bluuebunny/crossref_metadata_2025 huggingface dataset:
Cocoa Farmer's Use Of Approved Pesticides And Compliance With Safety Standards In Obuasi Municipality, Ghana
Authors: Hyde-Cooper Wilhemina , Tham-Agyekum Enoch  Kwame , Bakang John-Eudes Andivi , Ntem Supernatural , Ankuyi Fred , Mohammed Rubaba
Published: July 2024

Amidst the agricultural landscape of Ghana lies a complex interplay of practices governing the use of approved pesticides and adherence to safety standards among farmers. By analysing data gleaned from 400 farmers through the multistage sampling technique, our aim is reveal the multifaceted influences that shape farmers' decisions in the use of approved pesticides and safety compliance. Age, education, marital status, farm ownership, experience, farm size, access to equipment and services, cooperative membership, secondary occupations, and income, significantly influence farmers' choices in the use of approved pesticides. Furthermore, compliance with safety protocols is found to be influenced by factors such as farm size, access to extension services, and the perceived relative advantage of pesticides. We advocate for policies that promote the use of approved pesticides and prioritise safety standards in agricultural practices. This may include strengthening regulatory frameworks, incentivising sustainable farming practices, and enforcing penalties for non-compliance with safety regulations.
Potassium, Zinc, and Boron Nutrients Effect on Sorghum (Sorghum bicolor L. Moench) Yield in Wag-Lasta, Northern, Ethiopia
Authors: Esubalew Tilahun , Sebnie Workat
Published: July 2024

In Ethiopia using inorganic fertilizer started in the early 1970s. But it still depended solely on urea and DAP. Today, according to ATA and Ministry of Agriculture and Natural Resources K, Zn, B, S, and Cu are in deficit in Ethiopia and Amhara Region as well as in Wag-Lasta areas. But some studies conducted in Wag-Lasta and throughout the region in different crops indicate that these nutrients had no response on crop yields. So, this experiment was conducted in 2017 rain feed cropping season on five farmers’ parcels per location to verify the response of sorghum to potassium, zinc, and boron nutrients. The treatments were: NPS, NPSK, NPSZnB, and NPSZnBK, with the recommended rate of 46 and 23 kg ha-1 N and P2O5,respectivelyfor Sekota,23 kg ha-1N, andP2O5 for Lasta. Moreover, 150, 1.47, and 0.07 kg ha-1 KCl, Zn, and B, respectively used uniformly in both locations. The experiment was laid out in randomized complete block design (RCBD) with three replications. The collected data were analyzed by SAS software version 9.0. Analysis of variance revealed that the application of potassium, zinc, and boron had no significant effect (P ≤0.05) on sorghum yield and yield components at all sites. The exchangeable potassium content in the soil of the study sites is above the critical value level. The result disagrees with the soil fertility map which showed more than 98% of potassium deficiency and more than 80% NPSZnB deficiency. Hence, the application of K, Zn, and B nutrients had no yield advantage over the recommended N and P nutrients in the Wag-Lasta areas. Therefore, currently to increase production and productivity of crops in Wag-Lasta areas using of recommended rate of nitrogen and phosphorous with organic fertilizer sources for each district is the best option rather than using K, Zn, and B nutrients.
Nutrition assessment of school-going children in the rural area of District Swabi, Pakistan
Authors: Ullah Shakir , Islam Umair , Rahman Iqbal Khan , Muhammad Noor , Muhammad Iqbal , Khan Hamza , Khan Abbas , Ali Basit
Published: July 2024

Anemia and malnutrition are global health problem among all nutritional disorder with high morbidity and mortality in school aged children. Therefore the aims of the study assist the prevalence and risk factors of anemia, and malnutrition among school-going children of District Swabi Pakistan. A total of 600 school aged children of aged 4-15 years were included in the study in 2023. Hematocrit level was obtained using a centrifuge microhematocrit, and converted to hemoglobin using standard conversion. Nutritional status was determined by the anthropometric measurements, and demographic characteristics were obtained by questionnaire. Anemia and malnutrition were defined according to the World Health Organization standards. In current research work 600 children were selected for the assessment of nutritional status in which 105(17.5%) were found malnutrated. Moderate frequency of assessment were found among anemia 25(23.80%), stunting 22(21%) and underweight 18(17%) respectively. High frequency was found in malnutrition 40(38%) while very low frequency was seen in wasting 2(1.90%). Gender wise assessment of the students shows that the nutritional deficiencies were slightly high in male as compare to female students in comparison of Anemia, Malnutrition, Stunting, and Underweight and in wasting respectively. Aged group wised assessment of the students shows that the nutritional deficiencies were slightly high in low aged student (4-7 years) as compare to 8-11 years and 12-15 years in both gender. Among them Malnutrition were very high leading by Anemia while Underweight and wasting of very low frequency respectively.
DEPOSITION QUALITY OPTIMIZATION OF ADDITIVE FRICTION STIR DEPOSITED ALUMINIUM ALLOY USING UNSUPERVISED MACHINE LEARNING
Authors: Mishra Akshansh ,   School of Industrial and Information Engineering, Politecnico Di Milano,  Italy
Published: July 2024

Additive friction stir deposition (AFSD) is a promising solid-state additive manufacturing technology, but achieving continuous high deposition quality remains challenging due to complex process-structure connections. This study investigates unsupervised machine learning algorithms for mapping process parameters to deposition outcomes without requiring extensive labelled data. On experimental deposition data, algorithms including hierarchical clustering, k-means, spectral clustering, Gaussian mixtures, autoencoders, and self-organizing maps are used. The algorithms find intrinsic patterns and groupings in the multi- factor process data in an unbiased manner. With a silhouette score of 0.7618, k-means clustering performed the best, showing cohesive data clustering. Visualizations like dendrograms and trained maps shed light on the links between process parameters and deposition quality. The cluster analysis identifies process conditions that result in poor deposition quality. This highlights the ability of unsupervised approaches to capture deposition process patterns based solely on data with no prior system knowledge. This data-driven strategy has the potential to significantly improve AFSD process optimization and control, with implications for boosting industrial adoption. The unsupervised learning framework lays the groundwork for using process data to improve the quality and productivity of advanced manufacturing procedures.
Complementary Topological Indices
Authors: Furtula Boris ,   University of Kragujevac, Faculty of Science, Serbia, Oz Mert Sinan ,   Faculty of Engineering and Natural Sciences, Bursa Technical University, Bursa, Turkey
Published: July 2024

An edge of a graph can be geometrically represented by points (dr, ds) and (ds,dr) in a 2D coordinate system, where coordinates are, obviously, the degrees of the edge’s end-vertices. Recently, using such a geometrical point of view of a graph edge, a couple of topological invariants were put forward. They have attracted considerable attention among chemical graph theorists. This paper introduces a novel approach for devising “geometrical” topological indices. Finally, special attention is focused on the complementary second Zagreb index as a representative of the introduced approach.
Kumpulan Khutbah Jum'at
Authors:   Sekolah Tinggi Ilmu Hukum Biak-Papua, Lobubun Muslim , Ar-Rasyid Yanuriansyah ,   Sekolah Tinggi Ilmu Hukum Biak-Papua
Published: July 2024

Buku ini ialah sebagai media dakwah serta panduan khususnya bagi umat Islam untuk mendapatkan referensi dan mempelajari khutbah jumat secara mudah dan efisien. Selain itu, seringkali ditemukan penyampaian khutbah jumat yang tidak sesuai dengan esensi dan maksud tujuan yang hendak dicapai akibatnya banyak dari jamaah yang tidak mengetahui isi dan kandungan dalam khutbah tersebut dan mengakibatkan jamaah mengantuk karena kandungan yang tidak sistematis.
Peningkatan Kualitas Citra Karikatur Menggunakan Filter Maksimum dan Filter Median
Authors: Noviani Noviani
Published: July 2024

Quality improvement is basically how to overcome various problems that will arise to achieve the expected quality. Quality improvement is an activity to measure performance, benchmarking with standards and any systematic effort to improve performance in order to achieve expected standards. In improving the quality of this caricature image using a maximum filter and a median filter is basically a method to reduce or eliminate noise in a digital image or image, smoothing with a median filter to replace pixels with the highest value of a series formed from a matrix that matches the size of filter window. This filter works by selecting the intensity of the pixel in the middle, after pixel_pixel included in the filter is sorted
Rodent reservoirs: unraveling spectrum of zoonotic and pathogenic bacteria
Authors: Mpinga Agnes , Kazwala Rudovick , Kumburu Happiness , Mathew Coletha
Published: July 2024

Background: Zoonotic diseases are the major public health threat, with over 70% originating from wildlife. Rodents, while beneficial to the environment, transmit many zoonotic diseases such as hemorrhagic fevers, plague, tularemia, and leptospirosis, mainly due to increased agriculture and land use changes. Understanding rodent-borne pathogens is essential for effective intervention. Therefore, this study aimed to identify pathogenic and zoonotic bacteria in rodents and identify rodent species in the study area.
Methods: A total of 116 rodents achieved samples (101 oral-pharyngeal and 15 rectal swabs) collected from Kibondo, Uvinza and Kyerwa were used in this study. Total RNA (Ribonucleic Acid) was extracted from each swab sample and then pooled based on rodent species, location and swab types to make twelve pools. A portion of pooled swabs were polyadenylated and used for metagenomics sequence libraries preparation. A 16S rRNA (ribosomal Ribonucleic Acid) metagenomics sequencing was performed on 12 pools by using MinIon platform in order to identify microbial diversity.
Results: A total of 13 different microbial communities includinng bacteria were identified; where, 15 families of potentially pathogenic, zoonotic and bacteria of unknown zoonotic potential were also identified. These families included Mycobacteriacea, Helicobacteriacea, Enterobacteriacea, Vibrionacea, Staphylococcaceae, Nocardiaceae, Bacillaceae, Pasteurellaceae, Streptococcaceae, Campylobacteraceae, Leptospiraceae, Brachyspiraceae, Moraxellaceae, Enterococcaea, Flavobacteriacea. Potentially zoonotic pathogenic bacteria including Mycobacterium tuberculosis, Vibrio cholerae, Helicobacter pylori and Vibrio parahaemolyticus are reported in this study.
Conclusion: This study identifies several bacteria of public and veterinary importance, highlighting the possibility of increased risk of human infection and risk of cross-transmission between rodents, humans, and animals given the proximity between rodents, humans and animals. While no concrete evidence of rodent-to-human transmission was found, we hypothesize that rodents are a potential infection source, especially in resource-poor areas with close rodent-human contact.
Topical corticosteroids in the treatment of acute sunburn: a systematic review
Authors: Panjaitan Andre , Haroen Marina
Published: July 2024

Background: Acute sunburn is a prevalent dermatological issue, particularly affecting individuals with fair skin types I-III. It is characterized by erythema, edema, and discomfort due to ultraviolet (UV) radiation exposure. Topical corticosteroids are commonly used for their anti-inflammatory properties, but their efficacy in sunburn treatment is debated due to limited high-quality evidence from randomized controlled trials (RCTs). This study aims to assess the efficacy of topical corticosteroids in relieving symptoms and inflammation of sunburn. 
Methods: A systematic review was conducted by searching PubMed, Web of Science, ProQuest, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) for studies published up to April 30, 2024. Keywords included combinations of terms related to corticosteroids, topical application, and sunburn. Studies were selected based on PRISMA 2020 guidelines, focusing on adult patients treated with topical corticosteroids compared to placebo. Data extraction and quality assessment were independently performed by two researchers using the Cochrane Collaboration’s Risk of Bias tool.
Results: The review included six RCTs with a total of 339 participants, aged 18-68 years, conducted in Europe and the USA. Various topical corticosteroids were studied, including methylprednisolone aceponate, hydrocortisone 17-butyrate, and hydrocortisone-21-acetate. Treatment durations ranged from single applications to twice daily for seven days. The results demonstrated that prolonged treatment with topical corticosteroids significantly reduced sunburn symptoms such as erythema and pain. When applied for seven days, treated areas showed lower sunburn reaction scores and reduced inflammation compared to untreated areas. Early application of corticosteroids, particularly within 6 hours post-exposure, was more effective than later applications. Histological analyses supported these findings, showing improvements in epidermal thickness and reduced dermal inflammation in treated areas.
Conclusion: Topical corticosteroids can effectively alleviate acute sunburn symptoms and aid skin recovery by targeting inflammatory pathways. Their efficacy is enhanced with prolonged and early application. Further research is needed to optimize treatment protocols and assess long-term effects to fully realize the therapeutic potential of corticosteroid therapy in managing acute sunburn.
The Effect of Life Kinetic Number Training on the Concentration Level of Female Volleyball Athletes Aged 13-15 Years
Authors: Fauzi Fauzi , Pranatahadi SB , Dwihandaka Riky , Sabillah Muhamad Ichsan , Rohmah Dyah Ayu Intan , Fauzi Lailla Affianti
Published: July 2024

The purpose of this study was to determine the effect of life kinetic number training on the concentration level of female volleyball athletes aged 13-15 years. This study used an experimental method with a one group pretest-postest design. The sample in this study amounted to 22 athletes, which was taken through purposive sampling techniques. Data collection techniques in this study are tests and measurements. The instrument in this study uses a concentration test, namely the concentration grid test. The data analysis technique uses a t test (Paired Sample Test) which is analyzed using SPSS 25. The results of this study showed that the calculated t value of 13.791 was greater than the table t of 2.080, and the paired sample t test showed that the result of Sig. (2-tailed) 0.000 was less than 0.05 which means that there was a significant influence between life kinetic number training on the concentration level of female volleyball athletes aged 13-15 years. So it can be concluded in this study that life kinetic number training is one of the most effective exercise models in order to increase the concentration of female volleyball athletes aged 13-15.
Keywords: kinetic life, concentration, volleyball.
Article RETRACTED: include references that are unrelated to the subject of the article and/or the context in which they are cited Circuit training improves physiological conditions among wheelchair basket players
Authors: Tafuri Francesco , Martinez-Roig Rosabel , Setyawan Hendra , Susanto Nugroho , Anam Khoiril , Saraiello Emma , Avino Umberto , Latino Francesca
Published: July 2024

The utilization of a wheelchair exclusively has a profound impact on an individual's musculoskeletal, metabolic, and cardiorespiratory functions. Various programs focusing on physical activity intervention have proven to effectively enhance these physiological responses in wheelchair users. Nevertheless, there has been a limited number of studies investigating the impact of a circuit training physical activity adaptive program on improving these parameters in wheelchair basketball participants. Therefore, the primary aim of this research was to evaluate and identify alterations in cardiorespiratory fitness and musculoskeletal strength among wheelchair basketball players following a circuit training intervention. The study involved 36 male wheelchair basketball athletes with spinal cord injuries aged between 19 and 26 years. They were divided into an experimental group participating in a circuit training program [EG, n = 18], and a control group undergoing exclusively aerobic upper-body exercise training [CG, n = 18]. Anthropometric measurements and the 12-minute wheelchair propulsion distance test, which evaluates the maximal oxygen uptake (VO2max), were conducted for all participants at the commencement and conclusion of the training period. The results demonstrated a significant interaction between Time and Group for the 12-minute wheelchair propulsion distance variable, indicating a notable improvement in the intervention group (p < 0.001). Conversely, no significant changes were observed in the control group. Hence, the findings suggest that incorporating circuit training exercises into the daily training regimen can have a substantial positive influence on the cardiorespiratory fitness and musculoskeletal strength of wheelchair basketball players.
Key words: physiology; exercise; sport; spinal cord injuries; cardiorespiratory fitness.
Riesgo de salud psicológica y estado nutricional en estudiantes de Educación Física de universidades chilenas en periodo de pandemia por COVID-19 (Nutritional status and psychological health in Physical Education students from Chilean universities in the period of the COVID-19 pandemic)
Authors: Faúndez-Casanova César , Vargas Vitoria Rodrigo , Flández Valderrama Jorge , Luna Villouta Pablo , Luarte Rocha Cristian , Quilodrán Castillo Pedro , Quilodrán Castillo Luis
Published: July 2024

El presente estudio tiene como objetivo determinar riesgo de la salud psicológica y estado nutricional en estudiantes de Educación Física, pertenecientes a distintas Universidades Chilenas en periodo de pandemia por COVID-19, pertenecientes a distintas Universidades Chilenas. Correspondió a un enfoque cuantitativo de tipo descriptivo, de corte transversal, no experimental. La muestra estuvo conformada por 254 adultos-jóvenes (21.46±2.61 años) quienes cursaban entre primer y último año de pre-grado de Educación Física pertenecientes 7 universidades de Chile. Se empleó el cuestionario de Impacto Psicológico del Coronavirus (CIPC). En cuanto a los resultados, se observó que: en promedio más del 30% de la muestra se encontraba con sobrepeso y obesidad. En cuanto al riesgo de salud psicológica tanto hombres como mujeres, alcanzaron una alta puntuación en el CIPC, situándolos en un riesgo alto de salud. Los estudiantes de Educación Física durante el periodo de confinamiento producto de la pandemia, en su mayoría presentan un estado nutricional normal (IMC) y respecto al riesgo de salud psicológica, un elevado porcentaje alcanza un alto impacto para su salud, siendo las mujeres quienes presentan un riesgo mayor de salud psicológica.
Palabras clave: IMC; CIPC; Salud; Educación Superior; Pandemia.
Abstract. The objective of this study is to determine nutritional status and psychological health in Physical Education students belonging to different Chilean Universities in the period of the COVID-19 pandemic. It corresponded to a quantitative, descriptive, cross-sectional, non-experimental approach. The population consisted of 254 young adults (21.46 ± 2.61 years) who were in their first and last year of undergraduate Physical Education belonging to 7 Chilean universities. The Coronavirus Psychological Impact Questionnaire (CIPC) was used. Regarding the results, it was observed that: on average more than 30% of the sample was overweight and obese. Regarding psychological health, both men and women achieved a high score on the CIPC, placing them at high health risk. Physical Education students during the period of confinement as result of the pandemic, mostly present a normal nutritional status (IMC) and regarding psychological health, a high percentage reaches a high impact on their psychological health, being women who present decreased psychological well-being and increased alertness.
Keywords: Nutritional condition; Mental health; University students; Higher education; Pandemic.
Artificial intelligence and critical thinking
Authors: Coskun Benlidayi I.
Published: July 2024

Artificial intelligence and critical thinking
Association of interleukin-1 and interleukin-6 levels in lateralized temporal epilepsy patients
Authors: Varoglu Asuman Orhan , Avarisli Aysenur , Keskin Havva , Erman Hayriye
Published: July 2024

Objective: To explore the clinical significance of interleukin-1 and interleukin-6 in the development of lateralized temporal epilepsy.
Method: The prospective study was conducted from January to April of 2022 at the Neurology Department of Training and Research Hospital, Istanbul Medeniyet University, Turkey, and comprised patients with lateralized temporal epilepsy aged 18-86 years who were in the interictal period in group A and healthy controls in group B. The levels of interleukin-1 and interleukin-6 of patients in both groups were compared. Data was analysed using SPSS 25.
Results: Of the 92 subjects, 60(65.2%) were in group A; 35(58.3%) were males and 25(41.7%) were females with a median age of 37.5 years (interquartile range: 2.2-42.7 years). There were 32(34.8%) subjects in group B; 19(40.6%) females and 13(40.6%) males with a median age of 40.5 years (interquartile range: 25-50 years) (p>0.05). Within group A, 41(68.3%) patients had left-sided epilepsy and 19(31.7%) had right-sided epilepsy (p<0.001). Both interleukin-1 and interleukin-6 levels were lower in group A than in group B (p<0.001). Both interleukin levels did not significantly differ between right and left-lateralised temporal seizures (p=0.44). In the left-lateralized temporal seizures, interleukin-1 levels correlated with epilepsy duration (p<0.006), lower onset age (p<0.050), and presence of prenatal risk (p<0.028). Interleukin-1 and interleukin-6 levels were positively correlated with each other for lateralized temporal epileptic hemispheres (p<0.001).
Conclusion: Interleukin-1 level was correlated with epilepsy duration, lower onset age, and presence of prenatal risk in the left-lateralized temporal epilepsy.
Key Words: Focal epilepsy, Partial epilepsy, Lateralisation, Prognosis, Interleukin-1, Interleukin-6, Cytokine.
The effects of ankle mulligan mobilisation in children with cerebral palsy: a randomized single blind control study
Authors: Ratib Shaban Ragheb Abushameh  , Güçhan Topcu Zehra , Ayse Nur Tunal  , Akram Amro  , Azzam AlArab
Published: July 2024

Objective: To assess the impact of range of motion changes before and after Mulligan mobilisation with ankle movement interventions on the daily lives of children with diplegic cerebral palsy.
Method: The single blind randomised controlled study was conducted from July 30, 2022, to January 10, 2023, at 3 rehabilitation centres in Hebron, Palestine, after approval from the ethics review committee of Eastern Mediterranean University, Northern Cyprus, and comprised children with cerebral palsy, who were randomised into intervention group IG and control group CG. All the subjects received regular physiotherapy sessions, overseen by their parents, while those in group IG received mobilisation with ankle movement treatment 3 times per week for 4 weeks. Post-intervention assessment of ankle range of motion, balance, functional performance and quality of life was done using a goniometer, the timed up and go test, 88-item gross motor function measure, 6-minute walk test and the cerebral palsy quality of life questionnaire. Data was analysed using SPSS 24.
Results: Of the 64 patients, 40(63%) were girls, and 24(37%) were boys. The overall age range was aged 4-12 years. There were 32(50%) patients in each of the two groups. Mobilisation with movement had a significant effect on active and passive range of motion for the left and right ankles (p<0.05) as well as on balance, gross motor function and quality of life (p>0.05). However, mobilisation with movement had no significant effect on the the distance covered during the 6-minute walk test (p>0.05).
Conclusion: Mobilisation with movement had a significant impact on active and passive ankle range of motion, balance and quality of life in diplegic children with cerebral palsy, but it had no impact on gait function.
Clinical trial registration number: The study was registered at the United States National Institutes of Health (ClinicalTrials.gov) with registration number NCT05500924.
Key Words: Cerebral palsy, Mobilisation, Range of motion, Function, Quality of life.
HABIT training in unilateral spastic cerebral palsy children having mirror movement disorder
Authors: Shahid Javeria , Mir Arif Hussain Talpur  , Hassan Rauf
Published: July 2024

The single-arm feasibility study was planned to evaluate the therapeutic effect of hand arm bimanual intensive training in improving the fine and gross motor functions of hand, and in the reduction of intensity with respect to mirror movement disorder. The sample comprised unilateral spastic cerebral palsy children aged 6-16 years who were having mirror movement disorder and were able to make a gross grip. The hand arm bimanual intensive training was provided to the participants for 6 hours per day for 15 days for a total of 90 hours. Comparison of baseline and post-intervention showed that the functional independence level of children had improved, with improvement in unimanual and bimanual hand performance (p less than 0.05). However, there was no improvement seen in the severity of mirror movements (p>0.05).
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Unused, leftover and expired medicine and disposal practices among health sciences faculty students in Burdur, Turkey
Authors: Koksoy Serkan
Published: July 2024

Objective: To evaluate the opinions of university-level Health Sciences students about unused, leftover and expired medicine, as well as their disposal practices, and to classify the medicines.
Methods: The cross-sectional study was conducted from April 1 to May 31, 2023, at the Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Turkey, and comprised those studying at the Nursing, Nutrition Dietetics and Physical Therapy and Rehabilitation departments. Data was collected using Google Forms. The Anatomical Therapeutic Chemical classification was used for classifying pharmaceutical active ingredients. Data was analysed using SPSS 24.
Results: Of the 373 participants, 272(73%) were females and 101(27%) were males. The overall mean age was 20.8±2.8 years. There were 348(93.3%) subejcts who reported having a total of 845 boxes of leftover and unused medicines in their homes (2.3±1.9 per capita), while 25(6.7%) participants had none. The medicines were stored in the kitchen 261(61.5%) as the storage area, and in the refrigerator 181(40.2%) as the storage unit. The expired medicine was disposed of in the garbage in 328(86.1%) cases. Self-medication was prevalent in 325(87.1%) cases. Anatomical Therapeutic Chemical classification analysis showed that paracetamol, acetylsalicylic acid, paracetamol+caffeine and metamizole sodium was the most common group of leftover and unused medicines 283(81.3%)
Conclusion: High prevalence of unused and leftover medicine, disposal of medicine in household garbage, and self-medication behaviour indicated a serious public health and environmental problem.
Key Words: Pharmaceutical, Public health, Self-medication, Turkey.
Balancing Costs and Care: Nonoperative Appendicitis Treatment Outcomes in Pakistan
Authors: Bilal Fattani  , Umme Roman Akhtar  , Khushboo Nusrat
Published: July 2024

Dear Respected Editor,
In Pakistan, approximately 110,000 cases of appendicitis are reported annually [1], highlighting the condition's prevalence and significance. Traditional management predominantly revolves around widely practiced surgical intervention, such as appendectomy. [2]. Immediate appendectomy has become the standard treatment due to the significant morbidity and mortality difference between perforated and non-perforated acute appendicitis. However, the country's healthcare landscape presents a complex challenge due to varying regional access to medical resources. This variation in healthcare infrastructure exacerbates the difficulty of effectively managing appendicitis and underscores the need for solutions that strike a balance between clinical outcomes and economic considerations.
While appendectomy remains a standard surgical procedure, it comes with inherent disadvantages, chief among them being the cost burden it places on patients and healthcare systems [3]. For patients in a low- to middle-income nation like Pakistan, the financial strain associated with surgery—which includes preoperative evaluations, surgical costs, hospital stays, and postoperative care—can be challenging [4]. Furthermore, the ripple effects affect the whole healthcare system, diverting resources that may otherwise be used for other urgent medical needs. A study by Siddiqui et al. emphasizes the need for a comprehensive analysis of economic factors in appendicitis management, particularly in low- and middle-income countries like Pakistan. The challenges in countries such as Pakistan require the exploration of alternative approaches that can optimize clinical outcomes while effectively managing healthcare costs without compromising patient care. [2]
The recent study by Lee et al. introduces a promising alternative to conventional appendicitis management [5]. The research focuses on nonoperative treatment approaches, such as antibiotic therapy and observation, which have gained traction for their potential benefits Further, the study shows that the majority of the patients who had nonoperative treatment did not encounter a recurrence of appendicitis and were able to avoid surgical intervention for a period of around 20 years. Furthermore, there is a lack of data indicating any long-term dangers associated with nonoperative care. One of the prominent advantages lies in the reduction of immediate healthcare expenses, which can alleviate the financial burden on both patients and healthcare systems. By presenting evidence on the effectiveness and safety of nonoperative approaches, this study opens avenues for a paradigm shift in appendicitis management in Pakistan. The potential to achieve comparable clinical outcomes while minimizing the economic burden is a compelling proposition that warrants further exploration and consideration within Pakistan's healthcare challenges.
Viral Hepatitis in Pakistan; a global concern
Authors: Ishaq Muhammad Uzair , Rasheed Faisal
Published: July 2024

Dear Mam,
Around 1.4 million people die each year from problems connected to hepatitis, with HBV infection accounting for the majority of cases and HCV infection coming in second1. Infection with HCV and HBV can range in severity from a mild illness with viral clearance to chronic hepatitis C that may lead to liver failure and death. There are an estimated 411,000 annual HCV-attributable deaths globally, with most of these resulting from liver cirrhosis or hepatocellular carcinoma that can manifest decades after infection2.
According to the WHO report, hepatitis is the eighth highest cause of mortality. Pakistan bears the second-largest burden of hepatitis C globally, with a nationwide prevalence of 4.8% 1.A review of ninety different studies conducted in Pakistan observed that the prevalence of HCV infection in the adult population of Pakistan was 11.55%. Drug users were found to have the highest prevalence of 51%. The percentage prevalence of HCV found for all of the provinces was Punjab: 5.46%, Sindh: 2.55%, Khyber Pakhtunkhwa: 6.07%, Baluchistan: 25.77%, and federally administrated tribal areas: 3.37%. The study further observed that the average prevalence of viral hepatitis in Pakistan was a whopping 8.64%1.
The main risk factors for transmission of viral hepatitis in Pakistan are unprotected sexual contact, quackery, use of unsterilized instruments in neighbourhood barber shops and shortage of designated maternity and obstetric centers3. People in Pakistan receive an unusually high number of therapeutic injections, estimated at between 4-5 injections a person per annum. An estimated 17 to 50% of these are given with previously used syringes2.
It is high time our healthcare authorities, hospital administrators, health ministries and policy makers start making a comprehensive plan to curb viral hepatitis transmission in Pakistan. As for primary prevention, awareness campaigns should be organized, quackery be stopped, barbers trained in prevention of blood-borne pathogens transmission and barber shops regularized and registered. For secondary prevention, nation-wide screening campaigns should be organized with a focus on High-prevalence areas such as Baluchistan, antiviral drugs be made in the country, economical provision of antiviral drugs to the masses, provision of rapid diagnostic kits to the hospitals and designated hepatitis centres should be established in each district. The healthcare commissions should make Task-forces to curb quackery and lodge police reports against those involved in it. Together, we can make a healthy Pakistan!
Developing partnership with patients and carers: A need of the time for mental health service delivery
Authors: Afzal Javed
Published: July 2024

Contemporary practice of psychiatry is witnessing a radicle shift in the care of mentally ill. As compared to the 20th century, we are now moving towards community psychiatry and large mental hospitals and asylums are closing with a shift to manage these patients closer to their homes. Following these changes in mental health care, current literature provides growing evidence for developing partnership with patients, carers and family members in the delivery of mental health services. While this approach is appreciated for improving the quality of life of patients, there has also been some concerns about increasing burden of carers and families when they have limited resources and support to face the challenges in dealing with the management of their patients.1
Treatment and management of mental health problems are complex and needs a wider recognition for having patients and care-givers involvement in the treatment processes. Patients with mental health problems unfortunately suffer from a wide range of psychosocial adversities and require engagement leading to more empowerment in decision making processes. Furthermore, quality of health services can be measured by the experiences of patients and their families. Their viewpoints can reflect their happiness as well as the effectiveness of the services that could be based on their knowledge and understanding of their role in the treatment processes.
However, in many societies, the nature and role of families are either undermined or not fully understood.2 Families may be considered as a cause for the onset of mental health issues and can be blamed for causing or triggering the illnesses. Similarly, the clinicians are given the full authority to decide about the treatment choices and preferred possibilities. Their role may be acknowledged as “the ultimate expert” who can decide in a final way and patients or families may have limited opinions in such decisions. Professionals may also consider confidentiality issues as a primary reason for not sharing information and taking relatives or family members on board, so they are frequently excluded from the decision-making processes. Apart from confidentiality reasons, clinicians may not have sufficient training and skills to deal with families and patients in terms of supporting and dealing with their concerns.3
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The KgA1c Paradox: Widening the spectrum
Authors: Sanjay Kalra  , Suneet Verma  , Nitin Kapoor
Published: July 2024

The term KgA1c paradox is used to describe the unwantedrise in weight that occurs when HbA1c is controlled usingconventional therapy. We highlight facets ofpathophysiology, prevention, pharmacology, personcentred care, and epidemiology, which correspond to theconcept of KgA1c paradox. We suggest a novel index,KgA1c product [(BMI) x (HbA1c)], which can be used toevaluate efficacy of drugs, and assess metabolic control inpersons with diabetes,Keywords: Diabesity, diabetes, HbA1c, metabolicsyndrome, overweight, obesity
Super Mario sign at somatostatin receptor PET/CT
Authors: Sharjeel Usmani  , Khulood Al Riyami  , Anjali Jain  , Muneera Al Maraghy
Published: July 2024

68Ga-DOTA NOC PET-CT imaging has been shown to have high accuracy for the evaluation of neuroendocrine tumours. Wepresent the case of a 59-year-old male with well differentiated gastric neuroendocrine tumour (grade II) treated with surgery.68Ga-DOTA NOC PET/CT was performed to rule out metastasis. 68Ga-DOTA NOC showed physiological uptake in the bilateraladrenal and horseshoe kidney appearing as the famous character Super Mario. There is no evidence of any abnormalsomatostatin avid lesion.Keywords: 68Ga-DOTA NOC PET-CT, horseshoe kidney, neuroendocrine tumors, PET/CT
Response of various histological types of locally advanced rectal cancer to neoadjuvant multimodality therapy
Authors: Nadeem Muhammad Sohaib , Ujala Ali  , Khan Amjad , Wajid Imran , Riaz Omer , Azeem Muhammad Tariq
Published: July 2024

Objective: To determine the response of various histological types of locally advanced rectal cancer to neoadjuvant multimodality therapy.
Method: The non-randomised, quasi-experimental retrospective cohort study was conducted at the Combined Military Hospital, Rawalpindi, Pakistan, and comprised data of patients treated between January 1, 2020, to September 30, 2021. The data retrieved related to histologically proven and locally advanced rectal cancer patients aged 18-70 years receiving neoadjuvant chemoradiotherapy. Radiotherapy dose was 45 gray to pelvis with a boost to gross tumour of 5.4 gray in 3 fractions by using volumetric arc therapy concurrently with capecitabine 625mg/m² daily. A magnetic resonance imaging scan of pelvis with contrast was done at 5-10 weeks before surgery. Histological response to neoadjuvant treatment of various histological types was evaluated using the Rectal Cancer Regression Grade. Data was analysed using SPSS 22.
Results: Of the 182 patients evaluated, 108(59.34%) were included; 64(59.3%) males and 44(40.7%) females. The overall mean age was 45.4±5.2 years. Regression status was grade 1 in 24(22%) patients, grade 2 in 43(40%) and grade 3 in 41(38%) (p=0.074). There were 12(11.11%) patients with signet ring cell, and 10(83.3%) showed pathological tumour regression. There were 17(15.74%) patients with mucinous variant, and 12(70.5%) of had tumour regression. There were 79(73.15%) patients with adenocarcinoma, and 59(74.6%) of them showed tumour regression. .
Conclusion: There was less tumour regression in mucinous and signet ring cell variants of adenocarcinoma. Modification and intensification of neoadjuvant therapy may be required in such histologies.
Key Words: Chemoradiation, Colorectal cancer, Neoadjuvant, Rectal cancer pathology.
Comparison of outcome of botulinum toxin injection with and without glyceryl trinitrate in chronic anal fissure in terms of post operative pain and healing
Authors: Hussain Shabeer , Ammar Ahmed Siddique , Hameed Ahmed Raza , Aslam Imran , Afzal Ameer
Published: July 2024

Objective: To compare the outcome of botulinum toxin injection with and without glyceryl trinitrate with respect to postoperative pain and healing in the treatment of anal fissures.
Method: The prospective, comparative study was conducted at the Department of General Surgery, Mayo Hospital, Lahore, Pakistan, from September 1, 2021, to August 31, 2022, and comprised adult chronic anal fissure patients of either gender. They were randomised using the lottery method into group A which received botulinum toxin injection, and group B which received botulinum toxin injection plus 1g of 0.2% topical glyceryl trinitrate cream. Post-operative pain was measured 24 hours after the procedure using the visual analogue scale. Healing was assessed by examining the wound for the appearance of granulation tissue 4 weeks post-procedure. Data was analysed using SPSS 26.
Results: Of the 88 patients, 44(50%) were in group A; 32(72.7%) males and 12(27.3%) females with mean age 33.91±14.8 years. There were 44(50%) patients in group B; 35(79.5%) males and 9(20.5%) females with mean age range 36.33±14.9 years. The mean postoperative pain at 24 hours in group A was 4.67±1.16 and it was 3.06±0.65 in group B (p=0.009). In group A, 23(69.7%) patients showed complete healing at 4 weeks compared to 30(90.9%) in group B (p=0.030).
Conclusion: Botulinum toxin injection with glyceryl trinitrate could be considered as first line of treatment for chronic anal fissure in patients who refuse surgery and with previous sphincter surgery.
Key Words: Anal fissure, Lateral internal anal sphincterotomy, Botulinum toxin injection, Glyceryl trinitrate, Granulation tissue.
E-gaming: an active learning pedagogy for engaging learners in a private university in Karachi, Pakistan
Authors: Laila Akber Cassum  , Fatima Syeda Sadia
Published: July 2024

There is a radical shift in teaching and learning pedagogies to engage the learners in healthcare profession. It was a tough challenge for Pakistani educators of an esteemed university to motivate and assess the learners for concept absorption and critical reasoning using creative approaches.
Teaching and learning styles have changed fundamentally from conventional teacher centred to inquiry-based student-centred approach. Classroom teaching in recognised nursing and medical institutes in Pakistan have transformed to blended and entirely online methodologies with the integration of diverse active learning strategies. The educators grapple to engage the millennials and to encounter this, gaming technological platform was used to facilitate the learners for maximum integration, active participation, and create an exciting learning experience. Various e-gaming tools, such as Kahoot, Jamboard, Padlet Wall, Ed-Puzzle, Mentimeter, etc., were used in nursing and medical courses and were highly appreciated by the leaners to retain, review, and self-assess.
Knowledge of BRCA gene among young Pakistani adults: a short report
Authors: Shahir Muhammad Ibne Rasa  , Daler Ahmad  , Mishaal Hasan  , Agha Hashim Raza Khan  , Minahil Farhan  , Farzad Effan
Published: July 2024

A total of 271 young Pakistani adults responded to a self-designed multiple choice-based questionnaire (Alpha = 0.83) which was then used to assess the levels of knowledge regarding breast cancer susceptibility (BRCA) gene mutation. Overall knowledge levels were assessed using the sum score of each response; any possible significance between knowledge scores and educational backgrounds as well as gender were also tested. The results show that 63.8% of the sample population had awareness about BRCA gene mutation. Knowledge scores were comparable across both groups (medical and non-medical educational backgrounds) with 13.8% of medical and 13.5% of non-medical respondents demonstrating a high level of knowledge about the BRCA gene mutation and its testing. Neither gender nor educational background had a significant influence on knowledge scores. The results from this report suggest that awareness regarding BRCA gene was adequate, while knowledge levels were noted to be poor among the sample population.
Keywords: Breast cancer, Pakistan, Awareness, Knowledge, Gene.
Post-traumatic stress disorder as the most typical response to a traumatic event: clinical observation and literature review
Authors: Petelin Dmitry S. ,   Sechenov First Moscow State Medical University (Sechenov University), Isaeva Polina S. , Smoleevsky Alexander G. , Tolokonin Artem O. , Volel Beatrice A. ,   Pirogov Russian National Research Medical University,   Sechenov First Moscow State Medical University (Sechenov University),   Clinic for psychosomatic diseases Neo Vita,   Sechenov First Moscow State Medical University (Sechenov University),   Mental Health Research Center of Russian Academy of Medical Sciences
Published: July 2024

The article presents a clinical observation of a patient with post-traumatic stress disorder, which manifested itself after a traumatic situation in the family. A brief overview of the conceptual evolution of post-traumatic stress disorder is given, the clinical picture and modern approaches to diagnosing the disorder under discussion are described. Evidence-based approaches to psychotherapy and psychopharmacotherapy for post-traumatic stress disorder are presented.
Calcifying fibrous tumor of the stomach: a review of the literature and a clinical case
Authors: Novikova Tatyana V. ,   Vladimirsky Moscow Regional Research Clinical Institute (MONIKI), Verbovsky Aleksandr N. , Setdikova Galiya R. , Tyurina Vlada M. , Eremeeva Elizaveta R. , Shikina Valentina E. , Semenkov Alexey V. ,   Vladimirsky Moscow Regional Research Clinical Institute (MONIKI),   Vladimirsky Moscow Regional Research Clinical Institute (MONIKI),   Vladimirsky Moscow Regional Research Clinical Institute (MONIKI),   Vladimirsky Moscow Regional Research Clinical Institute (MONIKI),   Vladimirsky Moscow Regional Research Clinical Institute (MONIKI),   Vladimirsky Moscow Regional Research Clinical Institute (MONIKI),   Sechenov First Moscow State Medical University (Sechenov University)
Published: July 2024

Relevance. A calcifying fibrous tumor is a rare benign mesenchymal neoplasm with predominant localization in the limbs, neck, and deep soft tissues, and isolated cases of localization in the gastrointestinal tract. About 25 cases of this tumor that developed in the wall of the stomach are described in the English-language literature. Research goal. A review of the literature on calcifying fibrous tumors of the gastrointestinal tract. Presentation of a rare clinical case of calcifying fibrous tumor of the stomach. Materials and methods. Analysis of the literature on calcifying fibrous tumors of the gastrointestinal tract. Due to the rarity of calcifying fibrous tumor of the stomach, we present our own clinical case. Results. Demonstration of effective endoscopic treatment of a 51-year-old patient with a calcifying fibrous tumor of the body of the stomach. Conclusion. A detailed analysis of the literature demonstrates that the use of modern diagnostic methods leads to an increase in the frequency of detection of calcific fibrous tumors of the gastrointestinal tract. It may not be as rare for the gastrointestinal tract as previously thought. Despite the fact that clinical and imaging data are of little specificity and final verification is possible only after morphological examination, physicians of related specialties should keep this tumor in mind and include it in the differential series, especially when choosing a surgical method of treatment.