bluuebunny/crossref_metadata_2025 huggingface dataset:
Determinants of operational performance of pharmaceutical wholesalers’ companies in Bali province
Authors: Pramudana Komang Agus Satria , Yasa Ni Nyoman Kerti , Ekawati Ni Wayan , Setiawan Putu Yudi
Published: June 2023

Pharmaceutical distribution companies or also known as Pharmaceutical Drug Wholesalers (PBF) play a significant role in the distribution of pharmaceutical products in Indonesia. Without the role of PBF, the drug will not reach the patients from the manufacturer. The PBF appointed by the manufacturer to distribute the product, has operational performance targets that must be achieved. However, like other businesses, PBF operational performance is also affected by external factors, such as the COVID-19 pandemic, government regulations and competition intensity. The impact of internal factors such as limited company resources is also investigated in this research. This research tries to explore the impact of external factors, those are: the pandemic of COVID-19, government regulations, competition intensity and internal factors that are the company's limited resources to PBF operational performance. Sales strategy is also used as mediating variables from external and internal factors to operational performance, thus operational control as moderating variable from sales strategy to operational performance respectively. Data collection was obtained by questionnaires and interviews with 44 PBF operational leaders in Bali, Indonesia. Data analyzing using SmartPLS 3.0. The COVID-19 pandemic, government regulations, competition intensity and company’s limited resources have a negative impact on the company's operational performance. Sales strategy serves as a mediating variable from external and internal factors to operational performance. Operational control plays a significant role in moderating sales strategy and the performance of operational. The theoretical implication of this research is to enhance The Contingency Theory, which claims that the business environment, strategy, and control are three major contingency elements that are linked. The findings of this study also strengthen the concept of Transaction Cost Theory, which states that the relationship between the parties in a transaction is associated with rights and obligations that are poured into a very detailed agreement. The operational performance required by the principal to PBF is also included in the agreement and PBF should strive to achieve that operational performance.
Do tax disputes affect firm value?
Authors: Noviari Naniek , Wiksuana I Gusti Bagus , Artini Luh Gede Sri , Sudana I Putu
Published: June 2023

This study examines the effect of tax disputes on firm value with industry profiles as a moderator. The population of this study is non-financial companies that are listed on the Indonesia Stock Exchange and disclosed tax disputes during the 2014-2019 period. The purposive sampling technique was applied, and 292 observations were obtained. A mixed-method approach is used in this study. First, a panel data regression analysis was performed using a tool called EViews 12. Second, to deepen the empirical nature of this research, and with the results of the panel data regression analysis having already been obtained, tax consultants who have legal power of attorney at the tax court were invited to a focus group discussion (FGD) that was held in Bali. The results of this study find that tax disputes have a negative effect on firm value. This study also demonstrates that an industry having a high profile weakens the negative effect of tax disputes on firm value. The research findings provide an understanding of tax disputes, firm values, and industry profiles within the framework of signaling theory and legitimacy theory. The limitation of this research is that it does not discuss typical tax dispute cases (whether material disputes or judicial disputes) due to data limitations.
The assessment of fresh fruit bunches supply chain of palm oil independent smallholder farmers in southeast Sulawesi
Authors: Witjaksono Julian , Yaumidin Umi Karomah , Djaenudin Deden , Astana Satria , Harianja Alfonsus H. , Fery Samuel , Hasibuan Abdul Muis , Khotimah Husnul , Hidayatina Achsanah , Rusdin Rusdin , Bungati Bungati , Imran Imran , Rusdi Rusdi , Purba Resmayati
Published: June 2023

Palm oil commodity in Indonesia is the cash crop for smallholder farmers especially in the dry land area. This smallholder has contributed to produce Crude Palm Oil (CPO) about more than 40 percent in the supply chain. This study is aimed to identify downstream and upstream in the line of CPO palm oil. Secondly, is to know the role of the actors in the CPO supply chain and its traceability. This study employed the traceability method of networking of CPO supply chain in Southeast Sulawesi. Indonesia. Two research sites were conducted as the implementation of survey, observation, interviews and Focus Group Discussion (FGD). The respondents have chosen from the downstream to upstream of the CPO supply chain. Independent farmers, middlemen, delivery order, and Fruit Fresh Bunches (FFB) mills to produce CPO have been interviewed as the key informant of this research. Traceability study shows that the main source of FFB came from the core of PT. Damai Jaya Lestari both in the research site, plasma, and independent farmer. In North Konawe, the downstream line that farmers sell the FFB to the middlemen then they bring to the agency who has the delivery order from the CPO mills. Meanwhile, in Kolaka District, Independent farmers sold the FFB to the agency who has the contract with the PT. Damai Jaya Lestari in Plasma Village, Poliggona Sub District. In terms of the green economy, waste such empty bunches were limited access for farmers who wanted to proceed with the waste for organic fertilizer and feeding cows. The role and the traceability study show that independent farmers have no access to utilize the waste of empty bunches, no protection from the Damai Jaya Lestari as the CPO mills, and have no institutional farmers as the farmers group.
The technological enhancement and its impact on corporate financial performance in the context of the industrial revolution 4.0: The case of Vietnam
Authors: Thuy Luong Thu
Published: June 2023

Businesses play an important role in the economy in most countries. Businesses contribute to increased productivity, output and jobs for the economy. Therefore, governments of countries always create favorable business environments to help businesses operate more efficiently, and thereby contribute to the economy. Transforming the industrial revolution 4.0 has brought businesses certain benefits to operations, improving productivity and efficiency. Using data in real estate businesses, through regression analysis, the research results confirm the technology factor has not yet affected the financial performance of enterprises, which can show that businesses need enough time to absorb technology in production activities to have a change in its output. In addition, there exists the negative relationship of leverage in the business and financial performance. Or it can also be confirmed that enterprises that choose their own capital are often more effective than enterprises that choose capital from loans and external financing. The study also confirms that enterprises with the ability to manage total asset turnover have higher financial efficiency. However, the research shows that interest rates have a negative effect on business operations, businesses with high interest rates have a negative effect on business operations, and vice versa.
The effects of the blockchain technology and big data analytics on supply chain performance: The mediating effect supply chain risk management
Authors: Kalbouneh Nevin Youssef , Bataineh Khaled Adnan , Al-Hamad Abd Al-Salam Ahmad , Dwakat Mohammad Kamel Al , Abualoush Shadi , Almasarweh Mohammad Salameh , Al-Smadi Raed Walid
Published: June 2023

The purpose of this paper is to investigate potential links between Blockchain technology (BCT) and big data analytics (BDA) with supply chain risk management (SCRM) and supply chain performance (SCP) in the Jordanian Chemical and Cosmetic Industries Sector. Additionally, the paper tests a conceptual model that links SCRM to indirect effects. To test our proposition, data were collected from 364 employees working in Jordanian Chemical and Cosmetic Industries Sector. The data were analyzed using structural equation modeling with aid of the Lavaan R package. The results show that the influences of blockchain technology and big data analytics on supply chain performance do occur directly, and indirectly through the cascading of a supply chain risk management.
The impact of green human resource management on green pharmaceutical supply chain management practices
Authors: Dahinine Benameur , Laghouag Abderrazak , Sahel Wassila Ben , Guendouz Tarik , Bennaceur Abdelhamid
Published: June 2023

Today's competition is among supply chains rather than enterprises as independent actors. Additionally, the success of the actors within the SC network, through the improvement of the global performance, depends on how well they handle the growing environmental problems. For this reason, much attention is given to the greening concept. This paper aims to investigate the Green Human Resource Management (GHRM) impact on Green Supply chain Management (GSCM) in a strategic sector, namely the pharmaceutical sector. Our interest to deal with this issue was aroused by the fact that there are no studies exploring the causality relationships in the pharmaceutical sector in Saudi Arabia. Based on deductive methodology, a questionnaire has been developed. A research sample included 109 pharmaceutical companies operating in KSA. The results highlight a significant impact of GHRM on GSCM practices. In other words, training and performance appraisal, recruitment, and eco-behavior-based rewards influence GSCM practices positively. Based on the results, the study provides new theoretical insights and practical suggestions.
The mediating role of green supply chain management in the relationship between eco-efficiency and SMEs sustainability performance
Authors: Novitasari Dewiana , Wijayanti Tri Cicik , Susilowati Dwi , Saragih Darwin Raja Unggul , Sim Edmund Thaddeus , Siskawati Eka , Harnoko Agustinus Darto , Kartikasari Dwi
Published: June 2023

The purpose of this study is to analyze the relationship between eco-efficiency and sustainability performance, the relationship between eco-supply chain management and sustainability performance and analyze the mediating role of Eco-Supply Chain Management on the relationship between eco-efficiency and sustainability performance. The study method is a quantitative survey which is executed through the partial least square structural equation model (SEM-PLS) with a statistical data processing tool, namely SmartPLS 4.0 software. Research data was obtained by distributing online questionnaires through social media designed using a Likert scale of 7. Respondents in this study were 590 SMEs owners in Java Island, Indonesia. The results of the study indicate that eco-efficiency had a positive and significant effect on sustainability performance, green supply chain management (GSCM) had a positive and significant effect on sustainability performance. GSCM also plays a full mediating role in the relationship between eco-efficiency and sustainability performance. This research is expected to be a source of reference for further research in discussing issues related to the implementation of eco-efficiency and GSCM.
Increasing product competitiveness in weaving SMEs: The role of competency, creativity, and performance
Authors: Martini Ida Ayu Oka , Arsawan I Wayan Edi , Sari Desak Made Febri Purnama , Muna Nilna
Published: June 2023

This study examines the link between employee competency, creativity, and performance in generating product competitiveness in the weaving industry. It also analyzed the moderating role of time sufficiency in reinforcing employee performance and product competitiveness. This study was designed quantitatively by administering a questionnaire to 662 employees from 331 weaving SMEs in Indonesia using structural equation modelling. The analysis revealed that employee competency positively affects creativity, performance, and product competitiveness. Additionally, time sufficiency was confirmed as moderator in strengthening the linkage between employee creativity, performance, and product competitiveness.
Çocuklarda otizm şiddetinin sosyal iletişim ile ilişkisi*
Authors: KARABAŞ Abdurrahman , AYDIN Mehmet Fatih
Published: June 2023

Amaç: Karaman ilinde rehabilitasyon eğitimi veren okullar ile normal eğitim veren okullardaki çocuklarda otizm şiddetinin sosyal iletişim ile ilişkisini incelemektir. Yöntem: Çalışma Karaman ilinde 2021 yılı ocak ve haziran aylarında gerçekleştirilmiştir. Araştırma deneysel olmayan, nitel ve vaka kontrol şeklinde gerçekleştirilmiştir. Örneklem seçiminde olasılıksız örneklemelerden gelişigüzel örnekleme kullanılmıştır ve evreni temsil etme yeterliliği yoktur. Araştırmanın örneklemi, Karaman ilinden 4- 18 yaş arası 50 otizm tanılı ve 50 otizm tanısız toplam 100 çocuktur. Veriler sosyodemografik anket, sosyal iletişim ölçeği ve çocukluk otizm değerlendirme ölçeği kullanılarak toplandı. Verilerin analizinde IBM SPSS Statistics 22 kullanılmıştır. One-Way ANOVA (bağımsız gruplarda tek yönlü varyans analizi), t testi, grup değişkenleri arasındaki farkı belirleyebilmek için Bonferroni kullanılmıştır. Anlamlılık değeri p
Türkiye’de hemşirelik alanında sağlık inanç modeline dayalı yapılan doktora tezlerinin incelenmesi: bibliyometrik bir analiz
Authors: DENİZ AKAN Dilan
Published: June 2023

Amaç: Araştırmada, Türkiye’de hemşirelik alanında Sağlık İnanç Modeli’ne dayalı yapılan doktora tezlerinin bibliyometrik analiz yöntemiyle incelenmesi amaçlanmıştır.

Yöntem: Retrospektif-tanımlayıcı tipteki araştırmada, tezlere ulaşabilmek amacıyla Yüksek Öğretim Kurumu Ulusal Tez Merkezi tarama motorunda “Sağlık İnanç Modeli” ve “hemşirelik” anahtar kelimeleriyle Türkçe ve İngilizce olarak tarama yapılmıştır. Yapılan taramalar sonucunda; hemşirelik alanında 2012-2022 yılları arasında Sağlık İnanç Modeli’ne dayalı olarak yapılan, erişime açık ve dahil etme kriterlerini karşılayan 30 doktora tez çalışması araştırma kapsamında incelenmiştir. Tezler, araştırmacı tarafından geliştirilen “Veri Toplama Formu” aracılığıyla değerlendirilmiştir. Veriler, IBM SPSS 25 paket programında analiz edilmiş olup verilerin değerlendirilmesinde tanımlayıcı istatistiksel yöntemler kullanılmıştır.

Bulgular: Araştırma kapsamına alınan tezlerin; %30’unun Dokuz Eylül Üniversitesi’nde, %90’ının sağlık bilimleri enstitüsünde, %43,3’ünün halk sağlığı hemşireliği anabilim dalında ve %69,3’ünün danışmanlığının profesörler tarafından yürütüldüğü tespit edilmiştir. Tezlerde en sık kullanılan araştırma tasarımlarının yarı deneysel (%46,2) ve deneysel (%46,2) araştırma tasarımı olduğu, en üretken yılların 2018 (n=6) ve 2020 (n=6) yılları olduğu saptanmıştır.

Sonuç: Sonuç olarak, son yıllarda hemşirelik alanında Sağlık İnanç Modeli’ne dayalı yapılan çalışmaların giderek artmakta olduğu ancak halen istenilen düzeye ulaşmadığı belirlenmiştir. Bireylerin korucuyu/önleyici sağlık davranışlarını geliştirmek ve semptom yönetimini sağlayabilmek amacıyla daha fazla sayıda Sağlık İnanç Modeli’ne dayalı araştırmaların yapılmasına ihtiyaç olduğu söylenebilir. Yapılan bu çalışmanın, hemşirelik literatürüne katkı sağlayacağı ve ileride bu alanda çalışmayı düşünen bilim insanlarına ve lisansüstü öğrencilere yol gösterici olacağı tahmin edilmektedir.
Yaşlılarda malnütrisyon, nedenleri ve etkileri
Authors: GÜL DİKME Tuğba
Published: June 2023

Çoğunlukla yaşlı bireylerde görülen malnütrisyon yaşlı bireylere zarar veren en önemli faktörlerden biridir. Birçok yaşlı birey çeşitli fizyolojik, sosyolojik, psikolojik ve ekonomik nedenlerle malnütrisyon riski altındadır. Bu durum yaşlı bireylerin yaşam kalitelerini ve bağımsız yaşayabilmelerini etkiler. Yaşlılarda çeşitli sebeplerden dolayı besin alımındaki azalmalar vücudun ihtiyacı olan elzem beslenme öğelerinin alınmasına engel olur. Yaşlılarda yetersiz beslenmeye bağlı olarak makro ve mikro besin eksikliği gelişerek kilo kaybı meydana gelir. Bu durum giderek ağırlaşarak yaşlılarda sağlıkla ilgili diğer sorunlara neden olur. İleri yaşlarda daha da artan yetersiz beslenme, birçok hastalığa yakalanma riskini artırmaktadır. Ayrıca rejeneratif kapasitelerinin bozulması nedeniyle yaşlıların mevcut durumu daha da kötüleştirir. Sonuçta malnütrisyon yaşlı hastalarda daha yüksek morbidite ve mortalite ile sonuçlanır. Bu nedenle yaşlılarda mevcut beslenme eksiklikleri durumuyla mücadele ederek yetersiz beslenmenin önüne geçmek ve sağlıklı bir beslenme tarzını teşvik etmek en önemli adımlardır.
GEBELERDE COVID-19 SALGININA YÖNELİK ALGI VE TUTUMLARININ BELİRLENMESİ
Authors: TAHAN Beril Ezgi , KARAKAŞ Sevda
Published: June 2023

Giriş ve Amaç: COVID-19 dünya genelinde sağlık problemi oluşturmuş, enfekte olan bireylerde hafif veya orta seviyede semptom gösterirken bazı kişilerde ciddi semptomlara ulaşmıştır. Bu araştırma gebelerin COVID-19’a karşı algı ve tutumlarını belirlemek amacıyla yapılan tanımlayıcı tipte bir çalışmadır. Gereç ve Yöntem: Araştırma 17.11.2021 – 06.01.2022 tarihleri arasında Çerkezköy İrmet Hastanesi kadın doğum polikliniğine başvuran 300 gebeden oluşmaktadır. Literatür doğrultusunda hazırlanan tanımlayıcı soru formu ve COVID-19 Salgınına Yönelik Algı ve Tutumları Değerlendirme Ölçeği kullanıldı. Bulgular: Çalışmaya katılan gebelerin %39,7’si 26-30 yaş aralığındadır. Katılımcıların %26’sı gebeliğinin COVID-19 salgınından etkilendiği, %42’si koruyucu önlemleri öğrenip uygulayarak sağlık arama davranışına başvurduğu belirlenirken %12,7’si sağlık arama davranışından kaçınmaktadır. Sonuç: Katılımcıların hastalık algısının bulaşıcılık alt boyutu puanlar ortalama 4,04±0,75 ve kaçınma davranışlarından kişisel temastan kaçınma alt boyutunun ortalama puanı 4,17±0,75 olup bu yönde inancın yüksek olduğuna ulaşıldı. Hemşirelerin gebelere hastalık hakkında eğitim vermesi algı ve tutumlar açısından önemlidir.
Effect of Health Education Supported with Motivational Interviewing on Medication Adherence of COVID-19 Patients Receiving Home Care
Authors: YILMAZ Burcu , ÖZDEMİR Serpil
Published: June 2023

Objective: The objective of this study is to determine the effect of health education supported with motivational interviewing on medication adherence of COVID-19 patients receiving home care. Materials and Methods: This study was carried out in Gelibolu in Turkey between the dates of June 2021 - January 2022. Participants who meet the inclusion criteria of the study were assigned to the intervention group (50) and control group (50) using the block randomization method. Data at the beginning of the study were collected with the "Sociodemographic Questionnaire Form" and "Medication Adherence Reporting Scale" which were developed by the researchers according to the literature. At the end of the study the participants completed the "Medication Adherence Reporting Scale" and the questionnaire for "Medication Treatment Satisfaction Level". Data obtained were evaluated with the statistical analysis of percentage, frequency, mean, Mann Whitney U, Wilcoxon test using SPSS 22.00 program. Results and Conclusion: At the end of the study, the mean "Medication Adherence Reporting Scale" score of the participants in the intervention group (16.12±5.37) was higher than the mean score of the participants in the control group (9.96±5.62) (p
X ve Y Kuşağındaki Hemşirelerin Bakım Davranışı Özellikleri ve Mesleğe Bağlılıklarının Değerlendirilmesi
Authors: LAFÇI Diğdem , CANLI Fatma
Published: June 2023

Amaç: Bu araştırmanın amacı, X ve Y kuşağındaki hemşirelerin bakım davranışlarının ve mesleğe bağlılıklarının belirlenmesidir.

Gereç ve Yöntem: Tanımlayıcı, kesitsel ve karşılaştırmalı tasarımda yapılan bu araştırma, Mersin’de bir devlet hastanesinde çalışan 400 hemşire ile gerçekleştirilmiştir. Veriler, “Tanıtıcı Bilgi Formu”, “Bakım Davranışları Ölçeği-24” ve “Hemşirelikte Mesleğe Bağlılık Ölçeği” ile toplanmıştır. Verilerin değerlendirilmesinde tanımlayıcı istatistikler, Independent-Samples T testi, OneAway ANOVA, Kruskall Wallis testi ve Sperman Brown Korelasyon kullanılmıştır.

Bulgular: X ve Y kuşağındaki hemşirelerin bakım davranışları düzeylerinin yüksek ve mesleki bağlılıklarının orta düzeyde olduğu saptanmıştır. Yoğun bakım ünitelerinde çalışanlarda, kurumdan ayrılma düşüncesi olmayanlarda ve verilen bakımı çok yeterli bulanlarda bakım davranışlarının yüksek olduğu bulunmuştur (p
ÖRGÜTSEL İLETİŞİM İKLİMİ ALGISI İLE İLİŞKİLİ BAZI DEĞİŞKENLER: BİR İLDEKİ İKİ KAMU KURUMU ÖRNEĞİ
Authors: BAŞ Kazım
Published: June 2023

Amaç: Tanımlayıcı türden olan bu çalışma, bir ildeki kamu üniversitesi ile hastanelerinde çalışanların örgütsel iletişim iklimi algısıyla ilişkili bazı değişkenleri değerlendirmek amacıyla yürütüldü.

Gereç ve Yöntem: Araştırma örneklemini bir ildeki kamu üniversitesi ile hastanelerinde çalışan toplam 1143 çalışandan ulaşılan ve araştırmaya gönüllü katılan 446 kişi oluşturdu. Araştırma verileri 20 Haziran 2022-23 Aralık 2022 tarihlerinde, çalışanların işyerlerinde, yüz yüze görüşme tekniği kullanılarak toplandı. Araştırma verilerinin toplanmasında “anket formu” ve “örgütsel iletişim iklimi ölçeği” kullanıldı. Elde edilen verilerin analizinde, sayı, yüzdelik, ortalama, standart sapma, bağımsız gruplarda t-testi, Kruskal Wallis ve Anova testleri kullanıldı.

Bulgular ve Sonuç: Çalışanların yaş ortalaması 36.84±8.13 olup, %52’sinin üniversite, %48’inin de hastanelerde çalıştığı belirlendi. Çalışanların örgütsel iletişim iklimi algılarının olumlu fakat yüksek olmadığı görüldü. Çalışanların örgütsel iletişim iklimi algıları öğrenim düzeyi, çalışılan kurum, çalışma deneyimi ve mesleklerine göre önemli fark olduğu ve bu fark istatistiksel olarak anlamlı bulundu (p
Attitude of Postgraduate Medical and Nursing Students towards Inter-professional Learning
Authors: Noor Nazi , Kousar Samina , Malik Rozina , Yasmin Rizwana , Emennual Shazia , Naz Afshan Mehwish
Published: June 2023

Background: Globalisation, newly discovered diseases, and technological improvements have been noted to have significantly altered the healthcare system in recent years, which is continuously affecting healthcare outcomes. These adjustments necessitate standard care from medical specialists, who must be highly motivated to collaborate as a team. Aim: To assess and compare the attitudes of postgraduate medical and nursing students towards inter-professional learning. Study design: Comparative cross-sectional study. Methodology: Purposive sampling approach and a comparative cross-sectional study design were used to study postgraduate medical and nursing students from the University of Health Sciences and the University of Lahore. One hundred twenty (120) of the three hundred and twelve (312) postgraduate medical and nursing students who were contacted for data collection completed the survey. The 19 items of the RIPL, or Readiness to Inter-professional Learning Scale, were used to collect the data. In order to analyze the data, SPSS 23 was used. Results: Ages of study participants ranged from 21 to 52, with a mean of 32.4 +/- 6.4. 62 (51.7%) and 58(48.3%) of the 120 people were from the University of Health Sciences, Lahore, respectively. The mean readiness score on the Inter-professional Learning Scale, with a range of 42 to 86, was 72.4 6.97 overall. In the categories of duty and responsibility and teamwork and collaboration, there was no appreciable difference between postgraduate medical and nursing students' mean attitudes scores. Practical Implication: IPL as a pedagogical tool because it gives the concepts of collaborative practice, as represented by the IPL idea, a framework. Students must always be prepared to participate in inter-professional learning if IPL is to be successfully promoted, as doing so will expand their knowledge, skills, and understanding of responsibilities of healthcare professionals. Conclusion: It was concluded that early adoption of inter-professional learning programmes at the beginning of professional training and the provision of a suitable learning environment for healthcare learners will promote collaboration and cooperation in clinical settings, which may also improve patient and family satisfaction. Keywords: Inter-professional Learning, Post-graduate Nurses, Knowledge and Attitude.
Assessment of Stress Level and Quality of Life in Spinal Cord Injury Patients
Authors: Yasmin Rizwana , , Kousar Samina , Sultana Saima , Noor Nazi , Amin Jauhar , Abbasi Salma Iftikhar
Published: June 2023

Background: Spinal cord injury (SCI) involves severe physical, social, and also psychological consequences, and cause severe disturbance in normal daily activities of a person. Aim: To assess the stress level and quality of life (QOL) variation among spinal cord injured individuals. Study design: Descriptive Cross sectional. Methodology: Simple random sampling recruited 165 participants (15-75 years) both genders, from government and public hospitals of Lahore and Islamabad. Data was collected by using The “Perceived Stress Scale (PSS-14 item)”and “WHOQOL-BREF” (26-item). Data SPSS v.24 analyzed the data. Quantitative data was expressed in terms of frequency and percentages. Results were shown in tabular and graph forms. Results: On PSS questionnaires 87.9% experience moderate stress, 12.1% experience severe stress. On WHOQOL-Bref the average score of physical health was 53.18, psychological health was 55.42, social relationship was 69.16 and the lowest most score among four domains was environmental health 52.73. Practical Impact: This study provided information regarding the perceived level of stress and QOL in SCI patients that is the most ignorant portion of our society and recognized the importance of assessing variation of stress and QOL in these patients so health care team take appropriate decisions for the improvement of the health status of these client. Conclusion: It was concluded that SCI patients had moderate stress level and face life threatening complication associated with this injury. Thus, both physical disability and psychological disturbance may adversely impact their stress level and quality of life. Keywords: Stress, Quality of life, Spinal cord injury and Psychological Impact.
Botulinum Injection and Sphincterotomy for Management of Anal Fissure in Terms of Healing of Anal Fissure: A Randomized Controlled Trial
Authors: Minhas Rashid , Akbar Ali , Mushtaq Muhammad , Mehmood Rashid , Siiddique Humayun , Ali Manzar
Published: June 2023

Aim: To compare the efficacy of botulinum injection with lateral internal sphincterotomydone for management of anal fissure in terms of healing of anal fissure Study design: Randomized controlled trail Setting and duration: Department of General Surgery, K.E. Medical University, Lahore from April, 2019 to Oct, 2019 Methodology: All 350(175 cases in each group) cases meeting inclusion criteria were enrolled through department of Surgery KEMU. Patients were randomly allocated in two groups, group A and B by Lottery method. Patients in group ‘A’ received treatment with 0.5 ml (20 units) Botulinum toxin injection on each side of anal fissure in the internal anal sphincters under direct vision and digital examination at 3 or 9 o’clock position in lithotomy position under strict aseptic measures by single expert surgeon having at least five years’ post fellowship experience. Patients in group ‘B’ underwent lateral internal anal sphincterotomy under general anesthesia by single expert surgeon also having at least five years’ post fellowship experience. Patients were discharged on 1st post operation day on oral antibiotics, analgesics, stool softeners and were advised sitz bath. In both groups, patients were followed up for 2 months. Results: The mean age of all patients was 43.09 ± 10.68 years while the mean age in Group-A was 43.17±10.32 years and in Group-B was 43.02±11.06 years. The efficacy in Group-A was seen in 158(90.3%) while the efficacy was seen in 114(65.1%) of Group-B, the efficacy of treatment was higher in group-A when compared with Group-B, p-value < 0.001. Conclusion: Botulinum toxin injection for the treatment of anal fissure has yielded higher rates of healing than lateral internal sphincterotomy. This suggests that botulinum injection could provide temporary relief from sphincter spasm, allowing for faster fissure healing and improved quality of life, with fewer risks of complications. Keywords: Sphincterotomy, anal fissure, healing of anal fissure, rectal pain, anal pain, anal surgery
Frequency of Cervical Lymph Node Extracapsular Spread in Oral Squamous Cell Carcinoma Patients
Authors: Khan Abdullah , Warraich Riaz Ahmed , Rahim Ashfaq-ur- , Ali Sadiq , Nauman Muhammad , Ali Asif
Published: June 2023

Aim: To estimate the frequency of cervical lymph node extracapsular spread in oral squamous cell carcinoma patients. Methodology: This prospective study was conducted in the Department of Oral and Maxillofacial Surgery, The University of Lahore from 1st December 2021 to 30th November 2022 and 50 diagnosed cases of oral squamous cell carcinoma were enrolled. Computed tomography scan was conducted for the diagnosis in addition to the histopathology of the samples. The CT scan images were used for identification of lymph node size, shape, and central necrosis. The frequency of the extracapsular extension of lymph nodes with the central necrosis was correlated with histopathology. Results: The mean age of the patients was 60.5± 11.1 years with 60% of the cases were males and 40% of the cases were females. 36% of those patients were having a history of smoking, 22% were having a history of taking pan, 14% supari & chalia, 8% alcoholics and 6% consuming gutka. The primary tumor site identified through clinical and diagnostic imaging was anterior 2/3rd of tongue in 38% followed by posterior 1/3rd of tongue in 20%, buccal mucosa 14%, mandible and lip each as 10%, maxilla 4%, floor of mouth and retromolar trigone region each as 2%. It was observed that T3 and T4 cases had more ECS than T1 and T2 with a percentage of 20% and 30% respectively. Practical implication: Knowledge of frequency and burden of this disease in Pakistan will assist in generating more efficient management and treatment protocols with early detection strategies of oral squamous cell carcinoma through association analysis and biomarker role of cervical lymph node extracapsular spread. Conclusion: Extracapsular spread is observed more in patients having advanced stage tumor or having advanced grade of oral squamous cell carcinoma. Key words: Extracapsular spread, Oral squamous cell carcinoma, Recurrence, Histopathological examination
Extensively Drug Resistance Enteric Fever in Tertiary Care Hospital
Authors: Feroz Bushra , Khushdil Arshad , Memon Imran Ahmad , Nawaz Sadaf , Shahzadi Maryam , Akhtar Waqas
Published: June 2023

Background: Salmonella enterica causes typhoid and paratyphoid fevers. Pakistan and other South Asian nations with little resources, including those with poor sanitation and hygiene, are particularly susceptible to enteric fever. Enteric fever is a disease which is extensively resistant to majority of antibiotics and these strains are rapidly spreading in Pakistan, raising concerns about the global failure of antibiotics. Study design: Descriptive cross-sectional study. Place and duration of study: Department of Pediatrics, CMH Quetta from 1st July 2022 to 31st December 2022. Methodology: A hospital based study in which history of fever for minimum of three days in the previous seven days, and blood test recommendation from a doctor were requirements for enrolment in the study. Individuals who had blood cultures that tested positive for enteric fever were enrolled. Results: Salmonella Typhi made up 52(94%) of the isolates and S. Para typhi made up 6%. 33(60%) of isolates were extensively drug-resistant (XDR), resistant to first-line antibiotics, fluoroquinolones, and third generation cephalosporin’s, and 8(15%) of isolates were extremely drug-resistant (MDR) to first-line antibiotics. Conclusion: In the current region of Pakistan, enteric fever is widespread. Over the course of the monitoring period, the incidence of typhoid fever has risen. With the advent of XDR typhoid, resistance to antimicrobial agents has also increased. Keywords: Enteric fever, Burden, Salmonella typhi, Typhoid fever
Immunization Practices in Children Presenting to Outpatient Department of a Tertiary Care Hospital
Authors: Feroz Bushra , Khushdil Arshad , Memon Imran Ahmad , Nawaz Sadaf , Shahzadi Maryam , Akhtar Waqas
Published: June 2023

Background: Immunization has tremendously reduced the incidence of childhood illnesses. Aim: To identify the causes of failure of immunization in our setups and help strengthen the EPI by solving those causes. Study design: Descriptive cross-sectional study. Place and duration of study: Department of Paediatrics, CMH Quetta from July 2022 to December 2022. Methodology: Two hundred and seven children (0-24 months) of both genders with acute diarrhoea passing three or more loose stools per day for no longer than two weeks were chosen. Using EPI cards, all parents of these patients were asked about their children's vaccination status. The demographic information like name, age and gender were noted. Results: There were 104 (51%) females and 103 (49%) females with a mean age of 18±1.5 months. 91.8% received BCG and OPV0, about 82% received Penta +OPV1+Hib at 6 weeks and 157 children were vaccinated at 10 weeks. Complete vaccination was received by 137 children at the age of 14 weeks, 52% of the children received measles vaccine, however, only 32% of the children had received their second dose of the measles vaccine by the time they were 15 months old. Conclusion: The immunization practices in children were decreased with advancing age of the children. The vaccination rate was highest at birth, 6 weeks and 10 weeks but significantly reduced at 9 months and 15 months. A robust awareness campaign is needed in order to sensitize the parents regarding the immunization of their children particularly at 9 months and 15 months of age. Keywords: Immunization, EPI, Polio, Measles, Tuberculosis, Diphtheria
Association of Smoked and Smokeless Tobacco with Tooth Loss
Authors: Jabeen Bushra , Afshan Zareen , Aslam Kashif , Iftikhar Mashal , Rasool Salik , Ahsan Hammad
Published: June 2023

Background: Tooth loss is associated with numerous factors which includes smoking, systemic diseases, age, poor oral hygiene, level of education and socio economic status etc. Association of tobacco and tooth loss is known but relationship of other modes of tobacco i.e. smokeless tobacco (chewable) with tooth loss is in dearth. Aim: To figure out the relationship oftooth loss with smokeless tobacco along with other variables such as presence of tobacco use (both smoked and smokeless), age and gender. Methodology: Three hundred and thirty six participants were included in this study. ‘Controls’ were based on the presence of all teeth and ‘Cases’ were based on one or more than one tooth missing. Participants’ were questioned about use of smokeless tobacco (chewable), presence of tobacco use (both smokeless and smoked), age (> than 30 or < less than 30) and gender (male or female). Results: There was no statistically significance of tooth loss (dependent variable) with any of the independent variables such as smokeless tobacco, age and gender. However presence of tobacco use i.e. both smokeless and smoked has 1 time more chance of tooth loss (OR=1.535) (C.I=0.54-4.335) as compared to absence of tobacco use. Practical implication: This study will figure out the association of tooth loss with use of smokeless tobacco because research in this aspect is insufficient. Results of this study would help in determining smokeless tobacco as a reason of tooth loss. Conclusions: Presence of tobacco use either smokeless or smoked can lead to tooth loss. Keywords: Tooth loss, Smoked and smokeless tobacco, Gender, Age
Study Comparing the Shear Bond Forte of Ceramics with Metal Reinforcement to Unreinforced Ceramic Brackets
Authors: . Asadullah , Gul Hafsa , Shah Syed Wasif Ali , Fayyaz Fawad , Gul Zubair , Farooq Muhammad Asim
Published: June 2023

Background: In an effort to address the growing need for more aesthetic appliances, ceramic brackets were introduced into orthodontics. The need for more aesthetic and less obvious appliances has risen as a result of adult orthodontic therapy. Aim: To assess the shear bond strength of the Clarity and Transcend 6000 brackets as well as the bracket breakdown mechanism while utilising shear force with Schimadzu testing equipment, information from this study will be useful for orthodontic participants as well as practitioners. Methodology: This comparative study was conducted at Orthodontic Department, Bacha Khan College of Dentistry, Mardan from 1st July 2021 to 31st December 2022. A total of 150 brackets (75 reinforced ceramic brackets and 75 conventional ceramic brackets in each cluster) were enrolled. The first premolar teeth that had been pulled in their entirety for orthodontic treatment were chosen to be bonded. Only the first maxillary premolar teeth with undamaged surfaces that had recently been removed and preserved were used. Premolars that had broken down or decayed were eliminated. Result: There was no statistically significant difference amongst the two brackets evaluated, according to an independent t-test associating the clarity and transcends 6000 ceramic brackets. Conclusion: The differences in adhesive remnant index ratings and shear bond forte between the Transcend 6000 ceramic and Clarity were negligible. Key words: Adhesive remnant index (ARI), De-bonding, Shear bond strength
Correlation between the Inner Canthal Distance and the Upper Central Incisor Mesiodistal Width Using the Decreasing Function of the Golden Ratio
Authors: Hayat Kajal , Waqar Hanzala , Hussain Yasir , Ahmad Shahwar , Khan Muhammad Salman , Babar Zaheer
Published: June 2023

Background: Optimal aesthetics without sacrificing function is one of the main goals of prosthodontists. The face is the most noticeable aspect of the body, and a grin significantly increases one's sense of self-worth. Since aesthetics and subsequently self-esteem are both impacted by the loss of anterior teeth, this frequently causes psychological anguish for the patient. The quality of life and self-esteem of patients are improved by the proper tooth location and choice employing the art of dentogenics to simulate real teeth. Aim: To determine whether there is a relationship between the average mesiodistal width of the upper central incisor and the inner canthal distance when the ICD is multiplied by the decreasing golden ratio, as well as to evaluate the significance of this relationship in predicting mesiodistal width of the upper central incisor in subjects with edentate disease. Methodology: This cross-sectional study was carried out at Department of Prosthodontics, Bacha Khan College of Dentistry Mardan from October 2022 to March 2023. Four hundred and fifty dentate Pakistani subjects without dental or facial abnormalities, aged 18 to 40, were examined. With the use of veriner callipers, the central upper incisors were noted mesiodistally amongst the interproximal contact sites and inner canthal space. The inner canthal space was multiplied by 0.618, and the width of the central incisor was calculated by dividing the result by 2. Results: Statistically significant finding demonstrated with inner canthal distance was exposed to the golden ratio. There was only a modest link among the practical mesiodistal width of the central upper incisors and the estimated central upper incisor width. Conclusion: For edentulous patients, choosing the width of the upper central incisors using the decreasing value of the inner canthal distance's golden ratio was not a valid predictor. Keywords: Edentulous, Golden ratio, Inner canthal distance (ICD)
The Athletes versus Lung Volume Responses of Non-Athlete Children to Intense Exercise
Authors: Khan Muhammad Salman
Published: June 2023

Background: Results from spirometry can be impacted by factors such as age, gender, weight, height, ethnicity, physical fitness, smoking habits, workout, and environmental factors. Aim: To compare the spirometry lung volumes of children who were athletes to those of children who were not. Methodology: This descriptive, cross-sectional study was conducted at Department of Physiology, Gomal Medical College, Dera Ismail Khan from 1st March 2022 to 30th November 2022. Spirometry was done on a total of 1,500 subjects, and 1100 recordings that satisfied the 2005 ATS/ERS task force acceptance criteria were chosen. Children and teenagers between the ages of 8 and 18 participated. An altered version of the International Study of Asthma and Allergies in Childhood (ISAAC) Questionnaire 17 was utilized prior to the test. A record of physical measurements, height, and weight was made. On all subjects, a thorough physical and systemic examination was done. Results: Variables related to pulmonary function, such as FVC, FEV1, FEV1/FVC ratio, PEFR, and FEF25-75% were 1.13±0.64, 1.05±0.62, 82.01±3.51, 212.1±58.8 and 1.61±0.1 respectively. Conclusion: When interpreting spirometry data, age and physical activity should be taken into account as they have a significant impact on spirometry reference values. Young children should be encouraged to engage in physical activity since it increases lung volumes, especially during intense exercise in athletes. Key words: Spirometry, Athletes, Physical activity, Pulmonary function testing, Reference values
Complications and Outcome of Children Presenting with Tuberculosis Meningitis
Authors: Amjad Tahreem , Nazir Tahira , . Sanaullah , Khalil Urwa , Anwar Muhammad , Siddique Shazia
Published: June 2023

Aim: To determine the frequency of complications and outcome in children with tubercular meningitis. Study design: Descriptive case series. Place and duration of study: Department of Paediatric Medicine, The Children’s Hospital and Institute of Child Health Lahore from 1st July 2021 to 31st December 2021. Methodology: One hundred and forty children of both genders aged between 1-12 years diagnosed of tuberculous meningitis which were treated as per department protocols and were evaluated for various complications of TBM; seizures, tuberculoma, tuberculous brain abscess and hydrocephalus. Outcome of these children was evaluated after 3 months in terms of death and survival with and without sequelae; cognitive impairment, motor deficit, aphasias and seizures. Results: The mean age of the children was 4.9±2.6 years with 88(62.9%) boys and 52 (37.1%) girls. Among the various complications of TBM, tuberculoma was the most frequent and was observed in 73(52.1%) children followed by hydrocephalus 53(37.9%), seizures 20(14.3%) and tubercular brain abscess 11(7.9%). 16(11.4%) children died while 124(88.6%) children survived of TBM. Out of 124 children who survived, 72(58.1%) children had sequelae. Practical implication: Understanding the complication and related outcomes can assist in pre-empting the related issued in cases of tuberculosis meningitis and therefore assist in better treatment by promptly preventing sever complications identified through this research. Conclusion: Tuberculoma and hydrocephalus were observed as the most frequent complications in children presenting with tuberculous meningitis and majority of these children survived with long term disability. Keywords: Extrapulmonary tuberculosis, Tuberculous meningitis, Complications, Outcome
Efficacy of Danazol Versus Panadol In Management Of Resistant Mastalgia
Authors: Aslam Maila , Khan Farid Ullah , Mirza Tahir , Huma Ghazala , Latif Ansar
Published: June 2023

Aim: To determine the effectiveness of Danazol versus Panadol in the treatment of mastalgia. Study Design: Prospective Study. Place and Duration: Combined Military Hospital, Peshawar; from February 2022 to March 2023 Methods: Total 54 women with range age 18-42 years presented in this study. Female patients of reproductive age group with moderate to severe breast pain and resistant cases (taken analgesia for 3 months) were included. Age, body mass index, place of residence, level of education and marital status were among the many comprehensive demographics obtained after receiving informed written consent from enrolled patients. Women were equally divided in two groups I received Danazol 100mg oral twice a day and group II received Panadol oral in 27 patients for 3-months. Post-treatment effectiveness among both groups was compared. SPSS 20.0 was used to analyze all data. Results: In all 54 females, 22 (40.7%) had age 28-30 years, 18 (33.3%)cases had age 31-40 years and 14 (25.9%) cases had age 41-42 years. In group I mean BVMI was 22. 11±4.28 kg/m2and in group II mean BMI was 21.7±6.30 kg/m2. We found a significantly excellent results in group I among 21 (77.8%) cases in terms of reduction in breast pain, as compared to group II in 15 (55.6%) cases with P value <0.004. Frequency of menstrual problem, weight gain and hirsutism was higher 11 (40.7%) as compared to Danazol group in 9 (33.3%) cases but did not found any significant difference. Practical implication: Effective use of Danazol reduces the need for Panadol. Therefore, there will be a decrease in Panadol Overuse. Conclusion: We concluded in this study that use of Danazol in the treatment of resistant mastalgia was effective and useful as compared to Panadol in terms of pain retrieve and less recurrence rate. Keyword: Mastalgia, Danazol, Panadol, Side Effects, Recurrence, Resistance
Antimicrobial Sensitivity of Salmonella Species in Children - A Single-Centered Study
Authors: Rehman Sijad-ur- , Gul Haji , Ahad Abdul , Muhammad Naveed , Bibi Romana , Ullah Inayat
Published: June 2023

Background: Salmonellae are gram-negative, facultative anaerobic bacteria. Typhoid fever has a non-specific and varied appearance in its early stages. A high-grade fever (>38oC) is the most common presenting sign. Salmonella pathogenicity is primarily determined bythe virulence components it possesses, such as Salmonella pathogenicity islands (SPIs), virulence plasmids, pili, and enterotoxins.The most common drug used was cefixime (66.6%), then ciprofloxacin, and according to a comparable study conducted in Pakistan (33.3%). Cefixime and ceftriaxone had a sensitivity of 60.9% and 65.8%, respectively. In 50.1% of S.typhi isolates, ciprofloxacin sensitivity was observed. Aim: To determine the frequency of the most common salmonella specie and its drug sensitivity in children. Methodology:This descriptive study was conducted in the Department of Pediatrics Bacha Khan Medical Complex Swabi from April 2022 to October 2022 in children with suspected enteric fever. Blood culture reports of suspected patients were sent to the laboratory and reports were followed, before reports arrived patients were started on antibiotics. The sensitivity of drugs was measured by calculating frequency and percentages. Results: This study was conducted on 63 children having blood culture reports presented to us with suspected enteric fever including 25 females and 38 males with a mean age of 6.4±27 years. The most common organism in the blood culture of children presented with enteric fever was salmonella typhi (95.2%). Salmonella paratyphoid species shows 100% sensitivity to co-triaxle, co-trimoxazole and amikacin while 50.8% to azithromycin. Salmonella paratyphi A with 100% sensitivity to amikacin, ampicillin, azithromycin, cefepime, cefoperazone, cefotaxime, co-amoxiclav and colistin. While salmonella typhi were found to be 95.2% with drugs sensitivity amikacin, colistin, fosfomycin, co-trimoxazole, and ertapenem (100%) and ciprofloxacin (73%). Practical implication: by knowing the most common organism and its drug’s sensitivity and resistance, the resistance to antibiotics will be reduced, and targeted antibiotics will be used. Conclusion: Salmonella typhiwas the most common pathogen detected in blood culture (95.2%) with 100%drug sensitivity to amikacin, colistin, fosfomycin, co-trimoxazole, and ertapenem. Keywords: Salmonellatyphi, sensitivity, blood culture, children, enteric fever