bluuebunny/crossref_metadata_2025 huggingface dataset:
Violencia familiar y trastorno depresivo en mujeres e integrantes del grupo familiar en la jurisdicción de la Comisaría de Familia de Lima
Authors: Benavides Román Alexander Masías , Rivera Fernández Dorothy Herfilia , Chávez Yomona Marleny
Published: January 2022

El objetivo del presente artículo es sistematizar evidencia científica disponible sobre violencia familiar y su relación con los trastornos depresivos. La investigación estuvo orientada a la indagación bibliográfica en la base de datos de Scielo. Se enfocó en la temática de violencia intrafamiliar y generación de la afección mental, especialmente los trastornos depresivos y pautas para prevenirlos, de utilidad para el quehacer investigativo y asistencial de autoridades, operadores judiciales y profesionales de la salud. Entre los principales resultados se obtuvo que los trastornos depresivos están fuertemente asociados a la violencia intrafamiliar. Asimismo, se estableció que las mujeres, en especial las embarazadas, expuestas a violencia por sus parejas íntimas, sufrieron de maltratos psicológicos (presentando signos depresivos), seguidos de maltratos físicos, violencia sexual y violencia económica-patrimonial; al respecto el MINP (noviembre 2020), señaló que, de 58 595 mujeres sometidas a violencia familiar, entre los 18 y 59 años de edad, el 49.8% era por violencia psicológica. De otro lado, los niños y adolescentes también se vieron afectados en su salud mental, a consecuencia de las agresiones ejercidas por sus padres, alterándose sus procesos psicosociales y convirtiéndose en un factor de riesgo para síntomas depresivos u otras conductas autodestructivas. En ese sentido, el MINSA informó que los trastornos más habituales en infantes y jóvenes son por problemas emocionales, como depresión o ansiedad ligados a violencia doméstica. Por último, los adultos mayores integrantes del grupo familiar, también fueron afectados por algún tipo de violencia, sobre todo la psicológica, en especial los adultos entre los 70 y 79 años de edad, que presentaron signos de depresión.
ANALISIS FAKTOR YANG MEMPENGARUHI MOTIVASI BELAJAR SISWA SEKOLAH DASAR NEGERI 093 MANDAILING NATAL
Authors: Hamidah Nur , Irsan Barus Muhammad
Published: January 2022

Penelitian ini bertujuan untuk Menganalisis Faktor Yang Mempengaruhi Motivasi Belajar Siswa SDN 093 Kecamatan Panyabungan Kota Kabupaten Mandailing Natal. Metode yang digunakan adalah kualitatif deskriftif dengan cara mengumpulkan data baik secara langsung turun ke lapangan untuk mendapatkan informasi yang akurat tentang objek penelitian penulis, sumber data yang digunakan berupa data skunder dan primer, dan teknik pengumpulan data dengan cara observasi, wawancara dan dokumentasi. Hasil penelitian ini menunjukkan, (1) motivasi belajar siswa adalah untuk mendapatkan hadiah, pujian, prestasi, dan nilai yang bagus; ( 2) faktor yang mempengaruhi motivasi belajar siswa adalah faktor internal yaitu faktor yang bersumber dari dalam diri siswa yaitu kondisi jasmani dan rohani, kemampuan siswa, dan perhatian. Kedua faktor eksternal yaitu faktor yang bersumber dari luar diri siswa seperti upaya guru membelajarkan siswa, fasilitas belajar dan kondisi lingkungan di sekitar siswa.
PENINGKATAN KETERAMPILAN BERHITUNG SISWA MELALUI PENERAPAN MEDIA BRAILLE BAPER DI SLB CURUP
Authors: Coryzoeniawati Coryzoeniawati
Published: January 2022

Getting proper education is the right of every citizen, both normal students and students with special needs (disabilities). In this case, the tools and learning media needed are very important to support teaching and learning activities. However, there are more learning tools and media available for normal students than students with special needs. The results of the observations that the author saw in SLB Rejang Lebong were still lacking in learning tools in special schools, especially learning tools for counting, especially blind children. Thus encouraging the author to be able to create a learning aid, especially in numeracy skills for children with disabilities, especially blind children in SLB Rejang Lebong Bengkulu.

Starting from the problem above, the writer tries to deal with this problem by creating learning media, especially for blind children, namely "Braile Baper" which is simultaneously used as a research on the principle of usefulness of the tool in SLB Rejang Lebong which is a tool used. to practice multiplication counting skills in a simple and fast and not boring way so that it is expected to be useful to help improve understanding of blind children in learning media for numeracy skills in mathematics, especially in arithmetic operations material. The results of the application of the Braille Baper learning media that the student activities observed during the learning process were good, seen in the student activity observation sheets as well as interviews with students applying the Braille Baper learning media were responded positively and effectively applied in learning, especially for blind children.
An Econometric Study of the Factors Influencing Participation in Urban and Community Forestry Programs in the United States
Authors: Wall Brandon , Straka Thomas , Miller Stephen
Published: January 2022

Public participation in urban and community forestry (U&CF) programs in the contiguous 48 states of the United States can be explained by several different factors using econometric methods. The state’s percent of working population, income level, percent of forested land, dominant political affiliation, state government expenditures on education, and the number of communities participating in U&CF programs help explain the public participation rates in the programs. These factors accounted for 52% (R 2= 0.5218) of the variability in public participation in U&CF programs in 2003. Knowing the factors that influence pubic participation in U&CF programs is vital to the success of the program and can assist federal, state, and local decision-makers in planning efforts.
Residents’ Attitudes Toward Street Trees in the UK and U.S. Communities
Authors: Schroeder Herbert , Flannigan John , Coles Richard
Published: January 2022

Research on residents’ attitudes has shown that street trees are highly valued elements of the urban environment and that their benefits far outweigh their annoyances. Much of this research was done in communities in the United States, and it is uncertain whether the findings can be generalized to other communities or countries. We compared residents’ opinions of street trees, perceptions of the benefits and annoyances trees provide, and preferences for tree size, shape, and growth rate between three communities in the United States and the United Kingdom. Overall, opinions of nearby street trees were positive and did not differ between the two UK communities and the U.S. community. Respondents in the UK communities rated annoyances as more serious, shade as less of a benefit, and physical benefits as more significant than did the residents of the U.S. community. Respondents in the two UK communities also preferred smaller trees with slower growth rates. Although these comparisons cannot be used to make inferences about differences between the entire United Kingdom and United States, they do suggest some specific ways in which community characteristics such as climate and proximity of trees to houses may contribute to variation in attitudes toward trees.
A Private Tree By-Law’s Contribution to Maintaining a Diverse Urban Forest: Exploring Homeowners’ Replanting Compliance and the Role of Construction Activities in Toronto, Canada
Authors: Conway Tenley , Khatib Jihan , Tetreult Janele , Almas Andrew
Published: January 2022

Many municipalities are working to protect and grow their urban forest, including adopting private tree regulations. Such regulations typically require property-owners to apply for a permit to remove trees and, if the permit is granted, plant replacement trees. Even with such regulations, many private trees are removed each year, particularly on residential property. Property-level construction activity, including expanding building footprints, replacing an older home with a new one, and increasing hardscaping, is emerging as a key driver of residential tree loss. This study addresses whether homeowners who receive a permit to remove one or more trees comply with the requirement to plant replacement trees to better understand the effect of private tree regulation. We explore this question through a written survey of homeowners who received a tree removal permit and site visits in Toronto (Ontario, Canada). While 70% of all survey participants planted the required replacement trees 2 to 3 years after receiving the permit, only 54% of homeowners whose permit was associated with construction planted. Additionally, most replacement trees were in good health but were dominated by a few genera. We also found significant differences in replacement planting and tree survival across the city’s 4 management districts. This study highlights that if resources supporting private tree regulations are limited, tree permits associated with construction should be prioritized for follow-up. Additionally, guidance about diverse species to plant should be communicated to ensure that private tree regulations are supporting the long-term protection of the urban forest.
Responder a la realidad: Programa de Servicio Social Universitario y su fundamento en el Paradigma Pedagógico Ignaciano (PPI)
Authors: Bautista Mulia Sarai , Minakata Quiroga María José , Talamantes Casillas Marcela
Published: January 2022

El Modelo de Servicio Social de la Universidad Iberoamericana Ciudad de México se ha caracterizado por integrar de manera curricular el servicio social obligatorio, que tiene como eje articulador el Paradigma Pedagógico Ignaciano (PPI). En agosto de 2020, dicho modelo se incorporó a una apuesta ético-política universitaria centrada en la excelencia académica con un énfasis en la promoción social: la Trayectoria de Formación y Acción Social Universitaria (FASU) de los Planes de Estudio Manresa. Éstos tienen como base tres temas transversales: género, sustentabilidad e interculturalidad. En el presente artículo se hace una caracterización —a modo de diagnóstico— de las dinámicas de la asignatura Práctica Profesional y Servicio Social, desde el PPI, con el propósito de identificar la presencia de los temas transversales en la actualidad. El trabajo concluye con recomendaciones concretas para la implementación de la asignatura curricular que acompañará al servicio social universitario en los Planes Manresa, el Taller de Formación y Acción Social.
PENANGANAN DAMPAK VIRUS CORONA (COVID-19) DALAM KEGIATAN PENGABDIAN KEPADA MASYARAKAT OLEH DOSEN DAN MAHASISWA DI DESA KARANGJOMPO KEC. TIRTO DAN DESA API-API KEC. WONOKERTO KAB. PEKALONGAN
Authors: Nasir StRahmatullah , Wahyu Permadi Yulian
Published: January 2022

Infeksi virus corona disebut COVID-19 dan pertama kali ditemukan di kota Wuhan, Cina, pada akhir Desember 2019. Virus ini menular dengan cepat dan telah menyebar ke wilayah lain di Cina dan ke beberapa negara, termasuk Indonesia. Corona virus adalah kumpulan virus yang bisa menginfeksi sistem pernapasan. Dengan kondisi demikian perlu adanya keprihatinan seluruh dosen Program Studi Sarjana Farmasi Fakultas Ilmu Kesehatan Universitas Muhammadiyah Pekajangan Pekalongan untuk melakukan pengabdian kepada masyarakat penanganan pencegahan virus korona di wilayah kabupaten pekalongan untuk memberikan solusi pencegahan dengan tujuan untuk menekan jumlah penderita virus corona. Pengabdian masyarakat dosen juga bertujuan untuk memberikan/mengabdikan  ilmu yang dimilikinya untuk peningkatan kualitas hidup masyarakat baik dibidang kesehatan atau di bidang ekonomi. Metode pelaksanaan yang diterapkan adalah dengan Memberikan informasi mengenai bagaimana langkah-langkah yang perlu dilakukan untuk pencegahan apabila terjadi gejala-gejala terinfeksi Virus Covid 19. Memberikan informasi kepada masyarakat mengenai pola hidup bersih dan  sehat terutama untuk pencegahan virus covid 19 yang saat sedang mewabah. Memberikan bantuan paket sembako kepada masyarakat, sehingga bisa sedikit meringankan beban permasalahan ekonomi karena masa pandemi ini sebagian besar masyarakat terdampak yaitu banyak lapangan pekerjaan yang hilang. Memberikan handsanitizer dan handwasher kepada masyarakat, tempat ibadah (masjid, mushola), perkantoran di lingkungan Desa Karangjompo Kec. Tirto dan Desa Api-api Kec. Wonokerto Kab. Pekalongan.
PERENCANAAN STRATEGIS DALAM UPAYA PENINGKATAN MUTU LULUSAN DI MTs DARUL ILMI PANGKALAN BERANDAN
Authors: Diyan Yusri Anggun Indah Sari Rambe, Pitri Nasution,
Published: January 2022

Tujuan dari penelitian ini sebagai berikut:1) Untuk mendeskripsikan perencanaan strategis yang di MTs Darul Ilmi Pangkalan Berandan. 2) Untuk mendeskripsikan mekanisme pelaksanaan perencanaan di sekolah MTs Darul Ilmi Pangkalan Berandan.3) Untuk mendeskripsikan cara  menyusun perencanaan strategis yang  efektif dan optimal di MTs Darul Ilmi Pangkalan Berandan.4) Untuk mendeskripsikan perencanaan manajemen strategis tersebut dikaitkan dengan visi misi sekolah MTs Darul Ilmi Pangkalan Berandan. Metode yang digunakan dalam penelitian ini adalah deskriptif, dengan pengambilan data, wawancara, dokumentasi,  dan subjek ini adalah kepala madrasah, wakil kepala madrasah, dan guru bidang studi. Adapun hasil penelitian ini adalah berdasarkan hasil penelitian yang  peneliti temukan di MTs Darul Ilmi Pangkalan Berandan adalah  bagaimana perencanaan strategis yang telah dilakukan oleh kepala madrasah. Setiap pemimpin jika ingin membuat suatu program maka ia harus membuat planning(perencanaan). Penyusunan strategi d sekolah ini dimulai dari mengembangkan pernyataan visi dan misi, melakukan audit internal dan eksternal, menetapkan tujuan jangka panjang, menyusun rencana strategis  dan menciptakan mutu lulusan secara efektif  dan efesien dengan langkah strategi mempunyai komponen, langkah- langkah strategi yang pertama penguatan kepada SDM guru. Mekanisme penerapan rencana strategis dengan cara membenahi terlebih dahulu guru setelah itu siswanya tahap berikutnya membenahi strukturnya tahap akhir keberhasilan yang akan berkelanjutan. Sehingga sekolah ini menjadi sekolah yang terfavoritkan di Pangkalan Berandan mempunyai jumlah murid yang banyak untuk masuk di sekolah ini.
Analisis Faktor Penyebab Kesulitan Belajar Matematika Kelas IV Sekolah Dasar Negeri
Authors: Rika Audina Dara Fitrah Dwi,
Published: January 2022

Penelitian ini bertujuan untuk: (1) Mengetahui kesulitan yang dialami siswa dalam belajar matematika kelas; (2) Mengetahui penyebab siswa kesulitan dalam belajar matematika di kelas; (3) Mengungkapkan upaya yang dapat dilakukan untuk mengatasi kesulitan belajar matematika kelas IV Sekolah Dasar Negeri. Sumber data penelitian ini adalah kelas IV Sekolah Dasar Negeri. Pengumpulan data penelitian ini dikumpulkan dengan menggunakan instrumen penelitian berupa angket, lembar pedoman observasi dan panduan wawancara. Teknik analisis data dalam penelitian ini menggunakan deskriptif kuantitatif. Hasil penelitian menunjukkan beberapa kesimpuan yakni: (1) Kesulitan belajar matematika terdiri dari tiga kompenen yaitu kesulitan memahami konsep, kesulitan dalam keterampilan, dan kesulitan memecahkan masalah; (2) Faktor yang menyebabkan kesulitan belajar matematika berasal dari faktor internal dan faktor eksternal. Faktor internal meliputi sikap siswa dalam belajar matematika, motivasi belajar siswa yang masih rendah, kesehatan tubuh yang tidak optimal, dan kemampuan pengindraan siswa yang kurang. Sedangkan faktor eksternal antara lain kurangnya variasi mengajar guru, penggunaan media pembelajaran yang belum maksimal, sarana prasarana di sekolah, serta lingkungan keluarga; (3) Upaya yang dapat dilakukan dengan mengajarkan matematika dengan menyenangkan, menggunakan media pembelajaran yang kongret, memperbanyak latihan soal, dan menjalin kerja sama dengan orang tua siswa.
Clinical, Biochemical and Radiological Factors Affecting the Prognosis of Neurological Deficit Improvement in Spinal Tuberculosis Patients at Hospitals of Sabah
Authors: Zamzuri Zakaria  , Harkeerat Singh Sukhdarshan Singh  , Mohd Ariff Sharifuddin  , Rajandra Kumar Karupiah  , Mohd Adham Shah Ayeop  , Naveen Vijayasingham
Published: January 2022

The incidence of spinal tuberculosis is highest in developing nations. We aimed to analysethe clinical, biochemical, and radiological parameters in spinal tuberculosis patients withsignificant neurological impairment in relation to their functional outcome. This cross-sectional study involved 224 patients who had been presented to three hospitals in Sabah from July 2017 to June 2018, with significant neurological impairment fulfilling the inclusion criteria were enrolled. Diagnosis of spinal tuberculosis was determined by clinical and radiological factors and confirmed with histopathology, micro bacteriology, and immunoassay. Patients with significant neurology received standard treatment protocol according to the middle pathway regime, anti-tuberculosis for the first three weeks, and were subjected to surgery if there was no improvement. Age, duration of symptoms, c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white cell count (WCC), thoracolumbar spine involvement, and presence of soft tissue collection were evaluated. Modified Barthel Index (MBI) was used to assess the functional outcome. After a year, 146 patients (65.1%) had good functional outcomes and 78 patients had no significant improvement. On univariate analysis, there were no significant correlations between functional outcome and age (p>0.45); duration of symptoms (p>0.68); CRP (p>0.76); WCC (p>0.99); and presence of soft tissue collection (p>0.21).. High ESR (p<0.008) and thoracolumbar lesions were associated with poor functional outcomes (p<0.033). Higher ESR values and thoracolumbar lesions were associated with poor prognostic factors functional outcome in spinal tuberculosis patients.
TEMPERAMENTAL DIMENSIONS AMONG YOUNG STUTTERERS AND TYPICALLY DEVELOPING CHILDREN
Authors: Mushtaq Zubia , Mumtaz Nazia , Saqulain Ghulam
Published: January 2022

Objective: To compare the temperamental characteristics of children who stutter with those who do not stutter.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Ayub Medical Complex, Abbottabad, from Jun to Nov 2018.

Methodology: We recruited 120 children of both genders aged 3-8 years. Sample recruited included two groups including 60 children with stuttering (CWS) and 60 children with no stuttering (CWNS), using consecutive sampling. After taking consent, data was gathered using demographic sheet and Children Behavioral Questionnaire (CBQ) from the sample population. Statistical analysis was done using SPSS-21.

Results: The sample included 82 (68.3% males and 38 (31.7%) female children. t-test results of children with stuttering and children with no stuttering showed statistically significant difference for effortful control (p<0.05) including dimension of inhibitory control, low intensity pleasure and perceptual sensitivity. However, the values for Surgency Extraversion and Negative affectivity were not statistically significant though results showed higher and lower mean scores respectively for stutterers compared to non-stutterers. However, the dimensions of anger, frustration, discomfort and falling reactivity showed statistically significant difference (p<0.05).

Conclusion: Children with stuttering and children with no stuttering differ in their temperamental characteristics with statistically significant difference for effortful control with lower control in stutterers.
OCCUPATIONAL NOISE INDUCED HEARING LOSS: IT’S FREQUENCY & RISK FACTORS
Authors: Pattafi Muhammad Javid Iqbal , Mumtaz Nazia , Saqulain Ghulam
Published: January 2022

Objective: To determine the frequency and risk factors of occupational noise induced hearing loss.

Study Design: Cross sectional study.

Place and Duration of Study: Dispensary Unit of Jaith Bhuta Sugar Mill near Rahim Yar Khan, Southern Punjab.from Aug 2017 to Jan 2018.

Methodology: This study was conducted using nonprobability consecutive sampling. n=300 workers of bothgenders aged 18-40 years were assessed. Basic demographic parameters, otoscopic examination and Pure Tone Audiometry were used for data collection. The Data was analyzed by using SPSS version 21.

Results: Study included 215 (71.7%) males and 85 (28.3%) females with male to female ratio of 2.53: 1 and meanage of 28.34 ± 4.61 years. The frequency rate of hearing impairment (HI) was 90 (30%) out of 300 respondents inthis study. Out of 70 (100%) of respondents were affected with duration of job of 6-10 years. There was significant association between gender, age, education, duration of noise exposure with occupational noise induced hearing loss with p-value <0.001.

Conclusion: There was high frequency of occupational noise induced hearing loss (ONIHL) with significantrisk factors being level and duration of exposure to noise (ETN), age, gender, education and hearing protectivedevices (HPD)’s.
FREQUENCY OF BONE EROSION ON COMPUTERIZED TOMOGRAPGHY SCAN IN ALLERGIC FUNGAL RHINOSINUSITIS
Authors: Ali Muhammad , Attiq Saima , Raza Sayed Nusrat , Hakim Abdul , Ahmed Shakeel , Ali Shaukat , Akbar Farhan , Abbas Syed Waqar
Published: January 2022

Objective: To analyze the frequency and sites of bone erosion on computerized tomograghy scan in Allergic Fungal Rhinosinustis in Pakistan.

Study Design: Retrospective observational study.

Place and Duration of Study: Department of ENT, Combined Military Hospital Lahore, Malir Karachi and Rawalpindi, from Jan 2010 to Dec 2019.

Methodology: Total 230 cases of Allergic Fungal Rhinosinusitis were screened, out of which 85 patients having bone erosions on computerized tomograpghy scan were included in the study. Bone erosion in different paranasal sinuses and their sub sites were evaluated. Depending upon the number of bone erosion, patients were divided into three categories as mild, moderate and severe. Those having erosion at a single site were labelled as mild, those with two sub sites of erosion as moderate and those with more than two subsites of erosion were labelled as severe cases.

Results: Detailed evaluation of computerized tomography scan of paranasal sinuses revealed bone erosion in 85/230 (36.9%) cases. Mean affected age was 23.96 ± 12.71 years. There were 52 (61.1%) males and 33 (38.9%) females. Ethmoid sinus was the most commonly involved sinus to have bone erosions 55 (38.19%) followed by maxillary sinus 38 (26.38%) then sphenoid sinus 27 (18.75%) and lastly frontal sinus 24 (16.6%). Out of 85 patients 48 (56.1%) were having mild, 22 (25.8%) moderate and 15 (17.6%) had severe disease.

Conclusion: Allergic Fungal Rhinosinusitis has high frequency of bone erosion. Computerized tomography scan is an important and effective investigation in finding these bony erosions and ethmoid sinus is the.....
EXPERIENCE OF DOING ENDOSCOPIC SINUS SURGERY FOR CHRONIC MAXILLARY SINUSITIS WITHOUT PRE-OPERATIVE CT-SCAN IN A PERIPHERAL HOSPITAL
Authors: Asghar Adnan , Aslam Sohail , Bukhari Syed Muhammad Asad Shabbir , Ijaz Umar , Iqbal Shahid , Latif Saira
Published: January 2022

Objective: To determine frequency of our complications of endoscopic sinus surgery without pre-operative CT-Scan and to compare this frequency with other similar studies done with the help of pre-operative CT-Scans.

Study Design: Cross sectional study.

Place and Duration of Study: ENT Department, Combined Military Hospital Skardu Pakistan, from Jun 2017 to Jun 2019.

Methodology: Total 69 patients (116 Sides) were operated under general anesthesia by using 0 and 30 degree endoscopes to address the Maxillary sinusitis. Frequency of complications was compared to other studies by applying chi-square test for goodness of fit. The complications were also correlated to ages of patients by applying Spearman correlation analysis.

Results: Mean age was 29.75 ± 10.9 years (range 15-75). Overall complications rate was 4.3% (5 out of 116 sides, 95% confidence interval 4.23-4.4). Peri-orbital ecchymosis and peri-orbital emphysema were most commonly occurring complications (4.3%). This complication rate was compared to few other studies, which proved that difference was not statistically significant. Correlation of occurrences of orbital complications with the age proved that there was no statistically significant correlation (Correlation coefficient r=-0.085, p-value 0.276).

Conclusion: Isolated chronic maxillary sinusitis refractory to medical treatment can be treated by endoscopic sinus surgery without pre-operative CT-Scan.
TOTAL ENDOSCOPIC STAPES SURGERY. OUR TECHNIQUE AND EXPERIENCE OF 45 CASES
Authors: Najam Muhammad Atif , Sarwar Urwa , Raza Maqbool , Khan Khalid Azam , Saleem Humaira , Niazi Najam-Us-Saqib , Rashid Muhammad , Riaz Naeem
Published: January 2022

Objective: To assess the hearing results of transcanal endoscopic stapedotomy

Study Design: Descriptive study.

Place and Duration of Study: Pakistan Naval Ship Hafeez Islamabad Pakistan, from Jun 2016 to Jun 2020.

Methodology: All patients with surgically confirmed otosclerosis were included in the study. All patients were operated with 0-degree 3mm, 14cm rigid endoscope under general anesthesia. Preoperative and post operative air bone gap was noted along with demographic data, middle ear anomalies (persistent stapedial artery, dehiscent facial nerve, anteriorly placed facial nerve, floating foot plate) and injury to chorda tympani. Postoperative air bone gap (A-B Gap) was documented 12 weeks after surgery. All patients were followed up for 6-12 months

Results: Mean age of patients was, 37 years and standard deviation was 12.34 (range 27-52 years). Out of total 45 cases 13 were males (29%) and 32 females (71.%). Four (8.8%) patients had dehiscent facial canal and 1 (2.2%) patient had persistent stapedial artery. Average preoperative A-B gap was 35 db and Average Postoperative A-B Gap was 7 db. Chorda tympani was preserved in all cases. One patient (2.2%) complained of altered taste which resolved after 3 months. Four patients had Postoperative vertigo that lasted 2 days on average.

Conclusion: Endoscopic trans canal Stapes surgery is scarless safe effective procedure demonstrable hearing benefits in all patients with minimum complications. The Technique is single handed and has steep learning curve.
DEPRESSION AND ITS ASSOCIATED FACTORS: A STUDY ON CAREGIVERS OF PSYCHIATRIC PATIENTS
Authors: Sohail Nomita , Hussain Shiraz , Kakar Siddique , Khan Sana , Alimudin Mohsin , Kamran Mohammad , Ali Sohail
Published: January 2022

Objective: To determine the frequency and association of depression among caregivers of psychiatric patients.

Study Design: Cross-sectional study.

Study place and duration: Outpatient Department of a Tertiary Care Hospital, Rawalpindi, from Sep 2016 to Apr 2017.

Methodology: A total of 200 caregivers of psychiatric patients were included in this study. Each caregiver was interviewed by a consultant psychiatrist to measure the frequency of depression according to International Classification of Disease-10 (ICD10) criteria and Hospital Anxiety and Depression Scale (HADS) score of >8. Socio-demographic factors were associated with presence of depression by using chi-square test.

Results: The mean age observed was 35.36 ± 8.39 years. There were 84 (42%) males and 116 (58%) females. Depression was found in 95 (47.5%) caregivers of psychiatric patients in our analysis. Female gender, low socio-economic status and type of psychiatric illness had significant relationship with presence of depression among our target population.

Conclusion: Depression was a highly common undiagnosed entity among the caregivers of psychiatric patients. Female caregivers or caregivers with low socio-economic status should be screened especially for depression in addition to caregivers of patients suffering from psychotic illness.
DISSERTATION WRITING: AN ANALYSIS OF VARIOUS BARRIERS TO ITS SUCCESS IN PROMOTING RESEARCH CULTURE IN PAKISTAN
Authors: Nawaz Qudsia , Tabbasum Humaira , Baqai Shehla
Published: January 2022

Objective: To identify evidence of success or otherwise of measures like dissertation to promote high quality medical research in the students undergoing postgraduate specialty training despite of many efforts, the quality of medical research in the country remains in turmoil and unrest prevails in the medical community as well.

Study Design: Cross-sectional survey.

Place and Duration of Study: Combined Military Hospital Lahore Pakistan, from Jan 2017 to Dec 2018.

Methodology: This study was conducted by using Google forms, interviewing the college’s affiliates, which include supervisors, fresh graduates and current trainees using a structured questionnaire, to get an idea of the participants’ view regarding magnitude of the problem, its causes and possible solution.

Results: A total of 94 participants responded to the online questionnaire. Among these, 34 (36%) fell in the age group 29-34 years, followed by 19 (20.2%) in the age group 35-40 years. Among the participants, 56 (59.6%) were females. Sixty-six (74%) participants agreed that dissertation writing was not an effective tool in promoting research culture in the country.

Conclusion: The current system of Dissertation-writing is not efficient in promoting research skills of the postgraduate trainees and systemic improvements are urgently needed, which would also brighten the image of medical education in the country.
ASSESSMENT OF SLEEP QUALITY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A PROSPECTIVE OBSERVATIONAL STUDY FROM A TERTIARY CARE CENTRE
Authors: Batool Syeda Ramsha , Hasan Insia , Dars Jawed Akbar , Batool Rabisa , Ahmed Syed Masroor , Iqbal Muhammad
Published: January 2022

Objective: To evaluate the quality of sleep-in patients diagnosed with Type 2 Diabetes Mellitus (T2DM).

Study Design: Prospective observational study.

Place and Duration of Duration: Psychiatry Department and Medicine Ward of Jinnah Postgraduate Medical Centre, Karachi Pakistan, from Apr to Nov 2018.

Methodology: All patients with Type 2 Diabetes Mellitus were included in the study. All cases under age 30, type I diabetes, gestational diabetes and patients with severe illness were excluded. The data of sociodemographic lifestyle factors was collected through a pre-designed semi-structured questionnaire and sleep quality of patients was assessed using Pittsburg Sleep Quality Index (PSQI). The results of the data were analyzed by using SPSS version 24.

Results: Out of 260 patients with Type 2 Diabetes Mellitus, 197 (76%) were female. The mean age of the sample was 55.7 ± 9.89 years, with only 54 (20.8%) having normal body mass index. More than 50% of sample was poor sleepers and educational status was found to be strongly associated with quality of sleep (p-value <0.05).

Conclusion: The present study indicates that patients with Diabetes Mellitus often experienced sleep irregularities hence poor sleep quality. There is a need to increase the awareness regarding sleep quality among patients and health professionals as well while assessing the patients with Diabetes Mellitus.
EFFECTIVENESS OF STEROIDS VERSUS IMMUNOMODULATORS INTREATMENT OF VERNAL KERATO-CONJUNCTIVITIS. A STUDY AT ARMED FORCES INSTITUTE OF OPHTHALMOLOGY
Authors: Arsalan Zahra , Zafar Omer , Naqvi Syed Abid Hassan , Ain Qurat Ul
Published: January 2022

Objective: To evaluate whether steroids or immunomodulator is a better mode of treatment in long term management of vernal keratoconjunctivitis.Study Design: A quasi experimental study.

Place and Duration of Study: Armed Forces institute of Ophthalmology, Rawalpindi, from Feb 2019 to Oct 2019.

Methodology: Ninety-two patients in between ages of 5-20 years were divided into two equal groups of 46 patients each. After instillation of 0.1% Fluoromethalone (steroid) into both eyes of patients of vernal keratoconjunctivitis, in group A and outcomes were compared with those of 0.05% Cyclosporine (immunomodulator) administered in the same manner in group B. All the patients were followed up regularly after 1, 3, and 6 weeks, 3 months, and 6 months and data recorded for inference.

Results: Both the drugs were found to effectively reduce the foreign body sensation but had no or minimal effect on visual acuity and intraocular pressure (p-vale<0.001). Few patients in steroid group showed noticeable rise of intraocular pressure. (p=0.02). Cyclosporine was found to markedly reduce the mucoid discharge and photophobia without any adverse side effects (p-value=0.02).

Conclusion: Cyclosporine appears to be more effective in control of mucous discharge and inflammation than steroids in vernal keratoconjunctivitis with minimal or no side effects and hence was found to be a safe alternative to steroid usage in long-term treatment groups.
COMPARISON OF HAEMODYNAMIC STABILITY WITH 0.5% AND 0.75% HYPERBARIC BUPIVACAINE DURING SPINAL ANAESTHESIA IN WOMEN UNDERGOING CAESAREAN SECTION
Authors: Iftikhar Hina , Aslam Aneel , Rehman Habib Ur , Ali Zulfiqar , Abbass Mohammad Ali , Haider Zulfiqar
Published: January 2022

Objective: To compare the effect of 0.5% and 0.75% hyperbaric Bupivacaine on haemodynamic stability in terms of mean systolic blood pressure and heart rate recorded at 4 min in patients undergoing caesarian section in spinal anesthesia.

Study Design: Quasi experimental study.

Place and Duration of Study: Department of Anaesthesiology, Combined Military Hospital, Malir, from Jul to Dec 2018.

Methodology: The patients were assigned in two groups (A and B) using lottery method. Group A received 0.5% hyperbaric Bupivacaine solution. Group B received 0.5% hyperbaric Bupivacaine solution. Spinal anaesthesia was given, blood pressure and heart rate were recorded. Data were analyzed in SPSS version 23. Both groups were compared for mean systolic blood pressure and heart rate by using independent sample t-test.

Results: The mean age of patients was 29.62 ± 6.21 years in 0.75% Bupivacaine group while 29.31 ± 6.20 years in 0.5% Bupivacaine group. The mean systolic blood pressure of patients was 111.63 ± 5.96 mmHg in 0.75% Bupivacaine group while 117.16 ± 7.12 mmHg in 0.5% Bupivacaine group. The difference was significant in both groups (p-value <0.05). The mean heart rate of patients was 92.27 ± 4.71 beats per min (bpm) in 0.75% Bupivacaine group while 97.68 ± 4.58 bpm in 0.5% Bupivacaine group. The difference was significant in both groups (p-value <0.05).

Conclusion: 0.5% hyperbaric Bupivacaine was better than 0.75% hyperbaric Bupivacaine solution in spinal anaesthesia during caesarean section.
COMPARISON OF PROGRESSIVE MUSCULAR RELAXATION (PMR) AND MUSIC THERAPY (MT) IN REDUCING THE ANXIETY, DEPRESSION AND STRESS SYMPTOMS AMONG NURSES
Authors: Mustafa Nazia , Farzeen Midhat , Kiani Shoaib , Khan Sana , Ain Noor Ul , Mumtaz Jaweria
Published: January 2022

Objective: To compare the progressive muscular relaxation and music therapy in reducing the anxiety, depression and stress symptoms among nurses.

Study Design: Quasi-experimental Study.

Place and Duration of Study: Various hospitals in Rawalpindi, from Mar 2018 to Mar 2019.

Methodology: Sample of study was 20 female nurses. They were assessed by using depression, anxiety and stress scale (DASS21), Urdu version. Study participants were randomized into two groups, group 1= who received the music therapy (n=10); group 2=who receive progressive muscular relaxation (n=10). Both the groups were provided with 4 sessions of both interventions for one month. After completion of intervention, post assessment was carried immediately and analysis was carried out.

Results: Mean age of nurses was 31 ± 7.42 years (range from 19-45 years). Significant difference was found which showed that progressive muscular relaxation was more effective in reducing the symptoms of depression and stress as compared to music therapy. Whereas, no significant difference (p>0.05) was found on anxiety (both the treatments equally reduced the anxiety).

Conclusion: Progressive muscular relaxation was found to be more effective in reducing stress and depression in nurses than music therapy. The use of such techniques can serve as an additional therapy in the treatment of stress, anxiety and depression and can be used to reduce the need for pharmacological therapy.
RIFAXIMIN EFFECTIVENESS IN PREVENTING THE RECURRENCE OF HEPATIC ENCEPHALOPATHY AMONG PATIENTS WITH LIVER CIRRHOSIS
Authors: Saleem Muhammad Zulqurnain , Saleem Muhammad Hasan , Saleem Husnain , Aasil Muhammad Ali
Published: January 2022

Objective: To determine the effectiveness of rifaximin in reducing the frequency of recurrence of hepatic encephalopathy among patients with liver cirrhosis.

Study Design: Descriptive case series.

Place and Duration of Study: Outpatient department of Combined Military Hospital Peshawar from Jan to Jun 2017.

Methodology: We included one hundred patients of either gender having liver cirrhosis with child Pugh B or C class with at least two previous episodes of hepatic encephalopathy. Patients were followed for six months to have any recurrence of hepatic encephalopathy. Conventional group was defined as having standard regimen including lactulose. Rifaximin treatment was defined as a 550mg BD daily dosing along with standard prescription.

Results: Fifty patients were on conventional treatment to prevent recurrence of hepatic encephalopathy while 50 patients were using rifaximin in addition to standard prescription. The average age of 54.8 ± 6.1 years with 58% male patients and 48% in child-pugh B class. Thirty (30%) patients developed hepatic encephalopathy among the study population. 14 patients with recurrence belong to rifaximin group while 16 were on conventional treatment (p-value >0.05) showing a non-significant difference. Post stratification revealed only age as a significant predictor of recurrence of hepatic encephalopathy in our study population (p<0.05).

Conclusion: Frequency of hepatic encephalopathy is similar in conventional treatment with Lactulose over six months of follow up as compared with rifaximin.
ERECTILE DYSFUNCTION AND ASSOCIATED SOCIO-DEMOGRAPHIC FACTORS AMONG PATIENTS SUFFERING FROM ASTHMA
Authors: Sultan Omer , Khalid Muhammad , Athar Muhammad Hammad
Published: January 2022

Objective: To determine the frequency of erectile dysfunction among the patients of asthma and analyze the associated socio demographic factors.

Study Design: Cross sectional study.

Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital Rawalpindi, from Oct to Dec 2018.

Methodology: One hundred and fifty seven patients of asthma diagnosed for more than one year by a consultant medical specialist or pulmonologist were included in the study. Erectile dysfunction was assessed by using the International Index of Erectile Function-5 (IIEF-5).

Results: Out of 157 patients of asthma, 74 (47.1%) had no erectile dysfunction, 50 (31.8%) had mild, 17 (10.8%) had mild to moderate, 11 (7.1%) had moderate and 5 (3.2%) had severe erectile dysfunction. Mean age of the study participants was 41.74 ± 3.16. Mean duration of asthma among the patients in this study was 5.98 ± 4.38 years. Poly-pharmacy and long duration of illness had significant association with erectile dysfunction (p-value<0.05).

Conclusion: There is a high frequency of erectile dysfunction among the patients suffering from asthma. Chronic illness when not under adequate control for a long time or is under control with poly pharmacy might give rise to problems which may be more troublesome than the primary illness.
PREDICTORS OF MORTALITY WITHIN 8 WEEKS AFTER ENDOSCOPIC TREATMENT OF GASTRIC VARICEAL BLEED WITH N-BUTYL 2-CYANOACRYLATE IN CIRRHOTIC PATIENTS
Authors: Ahmad Mahmood , Mahmud Yasir , Rasheed Sidra , Muaaz Muhammad , Afzal Muhammad Naeem , Nadeem Muhammad Arif
Published: January 2022

Objective: To assess the predictors associated with mortality within 8 weeks in patients undergoing endoscopic N-butyl-2- cyanoacrylate treatment.

Study Design: Prospective comparative study.

Place and Duration of Study: Department of Gastroenterology, Services Institute of Medical Sciences, Lahore Pakistan, from Mar 2018 to Mar 2019.

Methodology: A total of 106 patients of gastric variceal bleed were enrolled in the study. Tissue glue was injected into the varix endoscopically and mortality within 8 weeks after endoscopic intervention was noted.

Results: Among the enrolled patients, 65 (61.3%) were male and 41(38.7%) were female. Mortality was noted in 19 (17.9%) patients within 8 weeks after endoscopic therapy. Chi-square analysis showed creatinine >1.5, Child Pugh score >9, MELD score >18, re-bleeding within 7 days, low blood pressure <90/60 at presentation and hepatic encephalopathy as significant predictors of mortality (p<0.005).

Conclusion: Cirrhotic patients undergoing endoscopic injection of gastric varix with N-butyl 2-cyanoacrylate after gastric variceal bleed have high risk of death within 8 weeks.
GONIAL ANGLE DETERMINATION; A COMPARISON BETWEEN LATERAL CEPHALOGRAM AND BOTH HEMISPHERES OF ORTHOPANTOMOGRAM
Authors: Khan Mehwish , Akhtar Faheem Nake , Jan Abdullah , Hamid Fatima , Tariq Sana
Published: January 2022

Objective: To evaluate the mean values of Genial angle measured by Lateral cephalogram and Orthopantomogram.

Study Design: comparative cross sectional study.

Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi, from Aug 2018 to Feb 2019.

Methodology: Patients irrespective of gender between the ages of 13-20 who reported for the treatment of class I malocclusion with complete anterior dentition were included. Orthopantomogram and lateral cephalogram were drawn by the same person. Gonial angle on orthopantomogram was measured by drawing tangents on posterior border of ramus and lower border of mandible on both halves of orthopantomogram. On lateral cephalogram the angle was measured between ramus and mandible. Gonial angle measured from lateral cephalogram and orthopantomogram were compared. T-test was applied.

Results: Mean age of the individuals was 18.33 ± 3.97 years. The mean gonial angle measured on lateral cephalogram was 122.66 ± 1.64 degrees while the mean gonial angle measured on right and left side of orthopantomogram was 122.41 ± 1.56 degrees and 122.33 ± 1.55 degrees respectively.

Conclusion: Orthopantomogram can also be used to measure gonial angle as accurately as a lateral cephalogram with the advantage that there are no superimpositions and both the gonial angles can be measured simultaneously on orthopantomogram.
PERCEPTIONS OF CONTINUING MEDICAL EDUCATION PARTICIPANTS REGARDING IMPROVEMENT OF PATIENT CARE THROUGH CONTINUING MEDICAL EDUCATION ACTIVITIES IN LAHORE DISTRICT
Authors: Tufail Shazia , Khan Junaid Sarfraz , Baqai Shehla , Mustafa Nilofar
Published: January 2022

Objective: To explore the perceptions of Continuing Medical Education participants about the improvement of patient care through Continuing Medical Education activities and to explore the factors hampering or favouring improvement of patient care through Continuing Medical Education activities.

Study Design: Qualitative phenomenological study.

Place and Duration of Study: University of Health Sciences, Lahore, from Dec 2016 to May 2017.

Methodology: In qualitative phenomenological study conducted at University of Health Sciences, Lahore from Dec 2016 to May 2017, semi structured in-depth interviews were conducted individually from 10 General Practitioners which were audiorecorded and transcribed. Code labels were assigned manually and grouped together into broader themes. Interpretation ofthemes was done after thematic analysis.

Results: Two participants were female and ten were male with experience ranging between 20-38 years. Three main themes with sub-themes were identified: (1) positive talk (Affirming the link between Continuing Medical Education and improved patient care), (2) negative talk (perceived hindrances in gaining full benefit from Continuing Medical Education activities), (3) concerns regarding current Continuing Medical Education activities.

Conclusion: Participants were found inclined towards Continuing Medical Education activities and felt more confident and comfortable in managing their patients. However, they felt that physicians working in rural areas were dealing directly with all sorts of patients and were more in need of targeted and tailored Continuing Medical Education activities.
PRE-EMPTIVE EFFECT OF INTRAVENOUS PARACETAMOL VERSUS INTRAVENOUS KETOROLAC ON POST-OPERATIVE PAIN AND SHIVERING AFTER SEPTOPLASTY UNDER GENERAL ANESTHESIA: A COMPARATIVE STUDY
Authors: Kashif Sanum , Kundi M Nasir , Khan Taimur Azam
Published: January 2022

Objective: To observe the pre-emptive effect of intravenous paracetamol versus intravenous ketorolac in preventing postoperative shivering and pain after septoplasty in postoperative care unit.

Study Design: Prospective comparative study.

Place and Duration of Study: Main Operation Theatre of Frontier Corps Hospital Quetta, from Sep to Dec 2019.

Methodology: After ethical committee approval, 90 American Society of Anaesthesiologist (ASA-I patients, aged between 18-45 years, scheduled for septoplasty, were recruited and divided into three equal groups, Paracetamol (PA), Ketorolac (KE) and Placebo (PL) as per computer generated table. The paracetamol (PA) group (n=30) received 1gm intravenous paracetamol, ketorolac (KE) group (n=30) received 30mg intravenous ketorolac and group placebo (PL) received 100ml normal saline, 20 minutes before completion of surgery. Postoperative shivering and pain was assessed via four-point scale and visual analogue scale (VAS) respectively, in post-anesthesia care unit at 10 and 30 minutes post-extubation.

Results: Mean visual analog scale (VAS) score in paracetamol group was 2.7 ± 1.41, ketorolac group was 2.3 ± 1.24 and in placebo group was 3.6 ± 1.44, with a p-value of 0.002. Mean four point shivering score in paracetamol group was 0.3 ± 0.55, ketorolac was 0.7 ± 0.78 and placebo group was 1.4 ± 1.00, with a p-value of <0.001.

Conclusion: The effect of paracetamol is better than ketorolac in preventing pain and shivering after septoplasty under general anesthesia.
EVALUATION OF IMPROVEMENT IN RENAL FUNCTION AFTER FIRST-LINE CHEMOTHERAPY IN MULTIPLE MYELOMA PATIENTS PRESENTING WITH RENAL IMPAIRMENT
Authors: Hamdani Syed Abdul Mannan , Wahab Abdul , Azhar Musa , Iftikhar Faiza , Ahsan Bushra , Ahmad Usman
Published: January 2022

Objective: To evaluate the effect of response to first-line chemotherapy on renal functions in multiple myeloma (MM) patients.

Study Design: Cross-sectional study.

Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital, Lahore, from Jan 2013 to Dec 2017.

Methodology: Multiple myeloma patients with renal impairment (RI) at baseline were included. Data was collected from the hospital registry.The variables assessed pre and post first-line chemotherapywere age, gender, initial estimated glomerular filteration rate and serum creatinine levels. Progression-free survivaland overall survival (OS) was calculated for both groups of patients i.e those who had improvement in renal funtions and those who did not show improvement. Kaplan-Meier curves were drawn, and SPSS-20 was used for data analysis.

Results: Mean age was 48 ± 7 years. Out of 139 myeloma patients, 35 (25.1%) had RI at baseline. Males were 23 (65.7%), while females were 12 (34.3%). Cyclophosphamide, thalidomide and deamethsone (CTD)were used in the majority 30 (85.7%) followed by boretzomib, thalidomide and dexamethasone (VTD) in 2 (5.7%) patients. Boretezomib and dexamethasone (BorDex), lenalidomide and dexamethasone (Len Dex), lenalidomde, cyclophosphamide and dexamethasone (LCD) were given to 1 (2.8%) patient each. Serum creatinine levels normalized in 19 (54.3%). Dialysis was required in 11 (31.4%) patients out of which 3 (8.6%) got dialysis-independent while 8 (22.9%) patients remained dialysis-dependent. The medianoverall survival in whomcreatinine levels normalized was 35 months while it was 15 months in those in whom it did not normalize.

Conclusion: Prompt administration of chemotherapy regimens can lead to an improvement in renal function....................