 6 cases of primary amebic meningoencephalitis (PAM) caused by N. fowleri were reported which took at least 5 lives in 2022.1
Naegleria fowleri is a non-parasitic, thermophilic, disease-causing flagellate amoeba. N. fowleri can tolerate high temperatures (up to 45%) and mainly consumes bacteria due to which it is usually found in warm freshwater bodies.2 The stage in which it is considered most infective is the trophozoite stage which is also its reproductive stage and it requires favourable conditions for this stage to be exhibited.2 The main route of entry for N. Fowleri is the olfactory route when water contaminated with this pathogen is forcefully inhaled during water-related activities like swimming and ablution etc.2
Signs and symptoms of PAM are similar to those of viral or bacterial meningitis including fever, headache, stiff neck, vomiting, anorexia, and seizures. This is the reason Naegleria fowleri is also commonly known as “brain-eating amoeba”. This similarity makes it difficult for physicians to diagnose it early. PAM can cause death within 3 to 7 days after the symptoms appear.3
After the first case of PAM which was reported in 2008, approximately 150 cases have been reported from Karachi alone. In only a decade, the number of PAM cases in Pakistan exceeded those reported in the USA in half a century (i.e. 142 cases between 1968 and 2019)4. Aga Khan University Hospital, Karachi, Pakistan has observed a death rate of approximately 20 deaths per year due to PAM in Pakistan.5
Naegleria fowleri can be killed by chlorinating water and the ensuing disease and deaths can be eliminated but due to the failure of the Karachi Water and Sewerage Board before supplying it to houses and then the use of that water for bathing and ablution, this pathogen continues to cause deaths every year.6
According to the WHO, free chlorine having residual concentration equal to or more than 0.5 mg/L, at pH less than 8.0 and 20°C, after a contact time of at least 30 minutes is effective for chlorine disinfection. The government should make sure that this level of chlorine is maintained throughout the distribution system.2
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Epidemiology of male urethral strictures in Pakistan
Authors: Abidi Syed Saeed , Gazder Tanzeel , Manzoor Hussain  , Syed Rabiullah  , Mazahir Zulfiqar  , Rizvi Syed Adibul Hasan
Published: September 2023

Urethral stricture disease is relatively common in Pakistan, constituting 4-5% of the urological workload. Despite the high prevalence, little is known about its epidemiology in the country. The current narrative review comprised search on PubMed, Pak MediNet and Google Scholar databases for studies done in Pakistan and published between January 1, 2000, and December 31, 2021. The search yielded 30 local publications on stricture urethra. Demographic data as well as causes and management pattern of male urethral stricture were noted and analysed. There were 5,021 patients, with 3850 (76.6%) being from the province of Sindh. The disease was in majority impact younger patients aged up to 40 years n=1572, while after the age of 60 years, 248 (9%) patients had the disease. The common cause was trauma due to road traffic accidents in both anterior and posterior strictures compared to idiopathic cause reported in the West.
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Mental Health Issue Accelerates Aging Faster than Smoking – Study Rings Alarm for Pakistan where it still remains a Taboo!
Authors: Noman Adil  , Aruba Jamal  , Sumbul Soha
Published: September 2023

Madam, Mental health is defined as a state of mental well-being that enables people to cope with the stresses of life, realise their potential, learn and work well, and contribute to their community as a whole. (1) A recently published study in the journal Aging (2), revealed that mental health can be more deteriorating than smoking. The researchers used an ageing clock to measure how it impacted the pace of aging in 12,000 Chinese adults. Researchers found that smoking speeds up the rate of ageing by 1.25 years whereas mental health factors accelerated it by 1.65 years. The aging clock used blood, DNA and genetic test of individuals to measure their biological aging pace. The mental health variables tested included Depression, Sleep Issues, Hopelessness, Feeling unhappy, Loneliness, Married, Widowed, and Living in a Rural area. (2) Ageing directly predisposes individuals to diseases like Diabetes Type 2, Cancer, Cardiovascular and Neurological disorders which significantly affect the lifestyle and lifespan of individuals.(3)
Talking about mental health is still seen as Taboo in Pakistan, and that’s why people don’t consider consulting about their mental health issues. Statistics have revealed that more than 14 million Pakistanis suffer from some sort of psychiatric illness and the majority of these believe that these are caused by supernatural forces such as spirit possession etc. This is mainly due to lack of awareness about mental disorders and shortage of mental health professionals. (4) The modern study showing mental health factors accelerated ageing faster than smoking (2), is an eye-opener and alarm for our society where we now do stress upon the hazardous effects of smoking, we also need to equally emphasize about working on Mental Health awareness on mass scales utilising media, health policies, and community health care programmes. Family is the primary source of your nurturing, and it is necessary to make Parents also realise that they should establish such a relation with their children that they can easily talk about any of their issues comfortably with them. An emphasis on considering mental health issues need serious professional consultation. Along with keeping a balanced life, spending quality time with family and friends, ease of interaction is needed to ensure that our population doesn’t fall prey to these issues and cost them their whole life.
Irrigation suction therapy reduces post-hysterectomy surgical site infection in middle-aged and older diabetic women: a randomized prospective study
Authors: Saaqib Shazia , Naheed Munazza
Published: September 2023

Objective: To determine whether or not closed wound irrigation and suction therapy can reduce post-hysterectomy surgical site infections in middle-aged diabetic women without increasing pain, causing complications or lowering patient satisfaction.
Method: The prospective randomised controlled study was conducted from April 2017 to March 2022 at Lady Willingdon Hospital, Lahore, Pakistan, and comprised women aged >40 years with body mass index >25kg/m2 who were scheduled for hysterectomy. The subjects were randomised into intervention group A and control group B.  In the irrigation and suction group A, subcutaneous drains were inserted for daily closed wound saline irrigation followed by full-day suction for 3 days. In control group B, wound closure was done without drains and irrigation and suction. Wounds were assessed daily during hospitalisation and at 4, 8 and 12 weeks postoperatively. Primary outcome was surgical site infection rate, fever, white blood cell count, pain score and length of hospital stay. Secondary outcomes were readmission rate, wound pain during follow-up other complications and patient satisfaction. Data was analysed using SPSS 20.
Results: Of the 334 patients, 300(89.8%) were included; 150(50%) in group A with mean age 56.66±9.264 years, and 150(50%) in group B with mean age 55.77±9.394 years. However, the study was completed by 274(91.3%) subjects; 138(50.4%) in group A and 136(49.6%) in group B. Group A had significantly fewer surgical site infections (p<0.0001), lower white blood cell count (p<0.0001), fever (p<0.001) and pain scores (p<.0001), shorter hospital stay (p<.0001) and higher patient satisfaction (p<.0001) compared to group B. Follow-up pain scores and other complications did not differ significantly between the groups (p>0.05).
Conclusion: Irrigation and suction strategy reduced surgical site infection rates without increasing pain, causing complication or compromising patient satisfaction.
Key Words: Surgical site infection, Elderly, Diabetic women, Abdominal hysterectomy, Suction, Irrigation, Satisfaction.
Traffic noise: More than just mere annoyance?
Authors: Quraishy Maryam Saida , Dar Arifa , Narejo Savera
Published: September 2023

Madam, As industrialisation and technology become more global, quality of life is far better than years before. One such development is better transportation. With the advent of cars and buses, transport is easier than ever and is an integral part of almost everyone’s daily life. However, with any fast-paced change, novel situations bring along problems. Along with convenience, increased traffic brings along its own issues, one of which is the increase in environmental noise.
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Programmatic assessment prototype design using integrated system thinking and design thinking framework
Authors: Farrukh Khadija , Shahid Fareeha
Published: September 2023

Objective: To design a prototype programmatic assessment model using integration of system thinking and design thinking frameworks, and to explore barriers in the way of its implementation in medical education.
Method: The qualitative case-study was conducted at Bahria University Medical and Dental College, Karachi from September to December 2022. Methodological approaches used were systems thinking and design thinking. Philosophical paradigm used was critical realism. Maximum variation purposive sampling technique was used for selecting faculty members and medical students. Data was collected in two sets of semi-structured interviews. The initial interviews were at the levels of empathise, define and ideate. After that low-fidelity prototype programmatic assessment design was created and presented to the participants. The second set of interviews were focussed on feedback on prototype of programmatic assessment design. Pattern matching method was used for data analysis.
Results: Of the 65 subjects, 20(30.7%) were faculty members; 5(25%) lecturers and 5(25%) professors each from basic and clinical sciences. The remaining 45(69.2%) were students; 5(11.1%)from each year of medical and dental streams. Initial interviews revealed that after failure, students struggle to understand the cause of failure as assessment system lacked narrative feedback mechanism and numbers or pass/fail decisions were not self-explanatory. Students lacked attitude towards continued improvement, formative assessment were not taken seriously as they carried only 10% weightage. After the programmatic assessment design was presented to the participants, faculty members voiced concerns regarding faculty training, shortage of resources and legal issues related to its implementation. Students supported the design, especially continued narrative feedback for their academic improvement. Portfolio development was considered a time-consuming task and they had reservations regarding their ability to make quality assessment portfolio.
Conclusion: Implementation of programmatic assessment required faculty development and was resource-intensive, but stakeholders, especially students, were found interested in its implementation in medical education.
Key Words: Programmatic assessment, Medical education, Medical students.
Urgent need for the introduction of Tenecteplase in Pakistan: A Call to action for improved stroke and Mi Care
Authors: Yousaf Mirza Rehan , Hamza Naeem  , Shahid Muhammad Bilal
Published: September 2023

Madam, Tenecteplase is a recombinant tissue plasminogen activator (tPA) that is used in many countries worldwide for reperfusion in acute ischemic stroke (AIS) and STEMI because of its longer half-life and high fibrin specificity compared to other tPAs (e.g., alteplase) and Streptokinase.1 Tenecteplase binds with fibrin-rich clots using its fibronectin finger-like and kringle-2 domains. The binding allows the protease domain to cleave the Arg/Val bond, converting plasminogen into plasmin, which breaks the fibrin matrix of the thrombus, resulting in clot dissolution. While Stroke and MI remain in the top 5 leading causes of death in Pakistan2, this highly efficient thrombolytic agent is not yet accessible in most hospitals for reperfusion in acute ischemic stroke and myocardial infarction cases.
Many studies offer promising results, with tenecteplase being a better thrombolytic agent for acute ischemic stroke and STEMI than alteplase. In India, studies declare tenecteplase effective and safe in STEMI patients with clinically successful thrombolysis reported in 80.67% of patients, while intracranial hemorrhage associated with tenecteplase was only 0.39%.3 Tenecteplase is more efficient and at least as safe as alteplase for acute ischemic stroke. According to a meta-analysis involving 2031 patients, the patients given Tenecteplase showed higher recanalization rates (ARD=0.11, 95%CI) and early neurological improvement (ARD=0.10, 95% CI) compared to patients given alteplase.4 Tenecteplase also has a lower cost and a more favorable pharmacokinetic profile allowing bolus injection.
Regrettably, Tenecteplase is not yet accessible in Pakistan due to unclear political and administrative factors, and border restrictions. Studies claim that only six hospitals in Pakistan currently offer intravenous thrombolytic therapy with alteplase, all being private tertiary care hospitals.5 While the world is adopting Tenecteplase instead of alteplase because of its better results, a more favourable side effects profile, and lower cost, our healthcare system is still dependent on SK for IV thrombolysis in cases of STEMI, which too is sometimes not available in many hospitals.
In light of available evidence suggesting Tenecteplase as a better alternative to alteplase and Streptokinase, the health government and hospital policymakers should consider introducing tenecteplase in Pakistan as the standard care for STEMI, New Onset LBBB (Left Bundle Branch Block), Acute Ischemic Stroke, Prosthetic Valve Thrombosis, Pulmonary Embolism, and Deep Venous Thrombosis.
Proton pump inhibitors for HIV+ patients- a word of caution
Authors: Ahmed Minahel
Published: September 2023

Madam,
HIV (human immunodeficiency virus) is on the rise in Pakistan. A Lancet global health modeling study reports that patient registration with the National Aids Control Program (NACP) has risen from 4500 in 2013 to 24331 in 2019 [1]. In HIV+ patients, the gastrointestinal tract is a common site of infection, often leading to anorexia, dysphagia, vomiting, weight loss, and diarrhoea. A study conducted in 2016 showed that 80% of HIV-infected adults had moderate-severe GERD (gastro-oesophageal reflux disorder) symptoms [2]. Physicians often prescribe proton pump inhibitors (PPIs) to treat GERD and stomach or duodenal ulcers. This class of drugs is the most potent inhibitor of gastric acid secretion and is ,unfortunately, prescribed excessively and often inappropriately, regardless of if the patient is HIV+. A recent study shows that 66.2% of patients in a tertiary care hospital in Karachi, Pakistan receive PPIs without proper indication [3].
However, PPIs being prescribed inappropriately pose severe health risks to individuals that are HIV+. A recent study in 2019 raised the valid concern that the use of PPIs in patients already receiving anti-retroviral (ARV) therapy in HIV+ patients could very well be related to an increased risk of acute kidney infection (AKI) [4]. This is not the only research to show the adverse effect of PPI use in HIV patients. A 2017 study shows statistically significant increased innate immune activation due to the translocation of microbial products in HIV+ patients taking PPIs [5]. This can carry serious future implications for these patients post-treatment because higher levels of innate immune activation markers are associated with immunological failure in HIV-treated patients [6].
These statistics raise a very critical question- is it safe for PPIs to be prescribed so freely without any attention to patients being HIV+ or on ARV therapy? It is suggested that existing and future ARV therapies be planned carefully if PPIs are prescribed, and close attention be paid to a patient’s virologic response. In the case of acute hospital admission, where PPIs are prescribed for preventing  stress-induced or GI ulcers, medication reconciliation algorithms that acknowledge the interaction between protease inhibitors (PIs) and PPIs should be used [7]. It would be prudent to use PPIs strictly when prescribed and for lesser periods of time.
Fibromyalgia: a neglected stress-related illness in Pakistan
Authors: Daniyal Muhammad Alam  , Rahmah Muhammad  , Muhammad Ashhal Iftekhar
Published: September 2023

Madam,
In Pakistan, cases of stress-related illnesses are on a steady incline. Fibromyalgia is a rapidly growing example of an illness characterized by widespread chronic pain, especially on specific tender points.1 This can be caused by stress, depression, anxiety, or traumatic events present in one's daily life. However, the exact cause is unknown.1 Sleep disturbance, headache, morning stiffness, and fatigue are among the most diagnosed symptoms of Fibromyalgia.1 This illness was found to be high among workers in stressful hospital settings especially the youngest ones.2
In an analysis conducted at Indus Hospital, Karachi, from December 2016 to March 2018, 149 (55.8%) patients of 267 were diagnosed with Fibromyalgia. In this study, stress was found to be the most common factor (56%), followed by disturbed sleep (33%), amongst a variety of other variables (4.5%). ¹ Stress and emotional traumas are usually the triggering factors and are more common in a country like Pakistan, where going to therapy is considered taboo or too expensive unfortunately. As a result of this, fibromyalgia remains undiagnosed in most patients until later in life, when the condition has worsened and becomes much more severe. As far as hindrances in diagnosing Fibromyalgia are concerned, research shows that cost is not one of these obstacles as patients with fibromyalgia visit their physicians much more due to other common illnesses such as diabetes despite a similar physician's fee.3 Diagnosing this disease can be a major challenge in Pakistan. Despite physicians having satisfactory knowledge regarding fibromyalgia, a knowledge gap still exists concerning the various diagnostic criteria.4
Studies have shown that non-pharmacological therapies, especially physical therapy, have increased as an alternate treatment for fibromyalgia in recent years.5 But there is still vast unexplored potential as to the effectiveness of psychological treatments for Fibromyalgia. We should aim to make physical and psychological therapies for fibromyalgia easily accessible and readily available to the public. Awareness amongst medical professionals is essential, as a greater understanding leads to an early diagnosis and more effective treatment of patients. And so, we need further extensive studies to not only spread awareness of this neglected and exacerbating, but also provide a solution to it as well.
A word of caution against baby formula
Authors: Mushood Ahmed  , Salwa Khurshid  , Qura-Tul-Ain
Published: September 2023

Madam,
WHO recommends that infants should be exclusively fed on breastmilk till 6 months after birth. It is considered an ideal infant food for its proven health benefits(1). But in the past few decades, the use of baby formula has increased considerably. This can be attributed to aggressive media marketing, where the formula is often claimed as an equally beneficial substitute for breastfeeding(2).
An international cross-sectional survey was done recently to determine the health claims of baby formula and to assess the quality of evidence used(3). One of the common claims made by infant formula-making companies is the presence of PUFA (polyunsaturated fatty acids) in their products and its crucial role in brain development. The study found that companies were unable to substantiate this association. Other claims, including the presence of probiotics and boosting the immune system also do not have any profound scientific basis or research. Health benefits-related claims were made often without sufficient evidence or the evidence given had a high risk of bias. Studies used to support claims had a conflict of interest in many cases as the studies either had direct support from the formula industry or the authors had some affiliations with the company. Less than 15 per cent of products used human clinical trials to support their claims. Around 90 per cent of the trials either had missing data or finding not in favour of the claim made by the company. This is in contrast to the statements such as “supported by over 40 years of research” or “widely studied” which are routinely made by formula-making companies and have a high potential for misguiding parents and healthcare providers.
Many parents are inclined to use baby formula because of its marketing and easy accessibility(4). But this study has raised several questions about regulating the formula industry and its potential usage as a substitute for breastfeeding. Heath experts have suggested to governments that formula should be sold in plain packaging and there should be a proper check on the marketing of infant formula. Governments from all over the world need to pay attention to this ever-rising industry of 50 billion dollars and strict protocols should be introduced that companies have to follow.
Intrarater reliability of cervical range of motion device among adults with and without chronic non-specific neck pain
Authors: Akhter Saeed , Hamayun Zafar  , Ashfaq Ahmad  , Waqas Ahmed Farooqui
Published: September 2023

Objectives: To evaluate the intrarater reliability of the cervical range of motion device among adults with and without chronic non-specific neck pain.
Method: The analytical, cross-sectional study was conducted from January to March 2019 at the Sindh Institute of Physical Medicine and Rehabilitation, Karachi, and comprised healthy adults with no neck pain in the preceding 6 months in Group A, and adults of either gender with chronic non-specific neck pain for >3 months in Group B. The two groups were further divided into age groups 21-30 years, 31-40 years and 41-50 years. A cervical range of motion device was used to measure the range of flexion, extension, right and left lateral flexion and right and left rotation of all the subjects. The measurements were taken by a single tester on day-1 and day-3 to assess the intrarater reliability. Data was analysed using SPSS 26.
Results: Of the 60 subjects, there were 30(50%) in each of the two groups. Within the groups, there were 10(33.3%) subjects in each of the 3 age subgroups. Overall, there were 27(45%) males and 33(55%) females. In Group A, the intraclass correlation coefficient values for all cervical ranges were between 0.81 and 0.99, whereas in Group B, the values ranged from 0.64 to 0.88. The intraclass correlation coefficient values yielded good to excellent agreement in both groups (>0.75) except for left lateral flexion in Group B (p=0.64), and all the values were statistically significant (p<0.05).
Conclusion: There was good to excellent intrarater reliability of cervical range of motion device in adults with and without chronic non-specific neck pain.
Key Words: Reliability, Range of motion, Spinal column, Non-specific neck pain.
Pengaruh Amalan Kepimpinan Distributif Terhadap Kompetensi Kerja Guru
Authors: Ibrahim Mohd Notfi , Musa Khalip
Published: September 2023

Pelan Pembangunan Pendidikan Malaysia (PPPM 2013-2025) bertujuan memartabatkan pendidikan negara setaraf dengan pendidikan yang diamalkan di negara-negara maju. Antara fokus utamanya adalah bagi memartabatkan profesion keguruan serta memperkenalkan gaya kepimpinan sekolah kepada amalan kepimpinan distributif di sekolah. Bagi menyokong usaha murni ini, satu kajian telah dijalankan bagi mengenal pasti tahap amalan kepimpinan distributif yang diamalkan di sekolah pada hari ini. Selain bentuk amalan kepimpinan di sekolah, isu berhubung tahap kompetensi kerja guru juga sangat berkait rapat dengan kejayaan sistem pendidikan dalam menentukan tahap kemenjadian murid. Bagi mengenal pasti isu kepimpinan di sekolah dan juga kompetensi kerja guru satu kajian kuantitatif yang melibatkan 375 orang guru di sekolah rendah dalam negeri Pahang telah dijalankan. Hasil daripada kajian ini menunjukkan tahap amalan kepimpinan distributif dalam kalangan guru besar sekolah rendah di negeri Pahang adalah tinggi iaitu pada nilai (M=4.34,SP= .377) manakala tahap kompetensi kerja guru di sekolah rendah dalam negeri Pahang juga adalah tinggi iaitu pada tahap (M=4.37,SP=.342). Kajian juga menunjukkan bahawa dimensi bagi amalan kepimpinan distributif adalah merupakan faktor peramal terhadap peningkatan kompetensi kerja guru pada nilai (R²=0.852) dan nilai ß adalah (0.615,p<0.05).
GENDER-SPECIFIC DIFFERENCES IN PARENTING: EXPLORING ATTITUDES TOWARDS GENDER-RESPONSIVE PARENTING
Authors: Kamdar Malvika , Patel Vipul
Published: September 2023

This article delves into the topic of gender-specific differences in parenting and examines the importance of adopting a gender-responsive parenting approach. Parenting practices have traditionally been influenced by gender roles and stereotypes, with mothers and fathers often adopting distinct styles in raising their children. However, with changing societal norms and a deeper understanding of gender dynamics, the concept of gender-responsive parenting has emerged.
The article reviews existing research on communication patterns, discipline styles, and gender stereotypes prevalent in parenting. It highlights that mothers tend to emphasize emotional expression and communication, while fathers may lean towards more authoritative and disciplinary methods. Moreover, parents inadvertently perpetuate gender stereotypes by assigning gender-specific activities and expectations to their children.
The article underscores the significance of challenging traditional gender norms and promoting gender-inclusive parenting practices. By encouraging open communication and emotional expression in both boys and girls, parents can foster empathy and emotional intelligence. An equitable division of household and caregiving responsibilities is also crucial in nurturing healthier parent-child relationships.
The study emphasizes the need for parents to adopt a gender-responsive approach, breaking away from rigid gender stereotypes, and allowing children the freedom to express themselves authentically. By understanding and embracing gender-responsive parenting, we can create a more inclusive and accepting society where all children can flourish, irrespective of their gender. The article concludes with practical recommendations to help parents adopt gender-responsive parenting strategies effectively.
THE OLD AGE AND DEATH – THE DEEPEST CRITICAL THOUGHT
Authors: Makwana Gautam
Published: September 2023

The elderly were shielded by the depersonalization of medicine brought on by individualism and competitiveness. As they get closer to the end of their lives, older patients frequently need to make peace with themselves and acknowledge their accomplishments and shortcomings. Medical professionals should therefore be considerate while speaking with patients and providing them with information. The terror of the elderly is not death itself, but rather their current state of abandonment. Death denial and terror are nonsensical because life is only given with the condition that it will end one day. In this context, the objectives of medical care are to accompany and lessen pain, not necessarily to provide therapies that attempt to extend biological life. Today's world has undergone significant changes as a result of the denial of death, which directly affect how those who are terminally ill are cared for. There has also been a significant change in how terminally ill persons pass away. This essay offers a succinct history of death as well as a look at some of the religious teachings on pain and death. It also talks on how the medicalization of death stops the dying person from communicating with their surroundings, paying off debts, forgiving and receiving forgiveness, and being fully himself in the short time they have left. This essay concludes that the correct function for a doctor to play is to ‘listen’ to what the patient needs. By doing this, the doctor's profession will become a more magnificent, decent, humane, and ennobling activity.
Percepção dos cuidadores de pacientes com deficiência sobre o tratamento odontológico sob anestesia geral
Authors: Da Silva Arduim Andressa , Irmgard Bartschi Gabatz Ruth , Sousa Azevedo Marina
Published: September 2023

Introdução: A necessidade de tratamentos odontológicos acumulados somados à falta de cooperaçãodo paciente são as principais razões que levam a pessoa com deficiência a necessitar de atendimentoodontológico sob anestesia geral. Objetivos: Conhecer a percepção dos cuidadores de pacientes comdeficiência acerca da necessidade do tratamento odontológico sob anestesia geral. Métodos: Estudocom abordagem qualitativa. Coletaram-se os dados entre abril e julho de 2017 por meio de entrevistassemiestruturadas. Resultados: Participaram 12 cuidadores de nove pacientes com deficiência, comfaixa etária de 25 a 73 anos e renda média de 2,5 salários-mínimos. O procedimento odontológicoé percebido como solução de problemas para o paciente quanto ao âmbito funcional (mastigação ealimentação), quanto ao âmbito da estética (questão relativa à inserção social) e quanto ao alívio dador física. Além disso, o procedimento odontológico também é percebido como solução de problemaspara as famílias, pois as necessidades dos pacientes refletem diretamente na vida do cuidador e dosdemais membros da família, que se ocupam do cuidado e se preocupam em resolver os problemasodontológicos que prejudicam o paciente, interferindo na rotina familiar. Conclusão: Os cuidadorespercebem o procedimento odontológico sob anestesia geral como uma solução de problemas deordem funcional, estética e de dor física para a pessoa com deficiência. Ademais, é percebido comouma solução de problemas para a família, pois esta se preocupa com o bem-estar do paciente ecompreende os cuidados como obrigação com um impacto direto na dinâmica familiar.
Közép- és Kelet-Európa beruházás- és exportösztönzési stratégiája, különös tekintettel a V4-ek változékony jogi környezetére
Authors: Szalai Ildikó
Published: September 2023

A Lisszaboni Szerződés fokozottabb uniós hatásköri rendje, majd az Európai Unió Bírósága által 2018. március 6-án a szlovák szállal rendelkező Achmea-ügyben hozott döntése következtében a nemzetközi beruházásvédelmi jog uniós viszonylatban jelentős változáson megy keresztül, ami valamennyi tagállam gazdaságpolitikájára hatással van. A tanulmány a Magyarország, Lengyelország, Csehország és Szlovákia beruházás-ösztönzési és -védelmi stratégiájára ható uniós szabályozási környezetet elemzi jogi szempontból. Ezek a közép- és kelet-európai államok egyben a visegrádi csoport tagjai, így vizsgálat tárgya, hogy az EU-ba betagozódott, szubregionális szinten szerveződő országcsoport érdekei milyen mértékben érvényesültek és érvényesülhetnek az uniós szabályozás alatt.
Deglobalizáció és változó értékláncok? Értelmezési kísérlet a technológiai ciklusok kontextusában
Authors: Szanyi Miklós
Published: September 2023

Egyes becslések szerint a globális értékláncok bonyolítják le a világkereskedelem 30-50 százalékát. Ezek a hálózatok a globalizáció viszonyai között a gazdasági működés kiemelt szervezeti modelljévé váltak. Elterjedésük sebességét a világkereskedelem mellett a külföldi közvetlen tőkebefektetések forgalmának bővülése is jelezte. 2008 után mindkét folyamat megtorpant. Egyes vélemények szerint ez az értékláncok és a globalizáció folyamatának visszafordulását jelzi. Más vélemények szerint csupán a folyamatok lassulása figyelhető meg. Ez a cikk amellett érvel, hogy a globális értékláncok átalakítása a 2008 utáni gazdasági sokkok és gazdaságpolitikai trendváltás ellenére korlátozott maradt. Az adatsorok trendjében látható változást legalább ennyire befolyásolta a kialakulóban lévő új internetalapú gazdasági paradigma térnyerése. Az új paradigma fő üzleti modellje ugyanis már nem a hagyományos globális értéklánc, hanem a platformgazdaság. Ennek a terjeszkedése nem kötött a világkereskedelmi forgalom vagy a külföldi közvetlen befektetések bővüléséhez. Ezt az érvet támasztja alá az is, hogy az értékláncok mutatószámainak csökkenését elsősorban az amerikai gazdaságra vonatkozóan lehet tapasztalni. Az új műszaki- gazdasági paradigma itt fejlődik a leggyorsabban, a legtöbb platformalapú cég amerikai.
Gazdaságunk alkalmazkodása ütemkésésekkel, 2020–2023: helyzetértékelés és kilátások
Authors: Bod Péter Ákos
Published: September 2023

Gazdasági teljesítményünket különös hullámzások jellemezték 2019 után, részben külső hatásokra, jelentős részt viszont belső gazdaságpolitikai okokból, valamint a kialakult gazdaságszerkezet következményeként. Az elemzés kitér világgazdasági környezetünk alakulására, majd a magyar gazdasági folyamatokat formáló belső tényezőket vizsgálja. A politikai és szabályozói ráhatások nyomán a gazdaság a szükségesnél később reagált lényeges változásokra, a térségi normákhoz képest jelentősen egyensúlyhiányossá vált a turbulens években. Az alkalmazkodás hatásfokát és időbeliségét rontja a gazdasági szerkezet, amelyben az utóbbi évtized alatt megnőtt a tőke- és anyagigényes üzleti tevékenységek súlya. A 2023 utáni új szakasznak kritikusan fontos kérdése, hogy Magyarország a kialakult szerkezetével miként tud alkalmazkodni az európai térség új makrogazdasági normáihoz, valamint a kibontakozó technológiai, geopolitikai, klimatikus és társadalmi változásokhoz.
PERANCANGAN SISTEM INFORMASI PENGARSIPAN SURAT PT.PERKEBUNAN NUSANTARA VII BAGIAN KANTOR KOMODITI TEH 2
Authors: Yoseptry Ricky , Khaerunnisa Silmi Aghnia , Prayoga Aditya Nur
Published: September 2023

Information systems are connected components that work together to collect, process, store and disseminate information to support decision making, coordination, control and to provide an overview of activities within the company, especially in archiving mail data. Archives are documentation of activities or events packaged in various forms made and received by institutions. In a company, data archives are one of the important points that are very influential. PT Perkebunan Nusantara VIII, especially the Tea Commodity Office 2 which is in charge of controlling plantations in West Java, should have a modern and structured letter data archiving information system, but in fact the data is not organized and can even be accessed by anyone. A letter archive information system application is needed so that it can help overcome obstacles in managing documents properly and limiting access rights. The application design is made object oriented using UML (Unified Modeling Language) using the Waterfall method because this method can develop software that allows system development to be carried out in a structured and systematic manner.