bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatitis B Virus Infection and the Risk of Coronary Atherosclerosis
Authors: Ghotaslou Reza , Aslanabadi Nasser , Ghojazadeh Morteza
Published: February 2023

Introduction: Many studies have reported on the association between human coronary artery disease (CAD) and certain persistent bacterial and viral infections. Currently, it is unclear whether hepatitis B virus infection is associated with the risk of the atherosclerosis. The aim of this study was to investigate the possible association between hepatitis B virus infection and angiography-proven CAD.

Materials and Methods: Sera from 5004 patients who underwent coronary angiography were tested for hepatitis B surface antigen (HBsAg) by enzyme-linked immunosorbant assay at Madani Heart Hospital, Tabriz University of Medical Sciences, Iran.

Results: Our study population comprised 66% male and 34% female, with an age range of 36 to 86 years. The prevalence of HBsAg positivity tended to be higher in CAD patients than in those without CAD (3.28% versus 2.17%), but the difference was not statistically significant.

Conclusion: Our results suggest that hepatitis B virus infection is not associated with coronary atherosclerosis in this population.

Key words: Atherosclerosis, Coronary artery disease, Hepatitis B virus
Innovative “Case-Based Integrated Teaching” in an Undergraduate Medical Curriculum: Development and Teachers’ and Students’ Responses
Authors: Chan Wing Pong , Hsu Chung Yi , Hong Chuang Ye
Published: February 2023

Introduction: We developed “Case-Based Integrated Teaching (C-BIT)” in our medical school to integrate the content of various disciplines through a core patient design that introduces major diseases to students. This article presents the concepts, development and initial evaluation of the teachers’ and students’ responses to C-BIT.

Materials and Methods: Teachers’ manuals for 18 major diseases were completed. Eighty teachers from various disciplines participated in writing the first 10 manuals. On the basis of this experience, 57 teachers subsequently prepared another 8 manuals. Each manual is composed of a brief summary of a patient with a major disease, learning objectives, case presentation, questions, a teaching guide and references for all disciplines. Teachers’ and students’ responses to a questionnaire were recorded.

Results: Most respondents agreed that C-BIT is patient-centred and can be used to improve curriculum integration, reduce duplication in teaching and enhance communication among the faculty members from various disciplines. One-third of the teachers contributed to more than one C-BIT manual, indicating their enthusiasm for the development of C-BIT. Most of the students agreed that C-BIT can enhance discussion, integrate the curriculum and promote active learning.

Conclusion: We have developed a new format for teaching materials that enhance teacherstudent and teacher-teacher interactions, reduces redundant content and integrates disciplines through patient-oriented medical education.

Key words: Case-based learning, Integrated disciplines, Medical education, Teaching materials, Teaching methods
Step-2 Thai Medical Licensing Examination Result: A Follow-up Study
Authors: Wanvarie Samkaew , Prakunhungsit Supavadee
Published: February 2023

Introduction: The Thai medical students sat for the Medical Licensing Examination of Thailand (MLET) Step 2 for the first time in 2008. This paper analysed the first batch of Ramathibodi students taking the MLET Steps 1 and 2 in 2006 and 2008 respectively. Materials and Methods: The scores from the MLET Steps1 and 2, and fifth-year cumulative grade point averages (GPAX) of 108 students were analysed. Results: Only 6 (5.6%) students failed the MLET Step 2 examination. Students who failed the MLET Step1 were more likely to fail their MLET Step 2 (relative risk, 5.8; 95% confidence interval, 1.3-26.0). Students with low GPAX or scoring in the lowest quintile or tertile on the MLET Step1 were also at increased risk of failing the LET Step 2. Conclusions: The data suggest that performance on the MLET Step 1 and GPAX are important predictors of a student’s chances of passing the MLET Step 2. Students with poor academic achievement or failing the MLET Step1 should be given intensive tutorials to pass the medical licensing examination. Key words: Clinical Science, Medical licensure, National test
Development of a Tool to Evaluate Health Science Students’ Experiences of an Interprofessional Education (IPE) Programme
Authors: Lê Quynh , Spencer Judy , Whelan Jessica
Published: February 2023

Introduction: The Rural Interprofessional Programme Emergency Retreat (RIPPER) is an educational programme collaboratively developed and evaluated by an interprofessional team from Schools within Faculty of Health Science (FHS), University of Tasmania (UTAS), Australia. The aims of RIPPER are to foster and facilitate positive and productive interprofessional learning experiences for undergraduate students in a rural setting; and to develop a firmly embedded and sustainable interprofessional healthcare module within the health science curriculum. This paper reports on the development of a reliable and valid survey tool to evaluate students’ understandings and experiences of this interprofessional learning programme.

Materials and Methods: Twenty-nine students from the Schools of Nursing, Medicine and Pharmacy of the FHS, UTAS participated in the RIPPER programme which offers a number of interactive rural emergency healthcare scenarios using high- and low-fidelity simulation. To evaluate the programme a survey which consisted of 2 main components was developed and implemented before and after the programme. The first component was designed to gather students’ demographic information, their understanding of the interprofessional practice concepts, and their expectations of the RIPPER programme using open-ended questions. The second component consisted of a 5-point Likert scale for students to rank their level of agreement pre- and post- intervention with 12 statements about team working, programme evaluation and collaborative learning. Three processes were used to establish the validity and reliability of the survey. Content validity was assessed by academics and experts in health science education. Construct validity was assessed using exploratory factor analysis. The internal consistency and reliability of the survey was checked using Cronbach’s alpha coefficient.
Results: Factor analysis of the 12 statements identified 3 main factors including appreciation of professional roles and responsibilities, improved professional practice based on effective teamwork and the importance of students learning and working together for improved clinical practice. Reliability of the survey was established. The survey is able to evaluate students’ understandings and experiences of this interprofessional learning programme.

Key words: Interdisciplinary learning, Interprofessional practice, Rural health
Clinical Evaluation of Arthroscopic-assisted Allograft Meniscal Transplantation
Authors: Chang Haw Chong , Teh Kai Lin , Leong Kah Lai , Mak Su Lian , Karim Sarina Abdul
Published: February 2023

Introduction: A meniscal deficient knee is at risk of early degenerative osteoarthritis. Allograft meniscal transplantation has been used to treat the meniscus deficiency to alleviate pain symptoms and to delay progression to arthritis. This case series aims to assess the postoperative outcomes of patients who have undergone meniscal allograft transplantation in our hospital.

Materials and Methods: This is a prospective clinical review of prospectively collected data of our Meniscal Transplantation Programme from 2004 to 2007. Twelve meniscal allografts were implanted in 12 males with symptomatic knees, using arthroscopically assisted techniques. Preoperative and postoperative assessments were conducted using the Visual Analogue Scale (VAS), Tegner Activity Level Scale, Lysholm Knee Scoring Scale, and 2000 International Knee Documentation Committee (IKDC) scoring systems.

Results: The mean age was 26.7 years with a mean follow-up of 17 months (range, 5 to 37). The VAS score for pain improved from 5.5 (3- 10) to 1.4 (0-2) [P<0.05], Tegner from 3 (2-5) to 5.9 (3-9) [P <0.05], Lysholm from 62.5 (27-88) to 88.6 (70-100) [P <0.05], IKDC Subjective Score from 50 (24-79) to 79.5 (56-95) [P <0.05]. Overall IKDC Knee Examination Grades revealed 10 nearly normal and 2 abnormal scores.
Conclusions: This is the first series of allograft meniscal transplantation from Southeast Asia. Patient outcome evaluation via VAS, Tegner Activity Level Scale, Lysholm Knee Scoring Scale and 2000 IKDC Knee Evaluation Form showed improvement in symptoms and knee function after implantation.

Key words: Meniscus allograft, Outcome, Transplantation
Concurrent Validity of Power Output Derived from the Non-motorised Treadmill Test in Sedentary Adults
Authors: Chia Michael , Lim Jamie M
Published: February 2023

Introduction: Many consider the Wingate Anaerobic Test (WAnT) as a reference standard assessment mode in the measurement of lower limb short-term power output. However the WAnT is criticised for having low ecological validity, in non-cycling tasks and is reliant on a pre-determined applied force, which might not elicit the highest power output. A viable alternative to the WAnT is the Non-Motorised Treadmill (NMT) Test, which allows for power measurement in all-out intensity effort sprint-running. With the reliability of the NMT to elicit power in sedentary adults already established, the aim was to compare peak power (PP) and mean power (MP) derived from a 10-s sprint on the NMT to that derived from a 10-s WAnT, to establish concurrent validity.

Materials and Methods: Twelve male [age 26.6 ± 2.4 years, body mass (BM) 63.0 ± 7.2 kg] and 11 female (age 25.3 ± 3.6 years, BM 51.0 ± 4.0 kg) sedentary adults participated in the study. PP and MP in absolute, ratio-scaled and allometrically-scaled to BM were analysed. Ratio limits of agreement (LOA) was used to establish the agreement between PP and MP from the NMT and the WAnT.
Results: PP in absolute and ratio-scaled to BM from the NMT was between 1.04 and 1.12 times that of PP from the WAnT in 95% of the attempts (PP: NMT, 647.1 ± 176.4W vs WAnT, 597.0 ± 146.0W). MP in absolute and ratio-scaled to BM from the NMT test was between 0.88 and 0.97 times of that from the WAnT (MP: NMT, 508.9 ± 130.7W vs WAnT, 548.7 ± 131.3W). Power produced on the NMT and the WAnT by sedentary adults shared moderate and acceptable levels of agreement.
Conclusions: These results affirmed that the NMT could be considered as a viable alternative to the WAnT for the assessment of PP and MP in all-out intensity sprint-running lasting 10 s in sedentary adults.

Key words: Ratio limits of agreement, Validity, Wingate Anaerobic Test
Modelling Maximal Oxygen Uptake in Athletes: Allometric Scaling Versus Ratio-Scaling in Relation to Body Mass
Authors: Chia Michael , Aziz Abdul Rashid
Published: February 2023

Introduction: Maximal oxygen uptake, VO2 & peak, among athletes is an important foundation for all training programmes to enhance competition performance. In Singapore, the VO2 & peak of athletes is apparently not widely known. There is also controversy in the modelling or scaling of maximal oxygen uptake for differences in body size – the use of ratio-scaling remains common but allometric scaling is gaining acceptance as the method of choice.

Materials and Methods: One hundred fifty-eight male (age, 21.7 ± 4.9 years; body mass, 64.8 ± 8.6 kg) and 28 female (age, 21.9 ± 7.0 years; body mass, 53.0 ± 7.0 kg) athletes completed a maximal treadmill run to volitional exhaustion, to determine VO2 & peak.
Results: VO2 & peak in L/min of female athletes was 67.8% that of male athletes (2.53 ± 0.29 vs. 3.73 ± 0.53 L/min), and VO2 & peak in mL/kg BM1.0/min of female athletes was 83.4% of male athletes (48.4 ± 7.2 vs. 58.0 ± 6.9 mL/kg BM1.0/min). Ratio-scaling of VO2 & peak did not create a size-free variable and was unsuitable as a scaling method. Instead, VO2 & peak, that was independent of the effect of body mass in male and female athletes, was best described using 2 separate and allometrically-derived sex-specific regression equations; these were VO2 & peak = 2.23 BM0.67 for male athletes and VO2 & peak = 2.23 BM0.24 for female athletes.

Key words: Athletes, Maximal oxygen uptake, Scaling
Common Lower Limb Sports-related Overuse Injuries in Young Athletes
Authors: Lau Leok Lim , Mahadev Arjandas , Hui James HP
Published: February 2023

Introduction: Sports injuries in children and adolescent present a unique challenge to the physician. They are often seen for clinical conditions unique to their age group. This paper highlights the epidemiological aspect of sports-related overuse injuries in this age group.

Materials and Methods: This retrospective study reviewed all the paediatric patients diagnosed with overuses injuries during a 5 years and 7 months period. The overuse injuries were anterior superior iliac spine avulsion fracture, Osgood-Schlatter disease, Sinding-Larson-Johansson disease, osteochondritis dissecan and Sever’s disease. We reviewed the literature and attempted to give an overview for each condition and the anatomical differences that contributed to their occurrence in this age group.
Results: A total of 506 cases of the overuse injuries were seen during the study period. Seventy-three per cent were male patients. The knee joint was the commonest affected joint while the hip was the least affected joint. The mean age at diagnosis was younger in female compared to male for all conditions except in Sinding-Larson Johansson syndrome. Female was diagnosed at a mean age of 11.7 years while male at 10.8 years. Osgood-Schlatter disease was the commonest among the overuse injuries. There was no discernible racial predilection for these conditions except in the patients with anterior superior iliac spine avulsion.
Conclusions: Overuse injuries are not uncommon in children and adolescent. An adequate understanding of the anatomy of the sports the children participated in as well as the anatomical differences between adult and children may assist the primary care providers better meet parents’ and coaches’ expectations.

Key words: Apophysitis, Osgood-Schlatter disease, Osteochondritis dissecan, Overuse injuries, Sever’s disease, Sinding-Larson-Johansson disease
Auricular Anthropometry of Newborns at the Singapore General Hospital
Authors: Lian Wee Bin , Cheng Maureen S , Tiong Ing Hua , Yeo Cheo Lian
Published: February 2023

Introduction: External ear abnormalities accompany many syndromes and genetic conditions. Yet, there are currently limited Asian references and no local norms for ear measurements and definitions for “low-set ears”. The authors therefore describe ear measurements in a Singapore newborn population and seek to establish the applicability of the general accepted definition of “low-set ears” being that of “less than a third of the entire ear height being above the inter-medial canthal line”.

Materials and Methods: Babies managed by the Department of Neonatal and Developmental Medicine during a 3-week period were measured by 2 investigators using the Feingold and Bossert technique. Intra- and inter-rater reliabilities were calculated. The influence of various anthropometric factors on and their relationships with ear length (EL) and width (EW) was analysed.
Results: A total of 104 neonates (20% preterm at birth) were included in this study. Median gestation was 38 weeks (range, 32 to 42). Mean birth weight was 2910 ± 657 g. Mean EW and EL for term infants were 2.1 ± 0.1 cm and 3.6 ± 0.3 cm respectively, without significant differences for different-sided ears, investigators, race or gender. Mean percentage of right and left ear above the denoted line was 52 ± 9% and 47 ± 10% respectively (P = 0.000), with 3rd percentile being 33%.
Conclusions: Singaporean neonatal ears are comparable with other Asian neonates – larger than Hong Kong Chinese babies, though similar to Japanese newborns – but smaller than Caucasian neonates. The definition of “low-set ears” is consistent with the general accepted definition.

Key words: Babies, Ear length and width, Ear measurements, Low-set ears
Outcome of Severe Head Injured Patients Admitted to Intensive Care During Weekday Shifts Compared to Nights and Weekends
Authors: Rathakrishnan Rahul , Berne Yeh I , Quek Keng K , Hong Chiew S , Ong Benjamin KC , Chan Bernard PL , Sharma Vijay K
Published: February 2023

Introduction: Some studies have demonstrated an increased risk of death for patients admitted at nights or during weekends. This study was undertaken to investigate the demographic profile, medical interventions and outcome of severe head injury patients stratified according to day and time of admission to a specialised neurosciences intensive care unit (NICU).

Materials and Methods: A retrospective study using a prospectively maintained severe head injury database in a tertiary hospital. Admissions to the NICU were grouped into weekdays, weeknights and weekends. A comparison of patients admitted during the day and night hours were also made.
Results: A total of 838 severe head injury patients admitted to NICU were included in the study, of which 263 were admitted on weekdays, 327 on weeknights and 248 on weekends. More patients were admitted during the night (496) compared to during the day (342). There were no significant differences in the demographic profile, mechanism of injury, severity of injury, need for neurosurgical intervention, and duration of mechanical ventilation, intensive care unit (ICU) stay and mortality associated with day and time of admission. In multivariate analyses controlling for confounding factors, no statistically significant difference in ICU mortality was found with the day and time of admission.
Conclusions: There were more severe head injury patients admitted to ICU at night and on weekends, with no significant difference in demographic profile, types of injuries, need for neurosurgical interventions and duration of ICU stay and mortality in a specialised NICU with adequate staffing and requisite diagnostic and therapeutic modalities available.

Key words: Cerebral ischaemia, CT angiography, Transcranial Doppler
Clinical Characteristics of Renal Infarction in an Asian Population
Authors: Huang Chien-Cheng , Chen Wei-Lung , Chen Jiann-Hwa , Wu Yung-Lung , Shiao Chi-Jei
Published: February 2023

Introduction: Renal infarction is a rare and easily missed disease. There is even less meaningful information on renal infarction in the Asian population. Thus, the aim of this study was to clarify the clinical characteristics of the disease in Asian patients.

Clinical Picture: Over a period of 10 years, 38 Chinese patients with renal infarction diagnosed by contract-enhanced CT or angiography were enrolled in this study. Their demographic data, clinical characteristics, laboratory and image results, risk factors or suspected causes, treatment and final outcomes were retrospectively reviewed. The results were also compared with the analogous Western data. The mean age of the sample population was 60.8 ± 17.6 years, with patients aged over 50 years and males predominating. The most common symptoms/signs were abdominal (57.9%) and flank pain/tenderness (50%). Only 23.7% of patients had suffered previous thromboembolic events such as coronary or peripheral artery diseases, or cerebral infarction. Cardiogenic factors, such as atrial fibrillation, intra-cardiac thrombus, infective endocarditis and valvular heart disease, were the main causes of renal infarction (57.9%). The most common laboratory abnormalities were elevated serum LDH (92.1%) and proteinuria (76.3%). Only half of the cases involved haematuria at initial presentation.
Treatment and Outcome: One-third of the sample suffered renal impairment after the renal infarction. Overall mortality rate during admission was 13.2% (n = 5). The cause of death was usually not the renal infarction itself but rather the underlying disease and its complications. There was no difference in outcome for anticoagulation treatment with or without thrombolytics. Compared to their Western counterparts, the proportion of males (71.1% versus 48.3%) and bilateral renal infarctions (31.6% versus 12.4%) were significantly higher, and the percentage of leukocytosis (50% versus 85%) significantly lower in our Asian patients.
Conclusion: Clinical presentation of renal infarction is usually non-specific and differs for Asian and Western populations. In our Asian patients, the most common clinical characteristics were abdominal pain/tenderness, flank pain/tenderness, elevated serum LDH and proteinuria. Early diagnosis and treatment are imperative because of the high rate of renal impairment and associated mortality. If this disease is suspected, contrast-enhanced CT is suggested to exclude or confirm renal infarction and anticoagulation alone is currently the favored treatment.

Key words: Asian, Renal infarction, Taiwan
The Efficacy of Influenza Vaccination in Healthcare Workers in a Tropical Setting: A Prospective Investigator Blinded Observational Study
Authors: Kheok Si Wei , Chong Chia Yin , McCarthy Grace , Lim Wai Yee , Goh Khean Teik , Razak Lubna , Tee Nancy WS , Tambyah Paul Ananth
Published: February 2023

Introduction: Influenza vaccine has been shown to be highly effective in temperate regions with well-defined seasonal influenza. Healthcare workers (HCWs) are advised to receive regular influenza vaccination to protect themselves and their patients. However, there are limited data on the efficacy of influenza vaccine in HCWs in the tropics. Materials and Methods: In this observational, investigator blinded cohort study, bi-monthly questionnaires recording influenza-like illness (ILI) episodes and medical leave were administered to 541 HCWs at the Singapore National University Hospital and KK Women’s and Children’s Hospital from 2004 to 2005. ILI was defined according to a standard symptom score. Results: Baseline characteristics were comparable in both the vaccinated and non-vaccinated groups. Overall, the relative risk of self-reported ILI in vaccinated HCWs was 1.13 [95% confidence interval (CI), 0.98-1.13; P=0.107]; medical leave taken was lower in the vaccinated group [mean 0.26 ± 0.6 days per visit, compared with 0.30 ± 0.5 days in the non-vaccinated group (P=0.40)]. Because of the reported Northern Hemisphere 2003/04 vaccine mismatch, we stratified the cohort and determined that the group which received a matched vaccine had a relative risk of ILI of 0.49 (95% CI, 0.37-0.66; P<0.001), achieving a vaccine efficacy of 51%. Mean medical leave decreased significantly in HCWs who received the matched vaccine, compared with those who did not receive vaccination (0.13 ± 0.3 vs 0.30 ± 0.5; P<0.001) and with HCWs vaccinated with mismatched strains (0.13 ± 0.3 vs 0.39 ± 0.9; P=0.01). Conclusions: A well-matched influenza vaccine is effective in preventing ILI and reducing sickness absence in healthcare workers in tropical settings. Efforts need to be made to increase influenza vaccination rates and to improve the currently available vaccines. Key words: Efficacy, Healthcare workers, Influenza vaccination, Vaccine mismatch
Antiviral Drugs for the Control of Pandemic Influenza Virus
Authors: Sugrue Richard J , Tan Boon-Huan , Yeo Dawn SY , Sutejo Richard
Published: February 2023

In the advent of an influenza virus pandemic it is likely that the administration of antiviral drugs will be an important first line of defence against the virus. The drugs currently in use are effective against seasonal influenza virus infection, and some cases have been used in the treatment of patients infected with the avian H5N1 influenza virus. However, it is becoming clear that the emergence of drug-resistant viruses will potentially be a major problem in the future efforts to control influenza virus infection. In addition, during a new pandemic, sufficient quantities of these agents will need to be distributed to many different parts of the world, possibly at short notice. In this review we provide an overview of some of the drugs that are currently available for the treatment and prevention of influenza virus infection. In addition, basic research on influenza virus is providing a much better understanding of the biology of the virus, which is offering the possibility of new anti-influenza virus drugs. We therefore also review some new antiviral strategies that are being reported in the scientific literature, which may form the basis of the next generation of antiviral strategies during a future influenza virus pandemic.

Key words: Antiviral, Amantadine, Pandemic influenza virus, Oseltamivir, siRNA
Concomitant Coronary Artery Disease Among Asian Ischaemic Stroke Patients
Authors: Silva Deidre Anne De , Woon Fung Peng , Moe Kyaw Thu , Chen Christopher LH , Chang Hui Meng , Wong Meng Cheong
Published: February 2023

Introduction: Coronary artery disease (CAD) is the leading cause of death following ischaemic stroke. We aimed to study the prevalence and associations of concomitant CAD among ischaemic stroke patients in Singapore.

Materials and Methods: We prospectively studied 2686 consecutive Asian ischaemic stroke patients.

Results: CAD was prevalent among 24% of the study patients. Older age, hypertension, diabetes, hyperlipidaemia, atrial fibrillation, large stroke and South Asian ethnicity were independently associated with CAD.

Conclusions: The variables found to be associated with CAD are known atherosclerotic risk factors (older age, hypertension, diabetes, hyperlipidaemia) or associations of cardioembolic stroke (atrial fibrillation, large stroke). The over-representation of South Asians with concomitant CAD is consistent with the high burden of CAD in this ethnic group.

Key words: Associations, Atherosclerosis, Risk factors
Placental Calcification in Pseudoxanthoma Elasticum
Authors: Tan Wei Ching , Rodeck Charles H
Published: February 2023

Introduction: Pseudoxanthoma elasticum (PXE) is an inherited multisystem disorder of the elastic tissue and the objective of this case report is to correlate ultrasonographic and histological appearances of placental calcification in PXE.

Clinical Picture: We report a case of a 37-year-old white woman with PXE, whose antenatal imaging showed a markedly echogenic placenta due to extensive calcification confirmed on postpartum placental histology.

Outcome: There were no maternal or fetal complications in the antenatal period. A healthy baby of appropriate maturity and weight was delivered via Caesarean section and remained well at 6 months.

Conclusion: The majority of cases of PXE is caused by mutations in the ABCC6 gene. Serious complications in pregnancy can include gastrointestinal haemorrhage, congestive heart failure and cardiac arrhythmia but has not been shown to be associated with markedly increased fetal loss or adverse reproductive outcomes as reported in previous literature. Apart from the cosmetic deterioration of the abdominal skin, there were few serious complications and most have normal pregnancies. Obstetric prognosis is dependent on the vascular damage caused by the illness. There is no basis for advising women with PXE to avoid becoming pregnant, and most pregnancies in PXE are uncomplicated.

Key words: Angioid streaks, Echogenic placenta, Gastrointestinal haemorrhage
Sleep Disturbances in Singaporean Children with Attention Deficit Hyperactivity Disorder
Authors: Lim Choon Guan , Ooi Yoon Phaik , Fung Daniel SS , Kaur Archana
Published: February 2023

Introduction: Many studies have reported various levels of association between sleep disorders and attention deficit hyperactivity disorder (ADHD). This study aims to investigate sleep disturbances in children with ADHD prior to treatment and during treatment.

Materials and Methods: This study recruited 114 child and adolescent patients diagnosed with ADHD and 60 normal patients. Sleep disturbances are assessed using the parent-rated Child Behaviour Checklist (CBCL) questionnaire. In addition, chart reviews and semi-structured clinical interviews were conducted for 54 patients with ADHD who had been seen at the clinic since 2002 to examine the sleep disturbances they experienced during treatment over a 4-year period.

Results: Compared to the normal subjects, parents of children with ADHD reported that their children slept less. The summation score of the sleep items on the CBCL was also significantly higher in the ADHD group. Girls with ADHD also had more “trouble sleeping”. When children with ADHD received treatment with medications, they experienced sleep-related side effects. Out of the 54 children with ADHD, 18.5% experienced sleep disturbance related to medication, with 13.0% reporting daytime somnolence and 5.5% reporting insomnia.

Conclusion: Our study showed that there was an increased frequency of sleep disturbances in children with ADHD prior to treatment with medications. The children in our study appeared to sleep less. A significant proportion also experienced sleep disturbance during treatment with medication, of which daytime somnolence and insomnia were the most commonly reported problems. Future research in this area is needed to further examine the range of sleep disorders in ADHD children locally.

Key words: Child Behaviour Checklist, Insomnia, Methylphenidate
Treatment of Circadian Rhythm Sleep Disorders with Light
Authors: Chuah Lisa YM , Chee Michael WL
Published: February 2023

Sleep loss can severely impact on the integrity of cognitive functions. This review highlights the recent functional neuroimaging studies on the brain’s response while performing cognitive tasks when deprived of sleep. Among sleep-deprived healthy volunteers, reduced attention, accompanied by lowered parieto-occipital activation, may underlie performance decrements seen in other “higher cognitive domains”. Functional neuroimaging in this setting has increased our understanding of how the brain responds to, and compensates for, sleep loss. Functional neuroimaging may also provide a safe, reproducible and non-invasive means to evaluate the cognitive and neural impact of therapeutic interventions designed to treat sleep disorders and/ or to reduce the negative cognitive impact of sleep loss.

Key words: Attention, Cognition, Functional neuroimaging, Memory, Sleep deprivation
Behavioural Sleep Disorders in Children and Adolescents
Authors: Mindell Jodi A , Meltzer Lisa J
Published: February 2023

Studies indicate that sleep problems in children and adolescents are highly prevalent, with prevalence rates ranging from 25% to 40%. They are even more common in special populations, especially children with psychiatric issues. Furthermore, sleep issues are often persistent. Unfortunately, sleep disturbances often do not receive the attention that they deserve, especially since they are often highly amenable to intervention. Sleep problems, in general, range from those that are physiologically-based, such as obstructive sleep apnoea and restless legs syndrome, to those that are behaviorally-based. The behaviourally-based sleep disorders are reviewed, including a discussion of assessment, prevalence and treatment. Non-pharmacologic approaches are usually the preferred treatment and have received the most empirical support in paediatric populations. It is strongly recommended that all paediatric healthcare providers consider sleep issues in their comprehensive assessment of all children and adolescents, especially those with psychiatric issues, and provide preventive education as part of their usual standard of care.

Key words: Adolescents, Behaviour, Children, Non-pharmacological treatments, Sleep
Metastasis to the Sinonasal Tract from Sigmoid Colon Adenocarcinoma
Authors: Athar Primuharsa Putra bin Sabir Husin , Norhan Norleza bte Ahmad , Saim Lokman bin , Rose Isa bin Md , Ramli Roszalina bte
Published: February 2023

Introduction: Metastatic adenocarcinoma from the gastrointestinal tract to the sinonasal tract is rare. The histological morphology of this lesion is indistinguishable from the colonic variant of primary sinus adenocarcinoma or intestinal-type adenocarcinoma (ITAC).

Clinical Picture: This is a report of a case of metastatic adenocarcinoma of colorectal origin to the paranasal sinuses in a 52-year-old female who was previously treated for adenocarcinoma of the sigmoid colon. A histologic study of the surgical specimen from the sinonasal cavity demonstrated a tumour identical to the patient’s prior primary tumour of the colon. The sinonasal neoplastic tissue showed marked positivity for carcinoembryonic antigen and expressed cytokeratin 20, which differentiates metastatic colonic adenocarcinoma from ITAC.

Treatment/Outcome: The patient received palliative radiation but died 3 months after the diagnosis.

Conclusion: Distinguishing metastatic adenocarcinoma from gastrointestinal tract from ITAC can be difficult. In view of the resemblance, immunohistochemical staining can help in differentiating them. It is important to recognise these as metastatic lesions as the treatment is mainly palliative.

Key words: Cytokeratin 20, Intestinal-type adenocarcinoma, Sinonasal metastatic adenocarcinoma
Developing Key Account and Distributor Management to Stimulate Sales in Krakatau Steel
Authors:   School of Business Management, Bandung Institute of Technology, Indonesia, Salim Muhammad Qolbun , Lantu Donald Crestofel ,   School of Business Management, Bandung Institute of Technology, Indonesia
Published: February 2023

Krakatau Steel (KS) is a steel manufacturer in Indonesia. As a steel manufacturer, KS has to operate efficiently by achieving the economies of scale. Plays in commodity, make KS has to deal with price fluctuation. In uptrend price, customers tend to place more order to maximize the profit. Customers tend to place less order in the downtrend price to minimize the risk of high price inventory. KS has domestic competitors like Gunung Raja Paksi, Gunawan Dian Jaya Steel, Java Pacific, and ArcelorMittal Nippon Steel. KS also has competitor from import like China, Japan and Korea. To fulfil production capacity constantly, KS has to collaborate with its custmers, understanding their needs and fulfil it with the product and service that delivered. There are several categories of customers in this industry, large fabricators, small fabricators, large resellers, small resellers, projects and retailers. Large fabricators and large resellers have a big portion in order placement. KS has to select large fabricators and large resellers to join with key account and distributor management. Then categorize it into strategic customers, star customers, status customers or streamline customers. KS has to collaborate with every category differently to be effective and efficient.
The Forgotten Factors Affecting the Expansion of Medical Laboratory Services to cope up the Rising Health Demands in Sri Lanka
Authors:   Ministry of Health Sri Lanka, M. D. A. Krishanth, , I. M. S. M. Rajakaruna, ,   Ministry of Health Sri Lanka, K. A. R. P. Jayathilake, ,   Ministry of Health Sri Lanka
Published: February 2023

Introduction: The government of Sri Lanka identifies health laboratory service as an essential component in the health care service and is committed to providing quality essential laboratory services to healthcare seekers. Ministry of Health, Sri Lanka is responsible for the establishment and enactment of relevant legislation, and for providing technical and managerial guidelines for the maintenance of laboratories which comply with nationally and internationally accepted standards. Epidemiological and demographic transitions in Sri Lanka have compelled it to focus its attention to combat noncommunicable diseases, which are accounting for an estimated 80% of the annual deaths in the country. Improvement of diagnostics was identified as a priority in Health Master Plan 2016-2025 and by Primary Health Care System Strengthening Project. Methodology and results: Qualitative methods such as key informant interviews, attending meetings and desk reviews were used to collect the factors affecting the expansion of laboratory services and the most crucial factors were identified by using the 80:20 rule. Issues related to the implementation of the National Laboratory Policy, laboratory financing, human resource issues, accreditation, and lack of making sense of data were found to be the most crucial factors that need to be addressed strategically to successfully expand laboratory services across healthcare institutions. Conclusions: It is essential to improve the competencies and capabilities of the Policy Analysis and Development Unit of the Ministry of Health to facilitate policy analysis, reviews, and preparation of groundwork for National Policy enactment. Lack of accredited health laboratories and a plan to accredit may reflect adversely on the technical competence. Widespread unavailability and compartmentalization of information management systems have led to underutilization of laboratory-related data and this has resulted in a lack of a viable plan for evidence-based laboratory finance allocation and human resource development.
Measuring Self–Serving Cognitive Distortions in School Dropout Adolescents (Boys)
Authors:   Ph.D. Research Scholar, Department of Psychology, PSG College of Arts & Science, Coimbatore -641014, K Mohanapriya
Published: February 2023

Adolescence is an important period in the life span which includes physical, and psychological changes. These changes can be difficult for an adolescent to adjust which can lead to different adversities. Sometimes overcoming such adversities can be problematic and leads to cognitive distortions known as biased thinking. Aim: the study aims to measure self-serving cognitive distortions in school drop -out boys. Sample: The sample size is n-40, and the samples were collected from various places in Madurai District, Tamil Nadu using the Purposive sampling method. Materials: informed consent form, socio-demographic variables, and the How I think questionnaire ( Barriga, et al, 2001). Results: From the results, it was found that the scoring for the dimensions Self-centered, blaming others, minimizing/mislabeling, assuming the worst, oppositional defiance, physical aggression, lying, and stealing fall under the clinical category which means there exists externalizing psychopathology. The study shows that the samples tend to engage in deviant behavior like aggression, violent behaviors, stealing, substance use, and criminal behavior
Stress Management Strategies and Employee Performance: An Application of Correlational Research Design on Manufacturing Firms in Edo State, Nigeria
Authors:   Dept. of Business Administration Delta State University,Abraka, Ogomegbunam Odita Anthony
Published: February 2023

This study examined stress management strategies and employee performance in manufacturing firms in Edo State. Four research questions and four hypotheses guided this research. This study employed the correlational research design and covered all the manufacturing firms in Edo State but five of them were randomly picked for the study and their employees totaled into 1,663, which served as the study’s population, out of which 301 employees were sampled using Taro Yamane’s formula. The instrument for data collection was a self-structured questionnaire. Out of the 301 copies administered, only 264 were found usable for further data analysis and both descriptive and Pearson’s and Spearman’s rank correlation statistics were employed to analyze the study’s data and hypotheses. It was found out that employees in manufacturing firms receive maximum workplace social support and this helps them deal with stressful work situations; and they have high coping competence in handling stress. Also, it was revealed that time management was the most adopted stress management strategy among workers in manufacturing firms and they practice it to a high extent. In addition, it was discovered that mind-body strategy of time management is adopted by the employees, although, not to a very high extent when compared with their adoption of other stress management techniques. More so, the results of the tested hypotheses revealed that there exists a statistically significant correlation between all the stress management strategies outlined in the study and employees’ performance in manufacturing firms. Based on the findings, the researcher recommended that the management of manufacturing firms should sensitize their employees in understanding the benefits of mind-body interventions such as massage, yoga, etc. and how to make good use of them for reducing stress levels.
Особенности хронической сердечной недостаточности пациентов, госпитализированных в РСНПМЦК Узбекистана
Authors: Aбдуллаев Тимур , Фозилов Хуршид , Гуломов Хумоюн , Цой Игорь , Ганиева Наргиза
Published: February 2023

В данной статье описаны особенности течения хронической сердечной недостаточности у больных, поступивших в отделение сердечной недостаточности и некоронарогенных заболеваний миокарда РСНПМЦК Узбекистана.
Токнинг сохта ун-шудринг (милдью) касаллиги (шарҳ)
Authors: Содиқов Бахром , Соатов Толиб , Намозова Одина , Эргашев Азамат
Published: February 2023

Ушбу шарҳда токнинг сохта ун-шудринг ёки милдью касаллиги ҳақида умумий маълумотлар келтирилган бўлиб, унда мазкур касалликнинг қўзғатувчиси, тарқалиши, ривожланиши ва ҳосилдорликка таъсири ҳамда унга қарши кураш бўйича маълумотлар келтирилди. Дунё фитопатолог олимларининг берган маълумотларини чуқур таҳлил қилганимизда шу нарса маълум бўлдики, P. viticola ток ўсимлигининг барча яшил қисмини зарарлайдиган облигат паразити бўлиб, токнинг энг асосий патогенларидан бири ҳисобланади. Касалликнинг ривожланиши учун ҳаво ҳарорати 6 дан 26 ° C гача ҳамда ҳавонинг нисбий намлиги 90% дан юқори бўлиши оптимал ҳисобланади. Касалликнинг кучли ривожланиши натижасида ҳосилдорлик 40-90 % гача камайиши мумкин.
Основные направления социальной политики Узбекистана в контексте “Стратегии Действий”
Authors: Аминова Азиза
Published: February 2023

В статье освещена политика государства, направленная на совершенствование социальной политики на основе «Стратегии действий», включающая внедрение новых механизмов взаимодействия административных органов с народом, усовершенствование деятельности социальных институтов, местных органов. Раскрыта роль государства в повышении материального благосостояния граждан республики, повышение заработной платы, совершенствование деятельности банков. Проанализированы программы, направленные на модернизацию жилищной сферы, посредством улучшения производственных и социальных инфраструктур  городской и сельской местности. Освещены вопросы реформирования медицинского обслуживания, внедрение инновационных методов оказания услуг и производства медицинских препаратов, внедрение новых качественных методов борьбы с бедностью через повышение трудозанятости, развитие предпринимательства.
Сочинение «Фирдаус ал-икбал» и изучение периода правления Мухаммада Рахимхана I зарубежными востоковедами
Authors: Сапарбаев Бунёдбек
Published: February 2023

В статье пойдет речь о произведении «Фирдаус ал-икбал» и изучении периода правления Мухаммада Рахимхана I зарубежными востоковедами. Приводится информация о вкладе зарубежных востоковедов в изучение периода правления Мухаммада Рахимхана I. Например, такие ученые, как А.Л. Кун, П.П. Иванов, В.В. Бартольд, Ю.Э. Брегель, тщательно проанализировали произведение «Фирдаус ал-икбал» и эпоху Мухаммад Рахимхана I. В статье представлены факты того, что это произведение является основным первоисточником в изучении истории Хорезма, особенно эпохи Мухаммад Рахимхана I.  Это: перевод  П.П. Иванова  на  русский язык  части сочинения «Фирдаус ал-икбал» об истории туркмен; запись А.Л. Куном кратких заметок на основе рукописи «Фирдаус ал-икбал» о событиях в Хивинском ханстве от Абулгазихана до начала XIX века; В.В. Бартольд подготовил текст этого произведения, но бывшая советская цензура не разрешила публикацию, однако  В.В.Бартольд высказал высокое мнение о произведении  «Фирдаус ал-икбал» и был первым, кто представил это произведение на Западе; в 1988 году «Фирдаус ал-икбал» был переведен и издан историком Ю.Э.Брегелем на английском языке; в 2010 году произведение было опубликовано на узбекском языке. Кроме того, приводятся сведения о воспоминаниях путешественников, посетивших Хивинское ханство, Н.Н.Муравьева, Г.Вамбери, о Хивинском ханстве, хивинских ханах, таких как Мухаммад Рахимхан I, Сайид Мухаммадхан.
Сувдан фойдаланишни тартибга солишнинг фуқаролик-ҳуқуқий масалалари: Ўзбекистон Республикаси Сув кодексини қабул қилишнинг зарурати
Authors: Сайдахмедов Умид
Published: February 2023

Мазкур мақолада бугунги кунда Ўзбекистонда сувдан фойдаланишни тартибга солишнинг ҳуқуқий асосларини такомиллаштиришнинг институционал механизмлари ва халқаро ҳуқуқий режимлари ҳужжатлар асосида ўрганилган. Шунингдек, мақолада сувдан фойдаланишнинг тартибга солишда норматив-ҳуқуқий ҳужжатларнинг таҳлили, Сув кодексини қабул қилишнинг зарурати, ғояси, мақсади ва вазифалари нималардан иборат бўлиши лозимлиги, уни қабул қилинишидан кутилаётган натижалар ҳақида тўхталиниб, тегишли таклифлар ҳамда тавсиялар ишлаб чиқилган
Основные критерии выявления беспристрастности и независимости арбитров в арбитражном разбирательстве
Authors: Иноятова Сохиба
Published: February 2023

В настоящей статье изучаются роль и значение Руководящих принципов о конфликтах интересов в международном арбитраже – IBA Guidelines on Conflicts of Interest in International Arbitration (2014). Разбирая основные стандарты беспристрастности и независимости арбитров в международном коммерческом арбитраже, автор раскрывает суть и правовую природу данных принципов.
Психологик тренинг ёш раҳбарларнинг стрессга бардошлилигини ошириш усули сифатида
Authors: Инагамова Лола
Published: February 2023

Мақолада ёш раҳбарларнинг стрессга бардошлилигини ошириш  бўйича тренингнинг методологияси ва босқичлари муҳокама қилиган. Шунингдек, иш жойида ёш раҳбарлар учун стрессга бардошлилик бўйича тренингни тайёрлаш ва амалга ошириш юзасидан  тренернинг малакаси ва компетенцияси  таҳлил қилинади.
Exploration Of Local Culture In English Classroom Practices Through Project Based Learning
Authors: Wijirahayu Suciana , Tengku Hantamah  , Amirudin
Published: February 2023

Interesting aspects from the cultural experience, lifestyle, tourism, habit, and food from Indonesian customs were part of the projects for the students in this study to express in English. For instance, we assigned the students to find information about any culture in Indonesia that they think is unique. They designed a project to describe the uniqueness of people, things, and places. By implementing them in the project, the students could pleasantly learn English and motivate them to speak in English as we ask them to present their group’s findings at the end of the project