bluuebunny/crossref_metadata_2025 huggingface dataset:
Diseño de una estrategia para el cambio de percepción y conducta ambiental: Teoría y estudio de caso del proceso cognitivo de divulgación y apropiación de conocimiento en usuarios
Authors: García Jiménez Esteban , Mendoza Sánchez Magdalena , Maldonado Azpeitia Luis Fernando , Hernández López Ma. Sandra
Published: October 2022

Uno de los problemas actuales es la disposición apropiada de los residuos sólidos urbanos (RSU); sin embargo, no solo basta pensar y actuar enfocados en la disposición. Es necesario considerar el origen y las decisiones de compra que los distintos usuarios toman sin considerar la está de disposición de los residuos generados de manera diaria. Es por lo que esta investigación busca desarrollar de manera teórica y práctica una estrategia que favorezca el cambio de percepción ambiental en los individuos haciendo uso de herramientas de divulgación y apropiación del conocimiento.  

La presente estrategia cuenta con un eje metodológico centrado en la escucha del usuario, mismo que es segmentado acorde a la precepción ambiental. Comprender la segmentación del usuario es primordial para fomentar la flexibilidad cognitiva mediante el uso de algunas herramientas lúdicas y herramientas centradas en el usuario como los diagramas de afinidad. Así bien, se valida la estrategia con 3 diferentes grupos de usuarios bajo diferentes condiciones y frecuencias de aplicación de la estrategia.

La investigación muestra el impacto positivo en usuarios con más de una inmercion en la estrategia planteada, así como se logra identificar un impacto significativo en grupos de personas en los cuales con una percepción ambiental intermedia – alta. Es sumamente importante trabajar en estrategias que se implementen antes de la generación de RSU, ya que de esta forma se desarrollaran estrategias de corrección y no solo de contención
ALTERAÇÕES DA SEXUALIDADE DURANTE A GRAVIDEZ: UMA REVISÃO SISTEMÁTICA
Authors: Moreira Anellita Gonçalves Chambel Mendes , Henriques Catarina Maria Pinto , Frias Ana Maria Aguiar
Published: October 2022

A gravidez é uma fase de alterações físicas, emocionais e sociais tanto para a mulher como para o seu parceiro, e que pode influenciar a intimidade e a atividade sexual do casal. Com o objetivo de identificar de que forma a gravidez altera a vida sexual e qual a perceção masculina sobre a sexualidade durante a gestação, foi realizada uma revisão sistemática da literatura com o objetivo de responder à questão de investigação “Quais a evidências científicas sobre as alterações da sexualidade na gravidez?”. Para tal, foi efetuada uma pesquisa nas bases de dados PubMed, Web Of Science e EBSCO. Através do método de pesquisa boleano, com a aplicação dos descritores MESH “Sexology”, “Sexuality”, “Sexual Behaviour”, “Pregrant Women” e “Pregnancy foram selecionados e analisados dez artigos publicados entre 2016 e 2021. A revisão sistemática permitiu concluir que à medida que a gravidez avança as mulheres relatam uma pior função sexual e que, existem lacunas ao nível do conhecimento sobre a sexualidade durante a gravidez, bem como, sobre perceção masculina acerca do tema. Assim, é necessária mais evidência científica de forma a identificar dificuldades experienciada pela mulher e pelo parceiro, colmatando a falta de informação e contribuindo para a mudança de comportamento e vivência sexual saudável durante a gestação
DESCONFORTOS DA GRAVIDEZ E BEM ESTAR DA MULHER GRÁVIDA: REVISÃO INTEGRATIVA
Authors: Galhanas Ana Isabel Ramalho , Frias Ana Maria Aguiar
Published: October 2022

Na Gravidez há modificações fisiológicas, psíquicas e sociais. Estas modificações vão desde a primeira semana de gestação até ao final da gravidez. Em resposta às necessidades do organismo materno, próprias desta fase, surgem alterações fisiológicas, que poderão alterar o bem-estar da mulher. Objetivo: Compreender quais as alterações mais frequentes, sentidas pelas grávidas, com impacto no seu bem-estar e qualidade de vida. Métodos: Revisão integrativa da literatura. Foi realizada a pesquisa de artigos científicos, através da plataforma eletrónica EBSCOhost, Biblioteca Virtual em Saúde (BVS) e Google académico, publicados entre 2010 e 2021. Os artigos selecionados foram aqueles que faziam enfoque a estudos sobre alterações fisiológicas da gravidez e a implicação destas na qualidade de vida da grávida. Resultados: foram selecionados 6 artigos que revelam a ocorrência de diversas alterações no sistema cardiovascular, respiratório e gastrintestinal em resposta às necessidades próprias gravidez, provocando sensibilização, sinais e sintomas que interferem no bem-estar da grávida. Conclusão: Durante a gravidez, as intervenções de enfermagem são essenciais para evitar complicações. Os profissionais devem identificar essas adaptações, bem como as suas consequências fornecendo orientações que contribuam para o alívio dos sintomas apresentados e possibilitem a compreensão da sintomatologia de forma a que a grávida vivencie este período com melhor qualidade de vida.
AROMATERAPIA PARA ALÍVIO DA DOR NO PROCESSO DE PARTURIÇÃO: REVISÃO INTEGRATIVA
Authors: Melo Campos Paola , Bellotto Paula Cristina Barth , Silva Marcela Rosa da , Cunha Marcia Cordeiro da , Krebs Vanine Arieta , Bravo Amanda Fiorenzano , Abrão Rafaela
Published: October 2022

Objetivo: Identificar as evidências científicas sobre o uso de aromaterapia durante o trabalho de parto como um método não farmacológico para o alívio da dor. Métodos: Esse estudo trata-se de uma revisão integrativa realizada em cinco etapas: formulação do problema, coleta de dados, avaliação dos dados, análise e interpretação dos dados e apresentação dos resultados. Todos os preceitos éticos da pesquisa foram seguidos. Resultados: A aromaterapia apresenta efeitos benéficos para o alívio da dor no trabalho de parto e deve ser recomendada para as parturientes por serem métodos simples, de baixo custo e de fácil aplicação. Conclusão: Conclui-se que a aromaterapia, assim como os demais métodos não farmacológicos devem ser escolhidos individualmente para cada parturiente e é fundamental que toda a equipe de saúde se envolva, apoiando e viabilizando a realização dessas práticas para a melhor assistência ao parto e nascimento. A aromaterapia torna o processo de parturição mais satisfatório para as mulheres, pois auxilia na atuação de outros sistemas corporais.
Modern Thermodynamic Analysis by the Energic-Exergic Method of Gas Turbine Power Plants 55 MW in Taza-Iraq
Authors: Wadhah H. Al Doori  , Anmmar Mahmoud Ahmed  , Ahmed Hasan Ahmed
Published: October 2022

Abstract Because of the increasing demand for energy in the recent period, it has become necessary to intensify the study in the field of evaluating the performance of the gas station under the first and second laws efficiency. The energy and exergy losses of gas stations are represented by the compressor, combustion chamber, and turbine. Therefore, this work aims to analyze the energy and exergy of a 55 MW Taza gas power station. The investigation demonstrated that the most significant misfortunes of the exergy happened in the combustion chamber, where was 66.5MW the most minimal misfortunes in the compressor 5MW while the misfortunes in the turbine 8.4MW. The thermal efficiency of the gas turbine power plant was 33.06%, while the exergy efficiency was 32.39%. The novelty of the current work concentrated on obtaining the Grassmann graph for each component.
Reinforcement T-Joint Design and Structural Validation for a Hydroelectric Power Plant: Study Case
Authors: Jorge Sierra del Rio  , David Hernández  , Edwin Correa Quintana  , Arley Cardona Vargas  , Carlos E. Arrieta  , Danilo Valencia
Published: October 2022

Branch pipe T-joints are used to connect and bifurcate hydraulic channels in big hydraulic power plants size. These components are submitted to enormous strengths that must be counteracted by integrated structures to the T-joint, for this case specified arrangement type "Nun neck". The main objective in this work is about validate structurally by numerical analysis the branch pipe T-joint design with reinforcement type “Nun Neck” to the operational established conditions in hydraulic channel design. The structural T-joint design was made following AISI Buried steel Penstocks and ASME section VIII Div. 1 standards. The simulation process was made by Multiphysics Simulation Software, Ansys Workbench V 17. The branch pipe T-joint CAD model is set as 1700 mm in diameter to flow and 1200mm to derivation. The computational simulation process was executed using the mechanical structure module in ANSYS Workbench V17.0 commercial version. The boundary conditions settings were established based on internal operational pressure given as 353.14 mWC and fixed restrictions in the areas of contact with the pipe. Equivalent Von Mises stress contours were determined looking to validate the stress state in branch T-joint, findings demonstrate that the proposed design has structural failures that must had been reinforced by civil works.
Numerical Method to Generate and Evaluate Environmental Wind Over Hills: Comparison of Pedestrian Winds Over Hills and Plains
Authors: Siddharth Jena  , Ajay Gairola
Published: October 2022

It is well known that the wind profile at altitudes below 10m from mean sea level (MSL) depends on the geometry of terrain, due to the boundary layer phenomenon. Hence, the profile of wind changes for hilly terrains and mountainous regions when compared with the plain regions. This phenomenon has become important to study due to the large-scale urbanisation taking place over hilly regions. The changing wind profile presents a challenge to evaluate the pedestrian winds, as depending on the aspect of the terrain an additional vertical velocity component is experienced due to the upwind climb of the winds. This creates a wind profile that is twisted in form. While wind tunnel studies have attempted to recreate this twisted wind profile (TWP), due to the inherent deficiency of wind tunnels to simultaneously map velocity and flow conditions, a lack of three-dimensional flow profile hinders pedestrian comfort evaluation. In the wind tunnel studies, it was also observed that small vertical eddies and wakes behind the interfering building were not identified which are an important factor to determine the pollution load dispersion. The authors have developed a numerical model to generate the twisted wind profile. The specialty of the numerical model lies in it’s unique boundary conditions that enable the visualization and quantification of the complete 3D wind profile, when the wind over a hilly terrain interacts with urban infrastructures. The developed model was validated with the wind tunnel experiments done previously by Tse and colleagues. The specialty of the model is that it ensures horizontal homogeneity while creating vertical heterogeneity. From the 3D flow profile hence generated the authors were able to deduce that the impact of twisted wind profile depends on the yaw angle of wind interacting with the structure and not on the wind attack angle. Also, the more the twist of the wind, more is the clockwise shifting of the far wakes behind the building. It was also seen that there are more low velocity zones in the pedestrian winds over a hill in comparison to that over the plains. The vertical eddies that aid in convective removal of pollutants were also missing in case of pedestrian winds over hilly terrains, which raises the risk of pollutant accumulation. The same was also observed in Hong-Kong during COVID 19, where due to the twisted nature of wind flow, the virus load increased and natural ventilation was inadequate in the removal of the viral load in the air near urban areas.
Predictors of Non-adherence to iron chelation therapy in pediatric thalassemia patients
Authors: Kanwal Muniba , Ahmad Rizwan Shafeeq , Tariq Naima , Rehan Gul -e-
Published: October 2022

Objective: This study was conducted to identify predictors of non-adherence to iron chelation therapy among children suffering from β-thalassemia major across different treatment regimens.Materials and Methods: It was a cross-sectional study carried out from 1st January 2019 to 30th June 2019. The study was conducted at the Pakistan Institute of Thalassemia, Islamabad. Children between the ages of 2 -16 years suffering from β-Thalassemia major and taking iron chelation therapy were included in the study. Chelation adherence for this analysis was defined as the percent of doses taken in the last 12 weeks out of those prescribed. Guardians of patients were interviewed using a questionnaire and medical records were checked. Data were analysed using SPSS 20.0. Multivariate analysis was conducted to identify the predictors for non-adherence to chelation therapy. The significant value was set at ≤ 0.05.Results: Mean age of the patients in our study was 8.90± 3.74 years. There were 33 males and 64 females. Most of the patients n=87 (89.7%) were taking oral iron chelation therapy. The mean score for chelation adherence was 67.12%. Among the multiple demographic, medical-related, and patient-related factors analysed, travel time from the patient’s residence to the treatment centre and the number of transfusions per year were found to be significant predictors (p-value ≤0.05) of non-adherence to iron chelation therapy. Conclusion: Overall, the study provides strong evidence that healthcare-related factors play a major role in patients’ adherence to treatment. A systemic approach should be taken to ensure patient adherence during the management of paediatric thalassemic patients.
Chest X-Ray as a Diagnostic and Prognostic Tool For Covid-19; A Tertiary Care Hospital Based Study
Authors: Sattar Muhammad Farooq , Niaz Furquana , Ali Arshad , Shams Nadia , Islam Nayyer Ul , Meraj Lubna
Published: October 2022

Introduction: The radiological investigations are not diagnostic of COVID-19 disease but help in management. CT scan is not available worldwide; therefore, x-ray chest (CXR) is ideal for assessment of disease severity using scoring system. This study was conducted to see various CXR findings and relation of severity with outcome. Materials and Methods: This study was conducted at Dallah hospital Saudi Arabia. All admitted confirmed cases of COVID-19, above age of 18-year were included. CXR were done at baseline, after 5-7 days and after 13-15 days. Patient with previous heart failure, chronic obstructive pulmonary diseases or pulmonary fibrosis, Pregnant and lactating ladies were also excluded.Results: Out of total 629 patients 67.6 % were males. There was no statically significant difference in mortality in male to female patients. The mean age was 42.67+15.13 (range 18-83) years. Patients with age more than 50-year were 58.9% and had severe infection (p=0.041) with high mortality (p=0.045). The 63% patients had abnormal CXR at baseline. The common CXR features detected were consolidation (45%), followed by ground glass appearance (43%). Only 0.8% patients had pleural effusion and one patient with pneumothorax. Patients with bilateral lung infiltration was 67.5% and mostly it was in lower zones (63%). The follow-up CXR revealed an increase in severity score related to mortality (p<0.001). Conclusion: In COVID-19 infection CXR may be a predictor of severity of disease and monitoring of disease may be done by serial CXR.
“Deficiencies in mention of post-op complications on consent form”
Authors: Tehniyat Wajiha
Published: October 2022

Introduction: Consent is an art, which is mandatory to be undertaken before any intervention on a patient. For surgical procedures, it becomes even more important, and written formal consent is required for patient safety, quality assurance, and medico-legal aspects later. Procedure-related complications are the most important part of consent on which decisions to undergo surgery are made and also post-operative course is determined.

Many times the consent forms are found to have missing information which results in medico-legal issues later on. Our aim, therefore, was to look at the accuracy of complications mentioned on the consent form. For the audit, we selected the 2 most frequently performed surgical procedures (Cholecystectomy and inguinal hernias).

Materials and Methods:  Consent forms for the mentioned procedures were reviewed retrospectively to look for the mention of standard well-known complications associated with the procedures. Duration of study one month with consecutive sampling. Data were analysed for the accuracy of all known complications.

Results: %age accuracy of the documented complications were calculated for consultants and non-consultants. Overall average % accuracy was also calculated.

 

Conclusion: We concluded that in our standard consent forms documenting complications varies from the person-person and often few complications are missed leading to problems later on. Hence patient safety and quality assurance are compromised. Also, legal issues can arise affecting the surgeon.

Consultants and trainees both are involved in consenting patients. Our consent forms are general. Procedure-specific forms/ Stickers might help in the reduction of deficiencies and thus can improve the experience and prevent litigation and medico-legal implications.
“Efficacy of current familial breast cancer screening practices and its impact on national cancer programme”
Authors: Tehniyat Wajiha
Published: October 2022

Introduction:  Breast cancer has been the leading cause of cancer in females over the last few decades. Familial inheritance of breast cancer is proven and investigated deeply. The need of the day is to risk stratify it before the actual problem arises and to standardise the process across the UK which is not yet addressed.

Objective:  The objective of this study is to assess the efficacy of current referrals to familial breast cancer clinics from all sources and their impact on the national breast cancer programme.

Materials and Methods:  This is a retrospective study of patients referred to the breast cancer family history clinic at King’s Mill Hospital Breast Surgery Department between Jan-Dec 2017. A case note review of these cases was undertaken and data was collected on a proforma shown below. For analysis data was entered on FaHRAS and according to the risk calculated appropriateness of referrals to secondary care was measured.

Results: Results of our study showed that 73% of the referrals made in 2017 from primary care were appropriate, while 27% were stratified as in-appropriate referrals. Those missed might be more than expected but there is no way to assess the missed ones.

Conclusion: In the conclusion, this study identifies the tip of the iceberg regarding the issue but the problem is far bigger. If screening is done in primary care, missed cases and inappropriate referrals could be effectively reduced significantly.
Comparison of Histoacryl® plus Lipiodol® versus Histoacryl® plus vitamin D3 in the management of isolated fundal varices: A retrospective comparative study
Authors: Khan Dilaram , Aamir Naveed , Hassan Muhammad Kamran , Ali Farman , Alam Fakhare , Khan Hashmatullah
Published: October 2022

Objective: According to recent guidelines Histoacryl® (N-butyl-2 -Cyanoacrylate) injection is the first line therapy for the endoscopic obliteration of gastric varices. Lipiodol is commonly used to facilitate injection Histoacryl® but it is expensive. In this study we compare Lipiodol with Vitamin D3 injection as priming agents for Histoacryl injection in terms of efficacy and safety in the management of isolated fundal varices.

Methods: This is a retrospective comparative study conducted at Gastroenterology Unit, Lady Reading hospital Peshawar. Patients’ information was collected from March, 2012 to January, 2020 from medical records and statistically analyzed in terms of fundal varices obliteration, re-bleeding, mortality, and adverse events related to treatment.

Results: From March, 2012 to January, 2020, 171 patients met the criteria. 7 cases lost follow up, and all the cases in both groups were treated successfully. There were no adverse events related to procedure in either group. Twenty six patients developed upper GI re-bleeding, which did not differ significantly betweenthe twogroups. There was also no difference between the groups in terms of treatment failure, complications, varices obliteration, and mortality.

Conclusion: Vitamin D3 is as safe and effective as Lipoidol when used as priming agent for Histoacryl injection for obliteration of isolated fundal varices and can be used as a cheaper alternative to Lipoidol.
Mortality in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Lower and Higher Decaf Scores
Authors: Daud Sara , Ambreen Asma , Shafique Aisha , Awan Shomaila , Sabir Asma , Zaheer Nabila
Published: October 2022

Background: To determine diagnostic accuracy of DECAF score in predicting mortality in patients with acute exacerbation of chronic obstructive pulmonary disease having DECAF score <4 and within 7 days of hospital admission keeping actual mortality as gold standard. Methods: In this cross sectional validation study, 146 Patients with COPD were selected from emergency and OPD of Fauji Foundation Hospital Rawalpindi presenting with signs and symptoms of acute exacerbation of COPD from 15 may 2017-15 Nov. 2017.The procedure began after taking informed consent of the patients. Clinical features documented and investigations were sent. The expense of all the tests was borne by the hospital administration and not the patient. A specially designed Performa was used for data collection. RESULTS: Mean age (years) in the study is 64.90+0.93. Patients with DECAF score of 1, 2 and 3 are (2.7+26+35.6 =64.3) are 64 %. The cases with DECAF score of 4 are 26.7% and the cases with DECAF score of 5 and 6 are 8.9%. DECAF score versus mortality with different age groups and duration of smoking gave reasonably high values of sensitivity and, specificity. Also the PPV and NPV values are appropriate. The minimum diagnostic accuracy is 71.23% indicating that this test is appropriate in predicting the true status of the cases.CONCLUSION: The study concludes that DECAF score is a useful predictor of mortality in patients admitted with acute exacerbation of COPD. Patients admitted in hospital with high DECAF score of should be admitted in intensive care unit because they may require invasive ventilation due to respiratory failure and high mortality. KEYWORDS: Chronic obstructive pulmonary disease, acute ex
Lipid Profiles and Its Association with Pre-Eclampsia and Eclampsia in Nulliparous Pregnant Women
Authors: Shaheen Asmat , Luqman Muhammad Waqas , Shah Syed Fahim , Zeb Fozia , Khan Atta Ullah , Ahmed Zahoor
Published: October 2022

Objectives: To access the lipid profiles and its association with pre-eclampsia and eclampsia in nulliparous pregnant women.

Material and Methods: This cross-sectional study was performed on 234 nulliparous pregnant women with gestation period of  > 20 weeks and aged 15-45 years, from March to October 2014, in Institute of Basic Medical Sciences (IBMS), Khyber Medical University (KMU), Peshawar, Pakistan with cooperation from gynecology and obstetrics departments of three tertiary-care hospitals of Peshawar & Khyber Medical College, Peshawar,  Khyber Pakhtunkhwa (KP), Pakistan. Subjects were assigned to three groups i.e., group A, group B and group C. For performing biochemical assays and lipid profiling, through ELISA, blood samples were collected from already subjects both with the disease and the controls.

Results: Both subjects having pre-eclampsia and eclampsia showed significant elevated levels (p < 0.001) for low density lipoproteins cholesterols (LDL-c), high density lipoprotein cholesterol (HDL-c), total cholesterol (TC)/HDL-c and LDL-c/HDL-c ratio. But TC of pre-eclampsia subjects were found significantly elevated (p < 0.001) in relation to controls. LDL-c/HDL-c and TC/HDL-c also revealed an elevated significant change (p < 0.001) both for pre-eclamptic and eclamptic subjects. On the other hand, only TG/HDL-c in pre-eclamptic patients was found significantly higher (p<0.004) when compared to control group. 

Conclusion: Serum lipid levels were observed higher in pre-eclampsia and eclampsia patients hence an early assessment is necessary to prevent complications in such patients.
Skin Changes in Newly Diagnosed Cases of Hypothyroidism
Authors: Niaz Furquana , Shams Nadia , Meraj Lubna , Ahmed Sadaf , Ahmed Najia , Sheikh Irfan
Published: October 2022

Introduction: Thyroid disorders are frequent in our population that leads to variety of cutaneous manifestations. Aim of our study was to determine the frequencies of skin changes of hypothyroidism and their association with gender.

Methodology: This observational study was conducted at RIHS Islamabad (Ist Jun to 31st Dec 2019) after ethical approval. 105 patients (>18years age) of both genders. Confirmed to have hypothyroidism on the basis of thyroid function tests were included. Secondary hypothyroidism, sick thyroid disease, pregnant women, receiving thyroxin therapy, carcinoma of thyroid, critically ill cases, post-thyroidectomy and iatrogenic thyroid cases were excluded. After informed consent, demographic details were documented. Patients were clinically evaluated and examined in detail including dermatological examination for cutaneous manifestations. Various skin findings are studies with respect to gender. Data was analysed by SPSS version 21 with Chi-square test as a test of significance, significant p<0.05.

Results: Among 105 cases of hypothyroidism (62% females and 38% males, mean age was 38.04+12.61 years. Mean TSH level was found to be 32.08 + 33.96 (mean TSH was 35.31+37.31 in females Vs. 26.96 + 27.19 in males; p=0.001). Common skin findings were dry skin in 69.5%, diffuse hair loss in 58%, coarse skin in 57%, pruritis in 51.4%, madarosis 37%, seborrheic dermatitis 34%, coarse scalp hairs 27% and slow nail growth in 23%. The brittle nails, alopecia areata, chronic urticaria, acanthosis nigricans, ivory yellow skin, purpura ecchymosis, ichthyosis, herpes simplex and certain other findings were found in <20% cases. Obesity was observed in 53(50.5%) cases, Type 2 diabetes in 20(19%), hypertension in 23(21.9%), dyslipidaemia in 12(11.4%) and anaemia in 9(8.6%). Obesity, diabetes, dyslipidaemia had no association with gender (p>0.05). However, hypertension and anaemia were significantly frequent amongst females (p<0.05). The dry, coarse skin, diffuse hair loss and seborrheic dermatitis were associated with female gender (p>0.05). Slow nail growth, brittle nails, acne vulgaris, acrochordons, vitiligo, xanthelasma were more common in males however the difference wasn’t statistically significant.

Conclusion: Skin acts as an important diagnostic window to diseases affecting internal organs including thyroid disorders. Authors recommend screening for thyroid functions, diabetes, hypertension, dyslipidaemia, obesity and anaemia in patients presenting with suggestive dermatological manifestations irrespective of age and gender.

KEYWORDS:  Hypothyroidism.  Thyroid Diseases.  Skin Changes. Thyroid Stimulating Hormone. Thyroid Gland.
Can “HINTS” aid the Diagnosis of Posterior Circulation Stroke among patients with Acute Vestibular Syndrome?
Authors: Tahir Sidra , Tahir Nouvaira , Meraj Lubna , Zaka Neelum , Zaman Sadaf , Malik Kausar
Published: October 2022

Introduction:

Identifying posterior circulation stroke in patients with AVS without obvious focal neurological deficits poses a difficult diagnostic challenge. It is estimated that about 10% to 20% of patients who present with acute dizziness to the Emergency department have AVS7. Most AVS patients have a benign peripheral vestibular cause (vestibular neuritis or nonbacterial labyrinthitis), but about 25% have brainstem or cerebellar strokes7, 9-10. Rapid, accurate diagnosis of posterior stroke is important for early management as well as prevention of devastating complications. HINTS is a clinical three-step bedside oculomotor exam, that has been suggested of high diagnostic accuracy in identifying posterior circulation stroke in patients with isolated continuous vertigo.

Methods:

A comprehensive systematic search of literature was done using the NHS Evidence healthcare databases Medline, EMBASE, CLINIL, Google scholar and Cochrane.

Results:

10 relevant articles were identified, combining the results of all six prospective studies showed a total of 338 patients on which Clinical HINTS exam was performed. The overall Hints exam sensitivity was 96.86% 95%CI (92.8-99), specificity 96.09% 95%CI (92.1-98.4) and negative predictive value was 0.03 95%CI (0.01-0.08). ROC analysis was done in which area under curve was found to be 0.965.

Conclusion:

Delay in diagnosis of posterior stroke can result in 8-fold increase in mortality7. HINTS is a useful clinical bed side oculomotor exam, which if done appropriately by trained ED doctors, could aid in the early recognition of a subtly presenting posterior stroke with “acute isolated continuous vertigo”. Hence, will improve the overall diagnostic evaluation of acute vestibular syndrome.
Impact of Dermatophytosis on the Quality of Life in Patients Attending a Tertiary Care Hospital, Karachi
Authors: Khoso Bahram Khan , Uddin Fakhur , Hussain Wajid , Dashti Meeran Mohammad Omar
Published: October 2022

Abstract

Objectives: To determine the impact of dermatophytosis on quality of life (QoL) of patients at tertiary care hospital, Karachi.

Methods: The cross-sectional descriptive research was piloted in the Departments of Dermatology and Microbiology, Jinnah Postgraduate Medical Centre (JPMC) Karachi, a leading public tertiary care hospital during the July 2019 to December 2019. The patients <16 years aged were excluded from this study. The KOH (10%) wet mount was performed for fungal hyphae and spore observation in specimens. Quality of life was determined by dermatology life quality index (DLQI) scores and their association with different variables was evaluated by using t-test and Fisher test.

Results: A total of 300 dermatophytosis patients were analyzed. The majority of the patients were of no education category. The active age group (16-30 years) showing higher frequency (138; 46.0%) and followed by age group of 31-50 years (126; 42.0%)).  In present study DLQI score mean was 13.4 ± 7.3. Unexposed area was the main site 249 (83.0%). Dermatophytosis has effect on the quality of life (QoL) in majority (98.7%) of the patients. The DLQI score was significantly higher in unexposed and both sites involvement (P < 0.001). DLQI score was not affected by the age, sex, literacy, addiction and other demographic variables.

Conclusion: This study revealed that dermatophytosis has a significant impact on the quality of life (QoL) in these patients.
Relapse Rate after Opioid Detoxification in Drug Addict Patients
Authors: Gul Beenish , Asghar Rabia , Ahmad Hafiz Shafique , Shaheen Azmat , Arshad Naveed
Published: October 2022

Background: Drug addiction is widely regarded as a pathological condition that involves the continued abuse of drugs in the development of drug-seeking behavior and a decrease in the ability to respond to naturally rewarding stimuli.

Objective: To determine the frequency of relapse after opioid detoxification in drug addict patients.

Methods: A descriptive cross-sectional survey was performed in psychiatry department of Pakistan Institute of Medical Sciences, PIMS, Islamabad, from October 2017 to April 2018. All adult patients who were using cannabis for at least 1 year, irrespective of gender ages between 18 to 60 years were included in the study. For drug use characteristics about preferred choice of drugs and injection-related risk behaviors were noted and analyzed. All findings were entered in a structured Proforma. Data was entered in SPSS version 21 and analyzed. Effects modifiers like age, gender, marital status, types of drugs, etc., were controlled by stratification. Post stratification chi square test was applied. A p value ≤ 0.05 was considered significant.

Results: Total 310 patients were included; 83% patients were male and 17% were females. The mean age of the patients was 39.02±21.42 years. 70% patients had relapse after opioid detoxification while 30% patients had NO relapse. The relapse rate after detoxification was more common in first month of detoxification (56%). After 3 months the relapse rate after detoxification was 12.5%. The statistical analysis showed that there was a very significant association between types of drugs, ages of patients, marital status and relapse rate (p ≤ 0.05). There was an insignificant association between gender and relapse rate (p ≥ 0.5).

Conclusion: The study concluded that the relapse within six months of opioid detoxification in drug addicts is very common. Many factors contribute in relapse rate.
Emerging Risk Factors for Impaired Lung Function in Chemical Industry Workers of Faisalabad
Authors: Shireen Jawed, Benash Altaf, Anam Rehman, Noor-i-Kiran Naeem Shireen Jawed, Benash Altaf, Anam Rehman, Noor-i-Kiran Naeem
Published: October 2022

Objective: To determine the impact, obesity and age on the lung functions determined by PEFR of healthy workers of chemical industries.

Methodology:  This was a cross sectional study performed at private medical college of Faisalabad. Three days medical camp was arranged during 2nd to 4th  September 2020 after taking approval from institutional ethical committee. All relevant information including age, residence and history about chemical exposure were recorded in a structured proforma. Obesity was determined on basis of BMI grading. BMI was calculated from estimated Height and weight   PEFR of each participant was determined using Wright’s Peak flow meter.  Data was analyzed by SPSS21.

Results: Mean± SD age, height and weight of the studied population was 38.85 ± 12.1, 170.07  ±12.0   and 78.12 ±12.7. lowest PEFR value was found in subjects with age range 61 to 70 years as compred to youger subjects . The mean PEFR value were significantly different  with respect to various age catagoeies with  p value= 0.000 Highest mean PEFR values were found in  taller subjects having height ≥ 180 cm and lowest values were found in subjects with height 150-159 cm,  the difference in means was statisticaly significant with p value= 0.05.

Morbid  obese subjects showing comparatively  lower PEFR values in morbid obese  with significant p value =0.002.

. PEFR was found to be negatively associated with age ( p- value= 0.000*)  and BMI( p value =0.001*). Our results also showed weak positive association of PEFR with height, however this relation was not found to be statistically significant (p value= 0.081).

Conclusion: Peak expiratory flow rate is negatively associated with increasing BMI and age, reflecting that elderly and obese subjects are more prone to have affected lung function due to exposure to chemicals
Effectiveness of Ivermectin among COVID-19 patients: A Randomized Controlled Trial
Authors: Umar Muhammad , Shahid Rizwana , Khan Muhammad Mujeeb , Hayat Uzma , Nadar Ayesha , Afzal Sheema
Published: October 2022

Objectives: To determine the effectiveness of Ivermectin among COVID-19 patients in terms of mortality and biochemical / hematological attributes.

Materials and Methods:  A Randomized Controlled Trial (RCT) was carried out in Department of Infectious Diseases (DID) of Holy Family Hospital Rawalpindi during March 2021 through concurrent parallel study design. Apart from seeking Ethical approval for this research, DID was also licensed from Drug Regulatory Authority of Pakistan (DRAP) for this trial. Total 90 PCR positive COVID-19 patients were enrolled in this study via 1:1 randomization in experimental and control group without blinding. The control group received Standard of Care (SOC) starting from day 1 while experimental group was given SOC along with Ivermectin (200µg/kg) for 5 days. Study participants were assessed on day 0, 4, 7 and 10 for general symptoms through physical examination, blood oxygen saturation and diverse hematological and biochemical indicators in addition to adverse events. Data analysis was done by means of SPSS version 25.0. and Microsoft Excel 2010. Mean ± SD for age, length of hospital stay and time to PCR negativity were calculated. Independent sample t-test was applied to determine the mean difference in age, duration of hospital stay, time to PCR negativity, SpO2, oxygen supply, serum Hemoglobin, TLC, platelet count, Clinical Severity Score (CSS), urea and creatinine levels of both groups. The difference in secondary outcome (expiry / discharge) of both groups was compared by means of chi-square test. P-value ≤ 0.05 was considered significant. 95% Confidence Interval was also computed. Relative Risk (RR) was also measured to verify the effectiveness of Ivermectin in COVID patients

Results: Males constituted the majority (56.7%) of our study participants. Statistically insignificant difference in mean age (P = 0.42) and mean length of hospital stay (P= 0.32) between experimental and control group subjects was observed. Mean time to PCR negativity was reported to be significantly less (P= 0.002) in experimental group. Significant improvement was seen in PCR negativity (P<0.05), mean Clinical Severity Score (CSS) (P0.02), mean hemoglobin level (P=0.03) and mean platelet count (P=0.03). Difference in health outcome of both groups was determined to be statistically insignificant (P<0.2, 95% CI (-0.20 – 0.12)). Relative Risk of 0.8 proved the protective effect of Ivermectin in COVID.

Conclusion: Ivermectin was quite effective in reducing mortality and improving the health outcome in COVID-19 patients.
Conventional Cold steel and Modern technique BiZact LigaSure for tonsillectomy: A comparative analysis
Authors: Saleem Muhammad , Alamgir Ashar , Ali Syeda Jamila , Hyder Hafiz Sajjad , Bibi Sarwat , Tabassum Sumara
Published: October 2022

Introduction:

One of the bulk number of operations carried out at otorhinolaryngology department across globe is Tonsillectomy. With the advent of refined surgical tools along with surgical approaches, the conventional methods are now taken over by these new interventions. The study aims to explore the use and advantages of BiZact LigaSure tonsillectomy as compared to the old conventional method.

Material & Methods:

A comparative  study was conducted using non-probability purposive sampling technique at Aziz Fatimah Hospital, Faisalabad. 100 participants were divided in two groups. Group A (50 patients) underwent BiZact LigaSure tonsillectomy and Group B (50 patients) with conventional cold steel method. Per-operative variables such as Blood loss and Operative time and Post-operative variable such as Pain was assessed. The data was analyzed in SPSS 20 using independent t- test.

Results:

The mean age in group A and B was 12, 12 respectively. The blood loss calculated in Group A patients undergoing BiZact LigaSure tonsillectomy was 0.390.15 ml and in Group B 15.92.65 ml. The mean operation time in group A and B was calculated as 4.260.66 and 32.385.56. Both of these variables were recorded as highly significant as the P value = 0.000. Pain was assessed using the VAS pain scale. Post-operative pain variable was also recorded as highly significant variable.

Conclusion:

The study concludes that BiZact ligaSure tonsillectomy is more effective and safe procedure than the conventional cold steel method. This new intervention significantly reduces the blood loss during surgeries, operative time and post-operative pain.
Spectrum of Complications in Children with Moderate to Severe DKA Admitted in Pediatric Intensive Care Unit of a Tertiary Care Hospital
Authors: Aslam Ambreen , Sultana Nighat , Sarwar Muhammad , Jamil Anila , Kausar Fareeha , Waqar Umer
Published: October 2022

Introduction: Diabetic Ketoacidosis (DKA) is the major source of mortality and morbidity in type 1 Diabetes Mellitus. Cautious fluid resuscitation, insulin and electrolyte replacement along with observation for complications is the mainstay of treatment. Early identification of complications lead to better management and outcome.

Objective: To find out the complications of moderate to severe DKA in pediatric patients admitted in Pediatric Intensive Care Unit (PICU).

Methods: Cross-sectional Study was conducted in PICU of University of Child Health Sciences & The Children’s Hospital, Lahore from Jan, 2015 to Dec, 2018.Data was collected from retrospective records of patients admitted in PICU. All patients with moderate/severe DKA were included. Patients with developmental delay were excluded. Data was analyzed using SPSS version 25. Chi-square test was used to find out p-value.

Results: A total of 152 patients with moderate/severe DKA were included in the study, having mean age of 7.86 ± 4.06 years. Most patients 42% (n=64) were more than 10 years of age. Mean weight of the children was 19.89 ± 8.70 kg. Majority 59% (n= 89) were of new onset diabetes. Severe DKA was seen in 74% while moderate DKA in 26% patients. The complications seen were: hypokalemia 33% (n=50), cerebral edema 28% (n=42), hypernatremia 18% (n=27), hyponatremia 8% (n=12) and acute kidney injury (AKI) in 7% (n=11). Survival rate was 85% while mortality rate was 15%.

Conclusion: Hypokalemia and cerebral edema were the most common complications observed. Complications were more common in those patients who presented with DKA in first presentation.

Key words: complications, DKA severity, children, PICU.
Perception of Doctors towards Relationship with Pharmaceutical Industry
Authors: Ahmad Mumtaz , Zaka Neelam , Rahman Inayat Ur , Mumtaz Sehrish , Dodhy Mobina Ahsan , Meraj Lubna
Published: October 2022

Introduction: Doctors and pharmaceutical companies are the major components of the health care system. Their interdependency on such a large scale calls for a better relationship between two stakeholders of the health care system. Most of the time the relationship has a bad impact on the reputation of the prestigious medical profession as well as affects the health of the poor patient causing the malafied relationship. Materials and Methods: In order to see how the relationship works in the hospitals of Azad Kashmir, the study was conducted on the doctors of Abbas Institute of Medical Sciences, Muzaffarabad. A mixed type of study was conducted from January through June 2017. In this study, 100 doctors were selected for data collection by questionnaire method. While three different focus groups involving doctors from different specialties were made. Results: Out of 100 doctors, 36 doctors agreed that the doctors in AIMS are aware of such guidelines, 92 doctors agreed that there is a need for national guidelines to monitor the doctor and pharmaceutical company’s relationship, and 67 responded that doctors' prescription is influenced by the gifts given by pharmaceutical companies, 52 doctors agreed that pharmaceutical companies should be banned from giving gifts to physicians, 88 responded that the information provided by those representatives is only superficial and they don’t know the core information like side effects and mode of action of the drugs, 15 thought that yes it is ethical to accept the gifts from the pharmaceutical companies but only to the extent of samples of medicines. Out of 100, 89 doctors responded in favor of the incorporation of bioethics in the curriculum of medical education. During focus group discussion on the topic, three themes were finalized after detailed deliberation and these themes were, Doctor-Pharma Regulations, Accepting the gifts from Pharmaceutical Companies, and the influence of these Interactions on Physicians’ drug prescribing Behaviors and how the prescribing behaviors of doctors. Conclusion: Pharmaceutical companies have hijacked our whole health system to some extent and are polluted because of these Pharmaceutical companies’ representatives. There is a need to ascertain the fact that if this phenomenon is not controlled, in near future we will have to face very severe consequences and our patients will be at the mercy of pharmaceutical companies rather than the doctor.
Prescrição gradual - a influência do tempo na demora do ajuizamento de ação de reparação por danos imateriais e a relação com o quantum arbitrado
Authors: Almeida Felipe Cunha
Published: October 2022

Estes comentários analisaram julgamento proferido pelo Superior Tribunal de Justiça que entendeu por não ser permitido relacionar a demora no ajuizamento de ação de reparação der danos imateriais como critério de fixação da quantia devida, ao aproximar-se do prazo prescricional, na espécie de prescrição gradual.
Classificação e regime dos danos por descumprimento do contrato
Authors: Ferreira Flávio Henrique Silva
Published: October 2022

O presente trabalho tem como objetivos, em primeiro lugar, identificar os tipos de danos patrimoniais cuja indenização é permitida ao credor na hipótese de inadimplemento do contrato por parte do devedor e, em segundo lugar, elucidar aspectos do seu complexo regime jurídico. Elaboramos o argumento de que existem diferentes tipos de danos emergentes, cuja indenização é regida por um complexo conjunto de normas não explicitamente elaboradas pelo legislador. Buscamos identificar os tipos de danos patrimoniais indenizáveis e o seu regime jurídico a partir de uma análise comparativa da jurisprudência brasileira e estrangeira, com significativo destaque para a jurisprudência estrangeira.
Resenha do livro “Responsabilidade civil e nascimento indesejado: fundamentos para a reparação da falha de métodos contraceptivos”, de Daniel Amaral Carnaúba (Forense; Método, 2021)
Authors: Dias Daniel
Published: October 2022

Quem quer que esteja atuando em um caso – seja como advogado, promotor ou juiz – que envolva o tema da responsabilidade civil pelo nascimento indesejado, deveria ler o livro de Daniel Amaral Carnaúba, “Responsabilidade civil e Nascimento Indesejado: fundamentos para a reparação da falha de métodos contraceptivos”. O livro é o resultado de sua tese de doutorado, defendida em 15 de abril de 2016 na Faculdade de Direito da USP, perante a banca composta pelos professores Teresa Ancona Lopez (Presidente), Wanderley Fernandes (FGV SP), Rafael Peteffi da Silva (UFSC), Claudio Luiz Bueno de Godoy (USP) e Otavio Luiz Rodrigues Jr. (USP). Depois da defesa, o autor atualizou, aprofundou e expandiu consideravelmente a obra. E é essa versão enriquecida que foi publicada em 2021 pelas editoras Forense e Método, como parte da prestigiosa coleção Professor Rubens Limongi França.
Penerapan Pendekatan Komunikasi Intersubyektif Dari Jurgen Habermas Dalam Mengomunikasikan Ajaran Alkitab Dan Berita Injil: Sebuah Refleksi Teologis
Authors: Silitonga Roedy
Published: October 2022

This paper is the result of secondary research on the thoughts of Jurgen Habermas about intersubjective communication as an approach in communicating the teachings of the Bible and the Gospel message in the public sphere. This intersubjective communication puts a person in the position of being a communicator and being a communicant. The principle of equality and mutual respect is highly emphasized to find the best solution to the problems faced by humans. The purpose of writing this article is to encourage every Christian to communicate the teachings of the Bible and proclaim the Gospel message with an intersubjective communication approach in the context of religious plurality or belief and ethnic multiculturalism. Because there is a phenomenon that becomes a problem in communicating the teachings of the Bible and the Gospel message with a subject-object approach. The secondary research method used is literature study from various books and journals, followed by inductive descriptive analysis.