bluuebunny/crossref_metadata_2025 huggingface dataset:
A metodologia de resolução de problemas aplicada ao ensino de matrizes no Ensino Médio
Authors: Borges Thiago Silva , Barbosa Augusto Cesar Castro , Concordido Cláudia Ferreira Reis , Costa Marcus Vinicius Tovar
Published: September 2021

A metodologia de Resolução de Problemas (RP) é utilizada no processo de ensino-aprendizagem como ferramenta para a introdução do conceito de matrizes no Ensino Médio. Uma experiência foi realizada em cinco turmas do 3º ano do Ensino Médio de uma escola pública tradicional da cidade do Rio de Janeiro. O conteúdo proposto aborda, de forma contextualizada, temas do cotidiano dos alunos, de modo a proporcionar uma maior identificação destes com a proposta metodológica. Em três turmas (Grupo 2), os problemas abordados foram postos antes da apresentação formal dos conteúdos, permitindo que os alunos entrassem em contato com problemas cujas soluções ainda não estavam formalizadas. De maneira oposta, em outras duas turmas (Grupo 1), os mesmos problemas foram explorados apenas após a apresentação formal do conteúdo, servindo como aplicação do que havia sido apresentado em sala. Dois aspectos fundamentais devem ser destacados neste trabalho: em três turmas o ensino de matrizes foi realizado através da resolução de problemas; nas outras duas turmas, o tópico abordado foi desenvolvido para a resolução de problemas. Apesar de resultados semelhantes obtidos nos dois grupos, a dinâmica de trabalho RP explicitou uma maior participação dos alunos nas atividades propostas, mostrando maior aproveitamento do conteúdo trabalhado.
Análise dos benefícios da implantação do ERP corporativo em cloud computing
Authors:   Pontifícia Universidade Católica - SP, Costa Alcidis Ferreira da , Galegale Napoleão Verardi
Published: September 2021

A finalidade do presente artigo se centra em identificar em empresa do setor de e-commerce, os problemas de manutenção de ERP em servidor próprio, comparativamente aos benefícios e custos de implantação do mesmo ERP em Cloud Computing. Os estudos foram desenvolvidos em uma empresa de São Paulo/SP, que adota como objeto social o comércio eletrônico de produtos em geral, que vinha enfrentando dificuldades ligadas ao desempenho do ERP mantido em servidor próprio. A migração para nuvem trouxe ganho de performance ao eliminar problemas como lentidão e redução do tempo em que o sistema e suas integrações ficavam inoperantes, ao passo que, aumentou os gastos com tecnologia da informação ligados ao ERP corporativo.
Language communication in a pragmatic perspective: Flouting the cooperative principle
Authors: Komorowska Ewa
Published: September 2021

The aim of the article is a pragmatic analysis of various linguistic communication situations in the light of Grice’s principle of cooperation (1975). The analysis shows that language strategies involve a deliberate flouting of the cooperative principle using various pragmatic functions. The presented communication strategies in English, German, Polish and Russian show similarities in their occurrence. The sender may convey intentions not directly, but by hidden means of expression which often become an exponent of an apparent question, a change in the argumentative direction, the use of ambiguous words, irony or even silence. Hence, we can talk about the implementation of the pragmatic functions of “language avoidance”, “counter-argumentation”, “counter-proposal”, “irony” etc.
Red neuronal convolucional para la percepción espacial del robot InMoov a través de visión estereoscópica como tecnología de asistencia
Authors: Cortes Zarta Juan Felipe , Giraldo Tique Yesica Alejandra , Vergara Ramirez Carlos Felipe
Published: September 2021

En el desarrollo de los robots de asistencia un reto importante consiste en mejorar la percepción espacial de los robots para la identificación de objetos en diversos escenarios. Para ello, es preciso desarrollar herramientas de análisis y procesamiento de datos de visión estereoscópica artificial. Por esta razón, el presente artículo describe un algoritmo de redes neuronales convolucionales (CNN) implementado en una Raspberry Pi 3 ubicada en la cabeza de una réplica del robot humanoide de código abierto InMoov para estimar la posición en X, Y, Z de un objeto dentro de un entorno controlado. Este artículo explica la construcción de la parte superior del robot InMoov, la aplicación de Transfer Learning para detectar y segmentar un objeto dentro de un entorno controlado, el desarrollo de la arquitectura CNN y, por último, la asignación y evaluación de parámetros de entrenamiento. Como resultado, se obtuvo un error promedio estimado de 27 mm en la coordenada X, 21 mm en la coordenada Y y 4 mm en la coordenada Z. Estos datos son de gran impacto y necesarios al momento de usar esas coordenadas en un brazo robótico para que alcance el objeto y lo agarre, tema que queda pendiente para un futuro trabajo.
El amor romántico. La erotización de la violencia patriarcal
Authors: Velázquez Torres Blanca Olivia
Published: September 2021

En este libro se presenta la problemática de la construcción social del amor romántico y las significaciones que tiene en la vida de las mujeres, con un enfoque básicamente en las experiencias de mujeres con estudios de niveles superiores residentes en San Cristóbal de Las Casas. Se revisa el amor como campo de estudio en las ciencias sociales y humanas, dedicando particular atención al campo de la psicología. De esta manera, el amor romántico se visibiliza como una construcción social originada en un momento histórico, en un contexto específico y con propósitos determinados. El libro incluye fragmentos de relatos de vida para ampliar el campo de conocimientos feministas en relación con el amor, que ilustran las significaciones que tiene en la vida de las mujeres, y concluye con una propuesta de intervención que pueda servir como herramienta para el análisis de sus relaciones amorosas.
Vuelta de tuerca. Aproximaciones críticas sobre el proceso electoral 2017-2018 y primeros atisbos de la Cuarta Transformación en Chiapas y México
Authors: García Aguilar María del Carmen , Gómez Abarca Carlos de Jesús , Manuel Martínez Espinoza , Delmar Méndez Gómez , Jesús Solís Cruz , Pablo Uc , Daniel Villafuerte Solís
Published: September 2021

Una vuelta de tuerca ocurre cuando sucede un giro en el argumento que transforma de manera dramática lo que se relata. Portando esta metáfora, este texto que analiza los comicios del 1 de julio de 2018 y los escenarios latentes proyectados durante los primeros meses del gobierno de AMLO y la Cuarta Transformación, surge la pregunta: ¿Qué hace que las elecciones de 2018 puedan o no ser consideradas como un hito diferencial en la historia reciente del país? Y si lo son, ¿en qué grado? Las reflexiones se sitúan desde la historia reciente del sistema político chiapaneco y el comportamiento del electorado; el rol de los poderes fácticos empresariales en México y la geopolítica vista desde la frontera sur mexicana; las implicaciones del régimen de política social para interpretar el nuevo proyecto de gobierno nacional; el desenvolvimiento de la campaña electoral del Concejo Indígena de Gobierno impulsado por el CNI y el EZLN, y las implicaciones de la comunicación política electoral leída desde la prensa escrita a nivel local. El texto es una invitación a trascender las lecturas formales y simplistas de los procesos electorales, va más allá de las cifras y la analítica del recuento de votos para ofrecer las caras ocultas, las reacciones de los actores más allá de los partidos políticos.
Las mujeres de la costa: el mar ya no quiere dar más
Authors: Castro Apreza Inés
Published: September 2021

Nuestra investigación sobre la denominada región Costa, conformada por los municipios de Arriaga, Tonalá y Pijijiapan, partió de un indicador sintomático: es la zona del estado de Chiapas menos estudiada en el marco de las Ciencias Sociales y de las Humanidades. En cierto sentido, ello constituye una ventaja porque supone innovar en un terreno casi virgen.
Región de Los Altos. Territorios en disputa y resistencia cultural
Authors: Olivera Bustamante Mercedes
Published: September 2021

Este documento está dedicado a Los Altos de Chiapas. Además de exponer los efectos más importantes de la crisis en las mujeres marginales de la región -indígenas en su mayoría- damos cuenta de sus estrategias para sobrellevar las tensiones que les provocan en su persona y familia, las múltiples carencias que han surgido o se han acrecentado con la crisis de los últimos años.
Región Selva. Las mujeres y la selva: espacio de destrucción ecológica y marginalidad social
Authors: Gómez Lara Horacio
Published: September 2021

Este texto se divide en cuatro partes. La primera da cuenta de lo que es la selva y el etnocidio de los lacandones, indígenas que habitaban la selva a la llegada de los españoles; en la segunda parte analizo el saqueo de las maderas preciosas y el establecimiento y formas de trabajo de las primeras fincas en la región; la tercera está destinada al análisis de la transformación de la selva de espacio natural a espacio social complejo, poblado de agentes indígenas y no indígenas de diversos orígenes, posiciones, intereses y rebeldías: campesinos, ejidatarios, migrantes, peones y terratenientes, empresarios nacionales y trasnacionales, empleados y trabajadores, instituciones e instancias de gobierno nacionales, zapatistas, ejército, paramilitares, narcotraficantes, etc.; finalmente en la cuarta sección del texto hago referencia específica a la situación, condición y participación actual de las mujeres marginales de la región.
Sobrevivir en violencia. Mujeres pepenadoras y el Sistema de Recolección de Basura en San Cristóbal de Las Casas, Chiapas
Authors: Balcorta Sobrino Montserrat
Published: September 2021

Este libro de Montserrat Balcorta se enfoca en uno de los más acuciantes problemas de marginación y exclusión social sistémi-ca que vivimos no sólo en Chiapas, sino en todo el país y todos los países del mundo, fuertemente afectados por el capitalismo glo-bal. En este caso, la marginación y la exclusión se asocian a otro grave e histórico problema urbano, que es el de la recolección de basura, la cual también se ha convertido en una mercancía mane-jada empresarialmente. No obstante, la importancia del análisis que hace la autora de este apasionante problema está puesto en las recolectoras informales de basura, es decir, en las actoras más invisibilizadas, explotadas y desechables del sistema capitalista patriarcal, que participan en ese proceso en San Cristóbal de Las Casas.
El estudio de la vida política en antropología: una evaluación
Authors: Fábregas Puig Andrés
Published: September 2021

El análisis del poder es un tema estimulante para todo profesional de las ciencias sociales, y a la antropología correspondió la tarea de presentar una novedosa perspectiva para su estudio, dando a conocer modalidades que la politología clásica no había siquiera imaginado. De esto se ocupa Fábregas en su temprano estudio de la vida política en antropología, el cual confeccionó con las herramientas del análisis marxista, tan en boga en las décadas de los sesenta y setenta. La revisión que hace de diversas obras escritas por destacados estudiosos de la antropología política manifiesta la rigurosidad del autor, desplegando erudición y amplio manejo del tema.
VAGINAL BIRTH AFTER CAESAREAN SECTION;
Authors: ZAHIRUDDIN SANA , QURESHI SUMERA RAUF , FAROOQ UMER
Published: September 2021

Background: Cesarean section is the commonest obstetrical procedure, associated with increase in maternal morbidity,the cesarean section rate is steadily on the rise in our country which can give rise to a number of complications. Objective: To determinethe factors associated with successful vaginal delivery after previous cesarean section. Study Design: Cross sectional study. Period:May 2009 to October 2009. Setting: Liaquat university hospital, Hyderabad. Material and Methods: a total of 96 women which fulfilledthe selection criteria were included in the study. Results: The women included in the study had a mean age of+SD(range),29.94+4.41successful vaginal birth was observed in 57(59.5%) women and 39(40.6%) had an emergency repeat cesareandelivery. The factors favoring successful vaginal delivery were history of previous vaginal delivery and previous cesarean due to fetaldistress or breech presentation, and patients having cesarean due to non progress of labor and no prior vaginal delivery were less likely tohave a successful vaginal birth after having previous cesarean delivery. Conclusions: vaginal birth after caesarean section can berecommended in patients having prior vaginal delivery and previous caesarean due to fetal distress and breech presentation.
PRIMARY NEUROENDOCRINE TUMORS
Authors: JALBANI MALIK HUSSAIN , SHAIKH NISAR AHMED , SHAIKH GHULAM SHABIR
Published: September 2021

Objective: To evaluate clinical presentation and surgical out come of primary neuroendocrine tumors of Kidney, U. bladderand Prostate gland. Design: A Retrospective study. Setting: Urology Department, SMBBMU Larkana. Period: 2001-2011. Patients andMethods: Series of 6 patients of primary neuroendocrine tumors of Kidney, U. bladder and Prostate gland were identified from 1890cases of urinary tract tumors. Two cases of renal carcinoid, two cases of small cell carcinoma of urinary bladder and two cases of smallcell carcinoma of prostate glands. Renal carcinoid tumors presenting with lumbar pain and microscopic haematuria and identified on theultrasound. Small cell carcinoma of urinary bladder presenting with dysuria, gross haematuria and on ultrasound while small cellcarcinoma of prostate gland presenting with irritatory and obstructive symptoms and confirmed on DRE. Results: 6 patients(5 male and1 female),Mean age of patients were 45years and range was 35-55 years. All patients treated primarily by definitive surgery like RadicalNephrectomy, TURBT and Pallitive TURP and all tumors confirmed on histopathological examination and referred to LINAR Larkana forproper managements. Conclusions: primary neuroendocrine tumors of Kidney, U.bladder and Prostate gland are rare tumors. Carcinoidtumors have good prognosis but small cell carcinoma have poor prognosis so require prompt treatment.
ARTHRITIS IMPAIRMENT;
Authors: AZHER NAHEED , KALSOOM SAMIA , SAEED MUHAMMAD
Published: September 2021

Objective: The purpose of this study was to explore physical limitations and clothing problems among women withRheumatoid arthritis and designing functional clothing according to their needs. Design: This study is designed to be qualitative in nature,where the researcher explores case studies of adult female with rheumatoid arthritis. Therefore qualitative methods were used, employingdata collection by in-depth interviews and observations. Period: The study was conducted in 2010- 2012 in Lahore. Material &Methods: The present study gives a clear picture about clothing problems while donning and doffing, of adult females with rheumatoidarthritis and the need for adaptive clothing. Research process comprised of assessing clothing needs, providing comfort while donningand doffing through co-designing and evaluating comfort of an adaptive garment after wear trail of three weeks. The researcher did adetailed thematic analysis using predetermined codes to aid analysis, of all the information gathered from three female participants of thestudy. The researcher found what was missing in the clothing that the participants wore in their regular lives, and worked with them to findout what they wanted in the adaptive clothing that provides them comfort. Results: The adaptive clothing was a successful mean tosatisfy the participant’s needs and preferences in a better way. It was also found that the co-designing of the final product was a veryeffective means of doing so; adaptive clothing can offer arthritis women an easy, time saving and pain free way to dress.
CIRRHOTIC PATIENTS;
Authors: BAWANY MUHAMMAD ADNAN , LIAQUAT JAHANGIR , AKBER MUHMMAD , Naz Falak , Khanzada Shereen Rahat , Khahro Adnan Ali , Arain Saeed
Published: September 2021

Objective: To determine the frequency of upper GI bleeding and its predicting factors and esophageal varices in the patientswith liver cirrhosis disease admitted at medicine ward of Isra university hospital. Design: Prospective and observational study. Setting:Isra university hospital. Period: March 2012 to August 2012 (six months). Methods: Containing 100 patients, mean age was 45.8, and allthe patients with cirrhosis disease were included in this study with liver cirrhosis disease. All patients were under went endoscopy andFrequency of upper GI bleeding and varices presentation and classification according to grade were noted. Results: All the 100 patientswere selected on the basis of presenting liver cirrhosis disease. Male were more found than the female with the mean age 45.8. Mostlycirrhotic patients were found with HCV positive and upper GI bleeding were noted in (40%) of the cases. With the endoscopic findingmostly patients were noted in ll - lll grad of esophageal varices and according to child pug classification majority of patients was noted inclass “C” In addition, thrombocytopenia and red wale markings along with the presence of large sized varices were associated with thepresence of esophageal varices. Conclusions: In the conclusion of this study we found majority of the cirrhotic patients with HCV,Esophageal varices and thrombocytopenia are the important factors of upper GI bleeding. Knowledge and etiology of this manuscript mayhelpful in the prevention of oesophageal varices and upper GI bleeding.
TETANUS;
Authors: MUAZZAM MUHAMMAD , MANSOOR SHEHZAD ADIL , BADAR SUMERA , Nadeem Asif , Anwar Bilal , Waseer M. Hussain , Ali Shoukat
Published: September 2021

Background: Tetanus still remains a major public health problem in Pakistan like in most other developing countries, with ahigh morbidity and mortality. Objectives: To study the demographic profile the clinical profile, the outcome of the tetanus patients andeffectiveness of tetanus immunization coverage in district Faisalabad. Design: Retrospective record based study. Place and Duration:Surgical unit-5 DHQ Hospital, Faisalabad from January 2010 to December 2012. Subjects and Methods: All data of 198 patients oftetanus of any age and sex, diagnosed clinically was collected, compiled and analyzed from the Medical Records Department of theHospital. Results: Out of 198 patients of tetanus,138(69.7%) were males and 60(30.3%) were females. Their ages ranged from 1 to 85years with a mean and a standard deviation respectively of 29.36 and 17.48 years.162 (81.8%) were from rural and36(18.2%) were fromurban areas. 47(23.7%) patients were having prior immunization and151(76.3%) were not immunized. The most common presentingsymptoms were trismus (47.5%), body stiffness(24.2%),fits(19.2%) and respiratory distress(9.1%). 23(11.6%) patients were havingmild disease,71(35.9%) patients were having moderate disease,71(35.9%) patients were having severe disease and 33(16.7%) werehaving very severe disease. Overall mortality rate was 41.4%. Respiratory failure was the most common cause of death and there wasstatistically significant association between mortality and increasing grades of disease. Conclusions: By making expanded programmeof immunization(EPI) more effective and removing flaws from out-dated vaccination through incomplete vaccination. By improvingawareness in public and complete vaccination through EPI program, we can reduce the incidence of tetanus.
PULMONARY TUBERCULOSIS;
Authors: BHATTI SAEED AKRAM , KHAN ABDUL HASEEB , ALAM MAQBOOL
Published: September 2021

Objective: To assess the frequency of smear positive pulmonary tuberculosis patients diagnosed at private laboratories ofSargodha not included in the national DOTS (Direct Observational Therapy Short Course) programme. Study Design: A retrospectivestudy. Place and Duration of Study: Private laboratories of Sargodha from January 2007 to December 2012. Methodology: Dataanalysis of 3952 patients who reported to private laboratories of Sargodha for staining of sputum for AFB was carried out. They were allself reporting and were either suspects of pulmonary tuberculosis or had a history of contact with a smear positive case of TB. Stainingwas done by Ziehl-Neelson method. The smear results were reported as positive or negative. Results: Out of total 3952 specimens 373(9.21%) were found to be positive for the presence of acid fast bacilli. From these 373 positive cases 164 (44%) were female and 209(56%) were males. The age group most frequently associated with the smear positive result was aged > 55 years (13.89%) followed byage < 15 years (10%). Conclusions: A large number of smear positive patients are diagnosed in private sector. These patients are notregistered in DOTS programme of World Health Organization. Their number is not included in the calculating the prevalence TB in ourcountry. It is recommended that TB case notification should be made mandatory by law by private sector health care providers.
UTILIZATION OF OPERATION THEATRE;
Authors: BAKHTIAR, NIGHAT , JAWAID, MASOOD , KHALIQUE, ABDUL , Iqbal, Pervez
Published: September 2021

Objective: To find out the number and variety of different surgeries performed at the operation theatre of the Dow UniversityHospital. Methods: From January 2011 to December 2011, hospital operation theatre record was reviewed. Main outcome measureswere age, gender, medical record (MR) number, name of operations with their indications, specialty and type of anesthesia used duringthe procedure, type of surgery. Monthly trend of surgeries were also evaluated. Results: The total numbers of operations performedduring first year of operation theatre working were 539 cases. Number of emergency surgeries done was 42 (7.79%) and elective were497 (92.2%).Surgeries performed by General Surgery, Gynecology and Plastic surgery department were 319 (59.18%), 61 (11.3%), 54(10.0%). MR Number was not present in record register in 306 (56.7%) cases, indication for surgery was not written in 274 (50.8%)cases and name of surgery was missing in 18 (3.3%) cases. The most common case performed were different types of biopsies whileother common cases performed in the year 2011 were incision and drainage, cholecystectomies and hernia repair. Conclusions: Therecord maintained was overall satisfactory however needs further improvement. Computerization of records with training of staff aboutits proper maintenance can improve its quality with international standards.
MULTINODULAR GOITER;
Authors: BHATTI, ZULFIQAR ALI , PHULPOTO, JAVED AHMED , SHAIKH, NOOR AHMED
Published: September 2021

Objective: The object of this study was to determine the frequency and type of thyroid carcinoma in Multi nodular goiter(MNG) after surgical resection on histopathological basis. Introduction: Multi nodular goiter (MNG) is one of the common presentationsof various thyroid diseases. Thyroid nodules have been reported to be found in 4% to 7% of the population on neck palpation. Although incomparison to solitary nodule, the risk of malignancy in MNG is low but certain studies are showing significant risk. Material andmethods: This prospective, observational study was carried out in the surgical unit I of Ghulam Mohammad Mahar Medical collegehospital sukkur from 2007 to 2012. 94 cases with clinical diagnosis of MNG were analyzed during this period. All the patients wereadmitted through opd with routine investigations plus investigations specific to thyroid including thyroid profile, thyroid scan, FNAC ofdominant nodule before being subjected to surgery. All FNACs were carried out at agha khan university hospital Karachi. Histopathologyof operated specimen was the main criteria for malignancy. Results: Among the 94 cases which were included in this study, 9 (9.5%)cases containing foci of malignancy. Incidence of malignancy commonly occurs in females, papillary carcinoma is being the commonestentity. Conclusions: The incidence of malignancy in MNG in this study is 9.5% that is quite high. So people should be educated andencouraged to attend the thyroid clinics for proper evaluation and early diagnosis of Malignancy.
CHRONIC GOUT AND HYPERURICEMIA
Authors: Shah Faaiz Ali , Khan Haziqdad , . Kifayatullah , Durrani Zulfiqar Ali , . Smatullah , Khan Zahir
Published: September 2021

Objective: To assess the urate-lowering efficacy and safety of Febuxostat versusAllopurinol in subjects with hyperuricemia and gout. Study design: Randomized controlled trial.Place and duration of study: Department of Orthopaedic and Trauma Surgery Mardan MedicalComplex Teaching Hospital Bacha khan Medical College Mardan from February 2012 to March2013. Material and Methods: Fifty patients of chronic gout and hyperuricemia fulfilling theinclusion criteria were divided into two equal groups by random method having 25 patients eachand received either a fixed dose(80 mg) of Febuxostat (Group A) or Allopurinol (Group B) 300mgonce daily for 16 weeks. The primary end point was the percentage of patients reaching serumurate level <6.0 mg/dl (360 μ mol per liter) at final visit. The secondary end points includereduction in the incidence of gout flares and adverse drug reactions. Results: There were16(64%) males and 9(36%) females with mean age 44.92 years in group A while group B had15(60%) males and 10(40%) females with mean age 46.24 years. At final visit Febuxostat grouphad mean uric acid level of 4.72 mg/dl ±1.56 SD while Allopurinol group had mean serum uricacid level of 6.34 mg/dl ±1.82 SD with majority of patients (84%, n=21) in group A achievingserum uric acid level of < 6 mg/dl (360 μmol/l) while only 60 percent (n=15) of the patients ingroup B had serum urate level of < 6 mg/dl.(P= <0.05). Gout flare was reported in 12 % (n=3) ofgroup A patients and 36% (n=9) in group B patients. Adverse drug reactions were reported in12% (n=3) of group A patients while 24% (n=6) in group B. Conclusions: Febuxostat lowerdserum uric acid levels more potently than Allopurinol while having minimal gout flares and sideeffects.
ORAL HYGIENE
Authors: Hussain Mehmood , Hasan Syed Imran , Khan Moin , Arsalan Amna , Tabassum Shajia
Published: September 2021

Objective: To observe the status of oral hygiene and its association with otherfactors in patients visiting Hamdard University Dental Hospital. Study Design: It was adescriptive type of study. Place and Duration of study: The study was carried out at HamdardUniversity Dental Hospital, Karachi. Total duration of this study was one year. Methodology: Nonprobability purposive sampling technique was used. Total 581 patients were included in thisstudy, after taking consent structured questionnaire was administered to evaluate informationfrom all patients. Then patients were divided into three groups on the basis of their oral hygienestatus. Results: In this study 228 were males while 353 were females. In males only 6.1% patientshad good oral hygiene while 28.5% & 62.2% had fair and poor oral hygiene respectively. Infemales 8.2% had good oral hygiene while 39.6% & 18.13% had fair and poor oral hygienerespectively. Among males 88.1% use tooth brush while 3.5% use finger for teeth cleaning whilein females this ratio was 91.7% 7 3.3%. Conclusions: In males frequency of poor oral hygienewas comparatively high which may be linked to smoking and dietary habits.
NON-MALIGNANT LESIONS;
Authors: Soomro Aftab Ahmed , Magsi Pirbux , Sangi Hamid Ali , Chand Haresh
Published: September 2021

Background: The presence of a mass in the nasal cavity and paranasal sinusesmay seem to be simple problem, but it is very difficult to differentiate clinically from potentiallymalignant tumors. Objective: To evaluate the clinical presentation and histopathologicalfeatures of the non malignant lesions of nasal cavity and paranasal sinuses. Study Design:Prospective descriptive study. Place and duration of study: Study was carried out indepartments of Paediatrics and ENT at Ghulam Muhammad Mahar Medical College HospitalSukkur from Jan 2009 to Dec 2012. Patients and Methods: The study included all cases of nonmalignantmasses of nasal cavity and paranasal sinuses, those attended the Paediatric & ENTdepartment and underwent the surgical intervention. One hundred twenty non-malignant caseswere enrolled for this study. A separate pro-forma was filled to record the cases biodata, history,clinical examination, investigations and histopathological diagnosis. All histopathologicallyproven malignant masses were excluded from the study. Results: Out of 120 cases 78 (65%)were males and 42 (35%) were females, with M:F ratio of 1.8:1. The age of presentation rangedfrom 8 years to 70 years and mean age was 26.3years. Sinonasal masses were found to bebilateral in 20 cases (16.67%), right sided in 65 (54.17%) and left sided in 35 (29.16%) cases. Themain presenting symptoms were nasal blockage 110 (91.66%), nasal discharge 102 (85%),sneezing 60 (50%), hypoinsomnia 36 (30%), epistaxis 24 (20%), headache 20 (18.33%) andmouth breathing 18 (15%) cases. Polyp was the most common lesion in 86 (71.66%) casesobserved in this study. The common histopathological diagnosis was simple inflammatory nasalpolyp in 48 (40%), allergic nasal polyps 30 (25%) and fibroepithelial polyp in 8 (6.7%), invertedpapilloma in 12 (10%), angiofibroma 6 (5%), capillary hemangioma 4 (3.34%) andrhinosporidiosis 4 (3.34%) cases. Conclusions: Sinonasal masses have various differentialdiagnoses and are still thought to be simple problem in our society. There is a need for earlyrecognition and referral to ENT surgeon and need histopathological examination of every massto confirm the diagnosis.
HIRSCHSPRUNG’S DISEASE
Authors: Ishfaq Muhammad Imran , Ahmad Umar Farooq , Manzoor Saima
Published: September 2021

Objective: To determine the frequency of Hirschsprung’s Disease as a cause ofneonatal intestinal obstruction, to compare the results of treatment with others and to suggestmeans and ways to improve the deficiencies in our circumstances. Place and duration of study:Nishtar hospital and Ibn-e-Siena Hospital, Multan from January, 2008 to June, 2012.Methodology: A total number of 115 patients from neonatal age to more than 5 years werediagnosed and treated for Hirschsprung’s Disease. Results: Hirschsprung’s Disease was acause of neonatal obstruction in 26 (22.6%) patients. Hirschsprung’s Disease was a cause ofrecurrent diarrhea in 37 (32.17%) patients. 76 (66.08%) patients presented with chronicconstipation. 27 patients underwent for pull-through operation. Conclusions: The overallcomplications rate and stooling pattern after Soave’s procedure are not significantly differentfrom others.
FREQUENCY OF STROKE IN HYPERTENSIVE PATIENTS
Authors: Lohano Ashok Kumar , Samie Adnan , Siayal Noor Nabi
Published: September 2021

Objective: To determine the frequency of intracerebral hemorrhage inhypertensive patients. Study design: Cross sectional study. Setting: This study was conductedat Medical department of Peoples Medical College & Hospital Nawabshah, from 01-01-2012 to31-12-2012. Material and methods: Admitted patient through emergency department withhistory of hypertension more than two years, meeting the inclusion criteria taken consent fromattendant. Patient was referred for C.T scan brain presence of hyperdense area was consideredas intracerebral hemorrhage. Inclusive criteria were age >20 years, either sex and patients withhistory of hypertension more than two year with any two or more sign and symptoms like suddenunconsciousness or with hemiplegia, hemiparesis, dysarthria. Aphasia, cranial nerve palsies.Exclusion criteria were age less than 20 years, normotensive patients with cerebral hemorrhageand patients with traumatic hemorrhage. Results: Among 281 patients that had stroke, therewere 147 males and 134 females with a sex ratio males: female 1:1. Mean age of patientsadmitted with intracerebral hemorrhage was 37.89 ± 7.33 years with an average age amongmales and females was same. Duration of hypertension was greater than 20-25 years in most ofthe patients nearly 63.7%. Patients with long duration of diabetes and hypertension presentedwith intracerebral hemorrhage. Nearly all the patients with intracerebral hemorrhage weresmokers 145, only 2 patients were non smokers and nearly all had long history of smoking. The127 patients who presented with intracerebral hemorrhage were obese. All risk factors werestatistically significant and were responsible for intracerebral hemorrhage. Conclusions:Hypertension is a risk factor for intra cerebral hemorrhage. An effort should be made to controlblood pressure and other modifiable risk factors to reduce incidence of intra cerebralhemorrhage and improve patient outcomes.
VARICOSE VEINS;
Authors: Das Khanpal , Ahmed Shakeel , Abro Shahnawaz , Arain Muhammad Saeed
Published: September 2021

Objective: The objective of this study is to evaluate the outcome of the surgicalmanagement including the surgical techniques (ligation and stripping, phlebectomy) andrecurrence of varicose veins. Study design: Observational study. Setting: Study was conductedat the unit of general surgical of Liaquat University Hospital. Study period: One year fromFebruary 2011 to February 2012. Materials and methods: This study was contains 40 patients ofvaricose veins who were undergone surgery. The routine investigations were done. The patientsunderwent suitable treatment based on their clinical and investigational profile. The postoperative course was noted. Further the patients were followed up and final outcome evaluated.Results: From all of 40 cases females were more found in this study as compare to men andmostly patients were found in the age group of 41 to 60 and the second most common age groupwas 21-40. From the postoperative complications wound infection was noted in the majority ofthe cases 17.5%. 2 patient had recurrence of varicose veins i.e. 5.0%. Conclusions: Varicosevein surgery is safe, acceptable and cost effective as a day case or ambulatory surgicalprocedure. Preoperative selection of the patients is mandatory to achieve optimal results.Surgical techniques, (ligation and stripping, phlebectomy) has given good results at ourHospital.
MINIATURE RADIOGRAPHY
Authors: Salam Abdus , Din Saif Saif-Ud-
Published: September 2021

Objective: This study was designed to find out the utility of MMR in hospital-basedsetup. Study Design: An observational, analytical study. Place and duration: The study wasconducted at Radiology Department POF Hospital Wah Cantt for a period of two years. The studywas started on 01st August 2009 and ended on 31st July 2011. Results: Out of 1401 patientsattended 988 were advised MMR for pre employment med checkup and 413 reported for annualcheckup (Table I). 91% (1291) were male and 110 were female (Table II). Majority (64%) of thesubjects belonged to age group 20 to 30 years. (Table III).16 patient had pulmonary tuberculosis.(Table IV) Conclusions: MMR is suggestive rather than diagnostic .It merely separates personsfor whom further investigations are required. According to international standard our facility ismuch underutilized.
OSTEOARTHRITIS;
Authors: Awan Malik Muhammad Yasin , Ahmad Ijaz , Aziz Amer
Published: September 2021

Objective: To assess the efficacy and safety of aceclofenac in the treatment ofosteoarthritis. Study design: Randomized double blind Phase IV trial. Place and Duration ofstudy: This study was conducted in the department of Orthopaedics & Spine Surgery, GhurkiTrust Teaching Hospital, Lahore. The duration was eight weeks. Methodology: A total of 90subjects, fulfilling the inclusion criteria and willing to give free informed consent were enrolled inthis trial. All these subjects were randomized into two treatment groups (A & B). Subjects eitherreceived Aceclofenac 100 mg twice daily or Diclofenac 75 mg twice daily for 08 weeks. During thescreening visit, information on their demographic characteristics, medical history and previousand current medications were collected. A thorough physical examination and necessarylaboratory investigations were carried out before drug administration and after the completion oftreatment (end of week 8). Clinical examination was done at baseline visit, randomization and 2, 4and 8 weeks. Gastrointestinal (GI) safety was assessed using adverse drug reaction (ADR)reports. WOMAC questionnaire was used to see improvement in activities of daily living and painwas assessed using visual analogue scale (VAS). All data was collected in the case report form(CRF). Statistical evaluation was performed at the end of the trial and results were analyzed usingSPSS. Results: 70 subjects completed the study while 20 were lost in follow-up. There were 28males and 34 females in the study with mean age of 56 years. There was a significant decrease inWOMAC and VAS scores in both groups. In group A (Diclofenac group) VAS decreased from7.107 to 2.538 (p= 0.000) and WOMAC decreased from 32.75 to 7.38 (p=0.000). In group B(Aceclofenac group), VAS decreased from 7.912 to 6.0 (p=0.001) while WOMAC decreased from37.29 to 21.50 (p=0.000) showing the efficacy of both drugs. There was also significant decreasein the disease severity in both groups at the end of treatment. But the safety profile of (Diclofenac)group A was not significant (p=0.767) as compared to (Aceclofenac) group B (p=0.022).Conclusions: Aceclofenac is efficacious and safe drug for the treatment of osteoarthritis in adultsas compared to Diclofenac.
PREGNANCY INDUCED HYPERTENSION;
Authors: Khan Asghar , Fahim Amin , Qureshi Aneela , Nizamani Ghulam Shah , Azmi Mohammad Ahmed
Published: September 2021

Objective: To assess the early detection of thrombocytopenia in womenpresenting with varying degree of pregnancy induced hypertension (PIH). Study Design: A casecontrol study. Place of Study: Hematology laboratory Isra University Hospital Hyderabad.Duration of Study: From July 2009 to December 2010. Materials and Methods: Total 130pregnant women were included in this study. The subjects were divided into three groups asGroup 1 with pre-eclampsia, Group 2 with eclampsia and Group 3 with normotensive pregnantwomen as control group. The Group 1 was further divided into two sub groups such as Subgroup1a with mild preeclampsia and Sub-group 2b with severe pre-eclampsia. Results:Anticoagulated whole blood samples (5cc) from all subjects were analyzed for the detection ofthrombocytopenia for the possible involvement of pregnancy induced hypertension. It was notedthat out of total subjects, 33(25.39%) had mild pre-eclampsia, 17(13.07%) had severe preeclampsia,15(11.54%) had eclampsia and 65 (50.0%) were normotensive pregnant women.Based on the comparative findings, the results showed significant differences between group 3and group 1a (p-value 0.001), group 3 and group 1b (p-value 0.001), group 2 and group 3 alsoshowed same results (p-value 0.001) but the subjects of group 1a and 1b when compared,showed non-significant findings (p value 0.955). Conclusion: The results suggested that earlydetection of platelet count provide significant role for the assessment of severity of disease inwomen with pregnancy induced hypertension when compared with normotensive pregnantwomen.
SURGICAL MANAGEMENT OF MULTINODULAR GOITRE;
Authors: Ahmad Irshad , - Sarwat , Rehan A. G
Published: September 2021

Background: A prospective, analytical study conducted to compare the results oftotal thyroidectomy with subtotal thyroidectomy in the management of multinodular goitre.Objective: comparison of total thyroidectomy and subtotal thyroidectomy for the managementof multinodular goitre in terms of postoperative complications. Patients and Methods: Aprospective review of 120 patients with benign multinodular goitre (bilateral) undergoing totalthyroidecotmy (Group A=60) and subtotal thyroidecotmy (Group B=60) during 2 years period(2011-12) was undertaken. Evaluation of results was done by analyzing the data in SPSS version17. Results: In group A, total thyoidectomy was done, the postoperative complications werelesser (13.33%) than group B in whom subtotal thyroidectomy was done (16.67%). Thecomplications seen in group A were seroma formation 1(1.67%), external laryngeal nerve (ELN)palsy 2 (3.34%), recurrent laryngeal nerve (RLN) palsy (temporary) 2 (3.34%) andhypoparathyroidism 3 (5.00%). The complications seen in group B were tension haematoma 01(1.67%), seroma formation 2 (3.34%), ELN palsy 2 (3.34%), RLN palsy (temporary) 3 (5.00%) andhypoparathyroidism 2 (3.34%). No mortality was seen in both groups. Conclusions: Totalthyroidectomy is better procedure than subtotal thyroidectomy for the treatment of benignmulitnodular goitre. This procedure also prevents future need of surgery for recurrence andincidental thyroid cancer.
ADRENALINE;
Authors: Baloch Naseer Khan , Jafri Nusrat , Danyal Ahmed
Published: September 2021

There is no doubt that the effects of the catecholamines of the heart are mainly due to the stimulation of β-adrenoceptors but in the mid 1960’ s the first evidence was presented that a-adrenoceptors mediating positive inotrpoism exists also in the myocardium beside well established β -adrenoceptors. In our observation adrenaline shows a positive inotropic response. The response of adrenaline in presence of metoprolol (β1blocker) showed negative inotropic effect.
ACUTE APPENDICITIS;
Authors: Saeed Zahid
Published: September 2021

Background: Acute appendicitis is the commonest cause of acute abdomen presenting in emergency room, which is mainly diagnosed on clinical grounds. Objective: To determine the diagnostic accuracy in patient of acute appendicitis and to review the pathological diagnosis. Material and Method: A retrospective study was conducted at PNS SHIFA hospital at Karachi; from May 2012 to April 2013. A total of 120 patients were included in the study who presented with acute abdomen and clinically diagnosed as acute appendicitis. Emergency appendectomy was done in all consecutive subjects and intra operative finding along with histo-pathological reports were compared with clinical diagnosis. Results: A total of 120 patients were included in the study who underwent appendicectomy during this period. The majority of our patients were in the age group between 15-30 years (66.5%) and presented within 24 h of onset of symptoms. The most common symptoms were abdominal pain (100%), vomiting (57.4%) and anorexia (49.0%). Pyrexia was noted in 41.0%.Localized abdominal tenderness with positive release sign was mainly present. The most common incision was gridiron (57.2%) followed by Lanz (37.3%) and in remaining Rutherford Morrison incision was made. Acute appendiceal inflammation and gangrenous appendicitis was present in 67% and 13%, respectively. The perforation rate was 5.0% and there was a direct correlation with time of presentation. There were no patients with carcinoid tumour or adenocarcinoma. Parasites and other associated conditions were seen in 3 % of cases. On the basis of histo-pathological report, 84% were found to have acute appendicitis with negative appendicectomy rate of 16.0%. Conclusions: Clinical surgical skill is good enough to diagnose acute appendicitis but auxiliary diagnostic tools can help to elevate the diagnostic accuracy,but these are not 100% accurate and at times may not be available.So clinial good judgement is essential for proper diagnosis and that can be confirmed by histopathology report.
TYPE 2 DIABETES MELLITUS;
Authors: Jaffery Mukhtiar Hussain , Shah Nisar Ahmed , Jaffri Muhammad Sajid Abbas , Memon Athar Hussain , Shah Syed Zulfiquar Ali
Published: September 2021

Objective: To determine the frequency of raised C-reactive protein (CRP) in patients with type 2 diabetes mellitus. Patients and methods: This cross sectional descriptive study of six months study was conducted at Liaquat University Hospital Hyderabad from March 2013 to August 2013. All diabetic patients of ≥35 years age of either gender for >01 year duration visited at OPD were evaluated for C-reactive protein and their glycemic status by hemoglobin A1c. The data was analyzed in SPSS and the frequency and percentage was calculated. Results: During six month study period, total 100 diabetic patients were evaluated for C-reactive protein. Majority of patients were from urban areas 75/100 (75%). The mean ±SD for age of patients with diabetes mellitus was 51.63±7.82. The mean age ±SD of patient with raised CRP was 53±7.21. The mean ±SD for HbA1c in patients with raised CRP is 9.55±1.73. The mean random blood sugar level in patients with raised CRP was 247.42 ± 6.62. The majority of subjects from 50-69 years of age group with female predominance (p = 0.01) while the CRP was raised in 70(70%) patients in relation to age (p=0.02) and gender (p=0.01) respectively. Both HbA1c and CRP was raised in 64.9% (p = 0.04) in patients with type 2 diabetes mellitus. The mean ±SD of CRP was 5.8±1.21 while for male and female individuals with raised CRP was 3.52±1.22 and 5.7±1.63 respectively. Conclusions: The raised CRP was observed in patients with type 2 diabetes mellitus
HEMORRHAGIC STROKE;
Authors: Shahab Faisal , Shahwani Irfan Murtaza , Ansari Shuaib , Shah Syed Zulfiquar Ali
Published: September 2021

Objectives: To identify the frequency of risk factors in hemorrhagic stroke at Liaquat university of medical and health sciences. Patient and methods: This Descriptive case series study of six months was carried out in the department of medicine, Liaquat University of Medical and Health Sciences. Patients aged 20-70 years of age with hemorrhagic stroke on CT were enrolled in the study after taking consent from caretaker of patients. Detailed history focusing on hypertension, diabetes and smoking and their duration was taken. Blood pressure was recorded and fundoscopy was done to find out diabetic or hypertensive retinopathy. Thorough neurological examination and fasting / random blood glucose level was evaluated while the data was done was analyzed using SPSS version 16. Results: A total of 100 patients were included in the study during study period. 61% of patients were in > 50 years of age group with mean age of 53.4±11 years. A total of 66 (66%) were male; with male to female ratio was 2:1. Hypertension was present in 63% of cases, Diabetes was found in 24% cases and 44 patients were cigarette smokers. Conclusions: It was concluded that high blood pressure, diabetes mellitus and smoking are associated with hemorrhagic stroke.