bluuebunny/crossref_metadata_2025 huggingface dataset:
Reverência pela vida: por uma contracultura ecocêntrica no antropoceno
Authors: Vieira Paulo Freire , Florêncio Rui Dias
Published: December 2022

Neste ensaio de síntese bibliográfica os autores oferecem uma imagem cursiva da clivagem antropocentrismo-ecocentrismo no âmbito do pensamento ecopolítico dos anos 1990. A contribuição de Robyn Eckersley para a maturação de uma teoria política do ecologismo de corte ecocêntrico é assumida como um ponto de partida. A intenção é explorar as possibilidades de maturação da sua abordagem com base em aportes extraídos das pesquisas mais recentes em epistemologia da complexidade, biologia da cognição e aprendizagem sistêmica-transdisciplinar. De forma cursiva, o texto leva também em conta os desdobramentos desta linha de argumentação nos debates em curso sobre o enfoque de decrescimento convivial no movimento de crítica pós-desenvolvimentista do ideário neoliberal. Como hipótese de trabalho, os autores argumentam que a busca de saídas efetivas (ou à montante) para os dilemas do momento dependerão de algo ainda muito difuso e carente de legitimidade no imaginário coletivo globalizado, a saber: uma metamorfose cognitiva e ética inspirada numa cosmovisão ecocêntrica.
Go Big or Go Home? Right-Sizing Security Cooperation to Fragile States
Authors: Yi Randell
Published: December 2022

This article tests two competing candidate theories of security cooperation provision contained in the literature against a subset of stated strategic objectives by assessing whether the amount of aid spent over time correlates with intended outcomes. One is based on the principal-agent problem, while the other derives from the organizational behavior model. The focus is solely on fragile states since they represent the most policy-relevant and challenging cases. Quantitative analysis utilizes existing datasets to provide proxy measures for neopatrimonialism, praetorianism, and combat effectiveness, corresponding to political, political/military, and military dimensions of security cooperation efficacy, respectively. The results challenge the conventional wisdom that increasing foreign aid merely feeds corruption and that to bolster foreign militaries is to beg for a coup. Controlling for economic aid and GDP per capita, both small and large military assistance packages strongly correlate with a reduction in neopatrimonialism and deaths due to violent conflict and terrorism in recipient nations. While small aid programs appear to temper the risk of a coup, this relationship does not hold for large ones. This research also calls into question the oft-assumed degree to which principal-agent problems and organizational behavior hamper effective aid provision.
A Social Network Analysis of Mexico’s Dark Network Alliance Structure
Authors: Jones Nathan P. , Chindea Irina , Weisz Argomedo Daniel , Sullivan John
Published: December 2022

This article assesses Mexico’s organized crime alliance and subgroup network structures. Through social network analysis (SNA) of data from Lantia Consultores, a consulting firm in Mexico that specializes in the analysis of public policies, it demonstrates differential alliance structures within Mexico’s bipolar illicit network system. The Cártel de Jalisco Nueva Generación’s (CJNG) alliance structure is top-down and hierarchical, while the Sinaloa Cartel is denser, particularly in the broader Tierra Caliente region. Additionally, our analysis found a sparse overall network with many isolates (groups with no relations to other groups) and disconnected components. Further, we identified organized crime networks that might fill future power vacuums based on their network positions, following state or rival high-value targeting of major cartels. The implications of these findings are discussed, and policy recommendations are provided.
KEGIATAN REFLEKSI DIRI DALAM MANAJEMEN STRES KERJA PERAWAT
Authors: Tutpai Gertrudis , Martini Margareta , Maratning Anastasia , Chrismilasari Lucia Andi
Published: December 2022

Stress kerja yang dirasakan perawat terutama di Masa Pandemi Covid-19 ini memang cukup tinggi. Respon negatif terhadap stres juga muncul sebagai akibat dari mekanisme koping yang negatif. Respon negatif tersebut berupa stres, rasa takut dan keinginan untuk resign dari pekerjaan. Salah satu metode yang dapat dilakukan untuk memodifikasi dampak stres agar lebih positif adalah dengan kegiatan Refleksi Diri. Kegiatan Refleksi diri yang dilakukan kepada 20 tenaga perawat dengan metode Focus Group Discussion (FGD) dan ceramah. Hasil yang didapatkan bahwa 100% perawat telah memiliki nilai positif dan memiliki kemauan untuk terus menjalani profesinya setelah melakukan kegiatan refleksi diri. Melalui kegiatan refleksi diri perawat diberi kesempatan untuk menilai hal-hal positif dalam dirinya, menilai hal-hal positif dalam profesinya sebagai perawat. Melalui kegiatan refleksi diri juga nilai postif dapat tertanam sehingga akan membentuk perencanaan yang positif kedepannya terutama yang berkaitan dengan pekerjaannya.
Handicraft workshop of the Shenkur Holy Trinity maiden monastery of the 18th century
Authors: Koltsova Tatiana Mikhailovna
Published: December 2022

The article is devoted to previously unknown works of pictorial embroidery of the synodal period. The artworks represent the local cultural center of the Russian North and are published for the first time. In the first half and the middle of the 18th century, a unique gold-embroidery workshop, which reached a high artistic level, was formed in the Shenkur Holy Trinity Convent on the Vaga river. The creation of liturgical fabrics in the monastery was carried out not only by nuns, but also by so-called “belitsy”, women who lived in monastic cells without being tonsured, as well as residents of the city of Shenkursk. Mother Superior Euphemia (1727- 1749) and her sister Xenia were famous craftswomen, they embroidered on multi-colored fabrics with gold, silver and silk threads. Shrouds of Christ, intercessions of the Holy Virgin and epigonations made in the Shenkur Monastery are featured in several museum collections, mainly in the North. The handicraft workshop existed in the monastery for only a short period of time: from the beginning of the 18th century until the closing of the monastery in 1764. The Vaga craftswomen created their works on the basis of the ancient Russian gold embroidery tradition. The identification and attribution of liturgical fabrics enabled one to uncover distinctive features of Shenkur products: idiosyncratic technologies, rare iconography and peculiar style dating back to the art of the Baroque era. Liturgical clothing and epigonations made by the Vaga craftswomen were ordered and purchased for the bishops' councils of Arkhangelsk and Kholmogory, they are present in the collections of Nikolo-Korelsky, Antoniev-Siya and Solovetsky monasteries. Correspondingly, Shenkur church textiles and fabrics were used in the churches of the Vologda diocese. The article offers an unprecedented systematization of a completely new unexplored layer of museum objects. A number of conclusions are drawn on account of unknown written and visual sources found in museums and archives of the country. The second half of the nineteenth century saw the revival of women's handicraft in the Shenkursky Monastery. The article is illustrated by works found in the museum collections of the Arkhangelsk region, primarily the Arkhangelsk Museum of Local Lore. The scope of the study includes a completely new significant range of cultural monuments belonging to North Russian tradition. The results can be widely used in identifying and attributing works of pictorial embroidery.
COMPARISON OF TWO SUPRAGLOTTIC AIRWAY DEVICES IN MAINTAINING AIRWAY FOR SHORT SURGERIES
Authors: Ahmad Maqsood
Published: December 2022

Objective: To find the better supraglottic airway device in terms of advantages, and complications, in short surgeries following anesthesia and paralysis.

Study Design: Quasi-experimental study

Place and Duration of Study: Combined Military Hospital Okara and Armed Forces Institute of Urology, Rawalpindi Pakistan, from July 2018 to July 2020.

Methodology: Prospectively, 130 American Society of Anesthesiologist (ASA) 1, 2, and 3 patients, aged 15-60 years, scheduled for short urology or gynecological procedure were randomly divided into Group LMA (Group L, n=65) or i-gel group (Group G, n=65). Laryngeal mask airway and i-gel were inserted in respective groups after anesthesia induction and muscle paralysis. The parameters compared were: simplicity of insertion, time taken for insertion, insertion attempts, device exchanged, and complications rate of each device. The data thus obtained was analyzed with SPSS-16.

Results: LMA group was similar to i-gel group for gender distribution 68 (52%) vs. 62(47%) and surgery type 60 (urology 46.2%) vs. gynecology 70 (53.8%). The successful insertion rate at first attempt (38.4% vs. 40.7%) was similar in both devices. The device was changed in 3.07% of i-gel patient’s vs. 6.92% LMA group patients, and complication rate was not substantially different in either group (i-gel 5.3% vs. LMA 6%). The insertion time was less in i-gel group (17.62 sec ± 6.41 vs.22.06 sec ±7.92) which was statistically significant p≤0.05.

Conclusion: LMA and i-gel are the two supraglottic devices for maintaining airways with different indications from emergency lifesaving to routine surgical procedures but their use in situations like difficult.......
FACTORS LEADING TO CONVERSION OF LAPAROSCOPIC CHOLECYSTECTOMY TO OPEN CHOLECYSTECTOMY
Authors: Zubair Muhammad , Nasir Ammad Ud Din , Malik Arsalan Sharif , Shaukat Zeeshan , Naz Faheem Ullah , Ramzan Aman
Published: December 2022

Objective: To evaluate the various factors leading to conversion of laparoscopic cholecystectomy to open cholecystectomy.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from May 2020 to Sep 2021.

Methodology: This study was conducted on 200 patients who underwent laparoscopic cholecystectomy for any benign pathology during the study period. Data was collected for all the patients who required conversion of surgical procedure from laparoscopic to open cholecystectomy. Demographic and clinical risk factors were associated with conversion of procedure in the study participants.

Results: Out of 200 patients included in the final analysis 67 (33.5%) were male and 133 (66.5%) were female. Mean age of patients put who underwent laparoscopic surgery for benign gall bladder pathologies in our study was 43.46 ± 8.337 years. Gall stones were the commonest clinical condition for which laparoscopic cholecystectomy was done. Out of 26 (13%) patients underwent conversion of laparoscopic to open surgery. It was revealed that frozen Calots triangle (p-value-0.033), empyema gall bladder (p-value-0.018) and previous abdominal surgeries (p-value-0.013) were significantly related to conversion of laparoscopic to open surgery

Conclusion: Conversion rate of laparoscopic to open surgery for cholecystectomy was high in our study population. Patients who had previous abdominal surgeries or presence of frozen Calots triangle and empyema gall bladder were more at risk of conversion of surgery.
Comparison of Procalcitonin Versus C Reactive Protein in The Detection of Neonatal Sepsis
Authors: Ali Wahid , Shirazi Haider , Gul Shireen , Halim Alia , Ain Qurat-ul , Zaman Qaiser
Published: December 2022

Objective: To compare procalcitonin and C-reactive protein in the detection of neonatal sepsis keeping blood culture as gold standard.

Study Design: Cross sectional study.

Place and Duration of Study: Neonatal Intensive Care Unit, Children Hospital, Pakistan Institute of Medical Sciences, Islamabad, from Jul to Dec 2018.

Methodology: Neonates up to 28 days of age with the suspicion of sepsis were selected. All the patients with congenital malformation were excluded. Two bed-sided tests i.e., procalcitonin and C-reactive protein was performed using standardized laboratory methods. The diagnostic strength of both tests was compared.

Results: A total of 154 neonates were enrolled in this study. Male neonates were dominant in this study 95 (61.7%). The mean age of patients was 6.1 ± 3.8 days. C reactive protein had a sensitivity and specificity of 50.9% and 28.7% respectively. While procalcitonin was found to have a comparatively high sensitivity and specificity 73.6% and 38.6% respectively. On blood culture test; klebsiella pneumoniae, pseudomonas, staphylococcus aureus were found out to be the most common pathogens.

Conclusion: Procalcitonin has a better sensitivity and specificity than C reactive protein in the diagnosis of early neonatal sepsis.
Use of First Line AEDS For the Control of Acute Seizures in Pediatric Emergency DepartmentAn Experience of Tertiary Care Hospital
Authors: Bano Sanam , Chand Prem
Published: December 2022

Objective: To determine the use of first line drugs after the use of Diazepam for the control of seizures in children presenting to Pediatric Emergency Department.

Study Design: Cross-sectional study.

Place and Duration of Study: Pediatric Emergency Department, Aga Khan University Hospital, Karachi, from Jan to Dec 2018.

Methodology: All the patients from one month to 18 years of age who presented with the seizures at the Pediatric Emergency Department were included in the study. Patients with intractable epilepsy, taking multiple anti-epileptic drugs, patients on ketogenic diet and metabolic seizures were excluded. Demographic information along with the duration of seizure, type of seizure, use of anti-epileptic drugs (AEDs) and response in the form of cessation of seizure to anti-epileptic drugs were recorded.

Results: A total of 105 patients with seizures were included in this study. Mean age of the patients was 73.87 ± 54.7 months. Generalized seizures were observed in 78 (74.3%) patients. In 48 (45.7%) patients, seizures were <5 minutes of duration, while 65 (62%) patients were diagnosed cases of epilepsy. Loading dose of Levetiracetam 20 mg/kg was used as first line AED in 66 (62.9%) patients. Out of 66 patients who were given Levetiracetam, 41 (39%) did not require second drug.

Conclusion: Levetiracetam was the most commonly used first line long-acting drug at our institute in all the seizure types and controlled seizures in two-thirds of the patients.
Sinonasal Glomangiopericytoma - A Case Report
Authors: Nadeem Muhammad Sohaib , Ali Ujala , Zeb Adnan , Khan Muhammad Yousaf
Published: December 2022

Sinonasal glomangiopericytoma is a tumor showing similarities to a glomus tumor but is less aggressive with a low malignant potential. The treatment of choice is complete excision followed by a regular long-term surveillance. The role of adjuvant chemotherapy and radiation remains undetermined. Our patient was a 45-year-old man who presented with nasal obstruction. Endoscopic excision showed sinonasal glomangiopericytoma. No adjuvant treatment was offered and patient was advised active surveillance. Patient was on a regular three-monthly follow-up. There was no evidence of disease recurrence after one year.
Female Medical Students’ Relationship Styles And Their Intended Primary Care and Non-Primary Care Postgraduate Specialty Preferences
Authors: Memon Shabnam Iqbal , Shaikh Sirajul Haque
Published: December 2022

Objective: To compare the predominant relationship/attachment styles of final year female medical students of a Pakistani medical college with their intended primary care and non-primary care post-graduate speciality preferences.

Study Design: Cross-sectional comparative study.

Place and Duration of Study: Sir Syed College of Medical Sciences for Girls, Karachi, from Feb to Apr 2019.

Methodology: Final year MBBS students were included in the study. Students were asked to complete a validated relationship scales questionnaire to determine the dominant relationship/attachment style. Students were also asked to identify their intended first choice for post-graduate specialization from a list of 28 primary care and non-primary care post-graduate specialities.

Results: Out of 113 female students, 48 (43%) were found to have a predominantly dismissing relationship style (among four variants of relationship styles). Out of 95 (84%) students opted for a non-primary care speciality for pursuing post-graduation, out of which 37 (33%) students chose Obstetrics and Gynaecology. Comparison of participant’s relationship styles with postgraduate speciality showed no significant difference (p-value=0.40).

Conclusion: Medical students should be provided adequate and timely exposure to various specialities available for postgraduation (primary and non-primary care specialities) and should be guided appropriately to help them make informed career choices.
Frequency of Sapheno-Femoral Junction and Sapheno-Popliteal Junction Incompetence on Duplex Ultrasonography in Patients with Varicose Veins
Authors: Rauf Muhammad Haris , Slehria Atiq-Ur-Rehman , Qasmi Imran Masoud , Saleem Sultan , Sohail Marium
Published: December 2022

Objective: To determine frequency of sapheno-femoral junction (SFJ) and sapheno-popliteal junction (SPJ) incompetence on duplex ultrasonography in patients with varicose veins.Study Design: Cross-sectional study.Place and Duration of Study: Shaikh Khalifa Bin Zayed Al-Nahyan/Combined Military Hospital, Rawalakot, Azad Jammu & Kashmir, from Aug 2019 to Feb 2020.Methodology: A total of 70 patients were selected using non-probability, consecutive sampling. After ethical approval, informed consent and relevant history taking, duplex ultrasonography (DUS) was done in standing and supine positions in patients with varicose veins, fulfilling inclusion and exclusion criteria. Presence or absence of SFJ and SPJ incompetence was assessed.Results: Mean age was 41.99 ± 11.08 years with 36 (51.43%) patients between 36-50 years. Mean duration of disease was 6.33 ± 2.29 months while 47 (67.14%) patients had symptoms for more than 6 months at the time of presentation. Occupation wise, 40 (57.14%) patients were field workers while 30 (42.86%) were office and domestic workers. Isolated SFJ, SPJ and combined junction incompetence were found in 27 (38.57%), 20 (28.57%) and 23 (32.86%) patients respectively. Both SFJ and SPJ incompetence were more in obese patients (78.6% and 71.4% respectively) as compared to non-obese patients.

Conclusion: Frequency of SFJ incompetence was more than SPJ incompetence on DUS. Obesity, male gender and prolonged motionless standing predispose to the development of varicose veins. Preventive measures and early diagnosis can decrease disease burden.
Evaluation of Non-Pharmacological Remedies Adopted By The Patients with Diabetes Mellitus Type 2
Authors: Hasan Insia , Batool Syeda Ramsha , Dars Jawed Akbar , Batool Rabisa , Ahmad Syed Masroor , Afridi Muhammad Iqbal
Published: December 2022

Objectives: To determine the different types of non-pharmacological remedies adopted by the patients with type 2 diabetes.

Study Design: Cross-sectional study.

Place and Duration of Study: Jinnah Postgraduate Medical Centre, Karachi from Oct 2018 to Nov 2019.

Methodology: A total of 280 type 2 diabetes patients were enrolled in the study. All patients with multiple comorbidities and type 1 diabetes were excluded from the study. A pre-designed questionnaire was used to collect data using face to face interviews. The questionnaire was related to the biodata of the patients and the use of non-pharmacological measures to control the diabetes. Data was analyzed by using SPSS version 24.

Results: The mean age of the patients was 54.7 ± 9.77 years. About 256 (91.4%) stated that they used non-pharmacological measures along with their medications to control diabetes. Most of the patients 248 (96.8%), were only on dietary modifications; regular exercise 82 (32%) and various types of medicinal herbs/spices were used by 65 (25.3%) patients. Regular walking was the most common exercise chosen by patients and most of them preferred to walk 30 minutes daily. Out of 241 (97%) patients altered their diet to low carbohydrates and rice consumption, increased use of fruits and vegetables 29 (11.6%) and cereals by 24 (9.6%) patients.

Conclusion: The study concluded that patients were highly inclined towards the use of non-pharmacological measures to control their illness.
Physiotherapists’ Attitude Towards Professionalism
Authors: Mansoor Syeda Rafia , Akram Samrood , Naaz Anam , Ashraf Hafiza Sana , Sohail Maria
Published: December 2022

Objective: To find out the attitude of physiotherapists towards their profession and to assess the quality of professionalism in physiotherapists.

Study Design: Cross-sectional study.

Place and Duration of Study: Private and government physiotherapy setups in Lahore, Pakistan, from Oct 2019 to Dec 2019.

Methodology: 312 physical therapists were recruited in the study. A modified standard questionnaire by the American Physical Therapy Association (APTA) was used for the data collection. Data were analyzed by using SPSS 22.0.

Results: In the current study, 312 participants were included, out of which 54.2% were male physical therapists and 45.8% were female physical therapists. Their mean age was 26.27 ± 2.15 years. The average professionalism score was 270.56 ± 22.27. Quality of professionalism, measured in physical therapists was 5 (1.60%), 14 (4.5%), 106 (34%), 148 (47.44%), and 39 (12.50%) as poor, fair, good, and excellent professionalism, respectively.

Conclusion: The majority of physical therapists showed a borderline positive attitude and very few had a negative attitude towards professionalism. Moreover, good quality of professionalism was observed prominently in most of the physiotherapists, whereas, minority of them portrayed bad and poor professionalism.
Burden of Rota Virus Gastroenteritis in Children Under 5 Years of Age
Authors: Noor Misbah , Ghani Eijaz , Niazi Saifullah Khan , Junaid Muhammad , Khalid Saadiya , Shakoor Noman
Published: December 2022

Objective: To detect the burden of Rotavirus gastroenteritis in hospitalized and non-hospitalized children under 5 years of age.

Study Design: Retrospective observational study.

Place and Duration of Study: Department of Virology, Armed Forces Institute of Pathology, from Jan 2015 to Dec 2019.

Methodology: A total of 527 stool samples were analyzed using rapid immunochromatoghraphic testing kit for Rotavirus. Samples were received from both outdoor and indoor children under 5 years of age presenting with diarrheal illness.

Results: 197 (37.4%) patients were positive for rotavirus antigen in stool while 330 (62.6%) were negative. Mean age of participants was 13.4 months ± 16.6 (range: 1-60 months). Out of 197 (37.4%) stool samples which were positive for rotavirus antigen, 66 (33.5%) were female children and 131 (66.5%) were male children. Maximum positive rotavirus stool antigen was observed in 0-2 years age-group i.e., 173 (33%) while 24 (4.4%) were positive in 3-5 years age-group, 110 (20.9%) rotavirus positive samples were from Inpatient Department while 87 (16.5%) were received from Outpatient Department.

Conclusion: Rotavirus is a frequent cause of viral gastroenteritis in both hospitalized and non-hospitalized children. Maximum positivity is seen in children under 2 years of age.
Effect of Prone Positioning As Modality for Improvement in Bedside Oxygen Saturation in Awake Non-Intubated COVID-19 Patients and Its Relationship With High Resolution CT Chest Severity Score
Authors: Qayyum Uzma , Akhtar Naghmana , Nisar Shazia , Qayyum Ayesha , Hussain Amina , Kashif Amer Sohail
Published: December 2022

Objective: To evaluate the effectiveness of awake proning on bedside oxygen saturation in non-intubated severe COVID-19 cases and its association with high-resolution CT chest severity score.

Study Design: Prospective observational study.

Place and Duration of Study: Pak Emirates Military Hospital Pakistan, from Jun to Jul 2020.

Methodology: This study was conducted on 150 laboratories confirmed SARS-CoV-2 infected cases with moderate to severe category pneumonia, requiring supplemental oxygen but not mechanical ventilation, admitted in the High Dependency Unit of the Military Hospital. Bedside oxygen saturation was recorded via pulse oximeter before and after proning of 10 minutes to evaluate whether oxygen saturation increased, decreased or remained the same post proning.

Results: Out of 150 patients, it was observed that 67 (45%) patients showed 2% increase of oxygen saturation over 10 minutes of proning, 48 (32%) patients showed an increase of 1% while 20 (13%) patients showed an increase of 3%. It was also observed that 13 (14.7%) patients out of 88 patients, with HRCT severity score of >50% showed an increase of 3% compared to 7 (11%) patients out of 62 patients with HRCT severity score of <50%.

Conclusion: At least 60% of the patients showed an improvement of 2% or more after 10 minutes of proning, which concluded that awake proning in non-intubated patients may help improve oxygen saturation.
Primary and Secondary Enuresis in Children Presenting At Pediatric Outpatient Department of Combined Military Hospital Malir Cantt Karachi
Authors: Zahid Meha , Ali Arshad , Zaidi Syed Taqi Hasan , Saba Ameena , Shujaat Wasif , Samina Mubushra
Published: December 2022

Objective: To determine the frequency of primary and secondary enuresis in the children presenting at outpatient department of Tertiary Care Hospital.

Study Design: A cross sectional study.

Place and Duration of Study: Outpatient Department of Combined Military Hospital Malir, Karachi, from Feb to July 2019.

Methodology: A total of 1200 children with age range of 5-12 years were included in the study. Children presenting with severe acute illness or those with non-willing caregivers were excluded from the study.

Result: Out of the total 1200 study participants, 167 (13.9%) children gave the history of enuresis. There were 109 (65.6%) boys and 58 (34.4%) girls. The children with primary enuresis were 141 (84.3%) while 26 (15.62%) children had secondary enuresis. About 31 (18.7%) children had daytime enuresis, 115 (68.5%) had night-time and 21 (12.5%) children had both day and night time bed wetting. About 57 (34.37%) children previously got the treatment for enuresis which included fluid restriction in 21 (12.5%) and desmopressin in 36 (21.87%). Out of them 52 (91.2%) children showed complete response while 5 (8.77%) showed incomplete response.

Conclusion: Our study found that enuresis is more frequent among boys. Primary enuresis is more common than secondary enuresis and nocturnal enuresis is more common than diurnal enuresis.
An Impact of COVID-19 Pandemic on The Motivation and Psychological Well Being of Dermatology Residents
Authors: Mashhood Asher Ahmed , Shahzadi Shazia
Published: December 2022

Objective: To analyze the motivation and psychological well-being to perform duties during the COVID-19 pandemic among the dermatology residents.

Study Design: Cross-sectional survey.

Place and Duration of Study: Dermatology Department, Combined Military Hospital, Rawalpindi, from Mar to Sep 2020.

Methodology: A total of 155 dermatology residents were included in the study. Health care provider motivation scale (HCPMS) was used through online Google Doc due to lockdown. Secondary data was also generated from Google scholar, newspapers, journals, reports and the literature review.

Results: We analyzed the impact of COVID-19 on motivation and psychological well-being. The result showed that the COVID-19 pandemic has an adverse effect on motivation due to anxiety (31%), stress (23%) and depression (27%) among dermatology residents. There was statistically significant relationship between decreased motivation and increased stress levels and depression among dermatology residents performing COVID-19 duties (p<0.001).

Conclusion: Due to extra duties in the COVID-19 pandemic, the motivation and psychological well-being were severely affected among dermatology residents.
A Comparative Study of Minimal Invasive and Open Colorectal Surgeries with Regards To PostOperative Hospital Stay and Complications
Authors: Farooq Muhammad Zain , Mahmood Khalid , Zafar Muhammad Arsalan , Chatha Sohail Saqib , Saeed Muhammad Farhan , Qureshi Tansheet Mazhar
Published: December 2022

Objectives: To compare outcomes of laparoscopic surgery versus open surgery for colorectal carcinoma in terms of hospital stay and post-operative complications.

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Rawalpindi, from Mar 2020 to Mar 2021.

Methodology: We studied a total of 114 patients who were diagnosed with colorectal cancer and met the sample selection criteria. Patients with metastatic disease or previous history of abdominal surgery were excluded from the study. Patients were documented for hospital stay and followed for six months for the development of complications. Data was analyzed by SPSS version 26.

Results: We studied a population where 45 (39.5%) were male while 69 (60.5%) were female. The mean age of the sample was 46.96 ± 14.47 years. The study showed that the mean hospital stay was shorter in Group A: 5.40 ± 1.88 days versus 6.59 ± 1.68 days in Group B (p=0.001). Mean blood loss was 65.99 ± 16.41 mL in Group A versus 366.93 ± 95.36 in Group B (p<0.001). The complication rates in Group A and B were 6 (10.5%) and 11 (19.2%), respectively (p=0.18), while the rate of incisional hernia formation was 0 (0%) and 4 (6.9%) (p=0.042).

Conclusion: Laparoscopic surgery is superior to open surgery is the management in terms of shorter in-hospital stay and postoperative complications.
Contraceptive Awareness and Practices in Patients With Rheumatic Diseases Using Disease Modifying Anti-Rheumatic Drugs
Authors: Gul Shahzad , Khan Muhammad Muddasser , Rasheed Uzma , Tahir Saira , Zammurad Shazia
Published: December 2022

Objective: To determine the contraceptive awareness and practices in patients with rheumatic diseases using disease modifying anti-rheumatic drugs.

Study Design: Cross-sectional study.

Place and Duration of Study: Outpatient of Rheumatology, Department at Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Jan to Apr 2021.

Methodology: Patients with any rheumatic disease and taking teratogenic disease modifying anti-rheumatic drugs were included in the study. Patients were asked about if they were counseled regarding the risk of teratogenicity with the antirheumatic drugs and when to stop the drug before pregnancy.

Results: Out of total 150 patients, 87 (58.0%) female patients had Rheumatoid arthritis and 26 (17.3%) had Systemic lupus erythematosus. The majority of female patients (104, 69.3%) were using Methotrexate and 21 (14.0%) females were using Leflunomide. Only 53 (35.3%) females were counseled about drug teratogenicity. Most of the female patients (102, 68.0%) were never counseled about the use of contraception while taking anti-rheumatic drugs. The rate of use of contraceptives was even worse and merely 15 (10.0%) females were using contraceptives.

Conclusion: Majority of the patients with rheumatic diseases being treated with teratogenic disease modifying anti-rheumatic drugs, were not using any form of contraception. The rate of contraceptive use and counseling regarding contraceptives was noted to be very low.
Modified Graham's Patch Repair Versus Graham's Patch Repair for Treatment of Perforated Peptic Ulcer in Terms of Postoperative Morbidity / Mortality
Authors: Khan Fatima Kamran , Shah Mahin , Sheikh Irfan Ali , Mahmood Khalid , Hassan Neelofur
Published: December 2022

Objective: To compare the surgical procedures; graham’s patch repair and modified graham’s patch repair for the treatment of perforated peptic ulcer in terms of their post-operative morbidity and mortality.

Study Design: Comparative cross-sectional study.

Place and duration of study: Combined Military Hospital Rawalpindi, from May 2020 to Apr 2021.

Methodology: We conducted the study on 60 subjects divided into groups of two, (Group A and Group B) selected via convenience sampling. Group A underwent Graham’s repair and Group B underwent modified Graham’s repair. The morbidity and mortality of both the groups was compared statistically with data analysis done using SPSS-23.

Results: The average operating time and hospital stay was 84.93 ± 7.06 minutes and 7.3 ± 1.63 days for group A and 96.9 ± 9.67 minutes and 7.56 ± 2.27 days for group B, respectively. For both groups, there was no significant association to any complications (p>0.05).

Conclusion: Graham’s repair and modified Graham’s repair are equally effective leaving the decision to the surgeon's preference. We however recommend using Graham’s repair in unstable patients.
Nodular Lymphocytic Predominant Hodgkin Lymphoma (NLPHL); Treatment Outcome Study in a Tertiary Care Cancer Hospital in Pakistan
Authors: . Chandumal , Shah Mohammad Iqbal , Abu Bakar Muhammad , Sheikh Fareeha , Nadeem Iqra , Kulsoom Umme , Siddiqui Neelam
Published: December 2022

Objective: To determine the demographics, clinical characteristics and treatment outcomes of nodular lymphocytic predominant Hodgkin lymphoma (NLPHL) patients treated at our hospital.

Study Design: Retrospective longitudinal study.

Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan from 1996 to 2016.

Methodology: We collected clinical data of all the cases of HL diagnosed over twenty years (between 1996 and 2016) from our electronic hospital information system (HIS). A total of 3426 HL patients were identified, out of whom the pathologically confirmed diagnosis of nodular lymphocytic predominant Hodgkin lymphoma (NLPHL) was identified.

Results: In this study, eighty-four patients were studied. The majority of the patients were male (80%). B symptoms were present in 35%. There were 24% patients in stage-I (n=20/84), 33% in stage-II (n=28/84), 12% in stage III (n=10/84) and 31% in stage IV (n=26/84). Hence, early-stage was seen in 57% (n=48/84) and advanced stage was 43% (n=36/84) respectively. The Median follows up time was 30 months (range: 1-60 months). Patients were treated with chemotherapy in most cases (48%), radiotherapy alone in 14% cases, and combined modality (chemotherapy and radiotherapy) was used in 38% patients. The estimated 5–year disease-free survival was 73% and overall survival was 86%. Autologous stem cell transplant was done in only one patient whose disease had transformed from NLPHL to T-rich cell B cell lymphoma.

Conclusion: This study confirmed the divergent features of NLPHL with a comparatively good long-term prognosis. Most patients achieved an excellent response to first-line therapy. There was...
Left Sided Abdominal Ectopic Pregnancy with Placenta in Rudimentary Horn-Complicated With Acute Renal Failure: A Case Report
Authors: Shafiq Nighat , Muzaffar Tabassum , Fatima Sadia , Sohail Amina
Published: December 2022

Though unicornuate uterus with rudimentary horn is a rare Mullerian duct malformation, it is marked with frequent undesired gynaecological and obstetrical complications. Rupture of gravid horn results in maternal and foetal morbidity and mortality. A case of rudimentary horn pregnancy at 15 ± 4 weeks was reported here, with acute renal failure in the postoperative period. The favorable maternal outcome was only ensured after extensive hemodialysis sessions apart from appropriate intensive care management.
Rehabilitation of Partial Hand Amputations in Pakistan
Authors: Khalil Muhammad Tawab , Raza Ali
Published: December 2022

Objective: To describe prosthetic/cosmetic rehabilitation of partial hand amputations.

Study Design: Case series.

Place and Duration of Study: Out Patient Department (OPD) of the Rehabilitation Department Combined Military Hospital Multan from Jul to May 2020.

Methodology: Patients with partial hand amputations, due to any cause, reporting to OPD of Rehabilitation Department in CMH Multan were included. Demographic data (age, gender, education), cause, type and duration of injury and cosmetic intervention were documented.

Results: A total of 10 patients were recruited. All the participants were males. The mean age of the patients was 34.1 ± 2.8 years. The average duration of amputation was 5.2 ± 1.7 years. The most common cause of amputation was blast injury (n=3), followed by injury with heavy machinery (n=2), firearm injury (n=2), fall from the train (n=1), electric injury by high tension wire (n=1), and frostbite (n=1). The type of amputation included: left transmetacarpal with thumb sparing (n=3), ray amputation of the right index finger (n=3), right transmetacarpal with thumb sparing (n=1), ray amputation of the right middle finger (n=1), amputation left partial thumb and index finger (n=1), the right fourth and fifth finger amputation (n=1). All the patients could carry out activities of daily living even without a prosthesis. Ottobock silicon finger fillers with cosmetic sleeves were provided to all the patients.

Conclusion: Aesthetically acceptable silicon finger fillers are the mainstay of rehabilitation of hand amputations in lower-middle-income countries with poor access to rehabilitation.
Optical Coherence Tomography Angiography (OCTA) Analysis of Perifoveal Capillary Arcade in Patients with Retinal Vein Occlusion Treated with Anti-VEGF
Authors: Wajid Nida , Muzaffar Waqar , Arain Muhammad Aamir
Published: December 2022

Objective: To evaluate the changes in perifoveal capillary arcade in patients with retinal vein occlusion treated with intravitreal injections of anti-vascular endothelial growth factor for macular edema resulting from retinal vein occlusion with OCTA.

Study Design: Quasi-experimental study.Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jul 2018 to Jul 2019.

Methodology: Patients diagnosed as case of retinal vein occlusion underwent complete eye examination. Optical coherence tomography angiography (OCTA) was done in all the patients. Patients having macular edema were prescribed intravitreal anti-vascular endothelial growth factor inhibitors on monthly basis. OCTA was repeated at the third month.

Results: In this study, 50 eyes were evaluated. After treatment patients having perifoveal capillary arcade of less than two quadrants increased from 47.7-68.8% (p<0.002) in the superficial capillary plexus and in deep capillary plexus this number increased from 50% to 88.6% (p<0.05). There was also a significant decrease in the number of macular cysts in the superficial and deep capillary plexus post treatment (p<0.05). Mean En face vascular density in superficial capillary plexus decreased in all the quadrants specially the foveal zone.

Conclusion: Optical coherence tomography angiography (OCTA) showed a qualitative improvement in perifoveal arcade disruption and decrease in the number of cystic spaces. Quantitative analysis revealed a significant reduction in vessel density in all quadrants. It enables us to follow up patients with retinal vein occlusion and study the vascular arcade changes with time and treatment.
Pattern of Different Immunohistochemical Stains in Various Types of Hepatoblastoma
Authors: Maqbool Hina , Mushtaq Sajid , Hussain Mudassar , Sheikh Umer Nisar , Hassan Usman , Sarwar Saud , Hameed Maryam , Mehmood Mohammad Tariq , Ahmad Asad Hayat
Published: December 2022

Objective: To assess the utility of four immunohistochemical stains in the categorization of hepatoblastoma.

Study Design: Retrospective longitudinal study.

Place and Duration of Study: Histopathology Department, Shaukat Khanum Memorial Cancer Hospital, Peshawar Pakistan, from 2016 to 2018.

Methodology: We retrospectively reviewed 50 cases of hepatoblastoma from 2016-2018, from our hospital database and studied the pattern of four immunohistochemical stains (Beta-catenin, Glutamine synthetase, Heppar 1 and Cyclin D1) in various subtypes.

Results: Ten out of fifty cases were mixed epithelial and mesenchymal hepatoblastomas, and forty were pure epithelial. In the pure epithelial category, the fetal subtype showed Heppar 1 and Cyclin D1 positivity in twenty-eight cases, while Glutamine synthetase and Beta-catenin were positive in all the thirty cases. One case of embryonal subtype displayed negativity for Heppar 1; the rest of the immunohistochemical stains were positive. Ten tumours exhibiting mixed epithelial and mesenchymal morphology showed positivity for all the four immunohistochemical stains in the epithelial component. However, Heppar 1 and cyclin D1 were negative in the mesenchymal component in all the ten cases. Five cases (50%) showed Glutamine synthetase and Beta-catenin positivity in the mesenchymal component.

Conclusion: All the four immunohistochemical stains, especially Beta-catenin and Glutamine synthetase, were efficient diagnostic tool, especially for tumours with complex or vague morphological features.
Renal Hydatid Cyst Mimicking Renal Cell Carcinoma; A Case Report
Authors: Habib Bilal , Anwar Khursheed , Roman Mohammad , Khan Irfan Ullah , Iqbal Saeed
Published: December 2022

Renal hydatid cyst is a rare entity as compared to hepatic hydatid cyst. However, literature manifests case reports of renal hydatid cysts. The establishment of diagnosis becomes difficult in non-endemic areas. The tumour is well-considered on clinical examination and radiological investigations for this condition. We presented a case of renal hydatid cyst in a 45-yearsold male patient who presented with hematuria and was labelled as renal cell carcinoma clinically and radiologically. However, histopathology confirmed the diagnosis of renal hydatid cyst.
Pre-Treatment with Ketorolac Alongside Venous Occlusion Can Reduce the Pain of Propofol Injection; A Quasi-Experimental Study
Authors: Haider Syed Zulfiqar , Khoso Mujahid Ali , Ayaz Saeed Bin , Abbas Muhammed Ali , Rehman Habib Ur , Iftikhar Hina
Published: December 2022

Objective: To investigate the efficacy of Ketorolac with and without venous occlusion to relieve pain associated with Propofol injection.

Study Design: Quasi-experimental study.

Place and Duration of Study: Anesthesiology Department, Combined Military Hospital Multan, from Jan 2020 to Mar 2021.

Methodology: One hundred and twenty patients of age more than 16 years with ASA physical status 1 and 2, undergoing elective surgery at Combined Military Hospital Multan were selected. Patients were allocated into the groups to receive Saline with sham occlusion (group-A), 10 mg Ketorolac with sham occlusion (Group-B), or 10 mg Ketorolac with full venous occlusion for 120 seconds (Group-C). Before surgery, the patients were asked to rate any local discomfort on a scale of 0-3 ten seconds after receiving a Propofol injection. On the seventh post-operative day, all the patients were handed a questionnaire to describe any untoward symptoms.

Results: The mean age of the patients was 48.3 ± 2.8 years (range: 16 to 80 years). Mild discomfort was experienced by 4 (10%) patients, while 12 (30%) patients had moderate pain and 5 (12.5%) patients experienced severe pain in Group-A. In group- B, 16 (40%) patients had mild discomfort, 7 (17.5%) had moderate pain, and 5 (12.5%) had severe pain. In Group-C, 10 (25%) individuals experienced mild discomfort, 5 (12.5%) patients experienced moderate pain, whereas none of the patients experienced severe pain (p<0.001). Patients among the three groups reported no significant difference in post-injection venous sequelae.

Conclusion: Pre-treatment with 10 mg Ketorolac and venous occlusion for 120 seconds...
Developing Entrustable Professional Activities (EPAS) for House Officer to Practice Safely and Independently in Dentistry; A Qualitative Study Using Interpretive Paradigm
Authors: . Waqar-Un-Nisa , Orakzai Gulmina Saeed , Jamil Brekhna
Published: December 2022

Objective: To develop entrustable professional activities for a one-year house job in dentistry.

Study Design: Qualitative study (Interpretive Paradigm).

Place and Duration of Study: Khyber College of Dentistry and Sardar Begum Dental College, Peshawar Pakistan, from Sep 2017 to May 2018.

Methodology: A five-step approach was used to develop four EPAs for a one-year house job. Using maximum variation sampling, faculty members from eleven disciplines of dentistry working in public and private dental colleges of Khyber Pakhtunkhwa and charge of training dental interns participated in the study. Three focus group interviews and three in-depth interviews were conducted. Data was transcribed and thematic analysis was done.

Results: The EPAs were developed for a one-year house job using the five-step approach. This process resulted in developing the content of four EPAs in detail, analysing the results into competencies aligned with Pakistan medical and dental council, assessment methods such as multisource feedback, direct observation, mini CEX assessment with peer coaching and role modelling teaching strategies for each activity. Participants agreed on trusting the house officer to perform independently with a gradual shift of supervision scale from direct action to indirect and finally enacting the EPAs unsupervised.

Conclusion: This study presents the foundation for using specific EPAs in dentistry, a step towards a competency-based approach. The content of EPAs for a transition period of a one-year house job in dentistry was developed using the 5-stage approach. These EPAs can provide explicit guidance for the engagement of dental house officers in clinical workplace activities.
Preventing Catheter Related Bladder Discomfort (CRBD) in male patients undergoing Lower Urinary tract surgery with Bilateral Pudendal Nerve Block:A Randomized Controlled Trial
Authors: Yasrab Mohammad , Haider Naqvi Syed Ehtesham , Ahmed Fariha , Ahmed Madiha , Rana Sumbal , Khushdil Arshad
Published: December 2022

Objective: To compare the frequency and severity of post-operative CRBD in patients undergoing TURP and TURBT with spinal anaesthesia with pudendal nerve block against spinal anaesthesia alone.

Study Design: A randomized controlled trial (Clinical trials.gov: NCT05022160)

Place and Duration of Study: Armed Forces Institute of Urology (AFIU), Rawalpindi Pakistan, from Aug to Nov, 2021.

Methodology: The trial comprised 250 patients scheduled to have a transurethral resection of the prostate (TURP) or a transurethral resection of a bladder tumour (TURBT) under spinal anaesthesia. They were split into two groups: study (group-P) and control (group-C). After surgery, the patients in the study-group were given a bilateral pudendal nerve block. At 3, 8, 12, and 24 hours following surgery, the frequency and severity of catheter-related bladder discomfort (CRBD) were documented.

Results: CRBD frequencies were significantly lower in pudendal group at 3 hours 42 (33.8%) vs 72 (58.5%), p <0.001), 8 hours 81 (65.3%) vs 111 (90.2%), p<0.001 and 12 hours 53 (42.7%) vs 73 (59.3%), p=0.009 after the surgery. The postoperative pain score in pudendal group was lower at 3 hours (p<0.001), 8 hours (p <0.001), and 12 hours (p=0.02) but there was no statistically significant difference between the two groups at 24 hours (p=0.06).

Conclusion: When used in conjunction with spinal anaesthesia, a pudendal nerve block reduces the frequency and severity of catheter-related bladder discomfort for up to 12 hours after surgery.