bluuebunny/crossref_metadata_2025 huggingface dataset:
THE IMPORTANCE OF HAND WASHING IN THE HOSPITAL ENVIRONMENT
Authors: Ana Claudia , Lima Igor , Carmona Lidia , Leite Mayara , Dias da Silva Luiz
Published: September 2023

Knowing that hospitals are institutions to promote healing and care for citizens who need assistance to restore their health. It is essential that the Health Institution promotes humanized, safe and correct care in accordance with duly standardized procedures and standards to obtain an effective result. However, we know that this is not the reality we experience. We still have high rates of hospital infections, which leads us to reflect on the basic rules of care necessary for the essential contribution to combating hospital infections. It was between 1818/1865 that the Hungarian doctor Ignes Philip Semmelweis came across a high increase in the rate of puerperal fever, he highlighted and postulated the obligation of hand hygiene with chlorinated solution between care for each patient, he noted the enormous reduction in the rate of maternal mortality. Thus beginning an essential procedure for health care and assistance. Despite the greater focus on the transmission of diseases in hospital environments and in our society in general, the practice of hand hygiene still acts precariously. It was in 1975 that guides and guidelines began to emerge regarding the practice of correct hand hygiene. Techniques were developed and standardized through COREN. These being: simple, antiseptic, surgical and pre-operative hygiene. Hand hygiene was one of the globally effective ways to prevent the spread of the recent Pandemic we have suffered. COVID 19. And much of this spread was due to a lack of information/awareness among the large population, where the practice of this procedure (which must be carried out daily among homes) was not completely understood. Practice is essential for everyday life, and can be replaced by the use of alcohol gel in the absence of water and soap (as long as there is no dirt on the hands. In a hospital environment, hand hygiene procedures are defined for each care procedure, depending on the The nursing team continuously observes them, making the team aware that correct hygiene ensures the health of professionals, patients and the Hospital Environment, reducing contagion. (promoted in the institution occupies a bed, he is administered medicines that could treat another patient). And mainly and not death. Basic, cheap and effective practice as long as it is correctly carried out. In this way, it is highlighted that Continuous Education campaigns for Awareness of the entire population is required to discuss the topic “hand hygiene”, not only as a rule and mandatory in the Hospital Environment, essential to promote health in the units. But also in society in general.
Chronic Kidney Disease and Associated Risk Factors Among Patients with Type-2 Diabetes Mellitus in a Tertiary Care Hospital
Authors: Islam Farrukh , Siddiqui Hamid Jamal , Khalid Abeer , Farrukh Ghazal , Yousaf Shagufta , Ahmed Abeera
Published: September 2023

Objective: To determine the frequency of chronic kidney disease and its associated risk factors in patients with type 2 Diabetes Mellitus.

Study Design: Cross-sectional study.

Place and Duration of Study: Combined Military Hospital Malir Cantt, Karachi, from Jan to Jun 2019.

Methodology: A total of 203 adult patients with Type 2 Diabetes Mellitus were included in the study after taking informed consent on the justification of inclusion/exclusion criteria. The estimated Glomerular filtration rate was calculated for each patient using Creatinine based chronic kidney disease epidemiology collaboration (CKD-EPI) equation. Chronic kidney disease was defined as decreased glomerular filtration rate of <60 mL/min per 1.73m2. In addition, risk factors for developing chronic kidney disease, including Body Mass Index and blood pressure, were clinically determined.

Results: Out of 203 patients with type 2 diabetes mellitus, 65(32%) had Chronic kidney disease. Most of them, 34(52.30%), were in Chronic kidney disease stage 3, while 21(32.30%) were in stages 4 and 10(15.40%) were having stage 5. Increasing age, smoking, female gender and higher body mass index were positively correlated with the development of chronic kidney disease in diabetes patients.

Conclusion: Chronic kidney disease is a frequently observed complication in diabetes patients. Early detection and appropriate treatment can help in retarding progression to advanced stages of chronic kidney disease. Regular screening of diabetes patients for chronic kidney disease and associated risk factors is therefore recommended.
Comparison of Ultrasound-Guided Nerve Block with Ultrasound-Guided Nerve Stimulation Technique for Obturator Nerve Block in Transurethral Resection of Bladder Tumour
Authors: Ahmad Mirza Sijeel , Khan Umer , Haider Syed Aftab , Sultan Atqua , Khanum Shazia , Saleemi Muhammad Saleem
Published: September 2023

Objective: To compare the ultrasound-guided nerve block with ultrasound-guided nerve stimulation technique for obturator nerve block (ONB) in patients undergoing transurethral resection of bladder tumour (TURBT).

Study Design: Prospective comparative study.

Place and Duration of Study: Department of Anesthesiology, Nishtar Medical University/Hospital Multan from Jan to Jul 2019.

Methodology: A total of 80 patients were divided into two groups. In Group-I, an ultrasound-guided nerve block was applied, while in Group-II, an ultrasound-guided nerve stimulation technique was applied for the block. Time of onset/ success of motor block and ease of approach were the primary study endpoints. At the same time, the surgeon and patient satisfaction were secondary endpoints.

Results: Motor block onset time was 6.58±2.16 minutes in Group-II versus 12.41±2.39 minutes in Group-I (p-value <0.001). Block performance time was 4.34±0.78 minutes in Group-II versus 2.09±0.46 minutes in Group-I (p-value <0.001). The block success rate was also higher in Group-II, with 36(90%) patients, compared to 31(77.5%) in Group-I, with an insignificant pvalue of 0.12. Surgeons were satisfied by the quality of the obturator nerve block in 37(92.5%) cases in Group -II and only 30 (75%) cases in Group-I (p-value 0.03).

Conclusion: The ultrasound-guided nerve stimulator is superior to the Ultrasound-guided nerve block for Obturator nerve block (ONB) and is associated with higher patient and surgeon satisfaction.
Comparison of the Functional OutcomeBetween Intra-Articular Corticosteroid Injection versus Platelet-Rich Plasma in Patients with Adhesive Capsulitis
Authors: Ahmad Ijaz , Akhtar Noreen , Butt Aamir Waheed , Khattak Abdul Latif , Shafaat Hina Kanwal , Mahboob Farah
Published: September 2023

Objective: To compare mean resting pain relief and passive external rotation improvement by Intra-articular Steroid versus intra-articular Platelet Rich Plasma injection in patients with adhesive capsulitis.

Study Design: Prospective comparative study.

Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi Pakistan, from Jan to Jun 2019.

Methodology: A total of 60 patients were included in the study. Group-A and B received Intra-articular 40mg Triamcinolone Acetonide with 1 ml 1% Lignocaine and platelet-rich plasma injections in affected shoulders, respectively. Pain severity was assessed on the Numeric Rating Scale, and passive external rotation was assessed by goniometry at baseline, i.e., preintervention, six weeks and 12 weeks intervals.

Results: In our study, the NRS scale for pain was 3.030.76 at six weeks and 1.230.77 at 12 weeks with PRP versus 5.070.87 at six weeks and 3.200.89 with Corticosteroids at 12 weeks post-intervention, with the p-value of <0.001 showing increased efficacy of PRP. While passive external rotation was 70.275.26 at six weeks and 82.304.84 at 12 weeks with PRP versus 61.35.28 at six weeks and 71.806.99 with corticosteroids at 12 weeks post-intervention, with the p-value of <0.001 showing increased efficacy of PRP.

Conclusion: There was a significant improvement in mean resting pain relief and passive external rotation after platelet-rich plasma injection in the shoulder joint adhesive capsulitis compared to intra-articular Steroids.
Diagnostic Accuracy of Ultrasonography Versus Magnetic Resonance Imaging in the Detection of Endometrial Carcinoma Keeping Histopathology as Gold Standard
Authors: Ehsan Jovaria , Majeed Ayesha Isani , Haq M Ehsan ul , Riaz Ramish , Ehsan Asma , Ehsan Momna
Published: September 2023

Objective: To calculate the diagnostic accuracy of Ultrasonography versus Magnetic Resonance Imaging in detecting endometrial carcinoma with histopathology kept as a gold standard.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Diagnostic Radiology, Pakistan Institute of Medical Sciences Hospital, Islamabad Pakistan, from Apr 2019 to Apr 2020.

Methodology: This study included patients of perimenopausal and post-menopausal age groups with abnormal uterine bleeding having a high index of suspicion for endometrial malignancy referred from the Gynecology department for an ultrasound examination. Patients having high suspicion for malignancy or inconclusive evidence on ultrasound were considered for Magnetic Resonance Imaging(MRI). All of them were followed for histopathological reports after surgical exploration. Clinical, sonological and Magnetic Resonance Imaging (MRI) findings, along with histopathological diagnosis, were documented.

Results: Mean age of the patients was 56.58±10.28. Of these eight patients, 8(21.1%) did not have carcinoma upon histopathology. The most common type of carcinoma was poorly differentiated endometrial adenocarcinoma. The diagnostic accuracy of ultrasound was found to be 47.35%, while that for Magnetic Resonance Imaging (MRI) was 71.05%. Sensitivity and specificity for Ultrasound versus Magnetic Resonance Imaging (MRI) were 53.33% versus 66.67% and 75% versus 87.50%, respectively. The mean endometrial thickness on ultrasound was 15.97±5.64 mm, while on MRI was 15.42±6.9 mm.

Conclusion: Magnetic Resonance Imaging (MRI) is a more accurate and sensitive modality in detecting endometrial carcinoma in patients with abnormal uterine bleeding.
Clinical Significance of Delta Neutrophil Index as Diagnostic Indicator for Patients in Sepsis
Authors: Sarwar Nozaif , Iqbal Muhammad , Sajjad Zunera , Shoaib Muhammad , Hussain Korejo Saqib , Chaudhary Umer
Published: September 2023

Objective: To determine the clinical significance sof Delta Neutrophil Index (DNI) in diagnosing sepsis.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Pathology, Pakistan Navy Ship, Shifa Hospital, Karachi from Jan to Jun 2020.

Methodology: The study included one hundred and fifty patients with systemic inflammatory response syndrome (SIRS) sadmitted to the medical intensive care unit (ICU). Delta Neutrophil Index (DNI) is the difference in leukocyte sub-fractions recognized by myeloperoxidase reactive cells and nuclear lobularity channels. A specific blood cell analyzer measured DNI, and a cut-off of 2.7% was used to diagnose the sepsis. Positive blood culture was considered the gold standard.Results: The Delta Neutrophil Index (DNI) showed a sensitivity of 72.2% and a specificity of 97.6%, respectively. The area under the receiver operating characteristics curve (ROC) was determined to be 0.82(0.81–0.94). The threshold efficiency was 2.5 per cent for the highest diagnostic accuracy.

Conclusion: As an early diagnostic measure for evaluating patients with septicemia, the Delta neutrophil index can be a reasonable and effective indicator and should be encouraged in regular screening programs.Keywords: Delta neutrophil index, Immature granulocyte, Infectious disease, Systemic inflammation, Sepsis
Evaluating Skills and Confidence Status of House Officers in Managing Dental Patients: A Mixed Method Study in a Private Dental Institute of Karachi
Authors: Buksh Hudebia Allah , Usmani Ambreen , Shaikh Sirajul Haque
Published: September 2023

Objective: To evaluate the skills and confidence status of house officers in managing dental patients.

Study Design: Mixed method (Sequential-explanatory) study.

Place and Duration of Study: Altamash Institute of Dental Medicine, Karachi Pakistan, from Mar 2019 to Mar 2020.

Methodology: A self-administered questionnaire was developed for the 1st phase of the study. After validation from the content experts, a pilot test was run on 18 house officers before administering the questionnaire. It included 46 dental procedures; participants rated their skills and confidence in performing them using a Likert scale of 1 to 5 points ranging from poor to excellent. In the 2nd phase, sixteen face-to-face interviews were conducted to explain the reasons for acquiring skills and confidence status.

Results: The response rate was 100%. Fifty-eight house officers filled out the questionnaire. Participants with multiple rotations reported significantly above average confidence status with multiple rotations of retainer insertion (81%), treatment of malocclusion using removable appliances (82%), fissure sealants (78%), anterior endodontic (80%), posterior amalgam (69%), oral hygiene (69%), and diagnosis of caries (67%), TMJ disorders (69%), rubber dam placement (71%) and properly prescribed recommended medicine (65%) when compared to the single rotation. The most important high-confidence status themes in evaluating skills were practising the procedures and internal motivation.

Conclusion: Multiple rotations with repeated practice sessions enhanced house officers' skills and confidence status.Procedures that were least practised scored the lowest in overall mean confidence.Keywords: Confidence status, Curriculum, Dental graduates, Dental procedures, Evaluation, House officers, Skills.
Comparative Assessment of Patient’s Acceptability between Hawley and Vacuum-Formed Retainer in Patients Treated with Fixed Orthodontics Appliance
Authors: Bibi Khadija , Jan Abdullah , Hameed Munza , Afgan Nimra , Alamzeb Haseeb , Malik Sundas
Published: September 2023

Objective: To compare the acceptability of Vacuum-formed Retainers and Hawley Retainers in two groups of fixed orthodontics patients over three months.

Study Design: Quasi-experimental study.

Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Jan 2019 to Mar 2020.

Methodology: Eighty-two Patients treated with fixed orthodontics appliances in the department of orthodontics of Armed Forces Institute of Dentistry, who met the inclusion and exclusion criteria were recruited for the study. Patient acceptance was evaluated through a ten-question questionnaire regarding biting, fitting, hygiene, speech, swallowing, appearance, selfconfidence, gingival irritation, durability and comfort. Patients were evaluated on a 10cm long Visual analogue scale over three months in the post-orthodontics retention phase, after one week (T1), one month (T2) and three months (T3) of follow-up.

Results: The vacuumed-formed retainer was significantly better in terms of speech (p<0.01), appearance (p<0.001), durability (p<0.001), gingival irritation (p<0.001), swallowing (p<0.001), self-confidence, and comfort (p<0.001). There was no significant difference in terms of fitting, hygiene and biting.

Conclusion: The vacuumed-formed retainer was significantly better accepted in terms of speech, swallowing, appearance, self confidence, durability, gingival irritation and comfort.
Efficacy of L-Ornithine L-Aspartate in Recovery of Patients Suffering from Acute Viral Hepatitis
Authors: Bilal Ebtihal , Burney Shamaila , Sajid Muhammad Usman , Zulfiqar Asim , Farooq Muhammad , Shaukat Nabila
Published: September 2023

Objective: To assess the efficacy of L-Ornithine L-Aspartate (LOLA) compared with non-LOLA Group in the recovery of patients with acute viral hepatitis.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of General Medicine, Railway Hospital, Rawalpindi Pakistan, from Aug 2020 to Jan 2021.

Methodology: All patients of either gender, aged >18 years with acute viral hepatitis were included. All patients were divided into two groups. LOLA-Group (Group-A) was given as an infusion over 24 hours at a dosage of 300 grams for three consecutive days. Whereas Group-B had patients to whom L-Ornithine L-Aspartate (LOLA) was not administered. The efficacy was defined as no signs and symptoms in comparison to baseline (clinical improvement), LFTs improved to more than half compared to baseline, and INR was <1.2 at seven days’ follow-up.

Results: Of 128 patients, the median age was 28 years (20-32). A significant median difference in total bilirubin on the seventh day (p-value 0.044) was observed for the L-Ornithine L-Aspartate (LOLA)-Group. In addition, the efficacy was found to be significantly higher among patients in the Control Group as compared to the patients in the Treatment Group, i.e., 54(84.4%) and 40(62.5%), respectively (p-value 0.005).

Conclusion: This study showed that the outcome of L-Ornithine L-Aspartate (LOLA) is not very effective in managing patients with acute viral hepatitis.
Ligament Reconstruction in Patients Operated Arthroscopically with Bone-Patellar Bone Graft Using Lysholm Score
Authors: Rehman Khalil Ur , Inam Shahzad , Rehman Atiq Ur , Javid Mohsin , Khan Idris , Akbar Syed Arsalan
Published: September 2023

Objective: To assess the mean Lysholm score after arthroscopic anterior cruciate ligament Anterior Cruciate Ligament (ACL) reconstruction with a bone-patellar tendon-bone graft.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Department of Orthopaedic, Combined Military Hospital, Peshawar Pakistan, from Oct 2020 to Apr 2021.

Methodology: Arthroscopic anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft was performed in 70 patients. Baseline characteristics were recorded, and patients were followed up for six months. Functional outcome was determined using the Lysholm score.

Results: The mean age of patients was 32.38±11.83 years. The majority, 59(84.3%) of the patients were males. Of the 70 patients, 36(51.4%) had a right knee involved. The mean Lysholm score at baseline was 50.46±6.93. At six months, a Lysholm score of 85.49±9.05 was recorded, and the mean difference was found to be statistically significant (p<0.001) using paired t-test.

Conclusion: Significant change in Lysholm score at six months was observed in the study sample. Reconstructing the anterior cruciate ligament with a bone-patellar-tendon bone graft improved the Lysholm score and, thus, functional outcome.Keywords: Anterior cruciate ligament reconstruction (ACL); Arthroscopy, Bone-patellar tendon-bone, Lysholm score.
Frequency of PDGFRA, PDGFRB and FGFR1 Gene Rearrangements in Patients with Eosinophilia and Their Clinico-Haematologic Parameters
Authors: Jalil Saniya , Robert Helen Mary , Saeed Hamid , Abbasi Asad Mehmood , Latif Aamna , Sardar Annum
Published: September 2023

Objective: To determine the frequency and clinico-haematological features of PDGFRA, PDGFRB and FGFR1 gene rearrangements in patients with persistent Eosinophilia using Fluorescence in situ hybridization.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Dec 2018 to Dec 2019.

Methodology: All Patients who presented to AFIP having absolute eosinophil count >1.5x109/L persistent for over six months or with Myeloid or Lymphoid neoplasms with persistent Eosinophilia were studied. Patients having reactive Eosinophilia and those on treatment were excluded. Interphase FISH studies were performed. In addition, 2.5ml of sodium heparin blood was taken. After the denaturation of DNA, slides were set up according to standard protocol. FIP1L1/CHIC2/PDGFRA dual colour probe was applied for PDGFRA, 5q32 PDGFRA break apart probe for PDGFRB and XL FGFR1 break apart probe for FGFR1 gene rearrangement.

Results: A total of 60 patients were included in the study. Of these, 50(83.3%) were males, and 10(16.7%) were females, with an average absolute Eosinophilia count of 5.92±7.10x109/L. The only rearrangement detected in patients with Eosinophilia was FIPILI-PDGFRA gene fusion, detected in 20% of the patients. No other rearrangement was found.

Conclusion: PDGFRA, PDGFRB and FGFR1 mutations are rare yet most prominent in patients with clonal Eosinophilia. About 80% of eosinophilic patients were found to have idiopathic Eosinophilia, which requires further consideration to address the disease prevalence.
Pre-Hospital Delaying Factors in Patients of Acute Ischemic Stroke who are Candidates for Thrombolytic Therapy
Authors: Ali Kamran , Nawaz Khurram Haq , Hassan Wahaj Ul , Waqar Raja Muhammad
Published: September 2023

Objective: To identify and statistically evaluate pre-hospital delaying factors for thrombolysis in Acute Ischemic Stroke (AIS).

Study Design: Cross-sectional study.

Place And Duration OF Study: Emergency/Neurology Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2020 to Mar 2021.

Methodology: Patients older than 18 years and who reported to the emergency/Neurology clinic with stroke symptoms were included in the study. The patients or their relatives were interviewed with a detailed questionnaire that recorded patients' National Institute of Health Stroke Scale and other socio-demographic variables. In addition, the patients were grouped based on time of arrival to the hospital: Early (<4.5 hours) and Late (>4.5 hours), and the variables recorded were compared with each other.

Results: Of 98 patients, 71(72.5%) arrived early, and 27(27.5%) arrived late. Seventy patients (72%) were male, and 28(28%) were female. Only 18 patients availed of the ambulance service, whereas the rest of the study participants reached the hospital using private transportation.

Conclusion: Female gender, NIHSS score of 10 or below and using transport other than ambulance adversely affect the hospital arrival time of acute ischemic stroke patients.
Comparison of Total Thyroidectomy with Ligasure Small Jaw Device and Harmonic Scalpel
Authors: Salamat Zaki Hussain , Majid Muhammad , Ali Liaquat , Ali Hafiz Asghar , Yasin Talha
Published: September 2023

Objective: To compare our experience with the LigaSure small jaw device and Harmonic scalpel in total thyroidectomy regarding operative time and major complications associated with surgery.

Study Design: Prospective comparative study.

Place and Study Duration: General Surgery Department, Pak Emirates Military Hospital, Rawalpindi and Combined Military Hospital, Kohat Pakistan, from Oct 2017 to Apr 2020.

Methodology: This study included 150 patients diagnosed with simple/toxic multinodular goitre, thyroid carcinoma, and diffuse thyroid enlargement. Eighty-one patients were randomly assigned to the LigaSure Group and 69 to the Harmonic Group who underwent total thyroidectomy. Mean operative time and major complications like blood loss, hematoma, hypocalcemia, recurrent laryngeal injury, and surgical site infection were compared.

Results: Median (IQR) operative time of the LigaSure small jaw device was 55.00(11) minutes, and that of the Harmonic scalpel was 60.00 (11) (p<0.001). The postoperative hematoma formation in the LigaSure small jaw device was 1(1.2%), and that in the Harmonic scalpel Group was 0(0%) (p=0.35). There was no bilateral nerve injury in both Group. The percentage of hypocalcemia (second postoperative day to seventh postoperative day) in the LigaSure small jaw device was 2(2.5%), and that in the Harmonic scalpel Group was 2(2.9%) (p=0.9).

Conclusion: The mean operative time of Thyroid surgery with a LigaSure small jaw device is less than that with a Harmonic scalpel. There is no difference in intraoperative blood loss and postoperative complications between them.
Sonographic Relation between Adnexal Masses and Endometrial Thickness in Infertile Females with Hormonal Imbalance
Authors: Yousaf Farooq Syed Muhammad , Gilani Syed Amir , Tul Sughra Syeda Khadija , Iqbal Amjad , . Mahjabeen , Abidin Syed Zain ul , Jallad Lina Khaled
Published: September 2023

Objective: To determine the sonographic relation between adnexal masses and endometrial thickness in infertile females with hormonal imbalances.

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Department of Radiology, Gilani Ultrasound Center, Jamiat Hospital & Green Town Clinic, Lahore Pakistan, from Mar 2019 to Jan 2020.

Methodology: In this study, 150 infertile females with adnexal masses, aged 18 to 45, were included. Data were collected according to the age, adnexal masses, endometrium thickness, and type of infertility hormonal levels. The endometrium thickness was measured in the sagittal plane at the thickest echogenic area from one basal endometrial interface across the endometrial canal to the other basal surface.

Results: The mean age was 32.55±6.33 years. Out of 150 patients, 97 patients with abnormal and 53 were with normal hormonal levels. Follicular cysts (33%), Polycystic ovarian syndrome (29.9%) and 23.7% hemorrhagic cysts were found with abnormal hormonal levels.

Conclusion: There was a significant correlation between adnexal masses and endometrial thickness in infertile females with abnormal hormonal levels.
Evaluation of Serum Estrogen, Progesterone, Prolactin and Testosterone in Patients of Melasma
Authors: Kanwal Shamsa , Rehman Farid ur , Qureshi Sana Waqar , Khan Rab Nawaz , Jehanger Amna , Yousaf Muhammad Javad
Published: September 2023

Objective: To evaluate the estrogen, progesterone, Prolactin and testosterone serum levels in melasma patients.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Dermatology Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from Jul to Dec2020.

Methodology: A total of 40 patients with melasma and 40 without melasma were included in this study. The study comprisedfemale melasma patients aged 20 to 50 years old. All participants were tested for serum estrogen, progesterone, Prolactin andtestosterone levels using immunoassay in the follicular phase (9th day) of the menstrual cycle.

Results: The statistically significant increase in serum progesterone (p=0.001) was found in patients with melasma. Asignificant decrease in prolactin levels (p=0.0001) was found in patients with melasma. No association was found betweenGroup-1 and Group-2 regarding serum estradiol and testosterone (p=0.070 and p=0.461 respectively)

Conclusion: Patients with melasma have increased progesterone levels and decreased serum prolactin levels.
Diagnostic Accuracy of Elastography to Differentiate Between Benign and Malignant Lymph Nodes of Head and Neck Region taking Histopathology as the Gold Standard
Authors: Rasheed Bhutta Muzammil , Majeed Ayesha Isani , Khan Amir , Zafar Ibtesam , Azad Hina , Akhtar Samina
Published: September 2023

Objective: To estimate the diagnostic accuracy of Elastography to distinguish between benign and malignant lymph nodes of the head and neck region; taking histopathology as the gold standard.

Study Design: Cross-sectional study.

Place and Duration of Study: Radiology Department, Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Jul to Oct 2021.

Methodology: Elastography, Color Doppler and B-mode ultrasound were used to examine fifty participants with enlarged cervical lymph nodes. Elastographic forms (1–5) were characterized based on the hard area in the cervical lymph nodes. In addition, the shear wave elastography of cervical lymph nodes was evaluated. Outcomes of diagnostic sono-elastographic parameters were matched with the histopathology of lymph nodes as a reference of standard.

Results: The mean age of patients was 30.50±8.95 years. Out of 50 patients, 31(62%) were men, and 19(38%) were women. Out of 50 patients enrolled, 29(58%) showed benign lymph nodes, while 21(42%) showed malignant lymph nodes on elastography.All 50 patients underwent a biopsy for histopathology.

Conclusion: Ultrasound elastography has high diagnostic accuracy in differentiating benign from malignant lymph nodes. Therefore, it can be used as a reliable and non-invasive modality for diagnosing lymphadenopathy in the cervical region.Keywords: Cervical, Elasticity imaging techniques, Elastography, Lymph nodes, Lymphadenopathy, Neck, Ultrasound
Entrepreneurship in emerging cities: mitigating impediments to small business development in Tshwane, South Africa
Authors: Boks Hayley , Mazenda Adrino
Published: September 2023

This article explores, and offers recommendations to address, the factors impeding small business development in the City of Tshwane (formerly Pretoria), Gauteng Province, South Africa. It also examines small business development in the broader context of South Africa and other emerging economies. The research adopted a qualitative case study approach based on a systematic analysis of documents concerning governance and small business development in Tshwane. Obstacles for small businesses identified in this study include red tape and regulatory failure, inadequate infrastructure and support services, supply chain management challenges and a lack of markets, as well as inadequate vocational, educational and skills training opportunities for local entrepreneurs. The City of Tshwane needs to foster synergies between small businesses and the market to sustain growth and development. Its Integrated Development Plan should incorporate targeted measures to support competitive emerging businesses.
The relationship between the medial longitudinal arch and lower back disability among vocational school dancer
Authors: Ni Putu Diyah Ayuningtiyas  , Made Hendra Satria Nugraha  , Anak Agung Gede Angga Puspa Negara  , Ni Komang Ayu Juni Antari
Published: September 2023

Background: Gianyar is one of the districts in Bali, Indonesia, that still maintain customs and traditions in ceremonies and rituals carried out as an implementation of culture. To support these activities, the performing arts commonly presented are traditional dance. The various foot movements in traditional dance will undoubtedly be a problem if there is a deformity in the foot. There is a phenomenon where abnormalities in the shape of the arch of the foot can potentially cause lower back disability. Deformities in the arch of the foot can affect the gait cycle, leg length, and the arrangement of the pelvic bones, which can trigger lower back pain.

Objective: The purpose of this study was to determine the relationship between the medial longitudinal arch and lower back disability in traditional dancer

Methods: This study is an analytical observational study with a cross-sectional research design conducted in December-January 2023. The study subjects were 74 students from Vocational School 3 of Sukawati. Majoring in traditional dance, aged 15 to 18 years, with a non-probability sampling technique using purposive sampling.

Results: The researchers conducted anamnesis and examination according to inclusion and exclusion criteria and then observed the presence of a flat foot by measuring the Clarke angle value. The analysis used was bivariate analysis with the Spearman correlation test. The bivariate analysis results showed a significant relationship (p=0.000) between the medial longitudinal arch and lower back disability in traditional dancers at Vocational School 3 of Sukawati, with a muscular correlation strength and negative correlation coefficient value of -0.705.

Conclusion: There is a significant relationship between the medial longitudinal arch and lower back disability in traditional dancers at Vocational School 3 of Sukawati.
Relationship between a sitting position and complaints of nonspecific low back pain among the Buton Sorong weavers
Authors: Zulima Zainul Muhlisi Mahfud , Utama Anak Agung Gede Eka Septian , Saraswati Putu Ayu Sita , Andayani Ni Luh Nopi
Published: September 2023

Background: Weaving has risk for experiencing nonspecific low back pain (LBP) that caused by bad posture and prolonged sitting duration. Poor sitting position causes musculoskeletal disorders, one of which is pain. Complaints of pain that is felt in the waist, causing functional limitation of movement when moving due to postural errors, are called nonspecific LBP. Weavers with good body positions have a low risk of nonspecific LBP complaints and increased productivity. This study aimed to determine the relationship between sitting position and nonspecific LBP complaints in Buton Sarong weavers in Baubau City.

Methods: This study used an analytic observational research design with a cross-sectional approach. The research subjects were taken using probability and purposive sampling techniques. The independent variable measured was the sitting position using the rapid entire body assessment (REBA). The dependent variable measured was nonspecific LBP using a physiotherapy history-taking process.

Results: There were 63 weavers in this study, 51 people (81%) had a low sitting position, and 12 (19%) had medium risk. The Spearman's rho non-parametric analysis test showed no relationship between sitting position and nonspecific LBP complaints in this population (p=0.819).

Conclusion: There is no significant relationship between sitting position and nonspecific LBP complaints.
The relationship between body mass index and musculoskeletal disorders among tailors
Authors: Ayunindya Dewa Ayu Agung Megaretha , Tianing Ni Wayan , Winaya I Made Niko , Muliarta I Made
Published: September 2023

Background: Humans have a demand to have more abilities so that the role produced is as desired. Muscles and bones are important for workers to do their jobs. Complaints related to muscles and bones can be called musculoskeletal disorders. Body mass index (BMI) is one of the factors influencing the incidence of musculoskeletal problems. This is because people with a high score of BMI will try to support their weight by tightening the muscles in their lower back. On the other hand, if this happens frequently, the spinal cord pads will be under a lot of pressure. This study aimed to establish a relationship between BMI and musculoskeletal disorders.

Methods: This study used analytic observational cross-sectional research as the study design. Were 53 individuals used as samples in this study utilizing a purposive sampling method based on exclusion and inclusion criteria.

Results: Data on BMI and musculoskeletal disorders were analyzed using the Pearson correlation test, which found a significant correlation of p=0.000 (p<0.05).

Conclusion: Based on the study's results, it can be concluded that there was a relationship between BMI and musculoskeletal disorders among tailors in Denpasar City.
Scapula manipulation on frozen shoulder condition: a case study
Authors: Ashrifah Ayuni , Perdana Suryo Saputra , Kingkinnarti
Published: September 2023

Background: Frozen shoulder or adhesive capsulitis is a stiffness in the shoulder joint, namely the thickening of the shoulder joint capsule tissue, resulting in pain and limited shoulder joint movement. In Indonesia, 2-11% of frozen shoulder sufferers have diabetes. Complaints in the shoulder also often accompany human movement activities due to gaps in body functions, including a frozen shoulder.

Case description: This was a case study of a patient aged 56 years with a diagnosis of frozen shoulder; this case was taken at Dr. Harjono Ponorogo Hospital, held from March 3, 2023, to March 23, 2023. The physiotherapy problems encountered in this case included pain, limited joint motion, weakness in muscle strength, and limited functional activity.

Conclusion: At three meetings, the patient was given intervention in the form of scapular mobilization, which decreased pain and increased the range of motion on the shoulder. A decrease in limitations can also be seen from the measurements used by the shoulder pain and disability index (SPADI), but in the SPADI assessment, there were no significant changes.
The influence of brain gym on changes in the numerical ability of grade I elementary students
Authors: Agustina Atika , Rayi Ardhiani
Published: September 2023

Introduction: The child is one of the important human resources in building a nation with improved quality and quality of life. One of which is the issue of education. Education is a process of self-development potential to increase optimal knowledge. Therefore, using a brain gym to improve children's learning abilities is more optimal. This study is to determine the effect of brain gym on the change of numeracy skills in grade 1 elementary school children.

Methods: This research was pre-experimental with a one-group pretest-posttest approach with purposive sampling. The respondents were 19 samples that fulfilled the inclusion and exclusion criteria in public elementary school 1 Jatiwarna, Bekasi, Indonesia. Data were taken before and after the three weeks of brain training exercises using the 1st-grade end-of-year skills test. Analysis of univariate data used Shapiro Wilk and bivariate using paired sample t-test.

Results: From 20 respondents, the average counting ability before intervention was 65.20, and after intervention was 80.60. The results showed an effect of the Brain Gym intervention on the counting abilities of children with p=0.000 <α (0.05).

Conclusion: Based on these results, it can be concluded that exercise brain gym influenced the increase in children's numeracy skills at Public Elementary School 1 Jatiwarna Bekasi in 2018.
The effectiveness of combining ultrasound therapy with splinting and exercise therapy for patients with carpal tunnel syndrome
Authors: Thanaya Sayu Aryantari Putri , Saraswati Putu Ayu Sita , Barani Made Donna Safira Pitaloka
Published: September 2023

Background: Carpal tunnel syndrome (CTS) can cause patients to experience negative symptoms that can significantly affect their ability to use their hands to perform daily activities. This study aimed to compare the effectiveness of a combination of splinting and exercise therapy with or without ultrasound therapy in improving CTS symptoms and the functional status of patients.

Methods: This randomized pre and post-test control group design study was conducted in private physiotherapy practices in the Denpasar area from August to September 2022. Twenty-four subjects with unilateral CTS were randomly divided into an Intervention Group (n=12; splinting, exercise therapy, and ultrasound therapy) and a Control Group (n=12; splinting and exercise therapy only). Splinting was used all day and night for four weeks. Exercise therapy was given three times per week for four weeks. Ultrasound therapy was given once a day, three times per week, for four weeks. The subject's symptoms and functional status before and after treatment were evaluated using the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), which consists of the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS).

Results: Significant improvements were found in SSS and FSS in Group 1 (SSS: p=0.000; FSS: p=0.000) and Group 2 (SSS: p=0.000; FSS: p=0.000), and a significant between-group difference was found in SSS (p=0.000) and FSS (p=0.001).

Conclusion: The addition of ultrasound therapy to splinting and exercise therapy is more effective than that in improving the symptoms and functional status of patients with CTS.
The relationship between fatigue level and dyspnea in post-COVID-19 patients
Authors: Multazam Ali , Herlianti  , Rahmawati Nurul Aini
Published: September 2023

Background: Post-coronavirus disease 2019 (Post-covid-19) is a term used to describe people with COVID-19 symptoms that persist after two weeks from the onset of symptoms. Some of the most common post covid-19 symptoms are fatigue and dyspnea. Fatigue is a feeling of physical or mental debilitation resulting from a person's immune and psychological changes. Breathing becomes faster and shorter when insufficient oxygen reaches the lungs, a condition known as dyspnea.

Methods: This study used the cross-sectional design. The population of this study consisted of post-COVID-19 patients who live in Malang Raya, with a sample size of 56 respondents. Data collection using the Fatigue Severity Scale questionnaire to measure fatigue levels and the Borg Scale to measure dyspnea levels.

Results: The results of Spearman's test obtained a value of r= 0.498, with a moderate correlation, indicating there was a relationship between the level of fatigue and dyspnea.

Conclusion: There was a relationship between fatigue level and dyspnea in post-COVID-19 patients.
Relationship between lifting load and shoulder pain complaints in material transport workers
Authors: I Putu Meika Semara Putra  , Ni Luh Putu Gita Karunia Saraswati  , I Putu Adiartha Griadhi  , Anak Ayu Nyoman Trisna Narta Dewi
Published: September 2023

Background: Many workers have experienced increased shoulder pain due to lifting and transporting materials. Workers who lift too heavy a load can cause unhealthy body conditions and experience pain complaints in the shoulder area. This study aimed to determine the relationship between lifting weights and shoulder pain complaints of material transport workers in Gianyar.

Methods: This research used the cross-sectional design. The research was conducted offline or directly in the field. The sampling technique used is using total sampling with a total of 64 people. The Spearman rho test was used to analyze the data.

Results: The research results on lifting weights with shoulder pain were obtained from research samples with complaints of shoulder pain. Namely, there were 62 people, 99% without complaints of shoulder pain, as much as 1%. Through the Spearman test, the pain value p = 0.000, and the r-value in the relationship of shoulder pain complaints is r = 0.551.

Conclusion: There was a relationship between lifting weights and shoulder pain complaints in material transport workers in Gianyar.
BIBLIOMETRIC ANALYSIS OF THE RELATIONSHIP BETWEEN FAMILY OWNERSHIP, FAMILY GOVERNANCE, CLAN GOVERNANCE, AND TRIBAL GOVERNANCE: A FUTURE RESEARCH AGENDA
Authors:   Universitas Jenderal Soedirman Indonesia, Utami Yuni , Jati Dian Purnomo ,   Universitas Jenderal Soedirman Indonesia, Yunanto Ary ,   Universitas Jenderal Soedirman Indonesia
Published: September 2023

This article aims to fill the gap in the literature related to clan and tribal governance which has not been studied much, by looking at previous literature studies and linking to literature studies discussing family ownership, family business, and family governance based on searches in Scopus reputable journals assisted with tools Publish or Pearish, VOSviewer, and Blibliomagika software that is linked and developed for future research topics. Using a literature review, assisted by Publish or Pearish (POP) software, VOSviewer To estimate the model and analyze data collected from the Scopus database. The data is then broken down based on the annual document, subject area, search keywords, authors, published journals, affiliations, the country of origin of the publication, and clarifying the future research agenda. The results of the study show that the terms clan, tribal and family governance have not been disclosed much in previous research even though these topics can be studied more broadly than the concepts of family ownership and family business. From this concept, it can be directed and connected to the concept of entrepreneurship, SMEs family, CSR, financial reporting, family shareholders, cash flow, non-family firms, and many more. The practical implications of the results of this research are to fill the gap in the literature on clan/tribal governance, which is still interesting to develop. The originality of the study provides clarity on the relationship between family ownership, family business, and its developments that lead to family governance.
DYNAMICS OF STAKEHOLDER NETWORK IN TOURISM VILLAGE DEVELOPMENT DURING THE COVID-19 PANDEMIC ON MODELING CHARACTERISTICS AT TISTA AND PEJATEN TOURISM VILLAGES, TABANAN DISTRICT
Authors:   Udayana University, Bali, Indonesia, Noak Piers Andreas , Erviantono Tedi ,   Udayana University, Bali, Indonesia
Published: September 2023

This study discusses the relations dynamics between stakeholders such as indigenous peoples, the private sector, and State, especially in the destinations management of tourist villages during Covid 19 pandemic. This pandemic has brought significant changes to the pattern and performance of tourism management in Bali. One of them is in the destination’s development of tourist villages in Bali. The Covid-19 pandemic has brought significant changes to the pattern and performance of tourism management in Bali. In the tourism management due to Covid 19 pandemic, all parties involved should be followed the regulation to prevent this separation such as the implementation of health protocols, tourism promotion activities that shift towards online, adjustment changing in user behavior in traveling. This research applies theoretical frame of Actor Network Theory (ANT). This theory provides a methodological tool in exploring the ideal forms of dynamics relations among the three stakeholders that are strongly influenced by the discourse that arises and takes place around them, including placing patterns of non-human actor relationships that also determine new behavior in relationships, especially in efforts to develop tourism villages. The data collection used is interviews, observations, and documentation by implementing locus studies at two villages namely Tista and Pejaten Villages moreover they have different focus on development such as natural development, religious tourism, and handicraft development. The results show that network modeling between stakeholders in Tista and Pejaten Tourism Villages more receiving instructional programs or in terms of political science, it is dominated by vertical or unidirectional power, namely local governments, in this case provincial governments that directly carry out guidance considering the importance of uniformity commands for tourism implementation in the new normal phase. They are based on being directed at the concept of community-based tourism, which is very effective in being used in the midst of the COVID-19 pandemic as an effort to recover the community’s economy which is declining and reorganize the tourism implementation that does not pay attention to the local community. Through the application concept of community-based tourism, the implementation of tourism through tourism villages is expected to achieve tourism goals, especially increasing economic growth, improving people's welfare, eliminating poverty, and overcoming unemployment which is now widely occurring due to the COVID-19 pandemic.