bluuebunny/crossref_metadata_2025 huggingface dataset:
PSL Eye: Predicting the Winning Team in Pakistan Super League (PSL) Matches
Authors: Mahmood Tariq , Riaz Muhammad , Nasir Muhammad , Afzal Uzma , Tariq Sohaib , Siddiqui Muhammad Hamza
Published: July 2021

Pakistan Super League (PSL) is a well-known T20 cricket league with millions of viewers. With this large viewer base, predicting the outcome of PSL matches opens a new research avenue for academic researchers.  In this paper, we collect PSL data from relevant sources and generate a validated data set for machine learning experiments. We implement the “PSL Eye” solution which employs Neural Networks (NNs) to predict the match winning team. We preprocess the dataset to eliminate the extra variables then we tune the hyper parameters of NN. After acquiring the optimal values of hyper parameters, we run our NN based PSL Eye to obtain the final results. The overall accuracy of PSL-Eye with testing data set is 82% which is very promising and shows the importance of NN in predicting PSL match outcome.
Strategi Perancangan Pusat Pengolahan Teh Terpadu di Kabupaten Kepahiang Bengkulu dengan Pendekatan Arsitektur Organik
Authors: Putra Aditya Ariantama , Tisnawati Endah
Published: July 2021

Tersedianya sumber daya alam pertanian yang melimpah membuat pemerintah harus memikirkan cara mengelolah dan pemanfaatan sumber daya alam tersebut agar mampu menolong ekonomi, sosial dan alam daerah Kabupaten Kepahiang. Potensi yang paling menonjol yang ada di Provinsi Bengkulu selain pertambangan adalah perkebunan dan pertanian khususnya pertanian teh, pertanian teh yang tersedia sangat melimpah dan saat ini juga sangat di minati oleh masyarakat seiring dengan kesadaran masyarakat akan teh yang bisa di bermanfaat menjadi minuman yang menyehatkan dan juga permintaan pasar internasional pada teh dari indonesia yang semakin tinggi.Meskipun begitu, potensi ini tidak diimbangi dengan penyediaan sarana dan fasilitas yang mendukung potensi pengolahan teh di daerah Kabupaten Kepahiang. Permasalahan tersebut menjadi dasar dalam membuat konsep, dari masalah yang ada maka konsep pusat pengolahan teh terpadu menggunakan pendekatan arsitektur organik. Pendekatan tersebut menjawab masalah yang ada. Arsitektur organik memiliki karakter yang harmonis dengan alam sehingga dalam mendesain pusat pengolahan teh, alam menjadi fokus utama. Oleh karena itu perencanaan Pusat Pengolahan Teh Terpadu di Kabupaten Kepahiang diharapkankan dapat menjadi penyedia fasilitas yang mampu mengembangkan potensi yang ada serta menjadi ikon baru dari daerah Kabupaten Kepahiang, Provinsi Bengkulu.
Kajian Penilaian Greenship GBCI dalam Menunjang Pembelajaran Arsitektur Hijau
Authors: Adi Alifiano Rezka , Ernawati Ernawati
Published: July 2021

Isu pemanasan global akhir-akhir ini telah memberikan dampak yang besar seperti perubahan pola iklim, krisis sumber daya alam, dan pencemaran limbah. Konsep arsitektur hijau menjadi salah satu konsep yang diharapkan mampu menjadi solusi atas isu-isu lingkungan. Di Indonesia, terdapat lembaga Green Building Council Indonesia atau GBCI sebagai lembaga mandiri yang berkomitmen dalam mengawal perencanaan dan perancangan pembangunan berbasis arsitektur hijau. Untuk perangkat tolok ukur bangunan hijau di Indonesia, GBCI mengeluarkan sistem rating yang dikenal dengan nama Greenship. Greenship ini disusun dengan mempertimbangkan kondisi, karakter alam, peraturan, dan standar yang berlaku di Indonesia. Penelitian ini berfokus pada pengkajian parameter arsitektur hijau berdasarkan rumusan yang terdapat dalam dokumen Greenship terhadap kasus-kasus bangunan gedung yang disiapkan setiap mahasiswa. Penelitian ini menggunakan metode kuantitatif dengan strategi eksperimental dan simulasi menggunakan beberapa software simulasi. Evaluasi pemahaman mahasiswa terhadap setiap kategori pada Greenship dilakukan dengan menggunakan teknik kuisioner. Hasil penelitian menunjukkan bahwa setiap kategori yang ada pada greenship dapat membantu dalam mengidentifikasi berbagai macam faktor dalam bangunan yang menunjang konsep arsitektur hijau. Melalui kuisioner yang dibagikan, mahasiswa secara umum merasa terbantu dalam memahami konsep arsitektur hijau melalui praktek penilaian Greenship pada kasus suatu bangunan.
Analisis Transaksi Konsumen Bidang Data Mining Menggunakan Algoritma Apriori Untuk Rekomendasi Bundling Produk Pada 212 Mart Kota Lhokseumawe
Authors: Mutasar Mutasar , Niesa Chaeroen
Published: July 2021

212 Mart Lhokseumawe yang bernaung di bawah PT. Syirkah Mubarakah Lhokseumawe adalah sebuah usaha ritel yang baru saja dirintis. Dalam operasionalnya masih banyak kendala yang dihadapi sehingga omzet penjualan harian masih jauh dari yang diharapkan, namun peneliti ingin menawarkan sebuah solusi untuk meningkatkan penjualan produk dengan teknik Bundling Produk yang masih diterapkan secara konvensional. Tujuan dari penelitian ini adalah merancang dan membangun sebuah aplikasi data mining untuk memprediksi hasil penjualan barang yang diminati konsumen pada 212Mart Kota Lhokseumawe dengan menggunakan algoritma apriori berdasarkan data transaksi penjualan. Algoritma Apriori adalah salah suatu algoritma yang melakukan pencarian frequent itemset dengan menggunakan teknik association rule. Algoritma Apriori menggunakan pengetahuan frekuensi atribut yang telah diketahui sebelumnya untuk memproses informasi selanjutnya. Pada algoritma Apriori menentukan kandidat yang mungkin muncul dengan cara memperhatikan minimum support dan minimum confidence. Implementasi dari hasil pengolahan data transaksi penjualan diproses dengan algoritma apriori sehingga akan menghasilkan sebuah output penawaran Bundling Barang kepada konsumen dan menawarkan harga yang relative lebih ekonomis. Proses data mining ini melalui tahapan pengenalan pola perilaku dan transaksi konsumen pada 212 Mart Kota Lhokseumawe
Implementasi Sistem Pendukung Keputusan Penentuan Dalam Memprediksi Kinerja Dosen Terbaik Metode Saw
Authors: Fajri Riyadhul
Published: July 2021

Sistem Pendukung Keputusan (SPK) adalah sistem yang dapat membantu seseorang dalam mengambil keputusan yang akurat dan tepat sasaran. Ada beberapa metode yang dapat digunakan dalam membangun suatu SPK diantaranya saw  merupakan metode yang paling banyak digunakan dalam memecahkan permasalahan yang bersifat multikriteria, seperti dalam SPK penentuan kinerja dosen terbaik. Penelitian ini menggunakan metode SAW dalam menentukan penentuan kinerja dosen terbaik, ada beberapa kriteria yang menjadi dasar pengambilan keputusan antara Kedisplinan, Pemaparan perkuliahan yang update, Penampilan, Silabus, Laporan kinerja, yang diurutkan dari yang tertinggi hingga terendah, sehingga dapat dengan mudah mengambil keputusan dengan melihat hasil tersebut
Sistem Pendeteksi Epilepsi Dengan Algoritma K-Means Clustering Sebagai Pendeteksi Penyakit Berbasis Sistem Pakar Pada Masa Pandemi Covid-19
Authors: Johan T. Muhammad
Published: July 2021

Pengaruh perkembangan ilmu komputer telah menjamah berbagai bidang, contohnya saja pada  bidang  kedokteran,  militer  dan  lain-lain.  Mengingat  semakin  pesatnya  perkembangan teknologi  yang  semakin  maju  khususnya  dibidang  komputer,  maka  banyak  orang  yang memanfaatkan  komputer  sebagai  alat  bantu.  Tidak  ketinggalan  juga  termasuk  dalam  bidang kedokteran,  komputer  telah  masuk  didalamnya  sebagai  alat  bantu  untuk  mengerjakan  suatu pekerjaan  ataupun  melakukan  identifikasi  suatu  penyakit  tertentu  yang  memudahkan  pekerjaan manusia. Untuk  menentukan jenis  penyakit  dan  cara  penanggulangannya  serta  menggunakan  metode  Waterfall  untuk pengembangan  sistemnya.  Sistem  pakar  ini  juga akan menggunakan konsep K-Means Clustering Aplikasi  ini  dibuat  dengan  menggunakan  bahasa  pemrograman  PHP  dan database  MySQL  sebagai  tempat  penyimpanan  data-data  yang  dibutuhkan  dalam  pembuatan aplikasi. Adobe Dreamweaver untuk desain Web. Penelitian  ini  menghasilkan  aplikasi  sistem  pakar  mendiagnosa  penyakit  epilepsi  berbasis  web  sehingga  dapat  membantu  user  untuk  memperoleh informasi yang diinginkan. Penyusunan sistem pakar ini berupa user dan admin. Melalui sistem ini,  user  dapat  mengidentifikasi penyakit berdasarkan gejala-gejala yang menyerangnya. Sistem juga mempunyai  kemampuan  untuk  menambah,  mengupdate,  serta  menghapus  ciri  dan  gejala pada la beserta hasil konsultasi yang dilakukan oleh admin
ANALISIS TINGKAT EFISIENSI PENGGUNAAN MODAL MELALUI PENDEKATAN DU PONT SYSTEM PADA PT SIANTAR TOP TBK
Authors: Maulina Fera
Published: July 2021

This study aims to describe and analyze the efficiency of the use of capital through the Du Pont approach. The data analysis that will be used is quantitative with the data source, namely secondary data obtained from the 2016-2019 financial statements of PT Siantar Top Tbk. The research variables used are: (1) Asset Turn Over, to show the company's ability to manage all assets to generate sales; (2) Net Profit Margin, to show how much net profit the company gets; (3) Return on Assets, to measure the rate of return of all existing assets; (4) Equity Multiplier, to describe how much equity is compared to the company's total assets or how much assets are financed by debt and; (5) Return on Equity, to measure the rate of return of all existing capital. The results showed that the company's ability to manage its capital in generating net profit was efficient. Factors that affect Return on Equity is the tendency of increasing Net Profit Margin, Total Assets Turn Over, and Return on Assets. This shows that the company's ability to generate net profit from sales, manage assets and investments owned in generating sales and net profit is efficient
EFFECT OF AGE, GENDER AND DURATION OF DIABETES MELLITUS ON THYROID DYSFUNCTION IN PATIENTS OF DIABETIC
Authors: Ali Kamran , Shah Sajid Ali , Ali Syed Murtaza , Akbar Raja Jibran , Raza Syed Qasim , Kadir Sadia
Published: July 2021

Objective: To compare the effect of age, gender and duration of diabetes mellitus on thyroid dysfunction in patients of diabetic

Study Design: Comparative cross sectional study.

Place and Duration of Study: Medicine department, Combined Military Hospital, Peshawar, from Oct 2015 to Oct 2017.

Methodology: The study was conducted after taking permission from hospital ethical review committee. Information was entered in the proforma, which included demographic information like age in years, gender, duration of disease and type of diabetes mellitus (DM) type. Already diagnosed patients with diabetes mellitus were included in the study. Thyroid function tests were carried out by standard laboratory procedure.

Results: A total of 179 patients were included in our study, 114 (63.7%) were female and 65 (36.3%) were male. Mean body mass index in our study was 29.85 ± 3.88 kg/m2. Out of 179 patients 46 (25.7%) had thyroid dysfunction (TD). Out of the 46 patients with thyroid dysfunction, 14 patients (7.8%) had clinical hypothyroidism, while subclinical hypothyroidism was seen in 25 patients (14%). Clinical hyperthyroidism was reported in 3 (1.7%), while subclinical hyperthyroidism in 4 (2.2%) patients respectively.

Conclusion: Age of patients, gender and duration of disease affect thyroid functions in patients with diabetes mellitus. Thyroid profile should be carried out in diabetic patients whose blood sugar level is difficult to control.
COMPARISON OF OUTCOMES BETWEEN EARLY AND DELAYED LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CALCULOUS CHOLECYSTITIS
Authors: Ismail Muhammad , Wattoo Nasir Mehmood , Butt Muhammad Qasim , Naz Fareeha
Published: July 2021

Objective: To compare early versus delayed laparoscopic cholecystectomy in acute calculous cholecystitis in terms of mean operative time, hospital stay, conversion rate to open surgery and post-operative complications.

Study Design: Quasi experimental study.

Place and Duration of Study: Army Liver Transplant Unit, Department of Surgery, Pak-Emirates Military Hospital Rawalpindi, from Jul to Dec 2018.

Methodology: A total of 170 patients (85 in each group) diagnosed as a case of acute calculous cholecystitis who met the sample selection criteria were included. Group A patients underwent early laparoscopic cholecystectomy within 72 hours of admission while group B patients underwent conservative management followed by delayed laparoscopic cholecystectomy after 6 weeks. All patients were followed for operative time, hospital stay, per-operative difficulties encountered and post-operative complications.

Results: Group A had a mean operation time of 43.9 ± 11.1 minutes, while group B had a mean operation time of 45.8 ± 10.1 minutes (p=0.83). The mean duration of hospitalization was 2.8 ± 1.1 days in group A and 5.3 ± 0.8 days in group B (p<0.001). Complications were measured at a frequency of 14.1% in group A and 5.9% in group B (p=0.07).

Conclusion: Early laparoscopic cholecystectomy is better than delayed laparoscopic cholecystectomy in acute calculous cholecystitis in terms of hospital stay and per-operative difficulties faced. The post-operative complications between the two groups are comparable.
COMPARING THE EFFECTS OF INTRANASAL BETAMETHASONE SODIUM SULPHATE AND BECLOMETHASONE DIPROPIONATE IN PATIENTS WITH ALLERGIC RHINITIS
Authors: Khan Amir Ali , Syed Tehmina Rehman , Ahmed Attique , Rafique Usman
Published: July 2021

Objective: To compare the effects of Intranasal Betamethasone and Beclomethasone in patients with Allergic Rhinitis.

Study Design: Quasi experimental study.

Place and Duration of Study: Combined Military Hospital Bahawalpur and Shahida Islam Medical and Dental College Lodhran, from Mar 2018 to Feb 2019.

Methodology: A total of 200 patients who were between 22-55 years of age were included in this study. Half of them received Intranasal Betamethasone were compared with the other half who received Intranasal Beclomethasone. Clinical success was compared in both groups in terms of patients becoming a symptomatic.

Results: Clinical symptoms were markedly reduced in both groups at the end of the study as 94 (94%) and 78 (78%) of patients who were on Intranasal Betamethasone and Intranasal Beclomethasone respectively showing that Intranasal Betamethasone is superior to Intranasal Beclomethasone in controlling Allergic Rhinitis symptoms. Chi square test is applied and p-value calculated (p=0.045) significant.

Conclusion: Intranasal Betamethasone is far more effective drug as compare to Intranasal Beclomethasone in controlling allergic symptoms.
ASSOCIATION OF SEROPOSITIVITY FOR CMV IGM AND IGG WITH ADVERSE PREGNANCY OUTCOME
Authors: Amna Ambreen , Nadeem Farkhunda , Fahim Amin , Jatoi Altaf Hussian , Abbas Kanwal , Anas Sumayya
Published: July 2021

Objective: To find out the prevalence of antibodies against cytomegalovirus and their association with adverse pregnancy outcome in women, at Isra University Hospital Hyderabad.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Gynaecology & Obstetrics, Isra University Hospital (IUH) Hyderabad, from Jan to Jun 2018.

Methodology: Cytomegalovirus IgM and IgG antibodies in 305 women of reproductive age group were measured using the Enzyme Linked Fluorescent Assaysystem kit.

Results: The combined positivity of anti cytomegalovirus IgG and IgM antibodies was 93 (30.40%). About 37 (37.37%) and 28 (34.14%) women were found to be seropositive for cytomegalovirus antibodies who had history of spontaneous miscarriage and recurrent miscarriages respectively.

Conclusion: Higher association of seropositivity for cytomegalovirus IgM and IgG with bad obstetrical history and low economy was found.
SPECTRUM OF FINDINGS IN PATIENTS PRESENTING FOR UPPER GASTROINTESTINAL ENDOSCOPY AT A TERTIARY CARE HOSPITAL AND THE INFLUENCE OF AGE AND GENDER
Authors: Hassan Fayyaz , Ahmad Khalil , Ayaz Saeed Bin , Khalil Heyyan Bin
Published: July 2021

Objective: To determine the spectrum of findings in patients presenting for upper gastrointestinal (UGI) endoscopy and investigate role of age and gender.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Gastroenterology & Internal Medicine, Combined Military Hospital Kharian, from Jul 2017 to Mar 2019.

Methodology: The data regarding 638 consecutive patients who underwent upper gastrointestinal endoscopy in the department were collected from the computer-based database and patients were stratified into two groups according to their age: ≤50 and >50 years.

Results: The mean age was 50.2 ± 17.4 (range: 7-100) years. There were 431 males and 207 females. The commonest presenting complaint was decompensated chronic liver disease (CLD) 162 (25.4%). The upper gastrointestinal endoscopy was normal in 306 (48%) and abnormal in 332 (52%) patients. The commonest abnormality seen on upper gastrointestinal endoscopy was esophageal varices seen in 167 (26.2%) followed by non-specific gastropathy, and hiatal hernia seen in 28 (4.4%) and 21 (3.3%) patients respectively. No significant differences were observed among males and females for a positive upper gastrointestinal endoscopy. Significantly large number of patients of age >50 years had an abnormal upper gastrointestinal endoscopy (p<0.001). The commonest upper gastrointestinal endoscopic abnormalities were similar in both genders and age-groups.

Conclusion: The commonest finding on upper gastrointestinal endoscopy were esophageal varices and non-specific gastropathies. Females and patients ≤50 years had a higher prevalence of a normal upper gastrointestinal endoscopy. The commonly observed upper gastrointestinal endoscopy findings were generally similar among the genders and the age-groups.
COMPARISON OF SEVOFLURANE VERSUS PROPOFOL FOR TRACHEAL INTUBATION IN CHILDREN
Authors: Ali Zulfiqar , Hussain Azhar , Malik Aamer Mahmood , Ahmed Arslan , Saqib Mohammad , Qadri Anjum
Published: July 2021

Objective: To compare the quality of intubation and hemodynamic response in children undergoing endotracheal intubation facilitated with propofol versus sevoflurane.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Anesthesia, Combined Military Hospital Multan, from Aug 2018 to Apr 2019.

Methodology: A total number of 112 children planned for tracheal intubation were included in this randomized controlled trial. Patients were randomly allocated into two equal groups. In group P (propofol) patient’s 2.5-3.0 mg/kg propofol was given before insertion of endotracheal tube and in group S (sevoflurane) patients 8.0% sevoflurane with 100% O2. Quality of intubation was assessed in all children at the time of intubation. Hemodynamic response of patients was also noted before induction of anesthesia, immediately after intubation and after 5 minutes of intubation.

Results: Mean age of children included in this study was 2.11 ± 0.80 years. Quality of intubation was excellent in 51 (91.1%) patients in propofol group and in 38 (67.9%) patients in sevoflurane group (p-value 0.009). Mean HR after 5 minutes of intubation in group S and group P 111.98 ± 5.43 beats/min versus 109.05 ± 5.99 beats/min with p-value 0.008. Mean arterial pressure after 3 minutes of intubation mean arterial pressure in group S and P was 74.58 ± 4.45 mmHg versus 71.0 ± 3.90 mmHg with p-value <0.001. After 5 minutes of intubation mean arterial pressure in group S and P was 73.16 ± 4.13 mmHg versus 68.61 ± 4.07 mmHg with p-value <0.001.

Conclusion: Sevoflurane was found to be associated.........
FREQUENCY OF STRESS HYPERGLYCEMIA AND MORTALITY IN PATIENTS WITH HYPERGLYCEMIA IN MEDICAL INTENSIVE CARE UNIT
Authors: Satti Shahzeb Ahmed , Khattak Abdul Latif , Tariq Abdul Moueed , Majoka Sultan Mehmood , Naeem Arshad , Din Rafi Ud
Published: July 2021

Objective: To assess the frequency of stress hyperglycemia and mortality in patients with hyperglycemia admitted in medical Intensive Care Unit.

Study Design: Cross-sectional study.

Place and Duration of Study: Medical Intensive Care Unit, Combined Military Hospital Quetta, from Nov 2018 to Jun 2019.

Methodology: A total of 150 adult patients of age between 18-80 years, of both genders, with Intensive Care Unit stay >24 hours, who were treated in medical Intensive Care Unit during study period, were included in the study. Those patients with duration of stay <24 hours, paediatric patients, surgical and pregnant patients and those who were on chronic steroid therapy and those who were given TPN and dextrose infusions were excluded. The blood sugar fasting was measured daily and blood sugar random was measured on admission and twice daily. The patients were segregated into three groups: Normoglycemia, Diabetes mellitus and Stress hyperglycaemia. The frequency of patients and outcome of patients in terms of death was observed in all groups.

Results: The mean age of study population was 55.02 ± 18.14 years, with 99 (66%) were males while 51 (34%) were females. Among study population 77 (51.3%) had normoglycemia, 46 (30.7%) had Diabetes Mellitus while 27 (18%) had stress hyperglycaemia. Out of 77 patients with normoglycemia 10 (12.9%) died, while number of deaths in patients with diabetes mellitus and stress hyperglycaemia was 21 (45.6%) and 15 (55.5%) respectively. The mean maximum blood glucose in those who survived and died was 214.39 ± 100.69 mg/dl and 295.26 ± 122.60................
THE USE OF MICRO-OSTEOPERFORATION CONCEPT FOR ACCELERATING DIFFERENTIAL TOOTH MOVEMENT
Authors: Ahsan Zoyia , Khan Mehwish , Jan Abdullah , Shah Tooba Ishtiaq , Naeem Saad
Published: July 2021

Objective: To compare the rate of accelerated tooth movement in canine retraction with micro-osteoperforation on one side and control on the other.

Study Design: Quasi experimental study.

Place and Duration of Study: Orthodontics department, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Jul 2018 to Jan 2019.

Methodology: A total of 30 patients were inducted. After alignment and extraction of maxillary first premolars, canine retraction was started with closed NiTi coil spring on both sides of the maxillary arch. Micro-osteoperforation was done on the right side and other side was a control side. The distance between the lateral incisor and the canine was measured on both sides before micro-osteoperforation. The same measurements were recorded after three weeks of retraction. The difference between pre and post retraction measurements was recorded. The difference in the rate of canine retraction between both modalities was compared using independent sample t-test.

Results: The study included 17 males (56%) and 13 females (43%). The mean rate of tooth movement at experimental side of maxilla was 1.6 ± 0.52 mm and on control side was 0.66 ± 0.31 mm (p<0.05).

Conclusion: Micro-osteoperforation was an effective, comfortable, and safe procedure to accelerate tooth movement (1.6 times in accordance with this study). It significantly shorten the duration of orthodontic treatment.
FREQUENCY AND PREDICTORS OF ACCESS FAILURE IN PATIENTS UNDERGOING URETERORENOSCOPY FOR UPPER URINARY TRACT CALCULI
Authors: Rafi Ahsan , Aziz Wajahat , Ather Hammad
Published: July 2021

Objective: To determine the frequency and factors responsible for access failure during primary ureteroscopy (URS).

Study Design: Cross-sectional study.

Place and Duration of Study: Aga Khan University, Karachi Pakistan, from Jan to Jul 2019.

Methodology: All patients undergoing Ureterorenoscopy for upper urinary tract urolithiasis were included. Ureterorenoscopy was performed with either semi rigid, rigid digital or fiber opticflexible ureterorenoscope as appropriate. Data was collected for demographics, history of stone passage, previous Ureterorenoscopy /double J stenting and history of stent placement. Preoperative imaging reviewed for stone location, size and number. Level of access failure (proximal/mid/distal ureter) was noted. Post-operative complications and need of ancillary procedure was noted.

Results: We included 250 participants undergoing ureteroscopy for the upper urinary tract calculi. Mean age of the patients was 44.15 ± 13.76 years. Mean stone size was 9.12 ± 4.23mm. Overall access failure rate was found to be 8% (20/250), all required an ancillary procedure. None of the patients with previous history of endoscopic intervention or stone passage had access failure. On univariate and multivariate analysis only stone location was found to be significant factor predicting access failure.

Conclusion: Failure to access is not uncommon during primary ureteroscopy. Access failure is more common in proximal ureteral stone and in patients with no previous episode of ureteral stones and procedure. Information from this study will help in counseling patients’ pre-operatively and may be a guide to urologists on pre stenting of selected patients at high risk of access failure.
COMPARISON BETWEEN HYPERBARIC BUPIVACAINE PLUS FENTANYL AND HYPERBARIC BUPIVACAINE ALONE IN SPINAL ANESTHESIA FOR CAESAREAN SECTION
Authors: Iqbal Fatima , Faridi Manzoor Ahmed , Saeed Aisha , Shah Inamullah
Published: July 2021

Objective: To compare the result of the combination of hyperbaric bupivacaine plus fentanyl with hyperbaric bupivacaine alone in patients undergoing caesarean section in spinal anaesthesia.

Study Design: Comparative, cross-sectional study.

Place and Duration of Study: Department of Anesthesia, Fauji Foundation Hospital, Rawalpindi Pakistan, from Dec 2017 to Jun 2018.

Methodology: After consulting the institutional ethical review committees a total of 60 females between ages 18-40 years were enrolled for caesarean section delivery. They were divided into two groups. The study group (n=30) received a subarachnoid injection of 0.5% hyperbaric bupivacaine (10mg) 2ml with 25ug of fentanyl 0.5ml and control group (n=30) was injected 0.5% hyperbaric bupivacaine 12.5mg (2.5 ml) only. Pain experienced during the procedure was assessed by using 10-point visual analogue scoring method. The mean duration of analgesia, mean arterial blood pressure and heart rate after surgery were compared between two groups.

Results: The mean duration of analgesia was 206.5/min ± 6.4 in the study group and it was 163.6min ± 7.2 in the control group (p=0.001). Mean arterial BP after surgery was 92.3mmHg ± 3.8 in the study group and 88.7mmHg ± 4.1 in the control group (p=0.001). The mean heart rate recorded after surgery was 75.2/min ± 5.2 in the study group and it was 70.4/min ± 6.1 in the control group (p=0.001).

Conclusions: The mean duration of analgesia was significantly longer in the study group when compared with the control group with better mean arterial blood pressure and heart rate response after Caesarean section.
SKELETAL MATURATION EVALUATION USING MANDIBULAR SECOND MOLAR CALCIFICATION STAGES
Authors: Nizam Fakhira , Mengal Nasrullah , Tareen Mirza , Hayat Sumbal
Published: July 2021

Objective: To examine the relationship between skeletal maturity and mandibular second molar calcification stages and assessing mandibular second molar as a diagnostic tool for skeletal maturity evaluation.

Study Design: Cross sectional study.

Place and Duration of Study: Orthodontic department, Sandeman Provincial Hospital, Quetta, from Jan to Jun 2019.

Methodology: The sample size of the study 240 comprised of equal number of males and females. Inclusion criteria was defined to include the patients (male and female) with the age from 9-16 years; on the same time, patients without facial asymmetry and without prior history of facial or neck trauma/injury or surgery were considered for the present study. Exclusion criteria was defined to exclude those patients from the study hoe had the history of bone disease and major illness in past; known cases of muscular dystrophy; any congenital malformation of cervical vertebrae and tooth caries; Low quality x-ray with poor contrast.

Results: The study revealed association between Demirjian Index and Cervical Vertebrae Maturation Index stages (0.875) with the statistical significance. Demirjian Index Stage H indicated the greater percentage distribution at stage 4 and 6 of Cervical Vertebrae Maturation for males. Similarly, in females, demirjian index stages G and H showed the greater percentage at stage 4 and 6 of cervical vertebrae maturation index respectively.

Conclusion: Analysis indicated that cervical vertebrae maturation index and Demirjian Index (DI) occurred earlier in femalesthan males.
COMPARISON OF FREQUENCY OF ABNORMAL FETAL HEART RATE IN CONTINUOUS VERSUS DISCONTINUOUS USE OF OXYTOCIN INFUSION FOR AUGMENTATION OF LABOUR
Authors: Anjum Mehwish , Mustafa Nilofar , Mushtaq Qurratulain , Aslam Pakeza , Qamar Saima , Sarwar Riffat
Published: July 2021

Objective: To compare the frequency of abnormal fetal heart rate in continuous versus discontinuous use of oxytocin infusion for augmentation of labour.

Study Design: Comparative cross sectional study.

Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital Lahore, from Feb to Aug 2018.

Methodology: After fulfilling the inclusion criteria, 76 patients were equally divided in two groups A and B. In both groups, at 3 cm dilatation, intravenous infusion of 5 IU oxytocin in 500 cc normal saline was initiated at infusion rate 3.3mIU/minute Carditocography was initiated 10 minutes before infusion and then continued. An increment in infusion of 3.3mIU/minute was done every 20 minutes till 4 to 5 contractions in 10 minutes were achieved. After this, no more increment was done. The maximum rate was 30mIU/minute. Once cervix was 5 cm dilated, infusion was continued in group A and discontinued in group B for 2 hours. Fetal heart rate was noted on cardiotocography from 20 minutes before initiation of infusion till 2 hours after 5cm.

Results: Age of the patients was 25.4 ± 3.5 years in group A and 26.1 ± 2.4 years in group B. Mean gestation age was 39.2 ± 1.1 weeks in group A and 38.6 ± 1.3 weeks in group B. Group A had significantly more abnormal fetal heart rate compared to group B (p=0.016).

Conclusion: Discontinuous oxytocin infusion in labour showed significantly less abnormal fetal heart rate compared to continuous oxytocin infusion (p=0.016).
DEPRESSION AND ANXIETY IN CORRELATION TO BODY AREAS INVOLVED IN PATIENTS OF BURNS
Authors: Ali Ghazanfar , Khan Sikander Ali , Ahmed Muzzafar , Malik Muhammad Sheraz Afzal , Almas Danish , Majid Abdul
Published: July 2021

Objective: To evaluate the severity of depression and anxiety among patients of burns and correlate depression and anxiety with areas of body involved in burns.

Study Design: A cross-sectional study.

Place and Duration of Study: The departments of Psychiatry and department of Plastic Surgery, Combined Military Hospital Multan, from Oct 2019 to Mar 2020.

Methodology: Through consecutive sampling, 56 patients of burns reporting to burns unit were assessed for anxiety and/ or depression based on the diagnostic criteria of International Classification of Diseases version 10. Symptom severity was assessed using Beck Depressive Inventory for depression and Beck Anxiety Inventory for anxiety. Descriptive statistics like mean with standard deviation was calculated for age. Frequency along with percentages was calculated for sociodemographic variables, Anxiety and depression.

Results: Depression was present among 30 (53%) of participants out of which 16 (53.5%) had mild, 11 (37.9%) had moderate while only 3 (12.5%) had severe depression. Anxiety was seen among 50 (89%) of participants out of which sixteen (32.1%) had mild, 26 (51.7%) had moderate while 8 (16%) had severe anxiety. Significant correlation existed among the major area involved in burn with both anxiety and depression (p<0.01).

Conclusion: There is a very high prevalence of anxiety and depression among patients of burn. Significant positive correlation existed between the level of anxiety and the areas involved in burns.
EFFECTIVENESS OF SUPERVISED TOOTH BRUSHING EXERCISE ON THE ORAL HYGIENE STATUS OF SCHOOL GOING CHILDREN IN PESHAWAR
Authors: Nasir Samrina , Jawed Rubab , Kibria Zeeshan , Makhdoom Shazia , Khan Aiman , Saleem Momina
Published: July 2021

Objective: To determine the effects of supervised tooth brushing exercise on the oral hygiene status of school going children in Peshawar.

Study Design: Prospective observational study.

Place and Duration of Study: This study was conducted at a girl’s government school in university town, Peshawar, from Jul to Dec 2018.

Methodology: All girls between age 7-10 years with mixed dentition, minimum plaque index score 2 and gingival index score 0 were included in the study. Sixty four girls were allocated into group A (intervention) and group B (control) using computer generated random numbers. Intervention group (32 subjects) was exposed to video plus supervised tooth brushing on a cast model while control group (32 subjects) only exposed to video on brushing technique. The plaque index score was recorded for oral hygiene status as outcome measure of intervention after one month.

Results: The mean age of the participants was 9.53 ± 1.08 years. There was statistically significant difference in the plaque scores of interventional and control group after one month (0.3125 ± 0.470 vs. 1.312 ± 0.644, p<0.001) as compared to baseline data (1.90 ± 0.296 vs. 2.0 ± 0.00, p=0.83). The difference for frequency of tooth brushing between the two groups was not statistically significant (p=0.088). Parental watch during tooth brushing between the two groups was statistically insignificant (p=0.055).

Conclusion: Supervised tooth brushing improved the oral hygiene status of the children therefore oral health education was effective in establishing good oral health among school children.
SINGLE CENTRE, OPEN-LABEL & NON RANDOMIZED CLINICAL TRIAL TESTING LMWH EFFICACY ON PERINATAL OUTCOME INLATE SECOND TRIMESTER OLIGOHYDRAMNIOS CASES
Authors: Iftikhar Bushra , Shahid Aysha , Akram Nuzhat Aisha , Afsheen Afeera , Mushtaq Rabia , Ehsan Ambreen
Published: July 2021

Objective: To find out low molecular weight heparin (LMWH) efficacy inlate second trimester oligohydramnios cases.

Study Design: Quasi-experimental study.

Place and Duration of Study: Combined Military Hospital Malir, from Jan to Jun 2017.

Methodology: A total of 30 patients having amniotic fluid index (AFI) <8 on ultrasound scan during their late second trimester phase were enrolled in the study after informed consent. Exclusion criteria included congenital anomalies on U/S, PPROM, and drug-induced oligohydramnios. Personal, medical and obstetric history was obtained for age, parity and co-morbids like hypertension, antiphospholipid syndrome, and previous oligohydramnios. Low molecular weight heparin was started at dose of 0.5mg/kg of body weight subcutaneously for 8-12 weeks and stopped 24 hours prior to delivery. Rescan for amniotic fluid index and fetal bio-metry assessment done every 2 weeks till date of delivery. Fetal outcome in terms of maturity, mode of delivery, birth weight, APGAR score and need for NICU admission were measured.

Results: There were 28 live births and two intrauterine deaths. Twelve patients were delivered normally and 18 had elective LSCS. Of twenty eight cases, eight were premature low birth weight (LBW) babies. Twenty six patients showed significant improvement in amniotic fluid index. Average birth weight was 2.5kg. Neonates showed an average APGAR score of 7. Eight neonates admitted in NICU (for prematurity and/or low birth weight) and discharged within a week.

Conclusion: Low molecular weight heparin plays significant role in treating oligohydramnios in cases with or without risk factors. However further studies with large sample............
HIGH-RESOLUTION CT (HRCT) CHEST FINDINGS IN PCR POSITIVE PATIENTS OF COVID19 AT COMBINED MILITARY HOSPITAL RAWALPINDI
Authors: Khan Javed Ahmad , Asmat Faryal , Siddiqi Fuad Ahmad , Tareen Tariq Bashir , Hassan Fayyaz , Mehreen Sobia , Sultan Ayesha , Ejaz Amen
Published: July 2021

Objective: To study High resolution computed tomography chest findings in polymerase chain reaction (PCR) positive patients of COVID-19.

Study Design: Cross sectional study.

Place and Duration of Study: Combined Military Hospital Rawalpindi, from May to Jun 2020.

Methodology: Study included high resolution computed tomography chest of 200 patients admitted to COVID ward who were polymerase chain reaction positive. Patients having previously diagnosed Interstitial lung disease were excluded. Informed consent from patients were taken. Different findings on High resolution computed tomography chest were summarized as percent of total cases. British society of thoracic imaging (BSTI) classification was used to classify high resolution computed tomography chest patterns of COVID-19 pneumonia.

Results: Out of 200 patients included in study, 7 had previous changes on their chest imaging and were excluded. 193 patients (145 males and 48 females) enrolled had a median age of 52 years. One hundred and two patients (52.9%) showed classical pattern for COVID-19, 81 patients (41.9%) had indeterminate changes, 3 patients (1.6%) had atypical changes while 7 (3.6%) had normal high resolution computed tomography chest. Four had pleural effusions while 5 had mediastinal lymphadenopathy. One hundred and eight nine (97.9%) patients had bilateral lung involvement, 145 (75.1%) had central and peripheral while 48 (24.9%) had peripheral invol-vement only. One hundred and forteen (59%) patients had ground glass opacities while 70 (36.3%) had ground glass opacities with consolidation. Nine (4.7%) patients presented with consolidation only.

Conclusion: High resolution computed tomography chest and COVID polymerase chain reaction done at the same time.........
USING FLIPPED CLASSROOM FOR TEACHING PROCEDURAL SKILL IN RESIDENCY SPECIALLY DERMATOLOGY–A SYSTEMATIC REVIEW
Authors: Malik Sakina Sadiq , Yasmeen Rahila , Naveed Ayesha , Naveed Tehseen , Saleem Sadaf
Published: July 2021

Objective: To review the available literature investigating effectiveness of flipped classroom (FC) in context to teaching of procedural skills in residency in various medical fields especially in dermatology.

Study Design: Systematic review.

Place and Duration of Study: Flipped classroom meeting out inclusion criteria published in 9 years from 2012 to 2020.

Methodology: Flipped classroom meeting out inclusion criteria published in 9 years from 2012 to 2020 were reviewed by the authors and co-authors as per their feasibility and discussion done by video conferencing by mobile software apps.

Results: To review of 25 full-text articles. Strategic organization of course material, wise choice of pre-class activities, usage of Virtual learning environment, class time utilization tailored to learners needs, adherence to timelines, proper training of staff and proper evaluation; are required for successful implementation of flipped classroom. Students had positive perceptions about this technique.

Conclusion: Flipped classroom is an effective teaching method for procedural skills training in post graduate medical training.
CORRELATE BETWEEN BIOFILM FORMATION AND AZOLE ANTIFUNGAL SUSCEPTIBILITY AGAINST PLANKTONIC AND SESSILE CANDIDA ALBICANS CLINICAL ISOLATES
Authors: Salim Saira , Afzal Raja Kamran , Hassan Shahzad , Ikram Aamir , Hussain Amir , Khan Maria
Published: July 2021

Objective: To assess the correlation between biofilm formation and azole antifungal susceptibility against plank tonic and sessile clinical isolates of C.albicans.

Study Design: Prospective observational study.

Place and Duration of Study: Combined Military Hospital Peshawar, from Jun 2016 to Sep 2017.

Methodology: All standard microbiological procedures were carried out according to latest Clinical & laboratory standard institute (CLSI) guidelines. After gram staining and presumptive identification on CHRO Magar Candida, the isolates were biochemically identified by API AUX Candida as C.albicans. Planktonic antifungal susceptibility was carried out by Kirby Bauer disk diffusion method on 300 C.albicans isolates. Broth microdilution method was used to determine Minimum inhibitory concentration (MICs) of plank tonic cells and micro titer assay was used for assessment of biofilm formation by C.albicans.

Results: In planktonic antifungal susceptibility, fluconazole was susceptible against 195 (65%) and voriconazole against 241 (80%) C. albicans isolates. C. albicans was found susceptible dose dependent (SDD) to fluconazole in 28 (9%) and to voriconazole in 21 (7%) isolates. Seventy-seven (26%) and 38 (13%) C.albicans isolates were found fluconazole and voriconazole resistant, respectively. Sessile antifungal susceptibility was carried out through broth micro dilution method in which 160 (53%) were susceptible, 42 (14%) were susceptible dose dependent SDD and 98 (33%) were resistance to voriconazole, and 161 (54%) were susceptible, 36 (12%) were SDD and 103 (34%) were found resistant to fluconazole. Biofilm forming isolates of C.albicans were observed to be 285 (95%).The p-value is highly significance i.e. <0.01 between......
MDR BACTERIAL INFECTIONS IN CRITICALLY ILL COVID-19 PATIENTS IN A TERTIARY CARE HOSPITAL (OF PAKISTAN)
Authors: Tayyab Nadia , Furqan Warda , Nasrullah Amnah , Usman Javaid , Ali Sakhawat , Khan Asad Zaman
Published: July 2021

Objective: To identify antimicrobial susceptibility pattern of multidrug resistant bacteria causing secondary infections in COVID-19 patients in ICU’ sofa tertiary care hospital.

Study Design: Cross–sectional study.

Place and Duration of Study: Department of Microbiology, Pak Emirates Military Hospital, Rawalpindi, from Apr to Jul 2020.

Methodology: This study included blood samples and endotracheal aspirates from 114 critically ill COVID-19 patients. Peripheral blood specimens were collected fromthe patients with secondary bacterial blood stream infections and endotracheal aspirates were collected from patients with ventilator associated pneumonia for culture and sensitivity. The results were interpreted according to Clinical & Laboratory Standard Institute (CLSI) 2020.

Results: A total of 114 COVID-19 patients were admitted in ICU during that time period. Fourteen (12.28%) were female and 100 (87.71%) were male, age distribution was between 36-82 years. Sixty six paired blood samples were sent to the microbiology lab out of which 51 (77.2%) showed bacterial growth while 15 (22.7%) samples were negative. Out of 50 endotracheal aspirates, 42 showed bacterial growth (84%) and 8 samples did not show any significant bacterial growth (16%). Most of the endotracheal aspirates showed growth of >1 bacterial isolates. The most common gram-negative organisms were Acinetobacter baumannii (n=54) and Klebsiella pneumonia (n=26) and most common gram-positive organism isolated was Enterococcus faecium (n=9). All isolated organisms were multidrug resistant.

Conclusion: Poor antimicrobial stewardship particularly in critical care units resulted in secondary bacterial infections in COVID-19 patients. The pathogens isolated were multidrug resistant including Acinetobacter baumannii, Klebsiella pneumonia and Enterococcus faecium.
EXPRESSION OF ERG IMMUNOHISTOCHEMICAL STAIN IN PROSTATIC ADENOCARCINOMA
Authors: Nabi Sana Ghulam , Khan Erum , Mushtaq Sajid , Hassan Usman , Hussain Mudassar
Published: July 2021

Objective: To investigate the incidence ERG fusion positive adenocarcinoma and its correlation with gleason grade and gleason group.

Study Design: Cross-sectional study.

Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital & Research Centre (SKMCH & RC), Lahore Pakistan, from Jan 2018 to Jan 2019.

Methodology: A total of 100 cases of prostatic adenocarcinoma were retrieved and ERG immunohistochemical stain was applied on all these cases. ERG expression, extent of staining, percentage of tumor cells positive for ERG, pattern of staining was recorded. We found out relationship of ERG expression and gleason grade/gleason group.

Results: ERG expression was seen in 62/100 (62%) cases. Mean patient age of ERG positive prostatic adenocarcinoma patients was 69.68 years. In GG1 (14.5%) 9 cases exhibited ERG positivity. In GG2-3, 41.93% cases and in GG4-5, 43.54% cases showed ERG expression.

Conclusion: To conclude, age of presentation of ERG positive adenocarcinoma was high. ERG expression was seen in 62% of our cases which was much higher than reported in other Asian countries. In our study we found a significant correlation between ERG expression and high gleason grade group.
FREQUENCY AND ASSOCIATIONS OF MARCUS GUNN PHENOMENON IN CONGENITAL PTOSIS
Authors: Ahmad Maqsood , Imtiaz Hafiza Sadia , Iqbal Usama , Sharjeel Muhammad , Zahir Syed Imad , Hussain Ibrar
Published: July 2021

Objective: To determine the frequency and various associations of Marcus Gunn Phenomenon in patients of congenital ptosis.

Study Design: Cross-sectional observational study.

Place and Duration of Study: Department of Ophthalmology, Khyber Teaching Hospital, Peshawar, from Jun to Sep 2020.

Methodology: A total of 100 patients with congenital ptosis were included. Patients with any cause of secondary or acquired ptosis were excluded. Congenital ptosis was classified as simple and complex. Assessment for ptosis severity, presence of jaw winking ptosis, jaw winking severity, refractive error, amblyopia, strabismus, systemic association and family history for congenital ptosis was performed.

Results: Simple congenital ptosis was the most common type overall (84%). A total of 60% patients were males and 40% were females. More than 90% of the patients had severe ptosis. Ninety eight percent cases had onset since birth. No patient had systemic association or positive family history. Nine percent frequency of Marcus Gunn Phenomenon was noted with congenital ptosis. All the patients with Marcus Gunn Phenomenon had unilateral presentation. Left eye was affected predominantly (88.89%). A total of 22.22% of the patients with Marcus Gunn Phenomenon had anisometropic amblyopia. No other ocular or systemic association of Marcus Gunn Phenomenon was observed.

Conclusion: Simple congenital ptosis is the most common type of congenital ptosis. The authors report 9% frequency of Marcus Gunn Phenomenon with congenital ptosis and left side effected predominantly. Anisometropic amblyopia was the major ocular association of Marcus Gunn Phenomenon observed.
Didactic and Certified Trauma and Acute Care Surgery Fellowship is Inevitable Demand of Pakistan
Authors: Saqib Sabah Uddin
Published: July 2021

Discussions about the content and competencies of any postgraduate training program mainly focus onwhat the graduates need in long run after completion of training1. However, from the prospect of any progressive country, a post-graduate training program should also liaise with the demands of the country. Overthe past decade, the acute care surgery practice paradigm has become a defined entity in the developed world and didactic fellowship training programs in trauma and acute surgery have been implemented. In recent years, the American Association for Surgery has matured to 20 different disciplines of trauma and acute care2.