bluuebunny/crossref_metadata_2025 huggingface dataset:
Hydrogeological and Hydrogeochemical Evaluation of Urban Wetlands for Sustainable Cities: A case study from İzmir
Authors: SOMAY Melis
Published: September 2022

Yeşil süngerler olarak isimlendirilen kentsel sulak alanlar, iklim değişikliğine adaptasyona katkıda bulunan sürdürülebilir mavi-yeşil altyapının temel öğeleridir. Akıllı kentlerdeki en önemli basamak olan akıllı su yönetimi içerisinde doğal veya yapay kentsel sulak alanlar bulundukları bölgenin su rejimini düzenler, doğal arıtma işlevi ile su kalitesini arttırır, bünyesindeki sulak alan bitkileri ile fazla olan yüzey suyu ve sel sularının hızlarını kesip bünyelerine hapsederler. Tüm bu özellikleri ile kentlerde sürdürülebilirlik ve geri dönüşüm sağlayan canlı bir mekanizmadırlar. İzmir ili, Türkiye’nin 3. büyük kenti olup bünyesinde iki adet doğal kentsel sulak alan barındıran dünyadaki nadir kentlerden biridir. İzmir Kuş Cenneti(İKC) ve İnciraltı-Çakalburnu sulak alanı(İÇS), İzmir Körfezi’nin kuzey ve güneyinde bulunan iki adet doğal kentsel sulak alandır. İKC, Gediz Nehrinin deltası olup Ramsar Sözleşmesi kapsamında korunmaktadır. Hem tatlı su ekosistemi (maksimum elektriksel iletkenlik(EC) 4490µS/cm) hem de tuzlu su ekosistemini (maksimum EC 129400µS/cm) bünyesinde barındırır. Tatlı su ekosistemi genellikle “karışık su” tipinde olup tuzlu su ekosistemi ise Na-Cl su tipindedir. İÇS’de Çakalburnu lagünü ve İzmir Kent Orman'ından oluşan bir sulak alandır. Lagün, körfez ile etkileşim halinde olduğu için tuzlu su ekosistemini barındırır. Lagünde sular Na-Cl su tipinde olup maksimum EC 56700µS/cm olarak ölçülmüştür. Lagünü besleyen yeraltı suları ise Ca-Na-HCO3-Cl su tipindedir. Her iki sulak alan da kontrolsüz kentleşmenin yıpratıcı süreçlerinin tehdidi altında olup koruma alanları içerinde korunmaları gerekmektedir. Eğer korunmazlarsa konut, tarım ve sanayi için arazi arayışında kurutulur, kirlenir ve bozulurlar. Sırf doğal yaşam alanları oldukları için değil, kentleri sel baskınlarından, ısı adalarından ve kirlilik yükü ile gelen yüzey sularının doğal olarak arıtılmasından ötürü de çok kıymetli alanlardır.
How to GAN Higher Jet Resolution
Authors: Baldi Pierre , Blecher Lukas , Butter Anja , Collado Julian , Howard Jessica N. , Keilbach Fabian , Plehn Tilman , Kasieczka Gregor , Whiteson Daniel
Published: September 2022

QCD-jets at the LHC are described by simple physics
principles. We show how super-resolution generative networks can
learn the underlying structures and use them to improve the
resolution of jet images. We test this approach on massless QCD-jets
and on fat top-jets and find that the network reproduces their main
features even without training on pure samples. In addition, we show
how a slim network architecture can be constructed once we have
control of the full network performance.
Coping emotional discomfort at retail checkout: Potential distractions and implications
Authors: P Vinish , Pinto Prakash , Thonse Hawaldar Iqbal , M. Munshi M.
Published: September 2022

Retail customers often wait to complete their purchases during the checkout process. Prior research suggests that long checkout lines and service delays negatively affect customers’ evaluation of store services. The present study investigates the potential customer and in-store distractions and their implication for emotional discomfort due to crowding stress. This study employed a cross-sectional research design and surveyed 385 respondents visiting the target retail outlets in Bengaluru, India. Correlation analysis explored the relationship between self-distraction, in-store distractions, and emotional discomfort. The study found that self-distraction negatively correlates with discomfort while in the queue (r = –0.119) and discomfort during the billing (r = –0.119). In contrast, in-store distractions (r = –0.161) and video displays near the checkout area (r = 0.116) effectively reduce emotional discomfort while in the queue. Additionally, point-of-purchase (POP) display (r = –0.265) and availability of refreshments near the billing counter (r = –0.175) are effective in reducing emotional discomfort during the billing. This study thus offers viable and affordable methods of improving the customer’s waiting experience while contributing to store profits.
Competitiveness and complementarity of agricultural products between Thailand and China on a short-term basis
Authors: Tao Zhe
Published: September 2022

China and Thailand belong to Regional Comprehensive Economic Partnership countries, and agricultural trade is vital to Thailand’s economy. Competition in agricultural trade between countries is fierce. Therefore, it is crucial to understand the advantages and disadvantages of agricultural trade between Thailand and China. Complementarity and competitiveness of international business show the benefits and drawbacks of cross-border exports and the trend of future exports. This study uses quantitative techniques to analyze the agricultural trade between Thailand and China. It employed four methods, including the calculations of the Grubel-Lloyd index, revealed comparative advantage index (RCA), trade intensity index (TII), and trade complementarity index (TCI). The result of method 1 indicates that Thailand’s agricultural trade has a more substantial competitive advantage (three years average RCA = 1.69 > 1.25) than China (three years average RCA = 0.37 < 0.8) from 2017 to 2019; they are complementary in specific categories of agricultural products. The result of method 2 indicates that items 03, 07, 13, and 14 of China’s exports and Thailand’s imports have strong complementarity. Items 10, 11, 17, and 19 of Thailand’s exports and China’s imports have strong complementarity. The result of method 3 indicates that the positive factor on bilateral trade flow is significant. The result of method 4 indicates that items 06, 07, 12, 19, 20, and 21 have advantages in intra-industry trade, and items 09, 10, 13, and 18 have advantages in inter-industry trade. The paper has important implications for Thailand’s government to formulate relevant trade policies to enhance its agricultural export competitiveness, which is also conducive to developing bilateral agricultural trade.
Práticas de ensino na pandemia: uma visão a partir do desenvolvimento bioecológico
Authors: Cury de Barros Bruna , Marini Carolina , De Medeiros Rodrigues Reali Aline Maria
Published: September 2022

Este trabalho tem como objetivo analisar as mudanças vivenciadas por quatro professoras experientes dos Anos Iniciais do Ensino Fundamental durante o primeiro ano da pandemia do coronavírus, considerando suas aprendizagens e desenvolvimento profissional. Além de serem professoras, as participantes atuavam simultaneamente como mentoras de professoras iniciantes no Programa Híbrido de Mentoria (PHM). Os dados referem-se a respostas coletadas em um questionário on-line a partir de perguntas sobre a atuação docente em 2020. As análises fundamentam-se na concepção do desenvolvimento bioecológico (BRONFENBRENNER, 1994). Considerou-se aqui as inter-relações, influências e impactos causados pelos micro, meso, exo, macro e cronossistemas no atual contexto. A análise dos dados mostra que as participantes enfrentaram dificuldades, como falta de infraestrutura; transpor conhecimentos sobre ensinar adultos a ensinar crianças remotamente; elaboração do planejamento e da avaliação; estabelecimento de relações com os alunos e suas famílias; e falta ou demora de direcionamento da Secretaria Municipal de Ensino. Como mecanismo de auxílio às dificuldades, salientou-se o papel importante das redes de apoio presentes no microssistema da escola em que atuavam e no PHM. Em ambos os contextos, as participantes tiveram a oportunidade de trocar ideias e experiências para a construção de novas aprendizagens sobre o ensino remoto.
Rede federal de educação profissional, científica e tecnológica no Brasil: reflexões sobre a sua criação à luz das propostas educacionais de Antonio Gramsci
Authors: Magalhães Afonso Anthone Mateus , Regina Coutinho Gonzalez Wania
Published: September 2022

A expansão das vagas da Educação Profissional e Tecnológica (EPT), mediante criação dos Institutos Federais de Educação, Ciência e Tecnologia (IFs), foi uma das políticas educacionais de maior destaque nos governos Lula (2003-2011). O presente artigo busca analisar a proximidade entre a concepção de EPT implícita na criação da Rede Federal de Educação Profissional, Científica e Tecnológica e as propostas educacionais de Antonio Gramsci. Tais propostas foram discutidas a partir de pesquisa documental considerando sua historicidade, aspecto fundamental para uma melhor compreensão das formulações teóricas e propostas educacionais à época. No que se refere às possibilidades de aplicação das propostas gramscianas no sistema educacional nacional de EPT, foi analisada a política pública de criação dos IFs a partir da Lei n. 11.892/2008. Verificou-se que o texto legal traz grande aproximação com os ideais gramscianos ao criar institutos especializados com oferta desde a formação inicial e continuada de trabalhadores até a educação profissional tecnológica de graduação e pós-graduação em todos os ramos de investigação e de trabalho científico, em todos Estados do Brasil, um ambiente profícuo para desenvolvimento tanto de uma formação desinteressada como da interessada, com grande ligação entre teoria e prática, estimulando o espírito crítico voltado à investigação empírica.
Memórias da educação profissional e tecnológica em Campos dos Goytacazes, Rio de Janeiro: A escola de aprendizes e artífices em foco
Authors: Rezende da Silva Arthur , Souza Marcelino Valéria
Published: September 2022

Este artigo problematiza a relação existente entre a infância da classe trabalhadora, no início do século XX, com a dualidade, ainda persistente no século XXI, entre formação geral e a Educação Profissional e Tecnológica (EPT). Por meio da Análise Textual Discursiva (ATD) do Decreto Presidencial nº 7.566, de 23 de setembro de 1909, que cria a rede nacional de escolas de EPT e de fotografias da antiga Escola de Aprendizes Artífices de Campos dos Goytacazes, Rio de Janeiro, o artigo procura responder às seguintes questões norteadoras: Como as infâncias são retratadas na história da EPT, mais precisamente no início do século XX? Esse tratamento dado às infâncias tem relação com a dualidade histórica entre a formação propedêutica, para a elite, e a formação profissional, para os pobres? Constata-se que a EPT alcançou forte viés regenerativo devido às classes dominantes do início do século XX considerarem os desfavorecidos da fortuna ignorantes e passíveis à escola do vício e do crime. Assim, o tratamento dispensado às infâncias no início do século XX revela muito da persistente dualidade entre o saber fazer e o saber pensar que ainda ocorre no século XXI.

 

Palavras-Chave: Educação Profissional e Tecnológica. Escola de Aprendizes Artífices. Infâncias da classe trabalhadora brasileira. Análise Textual Discursiva.
Developing colloidal structure of beer by grain organic compounds
Authors: Gribkova Irina , Eliseev Mikhail , Zakharov Maxim , Kosareva Olga , Zakharova Varvara
Published: September 2022

The present article introduces the problem of determining the general structure of beer as a complex system of related biomolecules. The objective was to establish the correlation of various quantities of organic compounds in beer formulation.

The research featured samples of filtered pasteurized beer obtained from a retail chain shop in Moscow (Russia). The experiment relied on standard research methods, including instrumental methods of analysis, e.g., high-performance liquid chromatography (HPLC). The obtained experimental data underwent a statistical analysis using the Statistica software (StatSoft, 2016).

The research established the correlation between the type of grain (barley or wheat malt) and the content of organic compounds, e.g., β-glucan, polyphenols, soluble nitrogen, etc. The research also revealed some patterns in the distribution of proteins, which served as a framework for the system of organic compounds. The distribution of thiol proteins proved to depend on the dissolution degree of the grain and was different in barley light, barley dark, and wheat malt samples. The fraction distribution of β-glucan depended on the color of the malt. In light beer samples, it concentrated in high- and medium-molecular fractions of nitrogenous substances, in dark beer – in low-molecular fractions (≤ 63%). Initial wort density and alcohol content affected the amount of catechins and total polyphenols. Nitrogenous compounds depended on the color, initial extract, and alcohol content.

The nitrogenous structure and other organic compounds of beer proved to depend on protein substances. The research also revealed a number of factors that affected the fraction distribution of biomolecules in different beer sorts.
Molecular genetic studies of microbiocenosis and microstructure of jejunum wall in young rams grown on biofortified feed additives
Authors: Giro Tatiana , Ilina Larisa , Kulikovsky Andrey , Ziruk Irina , Giro Anna
Published: September 2022

The research featured the effect of a diet fortified with essential microelements on the ruminal microbiota of young rams. Ruminal microbiota is largely responsible for feed digestibility and body functioning of cattle. The study involved the contents of the rumens and jejuna of seven-month-old rams of the Edilbaev breed, which were subjected to a biofortified diet. The diet included the Russian feed additives Yoddar-Zn and DAFS-25 represent a protein-carbohydrate complex with plant silicon. The microflora of the digestive tract was tested using the molecular genetic method of terminal restriction fragment length polymorphism (T-RFLP) sequestration. The microstructural studies of the jejunum samples exploited light microscopy. The feed additives increased the population of cellulolytic and lactate-fermenting bacteria, as well as the Prevotella sp. microbiome and bifidobacteria in the rumen samples. The data obtained revealed the effect of essential microelements on the taxonomic pattern of microorganisms and the microflora profile. The research revealed the ratio of normal, opportunistic, pathogenic, nonculturable, and transit microflora. The jejunum wall samples obtained from the experimental group that fed on Yoddar-Zn and DAFS-25 had a more distinct micropicture of mucous membrane. Their rumen microflora balance had fewer pathogenic and opportunistic microorganisms, which was also confirmed by the jejunum morphology. The feed additives DAFS-25 and Yoddar-Zn proved beneficial for ram diet and inhibited the negative effect of pathogenic treponemas on the rumen. The additives improved digestion, absorption, and assimilation of food nutrients, as well as increased the livestock yield.
System within System: World Health Organization Building Blocks and Public-Private Partnership in Healthcare sector of Pakistan
Authors: Afzal Saira , Arshad Amber
Published: September 2022

"Health systems" (also called "health care systems" and "healthcare systems") are organizations that provide health care services to target populations by integrating
people, institutions, and resources. A health care system is nothing more than a collection of interdependent pieces and their relationships. People, organizations,
and behaviors whose primary goal is to promote, restore, or maintain health are part of a "health system." This system relies on the interdependence of its various
components. Numerous components that make up a health care system, like patients, families, communities, health departments, health care professionals, and
organizations responsible for funding health care are just a few examples. The duties and functions of each component are intertwined. WHO proposes supporting
and building a health care system based on the following framework, the Six Health System Building Blocks? It is possible to produce more equitable and long-lasting gains in health services and outcomes by enhancing the six components of the health system and 1 managing their interrelationships .
Artificial Intelligence and Medical Education
Authors: Hussain Sarwat , Bhatti Danish Ejaz
Published: September 2022

Artificial Intelligence (AI) is a branch of computer sciences that uses learning algorithms to calculate probability of outcome by using Bayes theorem and other statistical methods for a given certain input (Fig.1). When the chance of an event occurring is calculated over and over again after adding new data or evidence at each step, the probability can reach the level of near certainty for given inputs. Thousands, even millions of data points are incorporated in calculating posterior probability for predictive analytics. The analytics are input neutral as programs predict the future events irrespective of the type of the data. AI has, thus, blurred the boundaries between the physical, digital, and biological worlds. The initial learning process is considered training where inputs are given to the program already marked for the expected outcome. This training information can either be highly precise or very vague allowing different degrees of freedom to the program but also increasing the burden of training. Once trained an AI algorithm is able to predict or analyze given input to suggest the required outcome with some certainty. This improves with continued training through feedback.
Effectiveness of Problem Based Learning in Developing Knowledge of Undergraduate Nursing Students
Authors: Nasim Attia , Ghani Mansoor , Kausar Samina , Khatoon Kashifa
Published: September 2022

Background: Problem based learning (PBL) is an innovative and learner-centered teaching approach that improves nurses' theoretical knowledge, trains them practically, develops their critical and problem-solving skills to be used for overcoming environmental constraints during clinical practice. Objectives: The aim of this study was to determine the effectiveness of PBL in developing knowledge of undergraduate nursing students. Methods: This study conducted a pretest–posttest experimental design among B.Sc. Nursing students of Saida Waheed FMH College of Nursing Lahore. Lottery method of random sampling was used to recruit the participants for experiment group and control group. A PBL-based treatment for the experimental group and a series of lectures was traditionally delivered to the control group on the topic of Diabetes Mellitus. Data was collected using MCQs-based questionnaire during pre-test-post-test processes. Results: This study identified the problem-based learning as more effective teaching method than lecture method after observing a significant difference between the scores of post-tests of lecture method (LM) and problem-based learning. The participants of the experimental group significantly gained more knowledge scores than the members of LM. Conclusion: The intervention of PBL method has significantly improved more knowledge of the participants of experimental group than the members of LBL. It reflects that PBL is a more important and effective teaching method in developing knowledge of nursing students than lecture method.
Histopathological Grading and Staging of Invasive Ductal Carcinoma in Modified Radical Mastectomy Specimens
Authors: Javaid Quratul Ain , Kamal Farrukh , Iqbal Munazza , Sarfaraz Rahat , Qureshy Asmaa , Basharat Rabia
Published: September 2022

Background: Breast carcinoma is the most common malignancy in females associated with high mortality rate. Objective: The purpose of present study was to describe the histological grade and histopathological stage of invasive ductal carcinoma of breast among female patients and to determine the association of tumor size and histological grade withnodal metastasis. Methods: This is an analytical cross sectional study, conducted in the Department of Pathology Fatima Jinnah Medical University Lahore, Pakistan from September, 2019 till February, 2020. Female patients of all age groups who were diagnosedwith invasive ductal carcinoma and underwent modified radical mastectomy were included in the study. Tissue processed and Hematoxylin and Eosin staining was performed. All the sections were examined under the light microscope by myself and two other consultant pathologists independently. Histological grading of invasive ductal carcinoma was done by following Modified Scarff Bloom Richardson grading system and histopathological staging was done according to CAP protocols. Results: Total of 60 female patients diagnosed with invasive ductal carcinoma were included in the present study. Mean age of the patient calculated was 48.17± 13.12 years with age range from 26 to 90 years. Size of the tumor ranged from 1cm to 10cm. On microscopy, histological grade III was the most frequent grade (36, 60%). Out of total 60 cases n=43(71.6%) were diagnosed with regional lymph node metastasis and T2N1Mx( 17,38.3%) was the most frequent stage of the tumor. Statistically no significant association of tumor size and histological grade was observed with regional lymph node metastasis (p >0.05).
Vitamin D Deficiency in Acute Myocardial Infarction and its Association with Diabetes
Authors: Saeed Muhammad Khawar , Khan Asadullah , Chachar Aijaz Zeeshan Khan , Khanum Afshan , Khan Hajra
Published: September 2022

Background: Vitamin D deficiency is a global public health problem. Vitamin D deficiency is linked to a number of non skeletal major chronic diseases like cardiovascular disease.Objectives: To determine the frequency of vitamin D deficiency in patients presenting with ST segment elevated myocardial infarction. Methods: During the study period, 150 patients fulfilling the selection criteria of ST segment elevation Myocardial infarction were included in this study. A blood sample for 25-hydroxyl vitamin D level was drawn for each patient. Vitamin D deficiency was defined as less than or equal to 20g/dl. Vitamin D deficiency was stratified with demographics such as age, gender, and Comorbids such as smoking and Diabetes. Results: The mean age of the patients was 51.6±6.7 years. There were 80 (53.3%) male and 70 (46.7%) female patients. There were 52 (34.7%) smokers and 55 (36.7%) patients had diabetes mellitus as Comorbids. The mean serum vitamin D level was 23.46±0.82 ng/ml. Sixty-four patients (49.3%) had vitamin D deficiency with levels below 20ngml, while another 46(30.6%) had insufficient Vitamin D levels in ranges of 21-30ng/ml. There was no association of age, gender, smoking or Diabetes history with vitamin D deficiency (p value >90.05 for all these variables). Conclusion: Vitamin D deficiency is present in over half of patients with ST elevated Myocardial infarction. Only 20% of patients with acute myocardial infarction had normal vitamin D values, with remaining having insufficient levels. The deficiency was not associated with gender, age, or comorbidity such as smoking or Diabetes.
Ischemic Colitis induced by COVID-19: A Case Report
Authors: Rabbani Unaib , Aldukhayel Abdulrhman , Alresheedi Abdulhamid F
Published: September 2022

COVID-19 has been associated with coagulation disorders which add further to the morbidity and mortality caused by the disease itself. Ischemic colitis can result from hypercoagulable states. In this report we present a rare case of ischemic colitis induced by COVID-19 in 27-year-old male. Patient presented with severe generalized abdominal pain. CT abdomen showed filling defects, absent enhancement indicating venous bowel ischemia. CT-angiograph revealed complete thrombosis of portal, splenic, superior and inferior mesenteric veins. Patient was shifted to intensive care unit and kept nothing per orum. He was given Heparin, tramadol and paracetamol intravenously. COVID-19 Reverse transcription–polymerase chain reaction (RT–PCR) was positive. He was then given Favipiravir through nasogastric (NG) tube. On 4th day NG was removed and patient was subsequently discharged on 9th day. COVID-19 may lead to hypercoagulable states and gastrointestinal complications. COVID-19 patients with gastrointestinal symptoms should be evaluated carefully for possible ischemia.
Factors Associated with Early and Late Initiation of Antiretroviral Therapy among People Living with Human Immunodeficiency Virus in Lahore, Pakistan
Authors: Junaid Khunsa , Muzaffar Saad , Nazim Rabia , Arshad Amber , Khan Amjad , Zubair Hina
Published: September 2022

Background: Despite the availability of antiretroviral therapy (ART), HIV is still responsible for substantial illness and death, especially in developing countries. Early start of treatment (ART) is associated with better therapeutic outcome, reduced transmissibility of HIV, reduction in loss to follow-up, and remarkably reduced death rate. Objectives: To find out the factors associated with early and late Initiation of ART among patients affected by HIV in Lahore, Pakistan Methods: From November 2017 to April 2018, researchers conducted an analytical cross-sectional study on 156 HIV patients aged 18 and older that began antiretroviral therapy (ART) at Jinnah & Mayo Hospital, Lahore's HIV clinics. Samples were selected by non-probability convenience sampling and Univariate and multivariate analyses were performed to assess factors related to early and late Initiation of ART. The p-value of less than
Comparison of Low Dose Albumin Versus Full Dose Albumin in Improving Refractory Ascites in Cirrhotic Patients
Authors: Ahmed Maaz , Niaz Zafar , Mumtaz Sami Ullah , Lodhi Sidrah , Munir Aneeza , Abaidullah Sajid
Published: September 2022

Background: Refractory ascites is one of the most important complications of cirrhosis & albumin is considered highly effective in controlling it. Objective: To compare efficacy of 10g albumin versus 20g albumin in improving refractory ascites in cirrhotic patients.
Methods: This randomized control trial was conducted at department of Gastroenterology, Mayo hospital Lahore for 12 months. After ethical approval, 60 patients of chronic liver disease with refractory ascites were included in the study & were divided into two groups. Group A was administered with 20g albumin whereas; group B was given 10g albumin. Both groups were followed for next 3 days by measuring change in weight, abdominal girth and urine output. Data was analyzed by using SPSS v-21. Results: There was no considerable difference between two groups regarding change in weight, abdominal girth and urine output. There was no significant difference in albumin response for both the groups in reducing ascites (p=0.6022). Conclusion: Low dose albumin is as effective as full dose albumin for reducing refractory ascites among cirrhotic patients.
The Analysis of Published Research on Gout and Hyperuricemia from Pakistan in National Biomedical Literature
Authors: Rathore Farooq Azam , Ilyas Amara , Farooq Fareeha
Published: September 2022

Objective: This study analyzed the published research on gout and hyperuricemia in the national biomedical journals with an aim to highlight the research gaps in the management of gout and hyperuricemia in Pakistan. Methods: An online literature survey on global databases (Medline and Google Scholar) and local Pakistani database Pak Medinet was conducted from January to March 2018. Different keywords on gout and hyperuricemia in Pakistan were combined using Boolean operators. We included all kinds of manuscripts reporting work specifically related to gout or hyperuricemia from Pakistan and having the corresponding author or at least one author with an affiliation from a Pakistani institution. We also considered manuscript published on this topic in Pakistani journals by authors affiliated with other countries. Results: Thirty-four manuscripts were selected for review and analysis. Thirty-one manuscripts were written by local authors affiliated with institutions located in different cities of Pakistan. Five manuscripts had foreign authors, out of which two were authored by all Turkish authors, but others had Pakistani co- authors too. Most of the Manuscripts were published
in the category of original research article. None of them was a randomized clinical trial (RCT). Conclusion: The number and quality of studies published on gout and hyper-uricemia from Pakistan is low. There is a need to conduct more epidemiological and interventional studies to know the actual burden of gout in the country and RCTs to compare different drug treatments for managing gout in the local population.
Osteolytic Skull Lesions: Rare Finding in a Patient Presenting with Clinical Features of Progressive Multifocal Leukoencephalopathy (PML) With Unknown HIV Status
Authors: Bano Safia , Sardar Zomer , Kalim Muhammad , Numan Ahsan
Published: September 2022

Bacillary angiomatosis (BA) is a rare but an infrequent opportunistic infection reported mostly in HIV-infected patients. The most common site of involvement is the skin manifestation followed by solid organs involvement like liver and bone. Although most cutaneous manifestations are treatable, the other organs involvement can be fatal in some cases. We report a case of an isolated osteolytic lesion due to the Bacillary angiomatosis (BA). We conclude that Bacillary angiomatosis (BA) should be suspected and screened when an osteolytic bone lesion is identified in immunocompromised patients like HIV with or without cutaneous manifestations as it is deadly fatal if treatment is not given.
Implementation of National Licensing Examination (NLE) and its Impact on Global Healthcare: A Systematic Review
Authors: Saleem Shehzad , Afzal Saira
Published: September 2022

Background: A license required for full practice - National licensing examinations (NLEs) are required in most of the countries with well-established medical regulatory authorities. Objective: This systematic review aims to investigate the impact of NLEs after their implementation worldwide. Methods: Systematic review designed as per Kane's validity framework developed by Olivary et al. by exploring online databases such as: Wiley Online, Embase Medline (EBSCO); PubMed; JSTOR; Google Scholar and Science Direct; from
January 2005 to December 2020. Results: NLE exams and better patient outcomes (communication, satisfaction) are positively related and such exams help in development of a common medical curriculum and a better post-graduation entry point. Conclusions: In the present era, where more medical graduates are flying all across the globe for employment than ever before, NLE is becoming inevitable and helps to ensure that medical training satisfies a minimum standard of quality, which varies among Medical schools and colleges within a country and globally. Continual improvement is crucial for the identification of gaps in the medical licensing exams. The license holders must comply with National authorities and stay active in academic and clinical activities to stay licensed.
The Sustainable Development Goals: A Way Forward for Pakistan
Authors: Afzal Saira , Junaid Khunsa
Published: September 2022

The Sustainable Development Goals (SDGs) were adopted globally in September 2015 as a set of universal and transformative goals and targets to be implemented by 2030. The 17 development goals include 169 concise, global, and applicable to all countries; developing and developed—the SDGs address three interconnected dimensions: social, economic, and environmental. Health is interconnected with social, economic, and developmental/environmental determinants. 1 The SDGs include 244 indicators related to the five Ps: People, Planet, Prosperity, Peace, and Partnership. The SDGs are more comprehensive and people-centered than the MDGs, with the commitment to & quot; leave no one behind, & quot; i.e., reach vulnerable populations. Among the SDGs, Goal 3 directs countries to & quot; Ensure healthy lives and promote well-being for all ages & quot;; SDG3 includes 13 targets, four of which address implementation. 2 Thirteen SDGs are related to health and well-being and may be informed by less than 169 indicators. SDG 3 addresses chronic diseases, tobacco, alcohol, narcotics use, mental health, road safety, and pollution. However, health is not solely a component of Goal 3. Throughout the majority of the SDGs, some targets have a direct or indirect effect on health gains and thus require special consideration when developing strategies, policies, and plans to achieve the health goal and monitor progress. 2,3
Cannabis Abuse among Patients with Schizophrenia
Authors: Butt Ammara , Haider Fur , Saleem Fatima , Iftikhar Mariam , Dogar Farast Ali , Hamid Aamir
Published: September 2022

Background: Cannabis is the most frequently used substance among patients of schizophrenia. Past deliberate surveys have reported a strong association between cannabis abuse and schizophrenia. However; the whole frequency of cannabis abuse among schizophrenia patients remains ambiguous, as do the variables influencing this rate. Because cannabis abuse in schizophrenia is presently an active area of research, so there is a requirement for a fresh review particularly in our culture where studies are lacking on this topic. Objective: The current study explores the frequency of cannabis abuse among patients suffering from schizophrenia presenting in a tertiary care hospital of Lahore. Methods: Cross-sectional prospective research design was used. Sample of 381 diagnosed patients of schizophrenia using cannabis for at least one year was selected from Sir Ganga Ram Hospital, by convenient sampling technique. Drug Abuse
Screening Test was applied for the frequency of cannabis abuse. The data were stored and analysed in SPSS version 20. Results: The results revealed that cannabis abuse was present among 42.3% of the patients with schizophrenia. Chi-square analysis showed that there were significant differences among the frequencies of cannabis abuse regarding various age groups, where young age group had significantly higher ratio of cannabis abuse (p=.04). On using independent sample t-test for marital status and duration of the schizophrenia, it was found that cannabis abuse was significantly higher among unmarried patients (t=-4.24, p=.001), however, no significant differences were found for duration of schizophrenia (t=-1.50, p=0.43). Conclusion: The study highlights cannabis abuse is more prevalent in the males as compared to the females. Young age group of patients is more prone to cannabis. These findings can help to decrease the comorbidity of schizophrenia associated with cannabis abuse.
Predictability of Computerized Tomography as Compared to Ureteroscopy in Detection of Ureteric Stone in Patients with Indwelling Stents
Authors: Rashid Nawaz , -Rehman Zia-ur , Dogar Iqbal Hussain , Hashmi Kamran Sajjad , Nawaz Fareeha
Published: September 2022

Objective: The current gold standard for the diagnosis of ureteric stones in patients with a stent in situ is ureteroscopy but this study is planned to determine the positive predictive value of computerized tomography (CT) scan among such patients. Methods: This study involved patients who had ureteral stent in situ and were referred for re-evaluation of residual stones after extracorporeal shock wave lithotripsy. These patients underwent CT-scan for detection of ureteric stone. Later on, ureteroscopy was performed and ureteric stone was confirmed on direct visualization. Results: The mean age of the patients was 32.2±8.9 years. Male to female ratio of 1.7:1. CT scan shows a stone in 252 patients (70.2%) out of which 165 (46.0%) were confirmed on ureteroscopy. This yielded a sensitivity of 88.7 %, specificity of 49.7 %, positive predictive value of 65.5%, negative predictive value of 80.4% and diagnostic accuracy of 69.9% of CT
for detecting ureteric calculi in patients with ureteric stents (p value < 0.0001). Conclusion: CT scan owing to its limited diagnostic accuracy cannot replace ureteroscopy for detection of ureteric stones in patients with ureteric stents.
Intranasal Dexmedetomidine as Sedative for Non-Invasive Pediatric Diagnostic Procedures Outside Operating Room
Authors: Akhtar Ahmed Bilal , Ijaz Muhammad Khurram , Bashir Adeel , Khan Ahsun Waqar
Published: September 2022

Background: Children often require sedation for long non-invasive diagnostic procedures. Dexmedetomidine is a highly selective alpha 2-adrenoceptor agonist with sedative, anxiolytic and analgesic properties. It mimics natural sleep and allows patients to easily arouse with minimal effects on respiration and airway patency. Objective: To assess the successful completion of pediatric non-invasive diagnostic procedures with intranasal dexmedetomidine as a sedative agent. Methods: Seventy-nine subjects of age six months to twelve years scheduled for non-invasive diagnostic procedures were included. Dexmedetomidine (4 mcg/kg) was administered intranasally 25 minutes before the scheduled time of procedure. A sedation score of two or above as per the MICHIGAN sedation scale was considered satisfactory for starting the procedure. Results: Seventy-four (95%) out of the seventy-nine subjects were successfully sedated with Intranasal dexmedetomidine (p
Maternal Anemia and Risk of Small for Gestational Age
Authors: Tariq Sana , Zia Isran Basma , Kiani Sidra Nosheen , Shabir Rabiya
Published: September 2022

Introduction: Anemia in pregnancy results in impaired oxygen transport to the fetus and may result in intrauterine growth Retardation, low birth weight, small for gestational size, and neonatal death. Objective: This study is to assess the risk of small for gestational age in anemic pregnant females. Methods: This is a prospective cross-sectional study, Data was gathered from April 2019- to July 2020, all pregnant females registered in the gynecology department of Life-line hospital during the study were enrolled after signing informed consent. After laboratory investigation participants were divided into two groups, Group A had non-anemic and group B had anemic
females. SPSS version 20 was used to analyze the data. Continuous data is interpreted as mean and standard deviation. To assess the correlation between categorical variables chi-square test was performed, p-value < 0.05 was considered as significant. Results: A total of 500 participants were included in the study, 21-25 years mothers were reported as non-anemic and anemic with frequency of 165 and 100 respectively, While 25-30 years were 218 and 107 respectively. Gravidity of participants indicated a higher prevalence of anemia in mothers of 1 – 3 children with 156/302 participants falling in the category of parity 1-3. To assess the odds of getting SGA as a fetal outcome in anemic mothers, the OR test was performed and the result indicated a positive ratio (1.4) Conclusion: This study indicated a higher prevalence rate of small for gestational age in anemic mothers as compared to non-anemic, expressing the need for better nutritional and psychological assessments of reproductive-age females in Pakistan.
Correlation of Radiological Findings (High Resolution Computed Tomography Chest) with Anti-SARS-COV-2 Antibodies in Patients Visiting Tertiary Care Hospitals
Authors: Jaleel Anila , Shafique Mazhar , Asim Samar , Namoos Kiran , Saleem Uppal Sadaf , Pervaiz Saleem
Published: September 2022

Background: Coronavirus (COVID 19) pandemic has taken so many lives and has contributed to an increase in morbidity due to its complications. The research is still in infancy and much has yet to be investigated. Objective: To correlate the HRCT findings on chest with antibody testing in patients visiting tertiary care hospitals in Lahore. Methodology: Three hundred and thirty-two patients with mild, moderate and severe symptoms of COVID 19 were recruited. Those with raised CRP levels were sent for HRCT chest and PCR testing as protocol of the hospitals. All patients were tested with Rapid antibody kits for reactivity. Results: Showed that males were affected more than females. Similarly, non-health care workers were more affected. All patients with bilateral involvement of lungs on HRCT chest and positive PCR findings also tested reactive on antibody testing. However, a few people with bilateral lung involvement and negative on PCR testing got reactive results on Rapid antibody testing. Linear regression model shows significant correlation of HRCT chest findings with Ant-SARC- COV 2 antibodies. Conclusion: HRCT findings (Unilateral and bilateral lung infiltrates) correlated significantly with Anti SARC-COV 2 Antibodies.
The Versatile but Undermined Role of the Nursing Profession Needs the Attention of Health Planners and other Stakeholders
Authors: Anwar Sumair
Published: September 2022

In our society, nursing up till now could earn its role as a vocation instead of being a profession. By definition, a profession is the set of activities that persons perform to earn money, and the rules are prescribed by a society knowledge and skills attained based on by
1 training . Actually, the nurses have been struggling hard for many years to achieve professional status. The existence of a body of knowledge distinct from other disciplines is a distinguishing feature of a profession. Several sources of knowledge laid down the foundation of nursing and their practice for better quality of care including tradition, authority, borrowed knowledge, trial, and error. However, recently they directed their efforts to establish an overt body of knowledge so that nursing can be undoubtedly recognized as a diverse profession.
Type 2 Diabetes Mellitus(T2DM) in Pakistan: Prevalence, Trends and Management Strategies
Authors: Aslam Ramisha , Suhail Saman , Sajid Rabeea , Younis Bilal bin
Published: September 2022

The rising incidence of diabetes has become one of the major health problems worldwide. It is especially overburdening low-income countries like Pakistan which ranks 4th in diabetes prevalence. The purpose of this review article is to analyze the current approach to diabetes management in Pakistan and to highlight its deficiencies. It also discusses the future strategies that can help Pakistan to reduce the rising disease burden. Information was collected from the publications which were searched on 'Google scholar' and 'PubMed'. The latest data provided by IDF has shown diabetes prevalence in Pakistan to be 17.1% in 2019; 148% higher than previous reporting. The major obstacles in the effective management of diabetes are lack of resources, societal barriers and patient related issues. In order to reduce the load of diabetes, combined efforts of government, health care professionals and patients are required. In future, diabetes education of the patients as well as HealthCare providers, use of telemedicine for the management of chronic diseases and concept of precision medicine can be applied to decrease diabetes burden in Pakistan.
Hepatitis C Drugs Made in Pakistan
Authors: Waheed Nida , Fida Tooba , Fatima Saman , Waheed Osman Khalid
Published: September 2022

Hepatitis C is among the most prevalent liver diseases in the world caused by hepatitis C virus and it further predisposes the patient to liver cancers. This virus is transmitted through the use of infected syringes, infected blood transfusions and sexual contact with affected individuals. This disease is asymptomatic initially but may follow an acute or chronic progressive course. Pakistan has a significant ratio of hepatitis affected patients with every one out of 20 individuals being seropositive. The treatment of hepatitis and its success is dependent upon the early diagnosis of the disease through the identification of anti HCV antibodies and further disease confirmation by detection of HCV RNA through nucleic acid amplification tests. Ferozsons pharmaceutical company is credited with the introduction of effective Hepatitis C treatments in Pakistan which were initially were expensive. However, with the development of new and better medicines the cost reduced effectively and the treatment is now affordable by people with low income. Many actions have been taken at the government level which have made mass screening of the individuals along with appropriate and timely supply of medications possible. Another important step in eradicating Hepatitis C is the education of the public by advertisements, seminars and HCV courses
conducted by specialists. Project ECHO deserves mention, as it shows that people treated according to ECHO methodology have better prognosis than the others.
Prevalence of ST-Segment Elevation Myocardial Infarction (STEMI) in Pakistan and the Role of Primary Percutaneous Coronary Intervention (PPCI)
Authors: Ahmad Shahzaib , Sohail Anum , Chishti Muhammad Abubakar Shahid , Azeem Tariq
Published: September 2022

There are various strategies used for treating ST-segment elevated myocardial infarction (STEMI). Among those approaches, Primary percutaneous coronary intervention (PPCI) is the current treatment of choice for STEMI as it reperfuses the ischaemic cardiac tissue with fewer reported adverse events and a better survival rate. Although thrombolytic therapy is still used for STEMI in approximation, the benefits of PPCI outweigh thrombolytic therapy as thrombolytic therapy is associated with higher bleeding events and higher morbidity. The barriers in implementing a PPCI program and regional differences arise due to limited technologies, lack of proper training of first responders, lack of public awareness, and transport facilities and finances. Therefore, treatment varies between different regions of countries and even between different countries, including Pakistan. PPCI should be used in a timely manner as delayed use of this intervention can significantly reduce the benefits. We lack a coordinated approach to the delivery of this system in Pakistan; mainly, the
paramedical staff is not fully familiarised and trained for making a definite diagnosis and lacks referral portals. We need a comprehensive approach and program to identify factors that cause a delay in providing PPCI to STEMI patients and to eliminate the factors responsible for the delay. This will help in improving the survival rate morbidity in STEMI patients.
Digital Health and Future of Healthcare in Pakistan
Authors: Naeem Wara , Nadeem Hafiza Aqsa , Javed Ayesha , Ahmed Waqas
Published: September 2022

In today's fast paced world, the use of Information Technology (IT) in dispensing quality healthcare forms a cornerstone for the development of any health system. While the standard of Medical Education and training is quickly gaining impetus within Pakistan, we are severely lacking in use of digital platforms and electronic records to aid the process of healthcare delivery. There's no dearth of talent in Pakistan; in the field of Medicine or IT. However, there is a considerable lack in the understanding of how IT can revolutionize healthcare delivery. We see that there is an urgent need for the governmental institutions and the private sector medical institutions to recognize the importance of digital health in making medical practice more effective, efficient and error proof; so that Pakistan can shake off the burden of a centuries old and obsolete system of healthcare delivery. Here, we propose our roadmap vision for development of digital health systems in Pakistan and propose basic initiatives that must be taken at the grass roots level to expedite this process.
Diagnostic Significance of Schneiderian First Rank Symptoms
Authors: ALI M S , IZHAR N , BHATTI M R
Published: September 2022

Schizophrenia is considered to be the heartland of psychiatry and core of its clinical practice. There have been disagreements regarding its diagnostic criteria. Schneiderian first rank symptoms have been given much importance ill international classification systems. Prevalence of first rank symptoms has been reported to be from 28% to 73%. This study was done to estimate the prevalence of first rank symptoms in schizophrenia in patients presenting in outpatients departments of Mayo hospital Lahore and Institute of mental health Lahore. 168 patients were studied. Fifty patients were suffering from schizophrenia. Twenty-live patients each were suffering from mania and psychotic depression. Fifty patients had neurotic (disorders and 18 patients were suffering from drug-induced psychosis. ICD-10 was used as diagnostic criteria and Mellor’s definitions of first rank symptoms were used. Prevalence of first rank symptoms in schizophrenia was found to be 56%. Very few patients from other diagnostic categories had first rank symptoms. Prevalence of first rank symptoms in schizophrenia is lower than reported from studies done in the West. Local criteria and instruments should be developed for use in our own population.