bluuebunny/crossref_metadata_2025 huggingface dataset:
Aluminum Alloy, Sheet and Plate, Alclad, 4.4Cu - 1.5Mg - 0.60Mn (Alclad 2024, -T861 Sheet and Plate), Solution Heat Treated, 6% Cold Worked and Artificially Aged
Authors:   AMS D Nonferrous Alloys Committee
Published: April 2024

This specification covers an aluminum alloy in the form of alclad sheet and plate supplied in the -T861 temper.
Aluminum Alloy, Coiled Sheet, Alclad, 4.4Cu - 1.5Mg - 0.60Mn (Alclad 2024; -T4 Coiled Sheet), Solution Heat Treated
Authors:   AMS D Nonferrous Alloys Committee
Published: April 2024

This specification covers an aluminum alloy in the form of alclad coiled sheet from 0.010 to 0.128 inch (0.25 to 3.25 mm), inclusive, in thickness supplied in the -T4 temper (see 8.5).
Titanium Alloy Bars, Forgings and Forging Stock, 6.0Al - 6.0V - 2.0Sn, Solution Heat Treated and Aged
Authors:   AMS G Titanium and Refractory Metals Committee
Published: April 2024

This specification covers a titanium alloy in the form of bars up through 4.000 inches (101.60 mm) in nominal diameter or least distance between parallel sides, inclusive, forgings of thickness up through 4.000 inches (101.60 mm), inclusive, with bars and forgings having a maximum cross-sectional area of 32 square inches (204.46 cm2), and stock for forging of any size (see 8.6).
2.4 GHz Ve 5 GHz Monopol Antenlerin Farklı Duvar Parametreleri İçin Kapsama Alanlarının İncelenmesi
Authors: Niş Hüseyin Tarık , Tabakcıoğlu Mehmet Barış
Published: April 2024

Çalışma frekansının farklı olduğu bu Wi-Fi modullerinin kapsama alanları bir evin içerisindeki konumu ve odaların duvarlarının özellikleri çeşitli parametrelere bağlı olarak değişmektedir. Kapsama alanlarının üzerinde bu parametrelerin etkisinin araştırılması için bir ev tasarlanmış ve ev içerisindeki 3 farklı konum için odalara 2.4 GHz ve 5 GHz yayın yapan antenler içeren modemler yerleştirilmiştir. Ayrıca duvarların kalınlığı ve duvarın yapıldığı malzemenin kapsama alanına etkisi incelenmiştir. Analizler gerçekleştirilmeden önce 2.4 GHz ve 5 GHz frekansındaki monopol antenler için uzak alan ışıması elde edilmiş ve sonrasında elde edilen uzak alan ışıma verileriyle konut içerisindeki ışıma analizi gerçekleştirilmiştir. Yapılan analizler ve kıyaslamalar sonucunda 2.4 GHz modemin 5 GHz modeme göre daha fazla kapsama alanı sağladığı tespit edilmiş ve ayrıca, ahşap özellikli duvarın en iyi kapsama alanını sağladığı gözlemlenmiştir.
Açıklanabilir Yapay Zekaya Dayalı Müşteri Kaybı Analizi ve Elde Tutma Önerisi
Authors: Kök İbrahim
Published: April 2024

Mobil telekomünikasyon pazarında aboneler yüksek hizmet kalitesi, rekabetçi fiyatlandırma ve gelişmiş servis beklentisindedirler. Müşteri bu beklentilerini telekom servis sağlayıcısından karşılayamaması durumunda onu değiştirme yoluna gitmektedir. Hizmet sağlayıcı operatörlerin ise abone kaybı olarak nitelendirilen bu durumla başa çıkmak için abonelerin iletişim kalıpları, davranışları ve abonelik planlarına ait verileri analiz ederek stratejik öngörü sağlayan yorumlanabilir müşteri kaybı tahmin modellerine ihtiyacı vardır. Bu çalışmada biz K-En Yakın Komşu, Karar Ağacı, Rastgele Orman, Destek Vektör Makinesi ve Naïve Bayes algoritmalarına dayalı müşteri kaybı tahmin modelleri geliştiriyoruz. Aynı zamanda en başarılı algoritma sonuçlarının açıklanabilirliği ve yorumlanabilirliği için ELI5, LIME, SHAP ve karşıolgusal açıklanabilir yapay zeka yöntemleri kullanıyoruz. Bu sayede geliştirilen modeller incelenen abonelerin sadece operatörü değiştirip değiştirmediği değil aynı zamanda abone davranışına sebep olan özellikleri de çıktı olarak vermektedir. Geliştirilen açıklanabilir modeller aracılığıyla servis sağlayıcılara müşteri davranışlarının nasıl ve neden gerçekleştiğine dair kapsamlı analizler sunuyoruz.
Bandwidth Enhancement of a D-Crescent-Shaped Monopole Patch Antenna for Wireless Applications
Authors: Güler Cem , Bayer Keskin Sena Esen
Published: April 2024

A low-profile monopole patch antenna is proposed for wireless communication purposes, covering PCS1900, UMTS, LTE2300, LTE2500, ISM, and WLAN bands. The antenna features a novel double-crescent-shaped (D-Crescent-Shaped) patch with a partial ground plane to enhance bandwidth. Resonating at 2.4 GHz for ISM applications, the antenna, constructed on FR-4 dielectric, exhibits a proportional bandwidth of 38%, covering 1.91 GHz to 2.81 GHz. The design achieves a low-profile configuration with dimensions of 36.88×44.85 mm², featuring a thickness of 1.6 mm. The proposed antenna has a return loss of -56.1 dB and a directivity gain of 2.21 dBi. The proposed antenna, with its low-profile design, ease of manufacturing, and improved bandwidth and return loss, is well-suited for wireless communication applications across widely-used frequency ranges like PCS, UMTS, LTE2300, LTE2500, ISM, Wi-Fi, Bluetooth, and 4G LTE.
Forecasting of the Dental Workforce with Machine Learning Models
Authors: Atalan Abdulkadir , Şahin Hasan
Published: April 2024

The aim of this study is to determine the factors affecting the dental workforce in Turkey to estimate the dentists employed with machine learning models. The predicted results were obtained by applying machine learning methods; namely, generalized linear model (GLM), deep learning (DL), decision tree (DT), random forest (RF), gradient boosted trees (GBT), and support vector machine (SVM) were compared. The RF model, which has a high correlation value (R2=0.998) with the lowest error rate (RMSE=656.6, AE=393.1, RE=0.025, SE=496115.7), provided the best estimation result. The SVM model provided the worst estimate data based on the values of the performance measurement criteria. This study is the most comprehensive in terms of the dental workforce, which is among the healthcare resources. Finally, we present an example of future applications for machine learning models that will significantly impact dental healthcare management.
De la lectura a la percepción de la imagen
Authors: Álvarez Marco Antonio Marín , Gutiérrez Adriana Acero , Batista Miguel Ángel Herrera
Published: April 2024

A través de diferentes épocas, se ha tratado de dar un significado a la imagen visual con un término empleado recurrentemente: “la lectura de la imagen”, sin embargo, apegándonos estrictamente al significado de lectura , nos hemos cuestionado si realmente este ejercicio se lleva a cabo, o si en su lugar lo que se pretende expresar es que la percepción de la imagen visual conlleva un proceso de características complejas visuales y cognitivas. Este documento aborda dicho tema desde la óptica de la imagen como esencia, la cual nos da un amplio bagaje del significado de la imagen visual. Posteriormente analiza los argumentos por los cuales una imagen visual se interpreta, para encaminar al lector hacia una metodología desarrollada por Erwin Panofsky con un amplio sentido de la interpretación de la imagen desde tres elementos imprescindibles: la preiconografía, la iconografía y la iconología.
Career Change: Are there options after failing at the first attempt?
Authors: Luna José Alfredo Carazo , Galván Alejandra Velarde , Ruíz Diana Verónica Muñoz
Published: April 2024

For university students, the choice of a career represents a fundamental step in what will be their professional and personal life once they graduate. Before the beginning of a school cycle, the student faces one of the most important processes of analysis and choice in his life, which, if not done conscientiously, will lead to disappointment, frustration and low morale, asking himself if the career he has chosen was really the best option or if he had a last chance to change his plans. Studying an academic career implies that after finishing it, the student is faced with the possibility of improving his knowledge by studying a postgraduate degree that will improve his skills and raise his self-esteem. Higher education institutions present in their entrance schemes a series of educational programs, but if the student for some reason cannot advance from the beginning, he/she has a last option to change careers. Therefore, the present research is carried out in a university in the southeast of Mexico. Its purpose is to show the statistics of career alternatives that the student would have as a second opportunity in the case that in the career that was his first option he has not satisfactorily covered the academic requirements. A statistical methodology is applied that would help the school services area to recommend a second opportunity.
ANÁLISIS DE LA PREDICTIBILIDAD DE LAS CONCENTRACIONES ANUALES DE PM2.5 EN QUITO, APLICANDO LA ENTROPÍA DE KOLMOGÓROV-SINAI
Authors: Pino-Vallejo Marco , Tierra Alfonso , Perugachi Nelly
Published: April 2024

El material particulado de 2.5 micras conocido como PM2.5, se encuentran en el aire urbano, prin- cipalmente debido a la contaminación vehicular. Los efectos en la salud son irreversibles debido a que por su dimensión puede alojarse permanentemente en los alvéolos pulmonares. El objetivo de la investigación fue analizar la predictibilidad de las concentraciones de PM2.5 en Quito-Ecuador (0°13'12.46 "S, 78 ° 30'36.97" O, altura 2830 m), mediante la entropía de Kolmogórov-Sinai. Se uti- lizaron los datos históricos de las concentraciones de PM2.5, registrados por la Red de Monitoreo Atmosférico Metropolitano de Quito del período 2005-2016. Previo al análisis de predictibilidad se calcularon los parámetros de tiempo de retardo, la dimensión de encaje y exponentes de Lyapunov que determinan la dinámica del sistema, para procesar los datos se usa el modelo Tisian. El mayor número de exponentes positivos de Lyapunov se encuentran en los años 2011, 2013 y 2016. La en- tropía de Kolmogórov-Sinai tiene una tendencia a incrementarse en el transcurso de los 12 años analizados, lo cual implica una disminución en la predictibilidad de los datos de PM2.5, debido a la pérdida de información a lo largo de la evolución del sistema.
AGRUPACIÓN DE GENES EN CIENCIA INTENSIVA: COMPARACIÓN Y ANÁLISIS DE TENDENCIA MEDIANTE EL ÍNDICE DE ESTABILIDAD BIOLÓGICA
Authors: Urgilés Miguel , Ulcuango Michael , Pazmiño Rubén
Published: April 2024

Esta investigación evalúa el rendimiento de los algoritmos de agrupación más conocidos utilizando el índice de estabilidad biológica (BSI). Se realizó una comparación entre los algoritmos de agrupación, para determinar de estos cuál es el óptimo según el puntaje obtenido en cada algoritmo, la agrupación de génica en Ciencia Intensiva, el mismo que utiliza bases de datos extensas para cubrir casi todos los resultados que pudiesen ocurrir realmente. Se aplica este método a una base de datos de expresión de genes (Microarray). El análisis se lo realizó a la base de datos “mouse” incluida en el paquete clValid en el software R, para el estudio de las células mesenquimales de ratones (cresta neural y el mesodermo derivado), también se utiliza métodos gráficos como los dendogramas para un primer enfoque. Para la selección del algoritmo óptimo, se calculó el índice biológico de estabilidad para cada algoritmo de agrupación siendo el mejor, el que más cerca de la unidad se encuentre. En consecuencia, el algoritmo más estable para dicha base de datos es “Diana”. Para llegar a este resultado se visualizó gráficamente el número de clústeres con la respuesta obtenida en cada caso; se tomó como el algoritmo óptimo el que más se apegue a la realidad del problema teniendo en cuenta su puntaje en los índices y además con la ayuda de un gráfico de filogenética para un ultimo enfoque.
Análisis del cambio climático en un ecosistema alto andino, Riobamba-Ecuador
Authors: Pérez Natalia Alexandra , Mullo Héctor Salomón , Marcatoma Jessica Alexandra
Published: April 2024

El propósito de esta investigación es evidenciar la existencia del cambio climático en un ecosistema alto andino del Ecuador, a través del estudio de la tendencia lineal de la temperatura máxima, mínima, promedio y precipitación de la estación meteorológica (M1036)  del Instituto Nacional de Meteorología e Hidrología (INAMHI)  ubicada en la Escuela Superior Politécnica de Chimborazo (ESPOCH).  El análisis estadístico univariante de los promedios mensuales multianuales de los años 1976 a 2017 determinaron un clima seco en los meses de junio a septiembre y un clima húmedo en dos intervalos (febrero - mayo y octubre - diciembre). Por otra parte, mediante la prueba de Mann Kendall, se evidenció que la temperatura promedio presentó una tendencia decreciente (-0,004); mientras que la temperatura máxima,  mínima  y precipitación  tuvieron una tendencia creciente (0,0002; 0,003; y 0,039 respectivamente), donde las dos últimas son significativas al 5%. Concluyendo así, que el cambio climático es plausible en el área centro andina del Ecuador, generando problemas ambientales a los que nos debemos enfrentar,  y que los generadores de políticas públicas del país deben considerar como insumos para la planificación.
Relación de la concentración de clorofila con el contenido nutricional de seis arbustos forrajeros
Authors: Congo Carlos , Burbano Remigio , Chanaluisa Alexandra , Chuquimarca Edgar
Published: April 2024

El objetivo fue evaluar el contenido nutricional e índice de clorofila (ICC) de seis forrajes arbóreos, para ello se analizó el ICC, proteína, fósforo, potasio, calcio, magnesio y azufre a 30, 45 y 65 días. Se utilizó un diseño de bloques completamente al azar en parcelas divididas con seis repeticiones. Los resultados se compararon con un test de Tukey al 5 %, se realizaron correlaciones (Pearson) y regresiones lineales para determinar el efecto del ICC con los nutrientes. Los contenidos de ICC, proteína, fósforo, potasio, calcio, magnesio y azufre presentaron diferencia estadísticas (p < 0,05) para los factores arbustos forrajeros e intervalos de corte, y su intercacción. Leucaena presentó mayores contenidos de ICC en todos los intervalos. Los resultados de proteína fueron mayores en Gliricidia (30 días), Leucaena (45 días) y Moringa (60 días). Para fósforo los mejores valores se obtuvieron en Morus (30 días) y Moringa (30, 45 y 60 días). Tithonia alcanzó mayor concentración de potasio y calcio en los tres intervalos de corte, así como para magnesio (30 días). El ICC determinado con medidores de lectura directa permitió correlacionarse con el contenido de proteína y los nutrientes del tejido foliar P, K, Ca, Mg, S.
Unveiling neonatal intestinal obstruction due to total colonic atresia: A case report
Authors: Arbi Fawad Mueen , Anjum Muhammad Zulfiqar , Iqbal Zeeshan , Fatima Seerat
Published: April 2024

Background: Total colonic atresia is an uncommon congenital anomaly associated with neonatal intestinal obstruction, often necessitating prompt diagnosis and surgical intervention to prevent life-threatening complications. Understanding the etiology and optimal management strategies is crucial for ensuring favorable outcomes.
Case Presentation: We present a case of a full-term male neonate with total colonic atresia, who presented with failure to pass meconium, abdominal distension, and vomiting. Diagnostic imaging confirmed intestinal obstruction, leading to surgical exploration revealing an atretic colon extending from the Ileocolic Junction to the Rectosigmoid Junction. An ileostomy was performed, followed by meticulous postoperative care, resulting in a successful resolution of symptoms and discharge from the hospital.
Conclusion: Timely recognition and staged surgical management are paramount in addressing total colonic atresia, emphasizing the importance of early intervention for optimal patient outcomes. Long-term follow-up and comprehensive care are essential to ensure the overall well-being of affected newborns.
Management of orthodontically induced white spot lesions: a survey of the orthodontic practitioners of Pakistan
Authors: Shuja Mirza Ezaaf , Waqar Jeelani  , Maheen Ahmed  , Ahsan Khalid
Published: April 2024

Objectives: To assess the level of awareness among orthodontic practitioners about the diagnosis and management of orthodontically induced white spot lesions.
Method: The cross-sectional study was conducted from August 28, 2022, to March 3, 2023, at Bakhtawar Amin Medical and Dental College, Multan, and comprised orthodontic specialists and postgraduate residents. Data was collected using a 14-item questionnaire regarding diagnosis and management of orthodontically induced white spot lesions. The questionnaire was disseminated online, and the responses were compared between the groups. Data was analysed using SPSS 24.
Results: Of the 278 subjects, 205(73.7%) were residents; 156(75%) females and 49(24%) males with mean professional experience 4.24±4.08 years. There were 73(26.3%) specialists; 44(60.3%) females and 29(39.7%) males with mean professional experience 9.07±4.85 years. There were 48(66%) specialists and 131(64%) residents who thought the most commonly affected teeth with WSL were maxillary central incisors, while 30(41%) specialists and 38(33%) residents said the least commonly affected tooth was maxillary canine. Among the specialists, 29(38%) considered halting treatment and regular follow-up as the best approach to managing white spot lesions detected during orthodontic treatment, while 76(37%) residents preferred to use fluorides and casein phosphopeptide-amorphous calcium phosphate. There were significant differences between the specialists and residents for the items related to the incidence of white spot lesions, timing for additional precautions and measures for detection, management during active treatment and modalities of prevention (p<0.05).
Conclusion: Despite the being fairly common in orthodontic patients, the awareness regarding white spot lesions and related management protocols was found to be dubious in orthodontic practitioners, depicting lack of a standardised protocol.
Key Words: Dental caries, Dental white spots, Fixed orthodontic therapy.
Association of latent autoimmune diabetes of adults with type 3 polyglandular autoimmune syndrome—a diagnostic challenge
Authors: Urooj Lal Rehman  , Hafiz Muhammad Hamza  , Muhammad Muiz Malik  , Ayaz Ahmed Awan
Published: April 2024

Autoimmune polyendocrine syndromes (APS) encompass multiple endocrine gland insufficiencies associated with autoimmune disease. This case report underscores the importance of recognising the association between latent autoimmune diabetes of adults (LADA) and type 3 polyglandular syndrome. A 42-year-old man belonging to Rawalpindi, Pakistan, presented to the outpatient department (OPD) of Ali Medical Centre, Islamabad, in January 2023 with the complaints of extreme thirst and frequent urination. The patient reported consistently raised appetite and eating four to five meals a day along with abrupt weight loss, dry mouth, fatigue occasional dizziness, and dyspnoea. He was diagnosed with type 3 polyglandular syndrome with association of LADA. Daily administration of 10 units of glargine insulin, along with six units of rapid-acting insulin, was prescribed. The patient's HbA1c level reduced in a few months after successive follow-up.
---Continue
Attitude of undergraduate medical students towards euthanasia and physician-assisted suicide: a cross-sectional study
Authors: Mahnoor  , Shahid Aiza Noor , Shafiq Haleema , Aslam Noman , Ayub Ayesha
Published: April 2024

Euthanasia is categorically prohibited in Pakistan by Islamic law, but a clash of opinions among doctors and human rights advocates still prevails. As a result, medical students are becoming concerned about its practice and this problem needs to be addressed. A cross-sectional study was conducted at Faisalabad Medical University (FMU), Pakistan, from April 2023 to May 2023, using random sampling and statistical programme SPSS version 25, to assess the attitudes of medical students regarding euthanasia and physician-assisted suicide (PAS).
Despite the conditions and scenarios presented to the students, most of them expressed opposition to euthanasia and physician-assisted suicide because of their religious beliefs and optimistic approach to life. Most of them favoured palliative care and passive euthanasia.
---Continue
Harnessing the power of artificial intelligence: A new door for quick surgery in Pakistan
Authors: Farooqui Areeba , Wajid Aaliyan
Published: April 2024

Artificial intelligence (AI) has the potential to transform surgery in Pakistan, improving results, reducing complications, and increasing patient safety. Deep learning, a branch of machine learning, can assist surgeons in making wise judgments. Pubmed and Research Gate discuss the promise of AI in surgery. Incorporating AI in healthcare systems can expedite diagnosis and management while avoiding injudicious resource allocation.
AI-based techniques in cardiology, nephrology, and neurology enable high-accuracy detection of cardiovascular disease risks, kidney disease treatment, and epileptic episode identification. Neurological devices like bispectral index monitor (BIS) and Near-infrared spectroscopy (NIRS) utilize advanced technology for reliable monitoring and objective diagnosis of neurological issues (Ahmed, 2022). AI uses electronic data and neural network methods to evaluate operating room logistics, time management, and anesthesiologist activities using electronic data and neural network methods (Khan F. H., 2019). AI algorithms are effectively detect minute differences for accurate diagnosis, with studies showing high specificity, sensitivity, and inter-operator repeatability. AI can be used to train and assess neurosurgical residents and early mid-career surgeons, improving diagnosis and 3D simulation labs (Shlobin, 2022). Surgeons play a crucial role in adopting AI-based technologies for surgical care by partnering with data scientists to capture novel clinical data and generate meaningful interpretations. They should demand transparency and interpretability in algorithms to hold AI accountable for its predictions and recommendations.AI advancements in plastic surgery practice, research, and education offer opportunities for improvement. Combining AI-enabled decision-making tools with predictive analytics and human intuition, surgeons can make real-time decisions based on 3D planning, anatomical localization, and navigation (Rasteau, 2022). While current AI tools cannot perform complex surgical procedures, advancements may enable them to perform more complex tasks in the future.
Pakistan is a significant market for AI-based solutions, utilizing technology in various industries to address challenges and boost demand. The country has enhanced its self-security systems, including AI-powered missiles, cyber security, and effective cameras (Khan, 2022). AI allows tasks to be completed more precisely and efficiently, with machine learning and deep learning being advanced subtypes. In developing countries like Pakistan, AI tools are needed for patient-centred diagnosis and treatment assistance, especially in emergency surgery such as cardiac illnesses or life threatening bleeding caused road traffic accident. Hence insuring patient receive care timely. An appropriate budget should be allocated for AI technologies in the health sector.
The impact of artificial intelligence on medical diagnostics: A letter to the editor
Authors: Sahar Imtiaz  , Sheikh Abdul Qadir Jillani
Published: April 2024

Madam,
Artificial intelligence (AI) describes the generation of intelligent machines that are capable of carrying out activities that usually call for human intellect. (1) It involves creating algorithms and models that enable computers to learn from and analyze vast amounts of data, recognize patterns, make decisions, and even engage in natural language processing.  (2) AI has become increasingly important in various fields due to its potential to automate complex processes, enhance efficiency, and drive innovation. It can transform industries, improve decision-making, and revolutionize how we live and work.
In medical diagnostics, AI has had a profound impact on improving accuracy, efficiency, and patient outcomes. By leveraging machine learning algorithms, AI systems can process and analyze large volumes of medical data, including patient records, laboratory results, medical images, and genomic data. This allows for more accurate and timely diagnoses, as AI algorithms can detect subtle patterns and anomalies that may not be visible to human observers. AI-powered diagnostics can assist healthcare professionals in detecting diseases, predicting patient outcomes, and designing personalized treatment plans. (3) Furthermore, AI can contribute to the early detection of diseases, thereby enabling timely interventions and improving patient survival rates. For example, AI algorithms analyze medical imaging data, such as X-rays, MRIs, and CT scans, to detect abnormalities and potential signs of diseases like cancer. This helps radiologists and clinicians identify and diagnose conditions early when treatment options are more effective. (4) Additionally, AI aids in interpreting genetic data, allowing for the identification of genetic markers associated with specific diseases or drug responses. This information guides clinicians in selecting the most suitable treatment options for individual patients, leading to improved therapeutic outcomes. (5) AI in medical diagnostics also faces hurdles with data privacy and accessibility, as patient information must be handled securely. Ensuring AI algorithms are unbiased, and fair is a challenge to avoid disparities in healthcare outcomes. The interpretability of AI models is vital to building trust with healthcare professionals and facilitating their adoption. Regulatory compliance and ethical considerations are also significant factors that need to be addressed for the responsible and effective integration of AI in the medical field.
In conclusion, Artificial Intelligence (AI) is a transformative technology with the potential to revolutionize various industries, including medical diagnostics. Its ability to analyze vast amounts of data, recognize patterns, and make intelligent decisions has proven invaluable in improving diagnostic processes accuracy, efficiency, and effectiveness.
---Continue
Selective serotonin reuptake inhibitors use and dental implant failure: A call for awareness and caution
Authors: Amjad Amna , Rehman Hafsa
Published: April 2024

Dear Editor,
I am writing to express my concerns regarding the possible negative impact of selective serotonin reuptake inhibitor (SSRI) use on dental implants. Globally, depression is on the rise, especially in low-income countries (1). SSRIs are the most commonly prescribed antidepressants worldwide and may interfere with bone metabolism, which can affect dental implant success (2).
According to several studies, there was a higher risk of dental implant failure and peri-implant bone loss in SSRIS users compared to non-SSRIS users, and the association was found to be statistically significant (3–5). ). Smoking may also further increase this risk (3,4). Also, a decrease in the survival rates of dental implants was reported  (2,6). However, some studies found no statistically significant association between SSRIS use and dental implant failure (7,8). Therefore, further studies were needed to evaluate the effects of different dosages and durations of selective serotonin reuptake inhibitors on dental implant outcomes. This highlights an important issue, especially for countries like Pakistan, where the prevalence of depressive disorders ranges from 20% to 60% and smoking is common (9). This can be due to the prevailing economic crisis in the country and the overall shortage of job opportunities, which leads to an increase in poverty rates that can trigger stress and some serious depressive disorders. Dental implants are a widely used intervention for edentulous patients who are suffering from a reduced quality of life due to tooth loss. Dental implant failure can cause physical, emotional, and financial distress for both patients and dentists.
Therefore, it is suggested that readers be aware of these potential risks, take proper precautions, and consult their doctors before taking SSRIs or any other medication that can affect bone health. We urge dentists to take a proper history regarding SSRI use and consider an alternate class of anti-depressants for patients with dental implants.
Student Engagement in health Professional Education Using Artificial Intelligence
Authors: Farrukh Khadija
Published: April 2024

Student engagement is of significant importance in education for several reasons. Engaged students are more likely to understand and retain the material being taught. They actively participate in class, ask questions, and seek to understand concepts deeply. As a result, they often achieve better academic results1. Regardless of the growing interest in the field of student engagement, there is still a gap in research on student engagement in medical education. Pervious research studies on student engagement and its impact on learning processes suggests that student engagement is flexible and can be modified by different interventional strategies 1,2,3. Aim of this letter is to highlight the importance of student engagement in health professional education and suggestion strategies to integrate student engagement models with artificial intelligence tools. Engaged students are more likely to develop critical thinking and problem-solving skills. They are curious, explore topics beyond what is required, and analyse information independently. Students who are actively engaged in learning are less likely to exhibit disruptive behavior in the classroom. This creates a more conducive learning environment for all students. Engagement fosters a sense of self-efficacy, where students believe in their ability to succeed4. This self-confidence is essential for tackling challenges and pursuing higher levels of education and career goals. Three perspectives of student engagement are Psychological, Behavioural and Socio-cultural perspective. Psychological model is most relevant in educational context. Artificial intelligence can enhance educational cycle in multiple ways, the teaching and learning process, curriculum development, assessment and the educational content5. In comparison to e-learning methodologies metaverse provides increased accessibility and interactivity and users can access their virtual learning environment from anywhere with an internet connection, and have discussions and work together in real time. It is especially convenient for learners with job commitments or who live in rural remote areas to get an easily accessible educational experience and learn.
Indexed journals with no or low article processing charges: An alternative publishing venue for Pakistani researchers
Authors: Aamir Raoof Memon  , Ishtiaq Ahmed
Published: April 2024

Publishing research is an integral part of an individual’s academic career. It is a requirement during higher education (e.g., Masters, PhD). Publication profile is also needed for job appointments and promotions as a mandatory requirement by several organisations. For example, the Higher Education Commission of Pakistan has specified the number of publications required for academic jobs and promotions.1 Therefore, many of us in academia are under constant pressure to publish for further professional growth. However, two major questions for the researchers from low- and middle-income countries, particularly Pakistan, are: 1) what are the options for openaccess publishing with no or low article processing charges? and 2) are such journals indexed in major bibliographic databases such as Scopus, Web of Science and/or PubMed? To answer these questions, this editorial aims to present information about indexed journals with low or no article processing charges, with particular emphasis on journals from Pakistan.
Continued...
Slalom technique for multilevel degenerative spinal stenosis, surgical outcome and complication rate: review of our experience
Authors: Ghazwan Abdullah Hasan  , Hayder Qatran Raheem  , Khan Shahbaz , Yasameen Bani Wais  , Ahmed Alqatub  , Mustafa Katran
Published: April 2024

Lumbar canal stenosis (LCS) is a common spinal disease affecting the elderly. Primarily it is asymptomatic until there is neurogenic claudication. Minimally invasive surgical (MIS) techniques are used to treat patients with lumbar spinal stenosis (LSS), while tubular system with alternative multilevel decompression is specifically used for those with minimal back pain and no mechanical instability on dynamic imaging. The aim of the study is to evaluate surgical outcome of Slalom procedure and complications in Middle East population. One hundred and five patients with lumbar stenosis (61 males and 44 females) underwent the procedure between 2015-2021 who were regularly followed-up using preoperative and postoperative COMI score (the core outcome measure index) at six months after index surgery. Progressive improvement in COMI score from average seven pre-op score to an average of three after six months of index surgery.
---Continue
A comparison of port-site infiltration with bupivacaine alone vs. bupivacaine plus dexemedetomidine after diagnostic staging laparoscopy
Authors: Qureshi Rabeea Sajid , Alam Tanveer , Saleem Huma
Published: April 2024

Objective: To compare the effects of bupivacaine alone and in combination with dexmedetomidine following staging laparoscopies.
Method: The triple-blinded, prospective study was conducted from June to September 2021 at a tertiary care cancer hospital in Lahore, Pakistan, and comprised adult patients having American Society of Anaesthesiologists (grade I-III, weighing >30kg and undergoing diagnostic staging laparoscopy. The subjects were randomised into two equal groups. Group A received 6ml of 2mg/kg bupivacaine at each of the four laparoscopic port sites before skin closure, while group B additionally received 2µg/kg dexmedetomidine. The presence and severity of pain were recorded and assessed at 15 min, 1, 2 and 4 hours as well as at the time of discharge from the post-anaesthesia care unit. The time to first request for rescue analgesia, total morphine consumption, and the occurrence of any side effects during their stay were also recorded. Data was analysed using SPSS 23.
Results: Of the 30 patients, 15(50%) were in group A; 10(66.6%) males and 5(33.3%) females with mean age 43.27±7.59 years. There were 15(50%) patients in group B; 12(80%) males and 3(20%) females with mean age 41.36±12.42 years (p>0.05). Of the total, 29(96.66%) patients were classified as American Society of Anaesthesiologists grade II, and 1(3.33%) patient in group A was grade III. There was no significant difference between the groups in any of the outcome measures assessed (p>0.05), and none of the patients experienced any side effect throughout the post-operative stay.
Conclusion: The combination of dexmedetomidine and bupivacaine had no significant improvement in pain relief compared to bupivacaine alone.
Key Words: Diagnostic laparoscopy, Staging laparoscopy, laparoscopy, Dexmedetomidine, Bupivacaine, Local infiltration, Regional anaesthesia.
Mycophenolate mofetil vs. cyclophosphamide-based induction regimens for lupus nephritis: outcomes at a tertiary care centre in Lahore, Pakistan
Authors: Saeed Muhammad Ahmed , Asadullah Khan  , Faiza Naeem  , Nighat Mir Ahmad
Published: April 2024

Objective: To compare the efficacy of mycophenolate mofetil with intravenous cyclophosphamideas induction therapy in lupus nephritis.
Method: The observational, prospecrive,  cohort study was conducted at the Rheumatology Department of Fatima Memorial Hospital, Lahore, Pakistan, from July 2016 to June 2019, and comprised lupus nephritis patients. For induction therapy,  the patients were assigned at the discretion of the treating rheumatologist to mycophenolate mofetil group MMF, and intravenous cyclophosphamide group CYC. The later group was further divided into NIH subgroup that received the therapy as per the protocol of the  National Institutes of Health, and ELNT subgroup which recived the therapy as per the Euro Lupus Nephritis Trial protocol. Maintenance therapy in all groups was mycophenolate mofetil. Tacrolimus was added in case of non-response. The outcome was the achievement of complete renal response at 6, 12 and 24 months. Data was analysed using SPSS 26.
Results: Of the 131 patients, 126(96.2%) were females. The overall mean age was 27±7.7 years. There was 58(44.2%) patients in group MMF and 73(55.7%) in group CYC, which had subgroup NIH 46(63%) and subgrpup ELNT 27(37%). The complete renal response rates at 6, 12, and 24 months were 22 (43.1%), 35 (71.4%), and 40(83.3%) for group MMF; 5(12.5%), 9(22%) and 24 (58.5%) for subgroup NIH, and 6(26.1%), 8(36.4%) and 14(63.6%) for subgroup ELNT. Group MMF outcomes were significantly better than the rest (p<0.05).
Conclusion: Mycophenolate mofetil induction therapy was more effective than intraveenous cyclophosphamide in terms of achieving remission at 6, 12 and 24 months.
Key Words: Systemic lupus erythematous, Lupus nephritis, Mycophenolate mofetil, Cyclophosphamide.
The effect of enhanced recovery after surgery combined with fine surgical nursing on rehabilitation after lung cancer surgery
Authors: Dong Jiali , Zhu Xiaoling
Published: April 2024

Objective: To analyse the enhanced recovery after surgery approach combined with fine surgical nursing on recovery time, pain, sleep quality and satisfaction with care after lung cancer surgery.
Method: The cross-sectional study was conducted at the Nanjing Chest Hospital, China, from October 2019 to March 2022, and comprised non-small cell lung cancer patients undergoing single-port video-assisted thoracoscopic surgery. Patients receiving fine surgical nursing in addition to conventional enhanced recovery after surgery formed the intervention group A, while those receiving the conventional enhanced recovery after surgery care alone formed control group B. Intraoperative blood loss, operative time, extubation time and length of stay values for noted for both the groups using standard scales. Nursing satisfaction and the incidence of adverse reactions in the two groups were also noted. Data was analysed using SPSS 23.
Results: Of the 99 patients, 46(46.5%) were in group A; 23(50%) males and 23(50%) females with mean age 70.3±4.8 years and mean body mass index 26.76±2.55kg/m2. There were 53(53.5%) patients in group B: 16(30.2%) males and 37(69.8%) females with mean age 69.9±4.4 years and mean body mass index 25.93±2.40kg/m2 (p>0.05). Intraoperative blood loss, operative time, postoperative extubation time and length of stay in group A were lower than those in group B (p<0.05). Pain and sleep quality values in group A were lower, while health status value was higher than group B (p<0.05). Group A had significantly higher nursing satisfaction compared to group B (p<0.05).
Conclusion: The use of enhanced recovery after surgery combined with fine surgical nursing in patients with non-small cell lung cancer after video-assisted thoracoscopic surgery promoted postoperative recovery.
Key Word: Enhanced recovery after surgery, Thoracic surgery, Video-assisted, Non-small cell lung cancer, Visual analogue scale, Perioperative nursing.
Publications in pediatric critical care medicine: trends from Pakistan
Authors: Qalab Abbas  , Shahzad Muhammad , Ur Rehman Naveed , Cheema Zahra , Ahmed Abdul Rahim , Ul Haque Anwar
Published: April 2024

Objective: To analyse the characteristics of research published from Pakistan on paediatric critical care medicine.
Method: The exploratory study was conducted at the Aga Khan University, Karachi from July 2021 to March 2022, and comprised a comprehensive search on MedLine, Google Scholar and PakMediNet databases for literature from Pakistan pertaining to paediatric critical care medicine published between January 2010 and December 2021. The search was done using appropriate key words. Conference abstracts and papers authored by paediatric intensivists with unrelated topics were excluded. Data was extracted on a structured spreadsheet, and was subjected to bibliometric analysis. Data was analysed using SPSS 20.
Results: Of the 7,514 studies identified, 146(1.94%) were analysed. These were published in 51 journals with a frequency of 13.3 per year. There were 107(73.3%) original articles, 96(65.8%) were published in PubMed-indexed journals, and 35(24%) were published in locally indexed journals. Further, 100(69.4%) papers were published from 5 paediatric intensive care units in Karachi, and 81(56%) were contributed by a single private-sector hospital. The total citation count was 1072, with 2(1.4%) papers receiving >50 citations. There was a linear trend with some skewing and an annual growth rate of >15%.
Conclusion: Publications from Pakistan related to paediatric critical care medicine showed positive linear growth. There was a paucity of multicentre studies, randomised controlled trials, and high-impact publications.
Key Words: Bibliometric analysis, Paediatric critical care medicine, Publications, Pakistan, Research.
Acute pancreatitis- a narrative review
Authors: Zahabia Sohail  , Shaikh Hafsa , Nimra Iqbal  , Om Parkash
Published: April 2024

Acute pancreatitis is a common cause of acute abdominal pain and can range from mild oedema to severe necrosis of the pancreas. It has a significant impact on morbidity, mortality and financial burden. The global prevalence of pancreatitis is substantial, with the highest rates observed in central and eastern Europe. Diagnosing acute pancreatitis involves considering clinical symptoms, elevated serum amylase and/or lipase levels, and characteristic imaging findings. The causes of acute pancreatitis include obstructive disorders, such as gallstones and biliary sludge, alcohol consumption, smoking, drug-induced pancreatitis, metabolic disorders, trauma, medical procedures, infections, vascular diseases and autoimmune pancreatitis. Appropriate management of acute pancreatitis involves determining the severity of the condition, providing supportive care, addressing the underlying cause, and preventing complications. Advances in classifying the severity of acute pancreatitis and implementing goal-directed therapy have contributed to a decrease in mortality rates.
---Continue
Translation, cultural adaptation and psychometric analysis of Urdu version of Victorian; institute of sports assessment – achilles questionnaire for athletes with achilles tendinopathy
Authors: Jabbar Saima , Akram Sana , Khalid Khan Abdullah , Arslan Syed Asadullah , Noreen Aqsa , Irum Saiqa
Published: April 2024

Objective: To translate, culturally adapt and psychometrically analyse the Urdu version of the Victorian Institute of Sport Assessment-Achilles questionnaire.
Method: The cross-sectional study was conducted at the Pakistan Sports Board, Lahore, Pakistan, from June 17, 2021, to February 15, 2022, and comprised patients with Achilles tendinopathy in group A and healthy controls in group B. Beaton’s guidelines for cultural adaptation and validation for self-reported measures were followed to translate and validate the Victorian Institute of Sport Assessment-Achilles questionnaire in Urdu language. Data was analysed using SPSS 23.
Results: Of the 180 subjects with mean age 28.06±5.95 years, 125(69.6%) were males. There were 130(72.2%) patients in group A and 50(27.8%) controls in group B. The overall mean score of the Victorian Institute of Sport Assessment-Achilles questionnaire was 55.99 + 25.43; group A 41.14±9.54 and group B 94.60±4.22. The Urdu version exhibited excellent internal consistency with Cronbach’s alpha values 0.95, and excellent test-retest reliability (p<0.001). Absolute reliability was expressed by standard error of measurement 5.317 and minimal detectable change 6.38). Convergent validity demonstrated strong correlation with the physical domain (r=0.81) of the Urdu version of the World Health Organisation Quality of Life Brief Version.
Conclusion: The Victorian Institute of Sport Assessment-Achilles questionnaire could be utilised for assessing severity of Achilles tendinopathy among Urdu-speaking population for clinical as well as research purposes.
Key Words: Achilles tendinopathy, Translation, Psychometrics, Reliability and validity, VISA-A, Pakistan.
Determining nursing students’ attitudes towards, readiness for, expectations from, and satisfaction with distance education and their sense of alienation from their university
Authors: Oztas Duygu , Toru Fadime , Akgun Senay , Ozpulat Funda
Published: April 2024

Objective: To determine nursing students’ views on attitudes towards distance education during coronavirus disease 2019 pandemic.
Methods: The analytical, cross-sectional study was conducted in May and June 2022 at a state university in the Mediterranean region of Türkiye, and comprised nursing students. Data were collected using the Attitude Towards e-Learning Scale, e-Readiness for e-Learning and Expectations Scale, e-Satisfaction Scale, and University Alienation Scale. Data were analysed SPSS 26.
Results: Of the 322 participants, 213 (66.1%) were females, and 159 (49.4%) were staying in hostel dormitories. The mean age of the sample was 20.36±1.63 years. There was a significant, moderate and positive correlation between the students’ scores from with respect to readiness, satisfaction, transmission, practicality and content of distance learning (p<0.05). There was a significant, weak and positive correlation of readiness with the education process, interaction and assessment values (p Less-Than Or Equal To 0.05).
Conclusion: Alienation towards university education increased in relation to technology skills.
Key Words: Distance education, University students, COVID-19 pandemic.
Pattern of cytopenias & systemic immune-inflammation index among hospitalized patients of COVID-19
Authors: Ambreen Kashif  , Sadia Taj  , Sidra Sonia Chaudhry  , Saira Moin  , Aijaz Zeeshan Khan Chachar  , Ayaz Lone
Published: April 2024

Objectives: To compare the extent of cytopenias and systemic immune inflammation index of hospitalised coronavirus disease-2019 patients during the first and second/third waves of the pandemic.
Method: The retrospective, cross-sectional study was conducted in October 2021 at Fatima Memorial Hospital, Lahore, Pakistan, and comprised data of hospitalised coronavirus disease-2019 patients regardless of age and gender from May 2020 to June 2021. Data was segregated into first wave that lasted from May to July 2020, second wave that lasted from early November to mid-December 2020, and third wave that ranged from mid-March to June 2021. For comparison purposes, the data of first wave was in group A, while data of second and third waves was pooled into group B. Age, gender, comorbidities, requirement of ventilator support and outcome of the patients was noted. Inflammatory markers were compared on the basis of complete blood count and systemic immune-inflammation index data. Data was analysed using SPSS 25.
Results: Of the 202 patients, 90(44.5%) were in group A and 112(55.4%) were in group B. There were 108(53.5%) males and 94(46.5%) females. The median age in males was 58 years (interquartile range: 21 years) and it was 56 years (interquartile range: 21 years) in females. Neutrophilia (p<0.001), leukocytosis (p<0.001) and lymphocytopenia (p<0.001) had direct association with increased systemic immune-inflammation. Raised systemic immune-inflammation also had an association with increased requirement of ventilator support (p=0.2) and increased mortality (p=0.001). There were more females, more critical patients, more patients with anaemia, leukopenia, lymphocytopenia and thrombocytopenia in group B compared to group A (p<0.05). Need for ventilator suppor and mortality were also higher in group B compared to group A (p<0.05).
Conclusion: All the indicators analysed were worse during the second and third waves of coronavirus disease-2019 compared to the first wave of the pandemic.
Key Words: COVID-19, Thrombocytopenia, Leukopenia, Lymphopenia, Cytopenia.