bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of age on colour of dentition of Baghdad patients
Authors: Hassan A. K.
Published: September 2021

The aim of this study was to assess the effect of age on tooth colour and to record the range of tooth colour in patients in Baghdad, Iraq. A total of 650 patients who were treated by fixed prosthesis were included in the study. In younger patients the commonest colours found in teeth were white-red and yellow. The proportion of patients with grey colour and red-grey increased with age. Since each tooth might possess different shades in its surface, the quadrant method of shade selection is recommended
Mental health in EMRO: the future is now
Authors: Saraceno B.
Published: September 2021

Recognizing the magnitude of the problem of mental health disorders globally, the World Health Organization has made mental health the focus of the year 2001. In this paper three priority areas for action in the Eastern Mediterranean Region are suggested, namely: human rights, mental hospitals and community care, drug abuse, and reconstruction of the health care system in Afghanistan.
Mental health and psychiatry in the Middle East: historical development
Authors: Mohit A.
Published: September 2021

A brief account is given of attitudes towards mental health and the development of psychiatry in the Middle East from an historical perspective. The Middle East is considered as a cultural entity and the influence of the beliefs and practices of ancient times on the collective mind of the people of the Region is discussed.
Prevalence and correlates of childhood fears in Al-Ain, United Arab Emirates
Authors: Mohammed N. A. , Eapen V. , Bener A.
Published: September 2021

The prevalence of fear was explored in 340 adolescents in Al-Ain, United Arab Emirates. More than 50% reported feeling extremely frightened of 6 out of 60 fear items surveyed. These items were: someone dying in the family [66.5%], parents getting divorced [65.3%], the devil [63.8%], breaking a religious law [61.5%], being kidnapped [53.2%] and being adopted [49.9%]. The level of fear showed a significant positive correlation with female gender, parental death/divorce, living with a single parent/relatives, living in low income families and an adverse home environment. Nearly half of the children reported that the fear caused considerable distress and interfered with daily activities.
Effect of pre-instruction on anxiety levels of patients undergoing magnetic resonance imaging examination
Authors: Selim M. A.
Published: September 2021

Thistudy investigated differences in anxiety level of patients who received instruction prior to magnetic resonance imaging [MRI] compared to a control group that did not. Thus, 60 patients were randomly assigned to two groups. Patients in the study group received instructions designed by the researcher plus the routine hospital instructions, while the control group received the routine hospital instructions only. The State-Trait Anxiety Inventory was administered to both groups before and after MRI examination. Patients who received the designed instructions reported significantly lower levels of anxiety than the controls. The findings also indicated that 60% of the total sample used prayer to reduce anxiety. The study emphasizes the need for detailed information about the procedure and training in relaxation techniques.
Prevalence of hepatitis B virus among chronic schizophrenia patients
Authors: Said W. M. , Saleh R. , Jumaian N.
Published: September 2021

We aimed to determine the prevalence of hepatitis B surface antigen [HBsAg] among chronic schizophrenia patients in Jordan. Over a period of 12 months, 192 patients [106 male and 86 female] were tested for hepatitis B virus [HBV] by enzyme immunoassay. An equal number of age- and sex-matched healthy controls was also tested. Of the schizophrenia patients, 14 [10 male and 4 female] were positive for HBsAg while only 5 [4 male and 1 female] of the control subjects tested positive. The difference was not statistically significant but it indicates that chronic schizophrenia patients are a risk group for HBV infection and likely to benefit from preventive measures [health education and immunization against HBV].
Prescribing rationality and availability of antimalarial drugs in Hajjah, Yemen
Authors: Abdo Rabbo A.
Published: September 2021

Thistudy in 3 districts of Hajjah governorate, Yemen, used WHO core indicators to investigate irrational prescribing of antimalarial drugs in public and private health facilities. Laboratory diagnosis rates were low in public facilities [21.2% of encounters]. Informal prescriptions were issued in > 70% of encounters [public and private]. Important patient and drug information was missing from many prescriptions. Both public and private facilities had high rates of prescribing multiple drugs [mean 3.0 and 4.0 respectively per encounter, maximum 11], brand-name drugs [32.9% and 64.2%] and injections [17.2% and 33.5%]. The total number of antimalarial drugs registered in the country was found to be 98, with 52 different formulations and strengths of chloroquine. Efforts should be made to promote rational prescribing of antimalarials.
Imaginarios sociales en la novela gráfica Batman. Deathblow:
Authors: Coca Juan R.
Published: September 2021

Resumen: En este artículo se hace un estudio semiótico y hermenéutico de una novela gráfica llamada Batman/Deathblow. El texto pese a brevedad tiene complejidad y entidad semiótica suficiente como para ser analizado en solitario. En esta obra se muestra a un héroe más humanizado de lo que suele ser habitual en las novelas gráficas de Batman. El análisis nos permite comprender los elementos semióticos del personaje principal: Bruce Wayne. Además, el estudio semiótico y hermenéutico nos indica que los elementos culturales relacionados con el protagonista.

Abstract: It is making a semiótic and hermeneutics study in this article about a graphic novel named Batman/Deathblow. The text, despite its brevity, has complexity and semiotic entity sufficient to be analyzed alone. In this work, a more humanized hero is shown than is usually in the case of Batman graphic novels. Analysis allows us to understand the semiotic elements of the main character: Bruce Wayne. In addition, the semiotic and hermeneutical study indicates that the cultural elements related to the protagonist.
Kavak Çayı (Gelibolu, Çanakkale ) Mollusca Faunası ve Bazı Su Kalitesi Özelliklerinin Belirlenmesi
Authors: Bal Demet , Odabaşı Deniz Anıl , Zilifli Aytuğ
Published: September 2021

Marmara havzasının Batısında bulunan Kavak Çayının sucul Gastropoda ve Bivalvia faunası ile bazı su kalitesi özelliklerinin araştırılmasını amaçlayan bu çalışmada, Kavak Çayı havzasından seçilen beş istasyondan 2016 yılı içerisinde, makroomurgasız taban faunası ve su örneklemeleri mevsimsel olarak gerçekleştirilmiştir. Standart örnek-leme yöntemleri kullanılarak yapılan taban faunası örneklemelerinden sonra taban faunasındaki gastropod ve bivalv örneklerine ait bireylerin tür teşhis ve sayımları laboratuvarda gerçekleştirilmiştir. Molluska türlerinin istas-yonlara göre birey sayısı, baskınlık ve frekans değerleri hesaplanmıştır. Bunun yanında, tespit edilen türlerin tole-rans değerleri de verilmiştir. Örnekleme istasyonlarında yerinde ölçülen su sıcaklığı, çözünmüş oksijen (doygunluk ve yoğunluk), pH, toplam çözünmüş katılar, elektrik iletkenliği gibi parametreler kaydedilmiştir. Diğer su kalitesi parametrelerinden nütrient ve bazı elementler ise laboratuvarda iyon kromotografisi cihazı ile analiz edilmiştir. Çalışma sonuçlarına göre, araştırma bölgesinde sucul molluska faunasına ait toplam 17 takson belirlenmiştir. Yerinde ve laboratuvarda ölçülen su kalitesi parametreleri Türkiye Su Kalitesi Kontrolü Yönetmenliğine göre karşı-laştırıldığında, örnekleme istasyonlarının ölçülen parametrelere göre birinci (en yüksek) ve dördüncü kalite (en düşük) sınıfları arasında oldukları belirlenmiştir. Özellikle çözünmüş oksijen ve Alüminyum gibi bazı parametrele-rin etkisiyle su kalitesi sınıflarının düştüğü gözlenmiştir. Sonuç olarak, Kavak Çayı ve havzasında belirli su kalite parametrelerinin su kalitesini kötüleştirdiği, buna bağlı olarak da, ortamda yaşayan molluska faunası kompozisyo-nunun genel olarak organik kirliliğe toleranslı türlerden oluştukları görülmüştür.
Los rostros de la desigualdad educativa. Sexismo, racismo y discriminación en la educación superior
Authors: Bermúdez Urbina Flor Marina , Ramírez López Dulce Karol
Published: September 2021

La desigualdad educativa ha sido un tópico ampliamente estudiado en el campo de la sociología de la educación. Los estudios hasta ahora realizados analizan principalmente las brechas entre sectores sociales y grupos educativos, encontrando relaciones importantes entre el nivel de ingreso de las familias y sus logros educativos.
Políticas sociales y participación en México. El caso del programa Comedores Comunitarios
Authors: Martínez Espinoza Manuel Ignacio
Published: September 2021

En los últimos años la participación se ha definido como un componente fundamental de la política de desarrollo social en México. Sin embargo, en la práctica, la participación no se ha interpretado con la complejidad inherente de los conceptos políticos, su instrumentación se ha reducido a acciones concretas como pasar lista o elegir representantes y ha sido una dimensión ausente en las evaluaciones de los programas sociales. Con el objetivo de subsanar tales lagunas de conocimiento, en el presente libro se realiza un estudio crítico y metódico de los conceptos de participación y políticas sociales, se indaga sobre las particularidades que han tenido en México, se proponen modelos para su análisis y se explora el caso del programa Come­dores Comunitarios. Integrando la complejidad temática con un trata­miento exhaustivo y sistemático, el libro permite identificar concepcio­nes, instituciones, actores, procesos y resultados de la participación en el ámbito del desarrollo social en México.
A 59 pA/V and 62 nW Differential OTA with 0.35% THD for Biomedical Applications
Authors: Sanchotene Silva Rafael , Rodovalho Luís Henrique , Brum Marques Jefferson Luiz , Ramos Rodrigues Cesar
Published: September 2021

This paper presents a novel differential pA/V Operational Transconductance Amplifier (OTA) topology. The circuit is suitable for the implementation of fully integrated operational transconductance amplifier-capacitance (OTA-C) filters with small feature size capacitors, suited for electrophysiological signal acquisition and conditioning. Unlike typical OTA-Cs, the proposed topology consists of transconductance reduction technique based on unbalanced output branches thatallow current subtraction thus enabling transconductances in the order of pA/V. The technique is demonstrated through the design of a 59pA/V transconductor, which is very suited for designing long-time-constant filters. This OTA-C achieved a worst-case 0.35% THD with just 61.7nW average power consumption, which allows its applicability to biomedical implants. Simulations were carried out with STMicroelectronics 0.13µm HCMOS9 node using Cadence’s IC design tools. Weemployed the OTA in a design of a fourth-order bandpass filter with a narrow bandwidth of 12.5–21.8Hz. Similar results to the ideal transfer function, turn the proposed OTA ideal for biosensing-based applications.
Robust Convolutional Neural Networks in SRAM-based FPGAs: a Case Study in Image Classification
Authors: Benevenuti Fabio , Kastensmidt Fernanda Lima , Oliveira Ádria Barros de , Added Nemitala , Aguiar Vitor Ângelo Paulino de , Medina Nilberto H. , Guazzelli Marcilei Aparecida
Published: September 2021

This work discusses the main aspects of vulnerability and degradation of accuracy of an image classification engine implemented into SRAM-based FPGAs under faults. The image classification engine is an all-convolutional neural-network (CNN) trained with a dataset of traffic sign recognition benchmark. The Caffe and Ristretto frameworks were used for CNN training and fine-tuning while the ZynqNet inference engine was adopted as hardware implementation on a Xilinx 28 nm SRAM-based FPGA. The CNN under test was generated using an evolutive approach based on genetic algorithm. The methodologies for qualifying this CNN under faults is presented and both heavy-ions accelerated irradiation and emulated fault injection were performed. To cross validate results from radiation and fault injection, different implementations of the same CNN were tested using reduced arithmetic precision and protection of user data by Hamming codes, in combination with configuration memory healing by the scrubbing mechanism available in Xilinx FPGA. Some of these alternative implementations increased significantly the mission time of the CNN, when compared to the original ZynqNet operating on 32 bits floating point number, and the experiment suggests areas for further improvements on the fault injection methodology in use.
Robust and Energy-Efficient Hardware: The Case for Asynchronous Design
Authors: Calazans Ney Laert Vilar , Rodolfo Taciano Ares , Sartori Marcos L. L.
Published: September 2021

The current technologies behind the design of semiconductor integrated circuits allow embedding billions of components in a singe silicon die, enabling the construction of very complex circuits in a tiny space, dissipating little energy and producing huge amounts of useful computational work. However, the current levels of integration for electronic components in silicon and similar materials are not easily managed, as parameter variations grow steadily, making the design tasks increasingly challenging. Synchronous techniques have dominated the digital system design landscape for many decades, but their costs are increasingly hard to cope with. Asynchronous design and particularly quasi-delay insensitive design promises to deal with the same challenges more gracefully in current advanced nodes, and possibly irrevocably in future technology nodes. This article proposes a review of the state of the art in using asynchronous circuit design techniques to achieve energy-efficient and robust digital circuit and system design. In particular, the definition of a robust digital circuit comprises addressing several aspects to which a digital system design is expected to be robust to, including: (1) voltage variations; (2) process variations; (3) temperature variations; (4) circuit aging. Besides addressing energy-efficiency and all the mentioned robustness aspects, this work also approaches some of the state-of-the-art tools available to deal with asynchronous design, and points to desirable research development to be conducted in these subjects in the future.
Development of Test Instruments Based Computer- Higher Order Thinking (CBT-HOT) in Intermediate Reading Courses
Authors: Pusparini Indrawati , Sari Ike Dian Puspita
Published: September 2021

This  research developed  product of test instruments based computer -High Order Thinking (CBT-HOT)  in intermediate reading courses in Ikip Budi Utomo Malang. Test instruments based computer -High Order Thinking (CBT-HOT) in intermediate reading courses are high-level test package that are provided online by using a website as a basis for students who access it, so it is suitable to campus vision that must use ICT technology. The product consists of five test packages compiled with high-level criteria according to Taxonomy Bloom , those are package A, B, C, D and E. The design of this research adapts from the Borg and Gall model with the following steps (1) need analysis, (2) planning, (3) product development, (4) expert validation, (5) product revisions and (6) product trials. The objectives of this study are: (1) to produce scientific articles published in reputable national journals; (2) to produce scientific article published in international scientific journals; (3) produce CBT-HOT based test computer products that will be certified. The average value on material validation showed good results,  which the average score 2,81. The average value of media  validation also shows good results, which is 2.86. The average value in test instruments is 2.87.
The Effect of Talking Chips Technique Toward the Improvement of Students’ Speaking Achievement at one of the Senior High Schools in Bandung
Authors: Syafryadin Syafryadin
Published: September 2021

This study investigated how the Talking Chips Technique can help students to improve their speaking. The sample was only one class and  total number of students was 36 students. This study used a time series design and three data collection, i.e. note taking, participant observation, and speaking test. The data from observation were analyzed by using thematic analysis and band score of speaking. This study was conducted by using multiple pre-test and post-test. Therefore, the findings of this study were based on pre- test, treatments and post- test. During the treatments, there were problems related to classroom management (noisy, low participation, laughing), fluency (pause, flow and speed) and accuracy (pronunciation, grammar and vocabulary). Those problems could be minimized. After post-test, there were still problems, but the problems were fewer than previous ones like only fluency and accuracy because students had showed the awareness and enthusiasm in speaking English. This study showed the improvement of students’ speaking achievement from treatment until posttest. It was proved by the mean score pretest and posttest. In pre-test, the mean score of fluency was 61.1 and 62.81 for accuracy. In post-test, the mean score of fluency was 71.451 and accuracy was 74.69. Then, t- test for fluency was 7.05 and t-test for accuracy was 8.31 with t critical or table was 2.031. It meant that H1 was accepted. There was significance improvement of students’ speaking in terms of fluency and accuracy.  The findings suggest that the students still need further treatments to improve their speaking even though they have achieved the target.
Student' Perception and Problems in Learning English Using Google Classroom During the Covid-19 Pandemic
Authors: Diana Nova , Yunita Wisma , Harahap Alamsyah
Published: September 2021

The Covid-19 pandemic has occurred across the world. This causes all segments of human life to be disturbed including the education sector. The teaching and learning process tends to run ineffectively and should be done online. Online learning offers a learning process that can be done not only in the classroom but anywhere and anytime. One of the applications that can be used is Google classroom. This study aims to determine students' perceptions and problems in learning English using Google Classroom during the Covid-19 Pandemic at SMAN 6 Kota Bengkulu. This research was a mixed-method research involving 443 students in the academic year of 2020/2021. The data were collected using a questionnaire in the form of a Google form consisting of 50 questions with 4 answer choices, namely strongly agree, agree, disagree, and strongly disagree, and semi-structured interviews. The data obtained were analyzed quantitatively and qualitatively. The results of this research indicate that the students have a positive perception in learning English using Google classrooms during the Covid-19 pandemic at SMAN 6 Kota Bengkulu with the average score obtained was 1160 and was in the positive category. Moreover, the data obtained from the interview showed that most of the students experienced problems in learning English skills using Google classroom caused by lack of vocabulary. In addition, the problems in using the Google classroom application were in the opening and uploading files or videos. These findings are expected that the teachers should change their teaching habits by offering students innovative opportunities to improve their self-confidence, to control their learning, and to practice their language skills. The students should be more creative to solve the problems during learning English by using Google classroom even in the online process or not.
CLINICAL CHEMISTRY LABORATORY TESTING
Authors: SHAUKAT ASMA , Irfan Shahid , ARAIN TARIQ MAHMUD , Farrukh Soufia , SHAHID AMNA
Published: September 2021

Objective: To determine the affect of autonomy on clinical chemicaltesting in pathology department Quaid-i-Azam Medical College and to assess the change in the attitudes oflaboratorians and physicians Study design: Retrospective and comparative. Duration of study: 1-11-93 to 01-11-03Materials and Methods: A retrospective study was carried out from 1-11-93 to 01-11 03 in which records from 1-11-93to 1-11-03 were collected and evaluated .Separate record of each month’s revenue from clinical chemistry section wascalculated. In order to determine what changes have been brought about after autonomy a universal questionnairewas used to assess the attitudes of physicians and surgeons of hospital inquiring whether they noticed anyimprovement in the efficiency of clinical chemical test results after autonomy. 620 doctors were interviewed throughstructured questionnaire. The questionnaire was designed to assess the knowledge , attitude and practices of doctorstowards autonomy. In order to determine that who is the most beneficent of autonomy ,different records werecollected. and discussions were made with consultants. Results: Autonomy brought about a healthy change in the staffof clinical chemical section. Quality control has improved the morale of lab staff since technical deviations are morereadily identified and corrected within the lab, gross errors are rarely found by the clinicians and so their respect forand confidence in the lab has strengthened Replenishment of chemicals/reagents are timely made. The number ofavailable test has significantly increased which in turn has significantly raised the revenue generated since autonomy is awarded. Pilferage of chemicals has been stopped. Turn around time has been decreased. Clinical Chemical sectionparticipates in External Quality Assessment Scheme, NEQAPP (National External Quality Assessment ProgramPakistan),which is an essential part of the routine of a well –run lab. Patient is the most beneficent since autonomy isawarded to QMC/BVH, BWP. Conclusions: A significant improvement in the efficiency of the analytical performancehas strengthened the faith of laboratorians and physicians in the test results after autonomy
DEPRESSION AMONGST EPILEPTIC PATIENTS
Authors: KHAN KHALID HAYAT , TAHIR M. H.
Published: September 2021

Objective: To evaluate the proportion of depression amongst epilepticpatients. Study design: Cross-sectional study. Setting: The study was carried out in CMH Pano Aqil Period:September 2003 to September 2004. Material and Methods: One hundred consecutive cases of primary epilepsy fromthe outpatient department were included in the study sample. Patients with severe physical or mental disability wereexcluded from the study. Standardized translated Urdu version of Beck Depression Inventory was used to evaluatedepression. ICD-10 criteria for depression was used for such patients. Statistical significance was calculated by usingSPSS computer software programme. Results: Out of 100 epileptics, 36 patients were found to be depressed.Conclusion: There is very significant depressive morbidity in epileptic patients and is under diagnosed and henceunder treated. There is need to address this aspect very seriously.
POST-OPERATIVE PAIN RELIEF FOR LOWER ABDOMINAL SURGERY
Authors: FIRDOUS ROBINA
Published: September 2021

The severity of post-operative pain and the lack of efforts in relievingit have led to the involvement of Anaesthesiologists in the management of post-operative and acute pain. Parenteralopiates have been utilized for post-operative pain management. The identification of the opioid receptors on substantiagelatinosa has provided an alternate route i.e 1 the epidural route - for administering opiates. Objectives: To evaluateand compare the efficacy and side effects of parenteral Buprenorphine with those of Extradural Buprenorphine.Setting: Department of Anaesthesia, District Headquarter Hospital, Faisalabad. Period: The data was collected duringthe last three and a half years. Materials and Methods: Sixty adult patients of either sex and ages ranging from 35-45years, who underwent lower abdominal surgery, were randomly selected for the study. They were equally divided intotwo groups. Group I patients were administered Buprenorphine 0.3 mg through the epidural catheter in extraduralspace. Group II patients were given Buprenorphine 0.3 mg intramuscularly. Results: Buprenorphine through theepidural route gives better analgesia with fewer side effects as compared with the parenteral route.
ACUTE EPIGLOTTITIS
Authors: AHMED SHAFAQ , AHMED MAHMOOD , KAZMI ETIZAZ HADIER
Published: September 2021

A case of acute epiglottitis is presented here. The patient was in severe respiratory distress. He wasintubated and managed in general ICU. He made good recovery. ICU management and special consideration of thisdisease are discussed.
ABO & RHESUS BLOOD GROUPS
Authors: REHMAN ABDUL , Saeed Muhammad Akram , KHAN MUHAMMAD AYUB , Rafique Ahmad , ASHRAF MUHAMMAD , Ali Azam , Malik Saeed Ahmad
Published: September 2021

`Objective: To know the prevalence of ABO and Rhesus blood groups.Design: Observational cross sectional study. Setting: Blood transfusion Center Tehsil Headquarter HospitalLiaquatpur. Subjects and Methods: The data of blood donors from 2001 to 2003. Results: Total numbers of donorsstudied were 1389. The commonest ABO blood group was O present in 44.56% (CL 41.97% - 47.20%) followed byB in 32.54% (CL 30.13% - 35.06%), A in 20.88% (CL 18.82% - 23.10%) and AB in 2.02% (CL 1.39% - 2.91%) donorswhile 90.35% (CL 88.68% - 91.80%) donors were Rh +ve and 9.65% (CL 8.20% - 11.32%) were Rh -ve. Thecommonest ABO +ve group was O +ve present in 40.03% (CL 37.48% - 42.69%) followed by B +ve in 30.31% (CL27.95% - 32.78%), A +ve in 18.21% (CL 16.27% - 20.34%) and AB +ve in 1.8% (CL 1.21% - 2.66%) donors. The mostcommon ABO -ve was O -ve present in 4.54% (CL 3.56% - 5.77%), A -ve in 2.66% (CL 1.93% - 3.66%), B -ve in 2.23%(CL 1.57% - 3.17%) donors. Conclusion: Blood group O is the commonest ABO blood group and 90.35% are RH +vein this area.
OVARIAN TUMOURS
Authors: RAFIQ BUSHRA , RAO SHAHID IRSHAD , KOKAB HINA
Published: September 2021

Objectives: To correlate preoperative diagnosis with operative findingsregarding the type of ovarian tumours. Material and Methods: Setting: Gynaecology Unit-I, Nishtar Hospital, Multan.Sample size: 50 patients. Duration: One year from October 2001 to October 2002. Study Design: A prospectiveanalytical study. Results: Most common age group in benign tumours was 20-40 years. 50% of patients with malignanttumours were between 30-50 years. Out of 50 patients, 33.3% benign tumours were in unmarried girls. Only 5% ofcancers were in nullipara, while 80% of patients had two or more children. Most common presenting symptom wasabdominal/pelvic pain. Abdominal distension was present in 75% of malignant cases. Pressure effects, metastaticsymptoms and general symptoms were more frequently seen in malignant than benign cases. On ultrasonography,benign tumours were cystic in 83.3% of patients and 46% of these cystic tumours had either internal septations orechoes. 85% of malignant tumours were either solid or mixed. Ascites was detected in 60% of cancers. Abdominalascites was found in 75% of malignant cases intra-operatively. Irregular tumours and those with surface adhesionswere more likely to be malignant. The accuracy of preoperative diagnosis was found to be 84%, 5 cases initiallyconsidered malignant were later on found to be benign, while 3 cases diagnosed as benign preoperatively provedmalignant. Out of 50 cases, 46 (92%) cases were diagnosed as epithelial cell tumour on histopathology, while 4 cases(8%) were germ cell tumours. Conclusion: It was concluded that identification of risk factors, detailed enquiry of thepresenting symptoms and proper clinical examination of the tumour provide important information about the type ofovarian tumour. Ultrasonography is the best preoperative technique available to differentiate benign from malignantovarian tumours.
THROMBOCYTOPENIA IN CRITICALLY ILL SURGICAL PATIENTS
Authors: SIDDIQUE MUHAMMAD , Jaafri Asad Ullah , MASOOD SAYYED NAVEED , Hussain Fayyaz , SHAFFI RUBEENA NAZLI
Published: September 2021

Thrombocytopenia is a well known complication in the surgical intensivecare unit (ICU) patients. The influence of thrombocytopenia on patient’s mortality is difficult to assess.Thrombocytopenia results in increased mortality and transfusion requirement of platelets and other blood products, hasnot been confirmed by previous studies. We performed a case control study in surgical intensive care unit of CombinedMilitary Hospital Rawalpindi in which 119 critically ill surgical patients developed thrombocytopenia of less than 50x109platelets/L. These patients were carefully matched with control patients for the severity of underlying disease andimportant variables. Purpose of study was to evaluate attributable mortality and transfusion requirement inthrombocytopenic patients at that unit.. Fifty-two (44%) cases died versus forty (33%) control patients. Eighty one (76%)matched pairs had a concordant outcome and in 25% of those pairs, the cases died (exact binomial probabilities0.036). The estimated attributable mortality rate was 18.4% (95% confidence interval 3.12-11.8) and the estimated oddsratio was 2.6 (95% confidence interval 1.02-7.10). The estimated attributable transfusion requirement was 23% (95%confidence interval 5.3-43.5) and the estimated odds ratio was 1.51.This study suggests that thrombocytopenia of lessthan 50x10 /L seems to be a marker 9 of severity the illness and increases risk of death. Thrombocytopenia also leadsto more blood product consumption.
NUTRITIONAL STATUS AND MICRONUTRIENT LEVELS OF CHILDREN WITH CELIAC DISEASE BEFORE AND AFTER GLUTEN FREE DIET
Authors: AYESHA HINA , Butt Muhammed Asghar , SHAMOON MUHAMMED , Ahmed Maqbool , NAZIR BUSHRA , Baloch Ghulam Raza
Published: September 2021

Introduction: Celiac disease is an autoimmune inflammatory disorder ofsmall intestine precipitated by ingestion of gluten. Clinical and histological improvement occurs on withdrawal of glutenfrom the diet. Objectives: The present study were to identify the trace mineral deficiency in newly diagnosed celiacchildren and to assess how far these deficiencies are corrected after strict gluten free diet. The study also assessedthe nutritional status of celiac children compared to the healthy controls before and after Gluten Free Diet. Setting:Department of Pediatrics Punjab Medical College Faisalabad. Duration: January 2004 to March 2005. Study Design:Interventional case control study. Patients and Methods: 22 children aged 2 to 14 years diagnosed as Celiac diseaseon the basis of typical intestinal biopsy findings were included. 15 healthy children served as controls. Anthropometricmeasurements and serum Zinc Copper Magnesium and Iron along with albumin were done for both patients andcontrols initially and repeated after 6 months while patients were receiving strict GFD and controls receiving normaldiet. The general linear model was used for the analysis of variance using SPSS (2004). Results: Serum Zinc wasbelow the reference range in 68%. Serum copper and Magnesium in 31%, Iron in 95%and albumin in 59% of thepatients. There was a statistically significant increase in serum zinc, iron and magnesium levels (p value, < 0 05) whileserum copper and albumin did not show any significant rise after Gluten free diet. Control group did not show any significant change in their trace mineral levels .Celiac patients gained more weight (mean 4.47 versus 2.91 cm) andheight (3.34cm versus 1.022 cm) as compared to the control group. Conclusion: Celiac children receiving strict Glutenfree diet and showing good clinical response probably do not need mineral supplementation.
CATARACT SURGERY
Authors: RUSTAM NAEEM , HUSSAIN IRSHAD , WASEEM MUHAMMAD
Published: September 2021

Objective: To investigate the course of intraocular pressure after cataract surgery in patients havingpseudo exfoliation syndrome but without any evidence of glaucoma. Design: Prospective age-matched comparativetype. Place and Duration of Study: Department of Ophthalmology, Combined Military Hospital, Peshawar and MilitaryHospital, Rawalpindi. From 1 November 2003 to 30 April st th 2004. Patients and Methods: Ninety five patients havingcataract, were divided into two groups. Group I consisted of forty five patients with pseudo exfoliation syndrome andGroup II comprised control group of fifty patients not having pseudo exfoliation. All the patients underwent extracapsularcataract extraction with posterior chamber intraocular lens implantation. The intra- ocular pressure wasmeasured pre-operatively as well as on 7th post-operative day, 1st and 3rd post-operative months, in addition to otherpre- and post-operative evaluation. Results: Statistically, there was no significant difference in the pre-operativeintraocular pressure between the two study groups. At 7th post-operative day, the intraocular pressure was below 18mm of Hg in all the patients. First and 3rd month after the surgery, a decrease in intraocular pressure was observed.The inter-group differences in intraocular pressures at 1st and 3rd post-operative months were statistically not significant.Conclusion: Seven days after extra-capsular cataract extraction with posterior chamber intraocular lens implantation,no increase in intraocular pressure was observed in the eyes with pseudo exfoliation syndrome. Three months aftercataract surgery, intraocular pressure levels decreased in eyes with pseudo exfoliation syndrome similarly as in controlgroup.
GINGIVAL HYPERPLASIA
Authors: KAZI ANILA , KARIM NASIM , ANSARI MUNAWAR ALAM , Ali Mehar
Published: September 2021

Objective: Calcium ion plays an important role in gingival hyperplasia due toits effects on hemostatic balance of epithelial differentiation and apoptosis. It is hypothesized that non inflamed gingivalfibroblasts are less active and do not respond to circulating drugs. While the fibroblasts within inflamed tissue are in anactive state. Hence a study was conducted to investigate and assess the relationship between oral hygiene and severityof gingival hyperplasia in hypertensive patients receiving verapamil. Design of study : In the present comparativeinvestigation, clinical periodontal parameters were determined. Material & Methods: Thirty hypertensive patients whowere taking verapamil 240 mg/day in divided doses selected randomly. Subjects were divided in to HEL groups. Agingival enlargement score was assessed for each patient by using hyper plastic index, while using plaque indexassessed the oral hygiene status. Results: There were highly significant differences between test groups E and L, whenthey were compared with group H (Healthy group). Mean plaque index and hyper plastic index varied between testgroups H, E and L. The differences showed statistical high significance. Conclusions: Oral hygiene plays a decisiverole in the development of gingival hyperplasia and the incidence can be controlled successfully by meticulousprofessional and individual oral hygiene.
FROSTBITE IN GANGRENE
Authors: AKHTAR MUHAMMAD RIAZ , KHAN MUHAMMAD BABAR , MASHHOOD ASHER AHMED
Published: September 2021

Objective: The objective of this study is to determine if classification of cases of frost bite in 1st, 2nd,3rd and 4th degree have any predictive value on the future complications e.g. skin necrosis and gangrene. Study design:A non-interventional and descriptive study. Place and duration of study: The study was carried out at the SurgicalDepartment, of Combined Military Hospital Gilgit from January 2002 to February 2005. Material and methods: All thepatients who reported to the hospital with frost bite were admitted and enrolled in the study. The local examination ofwound was done and all the physical signs were recorded. The frost bite was labeled according to the severity from 1stto 4th degree in accordance to the specified criteria. All the patients were placed on a standard treatment protocolcomprising of injection of Benzyl Penicillin 10 lac U x 6 hourly, injection of Heparin 5000 IU s/c x 6 hourly and tabletsIbuprofen 400mg x 8 hourly for 5-7 days. The condition of wound was assessed daily till 8 weeks after admission. Theend point of medical treatment was a clear demarcation of dry gangrenous and viable tissue, or the formation of moistgangrene or infection in frost bitten area which was spreading proximally. Once this condition was reached the patientswere planned for amputation surgery. Results: Total numbers of patients included were 96. Among them 33 had 1stdegree, 37 had 2nd degree, 16 had 3rd degree and 10 had 4th degree frost bite. All the 33 patients of 1st degree frost biterecovered well and were discharged from the hospital without any surgical intervention. 16 patients among the total 37who sustained 2nd degree frost bite developed superficial ulcers over the skin. These patients required regular wounddressings and recovered well by 6 weeks of treatment without any limb loss. 7 out of total 16 patients of 3rd degree andall the 10 patients of 4th degree frost bite developed gangrenes. They were observed till 8 weeks and after that theyunderwent amputations. Conclusion: In accordance to the results it is concluded that most of the patients who had3rd degree of frostbite and all the patients who sustained 4th degree frost bite developed gangrene by 8 weeks ofhospitalization despite of the treatment. None of the patient of 1st and 2nd degree frostbite developed gangrene. Hencethe initial assessment of a patient was very useful in predicting the chances of development of gangrene.
FULL TERM SECONDARY ABDOMINAL PREGNANCY
Authors: FARHAT RAHILA , ROOHI MAHNAAZ
Published: September 2021

In properly evaluated patients full term abdominal pregnancy can be managed, although advancedabdominal pregnancy is a complex condition demanding challenging management. This care report describes caseof a young lady 35 years age who was diagnosed as a case of secondary abdominal pregnancy and was managedsuccessfully.
CHRONIC ANAL FISSURE
Authors: SHAUKAT AYESHA , ASLAM MUHAMMAD , ZAFAR FARID , Choudhri Aftab A
Published: September 2021

To evaluate the role of chemical sphincterotomy in the treatment of chronic anal fissure.To compare the effects of xylocaine gelly 5% with GTN 0.2%. Design: Comparative study. Setting: Outdoor andEmergency Department of Surgical unit II and III of Sir Ganga Ram Hospital Lahore Period During the year 2004Methods and materials: 40 patients of chronic anal fissure were included in study and was divided in a randomizedmanner into two groups and the effects, out come and side effects of the Xylocaine 5% and GTN 0.2% were noted,while treating the patients of chronic anal fissure. Results: At 4 weeks only 2 patients of Group A (xylocaine 5%)showed healing evidence while 8 patients of Group B (GTN 0.2%) had shown the healing of the anal fissure. At the endof the 6 weeks a total of 4 patients of Group A showed healing while in case of Group B 14 patients had shown thehealing of the anal fissure. Conclusion: Our study suggests that topical GTN produces successful chemicalsphincterotomy. It not only helps in relieving pain but also promotes healing of fissure. Lignocaine may help in relievingpain but it is not effective in healing of fissure.
BIOPHYSICAL SCORE
Authors: AFZAL AYSHA , NASREEN KHALIDA
Published: September 2021

A pregnancy is defined as high risk when there is a likelihood of anadverse outcome to the woman and or her baby that is greater than the incidence of that outcome in the generalpregnant population. Objectives: To determine the efficacy and predictive value of biophysical profile in detectingperinatal outcome. Design: Observational study. Setting: Obstetrics and Gynaecology department, PNS SHIFA KarachiPeriod: From February 2003 to October 2003. Patients and Methods: The study was carried on 100 randomlyselected high risk pregnant patients who reported to gynae OPD or were referred from different armed forces hospitalsfrom all over sindh . Manning’s biophysical profile excluding nonstress test and including only ultrasound basedparameters were employed for fetal screening ( BPS 8/8). These parameters include four variables i.e fetal breathingmovement, fetal tone, fetal movements, and amniotic fluid volume. Nonstress test and Doppler studies were used asbackup tests where biophysical profile was abnormal. All cases selected were admitted in the hospital and each hadan admission biophysical profile followed by subsequent monitoring. Parameters for abnormal perinatal outcome includefetal distress in labour, five minute apgar score less than 7/10, admission of newborn to intensive care unit and stillbirthor neonatal death. The result of last biophysical profile is compared with perinatal outcome. For statistical analysis thepredictive value, specificity and sensitivity are used to determine the ability of biophysical profile to predict an abnormalperinatal outcome. Results: Out of 100 cases 92 had a normal biophysical profile in the last scan of 8/8. 90 cases hada normal perinatal outcome with A/S > 7/10. In two cases A/S at 1 and 5 minute is < 7/10 with one baby shifted tonursery for delayed cry. 08 cases had an abnormal biophysical profile with scores of 4/8 and 2/8. There was one falsepositive who showed abnormal biophysical profile but baby was born with an A/S of 8/10 at 05 minutes. There was noneonatal death in this study group. The sensitivity of biophysical profile was 77.7%, specificity 98.90%. predictive valuefor a positive test was 87.5%, predictive value for a negative test was 97.8%. Conclusion: Biophysical profile is highlyaccurate and reliable test of diagnosing fetal status.
ESOPHAGEAL DILATATIONS
Authors: KHAN IFTIKHAR HUSSAIN , QURESHI KHALID HUSSAIN , ALI MUHAMMAD
Published: September 2021

508 esophageal dilatations were performed in our unit from January 2003 to May 2005. Thesedilatations were performed using Savary Gilliard dilator system. Instead of using image intensifier to confirm guide wireposition, abdominal palpation was used for this purpose. 508 dilatations were performed in a total of 119 patients. Sixtythree patients underwent more than one dilatation. 71 dilatations were performed under local anaesthesia using flexedscope 437 were performed under general anaesthesia using rigid scope. Our postoperative observation protocol isgiven which was developed to pick up iatrogenic esophageal tear at an early stage. Out of 508 dilatation performed,18 perforations occurred. Eleven patients had a minor confined leak. They were managed conservatively and allsurvived. Seven patients had a major leak. Out of those, three died resulting in an overall 0.59% procedure relatedmortality, while mortality for major leak group was 43%. None of the patients undergoing dilatation under localanaesthetic had a perforation. Following the protocol, no significant iatrogenic esophageal injury was missed. Weconclude that esophageal dilatation can safely be performed using Savary Gilliard dilator system. Correct positioningof guide wire can confidently be confirmed by abdominal palpation in a large majority of patients. Minor leaks can bemanaged conservatively with excellent outcome. A well functioning protocol to pick up any iatrogenic esophageal injuryearly is vital to keep a dilatation programme safe.
NEUROLEPTIC MALIGNANT SYNDROME
Authors: AKHTAR MUHAMMAD SAEED , SULIMAN MUHAMMAD IMRAN , ALI MUHAMMAD SOHAIL
Published: September 2021

Neuroleptic malignant syndrome is a rare but life threatening reaction toa neuroleptic medication. Even in state-of-the-art centers, the mortality rate is reported as 5-12%. We present a reportof a successfully managed patient with neuroleptic malignant syndrome, in Faisalabad, Pakistan. This is followed bya brief discussion about the syndrome, with a compilation of latest recommendations about assessment andmanagement.
EHLER DANLOS SYNDROME WITH PREGNANCY
Authors: ATA NABEELA
Published: September 2021

Ehlers Danlos syndrome is a group of disorders, whichhave common feature including easy bruising jointhypermobility skin that stretches easily and weakness oftissue 1. It is inherited in the genes that are passed fromparents to off spring. They are categorized according tothe form of genetic transmission into different types withmany features differing between patients in any giventype. In 2001, researches discovered a new form orEhlers Danlos syndrome that is caused by an inheritedabnormality in a protein other than collagen that alsonormally plays a role in binding together the cells of ourtissue (including the skin, tendons, muscle and bloodvessels). Abnormalities in this protein called tenascin,also lead to a form that tensacin could play a role inregulating the normal distribution of collage in connectivetime of the body2.
MORTALITY PATTERN
Authors: -REHMAN ATIF-UR , AKHTAR MUHAMMAD SALEEM , ANJUM ABDUL HAMEED
Published: September 2021

Introduction: Health planning requires reliable information about rates, ages and causes of mortalityin the different sections of society. Precise and reliable information of this nature is lacking in our country because ofunder reporting of births and deaths, poor recall of data and age at death and inability in determining the exact causeof death. Objective: To assess the frequency of mortality caused by different diseases in medical and allied units.Setting: Medical units and allied specialties wards of Nishtar Hospital, Multan. Duration: From 1st January 2001 to 31stDecember 2001. Study Design: A descriptive/Analytic study. Materials & Methods: 1017 patients who died in the year2001 were included. Results: The male patients who died in one year were 648(63.7%) and female deaths thatoccurred in one year were 369(36.3%). Most of the deaths were caused by ischemic heart disease. It was responsiblefor 320 deaths (32%). Another important cause of death was cerebrovascular accident responsible for 204 deaths(20.05%). Chronic liver disease ranked on 3rd number causing 146 deaths (14.35%). Chronic renal failure on 4th numbercausing 87 deaths (8.5%). On 5th number malignancies causing 62(6.09%) deaths. Meningitis occupied 6th numbercausing 59(5.8%) deaths. On 7th number, pulmonary tuberculosis causing 31(3.04%) deaths. On 8th number acute renalfailure causing 29(2.85%) deaths. Then cerebral malaria on 9th number causing 20(1.96%) deaths. COPD causing 17deaths (1.67%). Septicemia causing 15 deaths (1.47%) and on 11th number. On 12th and 13th number, pneumoniacausing 14 deaths (1.37%) and poisoning causing 13 deaths (1.27%) of total mortality respectively. Conclusion: It hasbeen concluded that major killers in this area are ischemic heart diseases, cerebrovascular accidents, chronic liverdiseases and chronic renal failure. So major part of health resources should be spent to decrease the mortality causedby these diseases.
EXERCISE TOLERANCE TEST
Authors: AHMAD AYAZ , KAYANI KHALID AMJAD
Published: September 2021

Objective: To ascertain the role of Exercise Tolerance Test as ascreening tool for coronary artery disease, in asymptomatic men who had one or more risk factors for developingischemic heart disease. Design: A descriptive study. Place and Time Period: Department of Medicine PAF HospitalMushaf Sarghoda from March 2004 to March 2005. Patients and Methods: A total no of 100 asymptomatic men age25-50 years with mean age of 38 years were included in the study. They were divided in to five groups according tonumber of risk factors they had for developing CAD. Following risk factors were included in the study (hypertension,diabetes ,smoking, obesity, hyper-lipidemia, family history of CAD.). All of them underwent E.T.T over treadmill usingmodified Bruce protocol. Test was considered positive if 2mm or more ST segment depression was noted .those testedpositive had coronary angiogram done to confirmed IHD. Results: Seven out of 100 tested positive for IHD on E.T.T.Those tested positive underwent coronary angiography 6 out of seven showed significant narrowing of coronaryarteries and 1 had normal angiogram. These results showed that E.T.T has a 76% sensitivity and 87% Specificity.Conclusion: E.T.T is an important, reliable and cost effective test to detect latent CAD in asymptomatic persons whohad multiple risk factors for developing CAD.