bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and factors associated with domestic violence amongst married women in urban and rural areas of Kano State, Nigeria
Authors: Hayatu Zainab , Garba Rayyan Muhammad , Abdullahi Nafisat Tijjani , Maizare Hajara Ibrahim , Farouk Shaheeda Labaran , Ibrahim Usman Muhammad , Ayaba Aminatu Kwaku , Tsigah-Ahmed Fatimah Isma’il , Jalo Rabiu Ibrahim , Amole Taiwo Gboluwaga
Published: November 2023

Domestic violence against women, in its various forms, remains endemic in communities and countries globally and is coupled with contributing marital disharmonies, adverse health outcomes on the victims, their children, immediate families and the community. The study assessed and compared prevalence and factors associated with DV amongst married women in urban and rural areas of Kano, Nigeria. Using a comparative cross-sectional study design, 493 married women were studied. Multistage sampling technique was used to select respondents and data collected using an adapted structured interviewer administered questionnaire. Analysis was done using SPSS vs 25. The overall prevalence of DV was 23%; of which less than a quarter of the urban (17%) and over three quarters of the rural (83%) married women experienced at least one form of DV. Most reported forms in the urban vs rural were: verbal abuse (in form of humiliation, insults and threatening to attack) 15% vs 83%; physical abuse (in form of push, slap, and arm twisting) 6% vs 28%. Older age (women > 45 years) [p=0.00, AOR=0.228, 95% CI=0.096-0.539], and husband’s non-smoking habit [p=0.00, AOR=0.226, 95% CI=0.110-0.467] were protective for the experience of domestic violence. DV was prevalent among married women particularly among those living in the rural area and the younger women. Women whose husbands engaged in smoking were more at risk. Efforts should be made to provide education and support for vulnerable women exposed to DV.
Evaluation of the SD Bioline Syphilis 3.0 rapid immunochromatographic test for syphilis screening in Burkina Faso
Authors: Traoré Oumar , Kpoda Dissinviel  Stéphane , Soubeiga Adama Patrice , Henry-Sangaré Rokiatou , Ajayi Abraham , Ouédraogo Casimir , Drabo Maxime Koiné , Kabré Elie , Sangaré Lassana
Published: November 2023

Syphilis remains a global health problem. In Burkina Faso, cases of syphilis are still prevalent despite concerted effort in the fight against sexually transmitted infections. The availability of Treponema pallidum haemagglutination assay in the diagnosis of syphilis has not eliminated the challenges encountered in the diagnosis of syphilis in Burkina Faso, hence the difficulty in case management. This study evaluated the diagnostic performance of SD Bioline syphilis 3.0 test against the combination of venereal disease research laboratory (VDRL) and Treponema pallidum haemagglutination assay (TPHA) a reference test used routinely in Burkina Faso. A total of 633 serum samples collected from suspected syphilis infected participants were tested for syphilis using the combination of VDRL, TPHA and SD Bioline syphilis 3.0, a rapid immunochromatographic test (ICT). The sensitivity and specificity of SD Bioline syphilis 3.0 test were 100% and 92%, and the positive and negative predictive values were 85.95% and 100%, respectively, compared to the classical TPHA test used for screening/diagnosis of syphilis. The SD Bioline Syphilis 3.0 test gave good diagnostic accuracy compared to the VDRL and TPHA tests (p<0.001). SD Bioline syphilis ICT test could be used in health facilities for screening and diagnosis of syphilis in Burkina Faso.
Dynamique spatio-temporelle de la végétation contractée de l’ouest du Niger suivant le gradient pluviométrique et d’anthropisation de 1990 à 2020
Authors: Aboubacar Amadou , Bachir Mourtala , Abdoulaye Diouf , Guimbo Iro Dan
Published: November 2023

La végétation contractée de l’ouest du Niger constitue des écosystèmes dans lesquels les communautés locales tirent l’essentiel de leur subsistance de l’exploitation du bois. Les animaux y pâturent pendant toute la saison des pluies. Sa dégradation s’est accentuée ces trois dernières décennies, sous l’effet, principalement de la pression anthropique et du climat. Cette étude visait à analyser la dynamique de cette végétation de 1990 à 2020, dans les communes de Kouré, Farey, Gaya et Tanda. Les images Landsat 5TM (1990) et Landsat 8 de novembre (2020) ont été utilisées. La classification non supervisée par l’algorithme iso-data et le calcul des superficies au moyen du logiciel ENVI et Excel ont permis de quantifier les transformations spatiales survenues sur la base du fichier HBF, dont la sortie est une matrice de transition. Les NDVI ont été calculés grâce à la commande Quick statistic d’ENVI et les indices Standardisés des Précipitations à partir des cumuls annuels des précipitations. Les résultats ont montré une régression de végétation contractée régulière de 63,26%, de 55,76% et de 34,75% respectivement à Kouré, à Farey et dans le bloc Gaya/Tanda. De plus, une régression de la végétation contractée dégradée de 40,74%, de 555,39% et de 8,29% été enregistrée respectivement à Kouré à Farey et dans le au bloc Gaya/Tanda. La corrélation positive entre l’indice standardisé de précipitation et l’indice de végétation a été significative à Farey et non significatif à Kouré et Gaya.

 The contracted vegetation of western Niger constitutes ecosystems in which local communities derive most of their livelihood from timber exploitation. Animals graze here throughout the rainy season. Its degradation has increased over the last three decades, mainly due to anthropic pressure and climate. The aim of this study was to analyze the dynamics of this vegetation from 1990 to 2020, in the communes of Kouré, Farey, Gaya and Tanda. Landsat 5TM (1990) and Landsat 8 November (2020) images were used. Unsupervised classification using the iso-data algorithm and area calculations using ENVI and Excel software were used to quantify spatial transformations based on the HBF file, the output of which is a transition matrix. NDVI was calculated using ENVI's Quick statistic command, and Standardized Precipitation Indices were calculated from annual rainfall totals. The results showed a regular contracted vegetation regression of 63.26%, 55.76% and 34.75% respectively at Kouré, Farey and in the Gaya/Tanda block. In addition, a regression of degraded contracted vegetation of 40.74%, 555.39% and 8.29% was recorded in Kouré, Farey and the Gaya/Tanda block respectively. The positive correlation between the standardized rainfall index and the vegetation index was significant in Farey and insignificant in Kouré and Gaya.
Collective Leadership Competencies among Agricultural Researchers in Selected Agricultural Institutes in Oyo State, Nigeria
Authors: Oose Matthew Olalekan , Otufale Gbolahan Ayodapo , Oyeyinka Richard Akinwumi , Popoola Delight Adeola
Published: November 2023

The study assessed the collective leadership competencies of agricultural researchers in selected agricultural institutes in Oyo state,  Nigeria. A multistage sampling procedure was used to select 177 agricultural researchers for the study. Data were analyzed using,  percentages, weighted mean scores, and logit regression analysis. Results showed that 28.4% of the employee daily create and maintain  clarity in their professional vision. Also, the result on the compass dimension of employees’ engagement showed that 47.7% invested  their time in relationship building. In addition, for the compass dimension on innovation, 63.6% of the employees stated that they nurture  creativity and stay open to new ideas. For collective intelligence, 38.0% of the employees revealed daily established structured  dialogues that harvest different perspectives. There was a significant relationship between future possibilities (r=0.03*),  innovation (r=0.001*), and collective leadership competencies. The agricultural researchers’ collective leadership competencies are very  low. Sensitization workshops on collective leadership be organized by relevant institutions for agricultural researchers.
Comparison of prevalence of mental distress, help-seeking behaviour of undergraduates in public and private Universities in Osun State, Nigeria
Authors: Odia B.O. , Esimai O.A. , Ijadunola M.Y. , Opeloye R.O. , Elugbaju O.T.
Published: November 2023

Objective: Mental distress is prevalent and increasing in tertiary institutions. This study compared the prevalence of mental distress and  help-seeking behaviour among undergraduates in public and private universities in Osun State, Nigeria.

Methods: A comparative cross-sectional design was used to collect data from 910 respondents in one public and one private university of  Osun State, using a multistage sampling technique. Data was collected with pre-tested, semi-structured, self-administered  questionnaires. Data were analysed using IBM SPSS version 22. Univariate and bivariate analyses were conducted with a level of statistical  significance set at p < 0.05. Ethical clearance was obtained from the Institute of Public Health Obafemi Awolowo University. 

Results: The mean age and standard deviation for public university students was 20.74 ± 2.19 years and 19.02 ± 2.27 years for private  university students (p<0.001). The prevalence of mental distress was 40.4% in the public university and 43.6% in the private university  (p=0.324). All respondents with mental distress in both universities sought help in the preceding 12 months. Respondents in both  institutions commonly sought informal sources of help from parents and friends. A significantly higher proportion of respondents in the  private university (62.9%) sought help from formal sources in the 12 months prior to the study compared with respondents in the public university (37.1%) (p=0.012).

Conclusion: The prevalence of mental distress is high in both universities with informal sources of help- seeking frequently reported. There is a need for university authorities to promote professional help-seeking in these universities.
Detection of African swine fever virus genotype II in domestic pigs during a hemorrhagic fever outbreak in Ogun State, Nigeria
Authors: Onoja A.B. , Ifeorah I.M. , Jolaoso M. , Onoja I.A.
Published: November 2023

African swine fever outbreaks are ongoing in Europe and other parts of the world. In Nigeria, genotype I has been previously described, while genotype II was only reported recently. This study investigated a major disease outbreak in one of the largest pig farms in Nigeria, detected the etiology and determined the evolutionary history of African swine fever virus. Viral DNA was extracted and used to confirm the circulation of the African swine fever virus (ASFV) by Polymerase Chain Reaction, followed by the sequencing of the amplified products by Sanger’s method. Phylogenetic analysis showed that all the ASFV detected in this study belong to genotype II and clustered with reference strains from the Euro-Asian region and Tanzania in East Africa. This being the second report of ASFV genotype II in quick succession from Nigeria, suggests there may have been an unrecognized indigenous circulation or re-emergence of previously contained, or introduction of ASFV genotype II into the country. This reinforces the need for active surveillance and biosecurity measures to prevent and control transmission.
Comparative pregnancy diagnosis of digital rectal palpation technique, ultrasonography, progesterone assay and non-return-to-heat in Red Sokoto goat.
Authors: Bello A. A. , Voh Jr A. A. , Ogwu D. , Ayo J. O.
Published: November 2023

Comparative pregnancy diagnosis was carried out to evaluation the effectiveness of digital rectal palpation technique in Red Sokoto goat, at Small Ruminant Research Program of National Animal Production Research Institute, Shika, Zaria. Forty two does were randomly divided into groups A, B and C, (n = 14 each). Semen was collected from two Red Sokoto bucks using artificial vagina, processed and stored at 4˚C. Oestrus was synchronised with prostaglandin F2-alpha, and oestrus detected by apronised bucks and visual observation. Breeding was by artificial inseminating for groups A and B while group C bred by natural service. Comparative pregnancy diagnosis was carried out using ultrasonography (US) and digital rectal palpation technique (DRP) on day 14, 21, 28 and 126, while progesterone assay (P4) and non-return-to-heat (NRH) on day 21, post-breeding. Pregnancy rates on day 21 were 64.3 %, 92.9 % and 100 % (US); 42.9 %, 57.1 % and 57.1 % (DRP); 78.6 %, 78.6 % and 100 % (P4); 85.7 %, 78.6 % and 92.9 % (NRH). There was significant (P < 0.05) difference between US, DRP, P4 and NRH in groups B and C. It was concluded that DRP technique was effective in early pregnancy diagnosis (days 14, 21, and 28) in Red Sokoto goat does.
Factors influencing utilisation of insecticide treated nets among children under-five years of age in Kpone-On-Sea in the Kpone Katamanso District in Ghana
Authors: Amara Rebecca , Eden-Hotah Joseph , Quaki Isabell
Published: November 2023

Children under-five years of age are among the vulnerable group mostly affected by morbidity and mortality due to malaria. Insecticide  treated nets (ITNs) have proved to be effective in reducing malaria transmission  and increasing child survival. Significant investment into  scaling up of ITNs has been done but achieving actual  utilisation among beneficiaries is still a challenge in malaria endemic regions  including Ghana. The study aimed  to assess factors influencing utilisation of ITNs among children under-five years in Kpone-On-Sea in  Ghana. We  used a cross-sectional community survey design to determine the proportion of children under-five years of  age sleeping  under ITNs and factors influencing utilisation of ITNs among care-givers in Kpone-On-Sea. We  randomly sampled 325 care-givers of  children under-five years between March and June 2017. Microsoft Excel  version 2016 and SPSS were used for data entry and analysis,  and further analysis was conducted using STATA  version 14 software. Chi-square test was used to test for associations and multiple  logistic regression to  determine strength of associations. We found that the proportion of children under-five years sleeping under  ITNs  was 91%. Factors associated with ITN utilisation among children under-five years included caregivers’  level of education (p<0.01), their  awareness that children under-five years are most at risk of malaria (P<0.05),  knowledge that ITN protect against mosquito bite (P<0.02),  knowledge on the importance of ITNs in preventing  malaria (P<0.01), ITN ownership (P<0.03), type of ITN owned (p<0.02) and the period  within which caregivers  utilise ITN (P<0.00). We also found high ownership of ITNs among caregivers, and no difference between  caregivers’ knowledge on malaria and its prevention. These data improved the current knowledge of ITNs  utilisation among caregivers  of children under-five years and offer opportunities to conduct further studies in  other regions of Ghana.
A szimmetria jelenléte Silviu Purcărete előadásaiban
Authors:   Babeș-Bolyai University, Cluj-Napoca, Böjthe Pál
Published: November 2023

The Greek word symmetry means correct proportion. The basis for this study is the interesting fact according to which symmetry has been known to be the father of boredom in the theatre at least since Meiningenism. To describe a work of art as symmetrical is to say that the bisector axis divides the whole into two exactly corresponding parts. This articulation expresses immobility and constancy, and evokes a sense of these in the viewer, or in the listener in the case of a poem, theatre or music performance. Therefore, the more or less regular use of symmetry today seems a kind of reminiscence of a hundred years ago. In contrast, Silviu Purcărete – whom Lehmann classifies as a post-dramatic director, and who, according to other opinions, can be considered a fully 21st-century director – is a keen user of symmetry in his performances. We will first briefly discuss the concept of symmetry. This will be followed by examples of symmetry from three theatre performances by Silviu Purcărete. Finally, some reflections are presented on the use of symmetry in Silviu Purcărete’s case.
Az első női rendezők Magyarországon
Authors:   Research Centre for the Humanities, Budapest, Porogi Dorka
Published: November 2023

This thesis focuses on the careers of women directors in 20th-century Hungary. Its purpose is to serve as a fundamental database and provide inspiration for future sociological, theatre historical, professionalization, and gender studies. Firstly, it examines the proportion of women who pursued theatre directing as a profession in Hungary and remained in the field. Subsequently, it delves into the careers and biographies of five directors from the first half of the century.
RANCANG BANGUN SISTEM KEMANAN RUMAH DENGAN MENGGUNAKAN MODULE NODEMCU BERBASIS IOT (INTERNET OF THINGS)
Authors: Salmon Salmon , Rangan Andi Yusika , Ramadhan Bagus Ari
Published: November 2023

Penelitian dilakukan untuk dapat membuat sebuah Rancang Bangun Sistem Kemanan Rumah Dengan Menggunakan Module Nodemcu Berbasis IoT (Internet Of Things) yang nanti nya jika penelitian ini berhasil bisa membantu pemilik rumah untuk mengawasi rumah mereka jika rumah tersebut dalam keadaan kosong.

Penelitian ini dilakukan sebuah Perumahan Talang Sari Regency yang beralamat di Tanah Merah Samarinda Utara. metode pengumpulan data yang digunakan yaitu wawancara yang mengajukan pertanyaan-pertanyaan yang berkaitan dengan pemillik rumah. Dengan cara observasi, yaitu mengadakan pengamatan secara langsung rumah yang bersangkutan.

Adapun hasil akhir dari penelitian ini yakni berupa Rancang Bangun Sistem Kemanan Rumah Dengan Menggunakan Module Nodemcu Berbasis IoT (Internet Of Things) yang dapat membantu pemilik rumah untuk menginggalkan rumahnya dengan aman.
Role of AI in Changing the Physical and Online Shopping Experience of Clothes and Fashion Products
Authors:   Department of Fashion Design and Technology, Takoradi Technical University, Takoradi, Ghana, Ademtsu James Tetteh , Pathak Dr. Pragya ,   Assistant Professor PID, Dept. of Fashion Design, Parul University, Vadodara, Gujarat, Oduraa Osei Dinah Bridget ,   Creative Arts Department, Bia Lamplighter College of Education
Published: November 2023

The study focuses on how AI may help with visual searches and personalised suggestions for online buying. To provide personalised apparel suggestions based on individual tastes, AI systems may analyse customer data and behaviour. Customers may use photographs as search queries to locate comparable fashion goods thanks to visual search capabilities driven by AI, which makes online shopping more effective and practical. The ethical and societal ramifications of AI in the fashion business are also covered in the research. In light of the volume of personal data that AI systems gather, it examines privacy and data security issues. It also examines the influence of AI algorithms' inclusion and prejudice on fashion suggestions. The study also looks at how AI may affect the workforce and traditional retail occupations, considering the automation of some processes and the demand for new skill sets. Another important component of background research is comprehending customer impressions of the adoption of AI in the fashion business. By accomplishing these objectives, the study intends to provide a comprehensive understanding of the role of AI in transforming the physical and online shopping experience of clothes and fashion products, including its benefits, challenges, and implications for consumers and the fashion industry as a whole. To evaluate whether AI systems can improve the shopping experience, researchers may create proof-of-concept models or prototypes. Virtual stylists, individualised product suggestions, virtual changing rooms, and tools for analyzing fashion trends based on AI are a few examples of these prototypes. research limitations highlight the complexities and evolving nature of studying the role of AI in transforming the shopping experience of clothes and fashion products. Researchers must acknowledge and address these limitations to provide meaningful and actionable insights for the industry. Researchers can improve the development and responsible application of AI technologies in the fashion sector by focusing on these areas, which will ultimately improve customers' overall purchasing experiences.
Varicella Zoster Virus (VZV) Infection: A Comprehensive Review of Chickenpox
Authors:   Universidad Autónoma de Guadalajara, Guadalajara, Jalisco. México., Falcón Daniela Itzel Moreno , Dávila Báez Daniela Alejandra ,   Universidad Autónoma de Guadalajara, Guadalajara, Jalisco. México., Duran Vera Miguel ,   Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Guadalajara, Jalisco. México., Framery Gruter Emma Laura Marie ,   Universidad Autónoma de Guadalajara, Guadalajara, Jalisco. México., Narváez Paredes Marlo Ramón ,   Universidad Autónoma de Tlaxcala, Tlaxcala. México., Campos Fátima Elizabeth López ,   Universidad Autónoma de Guadalajara, Guadalajara, Jalisco. México.
Published: November 2023

Varicella, commonly known as chickenpox, is a contagious infectious disease caused by the varicella zoster virus (VZV). Although often considered a benign childhood illness, chickenpox can lead to severe complications, particularly in susceptible populations. This article provides a comprehensive review of chickenpox, delving into its etiology, pathogenesis, clinical manifestations, and the evolving landscape of prevention and treatment. Additionally, we explore the implications of chickenpox in the context of public health and emerging trends in vaccination strategies.
The Effectiveness of Using an Electric Toothbrush as a Plaque Control Tool in School-Autistic Children
Authors:   Faculty of Dentistry, University of Jember, Jember Indonesia, Sukanto Sukanto , Lazuardi Prima Rahman ,   Faculty of Dentistry, University of Jember, Jember Indonesia, Ermawati Tantin ,   Faculty of Dentistry, University of Jember, Jember Indonesia, Probosari Niken ,   Faculty of Dentistry, University of Jember, Jember Indonesia, Setyorini Dyah ,   Faculty of Dentistry, University of Jember, Jember Indonesia, Budirahardjo Roedy ,   Faculty of Dentistry, University of Jember, Jember Indonesia, Prihatiningrum Berlian ,   Faculty of Dentistry, University of Jember, Jember Indonesia, Pemana Shita Amandia Dewi ,   Faculty of Dentistry, University of Jember, Jember Indonesia
Published: November 2023

Background: Autism is a condition of developmental abnormalities that have an impact on various aspects of life, including dental and oral health. An electric toothbrush is needed as a means of plaque control. Electric toothbrushes offer advantages such as timer features, increase accessibility, etc. Purpose: This study aims to determine the effectiveness of electric toothbrushes as a means of plaque control in children with autism. Methods: This study used the One Group Pretest Posttest research design and consisted of 24 subjects. This study used the Loe and Silness plaque index measurement. Before the research, education was carried out on the research subjects. The study was conducted by comparing the effectiveness of manual and electric toothbrushes on research subjects. Index scores were recorded before and after treatment. Results: The use of manual and electric toothbrushes both reduced the Loe and Silness plaque index scores. The use of a manual toothbrush reduced the mean plaque index score by 0.828 (34.07%). The use of an electric toothbrush reduced the average plaque index score by 1.10 (48.24%). The results of the paired t test (P <0.05) showed that there was a significant difference between the use of a manual toothbrush and an electric toothbrush. Conclusion: The use of an electric toothbrush can reduce plaque scores and is effective as a means of plaque control in school-age autistic children.
Advancements in Glioblastoma Management: A Comprehensive Review of Therapeutic Strategies and Future Directions
Authors:   Hospital General de Zona 1-A Dr. Rodolfo Antonio de Mucha Macías. Hospital de Especialidades Dr. Bernardo Sepúlveda Gutiérrez. Centro Médico Nacional Siglo XXI. IMSS., Mendoza Alejandro Arias , Martin Francisco Vázquez ,   Universidad Autónoma De Guadalajara, Guadalajara, Jalisco. México., Avalos Jessica Arlene ,   Universidad Autónoma De Guadalajara, Guadalajara, Jalisco. México., Ortega Valls Teresa Jannete ,   Universidad Autónoma De Guadalajara, Guadalajara, Jalisco. México., Jimenez Hector Manuel Valdez ,   Universidad Autónoma De Guadalajara, Guadalajara, Jalisco. México., Perea Emmanuel Bautista ,   Universidad Nacional Autónoma de México, Facultad de estudios Superiores Iztacala.
Published: November 2023

Glioblastoma, the most aggressive and lethal primary brain tumor, presents a formidable challenge to clinicians and researchers alike. This article provides a comprehensive overview of the latest developments in the management of glioblastoma, focusing on therapeutic strategies and emerging directions for improved patient outcomes. The aggressive nature of glioblastoma calls for a multifaceted approach, and this review examines the current state of surgical, radiotherapeutic, and chemotherapeutic interventions. Furthermore, we explore the promising avenues of targeted therapies, immunotherapy, and the role of precision medicine in tailoring treatment for individual patients. Additionally, we discuss the challenges of overcoming treatment resistance, the potential of combining modalities, and the impact of genetic and molecular profiling. This article serves as a critical resource for clinicians, researchers, and policymakers involved in the ongoing battle against glioblastoma, shedding light on the evolving landscape of glioblastoma management
Zaken Cabinet Map and Presidential Prerogrative in the Perspective of Multiparty Presidential System in Indonesia
Authors:   Faculty of Law, Atma Jaya Yogyakarta University, Special Region of Yogyakarta, Indonesia, Cipto Handoyo Benediktus Hestu , Maheswara Giovanni Battista ,   Faculty of Law, Satya Wacana Christian University, Salatiga, Central Java, Indonesia
Published: November 2023

Constitutionally, the system of government chosen by the Indonesian people is a presidential system with a multiparty system. This system of government makes the President shackled by political parties when he wants to arrange the cabinet, which is his prerogative. This article will discuss the problem of how the zaken cabinet map of the multiparty presidential system in the perspective of scientific expertise or scientific approach/expertise approach can ve implemented side by side with the interests of coalition political parties in Indonesia. By using normative juridical analysis, it is concluded that the zaken cabinet map of the multiparty presidential system in the perspecive of scientific expertise or scientific approach/expertise approach can be implemented side by side with the interset of coalition political parties in Indonesia with minimum ratio of 32,35% (Thirty-two point thirty-five percent) filled by experts/professionals and the rest can be left to the political parties supporting the president / vice president as a manifestation of “political rewards”
Can the choice of resuscitation fluid in a patient with traumatic brain injury affect the outcome?
Authors: Nadeem Umar , Sarwar Sobia , Bilal Ahmad
Published: November 2023

Madam,
Traumatic brain injury (TBI) refers to non-congenital, non-degenerative damage to the brain caused by an external mechanical force which can lead to permanent or temporary impairment of cognitive, psychosocial, and physical functions, accompanied by a reduced or altered state of consciousness.1 TBI is the most frequently occurring among common neurological disorders and accounts for a significant public health challenge.2 TBI has a high prevalence worldwide in adolescent (15 to 18 years) and elderly (>65 years) groups with a reported incidence of 1.7 million cases in the US alone.3  Pakistan also has a high prevalence of TBI with approximately one-third of its population being affected by it mainly due to the high incidence of road traffic accidents.4
Patients with TBI often present with clinical features of shock especially when the mechanism of injury is associated with high-energy trauma like road traffic accidents. In such cases, there is an imminent need for fluid resuscitation which becomes more important in under-served areas where immediate neurosurgical care is not available. It is widely known that crystalloids are superior to colloids for the resuscitation of the patient in such settings.5 The ringer lactate solution is usually preferred over normal saline for resuscitation in non-TBI settings because of lower mortality but the same is not true in TBI settings in which normal saline has been reported with significantly lower mortality. This difference can be attributed to the fact that ringer lactate being a balanced crystalloid, is hypo-osmotic, and thus can increase the intracranial pressure as well as the incidence of hyponatremia in patients with TBI.6 Therefore, in TBI, normal saline should be the fluid of choice for resuscitation instead of ringer lactate solution.
The choice of fluid for resuscitation is of paramount importance in TBI, especially in a country like Pakistan where advanced healthcare facilities for neurosurgical care are not available in every city and village. Hence, many patients get referred to tertiary care centers from primary and secondary care centers after initial resuscitation for further management. In such cases, the correct choice of resuscitation fluid can significantly help in improving the odds of survival till patient’s arrival at higher care facility, and thereby help in decreasing the overall mortality associated with TBI.
The Valproic Acid Dilemma: Safe Alternatives for Pregnant Women and women of childbearing age with Epilepsy
Authors: Abid Momina , FNU javairia  , Abdul Basit
Published: November 2023

Madam,
Valproic acid is a widely used anticonvulsant medication that exerts its therapeutic effects by increasing GABA activity in the brain, making it a first-line therapy for focal and generalized seizures. However, despite its efficacy, the medication is associated with significant adverse effects in pregnant or childbearing-age women, with teratogenicity being the most severe outcome.
A Study1  published in Italy raised some serious concerns regarding prenatal exposure to valproic acid, which can affect the prenatal and postnatal intellectual development of the newborn, and the use of alternative drugs was preferred to reduce unwanted exposure to the drug.
Nordforks.org’s research and Taiwan’s2 research program 2022 concluded that the exposure of pregnant women to sodium valproate increases the chance of autism and intellectual disability up to 3 folds or more. In many countries of the world, the prescription of this drug during childbearing age has been banned and alternative medicine are prescribed instead.
In a study conducted in Brazil, it was discussed  that these antidepressants cause changes in gene expression, leading to structural and functional changes in various regions of the brain, leading to intellectual disabilities.
A group of researchers conducted a  meta-analysis3 i.e., published in Canada, concluded that  Medications like lamotrigine and levetiracetam have been proven to be statistically less teratogenic than valproate and monotherapy is preferred over polytherapy and the meta-analysis4 published in 2022 has proved lamotrigine to be the most suitable first-line alternatives to valproic acid.
According to JAMA's publication of 20235, taking sodium valproate during or before pregnancy increases the risk of neurodevelopmental disorders in children. On the other hand, prenatal exposure to lamotrigine does not increase the risk of such disorders.
In a developing country such as Pakistan, where a large proportion of the population requires proper counseling regarding medical treatments and follow-ups, physicians need to exercise due diligence when prescribing sodium valproate, particularly to female patients. The physician should ascertain whether the patient is of childbearing age and, if so, inquire about their marital status and pregnancy plans. Moreover, the physician must inform the patient and their attendants about the adverse effects of the drug if taken during pregnancy, the significance of alternative drugs, and the importance of regular follow-ups. The doctors must prioritize ensuring that patient receives thorough counselling on these issues to avoid mishaps in the future.
Diabetic pneumopathy: A latest finding
Authors: Ariba Fida  , Javed Muhammad Sheheryar , Fezan Rasool
Published: November 2023

Madam,
Diabetes is one of the major causes of death not only in Pakistan but worldwide. In Pakistan alone, approximately 33 million people suffer from Type 2 diabetes mellitus, with an additional 11 million adults with impaired glucose tolerance, while approximately nine million people with diabetes remain undiagnosed1. Diabetes causes many fatal complications including hypertension, myocardial infarction, stroke, chronic kidney disease, neuropathy, etc. To lower the morbidity and mortality rates, prompt screening and treatment of complications of diabetes should be done, especially the lesser-known complications.
In the past, a strong association between idiopathic pulmonary fibrosis and diabetes was noted by some physicians. This association was established by Stefan Kopf et al2. More recently a study funded by Diabetes UK (a British-based patient, healthcare professional, and research charity) at the Imperial College of London claimed that there is a strong association between lung disorders and Type 2 diabetes mellitus3. This study examined data from approximately 500,000 individuals in 17 large-scale investigations. According to the investigation, type 2 diabetics' elevated blood sugar levels directly affect lung function. For instance an increase in typical blood sugar levels from 4 mmol/L to 12 mmol/L. might cause a 20% decline in lung function and capacity. Dr. Ben Jones, Dr. Marika Kaakinen and Dr. Elizabeth Robertson were in pivotal positions in this research and they all quoted lung disorders occurring in Type 2 diabetic patients as a direct complication of diabetes3. Rajasurya V et al defined diabetic lung or diabetic pneumopathy as a condition characterized by progressive lung disease caused by the microvascular complications associated with diabetes mellitus4. The direct complications of diabetes mellitus in the lungs include interstitial lung disease and idiopathic pulmonary fibrosis. Interstitial lung disease involves different degrees of inflammation and fibrosis in the pulmonary parenchyma and Idiopathic pulmonary fibrosis involves chronic progressive fibrosis leading to progressive pulmonary failure4.
Knowing the extent of diabetic patients present in Pakistan and how quickly this number can escalate5,a clinical trial should be replicated on a larger population. There is a need to establish protocols for screening of diabetes related pneumopathy. People should be educated about these lesser-known complications of diabetes, and diabetic patients should be trained to perform pulmonary function tests at home. Overall these measures will surely help to improve the quality of life of a diabetic patient and to reduce gross morbidity and mortality rates.
Differences of sexual differentiation: A place under the sun
Authors: Sanjay Kalra
Published: November 2023

Binary rubrics are used to differentiate between living and non-living, animal and plant, vertebrate and invertebrate, mammalian and non-mammalian, as well as male and female organisms. While this approach helps in classifying the vast majority of the target population, we must remember that these frameworks are man-made. Many human beings may be born with phenotypic, karyotypic, gonadal and/or genital characteristics that “do not fit typical binary notion of male or female bodies”.1 Such births may as frequently as once in every 50 births, though 1 and 2 per 1,000 live births require, and/or receive “corrective” genital surgery.2 Intersex conditions are defined in various ways. Ambiguous genitalia and atypical genitalia occur if genetic and hormonal development are disturbed, and genital differentiation is hampered. A more inclusive term, difference of sexual development (DSD) uses karyotyping to classify such conditions. Types of DSDS include 46XX and 46XY sex chromosome DSD, XX and XY sex reversal, and ovotesticular disorders.3 Though frequently confused with transgender persons, and those with non-heterosexual orientation, persons with DSD are different from these. Hence, distinct advocacy for DSD needs to be carried out. As United Nations Human Rights states, “intersex children and adults are often stigmatized and subjected to multiple human rights violations, including violations of their rights to health and physical integrity, to be free from torture and ill-treatment, and to equality and non-discrimination.” 1 While South Asian countries have progressive legislation for transgender rights, awareness about the unique challenges faced by intersex people is lacking.4 Considering the near ubiquitous presence of endocrine disruptor chemicals in our environment, it may be prudent to expect, and prepare for, and increase in the incidence of differences of sexual differentiation.5 The case of persistent Mullerian duct syndrome, published6 in the current issue of the Journal of Pakistan Medical Association, should serve as a stimulus to enhance awareness and advocacy of this, as well as other DSD. Apart from ensuring accurate and appropriate diagnosis, one must focus on person sensitive communication, psychological support and social modulation.7 We commend the authors6 for their work in the field of DSD. Much more needs to be done, however. Policy makers, planners, members of the public, and persons living with DSD should work collectively to ensure that persons living with DSD should get their rightful place under the sun.
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Allotriophagy and Allotriodipsia in Endocrinology
Authors: Sanjay Kalra  , Avivar Awasthi  , Saurabh Arora  , Nitin Kapoor
Published: November 2023

Allotriophagy is defined as food cravings that are different from the expected or the norm. It gives clinical pointers to an underlying diagnosis. We propose a new term, allotriodipsia which suggests a preference for beverages that are different from the norm. Taken together, these two entities may point towards certain endocrinological abnormalities and iatrogenic sequelae. In this communication we highlight the clinical relevance of allotriophagy and allotriodipsia.
Keywords: Allotriophagy, Allotriodipsia, Anorexia nervosa, Bulimia nervosa, Food fads, Orthorexia nervosa, Osteomalacia, Sheehan’s syndrome.
Psychovigilance in diabetes
Authors: Sanjay Kalra  , Komal Verma  , Navneet Agrawal  , Atul Dhingra
Published: November 2023

Diabetes is associated with a myriad of mental health challenges, ranging from distress and depression to schizophrenia and substance abuse. These conditions are associated with hyperglycaemia, and also interfere with efforts to achieve good glucose control. One way in which this can be handled is by screening, early diagnosis, and timely management of mental health dysfunction and disorders. We term this action as psychovigilance.
Keywords: Anxiety, depression, diabetes distress, psychosocial aspects, type 1 diabetes, type 2 diabetes
Raman Spectroscopy: Can it change the future of Brain Tumour Surgery?
Authors: Qurat-Ul-Ain Virani  , Hafiza Fatima Aziz  , Shahzad Shamim
Published: November 2023

Raman Spectroscopy (RS) is one of several techniques being used to identify tumour tissue during brain surgery. It is emerging as a novel investigative and diagnostic tool. The application of RS in cancer treatment has displayed promising results. This review centers around its clinical implication in brain tumours.
Keywords: Raman spectroscopy, brain tumour, neurosurgery
Combined medial and lateral bucket handle meniscus tears with associated complete anterior cruciate ligament tear-a case report
Authors: Sohail Muhammad Amir , Bashir Amna , Umair Ul Hassan
Published: November 2023

The majority of meniscal tears in bucket handles are associated with anterior cruciate ligament (ACL) impairment. Its a rare condition which is rarely encountered when the meniscus has a bucket handle on both sides of the compartment. Here we present the case of a 28-year-old male cricket player with a total ACL rupture, a double Posterior Cruciate ligament (PCL) sign on MRI (Magnetic Resonance Imaging), an uncommon occurrence of a complex bucket handle rupture of the medial meniscus with a double PCL sign. It was a complete ACL tear and displaced bucket handle medial meniscus that was also visible on the magnetic resonance imaging. In this report, double PCL sign was shown on MRI and that was confirmed during the arthroscopic procedure.
Keywords: Complete ACL tear, combined medial & lateral bucket handle, meniscus tears.
Is a Therapeutic approach required to treat Insomnia in Pakistan?
Authors: Fatima Laveeza , Ahmad Danial  , Moosa Zulfiqar Ali
Published: November 2023

Insomnia, defined as difficulty falling or staying asleep, is prevalent among one-third of the general population. (1) It can give rise to various physical and mental problems, such as obesity, diabetes, anxiety, and depression. (2) While there are many effective medications for insomnia, a therapeutic approach for treating it is more likely to be dependable over time. A meta-analysis exploring the benefits of cognitive behavioural therapy (CBT) for chronic insomnia revealed an improvement of sleep onset latency by 19.03 minutes, a gain of total sleep time by 7.61 minutes, and improved sleep efficiency by 9.91%. (3)CBT has been recognized as a first-line treatment for insomnia by NIH Consensus and State of the Science Statements (4)as it is equally effective as medication for a brief treatment and is more reliable over time.
One in every three persons in Pakistan is reported to have sleep problems and, a third of those take sleeping pills. (5)In developing countries like Pakistan, where people don't have resources, a therapeutic approach is likely to reduce the cost and risk of adverse effects of medications. Pakistan is a pill-oriented society, and people prefer pills over therapy. The awareness among the population to adopt treatments or shift to therapeutic interventions is close to none. The cultural stigma associated with therapy is a significant hurdle as well. Unlike medicines, therapy reduces the risk of relapse after its discontinuation. Introducing therapy in the public sector can result in more jobs for therapists and counsellors and provide a cheaper alternative to pills. The best way to introduce CBT among the population is through awareness campaigns, media, and discussions on public platforms. In addition, counsellors can provide outreach in places where additional resources are required to combat the stigma associated with psychotherapy and inform people regarding its benefits. Counsellors collaborating with other health care professionals and gaining a valuable referral source from primary care physicians can also be a meaningful strategy. It would be worth mentioning here that more studies comparing the pills to CBT should be conducted to address the issue.
The Effectiveness Dimension of Training Initiatives on the Competitiveness and Sustainability of Micro-Asnaf Entrepreneurs.
Authors: Mohamed Shith Mohd Sirajuddin Siswadi Putera , Ahmad Rosli Muhammad Syahrul Deen , Yahya Mohammad Hasif , Abdul Rahim Memiyanty , Md Ismail Mohamad Afandi
Published: November 2023

The aim of this research study is to assess the effectiveness of training initiatives on the competitiveness and sustainability of Asnaf Micro-entrepreneurs (UMA). Asnaf Micro-entrepreneurs represent a vulnerable group that requires support and intervention to enhance their capabilities and entrepreneurial competitiveness. This study employs a quantitative research approach and collects data from a sample of n = 308 UMA participants who have undergone various training programmes. The Partial Least Squares Structural Equation Modelling (PLS-SEM) technique is used to analyse the data. The research findings reveal a significant positive relationship between different dimensions of training and the competitiveness of UMAs. Firstly, knowledge and skill development shows a significant positive effect on UMAs competitiveness, emphasising the importance of equipping UMAs with the necessary knowledge and expertise. Secondly, mindset and attitude formation is found to significantly influence UMA competitiveness, highlighting the role of fostering a growth-oriented mindset and a positive attitude in entrepreneurial success. Thirdly, networking initiatives and collaboration is proven to have a significant positive relationship with UMA competitiveness, highlighting the importance of nurturing networks, partnerships, and collaboration opportunities. Fourthly, access to resources and support demonstrates a significant positive effect on UMA competitiveness, emphasising the importance of providing UMA with adequate resources and support mechanisms.
Towards the implementation of the ‘School on the Shop Floor’ Curriculum Strategy in Zimbabwe Secondary Schools
Authors: Sithole Aleck , Hahlani Onismo Stephen , Muzari Tapiwa
Published: November 2023

The purpose of this study was to unpack why the School on the Shop Floor curriculum strategy has yet to be implemented since its birth in 2015 (Moyo,2015) before the competence-based curriculum was introduced in Zimbabwe Secondary Schools in 2017 (MoPSE,2015). The notion was to unearth the causalities of failure to embrace this educational thrust towards education 5.0’s initiative, teaching, research, community service, innovation, and industrialization by the school heads, heads of departments, and subject teachers. The study was guided by the bottom-up model for policy implementation based on a competence-based education curriculum that hinges on the transformation of society’s lives through innovations and industrialization by Royan and Grayson in 2003. The qualitative case study design was employed, where semi-structured interviews were instituted in data collection from school heads, heads of departments, subject teachers, and training officers. Selected school heads, heads of departments, subject teachers, and training officers were purposively considered to participate in the study. Three subject teachers, three training officers, three heads of departments, and three heads of schools comprised the selected participants. The study findings indicated that inadequate human, capital, and material resources were the major hitches to the implementation of a competence-based curriculum strategy in Zimbabwe secondary schools. The study was evaluated against Education 5.0 with the insertion of innovation and industrialization. All participants lamented the need for public-private partnerships in curriculum design and implementation, shared resources, knowledge, and skills for the benefit of the learners and community. The researcher recommends that the authorities under this Ministry of Primary and Secondary Education, (MoPSE) should observe that all incapacitated schools need to be resourced for the benefit of all the learners regardless of the regional sphere towards the development of the country and the world’s labor force to promote community service and entrepreneurship skills development (ESD).