bluuebunny/crossref_metadata_2025 huggingface dataset:
Electricity Retail Rate Design in a Decarbonizing Economy: An Analysis of Time-of-use and Critical Peak Pricing
Authors: Schittekatte Tim , Mallapragada Dharik , Joskow Paul L. , Schmalensee Richard
Published: May 2023

Currently, the main component of most U.S. consumers’ electricity bills is based on a constant price per kWh consumed. As intermittent renewable resources and flexible loads that can be shifted within days (such as electric vehicle charging) gain prominence in the electricity system, the efficiency gains to be realized from basing bills instead on wholesale spot prices increase. There is little political support for this change, however. We focus on second-best alternatives: time-of-use (TOU) rates and critical peak pricing (CPP). We introduce alternative assessment criteria that focus on intra-day load shifting. Using historical data, we find that TOU rates can reasonably replicate the intra-day load-shifting incentives provided under spot pricing. Thus, TOU rates, especially when complemented with CPP involving load control during infrequent scarcity price events, can be considerably more socially valuable than previously estimated.
GRANULAR CELL ASTROCYTOMA
Authors: Batool Ayma , Azra Bashir  , Saira Javed  , Samina Zaman  , Akhtar Sohail Chughtai
Published: May 2023

Granular cell astrocytoma (GCA) is a rare glial neoplasm composed of abundant granular cytoplasm gives immunoreactivity for GFAP and S100 stains. We report a case of GCA in a 64 years old male presented with history of fits, right sided weakness and loss of consciousness. The microscopy showed sheets of large cells with abundant eosinophilic granular cytoplasm. No high-grade features were seen. Its differential diagnosis includes most of the benign histiocytic conditions. Granular cell astrocytoma has an aggressive clinical course and its survival rate is less than 1 year. That's why early correct diagnosis is very essential.
OUTCOME OF THE DISTAL RADIUS FRACTURES MANAGED WITH ACROSS WRIST EXTERNAL FIXATOR VS BUTTRESS PLATE
Authors: Ali Rehman , Anis Ilyas  , Hizbullah Riaz  , Umar Faheem  , Junaid Khan  , Naeem Ahmed  , Amir Aziz
Published: May 2023

Background: Distal radius fracture is one of the most common injuries presented to emergency department and can be presented in any age group. In young patients the most common cause is Road Traffic Accident (RTA), while old patient history of fall is the most common cause. Different surgical options are available to treat this injury. This study aims to compare the outcome of volar buttress plate vs across wrist external fixator for Arbeitsgemeinschaft fÃ¼r Osteosynthesefragen (AO) type C2/C3 fracture of the distal radius. Methods: A retrospective comparative study between July 2020 to June 2021 at Ghurki Trust Teaching Hospital was done and a total of 50 patients who underwent surgical intervention for AO C2/C3 fracture of the distal Radius, were included. The follow-up period was 12 weeks. QuickDASH score was used to find out patient's functional outcomes. Functional outcome was analyzed between the two groups using Mann-Whitney U test, using SPSS version 21. Result: There was no significant statistical difference between the functional outcome of patients with distal radius fracture treated with across wrist external fixator vs volar buttress plate, in term of QuickDASH score. Furthermore, age and gender also were having no effect on functional outcome in our population. Conclusion: Across wrist external fixator is a reasonable option for AO C2/C3 type fractures of the distal radius with comparable results with volar buttress plate. It is the procedure of choice in high volume tertiary care hospitals like Gurki Trust Teaching hospital as it saves time, have similar functional outcome score, no need to re-open for removal of implant, less chances of tendon rupture as compared to volar buttress plate for distal radius fracture.
TRANS ORAL ENDOSCOPIC THYROIDECTOMY VESTIBULAR APPROACH (TOETVA), CASE SERIES OF THE FIRST CLINICAL EXPERIENCE FROM PAKISTAN
Authors: Iqra Zakir  , Ahmad Nawaz
Published: May 2023

Background: The objective of the study to assess the workability and cosmetic outcome of endoscopic thyroidectomy vestibular approach (TOETVA) and share results of underdeveloped country with the world about their first clinical experience. Methods: We performed TOETVA in 3 patients presenting with thyroid nodules in our hospital, between October 2020 and December 2020 at Liaquat National hospital. Three-port technique was used, one 10-mm port for camera and two 5-mm ports for working. All ports were passed through oral vestibule. The demographic data of the patients and surgical outcomes were retrospectively reviewed. The surgery was completed successfully in all 3 patients. The operative time was between 120-150 mins. Results: No complications such as recurrent laryngeal nerve palsy, mental nerve injury or parathyroid gland injury damage occurred in patients postoperatively. No visible scarring occurred in the patients postoperatively. Patients remain stable after surgery and got discharged next day. No complications were noted in 6 months follow up. Conclusion: TOETVA is safe, feasible, effective and scar free option as compared to conventional thyroid surgery.
LOWER LIMB SALVAGE FOR TUMOURS AROUND THE KNEE USING ONCOLOGICAL RESECTIONS AND MEGAPROSTHETIC RECONSTRUCTIONS
Authors: Faridullah Khan Zimri  , Saaiq Muhammad , Muhammad Nouman  , Faisal Qayyum
Published: May 2023

Background: This descriptive case series documented the clinical presentation of tumours around the knee in our population and explored the outcome of lower limb salvage with oncological resections and megaprosthetic reconstructions. The variables analysed included return of knee function, disease free survival and any complications observed over a follow up period of 5-years. Methods: The study spanned over a period of 13-years. It included adult patients of all genders who presented with tumours around the knee and underwent tumour resections followed by megaprosthetic reconstructions at our institute. Results: Out of 73 patients, there were 43 (58.90%) males and 30 (41.09%) females. Their ages ranged between 16-53 years with a mean of 32.97±10.68 years. The tumours included giant cell tumours (n=41), osteosarcomas (n=24), Spindle cell sarcoma (n=5), chondrosarcoma (n=2) and Ewing's sarcoma (n=1). The average postoperative musculoskeletal tumour society (MSTS) score was 84.65%. Various complications encountered included superficial infections/ delayed wound healing among 9 (12.32%) patients, local recurrence in 6 (8.21%), deep infections among 5 (6.84%) and transient palsy of peroneal nerve in 3 (4.10%) cases. There was aseptic loosening and traumatic disruption of extensor mechanism one each (1.36%). There were 7 (9.58%) mortalities in our series. Conclusion: Giant cell tumours and osteosarcomas were the most frequent tumours observed around the knee. The tumours affected relatively younger population. Safe oncological resections of the tumours followed by megaprosthetic reconstructions provided reasonable outcome in the majority of patients.
12 MONTH'S ASSESSMENT OF CLINICAL EFFICACY OF RESIN MODIFIED GLASS IONOMER CEMENT AND FLOWABLE COMPOSITES IN RESTORATION OF NON-CARIOUS CERVICAL LESIONS, A RANDOMIZED CLINICAL TRIAL
Authors: Saghir Atikah , Tehmina Rehman  , Bushra Irum  , Zarah Afreen  , Ammarah  , Faisal Nawaz Khan
Published: May 2023

Background: The objective of this study was to compare the clinical efficacy of Resin modified glass ionomer cement and Flowable composite in terms of retention, marginal adaptation and surface texture using United States Public Health Service criteria in non-carious cervical lesions measured over a period of one year. Methods: A Randomized Clinical Trial is conducted with Informed consent on 60 patients who are randomly allocated into 2 groups with at least 2 Non-Carious Cervical Lesions in each. Group 1 is used for Flowable Composite while group 2 is used for resin modified glass ionomer cement. A recall is maintained to draw conclusions between two materials in terms of occurrence of marginal adaptation, retention and surface texture, to show which material is superior to other. Results: Out of 30 restorations in 12 months follow up, only 19 found to be present in flowable composite group while in resin modified glass ionomer cement group, 28 are retained. Regarding margin integrity, Group 1 showed 21 intact margins whereas 23 margins were intact in group 2, while 18 and 25 showed smooth surface in flowable composite and Resin modified glass ionomer cement group respectively, on exploration. Conclusion: It can be concluded from our study that Resin modified glass ionomer cement is superior to Flowable composite in terms of retention (p=0.005) and surface texture (p=0.045) in restoration of non-carious cervical lesion.
FREQUENCY OF STONE CLEARANCE AFTER TRANSURETHRAL FRAGMENTATION OF LARGE URINARY BLADDER CALCULI USING PNEUMATIC SWISS LITHOCLAST
Authors: Shawana Asad  , Bilawal Gul  , Mir Jalal-ud-din  , Sher Ali Khan  , Rabeeha Bashir  , Hina Rafaqat
Published: May 2023

Background: Vesical calculi refer to stones in the urinary bladder. The causes of bladder stones include bladder outlet obstruction, neurogenic voiding dysfunction, infection, or foreign bodies. Very rarely, these vesical calculi may reach very large sizes and the largest dimension can sometimes reach 13 centimeters. Methods: This descriptive cross-sectional study was conducted from 1ST May 2019 to 31st October, 2019 at Institute of Kidney Diseases, Urology Department, Hayatabad Peshawar. 164 patients with vesical stone were included in study. Ultrasound-KUB was used for diagnosis of vesical stone and after informed consent, and they underwent transurethral nephroscopic lithotripsy via the pneumatic Swiss Lithoclast. Results: Frequency of stone clearance was 96.34%. No statistically significant association of stone clearance was observed with age, gender, number of stones or max dimension of largest stone in the bladder (p > 0.05).  Conclusion: Transurethral nephroscopic pneumatic lithotripsy via pneumatic Swiss Lithoclast is safe and effective procedure for treatment of large vesical stones. However, this being the first such study in adults, more data is needed to confirm these findings.
ANALYSIS OF INHIBITORY EFFECT OF TRANSCRIPTIONAL REGULATORY PROTEIN (STY 4289) OF SALMONELLA TYPHI CT18 BY HOMOLOGY MODELLING
Authors: Farid Anila , Saadia Sadiq  , Rehana Rasool  , Ghazala Rasool  , Ajmal Hussain  , Muhammad Fawad
Published: May 2023

Background: Salmonella typhi cause typhoid fever which is life threatening disease. It effects approximately 600,000 people per annum around the world. Food and water are the integral components through which this disease is transmitted and becomes base of typhoid. It spreads widely where cleanliness is very poor. Objective was to analyse three-dimensional structure of transcriptional regulator of Salmonella typhi CT18 by homology modelling to inhibit virulent effect of salmonella typhi. Methods: Bioinformatics tools and programs like comprehensive Microbial resource (CMR). Interproscan, Basic Local Alignment Search tool (BLAST), Modeller 9.10, Procheck and Prosa were used as bioinformatic tools for effective study of protein. Results: Homology modelling is an appropriate and precise method to find three-dimensional transcriptional regulator to stop its virulency. Conclusion: Homology modelling is computational and accurate method to find 3D structure of transcriptional regulator to inhibit its virulence effect of causing disease.
RISING RESISTANCE IN UROPATHOGENS WITH AN INDICATION OF NITROFURANTOIN MIC CREEP
Authors: Hasan Azra S , Richa Garg  , Sowmya nasimuddin  , Sneha Dey  , Ayan Das  , Syed Md. Moosi Raza Ali  , Sumit Rai  , Dalip K. Kakru
Published: May 2023

Background: The irrational use of antibiotics has led to the emergence of multi drug resistant pathogens. The phenomenon of MIC creeps occurs when organisms start showing raised MIC but within susceptible range giving an indication of the prevalence of rise in resistant pathogens in an area Methods: A cross sectional study in a large tertiary care hospital in North India to observe the susceptibility pattern among uropathogens and the possibility of MIC creeps. The Antimicrobial Susceptibility Testing (AST) and Minimum Inhibitory Concentration (MIC) were conducted by Vitek Compact 2. The identification of Extended Spectrum Beta Lactamase (ESBL) producers and Carbapenem Resistant Enterobacteriaceae (CRE) among Escherichia coli were noted. The MIC 50 and MIC 90 for Nitrofurantoin, the most widely used antibiotic for lower UTI, was calculated to investigate the phenomenon of MIC creep. Results: In our study, a total of 2522 urine samples were analyzed:1538 (61%) were positive with the commonest isolate being E. coli (n=736, 47.8%) followed by Klebsiella spp. (n=178, 11%). Less than 10% of resistance was observed for Fosfomycin, Amikacin, Nitrofurantoin, Imipenem, Meropenem and Colistin. ESBL producers and CRE E. coli were 528 (72% of 736) and 79 (11% of 736) respectively. Overall, 119/736 samples had an MIC ‰¥128. Amongst the ESBL producers, 96/528 had MIC ‰¥ 128 and amongst the CRE, 13/79 had MIC ‰¥ 128. Discussion: E. coli can be used to reflect the trends in development of resistance. In the current study, it was observed that E. coli showed a reduced susceptibility for Nitrofurantoin indicated by a creeping increase in MIC albeit within normal range. Conclusion: Trends in rising MIC should alert prescribers to use drugs such as Nitrofurantoin judiciously. Antimicrobial stewardship practices should be strongly implemented in hospitals to curb rising resistance and obtain better treatment outcomes for patients with infectious diseases.
VISUAL OUTCOMES WITH INTRAOCULAR TRIFOCAL LENS IMPLANT
Authors: Sarfaraz Sana Ahmed , Muhammad Ali Haider  , Hussain Ahmed Khaqan  , Nida Usman  , Arslan Ahmed  , Uzma Sattar  , Hasnain Muhammad Buksh  , Rahila Ikram
Published: May 2023

Background: Cataract surgery has become one of the most common surgeries in the world with one in every four surgeries performed being a cataract extraction and the numbers are expected to increase by 16 percent in the USA alone by 2024 as compared to the current statistics. The aim of the study is to analyze the visual outcomes of intraocular lens implants for various visual ranges. Methods: This non-comparative interventional study was conducted at the Ophthalmology department of Al Ehsan Eye Hospital from Jan to Dec 2021. It included patients who underwent uneventful phacoemulsification with an intraocular lens implant and analysis of the visual outcomes for uncorrected distance (UDVA), uncorrected intermediate distance (UIVA), and uncorrected near distance (UNVA). Results: Independent sample t-test was applied to observe the mean values of recorded far vision on the 1stday, 1 week, and 1 month after the trifocal intraocular lens implantation. It showed a significant difference with a p-value of 0.00 on 1st day, 1 week, and 1 month after was 0.3±0.1, 0.17±0.09, and 0.14±0.08 respectively. Mean improvement in near vision after 1 month was N6 with S.D 1.03 and in intermediate vision was N8±1.4 respectively. Conclusion: Trifocal Intraocular lens implantation offers an improved vision for near, intermediate, and distant visual ranges without the need for correction.
EFFECTIVENESS OF SADDLE BLOCK VS SPINAL ANAESTHESIA IN TURP: AN OPEN LABEL RANDOMIZED CONTROL TRIAL
Authors: Nida Shahid  , Muhammad Wajid Iqbal  , Syed Nurul Haque  , Asim Masroor Rashid  , Salman Shaukat
Published: May 2023

Background: One of the most frequent diseases among male gender is benign prostatic hyperplasia. Transurethral resection of the prostate (TURP) is a minimally invasive procedure for resection of prostate through endoscopic technique. Recently there was a debate on role of saddle block in TURP. There we aimed to determine the effectiveness of spinal anaesthesia versus saddle block in terms of hemodynamic stability and vasoprbessor requirement in TURP. Methods: This open label randomized control trial was performed at Hamdard University Hospital, Karachi, Pakistan, during 1st October, 2021 to 31st March, 2022. Male patients of age 45-65 years requiring TURP, with well controlled diabetes and hypertension of ASA grade I-II were included into the study and randomly assigned into two study groups. Patients' parameters including blood pressure, heart rate, mean arterial pressure and oxygen saturation (SPO2) were measured at baseline and intraoperative at every fifth minute interval till surgery completion. Patients' other parameters including age, surgery duration and comorbidity were also recorded. Results: Total 60 patients with 30 patients in each group were enrolled into the study. Maximum fall in systolic blood pressure, diastolic blood pressure, pulse rate and mean arterial pressure from baseline was significantly lower in patients receiving saddle block anaesthesia than spinal anaesthesia. Maximum fall in SPO2 was not significantly different among two study groups. Maximum fall in all parameters excluding SPO2 was significant between two groups for initial 20 minutes of the procedure. No statistically significant maximum fall was seen for all of the parameters beyond 20 minutes of the procedure. Vasopressor consumption was significantly lower in saddle block group than spinal anaesthesia. Conclusion: Application of saddle block anaesthesia is effective for TURP procedure with controlled hemodynamic status than spinal anaesthesia. Moreover, saddle block requires less vasopressor consumption than spinal anaesthesia technique.
VAGINAL CUFF DEHISCENCE AFTER TOTAL LAPAROSCOPIC HYSTERECTOMY: PROSPECTIVE COMPARISON OF TWO TYPES OF SUTURING TECHNIQUES
Authors: Dojki Samina Saleem , Alia Bano  , Saliha Kanwal
Published: May 2023

Background: To compare the frequency of vaginal cuff dehiscence after total laparoscopic hysterectomy between two different suturing techniques. Place and duration of study: The study was conducted at three centers; postgraduate tertiary care hospital, university affiliated hospital and private multidisciplinary hospital. The studied duration was from January 2019 to June 2020. Method: All patients with indication of total laparoscopic hysterectomy during the study period were included. These were randomly divided in to two groups A and B. Group A was performed upon the conventional interrupted figure of 8 vault suturing and group B with continuous, running, double layered suturing. Keeping the demographics almost same the frequency of a known but rare complication of vaginal cuff dehiscence (VCD) was determined. Results: A total of 195 patients were enrolled. Of these 87 were in group A and 108 in group B. The results were unequivocal as only one patient had the said complication. Conclusion: The morbid complication has no relation with the technique of vault suturing.
GIANT PENOSCROTAL LYMPHEDEMA: PLANNING AND SURGICAL TECHNIQUE TO TREAT A RARE DEBILITATING DISEASE
Authors: Ata ul Haq  , Afzal Muhammad Omar , Tarar Moazzam Nazeer
Published: May 2023

Background: Giant penoscrotal lymphedema is a rare condition and is treated by surgical debulking and reconstruction with remaining skin and skin grafts. The described techniques may result in a staged surgery, multiple blood transfusions, orchidectomy and early debulking of the scrotal skin. We present a case series describing our technique to address all the concerns, discuss management to decrease progression and transmission in secondary cases and present a novel questionnaire to assess of quality of life of these patients. Methods: This descriptive case series was done from July 2016 to October 2019. Patients with Campisi grade 5 disease were included. Clinical assessment and relevant investigations were done to identify the cause and confirm the extent of the disease. Procedural detail, post-op haemoglobin levels (Hb), need for transfusion and weight of excised specimen were recorded. Wound healing, recurrence and body mass index were noted on follow up. Scrotal lymphedema quality questionnaire was developed and was filled on follow-up visit. Results: Twelve patients were operated on. The mean history was 3.0±0.5 years. 4 tested positive for microfilariae, while 4 out of 8 who tested negative had taken the anthelmintic drug. The mean weight excised was 15.8±2.3 kg, mean pre-operative score on quality-of-life assessment questionnaire was 83.3±2.6 versus 9.3±0.8 post operatively. Mean follow up time was 1.4±0.6 years. 1 patient had a minor recurrence necessitating re excision. Mean Hb was 13.5 ± 0.5 mg/dl preoperatively compared to 11.8±0.5 mg/dl post operatively, with none requiring transfusion. Conclusion: Single staged excision with split thickness skin grafting is an effective and safe way to treat patients with giant scrotal lymphedema. It's the single best way to address the quality of life of patients.
RENAL TUMOURS OF NON-CLEAR CELL HISTOLOGY, 10 YEARS' EXPERIENCE IN A SPECIALIZED CENTRE
Authors: Masood Yasir , Adnan Siddique , Fiaz Shaukat , Sheheryar Hanif  , Cheema Zubair Ahmad , `Mir Khurram
Published: May 2023

Background: Non-clear cell renal cell carcinomas are uncommon renal tumours with diverse histologically and genetically defined entities. Due to limited clinical outcomes data, no standardized management approach can be offered to these patients. This study aimed to analyse outcomes of non-clear cell renal cell carcinoma after surgical resection of localized renal tumours in our population. Methods: Patients with renal tumours who underwent partial or radical nephrectomy at the department of urology, from January 2010 to December 2019 were identified and evaluated, in terms of prevalence, presentation, recurrence, and survival outcome. Results: Non-clear cell tumours were found in one-fourth of the total number of nephrectomies performed during this period for renal cell carcinoma (RCC). The mean age was 50.48±14.76 years (range 18-89 years) with 57% being of the male gender. The predominant types were chromophobe RCC, papillary RCC, and sarcomatoid RCC, in all non-clear cell renal tumours. Mean Recurrence Free Survival (RFS) for all tumours was 75.26±2.7 months. The projected 5 years RFS of papillary RCC, chromophobe RCC and sarcomatoid RCC were 94.2%, 84.3% and 62.5% respectively. Conclusion: RCC of non-clear-cell histology depicts excellent survival in patients with localized renal tumours. Furthermore, sarcomatoid RCC has worse recurrence free survival followed by chromophobe RCC and papillary RCC, in our population subset.
OUTCOME OF THE COMPRESSION DRESSING FOR TWO DAYS VS SEVEN DAYS AFTER VARICOSE VEIN SURGERY
Authors: Aamir Khan  , Shehdost  , Naima Shakeel  , Ahmad Rafique
Published: May 2023

Background: Incompetence of the great saphenous vein (GSV) is a global issue and the most prevalent cause of chronic venous disease of leg. Clinical manifestations range from moderate to severe, including tiredness, heaviness, and irritation, as well as hyperpigmentation and leg ulcers. Significant advancements in GSV ablation employing percutaneous methods, such as endovenous laser ablation, have been made in recent years. (EVLA). Objective of the study is to compare the outcome of the compression dressing for two days vs. seven days after varicose vein surgery. This case control study was performed on the Surgical floor, Mayo Hospital, Lahore, from September 15 to March 15, 2020. Methods: We took a sum of 60 patients admitted from the outpatient department fulfilling the inclusion criteria after the approval of the ethical committee of the hospital. Group-A wore compression dressing for 2 days after surgery and Group-B wore compression dressing for seven days after surgery. Each patient received 1gm paracetamol I/V 8 hourly followed by tab. paracetamol 500mg P/O 8 hourly. Then the outcome of compression dressing was analyzed in form of mean postoperative pain. The mean pain score was assessed on 1 week. Data were entered in SSPS v23.0 and stratification of pain score was done against age, gender, and grades of varicose veins. A comparison of the two groups was done by applying a t-test. A p-value ‰¤of 0.05 was considered statistically significant. Results: We took a sum of 60 patients with Primary varicose veins based on their eligibility for this study. Patients were divided into two groups, i.e., Group-A (Compression dressing for 2 days) and Group-B (Compression dressing for 7 days). Average ages of patients in group A were 33.4±9.6 years and in the group, B was 35.4±9.9 years. A mean pain score of 4.5±1.2 was noted in patients in group-A (Compression dressing for 2 days) while 2.9±0.8 in patients in group B (Compression dressing for 7 days) with a p-value of 0.0001 which is statistically significant. Conclusion: When compression stockings are used for more than two days after the Trendelenburg's procedure is done, it can lead to lesser pain and enhanced physical activity in the first week post operatively.
Medical Reversals and Controversial Drug Therapies during COVID-19 Pandemic
Authors: Mansoor Faraz , Kamran Saeed
Published: May 2023

Medical reversal can be defined as a phenomenon when statistically more powerful results of new clinical trials leads to a change of clinical practice. While the list of the treatments performed during this pandemic is a lengthy one and the pandemic is still ongoing, we will be mainly focusing on: Azithromycin, Anti-SARS-CoV-2 Monoclonal Antibodies, Chloroquine, Convalescent plasma, Hydroxychloroquine, Ivermectin, Remdesivir, Lopinavir and Ritonavir. One of the main reason of writing this manuscript is to highlight the challenges faced by the healthcare staff in finding a cure for this novel Corona Virus and the prevalemce of medical reversals in our clinical practice.
FREQUENCY OF PRIMIGRAVIDA IN PATIENTS WITH ECLAMPSIA
Authors: Faiza  , Ruqqia Sultana  , Jawaris Batool  , Shah Khalid  , Abdul  Majid Khan
Published: May 2023

Background: Pregnancy-induced hypertension (PIH) occurs in about 5% of pregnancies and is a major cause of high perinatal and maternal morbidity and mortality. In several international studies, primigravidas were associated with a significantly higher incidence of eclampsia. The local studies so far have a small sample size and mainly focus on preeclampsia in all pregnant women. limited data is available on the frequency of eclampsia in primigravidas in our population. This study aims to determine the frequency of primigravidas in patients with eclampsia after 20 weeks of gestation. Methods: This descriptive Cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Ayub Teaching Hospital Abbottabad from 7/10/2020 to 7/4/2021. A total of 134 patients were observed. Diagnosis of eclampsia was based upon obstetrical history, presence of fits or coma, raised blood pressure and presence of proteinuria on urine complete examination. Immediate management included stabilizing the patient and delivery by Induction of labour or Caesarean section. The guardians of the patients explained the purpose and the benefits of the study and informed written consent was taken. Results:  Our study shows that among 134 patients, 96(72%) patients were in the age range of 18-27 years while 38 (28%) patients were in the age range of 28-35 years. The mean age was 30 years with SD±10.94.  Eighty-two (61%) patients had a POG range ‰¤34 weeks while 52 (39%) patients had a POG range >34 weeks. Forty-eight (36%) patients had BMI <27 Kg/m2 while 86 (64%) patients had BMI >27 Kg/m2. Fifty-six (42%) patients had a positive history of hypertension while 78(58%) patients had a negative history of hypertension. Out of 134 patients 102(76%) were primigravidas while 32(24%) were multigravidas. Conclusion: Our study concludes that the frequency of primigravidas was 76% in patients with eclampsia after 20 weeks of gestation presenting at tertiary care hospital Abbottabad.
DEFINING NORMAL REFERENCE RANGE FOR THE CROSS-SECTIONAL AREA OF THE MEDIAN NERVE AT THE WRIST AND FOREARM USING HIGH-RESOLUTION ULTRASONOGRAPHY IN ASYMPTOMATIC PAKISTANI ADULTS
Authors: Rashed Nazer  , Rauf Maria , Farheen Raza  , Balqees Yawar Fiaz  , Madiha Saeed Wahla  , Raheela Aqeel
Published: May 2023

Background: Carpal tunnel syndrome (CTS) can be diagnosed easily on ultrasonography (USG); which is a cheap, non-invasive and readily available modality. However, there is wide normal variation in the normal values of cross-sectional area (CSA) of median nerve among different populations; therefore, its necessary to establish a normal range of variability in median nerve dimensions in different populations. Method: A total of 500 asymptomatic patients i.e., 1000 median nerves were evaluated at the distal wrist crease and mid-forearm by 3 expert radiologists independently. All patients having a positive nerve conduction study or history of carpal tunnel syndrome and wrist trauma were excluded. Ultrasound was performed with a 7.5-15 MHz high-frequency linear probe. SPSS v 20 was used to analyze data. Results: the study population had a mean age of 31.40±10.11 years with a female-to-male ratio of 1.36:1. Mean BMI was 22.15±4.34 Kg/m2. The mean cross-section area of the median nerve at the right wrist was calculated to be 6.8±1.96 mm2 and the left wrist was 6.6±1.96 mm2. The mean median nerve cross-section area at the right mid-forearm was 5.3±1.46 mm2 and the left mid-forearm was 5.2±1.50 mm2. A decrease in mean median nerve cross-section areas was noted by moving from wrist to forearm. Similarly, males showed higher median nerve CSA than females. Conclusion: Mean median nerve cross-section area was found to be different from Western countries. This warrants the utilization of the data of the Pakistani population to establish our own normal reference range for median nerve cross-sectional area to avoid misdiagnoses.
OUTCOMES OF RECONSTRUCTION WITH VASCULARIZED VS NON-VASCULARIZED BONE GRAFT AFTER RESECTION OF BONE TUMOURS- A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Ali Sheikh Muhammad Ebad , Razak Sufyan , Khan Wajiha Fatima , Khan Shiza , Khaimchandani Devya , Akhtar Umme Roman , Badaruddin Sahito  , Abbasi Ahmed Nadeem
Published: May 2023

Background: Vascularized (VBG) and non-vascularized (NVBG) bone grafting are two crucial biological reconstructive techniques in the management of bone tumours. The objective of this study is to compare the outcomes of reconstruction with vascularized and non-vascularized bone grafts after resection of bone tumours. Methods: A systematic evaluation of the literature from 2012-2021 was undertaken using the online databases PubMed/Medline, Google Scholar, and Cochrane Library considering only comparative articles with specific outcomes for the restoration of the defect with vascularized and non-vascularized bone graft following the resection of bone tumours. The quality of the research methodology was evaluated using Oxford Quality Scoring System and Newcastle Ottawa Scale for randomized trials and non-randomized comparison research respectively. The SPSS version 23 was used to examine the data that was collected. Musculoskeletal tumour society score (MSTS), bone union time, and complications were the outcomes of this review. Results: Four clinical publications were considered, totalling 178 participants (92 men and 86 women) with 90 patients with VBG and 88 with NVBG. MSTS score and bone union time were the key outcomes that were measured. The overall MSTS (p>0.05) and rate of complications (p>0.05) results were comparable between the two groups, however, VBG had a better rate of bone union (p<0.001). Conclusion: As a result of the quicker bone union, our systematic evaluation demonstrated that VBG causes earlier recovery. Complication rates and functional results were the same in both groups. The link between the bone union time and functional score following VBG and NVBG must also be demonstrated.
COMPARISON BETWEEN TWO TYPES OF MATRIX SYSTEMS FOR CONTACT TIGHTNESS IN CLASS-II COMPOSITE RESTORATIONS
Authors: Muhammad Asif  , Imran Khattak  , Qureshi Asim , Muhammad Zain  , Naveed Aslam  , Muhammad Izaz Khan
Published: May 2023

Background: The reconstruction of proximal defects with tight contacts has always been a challenge for dental clinicians, especially with composite material. Recent literature shows that the most frequently used matrix systems for restoration of proximal cavities are circumferential or sectional matrix band systems. The objective of this study was to compare the contact tightness that is achieved with these two matrix band systems when using composite material. Methods: A total of 30 patients, i.e., 60 cavities were selected in this quasi-experimental study. Since patients with two cavities in the posterior teeth were selected. Both the cavities where restored with circumferential system, i.e., Tofflemire and sectional matrix band system, i.e., Palodent plus on the same appointment. Hence both systems were used in every patient and then contact tightness assessed based on an evaluation criterion, i.e., FÃ©dÃ©ration Dentaire Internationale clinical criteria for evaluation of contact in direct and indirect restorations. To make a comparison between the two systems chi square test was used and p<0.05. Results: The mean age of the patients in the study was 31 years (SD, 7.59 years) with range from 18 to 45 years. Most of the contact tightness in Palodent matrix system was score 1 (n=33, 55%) and score 2 (n=17, 28.3%) while in Tofflemire was score 4 (n=28, 46.7%) and score 5 (n=19, 31.7%). Statistical analysis showed significance (p=.037) between Palodent matrix system contact tightness and Tofflemire. Conclusion: The sectional matrix band system was statistically superior to the circumferential matrix band system in achieving a tighter contact for class II composite restorations
Coming to Terms with the Communist Regime in Slovakia
Authors:   Nation`s Memory Institute, Bratislava, Jašek Peter
Published: May 2023

The paper deals with the complicated process of coming to terms with the communist regime in Slovakia. Since the fall of the communism in 1989 the process has attracted the attention of researchers and the public. In many ways, this process is seen to have been unsuccessful –communist crimes remain unpunished and the “drawing of thick lines” prevails. Some representatives of the communist regime have even been honoured with memorial plaques, despite public protests. However, the situation has changed in recent years. Several acts have been adopted to help former political prisoners and to reduce the pensions of communist officials.
Nationality descended from the mother and enhanced in the region - a comparative study
Authors:   Ministry of Higher Education and Scientific Research - Iraq, Salman Shehayeb Lecturer Dr. Ahmed
Published: May 2023

Nationality is defined in private international law as: It is a legal and regulatory center regulated by the state according to its discretionary power. In order for it to be a political, legal and spiritual bond between the individual and the state, it entails obligations and is one of the tools for determining the people’s corner in it. It contains national individuals without foreigners due to the social and economic developments that have prevailed in the third world countries in recent times, including Arab societies, where the relations between foreigners and nationals overlapped, and the large number of mixed marriages between them. The difference in laws between countries in regulating their nationality has led to a large number of statelessness for individuals born to Arab mothers and foreign fathers. Explanation of how to impose the nationality of the mother in the Iraqi nationality law and comparative laws And that through two sections. The first is the concept of nationality, where it deals with the concept of nationality by addressing its definition in the first requirement, and in the second requirement, the pillars of nationality. As for the second topic, it showed the position of the legislation on the nationality of the mother and the reinforcement of the right of the region through two demands. From the results of this research, which help to solve the problem.
The effect of modern media devices upon the public opinion guarantying the legitimacy of authority
Authors:   University of Diyala - College of Law and Political Science - Iraq, Adnan Abdullah Lecturer Dr. Balasim , Fadhel Hussien Lecturer Dr. Ahmed ,   University of Diyala - College of Law and Political Science - Iraq
Published: May 2023

It is essential to identify the concepts of public opinion and the legitimacy of power and the modern media for through define the concept of public opinion shows us how the contribution of individuals defining in the evaluation of the actions of the rulers and their acceptance by the people. One of the most important means of public opinion is the modern media, like satellite channels, Internet and mobile phone through with individuals can express their views about how to exercise power. The modern media have contributed in enabling individuals express their views and criticism of the work of the rulers essily and with lower costs and these contributed means in the formation of popular protests, and sits in, and revolutions that toppled the rulers of illegal , also used the political parties and civil society institutions such means in the formation of public opinion and the delivery of voice for individuals and through it showed its assessment of the work of the referees and the legality of their actions .And we have focused through this research on the effectiveness of the use of new media in the Arab countries in particular, given the nature of the stage taking place in these countries calls for freedom of expression and to change Systems despotic political , which has lost its legitimacy will show how to use the people in the Arab world these modern means and how it affected including the events of this change.
The influence of environmental problems on world security
Authors:   College of Political Science-University of Baghdad, Mahdi Salih Lecturer Dr. Yusra
Published: May 2023

In the context of the world in which we live and which quickly movement and the frequency change the natural environment suffered tremendous human pressure Sort several adverse effects as a result of apathy and seek to make life more comfortable and easier through the recruitment of technical development in all spheres of life . Has become a threat to the chain 's natural cycle of life that we are living through the depletion of resources and excreted for gases and vapors and toxic waste and left without treatment to be reached accumulated so alarming, prompting the United Nations and international organizations to hold conferences did not achieve the desired results in terms reneged on most of the countries of their obligations and turn the other part like the United States to reject many of the decisions of this conference , which generated a new gap between the north and south.
PEMBERDAYAAN KELOMPOK REMAJA DALAM PENCEGAHAN STIGMA DAN DISKRIMINASI PADA ORANG DENGAN HIV/AIDS BERBASIS SERVICE-LEARNING
Authors: Arisudhana Gede Arya Bagus , Dewi Desak Putu Risna , Agustini IGA Ratih
Published: May 2023

Latar Belakang: Stigma dan diskriminasi menjadi salah satu masalah yang berdampak pada keterbukaan status HIV positif Orang Dengan HIV dan AIDS (ODHA). Terjadinya stigma dan diskriminasi memiliki persentase yang tinggi pada remaja. Dibutuhkan metode yang tepat dalam meningkatkan pemahaman remaja pada kondisi HIV dan AIDS. Tujuan: Pengabdian masyarakat ini bertujuan untuk memberdayakan remaja dalam mencegah stigma dan diskriminasi pada ODHA berbasis service learning. Metode: Populasi pada pengabdian masyarakat ini adalah remaja di Banjar Sigaran Desa Sedang, Kecamatan Abiansemal Kabupaten Badung. Metode yang digunakan pada pengabdian ini adalah pendekatan service learning. jumlah partisipan pada kegiatan ini adalah 25 orang. Evaluasi dilakukan menggunakan lembar observasi pada perilaku stigma dan diskriminasi dan kusioner pengetahuan tentang HIV dan AIDS. Hasil: Sebagian besar pengetahuan remaja setelah mengikuti kegiatan pengabdian masyarakat ini berada pada kategori baik (60%). Perilaku stigma pada ODHA oleh remaja setelah mengikuti kegiatan ini diketahui 80% tidak melakukan stigma dan diskriminasi. Kesimpulan: Pemberdayaan remaja menggunakan metode service learning efektif dalam mencegah terjadinya stigma dan diskriminasi.
Genetic diversity and relationships among wild and cultivated Ficus carica L.: Usefulness of RGA markers
Authors: Haffar Sahar , Baraket Ghada , Usai Gabriele , Aounallah Aymen , Ben Abdelkrim Ahmed , Chatti Khaled , Salhi Hannachi Amel
Published: May 2023

Disease resistance and the maintenance of genetic diversity in wild and cultivated populations are very important challenges to implement breeding program and markers assisted selection of Ficus carica L. facing climate change and its consequences. Resistance gene analogs (RGA) markers were used for variety discrimination and assessment of genetic structure and diversity of wild and cultivated Ficus carica L. species in Tunisia. The RGA markers were efficient and reliable markers for discriminating wild and cultivated fig. The high level of polymorphism (95.65) detected suggests the effectiveness of RGAs for both genetic fingerprinting and relationships assessment in wild and cultivated fig. The detected markers may represent candidate genes for disease resistance and could be further used to facilitate the identification of candidate genes and accelerate the genetic improvement of disease resistance in breeding programs of Ficus carica species.
Trudnoci spoeczno-emocjonalne dzieci w wieku przedszkolnym, wywoane pandemi COVID-19
Authors: Januszewska Olimpia , Kierzkowska Iryna
Published: May 2023

W artykule przedstawiono analiz teoretyczno-empiryczn problematyki wystpowania u dzieci w wieku przedszkolnym trudnoci spoeczno-emocjonalnych, ktre zostay wywoane lub pogbione wskutek pandemii COVID-19. W aspekcie teoretycznym, w ujciu psychologicznym i pedagogicznym, zwrcono uwag na problemy powstae wskutek pandemii, omwiono specyfik realizacji procesu edukacyjnego w formie edukacji zdalnej oraz konsekwencje tego typu edukacji w rozwoju dzieci w wieku przedszkolnym. Analiza empiryczna skupia si wok trudnoci spoecznych i emocjonalnych, ktre zaobserwowano u dzieci w wieku przedszkolnym po powrocie do edukacji w trybie stacjonarnym.
Trends in the Development of Primary Education in Ukraine at the Present Stage
Authors: Maftyn Larysa
Published: May 2023

Artyku powicony jest analizie aktualnych problemw pedagogiki szkolnictwa podstawowego na Ukrainie. Wdroenie koncepcji Nowej Ukraiskiej Szkoy obejmuje: realizacj podejcia kompetencyjnego, ksztacenie osobowoci zdolnej do samoksztacenia i samorozwoju, zdolnej do krytycznego mylenia, denia do kreatywnoci i zmian na lepsze; stworzenie nowej przestrzeni edukacyjnej takiego rodowiska edukacyjnego, w ktrym uczniowie s aktywnymi podmiotami.Jednak deklarowane cele nie zawsze mog by w peni zrealizowane. Wynika to z rnych czynnikw, w tym: krytycznego stosunku do zmian pewnej czci spoeczestwa; problemw wsparcia metodycznego, testowania i propagowania nowych metod i materiaw metodycznych; problemw z dostpnoci podrcznikw; kompetencjami nauczyciela w zakresie wyboru, treci, druku, jakoci, zada edukacyjnych; niezgodnoci z wymaganiami dotyczcymi liczby uczniw w klasie itp. W warunkach rosyjskiej agresji priorytetowe staj si rwnie kwestie tworzenia bezpiecznego rodowiska edukacyjnego, wsparcia psychologicznego i waciwej organizacji procesu edukacyjnego. Autorka podkrela, e specyfik funkcjonowania ukraiskiego systemu edukacji na obecnym etapie jest rwnie przezwycianie wyzwa spowodowanych rosyjsk inwazj; znajdowanie sposobw rozwizywania problemw w zakresie organizacji edukacji, jej jakoci, ochrony zdrowia uczniw, stosowania skutecznych innowacyjnych technologii itp.
Strategiczne znaczenie Cieniny Ormuz i jego implikacje dla bezpieczestwa energetycznego Europy w kontekcie agresji Rosji na Ukrain
Authors: Kaczmarek Krzysztof , Włodyka Ewa Maria
Published: May 2023

W artykule zostaa podjta prba analizy moliwoci oddziaywania Rosji na dziaania Iranu w regionie Zatoki Perskiej w kontekcie wojny w Ukrainie. Przedstawiony zosta rwnie zarys stosunkw midzypastwowych w regionie i moliwych implikacji wsppracy Rosji z Iranem dla globalnego rynku wglowodorw. Odejcie (cho obecnie jedynie deklaratywne) pastw europejskich od rosyjskich dostaw surowcw energetycznych moe skutkowa dziaaniami Iranu na rzecz ograniczenia eglugi przez Cienin Ormuz. Dziaania takie poczone z akcjami dezinformacyjnymi mog stanowi element oddziaywa hybrydowych majcych na celu wymuszenie na Zachodzie powrt do rosyjskich surowcw energetycznych. Chocia nie jest to niemoliwe, ale mao prawdopodobne, aby Rosja angaowaa si w otwarte dziaania militarne w rejonie Zatoki Perskiej. Jednak mog si zdarzy niewyjanione wypadki.
Modernizare și politică în Bucovina la sfârșitul secolului al XIX-lea și începutul secolului al XX-lea
Authors:   Institutul „Bucovina” Rădăuți, Olaru Marian
Published: May 2023

"The following text presents the evolution of the political relations between the national groups in Bukovina at the end of the nineteenth century and the beginning of the XXth century, insisting on the results of the elections during the mentioned period. The electoral statistical data and the various pre- and post-electoral agreements prove the increase of the involvement on the political scene and the political diversity of the parties that activated on the territory of Bukovina. "
Consemnări despre Marea Serbare Națională de la Putna din 1871 și comemorările ei în manuscrise inedite aflate în colecțiile „Fond Bucovina”, Biblioteca Bucovinei „I. G. Sbiera”
Authors:   Biblioteca Bucovinei „I. G. Sbiera”, Suceava, Ienache-Adamovici Simona-Teodora
Published: May 2023

"A foray into the manuscript collections of the “I. G. Sbiera” Bukovina Library from Suceava brought to light two manuscripts that have not been published with references to the National Celebration in Putna in 1871, and some correspondence pages between some personalities of cultural life. The topic is treated extensively by Dr. Ion Negură, in a manuscript from 1981, and tangentially to the establishment of the company “Arboroasa” by Prof. Pintea Socaciu and Prof. Reveca Dușceac-Prelipceanu. Ion Negură’s manuscript work refers to aspects related to the history of Bukovina, academic societies, a rich correspondence with Nicodim Ițcuș and has not been capitalized until today. Probably the manuscript about this event from the life of the Romanian Youth (“junime”) was prepared for publication, but it does not appear mentioned in other subsequent studies regarding the Great feast of Putna. The second mentioned manuscript refers to the “Arboroasa” Academic Society (1875–1938), for the establishment of which the Putna Celebration was the engine, through the decision of the Student Congress to establish societies in all university centres. "