bluuebunny/crossref_metadata_2025 huggingface dataset:
O juiz das garantias no projeto de reforma do código de processo penal: uma revisão narrativa
Authors: Busch Rafael , De Souza Lima Neto João Onofre , Fabricio Bregalda Schneider  , Marcos Henrique Oliveira Andrade Gois  , Joberth Silva de Carvalho  , Carlos Paim Rifan Quintam
Published: January 2023

RESUMO: O Juiz das Garantias é o magistrado encarregado de supervisionar o processo penal desde o seu início até o seu término, tendo como objetivo principal garantir o Estado de Direito e a proteção dos direitos fundamentais dos acusados. Neste sentido, este estudo tem como objetivo analisar a introdução do juiz das garantas nas fases de inquérito policial, bem como entender os reflexos que podem surgir, de forma negativa, ao atual sistema de acusação a respeito da competência das Autoridades Policiais em todo o processo investigativo. Para tanto, utilizou-se como metodologia a revisão narrativa, que se constitui pela procura por estudos existentes que abordem o problema de pesquisa, reunindo diferentes informações obtidas por outros autores da literatura científica para compreender o objeto em questão. Foi possível perceber que o juiz das garantias foi introduzido para promover a eficiência e a eficácia do sistema processual penal brasileiro, garantindo aos acusados ​​maior acesso à justiça, eficiência no tratamento dos casos, maior celeridade e melhoria da qualidade da decisão judicial. Além disso, ele foi projetado para garantir que os direitos fundamentais dos acusados ​​sejam respeitados. Portanto, conclui-se que, embora a implantação do juiz das garantias tenha sido amplamente bem-sucedida, ainda é necessário a realização de alguns ajustes para garantir o pleno funcionamento do cargo.
Kanban Digital dan Real-Time Repoting Untuk Production Planing Control
Authors: Anggoro Kukuh , Angga Negoro Dimas
Published: January 2023

Pada saat ini untuk meningkatkan keefektifan dan keefesienan perusahaan dibutuhkan suatu pendekatan keilmuan yang sudah teruji. Konsep kanban sudah dipublikasikan cukup lama dan membuktikan bahwa dengan menerapkannya akan meningkatkan efesiensi. Penelitian ini dilakukan untuk meningkatan keefektifan dan keefesienan konsep kanban dengan cara digitalisasi. Studi kasus dilakukan di perusahaan yang sudah menerapkan sistem Kanban yang sudah terintegrasi dengan Sistem ERP-nya yang berupa Ms Dynamics AX.Penelitian ini dimulai dengan wawancara dan observasi. Hasil dari wawancara menghasilkan masalah utama yakni ketidaksesuaian rencana dari departemen production planing ke bagian produksi sehingga WIP atau produksi berlebih menjadi tinggi. Setelah itu penelitian ini merekomendasikan konsep digital untuk mengurangi masalah yang terjadi dan dihitung nilai efesiensi yang didapat. Penghitungan efesiensi dari konsep digital dengan cara melakukan simuliasi. Hasil Simulasi tersebut menghasilkan 33% penurunan WIP produksi dan saat diambil realisasi 3 bulan sebagai pembuktian didapat hasil yang lebih baik dari hasil simulasi yakni sebesar 36% dari rata-rata data saat sebelum mengimplementasikan konsep digital. Dan Diakhir penelitian nilai effesiensi yang didapatkan menghasilkan ROI 539% dalam 5 tahun. Sehingga dapat disimpulkan bahwa penerapan digitalisasi akan menaikan nilai keefektifan dan keefesienan sistem kanban yang sudah diterapkan secara manual sebelumnya.
Reviewer Acknowledgements for Business and Economic Research, Vol. 12, No. 4
Authors: Young Daisy
Published: January 2023

Business and Economic Research (BER) would like to thank the following reviewers for reviewing manuscripts from September 1, 2022, to January 1, 2023. Their comments and suggestions were of great help to the authors in improving the quality of their papers. Many authors, regardless of whether BER publishes their work, appreciate the helpful feedback provided by the reviewers. Macrothink Publishing appreciates the following reviewers’ rigorous and conscientious efforts for this journal. Each of the reviewers listed below returned at least one review during this period.Abeer M. Ali Abd ElkhalekAhmed ZouhairAlmir A. AlihodžićAngela WrightBratu (Simionescu) MihaelaCosimo MagazzinoCristina Alina NaftanailaElena GurguFayez Bassam ShriedehHengky Sumisto HalimJosé MartinsKimty SengMamta SinghMohsen MohagheghMuddassar SarfrazNemer BadwanOleksandr V. DluhopolskyiRoderikus Agus TrihatmokoRomeo Victor IonescuSantosh B. ManjegowdaShyamkumar D. KalpandeYixun XingZi-Yi Guo
The major proximal femoral defects: megaprosthesis in non oncological patients - A case series
Authors: Zanchini Fabio , Piscopo Antonio , Cipolloni Valerio , Vitiello Raffaele , Piscopo Davide , Fusini Federico , Cacciapuoti Stefano , Panni Alfredo Schiavone , Pola Ernico
Published: January 2023

We identified 39 patients (23 female and 16 male) underwent hip revisions through mega-prosthesis. The most common causes were periprosthetic fractures, periprosthetic osteolysis and consequences of infected arthroplasty. The average follow-up was 5 years (2.1 to 6.5), and average age was 69 years (47 to 78). At the final follow-up all the implants resulted functional and osteointegrated. The Merle D’Aubignè and Postel hip rating scale was used for the evaluation, better results were observed in periprosthetic fractures. Postoperative complications occurred in eight patients. Thus, megaprosthesis were a reasonable surgical option in the management of major femoral defects.
A Rare Case of a Lisfranc Ligament Transection
Authors: Martin Murphy P. , Patel Akshar H. , Cole Matthew W. , Gadinsky Naomi E. , Collins Lacee , Sherman William F.
Published: January 2023

Ligamentous Lisfranc injuries, which mimic a surgical transection are rare. Left untreated or missed, these injuries may result in severe complications including long-term disability. The present case describes a unique mechanism of injury via a sharp object puncture through the plantar surface of the midfoot. It highlights the utility of planning staged procedures to remove a large foreign body object, reports notable intraoperative techniques, and provides a decision management guide for treating this type of injury. Extensive surgical planning may be required when encountering similar cases and knowledge of this may be useful to providers.
Brivaracetam to Treat Partial Onset Seizures in Adults
Authors: Latimer Dustin , Le David , Falgoust Evan , Ingraffia Patrick , Abd-Elsayed Alaa , Cornett Elyse M. , Singh Rupin , Choi JooHee , Varrassi Giustino , Kaye Adam M. , Kaye Alan D. , Ganti Latha
Published: January 2023

Purpose of Review

Seizures are a hyperexcitable, and hypersynchronous imbalance between excitatory and inhibitory factors (E/I imbalance) in neurotransmission, and epilepsy is the recurrent manifestation of seizures within a reasonable time frame and without being attributable to a reversible cause. Brivaracetam is a derivative of the antiepileptic agent, levetiracetam, that is used as adjuvant therapy for focal onset seizures. It was approved by the FDA in 2016 and has shown promising results with minimal adverse effect reactions in clinical trials.

Recent Findings

Brivaracetam has been used in multiple clinical trials at various dosages in adults that have partial-onset seizures refractory to conventional treatment. A meta-analysis in 2016 showed that brivaracetam as adjunctive therapy was statically significant in its reduction of adults with drug-refractory seizure frequency.1 The most commonly reported adverse effects that patients who were taking brivaracetam experienced were somnolence, headache, and dizziness. Further studies are necessary to conclude long term efficacy and safety profile of brivaracetam.

Conclusion

The treatment of epilepsy with pharmacologic agents is a difficult task due to balancing the efficacy of the drug with the side effect profile that will allow for the best quality of life for the patient. There are approximately 30 antiepileptic agents for clinicians to choose from. Brivaracetam is a novel antiepileptic agent that was approved for use by the FDA in 2016 and is showing promising results as monotherapy and adjunctive therapy in individuals with drug-refractory focal seizures while minimizing adverse drug reactions.
Review of Interventional Therapies for Refractory Pediatric Migraine
Authors: Peck Jacquelin , Zeien Justin , Patel Megha , Cornett Elyse M. , Berger Amnon A. , Hasoon Jamal , Kassem Hisham , Jung Jai Won , Ramírez Giovanni F. , Fugueroa Paola Colon , Singhal Neil R. , Song Jaehong , Kaye Adam M. , Kaye Alan D. , Koushik Sarang S. , Strand Natalie H. , Ganti Latha
Published: January 2023

This is a review of the latest and seminal evidence in pediatric migraine. It covers the etiology and pathophysiology known today, and then will review treatment options, efficacy and safety, quality of data and indications. Though migraine is usually regarded as an infliction in adults, it is not uncommon in the pediatric population and affects up to 8% of children. Children may experience migraine differently than adults, and present not only with headache but also frequent gastrointestinal symptoms. They are frequently shorter in duration than in adults. Traditional migraine treatment in adults is less effective in children. In this population, adjunct therapies – such as interventional techniques – should be considered when traditional treatment fails, including Botulinum Toxin A (BTA) injections, peripheral nerve and ganglion blocks. BTA injections are FDA approved for migraine prophylaxis in adults, but currently not in children; however, recent evidence shows efficacy and safety in pediatric migraine management. Nerve blocks stop nociceptive afferent fibers through injection of local anesthetics, and it may be associated with the local injection of corticosteroids. Although more common in adults, recent data suggests they are safe and effective in children and adolescents. Blocking the sphenopalatine ganglion can be achieved through nasal approach, and achieves a similar action by blocking the entire ganglion. Interventional techniques may provide a key component in the alleviation of this otherwise debilitating chronic migraine pain. Though most studies have been performed in adults, new studies provide encouraging results for treatment in children.
Understanding factors that influence whether a woman will seek care for reproductive health: A national survey
Authors: Kanyadan Pooja , Ganti Latha , Mangal Rohan , Stead Thor , Hahn Lindsey , Sosa Marcos
Published: January 2023

A number of studies have characterized the importance of regular

OB/GYN visits for women who are above the age of 18. As more

emphasis is placed on reproductive healthcare, there has been an overall

decrease in the rates of adverse sexual and reproductive health

outcomes. In this study, a population of 200 women were surveyed to

find factors that influence whether they had sought care from an OB/GYN

in the past year. These results can be further extrapolated to whether

women will seek OB/GYN healthcare in the future. A survey research

platform was used to collect demographic data in addition to the survey

responses. Thirteen survey questions were designed, some of which

were adapted from the NIH Healthcare Access and Utilization Survey.

This study found that women of minority races (African American and

Hispanic) were more likely to report that they didn’t feel like they were

asked for their opinions about their healthcare. Additionally, women who

were younger, who didn’t feel like they were asked for their opinions,

and who were of minority races were more likely to have not seen an

OB/GYN in the past year. These findings can be used to focus on fixing

the factors that deter women from seeking regular OB/GYN care. Efforts

must be made to ensure that patients feel supported and understood, for

this is the only way that we can make progress towards a healthier

society.
Professional quality of life and psychopathological symptoms among first-line healthcare workers facing COVID-19 pandemic: an exploratory study in an Italian southern hospital
Authors: Varrasi Simone , Guerrera Claudia Savia , Platania Giuseppe Alessio , Castellano Sabrina , Pirrone Concetta , Caponnetto Pasquale , Nicolosi Costanza , Insanguine Francesca , Greco Emanuela , Perrone Mariacatena , Pulvirenti Carmen , Randazzo Diletta , Ferro Gabriele , Consoli Maurizio , Di Nuovo Santo
Published: January 2023

Background

The COVID-19 pandemic has significantly affected the mental health of healthcare workers, who have taken on the major problems triggered by the emergency. The mental consequences concern high levels of insomnia, anxiety, depression and burnout, which inevitably affect their professional quality of life too.

Objective

The aim of this study was to analyze the relationship between psychopathological symptoms (tested with the Depression Anxiety Stress Scale, DASS-21) and professional quality of life (measured with the Professional Quality of Life Scale, ProQol) in a hospital of southern Italy.

Methods

204 healthcare workers were recruited by non-probabilistic sampling and divided by age, gender, work roles (physicians, nurses and intermediate care technicians) and clinical departments (Cardio-medicine, Infectious Diseases, Emergency Medicine, First Aid, Obstetrics and Pneumology).

Results

The results showed higher levels of Secondary Traumatic Stress, Depression, Anxiety and Stress in women than in men. Physicians and nurses experienced lower levels of Compassion Satisfaction but higher Burnout than intermediate care technicians; likewise, nurses were more anxious than physicians. The Emergency Medicine had higher scores in Compassion Satisfaction than Infectious Disease, Pneumology, Obstetrics and Cardio-Medicine.

Conclusion

In light of what has been said so far, it appears essential to intervene on the first mild signs of Burnout and Secondary Traumatic Stress, because they precede the onset of Depression, Stress and Anxiety in healthcare workers.
Importance of Yoga philosophy of Vivekananda in modern era
Authors:   vice principal, Balaji institute of education,  rangbadi kota rajasthan, India, Namdev Dr. Deepshikha
Published: January 2023

हमारी भारतीय संस्कृति समस्त विद्याओं की जननी है इस संस्कृति में शायद ही ज्ञान का कोई ऐसा क्षेत्र बचा होगा जिस का समावेश हमारी संस्कृति में ना हुआ हो यहां पर ज्ञान और अनेक गोपनीय विद्याओं की एक ऐसी श्रंखला देखने को मिलती है जो शायद ही अन्यत्र कहीं प्राप्त होती होगी इसी श्रंखला में एक श्रंखला और परंपरा दिखाई देती है योग की भारतीय संस्कृति की जो वैदिक परंपरा है उस पर यदि हम दृष्टिपात करें तो योग विद्या का बहुत ही गहन और अनिर्वचनीय ज्ञान का वर्णन देखने को मिलता है हमारी संस्कृति में परंपरा में ऐसे महर्षि ऋषि मुनि विलक्षण प्रतिभाओं का अखंड सागर था जिसकी उच्च स्तरीय ज्ञान उर्जा भंडार से हम आज भी वो तो रोते हैं और सुरक्षित एवं स्वस्थ हैं हमारे हमारे इस शोधपत्र में हम यह बताने का प्रयास करेंगे की अनेक प्रतिभाओं में योग की अनेक धाराओं में स्वामी विवेकानंद का योग किस प्रकार समाज के लिए आज के आधुनिक युग के लिए लाभप्रद है उनके व्यक्तित्व विकास के लिए उनके सर्वांगीण विकास के लिए क्योंकि आज जितनी समस्याएं हैं जितने भी कष्ट हैं उनका कारण कहीं ना कहीं मनुष्य स्वयं है यह मानव जाति अपनी अव्यवस्थाओं के कारण चाय में वैचारिक हूं चाहे वह मानसिक आध्यात्मिक होम पारिवारिक हूं या सामाजिक सभी ने कहीं ना कहीं एक व्यवस्था देखने को मिलती है जो हमारे कष्ट का हमारे बंधन का कारण बनती है और हमारे साधना मार्ग में एक बहुत बड़ी बाधा के रूप में देखने को मिलती है किस प्रकार हम इस जाल से बाहर निकले जो स्वयं मानव ने अपने लिए बोल रखा है इसका बहुत ही स्पष्ट और सरल रूप में वर्णन हमें स्वामी विवेकानंद के योग दर्शन से प्राप्त होगा।
Comparison of learning achievement of Science and Language Competence of Govt. School Boy Students at Secondary Level
Authors:   Research Scholar, School of Education, Career Point University, Kota, Rajasthan, Sharma Rama , Srivastava Dr Abhishek ,   Professor & Head, department of Education, Maharishi University of Management & Technology, Bilaspur, Chhatisgarh
Published: January 2023

The increasing importance of science education over the decade has resulted a vibrant area of academic scholarship as well as critical studies on the subject. There is an extensive body of research based literature on the subject of impact of language on science learning. Before all else there is a need to shift through relevant studies on the subject of impact of language on science learning to understand the work already done and finding already made so as to avoid duplication of research work and also to understand the issues involved clearly. The main purpose of the research is to study the impact of language on the science learning competence of secondary level students: a comparative study. In this present paper, I would attempt a comparison on the basis of gender and types of school as a result of analysis, interpretation and discussion of the data collected from different areas of study the investigator.
Impact of Yoga on mental health and sports of students
Authors:   Research Scholar, Department of Yoga, Dev Sanskriti Vishwavidyalaya, Sankara, Kumhari, Durg, Soni1 Pradip Kumar , Kashyap Dr. Brijesh ,   Assistant Professor, Department of Yoga, Dev Sanskriti Vishwavidyalaya, Sankara, Kumhari, Durg, Upadhyay Dr. Prashant ,   Assistant Professor, Department of Education, Maharishi University of Management & Technology, Bilaspur (C.G.)
Published: January 2023

प्रस्तुत अध्ययन का उद्देश्य खेलकूद में भाग लेने वाले छात्रों में योग के प्रभाव से होने वाले लाभ को जानना है। योग भारतीय दार्शनिक प्रणालियों में से एक है जो स्वस्थ जीवन, व्यवहार और विचारों को विकसित करने के लिए शरीर के साथ काम करने के महत्व पर जोर देती है। योग की सभी तकनीकों में शारीरिक मुद्राएं, जिन्हें संस्कृत में आसन कहा जाता है, वे हैं। खेल और जिम्नास्टिक, शारीरिक शिक्षा के दायरे में आते हैं। आज के हमारे आधुनिक समाज में शारीरिक शिक्षा शब्द को विभिन्न तरीकों से बतलाया गया है। कुछ लोगों का मानना है कि यह शरीर की शिक्षा है, जो शरीर को कुछ कौशल और क्षमताओं को विकसित करने के लिए शिक्षित करता है, जैसे खेल में। बाकी लोगों को लगता है कि यह शरीर की शिक्षा है, जो बाहर काम कर रही है केवल अपने रूप में सुधार करने के लिए है। लेकिन देखा जाये तो शारीरिक शिक्षा की अभिव्यक्ति का मूल अर्थ शरीर के माध्यम से शिक्षा है। यह शरीर के साथ मिलकर काम का उपयोग शिक्षा के महान लक्ष्यों तक पहुँचने के लिए एक रणनीति के रूप में कर रहा है जो एक दूसरे और पर्यावरण के साथ हमारे संबंधों में स्वायत्तता और नैतिकता लाता है। यह याद रखना है कि खेल और जिम्नास्टिक शारीरिक शिक्षा के दायरे में आते हैं। योग और खेल दोनों अपने मूल रूप में शरीर का उपयोग उन दृष्टिकोणों और क्षमताओं, को बढ़ाने और विकसित करने के लिए एक सामान के रूप में करते हैं जो शारीरिक और मानसिक स्वास्थ्य, एकाग्रता को प्राप्त करने के लिए महत्वपूर्ण हैं।
Feministic images of Women in Anita Desai's selected novels
Authors:   Assistant Professor, Maharishi University of Management & Technology,  Bilaspur, C.G., India,, Sarkar Dr. Shilpa
Published: January 2023

Anita Desai is one of the most prominent Indian novelists of India. Her writing is different from other novelists as she deals with psychological problems in her novels. She is very much interested in the interior landscapes of the mind of her characters. Most of her novels have the theme of alienation, isolation, loneliness, loss of identity and importance of communication in married life. Anita Desai beautifully picturizes the complexities of man-woman relationships in her novels. The objective of this study is to show the feministic perspective of Anita Desai’s women characters in her novels.
Synthesizability improvement of B4C ceramics by optimizing the process temperature and atmosphere
Authors: Feiz Seyed Faridaddin , Nikzad Leila , Majidian Hudsa , Salahi Esmaeil
Published: January 2023

In this research, the effects of synthesis temperature, holding time, and furnace atmosphere on the synthesizability of B4C ceramics using glucose and boric acid as the starting materials were scrutinized. Three temperatures of 1300, 1400, and 1500 °C were selected as synthesis temperatures. The synthesis process was carried out in a tubular furnace for 4 h in Ar atmosphere. To scrutinize the interactive effect of synthesis temperature and holding time, three samples were synthesized at 1500, 1400, and 1300 °C for 4, 8, and 12 h, respectively. Moreover, two types of controlled atmospheres, traditional Ar and an innovative CO/CO2 setup, were considered to optimize the synthesis process. X-ray diffraction (XRD) patterns were employed to determine the optimum synthesis temperature and atmosphere based on the detection of B4C peaks as the desired product and undesirable hydrocarbon and carbon byproducts. The results showed that B4C synthesized at 1500 °C for 4 h in Ar atmosphere contained the least byproduct impurities, so this temperature was chosen as the optimal choice. However, the sample fabricated at 1400 °C for 8 h is a good choice in cases where lower manufacturing temperatures are desired. The efficiency of the innovative setup was similar to the traditional one; therefore, considering the economic aspects, the CO/CO2 atmosphere was chosen as an acceptable option for B4C synthesis.
Clinical Evaluation of the Failures in Fixed Partial Dentures
Authors: Iswalhia Magdi Mohamed , Benjareed Amal Emhemed
Published: January 2023

The researchers in this study set out to do just that by investigating what goes wrong with people's permanent dental prostheses in Libya. One hundred patients from the clinic in Gharyan, Libya, who had come in complaining of problems with their fixed dental prostheses were included in the study, and the reasons for their failure were categorized using Manappallil's system. Failures in Class 3 accounted for 30% of all failures, Class 4 for 24%, Classes, 2, and 4 for 8%, Classes 5 and 6 for 15%, and Class 6 for 11%. Class 1 for 8%, Class 2 for 12%, Class 4 for 24% Class 5 for 15 % and Class 6 for 11%. Unserviceable restorations due to poor margins were indicated as the most common cause of failure in class 3 failures in the current study. Keywords: Rehabilitation, Fixed partial dentures, Failure classification, success.
Frequency of H.Pylori in Liver Cirrhosis Patients with Overt Hepatic Encephalopathy: A Cross-Sectional Study Design
Authors: Ullah Zabih , Alam Shaista , Khan Aurangzaib , Khattak Munaza , , Ullah Zabih , Orakzai Shabir Ahmed , Ahmed Siyab
Published: January 2023

Objective: The study aim is to evaluate the frequency of H. pylori in Liver cirrhosis patients with overt HE. Place and duration of study: This Study is conducted in the department of Pathology, Peshawar Institute of Medical Sciences (PIMS) Peshawar and The duration of study is from Ist April, 2022 till 30th September, 2022. Material and Method: Cross sectional study design having sample size of 140 individuals suffering from H.pylori infections also having a history of hepatic insufficiency.Non-probability sampling technique is used, Patients having age greater than 30 years of any sex but having an history of hepatic cirrhosis for the last 5-6 months, ultrasounds for overt Hepatic encephalopathy are included in this study design. Sample participants having different age strata, disease duration and child’s pugh classification are expressed in means and standard deviation with the help of SPSS. Results: Patients having helicobacter pylori infection in hepatic cirrohsis with overt hepatic encephalopathy are 44(31.4%) and 96 (68.4%) patients have not suffering from any simultaneous infection. There are 65(46.4%) males and 75(53.6% ) females, The mean duration of disease in our study is 4.89+ 1.5 years. Stratification with duration of disease in years in shown in table 1, having significant result with p-value of 0.000. Startified findings of CP is found to be insignificant with H.Pylori infection(p-value=0.500). Practical Implications: According to this study, H pylori infection should be promptly assessed in all patients with liver cirrhosis. The patients' chances of developing hepatic encephalopathy and bleeding chances as a result of the H pylori infection. It may be possible to lessen the severity of consequences such bleeding from esophageal varices, portal hypertensive gastropathy, and hepatic encephalopathy with the early identification and subsequent eradication of H pylori infection. Conclusion: The conclusive remarks of this study shows the prevalence of less frequency of Helicobacter pylori infections in Liver cirrhosis in the patients of Pakistan. But, among all of them Helicobacter Pylori causes prolongation in duration of liver cirrhosis. This study also highlights that as aged patients with liver cirrhosis having more cases of having helicobacter pylori infection. Keywords: Hepatic Encephalopathy, Child’s Pugh Classification,Helicobacter Pylori infection, Liver insufficiency
COVID-19 Vaccination Induced Neurological Complications; A Systematic Literature Review
Authors: Thompson Paul Wesley
Published: January 2023

Introduction: Vaccination against COVID-19 is proved successful in reducing the transmission of disease globally along with reducing the severity of disease but vaccine associated adverse effects (VAERS) questions the safety profile of COVID-19 vaccines especially the serious neurological adverse effects that are responsible for post-vaccination mortalities globally. Aim: To review the neurological adverse effects of COVID-19 vaccines and identify their possible pathophysiology Method: The literature search was conducted by two researchers. The database of Google Scholar was used to search relevant literature. All the articles published between 1st Jan, 2018 to 1st Jan 2022 were screened for inclusion and exclusion criteria. Results: The search strategy resulted in 278 articles of which, 1duplicates were removed and 277 articles were screened according to inclusion exclusion criteria, 103 articles were excluded and a total of 20 articles were included in review of which there were 17 case reports,1 observational studies, 1 case series and 1 case-control study. Conclusion: The findings of review provide a deep insight of neurological complications that can occur in individuals after receiving COVID-19 vaccination and the clinicians should be conscious while dealing with a patient with new-onset neurological symptoms after vaccination against COVID-19 unless a causal association is developed between the vaccine and serious neurological adverse events by future researches. Keywords: COVID-19, Post-vaccination, Neurological Complications, Vaccine Associated Adverse events, Acute Ischemic Stroke and GBS
Pattern of Coronary Artery Diseases in Patients Having Age Less Than 40 Years with Acute Coronary Syndrome
Authors: Zaman Muhammad Haidar , Yaqoob Naveed , Ilyas Muhammad , Zeb Falak , Khalid Fahad , Ali Nawab
Published: January 2023

Aim: To assess the pattern of coronary artery diseases in patients older than 40 years with acute coronary syndrome. Material and methods: This cross-sectional study was conducted at the cardiology department of ABC hospital. A total of 130 patients presenting with the acute coronary syndrome were enrolled. The pattern of coronary artery diseases was assessed. Categorical variables were presented as frequencies and percentages, while numerical variables were presented as mean and SD. Results: The mean age of the patients in our study was 27.96±5.48 years. Most of the patients were male, accounting for 106 (81.5%). The most common factor was smoking 55.4% followed by hypertension 51.5%. Single vessel disease was a typical pattern presented in patients 37.7%. Three vessels disease was the second typical pattern observed in 22.3%. Conclusion: Smoking and hypertension are the leading causes of coronary artery diseases. Single vessel disease is the most common pattern in coronary artery disease patients younger than 40 years. Keywords: Acute coronary syndrome, Coronary artery disease, Pattern, Risk factors
Effectiveness of Integrated Management of Neonatal Childhood Illness (IMNCI) Tool in Chest X-Ray Positive Pneumonia Cases among Children Ages 2 Months to 5 Years A Cross-Sectional Study
Authors: Haque Anwar-Ul- , Akbar Jalal Uddin , Mehdi Zafar , Mehmood Arshad , Yaqoob Ashifa , Durrani Hamid Mumtaz , Haque Saif Ul , Noor Anjum Un
Published: January 2023

IMNCI tool has widely been applied in many countries for screening, clinical diagnosis, and as a management tool for many common diseases, including cases of pneumonia. This study determines the effectiveness of IMNCI tools in the diagnosis of pneumonia as that of diagnosing pneumonia by gold standard method of X-ray Chest PA view besides finding out the sustainability in using the IMNCI guided antibiotics in managing cases of pneumonia from first care to the tertiary care facilities. Methodology: We conducted a prospective, cross-sectional study among children with World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) chest-indrawing pneumonia at a tertiary care hospital in Pakistan and assessed CXR examinations. The primary endpoint was interrater reliability between CXR for pneumonia diagnosis among children with WHO IMCI chest-indrawing pneumonia. Results: The study was done among 165 children aged between 2 months to 59 months who have visited Fatima Hospital, Baqai Medical University, due to their medical condition of cough OR fast breathing. Most of the mothers had been taking antibiotics for their sick children before they reached our set up and very few of them (15%) were found adherent to taking IMCI guided IMCI-guided antibiotic Amoxicillin, whereas the rest of all a huge majority of the cases were found using non-IMCI guided antibiotics constituting 85%, means other than oral Amoxicillin. A Sensitivity of 68.75% and a Specificity of 92.3% were found to IMCI tools validity in diagnosing pneumonia against X-ray chest positivity. Conclusion: This study concludes that the accuracy of IMCI tools in recognizing childhood pneumonia was good rather than the diagnosis as that to the positive findings in Xray Chest findings. However, with good sensitivity and the best specificity with high PPV, it can be the best screening tool for the early detection of pneumonia among children<5 years and can achieve a better outcome with in-time recognition, appropriate care seeking, and early intervention avoiding irrational antibiotics. Keywords: ARI: Acute Respiratory Infection, AIDS: Acquired Immunodeficiency Syndrome, BMU: Baqai Medical University, IMCI: Integrated Management of Childhood Illness, IMNCI: Integrated Management of Neonatal & Childhood Illness, WHO: World Health Organization, UNICEF: United Nations International Children’s Education Funds, MDG: Millennium Development Goal, SDG: Sustainable Development Goal, MNCH: Maternal, Neonatal & Child Health Program
Diabetic Retinopathy Prevalence in Patients with Established Diabetes Mellitus:A tertiary Care Hospital Study
Authors: Sethi Muhammad Junaid , Khan Umer , , Junaid Natasha , Gul Nazli , Ullah Ishan , Israr Muhammad
Published: January 2023

Background: Diabetic retinopathy is one of the microvascular consequences of this metabolic disorder. Objectives: To establish a clear conclusion on the Prevalence of diabetic retinopathy in those who have already been diagnosed with diabetes. Methods: This was a tertiary care hospital study performed at the Peshawar ophthalmology outdoor clinic. The research period for this article was from 01 June 2020 to 05 December 2020. Male and female patients with diabetes mellitus comprised 86 participants in this research. Fundoscopy was performed on all patients in the medical clinic to check for diabetic retinopathy. Results: average age was 55.099±6.20 years, the Duration of diabetes was 09.29±03.62 years, and the average weight was 85.061±07.55Kg. There were 67% male patients and 33% female ones One-third of diabetic patients were found to have retinopathy. Conclusion: Diabetic retinopathy, length of time with diabetes, and diabetes mellitus are all relevant terms. Keywords: diabetes retinopathy, diabetes mellitus, Duration of diabetes
The Genetics and Clinical Presentation of Retinitis Pigmentosa A Tertiary Care Hospital Study
Authors: Sethi Muhammad Junaid , Khan Umer , Junaid Natasha , Gul Nazli , Ullah Ishan , Israr Muhammad
Published: January 2023

Objective: This study aims to analyze the retinitis pigmentosa patients' Clinical Presentation and inheritance patterns. Research conducted at the tertiary care hospital Material and methods: this tertiary care hospital study was carried out at a level I trauma center between 05 January 2018 to 05 January 2021. fifty-six patients and members of their families underwent an ophthalmic evaluation to help identify those with the condition and define its phenotype. The family tree was traced. Several relatives also had optical gheremco tomography and fundus photography. Results: at Presentation, 52 eyes (47%) were judged to be legally blind, whereas 38 (32%) had some degree of visual impairment. The visual field was narrowed in 22 instances ( 40%) due to the brightness of the interaction. In terms of inheritance patterns, we discovered that three cases were autosomal dominant (4%), 39 cases were autosomal recessive (70%), and three cases were x-linked (6%). Of the total cases, 11 (20%) were isolated incidents. There were 48 patients with a conventional retinitis pigmentosa image (86%) and eight patients with an unusual RP picture (12%), including three instances of pericentric RP (5%), 3 cases of Usher's disease (4%) and 1 case of retinitis punctata albescence (2%) bardet-biedl were identified in a single patient. Conclusions: Retinitis Pigmentosa Patients Have A Very Significant Risk Of Becoming Blind. Autosomal Recessive sporadically follows the Most Prevalent Pattern Of Inheritance. Early Detection Of Retinitis Pigmentosa Is Important In Preventing Blindness From The Disease, As Is Encouraging Patients To Forego Marriages To First Cousins. Keywords: Genetics and Clinical, Presentation, Retinitis Pigmentosa, kpc
Assessment Clinical Association of Thyroid Function in Women of Reproductive Age Group with Abnormal Uterine Bleeding
Authors: Chaudhary Rabia , Aftab Komal , Iqbal Ghazala , Moazzam Summaiya , Chandio MS. Khushboo , Naveel Tania
Published: January 2023

Background: Abnormal Uterine Bleeding occurs when the frequency and quantity of menstrual bleeding in females is significantly altered. It is the most prevalent clinical presentation in gynecology, affecting more than 20% of the female population, and is characterized by variations from normal menstruation in terms of irregularity in periods, frequency, duration of blood flow, amount of blood loss, and cyclicity. Thyroid hormones had significant effects on the female reproductive system, such as delayed puberty, infertility, premature menopause, recurrent abortions, and AUB. The AUB is significantly associated with thyroid secretions, and any patient who complains of AUB or irregular menstruation must have thyrotoxicosis ruled out. Objectives: This study was conducted at the Department of Obstetrics and Gynecology, Nishtar Hospital, Multan, Pakistan, (2021-22) in order to evaluate the clinical association between thyroid function and AUB in women of different reproductive age groups. Methods: This cross-sectional study was conducted in the outpatient department of Obstetrics & Gynecology, Nishtar Hospital, Multan, from 1st December 2021 to 31st May 2022. 320 patients participated in the study and were examined clinic-pathologically and were allocated into three groups based on their thyroid profile (euthyroid, hyperthyroid and hypothyroid, respectively) and further predisposition risk factors were recorded and analyzed. Results: It was discovered that extreme age groups of adolescence and pre-menopause phase significantly (p<0.05) increased the incidence of AUB. The incidence of AUB was also elevated (p<0.05) among patients with an abnormal BMI, women with multiple pregnancies, and married women. The menstrual bleeding pattern was also studied in females, with polymenorrhea (131/320) being the most prevalent (p<0.05), followed by menorrhagia (79/320), metrorrhagia (59/320), oligomenorrhea (42/320), and amenorrhea (9/320) having a significantly lower incidence (p<0.05). The incidence rate of thyroid disorders was 28.12% (90/320), with hypothyroidism affecting 77(24.06%) and hyperthyroidism affecting 13(4.06%) patients (p<0.05). Practical implication: AUB is significantly associated (p<0.05) with thyroid hormones, therefore for early diagnosis of the underlying etiology and treatment of the patients by preventing hysterectomy and other serious surgical interventions, all patients presenting to OPD clinics with the complaint of AUB or irregular menstruation must be ruled out for a thyroid profile in the first instance. Conclusion: It was concluded that thyroid disorders directly affected the BMI, fertility and menstrual cycle of gynecology patients and increased the incidence of AUB along with the medical and gynecological complications. Keywords: Amenorrhea; Hyperthyroidism; Hypothyroidism; Polymenorrhea; Thyrotoxicosis.
Comparative Outcome of Three Different Approaches for Supracondylar Humeral Fractures in Children in Khyber Pakhtunkhwa, Pakistan
Authors: Shakeel Muhammad , Khan Mohib Ullah , Ullah Zia , Khan Muhammad Afrasiyab Javed , Essa Muhammad Asghar , Tahir Afifa
Published: January 2023

Background: The closed reduction and percutaneous pinning are the min treatment approaches tested in pediatric humerus supracondylar fractures but the treatment approach preferred in fractures without closed reduction is remains unclear. Objectives: The purpose of this study was to compare three common orthopaedic procedures for treating children with supracondylar humerus fractures of the displaced extension type. Methods: The current retrospective analytical study was started in the Department of Orthopedic at Khyber Teaching Medical College from 2015 to 2020, with the approval of the clinical research ethics committee. This analysis was conducted on 64 patients between the ages of 1 and 12 years who underwent hospital surgery for Gartland IIb, Gartland IIb, and Gartland III supracondylar humerus fracture. Results: A total of 64, 22 patients were from group A, in which 18 (81.81%) were male and only 4 (18.18%) were female, while in group B and C were 21 (80.76%), 5 (19.23%) and 14 (87.5%), 2 (12.50%) male and female, respectively. The injury on left elbow and right elbow in group A was recorded 68.18 and 31.81%, respectively. Among the total injured children, the left elbow was fractured in 47 (73.43%) case and the right one in 7 (10.93%). Approximately the duration of injury to therapeutic procedure was recorded 7.53±3.03 hours in the study. When compared to the group of displaced supracondylar humeral fractures that were conservatively handled, the functional and aesthetic treatment outcomes between the closed and open reduction with K-wire fixation groups were significantly different. According to this system, excellent, fair, good and poor functional outcomes were recorded in 10 (45.45%), 6 (27.27%), 4 (18.18%) and 2 (9.09%) patients of A group, respectively, while 13 (50%), 5 (19.23%), 5 (19.235), and 3 (11.50%) patients in group B, respectively. The poor and fair functional outcome was noted in 1 (6.25%) and 3 (18.75%) patients, respectively in group C. Practical implication: This is a critical surgical condition in children and they should be provided with the appropriate treatment to acquire the child's ability of movement. According to our findings among three management techniques, the most favorable was open reduction with K-wire fixation, and therefore was recommended with good success rate. Conclusion: It was thus concluded that open reduction with K-wire fixation is a good alternative to closed reduction with percutaneous pinning for treating displaced pediatric supracondylar humeral fracture. Keywords: Children; Supracondylar humerus fracture; Surgical treatment; Pediatric fractures; Pakistan
Efficacy and Safety of Endoscopic Balloon Dilatation for Treatment of Primary Obstruction Megaurater Up to 2 Years of Age
Authors: Ahmad Tariq , Khan Sher Wali , Khan Muhammad Javed
Published: January 2023

Endoscopic balloon dilatation (EBD) can be performed with different catheters and its durability is still controversial. The study aimed to compare long-term results of EBD performed <20 months of age using balloons of 4 mm vs. 6 mm in diameter. Retrospective study conducted of consecutive patients with unilateral primary obstructive megaureter (POM) undergoing EBD <24 months of age by two surgeons from January 2020 to January 2022. The technique was consistent, but for balloon diameter was 5 mm in group A vs. 6 mm in group B. End-points included peri-operative complications, success rate (improving dilatation and non-obstructive drainage on 9-month scintigraphy), and long-term outcome (need for reimplantation and diameter of retrovesical ureter at last ultrasound). The procedure was completed in all planned patient. Group A included 30 patients and Group B 60 patients. Groups were not significantly different for age (p < 0.09), gender (p < 0.1), laterality (p < 0.7), and preoperative median ureteral diameter (p Z 0.08). No perioperative complications occurred. Four group A patients required a cutting balloon to achieve a satisfactory dilatation of the vesicoureteral junction (p Z 0.009). After a median (range) follow-up of 70 (19e155) months, success rate was 73.3% vs. 83.3% (p Z 0.45), 4/15 group A and 5/30 group B patients required reimplantation within 2 years of EBD. In successful cases, median (range) ureteral diameter at last follow-up was 6 (0-17) mm vs. 5 (0-16) mm, which was significantly better than preoperative value (p Z 0.003 and p < 0.001, respectively), but not significantly different (p Z 0.8) between groups. EBD is an umbrella term that encompasses many technical variations, which can be key for success. Although limited by the small numbers and the comparison of patients treated over two subsequent periods, this is the first study focusing on the role of balloon size. The diameter of the balloon did not influence significantly long-term results, but the 6 mm balloon slightly increased the success rate of EBD to 83.3% and eliminated the need for cutting balloons to achieve a satisfactory dilatation.
Life Satisfaction in Patients with Critical Limb Ischemia Following Vascular Surgery and Endovascular Therapy
Authors: Khan Muhammad Shoaib , Awan Asadullah , Ali Irfan , Gilani Rabia , Jawad Nida , Falah Sheikh Qais
Published: January 2023

Objective: The purpose of this research is to assess the efficacy of vascular surgery and endovascular therapy for critical limb ischemia. Study Design: Prospective study Place and Duration: This prospective study was conducted at Dow International Medical College and Dow University of Health Sciences, OJHA Campus, Karachi in the period from April, 2022 to September, 2022. Methods: Total 90 patients had critical limb ischemia were presented. All the patients were enrolled after taking informed written consent. Included patients were admitted for revascularization and divided equally in two groups. Group I received vascular surgery in 45 cases and 45 cases of group II received endovascular treatment (PTA). At 3 months post-revascularization, all patients were evaluated using the ankle-brachial index (ABI), the 6-minute walking test, and the Nottingham Health Profile (NHP) questionnaire. SPSS 22.0 was used to analyze all data. Results: The mean age of the included cases in group I was 64.6±5.57 years and in group II mean age was 69.5±8.44 years. There were majority males 33 (73.3%) in group I and 36 (80%) in group II. Comorbidities were DM, HTN, Hyperlipidemia and CAD among all cases. ABI and 6-minute walking distance improved significantly three months after the treatment in both groups. At six months post-procedure, both groups had similar NHP Part I and Part II total scores. However, the surgical revascularization group had substantially higher domain scores in social isolation and physical abilities with p value <0.012. Conclusion: Our findings indicate that patients undergoing surgical revascularization or PTA for SFA stenosis have comparable overall scores on the NHP questionnaire three months after revascularization. Subjects who undergo surgical revascularization score significantly higher than those who undergo percutaneous transluminal angioplasty (PTA) on the NHP's social isolation and physical ability dimensions. Keywords: Peripheral bypass surgery, Peripheral arterial disease, Quality of life, Endovascular treatment
Fundoscopic Findings in Pregnancy Related Hypertensive Disorders and Its Association with Maternal and Fetal Outcomes
Authors: Fakhir Nazia , Shamsher Saadia , Anbreen Fauzia , Fateh Reema
Published: January 2023

Objectives: To determine the prevalence of retinal changes in pregnancy-related hypertensive disorders and their association with maternal and fetal outcomes. Introduction: There is a grave risk to both mother and child when hypertensive problems complicate pregnancy. However, hypertensive sort of disorders during pregnancy have been allied to poor maternal and also neonatal outcomes. This research aimed to evaluate effects of hypertensive sort of disorders of pregnancy on both mothers and their unborn children by analyzing the prevalence, causes, and treatment of these conditions. Subjects and methods: BBH Rawalpindi, Inpatient Department of Gynecology and Obstetrics conducted the case-control research during the period from January 2021 to June 2021. In all, 149 patients participated in the research. Because seven patients could not be located, 142 cases were analyzed. Mild class preeclampsia (65.0 instances), severe class preeclampsia (32.0 hot cases), and also eclampsia (one case) were the subcategories used to categorize patients further, according to research. Thirty-one women who were not hypertensive throughout pregnancy were enlisted as controls. Results: Ninety percent of cases manifested with some edema. About a quarter basically patients had proteinuria above 300.0 mg/24 hours (26.76%), nearly half had proteinuria over two g/24 hours (47.18%), and about a quarter had urine protein based excretion of 3.0-5.0 g/24 hours (25.35%). Usually, incidence of specially HELLP (normally hemolysis, increased liver based special enzymes, and also squat platelet tot up) set of symptoms was 2.80%, raised bilirubin levels were seen in 47%, illustration symptoms occurred in 6.4%, vaginal based hemorrhage occurred in 11.30%, in addition to 42.2% of cases involved the central nervous system. It was shown that eclampsia was the cause of mortality in 2.8% of all maternal deaths. 16.9 percent of births were stillbirths, while 4.23 percent of newborns died. Conclusion: Compared to pregnant women with normal blood pressure, those who suffer from hypertensive disorders of pregnancy have a higher risk of having a baby born with complications. Our research did find a declining trend, although it was less than those seen in other studies; this may be because more of our study's births occurred in hospitals. Keywords: Neonatal outcome, maternal outcome, acute renal failure, and the HELLP syndrome