bluuebunny/crossref_metadata_2025 huggingface dataset:
DIAGNOSTIK KESULITAN BELAJAR OPERASI HITUNG PEMBAGIAN BERSUSUN PADA SISWA KELAS V SEKOLAH DASAR
Authors: Rahmah Nuraziza , Nurjannah Nurjannah
Published: May 2024

This study aims to diagnose the learning difficulties of multilevel division arithmetic operations in fifth grade students at SD IT Wahdah Islamiyah Sinjai. This research is qualitative research with the subject of this research namely 3 students from class V at SD IT Wahdah Islamiyah Sinjai. The instruments used in this study were diagnostic tests and interview guidelines. For data collection, the technique used consisted of three parts, namely making observations, interviews, and documentation. As well as the analysis of the data used in the research, namely, data reduction, presenting data, and drawing conclusions. From the results of the study, it was concluded that the difficulties experienced by students were a lack of understanding of the concepts of tiered division, they were still weak in remembering multiplication and their haste in solving problems which resulted in students being less thorough. Therefore, the teacher must ensure that students understand and master the prerequisites of the division operation and provide lots of practice to students and provide tips or apply fun learning so that students feel comforTabel and can generate interest in learning mathematics.Penelitian ini bertujuan untuk mendiagnosis kesulitan belajar operasi hitung pembagian bersusun pada siswa kelas V SD IT Wahdah Islamiyah Sinjai. Penelitian ini merupakan penelitian kualitatif dengan subjek penelitian ini yaitu 3 orang siswa dari kelas V di SD IT Wahdah Islamiyah Sinjai. Instrumen yang digunakan dalam penelitian ini adalah tes diagnostik dan pedoman wawancara. Adapun dalam pengumpulan data, teknik yang digunakan terdiri dari tiga bagian, yaitu melakukan pengamatan (observasi), wawancara, dan dokumentasi. Serta analisis data yang digunakan dalam penelitian yaitu, reduksi data, menyajikan data, dan menarik kesimpulan. Dari hasil penelitian diperoleh kesimpulan bahwa kesulitan yang dialami oleh siswa yaitu kurangnya pemahaman terhadap konsep-konsep pembagian bersusun, masih lemah dalam mengingat perkalian dan sifat tergesah-gesah dalam menyelesaikan soal yang mengakibatkan siswa kurang teliti. Oleh karena itu, guru harus memastikan bahwa siswa telah memahami dan menguasai prasyarat dari operasi pembagian dan memberikan banyak latihan kepada siswa serta memberikan tips-tips atau menerapkan pembelajaran yang menyenangkan agar siswa merasa nyaman dan dapat membangkitkan minatnya dalam belajar matematika.
Prioritization criteria in policies and management of human resources for health: a proposal for a validated methodology
Authors: Oliveira Ana Paula Cavalcante de , Mion Ana Beatriz Zanardo , Batista Helen Fernanda Barbosa , Galante Mariana Lopes , Duré María Isabel , Craveiro Isabel , Mishima Silvana Martins , Padilla Mónica , Laus Ana Maria , Ventura Carla Aparecida Arena
Published: May 2024

Objective.

To create and validate criteria for prioritizing problems related to policies and management of the health workforce.

Methods.

This methodological study was divided into three stages. First, the criteria were elaborated by means of a systematized literature review. Second, the criteria were evaluated online by a committee of judges comprised of eight specialists. In the third stage, an evaluation was carried out by the target audience in a hybrid workshop. The participants evaluated the material using the Suitability Assessment of Materials instrument, adapted for the research.

Results.

Three prioritization criteria (relevance, window of opportunity and acceptability) and a scoring scale were developed based on the literature review. In the evaluation by the committee of judges, the approval percentage of the criteria and prioritization method was 84%. Modifications were made based on suggestions in relation to the material presented to the specialists. In the pre-test stage, the approval percentage varied by item, with six of them reaching a maximum approval of 100% (corresponding to approximately 46% of the items), four reaching 92% and three achieving 83% each, indicating positive results.

Conclusions.

The developed criteria were considered valid for use in the context of policies and management in the area of human resources for health.
The importance of basic and translational research in caring for children with malignant solid tumors in Latin America
Authors: Cancela María Belen , Dinardi Milagros , Aschero Rosario , Zugbi Santiago , Chantada Guillermo , Baroni Lorena , Schaiquevich Paula
Published: May 2024

Objective.

Basic and translational research in pediatric cancer are essential to improve patient care. To critically assess the developments achieved in these areas in Latin America, we systematically reviewed information published between 2013 and 2023.

Methods.

Studies of basic and translational research performed by investigators in Latin America evaluating pediatric malignant solid and central nervous system tumors were retrieved from PubMed. Original articles published in English between 2013 and 2023 were included. Collaborations among Latin American authors or among Latin American authors working with researchers from other continents were also included. Studies were excluded if they focused only on adults or on basic research in tumor biology not specifically related to the tumor types analyzed in this review.

Results.

A total of 550 articles were retrieved, but after removal of duplicates, 514 articles were included in the analysis, the majority of which were authored by researchers affiliated with institutions in Argentina, Brazil and Mexico. These countries also had the highest number of collaborations on original articles published with authors from Europe and North America. Argentina had the highest number of collaborations on original publications, with coauthors from Brazil and Uruguay. The median impact factor of the 244 journals in which articles were published was 3.5. The most commonly studied tumors were osteosarcomas, neuroblastomas and medulloblastomas; the most commonly studied areas were molecular analysis, tumor cell biology and biomarkers.

Conclusions.

In Latin America, research in pediatric oncology is on the agenda, despite a notable disparity in publication rates and frequency of collaboration between countries. There is a need to strengthen scientific collaboration within Latin America and with countries from other continents to promote research and to develop novel treatment strategies that reflect the local needs of children in Latin America who have solid tumors and brain cancer.
TIJOLOS DE SOLO-CIMENTO COM PERLITA COMO MCS E CINZA DE ALGAROBA E CA-JUEIRO COMO FÍLLER
Authors: Oliveira Luiz Alexandre Aquino de , Barros Sâmea Valensca Alves
Published: May 2024

Objetivo: O objetivo deste estudo é investigar a viabilidade técnica de tijolos de solo-cimento sem função estrutural confeccionados com perlita expandida como material cimentício suplementar e cinza de algaroba e cajueiro em substituição parcial ao solo.
Referencial Teórico: A pesquisa fundamentou-se nas normativas técnicas quanto as características que os materiais utilizados em tijolos de solo-cimento devem apresentar.
Método: Para o desenvolvimento desta pesquisa, traçou-se o planejamento experimental, que compreendeu as etapas: aquisição dos materiais convencionais e alternativos utilizados na confecção dos tijolos de solo-cimento; caracterização química-mineralógica da perlita expandida (PE) e cinza de algaroba e cajueiro (CAC); definição de qual uso seria dado a PE e CAC na mistura de solo-cimento; definição dos traços e moldagem dos corpos de prova; determinação da resistência à compressão simples e absorção de água dos tijolos de solo-cimento propostos.
Resultados e Discussão: Os resultados obtidos revelaram que os tijolos de solo-cimento sem função estrutural propostos apresentaram desempenho técnico e “pegada ambiental” adequados.
Implicações da Pesquisa: As implicações desta pesquisa contribuem para a popularização dos objetivos do desenvolvimento sustentável estabelecidos pela Organização das Nações Unidas, principalmente, em promover o consumo e produção sustentável no setor da construção civil.
Originalidade/Valor: Este estudo contribui para a literatura ao propor o uso concomitante de adição mineral e resíduo sólido na confecção de tijolos solo-cimento. A relevância e o valor desta pesquisa são evidenciados por sua originalidade em propor o uso simultâneo de materiais de características diferentes e com funções distintas na mistura solo-cimento, ainda não proposto na literatura.
KEEFEKTIFAN LAYANAN BIMBINGAN KELOMPOK DENGAN TEKNIK SOSIODRAMA UNTUK MENINGKATKAN KEPERCAYAAN DIRI SISWA KELAS XI IPA SMA NEGERI 1 TANJUNG
Authors: Susilowati Putri Suci , Rakhmawati Dini , Hartini Tri
Published: May 2024

The purpose of this study was to determine how effective group guidance services with sociodrama techniques are to increase the self-confidence of class XI science students at SMA Negeri 1 Tanjung. This type of research is a quantitative experiment with a True Experiment research method using a pretest posttest control group design. The samples taken were 20 students, 10 students for the experimental group and 10 students for the control group using purposive random sampling. In this study, data were obtained through research instruments in the form of a self-confidence scale and interviews. The research design used was pretest, treatment, and posttest. The treatment was carried out five times in the experimental group with an average of 69 to 86.1, an increase of 17.1. The results of the hypothesis test obtained that tcount = 100,662 were consulted with a significance level of 5% (0,05) namely 2,101. This shows that tcount = 100,662 > ttable = 2,101 It was concluded that group guidance services with sociodrama techniques were effective in increasing the self-confidence of class XI science students at SMA Negeri 1 Tanjung.
Pengaruh Resiliensi Akademik dan Self Efficacy Terhadap Stres Akademik
Authors: Nursaadah Ila , Widyaningrum Bakti , Sadiah Ati
Published: May 2024

Sistem pembelajaran yang semula pembelajaran tatap muka menjadi pembelajaran online menimbulkan masalah yaitu stres akademik. Oleh karena itu, penting untuk diteliti. Penelitian ini bertujuan untuk menganalisis pengaruh resiliensi akademik dan self efficacy terhadap stres akademik pada peserta didik kelas XI IPS SMA Negeri di Kecamatan Singaparna Tahun Ajaran 2022/2023. Metode yang digunakan yakni metode survey. Populasi dalam penelitian ini sebanyak 293 peserta didik, dan sampel sebanyak 169 peserta didik dengan menggunakan teknik perhitungan rumus slovin serta teknik pengambilan sampel yaitu simpel random sampling. Teknik pengumpulan data menggunakan kuesioner serta teknik analisis data menggunakan analisis regresi linier berganda dengan bantuan software SPSS 25. Adapun hasil penelitian menunjukkan bahwa : 1) Resiliensi akademik berpengaruh yang signifikan terhadap stres akademik dengan nilai signifikansi 0,039. 2) Self efficacy berpengaruh yang signifikan terhadap stres akademik dengan nilai signifikansi 0,000. 3) Resiliensi akademik dan self efficacy berpengaruh yang signifikan terhadap stres akademik dengan nilai signifikansi 0,000.
Nuevo registro y ampliación de distribución altitudinal de parasitismo del vaquero brilloso (Molothrus bonariensis) sobre el gorrión criollo (Zonotrichia capensis) en el área urbana de Quito, Pichincha, Ecuador
Authors: Valencia Aguilar Karen Estefania , Auqui-Calle Edison
Published: May 2024

Los casos de parasitismo del vaquero brilloso (Molothrus bonariensis) usando al gorrión criollo (Zonotrichia capensis) han sido reportados únicamente en zonas urbanas por debajo de los 2817 msnm en Ecuador. Entre enero y marzo de 2022, en la ciudad de Quito, Ecuador, a 3040 msnm, registramos un caso de parasitismo de M. bonariensis usando al gorrión Z. capensis como hospedero. Observamos al volantón de M. bonariensis solicitando insistentemente ser alimentado por los adultos del gorrión Z. capensis durante un periodo de 58 días, hasta que el volantón abandonó los cuidados parentales. Este caso representa una ampliación de 223 m en el rango altitudinal de parasitismo entre estas dos especies y aporta a la información de la expansión y colonización de M. bonariensis en zonas altoandinas. Nuestro registro de una más larga duración del periodo de cuidado parental del volantón tiene implicaciones en la relación parásito-hospedero, requiriendo de mayor gasto energético por hospederos pequeños.
Development of integration formations of fish farms in the Belgorod region
Authors: Truba Anatoliy , Akimov Evgeniy , Sharapov Yuriy
Published: May 2024

Modern commercial fish farming in Russia is mainly represented by small enterprises. However, in the Central Federal District, and above all in the Belgorod Region, objective conditions have now been created that allow for the processes of concentration of production (with its simultaneous specialization) on the basis of the creation of new management and production structures (corporate associations), taking into account regional peculiarities of production placement and cooperative relationships. There are such favorable conditions in commercial fish farming in the Belgorod region. Being in favorable natural and climatic conditions and using modern biotechnics and fish growing technology, favorable opportunities have developed in the Belgorod regions for the introduction of a cluster production system for the cultivation of high–value fish species (sturgeon, salmon). It is important to create well-managed companies with the participation of heads of local authorities and qualified specialists.
DYNAMICS OF POULTRY FARMING DEVELOPMENT IN THE KRASNODAR REGION
Authors: Kolonchin Konstantin , Nazar Marina
Published: May 2024

The article notes that the Krasnodar Territory is one of the five largest producers of poultry products in Russia. As of 01.01.2024, the poultry population amounted to 22 million heads. In 2023, poultry producers in the Krasnodar Territory produced 1,543.6 million eggs and 214.2 thousand tons of poultry meat in live weight. The leader of the industrial production of poultry products in the Krasnodar Territory is JSC Agrocomplex named after N.I. Tkachev. Kuban products are becoming more and more popular both in Russia and abroad. In recent years, the poultry industry in the Krasnodar Territory has been experiencing significant difficulties. According to the author, a necessary condition for the restoration of poultry farming is the close attention of the state. Effective support measures are needed to increase production volumes.
Problems and prospects of project financing in Russia in the context of increasing economic sanctions
Authors: Gusev Andrey , Dolgov Aleksandr
Published: May 2024

Relevance: In recent years, Russia has faced a number of economic sanctions that have had a significant impact on its economy. These sanctions have restricted access to international financial markets, making it difficult to attract investment and realise projects. Project finance plays a key role in economic development, enabling companies to raise the necessary resources to realise major investment projects. However, in the context of sanctions, the effective use of this instrument is becoming a challenge. In a changing economic environment, companies and organisations need to adapt and seek new approaches to financing their projects. Researching this topic can help in finding effective solutions, as well as understanding how sanctions affect project finance and what strategies can be used to overcome these challenges.
The purpose of this article is to analyse the current state of project finance in Russia and the world and to determine its prospects in the context of growing economic sanctions.
Research methods: Statistical, economic and comparative analyses were used to identify trends in the global and Russian project finance market, as well as to determine the main problems and potential areas of development,
The results of the article are based on the analysis of works of domestic and foreign economists and professional organisations in the field of project finance and economics in general. The results obtained can be used to identify further directions of project finance development, as well as to study the experience of work and organisation of project finance under sanctions.
Justification of individual measures to improve the economic security of an economic entity
Authors: Chepik Olga
Published: May 2024

based on the results of the analysis of the activities of a separate economic entity and in order to increase its economic security, it is proposed to optimize the supply of metal to the organization, introduce a new type of fencing into production, optimize the management of accounts receivable in order to minimize the liquidity risk.
METHODOLOGICAL APPROACH TO REGULATING THE IMPORT OF GOODS IN THE FIELD OF INFORMATION AND COMMUNICATION SERVICES
Authors: Levina Evgeniya
Published: May 2024

The article substantiates the prerequisites for the development of methodological support for customs tariff regulation of imports, provides a description of individual elements of the methodology, which makes it possible to establish different levels of customs duty rates when importing goods related to the support of information and communication services, uninterrupted operation of services and technological independence, and creates a sequence of implementation stages techniques. A description of a four-stage methodological approach to regulating the import of goods in the field of information and communication services using customs tariff measures is given, and the author’s procedure for calculating budget revenues when increasing the rates of import customs duties on the goods under study is given.
FEATURES OF HIGH-TECH VENTURE FINANCING BASED ON BLOCKCHAIN: WORLD EXPERIENCE
Authors: Gusev Andrey , Starshinkova Kseniya , Heba Ilya
Published: May 2024

in this article, authors examine the features of venture financing of high technologies in foreign countries. The definition of high technologies is given, the essence of venture financing is determined, and its organizational types are studied. Based on the analysis of the global venture capital investment market and the US experience, the features of high-tech venture financing in foreign countries are revealed.
Outcomes of Connective Tissue (CT) Graft on Periodontal Health in Relation to Dental Implants Placed in Esthetic Zone of Anterior Maxilla
Authors: Nazir Samar , Khan Safoora , Khan Muhammad Athar , Haider Muhammad Usman , Khan Nousheen , Hameed Marij
Published: May 2024

Background: Since 1998, maxillary anterior single immediate implant insertion and provisionalization (IIPP) has been successful and practical. It preserves natural gingival profiles without extending treatment time or needing a removable interim prosthesis. The gingival profile includes a hard tissue zone with bone and a soft tissue zone without bone, extending from the free gingival border to the bony crest's apex. Objective: The purpose of this study was to examine the effect of connective tissue transplant on the thickness and appearance of soft tissue around single implants in the anterior maxilla's aesthetic zone. Study Design: A Prospective cross-sectional study. Settings: A Prospective cross-sectional study was conducted CMH Dental College Multan. Duration: This study was conducted from January 2021 to April 2022. Methods: A total of 64 individuals were included who had criteria for a single cosmetic implant implantation. Detailed demographic information was recorded for enrolled patients once informed written consent was obtained. Patients were equally divided in two groups. Group I (consisting of 32 patients) underwent implant insertion and connective tissue graft implantation (1.50 mm thick) while group II (consisting of 32 patients) simply had implant insertion. Six-month and twelve-month clinical assessments were conducted. Postoperative pain and discomfort were measured. Results: There were 37 (57.8%) males and 27 (42.2%) females among all cases. Buccal tissue thickness in group I significantly increased from 2.45 ±1.80 mm at baseline to 4.0±1.1 mm after 6 months and 3.9±3.46 mm after 12 months (P <0.05), whereas no change was seen in the implant group. After a year, the buccal deficiencies in Group I were significantly less than those in the implant group (∆ -0.46±1.42 mm and ∆ -1.67 ±2.28 mm,). After 12 months, there was a statistically significant difference in proximal bone resorption between the two groups (0.59±0.37 mm and 1.0±0.19 mm), with group I exhibiting less bone resorption than the implant group. Conclusion: In this research, we observed that a single implant placed in the front maxilla in conjunction with a connective tissue graft may enhance peri-implant mucosa thickness and decrease proximal bone resorption.
Comparing Effect of Sitagliptin versus Empagliflozin as Add on Therapy to Metformin in Patients with Type 2 Diabetes Mellitus
Authors: Din Siraj Ud , Mumtaz Arif , Qasim Muhammad , Islam Umair Ul
Published: May 2024

Background: Type 2 Diabetes Mellitus (T2DM) presents a substantial health challenge. Metformin is established as a standard treatment. This study evaluates sitagliptin, a dipeptidyl peptidase-4 inhibitor, and empagliflozin, a sodium-glucose cotransporter-2 inhibitor, as adjunct therapies to improve T2DM management. Objective: To compare effect of sitagliptin versus empagliflozin as add on therapy to metformin in patients with T2DM. Study Design: It was a prospective comparative study. Settings: This study was conducted at the Department of Medicine, DHQ Teaching Hospital, KMU Institute of Medical Sciences, Kohat Pakistan. Duration: 6 months period from March-September, 2023. Methods: A sample size of 100 cases was randomly assigned to either Group A or Group B. In conjunction with the standard metformin regimen (1000 mg twice daily), eligible patients were randomly assigned in a 1:1 ratio to receive either 50 mg of sitagliptin (Group A) or 12.5 mg of empagliflozin (group B) twice daily over 12 weeks. Study visits were scheduled at screening, weeks 0, and 12 of therapy, with no permitted dosage adjustments for the investigational drug. All the data was collected in a predesigned format and data analysis was done using SPSS 27.0. Results: Mean age of the patients in this study was 52.58±10.0 years in which 43.0% (n=43) participants were male while remaining 57% (n=57) were females. Both the groups were comparable with each other and did not possess any inherit difference between them with regard to all baseline characteristics (p-value >0.05. After three months mean HbA1C in group B was significantly less than group A (8.00±0.13 vs. 7.42±0.08%; p-value=0.000). Mean change in HbA1c at three months from the values at presentation was significantly high in group B than group A (-0.70±0.25 vs. -1.33±0.17%; p-value=0.000). Comparison of mean weight between the groups shows significantly less mean weight in group B at three months than group A (64.14±4.25 vs. 61.84±4.89 kg; p-value=0.014). Mean change in weight at three months was significantly high in group B than group A. When mean change in HbA1C and mean reduction in weight in both the groups was stratified for age and gender, it produced same significance for all the stratifications (p-value=0.000). Conclusion: In conclusion, our study reveals that empagliflozin leads to superior glycemic control and greater weight reduction compared to sitagliptin as add on therapy to metformin in patients T2DM. These findings emphasize the potential benefits of individualized treatment strategies for optimized outcomes in T2DM management.
Association of Factors Affecting Measles Vaccine Coverage During Covid-19 Pandemic among the Children Aged 09-24 Months
Authors: Nizamani Shahmeer , Rahman Shazia , Siddiqui Muhammad Ilyas , Thebo Asif Ali , . Rutba
Published: May 2024

Background: The COVID-19 pandemic has had a significant impact on public health measures, including routine childhood immunizations. Measles, a highly contagious viral infection, remains a significant public health threat, and routine vaccination against measles is critical in preventing outbreaks. Objective: To evaluate the immunization status and factors affecting measles vaccination for measles vaccine coverage during COVID-19 in children aged 09–24 month. Study Design: Descriptive cross-sectional study. Settings: This study was done at department of community medicine and samples were collected from Union Council -II, District Tando Muhammad khan Sindh Pakistan. Duration: March 2020 to December 2020. Methods: All the children those who were aged 09 to 24 months, living in Tando Muhammad khan. UC-II, District Tando Muhammad Khan, parents/guardians who consent to participate in the study and those children who were defaulter of first dose of measles vaccine were included. All parents and guardians were interviewed regarding vaccination status according to the study protocol. Data were collected using a pre-designed and pre-tested questionnaire. The principal investigator conducted the interviews and filled out the questionnaire. However, in some instances, Lady Health Workers (LHWs) were also visited to provide assistance. Additionally, the previous year's records of measles immunization in Union Council-2 Tando Muhammad Khan were obtained from the District Health Office (DHO) in District Tando Muhammad Khan. The collected information was entered into SPSS version 22.0 for analysis. Results: The study involved 422 cases with a mean age of 13.4 months. The study found that 98.1% of the children received routine vaccinations, but only 1.95% did not visited vaccination centers during the pandemic. The main reasons for not getting the measles vaccination were fear of COVID-19 (50.5%) and lockdown (31.85%). Socioeconomic factors, such as disease (92.2%), economic crises (80.6%), and domestic issues (37.9%), also affected vaccination coverage. Even though the most parents believed that vaccination can save their child from measles (82.7%). Conclusion: The outbreak of COVID-19 has significantly impacted the vaccination rates for measles. Factors such as lockdowns, transportation issues, unreachable programs, child health-related issues, and financial crises have all contributed to a decline in measles vaccination rates. Fear of COVID-19 has led to a reluctance among some parents to bring their children to healthcare facilities for routine vaccinations.
Correlation of Menstrual Irregularities with Thyroid Disorders in Infertile Women
Authors: Rahman Rahat , Jan Fauzia , Faisal Nabeela , Aftab Lubna , Salman Amber , Waheed Anam
Published: May 2024

Background: In current era menstrual irregularities are very common problem mainly in adulthood age. It creates a lot of stress not only on the social behavior of females but can also leads to infertility especially if it is related to hormonal imbalance. Among them, thyroid dysfunction can result in reproductive cycle problems like menorrhagia which is commonly seen in hypothyroid females. Objective: The aim of this study was to highlight menstrual disorders & investigate thyroid hormone levels in both fertile & infertile women. As it will help us to evaluate the correlation between menstrual irregularities & hypo- and hyperthyroidism. Study Design: A case control study, patients were analyzed by the help of questionnaire which include history, clinical examination & laboratory investigations. Settings: This clinical study was done in Gynecology Department of Madinah Teaching Hospital, Faisalabad Pakistan. Duration: 6 months from February 2018 to July 2018. Methods: Almost 132 females belonging to 20-35 years of age were selected, among them 86 females were infertile & 46 were fertile. Results: Results were evaluated by SPSS version 20. Most of the infertile women were euthyroid and hyperthyroidism was more common among them. The prevalence of hyperthyroidism and hypothyroidism was about 26.7% and 9.3% respectively. Almost all infertile females with thyroid disorders showed menstrual irregularities. Thyroid hormonal status was also assessed with different types of menstrual disarrays and it was non-significant. Conclusion: Thyroid profile should be recommended to those infertile women who are having menstrual irregularities so that other needless investigations can be avoided. Evaluation of thyroid status in an infertile couple is important and easy. Its treatment is simple and has reversible or preventable effects on subfertility.
Role Of A Teacher In A Blended Learning MHPE Program: A Qualitative Analysis
Authors: Naveed Ayesha , Siddiq Amer , Khalid Saria , Shaikh Gul , Haque Ayesha , Farid Huma
Published: May 2024

Background: During the last two years, the pandemic has taken a toll on education. However, E learning tools and other innovative computer software technologies are being widely adopted to deliver educational elements of different courses to students who are placed in far off areas from the university campus. However, Teaching is demanding and complex task and the key limitations in total e-learning format included limited interactions with peer and teachers, communication problems, and insufficient sense of bonding between the teacher and student. To address these issues concept of “blended learning” was adopted. Blended learning escalates the chances of student engagement, enhance critical-thinking development and improve learning processes in the presence of a valued teacher. However, whenever innovative techniques are introduced, it becomes essential to ensure that there is no impact on instructional integrity. Thus, the response of students who are amongst the main stakeholders is absolutely vital to confirm an effective implementation of any teaching and learning approach. Objective: This study provides help to the faculty who newly incorporate BLA (blended learning approach), also it provides guidance for educators and curriculum planners to effectively plan their modules while incorporating a BL approach in medical education. Study Design: Qualitative study (Phenomenology). Settings: Three universities, Riphah International University Islamabad, University of Lahore, Lahore and Khyber Medical University, Peshawar in Pakistan. Duration: Six months from February to August 2017 Methods: Sampling was done by purposive (homogenous) sampling. Study population included MHPE students from three different universities of Pakistan. Population size was 10 MHPE students who completed their course work, and data was collected through one on one semi structured interviews. All interviews were audio recorded, transcribed and analyzed manually as well as by importing in NVivo software version 11. Results: By a thematic analysis a total of six major areas were identified that influences the student learning in blended programs. Out of these the major influencing factor came out to be the role of teachers’ both in online and face to face sessions. This blended course design helped them to become more self-regulated, self-directed, lifelong and active learners, and they were also able to transfer these learning skills to their students as well. Conclusion: Students hold a positive perception of the BLA being offered in this MHPE program.  Research findings suggests that a BL course design can be successfully used in postgraduate education as well as undergraduate studies it helped to impart new learning approaches in them. The main factors which were appreciated in these courses were flexible or hybrid course design, role of a teacher as facilitators who reinforced learning strategies towards learners’ professional needs.
Caesarean Scar Ectopic Pregnancy: 11 Case-Series Study in 2 Years at a Tertiary Care Hospital
Authors: Niaz Ammara , Naz Mubashra , Naeem Sadaf , Tahira Tasnim , Fatima Anees , Khalid Ayesha
Published: May 2024

Objective: The objective of this study was to evaluate the management, clinical features and outcome of caesarean scar pregnancies. Study Design: Descriptive case series. Settings: Department of Obstetrics & Gynecology, Faisalabad Medical University, Faisalabad Pakistan. Duration: Two years from 1st June 2019 to 31st May 2021. Methods: Medical records of the women with diagnosis of CSP were retrieved. The study included cases with gestational ages ranging from 5 weeks to 9 weeks who were referred to us. All the information regarding demographics, age, gestational age, symptoms at presentation, number of Caesarean sections, obstetric and gynecological history, ultrasound images, treatment given to the patients and hospital stay were retrieved from charts of the patients. Results: In this study, 11 cases of CSP were treated. One patient had pain in lower abdomen, two of 11 patients had no symptoms, 3 had lower abdominal pain with vaginal bleeding and 5 had vaginal bleeding only. All patients had history of caesarean sections. Gestational age of these patients was from 5 to 9 weeks. Five patients were treated with Methotrexate (MTX), 3 underwent emergency laparotomy and 3 were managed conservatively. Conclusion: Early diagnosis and management of patients having caesarean scar ectopic pregnancies can reduce the complications associated with this condition.
Does Every Patient with Symptomatic Gallstones Need Cholecystectomy?
Authors: Cheema Kamran , Azeem Muhammad , Anjum Nawaz , Raza Ahmad
Published: May 2024

Objective: The aim of this study is to identify the impact of preoperative clinical symptoms of biliary colic –whether classic, dyspeptic or atypical type- on operative or non-operative clinical outcome. Study Design: Prospective study. Settings: Department of Surgery, Sargodha Medical College, Sargodha Pakistan. Duration: 15-01-2016 to 01-12-2017. Methods:  Randomize control trial. Results:106 patients with cholelithiasis were evaluated, out of which 86.79% (n- 92) underwent cholecystectomy. 91.3% (n-84) were asymptomatic postoperatively. More than 50% patients presented with associated symptoms like GIRD/reflux, dyspepsia (n-57). Heartburn/reflux patients were unresolved postoperatively (P=0.03). Overall, 12.2% (n-13) of patients and 21.2% of patients with associated symptoms improve with medical treatment of peptic ulcer/H-pylori triple regimen therapy pre/postoperatively. Conclusion: Patients with symptomatic gall stone associated with atypical presentation, may benefit from PPI treatment or H. pylori testing before cholecystectomy.
Effect of COVID-19 Vaccine on Blood Donor Deferral Patterns in PIMS, Islamabad
Authors: Sijjeel Farwa , Khalid Ahmareen , Khan Muhammad Yousaf , Bibi Nayab , Tahir Aisha , Mushtaq Zoobia , Nawaz Basharat , Khalil Sana
Published: May 2024

Objective: To evaluate the effect of COVID-19 vaccine on overall donor deferral patterns in PIMS, Islamabad. Study Design: Cross-sectional descriptive study. Settings: This study was carried out at Blood Bank of Pakistan Institute of Medical Sciences (PIMS), Islamabad Pakistan. Duration: January 2019 to December 2021. Methods: The participants for donation were included in this cross-sectional study on the basis of certain criteria by taking their previous medical history physical examination, COVID-19 vaccination status, and transfusion-transmissible infections (TTI) screening results. All those donors who don’t meet these criteria were deferred. On the basis of causes, deferrals were categorized into temporary or permanent. Results: This study included a total of 84,669 potential donors during a period of three years (January 2019- December 2021), out of which 82,072 donors met inclusion criteria and donated blood during this period whereas 2597 donors were deferred. The overall deferred rate was 3.2% (n=2,717), out of which 13% (n=342) were deferred permanently and87% (n=2375) were deferred temporarily. The leading cause of permanent deferral includes hepatitis C (n=142), hepatitis B (n=106) and cardiac diseases (n=94). On the other hand, leading causes of temporary deferrals include COVID-19 vaccination, being under weight, underage, low HB, short gap, fatty veins and fever. Conclusion: The identification of deferrals is an important step for safe transfusions and helps to formulate criteria for efficient donor selection. The current study indicates a 3.2% deferral rate for blood donors and demands preventive steps for both donor and patient safety against HBV, HCV and AIDS.
Relationship between Emotional Intelligence and Depression in Teaching Faculty of Basic Sciences at a Private Medical College: A Cross Sectional Correlational Study
Authors: Ali Zaima , Zafar Uzma , Zaki Saima , Asrar Ansar , Naeem Faiqa Jabeen , Huda Noor Ul
Published: May 2024

Background: Emotional Intelligence (EI) spans five basic principles including awareness and management of self-emotions, ability to motivate oneself, awareness, and management of other’s emotions. EI takes a person to high level of professional as well as academic success by improving one’s cognitive performance far above the level attained by general intelligence (GI). In addition, EI enables one to control negative attributes such as anxiety, anger, and stress and highlight pragmatic and constructive feelings like congeniality, self-confidence and empathy. Objective: The current study was designed to estimate the level of emotional intelligence (EI) in teaching faculty of basic sciences at a private medical college and to check its correlation with depression. Study Design: Cross sectional correlational study. Settings: Lahore Medical & Dental College, Lahore Pakistan. Duration: December 2021- April 2022. Methods: Two questionnaires including “Leadership Toolkit Emotional Intelligence Questionnaire” and “Patient Health Care Questionnaire 9 were used to collect the data. After approval from Institutional Review Board, informed written consent was taken from the participants. Data was collected by using convenient sampling technique from faculty of basic science departments. SPSS 22 was utilized for analysis of the data. Results: In the current study a total number of 72 faculty members participated. Out of total 72 participants, 69.4% (50) were in the average EI range and 23.6% (17) had good EI with only 6.9% (5) falling in the poor EI range. The mean score for overall EI was higher in senior faculty as compared to junior members with a value of 189.7 but the difference was not statistically significant. Similarly, no significant difference was found among male and female participants regarding overall EI as well as its constructs. The sub-sections managing emotions, motivating one-self and social skills showed significant difference with a higher value in the senior faculty. Overall, EI was found to be inversely correlated with depression with a p value < 0.01. Conclusion: The score of Emotional Intelligence is reasonably good in the faculty of basic science departments. Moreover, EI has been found to be inversely correlated with depression.
Clinical Efficacy of Oxcarbazepine compared with Carbamazepine in terms of Pain Relief in the Management of Trigeminal Neuralgia
Authors: Paiker Sadia , Mehdi Syed Muhammad Zaki , Khattak Fatima , Hassan Labiba , Muzaffar Amna , Bashir Kiran
Published: May 2024

Background: Despite various pharmacological drugs used for the treatment of Trigeminal Neuralgia (TN), the clinical efficacy of carbamazepine with oxcarbazepine in terms of pain relief particularly in Pakistani population is poorly studied. This study aimed to compare the efficacy of carbamazepine with oxcarbazepine for treating Trigeminal Neuralgia. Objective: To compare oxcarbazepine with carbamazepine in the management of trigeminal neuralgia in terms of mean pain. Study Design: Quasi-Experimental study. Settings: Fauji Foundation Hospital, Rawalpindi Pakistan. Duration: 06 months i.e. 30th Apr 2018 to 30th Oct 2018. Methods: This single-centre, prospective clinical study was conducted on 70 patients diagnosed with TN. Patients were divided into two groups; Group A: Control group (n = 35), in which patients were given Carbamazepine 200mg twice a day upto1800mg and Group B: an Experimental group (n = 35), in which the patients receive Oxcarbazepine (300mg BD daily up-to 1800mg). The clinical parameters were evaluated by a self-reported questionnaire. Pain level was assessed at 1st and 2nd month follow-up using a Visual Analog Scale. Results: The mean postoperative pain was measured for both groups. Although the mean pain score at 1st follow-up month was similar for Group A (5.2±1.0) and B (4.9±1.1), p=0.328, higher clinical efficacy was observed in 2nd follow-up month for Group B– Oxcarbazepine (3.1±0.8) when compared with Group A– Carbamazepine (5.14±0.8) in terms of mean pain score that was statistically significant p<0.001. Conclusion: This study concludes that in term of pain relief, Oxcarbazepine appears to be a more effective as compared to Carbamazepine in the treatment of TN.
Outcome of Severe Anemia in Pregnancy; Experience at a Tertiary Care Hospital
Authors: Randhawa Sadia Afzal , Tarar Shahida Husain , Syed Sadaf Zahra , Bhoon Mahnoor Ahsan , Liaqat Jawairiah
Published: May 2024

Objective: The study was aimed at observing demographic diversity among pregnant women admitted to the labour room with Hemoglobin of less than 7gm/dl. It also observed perinatal and maternal outcomes and their associated complications. Study Design: Retrospective observational study. Settings: Gynae Unit I, Jinnah Hospital, Lahore Pakistan. Duration: 1st January 2022 to 30th June 2022. Methods: It is a retrospective observational study carried out in Gynae Unit I, Jinnah Hospital, Lahore Pakistan in between 1st January 2022 to 30th June 2022. All Patients presenting with Hemoglobin less than 7gm/dl and admitted in the Labour room were included in the study, and followed until delivery. A predesigned performa was filled for each of the 63 patients after their consent.  Results: During the study period, 2130 deliveries were carried out in the labour room, out of which 63 patients had a recorded level of Hemoglobin below 7gm/dl. The prevalence of severe anemia in our study was 2.9%. Most patients (51) were in the age group 20-35 years. Majority of the patients (45) were un-booked while only 18 were booked patients. 40 patients were in the gestational age group of 34-37 weeks. 30 were gravida 2-5, 25 of parity more than 5 and only 13 primigravida’s. 29 out of 63 patients had no complications while 34 had complications. Conclusion: Severe Anemia is a preventable cause, the focus needs to be on early and proper antenatal check-up’s, early diagnosis, and timely referral from rural and less equipped medical centres to better equipped hospitals.
Silent Threats Unveiled: Navigating the Landscape Endometrial Cancer in Women Over 50 - A Comprehensive Analysis of Post-Menopausal Bleeding as a Crucial Diagnostic Indicator
Authors: Sharif Rabia , Saleem Huma , Iqbal Saba , Manzoor Uzma , Maqsood Nosheen , Afzal Rabia
Published: May 2024

Background: Endometrial cancer, with a global incidence of 9 per 100,000 women and a 1% lifetime risk, predominantly affects women aged >50 years and commonly manifests as post-menopausal bleeding (PMB). Timely referral for further investigation is imperative in cases of PMB. Objective: This study aimed to determine the frequency of endometrial cancer in females with abnormal uterine bleeding (AUB) and compare this frequency between premenopausal and postmenopausal women presenting with AUB. Study Design: Descriptive cross-sectional study.  Settings: Department of Obstetrics & Gynecology, Independent University Hospital, Faisalabad Pakistan. Duration: Six months from December 15, 2022 to June 15, 2023. Methods: This study aimed to assess endometrial samples from 415 females over. Participants meeting inclusion criteria were enrolled from the Department's outpatient department, providing informed consent and demographic details. Endometrial sampling using Pipelle or D&C under general anesthesia was performed, and subsequent histopathology assessments in the hospital's pathology laboratory categorized findings into premenopausal and postmenopausal groups for comparative analysis. The study, initiated after ERC approval, spanned. Results: Out of 415 cases, 61.45% (n=255) were aged 30-50 years, while 38.55% (n=160) were aged 51-70 years, with a mean age of 48.52±7.02 years. The frequency of endometrial cancer in females with AUB was 6.51% (n=27). Comparing premenopausal (4.46%, n=10) to postmenopausal (8.90%, n=17) females with endometrial cancer, the p value was 0.06. Conclusion: While the overall frequency of endometrial cancer in females with AUB requires attention, this study emphasizes that the frequency is significantly lower in premenopausal compared to postmenopausal females presenting with AUB.
Comparison of Post-Operative Pain with Diclofenac Rectal Suppository vs Intravenous Tramadol in Patients Undergoing Inguinal Hernioplasty
Authors: Habib Aqib , Iqbal Muhammad Saleem , Choudry Zafar Ali , Lodhi Muhammad Faisal Bilal , Siddique Rohma , Haider Mussarat
Published: May 2024

Background: Pain is a highly intricate and distressing sensation that is subjective. There is uncertainty observed in the selection of optimal methods for intra and post-operative administration of analgesics for inguinal hernia repair surgery. Objective: To compare the mean postoperative pain score in diclofenac rectal suppositories with intravenous tramadol in patients undergoing inguinal hernioplasty. Study Design: Randomized control trial. Settings: Department of Surgery, Allied Hospital, Faisalabad Pakistan. Duration: From November 25, 2022 to May 25, 2023. Methods: After approval of the ethical board, patients from OPD / emergency were enrolled. All the patients undergo inguinal hernioplasty under regional anesthesia. In group A, patients received diclofenac rectal suppository 100 mg, and in group B, patients received intravenous tramadol 100 mg. The visual analog scale was explained to the patients. Pain was assessed after the 2nd, 6th, and 12th hour of hernioplasty. All the information noted on proforma. Results: Comparison of the mean post-operative pain score shows 3.67 ± 0.48 in Group A and 2.40 ± 0.50 in Group B at 2 hours, p-value 0.000, 3.64 ± 0.49 in Group A and 3.43 ± 0.50 in Group B at 6th Hour, p-value was 0.605, 3.30 ± 0.47 in Group A and 4.0 ± 0.79 in Group B at 12th hour, p-value=0.000. Conclusion: We concluded that diclofenac rectal suppository is significantly better than intravenous tramadol in patients undergoing inguinal hernioplasty in terms of mean postoperative pain score.
Nano Fat Graft Harvested from Abdomen in Comparison with Thigh in the Treatment of Hyperpigmentation of Face
Authors: Alam Muhammad Amin , Nasrullah Muhammad , Akhlaque Roomana , Fatima Samia , Imdad Sana , Alavi Hirra Rehman
Published: May 2024

Objective: To evaluate the outcomes of nano fat graft harvested from abdomen in comparison with thigh in the treatment of hyperpigmentation of face. Study Design: Randomized control trial. Settings: Plastic and Reconstructive Surgery department, Lahore General Hospital, Lahore Pakistan. Duration: 2 years January 2021-December 2023. Methods: The tissue thickness was also assessed through ultrasonographical imaging in all patients. Cases enrolled were divided into two groups wherein Group I was those cases where Nano fat graft was generated from the medial thigh fat while Group II were those cases where the abdomen region fat was used for the formation of the fat graft. A 10-cc syringe (14G needle) in multiple layers was used for injecting fat graft under local anesthesia.  Over corrections were performed up to 20-30% for due to absorption chance. Postoperative ultrasonography was performed and tissue thickness was observed after 3 months for comparing the fat survival and thickness rate. Results: The fat thickness in the application of medial thigh fat graft group I was observed slightly higher than the abdomen-based fat graft generated, although the variance was insignificant. It was observed that the rate of complications like bruising and pain was higher in the group I while seroma was lowed in group I than Group II. Conclusion: The Nano fat graft generated from the fat tissues of the medial thigh has higher efficacy and survival rate with lack of lethal complications than the nano graft generated form the abdomen fats.