bluuebunny/crossref_metadata_2025 huggingface dataset:
Neoadjuvant and Adjuvant Therapy for Renal Cell Carcinoma
Authors: Haas Naomi B. , Shevach Jeffrey , Davis Ian D. , Eisen Tim , Gross-Gupil Marine , Kapoor Anil , Master Viraj A. , Ryan Christopher W. , Schimdinger Manuela
Published: October 2023

Patients undergoing definitive surgery or ablative techniques for nonmetastatic kidney cancer have varying degrees of risk of recurrent disease post procedure. The ultimate goal of “adjuvant therapy” is to reduce the incidence of recurrent disease, and to cure more patients. We summarize the current state of perioperative therapy for kidney cancer and explore future directions to develop optimal adjuvant strategies. We define risk and risk of recurrence post-definitive therapy, describe the controversies surrounding the trial landscape of adjuvant vascular endothelial growth factor receptor tyrosine kinase inhibitors and immune checkpoint inhibitors. We review data on neoadjuvant therapy before advanced kidney cancer resection. Radiologic, ethnic, economic, and geographic considerations with respect to adjuvant therapy are highlighted, as well as adjuvant therapy issues especially pertinent to patients, future directions in adjuvant trial design specifically targeted to biomarkers and patient selection, and sequencing of treatment after adjuvant therapy in those patients with recurrence.
Analysis of the optimization of resources with Learning Analytics techniques
Authors: Torner M-E. , Aparicio-Fernández C. , Vivancos J-L. , Cañada-Soriano M.
Published: October 2023

This paper presents an empirical study based on the learning environment through different data analysis tools. The study is applied to the subject of Theory of Machines and Materials Resistance of the Chemical Engineering degree at the Universitat Politècnica de València (Spain), with the aim of being able to understand and optimise with greater knowledge the way of learning taught, to know what is more difficult for the students and to create a more personalised learning environment. In order to achieve this, it is important to have as much information as possible about the use and usefulness of the resources provided to the students as a teacher. Knowing this data will allow us to provide more efficient resources and to change those that, through data analysis, are not being useful to students. The results of this research show how, through applications such as Learning Analytics, greater performance can be obtained in both teaching and learning.
THEORY AND PHILOSOPHY OF SCIENCE ISLAMIZATION
Authors: Nabil Amir Ahmad
Published: September 2023

The paper discusses the rigorous framework of Islamization of knowledge, in light of its discursive philosophy and history and deep debates of Islamization of present-day knowledge. It looks into classical role of its major proponents and institutions in articulating the ideas of Islamization of knowledge and the essence of tawhid in late 1970-80s and its impact in spearheading the movement for dynamic and modern Islamic worldview and renewed religious consciousness. This was consistently undertaken by IIUM and IIIT in promoting the idea of Islamization of human knowledge and integration of knowledge and value. The study was qualitative in nature in the form of integrative library research. Data was collected from primary and secondary sources and analyzed using certain inductive and deductive method. The finding shows that fundamental issues in Islamization of knowledge has been articulated consistently with principal debate relating to classical ideas of its methodology and workplan
THE ROLE OF TPA DAARUL IQRO TEACHERS IN FOSTERING CHILDREN'S MORALS IN BABAKAN LEBAK BOGOR CITY
Authors: Fadil Khaidir , Budiyanto  , Gustiawati Syarifah
Published: September 2023

Research at TPA Daarul Iqro is a highlight that makes how the morals of the children at TPA Daarul Iqro are considered. The purpose of this study was to determine the role of the Daarul Iqro Al-Qur'an Education Park (TPA) Teacher in fostering children's morals. To find out the influencing factors in fostering children's morals at TPA Daarul Iqro. This research uses qualitative methods with a field study approach. Techniques in data collection used in this study are; observation, interviews and documentation. The type of interview used is an unstructured interview. The results of this study found that the role of the TPA teacher is not only teaching but also being a mentor, moral coach, as a guide / role model, TPA teachers must also be able to act as facilitators and motivators. supporting factors for moral development are parents, motivation and the surrounding environment, as well as inhibiting factors Peer groups and mass media. So, it can be concluded that the role of the TPA teacher in fostering morals is that the teacher not only play a role as a teacher, but also the teacher must be able to be a mentor, moral coach and facilitator
INTER-RELIGIOUS EDUCATION IN THE QUR'AN: THE VALUES ANALYSIS OF INTER-RELIGIOUS EDUCATION IN THE QUR'AN
Authors: Imronudin  , Muhammad Riza
Published: September 2023

According to the Qur'an, this study concludes that inter-religious education is education with an anthropocentric orientation based on equality, togetherness, and justice in a democratic world with a pluralistic society. Humans are expected to carry out their functions with the values of tolerance, dialogue, cooperation, and brotherhood. This is in line with what is commanded by God in the Qur'an. Research and data analysis in this study uses qualitative-exploratory methods. In contrast, the approach used is philosophical-normative, meaning that it tries to dive to obtain actual activities that are rarely known and discussed. As a result, the Qur'an contains the values of inter-religious education, namely
NEW INFORMATION AND COMMUNICATION TECHNOLOGIES (NTICS) IN EDUCATION
Authors: Nunes Sapori Aline
Published: September 2023

This article is the result of studies and research on the new information and communication technologies in education, the contribution and importance of digital literacy. It aims to open a discussion around digital literacy, in order to understand it better, and also to think about the different ways to incorporate the modalities of literacy into educational practices. The hypothesis that guides this investigation is that teachers do not yet have autonomy in the use of New Information and Communication Technologies (ICTs). This work disposed of the methodology the investigation on the bibliographic research, with basic strategic intention, descriptive objective, within a qualitative perspective when applying the hypothetical-deductive method. It is observed that there is still a lot of resistance of the teacher to develop active methodologies, mainly through remote teaching, with the emergence of the Coronavirus – COVID19 pandemic and the modifications related to teaching, numerous articles have been published, exposing the difficulties that people, although literate, suffer in the use of new technologies. The plans that began to be taught in virtual environments, have numerous resources to be used, allowing a greater diversity in the presentation of the programmatic content. Even so, access to such infrastructures provided through technologies becomes limited when both the teacher and the student do not have mastery of such tools.
Venous Thromboembolism Prophylaxis in Coronary Care Unit in a Cardiology Centre (A Clinical Audit & Re-Audit)
Authors: Saif Mohsin , Rahman Fahd Ur , Shafi Shoaib Iqbal , Khan Sikandar Azam , Hussain Anwar , Yousaf Husnain , Kamran Javeria , Siddique Muhammad Bilal , Hassan Waleed , Kamal Daniyal Ahmad
Published: October 2023

Objective: To assess the adherence of current practice of VTE prophylaxis prescription in patients in Armed Forces Institute of Cardiology (AFIC) and compare it to NICE guidelines.

Study Design: We designed a classic audit of assessing current practice against guidelines.

Place and Duration of Study: AFIC/NIHD, Rawalpindi, from Jan 2021 to Jul 2021.

Methodology: Two audits cycles were performed 6 months apart. Each cycle contained of two-point prevalence days, two weeks apart. 50 patients were evaluated each day making a total of 100 patients per cycle. Data was collected on preformed proformas. Repeat audit cycle was performed after 6 months similarly.

Results: In first audit cycle, we assessed n=100 patients. (n=81; 81%) patients were prescribed VTE prophylaxis within 48 hours of admission and n=19; 19% patients were not prescribed any form of VTE prophylaxis. n=11; 11% patients were getting incorrect dosage of VTE according to weight and renal function. Following education and awareness, second audit cycle was repeated after six months. Second cycle showed n=94; 94% patients were correctly receiving VTE prophylaxis. 100% of patients were getting correct dosage of VTE in second cycle.

Conclusion: Repeat audit cycle showed significant improvements in total adherence to VTE protocols and also improvements in prescription of correct dosage.
Correlation of Body Consciousness and Fear of Negative Appearance With Self-Esteem in University Students
Authors: Shahid Noman , Sarwar Amna , Qubtia Maria , Umar M. , Hassan Ahmad , Qamar Khadija
Published: October 2023

Objective: The purpose of this study was to evaluate the correlation between body image consciousness and fear of negative social appearance with self-esteem and confidence, and try to understand the attitudes regarding body image and the factors that lead to fear of negative appearance and low self-esteem.

Study design: A cross-sectional study.

Place and Duration of Study: The study was conducted online and the link to the questionnaire was shared through several social media platforms such as Facebook and WhatsApp. The study was conducted from Apr 2021 to Aug 2021.

Methodology: A cross-sectional study was done through an online survey that was created using google form. It used the Objectified Body Consciousness Scale (McKinley & Hyde, 1996), Fear of Negative Appearance evaluation scale (Lundgren,Anderson, & Thompson,2004), The Rosenberg Self-Esteem Scale (Rosenberg, 1965).

Result: A total of 561 responses were received in which 66.2% were female and 33.1% were males. Those responses were analyzed through SPSS2. The results demonstrated a direct proportionality between body image consciousness and a fear of negative social appearance while they demonstrated an inverse proportionality with self-esteem and confidence. It also showed that females have greater tendency for body surveillance, body shaming, fear, anxiety and low self-esteem related to it as compared to males. The Pearson correlation indicated a significant positive correlation between low self-esteem and family financial status.

Conclusions: Body image consciousness and its related fears are found in both male and female university students. Social appearance has psychological effects on students. The low self-esteem is related to negative body appearance. Financial statusalso affects self-esteem related to body image or to the fear of negative appearance. Females are more conscious about body image than males.
Perceptions of Medical Students on Anatomy Education Environment in Medical Colleges by Aeemi: A Bi-Centre, Comparative Study
Authors: Qamar Khadija , Malik Amna Abbas , Kiran Faiza , Yousaf Wasif Ali , Asif Masfah , Khalid Laiba , Naqvi Alisha Ali
Published: October 2023

Objective: The aim of the study was to evaluate the different constructs of the Anatomy learning environment and the perception of medical students regarding the teaching facilities.

Study Design: It was a thorough cross-sectional study.

Place and Duration of Study: The study was conducted in a public sector and private sector medical college over a period of 6 months from Nov 2021 to Apr 2022.

Methodology: It was a descriptive study in which a structured and self-administered questionnaire was distributed after obtaining consent from the subjects. For this study project, the best fit and validated model of The Anatomy Education Environment Measurement Inventory (AEEMI) was selected to evaluate the perception of medical students of educational climates with regard to teaching and learning anatomy. The sample size was 163 and 104 respectively. Data was collected from final year students of two medical colleges; one teaching Anatomy in a traditional manner and other teaching Anatomy via integration so we assumed that the Anatomy learning environment is different in both colleges.

Results: The analysis of data revealed that out of 163 students from the traditional curriculum, 75(46.0%) had a positive area about Perceptions of Anatomy Knowledge Relevance and 61(37.4%) had a positive area about Students’ Positive Perceptions of Anatomy Teachers. Moreover, 104 students from integrated curriculum (63.8%) had a positive area about Students Negative Perceptions of Anatomy Teachers and 36(22.1%) had a positive area about Students’ Perception of Anatomy Subject Mastery. In addition, 48(29.4%) out of 163 had positive areas about Students’ Perception of Anatomy Learning Resources. Students learning Anatomy via integration had positive perceptions in all five domains of inventory.

Conclusions: The data reveals that out of 163 students, 56(34.22%) had a positive perception of the constructs of the anatomy learning environment. Total 67(61%) students who were studying Anatomy via integration had positive perceptions about their Anatomy teachers, whereas 80(49%) students of traditional curriculum were of the view that Anatomy educators need to improve their teaching methodologies. Nearly 55(50%) students of integrated curriculum were satisfied that they have mastered the subject and 63(57%) were happy about novel and updated learning resources.
Case of Polymyositis Associated with Celiac Disease: A Case Report
Authors: Azeem Abdul Rehman , Aleem Maira , Azam Nadeem , Tahir Roshaan , Akhtar Ali
Published: October 2023

Polymyositis is an important subtype of idiopathic inflammatory myopathies characterized by muscle inflammation andweakness, often associated with other systemic diseases and malignancies. A male, 29 years of age, with a history of neckstiffness, generalized weakness and body aches, has been described. Physical examination, laboratory workup, electromyography and muscle biopsy suggest Polymyositis. Tumour markers were also checked to rule out any malignancy. This reporthighlights the importance of immunological workup in patients presenting with generalized symptoms.Keywords: Idiopathic Inflammatory myopathy, Polymyositis, Muscle biopsy.
Sensitivity of Carcinoembryonic Antigen Level in Head and Neck, Breast, Lung, Genitourinary, Gastrointestinal Carcinoma
Authors: Hashmi Madiha , Haider Ghulam , Danish Muhammad , Irhsad Razia , Hassan Anusha , Khan Salahuddin
Published: October 2023

Objective: To determine the Carcinoembryonic Antigen Levels among patients with epithelial carcinoma presenting at a tertiary care hospital.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi Pakistan, from May 2019 to May 2020.

Methodology: Two hundred six patients presenting with a confirmed diagnosis of epithelial carcinoma, aged more than 15 years and of either gender were enrolled in the study. The CEA levels in all the patients were measured using an ELISA kit. The CEA levels were classified as 0-3.0 ng/mL, 3.1-5.0 ng/mL, 5.1-10 ng/mL and >10ng/mL.

Results: The mean age of the cancer patients was estimated as 47.30±14.10 years. Most patients had rectum carcinoma 28(13.59%), followed by CA sigmoid 25(12.14%), respectively. The median CEA level was estimated as 5.80ng/mL ranging from 0.82 to 1000 ng/mL. About 76 patients had CEA level >10ng/mL (36.9%), 55 had CEA level 0-3.0 ng/mL (26.7%), 43 had CEA level 3.1-5.0ng/mL (20.9%), and 32 had CEA level 5.1-10.0ng/mL (15.5%). A statistically significant difference in proportions of CEA levels was found for histological type (p=0.001), type of cancer (p=0.001) and number of Mets (p=0.003).

Conclusion: Rectal cancer profoundly expressed carcinoembryonic antigen levels, followed by sigmoid, colon, and ovarian cancer. Moreover, there is a significant association among carcinoembryonic antigen levels, histology, type and metastasis of cancer.
High-resolution Ultrasonographic Diagnosis of Plantar Fasciitis: An Association of Magnetic Resonance Imaging and Ultrasound
Authors: Khan Amir , Ahmed Aliya , Zafar Ibtesam , Bhutta Muzammil Rasheed , Khan Muhammad Nasir Naeem , Ajaz Umar
Published: October 2023

Objective: To assess the role played by ultrasound in evaluating plantar fasciitis and associate the findings with Magnetic resonance imaging.

Study Design: Case series.

Place and Duration of Study: Department of Radiology, Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Nov 2020 to Apr 2021.

Methodology: All the patients underwent ultrasonography and magnetic resonance imaging scanning. The study and control Groups consisted of 38 patients.

Results: Out of 38 patients, plantar fascia thickness in symptomatic feet was measured with ultrasound for both the Study and Control Groups. The Control Group had slightly thinner plantar fasciitis (1.1-2.4 mm, 1.7 ± 0.06 mm; p =0.03) compared to the Study Group (2.9-6.9 mm; 4.9±1.4 mm). In addition, this study compared other plantar fasciitis diagnostic signs on sonography with the magnetic resonance imaging findings. The diagnostic accuracy of plantar fascia pathological focal echogenicity, plantar fascia oedema, perifascial oedema, and plantar fascia rupture was 15(80.6%), 12(60.7%), 15(77.1%), and 13(68.6%) respectively. The diagnostic accuracy of ultrasonography was lower while evaluating for calcaneal spurs.

Conclusion: The present study concluded that ultrasonography could be the basic initial diagnostic imaging modality to confirm clinically suspected cases of plantar fasciitis. However, magnetic resonance imaging could be the preferred diagnostic modality for suspected complex pathology and lack of clinical presentation.
Influencing Factors the Quality of Life in the Children with Cochlear Implants
Authors: Hussain Shah Syed Bilal , Ali Muhammad , Hakim Abdul , Malik Kamran Zamurrad , Niazi Kashif Obaid , Ahmed Shakeel
Published: October 2023

Objective: To assess the effect of cochlear implants on quality of life in the children.

Study Design: Cross-sectional study.

Place and Duration of Study: CMH, Rawalpindi Pakistan, from Jul 2021 to Feb 2022.

Methodology: Forty-five children, aged 2-5 years, of either gender having cochlear implantation already and came for followup were included in the study. Children with Cochlear Implants: Parental Perspectives (CCIPP) questionnaire were used for data collection.

Results: Among 45 cases, mean age was 4.29±0.73 years. We found that the improvement in communication with the known people was 51.1%, and before cochlear implantation, the effectiveness of hearing aids was slightly low (26.7%). Social relations received the highest ratings (mean=3.33, SD=1.36), followed by Well-being (mean=3.22, SD=1.36) and effects of implantation (mean=2.89, SD=0.95). Of 45 children, 60% of parents were satisfied with the improvement in communication, 66.7% for general functionality and autonomy, 71.1% for well-being and happiness, 77.8% for social relations, 73.3% for education and 71.1% for effects of implantation. A strong correlation was found between function in general and self-confidence of the child (r=0.761, p=0.001), self-confidence and education of the child (r=0.720, p=0.001) and function in general of the child and effect of implantation (r=0.725, p=0.001).

Conclusion: The Cochlear implantation was effective for children in hearing, language understanding, self-reliance and educational conditions.
Accuracy of Polyhydramnios for Detection of Fetal Anomalies on Ultrasound
Authors: Mohsin Iram , Aziz Sadaf , Aziz Iram , Azam Sehrish , Hamayun Pareesae
Published: October 2023

Objective: To determine the diagnostic accuracy of polyhydramnios for detecting fetal anomalies on ultrasound in singleton pregnancies.

Study Design: Cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Military Hospital, Rawalpindi Pakistan, from Oct 2018 to Apr 2019.

Methodology: A total of 145 pregnant females coming for antenatal/anomaly scans, aged 18 to 45 years, were included. All scans were obtained with a 3.5-5 MHz curvilinear transducer and obstetric settings of the ultrasound machine. AFI was calculated as the sum of the deepest, unobstructed, vertical length of each pocket of fluid measured in cm in all four quadrants and then added to the others. The radiologist observed fetal structural anomalies.

Results: Polyhydramnios was present in 15(10.34%) patients. The congenital fetal anomaly on ultrasound was present in 6(4.14%) cases. In polyhydramnios-positive patients, 05(3.4%) had a congenital fetal anomaly, and 10(6.8%) had no congenital fetal anomaly. Among 130 polyhydramnios-negative patients, 01(0.7%) had a congenital fetal anomaly, whereas 129(88.9%) had no congenital fetal anomaly. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of polyhydramnios for detecting fetal anomalies on ultrasound were 83.33%, 91.41%, 29.4%, 99.23% and 92.41%, respectively.

Conclusion: This study concluded that the diagnostic accuracy of polyhydramnios¸, significantly moderate to severe forms, is relatively high for detecting fetal anomalies on ultrasound.Keywords: Fetal anomalies, Polyhydramnios, Ultrasonography.
Comparison of Analgesic Effect of Intravenous Paracetamol with Intravenous Ketorolac in Patients Presenting With Renal Colic in the Emergency Department
Authors: Rizwan Muhammad Hamza , Ashraf Muhammad Nadeem , Shafqat Hira , Bakhsh Karim , Zareen Syeda Fatimah , Parvez Tamkeen
Published: October 2023

Objective: To compare the effects of intravenous (IV) Paracetamol and intravenous (IV) Ketorolac in pain management of patients with renal colic presenting to the emergency department (ED).

Study Design: Quasi-experimental study.

Place and Duration of Study: Emergency Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2021.

Methodology: Eighty patients were included in the study who were selected and divided into two groups, one receiving Paracetamol 1 g intravenous (PC-Group) and the other receiving Ketorolac 30 mg IV (KET-Group). Their effect was compared using differences in visual analogue scale (VAS) before and after giving analgesia. Record of vital signs pre and post-drug administration, adverse effects and need for rescue analgesia was maintained (Nalbuphine). If further analgesia was required, 100 mg intravenous was used as the rescue drug.

Results: Ketorolac (KET) Group had a mean age of 37.60±14.56 years, while the Paracetamol (PC) Group had a mean age of 43.2 ± 16.05 years. There was no statistically significant difference in the reduction of pain intensity after giving the drug in the respective study Groups (p=0.09). Adverse effects (p=0.17) and the need for rescue analgesia (p=0.34) were also comparable between the two Groups.

Conclusion: The use of either intravenous-PC or intravenous-KET in patients with renal colic had similar analgesic effects with no significant difference in side effects and need for rescue analgesia.
High Order Cesarean Section: Is It Associated With More Operative Complications Then Lower Order Cesarean Section
Authors: Akram Umbreen , Khan Sumaira , Khalil Adiba Akhtar , Siraj Asifa , Khan Samina Rehan , Yaqub Umairah
Published: October 2023

Objective: To detect complications associated with higher order versus lower order cesarean section.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital, Mardan Pakistan, from Mar to Aug 2021.

Methodology: The study was conducted on 210 women, the participants were categorised into two Groups: Group-I (Higherorder), who had undergone fourth and fifth cesarean sections, and Group-II (Lower order), who had undergone second and third Cesarean Sections. The presence of complications were noted in both the Groups.

Results: The frequency of higher and lower-order Cesarean Sections was 75(35.7%) and 135(64.3%), respectively. Mean gestational age and parity were 38.96±0.69 weeks and 3.49±2.12, respectively. Dense omental adhesion was a significantly common complication in both Groups. Scar dehiscence was 35(25.9%) among Group-II. There was no significant association between the high-order cesarean section and its complications.

Conclusion: The higher-order repeat cesarean section was not associated with more intraoperative complications when compared with lower-order cesarean section in our study. Certain factors like maternal age, parity and gestational age affect the intraoperative complications of the cesarean section.
A Comparative Study of Improvised Manual Vacuum Aspiration Versus Pipeline Sampling for Endometrial Sampling
Authors: Baqai Shehla , Nawaz Qudsia , Tufail Shazia , Tabassum Humaira , Nasreen Samia , Nayyer Shazia
Published: October 2023

Objective: To compare the safety and efficacy of Improvised S2Q manual vacuum aspiration and Pipelle sampling as a diagnostic procedure for the evaluation of women presenting with abnormal uterine bleeding.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital, Lahore Pakistan, from Oct 2021 to Aug 2022.

Methodology: A total of 148 females over 35 years of age with abnormal uterine bleeding, who needed endometrial sampling, were divided into two groups of 74 participants each. Group-A underwent endometrial sampling by Improvised S2Q manual vacuum aspiration, while Group-B underwent endometrial sampling by Pipelle sampler.

Results: Mean age of patients was 47.36±8.34 years in Group-A and 48.20±8.96 years in Group-B, while the mean BMI was 30.59±4.67 kg/m2 and 27.39±2.50 kg/m2 in Groups A and B, respectively. The volume of specimen obtained was found to be higher in the Improvised S2Q manual vacuum aspiration-Group as compared to the pipeline sampling-Group. The operating time in the Improvised S2Q manual vacuum aspiration-Group was 3.37±0.49 minutes, while in the pipeline sampling-Group, it was 3.20±0.55 minutes. No difference was found in the two procedures for side effects (tachycardia, pain/cramps) and complications (significant blood loss, perforation, infection), added analgesia or histopathology report.

Conclusion: Improvised S2Q manual vacuum aspiration can be used as an alternative low-cost procedure for endometrial sampling in women with abnormal uterine bleeding.Keywords: Biopsy, Curettage, Endometrium, Manual vacuum aspiration, Pipeline sampling.
Predictors of Failed Trial of Labour After Previous one Caesarean Section
Authors: Mahreen Anam , Viqar Ashraf  , Rabia Sajjad  , Naheed Hayat
Published: October 2023

OBJECTIVE To look for failed trail of labour after one caesarean section and predicting factors associated with failed labour

STUDY DESIGN Comparative Cross-sectional Study

SETTING AND DURATION OF STUDY Gynaecology and Obstetrics department Pak Emirates Military Hospital Rawalpindi.

From May 2021 to October 2021.

METHODS A prospective study was conducted on the women who were booked cases in our department for antenatal checkups and  labour. Those women with history of one caesarean section were recruited for the analysis. They underwent labour in our department and those with failed labour were diagnosed and managed by consultant obstetrician. Relevant clinical factors associated with failed labour among women with one previous caesarean section included in our study.

RESULTS A total of 380 women who underwent labour in our hospital with one previous caesarean section were recruited. Mean age of the women included in the study was 34.435±7.361 years. 162 (42.6%) had successful trial of labour while in 218 (57.4%) women trail of labour could not succeed. Statistical analysis revealed that gestation age more than 40 weeks, poor Bishop score (<5) at admission and requirement of labour augmentation (with oxytocin) were found statistically significantly associated with failed trial of labour in our study participants (p-value<0.05).

CONCLUSION Failed trial of labour was a common clinical condition in women with one previous caesarean section. Women with gestation age more than 40 weeks, poor bishop score at admission and requiring labour augmentation were more at risk of having failed trial in our study participants.
Awareness About the Risk Factors of Osteoarthritis Among Adult Population of Rawalpindi
Authors: Amanat Areej , Hasan Maria , Hasan Javeria
Published: October 2023

Objective: To assess awareness about risk factors of osteoarthritis among different groups of respondents according to their educational status.
Study Design: Cross sectional study.
Place and Duration of Study: Urban areas of Rawalpindi and Islamabad Pakistan, from Mar to Aug 2015.
Methodology: A cross sectional analysis was carried out amid 210 individuals ranging from 15-35 years from urban areas of Rawalpindi/Islamabad having education status above matriculation. A self-made questionnaire was used and SPSS version 22 was used for data analysis.
Results: Study included a total, 76(36.2%) males and 134(63.8%) females. Statistically significant difference of responses were observed when respondents were asked about previous joint injuries (p<0.001), repetitive stress on a particular joint (p<0.001)), family history (p<0.001), congenital malformation of joints and cartilages (p=0.001), metabolic diseases like diabetes and gout (p=0.004) and vitamin D deficiency (p<0.001)whereas all groups of respondents according to education status were well aware about risk factors including increasing age (p=0.761), female gender (p=0.106),obesity (p=0.722), cold weather (p=0.0478) and calcium deficiency (p=0.299).
Conclusion: People of higher level of education status were more aware about the risk factors of osteoarthritis as compared to those at lower levels.
Frequency of Ventilator Associated Pneumonia in Patientsof ContinuousFeed versus Bolus Enteral Feed
Authors: Ahmad Muhammad , Mahboob Meer  , Syed Mazhar Ali Naqvi  , Muhammad Hussain  , Sabir Khan  , Nadeem Siddique
Published: October 2023

Objective: To determine the frequency of ventilator associated pneumonia in continuous feed vs bolus enteral feeding.
Study Design: Comparative cross sectional study.
Place and Duration of Study: Department of intensive care unit, Services Hospital, Lahore and Services Institute of Medical Sciences, Lahore Pakistan, from Jan to Jun 2019.
Methodology: In this study the cases of both genders with age more than 18 years were enrolled. Patients with Previous History of gastroesophageal reflux disease, Hiatus Hernia, Esophageal & Abdominal Surgery, Gastrointestinal Bleed and those admitted already with Pneumonia, APACHE Score 20 or greater and those with Acute respiratory distress syndromewere excluded. The cases admitted in intensive care unit and requiring mechanical ventilation fulfilling inclusion and exclusion criteria were enrolled in this study. Continuous feed was offered to cases in Group A and bolus to those in B andwere looked for development of ventilator associated pneumonia.
Results: In this study, eighty cases (40 per Group) were enrolled. There were 26(65%) vs 25(62.5%) males in Group A and B respectively. The mean age was 51.85±12.61 vs 51.48±10.92 with p=0.88 in Group A and B. Mean ICU stay in Group A and B was 6.40±5.07 and 5.50±2.63 (p=0.32). Ventilator associated pneumonia was observed in 4(10%) vs 6(15%) cases in Group A and B respectively (p=0.74). Mean time for development of ventilator associated pneumonia in Group A and B was 4.67±1.15vs 4.80±1.09 day with p= 0.60.
Conclusion: Ventilator associated pneumonia was seen more in cases of bolus vs continuous fee
Total Etch versus Self Etch Adhesive; Effect on Post-Operative Sensitivity
Authors: Iftikhar Nazish , Hussain Syed Muzammil , Zahra Fatima Tu , Aslam Maha , Yousaf Ajmal , Bhangar Faisal
Published: October 2023

Objective: To compare post-operative sensitivity after placement of composite restoration in Class I cavity using total etch adhesive and self-etch adhesive.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Operative Dentistry, Armed Forces Institute of Dentistry (AFID), Rawalpindi Pakistan, from Jul to Dec 2019.
Methodology: Total 80 patients were chosen with Class-I cavities present on premolars and molars of both maxillary and mandibular arch. They were divided into two groups. 40 patients each in Group-A (Self etch adhesive) and in Group-B (Total etch adhesive). Composite restorations were sited in both groups and evaluated for post-operative sensitivit y after 24 hours and after one week. Data was recorded by using Visual Analog Score in response to air stimulus.
Results: The mean VAS scores for the Self Etch Group, group was lower than the Total Etch group at the 1-day (0.525 and 0.850 respectively), and 1-week (0.050 and 0.10 respectively) evaluation periods with a statistically significant difference after 24 hours only.
Conclusion: Significantly less post-operative sensitivity observed with Self Etch adhesive as compared to total etch following 24 hours of restoration placement. Sensitivity faded over the period of one week.
Add-On Therapy of Dapagliflozin to Metformin in Patients with Diabetes Mellitus Type-2; Efficacy and Renal Safety
Authors: Adil Benish , Arshad Rabbani  , Imran Arshad  , Sualeha Ahmed  , Muhammad Ali Khalid
Published: October 2023

Objective: To study efficacy of Dapagliflozin in treatment of diabetes mellitus type-2.
Study Design: Quasi-experimental study.
Place and Duration of Study: Medical unit, Benazir Bhutto Shaheed Hospital, Rawalpindi Pakistan from Jan to Dec 2019.
Patients & methods: Patients taking Dapagliflozin in combination with Metformin (MET+DAPA) (n=45) were compared to those taking other glucose lowering agent in combination with Metformin (MET+ other drug) (n=45) for the control of diabetes mellitus type-II. Efficacy of treatment was assessed by the level of glycosylated hemoglobin HbA1c, and renal safety assessed by serum creatinine level done at 6 and 12 months of treatment.
Results: Total 90 cases were studied including 60% male and 40% female cases with mean age 50.8±7.4 years. Patients taking Dapagliflozin + Metformin (n=45), and others taking Metformin+ other glucose lowering drug (n=45) were having mean values of BMI 32.8±5.9 kg/m2 & 33.4±7.2 kg/m2, HbA1c 8.4±1.2% & 9.1±1.6 % and blood urea nitrogen 6.7±1.4 & 6.5±1.8 mmol/L respectively. After 12 months treatment mean HbA1c level was reduced from 8.7 ± 1.4% to 6.6 ± 0.3%, BMI reduced significantly and no detrimental effects reported on renal function.
Conclusion: Patients with type-II diabetes mellitus taking Dapagliflozin in combination with Metformin showed good glycemic control and renal safety.
Association Between Level of Expression of Human Epidermal Growth Factor Receptor 2 (Her-2 Neu) And Age Among Breast Cancer Patients
Authors: Ahsan Mahnoor , Ghulam Haider  , Maliha Ashfaque  , Tooba Ather  , Abdus Sami Qureshi  , Wishhal Sundar
Published: October 2023

Objective: To determine the association between human epidermal growth factor receptor 2 with age among patients presenting with breast cancer.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Medical Oncology Department, Jinnah Postgraduate Medical Centre, Karachi Pakistan, from Aug 2019-Jan 2020.
Methodology: Total 194 females of age 20-85 years with confirmed diagnosis of breast cancer were included in the study. The immunohistochemistry was done for the status of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 and the validation of human epidermal growth factor receptor 2 was done by Fluorescent In situ Hybridization technique in each female.
Results: The patient’s age was from 24-82 years old with mean age of 46.57±11.45 year. Out of 194, 108 cases had positive progesterone receptor expression (55.7%), 114 had positive estrogen receptor expression (58.8%) and 67 had positive human epidermal growth factor receptor 2 expression (34.5%). The females of age greater 46 years were more likely to be human epidermal growth factor receptor 2 positive as compared to females of age less and equal to 46 years.
Conclusion: The results showed that females with age more than 40 years have significant association with human epidermal growth factor receptor 2, whereas age is an independent variable with regards to estrogen receptor and progesterone receptor status.
Comparison of Transcerebellar Diameter with Biparietal Diameter on Ultrasound for Gestational Age Measurement in Third Trimester of Pregnancy Using First Day of Last Menstrual Period for Actual Period of Gestation
Authors: Noreen Saira , Muhammad Usman Khan  , Nisar Ahmed  , Atiq ur Rehman Salehria  , Muhammad Zeeshan Ali  , Muhammad Rizwan Bashir Kiani
Published: October 2023

Objective: to evaluate how well biparietal diameter and transcerebellar diameter performed in estimating the gestational age of pregnant women in their third trimester.
Study Design: Cross-sectional study.
Place and Duration of Study: Armed Forces Institute of radiology and Imaging, Rawalpindi Pakistan, Feb to Aug 2022.
Methodology: There were 120 pregnant women who went to the Obstetrics and Gynecology Departmental walk-in clinic or Emergency room between weeks 28 and 40 of their pregnancies. Ultrasound was done on all patients that had been preselected after a complete history and physical examination had been completed; transcerebellar diameter (TCD) and biparietal diameter (BPD) were measured and compared with LMP.
Results: Mean age of the participants recruited in the study was 27.08±1.45 years. There was a significant increase in mean BPD from 28 weeks of gestation (68.01±7.4 mm) to 36 weeks of gestation (89.77±2.35 mm). During 28 weeks of gestation, the mean TCD was 30.3±1.49 mm, whereas at 36 weeks it peaked at 48.1±1.21 mm. By looking at the median gap between real and estimated GA by BPD, we find that when real GA rises, the magnitude of the age estimation error decreases significantly. The error was 3.22±0.17 days for GA at 28 weeks, 2.48±0.09 days at 34 weeks, and 2.18±0.01 days at 36 weeks. A statistically significant (p<0.001) shift in the mean error was observed. ..........
Conclusion: Both TCD and BPD were shown to be helpful in this study's context, however statistically speaking, TCD was superior to BPD. ...........
The Impact of A Successful Pterygium Excision on Corneal Astigmatism and Topography
Authors: Yousaf Waseem , Humayun Fakhar , Mumtaz Sadaf , Taimoor Ijlal , Ghani Muhammad Usman , Khan Taimoor Ashraf
Published: October 2023

Objective: To determine the impact of successful excision of pterygium on corneal astigmatism and topography.

Study Design: Quasi-experimental study.

Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Feb 2021 to Jul 2021.

Methodology: All 52 patients of pterygium who underwent surgical excision of the pterygium during the study period were included. The size of pterygium was measured in millimeters. Pre-operative automated keratometry and corneal topography was done, and changes in astigmatism, surface asymmetry index, surface regularity index, uncorrected visual acuity and best corrected visual acuity were measured postoperatively on the 7th day. Paired sample t-test was applied between pre- and post-operative astigmatism, surface asymmetry index, surface regularity index, uncorrected visual acuity and best corrected visual acuity.

Results: The mean age of participants was 42.02±13.3 years, with 22(42.3%) females and 30(57.7%) males. The male to female ratio is 1.36:1. The highest frequency of cases was noted in the age group, 31-50 years (42%), followed by 18-20 years (21%). Pterygium size was 2.25 to 4.10 mm, with a mean of 3.16±0.54mm. Pain and photophobia were noted in 5 cases. Pre- and postoperative comparison of astigmatism and corneal topography revealed a significant reduction in Surface Asymmetry Index and Surface Regularity Index values (p-value<0.001). Uncorrected Visual Acuity (p=0.002) and Best Corrected Visual Acuity also improved significantly after surgery (p=0.006).

Conclusions: This study concluded that pterygium excision brings a significant decrease in astigmatism and reversible corneal topography changes.
Relationship of Serum Vitamin B12 and Serum Homocysteine Levels with Pseudo Exfoliation Syndrome
Authors: Butt Waqas Rahim , Humayun Fakhar , Naeem Saquib , Ijaz Umar , Khan Umair Naeem , Khan Taimoor Ashraf
Published: October 2023

Objective: To evaluate the relationship of serum Vitamin B12 and serum Homocysteine levels with Pseudo Exfoliation Syndrome.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Ophthalmology, Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jun to Nov 2022.
Methodology: We included 55 individuals with unilateral Pseudo Exfoliation Syndrome without glaucoma and 50 healthy individuals as controls. All participants were subjected to the assessment of serum Homocysteine levels by high-performance liquid chromatography and Vitamin B12 levels by chemi-luminescent enzyme immunoassay.
Results: Thirty-two (58.18%) individuals out of 55 with unilateral Pseudo Exfoliation Syndrome had increased serum Homocysteine levels (>5umol/L). Of these 32, 25(78.12%) individuals had moderately high serum Homocysteine levels, while 7(21.87%) had severely high serum Homocysteine levels. Twenty-six (47.27%) out of 55 individuals with Pseudo Exfoliation Syndrome had decreased serum Vitamin B12 levels, while the rest 29(52.72%) had normal-range serum Vitamin B12 levels. In comparison, 7(14%) had reduced serum Vitamin B12 levels, while the rest, 43(86%), had normal serum Vitamin B12 levels.
Conclusion: Our study showed that raised Hcy levels were present in individuals with PXS without glaucoma and reduced serum Vitamin B12 levels. Assessment of Hcy level in individuals presenting with PXS may be undertaken as it is a known risk factor for vasuclopathies.
Cannabis and Psychosis: An Overview of The Relationship
Authors: Saraiva Rodrigo , Coentre Ricardo
Published: September 2023

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Vowels Changing Phenomenon in Al-Halabi’s Book “Umdatul Huffadh Fi Tafseer Asharafil Alfadh”
Authors: Ahmed Dilawer Jawhar , Hamad Saman Nadir
Published: October 2023

Morphological thought appeared at Al-Halabi clearly and clearly in its origination of the singular in his book (Umdatul Huffadh Fi Tafseer Asharafil Alfadh), which deals with the vocabulary of this lexical book, noting in his analysis the different morphological formulas mentioned in the words and the connotations that distinguish one use from another, and from the buildings The morphology that he mentioned and detailed in it the buildings of the multitude of multitudes, mentioning the standard ones, and what are memorized and not measured by these multitudes, and here we single out in these pages a group of Al-Halabi’s morphological references to the buildings of the multitude of multitudes and the meanings and connotations given to these formulas in a paper entitled (The form of plurality According to Al – Halabi in the book Umdatul Huffadh Fi Tafseer Asharafil Alfadh).
Legal Effects of Pregnancy Duration on Pregnant Woman's Flight in Air Transport: Comparative Study
Authors: Sulaiman Talib Braim , Ibrahim Bnar Zrar
Published: October 2023

Air flight has become an important means of modern transportation for members of society, including pregnant women. The term of pregnancy means the time that the fetus stays in its mother’s womb. The Iraqi, British and American legislators did not explicitly specify the duration of pregnancy, as the American and British law referred it to medical tests, and the Iraqi law to Islamic Sharia and jurisprudence. And that the duration of pregnancy has a significant impact on the laws of airlines and companies operating in the air field, as the laws of the majority of airlines, including the comparison countries (Iraq, Britain and America) stipulate the conditions or restrictions for the travel of a pregnant woman when she embarks on the flight, and these laws have a role in the possibility of pregnant women traveling by air, When the term of her pregnancy is close to the usual date of birth.The latest statistics indicate that the incidence of births on flights has increased greatly in recent decades due to the frequent trips of pregnant women to travel by this means of transportation.We have reached several results, perhaps the most important of which are: There is no disagreement among Islamic jurists on the issue of determining the minimum pregnancy period (six months), but there is a great deal of disagreement between them in determining the maximum length of pregnancy, and then we made a number of recommendations, the most important of which are: The last times on board civil aviation, and because the majority of these births occur in the case of early pregnancy, we suggest to pregnant women that they take into account the controls issued by the airline’s instructions when applying for a ticket, and we also suggest to the competent authority in the airlines to conduct a good audit when accepting the request to give the travel ticket to the woman pregnant woman.
Aesthetic Composition in "The Evening" Poem by The Poet Khalil Mutran
Authors: Mohammed Ayoub Haji
Published: October 2023

The poet Khalil Mutran was distinguished by his creativity in writing poetry. He also wrote many poems and left behind him a treasure of masterpieces and poems. His poetic style was distinctive; as he was distinguished by emotional honesty, sweet musical tone, and originality. In addition, the poet Khalil Mutran is considered one of the most innovative poets in modern Arabic poetry, and one of the most beautiful and well-known poems in all parts of the Arab world is the poem "Al-Masaa", which was included in some educational curricula. Through this study, we will shed light on the aesthetic aspects through which the poem "Evening" was formed.
Challenges of international migration in Georgia
Authors: Giguashvili Giuli
Published: October 2023

In the era of globalization, international migration has become massive. International labor and education markets allow people to study and work in a country of their choice. The right to move freely between countries is an essential human rights element. However, if migration processes are illegal, it can turn into a severe problem. Evaluating the political, cultural, and socio-economic consequences of international migration processes, promoting legal migration, developing a migration policy tailored to the country's interests, and creating the legal basis for its implementation are significant priorities of the state policy in any country. The paper identifies the main challenges of international migration in Georgia and discusses the legislation regulating migration processes. The dynamics of international migration, its positive and negative aspects, and the socio-economic problems of emigration and immigration are analyzed based on statistical-quantitative research methods. Opinions are expressed to perfect migration policy and overcome its challenges.
Assessment of time loss of buses in the route network
Authors: Dashdamirov Fuad
Published: October 2023

The article analyses the main time losses when buses move in the route network, and also considers the models used to evaluate each of them. The disadvantage of the used model for accounting for time lost by buses at controlled intersections when buses move along sections of routes is shown. Possible scenarios for buses passing through a given section of the route network with several intersections are described. A method for determining the probability of bus delays at intersections is considered.