bluuebunny/crossref_metadata_2025 huggingface dataset:
Smart Enclaves in the Borderland
Authors: McDuie-Ra Duncan
Published: May 2021

Imphal, the capital city of Manipur, was one of 100 cities awarded bids
in India’s Smart Cities Mission (SCM). The extension of the SCM to the
borderland is an extension of zone-logic, enrolling the recalcitrant frontier
into economic networks that cross India. Through a reading of Imphal’s
smart city bid and implementation strategy, this chapter makes three
main arguments. First, unlike zone-making projects in other parts of Asia
where local elites, brokers, and/or local governments doggedly pursue the
granting of zones, the extension of the SCM to Imphal has been driven
more by obligation than desire. Second, the idea of an “open city” is counter
to the lived reality of surveillance, checkpoints, and limits on mobility
and assembly that characterise life in the city. Third, Imphal’s meagre
bid and lack of preparedness is barely relevant to the smart city award,
as the geopolitical imperatives outweigh all other factors.
Post-Disaster Economies at the Margins
Authors: Plachta Nadine
Published: May 2021

This chapter is concerned with the making of development zones in Nepal’s
northern borderlands. Focusing on the shifting economic geographies of
traders and businessmen, I demonstrate that the current revival of border
markets and informal economies is inseparable from the combined processes
of state restructuring and infrastructural reconstruction that ensued after the
2015 earthquakes devastated large parts of the country. I seek to develop the
category of “informal development zones” to attend to the ways in which state
power is enacted to control and discipline the margins in the post-disaster moment,
while also foregrounding how rural inhabitants engage with, resist, or
support the formalities of state laws and regulations. Looking closely at local
narratives of social differences and insecurities, I show how people navigate
the complex space between competition and choice to carve out investment
strategies and entrepreneurial opportunities. Informal development zones are
transforming life in borderlands and offer an urgent reminder of the uncertain
and uneven outcomes of market economies following moments of rupture.
Development from the Margins
Authors: Hargyono Sindhunata
Published: May 2021

This paper argues that the moulding of the promise of development
zones with existing local aspirations for the future generates a powerful
affective force that potentially incites social transformation. The paper
demonstrates this argument by examining suspended development in an
Indonesian border village, Long Nawang, which is designated by the state
as a prospective border economic centre. The paper highlights how the
promise of accelerated development intensifies existing aspirations for
urbanity among border elites and villagers. The aspiration persists among
the elites even when development zones do not materialise as intended
due to delays in key development milestones in Long Nawang. The paper
illustrates this persistence by looking at how the elites use their authority
to fashion the villagers into tame development subjects in a vague bid to
keep the potential urbanised future alive.
From Boom to Bust – to Boom Again?
Authors: Rippa Alessandro
Published: May 2021

The Boten SEZ at the China-Laos border is undergoing major development
as part of China’s Belt and Road Initiative (BRI). Its story goes back to
2007 when Boten opened as a land concession for a Chinese hotel-casino
complex. Yet crime and mismanagement led to its abrupt closure in 2011,
when most people left. This chapter is based on research in Boten in
2015-2017, between the zone’s first failure and its current boom. After
introducing the history of Boten I show how “waiting” for development
became an embodied trope for those living in the SEZ throughout this
period. Secondly, I engage with the notion of “suspension” as an analytical
device to address development zones in the context of China’s global
ambitions.
Genealogies of Extraction
Authors: Mikkelsen Thomas , Eilenberg Michael
Published: May 2021

Taking departure from the failure of a planned but never realised special
economic zone (SEZ) in the Indonesian borderland city of Tarakan, we
argue that this planned SEZ would paradoxically not have been the island
of sovereign exception often associated with SEZs, but rather a zone
where central government would have had comparably more control
than they have in the surrounding borderlands. This leads us to argue
that the entire borderland surrounding Tarakan can be considered a de
facto development zone in itself. Additionally, the de facto development
zone is multigenerational, having been through a number of booms and
busts, triggering both migrations and environmental ruination, while
central state authority and interest have waxed and waned accordingly.
Roman Infrastructure in Early Medieval Britain
Authors: Fafinski Mateusz
Published: May 2021

Early Medieval Britain was more Roman than we think. The Roman Empire left vast infrastructural resources on the island. These resources lay buried not only in dirt and soil, but also in texts, laws, chronicles, charters, even churches and landscapes. This book uncovers them and shows how they shaped Early Medieval Britain. Infrastructures, material and symbolic, can work in ways that are not immediately obvious and exert an influence long after their creators have gone. Infrastructure can also rest dormant and be reactivated with a changed function, role and appearance. This is not a simple story of continuity and discontinuity: It is a story of adaptation and transformation, of how the Roman infrastructural past was used and re-used, and also how it influenced the later societies of Britain.
Global Perspectives on China's Belt and Road Initiative
Authors: Schneider Florian , Ferchen Matt , Forough Mohammadbagher , Ghiasy Richard , Gonzalez-Vicente Ruben , d’Hooghe Ingrid , Kuik Cheng-Chwee , Links Stacey , van der Lugt Sanne , Mosquera Valderrama Irma Johanna , Petkova Mirela , van der Putten Frans-Paul , Sampson Michael , Wang Jue
Published: May 2021

The year 2013 saw the launch of the largest, most influential investment initiative in recent memory: China's Belt and Road Initiative (BRI). This globe-spanning strategy has reshaped local economies and regional networks, and it has become a contested subject for scholars and practitioners alike. How should we make sense of the complex interactions that the BRI has enabled? Understanding these processes requires truly global perspectives alongside careful attention to the role that local actors play in giving shape to individual BRI projects. The contributions in Global Perspectives on China's Belt and Road Initiative: Asserting Agency through Regional Connectivity provide both 'big picture' assessments of China's role in regional and global interactions and detailed case studies that home in on the role agency plays in BRI dynamics. Written by leading area studies scholars with diverse disciplinary expertise, this book reveals how Chinese efforts to recalibrate the world are taken up, challenged, revamped, and reworked in diverse contexts around the world.
Reconstruction, Replication and Re-enactment in the Humanities and Social Sciences
Authors: Dupré Sven , Harris Anna , Kursell Julia , Lulof Patricia , Stols-Witlox Maartje , Kalshoven Petra Tjitske , Hillditch Jill , Fidom Johannes (Hans) , Peters Peter , Carlyle Dr. Leslie , Hagendijk Thijs , Principe Lawrence , Heering Peter , Vergunst Jo , Sibum H. Otto
Published: May 2021

Performative methods are playing an increasingly prominent role in research into historical production processes, materials, bodily knowledge and sensory skills, and in forms of education and public engagement in classrooms and museums. This book offers, for the first time, sustained, interdisciplinary reflections on performative methods, variously known as Reconstruction, Replication and Re-enactment (RRR) practices across the fields of history of science, archaeology, art history, conservation, musicology and anthropology. Each of these fields has distinct histories, approaches, tools and research questions. Researchers in the historical disciplines have used reconstructions to learn about the materials and practices of the past, while anthropologists and ethnographers have more often studied the re-enactments themselves, participating in these performances as engaged observers. In this book, authors bring their experiences of RRR practices within their discipline into conversation with RRR practices in other disciplines, providing a basis for interdisciplinary cross-fertilization.
The Iconization and Mythologization of Byron’s Life and Work in Nineteenth-Century Netherlands and Europe
Authors: Oosterholt Jan
Published: May 2021

Lord Byron is one of the most striking nineteenth-century examples of
an icon in the modern sense of the word. Far into the nineteenth century
Byron and the main characters from his poems remained models for the
rebellious ‘romantic’ hero: a modern version of Milton’s fallen angel. Much
has been written about Byron’s work, life and reputation. This enduring
interest makes ‘Byron’ ideally suited for a demonstration of research into
the historical development of an iconic person as a cultural model. The
chapter analyses the Dutch reception of Byron and shows its entanglement
with the discussion about the ‘un-Dutch’ character of Romanticism.
Paradoxically, there was also an appropriation of Byron, resulting in a
Christian ‘light’ version of the ‘Byronic hero’.
Brigitte Bardot: The Making, Recycling, and Afterlife of an Icon
Authors: Vincendeau Ginette
Published: May 2021

This chapter highlights the dynamics of the modern media icon by analyzing
how Brigitte Bardot was a star made by the image (photography and
film) and by reconstructing how her celebrity survived through the image.
It discusses the emergence, evolution and impact of Bardot as a cultural
icon and her continued relevance long after she stopped making films in
1973. In doing so, the chapter demonstrates how Bardot can be perceived
as an icon in several senses – literally as the model of photographers,
filmmakers and painters, culturally as creator and bearer of fashion and
lifestyle that were widely imitated, and symbolically as the articulation
of a sexualized rebellion against the conservative, patriarchal France of
the time.
Archive, Photography and the Language of Administration
Authors: Birkin Jane
Published: May 2021

This alternative study of archive and photography brings many types of image assemblages into view, always in relation to the regulated systems operating within the institutional milieu. The archive catalogue is presented as a critical tool for mapping image time, and the language of image description is seen as having a life, a worth and an aesthetic value of its own. Functioning at the intersection of text and image, the book combines media culture, archival techniques, and contemporary discourse on art and conceptual writing.
Nic Cheeseman et Jonathan Fischer (2019) - Authoritarian Africa: Repression, Resistance, and the Power of Ideas
Authors: Angelo Anaïs
Published: May 2021

Recensé : Cheeseman, Nic et Fischer Jonathan, Authoritarian Africa: Repression, Resistance, and the Power of Ideas, Oxford, Oxford University Press, 2019, 144 p.
CORRELATION OF TRISOMY 12 WITH CLINICAL FEATURES AND OTHER LABORTARY PARAMETERS IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKAEMIA
Authors: Ahmed Ali , Hussain Ch Altaf , Malik Hamid Saeed , Naeem M Abdul , Mehmood Rafia , . Khadija
Published: May 2021

Objective: To determine the frequency of trisomy 12 in B-Cell chronic lymphocytic leukaemia (CLL), to correlate its association with clinico-pathologic features and to determine the role of this cytogenetic defect to the prognosis.

Study Design: Cross sectional study.

Place and Duration of Study: Haematology department, Armed Forces Institute of Pathology, Rawalpindi, from May 2017 to Aug 2018.

Methodology: A total of 56 newly diagnosed patients of Chronic Lymphocytic Leukaemia were included in the study. Patients were diagnosed on the basis of National Cancer Institute Working Group guidelines. A detailed history and thorough clinical examination were performed and complete blood counts, biochemical profile, bone marrow examination, immunophenotyping on bone marrow/peripheral blood samples were done for the diagnosis of Chronic lymphocytic leukaemia. Interphase FISH studies were performed on blood/bone marrow aspiration for detection of Trisomy 12 were performed.

Results: Out of 56 patients, trisomy was detected in 12 (10.7%) patients. Out of 7 patients with trisomy 12, five patients presented in late stages (Binet stage B and C), however this association of Trisomy 12 with Binet stage was also statistically insignificant (p=0.474). About six with trisomy 12 were positive for CD 38, however this association was also not statistically significant (p=0.124). Results revealed that patients having trisomy 12 underwent chemotherapy at diagnosis and during follow ups as compared to patients having other cytogenic abnormalities. Moreover, patient with trisomy 12 develop progression in disease during course of illness, however association was statistically insignificant (p>0.05)............
COMPARATIVE STUDY OF SEROMA FORMATION IN HARMONIC SCALPEL VERSUS ELECTROCAUTERY IN POST MODIFIED RADICAL MASTECTOMY
Authors: Shahid Muhammad Farooq , Ibrahim Taseer , Muazzam Muhammad Ali , Chaudhry Hummaira , Bukhari Usman Shah , Ahmed Ghufran
Published: May 2021

Objective: To compare the frequency of seroma formation in harmonic scalpel vsunipolar electrocautery in post modified radical mastectomy (MRM).

Study Design: Quasi experimental study.

Place and Duration of Study: General Surgery Department, Pak Emirates Military Hospital Rawalpindi, from Jul to Dec 2017.

Methodology: Eighty women with breast carcinoma planned for modified radical mastectomy were included in the study with inclusion and exclusion criteria and divided in equal group A (Harmonic) and group B (Unipolar cautery). Randomization was performed by lottery method for both groups. A standard level III clearance was performed. All patients were followed up on weekly basis and seroma formation was evaluated in both groups.

Results: Mean age in group A and B was 51.36 ± 11.04 years vs 52 ± 11.19 years (p>0.05). Mean duration of complain in group A and B was 1.675 ± 0.47 months vs 1.775 ± 0.42 (p>0.05). Mean time of procedure in group A and B was 110.00 ± 4.71 mins vs 100.875 ± 5.14 (p>0.05). Mean body mass index in group A and B was 30.217 ± 4.99 kg/m2 vs 30.210 ± 5.31 kg/m2 (p>0.05). Seroma formation in group A and group B patients were found to be 5 (12.5%) vs 10 (25%) with (p>0.05).

Conclusion: Frequency of seroma formation in harmonic scalpel is lower than electrocautery in post modified radical mastectomy, so it can be safely performed along with harmonic scalpel with reduced duration of drainage and seroma formation.
DEMOGRAPHICS AND CORRELATION OF RISK FACTORS FOR HEPATOCELLULAR CARCINOMA IN PATIENTS PRESENTING TO A TERTIARY CARE FACILITY IN PAKISTAN
Authors: Rashid Hafsa , Alam Laima , Farooq Muhammad Asif , Ali Muhammad Zafar
Published: May 2021

Objective: Demographics of HCC in Pakistan. Correlation of HCC with its possible etiology. Correlation of tumoraggressiveness with PCR status and anti-viral treatment.

Study Design: Cross sectional study.

Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi from Jul 2017 to Jun 2018.

Methodology: Patients with age >18 years presenting with space occupying lesion(s) of liver were confirmed to be HCC according to standard guidelines. The variables such as age, gender, presence of cirrhosis, etiology of cirrhosis, tumor staging, viral status through PCR study and the treatment offered were documented. Baseline descriptive data was reported as mean with SD for continuous variables. Chi square test was used to compare qualitative data.

Results: A total of 195 patients were enrolled for one year. Male population with HCC was in predominance (75.9%). Sixty one percent of the afflicted population was having liver cirrhosis, 34.9% had decompensated cirrhosis and 3.8% had no cirrhosis. HCV accounted for the bulk of patients with cirrhosis (82%) followed by HBV (9.2%), HBV and HCV co-infection (3.1%), NASH and cryptogenic cirrhosis (1.5% each). Majority got diagnosed with triphasic CECT scan Abdomen, only 3.6% needed liver biopsy for diagnosis. Majority (43.6%) belonged to BCLC B. Viral PCR was positive for 58.5% and 73.8% of the patients were treatment naïve.

Conclusion: HCC shows highest rates seen in male patients presenting in old age. Gender, classes of cirrhosis, number of lesions, portal vein thrombosis and extrahepatic metastasis correlated with possible risk factors of HCC. Tumor aggressiveness correlated with PCR status..............
IMPACT OF PHYSICIAN LED LIFE STYLE MODIFICATIONS (DIET AND DAILY STEP COUNT BY USING PEDOMETER) ON GLYCEMIC CONTROL OF PATIENTS WITH TYPE II DIABETIC
Authors: Azhar Rimsha , Uttra Khurshid , Khan Andaleeb , Awan Marriam Hussain , Anwer Ayesha , Lodhi Muhammad Wajahat Alam , Qureshi Muhammad Waleed Hassan
Published: May 2021

Objective: To determine the impact of physician led life style modifications (diet and daily step count by using pedometer) on glycemic control of type II diabetic patients

Study Design: Quasi experimental study.

Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, Aug 2018 to Feb 2019.

Methodology: The sample population comprised of 200 diabetic patients reporting for the routine follow-up at a tertiary care hospital in Rawalpindi. Patients were divided into two groups by random method. Group A had the patients with continuation of the routine anti-diabetic medication while group received the physician led life style modifications in addition to the routine anti diabetic medication. Values of HBA1c among the groups were compared three months after the start of study.

Results: Mean age of the patients was 42.19 ± 6.175 years. Mean duration of DM in the study participants was 4.52 ± 4.166 years. Out of 115 patients were male while 85 were female. HBA1c in the intervention group was 7.96% ± 0.39 while in the control group was 7.04% ± 0.81. Difference between the two groups was statistically significant (p-value<0.01).

Conclusion: This study showed a significant difference in glycemic control of patients who received physician led life style modification in addition to conventional biological treatment than those who only received the routine anti-diabetic medication. Physicians should be trained to impart this sort of education to the diabetic patients in routine diabetic clinics.
VARIOUS FACTORS INVOLVED DURING SAFE LAPAROSCOPIC CHOLECYSTECTOMY IN CASES OF EMPYEMA GALL BLADDER
Authors: Ismail Muhammad , Watto Nasir Mehmood , Butt Muhammad Qasim , Naz Fareeha
Published: May 2021

Objective: To evaluate the various factors involved during the safe cholecystectomy performed by laparoscopic method in cases of empyema of gall bladder operated at Pak Emirates Military Hospital Rawalpindi.

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from Nov 2017 to Mar 2019.

Methodology: This study was performed on 70 patients undergoing cholecystectomy by laparoscopic method for empyema gall bladder during the study period. Adverse effects after the procedure were assessed in detail at 48 hours, at time of discharge and two weeks after the procedure on all the participants. Demographic profile and other factors were compared in the groups with and without the complications by using the chi-square test and binary logistic regression.

Results: Out of 70 patients included in the final analysis 24 (34.3%) were male and 46 (65.7%) were female. Mean age of patients who underwent laparoscopic surgery for empyema gall bladder in our study was 42.43 ± 3.161 years. Bile duct perforation and leakage 6 (8.5%) was the commonest complication among the patients included in our study followed by surgical site infection 5 (7.1%). With binary logistic regression we found that presence of co-morbids and high preoperative C reactive protein had a strong association with presence of complications among the patients undergoing cholecystectomy in our study while age, gender, transfusion during surgery were not linked with the complications during or after the study.

Conclusion: Limited number of patients faced the complications during or after the surgery. Patients with co-morbid.............
PRESCRIPTION AUDIT IN OUTPATIENT DEPARTMENTS OF TERTIARY CARE HOSPITALS; FACTS AND RECOMMENDATIONS
Authors: Khan Muhammad Wasiullah , Khurshied Saleh , Khurshid Nawal , Iqbal Rafay , Khizer M Azeem , Ahmed Hammad
Published: May 2021

Objective: To evaluate written prescriptions according to a checklist based on WHO guidelines (prescription audit). To compare prescriptions of senior and junior physicians and to provide data and recommendations.

Study Design: Cross-sectional, analytic study.

Place and Duration of Study: Pak Emirates Military Hospital, and Combined Military Hospital, Rawalpindi Pakistan, from March to Aug 2018.

Methodology: A total of 205 prescriptions using convenient sampling technique were analyzed according to a checklist based on WHO guidelines for standard prescription writing. Data was analyzed using SPSS-22.

Results: Out of total 205 prescriptions, 83 (40%) prescriptions belong to senior and 122 (60%) to junior physicians. Fifty (25%) prescriptions lacked patient name, 49 (24%) lacked age. Gender was mentioned in only 117 (57%) prescriptions. Date, diagnosis and dosage of drug were written in 170 (83%), 172 (84%) and 177 (86%) respectively while dosage form and route of administration were mentioned in 144 (70%) and 102 (50%) respectively. Generic name was written in only 75 (37%) prescriptions. Name and stamp of the doctor were available on 135 (66%) and 125 (61%) prescriptions respectively. A statistically significant association was observed between senior and junior physicians in terms of error in name of patient and dosage form (p=0.002& 0.005 respectively).

Conclusions: Prescriptions were mainly deficient in the generic names of drugs. Route of administration was missing in half of the prescriptions. None of the parameters was totally accurate. Prescriptions from junior physicians had more errors.
REMISSION RATE OF PRE-B ALL (ACUTE LYMPHOBLASTIC LEUKEMIA) AFTER INDUCTION CHEMOTHERAPY FOLLOWING UNITED KINGDOM ACUTE LYMPHOBLASTIC LEUKAEMIA 2011 (UKALL 2011) TRIAL PROTOCOL
Authors: Murtaza Hafiz Muhammad , Ghafoor Tariq , Iqbal Muhammad Shaheen
Published: May 2021

Objective: To find out the rate of remission of Pre-B Acute Lymphoblastic Leukaemia in children at the end of induction treatment with United Kingdom Acute Lymphoblastic Leukaemia (UKALL) 2011 chemotherapy protocol.

Study Design: Prospective observational study.

Place and Duration of Study: Paediatric Oncology Unit, Combined Military Hospital Rawalpindi, from Nov 2017 to Oct 2018.

Methodology: Data of newly diagnosed patients of Pre-B Acute lymphoblastic Leukaemia, between 1 and 15 years of age was analysed. Patients were divided into low and high-risk groups and treated with United Kingdom Acute Lymphoblastic Leukaemia 2011 induction chemotherapy on regimens A and B respectively. Bone marrow aspiration was performed at the end of induction therapy (28 days), to document their remission status. Patients having ≤5% of blast cells were categorized to be in remission state and those with >5% blast cells were not considered in a state of remission.

Results: A total of 79 patients, 45 (57%) male and 34 (43%) females were enrolled. The mean age was 5.79 ± 3.59 years. Fever (86.1%) and pallor (77.2%) were the most common presentations. Fifty-three (67.1%) patients were treated with regimen A and 26 (32.9%) had regimen B chemotherapy. Febrile neutropenia and myopathy were the most common complications seen in 73 (92.4%) and 54 (71.1%) patients respectively. Eight patients (10.1%) died during induction chemotherapy. Bone marrow aspiration done at the end showed a 100% rate of remission for both regimens A and B.

Conclusion: Risk-based treatment of paediatric Acute lymphoblastic Leukaemia............
CHOROIDAL THICKNESS IN PATIENTS WITH DIABETIC MACULAR EDEMA
Authors: Aqil Amash , Moin Muhammad , Abid Khadijah , Mehmood Ahsan
Published: May 2021

Objective: To evaluate central macular thickness and choroidal thickness in patients with macular edema due to diabetic retinopathy versus controls.

Study Design: Cross-sectional comparative study.

Place and Duration of Study: Department of Ophthalmology, Lahore General Hospital, Lahore, from Jan to Jul 2018.

Methodology: A retrospective data of 100 eyes from 50 patients having with diabetic macular edema associated with diabetic retinopathy was extracted from hospital registry. Additionally, 100 eyes of 50 individuals without any preexisting ocular conditions, comprising a control group was included in the study. Choroidal thickness measurements were made from the posterior edge of the retinal pigment epithelium to the choroid/sclera junction at subfoveal level using optical coherence tomography. Central macular thickness was also measured for all the enrolled patients.

Results: One hundred patients fulfilling the inclusion criteria were enrolled in our study. The mean age was 56.27 ± 14.41 years. The mean Central macular thickness of all the patients were reported as 270.49 ± 72.38 μm, while the choroidal thickness was 284.89 ± 96.51 μm. There was statistically significant difference in central macular thickness between both healthy and diabetic retinopathy with diabetic macular edema groups (p=0.001), whereas insignificant difference existed between the two groups forchoroidal thickness (p=0.735).

Conclusion: In patients with diabetic macular edema no significant change in choroidal thickness was observed compared with healthy controls, while the thickness of the retina was high in patients with macular edema due to diabetes.
EFFECTS OF THREE ORAL ANALGESICS ON POSTOPERATIVE PAIN FOLLOWING ROOT CANAL PREPARATION: A CONTROLLED CLINICAL TRIAL
Authors: Islam Shahid , Ali Muhammad , Shaikh Abubakar , Rashid Saqib , Hosein Tasleem , Baloch Jiand
Published: May 2021

Objective: To compare the effect of single dose of three analgesics on postoperative endodontic pain following pulpectomy in teeth with irreversible pulpitis.

Study Design: A quasi-experimental study.

Place and Duration of Study: Endodontics Department, Fatima Jinnah Dental College Hospital Karachi, from Jan to Oct 2018.

Methodology: In this Double Blind placebo controlled study, 120 subjects coming with the complaint of irreversible pulpitis in any one tooth were randomly allocated into 4 groups. Each group took either naproxen sodium (550mg), ibuprofen (400mg), tramadol (100mg) or placebo medication (multivitamin tablet) immediately after the pulpectomy appointment. A questionnaire was designed to assess the experienced pain based on VAS scale at 6, 12 and 24 hours postoperatively. KruskalWallis test was applied followed by post-hoc analysis to compare the VAS scores by taking p-value ≤0.05 as significant.

Results: Pain levels were significantly lower in experimental groups as compared to placebo (p<0.001) but there was no statistically significant difference between the effectiveness of naproxen, ibuprofen and tramadol at 6, 12 and 24 hours postoperatively.

Conclusion: Naproxen, Ibuprofen and Tramadol were found to beequally effective in reducing pain after instrumentation in teeth with irreversible pulpitis.
Academic Misconduct Among Medical Students; A Multiple College Study
Authors: Saeed Muhammad Akram , Farrukh Soufia , Hussain Wajahat , Badar Samina , Zaidi Arif Ahmed , Abbas Huda
Published: May 2021

Objective: To determine the frequency of academic misconduct among students of medical colleges affiliated with University of Health Sciences in Punjab.
Study Design: Cross-sectional analytical study.
Place and Duration of Study: Different Public and Private sector medical colleges in Punjab affiliated with University of Health Sciences, from Jan 2018 to Dec 2018.
Methodology: Multistage stratified random sampling technique was used to select the study subjects. Information was collected on a self-administered questionnaire containing the common trends of academic misconducts. Data was entered and analyzed through SPSS version 22.
Results: Total 2000 students were enrolled in the study with equal participation from public and private sector. Mean age of the respondents was 21.82±1.82 years. Overall frequency of academic misconduct was high i.e., 1928(96.4%). The most frequent academic misconduct was asking friend to mark the proxy (84.45%) and the least frequent reported misconduct was using cell phone for exchange of answers (14.25%). The difference of academic misconduct among students of public andprivate sector medical college students was significant (p-<0.001). The academic misconduct was also significantly different(p=0.005) among students from rural and urban residential backgrounds.
Conclusion: Academic misconduct was found a serious problem among medical students studying in public and private sector medical colleges of Punjab, Pakistan.Key words: Academic misconduct, Medical col
TO DETERMINE EFFICACY OF GRANISETRON VERSUS PLACEBO FOR REDUCING SHIVERING IN PATIENTS UNDERGOING LOWER SEGMENT CAESAREAN SECTION UNDER SPINAL ANAESTHESIA
Authors: Abbas Sana , Yasin Bilal , Khan Basit Mehmood , Hayat Umer , Hanif Rashid , Fayyaz Mohsin
Published: May 2021

Objective: To determine the efficacy of granisetron versus placebo (saline) for reducing shivering in patients undergoing lower segment caeserian section under spinal anaesthesia.

Study Design: Comparative cross - sectional study.

Place and Duration of Study: Department of Anaesthesia, Combined Military Hospital Rawalpindi, from Apr to Sep 2019.

Methodology: Total 178 patients undergoing lower segment ceaserian section under spinal anaesthesia with age ranges from 18-40 years of American Society of Anaesthesiologists status I & II with full term pregnancy scheduled for elective caesarean section under spinal anaesthesia. Group A (n=92) received an intravenous bolus of 1 mg granisetron in a 10ml syringe and Group B (n=86) received intravenous bolus of normal saline in a 10ml syringe, drugs were administered immediately before spinal anaesthesia by anaesthetist as coded syringes. Heart rate, blood pressure, core body temperature and shivering scores were measured at 0 minutes, 30 minutes and 60 minutes, average surgery time recorded to be 60 minutes.

Results: None of the patients in group A (drug group) exhibited appreciable post spinal shivering whereas 25 (29%) in group B (placebo) had clinically significant shivering necessitated administration of other established pharmacological agents to abort shivering in order to ensure patient comfort and satisfaction with statistically significant p-value of <0.05.

Conclusion: Prophylactic injection granisetron was efficacious against post spinal shivering, moreover provides worth while relief of nausea and vomiting which is dilemma with most of the drugs employed for control of post spinal shivering.
RELATIONSHIP BETWEEN RED BLOOD CELL AND PLATELET INDICES IN IRON DEFICIENCY ANEMIA
Authors: Rabbani Sahar , Farooq Muhammad , Naeem Samina , Naeem , Muhammad Abdul , Uddin Nasir , Zubair Muhammad
Published: May 2021

Objective: To find out the correlation between the red blood cell and platelet indices in patients presenting with iron deficiency anemia at a tertiary care hospital of Pakistan.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Hematology, Combined Military Hospital Lahore, from Sep 2018 to Mar 2019.

Methodology: The patients of age 1-70 years of either gender presenting with IDA were included in the study. The blood sample of patients were sent to laboratory to assess the red blood cell and platelet indices. SPSS-23 was used to analyze data.

Results: Two hundred and seven patients fulfilling the inclusion criteria were included in this study. The mean age was 25.6 ±17.8years. Correlation was weak and insignificant between haemoglobin and packed cell volume (r=-0.385**, p<0.01), haemoglobin and mean cell volume (r=-0.225**, p<0.01), packed cell volume and mean cell haemoglobin (r =0.263**, p<0.01), & mean cell haemoglobin and mean platelet volume (r=0.143*, p<0.05). Correlation was moderate and significant between platelet distribution width and mean platelet volume (r=0.511**) & platelet distribution width and platelet large cell ratio (0.502**, p<0.01). Correlation was strong between mean platelet volume and platelet large cell ratio (r=0.759**, p<0.01).

Conclusion: In conclusion, there was significant relation between red blood cell and platelets indices in iron deficiency anemia. Furthermore, haemoglobin and packed cell volume are weekly correlated, platelet distribution width and mean platelet volume are moderately correlated and mean platelet volume and platelet large cell ratio are strongly correlated.
LIMB ISCHAEMIA AND MULTISYSTEM DYSFUNCTION AS A CONSEQUENCE OF CHOLESTEROL EMBOLIZATION SYNDROME
Authors: Faisal Mohammad Jamal , Arif Anum , Bhatti Ahsin M
Published: May 2021

Following a Coronary artery bypass graft and insertion of an intra-aortic balloon pump, the 63 year-old male patient developed signs of progressive multi-organ dysfunction and ischaemic changes in both of his lower limbs. The diagnosis of cholesterol embolization syndrome was made. This condition has been noted to be a complication of invasive procedures and endovascular therapies, and is often overlooked and difficult to treat. While the patient’s renal function and pancreatitis showed improvement, the lower limb ischaemia was progressing. Eventually, the patient underwent a bilateral below knee amputation.
CHRONIC DIARRHEA IN SOLDIERS; FACTS
Authors: Hafeez Muhammad , Saeed Farrukh , Qureshi Zafar , Khan Saad Ali , Siddiqi Fuad Ahmad
Published: May 2021

Objective: To find out the underlying causes of chronic diarrhea in soldiers and how it differs from general population.

Study Design: Prospective comparative study.

Place and Duration of Study: Combined Military Hospital (CMH) Multan and Pak Emeritus Military Hospital (PEMH) Rawalpindi, from Dec 2017 to Jan 2020.

Methodology: All soldiers in active service, having diarrhea more than 4 weeks in study and non-soldiers of the same age were included in the control group. There were inquired in details about the diarrhea symptoms and investigations carried out accordingly to find out the underlying cause. The two groups were compared to find out any differences. The data were analyzed by SPSS version 22.

Results: Seventy one in study and 50 patients in control had their mean ages of 34.61 ± 8.35 and 32.42 ± 10.28 years. Mean duration of symptoms were 18 and 15 months in study and control groups respectively. Irritable Bowel Syndrome (IBS) was more common in both groups i.e. 14 (20%) and 20 (40%) in study and control groups respectively but frequency was more in second one. Seropositive celiac disease 13 (18.5%), seronegative villous atrophy 10 (14%) in study and Inflammatory Bowel Disease IBD 6 (12%) in control group were second most common conditions.

Conclusions: Irritable bowel syndrome is common in this age group. Celiac and seronegative villous atrophy is second common conditions in the study group.
EVALUATION OF CHONDROPROTECTIVE EFFECTS OF INTRA ARTICULAR PIROXICAM IN POST-TRAUMATIC OSTEOARTHRITIS MODEL OF RAT
Authors: Ishaq Noaman , Ali Shabana , Haider Qurra Tul Ain , Qaisrani Muhammad Abdul Basit , Malik Komal Mumtaz , Khan Muhammad Wasiullah
Published: May 2021

Objective: To evaluate the chondroprotective effect of piroxicam in post-traumatic osteoarthritis model of rat.

Study Design: Laboratory based experimental study.

Place and Duration of Study: Pharmacology department, Army Medical College, Rawalpindi, from Apr to Jun 2019.

Methodology: Project included sixteen rats of Sprague Dawley breed. Osteoarthritis was induced in anesthetized rats by surgical removal of medial meniscus and anterior cruciate ligament resection. After that rats were randomly allocated in two groups with eight rats in each group. Rats of group I were positive control that received 0.2 ml saline intra articularly once weekly for four weeks. Meanwhile rats of group II (treatment group) received 50 µl piroxicam intra articularly once weekly for four weeks. One week after the drug intervention, radiograph of the right knee joint of all rats were taken. Animals were then sacrificed with inhaled chloroform and part of proximal tibia was obtained for histopathological analysis.

Results: Comparison of radiographs of both groups depicted a significant p-value of <0.01. Meanwhile mean histopathological score of control group and treatment group were 11.50 ± 1.195 and 6.50 ± 1.195 respectively with a p-value of <0.01.

Conclusion: Intra articular administration of piroxicam in post-traumatic Osteoarthritis model of rats resulted in improvement in radiographic grades and histopathology scores.
ASSESSMENT OF STROMAL AND INTRA-EPITHELIAL TUMOR INFILTRATING LYMPHOCYTES IN COLORECTAL CARCINOMA AT ARMED FORCES INSTITUTE OF PATHOLOGY
Authors: Ameer Amna , Akhtar Farhan , Ud Din Hafeez , Ahmed Rabia
Published: May 2021

Objective: To conduct a morphological evaluation quantitatively of two types of tumor-infiltrating lymphocyte populations, including those located in the stroma and intraepithelial cancer structures, in patients with colorectal cancer.

Study Design: Cross sectional study.

Place and Duration of Study: Armed Forces Institute of Pathology, Rawalpindi, from Jan to Jul 2019.

Methodology: Three levels of infiltration in the stroma by tumor infiltrating lymphocytes were determined. Level 1 was weak meaning (0-20% of stromal TILs), level 2 was moderate meaning (>20-50% of stromal TILs); and level 3 was strong meaning (50-90% of stromal TILs). TILs within tumor cells were divided into two groups. 0 meaning absent (no TILs present) and 1 meaning present (≥TILs in tumor cells) 1.

Results: Out of 30 cases 22 were males and 8 females. Ages ranged between 25-83 with a mean of 57 years and a standard deviation of ± 16.4 years. All of the cases were diagnosed cases of adenocarcinoma. The levels of stromal tumor infiltrating lymphocytes was weak in 1 case, moderate in 18 cases and strong in 11 cases whereas intraepithelial lymphocytosis was seen in 22 cases.

Conclusion: These results confirm that the infiltration of tumor infiltrating lymphocytes into the tumor in patients with colorectal carcinoma serves an important role in the invasion and progression of the disease, and should be considered in routine examinations.
PREGNANCY OUTCOMES DO INFLUENCE BY EXTREMES OF BODY MASS INDEX
Authors: Razzaq Lubna , Devi Ramna , Tariq Sana , Seetlani Anchal , Jamshed Saira
Published: May 2021

Objective: To investigate whether extreme of body mass index (BMI) is associated with pregnancy outcomes.

Study Design: Retrospective cohort study.

Place and Duration of Study: Hamdard University Hospital, Karachi, Pakistan, from Feb 2019 to Jan 2020.

Methodology: We conducted a retrospective cohort study of 1000 women delivered in between February 2019 to January 2020. BMI is categorized into four groups according to the Asian-Pacific cutoff points as underweight (<18.5 kg/m2), normal weight (18.5–22.9 kg/m2), overweight (23–24.9 kg/m2), and obese (>25 kg/m2). Maternal outcomes measured were pre-eclampsia, gestational diabetes, delivery by cesarean section, instrumental delivery, anemia, postpartum hemorrhage and fetal outcome included small for gestational age and large for gestational age. Logistic regression model was used to adjust the confounder. Maternal outcomes were evaluated with relative risks and 95% confidence intervals.

Results: In results, 13%, 54%, 22%, 9% and 2% were underweight, normal body mass index, overweight, obese and morbidly obese categories respectively. The gestational diabetes, pre-eclampsia, labour induction, frequency of cesarean section, postpartum hemorrhage increased linearly with increasing body mass index and expressed as adjusted odds ratio (95% confidence interval) respectively: 10.0 (95% CI 3.5, 28.7), 5.3 (95% CI 2.0, 14.1), 2.7 (95% CI 1.1, 6.8), 4.9 (95% CI 2.8–8.8), 2.5 (95% CI 0.31– 20.6). The anemia and small for gestational age were found in underweight group with adjusted odd ratio2.47 (95% CI 1.6– 3.6), 4.6 (95% CI 2.6, 8.1) respectively........
ETHICAL DILEMMA OF CESAREAN SECTION ON MATERNAL REQUEST (CSMR)
Authors: Choudary Abeera , Siraj Asifa , Tariq Humaira , Chughtai Faiqa , Urooj Uzma
Published: May 2021

Objective: To study the demographic characteristics of pregnant ladies and factors contributing towards rise in cesarean section on maternal request to aid the obstetricians in decision making.

Study Design: Cross sectional analytical survey.

Place and Duration: Gynecology Department of Pak Emirates Military Hospital, Rawalpindi, from Nov 2019 to Mar 2020.

Methodology: One hundred and fifteen women of child bearing age requesting cesarean section were included in the study. Demographic details were noted. A study proforma was filled for determinants of primary and secondary tocophobia and factors that may be improved for vaginal delivery.Results: A total of 115 patients with mean age of 27.99 years were included. Amongst them, 88 (76.5%) were Punjabi with 92 (80%) living in rural area. Primigravida were 11 (9.6%), 83 (72.2%) had previous lower segment cesarean section and 3 (2.6%) had vaginal delivery. For primary tocophobia, 22 ( 24.4%) experienced anxiety. Fear of labor pains was seen in 20 (19.2%) and lack of control in 27 (26%). For secondary tocophobia, 15 (37.5%) were fearful of prolonged labor and 5 (22.5%) of sub optimal birth outcome. In women with previous one cesarean section, 13 (14.8%) correlated negatively with birth experience and 20 (22.7%) found timed cesarean section convenient. For vaginal delivery, pain relief was preferred by 19 (20.2%) and 31 (33%)wanted pain relief and attendant.

Conclusion: Better understanding of fears behind maternal request for cesarean section can lead to improved attitudes towards vaginal delivery. The negative perceptions of pregnant ladies should be addressed in antenatal.........
SPONTANEOUS PNEUMOTHORAX IN A PATIENT WITH COVID-19
Authors: Abidi Syed Turab Fatima , Shah Syed Asim Ali , Qadir Aziz Ullah , Hussain Huma , Yasmin Rifat , Afsar Anum , Hayat Ali Raza , Asghar Rabia
Published: May 2021

The coronavirus disease 2019 (COVID-19) frequently involves the respiratory system causing pneumonia. The disease started in December 2019 and is now a global pandemic. The disease is not limited to the respiratory system and cardiac, cutaneous, and neurological involvement has been reported. Psychiatric features of agitation and delirium have also been described in COVID-19. It is yet to be determined whether this will have any long term effect on the quality of life of these patients. We report a case of delirium in a COVID-19 patient who had also developed spontaneous pneumothorax on the day 15 of illness. Few of such case reports have been reported internationally but to the best of authors' knowledge, no such case has been reported in Pakistan.
FEEDBACK: DIFFERENT CONCEPTS AND PRACTICES IN A CULTURALLY DIFFERENT ENVIRONMENT-FACULTY PERCEPTIONS
Authors: Malik Ahsan , Kiran Faiza , Farooq Fareeha
Published: May 2021

Objective: To explore the faculty perceptions regarding the phenomenon of feedback and its‟ practices in a traditional undergraduate dental college in Pakistan.

Study Design: Qualitative following principles of phenomenology.

Place and Duration of Study: Rawal Institute of Health Sciences, Islamabad from Feb to Apr 2017.

Methodology: Purposive sampling was done, and data was gathered using semi-structured individual interviews of 12 BDS faculty members. Data was organized using qualitative software package Atlas.ti 8.0 and analyzed using thematic framework analysis.

Results: Feedback practices were found to be informally practiced in traditional BDS curriculum. Perceptions regarding purpose and beliefs on oral and written feedback were explored. The essence of the phenomenon under focus is described in terms of five domains denoted by five emergent themes: 1) „Understanding Feedback‟ through participants‟ response to/use of the term, 2) highly variant experiences of information exchange, 3) modes and forms of feedback, 4) factors affecting feedback and 5) methods achieving learning progression.

Conclusion: Faculty in our culturally different learning environment is devoid of formally instituted feedback practices, have understandings and practices that are both similar and dissimilar in nature to those often described in western-centric literature. Education about the phenomenon of feedback and faculty training to use it appropriately may help streamline the educational process in this context.
MUCOSECTOMY IN COMPLICATED APPENDICITIS
Authors: Naqvi Syeda Rifaat Qamar , Khan Fahad Ali , Khan Ayesha , Sultan Babar , Haider Anam , Khadim Rehana , Khan Palwasha , Qureshi Zaheer Ud Din
Published: May 2021

Objective: To describe the technique and results of mucosectomy; A surgical technique that is easy to perform, and has a lower morbidity and complication rate as compared to standard appendectomy in cases of complicated appendicitis.

Study Design: Quasi-experimental study.

Place and Duration of Study: Surgical - A Unit, Ayub Teaching Hospital, in Abbottabad, from Mar 2017 to Mar 2019.

Methodology: Patients included were those who presented with appendicular mass, phlegmon, recurrent appendicitis, appendicitis in uncommon locations, presence of adhesions, those cases of appendicular mass and phlegmon which was either not responding to medical treatment, or diagnosed per operatively being clinically not palpable or not seen on ultrasound. Per operative and post-operative variables were documented and analyzed. In mucosectomy, thesubserosal portion of the appendix i-emuscularis and mucosa of the appendix was dissected out from the serosa after ligation of the appendicular base, or ligation done after delivering the appendix out of the serosa. The serosa that was adherent to the surrounding gut, omentum or other viscera was left intact.

Results: A total of 192 patients were included in this study, half of which underwent standard appendectomy and a mucosectomy was performed on the rest. The mean time of surgery was 30 ± 1.2min as compared to the standard appendectomy group (55min ± 3.6). More than half of the patients undergoing standard appendectomy required extension of the incision (56.2%), only 8% required so from those on whom mucosectomy was performed. Per operative hemorrhage was seen in 32.2%, however inmucosectomy group only 1%.
REASONS OF CONFLICTS IN TERTIARY CARE HOSPITAL: A CROSS SECTIONAL STUDY
Authors: Sardar Tahir , Khan Muhammad Alamgir , Akhtar Muhammad Naveed , Gul Arshad
Published: May 2021

Objective: To assess the reasons of conflicts in tertiary care hospital Rawalpindi.

Study Design: Cross sectional study.

Place and Duration of Study: Tertiary care hospital Rawalpindi, from Aug 2008 to Jul 2009.

Methodology: Hospital staff comprising of health administrators, clinicians, nurses and paramedics working in tertiary care hospital Rawalpindi were included in the study.

Results: These questions were asked to assess the general understanding of the respondents regarding the subject of conflicts to deduct their possible response in conflict situations. As per "Traditional" view conflict was considered as dysfunctional, destructive and irrational. The "Human relations view" describes conflict as natural, suggests tolerating it whereas the latest “inter-actionist view” defines conflict as a means for keeping us viable and creative, and suggests encouraging it. Average 44% of the respondents, mainly administrators and clinicians have fair idea regarding current concept of conflict.

Conclusion: Clinical and administrative staffs of hospitals are like parts of a train track. The irrational relationship between them will result in distortion and lower quality of services. Therefore, effective strategies to decrease staffs‟ experience of conflict need to be developed. This might create a healthier and more productive work environment which positively affects the care quality.