bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamics of Entrepreneurship Education and Small and Medium Enterprises (SMEs) Development in North Central Nigeria
Authors: F.O. Egrinya , A.I. Ogbo , U.J. Laven , S.M. Peter
Published: December 2022

This study sought to determine entrepreneurship education and small and medium enterprises development in North Central, Nigeria. The nonchalant entrepreneurial attitude and intention of youths and individuals in the society has posed a lot of challenges leading to slow development of small and medium enterprises, with the resultant effects of poor economic growth and development. The specific objectives of the study were to: (i) Ascertain the extent to which entrepreneurship vocational training affects products development of small and medium enterprises in North Central, Nigeria; (ii) Determine the extent to which entrepreneurial skill acquisition enhances productivity of small and medium enterprises in North central, Nigeria; (iii) Determine the extent to which entrepreneurial networking affects market expansion of SMEs in North Central, Nigerian. On the conduct of the study, the survey design was used. The target population of the study was 17,973 consisting of all staff of private enterprises (including owner-founder) that are registered with the various state ministries of Trade, Commerce, Industry, and Tourism in North Central, Nigeria. A sample size of 377 was drawn from the population using Krejcie and Morgan sample size determination. Bowley’s proportional statistical technique was used to determine the proportional allocation of questionnaire to the number of enterprise and staff in each state. The instruments used for data collection was the mixed method: which is quantitative (structured questionnaire) and qualitative (interview) method. Face and content validity, a panel of management experts in the department was used to critiques the validity of the instrument. The instrument was checked for reliability using Test-retest method and the results computation was carried out using Spearman Ranking Correlation Coefficient of test-retest results and a value of 0.98 indicated a high degree of item consistency. The hypotheses were tested using Pearson product moment correlation technique for hypotheses one and two; simple linear regression for hypothesis three. The findings revealed that: To a large extent entrepreneurship vocational training enhances products development of small and medium enterprises in North Central, Nigeria (r=.979, p<0.05): Entrepreneurial skill acquisition enhances productivity of small and medium enterprises in North Central, Nigeria (r=.949, p<0.05). Based on the findings of the study, it was recommended that there should be more government and private sector involvement in the concept of entrepreneurship education; more so, policy makers and implementers should see entrepreneurship as a pivot engine that steers the economic hub of any nation to a virile and greater height. More importantly taking a turn from the “Asian tigers” economy, that has strategic turnaround was from entrepreneurship development.
Preparation and Evaluation of Sustained Release Tablet of Rifaximin by using Cross linked Sodium Alginate
Authors: Ahmad Wajid , Sheikh Rihan , Ahmad Razia , Khan Suhana
Published: December 2022

Rifaximin treats traveler's diarrhea and irritable bowel syndrome by stopping the growth of the bacteria that cause diarrhea. Rifaximin treats hepatic encephalopathy by stopping the growth of bacteria that produce toxins and that may worsen liver disease. The short half life and high frequency of administration of drug makes it a suitable candidate for designing sustained drug delivery system. The aim of the present investigation was to develop a sustained release matrix tablet of Rifaximin using sodium alginate and cross linked sodium alginate and to evaluate the drug release kinetics. In order to achieve the required sustained release profile, the tablets were prepared by a wet granulation method. The formulated tablets were characterized for pre-compression and post-compression parameters and they were in the acceptable limits. The drug release data obtained after an in vitro dissolution study was fitted to various release kinetic models in order to evaluate the release mechanism and kinetics. The criterion for selecting the best fit model was linearity (coefficient of correlation). Drug release mechanism was found to follow a complex mixture of diffusion, swelling and erosion. The dosage form holds the potential to control the release rate of drug and extend the duration of action of a drug.
Gây mê mổ cắt tuyến giáp cho bệnh nhân tăng áp lực mạch phổi nặng: Báo cáo một trường hợp lâm sàng
Authors: Võ Lưu Xuân , Giang Tạ Ngân
Published: December 2022

Gây mê cho bệnh nhân tăng áp lực mạch phổi nặng luôn là một thách thức đối với bác sĩ gây mê, vì đó là một trong các nguyên nhân làm tăng tỷ lệ mắc bệnh và tử vong chu phẫu ngay cả khi đó không phải là các ca mổ tim. Bác sĩ gây mê hồi sức cần có sự đánh giá kỹ lưỡng về tình trạng bệnh nhân và phối hợp chặt chẽ với bác sĩ ngoại khoa, bác sĩ tim mạch. Trước và sau mổ, bệnh nhân cần được theo dõi sát và tiếp tục duy trì các thuốc điều trị, sau khi đánh giá tình trạng bệnh nhân ổn định để mổ thì điều quan trọng trong quá trình gây mê và mổ là hạn chế các yếu tố làm nặng thêm tình trạng tăng áp lực mạch phổi như giảm O2 máu, tăng CO2 máu, nhiễm toan, hạ thân nhiệt, tránh các yếu tố gây mạch nhanh và hạn chế truyền dịch. Chúng tôi báo cáo một trường hợp nữ 43 tuổi, tiền sử đã mổ vá thông liên nhĩ cách 4 năm, không theo dõi và điều trị, được chỉ định mổ cắt tuyến giáp theo chương trình có tình trạng tăng áp lực mạch phổi nặng đo được trên siêu âm là 95mmHg, bệnh nhân đã được gây mê mổ cắt thùy phải tuyến giáp và đã xuất viện thành công.
Đánh giá kết quả bước đầu điều trị dị dạng tĩnh mạch vùng đầu mặt cổ bằng tiêm cồn tuyệt đối dưới hướng dẫn của dsa
Authors: Cương Nguyễn Ngọc , Sơn Chu Hồng , Linh Lê Tuấn
Published: December 2022

Nghiên cứu nhằm mô tả đặc điểm hình ảnh của dị dạng tĩnh mạch vùng đầu mặt cổ trên máy chụp mạch số hóa xóa nền (DSA) và đánh giá hiệu quả của phương pháp gây xơ bằng cồn tuyệt đối. Thiết kết nghiên cứu mô tả hồi cứu và tiến cứu với 25 bệnh nhân có tuổi trung bình 31,1. Dị dạng tĩnh mạch phân loại theo Puig năm 2003, có 9/25 tổn thuộc type I (36%), 15/25 thuộc type II (60%), 1/25 tổn thương thuộc type III (4%), 0/25 type IV. Tổng số lần can thiệp là 46 lần với lượng cồn tuyệt đối trung bình là 6,82 ± 3,42 ml/lần. 81,8% bệnh nhân sau can thiệp có tỷ lệ tắc ổ dị dạng trên 50% và chỉ 4% số bệnh nhân có phần trăm tắc dưới 25%. Về lâm sàng, 96% bệnh nhân cải thiện tốt triệu chứng, 1 bệnh nhân (4 %) không có sự cải thiện về triệu chứng. Không có biến chứng nặng về lâm sàng. Kết luận: gây xơ ổ dị dạng tĩnh mạch bằng cồn tuyệt đối là phương pháp an toàn và hiệu quả cho các dị dạng tĩnh mạch đầu mặt cổ.
Dẫn lưu đường mật qua da cấp cứu trong điều trị viêm đường mật cấp do sỏi tại Bệnh viện Đại học Y Hà Nội
Authors: Hưng Tô Quang , Long Trần Bảo , Hùng Vũ Đình , Hải Hoàng Bùi
Published: December 2022

Mục tiêu của nghiên cứu là đánh giá kết quả điều trị nội khoa kết hợp với dẫn lưu đường mật qua da cấp cứu ở bệnh nhân viêm đường mật cấp do sỏi tại Khoa Cấp cứu, Bệnh viện Đại học Y Hà Nội. Đây là một nghiên cứu mô tả, hồi cứu 32 bệnh nhân viêm đường mật cấp do sỏi, được điều trị nội khoa và dẫn lưu đường mật qua da. Kết quả có 31/32 (96,9%) bệnh nhân ổn định, có 1 trường hợp diễn biến nặng và tử vong tại nhà. Thời gian nằm tại khoa Cấp cứu và Hồi sức tích cực từ 2 - 20 ngày. Dẫn lưu qua đường mật gan trái được thực hiện ở 18/32 (65%) bệnh nhân. Có 3/32 (9,4%) bệnh nhân xuất hiện biến chứng chảy máu đường mật và 1 bệnh nhân biến chứng nhiễm trùng chân dẫn lưu. Nghiên cứu cho thấy kết hợp dẫn lưu đường mật qua da cấp cứu với điều trị nội khoa ở bệnh nhân viêm đường mật cấp do sỏi tại khoa Cấp cứu cho kết quả tốt, tỷ lệ biến chứng thấp và thời gian nằm hồi sức cấp cứu ngắn.
Báo cáo ca lâm sàng lấy dị vật bể thận qua đường hầm dẫn lưu thận
Authors: Long Hoàng , Anh Lê Tuấn
Published: December 2022

Dị vật bể thận mặc dù hiếm gặp nhưng đã được ghi nhận ở nhiều báo cáo. Các tác giả đều cho thấy phần lớn các dị vật này có nguồn gốc từ các vật liệu sử dụng trong phẫu thuật ngoại khoa và cần được lấy bỏ bằng các phương pháp khác nhau. Chúng tôi báo cáo 2 trường hợp dị vật bể thận đều là vật liệu sử dụng trong phẫu thuật tiết niệu và đã được tiến hành phẫu thuật lấy bỏ thông qua đường hầm vào bể thận tại Bệnh viện Đại học Y Hà Nội. Qua đó, chúng tôi nhận thấy sự cần thiết kiểm soát chặt chẽ của các vật liệu, phương tiện được sử dụng cả trong và sau phẫu thuật khi đưa vào cơ thể bệnh nhân để tránh các tai biến có thể xảy ra.
Vai trò của kết hợp thang điểm spesi với nồng độ crp-hs trong tiên lượng tử vong trong vòng 30 ngày ở bệnh nhân tắc động mạch phổi cấp: một nghiên cứu đa trung tâm tại Việt Nam
Authors: Cường Trần Văn , Linh Nguyễn Duy , Nghĩa Phan Nguyễn Đại , Hải Hoàng Bùi
Published: December 2022

Mục tiêu của nghiên cứu là tìm hiểu giá trị thang điểm sPESI và nồng độ CRP-hs trong tiên lượng tử vong ở ngày thứ 30 trên bệnh nhân tắc động mạch phổi cấp. Đây là nghiên cứu mô tả. Tắc động mạch phổi cấp xác định bằng cắt lớp vi tính đa dãy động mạch phổi có tiêm thuốc cản quang. Nghiên cứu thu thập được 162 bệnh nhân, tuổi trung bình 57,7 ± 18,9; 98 bệnh nhân (60,5%) là nữ. Có 27 (16,7%) ca tử vong trong 30 ngày. Giá trị tiên lượng độc lập thang điểm sPESI và nồng độ CRP-hs với AUC lần lượt là 0,74 và 0,65 với giá trị chẩn đoán dương tính tương ứng là 22,6% và 30,2%. Kết hợp sPESI và CRP-hs cho AUC là 0,66; độ đặc hiệu là 93,3%; giá trị chẩn đoán tiên lượng không tử vong trong 30 ngày là 89,3%.
Một số yếu tố tiên lượng nặng ở bệnh nhân đái tháo đường typ 2 mắc covid-19
Authors: Nga Vũ Bích , Thảo Đỗ Thu
Published: December 2022

Mục tiêu nghiên cứu nhằm khảo sát một số yếu tố tiên lượng nặng và tử vong ở bệnh nhân đái tháo đường typ 2 mắc COVID-19 tại Bệnh viện điều trị người bệnh COVID-19. Nghiên cứu tiến hành trên 241 bệnh nhân đái tháo đường typ 2 mắc covid  từ tháng 11/2021 đến tháng 3/2022. Nghiên cứu mô tả cắt ngang. Trong 241 bệnh nhân đái tháo đường typ 2, có 24,1% bệnh nhân tử vong. Tỷ lệ tử vong của nhóm đái tháo đường cao hơn nhóm không đái tháo đường, sự khác biệt có ý nghĩa thống kê. Nhóm bệnh nhân nặng và nguy kịch, tử vong có glucose máu, HbA1c, bạch cầu trung tính, ferritin, creatinin máu, D-dimer, Crp-hs, điểm SI X-quang ngực, nhịp thở cao hơn nhóm nhẹ và trung bình. Nhóm nặng, nguy kịch, tử vong có chỉ số SpO2 và bạch cầu lympho thấp hơn. Nhóm nặng và nguy kịch, tử vong cần hỗ trợ liệu pháp oxy liều cao hơn, tỉ lệ cần kiểm soát đường huyết bằng bơm tiêm điện cao hơn nhóm tiêm vaccin có tỷ lệ bệnh nhân nặng và nguy kịch thấp hơn nhóm không tiêm.
A New Approach Based on Centrality Value in Solving the Minimum Vertex Cover Problem: Malatya Centrality Algorithm
Authors: KARCİ Ali , YAKUT Selman , ÖZTEMİZ Furkan
Published: December 2022

The graph is a data structures and models that used to describe many real-world problems. Many engineering problems, such as safety and transportation, have a graph-like structure and are based on a similar model. Therefore, these problems can be solved using similar methods to the graph data model. Vertex cover problem that is used in modeling many problems is one of the important NP-complete problems in graph theory. Vertex-cover realization by using minimum number of vertex is called Minimum Vertex Cover Problem (MVCP). Since MVCP is an optimization problem, many algorithms and approaches have been proposed to solve this problem. In this article, Malatya algorithm, which offers an effective solution for the vertex-cover problem, is proposed. Malatya algorithm offers a polynomial approach to the vertex cover problem. In the proposed approach, MVCP consists of two steps, calculating the Malatya centrality value and selecting the covering nodes. In the first step, Malatya centrality values are calculated for the nodes in the graph. These values are calculated using Malatya algorithm. Malatya centrality value of each node in the graph consists of the sum of the ratios of the degree of the node to the degrees of the adjacent nodes. The second step is a node selection problem for the vertex cover. The node with the maximum Malatya centrality value is selected from the nodes in the graph and added to the solution set. Then this node and its coincident edges are removed from the graph. Malatya centrality values are calculated again for the new graph, and the node with the maximum Malatya centrality value is selected from these values, and the coincident edges to this node are removed from the graph. This process is continued until all the edges in the graph are covered. It is shown on the sample graph that the proposed Malatya algorithm provides an effective solution for MVCP. Successful test results and analyzes show the effectiveness of Malatya algorithm.
Real-Time Big Data Processing and Analytics: Concepts, Technologies, and Domains
Authors: KEKEVİ Uğur , AYDIN Ahmet Arif
Published: December 2022

In the digital era, data is one of the most important assets since it conceals valuable information. Developers of data-intensive systems have new challenges at each level of streaming, storing, and processing large quantities of data in a variety of forms and speeds. Obtaining useful information at the proper time and place is also crucial. Since the value of information is inversely proportional to time, real-time data processing and analytics are receiving more attention. Due to the importance of real-time data processing and analytics, this study focuses on real-time data processing concepts and terminology, popular technologies used in real-time data processing and analytics, popular NoSQL storage technologies used in real-time data processing, and real-time data processing application areas. The purpose of this paper is to provide researchers of real-time analysis and developers of data-intensive systems with a comparative perspective on real-time data processing by highlighting the key characteristics of real-time data processing technologies, NoSQL storage technologies, their application domains, and selected examples from previous studies.
A problemática socioambiental em um canto de (des)(en)canto do espaço urbano e a Educação Ambiental como via de (re)encantamento: um olhar sobre o Parque da Cidade de Aracaju, Sergipe, Brasil
Authors: Modesto Érica Andrade , Modesto Mônica Andrade
Published: December 2022

Este artigo objetiva discutir os impactos das modificações espaciais e urbanísticas ocorridas no Parque da Cidade, com base na reflexão sobre o direito à cidade e nas premissas geográficas, históricas e educacionais que circundam esse direito. O estudo partiu do seguinte problema: como a educação ambiental pode contribuir para a compreensão da cidade como um direito e, nessa perspectiva, para o enfrentamento dos impactos socioambientais decorrentes da restrição desse direito na zona norte de Aracaju/SE? A justificativa e relevância do estudo apresentam-se no fato de que o locus pesquisado vem sofrendo com a desigualdade social e com a vulnerabilidade socioambiental presente na capital, sendo mister apresentar possibilidades para a transformação da realidade local. Os procedimentos metodológicos foram delineados em etapas, a saber: levantamento e sistematização de aporte teórico e produção e análise de dados. Os dados foram produzidos com base na ferramenta “Imagens Históricas” do programa Google Earth e analisados à luz da literatura especializada. Os resultados sinalizam o parque como um canto de desencantoda capital em razão da restrição do direito à cidade e de fatores decorrentes dessa restrição, como falta de investimento por parte do poder público e degradação ambiental. Isso leva a Educação Ambiental a se apresentar como uma via para o despertar do (re)encantamento e do cuidado para com esse espaço e, consequentemente, para a apropriação do direito supracitado.
Association of Low Cardiac Output Syndrome with in Hospital Outcomes after on Pump Coronary Artery Bypass Grafting Surgery
Authors: Farogh Ajwad , Hasan Ahmad , Naz Farah , George Jacollin , Emmanuel Shagufta , Farhana Ayyazda
Published: December 2022

Objective: The main objective of current study was to explore the frequency of Low Cardiac Output Syndrome (LCOS) in patients underwent on-pump CABG. Study design and place: The study was carried out in Cardiac Care Center, Bahawalpur From March 15, 2019, to October 31, 2020, Materials and Methods: This prospective, descriptive study was conducted in the Cardiac Surgery, Cardiac Center Bahawalpur, Punjab. Total 250 patients were enrolled in this prospective, comparative study and divided into two groups. Group A (LVEF ≥40% ) and Group B LVEF <40%) the frequency of LCOS postoperatively was compared. the study was conducted. This study employed the non-probability, purposive sampling method. SPSS 22 was used to analyze data. Significant data was used as P-value 0.05. Results: The average age of the participants was 50 ± 4.67 in Group A as compare with Group B (53.44 ± 3.24) years with p-value 0.034. Total 144(57.6%) Male and 106(42.4%) were female patients. The frequency of LCOS was 19(15.2%) versus 25(20%) (P=0.021). Findings showed that the significant difference in outcomes in terms of Renal Dysfunction, Prior CVA, Stroke, ICU stay(days), Recent MI and mortality between the groups without LCOS and with LCOS. The findings of current study can be helpful for management in patients with low Ejection Fraction undergoing CABG which has been shown a higher perioperative risk and a better survival after myocardial revascularization. In this setting the long-term benefits clearly overcome an increased peri-operative mortality Conclusion: Those with pre-operative LVEF less than 40% had a significantly different frequency of LCOS than patients with LVEF greater than 40%. In comparison to patients without LCOS, individuals with LCOS had considerably worse outcomes in terms of stroke, respiratory failure, renal failure, ICU stay, hospital stay, and death. Keywords: CABG, LCOS, LVEF, CVA, MI, ICU
Awareness Regarding Causes of Infertility among Out-patients at a Tertiary Care Hospital in Lahore, Pakistan
Authors: Jawad Zobia , Mustafa Rubina , Kanwal Anikah , Khan Sadia
Published: December 2022

Objectives: To assess the general awareness regarding infertility and its causes; and identify, key knowledge gaps if any, related to the subject. Study Design: A cross-sectional study. Period: January, 2019 to December 2019. Setting: Lady Willingdon Hospital, Lahore, Pakistan. Material and Methods: Data collection was done by convenient sampling technique, from the 500 female participants (18 years and above) through an interview-based questionnaire (Cardiff Fertility Knowledge Scale, CFKS) , there was an assessment of the knowledge related to the causes leading to infertility such as lifestyle, smoking, use of contraception, infections of genital tract etc. There was determination of the association between socio-demographic variables and their mean knowledge scores. Data were analyzed using SPSS version 20. Results: The majority of the participant population (67%, n=340) was married, about more than half of the population was unemployed (n=280) compared to the employed population (n=220). While, nearly half of the participants (n=248, 49.5 %) did not believe that males and females contribute to infertility equally. The mean knowledge score of the study participants was 12.95 ± 2.48 points. The participants (n=165, 32%) believed that the previous usage of the intra-uterine device leads to infertility. Moreover, more than half of the participants (n=278, 55.9%) wrongly believed that a male partner achieving erection is a sign of fertility. Education (p=0.019) and marital status (p=0.03) were the only demographic factors that showed major differences with mean knowledge scores. Conclusion: It was found out that the awareness in the general population about the infertility and its causes was lacking. It is important that the education regarding the fertility related issues be more common, that can be planned through various awareness programs, workshops and seminars. This in turn can help the couples by directing them to seek timely and more focused medical help. Keywords: Infertility, knowledge, awareness, developing country.
Frequency of Prediabetes in patients of HIV Infection Presenting at Tertiary Care Hospital
Authors: Bilal Muhammad Haroon , Raziq Muhammad Abdul , Humayon Muhammad Ajwad , Hussain Tariq , Tahir Muhammad
Published: December 2022

Objective: To find out the frequency of prediabetes in patients of HIV presenting at tertiary care hospital. Study design: Cross sectional study. Place and duration: Department of Medicine, D.G Khan Hospital, D.G Khan. (January 2020 to December 2020) Methodology: Total 187 patients of HIV infection, age 20 years to 60 years both male or female with duration of HIV 10 years were selected and pre-diabetes was studies. Results: Total 187 patients of HIV infection was recruited for this study and prediabetes was assessed. Mean age and mean HIV infection duration was 37.81 ± 12.81 years and 5.31 ± 2.86 years. Prediabetes was noted in 63 (34%) patients. Male patients and female patients were 122 (65.24%) and 65 (34.76%) respectively. Prediabetes was found in 58 (47.54%) males and in 5 (7.69%) females. Prediabetes was significantly (P=0.000) associated with gender. Conclusion: This study showed a higher percentage of prediabetes among HIV infected patients. Most of the cases were belonged to 3rd and 4th decade of life. Males were more victim of HIV infection as compared to females and most of the males were prediabetics. No association of development of prediabetes with duration of HIV infected was noted. Keywords: Prediabetes, HIV infection, diabetes mellitus, IGT
Assessment of Neurocognitive Effect in Patients Undergoing Cardiopulmonary Bypass: A Prospective Longitudinal Study
Authors: Jamal Ahmed , Iqbal Usman Javed , Amjad Aroosa , Iqbal Rabia Javed , Abdullah Abrar Hussain, Hassan Abbas
Published: December 2022

Objective: To assess neurocognitive effects in patients who underwent cardiopulmonary bypass. Study Design & Setting: Using non probability purposive sampling, a prospective study design was used to collect the data from in tertiary care hospitals with 60 beds in ICU. Methodology: Patients who underwent CPB having no history of psychological and mental illness was recruited for the said study. We used a short test of global mental status to measure cognitive performance called the “Mini-Mental State Examination (MMSE)”.Wilcoxon test was used to analyze the pre- and post-operative changes over MMSE. The Folstein test, often known as the mini-mental state examination (MMSE), is a 30-point survey that has been widely used in clinical and research contexts to evaluate cognitive impairment. Different parameters; temporal, spatial, alternate, recognition, and recall were evaluated. P-value ≤0.05 was considered as significant. Results: In this study, a significant fall in spatial, temporal, short term recall, long term recall, object recognition, alternate, reading, writing, read and act, and drawing in post-operative MMSE scores was observed as compared to pre-operative. However, there was no significant change in command so there is little or no effect on command parameters in pre-operative and post-operative cardiopulmonary bypass patients. There was a significant difference between pre-operation and post-operation total scores i.e., a fall in the ‘total’ score of neurocognition occurred after cardiopulmonary bypass. Practical implication Study finding may be used for practical implications in managing neurocognitive outcome in patients undergoing cardiopulomonary bypass. Conclusion: This research concludes that neurocognition is affected in patients who underwent CPB, with CPB itself a bigger risk factor in causing postoperative neurocognitive dysfunction. Keywords: Cardiopulmonary bypass, Mental health, Neurocoagnitive impairment, POCD
Impact of Demographic Factors on Oral Health Knowledge and Attitude of patients with Type II Diabetesmellitus Visiting A THQ Hospital in Punjab, Pakistan
Authors: Riaz Farhan , Ehsan Afifa , Raza Ali , Abdullah Umer , Mehdi Muhammad Mutahir , Sahu Ejaz Hussain
Published: December 2022

Aim:Patients suffering from Diabetes Mellitus havea largerpossibilityofdeveloping oral diseases furthermore; those who have uncontrolled and long-duration of Diabetes Mellitusare also at a greater risk for acquiringperiodontaldisorders. The present study intended to investigate the association of oral fitness knowledge and attitude with different demographic factorsin patients with Type II Diabetes Mellitus visiting a secondary care provincial hospitalin Sargodha, Pakistan. Methods: The present study was a cross-sectional study piloted at a secondary care provincial hospital in District Sargodha which comprised 180 patients suffering from Type II Diabetes Mellitus.Information was collected using a systematized questionnaire which was handed out to study participants visiting the outpatient department of the hospital. Results:Oral health knowledge of the study participants were cross-tabulated with socio-economic and demographic factors and a significant association was seen with gender(P≤0.001), educational status(P≤0.0001), monthly income(P≤0.002), and marital status(P≤0.001). In the present study, 26% of males and 18% of females had adequate knowledge regarding oral health. Advanced levels of learningand income also transpiredto have a strong association with oral health awarenessand attitude(P≤0.01). Conclusions: Results of the present study suggest that oral well-being knowledge and attitude among patients with Type II Diabetes Mellitus were strongly associated in conjunction withgender, higher levels of education, and income. Based on these outcomes, communal-oriented oral well-being campaigns are indispensable to navigating the standard of living of patients with Type II Diabetes Mellitus. Keywords: Dental, Diabetes Mellitus, Knowledge, Oral Health, Oral complications, Type II Diabetes Mellitus.
Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography in Comparison to Endoscopic Retrograde Cholangiopancreatography in Obstructive Biliopathy
Authors: Naich Muhammad Ayub , Hussain Sagheer , Zamir Hina , Qamar Adeel , Cheema Fatima , Mustafa Zia Ul
Published: December 2022

Objective: To determine the diagnostic accuracy of magnetic-resonance-cholangio-pancreatography (MRCP) in diagnosis of obstructive biliopathy in comparison to endoscopic retrograde cholangio-pancreatography (ERCP) taking as gold standard. Study design: It is a cross sectional study. Place and duration of study: Study was conducted on the patients admitted in the gastroenterology department of Sir Ganga Ram Hospital Lahore. Study was completed in six months duration from January 2022 to June 2022. Methodology: Patients with the suspicion of obstructive biliopathies requiring ERCP were included in this study. Study sample was divided into two groups, in one group ERCP was done while other group underwent MRCP. Resulst of both techniques were reviewed by radiologist and gastroenterologist and compared with each other considering ERCP as gold standard. P-value <0.05 was considered statistically significance. Confidence interval was 95%. Results: Total 130 cases were divided into two groups with equal number of 65 patients in each. There were 75(57.6%) female and 55(42.3%) male cases. Mean age of the patients was 43.7± 3.5 years. Sensitivity of MRCP for obstructive biliopathies was 92.4%, specificity 90.7%, positive predictive value 88.3% and negative predictive value 89.2%. Conclusion: MRCP is a non-invasive investigation of choice in obstructive biliopathies having high diagnostic accuracy avoiding unnecessary complications of ERCPs. Keywords: MRCP, ERCP, Obstructive Biliopathy, CBD Stone, Stricture
Comparison of Surgical Outcomes of Fistulotomy and Fistulectomy for the Management of Simple Low Fistula-In-ANO
Authors: Ghaffar Naeem , Ali Mudassar , Abbas Kamran
Published: December 2022

Objective: This study is done to compare the fistulotomy and fistulectomy for the treatment of fistulas in ano. This study is designed for the comparison of these surgical procedures to find out their results. Materials and methodology: this study was done at the surgery department of Sir Ganga Ram hospital Lahore during Jan 2021 to Dec 2021. 60 patients were included in this study and they were divided in two groups each of 30 participants. The group 1 patients were treated with fistulotomy while those of group 2 were selected for fistulectomy surgeries. The patients aged 20 years to 65 years were part of this study who were admitted to the department of surgery for planned fistulas operations. Before surgery Consent was taken from the patients themselves or by their close relatives.
To Assess the Iron Reserves in Blood Donors by Measuring Serum Ferritin and Hemoglobin in the Children Hospital Lahore
Authors: Fateen Tooba , Ali Sehar Shamshad , Saqlain Nazish , Shafqat Faiza , Khalid Ayesha , Ali Kanwar Sajid , Kashif Zertaj
Published: December 2022

Introduction: Frequent contribution of blood can cause iron exhaustion in blood donors along with the problems related to it. Curtailing the proportion of iron reduction among blood donors is a crucial plan for boosting donor’s well-being. Aim & objectives: The aim of this analysis is to determine iron stocks by measuring serum ferritin in pre-donation male blood donors along with their relation with the hemoglobin concentration and frequency of blood donations. Study design: Cross-sectional study. Place and duration: Pathology (immunohematology) department and blood bank of University of Child Health Sciences, The Children Hospital Lahore from Aug 2021 to July 2022 Material and Methods: A total of 350 serum samples were processed to determine hemoglobin and serum ferritin concentrations. The study involved was performed on healthy blood donors. The method used was chemiluminescence for the simultaneous measurement of serum ferritin. Results: An aggregate of 350 serums were collected from the contributors in blood bank. Among them, 154 were the first-time donor and 196 were the frequent donors; the serum ferritin was markedly reduced in constant contributors. The mean value 105ng/mL was found in infrequent donors and 79.35ng/mL was found in frequent donors. There was no notable variance in hemoglobin of newbie and regular blood givers. However, a momentous variation in the pervasiveness of iron depletion between first‑time and regular donors is found. Conclusion: Blood donation has a noteworthy impact on iron stores and is one of the most important factors for iron shortage in contributors, specifically in those who donate blood again and again. Serum ferritin measurement ought to be incorporated in the blood donor preference especially in the evaluation of consistent blood givers to assure enough iron pools in the donor community in order to sustain a pertinent potential donor.
Surgical Audit of Leakage after Open Surgical Repair of Perforated Peptic Ulcer
Authors: Asghar Ibrahim , Fatima Saira , Shaikh Aisha , Shaikh Nargis , Qureshi Kanwal
Published: December 2022

Objective: to critically analyze the leakage after open surgical repair of peptic ulcer perforation. Methods: All patients who fulfilled the inclusion criteria and visited to surgical department SMBBMU, Larkana from September, 2018 to March, 2021 were included in the study. Informed consent was taken after explaining the procedure, risks and benefits of the study. X-ray abdomen erect posture, leukocyte count, and serum amylase were performed. After surgery, site of perforation and type of surgery were recorded. Patients were followed for 30 days in order to assess the leakage. Results: Mean ± SD of age was 42.6±8.5 years. Out of 203 patients included in the study, 145 (71.4%) were male while 58 (28.6%) were female, Leakage was noted in 13 (6.4%) patients. Conclusion: It is to be concluded that leakage was less likely prevalent after peptic ulcer perforation repair, but we cannot rule out residual confounders. Practical implication Keywords: Leakage, Peptic Ulcer Perforation, Repair, Peritonitis, Laparoscopy, Surgery.
Critical Analysis of the Frequency and Factors Leading to Hypocalcemia after Total/ Near Total Thyroidectomy
Authors: Sangi Marvi , Shaikh Aisha , Fatima Saira , Bhatti Nadia , Ali Muharam , Aamir Aasia
Published: December 2022

Objective: To critically analyze the frequency and factors leading to hypocalcemia in Total/ Near Total thyroidectomy Methods: This descriptive case series study was conducted over period of one year by taking sample of 138 patients of simple multinodular goiter or carcinoma of thyroid who underwent total/near total thyroidectomy and patients who had serum calcium <8mg/dl postoperatively. Recurrent thyroid surgery or patients undergoing lobectomy were excluded from the study. SPSS version 21 was used for data analysis. Mean ± SD represent the continuous variables & frequencies/ percentages represent the quantitiave results. Chi-square test was applied to analyze effect modification. P value <0.05 was taken as significant. Study was approved by the ethical review committee of the SMBBMU - Larkana. Results: The mean ± SD age of patients was 39.86 ± 11.5 years with a range from 22 to 60 years. The mean ± SD serum Pre-operative calcium was 9.64 ± 0.44 mg/dL. Post thyroidectomy) values of serum calcium were noted as mean ± SD 7.68 ± 2.11 mg/dL. Sixty five percent (n =90) of all patients were females. NTT- were 67.4% (n = 93) while TT- 32.6% (n = 45). Frequency of hypocalcemia was 28.3% (n = 39). More patients after TT developed hypocalcemia (44.4%) than NTT (20.4%) P value = 0.004). Old age, female gender, surgery for thyroid cancer and patient with lower preoperative serum calcium had a higher frequency of hypocalcemia after thyroidectomy. Practical implication Conclusion:The frequency of post thyroidectomy hypocalcemia in this study is 28.3%. Post thyroidectomy hypocalcemia is associated with both NTT and TT, however the frequency is more common (more than twice) after TT. Factors like old age, female gender, patients having thyroid cancer and having lower serum calcium preoperatively are strong effect-modifiers. Keywords: Total thyroidectomy. Near total thyroidectomy,Calcium, Hypocalcemia, .Parathyroid hormone.
Real World Data about the Characteristics of Adult Diabetes Mellitus Patients Visiting Outpatient Department of a Tertiary Care Hospital
Authors: Khatoon Shafat , Ali Ghazanfer , Ali Sher , Zafer Maria , Ghaffar Amber
Published: December 2022

Objective: To find our characteristics of adult diabetes mellitus (DM) patients visiting outpatient department (OPD) of a tertiary care hospital. Study Design: Observational, cross-sectional study. Place and Duration: Outpatient department of Medicine, Pakistan Institute of Medical Sciences, Islamabad Pakistan from October 2021 to March 2022. Methodology: We included a total of 200 patients. Inclusion criteria were patients of both genders aged 18 to 70 years having type-1 and type-2 diabetes mellitus with a disease duration history of at least 6 months visiting outpatient department. Socio-demographic data along with DM related characteristics including family history of DM, types of DM, types of medications being used and fasting/postprandial blood glucose levels were recorded. Frequency of various DM related complications at the time of enrollment were also noted. Results: In a total of 200 patients of DM, 129 (64.5%) were male and 71 (35.5%) female. Overall, mean age was 45.03±12.46 years while 91 (45.5%) patients were aged between 31 to 45 years. Mean BMI was 23.33±4.75 kg/m2. Positive family history of diabetes was found in 98 (49.0%) patients. Type-1 diabetes mellitus was reported by 13 (6.5%) patients while remaining 187 (93.5%) patients had type-2 diabetes mellitus. Mean Duration of diabetes was 7.65±7.60 years. There were 91 (45.5%) patients who were using oral plus injectable/insulin medications. Overall, mean fasting blood glucose was 148±49.06 mg/dl while mean 2-hour postprandial blood glucose was 235.07±58.80 mg/dl. Neuropathy was the most common diabetes related complications noted in 91 (45.5%) while gastrointestinal related complications were the 2nd most frequent complications observed in 31 (15.5%). Practical Implications: Vast majority of the DM patients reported hyperglycemia during routine follow ups which arises the need to revisit current management strategies. Conclusion: Majority of the patients with DM were male, middle aged and belonged to urban areas of residence. Nearly half of the DM patients reported neuropathy related complications. Keywords: Diabetes mellitus, neuropathy, hyperglycemia, insulin.
A Point of Care Quality Improvement Initiative for Enhancing Immediate Drying of Babies and Prevention of Hypothermia in Labor Room, Nishtar Medical University, Multan Pakistan
Authors: Akhter Asma , Bashir Humaira , Perveen Summaira , Karim Sajilah , Khakwani Ayesha Khan , Badar Mirab , Quddussi Huma
Published: December 2022

Objective: To find out the current status of prevention of neonatal hypothermia by firstly, initialization of immediate drying and skin to skin contact of all newborns delivered by spontaneous vaginal delivery, and secondly, to initiate early breast feeding. Methodology: This was an observational study carried out in labor room of Gyne Unit 1, Nishtar Medical University (NMU) and Hospital, Multan Pakistan from April to September 2019. Based on “Point of Care Quality Improvement (POCQI)” guidelines, Initially, data were collected for 4 weeks during morning shift (phase 1) utilizing 2 indicators i-e immediate drying and number of babies who developed hypothermia within one hour of birth. Data were analyzed; results interpreted, and necessary modifications made. After implementation of changes further data was collected for 24 hours shift of gyne unit 1 for the rest of study period including additional indicators i.e., initiation of early breastfeeding and skin to skin contact. Results: A total of 744 babies delivered over a period of six months during this initiative, which was carried out in 2 phases, the phase-1 comprised of four weeks and included study of 24 babies and the phase 2 included 720 babies over five months. During phase-1, all 24 (100%) newborns were dried immediately after birth and the temperature was recorded among 20 (83.3%) of the babies with lost to follow up of 4 (16.7%) babies due to shifting to NICU for intensive care. During the second phase, among 720 babies that were delivered, 590 (81.9%) received skin-to-skin care for minimum of half hour due to rapid turnover of patients for delivery in labor room. Breastfeeding was initiated within one hour after birth in 593 babies (82.3%). Temperature was recorded among 528 (73.3%) babies with 37 (5.1%) shifted to NICU. Hypothermia was observed in 10 babies (1.4%) during this phase. Practical Implications: Hypothermia is a preventable cause of neonatal mortality which can be easily prevented by training of health care providers, midwives, and lady health visitors to incorporate components of essential newborn care in their medical practice. Conclusion: Implementation of POQCI was found to be highly applicable yielding good response. Keywords: Newborn, hypothermia, immediate drying, point of care quality improvement, neonatal intensive care unit.
A Comparison of Clinical and Radiological Outcomes between Open and Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Chughtai Waqas Noor , Razzaque Muhammad Adeel , Ahmad Tanveer , Rehman Manqoosh Ur , Rashid Azhar , Maqsood Amjad
Published: December 2022

Objective: To compare the clinical, radiological and functional outcomes of patients between open TLIF and minimally invasive TLIF techniques. Study Design: Prospective cohort study Place and duration: Study was conducted at department of neurosurgery Bakhtawar Amin Hospital, Multan from August 2021 to July 2022 in duration of one year. Methodology: A total of 94 patients planned for transforaminal lumbar interbody fusion (TLIF) were enrolled in study. Main variables of study were intra operative blood loss, duration of surgery, VAS score, ODI index and functional score. SPSS version 24 was used for data analysis, t-test and chi square test were applied to see association among variables. P value less than or equal 0.05 was considered as significant. Results: Oswestry disability index readings were 35.16±2.18 and 5.12±0.61 in O-TLIF and MIS-TLIF groups respectively at 3 weeks after surgery. The differences were statistically insignificant, (p>0.050). Physical component summary of both the groups at different time intervals as shown better outcomes in MIS-TLIF group, no difference was found to be statistically significant except at 6 week. Mental component summary in both the groups was almost equal, (p>0.050). Implications: There was no local study on comparison of open and minimally invasive technique for TLIF, our study will fulfill the local reference gap and help the surgeons for choice of better management technique in future. Conclusion: Minimally invasive surgery TLIF technique is better in immediate benefits as soft tissue injury and iatrogenic injury which is associated with better post operative pain functional recovery time. So, minimal invasive interbody fusion is a safe and reliable option for short term (blood loss, post operative pain) and long term outcomes like functional recovery. Keywords: Interbody fusion, VAS score, SF-36, ODI index, TLIF Technique
Efficacy of Dexpanthenol, Olive Oil and Breast Milkfor the Nipple Crack Treatment in Lactating Mothers
Authors: Kousar Noreen , Ghaffor Muhammad Tariq , Shahzadi Sadaf , Sabir Sohail , Naseem Sajida , Haider Syeda Sabahat
Published: December 2022

Cracked nipple is a painful condition for lactating mothers and if untreated leads to lactational mastitis, breast abscesses Objectives: T o compare the efficacy of dexpanthenol, olive oil and breast milk for nipple cracks treatment in lactating mothers Outcome Measures: We measured the Severity of pain (the primary outcome) by using visual analogue scale (VAS) and healing of cracked nipple (Secondary outcome) was assess by Nipple trauma score (NTS) before treatment and after7days, 14 days of treatment Material And Methods: We conducted a quasi experimental study from march 2022 to end of august 2022 in sheikh zayed hospital, Rahim Yar Khan after ethical approval from institutional review board. The total numbers of 120patient were equally divided into three groups using Breast milk, Olive oil or Dexpanthenol respectively for their cracked nipples. The data was collected on predesigned Performa.Data Analysis Procedure: We measured the percentages ,means and standard deviations with the help of statistical package for social sciences version (SPSS) version 28. ANOVA test and Non-parametric test were also used to test the difference between study groups Results: At day0 baseline mean nipple pain score and nipple trauma score was same in all groups.At day 7 breast milk and olive oil show better reduction in pain as compared to Dexpanthenol.At day 14 olive oil showed statistically significant reduction in pain as compared to breast milk and dexpanthenol t. At day 7 and day 14 olive oil show statistically significant better healing of cracked nipples as compared to Breast milk and Dexpanthenol. Practical implication Conclusion: Our study is proving that olive oil is better than Breast milk and Dexpanthenol in term of pain relief and healing of cracked nipples proving hypothesis: H2 Keywords: Cracked nipple, olive oil, Breast milk, Dexpanthenol.
Comparison between Intracorporeal Pneumatic Lithotripsy and Extracorporeal Shock Wave Lithotripsy (ESWL) in terms of efficacy and Safety for Management of Proximal Ureteric Stones
Authors: Amjad Muhammad , Hyder Imran , Rehman Rana Ata Ur , Shafi Hammad , Seerwan Muhammad , Durrani Ali Shandar
Published: December 2022

Objective: To compare efficacy and safety of intracorporeal pneumatic lithotripsy versus extracorporeal shock wave lithotripsy (ESWL) in patients of upper ureteric stones having stone size from 10 to 15 mm. Study Design: Randomized control trial Setting: Study was done at department of Urology, Nishtar Hospital Multan. The duration of the study was from January 2021 to January 2022. Methodology: 140 patients were divided into two groups randomly. In group A ureterorenoscopy (URS) with Pneumatic Lithotripsy was used for proximal ureteric stones management. URS was performed under general anesthesia. In group B, ESWL was done for the management of proximal ureteric stones identified by ultrasound and fluoroscopy. SPSS version 23 was used for data analysis. Results: In this study In Intracorporeal Pneumatic Lithotripsy group the stone cleared in 90% patients and in ESWL group the stone cleared in 78.6% patients (p-value=0.595). In Intracorporeal Pneumatic Lithotripsy group the pain was present in 14.3% patients and in ESWL group the pain was present in 18.6% patients (p-value=0.494). In Intracorporeal Pneumatic Lithotripsy group the bleeding was noted in 25.7% patients and in ESWL group the bleeding was noted in 40.0% patients (p-value=0.072). Conclusion: This study concluded that intracorporeal pneumatic lithotripsy is a good alternate of ESWL for the management of upper ureteric stones (having size from 10 to 15mm). Keywords: Urolithiasis, Intracorporeal Pneumatic Lithotripsy, Extracorporeal Shock Wave Lithotripsy, Ureteric Stone
An Audit of Injuries Sustained in Two–Wheeler Accidents in the Metropolitan City of Karachi, Pakistan
Authors: Khan Farzana Azam , Naz Ramlah , Fatima mehreen , Tarmizi Zubair ahmed , Abbasi Qarar , Anwar Adina
Published: December 2022

Background: Road traffic accidents have major contribution in injury related mortality and disability in low income countries. Two-wheelers being a major mode of transportation due to absence of proper public transport system in Karachi hence most often reported accidents are related with two wheelers. In Karachi two wheelers are quite commonly being used as mode of transportation, number of two wheelers has increased to 10 folds since last 10 years because of lack of public transports and high fuel prices and easy availability on low monthly instalments. Objective: To analyze the injury pattern among two-wheeler riders in Karachi. Study Design: Retrospective study Place and Duration of Study: Three major medico-legal centres of Karachi (Civil, Jinnah, and Abbasi Shaheed Hospitals) from 1st January 2017 to 31st December 2021. Methodology: About 11444 two-wheeler incidents occurred on roads with the consent of Police Surgeon Office Karachi were enrolled. The patients' demographics, injuries sustained, date of the injuries, cause of the injuries, types of collision and outcomes were recorded. Results: Most of the riders engaged in accidents were between the ages of 18 and 30 years; 90.99% of the riders were men. The most frequent type of injuries found in two wheeler accidents were abrasions/grazes seen in (56.26%) cases followed by fractures (20.82%), head injuries (11.02%). Conclusion: Greater prevalence in the age group of 18-30 years, with male dominance analyzed. Fatal and non-fatal injuries were observed. Metro services mass transit programme to be encouraged so to decrease the traffic on road which will automatically reduce the number of accidents to wheeler as well as pillion riders strict efforts need to be made at both government and personal levels to reduce accidents in two-wheeler riders Keyword: Riders, Pillion, Road traffic accidents