bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Toxicity and Side Effects of Systemic Therapy for Renal Cell Carcinoma
Authors: Young Kate , Schmitt Andreas M. , Mukherji Deborah , Spain Lavinia , Schmidinger Manuela , Pickering Lisa M.
Published: October 2023

Standard approved systemic treatment options for the management of renal cancer have entirely transformed in the last 15 years and now comprise molecularly targeted therapies against the vascular endothelial growth factor receptor (VEGFR) and the mammalian target of rapamycin (mTOR) as well as immune checkpoint inhibitors. These agents may be used alone as monotherapies but increasingly are used in various combinations. The associated important improvements in cancer control and survival have therefore been accompanied by a range of new toxicities. Good management of these toxicities is important for patient safety and quality of life, and also to optimize patients’ opportunity to continue with and therefore benefit from these therapies. The most common toxicities associated with VEGFR tyrosine kinase inhibitors are fatigue, skin rashes, gastrointestinal, stomatitis, hypertension and other cardiovascular toxicities, and hematological and endocrine dysfunction. Common side effects of mTOR inhibitors include asthenia, stomatitis, skin rashes, pneumonitis, metabolic changes and infections. Checkpoint inhibitors can lead to toxicities of any organ system with those seen most frequently including dermatologic, gastrointestinal and hepatic, endocrine, musculoskeletal, and pulmonary, whilst renal, hematological, ophthalmic, cardiac and neurological toxicities are seen less often. In general terms, toxicity management should start preemptively with patient education and may also include a combination of supportive approaches, dose reduction, schedule alteration, treatment interruption and occasionally treatment cessation. Treatment of individual toxicities is dependent on the likely causative agent and is guided by its grade or severity. Specific recommendations for management are discussed in this chapter.
Hybrid Ureteroenteric Anastomosis Is Associated With Lower Stricture Rates in Ileal Conduit Urinary Diversion
Authors: Alhamdani Zein , Quin Kirby R. , Chinni Vidyasagar , Donellan Scott , Bolton Damien , Perera Marlon , Woon Dixon
Published: October 2023

BackgroundAnatomic complications of the ureteroenteric anastomosis in ileal conduit (IC) cause significant morbidity in patients post-cystectomy and cystoprostatectomy. The Bricker technique has a perceived disadvantage of increased risk for stricture, whereas the Wallace technique runs the risk for ureteral malignancy affecting both ureteric ends, and bilateral ureteric obstruction from a stone lodged at the anastomosis. We aimed to evaluate the safety, efficacy, and stricture rate of a novel hybrid ureteroenteric anastomosis technique. We compared these outcomes to the Bricker and Wallace anastomosis techniques for IC urinary diversion (ICUD).MethodsWe performed a retrospective chart review of patients who had undergone ICUD after cystectomy for bladder cancer from 2011 to 2016. Patients were categorized into groups undergoing the Bricker, Wallace, and hybrid ureteroanastomosic techniques. Strictures were identified during clinical follow-up or hospital presentations with complications.ResultsWe identified 68 patients suitable for inclusion. They were separated by Bricker, Wallace, and hybrid anastomosis techniques, with 19 (27.9%), 20 (29.4%), and 29 (42.6%) patients, respectively. Ureteroenteric anastomotic strictures occurred in 9 patients (5 Bricker, 3 Wallace, 1 hybrid). This difference in stricture rates for Bricker versus hybrid (26.3% vs. 3.4%; OR, 10 [95% CI, 1.1 to 121.1]; P = 0.02) was significant but was comparable for Wallace versus hybrid (15.0% vs. 3.4%; OR, 4.9 [0.7 to 66.0]; P = 0.15) and for Bricker versus Wallace (26.3% vs. 15.0%; OR, 2 [0.4 to 8.6]; P = 0.87). 15 patients (51%) in the hybrid group required oral antibiotics for a symptomatic urinary tract infection compared with 4 (21%) with Bricker and 8 (40%) with Wallace (P = 0.10). Median post-cystectomy follow-up and stricture formation time were 16 months (IQR, 4–36) and 9 months (7–32), respectively.ConclusionThe hybrid technique is a safe and efficacious alternative to the Bricker and Wallace anastomoses. It carries with it a risk for urinary tract infection that is eclipsed by substantially lowered rates of ureteric strictures requiring intervention while maintaining the advantage of separating the two ureters.
Disparities in Access to Virtual Care for Urinary Tract Infections During the COVID-19 Era
Authors: De-Witt-Foy Molly E. , Albersheim Jacob A. , Grove Shawn T. , Hamid Lina , Berryman Sally , Elliott Sean P.
Published: October 2023

Objective To characterize the difference in uptake of virtual care for urinary tract infections (UTIs) by demographic variables in the COVID-19 era. Methods We conducted a retrospective review of outpatient encounters for UTIs across a large health care system. The cohort was defined as patients with an encounter diagnosis of UTI via in-person or virtual care (telephone or technology-supported care), between March 1, 2020, and February 28, 2021. Analysis was limited to the first UTI encounter of the year for each patient. We compared the use of in-person and virtual visits by demographic variables using chi-square tests and multivariate logistic regression. Results A total of 6744 patients, with a mean age of 61 years, were seen for UTI during the study period. The majority of patients were White (85.5%) and female (83.7%), and were seen in person (55.9%). Of those seen virtually, 52.0% participated in telephone-only visits, and 47.9% were seen via technology-supported care, using video or chatbased platforms. On multivariate logistic regression, age under 30, lowest-quartile income, male sex, and a primary language other than English increased the odds that patients had been seen in person. Among those seen virtually, age over 50 significantly increased the odds of a telephone visit, as did being Black or Native American, having a lower-quartile income, and speaking a non-English primary language. Conclusions Although the expansion in virtual care has given some patients easier access to necessary care, the “digital divide” has worsened existing disparities for certain vulnerable populations. We demonstrate a difference in uptake of virtual health care by age, race, primary language, and income.
Trends Towards Sub-Specialization in Urology: What About Morocco?
Authors: El Anzaoui Jihad , Ammani Abdelghani , El Ammari Jalal Eddine , Farih My Hassan
Published: October 2023

None.
The Prostate Problem You Can’t Put Your Finger on the Normal Way: A Case of Perineal Prostate Cancer Post Transperineal Prostate Biopsy
Authors: Zhuo Kevin Yinkit , Kovacic James , Chung Amanda , Eade Thomas , Chalasani Venu
Published: October 2023

None.
Assessment of Epidemiology Courses in Health Management Undergraduate Education in Turkey
Authors: EREN Berna
Published: October 2023

Abstract

Objective: In today’s ever-changing health sector, health managers need to focus on promoting the health of populations, therefore they need a specialized understanding of epidemiology, as a necessary requirement for population-based management. Epidemiology is acknowledged as an important component of health management undergraduate education, which provides the knowledge and skills that health managers use in their efforts to promote quality of health. This cross-sectional descriptive study aims to assess the extent to which epidemiology is conducted in health management undergraduate programs in Turkey.

Material and Method: The current curricula of 75 health management undergraduate programs, listed on the Program Atlas of the Higher Education Council, are reviewed through universities' Information Package for National Qualifications Framework for Higher Education to profile the characteristics of epidemiology courses. Descriptive statistics was expressed as mean±standard deviation for continuous variables, frequency and percentage values were used for categorical variables.

Findings: A total of 60 (80.0%) programs have epidemiology in their curricula, yet the characteristics of these courses, such as their core/elective status, the semesters they are conducted, the weekly contact hours and ECTS credits, and the topics covered in the syllabus vary across programs.

Conclusion: The findings of this study reveal that there are variations regarding how epidemiology courses are conducted across health management undergraduate programs in Turkey. Apparently this poses a challenge against all efforts to ensure the uniformity of the minimum core competencies among all health management program graduates; and although the Health Management National Core Education Program has been a great starting point towards standardization, there are further steps to be taken to improve the health management undergraduate curricula in Turkey.
El impacto de la Inteligencia Artificial en la mejora de la atención al cliente: Una revisión sistémica
Authors: Rojas Ahumada Kenner Alexander , López Zavaleta Verónica , Mendoza de los Santos Alberto Carlos
Published: October 2023

La Inteligencia Artificial (IA) está ganando una importancia creciente en el sector del servicio al cliente, permitiendo automatizar procesos y mejorar la eficacia de las interacciones con los clientes. Esta revisión sistemática tiene como objetivo explorar de cómo se está utilizando la IA en el servicio de atención al cliente, identificar las limitaciones y ventajas de la implementación de la IA y analizar cómo influyen en la satisfacción del cliente, la recolección de literatura y selección se utilizó las pautas de la metodología PRISMA. A medida que la IA se ha convertido en una tecnología cada vez más relevante en el ámbito del servicio al cliente, es esencial examinar de manera sistemática su influencia en este contexto específico. Se encontró en que sectores se está utilizando más la IA en la atención al cliente y se presentarán las perspectivas futuras de esta tecnología en el servicio al cliente. Se pudo concluir que los chatbots son una de las aplicaciones más utilizadas en la atención al cliente para brindar respuestas rápidas y efectivas a las consultas de los usuarios. Sin embargo, es importante considerar los beneficios y limitaciones de esta tecnología, así como la importancia de la interacción humana en la satisfacción del cliente.
Clasificación de categorías de noticias usando BERT
Authors: Machado Medina Bradlhy Luis , Santillana Quirita César Alonso , Bautista Luque Sharmelyn Violeta
Published: October 2023

El presente proyecto consiste en desarrollar un modelo de Procesamiento del Lenguaje Natural para clasificar noticias utilizando un conjunto de datos o DataSets ya evaluados. El objetivo principal es crear un sistema que pueda identificar y asignar automáticamente las noticias a una de las categorías predefinidas: negocios, entretenimiento, política, deportes o tecnología. Esto implica el preprocesamiento de datos, extracción de características, entrenamiento de un modelo de machine learning y posteriormente su evaluación de rendimiento utilizando métricas como” precisión”,” recall 2” F1 − score”. Esto permitir ‘a determinar que tan bien el modelo puede predecir la categoría correcta para una noticia nueva o no etiquetada. Si el rendimiento del modelo es satisfactorio, se puede utilizar para clasificar noticias no etiquetadas en tiempo real. En resumen, se busca proporcionar una solución eficiente y precisa para organizar y etiquetar el contenido informativo de una noticia con ayuda de la Inteligencia Artificial.
Hackathon in Differentiated English for Specific Purposes Instruction of Information Technology Students
Authors: Synekop Oksana
Published: October 2023

The current study aims to check the effectiveness of differentiated ESP instruction using the hackathon. This study used the mixed research method. The participants of the study were 24 Information Technology (IT) students of the Physics and Technology Institute of National Technical University of Ukraine “Igor Sikorsky Kyiv Polytechnic Institute” who voluntarily took part in the study in 2022-2023. They were divided into two experimental groups and differentiated according to the social roles and the level of English language proficiency. Sensory, interactive and graphic scaffolding as the temporary assistance was integrated in the educational process. As shown by the results of the experimental learning, the second group, where the IT students performed auxiliary roles and the duration of scaffolding use was defined by both students and teachers, demonstrated significantly better results than the first group, where the IT students performed auxiliary roles and the duration of scaffolding use was defined by IT students only. Scaffolding should be regulated by both the teacher and the students. It was concluded that the use of hackathon with a focus on learners’ differentiation helps to diversify ESP learning at technical university and facilitates the development of professional communicative skills (speaking and writing) as well as other soft and hard skills.
Taphonomic analysis of Spinicaudata from two Triassic lacustrine systems affected by different volcanic processes
Authors: Bustos-Escalona Evelyn Luz , Mancuso Adriana Cecilia , Benavente Cecilia Andrea , Arcucci Andrea Beatriz
Published: October 2023

Spinicaudata are freshwater branchiopods. The growth and development of spinicaudata populations in freshwater environments depend on various physical, chemical, and biological factors. The action of volcanism modifies the limnological parameters in the process of fossilization of lacustrine deposits. This study identifies spinicaudatan assemblages in two Triassic lake systems in Argentina, and analyzes the dynamics of shell preservation according to the volcanic activity involved. Two taphonomic grades divided into three different second taphonomic grades were defined. The focus on taphonomic and chemistry studies addresses changes in spinicaudata abundance and richness through time, in different paleoenvironmental conditions, and shell preservation and chemical composition. The discussion highlights the importance of lava flow inflow and volcanic ash fall in the different lake systems. We emphasize the importance of taphonomic studies on the spinicaudata groups to understand their autochthonous and allochthonous populations in Triassic lake systems. In turn, we conclude that the post mortem processes experienced by the shells, the exposure time at the water-sediment interface, and the chemical alteration of the water into the paleolakes produced by the surrounding volcanic activity can explain the development and preservation of spinicaudata in these two Triassic lacustrine systems.
Review of bomb and ash flows: Genesis and case studies of a subset of block and ash flow deposits
Authors: Alvarado Guillermo E. , Toulkeridis Theofilos , Miyabuchi Yasuo , Pérez Wendy
Published: October 2023

Pyroclastic density currents with an abundance of cauliflower-shaped bombs are an uncommon type of deposit, called bomb and ash flow (BoAF) deposits in several papers. Although they are similar to block and ash flow (BAF) deposits (e.g., rich in juvenile blocks and breadcrusted bombs), they are often related to eruptions of mafic to intermediate magmas. In the current study, we analyze and compare historical and prehistorical BoAF-generating eruptions at Asama and Aso (Japan), Mayon (Philippines), Mt. Spurr (United States), Fuego (Guatemala), Arenal (Costa Rica), Cotopaxi and Tungurahua (Ecuador), and Láscar and Tilocálar volcanoes (Chile). Our review indicates that BoAFs show a substantial contribution of juvenile rounded material but with different rheologies and fragmentation mechanisms. This juvenile material is typically basaltic or andesitic, as it is more susceptible to form volcanic bombs with scoriaceous cauliflower textures. Thus, BoAFs could be a subset of the BAF deposits. The study and recognition of this type of deposit in volcanic sequences could be misinterpreted as a ballistic bomb deposit or even a hot bomb-rich lahar deposit, therefore, its appropriate interpretation is fundamental for volcanic hazard assessment.
Video Game Characters and Transmedia Storytelling
Authors: Blom Joleen
Published: October 2023

Characters are a vital aspect of today’s transmedia practices. Combining theories on fictional persons from Japanese and Euro-American practices, this book discusses video game characters embedded in our popular media culture in which they are constantly produced and re-imagined.

This book introduces the dynamic game character, a type of game character with a development structure that consists of multiple outcomes in a game. Through their actions and choices, players can influence these game characters’ identities and affect their possible destinies.

Games subvert the idea that fictional persons must maintain a coherent identity. This book shows that dynamic game characters challenge strategies of top-down control through close readings of the Mass Effect series, Persona 5, Hades, Animal Crossing: New Horizons and more. It is directed to all scholars interested in the topics of transmedia storytelling, video games, characters, and Japanese narratology.
How the dynamic game character develops
Authors: Blom Joleen
Published: October 2023

This chapter explains how dynamic game characters structurally develop in video games. First, I explain that dynamic game characters have a development structure with multiple outcomes that the player can activate, because a game is a cybermedium, which has the potential to change depending on how one plays. In the second part, I describe the different requirements for a game character to be considered dynamic. The final part focuses on the three types of dynamic game characters over which players have creative agency: as ludic agents, as narrative agents, and as performative agents. These agents develop predominantly as game pieces, through the game’s story, or through pre-coded scripts respectively.
Parasocial relationships with nonplayable characters
Authors: Blom Joleen
Published: October 2023

This chapter discusses the system of affection (SA), a bonding system designed so that players can create parasocial relationships with non-player characters (NPCs) acknowledged by the game. The first part of this chapter presents an overview of the common design elements of the SA to facilitate these relationships. The second part of this chapter provides two close readings to highlight how the SA works. I will show through an analysis of Persona 5 how affectionate bonds between the player character and NPCs are built and how this is reflected in the official transmedia adaptations of the game. An investigation of Hades will demonstrate how dynamic game characters can allow for a diversity of romantic queer and polyamorous relationships.
The future of dynamic game characters
Authors: Blom Joleen
Published: October 2023

This chapter reflects on the need to study fictional characters in the current transmedia landscape. As this landscape sees an increase in affective economics within transmedia franchises, dynamic game characters shape consumer desires and influence their purchasing decisions since these characters promise users creative agency. In this chapter, I will therefore chart my vision of how dynamic game characters will be depicted in the upcoming transmedia landscape.
Going Beyond Montagu
Authors: Andrea Bernadette
Published: October 2023

This chapter shifts attention from Lady Mary Wortley Montagu as a singular traveler to a network of women from diverse class, ethnic, racial, and religious backgrounds to complicate and enrich our view of the bilateral movement of early modern women between the British Isles and the Islamic empires of the era. Despite her representation as sui generis, Montagu did not travel alone nor was she the only woman on the “Turkish embassy. The documentary, literary, and visual record suggests she brought female servants from Britain and acquired more servants (and perhaps bought slaves) while in the Ottoman Empire. Rather than looking outwards to the elite Ottoman women Montagu idealizes, this chapter turns to these lower-status women (British and Ottoman) whose lives register as traces in the sources on this embassy.
The “Queen of Algiers”
Authors: Baskins Cristelle
Published: October 2023

This chapter reconstructs the travels of two marginalized, Cypriot Greeks, the young Anna and her mother Angela. In the wake of Lepanto in 1571, they were trafficked as captives across the Mediterranean; in Algiers, they became the renegade wives of Muslim men. In 1587, they reclaimed control of their fates, negotiating a dangerous and expensive return to Christendom for themselves, Angela’s renegade husband, two children, and nine black slaves. Accounts both factual and fictional celebrated the refugees and their protectors, Sixtus V and the Roman confraternity that sponsored their rescue. These captives turned catechumens navigated the networks of papal Rome with the aid of Camilla Peretti and Giulia Orsini, both active in church reform and women’s welfare. Yet, their social capital eroded with the pope’s demise in 1590.
An Exotic Migrant , Despina Basaraba Networks a New Life in Papal Rome circa 1600
Authors: Cohen Elizabeth S.
Published: October 2023

A well-born, but orphaned, young Greek woman from Constantinople, Despina Basaraba, migrated to Rome in 1598 with her French renegade husband and their three-year old son. With some social capital, but limited material resources and few contacts in the very foreign city, Despina, with her family, set about networking to build a new life. She cultivated ties with women of modest and higher social ranks and won the official patronage of the pope and the personal charity of his household steward. A trial record of Despina’s prosecution five years later for presumption of adultery lets us reconstruct in rare detail everyday connections, special alliances, and the occasional use of writing in face-to-face relationships. The story documents her gendered vulnerabilities, but also her resilient social agency.
“Wall Neighbors,” Mothers-in-Law, and Comadres
Authors: Holler Jacqueline
Published: October 2023

Studying practices of plebeian female solidarity in early colonial New Spain (1550–1670), this chapter argues that women’s networks were central to contesting masculine violence in a context where neither ecclesiastical nor civil law could effectively combat it. Using petitions for ecclesiastical divorce and Inquisition records involving magic, the chapter further contends that masculine violence itself provided an impetus and a catalyst for the formation of female networks of affective solidarity, support, and the exchange of legal and magical information.
Assessment of Vitamin D3 Level Among a Sample of Type 2 Diabetic Patients Attending Diabetes and Endocrinology Center in Al-Hilla City
Authors: Ahmed Mahdi Habeeb  , Atta Ah Mousa Al-Sarray  , Ali Hussein Al Hafidh  , Rafah Sabah Barrak  , Afraa Brahim
Published: October 2023

Vitamin D is found in foods in two primary forms: cholecalciferol (vitamin D3) and ergocalciferol (vitamin D2), with vitamin D3 being a fat-soluble vitamin.  that is necessary for calcium homeostasis and the maintenance of proper function in a variety of tissues. Humans get vitamin D from their diets or from being exposed to ultraviolet B radiation from the sun. Aside from its well-known effects on bone health, vitamin D has been hypothesized to play a role in various disease states and health situations, such as cardiovascular disease and type 2 diabetes. To assess vitamin D3 concentration in patients with type 2 diabetes, using the Vitamin D Total III kit on the Cobas E 411 device. A total of 300 people were recruited, with 150 people suffering from type 2 diabetes serving as cases and 150 healthy volunteers of the same gender and age being used as the control group. Both genders were represented, with an age group between 30 – 79 years. The collection of data lasts for five months, beginning Started in November 2022 to April 2023. The data was analyzed with the readily available statistical package SPSS-28, and Chi-square tests were used to evaluate the relationship among vitamin D, T2DM, and control. Data were provided in simple frequency, percentage, mean, standard deviation, and range measures. Type 2 diabetes patients' mean ± SD ages were 55.4 ± 10.1, while controls had a mean ± SD of age of 55.3 ± 10.0. the sociodemographic features of T2DM and participant control. Shows A statistically significant association was found in the variables of age groups, school level (P = 0.0001), and marital status (P = 0.008). The BMI: mean ± SD (29.69 ± 5.14) of T2DM was higher than the BMI: mean ± SD (24.41 ± 1.95) of controls, as well as the waist-to-height ratio, which showed that the mean ± SD (0.527 ± 0.046) of T2DM was greater than the control mean ± SD (0.483 ± 0.019) at level (P = 0.0001); T2DM patients had deficient and insufficient vitamin D3 levels (38.7% and 33.3%, respectively), whereas controls had deficient and insufficient vitamin D3 levels (28.7% and 30.0%, respectively). It was found that there is a significant difference between low vitamin D3 levels and individuals with type 2 diabetes, and A lack of vitamin D3 is related to an increased risk of developing T2DM.
Post-Traumatic Stress Disorder (PTSD) Among Healthcare Workers of Tertiary Care Hospitals of Rawalpindi; Amid the COVID-19 Pandemic
Authors: Mohsin Shamaila , Zahoor Mamoona , Mashhadi Syed Fawad , Khan Muhammad Arham , Khalid Taimur , Amanullah Mubaraka , Khan Shumaila , Abbasi Azwa , Khan Saifullah
Published: October 2023

Objective: To determine the prevalence of PTSD symptoms and its severity among HCWs, amid the COVID pandemic in a tertiary care setting.
Study Design: Cross sectional analytic study.
Place and Duration of Study: Pakistan Emirates Military Hospital, Rawalpindi Pakistan, from May to Aug 22.
Methodology: The study was conducted on 173 healthcare workers of a tertiary care hospital. The sample size was calculated using the Rao-soft calculator. Validated questionnaires such as the Impact of Event Scale-Revised (IES-R) and PTSD Checklist Civilian Version (PCL-C) were used to collect the data. Data was entered and analyzed by using Statistical Package for Social Sciences (SPSS) version 26.
Results: Out of 173 participants, majority of participants 90(52%) were male and single 103(63%). Mean age of the participating HCWs was 27(SD= 2.3). HCWs performing duties the in COVID-19 ward for one year were 66(38.2%) and majority were from Emergency medicine 61(35.3). Almost 150(86.71%) of HCWs did not experiencing any PTSD symptoms and those exhibiting a higher severity of symptoms were only 5(2.9%). There was no statistically significant difference in total and sub scales mean scores of IES-R among males and females (p= 0.28).
Conclusions: Our study concluded that prevalence of symptoms of PTSD was significantly low in Health Care Workers despite of the fact, majority of doctor participants were working in COVID-19 ward for one year. The symptoms were evident among healthcare professionals, however there was modest severity.
Maternal Perspectives of Newborn Hearing Loss in Resource Constrained Settings of Rawalpindi Pakistan
Authors: Mashhadi Syed Fawad , Raza Nusrat , Ammir Fatima , Sattar Aliya , Malik Asmara Ahmed , Niaz Saleem Asif
Published: October 2023

Objective: The objective of this study was to assess knowledge of mothers regarding risk factors, early identification, and intervention for infant hearing loss and to determine association between hearing loss and consanguineous marriages in Pakistan.
Study Design: Analytical cross-sectional study.
Place and Duration of Study: Out Patient Department of tertiary care hospitals in Rawalpindi Pakistan, from Mar to Jun 2021.
Methodology: 111 mothers consented to participate. Data was collected using a structured researcher administered questionnaire. It included four sections with 37 questions that were answered in yes, no, or unsure. Analysis was done using SPSS software.
Results: Mothers' knowledge of two risk factors was high with most respondents being aware of head injury or slap to the ear (n=94) being a risk for hearing loss, followed by ear pain/discharge (n=88). 66.7%(n=72) of participants considered use of ototoxic drugs by mother during pregnancy to be a potent risk factor for neonatal hearing loss. The mothers' understanding of natal causes such as delayed birth cry and neonatal jaundice was poor. Their understanding of postnatal causes such as high fever, frequent hospitalization, and long stay in NICU was also limited. Mothers who were employed had significantly more awareness in certain factors than housewives. 45.4% (n=49) of the mothers believed being in a cousin marriage influenced infant hearing loss while 38.9% (n=42) disagreed, and 15.7% (n=17) were unsure.Conclusion: Only half of all participating mothers were fully aware of the possible risk factors and causes of infant hearing loss. Seminars and public awareness programs should be arranged to educate mothers about risks of infant hearing loss.
Metacognitive Skills and Academic Performance among Medical Students-An Analytical Cross Sectional Survey
Authors: Misbah Samreen , Mashhadi Syed Fawad , Urooj Maryam , Parveen Musarrat , Aslam Muhammad Saqlain , Bilal Muhammad Haris , Shahzad Fatima , Ullah Muhammad Anayat
Published: October 2023

Objective: The study objectives were to identify the metacognitive skills in medical students and to find its association with their academic performance.
Study Design: Analytical cross-sectional study.
Place and Duration of Study: Army Medical College, Rawalpindi Pakistan, from May to Sep 2022.
Methodology: MBBS students from second, third and fourth year who had passed their last professional examination were included by convenience sampling. Sample size was calculated using WHO table and keeping 95% confidence level, d=0.05 and p= 0.20. Self-reported questionnaire Metacognitive Awareness Inventory was used to collect online data from 197 students. Hesitant students and incomplete questionnaires were excluded. Data analyzed through SPSS version 26. Mean and standard deviation for descriptive, independent t-test and one-way ANOVA were applied to find differences of mean among different groups (p<0.05 statistically significant).
Results: Among 115 males and 82 females, almost 92(46.70%) were from second year, 33(16.75%) from third year, and 72(36.54%) were from fourth year. Mean score and standard deviation of knowledge and regulation of cognition was 10±4.3 and 20.4±8.6 respectively. No significant difference of metacognition scores for two domains was found among both genders (p value 0.730, 0.509 respectively), four categories of percentage scores (p-value 0.290, 0.724respectively) and all years (p-value 0.077, 0.280 respectively). A significant strong positive linear correlation between knowledge and regulation was found (r=797; p<0.001).
Conclusions: Metacognitive skills in medical students were moderately developed in using strategies of both knowledge and regulation of cognition. No association was found between metacognitive skills and their academic performance.
Is Future of Medicine Safe in the Hands of Young Medical Practitioners? Perceptions of Medical Students Regarding Academic Misconduct
Authors: Misbah Samreen , Mashhadi Syed Fawad , Zuberi Fatima Ayaz , Ali Elia , Fatima Seerat , Haider Khinshan , Saeed Nasir , Riaz Muhammad Umar
Published: October 2023

Objective: To assess the self-reported attitude and behavior of MBBS students towards academic misconduct and to identify the differences of responses.
Study design: Analytical cross-sectional study.
Place and Duration of study: Army Medical College, Rawalpindi Pakistan, from May to Sep 2022.
Methodology: MBBS students from first to final year of both genders who consented to participate were included in the study while excluding unwilling students. Data were collected from 396 medical students by convenience sampling using avalidated questionnaire by the University of Dundee. After formal ethical approval responses were obtained on 14 scenarios.Data were analyzed by using IBM SPSS Statistics version 26. For descriptive statistics frequency and percentages wereidentified, and Pearson’s Chi-Square test was used to find out the differences in responses among all year (p<0.05).
Results: Among participants with mean age 20.93±1.57, there were 285(72%) males and 111(28%) females. In attitude response a significant difference was found for year one students as copying answers or asking about OSCE, copying from published papers, and submitting already submitted work were not considered wrong. In behavior response a significant difference was found for final year students in copying answer or discussing OSCE for degree exam.
Conclusion: Participants of this study were morally alert when it involves patients’ well-being, however there is vulnerability to commit academic misconduct in all years. Perspective of medical students on cheating, plagiarism, signature forgery is same regardless of seniority and gender. Students’ own consideration along with institutional policies may help creating culture against academic dishonesty.
Association between Sociodemographic Characteristics and Big Five Personality Traits of Undergraduate Medical Students in Pakistan: A Cross Sectional Analytical Study
Authors: Tariq Naseer Alam , Saeed Awan Bushra Ameer , Hussnain Ali , Ejaz Muddasir , Iftikhar Esha , Sehar Hunza , Pervaiz Iqra , Saeed Zahir
Published: October 2023

Objective: To analyze the relation between the three sociodemographic, characteristics gender birth order and class year characteristics on big five personality traits of medical students.
Study Design: Cross-sectional analytical study.
Place and Duration of Study: Study was conducted at Army Medical College, Rawalpindi Pakistan, from Jan to Jul 2022.
Methodology: The study included undergraduate medical students from first through final year belonging to an age group of 17-25 years and were willing to fill in the questionnaire through convenience sampling technique. Sample size as calculated by WHO calculator was 350
Results: Mean age of the participants was 21.14±1.20 years. Males were 73.4% and 26.6% were females. Majority were between age group “21-23 years”, n=281(74%), “middle born”, n=154(40%) and in “third year”, n=138(36) and “fourth year”,n=147(39%). There was a significant association between gender, birth order, age group and class year and attributes related to “conscientiousness(p=0.01), “neuroticism” (p=0.01); “extraversion “and openness to experience.
Conclusion: Results of this study revealed that big five personality traits were strongly associated with self-reported attributes of Conscientiousness, openness to experience, extraversion, agreeableness and neuroticism, Specifically, gender was associated with attributes of conscientiousness Birth order was associated with attributes of neuroticism and extraversion agreeableness had relatively strong associations with empathic concern and the class year was significantly associated with all Big five personality trait attributes assessed in the study.
Perceptions and Practices of Sanitary Workers toward Hepatitis B Virus Infection and Vaccination in Tertiary Care Hospitals of Rawalpindi: A Cross Sectional Analytical Study
Authors: Tariq Naseer Alam , Saeed Awan Bushra Ameer , Saleem Samia , Atif Muhammad , Sahiba Fatima , Musa Muhammad , Khan Mohammad Affaq
Published: October 2023

Objective: The purpose of this study is to evaluate the sanitary staff at selected tertiary care hospitals of Rawalpindi.
Study Design: Cross-sectional analytical study.
Place and Duration of Study: study was conducted from Nov 2021 to May 2022. In four Tertiary Care Hospitals in Rawalpindi Pakistan.
Methodology: The sample size of 200 was calculated as per the reference study. Convenience sampling technique was used.Hospital cleaners over the age of 18 who worked daily in all clinical units and were involved in cleaning, waste collection and disposal.
Results: In this study majority of the participants were males 178(89%) and majority 75(38%) were of age group 35-44 years and 45-54 years 69(35%). More than two third 156(78%) were married. Almost equal proportion of participants had middle 83(42%) and primary 77(39%) education There was significant association of gender with knowledge of Hepatitis-B (pvalue=0.004), knowledge of cure (p-value=0.001) and symptoms (p-value=00.02), transmission through blood transfusion (pvalue=0.027). There was also significant association between age group and provision of HBV vaccination to the staff (pvalue=0.009), knowledge of availability of HBV vaccination at hospital (p-value=0.001), screening for HBV (p-value=0.025),handling of sharps carefully (p-value=0.000), vaccination status for HBV (p-value=0.010), wearing gloves during work (pvalue=0.017).
Conclusion: the study offers helpful information into potential idiosyncrasies of sanitary workers and hospital cleaners that may serve as the foundation for future, more extensive studies.
Prevalence of Myopia and Assessment of Perceptions of its Associated Risk Factors among Medical Students in Rawalpindi
Authors: Rathore Mommana Ali , Mashhadi Syed Fawad , Waris Sami , Akhtar Areeba , Junaid Zainab , Tariq Khalid Bin , Arshad Hafsa , Meihran Faisal , Jabeen Sundas
Published: October 2023

Objective: To determine the prevalence of myopia among medical students and to assess the perception about the accompanying risk factors.
Study Design: Descriptive Cross Sectional.
Place and Duration of Study: Study was conducted among medical students of Rawalpindi Pakistan, over a time span of 6 months, from Dec 2021 to May 2022.
Methodology: Students participating in this study were belonging to both the genders with ages between 17-25 years. Students having history of LASIK surgery were excluded. A Pre-tested structured questionnaire was used for data collection and was distributed among students via Google Forms through various social media platforms. Analysis was done on SPSS version 26.
Results: A total of 300 students participated in this study, including 211(67%) females and 99(33%) males. About 150(50%) of the participants had myopia and 35(11.7%) of these had myopia since childhood. Among the myopes, 39(26%) were the ones whose parents had myopia and 98(65%) were the ones whose siblings had myopia too. Only 60(21%) students were aware of the risk factors such as increased mobile usage, reading in dim light, not wearing recommended glasses, sitting too close to TV screen. No statistically significant association was found between myopia and time spent on screen (p=0.333).
Conclusion: Myopia is widespread among medical students. Family history and genetics are linked to myopia. Time spent outdoors is very much less as compared to the time spent in front of screens by the students. A substantial proportion of students do not appear to be aware of current concepts and the actual risk factors leading to myopia.
Covid-19 Vaccine Hesitancy in Pakistan: A Cross-Sectional Study to Assess Resistance and Related Fears and Misconceptions
Authors: Rathore Mommana Ali , Mashhadi Syed Fawad , Hayat Fatima , Aziz Hamza , Hundal Asad , Ahmed Jawad , Shahzad Tayyab
Published: October 2023

Objective: The purpose of this study was to assess willingness to receive COVID-19 vaccine in Pakistan and to understand the reasons causing hesitation towards vaccine administration.
Study Design: A cross-sectional study was done through an online survey that was created using google forms.
Place and Duration of Study: The study was conducted online from Mar to Aug 2021 in different cities of Pakistan employing nonprobability convenience sampling technique. The link to the questionnaire was shared on different social media platforms such as WhatsApp and Facebook.
Methodology: Any individual over the age of 16 and willing to fill the questionnaire was enrolled. Questionnaire used were standardized Oxford COVID-19 vaccine hesitancy scale to assess intent and Oxford general vaccine hesitancy scale to assess attitude towards vaccinations in general. SPSS v25 was used for data analysis.
Results: A total of 589 valid responses were finally analyzed. Among the respondents, 24%(141) showed at least some hesitancy regarding COIVD-19 vaccination and 9%(53) of the respondents showed extreme hesitancy. The Pearson correlation coefficient indicated a significant positive correlation (p<0.000) between hesitancy to childhood vaccines and COVID vaccine hesitancy. There was also a significant correlation (p<0.000) between belief in conspiracy’s related to COVID-19 virus and refusal to get vaccinated.
Conclusion: Vaccine hesitancy is present in roughly 1/4th of the study population. Conspiracy theories and low vaccine acceptance among the general public pose a severe danger to COVID-19 vaccination success. Public vaccine education programs should be started to educate the public regarding their fear of vaccination.
The Medical Students’ Dilemma: E-Textbook or Printed Textbook? A Cross Sectional Study from Medical Colleges in Rawalpindi Pakistan
Authors: Tariq Naseer Alam , Saeed Awan Bushra Ameer , Ahmed Naseer , Amir Mohammad Taimoor , Rasheed Malik Abdullah , . Muneeb , . Yaseen
Published: October 2023

Objectives: To assess students’ perspectives of traditional learning and text books and more advanced e-learning and digital text books learning from digital and printed text.
Study Design: Cross-sectional study.
Place and Duration of Study: Course of six months from Jan to Jun 2022 in two Medical Colleges of Rawalpindi Pakistan.
Methodology: The study was a cross-sectional study carried out over course of six months from Jan to Jun 2022 in two Medical Colleges. Participants were 300, recruited through non-probability convenience sampling technique. A questionnaire and online survey were used to obtain information about response of medical students towards e-book and printed text effecting the quality of education. The data was analyzed using SPSS software version 23.0.
Results: Mean age of participants was 22±2.24 years and majority were between 21-24 years of age 212(71%) with almost equal proportions of males 140(47%) and females 160(53%) Significant association was found between gender and solid plan with traditional learning p=0.046 and more privacy of data in printed text, more reliability p=0.033.Significat association also found between age category and ease of modification of e text p=0.023, improvement in skills p=0.024 and also decrease in motivation due to technical disruption 0.034, instant feedback in e learning p=0.002.
Conclusion: Mean while Medical students favored the e-learning and digital books, they didn’t over rule completely thesignificance of traditional learning and paperback books.
Prevalence and Risk Factors of Gastroesophageal Reflux Disease Among Medical and Dental Students of Rawalpindi/Islamabad
Authors: Shahzad Asima , Mashhadi Syed Fawad , Shahid Mehreen , Khalid Sumaira , Rehman Ata Ur , Mukhtar Ashan , Ahmed Ishraq
Published: October 2023

Objectives: To determine the prevalence of gastroesophageal reflux disease among medical and dental students of Rawalpindi Islamabad Pakistan and to find the associated risk factors.
Study Design: Analytical cross-sectional study.
Place and Duration of Study: Students of Medical colleges in Rawalpindi Islamabad Pakistan, from March to May 2021.
Methodology: Non-probability convenience sampling technique was used. Sample size was found to be 352 using Rao soft.Only undergraduate students from Rawalpindi Islamabad Pakistan were included whereas postgraduate students were excluded. The data was collected via online distributed google forms and analyzed by SPSS version 25.0.
Results: There were 157(44.6%) males and 195(55.41%) females among whom 296(84.1%) were enrolled in medical program and 56(15.9%) in dental program. 94 students (26.7%) reported having symptoms of gastroesophageal reflux disease .Based on a GERD score of >=4, 35(9.94%) students were diagnosed with gastroesophageal reflux disease .Use of analgesics (OR=3.11[95% CI 1.32-7.36]; P≤0.010), family history of gastroesophageal reflux disease (OR=6.48[95% CI 3.09-13.57]; P≤0.000),family history of peptic ulcer (OR=2.85[95%CI 1.18-6.83] P≤0.038), frequent use of non-steroidal anti-inflammatory drugs(P≤0.013) had a significant association with the presence of gastroesophageal reflux disease .
Conclusion: Gastroesophageal reflux disease was diagnosed in approximately 10% of students. There was a significant association of Gastroesophageal reflux disease with use and frequent consumption of non-steroidal anti-inflammatory drugs and family history of peptic ulcer/Gastroesophageal reflux disease
Infective Etiologies in Patients with Bilateral Congenital Cataract
Authors: Qadir Abdul , Naeem Saquib , Khan Taimoor Ashraf , Khan Umair Naeem , Liaqat Talha , Butt Waqas Rahim
Published: October 2023

Objective: To determine the frequency of positive Toxoplasma, Rubella, Cytomegalovirus, Herpes Simplex virus and Syphilis serology in patients with bilateral congenital cataract and their correlation with different type of cataracts and age groups.

Study Design: Cross sectional study.

Place and Duration of Study: Department of Pediatric Ophthalmology and Strabismus, Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from May to Dec 2022.

Methodology: Data was collected by a single investigator on Microsoft Excel sheet including patient’s age, gender, mode of delivery, consanguinity of parents, and type of congenital cataract, results of TORCH Screening and Presence or absence of amblyopia. TORCHS screening comprised of serum IgM and IgG levels for Toxoplasmosis, Rubella, Cytomegalovirus, Herpes Simplex virus and Syphilis.

Results: A total of 134 patients reported to our institute with bilateral congenital cataract during the study period. Out of them 56 patients had positive results of TORCH screening (41.7%) Out of total 56 patients with bilateral congenital cataract testing positive for TORCH, 30(53.6%) were male while 26(46.4%) were female. Age range was from 1-17 months (9.2±4.2 months).Lamellar cataract was the most common cataract type in our study sample 16(28.6%).

Conclusion: In patients with bilateral congenital cataract positive TORCHS serology was most frequent. Serum Rubella IgM followed by Rubella IgG was positive in most cases. Most common age of presentation in our study was from 4-7 months. Furthermore, lamellar cataract followed by nuclear cataract was the commonest cataract type.