bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronaphobia and academic procrastination in health sciences students during the first 3-month pandemic lockdown
Authors: Yucel Hulya , Fatma Kanta Yilmaz  , Erim Ahsen
Published: June 2023

Objective: To determine the correlation between coronaphobia and academic procrastination among university students during the first 3-month coronavirus disease-2019 lockdown.
Method: The cross-sectional study was conducted from June to July 2020 at the Hamidiye Faculty of Health Sciences, the University of Health Sciences, Istanbul, Turkey, and comprised Health Sciences students of either gender across 10 departments. The coronavirus disease-2019 Phobia Scale and the Scale of Academic Procrastination Behaviour were used to gather data. The relationship of the scores was examined with respect to gender and academic level. Data was analysed using SPSS 21.
Results: Of the 743 subjects enrolled, 681(91.65%) completed the survey; 548(80.5%) females and 133(19.5%) males. The overall mean age was 20.91±1.94 years (range: 18-35 years). The largest group was that of first year students 229(33.6%). There was a significant correlation between coronaphobia and academic procrastination (p=0.001). Total coronaphobia (p=0.023) and psychological subscale scores (p=0.001) of women were significantly higher than men. Negative perceptions regarding instructors were higher in men than women (p=0.038). The academic year was not significantly associated with either coronaphobia (p=0.249) or procrastination (p=0.546).
Conclusion: The coronavirus disease-2019 created a phobia and this caused academic procrastination in health sciences students, especially women.
Key Words: COVID-19, Pandemic, Phobia, Procrastination, Education.
Brown tumour as an unusual but preventable cause of spinal cord compression: case report and literature review
Authors: Banu Sabiha , Furqan Saira
Published: June 2023

Brown tumour is an infrequent, focal, and benign osteolytic lesion which is a consequence of abnormal bone metabolism in hyperparathyroidism (both primary and secondary). It is also known as Osteoclastoma. In the present era, we rarely encounter skeletal disease caused by primary hyperparathyroidism. Although it is a rare presentation because of advancement of treatment but still can be encountered because of lack of standard care so we should have high index of suspicion to avoid this preventable complication. We report here a case of brown tumour in the thoracic vertebra of a young female patient with End Stage Renal Disease, who presented with backache and bilateral lower limb weakness. MRI of the spine showed multiple non-enhancing abnormal signals involving vertebral body of C2, posterior elements of C6, and bilateral sacral vertebra, suggestive of healed fractures versus bone forming tumours. She underwent laminectomy.
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Massive post-partum haemorrhage in a SARS-CoV-2 positive primi gravid patient: a case report
Authors: Ushna Ahmed  , Nida Najmi  , Rozilla Sadia Khan
Published: June 2023

A 20-year-old, primi gravid, south Asian woman, was referred from secondary care to Aga Khan University Hospital for further management of primary post-partum haemorrhage after a normal vaginal delivery, on July 12, 2021. She was otherwise healthy, with no known comorbidity. She tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during her admission, on account of universal Covid-19 testing policy. Initially, conservative measures were instituted to control bleeding, including bilateral internal iliac artery ligation, concluding with hysterectomy to stop the haemorrhage. Multiple units of blood products had to be transfused. Obstetrical haemorrhage being the menace in this case, the possibility of Covid-19 positive obstetrics patients being more susceptible to massive post-partum haemorrhage, requiring more radical life-saving procedures to be conducted earlier, was considered. In future, more observational studies will be needed to determine any association between Covid-19 infection and obstetric haemorrhage.
Keywords: Pregnancy, Covid-19, haemorrhage.
Effect of age, gender and type of varicosity on the post-operative pain score after seven-day compression dressing after varicose vein surgery
Authors: Noor Ul Ain  , Rana Sohail Ahmad  , Zainab Chaudhary  , Mohammad Sohail Asghar  , Sadaf Zafarullah  , Hafiz Syed Zaigham Ali Shah
Published: June 2023

Great saphenous vein insufficiency is linked to 80% of all remarkable lower limb varicosities. A total of 30 patients were enrolled from OPD fulfilling the inclusion criteria after the approval of the hospital’s ethical committee. Patients had compression dressing for seven days after surgery. The patients were divided into two groups—Group-A (Compression dressing for two days) and Group-B (Compression dressing for seven days). Stratification of pain score was done against age, gender, and grades of varicose veins, and after dividing into groups t- test was put into use. A p-value 0.05 was contemplated to be remarkable.
Thirty patients with primary varicose vein were enrolled in this study. The mean age of patients was 35.4±9.9 years. Mean pain score in these patients was 2.9±0.8 years.
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Relation of sleep and musculoskeletal disorders among workers: a systematic review
Authors: Zaheer Dania , Munawar Arooj , Ali Sarwat
Published: June 2023

Objective: To systematically review literature on the relationship of sleep with musculoskeletal disorders.
Method: The systematic review was conducted after approval from the ethics review board of the University of Lahore, Lahore, Pakistan, and comprised search of relevant literature published from 2012 to 2020 on Web of Science, Latin America and the Caribbean Literature on Health Sciences and PakMedinet electronic databases. The key words used during the search included workers, musculoskeletal pain, insomnia, musculoskeletal diseases, pain and sleep disorders. outcome measures were the Nordic Musculoskeletal Questionnaire, Numerical Rating Scale, Musculoskeletal Complaint Severity Index, Epworth Sleepiness Scale, Bergen Insomnia Scale, Karolinska Sleepiness Questionnaire and the National Institute for Occupational Safety and Health score. PROSPERO CRD42021281084
Results: Of the 1,538 studies found, 13(0.8%) were reviewed. The relationship between pain and sleep was not found among studies but, sleep disturbances were found to be linked to MSK pain in various parts of the body among workers.
Conclusion: Healthy lifestyle contributing to improvement in sleep quality and prevention of musculoskeletal pain should be considered in order to enhance the quality of life among workers.
Systematic review registration: PROSPERO CRD42021281084
Key Words: Allied health personnel, Insomnia, Musculoskeletal pain, Musculoskeletal diseases, Pain, Sleep disorders.
Pre-operative diagnosis of hydatid cyst in the breast: A case report of a rare entity and review of literature
Authors: Mahmood Sidrah , Mahmood Rabiaa
Published: June 2023

Hydatid cysts are mainly found in the liver and lungs. Only few cases have been reported in the breast and majority of these cases have been diagnosed post-operatively. We report a case of hydatid cyst of the breast diagnosed pre-operatively by fine needle aspiration and cytology (FNAC), without any complication. A 50 years old female presented with a slowly growing mobile lump in the left breast for 3 years. Mammography showed a circumscribed opacity in left breast. High resolution ultrasound displayed a unilocular cyst with some echogenic specks settling to the gravity dependent portion. An aspiration was planned and, as the cyst volume decreased, membranes appeared within the residual fluid and started settling down. Cytology of aspirated fluid revealed a hydatid cyst. Hydatid cysts in the breast are rare but possible, particularly in endemic regions.
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Is institutional review board (IRB) doing its job right? How to assess this
Authors: Asif Farah , Baig Shahtaj
Published: June 2023

Objectives: To audit the performance of the institutional review board at a cancer hospital.
Method: The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, in 2021, and comprised all records of the institutional review board from 2005 to 2021. The audit was based on a tool created by the Association for the Accreditation of Human Research Protection Programmes, and elements evaluated included terms of reference, membership lists, review records, meeting minutes, institutional research guidelines as well as other relevant policies.
Result: The institutional review board was found to be in 100% compliance with all the elements set forth in the Association for the Accreditation of Human Research Protection Programmes. The institutional review board was found to be an independent body with a diverse membership and the chairman was always an unaffiliated member. It had defined processes in line with relevant laws and guidelines. Review of research studies was devised to promote the ethical conduct of research.
Conclusion: Though a self-assessment, the audit objectively showed that the institutional review board was in cent per cent compliance with the evaluation instrument developed and used by the Association for the Accreditation of Human Research Protection Programmes. Nevertheless, it still needs further discussion as to how high levels of efficiency and performance of institutional review boards ultimately provide a higher degree of protection to human research participants.
Key Words: Ethics, Research, Ethics committees.
Correlation of kinesiophobia and upper extremity parameters in post mastectomy patients
Authors: Aleem Hijab , Rimsha Qazi  , Muhammad Ehab Azim  , Maria Ismail  , Humna Amer  , Madiha Ashfaq
Published: June 2023

Breast cancer, if diagnosed at advanced stages, often leads to surgical intervention, i.e. mastectomy, which later presents complications that add to morbidity. A cross-sectional analytical study was conducted to determine pain, upper limb ROM, grip strength, lymphoedema, and their co-relation with kinesiophobia in post mastectomy patients. A sample of 55 female patients was selected via non-probability purposive sampling. Kinesiophobia was assessed using Tampa Scale of kinesiophobia (TSK-11) and pain via Numeric Pain Rating Scale. Upper extremity ROM was measured using a plastic goniometer, grip strength by Jamar Hydraulic dynamometer, and limb volumes were calculated by summed truncated cone volume via circumferential tape measurements. Wilcoxon signed rank test and Spearman co-relation test was used for analysis. Significant difference between the limb volumes was noted (p=0.02) and a reduction in overall upper extremity ranges was seen (p<0.05). A positive significant co-relation between pain and TSK score (r= 0.300, p=0.026) was observed.
External auditory canal carcinoma with an unusually extensive invasion
Authors: Shahbaz Haania , Tahir Munira , Junaid Tehmina , Shakir Najwa , Ahmed Zeba
Published: June 2023

External auditory canal carcinoma, while starting out as a seemingly benign condition, if left untreated can have an aggressive course of disease and involve multiple lower cranial nerves. Squamous cell carcinoma remains the most frequent histological type of malignant neoplasm of the external auditory canal and temporal bone. Here we describe a patient with a history of chronic suppurative otitis media with an extensive spread, the tumour was reaching from the skull base to the oropharynx involving neurovasculature along with soft tissues and bones, as well as the cerebellum. The involvement of the recurrent laryngeal and hypoglossal nerves were the most unusual presentation here. The case differed from all previous reported cases as the spinal accessory nerve was to spared. Surgery and radiotherapy are the treatment options but for the inoperable cases presenting with an already poor prognosis, concomitant radiotherapy is the only choice.
Current practice of histopathology in Pakistan: difficulties, challenges, and solutions
Authors: Talat Zehra  , Zubair Ahmed  , Mahin Shams
Published: June 2023

Histopathology is the gold standard for diagnosis of cancers as well as many non- neoplastic diseases. Pakistan is a country of more than 220 million people and the fifth most populated country of the world. Unfortunately, it has a weak healthcare system in general and poor pathology services in particular. Till date, only 338 histopathologists have passed their fellowship examination in Pakistan; this has led to a very alarming situation considering the marked increase in the prevalence of cancer cases and other diseases which need histopathological interpretation. There are only 18 big histopathological labs in the country, the majority of which are located in major cities which further delays the diagnosis of patients who live in rural areas. Immediate steps are required for better histopathology services in the country. Adoption of digital tools may bridge the gaps of histopathology-practice and ensure consistency across the country.
Management of endotracheal tube air leak—a simple yet an effective manoeuver
Authors: Ghaffar Waleed Bin , Tamraiz Muhammad Adnan , Sohaib Muhammad
Published: June 2023

The management and maintenance of an airway can prevent life threatening complications. The handling of airway, especially in difficult airway and trauma patients, requires extreme caution. We have demonstrated a simple technique in the management of emergency airway, who was getting hypoxic due to severed endotracheal tube (ETT) cuff inflation line. A 20 G intravenous cannula was used, the leak was stopped, and the ETT balloon was inflated. Hence, the leakage and eventually hypoxia settled. We were able to manage emergency airway with this peculiar technique. The use of 20 G intravenous cannula can help to inflate a damaged ETT cuff inflation line. This is an inexpensive and effective manoeuver.
Keywords: Airway management; Intubation; Intratracheal; Cervical Vertebrae.
The utility of pre-procedural COVID-PCR testing for dental aerosol generating procedures is questionable
Authors: Syed Murtaza Raza Kazmi  , Wafa Zehra Jamal  , Khan Farhan Raza
Published: June 2023

Objectives: To compare the number of aerosol-generating procedures performed and the number of coronavirus disease-2019-positive workers in dental practice.
Method: The audit study was conducted in May 2021 at the Aga Khan University Hospital, Karachi, and comprised data from April 1, 2020, to March 31, 2021, which was retrieved from dental clinics at the main hospital and its Clifton branch as well as in three secondary care hospitals in Garden, Kharadar, Karimabad areas of Karachi, and one in Hyderabad, Pakistan. Data of individuals who followed mandatory pre-procedural polymerase chain reaction testing in addition to using personal protective equipment in the main hospital and Clifton branch was placed in group A, and of those using personal protective equipment only at the 4 satellite clinics with no testing was placed in group B. Dental charts of patients who underwent dental aerosol-generating procedures were analysed. Number of dental clinics affected by coronavirus disease-2019 and number of dental patients who were reported positive on pre-procedural polymerase chain reaction testing were evaluated. Data was analysed using SPSS 23.
Results: Of the 63 dental healthcare workers, 44(69.8%) were in group A and 19(30.2%) were in group B. In group A, 19(43.2%) were affected by coronavirus disease-2019 compared to 2(11%) in group B (p=0.01). Among 782(67.8%) patients who underwent polymerase chain reaction testing, 26(3.3%) turned out positive for coronavirus disease-2019. Due to the mandatory testing imposed on patients, 371/1153(32.2%) refused to get the desired dental treatment.
Conclusion: The benefit of pre-procedural testing in dentistry remained uncertain.
Does structured informational care reduce anxiety in patients undergoing MRI? A quasi-experimental study
Authors: Rasheed Binish , Rahim Anila , Ghulam Murtaza  , Quddusi Habiba , Ramzan Zoobia
Published: June 2023

Objective: To assess the anxiety level in patients undergoing magnetic resonance imaging, and to see if structured informational care reduces anxiety compared to conventional approach.
Method: The quasi-experimental study was conducted Dow Institute of Radiology, Dow University of Health Sciences Karachi, Pakistan from January 2020 to June 2021, and comprised adult patients of either gender undergoing magnetic resonance imaging of brain / cervical spine for the first time. They were divided into S-arm group exposed to structured information with pictures, recordings and videos, and C-arm group exposed to conventional information. The primary outcome was anxiety, measured by Beck Anxiety Inventory. Data was analysed using SPSS 11.
Results: Of the 280 subjects, 140(50%) were in the S-arm; 65(46.4%) males and 75(53.6%) females with mean age 41.1±15.2 years. The C-arm had 140(50%) subjects; 78(55.7%) males and 62(44.3%) females with mean age 44.2±13.9 years (p>0.05). The pre-procedure anxiety score of C-arm was 11.3±7.7 compared to 9.6±7.7 in S-arm (p=0.062. Post-procedure anxiety score in S-arm was 9.8±9.0 compared to 1.49±4.5 in C-armB (p<0.001).
Conclusion: Structured informational care aimed at familiarising the patient to the magnetic resonance imagaing machine and describing the relaxing manoeuvres during examinationI was found to be a cost-effective and simple method to alleviate anxiety in patients.
Key Words: Claustrophobia, Premature termination, Magnetic resonance imaging, Anxiety, Structured informational care.
Asymptomatic Dandy Walker malformation in an elderly male with acute haemorrhagic stroke – a case report
Authors: Minhaj Areeba , Minhaj Marium , Farooqui Muhammad Osama , Naseeb Muhammad Wahdan , Hafiz Muhammad Saad  , Shaheen Bhatty
Published: June 2023

Dandy-Walker Malformation (DWM) is a rare congenital anomaly of the posterior cranial fossa. Features of DWM include hypoplasia of the cerebellar vermis, enlargement of the posterior fossa, and cystic dilatation of the fourth ventricle. MRI is the modality to confirm the diagnosis. Treatment is usually symptomatic and required when signs of hydrocephalus develop. Rare cases of asymptomatic DWM diagnosed incidentally are reported in literature. We report a case of DWM in a 60-year-old male who presented with haemorrhagic stroke and was later found to have DWM on brain imaging.
Keywords: Dandy-Walker Malformation, Haemorrhagic Stroke.
Forecasting total fertility rates for urban and rural areas in Pakistan with a coherent functional modelForecasting total fertility rates for urban and rural areas in Pakistan with a coherent functional model
Authors: Waseem Hira Fatima , Farah Yasmeen
Published: June 2023

Objective: To project total fertility rates for urban and rural areas in Pakistan up to 2027 with 80% prediction intervals.
Method: The secondary-data study was conducted from March 2020 to August 2020 at Data Bank in the Department of Statistics, University of Karachi, Pakistan, and comprised publicly available data of the Pakistan Demographic Survey from 1984 to 2007. Two statistical models, the functional time series model and the coherent functional model, were used to make the predictions about age-specific fertility rates. The forecasting performance of the models was compared through error measures. Data was analysed using R version 3.6.3.
Results: The predicted total fertility rate was 1.7 (80% prediction interval: 0.4-4.4) births per woman for urban areas and 2.2 (80% prediction interval: 0.6-5.3) births per woman for rural areas in 2027 using coherent functional model. The total fertility rate predicted by the functional time series model was 2.1 (80% prediction interval: 1.6-2.6) births in urban areas and 2.7 (80% prediction interval: 1.7-4.1) births per woman in rural areas. The empirical comparison of forecast error measures obtained from the two models indicated that the coherent functional model performed better for forecasting total fertility rates for urban and rural areas in Pakistan.
Conclusion: The projection of fertility rate obtained by the functional time series model and the coherent functional model described the future fertility behaviour of urban and rural populations.
Key Words: Fertility, Forecast, Urban Population, Rural population, Age-specific fertility rates, Women.
Significance of nutrition in preventing miscarriage, an ignored but modifiable risk factor
Authors: Khan Mahnoor , Ali Samra
Published: June 2023

Madam,
Miscarriage or spontaneous abortion is defined as the pregnancy loss occurring before the 24th week of gestation. This term is used when an ultrasound has confirmed an intrauterine pregnancy1. It is the commonest adverse fate of pregnancy, with vaginal bleeding and abdominal pain as alarming symptoms. It is found that around 12-15% of confirmed pregnancies end up in a miscarriage. Although genetic factors (chromosomal abnormalities) top the list, maternal factors, especially nutritional status, can affect the developing embryo and result in early pregnancy foetal demise2. During pregnancy, maternal requirements for energy, macronutrients (carbohydrates, proteins and fats) and micronutrients increase to cope with the physiological changes occurring in the mother’s body and to support adequate foetal development. Two Case control studies have been conducted and have found a preventive effect of milk consumption and dairy products on spontaneous abortion3. There is also an association between decreased animal fat and carotene intake and increased risk of hydatidiform mole, which can ultimately lead to a miscarriage2. Studies proved that not only macronutrients but deficiency of micronutrients also contribute to poor pregnancy outcomes. Some essential micronutrients include iron, magnesium, zinc, vitamin b12 and folic acid., Due to its antioxidant effects, Vitamin C is also required during this stage and contributes to a healthy pregnancy1. Besides deficiencies, even excess of some micronutrients, like caffeine, especially during the pre-pregnancy state contributed to the risk of early pregnancy loss4. Studies have been done to determine the mechanism behind the nutrition’s effect on the outcome of pregnancy. In the pre pregnancy state, nutritional imbalances result in the alteration of germ cell morphology, which hinders the chances of fertilisation of the altered germ cell. In addition to this, nutritional status during the peri-implantation and placental developmental stage (embryonic stage) play a vital role in the establishment of pregnancy and fetal development so any deficiency during this stage increases the risk of miscarriage. Folic acid deficiency during this stage is harmful. Although it mainly results in the development of congenital anomalies in infants, it is seen that by increasing homocysteine levels it can also lead to miscarriage, although the association is still unknown1. Not only undernutrition but overweight and obesity in mothers also lead to poor pregnancy outcomes.
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Responding to burns - is our practice adequate?
Authors: Ahmed Moiz , Zahid Ibrahim
Published: June 2023

Madam,
Around 90% of burn related injuries are seen in low- and middle-income countries. Misfortune of such incidents lies in the fact that most of these are either preventable in the first place or can be efficiently managed before the casualty reaches the healthcare centre. According to a study1 conducted in Burns Ward of Civil Hospital Karachi, around 1,979 patients with burn-related injuries were admitted in just two-year period. Out of which, 715 patients (36.12%) expired. This mortality rate was higher in females (39.40%) and in people older than 60 (47.90%). A massive chunk of these deaths was accidental (95.80%), imposing the need to address the root cause of the issue. Another study2 showed that around 76% of students had never attended any formal training related to burns first aid management which is quite alarming. This again implies the extreme necessity to train and enable the masses to face burn related accidents.
Another real dread comes with the prevalence of myths in the community that lead to the worsening burn wounds at home. According to a study3 conducted in POF hospital in Wah Cantt, a statistically significant (81.28%, p<0.05) number of people lacked the understanding of burns first-aid. A vast fraction did not take immediate action upon facing a burn wound, making awareness sessions an exigency for such epidemiology. Another similar study4 interviewed parents and showcased that around 86.8% of parents didn’t irrigate the burn wound with tap water, which is considered a standard intervention for burn injury. Instead, a significant ratio (30%, p<0.05) of parents used traditional remedies, among which toothpaste application (16.70%) tops the list.
FRIP (First Response Initiative of Pakistan) is a non-governmental organization founded in 2010 aimed to educate the masses about the pre-hospital management of traumatic and non-traumatic injuries. One such aspect of its curriculum is burn management. Over more than ten years, it has instilled a standard method of burn wound care based on AHA’s (American Heart Association) guidelines among the masses and has taught ways to prevent it too. The effectiveness of such workshops is evidenced in a relevant study5 which reveals that a statistically significant difference (p<0.05) existed after similar sessions conducted as illustrated in Figure 1. These figures prove the importance of first aid workshops and the crucial role FRIP plays in solving pre-hospital burn management problems.
Iron deficiency anaemia: The psychological menace
Authors: Malik Manahil Tariq , Malik Rameen Tariq , Tariq Amera
Published: June 2023

Madam,
As per the World Health Organisation, anaemia is the condition of having an inadequate number of red blood cells or if the concentration of haemoglobin in them is reduced. Haemoglobin is a complex protein component of RBCs that carries oxygen around the body, a deficiency that can lead the person to experience fatigue, dyspnoea, weakness, dizziness etc.1 Such an ailment is bound to make daily life activities difficult and take a toll on one’s mental health.
The WHO approximates that anaemia is prevalent in two billion people world-wide. There are many reasons for anaemia, including nutritional deficiencies, menstruation, stomach ulcers, parasitic infections, chronic illnesses and haemoglobinopathies etc. Nutritional deficits are the most common cause of anaemia, among which iron deficiency is namely the guiltiest, accounting for half of the total cases world-wide. It is a global public health travesty, especially for children and pregnant women.1
A vital component in the synthesis of the haemoglobin molecule is iron. Haemoglobin that is iron-deprived produces hypochromic and microcytic red blood cells. Iron is associated with several neurological functions, a deficiency of which leads to poor myelination of the white matter as well as a disturbance in monoamine metabolism. Additionally, fluctuations in the levels of brain iron interfere with the homeostasis of neurotransmitters such as gamma-aminobutyric acid and glutamate. Enzymes for synthesising neurotransmitters like dopamine and serotonin- essential in the modification of mood, anxiety, and other emotional behaviours- require iron as a vital component.2 Abnormalities in the physiology of these neurochemicals due to disruptions in an adequate iron supply will undoubtedly increase the likelihood of associated disorders, including but not limited to depression, anxiety, sleeping issues, developmental and emotional afflictions etc.
A research paper comparing the risk of various psychiatric illnesses in patients with iron deficiency anaemia and healthy controls concluded the IDA group at a higher risk for developing anxiety, depression, sleep disruption, and psychotic disorders. Interestingly, it also found t that IDA with iron supplementation reported remarkably lower risks of psychiatric disturbances.3
It is, thus, necessary to monitor iron levels in anaemic individuals and where needed, introduce supplements to reduce the risk of developing and/or progression of psychiatric disorders. Further studies are also required to better expound on the relationship between iron deficiency anaemia and psychiatric illnesses.
Scarcity of pain medication in Pakistan following the devaluation of currency
Authors: Shabbir Muhammad Bilal , Zahoor Shaghaf , Ilyas Danial
Published: June 2023

Madam,
The scarcity of drugs harms patient safety and care.1 Media publications on the shortage of painkillers tend to generate panic and anxiety among the public owing to their role in patient analgesia and recovery. Pain, especially when untreated, has far-reaching consequences for patients' quality of life, including psychological, physical, social, and economic consequences. Untreated pain has proven to be associated with depression, mood fluctuations, and emotional instability, resulting in an overall low quality of life. The shortage of medicines is common globally, and the causes are multifaceted depending upon the region in consideration. Currently, Pakistan is in a similar crisis where the decreased availability of medications, among which analgesics constitute a vast proportion, is leaving many holes in quality, patient management and care protocols2-3 The reasons for the current crisis are multifactorial. However, the major chunk of it lies in the devaluation of the currency and the skyrocketing prices of petroleum, which has caused inflation among all utilities, including medicine. Reports by media outlets have shown an 80% increase in prices compared to prices five years prior. In contrast, the Pakistan Pharmaceutical Manufacturers Association (PPMA) chairman claimed only a 21–30% price increase. The gravity of the situation can be further augmented by the fact that the cost of paracetamol was increased from Rs 600/kg to Rs 2600/kg earlier this year, yet the medicine remains unavailable in the market.4 The scarcity of medication is not limited to pharmacies but has also found its way to hospitals, where the healthcare providers either have to prioritize patients when it comes to giving analgesia or there is no analgesia available in smaller setups.5 Another factor contributing to this predicament is the climate change-induced floods in the country. There is an increased demand for medicines, including painkillers, in flood-stricken areas and the decline in production due to non-availability of raw products owing to inflation has doubled the aftermath of this calamity. It is of the utmost urgency to mitigate this crisis, as analgesics are the most commonly used over-the-counter medicines and constitute a whole tier of patient care. To get to the bottom of the problem there needs to be more research, analysis, and investigation executed at a national level on how to streamline the production, distribution and sale of medicine, on alternative sources of treatment and if possible the placement of subsidies so that the barrier to the consumer is reduced.
Impact of cognitive impairment following traumatic brain injury on HRQOL in Pakistan
Authors: Ahmad Danial  , Fatima Laveeza , Muhammad Fawad Bosan
Published: June 2023

Madam,
Millions of people are affected by traumatic brain injury (TB) across the world each year. Road traffic accidents (RTAs) are among the top contributors of mild to severe TBI cases, and in developing countries like Pakistan, low literacy rates and lack of awareness regarding traffic rules have further aggravated the situation.(1) Many survivors of RTAs never return to their normal life and are made to live with persistent disabilities. The limitation of knowledge regarding post-TBI cognitive impairment has been noted, and it further adds a barrier to necessary actions. It's evident that following mild to moderate TBI, the patients are prone to cognitive impairment and its associated adverse effects.(2)
A recent 2019 study by Gorgoraptis et al. reported that cognitive impairment adversely effects health-related quality of life (HRQOL) following TBI.(3) In Pakistan’s already struggling healthcare system, there are a few emergency trauma centres with neurocritical care units in it. Another study indicates that TBI patients are not assessed by an experienced doctor most of the time, with poor reporting of the clinical findings and hence missing out on an important finding in such patients. (4) Computed Tomography (CT) scans for critical patients are available only in large centres and patient load, and cost of investigation can hinder to its timely availability for most TBI patients. Post TBI cognitive impairment can cause a significant burden on the healthcare system leading to other social implications as well. The patients are discharged once they get stabilized with no proper follow-up plans which can lead to other avoidable cognitive impairments like dementia, psychiatric problems, and behavioural changes.
 In TBI cases, risk assessment and more advanced investigations like MRI can be provided to the patients who suspected of any finding missed on a CT scan. Furthermore, TBI guidelines need to be reviewed and planned accordingly. A psychiatric team must assess patient’s mental status changes during the stay and if needed proper therapy must be initiated. Neuropsychological rehabilitation plays a pivotal role in cognitive impairments and can help decrease the burden of neurological diseases (5) and improves HRQOL of patients. Hence, a unified and interdisciplinary approach towards patients with traumatic brain injury is required so that not only can mortality be reduced but also to better the quality of life in survivors.
Analisis Pemberdayaan UMKM Melalui Filantropi Zakat Dalam Mewujudkan SDGs (Sustainable Development Goals)
Authors: Putri Salsabila , Sudiarti Sri , Harahap Rahmat Daim
Published: June 2023

MSMEs are one of the driving wheels of the economy that has the potential to realize the SDGs goals, namely without poverty and hunger. One that plays a role in realizing the SDGs by reducing the poverty rate is zakat. The purpose of this research in general is to realize sustainable development through empowering MSMEs. The research method used is qualitative with triangulation analysis techniques. The results of this study are that MSMEs can benefit from empowering productive zakat MSMEs provided by LAZ, which assistance can help develop their businesses and help prosper the family economy. This is one of the efforts that can be said to be successful in realizing one of the goals of sustainable development, namely without poverty and hunger

Keywords: MSME, Zakat, SDGs
Analisis Dampak Kebijakan Ecotourism di Wisata Alam Bukit Lawang Bagi Perekonomian Masyarakat
Authors: Aditya Eski , Jannah Nurul , Dharma Budi
Published: June 2023

This study aims to analyze how the impact of the existence of ecotourism policies implemented in Bukit Lawang nature tourism has on the community's economy. The research method used in this study is a qualitative descriptive method, namely by using an analysis of events, phenomena or social conditions. Source of data used is primary data. There are three data collection methods used, namely observation, interviews and documentation. Data validity techniques for data validity used in this study are source triangulation and method or technique triangulation. The results of this study indicate that the impact of the existence of ecotourism policies on Bukit Lawang nature tourism has a positive effect on several things, such as: reducing unemployment, increasing people's economic income, surrounding area income, utilization of natural resources and good human resources and also enhance nature conservation efforts. In addition, the sustainability of ecotourism requires collaboration or cooperation between tourism managers and the local community.

Keywords: Ecotourism Policy, Community Economy
Valuasi Ekonomi pada Wisata Pantai Pondok Permai dengan Travel Cost Model Perspektif Ekonomi Islam
Authors: Marpaung Maulida , Harahap Isnaini , Syarvina Wahyu
Published: June 2023

This Research used a quantitative descriptive method, using primary data in determining the sample, namely purposive random sampling using the slovin formula. This research aims to determine the effect of the independent variant (distance, travel cost,facilities) on the dependen variable (number of visits) to pondok Indah beach tourism. This research used the travel cost model (TCM) approach to determine the factors that influence the number of visits and estimate the economic value of Pondok permai beach. The result showed that the travel cost and facilities variable had a significant effect and the distance variable had no significant effect. From the calculation result, it is known that the economic value of Pondok permai beach tourism is Rp. 5.573.750.000 per year with a consumer surplus value of Rp.796.250 per individual per visit within a one year period. Based on Islamic perspective, Pondok permai beach tourism has implemented several criteria for halal tourism, such as protecting the coastal environment, managing and developing it wisely, providing prayer facilities and providing food and drinks that are guaranteed to be halal.

Keywords: Economic Valuation, Travel cost model, beach tourism, Islamic economic perspective.
Perananan Bimbingan Agama Dalam Mencegah Perjudian Online pada Kalangan Remaja di Desa Kuta Ujung Kecamatan Darul Hasanah Kabupaten Aceh Tenggara
Authors: Sahri Alfi , Kustiawan Winda
Published: June 2023

The rapid development of technology has made it the foundation of all human life. This can be seen in the pattern of human life that cannot be separated from technology. Technology has very positive benefits and can make human work easier if used properly and correctly, but technology can also have a vicious effect if it is not used wisely. One of the negative impacts produced by technological developments is that it is easy for teenagers to access online gambling. Gambling has been banned in religion, culture and criminal law. Teenagers who are expected to be the next generation of the nation will experience damaged morale if they continue to play online gambling. The impact of gambling is also very bad for teenagers. Qualitative research is the type of research used in this study, the chosen location is Kuta Ujung Village, Darul Hasanah District, Southeast Aceh District. Interviews, observation and documentation are data collection techniques, and Miles and Huberman's opinions are data analysis techniques. Factors that cause online gambling range from weak faith, bad environment, low level of education, lack of time, curiosity, addiction and also difficult economic factors. The role of religious guidance is very, very important for teenagers to prevent online gambling. Guidance by giving religious lectures, forming mosque youth and creating recitation programs for youth are the efforts of village authorities in motivating, facilitating and consolidating to prevent the rise of online gambling by teenagers.

Keywords: Online Gambling, Technological Developments, Adolescents
Upaya Guru BK dalam Mengatasi Perilaku Misbehavior Siswa
Authors: Nazla ,Jihan , Hasibuan Ali Daud
Published: June 2023

One of the good classroom management is the creation of a conducive class or class that is able to show that children can listen to every explanation or direction from the teacher. However, we often find that there are children who should be able to listen or mingle with others, but they show things that might interfere with learning in class. Disruptive behavior by children is behavior that does not support the learning process which is carried out repeatedly by students in class and comes in various forms according to the conditions of each class. Disruptive behavior is a child problem in class that cannot be taken lightly. Strategies for providing an effective learning environment include not only making good use of class time, creating an atmosphere conducive to interest in learning, and providing opportunities for activities that engage students' minds and imaginations, but also more importantly preventing and responding to student behavior that annoying in class. Many teachers who teach in class tend to ignore or think that this is normal child behavior or that the teacher doesn't really know how to deal with this disruptive behavior. For this reason, class teachers can take various actions to reduce disruptive behavior in class through various approaches, namely behavioristic, cognitive and humanistic.

 Abstract: Handling, Behavior, Cognitive, Humanistic
Pola Komunikasi Forum Kerukunan Antarumat Beragama (FKUB) Dalam Menciptakan Kerukunan Antarumat Beragama di Kota Medan
Authors: Khairiza DIta , Ritonga Muhammad Husni
Published: June 2023

Effective communication patterns are the key to creatng harmony between varous religions in the city of Medan. The Diversity Harmony Forum (FKUB) is an institution that plays an important role in promoting dialogue, understanding, and cooperation between various religions and beliefs iin the city of Medan. Ths study ams to analyze the communication patterns used by FKUB in creating harmony between various faths in the city of Medan. The research method used is qualitative research by condiucting in-diepth interviews with FKUB members and studying documentation related to FKUB activties. The results of the study show that FKUB's communication patterns are based on the principles of mutual respect, listening wth empathy, andi seeking solutions together. In iinternal communication, FKUB uses regular meetings and discusson groups to strengthen understanding and togetherness among members. Meanwhle, in external communication, FKUB implemented various strategies such as interfaith dialogue, join social activities, andi public campaigns to encourage dialogue between diverse people in Medan City.

Keywordis: communication pattern, forum for harmony among various people, harmony between various religions, Medan City.
Efektivitas Fintech Melalui Digital Payment terhadap Perkembangan UMKM di Indonesia
Authors: Dalimunthe Windi Mayani , Rahma Tri Inda Fadhila , Syarvina Wahyu
Published: June 2023

This study aims to see the effectiveness of fintech through digital payments on the development of in Indonesia with limited problems in the city of Medan. The type of research used is descriptive combination. The data source used is primary data by distributing questionnaires to respondents in this case business actors, micro, small and medium enterprises which are supported by research through interviews with business actors, micro, small and medium enterprises to see opinions about the application of digital payments on his business. The analytical technique used in this study is simple linear regression analysis by testing using the SPSS 26 application. The results of the study state that the digital payment variable has a positive and significant effect on the development of micro, small and medium enterprises. Meanwhile, based on the results of the interviews, it was taken that there was a positive impact from the provision of digital payments for in providing security, convenience and also speed in carrying out transaction processes

Keywords: Fintech, Digital Payment, Bussines, Micro, Small and Medium
Pengaruh Leverage, Profitabilitas, dan Likuiditas terhadap Earning Response Coefficient (ERC) pada PT BSI Tbk
Authors: Sipahutar Riky Dermawan , Yusrizal Yusrizal , Bi Rahmani Nur Ahmadi
Published: June 2023

This study aims to empirically examine the effect of Leverage, Profitability, and Liquidity on the Earning Response Coefficient (ERC) in Islamic banking companies. Data collection techniques using documentation and data analysis techniques using purposive sampling. Earning Response Coefficient (ERC) is a type of dependent variable that can be useful in research. However, the variables that are independent in this research are Leverage, Profitability, and Liquidity. The method used in this research is multiple linear regression analysis. This study uses a tool that is IBM SPSS Statistics 20 software program. The results of this study can be interpreted that simultaneously there is a positive and significant direct effect, namely Leverage, Profitability, and Liquidity on the Earning Response Coefficient. While partially Leverage has a significant negative effect on the Earning Response Coefficient, profitability has a significant positive effect on the Earning Response Coefficient, liquidity has no significant effect on the Earning Response Coefficient.

Keywords: Leverage, Profitability, Liquidity, Earning Response Coefficient (ERC), Bank Syariah Indonesia.
Analisis Yuridis dan Pandangan Hukum Pidana Islam Anak yang Membawa Senjata Tajam untuk Aksi Tawuran:
Authors: Shuhada Wahyu , Siregar Ramadhan Syahmedi
Published: June 2023

Sharp weapons are very useful and necessary in terms of arming oneself or defending or defending oneself from things that threaten the soul, but if misused or used is not in accordance with applicable laws and regulations, this research using normative legal research does not recognize field research ( field research) because what is being studied is legal materials so that it can be said to be library based, focusing on reading and analysis of the primary and secondary material. This research will then draw a conclusion regarding Juridical Analysis and Islamic Criminal Law Views of Children Carrying Sharp Weapons for Fighting Actions on a decision study (Number 70/Pid.Sus-Children/2022/PN Mdn). In Indonesia, the use of sharp weapons without rights and without permission is strictly prohibited because it can injure other people, therefore the State of Indonesia makes rules that prohibit its people fortunately not to carry or use sharp weapons carelessly which is contained in the Emergency Law of the Republic of Indonesia number 12 of 1951 Article 2 paragraphs 1 and 2. According to Islamic law there is no normative argument regarding criminal sanctions, especially in the form of imprisonment, because criminal sanctions against children in Islam are ta'dib (education) which are handed over to the waliyul amri (leader)

Keywords: Children, sharp weapons, crime
Pengaruh peraturan pAnalisis Hukum Pidana Positif dan Hukum Pidana Islam terhadap Aliran Sesat sebagai Modus Operandi enumpang pesawat dalam masa pandemi Covid-19 terhadap minat penumpang maskapai Citilink di Bandar Udara Internasional Ahmad Yani Semarang
Authors: Mendrofa Rizka Hanum , Siregar Ramadhan Syahmedi
Published: June 2023

Heretical sects are teachings or activities that deviate from religious norms. Misguided sects that are currently happening a lot both in Indonesia and in the world are sects that violate human rights. Apart from deviating from our spirituality and beliefs in religion, this sect also makes its followers victims of criminal acts by the sect leaders themselves. In collecting data the author uses normative juridical methods. The normative juridical method is library law research by examining library materials or with primary legal materials and secondary legal materials that support the author's research. The results of this study indicate that the modus operandi in committing a crime can be done in the name of religion. where this concerns the problem of our spirituality to God Almighty. This study concludes that deviant sects are also regulated in the Criminal Code where the sanctions for the perpetrators are in accordance with the conditions of the crime they committed. In the perspective of Islamic criminal law, the spread of deviant sects can be as Jarimah Hudud. In Criminal Law, efforts to overcome heretical sects are inseparable from the concept of crime prevention and in the Islamic view by strengthening faith and strengthening monotheism to Allah SWT

Keywords : Heretical sects, Modus operandi, Criminal acts