bluuebunny/crossref_metadata_2025 huggingface dataset:
Examining Applications Regarding Training Made to the Ombudsman Institution
Authors: TUNA Cem
Published: August 2021

Türkiye Cumhuriyeti 1982 Anayasa’na göre siyasi haklar ve ödevlerden biri dilekçe, bilgi edinme ve kamu denetçisine başvurma hakkıdır. Türkiye Büyük Millet Meclisi Başkanlığına bağlı olarak kurulan Kamu Denetçiliği Kurumu idarenin
işleyişiyle ilgili şikâyetleri inceler (Anayasa 74. Madde). İlgili yasa gereğince Kurum, idarenin işleyişi ile ilgili şikâyet üzerine, idarenin her türlü eylem ve işlemleri ile tutum ve davranışlarını; insan haklarına dayalı adalet
anlayışı içinde, hukuka ve hakkaniyete uygunluk yönlerinden incelemek, araştırmak ve idareye önerilerde bulunmakla görevlendirilmiştir. Kurum, hukukun üstünlüğünün sağlanması, iyi yönetim ilkelerinin yerleştirilmesi ve halka karşı
sorumluluk anlayışı içinde ve hakkaniyet temelinde, Türkiye Büyük Millet Meclisi’ne bağlı bir denetim mekanizması olarak 2013 yılından itibaren faaliyetlerini sürdürmekte, halkın avukatlığını yapmakta ve aldığı kararlar ile idareye
yol göstermektedir. Kuruma yapılan başvurular incelendiğinde, eğitim, eğitim hakkı, ders intibakı, sınav sonuçlarına itiraz, eğitim ücretine itiraz, ders muafiyeti, diplomanın iptali, lisans tamamlama programına katılma, öğretim,
ücretli öğretmenlik, araştırma görevliliği sınavı, rehber öğretmenlerin görevlendirilmesi, araştırma görevlisi olarak naklen atanma, mazerete dayalı yer değiştirme ve benzeri konularının yer aldığı saptanmıştır. Bu çalışmada, anayasal
bir hak olan kamu denetçiliği kurumuna başvurma hakkının kullanılmasıyla ilgili olarak 2018 yılında eğitimle ilgili alınan kararlar incelenmiştir. Çalışma nitel araştırma yöntemlerinden doküman incelemesine dayalıdır. Çalışmada
önce 2018 yılı karar örnekleri dokümanlarına ulaşılmış, kararların orijinalliği kontrol edilmiş, kararlar okunarak eğitimle ilgili olanlar ayrılmış, kararlar anlaşılmaya çalışılmış, veriler analiz edilmiş ve veriler kullanılmıştır.
Araştırma sonuçlarından öne çıkanlara göre, Kamu denetçiliği kurumuna toplumun her kesiminden eğitim bilimlerine alanına yönelik başvurular alınmıştır. Eğitim bilimleri alanını ilgilendiren bazı resmi kurum ve kuruluşların başvuruya
konu olduğu belgelenmiştir. Sosyal, siyasal ve kişisel alandaki anayasal haklar göz önünde bulundurulduğunda elde edilen veriler sosyal ve siyasal haklar konusunda başvuruların bulunduğunu; kişisel alanda ise herhangi bir başvurunun
bulunmadığını göstermektedir. Kamu denetçiliği kurumuna başvurular makul süre içerisinde sonuçlanmaktadır. Şikâyet edilen kurumlar, çoğu zaman iyi yönetim ilkelerine uymamaktadır. Çoğunlukla başvuru sahiplerinin başvurularının
kabul edildiği ve idareye işlemlerinin iptali yönünde tavsiyede bulunulduğu, bir kısım başvurularının kısmen kabul kısmen ret şeklinde alındığı, bir kısım başvuruların ise reddedildiği saptanmıştır. Çalışma sonuç ve önerilerle
son bulmaktadır.
An Investigation of Pre-School Teacher Candidates' Love of Children and Occupational Concerns (Kosovo Example).
Authors: Spahi Kovaç Esen , Tamnik Semra Çiço
Published: August 2021

Araştırma, Kosova’ da Prizren Üniversitesi Eğitim Fakültesi Okul Öncesi Öğretmenliği bölümünde okuyan okul öncesi öğretmen adaylarının çocuk sevgisi ve mesleki kaygı düzeylerinin belirlenmesi amacıyla yapılmıştır. Araştırmanın verileri,
2019-2020 öğretim yılında Prizren Üniversitesi Eğitim Fakültesi Okul Öncesi Öğretmenliği bölümünde öğrenim gören 80 öğrenciye “Barnett Çocuk Sevme Ölçeği” ve “Öğretmen Adayı Kaygı Ölçeği” nin uygulanmasıyla elde edilmiştir. Araştırma
sonucunda okul öncesi öğretmen adaylarının çocuk sevgisi düzeylerinin yüksek, mesleki kaygı düzeylerinin ise düşük olduğu tespit edilmiştir.
ÇOCUKARIN EĞİTİMİNDE OYUNUN ÖNEMİ VE ÖĞRETMENLERİN GÖRÜŞLERİ
Authors: Kotere Sera
Published: August 2021

Bu çalışmada okul kavramları açıklanarak, ilköğretim ve okulöncesi döneminde çocukların eğitiminde oyunun önemi, aralarında ilişkiye dikkat çekilmiştir. Nitel araştırma yöntemi ve veri toplama aracı olarak anket formu kullanılmıştır.
Araştırma, 2020–2021 eğitim–öğretim yılının ikinci döneminde, Prizren şehrinde bulunan 3 ilköğretim okulunda görev yapan 16 sınıf öğretmeniyle, 3 devlet ve 3 özel okulda görev yapan 14 anaokulu (Türk ve Arnavut) öğretmeniyle yapılmıştır.
Araştırma tarama modelinde gerçekleştirilmiştir. Yapılan analizler sonucu elde edilen bulgulara göre, öğretmenlerin oyunu bir öğrenme yöntemi, kişilik ve gelişimde önemli bir yer olduğu, çocukların kendini ifade etme biçimi, eğlence
aracı ve gelişim destekçisi olarak tanımladıkları belirtirlmiştir. Öğretmenlerin ise oyunlar esnasında gözlemci, ortamı sağlayan, yol gösteren, güvenliği sağlayan katılımcı rollerini üstlenerek çocukların oyunlarına dahil oldukları
sonucuna varılmıştır. Oyun için en ideal zaman dilimi 15dk-30dk olduğu ancak mevsimsel olarak farklılıkları gösterdiği sonucuna varılmıştır. Oyun esnasında tüm çocukları oyuna dahil etme görevini üstlenen öğretmenlerin, ödül olarak
sözel ifade, alkış ve sembol kullandıkları, ceza yöntemi olarak ise oyuna ara verdirme ve ceza kullanmamaları gözlemlenmiştir.
Analysis of Consumer Satisfaction and Loyalty Factors with CRM Approach in Agribusiness E-commerce Company
Authors: Goranda Iqra Rizky , Nurhayati Popong , Simanjuntak Megawati
Published: August 2021

XYZ e-commerce is a company that sells an agricultural product that draws benefits from the COVID-19 pandemic. The purpose of this research was to analyze CRM factors, satisfaction, and consumer loyalty. This study using quantitative research selected with convenience sampling. The online survey applied toward 232 respondents who were unsatisfied with the service in Jabodetabek and processed using Structural Equation Model (SEM).  Based on the SEM results, it was found that CRM has a significant effect on consumer satisfaction and consumer satisfaction with consumer loyalty. In contrast, CRM has no significant effect on consumer loyalty. This research concluded that XYZ needs to become a company that makes it easy for consumers, is professional, reliable and trustworthy. However, efforts need to be made to improve the relationship between criticism and suggestions, communication and providing information, regulating product availability, delivery time, and saving consumer costs—the results of this research results are expected to increase satisfaction and loyalty through the CRM approach.
Análisis temporal de la distribución de Dendroctonus mexicanus Hopkins (1905) en México (2009-2018)
Authors: Perez Miranda Ramiro , Gonzalez Hernandez Antonio , Velasco Bautista Efrain , Romero Sánchez Martín Enrique , Arriola Padilla Victor Javier , Acosta Mireles Miguel , Carrillo Anzures Fernando
Published: August 2021

En México, uno de los principales agentes de degradación forestal son los insectos descortezadores; entre ellos, Dendroctonus mexicanus es considerado uno de los más agresivos, ya que cada año afecta a varias especies de pino en México. El presente estudio tuvo como objetivo analizar la distribución temporal y espacial de esta especie, a partir de las bases de datos de las notificaciones forestales oficiales, entregadas a la Secretaría de Recursos Naturales (Semarnat) de 2009 a 2018. Las bases de datos se revisaron, analizaron y depuraron. Se correlacionó la variable área ecológica (norte, centro y sur) en la superficie afectada mediante un modelo de efectos fijos. Durante el intervalo de años en estudio, el escarabajo de la corteza se distribuyó en 25 estados de la república mexicana, principalmente en la Sierra Madre Occidental, Sierra Madre Oriental y Eje Neovolcánico Transversal. Los años con mayor número de registros fueron de 2012 a 2014, con presencia en bosques de pino-encino y encino-pino. Nuevo León, Chihuahua, Durango, Zacatecas y Michoacán tuvieron la mayor superficie afectada por D. mexicanus. Michoacán, Oaxaca, Durango, Estado de México, Nuevo León y Chihuahua fueron las entidades que presentaron una mayor cantidad de madera afectada por la plaga. El valor de la prueba global de F2,14 (efectos fijos) fue de 17.99, y el valor p fue de 0.0001. Entre las tres zonas analizadas existen diferencias altamente significativas en cuanto a la variable de respuesta.
Diversidad, estructura y servicios ecosistémicos del arbolado en cuatro parques de Texcoco mediante i-Tree Eco
Authors: Martinez-Trinidad Tomas , Hernández López Pablo , López-López Stephanie Fabiola , Mohedano Caballero Leopoldo
Published: August 2021

El objetivo fue conocer la estructura, diversidad y los servicios ecosistémicos del arbolado en cuatro parques de la ciudad de Texcoco de Mora, Estado de México. Se realizó un censo y análisis de los árboles existentes en las áreas verdes seleccionadas. Se determinó una población arbórea compuesta por 391 individuos, pertenecientes a 19 familias y 34 especies. Los taxones más comunes fueron Ficus benjamina (23 %), Schinus molle (13.8 %), Hesperocyparis lusitanica (10.2 %) y Ligustrum lucidum (10 %). El índice de Simpson (1-D) presentó un valor de 0.73 y el índice de Shannon-Wiener H’= 3.89, lo que indica una alta diversidad. Las tres especies más abundantes sobrepasan la regla de diversidad 10-20-30 de Santamour. Se estimaron tres servicios ecosistémicos principales a través del software i-Tree Eco v6: almacén de C, captura de C y producción de O2. El arbolado evaluado almacenó 28.85 Mg C ha-1, capturó 2.56 Mg C año-1 y produjo un total de 6 Mg O2 año-1. Además de lo anterior, se calculó que los árboles removieron un total de 0.06 Mg año-1 de contaminantes y contribuyeron a reducir la escorrentía del agua de lluvia en 107.9 m3 año-1. La información generada es útil para la administración y conservación del recurso arbóreo, así como en la valoración del arbolado de la ciudad de Texcoco.
EMERGENCY LAPAROTOMY;
Authors: Niaz Ch. Muhammad Atif , Talib Awais , Sultan Yasir , Niazi Asim Shahzad
Published: August 2021

Objectives: Emergency laparotomy followed by placement of drain is acommon procedure in tertiary care hospitals but there are contradictory evidences regardingits association with deep surgical site infection. Thus current study was planned with anobjective to compare the frequency of deep surgical site infection among patients with andwithout postoperative drains after undergoing an emergency laparotomy at a tertiary carehospital. Data source: Primary data based on patients undergoing emergency laparotomy attertiary care hospital. Study design: Randomized control trial. Setting: Department of surgicalunit-III, Jinnah Hospital Lahore. Duration of study: Study was conducted from January 2016to December 2016. Subjects & methods: About 400 patients of 15-70 years undergoingemergency laparotomy were selected using non-probability consecutive sampling techniqueafter informed consent. Information regarding their demographic characteristics and studyvariable was recorded in a structured proforma. All the subjects were randomized into twogroups i.e. with and without post-operative drains using table of random number. Frequencyof deep surgical site infection was assessed on 7th post operative day and data was analyzedusing SPSS version 21.0. Result: The mean age of patients was 38.92 ± 6.246 years withabout 229(57.2%) male patients. The frequency of development of deep surgical site infectionin first postoperative week was 51(12.7%) overall, with 24(12%) patients in the group of postoperativedrains and 27(13.5%) patients without post-operative drains. The differences betweentwo groups were statistically insignificant. Moreover, it was not significantly related to the age,gender, duration of stay in the hospital and smoking. Conclusion: It can be concluded from thestudy that there is no significantly increased risk of deep surgical site wound infection with orwithout placement of drain. So it is reasonable and safe approach to place a drain in the woundfor the early detection of bleeding or leakage to decrease the morbidity and complication in thepatients.
SURGICAL DISEASE IN RURAL AREA;
Authors: Rathore Farhan , Riaz Usman , Riaz Faizan , Rathore Altaf Hussain
Published: August 2021

Objectives: To find out the prevalence of surgical disease in rural areas ofPakistan. Place and Duration: All the surgical cases registered in Foundation Hospital RajanaDistrict Toba Tek Singh in 2012-2013. Methods: The whole data is analyzed by SSPS andcompared with the other studies of Pakistan and world. Results and Conclusion: Male andfemale are equal in number in Total 7788 cases excluding non-surgical cases between 1 dayto above 70 years age. Majority of the cases were between 21-50 years age group. Commoncause was Trauma, commonest disease was L.B.A and commonest operation was for Herniaand Gallbladder stones.
KELOIDS AND HYPERTROPHIC SCARS;
Authors: Butt Muhammad Qasim , Latif Ansar , Shamsher Khan Rana Mozammil , Mazhar Aslam Iqbal , Shabbir Faisal
Published: August 2021

Objectives: To compare the effectiveness of triamcinolone alone andtriamcinolone mixed with 5-flourouracil used for intralesional injection to treat symptomatichypertrophic scars and keloids. Study Design: Prospective study. Place & duration of study:Departments of Plastic and General Surgery, Khawaja Muhammad Safdar Medical College,Sialkot from January 2014 to September 2016. Material and Methods: Plastic and generalsurgery outpatients with symptomatic keloids and hypertrophic scars fulfilling inclusion criteriawere registered. Adult patients irrespective of gender, areas involved and size of the keloidswere included. Patients refusing treatment, pregnant and lactating women were excluded;similarly the patients not completing the follow up for at least 3 months were dropped from thestatistical analysis. Patients’ response to treatment was judged by the reduction in the physicalsize of keloids and subjective improvement in symptoms of itching, discomfort, pain, deformityor redness. Minimum of three sessions of treatment was must for assessment of outcome.Data was entered and analysis done by SPSS v 22. Results: Of the 293 outpatients 115 weretreated by the mixed triamcinolone and 5 flourouracil while 178 patients were injected withtriamcinolone only. Female patients were more in number with ratio of 2.8:1. Good responseto treatment with Triamcinolone alone was obtained in 69 (38.76%) while good response wasseen in 62 (53.91%) of patients with intralesional Triamcinolone mixed with 5-flourouracil.Conclusion: The intra-lesional steroid injection commonly used as its treatment has convincingresponse. The presently used mixture of steroids and 5-flourouracil has more promising resultsas regards patients’ improvement in symptomatology as well as physical reduction in the size.
CORONARY ARTERY DISEASE;
Authors: Abbas Shahid , Riaz Rehan , Javaid Imran , Hameed Naeem
Published: August 2021

Objectives: To determine the frequency of multivessel coronary artery disease(CAD) in patients suffering from inferior wall acute myocardial infarction (AMI) having STsegment depression in anterior chest leads. Study Design: Cross Sectional Survey. Setting:Department of Cardiology, Faisalabad Institute of Cardiology, Faisalabad. Period: December2013 to June 2014. Materials and Methods: After fulfilling the inclusion criteria, 120 patientswith acute inferior wall MI were studied. Patients were divided in two groups. Group I includedpatients with ST segments depression in leads V1-V3 and Group II with ST segment depressionin leads V4-V6. Age of patients ranged from 25 to 70 years. Results: The mean age was52.5±10.5 years. As regards sex distribution, 100 patients were male, 54 in Group I and 46in Group II. There were 20 female patients, 11 in Group I and 9 in Group II. Thirty six (30%)patients were diabetic, 22(33.8%) in Group I and 14(25.5%) in Group II. Forty five (37.5%)patients were hypertensive. Fifty two (43.3%) patients were smokers. Forty three (35.8%)patients had family history of ischemic heart disease, 25(38.5%) in Group I and 18(32.7%) inGroup II. Thirty five (29.2%) had hyperlipidemia, 20 (30.8%) in Group I and 15(29.2%) in GroupII. All patients underwent coronary angiogram. Thirty eight (31.7%) patients had single vesseldisease, 29(44.6%) patients in Group I and 9(16.4%) in Group II. Forty three (35.8%) patientshad double vessel coronary artery disease, 23 patients (35.4%) in Group I and 20(36.4%) inGroup II. Thirty nine (32.5%) had three vessel coronary artery disease, 13 (20%) in Group I and26 (47.3%) in Group II. Eighty three (69.2%) patients had multivessel coronary artery disease37(56.8%) in Group I and 46 (83.6%) in Group II (p value <0.002). Conclusion: The presence ofprecordial ST depression during acute inferior wall myocardial correlates well with multivesselCAD. Precordial ST-segment depression in acute inferior wall MI is related to anterior injury dueto LAD stenosis and these patients tend to have more severe CAD.
TWIN REVERSED ARTERIAL PERFUSION SEQUENCE (TRAP);
Authors: Saeed Pansota Mubasher , Niaz Muhammad Imran
Published: August 2021

Twin reversed arterial perfusion sequence (TRAP sequence) is a condition thatoccurs only in identical twins that share a placenta (monochorionic), in which one twin lackinga functioning cardiac system “acardiac monster” receives blood from the normally developingtwin called the “pump twin”. This places an enormous demand on the heart putting the pumptwin at risk for cardiac failure. Left untreated, the pump twin will die in 50 percent to 75 percentof cases. Here we present the case report of a 20 years old G2P1at 32 weeks POG with amonochorionic twin pregnancy. One of the twins was “acardiac acephalous” and the other a“pump twin” with mild hydrocephalous.
PAPILLARY THYROID CARCINOMA SIZE;
Authors: Khan Amjad Ali , Asghar Abdul Shaheed , Ishaq Muhammad , Akhund Israr Ahmed
Published: August 2021

Background: Papillary thyroid carcinoma (PTC) is the most common malignancyof thyroid gland. It constitutes about 90% of all well differentiated thyroid carcinomas and has anindolent course with excellent prognosis.1,2,3 Death due to papillary thyroid carcinoma is rare andaccounts for only 0.2% of cancer deaths in United States of America.4 The prevalence of PTChas increased world over due to the wider use of ultrasonography and fine needle aspirationcytology (FNAC) in the routine diagnostic workup. Also papillary thyroid microcarcinomas(PTMC) are being increasingly diagnosed as incidental findings in thyroid gland removed forother thyroid pathologies, like follicular adenoma, multi-nodular goiter or diffuse goiter, etc. Dueto uncertainty for this tumor to metastasize to the regional lymph nodes, it is usually not clearwhether the surgeon should take the patient to the operating room and proceed with lymphnode dissection or to wait and observe. Study Design: In this retrospective study from the yearPeriod: January 2012 to January 2015, a total of 43 cases of total thyroidectomy with regionallymph node dissection and with histopathological diagnosis of papillary thyroid carcinomawere retrieved from archives of Setting: Charsada Teaching Hospital affiliated with JinnahMedical College Peshawar. The slides and diagnoses of all the retrieved cases were reviewed.Information regarding primary tumor size, any metastasis in regional lymph nodes, patient’sage and presence or absence of any associated thyroid disease was noted and analyzed.Results: The analysis of the 43 cases of PTC showed that papillary thyroid carcinoma was morecommon in females than males. It affected age groups between 10 and 80 years of age andwas most common in the 4th decade of life. Cervical lymph node metastasis was directly relatedwith the size of primary papillary thyroid carcinoma. The commonly associated thyroid diseasesincluded Hashimoto’s thyroiditis, followed by multinodular goiter and rarely Graves’ disease.Conclusions: Papillary thyroid carcinoma is more common in females; it affects patients in theirfourth decade of life and is commonly associated with Hashimoto’s thyroiditis. Moreover thechances of cervical lymph node metastasis are directly proportional to the primary tumor size.
METABOLIC SYNDROME;
Authors: Khalid Mahrukh , Anwar Touseef , Rehman Naveed ur , Bashir Muhammad Badar
Published: August 2021

Introduction: Systemic lupus erythematosus (SLE) is a multiorgan autoimmunedisease with an increased incidence rate of thrombotic events (9–37%). Metabolic syndrome(MetS) may contribute to increased cardiovascular risk in (SLE). The Metabolic syndrome is moreprevalent in SLE patients than the general population and is associated with endothelial injuryand coronary atherosclerosis. Objective: To determine the frequency of metabolic syndromein systemic lupus erythematosus (SLE), patients presenting in a tertiary care hospital. StudyDesign: Cross-sectional survey. Study Settings: Medical out-patient Department of JinnahHospital Lahore. Duration of Study: Six months duration from 25th June 2014 to 26th December2014). Subjects and Methods: Non-probability purposive sampling was done on 78 SLEpatients (as per operational definition), which were enrolled after obtaining their written informedconsent. Metabolic syndrome was labeled as per operational definition. Data was recorded ona specially designed performa. Results: From 78 cases of SLE there were 4% male and 96%were female. The mean age was 20- 60 years with standard deviation of 40.21±10.67 years. Itwas observed that there were 38.5% cases of SLE with family history of CHD, 66.67% patientsof SLE were smokers, 48.7% patients had central obesity, 47.4% patients had high fastingblood glucose, 44.9% cases were with low HDL and 39.7% patients had high blood pressure.Metabolic syndrome was found in 33.3% patients of SLE. Metabolic syndrome was significantlyassociated with high blood pressure (p= 0.00), central obesity (p= 0.00), high blood glucose(p= 0.00), low HDL (p= 0.00) and gender p=0.01) but association with age (p=0.33), smoking(p=0.73) and family history of CHD (p=0.32) was not significant. Conclusion: The frequency ofmetabolic syndrome in SLE patients presenting in a tertiary care hospital was found to be 33%.Metabolic syndrome was significantly associated with SLE.
INTEGRATED PERFORMANCE ASSESSMENT;
Authors: Asad Munazza , Iqbal Khadija , Asim Aisha , Farman Sabir
Published: August 2021

Objectives: To assess first year MBBS students’ perceptions regardingIntegrated Performance Assessment and its relevance to clinical practice as compared withtraditional OSPEs. Study Design: Cross-sectional observational study. Setting: Al NafeesMedical College, Isra University, Islamabad. Period: Final week of First year MBBS students’professional exam held in November 2013. Methodology: Both interactive and static stationswere developed according to predetermined assessment blueprint. Clinical scenarioswere used as triggers followed by tasks relating to laboratory skills and or relevant physicalexamination on standardized subjects. Two to three tasks were given at each station. Checklistsfor standardized marking of observed stations were also developed. Feedback questionnairewas given to find out overall perception of students regarding this assessment process at theend of examination. The questionnaire comprised of 18 statements to be rated on 5-point Likertscale. Results: Almost all the students agreed that Integrated Performance Assessment wasbetter than traditional OSPEs. 73% of students agreed that stations were well organized and83.4% showed that the time duration for task completion was appropriate. 75% agreed thatstations reflected integration of various disciplines. 64 % were of the opinion that basic scienceknowledge was linked to clinical practice. 72.1% were of the opinion that it involved criticalthinking in clinical context. However, students suggested improving further in organizationand integration of stations. Conclusion: Students perceived IPA as a better tool of assessingapplication of basic science concepts and its clinical relevance in integrated curriculum format.
TUBERCULOSIS;
Authors: Liaqat Alia , Iqbal Muhammad Awais , Rehman Khadam Muhammad Abdur
Published: August 2021

Background: TB is highly prevalent in Pakistan. The Pakistan government has,therefore, given high priority to Tuberculosis control. It has declared TB to be considered asNational Emergency in 2001, and has extended the WHO suggested TB control strategy (orDOTS) throughout the all health services of the Health Ministry by May of 20051.Therefore it isvery essential to assess the knowledge about TB and its implementation in tertiary hospitalswhich are the main source of providing treatment. Objectives: To assess the knowledge ofmedical offices about the diagnosis of tuberculosis case, treatment of tuberculosis casesand the practice of TB DOTS by the MOs in teaching hospitals of Faisalabad City. Place andDuration of Study: It was carried out in teaching hospitals. “Allied Hospital and district headquarter hospital” in Faisalabad City, in one month from 10 June 2014 to July 10 2014, Fifty MOswere assessed by the questionnaires methodology. Study Design: The study design was crosssectional study. Sample Technique: Simple non-random sampling. Materials & Methods: TheMOs were given the questionnaires and before filling it, they were also provided with consentform, to get their consent in written. The sample of consent form and questionnaires aregiven at end. MOs are assessed randomly. Results: In this study, the response obtained inquestionnaires were analyzed individually. When we calculate the percentage of doctors haveknowledge about DOTS in Faisalabad. We get following results: 77.5% of MOS in teachinghospital of Faisalabad have knowledge about DOTS in Faisalabad. When we calculate thepercentage of doctors practicing DOTS in Faisalabad. We get following results so 18.64% ofMOs practice DOTS. Conclusion: It was concluded from this study that though majority of MOshave the knowledge but they are not practicing it. So there is a need of strict enforcement toimplement this program effectively to achieve a better control of TB under guidelines of WHO.
ACUTE CORONARY SYNDROME;
Authors: Maqbool Abubakar , Asghar Naeem , Ahmad Shakeel
Published: August 2021

Introduction: Atherosclerosis is intrinsically an inflammatory disease. Numerousstudies has shown that elevated levels of C-reactive protein (CRP) are associated with increasedcardiovascular risk. The objectives of this study was to determine the correlation of clinicaloutcome in terms of 30 day mortality with various level of C-reactive proteins among patientspresenting with acute coronary syndrome Study Design: Descriptive. Setting: Department ofCardiology, Punjab Institute of Cardiology Lahore. Period: 06 months. Material and Methods:Total 250 patients presented in emergency department and diagnosed as cases of acutecoronary syndrome base on history of chest pain, ECG and cardiac biochemical markers wereincluded in the study. Management of ACS was continued while CRP levels of each patientwere measured by latest Agglutination method. Results: Our study included 250 patients withacute coronary syndrome with a mean age of 52.90±10.34 years. Male patients were 220(88%). Regarding the clinical presentation of patients, 20 (8%) had unstable angina, 95(38%)had NSTEMI and 135 (54%) had STEMI.CRP level were measured, 184(73.6%) patients hadCRP levels < 22mg/L with mortality of 12 (6.5%) at 30 days and 66 (26.4%) patients hadCRP levels >22mg/L with mortality of which 13(19.6%) at 30 days. The mean CRP level was17.9±12.47, 18.08±15.73 and 22.38 + 17.92 for patients with unstable angina, NSTEMI andSTEMI respectively. The stratification of data for effect modifiers showed that 60(24%) patientshad diabetes, 138 (55.2%) patients had hypertension and 65(26%) patients were smokers.Conclusion: Patients having higher CRP levels had higher risk of 30 day mortality.
DIABETIC NEUROPATHY;
Authors: Imran Mehr , Fiaz Muhammad Umair , Arslan Muhammad , Khalid Ayesha
Published: August 2021

Objectives: To compare the efficacy of duloxetine with amitriptyline for reductionin the frequency of pain management in patients with diabetic neuropathy. Study Design: It isa Comparative, Randomized and Prospective study. Setting: Medical Unit-4, DHQ, Hospital,Faisalabad. Study Duration: 5 months, October, 2016 to February 2017. Methods: A total of100 cases (100 in each group) between the age 20-65 years of any gender, ≥ 5years historyof diabetes, symptoms of peripheral neuropathy for at least six months, having HbA1c >7.5%were included while those with co-existing other causes of peripheral neuropathy (porphyria,chronic renal failure, amyloidosis, leprosy, hypothyroidism), pregnant and lactating womenand use of Duloxetine or amitriptyline in previous three months were excluded from the study.Randomization was done by computer generated random number table, to allocate patientsto either group A (Duloxetine group) or group B (Amitriptyline group). Patients were instructedto take study medication in the morning, with a glass of water for up to 6 weeks. Group A wasgiven 60mg Duloxetine each day and Group B was given 75mg amitriptyline in a single dose.Baseline pain was recorded on VAS. Diary card was provided to all patients at the baseline visit.Each morning during the 1st 3 weeks, patients would be instructed to record the severity of thesymptoms in term of reduction in pain score recorded by visual analogue scale. After 3 weeks,an additional three weeks supply of medication was dispensed and patients were scheduled toreturn at week 6 for the final evaluation that was recorded by me in terms of reduction in painscore and also assessed for 50% reduction in pain score from base line that was labeled asreduced. Patients were followed up by keeping telephonic contacts of patients. Results: In ourstudy, out of 200 cases (100 in each group) 21%(n=21) in Group-A and 17%(n=17) in Group-Bwere between 20-40 years of age while 79%(n=79) in Group-A and 83%(n=83) in Group-Bwere between 41-65 years of age, mean+SD was calculated as 47.08+11.43 and 48.37+10.83respectively, 56%(n=56) in Group-A and 49%(n=49) in Group-B were male while 44%(n=44)in Group-a and 51%(n=51) in Group-B were females, comparison of efficacy in both groupswas done which shows that 62%(n=62) in Group-A and 35%(n=35) in Group-B were treatedeffectively, which shows a significant difference between the two groups. Conclusion: It isconcluded that the efficacy of duloxetine as compared to the amitriptyline in terms of reductionin frequency of pain in the management of patients of diabetic neuropathy is significantly higher.
TRANSCRANIAL DURAL REPAIR;
Authors: Amir Sohail , Qadir Maimoona , Usman Muhammad
Published: August 2021

Objectives: To determine efficacy of transcranial dural repair in managementof early traumatic cerebrospinal fluid (CSF) rhinorrhea by measuring the rate of resolution ofrhinorrhea following repair. Material and Study Design: Descriptive study. Period: 18 monthsfrom March 2014 to September 2015. Setting: Department of Neurosurgery Naseer Teachinghospital Peshawar. Methods: 30 patients, all head injury patients with CSF rhinorrhea of eithergender and any age, reporting to Accident and emergency department were included in thestudy. MRI Brain T2 Weighted in prone position done in all cases to identify the dural rent.Transcranial intradural repair was done through subfrontal approach. Post op complicationswere documented and follow at two months. Results: In this study 30 patients with cerebrospinalfluid (CSF) leak were observed. The minimum age was 8 years and the maximum was 59 years.23 (76.6%) were male and 7 (23.3%) were female. 18 (60%) patients have CSF rhinorrhea dueto road traffic accident, 7 (23.3%) patient with history of fall, while 5 (6.6%) patient were in othercategory. MRI brain T-2 Weighted done in all patient to identify the dural defect. The surgicalapproach was intradural in all of the 30 (100%) patients having fascia lata graft in 28 (93.3%)patients and pericranium in 2 (7%) patients to cover the defect properly. Among the immediatecomplications 3 (10%) patients had recurrent CSF leak, 2(6.6%) had meningitis, 5 (16.6%)had Pneumoencephalus while 3(10%) patients had other complications like subarachnoidhemorrhage, wound infection etc. The overall success rate was 90%. Conclusion: It isconcluded that in post traumatic cerebrospinal fluid (CSF) rhinorrhea, if the defect in dura isdemonstrated it must be repaired as soon as possible in order to prevent fulminant meningitis.
SALIVARY GLAND TUMOURS;
Authors: - Arifullah , Nasir Irfan Ul Islam , Hassan Syed Zafar , Muhammad Ghulam
Published: August 2021

Objectives: The objective of the study was to find the frequency of salivarygland tumours. Study Design: A descriptive study. Period: 1st Jan 2008 to 31st Dec 2010 (of 3years duration). Setting: ENT department Khyber Teaching Hospital and Surgical departmentHayatabad Medical Complex, Peshawar. Material and methods: Total number of 108 patientshaving salivary gland tumours enrolled from admitted patients in ENT department KhyberTeaching Hospital and Surgical department Hayatabad Medical Complex Peshawar. Thestudy was designed to find the frequency of salivary gland tumours. Results: In our studymost of the patients were having benign tumours (80.6%) with malignant counterpart in about19.4%. Overall the most common tumour was pleomorphic adenoma about 71.3% followed byMucoepidermoid 6.5%, adenoid cystic carcinoma 4.6% and Warthin’s tumour 4.6%. The mostcommonly involved salivary gland is parotid gland about 78.7% (85/108) with pleomorphicadenoma being the most common benign tumour and Mucoepidermoid the malignant variety.In submandibular gland/ sublingual glands the most common was pleomorphic adenomaand in minor salivary gland majority were malignant. Conclusion: Most of the salivary glandtumours are benign with majority of them are pleomorphic adenomas and parotid gland is themost common involved salivary gland.
FIBROIDS IN PREGNANCY;
Authors: Bano Shah , Awan Shabnam Naseer , Rahman Asma
Published: August 2021

Objectives: The objective of this study was to determine the frequency ofcomplications in pregnant women with fibroids in 3rd trimester. Study design: Descriptive CaseSeries. Setting: Department of Obstetrics & Gynecology, Nishtar Hospital, Multan. Period: 15thDecember 2014 to 15th June 2015. Subjects & Methodology: Where sample size was calculatedusing WHO sample size calculator using expected proportion of intrauterine growth restrictionp= 4%.11 163 pregnant women of 20-40 year of age with uterine fibroid of ≥3cm on ultrasoundwere included in this study. Patients of endometriosis and hypertension were excluded. Anobstetrical ultrasonography was done to confirm singleton pregnancy, size of uterine fibroidand to confirm gestational age. Patients were monitored until delivery and complications wererecorded. Preterm labour was defined as dilation of the cervix <4cm with the presence ofuterine contractions of ≥ 4 per hour of 30 seconds duration with intensity to effect progressiveeffacement, assessed by vaginal examination. Malpresentation was defined as a presentationin which baby’s bottom or feet, instead of head, are in position relative to the maternal pelvis byultrasound and IUGR was defined as fetal weight below the 10th percentile and fetal abdominalcircumference below the 10th percentile on ultrasound. Results: Age range in this studywas from 20 to 40 years with mean age of 32.773±1.99 years, mean gestational age34.730±2.44 weeks, fibroid size 5.736±1.51cm, duration of complain 5.018±1.41 months,height 1.561±0.11 meters, mean weight 73.619±13.66 Kg and mean BMI was 28.607±3.106Kg/m2. Majority of the patients were from 31-40 year group (89%). Preterm labour was seenin 15.3% patients, malpresentation was 7.4% and IUGR was seen in 6.1% patients. Conclusion:Our study conclude that, most common complication of uterine fibroids during pregnancy waspreterm labour followed by malpresentation and IUGR.
TOTAL KNEE ARTHROPLASTY;
Authors: Jabbar Faisal Abdul , Shah Rehana Ali , Hashim Muhammad
Published: August 2021

Objectives: We aim to evaluate the level of satisfaction after total knee arthroplastyprocedure in the patient population at a tertiary care hospital in Karachi, Pakistan, and to assessthe relationship between patient satisfaction and the outcome based on traditional scores.Methods: Study Design: Case series for determination of patient satisfaction. Period: Oneyear duration from April 2015 to May 2016. Setting: Tertiary care centre in Karachi, Pakistan.The inclusion criteria was all the patients with late stage osteoarthritis of the knee joint andunderwent total knee arthroplasty at our institute. Data was analyzed using SPSS version 22.Results: A total of n= 102 patients were included in the study while n= 109 knee surgerieswere done in total (n= 95 patients had unilateral surgery, while n= 7 patients had bilateralsurgeries on both the knee joints) n= 58 patients were females while n= 44 patients weremales, the median age was 60 years, patients had a mean body mass index (BMI) of 27kg/m2. Of the total surgeries performed n= 100 were in the satisfaction group while n= 9 were inthe dissatisfaction group. The majority of the patients reported that they would recommend theprocedure. The co morbid conditions did not affect the patient’s level of satisfaction having ap value of 0.678. In the dissatisfied group, there was no significant difference when it comes togender, the mean age of patients in the dissatisfaction group was higher than the mean age ofpatients in the satisfaction. We found that WOMAC scores for functioning and the final WOMACscores were correlated with patient satisfaction and that was statistically significant, similarlySF-36 form patients were satisfied about the improvement in the physical health while they didnot improve the mental health aspect of their disease. Conclusion: According to our studytotal knee arthroplasty is an effective treatment for osteoarthritis of the knee, patient satisfactionis correlated with post-operative WOMAC function and overall scores, and SF-36 physicalcomponent. It is important to keep patients expectations in check through proper counseling.
CATARACT DISEASE;
Authors: Saleem Shahan , Azeemi Muhammad Saleem , Abdullah Rehan
Published: August 2021

Introduction: Cataract is one of the reversible cause of decreased vision orcataract. Its highest incidence can be seen among senile and diabetics. Patients present inOpthalmology OPD with the cataract or with one of the complications of cataract. Objectives:To study the awareness of cataract disease, knowledge of risk factors and major barrierswhich result in the delayed presentation. Study Design: Cross sectional study. Setting: Itwas conducted in ophthalmology OPD. Duration: January 2017 to March 2017 (3 months).Materials & Methods: About 100 patients were selected by nonrandom purposive sampling.They were given questionnaires or direct questions were asked to fill the questionnaires.Results: 69% were males and 31% were females with age groups ranging from 35 to 95 yearsof age. Mean age was 60.90 with an SD of 11.28. About 74% of the patients were having alow educational level. For 71% of the patients, ophthalmologist was the source of informationabout his/her ailment. 57% of the people know about the nature of their disease. Regardingthe delay in presentation (36%) presented in less than 3 months after they first noticed blurringof vision. About 20% patient presented after a period of 1 year after feeling of low vision. 59%of patients knew that cataract incidence increases with age. 72% of patients knew that visioncan be restored after cataract surgery. Knowledge about the improvement of the eye conditionby microsurgery was 66%. Knowledge about the complications of cataract was estimated todecreased vision (61%), blindness (23%), pain (9%), cosmetic problems (2%), others (5%).Reasons for delay include waiting for cataract to mature (53%), financial problems (13%), toofar no people to accompany (12%), no time ( 10%), afraid (6%), don’t want to operate (4%),no reason (2%). Knowledge about the risk factors was estimated to be as diabetes (67%),hypertension (23%), others NOS (10%). Conclusion: There is a lack of awareness about thecataract disease, its complications and risk factors which result in the late presentation of thecataract patients. Patients, as well as general public, need to be educated by various means toprevent the complications of cataract and blindness.
RENAL DYSFUNCTION;
Authors: Ijaz Ayesha , Ijaz Asna , Saad Abubakr Ali , Zafar Salman , Safdar Sohail , Rafique Shoaib
Published: August 2021

Objectives: To determine the frequency of renal dysfunction in patients withacute coronary syndrome at a tertiary care hospital. Study design: Descriptive Cross-sectionalstudy. Setting: Department of Cardiology, Nishtar Hospital Multan. Duration of study: Sixmonths from November 2016 to May 2017. Subjects and Methods: Consecutive 285 patientswho met inclusion criteria of our study were enrolled from department of Cardiology, NishtarHospital Multan. History was taken and relevant investigations were done. Computer basedformula for MDRD eGFR was used to calculate eGFR in our patients. All these findings wereentered in pre-designed, pre – tested study questionnaire. Data was entered and analyzed usingcomputer based software SPSS version 20. All the quantitative variables of the study (suchas age, serum creatinine level, GFR value) were calculated for mean and standard deviation.Frequencies and percentages were calculated for categorical variables like gender, residentialarea, socioeconomic status, level of education, H/O diabetes, H/O hypertension, H/O smokingand family history of IHD etc. Results: We studied 285 patients of acute coronary syndromeadmitted in Cardiology department of Nishtar Hospital Multan, 210 (73.7%) were male and 75(26.3%) female. One hundred eighty (63.2%) were from rural area and 105 (36.8%) were urban.One hundred thirty two (46.3%) were from low income group, 144 (50.5%) from middle incomeand 9 (3.2%) were from high income group. Two hundred four (71.6%) patients presented withchest pain and 72 (25.3%) presented with chest pain and shortness of breath. One hundredeight (37.9%) were hypertensive, 63 (32.6%) were diabetic, 135 (47.4%) were smokers andfamily history of IHD was present in 102 (35.8%) of the cases. eGFR was calculated by MDRDeGFR formula. eGFR was less than 30 ml/min/1.73 m2 in 30 (10.5%) of the cases, 31-60 ml/min/1.73 m2 in 66 (23.2%) cases and eGFR was more than 60 ml/min/1.73 m2 in 189 (66.3%) ofthe cases. Conclusion: The present study reveals that the substantial proportion of our studypatients have underlying renal dysfunction. So eGFR estimation in ACS patients should begiven due consideration. This will help in the management of these patients and may improveshort and long term disease outcome. Further follow up studies especially in terms of morbidityand mortality in this sub-group of patients are suggested.
HYPERTENSIVE PATIENTS;
Authors: Mobin Ahsan , Manzoor Imtiaz , Lal Jawahar , Kumar Darshan
Published: August 2021

Introduction: Hypertension along with impaired glucose tolerance hasadditive effect on the development of complications. Insulin resistance mediates accelerateddevelopment of hypertension related complications. Study Design: Cross-sectional study.Setting: Outpatient department of Dow university hospital. Period: 1st March 2017 to 31st March2017. Method: OGTT was performed in 120 non-diabetic hypertensive patients presenting.Results: Among 120 patients, 77 were males whereas females were 43. Impaired glucosetolerance was found in 30.8 % patients. 40.5% were males and 59.4% were females. Conclusion:Impaired glucose tolerance can lead to future development of vascular complications inhypertensive patients due to lipogenic effects of insulin.
DENGUE FEVER;
Authors: Fayyaz Ayesha , Fayyaz Zahra , Fatima Samina
Published: August 2021

Introduction: Dengue can indicate a diverse clinical spectrum. The intensity ofhepatic involvement in patients, with dengue infection varies from soft injury to severe injury bymeans of jaundice and liver cell failure. Even if liver is not a most important objective limb, liverinvolvement is a renowned aspect. Objectives: The objective of this study was to assess liverinvolvement in dengue patients upto 12 years of age. Study Design: The study was Prospectiveobservational. Place and Duration of Study: Study was conducted in children ward, PaediatricDepartment, Holy Family Hospital Rawalpindi from August 2014 to October 2015. Methods:Upto 12 years of age, all suspected dengue children patients were screened and solitaryserologically established cases by dengue IgM capture ELISA were incorporated in the studyafter taking written permission from the parents of the patients. Patients were categorizedaccording to GCP dengue guidelines into dengue fever (DF), dengue hemorrhagic fever (DHF)and dengue shock syndrome (DSS). Results: Among 146 children, 78 were in the group of DF,35 were in the group of DHF and 33 were in the group of DSS. Most children (70 %) were above5 years. Fever was the leading illness followed by body aches, hepatomegly, rashes, edema,headache, petechiae, hepatic tenderness, pain in abdomen, vomiting, mucosal bleed andjaundice. Children with DSS have more liver involvement. Hepatomegaly and thickening of gallbladder was maximum in children with DSS and can be an indication of severe illness. Serumbilirubin, serum albumin, liver enzymes like ALT, AST and ALP were considerably elevated inchildren with DSS as compare to other two groups. 32 patients out of 33 with DSS had liverinvolvement. Conclusion: Dengue fever has become a main health issues at the moment inPakistan. Hepatic association in dengue in children has high fatality rate and spectrum variesfrom jaundice to rise of liver enzymes.
SITAGLIPTIN;
Authors: Ahmed Zaheer , Fareed Hassan , Musharraf Muhammad Usman
Published: August 2021

The objective of this stidy is to compare the mean reduction of HbA1c in patientstaking sitagliptin insulin combination with insulin alone in patients of type II Diabetes mellitus.Study Design: Randomized control trial (RCT). Setting: Medicine Department, Allied Hospital,Faisalabad. Period: August 2013 to February 2014. Methodology: Patients of both genderswith ages between 18 and 60 years having uncontrolled type 2 diabetes mellitus with HbA1ctaking insulin were included in the study while Pregnant or lactating mothers, patients withchronic liver disease and patients with renal insufficiency (creatinine >3.0mg/dl) were excludedfrom study. Patients were randomly divided into two groups (A &B) using computer generatedrandom number table. Group A was given Sitagliptin 50mg per day and dose was increasedto 100mg per day after 2 weeks if fasting blood sugar was more than 110mg/dl or 2 hourspostprandial blood sugar more than 140mg/dl. Dose of insulin in group A remained same asbefore start of study. Group B was kept on same regimen of insulin they were already taking anddose remained same. HbA1c was done at start of study and after 24 weeks. Primary outcomemeasure was mean reduction in HbA1c levels at 24 weeks from baseline. Results: 60 patientswere included in the study. Mean age was 52.7+8.43 years. 36(60%) were male and 24(40%)were female. Mean HbA1c at baseline was 8.361+0.523% in Group A on Sitagliptin-insulincombination and 8.187+0.432% in group B on insulin alone. Mean HbA1c at 24 weeks was7.767+0.428% in group A on Sitagliptin-insulin combination and 7.69+0.407% in group B oninsulin alone.Independent sample t-test was applied to change in HbA1c in Group A and Bduring 24 weeks of treatment. Mean change in HbA1c after 24 weeks in Group A was 0.600+ 0.315 and 0.49+ 0.19 in Group B after 24 weeks treatment (p-value 0.002) which is highlysignificant. Paired sample t-test was applied to HbA1c at baseline and 24 weeks of treatmentin group A and group B. There was a significant change in both groups after 24 weeks oftreatment in both groups (p-value <0 .000) which is highly significant. Chi Square test wasapplied on efficacy in group A and B. 22(73.33%) patients in group A and 14(46.67%) patientsin group B which achieved significant reduction in HbA1c. 8(26.67%) patients in group A and16(53.33%) patients in group B failed to achieve significant reduction in HbA1c. (P-value <0.032). Conclusion: It has been concluded from this study that insulin and sitagliptin-insulincombination both significantly reduce HbA1c in type 2 diabetes mellitus. However addition ofsitagliptin to uncontrolled diabetic patients already taking insulin, is more effective than insulinfor glycemic control of patients with type 2 diabetes mellitus.