bluuebunny/crossref_metadata_2025 huggingface dataset:
Forma locativa + sintagma preposicional locativo: análise da fala culta nas duas variedades do português
Authors: Viegas Elaine Marques Thomé
Published: July 2019

O artigo trata da ocorrência de locativo à esquerda do sintagma preposicional locativo, em amostras de fala culta da cidade do Rio de Janeiro, nas décadas de 1970 e de 1990, com base nos pressupostos da sociolinguística variacionista laboviana (LABOV, 1972; 1994), para um estudo em tempo real de curta duração (tendência e painel). Fundamentada em generalizações intuitivas, a hipótese sugerida é a de que o uso do locativo está relacionado à presença de elemento morfológico [+defi nido] no sintagma preposicional. A análise variacionista aponta que o uso dos locativos parece estar prioritariamente relacionado a duas variáveis independentes: o tipo de termo locativo contido no sintagma preposicional e o tipo de preposição introdutora do sintagma preposicional locativo. Ao contrário do previsto na análise introspectiva, foram registradas ocorrências de sintagma preposicional locativo introduzido pela preposição a e antecedidas por locativo, além de locativo sem categoria morfológica junto à preposição. O estudo de tendência e de painel revela que a comunidade pode ser considerada instável e o indivíduo estável, admitindo a hipótese de uma mudança geracional. Também são recolhidos dados de falada cidade de Lisboa; todavia, não foi possível executar um estudo de painel devido à incompletude da amostra. As duas variedades da língua portuguesa são confrontadas apenas em termos percentuais. O fenômeno é pouco frequente em língua portuguesa e parece estar restrito à fala.
El cambio subjetivo en el “Poema del manicomio” de Carlos Oquendo de Amat
Authors: Davila Alex , Huamán Abad
Published: July 2019

The objective was to interpret the "Poem of the Asylum" by Carlos Oquendo de Amat from the perspective of discourse analysis. The investigation is located within the qualitative approach and as a method the hermeneutics was used, based on the description and the reflection. The interpretation technique was the discourse analysis in its textual, semiotic, enunciative and pragmatic dimensions. As a general result, it is shown that in the poem the subjective change of the lyrical subject is described, at the personal level of the subject.
El poema “En la Calle” de José Paniagua Núñez bajo el análisis del discurso
Authors: Ccari Irma , Catacora Guido
Published: July 2019

The objective of this paper was to analyze and interpret the poem "En la calle" by José Paniagua Núñez. The research method was hermeneutics and the technique was Discourse Analysis, for which the following dimensions were considered:  a) textual dimension, b) semiotic dimension, c) enunciative dimension and d) pragmatic dimension. "En la calle" is a linguistic construction that meets the criteria of textuality. At a semiotic level, "En la calle" implies that the street itself is an element that lives and feels along with the author the inevitable passage of time, evoking memories and sensations with which he projects his longing. At the enunciative level, Paniagua expresses himself in the first person, including the street itself, it is not an "I" but "we", while expressing feelings full of subjectivity and reflection. Finally, at the pragmatic level, the enunciator complies with transmitting ideas to the reader or listener with the intention of producing reflection.
La empatía personal en el poema “Soy el otro” de Boris Espezúa
Authors: Chambi Yefre , Centeno Paul
Published: July 2019

The purpose of this article was to identify personal empathy in the poem "Soy el otro" by Boris Espezúa. The method of study that was used was the hermeneutics based on the description and reflection of the text or discourse, for it is counted in the account of phenomenology, the contribution of structuralism and the study of signs. The study technique that was applied was the analysis of the poetic discourse oriented in the textual, enunciative, semiotic and pragmatic dimension. Therefore, this work concluded that there is a manifestation of personal empathy, since the lyrical subject is externalized by the ability to be sociable, to establish good interpersonal relationships and to know others.
Evaluación formativa en el marco del enfoque por competencias
Authors: Bizarro Wilfredo , Sucari Wilson , Quispe-Coaquira Angela
Published: July 2019

The objective of the article was to carry out a bibliographic review on the formative evaluation, given the problems observed in basic education, referring to the difficulties in the evaluation practice in the classroom, from the management of the concepts, the planning and the application of the same in the development of the teaching-learning process, this in the competences-centered approach to learning; answering the questions; what and how we understand formative evaluation, what is evaluated, what is evaluated, what is evaluated, when is evaluated, who evaluates and how it is evaluated. The methodology used was focused on qualitative documentary research. It is concluded that the individual and collective performance of the students who are coparticipants of their evaluation must be evaluated, this implies the feedback according to the evidences, thus generating a transformation of the evaluative practice in the improvement of the learning with autonomy and reflection.
GORBACHEV – YELTSIN – PUTIN: DISCUSSION AROUND MODELS OF POLITICAL REGIME. WHAT'S NEXT?
Authors: MEDVEDEV N.P. , SLIZOVSKIY D.E. , GLEBOV V.A.
Published: July 2019

The present and future of political development in Russia is not in last place on the agenda of a wide variety of ideological and political forces and the widebranched structure of the media at home and abroad. Objectively, the way the present and future of the Russian Federation and its political regime are seen and thought of, on the one hand, inflames passions, and on the other hand, obscures the essence of the ideological and political discussion and disputes on the issue. There is a need to better understand the issue, because neither the expert community nor the political scientists have a dominant and reasonable understanding of either the relations of the Russian sociopolitical movement, or political parties to a worthy ideology, to the preferred technologies of sociopolitical development in Russia, or political tasks for the state, political parties, leaders and Russian civil society. The most characteristic indicator of the unfavorable situation in the understanding of the future is the reaction to the demands of the society, political rivals or opposition forces to power, or the ruling elite, heterogeneous in its interests. The article does not present reflections of skeptics or optimists, but an attempt, based on the analysis of expert assessments of the current political discourse and the dynamics of the three models of political development of the country under Mikhail Gorbachev, B.N. Yeltsin and Vladimir Putin, to show the chronic inevitability that the future political system and political regime will repeat past historical events, episodes and actions. Let no one be surprised or impressed by the importance of the experience of radical political and historical changes that have been and are experienced by Russia and their dependence on our actions and beliefs.
APGAR Score of Neonates Born to Anemic Mothers versus Non-Anemic Mothers
Authors: Bano Tasleem , Nazar Bushra , Raza Tahir Muhammad
Published: July 2019

Objective: To determine the effect of maternal iron deficiency anemia on APGAR score of neonates at one minute.Patients and Methods: This cross-sectional study was conducted at Aziz Bhatti Shaheed Teaching Hospital Gujrat from January 2017 to November 2017. In total 380 patients (50% anemic and 50% non-anemic mothers) were included in study. Grouping into anemic and non-anemic groups was done, based on their hemoglobin level, MCV, MCH and ferritin levels. APGAR score at 1 minute was noted in neonates born to both groups. Data was analyzed using SPSS 20.0. Chi square test was applied to evaluate the difference of APGAR score.Results: Mean age in anemic was 27+4.6 years and in non-anemic 26+5.1 years. The mean hemoglobin among anemic was 8.9+2.1 g/dl and among non-anemic 12.3+1.2 g/dL. Mean MCV in non-anemic 85.7+3.8 fl, while among anemic was 62.4+4.1 fl Mean ferritin levels among anemic were 7.4+1.1 ng/ml. Neonates delivered by anemic mothers had mean APGAR score of 6.5+0.2 and those delivered to non-anemic had 8.7+0.5. The APGAR score of neonates delivered by anemic and non-anemic showed a significant difference (p-value 0.00). The relative risk of having low APGAR score of infant in anemic compared to non-anemic mothers was 29.00 (95% CI, 13.1798-63.8098) with p<0.0001.Conclusion: Maternal anemia is significantly associated with poor APGAR score in neonates.
Immunohistochemical Expression of Epidermal Growth Factor Receptor in Different Histopathological Grades of Muco-epidermoid Carcinoma of Salivary Glands
Authors: Niazi Zainab , Naiyar Hashmi Shoaib , Muneer Saadia
Published: July 2019

Objective: To determine the immunohistochemical expression of Epidermal Growth Factor Receptor (EGFR) in different histopathological grades of mucoepidermoid carcinoma (MEC) in salivary glands.Patients and Methods: This cross-sectional study was conducted from August 2015 to September 2016 at Armed Forces Institte of Patholgy Rawalpindi (AFIP), to determine the immunohistochemical expression of Epidermal Growth Factor Receptor (EGFR) in different histopathological grades of mucoepidermoid carcinoma (MEC) in salivary glands. Thirty cases of MEC were retrieved from record files along with their paraffin blocks at AFIP, Rawalpindi. New histological diagnosis was made on freshly prepared Hematoxylin and Eosins section followed by application and analysis by immunostaining. Chi-square test was used to find the effect of EGFR on different grades of MEC.Results: Out of 30 cases, 24 cases were positive for EGFR. In case of low-grade mucoepidermoid carcinoma, 8 cases were weak positive, whereas remaining six were negative. Out of eight cases of intermediate grade mucoepidermoid carcinoma, 3 were week positive, whereas remaining five are strong positive. In high grade mucoepidermoid out of eight cases seven were strong positive. P-value for EGFR was calculated as .036. EGFR expression increased with increase in grade of tumor.Conclusion: The expression of EGFR increased with increase in grade of tumor.Key words: EGFR, Mucoepidermoid carcinoma, Salivary Glands
Comparison of Ranson’s Score, BISAP, and CTSI in Predicting the Severity of Acute Pancreatitis
Authors: Sarfraz Janjua Saad , Zaman Fakhar , Qamar Tehmina
Published: July 2019

Objective: To use of Ranson’s, BISAP and CTSI scoring system in predicting the severity and outcomes of patients with acute pancreatitis.Patients and Methods: One hundred and six (106) patients of acute pancreatitis were studied prospectively. Data of patient’s baseline demographics, clinical and radiological investigation was collected. BISAP score was calculated by obtaining data within 24 hours of admission, while Ranson score was calculated at the time of admission and at 48 hours of admission. CTSI was based on findings from CT scan of selected patients. Severity of acute pancreatitis was defined in terms of ICU admission, development of associated complications and mortality.ResultsOut of 106 patients, 55.7% were females and 44.3% were male patients. Regarding complications of Acute Pancreatitis, 9 (8.5%) patients were admitted in ICU, complications occurred in 33 (31.1%) patients while mortality occurred in 9 (8.5%) patients. Out of 106 patients 11 patients had Ransons score greater than 3. 04(36.4%) patients required ICU admission, 07(63.6%) patients developed complications and mortality of 5(45.5%) patients occurred. Patients with Bisap score greater 03, 6 (26%) patients required ICU admission, 17 (74%) developed complications and mortality of 8(34.7%) patients occurred. 24 patients underwent CECT abdomen and 4 patients had modified CTSI score of 8 to 10 (severe AP) out of which 4(100%) patients required ICU admission, 4(100%) patients developed complications and mortality occurred in 4(100%) patients. Conclusion: BISAP score is a useful prognostic scoring system for predicting the severity of acute pancreatitis and can be a crucial aid in determining the group of patients that have a high chance of need for intensive care during the course of their illness and therefore need early resuscitation; especially in resource-limited developing countries.
Mandibular Third Molars and Lower Anterior Crowding: Comparison of Opinions of Oral-Maxillofacial Surgeons and Orthodontists
Authors: Azeem Muhammad , Mudassar Saleem Muhammad , Mehmood Qureshi Sana , Mehmood Arshad , Imran Khan Muhammad , Ahmed Awais
Published: July 2019

Objective: To compare the opinion of orthodontists and oral-maxillofacial surgeons on relation between erupting mandibular third molars and lower incisal crowding.Patients and Methods: This descriptive study involved 100 Pakistani clinicians (50 orthodontists, 50 oral-maxillofacial surgeons) to answer online questionnaire regarding their opinions on link between erupting Mandibular Third Molars along with their extraction opinion with reference to development and prevention of lower incisal crowding. Data was analyzed using SPSS version 21.0. Pearson's chi-square test was applied and statistical significance was defined at <=0.05.Results: Statistically insignificant differences were found between oral-maxillofacial surgeons and orthodontists regarding question of erupting mandibular third molars in causing lower incisal crowding. Similarly, statistically insignificant differences between oral-maxillofacial surgeons and orthodontists were found regarding question of recommending preventive extraction of mandibular third molars for developing lower incisal crowding.Conclusion: No opinion differences were observed between Pakistani oral surgeons and orthodontists, regarding the link of lower third molar as a cause of lower incisal crowding.
Efficacy/ Validity of Neck Dissection and Radiotherapy for Cervical Nodal Disease - Clinicopathological Analysis
Authors: Ahmad Umar Mumtaz , Ahmed Jawwad , Saqulain Ghulam
Published: July 2019

Objective: To analyze treated head and neck malignancies with reference to frequency of cervical metastases and frequency of nodal recurrence following neck dissection and/ or radiotherapy for cervical metastases.Patients and Methods: This observational prospective study was conducted at ENT Department, Pakistan Institute of Medical Sciences, Islamabad over a period of 16 months. Study population was comprised of 15 cases of either gender and any age, with treated head and neck primary who developed metastatic neck disease and were included through non-probability sampling technique. Patients with primary site recurrence or distant metastases were excluded from the study. They were treated with neck dissection, radiotherapy or both for neck disease and followed up for a 1 year. Clinical data including age, gender, site and histopathology of treated primary tumor, nodal involvement both clinical and histopathological, treatment and post treatment result were recorded. Data was collected, tabulated and analyzed using Microsoft excel worksheet.Results: Out of total 15 cases, 17% patients were with N1 disease, 33% patients with N2a disease, and 50% were with N2b disease. Total 3 (20%) patients received radiotherapy (2 being unfit for surgery and 1 due to refused consent) and 12 (80%) patients underwent surgery. Out of these 12, 3 underwent RND, 7 MRND and 2 SND. Total 20% (3) developed recurrence.Conclusion: Combination of RND or MRND and radiotherapy is highly effective in controlling neck disease in controlled primary tumors.
Leptin to Adiponectin ratio as Atherogenic Index in Ischemic Heart Disease Patients
Authors: Kashif Nisar Muhammad , Afaq Erum , Afaq Humera , Jaleel Anila , Zuberi Adnan
Published: July 2019

Objective: To determine plasma adiponectin and leptin levels in subjects with and without ischemic heart disease (IHD) and to find the correlation between leptin, adiponectin to the number of coronary vessels disease-using angiography.Patients and Methods: This is a cross-sectional study conducted Ziauddin University. 80 subjects were recruited who were undergoing angiography. Height, weight, Waist and hip circumference were measured. BMI and WHR were calculated accordingly. Venous blood was drawn to measure adiponectin and leptin using ELISA.Results: Leptin to adiponectin ratio (LA ratio) was significantly increased in three and two vessel disease compared with single vessel and non-significant groups.Conclusion: The study shows that adiponectin decreases and leptin increases in multivessel disease. LA ratio has been found to correlate well in two and more than two vessel disease.
Vitamin D Deficiency in Patients with Diabetic Peripheral Neuropathy
Authors: Khan Hameedullah , Rajar Ihsanullah , Rauf Memon Abdul , Naeem Nadeem
Published: July 2019

Objective: To determine the frequency of vitamin D deficiency in patients presenting with diabetic peripheral neuropathyPatients and Methods: This cross sectional study was carried out in Department of Medicine and Neurology Indus Medical College, Tando Muhammad khan. from March 2017 to August 2017. Total 74 cases of Diabetes Mellitus presenting with peripheral diabetic neuropathy were selected for the study. Evolution of degree of Neuropathy was based on TCSS score as: {no neuropathy: ≤5, severe: ≥12, moderate: 9-11 and mild: 6-8}. Vitamin D level was categorized as (deficiency (0-20 ng/ml), insufficiency (21-30 ng/ml) sufficiency (>30 ng/ml), excess (>50 ng/ml) and toxicity (>100 ng/ml). All the data was entered in SPSS.Results: Total 74 patients with diabetic neuropathy were studied. Vast majority of patients 36(48.6%) were found in age group 51-60 years, Majority were males 45(60.8%). Most of the cases 35(47.3%) were with 1-3 years duration of neuropathy. Majority of patients 42(56.8%) were found with Mild peripheral neuropathy. Vitamin-D deficiency was present in 2(43.2%) cases and insufficiency was observed in 27(36.5%) cases. No significant association was found between vitamin D deficiency and severity of neuropathy.Conclusion: Vitamin D deficiency was found (43.2%) in patients of diabetic peripheral neuropathy. Vitamin screening and intake of supplement is necessary, will help to decrease the complication of peripheral neuropathy in Diabetic cases. Key words: Diabetes, Peripheral neuropathy, Vitamin D
Seroprevalence of Rubella IgG in Pregnant Females
Authors: Rana Huda , Chaudhary Rijja , Alam Saeed , Mahjabeen Wajiha
Published: July 2019

Objective: To find out the seropositivity of IgG rubella in pregnant women in Pakistan, to assess the prevalence of infection and to estimate the requirement of vaccination.Patients and Methods: In this retrospective cross sectional study total 730 females who visited Salma Kafeel Fertility Clinic (Rawalpindi) for antenatal checkup were inducted. Their age range was 18-45 years. The study was carried out from 2011-2016. ELISA serological testing was used to check the seroprevalence of Rubella IgG.Results: In total the 730 subjects were included in the study and divided in four groups according to their ages. The results were as follows: group 1(18-20yrs) 100% positive, group 2 (21-30yrs) 90.5% positive, group 3 (31-40yrs) 93.5% positive and lastly group 4 (>40yrs) 95%positive. Overall 92.32 % seropositivity was seen while 7.70% were found at risk of developing infection.Conclusion: There is a high prevalence of Rubella in females of child bearing age in Pakistan. This is alarming as it can result in high risk of CRS in newborns and fetal death. Therefore, women planning to become pregnant, who do not have natural immunity to rubella should be vaccinated at least 4 weeks prior to conception.
Multiple Cranial Neuropathies Involvement in Varicella Zoster Virus Infections
Authors: Zaman Qamar
Published: July 2019

Unlike the children, Varicella Zoster Virus (VZV) rarely cause disseminated infection of the CNS except those who have immunocompromised state in the form of HIV infection or using immunosuppressents. However, it may cause focal root infection in the form of shingles and rarely as an involvement of the cranial nerves. Infection involving the multiple cranial nerves has been observed only in some case reports. It is usually a self-limiting disease however early diagnosis and timely treatment may help in quick recovery. We are reporting an interesting case of VZV infection having typical rash and multiple cranial neuropathies.Key Words: Immunocompromised, Meningoencephalitis, Postherpetic neuralgia, Radiculopathy, Rash
Comparison of Ciprofloxacin and Amoxicillin/Clavulanic Acid in the Treatment of Chronic Rhinosinusitis
Authors: Shahan Zaimal , Saqulain Ghulam , Ahmed Jawwad
Published: July 2019

Objective: To compare ciprofloxacin with amoxicillin/ clavulanic acid in the treatment of chronic rhinosinusitis (CRS) in terms of frequency of improvement in symptom score.Patients and Methods: This randomized control trial was conducted at Department of Otorhinolaryngology, Capital Hospital Islamabad, from March 2015 to March 2016. Study population included 190 cases of Chronic Rhino Sinusitis (CRS) of either gender, aged 18 to 50 years and excluding confounders, divided in two groups. Group A received Ciprofloxacin 500 mg BD and Group B received Amoxicillin/ clavulanic acid 625 mg TDS for 10 days. Symptom score was recorded at start of treatment and finally at 16th week. Data analysis was done by SPSS 17.0. Chi Square was used to compare improvement of two groups. P-value ≤ 0.05 was considered significant.
Structural Violence and Pakistan’s Health Situation
Authors: Ahmed Abdullah Muhammad
Published: July 2019

Structural violence was first defined by Johan Galtung as “A form of violence wherein some social structure or social institution may harm people by preventing them from meeting their basic needs”1 The concept has been studied extensively over the years and is considered as a major reason for strangled development in various resource limited settings around the world. The idea of structural violence implies that people in power fail to provide essential services for the people they are responsible for; this failure can be intentional or unintentional, nevertheless long-term effects influence the marginalized population adversely.2
Appraisal of National Response to Chronic Hepatitis in Pakistan
Authors: Fatima Asif Amimah
Published: July 2019

Chronic hepatitis has emerged as a grave health crisis in Pakistan that is becoming increasingly difficult to control. The national response in the public and private sector is lacking realism, direction and strategy. The aim of the present review was to analyze the efforts directed towards elimination of this menace, outline the challenges and make pragmatic recommendations. We searched PubMed, Google Scholar and Google web search for relevant indexed literature in English using the Mesh terms ‘Chronic Hepatitis’, ‘Pakistan’, ‘Hepatitis B’, ‘Hepatitis C’, ‘Hepatitis prevention’, ‘National hepatitis control’, etc. Rigorous efforts to improve the capacity of the primary healthcare establishments are pivotal to contain further spread of hepatitis B and C infections. Combating quackery, regulating the use of medical sharps and making affordable hepatitis treatment accessible to the masses should be the principal focus of the government. Healthcare delivery units should be equipped to render complete coverage of essential quality hepatitis services in order to curb this menace.
Commonly Occurring Bacteria in Diabetic Foot Infections and their Sensitivity to various Antibiotics
Authors: -ullah Muneeb , Saeed Abbasi Awais , Niaz Seemab , Mahjbeen Wajiha
Published: July 2019

Background: Diabetic foot infections are a common cause of morbidity in type 1 & 2 Diabetes mellitus. The selection of appropriate empirical treatment is thus essential while treating such patients. The main objective of this study was to find out most prevalent bacteria and their sensitivity to various antibiotics in patients with diabetic foot infections.Material and Methods: This cross-sectional study was conducted in the Department of Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from January 2017 to December 2017. A total 118 patients were included through consecutive sampling technique. Samples were collected in the form of swab, pus or tissue material and were cultured on blood agar and microorganisms were identified using standard microbiological methods. Antimicrobial sensitivity was also checked. StatisticalPackage for Social Sciences (SPSS) version 22 was used to analyze data.Results: Out of 118 patients, 72% (n=85) were males while 28% (n=33) were females. Cultures of 105 patients were positive and most common organisms isolated were S. aureus (32.4%; n=34), E. coli (17.1%; n=18), P. aeruginosa (14.3%; n=15), Polymicrobials (14.3%; n=15) and K. pneumoniae (7.6%; n=8). Antibiotics to which organisms were most sensitive included Piperacillin/Tazobactam (69.5%; n=73), Imipenem (55.2%; n=58), Amikacin (43.8%; n=46), Vancomycin (40%; n=42) and Levofloxacin (38.1%; n=40).Conclusion: Most common organisms causing diabetic foot infections in our study were S. aureus, E. coli, P. aeruginosa, Polymicrobial and Klebsiella. Overall most sensitive antibiotics to these organisms included Piperacillin/Tazobactam, Imipenem,Amikacin, Vancomycin and Levofloxacin.
Comparative Efficacy and Safety of Low Dose versus High Dose Isotretinoin in Severe Acne Vulgaris Patients
Authors: Syed Maria , Afaq Ahmed Syed
Published: July 2019

Background: Oral isotretinoin is the recommended treatment for acne vulgaris, a skin disease especially common in teenagers and adolescents. This study was designed to compare the efficacy and safety of low dose with high dose isotretinoin in severe acne vulgaris patients.Material and Methods: This randomized controlled trial included 110 patients with a clinical diagnosis of acne vulgaris. They were divided into two groups. Both groups were matched for age (mean 18.2±3.7 vs 17.6±3.2 years), weight (mean 58±10.2 vs 60.7±9.3 Kg), gender and disease duration (3±1.1 vs 3±1.0 years). Group A received low dose oral isotretinoin (20 mg/day) while group B received standard high dose regimen (1mg/kg/day). All patients were followed up for 16 weeks to assess efficacy (assessment of complete remission) and safety (mucocutaneous side effects). All calculations were performed using SPSS v. 16 with p value <0.05 considered as statistically significant.Results: There was no statistically significant difference in efficacy. However, significantly fewer mucocutaneous side effects were reported in group A (80%) as compared to group B (100%). This safety profile spectrum was observed across all pre-defined subsets i.e chielitis (78.1% vs 98.2%), dry skin (69.1% vs 92.7%), dry mouth (47.2% vs 72.7%) and facial rash (12.7% vs 30.9%).Conclusion: In patients with severe acne vulgaris, efficacy (complete remission) of low dose oral isotretinoin is almost equal to conventional high dose regimen but it is statistically superior in terms of safety (mucocutaneous side effects).
Distribution of Extended-spectrum β-lactamase and Metallo-β-lactamase-producing Pseudomonas aeruginosa in Tertiary Care Hospitals of Lahore, Pakistan
Authors: Aneela Syeda , Ul-Ain Noor- , Abrar Samyyia , Saeed Muhammad , Hussain Shahida , Hannan Abdul , Riaz Saba
Published: July 2019

Background: Pseudomonas aeruginosa (P. aeruginosa) is an important bacterial pathogen most frequently associated with nosocomial infections, especially in immuno-compromised patients. Early detection of these life threatening, β-lactamase producing bacteria is essential for infection control and to prevent their dissemination. The aim of our study was to detect the presence of Extended-Spectrum β-Lactamase (ESBL) and Metallo-β-Lactamase (MBL) strains of Pseudomonas aeruginosa.Material and Methods: Eighty-eight identified strains of P. aeruginosa were collected from Chughtai Laboratories, Combined Military Hospital and Children Hospital, Lahore. These strains were sub-cultured and after confirming the cultural characteristics by Gram staining and colony morphology, manual biochemical identification was done. Susceptibility to various antibiotics and production of extended-spectrum β-lactamases (ESBLs) and metallo-β-lactamases (MBLs) were determined using modified Kirby Bauer disk diffusion method, double disk synergy test, combined disk synergy test (CDST) and inhibitor-potentiated disk diffusion test (IPD) respectively.Results: Out of eighty-eight strains tested, three were ESBL producers (3.4%) and eleven strains (12.5%) were found to be resistant to carbapenems. Of these, eight were MBL producers (72.7%). All these β-lactamase producing strains (14 strains) were multidrug-resistant (MDR). Piperacillin and piperacillin/tazobactam proved to be the most effective antibiotics in both types of β-lactamase producing strains.Conclusion: Our study shows noticeable emergence of β-lactamases (ESBLs & MBLs) in P. aeruginosa. All of these strains were MDR. It reveals a correlation of these β-lactamases with multidrug resistant genes.
Use of Pregabalin as a Pre-Medication for Post-Operative pain in patients undergoing Laparoscopic Cholecystectomy
Authors: Hussain Tabish , Anwar Mir Asifa , Zahir Jawad , Minhas Pervaiz
Published: July 2019

Background: Postoperative pain creates complications by increasing circulating level of catecholamines and systemic vascular resistance, thus putting the patients on increased risks of having stroke and myocardial infarction. In addition, it increases hospital stay, causing burden over economic as well as healthcare infrastructure. The aim of this study was to determine the frequency of pain in the postoperative period while using Pregabalin as pre-medication among patients undergoing laparoscopic cholecystectomy.Material and Methods: The randomized control trail was conducted at Department of Anesthesiology, Holy Family hospital, Rawalpindi from 1st Sept 2015 to 28th Feb 2016 over a period of 6 months. A total of 200 patients undergoing laparoscopic cholecystectomy were randomly divided in group A and B by consecutive non-probability lottery method. Group A received 100 mg oral Pregabalin 1 hour before surgery and Group B were not given Pregabalin and were taken as controls. Post-operative pain was measured by visual analog scale (VAS) in terms of pain scores at 4 hours postoperatively after the arrival of patient in the post-anesthesia care unit (PACU). SPSS version 17.0 was used to analyze the data.Results: A total of 200 patients were included in the study. There were 100 patients in each group. Based on the visual analog pain scores, 9 patients were pain free in group A compared with none in group B. Similarly, there were 55 patients in group A, who reported a pain score of 1 whereas no patient in group B had a VAS score of 1. There were 29 patients in group A and only 3 patients in group B with VAS score of 2 (90.6% vs. 9.4%). For VAS score of 3, there were 6 patients in group A and 34 patients from group B (15% vs. 85%). For a VAS score of 4, there were 1 patient in group A and 61 patients in group B (1.6% vs. 98.4%). Two patients in group B experienced a VAS score of 5. All this data was significant with chi square p value of 0.0001.Conclusion: Oral Pregabalin administered prior to laparoscopic cholecystectomy was effective in reducing postoperative pain in the patients. Further studies are needed for post-operative evaluation of side effects, different dosing schedules at different time intervals for both rest and dynamic pain.
Comparison of Caralluma tuberculata with Metformin for Anti-Diabetic Activity: An Animal Study
Authors: Saleh Faisal Muhammad , Hayat Waqar , Inayat Asad , Sohaib Muhammad , Iqbal Waheed
Published: July 2019

Background: Caralluma tuberculata, is a wild herb, which grows in the hills of Balochistan and has been known to have medicinal and nutritional properties since antiquity. This experimental research was designed to study the hypoglycemic properties of Caralluma tuberculata and to compare them with Metformin.Material and Methods: This was a laboratory-based animal experimental study. It was conducted in the Pharmacology laboratory of Khyber Medical University, Peshawar from February 2016 to August 2016. Two types of extracts of Caralluma tuberculata [crude extract and carbon tetrachloride (CCl4) extract] were prepared and administered to normal and alloxan treated diabetic rabbits. To study anti-diabetic activity, eighty-four rabbits were divided into two main groups. Group I (Normal/Non-Diabetic Rabbits; n= 21) and Group II (Diabetic/Alloxanized Rabbits; n=63). Each group was further divided into sub-groups (7 rabbits in each). Effect of Caralluma tuberculata, Metformin and 2% gum tragacanth on blood glucose levels were checked at 0, 2, 4, 6, 8, 12 and 24 hours of drug administration. The extracts were given in capsule form and in cooking oil. Data analysis was done using SPSS version 16. For calculation and comparison of the hypoglycemic effects at various doses and different time intervals, analysis of variance (ANOVA) and Tukey’s post hoc test were applied.Results: The crude extract, 200mg/kg body weight of Caralluma tuberculata showed significant decrease (p<0.001) in mean blood glucose levels from 2-hour till12 hours. Whereas, highly significant reduction of blood glucose was seen from 2 hours after treatment till 24 hours, when carbon tetrachloride (CCl4) fraction of Caralluma (100mg/kg body weight) in capsule form was administered. Metformin 500mg/kg body weight was given to compare its effects with plant crude extract and it was found that metformin appeared to be less effective in comparison with Caralluma tuberculata.Conclusion: Caralluma tuberculata lowered the blood glucose level and turned out to be more significant in developing hypoglycemia when taken with cooking oil. More work is essential to provide stronger evidence for the use of this natural agent in the management of Diabetes Mellites.
Vitamin D Deficiency in HCV Antiviral Treatment Responders versus Non-Responders
Authors: M Arif Rana , Aman Khan Fahad , Khan Imran , Aslam Kataria Muzammil , Iqbal Jawed , Ahmed Mukhtar
Published: July 2019

Background: Hepatitis C virus (HCV) is a major cause of chronic liver disease (CLD). Pakistan has a high burden of infectious diseases, including HCV. Its prevalence varies according to geographic regions in the country from about 2·4% to 6·5%. The objective of the study was to compare the frequency of vitamin D deficiency in responders and non-responders of antiviral treatment for chronic hepatitis C.Material and Methods: This comparative cross-sectional study was conducted in Hepatitis Clinic, Jinnah hospital, Lahore from 20th May to 20th November 2013. After ethical approval, participants were selected by using purposive non-probability sampling, 52 responder patients i.e. who were labeled negative for HCV RNA by PCR after 12 weeks of antiviral treatment and 52 non-responder patients were included in this study. Data was collected by using pretested structured questionnaire. Vitamin D3 levels were measured by ELISA and a cut-off value of below 30ng/ml was labeled as Vitamin D deficiency. SPSS version 21 was used to analyze data with p value less than 0.05 taken as statistically significant.Results: Out of 104 patients (mean age 35±8.1 years), 61.5% were males and 38.5 % were females. There was a significant difference in frequency of vitamin D deficiency in treatment responder group when compared to non-responders (p = 0.016). Mean level of vitamin D was 21.8±10.8ng/ml in responders whereas it was 15.6±7.5 in non-responders with a statistically significant difference (p = 0.001).Conclusion: This study concludes that there is a significant vitamin D deficiency among treatment non-responders as compared to treatment responders in patients with chronic hepatitis C.
Primary Renal Squamous Cell Carcinoma: An Unusual Malignancy
Authors: Mushtaq Huma , Tariq Naima , Atif Tehreem , Alam Saeed , Ahmed Mumtaz
Published: July 2019

Malignancies of the upper urinary tract are rare, accounting for about 8% of all malignancies of the renal system, presenting mostly as urothelial carcinoma. Squamous cell carcinoma (SCC) arising from the upper urinary tract is even more rare, accounting for about 0.5% of all malignancies of the renal system and 10% of all renal pelvic tumors. There are very few case reports in the indexed literature regarding renal squamous cell carcinoma. Here we present a case of SCC arising from the lower pole of left kidney, in a 35-year-old male resident of Muzaffarabad, Azad Kashmir.
Sudden Maternal Death from Suspected Amniotic Fluid Embolism and a Dead Baby Delivered with Natal Teeth
Authors: Kamran Ali Faiza , Fatima Khidri Feriha , Ali Shahani Kamran , Shah Rafia
Published: July 2019

Amniotic fluid embolism (AFE) is a rare presentation in obstetric emergencies that carries great risk for the life of both mother and fetus. It is usually characterized by sudden cardiovascular collapse, respiratory distress and disseminated intravascular coagulation. Here we present a case of sudden death of a pregnant woman due to suspected AFE. We also present a rare finding of natal teeth in her deceased baby, which along with reported AFE in the mother, is an unlikely event in the medical literature.
Etiological Spectrum of Pregnancy-Related Acute Renal Failure among Females at a Tertiary Care Hospital
Authors: Muzaffar Hussain Syed Muhammad , Mahmood Nasir Khalid , Adil Inam Qazi , Mahmud Khan Khalid
Published: July 2019

Background: Acute renal failure in pregnancy can be induced by any of the disorders leading to renal failure in the general population, such as acute tubular necrosis due to infection, glomerulonephritis related to lupus, or drug toxicity. There are, however, pregnancy complications characteristic of each trimester that can result in renal failure. The objective of this study was to determine the frequency of various causes of pregnancy-related acute renal failure among females presenting to a tertiary care hospital.
Teratogenic Effect of Sodium Phenytoin on Limb Development in Chick Embryos is Time-Mediated as Evident by Stereomicroscope
Authors: Binte Shahab Syed Hamd , Yunus Khan M. , Shafi Minhas Ruqqia
Published: July 2019

Background: Women suffering from seizure-related illnesses are prescribed phenytoin during pregnancy if the benefits outweigh the risks. But the teratogenic effect of this drug on limb development needs exploration. This study was designed to investigate the time-mediated teratogenic effect of sodium phenytoin on limb development of chick embryos on days 04 and 09 of development using the stereomicroscope and at the time of hatching. Material and Methods: This randomized control trial comprised of two main groups of fertilized chicken eggs (Egyptian Fayoumi breed), control group A and experimental group B, each having 90 eggs. Each experimental egg was injected with sodium phenytoin (3.5 mg, teratogenic dose) just before incubation. Both the groups were divided into three subgroups each A1, A2, & A3/B1, B2 & B3. Stereomicroscope was used to observe the limb buds and cartilaginous elements in subgroups 1 and 2 on days 04 and 09 of development respectively. The embryos of subgroups 3 were assessed for gross limb deformities on hatching. Survival was noted in all the subgroups.Results: The difference in limb bud size between experimental and controls was statistically insignificant. There was no variation or deformity in the bones. The experimental group 3 had gross limb defects on hatching and the difference in survival was also statistically significant in subgroups 3.Conclusion: Prenatal administration of sodium phenytoin induces limb defects in chick embryos as evident after hatching but limb anomalies are not observed on days 04 and 09 of development as investigated by stereomicroscope. We conclude that the teratogenic effect of phenytoin is time-mediated.
Comparative Study of Conventional Electrocautery Versus Ultrasonic Dissector in Laparoscopic Cholecystectomy
Authors: Bin Anis Saad , Muneeb Rehman Pir , Ahmad Farhan , Farooq Umar
Published: July 2019

Background: Laparoscopic cholecystectomy (LC) is very commonly performed for removal of gallstones. In routine, ultrasonic devices are used for laparoscopy involving the deeper operating fields, while electrosurgical devices are preferred for LC. However, nowadays both of these devices are used for LC. The objective of this study was to compare the surgical outcomes of ultrasonic dissector over conventional electrocautery in patients planned for LC. Material and Methods: This non-randomized clinical trial was conducted in general surgery unit, Jinnah hospital Lahore. The study duration was 15th January 2015 to 31st December 2016. In group A (n=100), patients were operated through three-port standard laparoscopic cholecystectomy and conventional electrosurgical cautery was used for dissection. While in group B (n=50), patients were operated through single incision laparoscopic surgery (SILS) and Harmonic dissector was used for sealing of cystic artery and cystic duct. SPSS version 23 was used for data analysis. Complications between electrocautery and ultrasonic dissector were compared using chi-square test/Fischer exact test and operative time was compared using student’s t-test with p-value ≤ 0.05 considered as statistically significant.Results: Out of 150 patients planned for laparoscopic cholecystectomy, 33 (22%) were males and 117 (78%) females. The mean age was 40±6.45 years with an age range of 12-80 years. In group A, intraoperative gall bladder perforation was found in 5 patients whereas in group B, there was only one patient with perforation. A total of 4 cases were converted to open cholecystectomy in group A due to difficult dissection in Calot’s triangle as compared to 1 case in group B. In group A, 3 cases had postoperative bile leakage in the drain. In two patients it settled over a period of 3 days. About 03 cases had wound infection in group A and 1 in group B. Mean operative time in group A was 42.2±8.93 minutes versus 35.7±4.85 minutes in group B (p-value 0.001).Conclusion: In this study, the rate of post-operative complications was similar between the two groups, but operative time was significantly shorter in the group B. Harmonic dissector enabled easy dissection of tissues with good hemostasis and less trafficking of instrument, avoiding use of clips and sutures during minimal invasive surgery.
Effectiveness of Tympanic Thermometry for diagnosing Acute Otitis Media
Authors: Zubair Muhammad , Saqulain Ghulam , Jawaid Arfat
Published: July 2019

Background: Acute Otitis Media (AOM) is a common upper respiratory tract infection (URTI) in children and usually presents with fever and otalgia. AOM is characterized by congested tympanic membrane and possible increase in temperature, which might be picked up by infrared tympanic thermometry. The objective of this study was to compare the temperature difference of tympanic membrane of affected ear with the unaffected ear and axilla in unilateral acute otitis media, and compare it with the control group.Material and Methods: This case control study comprised of 200 cases of both genders, aged up to 5 years. They were divided into two groups; Group A included 100 clinically diagnosed cases of acute otitis media (AOM), who reported in the ENT Outpatient Department (OPD) and Group B included 100 controls who presented in General Filter Clinic with no ear complaints. Cases with chronic ear disease, ear discharge, and use of local drugs including ear drops, impacted ear wax, tragal tenderness and congenital malformations of the ear were excluded by taking a detailed history. Clinical examination including otoscopy by an expert was done before subjecting patients to axillary and tympanic thermometry measurements and data recording. Data was collected and tabulated using Microsoft Excel Worksheet and analyzed by SPSS 16. Qualitative data like gender were presented as percentage and ratio, while means and standard deviation were calculated for the quantitative data. Difference between the means of experimental and control groups were analyzed by independent sample t-test and P value of less than or equal to 0.05 was taken as significant.Results: This study included 100 cases of unilateral AOM and 100 normal controls without AOM. In patients with AOM, the mean temperature difference between the affected ear and axilla was 1.41ºF as compared to 0.075ºF in controls (p=0.026). While the mean temperature difference between the affected ear and other ear was 0.65ºF as compared to 0.19ºF in controls (p=0.069).Conclusion: In acute otitis media, the temperature of affected ear is significantly higher than axilla but was not significantly higher than the other ear. The finding may help establish thermometry as a diagnostic tool in clinics manned by doctors not competent to do otoscopy.
Pattern of Angulations and Common Indications for Extraction of Impacted Mandibular Third Molar at KMU-Institute of Dental Sciences, Kohat
Authors: Sardar Tariq , Sheikh Gulrukh , Aslam Saddique , Muhammad Khan Numan , Akhtar Rana Javed
Published: July 2019

Background: The extraction of an impacted mandibular third molar (MTM), with associated pathologies or clinical manifestations is an important and one of the most frequent decisions in dentistry. The angle formed by the longitudinal axis of second and third molar is used to determine angulation of impacted MTM. The aim of this study was to identify the pattern of angulations of impacted mandibular third molar and common indications for extraction associated with these angulations.Material and Methods: This descriptive cross-sectional study was carried out at Department of Oral & Maxillofacial Surgery, Khyber Medical University Institute of Dental Sciences, Kohat, Khyber Pakhtunkhwa (KP) from November 2017 to July 2018. A total of 349 patients presenting with impacted mandibular third molars were included in this study. Name, age, gender, address, the angulation of the impacted tooth and the indication for extraction of the impacted tooth were recorded. Data comprising of qualitative and quantitative variables were analyzed using SPSS version 17.Results: Out of 349 patients, 206 were male and 143 females, with the male to female ratio of 1.4:1. The age range of the patients was from 18 years to 60 years with a mean age of 26 ± 6 years. The most common age group with impacted third molar was ≤ 25 years followed by 26 to 30 years’ age group. The most common angulation was mesioangular followed by vertical, horizontal and distoangular impacted mandibular third molar. Pericoronitis was the most common indication for extraction in all angulations except horizontal impaction where root resorption of the second molar was more common.Conclusion: Mesioangular is the most common angulation in impacted mandibular third molars. Pericoronitis is the main indication for all angulations of impacted mandibular third molars except horizontal angulation, occurring mostly in the third decade of life.
PENERAPAN ASPEK KESEJAHTERAAN PSIKOLOGIS DAN PEMAAFAN DALAM MEMBENTUK KESEHATAN MENTAL
Authors: Rahmah Hardiyanti
Published: July 2019

Kesehatan mental merupakan salah satu kunci untuk menjalani hidup dengan lebih produktif. Terutama pada individu yang memiliki risiko terkena gangguan mental, maka pelayanan kesehatan mental sangat diperlukan untuk meningkatkan kesejahteraan psikologis dan pemaafan pada diri mereka. Peneliti menggunakan studi literatur dalam metode penelitian ini. Studi literatur ini berfokus untuk membahas aspek-aspek kesejahteraan psikologis dan pemaafan dalam membentuk kesehatan mental yang positif. Hasil pembahasan pada studi literatur ini dianalisis dari beberapa jurnal dan buku teks yang berkaitan dengan variabel kesejahteraan psikologis, pemaafan dan kesehatan mental yang saling berkaitan satu sama lain.