bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Gadget Use on Psychological Development in Elementary School Children
Authors: Widya Rika , Rozana Salma , . Munisa
Published: August 2021

This paper discussed strategies and solutions that are carried out related to technology equality, namely technology, must be used by all students and potentially supervised by parents, appropriate assessments, preparing enrichment modules, and other things that can enrich literacy. Before learning, some teachers negotiate with students regarding the agreement on using the platform used in learning. Many platforms can be used in online learning, so it can be unclear if they do not focus on a particular platform. In addition to negotiations, it also aims to ensure that all students can access the same technology to support distance learning. Self-regulation is also an effort if it turns out that parental involvement is very weak in the learning process. However, parental involvement in the child's learning process is a must. This study describes how gadgets (positive and negative impacts) impact the mental development of children of developing age in kindergarten and elementary school at the Prof Kadirun Yahya foundation. A qualitative approach research method in this research and be used to examine a condition of a natural object, the researcher as a key instrument, data collection techniques are carried out by triangulation (observation, interviews, documentation), and the results of qualitative research are to understand the meaning, uniqueness, construct phenomena, and find hypotheses. The results of this study are that the use of gadgets has an impact on the psychological development of elementary school children. In this study, five kindergarten children and five elementary school children who used gadgets with a duration of more than 2 hours per day experienced behavioral changes. The impact is positive; children; children are easy to find information about learning and make it easier to communicate with friends. However, the negative impact of gadgets affects psychological development, especially aspects of emotional growth and moral development. In emotional growth, children who use gadgets become irritable, rebellious, imitate behavior in gadgets, and talk to themselves on gadgets. While the effect on moral development impacts discipline, children become lazy to do anything, leave their obligations to worship, and reduce learning time due to playing games and watching YouTube too often.

Keywords: Effect Technologies, Children, Impact Positive and Negative.
L’importance du contrôle de gestion dans la PME marocaine : cas de Cellulose du Maroc
Authors: Afertaly Abderrahim , Abrihiche Ayoub
Published: August 2021

Pour mieux saisir l’importance et l’évolution de contrôle de gestion on se pencher dans ce papier sur l’étude de cas de l’entreprise cellulose qui se trouve à Sidi Hya Lgharb Fabricant exportateur de la pâte à papier et on s’intéresse sur l’analyse des écarts et des couts préétablie pour avoir est ce que l’entreprise réalise vraiment ses prévision ou non, et aussi les outils de contrôle de gestion pour attirer et ressortir les résultats et les analyses sur la pratique de cette fonction et leur rapport avec la performance des entreprises.
EXPERIMENTAL SETTING FOR TESTING THE BOND STRENGTH BETWEEN METAL ALLOY AND PEEK
Authors:   Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University Plovdiv, Bulgaria., Georgiev Zhivko , Alexandrov Svetlin ,   Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University Plovdiv, Bulgaria., Tomova Zlatina ,   Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University Plovdiv, Bulgaria.
Published: August 2021

Purpose: The aim of the article is to present an experimental setting for bending strength testing of metal specimens covered with PEEK. Materials and methods: Three groups of metal specimens made of cobalt chromium alloy are produced using the lost wax technique: group 1 – specimens with a smooth metal surface; group 2 – sand blasted metal surface; group 3 - sand blasted metal surface with retention crystals. The shape and size of the specimens are designed to correspond to the retentive elements of the apparatus for micro tension and micro pressure LMT 100. PEEK is pressed over the specimens, and after thermal cycling, the bond between metal alloy and PEEK is studied using bending strength three-point micro testing. Results and discussion: The experimental setting is focused on the type of specific contact surface between the two materials. The design corresponds to the requirements of apparatus LMT 100 and allows the production of a big number of specimens. Because of the thermal regime of BioHPP pressing, it is impossible to add groups of specimens using contemporary adhesives on the metal surface. Conclusion: Created specimens allow strength investigation by three-point bending micro testing. The experimental setting provides the production of a big number of specimens with the same shape and size.
Կոմիտասից դեպի Բեթհովենյան տիրույթի որոշ տարրեր
Authors: Շախկուլյան Տաթևիկ
Published: August 2021

Հոդվածը քննարկում է Կոմիտասի կրած գերմանական ազդեցությունների որոշ հարցեր։ Մասնավորապես՝ քննարկվում է գերմանացի կոմպոզիտոր Լ․վ․ Բեթհովենի Op. 57 սոնատի թեմատիկ մոտիվի ակնհայտ նմանակումը Կոմիտասի լարային կվինտետում, որը Բեռլինում ուսանելիս իրականացված աշխատանք է։ Քննարկվում է նաև գերմանացի գրող Վ․ Գյոթեի երկու բանաստեղծությունների երաժշտական մարմնավորման հանգամանքը ինչպես Կոմիտասի, այնպես էլ Բեթհովենի կողմից։ Եթե Կոմիտասը ստեղծել է երկու առանձին երգ դաշնամուրային նվագակցությամբ, ապա Բեթհովենը երկու բանաստեղծությունների հիման վրա ստեղծել է մեկմասանի կանտատ երկսեռ երգչախմբի և սիմֆոնիկ նվագախմբի համար։
The article discusses some issues regarding the German influence on Komitas. In particular, the author focuses on the resemblance of the subject of L. v. Beethoven’s Piano Sonata No. 23, Op. 57 (known as Appassionata) to that of Komitas’s string quintet, which he wrote while studying in Berlin. The article also examines the musical embodiments by both Beethoven and Komitas of the German writer, poet J. W. Goethe’s two verses. Beethoven composed a single-movement cantata for mixed choir and symphony orchestra, while Komitas, basing on the same two verses, created two separate songs with piano accompaniment.
ՀՀ ԳԱԱ Արվեստի ինստիտուտի ներդրումընոր և նորագույն շրջանների հայ կերպարվեստի ուսումնասիրության մեջ
Authors: Ավագյան Արթուր
Published: August 2021

Հայ արվեստագիտական մտքի զարգացումը հասել է այն մակարդակին, երբ հրատապ կարիք է զգացվում գոնե համառոտ կերպով ուրվագծելու նրա անցած ուղին, իմաստավորելու նրա փորձը, արժևորելու մշակութային նշանակությունը: Այդ խնդրի մասնավոր, լոկալ ասպեկտներից է ՀՀ ԳԱԱ արվեստի ինստիտուտի դերը նոր և նորագույն հայ կերպարվեստի ուսումնասիրության գործում: Զանազան գիտական նախագծերի մշակմանն ու իրականացմանն ուղղված իր բազմամյա գործունեության ընթացքում ինստիտուտն զբաղեցրեց տվյալ բնագավառում առաջնային տեղը՝ նմանատիպ այլ հաստատություններից առանձնանալով թե՛ իր զուտ ակադեմիական կարգավիճակով և թե՛ իր աշխատանքի մասշտաբներով և արդյունքներով:
The current level of development of Armenian art criticism requires to at least briefly outline the passed path, conceptualize the experience, and evaluate its cultural significance. One of the specific, local aspects of this problem is the role of NAS RA Institute of Arts in the study of Armenian fine arts of the new and newest periods. During the many years of its activity, targeted at the development and implementation of various scholarly projects, the Institute holds one of the leading positions in this field, stands out among similar institutions thanks to its purely academic approach, as well as the scale and results of its work.
Կոմիտասին և հայոց ցեղասպանությանը նվիրված Տիգրան Մանսուրյանի երկերը
Authors: Արևշատյան Աննա
Published: August 2021

Among the works, dedicated to Komitas and the Armenian Genocide, the oeuvre of the outstanding contemporary Armenian composer Tigran Mansurian (born 1939) holds a special position. T. Mansurian addressed this topic back at the end of the 1960s. Most notable are, however, his large-scale compositions, created over the past decade, such as Concerto No. 4 for cello and string orchestra, "Where is thy brother Abel?" (2010), Requiem for soloists, mixed choir and chamber orchestra (2011), Sonata da chiesa for viola and piano (2015). The musical language and stylistic peculiarities of the above works testify to the fact that T. Mansurian is a direct successor to Komitas' creative traditions and an innovator, too, whose works have largely enriched contemporary Armenian music, imparting a new quality to the Armenian compositional thought.
Հայաստանի պատմական մայրաքաղաք Դվինի թանգարանացման խնդիրները
Authors: Սամուելյան Արև
Published: August 2021

Հոդվածը նվիրված է Հայաստանի պատմական մայրաքաղաք Դվինի պահպանության և վերջինիս թանգարանացման կազմակերպման հիմնախնդիրների վերհանմանը, որոնք կարոտ են հրատապ լուծման, ինչպես նաև՝ մի շարք անհրաժեշտ համալիր միջոցառումների իրականացման:
The present article considers the problems of preservation and museumification of Armenia’s historical capital Dvin. To solve the mentioned problems as soon as possible, complex measures need to be implemented. The archeological excavations of many years at the site of Dvin have uncovered ample multilayer architectural and urban planning material, pertaining to different consecutive historical periods. Such archeological heritage can be used to make Dvin a unique cultural-educational center, provided that adequate museumification work is accomplished.
Արփիար Արփիարյանի դերը Կոմիտասի ստեղծագործական ճակատագրում
Authors: Ասատրյան Աննա
Published: August 2021

The author of the first article in the press about Komitas was an Armenian writer, publicist and literary critic Arpiar Arpiaryan (1851-1908). In Constantinople, at the end of October 1892, A. Arpiaryan arranged a meeting with Komitas, which played a noticeable part both in Komitas Studies and in Komitas’ creative life. His impressions of the meeting A. Arpiaryan presented in the article “Sarkavag [Deacon] Soghomon” in the November 21, 1892 issue of the “Hayreniq” newspaper, whose editor-in-chief he was. A. Arpiaryan was among the first to commend the importance of work, carried out by young Soghomon. The “Hayreniq” newspaper of Constantinople, in issues 896,897 and 922 of the year 1894, reprinted from the July and August issues (7 and 8, 1894) of the “Ararat” monthly, published in Ejmiatzin, Soghomon Soghomonyan’s article “Armenian Church Tunes”, which had become a major milestone in the formation of Armenian musical medievistics. Thereby, A. Arpiaryan contributed to the elucidation of Komitas’ activity as a musicologist in his home country. In our opinion, the mentioned article had triggered Komitas’ decision to move, instead of Tiflis or Paris, to Constantinople, where the final act of his fruitful professional work was to develop.
2021: a year of water extremes
Authors: Webb Ashley , Fischer Christian , Cardascia Silvia
Published: August 2021

The year 2021 was marked by extreme hydro-climatic events, which take a significant toll on societies, economies and the environment. We promote a proactive whole of society perspective for dealing with such disasters.
How swachh (clean) is urban India today?
Authors:   Athena Infonomics, Lutra Bhitush , Karthykeyan Deepa
Published: August 2021

Where public supply has failed and made unsatisfactory progress in supplying drinking water, the private sector has readily stepped in to supply citizens with drinking water – most often to make big money. Much of the water bottling industry (i) provides a highly inelastic good, (ii) is immensely profitable and (iii) has significant negative externalities on public utilities, the natural environment and the quality of life in urban settings. The wide-spread introduction of a tax on the commercial water extraction and/or bottled or sachet water is ripe. The new mantra must not be “3Rs”, but “4Rs” – reduce, reuse, remunerate, recycle.
Corruption and integrity in the urban water and sanitation sector: A case study of Mexico City
Authors: Nesi Muhil
Published: August 2021

Despite considerable public funding, Mexico City faces inadequate and inequitably distributed water infrastructure. Corruption in public fund management and at the interface between institutions and individuals is fed by opaque governing systems. Local actors agree that sustainable water management must begin with systemic changes to enable transparent and participative governance.
Prevalence of Pneumonia Associated with Measles among Infants and Children
Authors: Khan Asadullah , Khan Abdul Moeed , Akbar Ali , Akram Muhammad , Ahmad Farhana , Sultan Allah Nawaz
Published: August 2021

Objective: The aim of this study is to determine the prevalence of pneumonia associated with measles among children and infants. Study Design: Cross-sectional Place and Duration: Pediatrics department of Lady Reading Hospital, Peshawar and Sharif Medical and Dental College, Lahore for six months duration from February 2020 to July 2020. Methods: Total 150 patients i.e children and infants of both genders were included in this study. Children were aged <5years of age. Patients’ detailed demographics height and weight were recorded after taking informed written consent from the authorities. Patients’ diagnosed measles were presented. Symptoms and frequency of pneumonia among all patients were assessed. Complete data was analyzed by SPSS 22.0 version. Results: There were 90 (60%) children and 60 (40%) infants. Among 150 patients, 100 (66.7%) were males and 50 (33.3%) were females. 70 (46.7%) cases had birth weight > 3kg. 30 (20%) patients had high socioeconomic status, 50 (33.3%) had middle and 70 (46.6%) cases had poor. 85 (56.7%) patients had rural residency. According to severity of measles, 35 (23.3%) had mild,45 (30%) cases had moderate and severity was among 70 (46.7%) patients. Prevalence of pneumonia was found among 95 (63.3%) cases. 40 (26.75) cases had measles vaccination. Conclusion: We concluded in this study that prevalence of pneumonia among children of measles were significantly high. It was due to less number of vaccination status with poor socio economic status among patients. It can be controlled by providing awareness of vaccination to the parents of children. Keywords: Pneumonia, Measles, Children, Infants, Prevalence
Frequency of Urinary Tract Infection in Children with Diarrhea
Authors: Akbar Ali , Khan Abdul Moeed , Khan Asadullah , Ahmad Farhana , Akram Muhammad , Sultan Allah Nawaz
Published: August 2021

Aim: To determine the frequency of UTI in children presented with diarrhea. Study Design: Cross-sectional Place and Duration: Pediatrics department of Alkhidmat Hospital, Peshawar and Sharif Medical and Dental College, Lahore for six months duration from October 2020 to March 2021. Methodology: Total 120 patients of both gender with ages 2 months to 5 years were enrolled in this study. After taking written consent from parents/guardians, detailed demographics including age, sex, residence, severity and complete medical history were examined and recorded. Urine samples were obtained for examination of urine culture. Data was analyzed by SPSS 24.0. Results: There were 78 (65%) males while 42 (35%) patients were females. 58 (48.33%) patients were ages <1 years, 45 (37.5%) had ages between 1 to 3 years and 17 (14.17%) were ages of >3 years. 36 (30%) patients had mild, 50 (41.67%) had moderate and 34 (28.33%) had severe diarrhea. UTI was found in 40 (33.33%) patients. E.coli was the commonest organism found in 28 (70%) patients followed by K. pneumonia in 12 (30%) patients. Conclusion: Frequency of urinary tract infection was high among children with diarrhea. E.coli was the commonest organism associated with UTI. Keywords: Urinary Tract Infection, Diarrhea, Children
The Association between Obesity and Prostate Volume in Patients with Benign Prostatic Hyperplasia
Authors: Rehman Ijaz ur , Hussain Syed Atif , Khan Humayun , Habib Bilal , Sheikh Raheel
Published: August 2021

Background and Aim:Prostate histological enlargement known as Benign Prostatic Hyperplasia (BPH) is the major challenge for aging men with substantial burden on the health care system. It is associated with incomplete emptying sensations and impedance in flow due to symptoms of the lower urinary tract. Patient of higher body mass index (BMI) or obese have larger prostate volume (PV) and increase in lower urinary tract symptoms (LUTS) compared to normal BMI patient as reported by many researchers. The current study aim was to correlate the association between obesity and prostate volume in BPH patients. Materials and Methods: This cross-sectional was conducted on 140 BPH patients with 45 years to 75 years age range admitted in the department of Urology, DHQ Teaching Hospital, Dera Ismail Khan for six months duration from July 2020 to December 2020. BMI of each individual was calculated using height and weight measurements. Measuring tape was used to measure waist circumference (WC) while Prostate volume (PV) was measured with Transrectal Ultrasound (TRUS). Demographic and clinical parameters such as diabetes, smoking, prostate specific antigen (PSA) and hypertension were recorded on pre-designed proforma. Outcome variables were BMI and prostate volume. Results:Patients were divided into three categories based on BMI namely Obese, overweight and normal. Mean value for age and BMI was 61.34±5.324 and 26.89±4.13 respectively. Mean PV of Obese, overweight and normal BMI were 61.34±7.5, 59±3.10 and 50.91±8.5 cm3 respectively. The PV average score was 58.42±6.53 cm3. The mean value for waist circumference (WC) and PSA were 97.20 and 5.10±3.23 with 1.2-5.9 range respectively. The correlation between PV and BMI as well as between WC and PV, diabetes, smoking and hypertension shown no significance (p value=0.195). However, PSA and PV correlation give significant (p value 0.001-0.009) correlation. Conclusion:Central obesity plays a key role in developing and promoting BPH. The highest prevalence of BPH was found in patients with BMI >30kg/m2 while lowest in men of BMI <23 kg/m2. The current study found higher frequency of BPH among patients with WC >90 cm and lowest in men of WC <90 cm. A positive correlation was found between WC, BMI and PV. Individual quality of life affected by LUTS caused by severe risk of BPH due to increase in obesity. Balance diet and physical exercise help in maintaining the healthier BMI among obese and aged men. Keywords: Benign prostate hypertrophy, Bladder outlet obstruction, Prostate volume
Comparison of MRI and CT for Detection of Acute Cerebral Haemorrahge
Authors: Nazir Memona , Baig Tahir , Hussain Atif , Tahir Muhammad , Ali Haider , Akram Muhammad Nauman
Published: August 2021

Objective: To compare the diagnostic accuracy of MRI and CT for detection of acute cerebral haemorrahge. Study Design: Comparative Study Place and Duration: Mohiuddin Islamic Teaching Hospital Mirpur AJK for period of six months from 1st August, 2020 to 31stJanuary, 2021. Methodology: A total of 20 patients of both genders with age of 25 years and onward with intracerebral hemorrhage who underwent MRI following CT in the first 6 hours of onset and last known well time and admission in stroke center were included in the study. The follow up time duration for both the scans was 24 hours to 48hours. The Mc-Nemar test was used to determine the comparison between MRI and CT on contingency table. Results: The mean age of the participants was 53.26±2.45. The frequency of the male participants was 13(65%) and that of female was 7(35%). All cases were of acute ICH 20(100%). The number of positive cases on MRI and CT scan was 17, while the frequency of positive cases on MRI and negative on CT scan was 3 with the p- value of less than 0.001 and a confidence interval of 95%. (See table 1 for details). The interrater reliability for acute ICH on MRI is from 0.72 to 0.80 on k statistics. The interrater reliability for acute ICH on CT is from 0.83 to 0.92. Conclusion: It is concluded that the findings of MRI scan were more accurate than CT in the detection of acute intracerebral hemorrhage. Keywords: Acute Cerebral Hemorrhage, MRI, CT, Diagnostic Accuracy
Mean Changes in Sperm Count in Adult Males after Varicocelectomy
Authors: Ullah Mohib , Ahmed Ibrahim , Ullah Sana , Rehman Sami ur , Khan Asif , Shah Muhammad Ali
Published: August 2021

Background: Varicocele, a bilateral vascular condition in which hypoxia can induce ischemic damage to both testes due to hydrostatic pressures in the venous drainage system, is a prominent cause of male infertility with a complex pathogenesis. varicocele make up 35% of primary infertility and 81% of secondary fertility. Methodology: A quasi-experimental study was conducted from January 2018 to September 2018 at urology department of Nawaz Sharif Kidney Hospital and Saidu Group of Teaching Hospitals, Swat. Sample size was 261. The study included all males between the ages of 20 and 60 who had clinically evident varicocele. Result: Results of our study P-value for pre-operative and post-operative sperm count was 0.00001 so statistically significant. According to the age distribution, 93 patients were in the age group 20-30 (35.63%), 70 patients in age group 31-40 years (27.01%), 60 patients aged 41-50 (22.98%), 38 patients aged 51 to 60 (14.26) %) are shown in Table 2. All cases had varicocele on the left side. Conclusion: After inguinal varicocelectomy, sperm count increases in adult patients with clinically palpable varicocele. Keywords: Adult male, Sperm count, Varicocele, Varicocelectomy.
Magnetic Resonance Imaging and Computed Tomography in Emergency Assessment of Patients with Suspected Acute Stroke: A Prospective Comparison
Authors: Ahmed Adnan , Nazir Memona , Jami Ajmaal , Tahir Muhammad , Khalil Mahnoor , Baig Tahir
Published: August 2021

Background: Timely diagnosis has become important because the safety and efficacy of acute cerebral ischemia depend on rapid and accurate assessment and treatment within a few hours of the onset of symptoms.The overall incidence of stroke is about 2.4 per thousand people, with a small geographical difference. Studies have shown that the echo MRI gradient is as accurate as CT within 6 hours of the onset of symptoms in patients with acute stroke. Methodology: This study is a one-time prospective comparison of CT and MRI in acute stroke assessment. The study was conducted from April 2020 to September 2020at the Hayatabad Medical Complex in Peshawar, with the ethical approval of the hospital ethical review committee. Regardless of the onset date, the severity of symptoms, or final clinical diagnosis, a series of patients suspected of further referral to a stroke staff at the hospital are eligible. Results: Results showed that out of 178 patients referred for clinical suspicion of stroke, acute stroke corresponds to almost two-thirds of the final clinical diagnosis. MRI found 92 out of 178 acute strokes and 29 out of 178 CT. According to study results, the MRI has a higher frequency for detecting any acute stroke (ischemic or hemorrhagic) compared with CT (p <0.0001). All four readers agreed that 143 patients with MRI and 103 patients with CT respectively, 143 patients (80%, 76–84%) had an acute stroke. Conclusion: MRI is better for detecting acute ischemia than CT and can detect both acute and chronic bleeding. This should therefore be the preferred test method for accurate diagnosis of patients with suspected acute stroke. Samples of patients cover a variety of diseases that may arise in an emergency with a suspected stroke so that the results can be applied immediately in the clinic. Keywords: Magnetic Resonance Imaging, Computed tomography, Acutestroke.
Fetomaternal Outcome of Pregnancy with COVID-19: An Observational Study in Tertiary Care Hospitals of Pakistan
Authors: Khan Nabila , Wasim Zahra , Rizwan Aesha Sadaf , Ahmad Afshan , Tahir Muhammad , Hashmi Irum Batool
Published: August 2021

Background: The new corona virus first appeared in Wuhan, China in December 2019 and has since spread around the world to other countries. The World Health Organization believes that this new CoV-19 epidemic is a public health emergency of international concern (PHEIC) on January 30, 2020Worldwide.The mortality rate of this viral infection ranges from 2% in Pakistan to 14.4% in Italy. Lympopenia, elevated transminase, proteinuria, increased LDH, and C-reactive protein levels are all common laboratory findings in the early stages of the disease. Covid patients have experienced a variety of complications, including extreme pneumonia, ARDS, heart defects, sepsis and septic shock, and respiratory tract super infection. Methodology: This retrospective observational research study was carried out at the Gynecology Unit of MardanMedical Complex, Mardan and Combined Military Hospital, Risalpur for 06 months duration from April 2020 to September 2020. In a pre-constructed data collection form, biochemical and radiological parameters of medical history, test results, symptoms, pregnancy, and neonatal outcomes were noted. Patients treated in an outpatient setting were not included in the study. Results: There were 121 patients in total, with mean age of 27 having standard deviation ± 5, having range 19-40 years. 48.3% pregnant women reported their first pregnancy(primigravida). 51.3% of SARS-Cov-2 were in their 3rd trimester while 34.7% were in their 35-40 weeks of gestational age. Common complications are gestational hypertension (PIH) (16 cases), hypothyroidism (14 cases) and gestational diabetes (GDM) 9 cases. More than half (53%) of patients are asymptomatic. Common symptoms are cough (22%) and fever (11%). The incidence of multiple organ failure was 2% as shown in table 01. Lymphopenia was common (84%). A CT scan of 24 patients showed bilateral invasion. Conclusion: COVID-19 has a negative impact on the foetus, according to our results. Although pregnant women do not seem to be more vulnerable to COVID-19 complications than non-pregnant adults, previous research has suggested that pregnant women could be at higher risk for negative pregnancy outcomes such as preterm birth, foetal pain and respiration, symptoms, and LBW in a newborn baby. Keywords: Corona virus, COVID-19, Pregnancy, Outcome.
Comparison of Human Thymus Gland between Young and Old Age
Authors: Mehboob Faiza , Mirani Ponum , Ameer M. Kamran , Shabeer Khurram , Qamar Muhammad Ali , Arshad Mah Noor
Published: August 2021

Aim: Study was conducted to examine the different parameters of human thymus glands of young and old patients and compare the findings between both age groups. Study Design: Comparative/observational study Place and Study: Study was conducted at Anatomy department of Nishtar Medical University Hospital, Multan for duration of six months from 15th January 2020 to 15th July 2020. Methods: Total 54 specimens of human thymus of 54 patients were enrolled in this study. All specimens were divided in to two groups I and II, Group I contains 27 patients with ages <30 years and group II with 27 patients having ages 45 to 60 years. All specimens were fixed in 10% formalin solution and then processed for paraffin embedding. Compare the different parameters such as thickness of interlobular connective tissue and thymic capsule, length and number of Hassal’s corpuscles between both groups. Data was analyzed by SPSS 24.0. Results: In group I 12 (44.44%) patients were ages <15 years and 15 (55.56%) patients were ages >15 years. In group 13 (48.15%) and 14 (51.85%) patients were ages <50 years and >50 years. There was a significant difference observed between both groups regarding thickness of interlobular connective tissue and thymic capsule, quantity and length of Hassal’s corpuscles with p-value <0.05. Conclusion: It is to be concluded that patients with young age had significantly less thickness of thymic capsule and interlobular connective tissue with more in number and decreasing size of Hassal’s corpuscles as compared to old age patients. Keywords: Human Thymus Glands, Young Age, Old Age
Multi Drug Resistance (MDR) Urinary Tract Infection: An Evidence Based Study
Authors: Orakzai Nasir , Ali Liaqat , Kakakhel Majid Khan , . Arshad , Hayat Faiza , Khan Ihsanullah
Published: August 2021

Background: Urinary tract infections are the most frequently reported infections that drive the use of antibiotics around the world. UTI is the 4th most common healthcare-associated infection. Multidrug-resistant (MDR) organisms are predominantly bacteria that are resistant to one or more classes of antimicrobials. The increasing rise in the incidence of MDR-UTI has resulted in increased morbidity, mortality, and treatment cost of the patients. Thus, it is important to highlight the magnitude of the problem, identify the risk factors that result in MDR-UTI, and to take appropriate measures to control its occurrence. Objective: To determine the magnitude of the multidrug-resistant bacteria, their antibiotic-resistant profile, andtheir effect on the treatment cost of the patients Methods: It is a descriptive study conducted in the Department of Urology at the Institute of Kidney Diseases (IKD) from Jan 2019 till 30th March 2020. A total of 54 patients with multi-drug resistant UTI were included in the study irrespective of age and gender. All the data was recorded on a structured pro-forma and was analyzed on SPSS. Results: A total of 3190 patients were operated on from Jan 2019 till 30th March 2020. Out of which 54 patients (1.6 %) developed MDR-UTI. Among them,38 were male and 16 females. The mean age of the patients was 41 ± 18.4. Urolithiasis with infections was found most frequent, in 32 (59.3%) patients. All patients were on broad-spectrum oral antibiotics and had a history of urethral catheterization before the development of MDR-UTI. The most common procedure was Emergency cystoscopy and DJ stent 15 (27.8%). Followed by Percutaneous nephrostomy in 8 (14.8%). Regarding co-morbidities, 38(68.5%) patients had none, 3 patients had diabetes and 6 patients were having Diabetes and Hypertension. Pseudomonas aeruginosa was found most frequent microorganisms in 34 (63%) patients while E.coli in 10 (18.5%) and Klebsiella in 5 (9.3%) patients. Colistin was found sensitive in 36 patients (66.7%). The mean hospital stay in MDR-UTI is 9.28± 5.17 days as compared to 2.1 days in routine cases. Approximately a 4-fold increase was observed in medicines alone in the management of MDR UTI. We recorded 1 mortality (1.9%), case of MDR urosepsis. Linear regression revealed previous use of antibiotics; catheterization, old age, and endo-urological procedures in an emergency as independent risk factors for MDR-UTI. Conclusion: MDR-uti is an emerging local problem. pseudomonas aeruginosa is the most frequently found microorganism in the present setup. it is associated with significant morbidity and very high treatment cost. Keywords: Urinary Tract Infection, Multidrug Resistance, Micro-Organism, Urology, Antimicrobials
Frequency of Bacteriological Organism in Patients with Thoracic Empyema
Authors: Salim Muhammad Umer , Dilawar Syed Mohammad Umair , Rehman Syed Tabish
Published: August 2021

Objective: To examine the frequency of bacteriological organism present in pleural fluid, in patients positive with thoracic empyema, assessed on the basis of pus culture test. Study Design: Cross-sectional study Place and Duration: Inpatient Department, Chest Medicine Ward 12, JPMC, Karachi, Pakistan for six months duration from 11 February 2019 to 10 August 2019. Methodology: One hundred and thirty nine patients diagnosed with Thoracic Empyema were included in this study. All patients included in the study shall undergo Pus Culture Test prior to identify the presence or absence of bacterial organism. Those with positive bacterial findings (mainly Staph Aureus and gram negative organisms) were further assessed for stratification with reference to their possible variable affecters. Results: There were 107 males and 32 females (%M: F ratio 77:23), with Empyema Thoracic, aged between 25-55 years and having a mean age of 36.28 year (± SD 8.206), were studied. The Pus Culture Test rate was 100% whereas duration of empyema was of average 18.38 days (± S.D 11.16). One hundred and four patients (74.82%) were carrying investigated bacteria which were staph. Aureus in 17 (12.50%) patients. GRAM NEGATIVE ORGANISMS in 87 (62.58%) patients. Echerea Coli in 12 (8.3%) patients, Pseudomonas. Aeruginosa in 46 (33.33%) patients, Klebseilla in 17(12.50%) patients, Enterococcus Species in 12 (8.3%) patients. While remaining thirty five patients (25.17%) were found to have other bacteria, including Streptococcus, Proteus Mirabillis and Acinobacter, responsible for Empyema. Conclusion: It is concluded that 74.82% patients had bacteria and among them 62.58% patients had gram negative organism. Pseudomonas Aeruginosa was the most common organism followed by Klebseilla and staph. Aureus. Keywords: Empyema, Thoracic, Pleural Effusion, Thoracentesis, Thoracostomy
Mortality Rate and Causing Factors in Ventilator Associated Pneumonia in Children
Authors: Farrukh Riffat , Naseer Amber , Masood Shaheen , Shakoor Ibrahim , Nasir Farhina , Sultana Sarwat
Published: August 2021

Aim: To estimate the incidence of ventilator-associated pneumonia (VAP) and to identify causing microbiological organismsand VAP related mortality rate in children admitted to the ICU. Study design: This was a Cross-sectional and an observational study. Study place and duration: In the Pediatric department of Abbasi Shaheed Hospital, Karachi, for one-year duration from May 2020 to May 2021. Methodology: All admitted children to the pediatric ICU (PICU) and ventilated were selected and observed for any features suggestive of VAP. All suspected children have Partial septic signs. A VAP will be categorized ifchild remains on ventilator for more than 48 hours and when a patient had 2 of these signs of nosocomial infection - TLC <4,000 or> 15,000 mm3 , fever> 101 ° F, CRP> 48 mg / L, neutrophils> 85% or a new chest X-rayexhibited pneumonia withradiological sign of progressive, persistent or new infiltrates. The chi-square test was used for comparison of percentages with a value of Less than 0.05 p. Results: Of all the cases admitted, the average length of ICU stay was 8.65 ± 6.45 per day. Children who needed VAP required 14.2 ±9.5 days of ventilation and 7.5± 5.2 days for children who have not VAP progression. Of 100 cohort of children necessitating ventilation, 22 died and 2 were left without advice or serious illness, with a total mortality of 22%. Conclusion: The VAP incidence in this study was 22%. Features related with a higher incidence of ventilator-associated pneumonia include age <1-year, continuous intravenous sedation and unplanned intubation in emergency situation. Features suggestive of underlying VAP encompassed, CRP> 48 mg / L, purulent tracheal secretions, positive tracheal culture of aspirate and positive X-ray results. Key words: Ventilator-associated pneumonia (VAP), Nosocomial infections,PICU and Children.
Comparison of Slow Rate versus Fast Rate Extracorporeal Shock Wave Lithotripsy in Patients with Urolithiasis
Authors: Kakar Muhammad Musa , . Asadullah , Khan Masha , Rehman Ijaz Ur
Published: August 2021

Objectives: To compare the success of slow rate with fast rate extracorporeal shock wave lithotripsy in patients undergoing treatment of urolithiasis. Study design: Randomized controlled trial Place & Duration of Study: This study was conducted in Urology Department of Sandeman Civil Hospital, Quetta for one year duration from 1stApril 2020 to 30thMarch 2021. Methods: Total ninety patients who were divided in two equal groups i.e. Group A in which patients received treatment with slow rate extracorporeal shock wave lithotripsy and group B in which patients received treatment with fast rate extracorporeal shock wave lithotripsy. Results: There were 32 (71.1%) male patients and 13 (28.9%) female patients in group A. In group B, there were 28 (62.2%) male patients and 17 (37.8%) female patients. Mean age in group A was 35.61+4.19 years while in group B, the mean age was 34.11+69.32 years. The success rate of slow rate extracorporeal shock wave lithotripsy was 36 (80%) and that of fast rate extracorporeal shock wave lithotripsy was 21 (46.7%) (p-<0.05). Conclusions: The slow rate extracorporeal shock wave lithotripsy is better than fast rate extracorporeal shock wave lithotripsy for elimination of urolithiasis. Keywords: Extracorporeal shock wave lithotripsy, Slow rate ESWL, Fast rate ESWL
Comparison of Diagnostic Accuracy of Portal Serum Ascitic Albumin Gradient (SAAG) with Ascitic Fluid Total Protien (AFTP) Differentiating Portal Hypertension from Non-Portal in Patients with Ascites
Authors: Khan Salman , Ullah Ihsan , Haq Moeen ul , Badshah Umar , Nazir Maryam
Published: August 2021

Introduction: Although majority of the cases of ascites have cirrhosis, there are 15% patients where there is a non-hepatic cause of fluid retention like malignancy, congestive heart failure and tuberculous peritonitis. Ascites is the most common complication of cirrhosis that leads to hospital admission. Objective:To compare the diagnostic Accuracy of Serum Ascitic Albumin Gradient (SAAG) and Ascitic Fluid Total Proteins in patients with ascites by taking Ultrasound abdomen & Pelvis as gold standard. There are international studies on the accuracy of SAAG in determining cause of ascites but not much local data. Additionally, SAAG is not widely used in our setup. The results of this study will add to the existing knowledge and will help in the diagnosis and better management of these patients. Material & Methods: A cross sectional validation study was conducted in the department of General Medicine, DHQTH, Dera Ismail Khan from 29th April to 29th Oct, 2019. Diagnostic Ascitic fluid was aspirated from the peritoneal cavity and ascitic fluid was sent to hospital laboratory for total protein and albumin. Blood was taken at the same time and was send to the hospital laboratory for the serum albumin. SAAG was calculated by subtracting ascitic albumin value from the serum albumin value. Both, Ascitic fluid total protein and SAAG values was documented in the proforma. Ultrasound Abdomen & Pelvis was done on each patient with special instruction for radiologist to comment upon Portal Vein diameter and any changes in its diameter with respiration. Results: As per comparison Of SAAG with ultrasound in detecting ascites, sensitivity was 36.26%, specificity was 75%, PPV was 84.62%, NPV was 23.68% and accuracy was 44.35%. P Value was 0.299. As per comparison of AFTP with ultrasound in detecting ascites, sensitivity was 33.33%, specificity was 59.34%, PPV was 17.78%, NPV was 77.14% and accuracy was 53.91%. P value was 0.513. Conclusion:SAAG exhibits that patients with ascites fluid possess the basis of portal hypertension. Thus we have come to this conclusion that SAAG can effectively enhance the diagnostic value of ascites fluid tests and therefore its classification can be considered to be a novel standard in the analysis of ascites fluid. Keywords: Diagnostic Accuracy, Ascites Volume, Ascitic Albumin Gradient (SAAG), Ascitic Fluid Total Proteins (AFTP)
Association between Trigeminal Neuralgia and Multiple Sclerosis: Role of Magnetic Resonance Imaging
Authors: Baig Tahir , Ahmed Adnan , Hussain Atif , Shah Rabia , Tahir Muhammad , Mehmood Rashid
Published: August 2021

Background: Trigeminal neuralgia (TN) is a severe neuropathic unilateral facial pain affecting about 30% percent of the world population. Neuropathic pains are considered to be associated with multiple sclerosis (MS).Multiple sclerosis is a chronic inflammatory condition causing demyelination and degeneration of axons in central nervous system. Objective: The objective of the study is to determine role of Magnetic Resonance Imaging to find association between trigeminal neuralgia and multiple sclerosis. Methods: The prospective cohort study was conducted for six months in Radiology Department of Hayatabad Medical Complex, Peshawar from September 2020 to February 2021. Initially 250 patients were screened for multiple sclerosis. The study recruited a total of 35 patients of MS visited neuroradiology department, out of which 26 patients were enrolled in the study. The participants with age of 18 years and onward of both genders with definitive symptoms of TN with MS that is having unilateral TN pain (that is sharp shooting electric pulse like) lasting for up-to 2minutes precipitated with an environmental stimulus were included in the study. The patients (n=6) with bilateral MS with TN and cognitive disturbances (n=3) were excluded from the study. Results: The study recruited a total of 26 participants with MS related TN. The clinical examination didn’t show any difference between the three groups with the p-value less than 0.001. Age at the onset of MS was younger in patients with MS related sensory disturbances compared to other two groups, with p-value less than 0.05. The frequency of the affected side was different in all three groups with the p-value less than 0.05 as tested by Fischer exact test. Trigeminal reflex tests done for different components such as R1 and SP1 showed longer latency periods for the affected side after stimulation and unaffected side after stimulation with the mean of 14.2± 4.4 and 15.3±3.2, 16.3±4.2 and 17.4±5.2ms and p-value less than 0.001 as shown by Wilcoxon test. Conclusion: The study showed significant association between trigeminal neuralgia and multiple sclerosis with the greater efficacy of using MRI as imaging technique to find this association. Keywords: Multiple sclerosis, Magnetic Resonance Imaging, Trigeminal neuralgia
Incidence and Risk factors of Uterine Scar Dehiscence after Previous Caesarean Section
Authors: Naz Rizwana , Shoaib Maryam , Naeem Sakina , Saifullah Samia , Ali Safia Ewaz
Published: August 2021

Objectives: To assess the incidence and risk factors of scar dehiscence. Methodology: This was a prospective observational study where a total of 210 patients were involved over a period of six months (May 2020 to November 2020) who came to Sandeman Provincial Hospital, BUMHS gynaecology unit 1. The parturient were above the age of 18 and had previous uncomplicated lower segment caesarean sections. Patients with previous classical caesarean section and ruptured uterus diagnosed pre or intra-operatively were excluded from the study. Sampling technique: Non-probability convenience sampling technique will be used. Results: In this study, the mean age of the patients was 31.57 ± 4.26 years, the mean gestational age was 34.43± 4.45 weeks. The incidence of scar dehiscence was observed in 47 patients. Conclusion: Uterine Scar Dehiscence is one of the factors that increases fetal and maternal morbidity and mortality rate. Its incidence is found to be related with C-sections, inadequately short intra-pregnancy time interval, preterm delivery, VBAC and trial labour. In this study, the incidence of scar dehiscence was 22.38%. Keywords: Previous one caesarean section, scar dehiscence, scar tenderness
Maternal Education and Acute Diarrhea Among Children Aged 2-5 Years In Pakistan: Cross Sectional Study
Authors: Ehsan Fatima , Ehsan Ayesha , Khan Wajahat Ullah , Masud Rizwan , Hanif Hamad , Zainub Abeerah , Laique Talha
Published: August 2021

Childhood diarrheal disease is the second leading cause of death globally. All over the world, children below five years of age experience, on average, 3.2 episodes of diarrhea per year. Objectives: To explore an association of maternal education with childhood diarrhea in Pakistan. Study Design: Cross sectional study. Methodology: This study was conducted from Aug 2016 to Jan 2017 in Combined Military Hospital (CMH), Peshawar following approval from ethical review board. Total children under study were 363 aged 2 to 5 years, amid whom 121 were acute diarrhea cases and 242 were healthy controls leading to cases control ratio as 1:2. Data collection was done through semi structured questionnaire asked from mothers. Statistical analysis: Data was analyzed by SPSS software, version 22. To compare the association of maternal education with acute diarrhea, chi square test was applied at 5% level of significance. Statistical significance was taken at p value <0.05. Results: In present study, there was significant association between formal education of mothers and acute diarrhea with a highly statistically significant association (p < 0.001) observed showing increased proportion of childhood diarrhea, with increasing levels of education in mothers. Conclusion: We concluded that a significant increase in childhood diarrhea with higher levels of maternal education refutes the commonly observed finding. We need to further probe the underlying causes to minimize this high observed morbidity. Key Words: Maternal Education, Child Health and Safety and Acute Childhood Diarrhea
Impact of BMI on Covid-19 Clinical Features and its Management: A Cross Sectional Study
Authors: Anwar M. Zeeshan , Masud Rizwan , Rafique Iffat , Gardezi Syed Anees Ahmad , Rehman Matloob ur , Ayaz Hira , Hashmi M. Razi ul Islam , Shoaib Shaiza , Hashmi Shoaib Naiyar , Laique Talha
Published: August 2021

The whole world is suffering from COVID-19 pandemic. This disease has halted life and has a negative impact on physical and mental health of all individuals. Objectives: To identify impact of BMI on Covid-19 clinical features and its management in terms of relationship among patients at government hospitals, Pakistan. Study Design: Cross-sectional study. Methodology: This study enrolled 206 patients having both genders and was carried at Life Diabetes Centre, Gujrat and CMH Kharian Medical College (CKMC), over a period of 3 months, Kharian-Pakistan following ethical review committee’s (ERC) approval. Statistical analysis: Data was analyzed by SPSS software, version 17. Parameters like age, gender and treatment taken were presented as frequency. Chi square was applied to see the correlation with p-value <0.05 as significant. Results: Total 206 patients were randomly selected, 89 male and 117 females. Among 206, patients (n=133) showed symptoms while rest of the patients (73) remained asymptomatic. There was no association of BMI with COVID-19 symptoms having P-value greater than 0.05. There was an association of BMI with gender as P-value (0.000*). There was an association of BMI with age having P-value (0.000*). Conclusion: From present study, we concluded that there was a correlation between BMI and individuals with higher BMI as they developed more serious symptoms and required active management strategies in comparison to individuals who were either underweight or normal weight. Key Words: Covid-19, BMI, Treatment and Gender.
Comparing Diameter of Hepatic Portion of Inferior Vena Cava During Normal Breathing in Normal Individuals Versus Cirrhotic Patients: Case Control Study
Authors: Israr Afshan , Khan Sehrish Shamrez , Azmat Sadia , Laique Talha
Published: August 2021

A non invasive ultrasound technique has been proposed as a mean of detection of early fibrosis by measuring changes in the diameter of the hepatic inferior vena cava (IVC). Objectives: To determine the mean diameter of hepatic portion of inferior vena cava and mean reduction in its diameter by inspiration in normal and cirrhotic patients using USG. Study Design: Case control study. Methodology: This study (n=60) was conducted after ethical review committee’s (ERC) approval from April-October 2018 at Department of Radiology, Military Hospital Rawalpindi. Patients with stage 5 and 6 of cirrhosis were taken as cases. Controls had sonographically normal livers. The maximal diameter of IVC was measured during normal breathing first followed by a deep breath. Statistical analysis: Data was analyzed by SPSS, v-20. Parameters were measured by applying t-test with p≤0.05 as significant. Results: The IVC diameter during deep inspiration was 1.217±0.168 cm and 1.711±0.422 cm among controls and cirrhotic cases respectively (p= 0.00). The mean IVC diameter decrease was 1.02±0.25 cm and 0.03±0.02 cm by inspiration among controls and cases respectively having statistically significant p-value (<0.05). Conclusion: We concluded that stiffness of the hepatic parenchyma have caused the physiological changes in the diameter of IVC enhanced by deep respiration. Thus, it can be used as a tool for evaluation of cirrhotic patients. Key Words: Cirrhosis, Hepatic Portion of Inferior Vena Cava, Liver and Sonography