bluuebunny/crossref_metadata_2025 huggingface dataset:
Dampak Manajemen Anggaran terhadap Penyerapan: Wawasan dari Jawa Timur
Authors: I Andriani Ratna Novy Hari , Biduri Sarwenda
Published: May 2024

Penelitian ini menginvestigasi pengaruh perencanaan anggaran, peraturan/regulasi, sumber daya manusia, pengadaan barang dan jasa, dan pelaksanaan anggaran terhadap pengelolaan dan penyerapan anggaran daerah di Dinas Pekerjaan Umum Bina Marga Provinsi Jawa Timur. Data dikumpulkan dari 68 responden yang bekerja di berbagai peran keuangan di 12 Unit Pelaksana Teknis (UPT) dan 5 Bidang Pelaksana Jalan dan Jembatan dengan menggunakan formulir G. Analisis regresi linier berganda digunakan untuk menganalisis data. Temuan menunjukkan bahwa perencanaan anggaran, sumber daya manusia, pengadaan barang dan jasa, dan pelaksanaan anggaran secara signifikan mempengaruhi penyerapan anggaran, sedangkan peraturan/regulasi tidak. Penelitian ini menyarankan perlunya peraturan yang lebih jelas dan menekankan pentingnya perencanaan yang efektif dan manajemen sumber daya manusia dalam meningkatkan penyerapan anggaran. Penelitian selanjutnya perlu mempertimbangkan jumlah sampel yang lebih besar untuk meningkatkan akurasi data dan mengeksplorasi faktor-faktor lain yang mempengaruhi penyerapan anggaran.
Revolusi Pengelolaan Keuangan: Dampak Transaksi Non-Tunai di Indonesia
Authors: Ula Naylul , Widodo Heri
Published: May 2024

Penerapan transaksi non-tunai dalam administrasi negara bertujuan untuk mencegah dan memberantas korupsi, serta memastikan pengelolaan keuangan yang akuntabel, transparan, efektif, dan efisien. Penelitian ini mengevaluasi proses dan tantangan penerapan transaksi non-tunai dalam pengelolaan APBD di beberapa kecamatan di Sidoarjo dengan menggunakan metode kualitatif interpretatif dengan pendekatan studi kasus. Penelitian ini dilakukan dari 1 Februari hingga 31 Maret 2023, melibatkan wawancara, observasi, dan analisis dokumentasi. Hasil penelitian menunjukkan bahwa transaksi non-tunai di kecamatan-kecamatan tersebut sesuai dengan prinsip tata kelola yang baik, meningkatkan akuntabilitas, transparansi, efisiensi, dan pengendalian arus kas. Meskipun ada beberapa gangguan sistem dan internet, manfaat yang diperoleh termasuk transaksi yang dapat ditelusuri, visibilitas saldo harian, dan pelaporan keuangan yang lebih efisien. Penelitian ini menyoroti dampak positif transaksi non-tunai terhadap pengelolaan keuangan pemerintah daerah, serta menyarankan perlunya perbaikan sistem dan penerapan yang lebih luas.
Upaya Penerapan Pendidikan Karakter Pancasila pada Siswa Sekolah Dasar
Authors: Ni’mah Nadhira Tita An , Siregar Muhamad Ahyar Fadly , Pane Agnes Agata , Manurung Celine Soraya Laura , Rajagukguk Natasya Aulina
Published: May 2024

Artikel ini bertujuan untuk menenamkan upaya secara mendalam penerapan mengenai pembentukan karakter melalui pendidikan Pancasila pada siswa di Sekolah Dasar. Pendidikan karakter sedari dini agar tertanam nilai nilai moral berakhlak mulia untuk di masa mendatang.  Pembentukan karakter siswa melalui pendidikan Pancasila menjadi suatu hal yang harus dilaksanakan karena siswa tidak hanya dididik secara kognitif tetapi juga mempunyai karakter dan budi pekerti baik sehingga kehidupan menjadi bermakna dan mempunyai tujuan di masyarakat dalam kehidupan. Hasilnya Pancasila mampu membentuk karakter mulai dari kebiasaan hidup mengenai sikap baik, beretika, dan bermoral sehingga dapat diterapkan di kehidupan sehari-hari. Penelitian ini menggunakan metode studi literatur dengan menelaah, membaca, merangkum berbagai artikel, jurnal, buku sesuai topik bahasan sehingga didapat hasil pembahasan. Kesimpulannya pendidikan karakter Pancasila dapat meningkatkan dan memberi pembelajaran yang tepat pada siswa di sekolah dasar agar menjadi lebih berkarakter siswa.
Inovasi Pembelajaran PKN di Era Digital dengan Pemanfaatan Teknologi dalam Meningkatkan Pemahaman Siswa
Authors: Shefira Adis , Dewi Nadia Rismala , Octaviani Regita
Published: May 2024

Perkembangan teknologi informasi dan komunikasi telah membawa perubahan signifikan dalam dunia pendidikan, termasuk dalam pembelajaran Pendidikan Kewarganegaraan (PKN). Penelitian ini bertujuan untuk mengeksplorasi inovasi pembelajaran PKN di era digital melalui pemanfaatan teknologi dalam meningkatkan pemahaman siswa. Metode penelitian yang digunakan adalah studi literatur yang komprehensif dari berbagai sumber terkait, seperti jurnal, buku, dan laporan penelitian. Hasil penelitian menunjukkan bahwa pemanfaatan teknologi dalam pembelajaran PKN, seperti multimedia interaktif, simulasi digital, dan pembelajaran online, dapat meningkatkan minat, motivasi, dan pemahaman siswa terhadap materi PKN. Selain itu, penggunaan teknologi juga memungkinkan pembelajaran yang lebih kontekstual, kolaboratif, dan berpusat pada siswa. Namun, penerapan teknologi dalam pembelajaran PKN juga memiliki tantangan, seperti akses teknologi yang terbatas dan kesiapan guru dalam mengintegrasikan teknologi secara efektif. Penelitian ini menyimpulkan bahwa inovasi pembelajaran PKN di era digital melalui pemanfaatan teknologi dapat menjadi solusi dalam meningkatkan kualitas pendidikan dan mempersiapkan siswa untuk menjadi warga negara yang aktif, kritis, dan bertanggung jawab di era digital.
Dampak Dukungan Emosional Teman Sebaya terhadap Remaja: Kajian Sistematik
Authors: Dewi Sri , Kurniati Noviani , Asmoro Damar Safitri
Published: May 2024

Artikel ini menyajikan hasil kajian sistematik mengenai artikel-artikel yang diterbitkan antara tahun 2014 dan tahun 2024 yang fokus kajiannya adalah tentang dampak dukungan emosional teman sebaya pada remaja dengan menggunakan database internasional dan nasional, seperti PubMed dan Google Scholar. Proses seleksi artikel dari berbagai database dilakukan dengan menggunakan Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Hasil analisis atas 6 artikel yang dipilih mengindikasikan bahwa dampak dukungan emosional teman sebaya terhadap remaja meliputi konsep diri yang positif, penurunan depresi, peningkatan kesehatan mental, kematangan karier, dan peningkatan afek positif. Bukti empiris ini menjadi dasar bagi remaja mengenai kesadaran akan kebahagiaannya.
Formação inicial de professores que ensinam matemática: ampliando o processo formativo para além do “ligue os pontos”
Authors: Lacanallo-Arrais Luciana Figueiredo , Moya Paula Tamirys , Santos Edilson de Araújo dos
Published: May 2024

Neste trabalho, objetiva-se apontar proposições sobre a prática pedagógica a partir de estudos desenvolvidos na disciplina de Estágio Curricular Supervisionado na educação infantil com conceitos matemáticos, diante do cenário atípico da pandemia de Covid-19, que assolou o mundo. Discute-se o papel atribuído à educação nesse contexto e se reafirma a indispensabilidade da escola e do ensino à apropriação dos conhecimentos elaborados pela humanidade e sua função essencial à constituição das novas gerações. A metodologia consiste em uma intervenção realizada com uma turma com crianças de 3 a 4 anos de um Centro de Educação Infantil, com base no conteúdo de medidas padronizadas e não padronizadas de comprimento, massa e capacidade através de ações de ensino pautadas na Teoria Histórico-Cultural e na Atividade Orientadora de Ensino, as quais objetivam explorar o conteúdo além do “ligue os pontos”.
Teratogenic Risk Potentiality of Blue Ternate (Clitoria ternatea) Leaf Extract Using Chorioallantoic Membrane (CAM) Assay: Phase One
Authors:   BS Nursing Students, College of Health Sciences, St. Paul University Surigao, Surigao City, M. Jawel Rheajean , C. Orquillo Sylphjenn ,   BS Nursing Students, College of Health Sciences, St. Paul University Surigao, Surigao City, M. Barcos Xycris Ezenette ,   BS Nursing Students, College of Health Sciences, St. Paul University Surigao, Surigao City, B. Guazon Carmel Grace ,   Faculty, College of Health Sciences, St. Paul University Surigao, Surigao City, A. Lumayno Arjune ,   Faculty, College of Education, Culture and Arts, St. Paul University Surigao, Surigao City, T. Ederio Nikko ,   Faculty, College of Education, Culture and Arts, St. Paul University Surigao, Surigao City
Published: May 2024

The study implemented a descriptive classic experimental design within a laboratory, utilizing the Chorioallantoic Membrane (CAM) assay to investigate the teratogenic potential of Blue Ternate (Clitoria ternatea) leaf extract using the different extract concentrations, and the phytochemical analysis screening unveiled the presence of flavonoids, saponins, tannins, alkaloids, and steroids in the leaves. The primary objectives encompassed the assessment of teratogenicity at various extract concentrations, comparing results with controls, and exploring the plant’s impact on embryonic development. While no significant differences emerged in primary and secondary blood vessels among treatments, a conspicuous variation in tertiary blood vessels indicated potential teratogenic effects at specific concentrations. Nevertheless, the study concluded that Clitoria ternatea exhibits promising therapeutic attributes. Recommendations include the implementation of public awareness programs elucidating the health benefits of Blue Ternate and further investigations into refining, storage practices, and potential teratogenicity in other plant parts. These insights, of considerable value to medical practitioners and future researchers, underscore the importance of caution and consultation, especially for pregnant individuals. In summary, the research significantly contributes to understanding Blue Ternate’s safety profile, presenting avenues for future exploration. The emphasis on careful consideration in medicinal applications, particularly during pregnancy, reinforces the need for responsible and informed decision-making in healthcare practices.
Knowledge of Mothers about Preterm Infant Care in Mosul City/ Iraq
Authors:   Master student College of Nursing/ University of Mosul., Kaleel Muneera Ibrahim , Ahmed Mahmoud, Mohammad ,   Assist. Prof. Dr.College of Nursing/ University of Mosul
Published: May 2024

Background & objectives: An infant who is born prematurely is more exposed to health complications than normal children in terms of the development of his lungs in particular, and is negatively linked to the chances of contracting diseases and death. The study aims to assess women’s knowledge about preterm infant care in Mosul city. Methodology: A descriptive study design was conducted in five government hospitals in Mosul city. The purposive sampling method was selected for the study, which consists of 221 women from preterm infant mothers in intensive care unit in Mosul hospitals. Data were collected through face-to-face interview by constructed questionnaire from the 22 of November 2023 until 20th of March / 2024. Descriptive statistics were calculated using SPSS software version 26. Results: The results of the study showed that mothers’ knowledge regarding caring for premature infants was good, except that their knowledge regarding vaccinations (1.750), preventing infections (1.33), and regarding umbilical cord care (1.40) was weak. Conclusions & recommendations: The study found that mothers' knowledge about caring for premature infants was good, but they lacked knowledge on infection prevention, vaccinations, and umbilical cord care. The researchers recommend health education for mothers on these topics, as premature infants have higher morbidity and mortality risks.
A Study on the Impact of Cruise Tourism Experience on Satisfaction, Revisit Behavior, and Consumer Spending Behavior
Authors: Huang Meng-Li , Li Yi-Min , Ho Ping-Tsan , Huang Hao-Chen
Published: May 2024

Abstract

This study focuses on exploring the impact of cruise tourism experiences on travelers' satisfaction, revisit intentions, and consumer spending behavior. By distributing questionnaires to cruise travelers and collecting 372 valid samples, the study conducted a comprehensive analysis using structural equation modeling (SEM). The empirical results show that cruise tourism experiences play a crucial role in enhancing travelers' intrinsic and extrinsic satisfaction. These satisfaction factors further positively influence travelers' revisit behavior and directly increase their consumer spending, highlighting the critical role of cruise service quality in promoting tourism sustainability and enhancing economic benefits. Additionally, the study found that improvements in the quality of services provided by cruise operators, such as accommodation, dining, and entertainment, can significantly enhance travelers' overall satisfaction. This not only fosters customer loyalty but also positively influences customers' revisit behavior and consumer spending behavior. These findings provide empirical support for cruise operators in improving services and formulating market strategies.

JEL classification numbers: Z30, Z32.
Keywords: Cruise tourism experience, Satisfaction, Revisit behavior, Consumer spending behavior.
Development of a New Non-Invasive Approach to Treat of Infantile Hemangioma with Growth-Inhibiting Endogenous Factors (Non-Invasive Approach to Treat of Infantile Hemangioma with Endogenous Factors)
Authors:   Chavchavadze av. N3, 01028, Tbilisi, Ivane Javakhishvili Tbilisi State University, Georgia, Dzidziguri Diana
Published: May 2024

Background: Infant hemangioma is a benign vascular tumor, the main reason for the development of which is genetic disorders occurring in embryogenesis. It should be noted that all methods of treating the disease, both general and local, have potential negative risks and side effects. The identification of endogenous regulatory factors and researching the possibilities of using them for treatment is relevant. There is the thermostable proteins complex (TPC) which has been identified in the cells of phylogenetically distant almost all organisms, which has the ability to decrease the mitotic activity of cells by inhibition of transcription. In the experimental model of hemangioma, it has been established that inhibition of capillary growth can only be achieved by injection. The aim of the work was to develop a new, less invasive method of hemangioma treatment with endogenous factors.
Paleolithic bifacial artefacts from Eastern Bohemia
Authors: Čechák Petr , Pacák Marek , Šída Petr
Published: May 2024

Four Paleolithic lithic artefacts that were produced using the bifacial technique are currently known from the territory of Eastern Bohemia. Three of them, namely a knife from Bolehošt’ and leafpoints from Jaroslav and Černčice, were subjected to traceology analysis and 3D models of these artefacts were created. These models served as a basis for enhanced visualisation of their surface features using APSS surface analysis. Although in the case of the knife from Bolehošt’ and the point from Jaroslav no traces could be detected by tracer analysis, the point from Černčice can probably be interpreted as a knife on the basis of this method. One of the fractures on the artefact is also interesting, which seems to be the result of its re-shaping during the Paleolithic. The APSS analysis, in turn, has been proved to be a very promising tool for the documentation of lithic artefacts whose surface is also heavily weathered.
Comparison of NEWS2 and PSI as mortality predictors in patients with community acquired pneumonia
Authors: Kumari Neelam , Saifullah Nausheen , Jafri Saira , Ahmed Aziz , Jawad Nadia , Ahmed Naseem
Published: May 2024

In the West, National Early Warning Score 2 (NEWS2) is commonly applied to predict the severity of illness using only bedside variables unlike the extensive Pneumonia Severity Index (PSI). The objective of this study was to compare these scores as mortality predictors in patients admitted with community acquired pneumonia (CAP). This cross-sectional study was conducted in Jinnah Postgraduate Medical Centre, Karachi, Pakistan, for six months in 2020 on 116 patients presenting with CAP. Cases of aspiration pneumonia, hospital acquired pneumonia, pulmonary tuberculosis, pulmonary embolism, and pulmonary oedema were excluded. In-hospital mortality was taken as the outcome of this study. The mean age of the participants was 46.9±20.5 years. The in-hospital mortalities were 45(38.8%). NEWS2 was 97.8% sensitive but only 15.5% specific in predicting the outcome, whereas PSI was less sensitive (68.9%) but more specific (50.7%), which showed that in comparison with PSI,
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Closing the gap: an urgent need for newborn screening of organic acid disorders in developing countries
Authors: Vankwani Soma , Wasim Muhammad , Mirza Munazza Raza , Awan Fazli Rabbi
Published: May 2024

Organic acid disorders are rare inherited metabolic disorders of key metabolic pathways. For the identification of specific organic acids, investigation of urinary metabolites and genetic testing are required through newborn screening programmes. Delayed diagnosis leads to complications, such as cardiac attacks, respiratory problems, neuro-developmental disorders, intellectual disability, and even premature death. The burden of such inherited disorders is quite high in developing countries of South Asia due to high rate of consanguinity in the region. Unfortunately, such disorders are left untreated due to the lack of screening facilities in such countries. The current narrative review was planned to highlight the urgent need for closing this gap and implementing effective newborn screening programmes for organic acid disorders in developing countries.
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Analysis of complications after out-of-hospital cardiac arrest of target temperature management
Authors: Yun Cheuh Hsiao , Lin Chun-Jung , Lin Kuan-Yu
Published: May 2024

Objective: To analyse the prevalence of complications related to out-of-hospital cardiac arrest patients achieving target temperature management within 360 minutes compared to those taking more than 360 minutes.
Method: The retrospective study was conducted at a medical centre in Taiwan, and comprised data from January 1, 2014, to December 31, 2020. Data was retrieved using the International Classification of Diseases version 10 codes I46.2, I46.8 and I46.9 related to adult patients of either gender presenting to the Emergency Medicine department with out-of-hospital cardiac arrest. Data included gender, age, medical history, body mass index, acute physiology and chronic health evaluation II score, blood glucose levels, electrocardiogram results, and complications occurring within the target temperature management timeframe. Data was divided into group A having patients who achieved target temperature management within 360 minutes, and group B having patients with delayed TTM of more than 360 minutes. Data was analysed using SPSS 22.
Results: Of the 127 patients, 76(59%) were males, 51(41%) were males, 47(37%) were aged >75 years, and 13(10.3%) were aged <50 years. Of the total, 65(51.2%) patients were in group A, and 62(48.8%) were in group B. Pneumonia, urinary tract infection, septic shock and gastrointestinal bleeding had lower incidence rates in group A than group B(p<0.05). The odds of death were 2.879 times higher in group B patients than group A (95% confidence interval: 1.908-8.916).
Conclusions: Hypothermia treatment should be started as soon as possible to achieve target temperature management within 360 minutes to reduce the risk of complications and mortality.
Key Words: Out-of-hospital cardiac arrest, Target temperature management, Risk of death.
Barriers to medical consultation and strategies for enhancing the prevention and reporting of child abuse: a cross-sectional survey of caregivers of paediatric patients at a tertiary care center in Karachi, Pakistan
Authors: Sana Saeed  , Mohammad Umer Junaid  , Marib Ghulam Rasool Malik  , Hareem Rauf  , Muhammad Osama Khan  , Kishwar Enam
Published: May 2024

Objective: To assess the knowledge of caregivers in a tertiary care setting about child abuse, their perception of potential barriers in the way of seeking medical advice for the victims, and to identify proposed solutions to ensure prevention and reporting of child abuse.
Method: The cross-sectional study was conducted from June to December 2022 at the paediatric ward of the Aga Khan University Hospital, Karachi, and comprised caregivers who were attendants of inpatients. Data was collected using a predesigned anonymous questionnaire consisting of demographic information and 27 items that were scored on a 6-point Likert scale. Data was analysed using SPSS 20.
Results: Of the 144 caregivers, 96(66.6%) were females and 48(33.3%) were males.  Overall, 86(59.7%) were aged <35 years, 132(91.7%) were married, and 120(83.3%) were the admitted child’s parent. The majority of caregivers 110(76.4%) perceived themselves to possess a high level of knowledge about child abuse. Barriers identified included a lack of trust in police and medicolegal departments 136(94.4%), fear of repercussion from the suspect 120(83.3%) and lack of confidentiality of the victims’ identity 116(80.6%). The proposed solutions included spreading awareness among teachers 136(94.4%) and caregivers 131(91.0%) about timely reporting and consultation, and developing proper mechanisms to follow-up on victims 133(92.4%). There were significant associations between some demographic characteristics of the respondents and their self-perceived knowledge and perceptions (p<0.05).
Conclusion: There was found a need to enhance public trust, ensure confidentiality, and fostering awareness through targeted strategies for a safer and more facilitative environment for children.
Key Words: Child abuse, Abuse reporting, Awareness, Caregivers.
Osmolar gap in hyponatraemia—an exploratory study
Authors: Memon Shoukat , Saeed Faiza , Alam Ashar , Chughtai Javeria , Imtiaz Salman
Published: May 2024

Hyponatraemia has indeed been extensively studied from multiple angles, including volume status, tonicity, and aetiology; however, the specific consideration of the osmolar gap (OG) within the context of hyponatraemia and its potential impact on their overall outcomes received limited attention in research. The current study represents an effort to address this gap in our understanding.
This prospective exploratory study was conducted on adults aged 14 years and older at the Indus Hospital, Karachi, from 2017 to 2020. The study involved categorising severity of hyponatraemia and volume status. The osmolar gap (OG) was calculated and categorised as either increased (OG>10) or normal (OG<10).
Among the 262 patients included in the study, there were 139 females and 123 males. Elevated OG was observed in 141(53.8%) patients. There were 28 (10.7%) recorded fatalities and majority of these individuals had an elevated OG.
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Outcomes of dorsal nasal augmentation using costochondral graft
Authors: Amna Kifayatullah  , Mamoon Rashid  , Saad Ur Rehman  , Ibrahim Khan
Published: May 2024

Objective: To assess functional and aesthetic outcomes in patients having undergone dorsal nasal augmentation with costochondral graft in a tertiary care setting.
Method: The single-centre, retrospective, observational study was conducted at Shifa International Hospital, Islamabad, Pakistan, and comprised data of patients who underwent dorsal nasal augmentation using costochondral graft between January 1, 2018, and December 31, 2022. Aesthetic outcomes in terms of patient satisfaction were assessed using Facial Appearance, Health-related Quality of Life and Adverse Effects scores. Data was analysed using SPSS 26.
Results: Of the 46 patients, 28(61%) were males and 18(39%) were females. The overall mean age was 28.39+9.13 years. Dorsal nasal deficiency occurred secondary to congenital causes in 12(26.1%) patients, trauma 19(41.3%) and prior surgery 15(32.6%). Postoperative complication rate was 7(15%); 3(6.5%) had recipient site infection and 2(4.3%) had rib graft resorption. Besides, 1(2.2%) patient reported pain 2 months postoperatively and 1(2.2%) had hypertrophic scarring. Patient satisfaction with the outcome was noted in all the 10 parameters analysed. Most commonly reported problem was that the nose was ‘looking thick/swollen’ by 12(26.1%) patients, but the issue resolved during 1-year follow-up.
Conclusion: Costochondral graft was found to be an ideal material for dorsal nasal augmentation, with high patient satisfaction rate.
Key Words: Costal cartilage, Patient satisfaction, Rhinoplasty.
Triage implementation in Pakistan: a case of broken healthcare system
Authors: Mansoor Misha , Shafiq Muhammad Hamza , Khalid Mubashra
Published: May 2024

Madam,
The death toll due to road traffic accidents (RTA) in Pakistan reached 28,170 in 2020, according to WHO. This accounts for 1.93% of all deaths in the World. (1) Mortality due to RTA is an ever-increasing concern and its management, especially in Pakistan, is still a bigger concern.
The efficient way of dealing with Trauma is by following globally accepted evidence-based “Advanced Trauma Life Support” guidelines. Triage being the first step in ATLS literally means “to sort”. In other words, identifying the greatest good for greatest numbers. The Emergency Department (ED) rule must be to manage patients based on the severity of problems and not on the order of arrival. Death can be prevented in the patients who benefit the most by getting medical attention the earliest. All the patients escorted and rescued from the place of incident should be sorted rapidly and given a colour-coded tag based on urgency.
Onsite triage is the most critical life saving measure. A Karachi based study concluded that most paramedics in ambulances had poor knowledge of pre-hospital management and 72.3% thought they could not do triage. (2) Similarly, another study at the emergency department of a tertiary care hospital in Karachi showed concerningly poor knowledge of triage.(3)
Only 5 CPSP accredited public hospitals in Pakistan have emergency medicine as a separate field which results in lack of triage implementation as EDs of most hospitals are run by internal medicine professionals and general surgeons. Simply, implementing triage has shown to reduce and ED mortality (by 3.80%), resources’ utilisation, and length of stay.(4)
Punjab, the development hub of Pakistan, provides 22 public hospitals, including only 12 fully functional ones, for dealing with trauma patients. DHQs bearing the burden of all trauma patients of districts are level-III trauma centres lacking in specialised surgical care and categorization of paediatric and adult patients. Other independent trauma care facilities are level-IV trauma centres which act as a relay to stabilise the patients before they are transferred to a better facility. A level-I trauma centre alone can increase 25% survival rate of trauma patients, but unfortunately Pakistan does not have a single level-I trauma centre. (5)
Therefore, all Rescue staff must be trained regularly for future enactment of triage to alleviate RTA associated mortality along with upgrading of trauma centres to level-I.
Challenges to Alzheimer Care in Pakistan
Authors: Ruzny Fathima Aamina , Mohamed Imtiyas Muhammed Ifham , Rizvie Abdul Raheem
Published: May 2024

Madam,
Alzheimer's, the prime culprit behind Dementia, is a neurodegenerative disorder that gradually erases memory and cognition, affecting daily tasks 1. Symptoms often emerge in later years, and in Pakistan, where a rising aging population and middle-income status prevail, the risk amplifies. By 2030, global dementia cases can soar to 1.3 million from 850,000 in 2015, surging to 3.6 million by 2050 without preventive action 2. Urgent attention beckons. Yet, challenges abound. With Pakistan’s depleting literacy rate currently of 58.9% in 2023, misconceptions are likely 3. Stigma, cultural norms, and language barriers shroud the path to treatment. Moreover, mental health issues like depression, an Alzheimer’s symptom, are seen as taboo, deterring help-seeking. Till date, the lack of national databases stifles research progress, and a shortage of neurologists-just less than 150 for millions of people-worsens with scarce training programs4. Private caretakers in this developing country may be limited. As this chronic Alzheimer's has no cure, high drug costs hinder adherence, while the affordability of the new "Leqembi" drug, if approved, raises concerns. Additionally, access to MRI and CT scanning equipment in Pakistan is not widespread and their procurement along with testing entail significant costs. Furthermore, government policies and funding for Alzheimer's treatment and research might be insufficient with the rising aging population.
NGOs in Pakistan related to Alzheimers are very limited- “Alzheimers Pakistan” the one and only centered in just three regions across this vast country.
Solutions for these challenges emerge as vibrant threads. How can we aid patients and families in Alzheimer education? Imagine engaging workshops and media partnerships with prominent figures like the UNICEF Goodwill ambassadors thereby igniting a good community-healthcare    bond, and envision ‘Alzheimer homes’ for patients lacking caregivers. Besides, a national database involving stakeholders, from NGOs to healthcare providers, can not only pave the way for easy data accessibility but also to proper treatment plans and protocols. Engaging these stakeholders could also lead to initiatives for more affordable medicines. For the shortage of neurologists, medical tourism initiatives that attract foreign neurologists to work temporarily in the country, sharing their expertise and contributing to healthcare delivery can be deployed. Targeted training for healthcare professionals and collaborating with international organizations for increased research, clinical trial participation and even in machinery purchase hold a promise to resolving this issue. Conclusively, emphasizing these concerns holds utmost significance in the pursuit of discovering effective interventions for this incurable ailment.
Semaglutide and weight loss – a concern for diabetics and pharmaceuticals
Authors: Admani Bushra , Fahim Mariam , Ahmed Huda
Published: May 2024

Madam,
On 4 June 2021, the FDA approved intravenous Wegovy (semaglutide) for weight-loss management in chronically obese individuals [1]. However, Wegovy, also sold under the name Ozempic, has long been a shortcut for rapid weight loss and gained a reputation as “the worst kept secret in Hollywood” [2]. A recent rise in the popularity of these drugs has led manufacturers struggle to meet the increased demands, resulting in shortages of the medication—even for critical diabetic patients for whom they were initially recommended [2]. In this letter, we scrutinise the possible adverse effects of the rising usage of semaglutide for weight loss.
A Semaglutide Treatment Effect in People with Obesity (STEP) trial of 3613 participants showed that 2.4 mg of semaglutide can cause clinically significant weight loss of 14.9% [95% CI] and improve cardiovascular function when used over 68 weeks [3]. The primary reported contraindications were gastrointestinal disturbances such as nausea, vomiting, and diarrhoea [3]. However, another STEP 1 trial the following year found that this weight loss was not sustainable as 1961 participants regained 11.6% (SD: 7.7) of the lost weight after discontinuation [4].
The increasing usage of semaglutide medication for purely aesthetic weight loss without diet and lifestyle modifications has become a pressing problem. The use of semaglutide by non-obese and non-diabetic individuals poses a public health threat as there is limited literature available on its contraindications in this population. Similarly, the original aim of drug development was to achieve sustained, clinically significant weight loss and seek to improve associated comorbidities, including cardiovascular diseases. These benefits are lost when the primary focus of semaglutide use becomes weight loss alone and other health parameters are ignored. Trials show that discontinuation can lead to regain of two-thirds of the lost weight and a reversal of cardio-metabolic improvements [5].
Moreover, this misinformed usage of semaglutide fuelled by media influence contributes to the age-old perception of ‘miracle drugs’ that allow quick fixes. Such erroneous beliefs can cause an unhealthy lifestyle and binging behaviours, highlighting the need for patient counselling at the time of prescription and stricter regulations on the distribution of semaglutide. Stricter regulations should also be implemented until the long-term effects and safety of using Wegovy, which contains a higher dose of medication (2.4 mg) as compared to antidiabetic semaglutide formulations, are extensively explored.
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Illicit over the counter availability and recreational use of Zolpidem by young adults: A letter to the editor
Authors: Gull Abdul Rehman , Afzal Zubia , Batool Humna
Published: May 2024

Dear Editor,
Zolpidem is a sedative-hypnotic drug that acts as a Central Nervous System (CNS) depressant by acting on GABA receptors. This drug, brand name Ambien, is prescribed mainly for short-term treatment of sleeping problems. However, recent trials and research also show its efficacy in treating various neurological disorders. It is one of the safest drug choices for insomnia, but like any other drug, it has various side effects that include nausea, vomiting, allergies, dizziness, metallic taste, etc. However, some of the concerning side effects include amnesia, parasomnia, and behaviour changes, including hallucinations, delusions, and depression (1). ‘Ambien Zombie’ was a term coined to describe people under the effect of the medication as they got involved in embarrassing activities including sleepwalking.
It is a Schedule 4 drug, which means ‘prescription only medicine’ as it has viable medical use but also a low probability of misuse or abuse. Despite the potentially alarming side effects in addition to dependence, which has been reported several times (1), it is becoming increasingly popular among young adults, including students, to use it for various purposes, including and especially recreational. These purposes are sleep, relief from anxiety or depression, feeling good, getting high, relaxing or zoning out, and out of curiosity, while some also use it to perform better at school (2,3). The calming effect of zolpidem on the brain gives a drugged effect, allowing the person to carry out compulsive activities and behaviour, hence called an ‘Ambien Zombie’ while most of the time, forgetting about it the next day (anterograde amnesia) (4). Even after realising this side of drug use, young adults use it for fun to feel disinhibited, or to achieve a euphoric state without any embarrassment.
The issue of concern is the widespread availability of this drug in pharmacies. As it is a class 4 drug, it should be given on a doctor’s prescription only. However, it is unfortunate that this is not being followed, especially in Pakistan. While some pharmacies ask for a prescription, the majority give it away freely to anyone asking for it, be it a student or a young doctor prescribing himself. This was mainly due to nonqualified salesmen in the pharmacies becoming a source of illicit sale practice for nonmedical prescription drug use (5). This easy accessibility of Zolpidem has rendered it to be a recreational drug for the youth.
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Film as an educational tool in medical pedagogy: a study on cinemeducation and its effectiveness
Authors: Cheema Usama Naveed , Sarmed Ibrahim  , Nukhbat Ullah Awan  , Haram Ashiq  , Wagma Sarmed  , Khalid Munir
Published: May 2024

Objective: To find out the possibilities and usefulness of introducing cinemeducation in medical institutions, and to formulate suggestive inserts for faculty and policy-makers.
Methods: The quantitative study was conducted in Lahore from January to June 2021 after approval from the ethics review committee of King Edward Medical University, Lahore, and comprised fourth and final year medical students. Relevant short clips from seven movies of different genres were selected and shown to the students who were then divided into eight equal groups. Every session lasted 30 minutes, and was followed by an interactive discussion between the students and faculty members. The critical aspects of the sessions were discussed and analysed. Data was collected using a 7-item questionnaire that was scored on a 5-point Likert scale. Data was analysed using SPSS 21.
Results: Of the 240 participants, the questionnaire was returned duly filled by 219(91.25%). Among them, 176(80.4%) said they found the experience worthwhile and that they would like to have such an experience again, while 184(84%) said such sessions should be made a part of regular curriculum. Also, 166(75.8%) participants felt that the session had helped them learn about crucial features of medicine, and 169(77%) thought that the session facilitated the understanding towards patient management.
Conclusion: Cinemeducation was found to be an excellent tool of pedagogy that should be incorporated in all the relevant disciplines of medicine and allied sciences.
Key Words: Cinemeducation, Methodology, Curriculum.
Comparative efficacy of tocotrienol and tocopherol (vitamin E) on atherosclerotic cardiovascular diseases in humans
Authors: Rafique Saima , Dilshad Ahmed Khan  , Kulsoom Farhat  , Muhammad Asghar Khan  , Mudassar Noor  , Mahjabeen Sharif
Published: May 2024

Objectives: To compare the efficacy of tocotrienol and tocopherol in the management of patients with atherosclerotic cardiovascular diseases.
Method: The systematic review was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines 2020, and comprised literature search from 2002 till January 5, 2023, on PubMed, Google Scholar, Cochrane Library, Google, Wiley-Inter Science Library, Medline, SpringerLink and Taylor and Francis databases. The search was conducted using key words, such as: “tocopherol”, “tocotrienol”, “vitamin E”, “dyslipidaemia”, “cardiovascular diseases” “cardioprotective”, “hypercholesterolemia” and “atherosclerosis” along with Boolean operators. Human clinical studies regarding the use of tocotrienol or tocopherol or comparison of its efficacy in patients having atherosclerosis, dyslipidaemia leading to cardiovascular diseases, and studies including details of efficacy of any of the four alpha, beta, gamma, delta isomers of tocopherol or tocotrienol were included. Pertinent data from the eligible studies was retrieved and reviewed.
Results: Of the 516 articles identified, 12(2.3%) were subjected to detailed analysis. Tocotrienol showed better anti-oxidant efficacy by decreasing inflammatory biomarkers, normalising serum lipid parameters and modulating micro-ribonucleic acid involved in cardiovascular diseases. Tocopherol shown heterogeneity of results by either decreasing or increasing the risk of mortality in atherosclerotic cardiovascular diseases.
Conclusion: Compared to tocopherol, tocotrienol was found to be safe and potential candidate for improving cardiovascular health in the management of atherosclerotic cardiovascular diseases.
Key Words: Cardiovascular diseases, Vitamin E, Atherosclerosis, Tocotrienol, Dyslipidaemia, Tocopherol, Hypercholesterolemia, Human studies.
Tubo-Ovarian ectopic pregnancy: a rare twin ectopic pregnancy
Authors: Khan Niama , Farooq Neha , Khan Mohsin
Published: May 2024

The most common twin ectopic pregnancy is heterotopic (1/7000). We are reporting a rare case of twin tubo-ovarian ectopic pregnancy, which was presented in the emergency department of Ayub Teaching Hospital Abbottabad. A 30-year-old female arrived with worsening lower Abdominal pain persisting for three weeks. She also had per-vaginal bleeding with passage of clots 1week ago. Clinical examination revealed a tense abdomen with tenderness in the left iliac fossa. Per-vaginally, there was cervical motion tenderness and fullness in the posterior fornix. Beta HCG level revealed a sub-optimal rise whereas Transabdominal ultrasound showed an echogenic shadow in the left ovary. The uterus appeared normal. On exploratory laparotomy a large left ovarian mass was seen with ruptured chronic right tubal pregnancy with adhesions. On cut-section of the ovary, a small foetus was evident.
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Long-term proton pump inhibitors therapy and prevalence of hyperprolactinemia. a cross-sectional study in outpatient gastroenterology clinics
Authors: Ashfaq Muhammad , Khan Adil Naseer , Alkahraman Yasser MSA , Haroon Muhammad Zeeshan
Published: May 2024

Objective: To evaluate serum prolactin and macroprolactin levels in patients on long-term proton pump inhibitors therapy.
Method: The cross-sectional study was conducted from January 2018 to November 2019 after approval from the ethics review committee of the Commission on Science and Technology for Sustainable Development in the South University, Abbottabad, Pakistan. And comprised patients from two gastroenterology outpatient clinics in the Khyber Pakhtunkhwa province using proton pump inhibitors for >3 months either alone or in combination with either histamine receptor antagonists or prokinetics. Blood samples were collected from each patient for hormonal screening. Data was analysed using SPSS 25.
Results: Of the 166 patients, 101(60.8%) were females and 65(39.2%) were males. The overall mean age was 42.5±14.2 years, and the median serum prolactin level was 23.2ng/ml (interquartile range: 14.0-38.0ng/ml). There were 96(58%) patients with normoprolactinemia and 70(42%) with hypreprolactinemia. There were 19(11.4%) patients using combination therapy, while the rest were on proton pump inhibitors monotherapy. There was a significant increase in serum prolactin level with combination therapy compared to monotherapy (p=0.001). Pateints having treatment duration 11-20 months (p=0.006) and >40 months (p=0.001) were at high risk of developing hyperprolactinemia.
Conclusion: Long-term use of proton pump inhibitors could increase serum prolactin levels, and appropriate evaluation is essential for clinical management.
Key Words: Proton pump inhibitors, Long-term therapy, Hyperprolactinemia, Omeprazole, Prolactin.
Management of chronic exogenous rhinolith with gingivonasal fistula: a case report
Authors: Puspitasari Foppi , Perkasa Fadjar
Published: May 2024

Recurrent rhinorrhoea that occurs chronically, needs to consider the possibility of a fistula in the nasal cavity, which has the potential to form a rhinolith. We report the case of a 39-year-old man with complaints of recurrent rhinorrhoea since four years ago, accompanied by thick secretions, symptoms of post-nasal drips, and olfactory disturbances. The patient had a history of removing the left upper molar (molar I), which causes a fistula in the tooth extraction site, making it more likely for food and drink to enter the left nasal cavity. Anterior rhinoscopy examination revealed a white mass in the left inferior meatus and a purulent odour discharge. In addition, there were gingival defects of the first molar teeth, multi-sinusitis, and nasal septum deviation. Rinolith extraction was performed using functional endoscopic sinus surgery, submucosal resection, and repair of gingivo-nasal defects with rotational flaps.
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Analisis Penerapan dan Pengembangan Aplikasi SIMKASDA (Sistem Informasi Manajemen Kas Daerah) dalam Meningkatkan Efisiensi Keberhasilan dan Pelaporan Keuangan: Studi Kasus BPPKAD Kota Probolinggo
Authors: Ulfa Adiranti  , Mohamad Djasuli
Published: May 2024

This study aims to analyze the impact of implementing and developing the Regional Cash Management Information System (SIMKASDA) on efficiency, success, and financial reporting at the regional level. The research method used qualitative research, focusing on the use of SIMKASDA application in BPPKAD Probolinggo City.  The results showed that the implementation of SIMKASDA significantly improved the efficiency of the regional cash management process. The system allows for more accurate monitoring of the DTH/RTH Reconciliation. This directly contributes to the success of local financial management by providing faster and more accurate information for stakeholders.  Such improved success is also reflected in the transparency and accuracy of financial reporting. SIMKASDA provides a platform that enables faster and structured preparation of financial reports, minimizes human error, and strengthens accountability in the management of public funds.  The discussion in this journal also identified some challenges faced during implementation, such as the need for intensive training and regular maintenance of the system. Research suggestions include increased training for users, regular system updates, and integration of the latest technology to ensure the continued success of SIMKASDA in the future.  Thus, this study provides in-depth insight into the contribution of SIMKASDA in improving operational efficiency, financial management success, and financial reporting quality at the local level.
Pengaruh Saving Behavior dan Literacy Finance Terhadap Retirement Preparedness pada Karyawan Swasta di PT. FCC Indonesia
Authors: Yusuf Zulkarnaen  , Rengga Madya Pranata  , Ujang Suherman
Published: May 2024

The aim of this research is to find out how saving habits and financial literacy at PT. FCC Indonesia private workers influence their preparation for retirement. This research methodology combines purposive sampling and survey methodology with a quantitative descriptive approach. Because retirement readiness must be prepared from an early age, the object of research is PT FCC Indonesia, with a sample size of 100 respondents aged 20 to 40 years. The findings of this study indicate that saving and financial literacy significantly improve a person's preparation for retirement. Although financial literacy is necessary to increase awareness of money and can help people make the right financial decisions, including the decision to invest in retirement, saving behavior is very important to grow savings that can be used to meet living expenses in retirement. The fact that this research is limited to PT. FCC Indonesia and its small sample size is one of its weaknesses. In order for the research findings to be applied more widely, larger sample sizes and more geographic locations should be used in future research. Based on research findings, private employees at PT. FCC Indonesia's preparation for retirement is greatly influenced by their savings and financial literacy. This is consistent with other research which finds a positive correlation between saving behavior, financial literacy, and retirement preparation. Knowledge about the variables that influence private employees' retirement preparations is further advanced through this research. This study implies that to ensure private sector employees' financial readiness for retirement, it is important to increase their level of financial literacy and saving behavior.