bluuebunny/crossref_metadata_2025 huggingface dataset:
Russian -Turkish relations and current international alliances in the Middle East "Study on the effect and Impact"
Authors: Meri Muthanna Faiq , Wadi Abdelalim -Fadel
Published: March 2019

International relations are affected by the interests that may be achieved by States or if those interests are harmed as a result of internal and external factors that are exposed to this or that state. The bilateral international relations are also affected by the alliances to which one or both sides of the relationship is involved. A set of geopolitical, economic, security and ideological interests negatively and positively. Such relations were also affected by the policy of axes and international alliances, which have long been joined by the two countries to contradictory alliances that have strained their relations. Turkey is a member of the four-party alliance and Turkey is a member of the Islamic alliance and then of the international coalition to fight the oppressive organization and the terrorist groups in Iraq and Syria. Each of these alliances has its objectives and members whose views differ from those of other member states, Hence, the impact on relations between Russia and Turkey was clear.
New International Factors of Twenty First Century
Authors: Tawfiq Al - Haramazi Saif Nasrat
Published: March 2019

There are many non-traditional additions to the influential works in the international or international context, which have expanded and become very large.

 Some of them have not entered into this field of international relations. Hence the need to supplement, renew and add new concepts

There digital (electronic) factor, has become the key to the hard and soft domination of international units, and an important input in international relations, especially the twenty-first century. We have been able to explore the reality of the international interaction based on (cooperation, competition, conflict).

In conclusion, the global system will remain state-based and international organizations. At the same time, it will continue to be born and no states in its interactions with the ease of use of digital technology by individuals on the planet..
British foreign policy towards the Palestinian cause since 2003
Authors: Salman Al - Shammari Mustafa Ibrahim , Hammadi Al-Hamdani Dhari Sarhan
Published: March 2019

The topic area of that’s paper dealing with role of Britain in established of Israel, so the paper argued the historical developments of Palestinian question and Role of Britain Government toward peace process since 1992, and then its insight toward plan of Palestinian State.

That’s paper also argued the British Policy toward Israeli violations toward Palestinians people, and increased with settlement policy by many procedures like demolition of houses, or lands confiscation, the researcher argued the Britain position toward that’s violations beside the political developments which happens in Britain after Theresa May took over the power in Ten Downing Street
The dimensions of the Moroccan position on the Gulf crisis 1990-1991
Authors: Nassif Al Obeidi Nazhan Hammoud , Abu Khamra Abdul Wahab Abdul Aziz
Published: March 2019

The Gulf crisis 1990-1991 is one of the important historical events of the 1990s, which gave rise to the new world order by the sovereignty of the United States of America on this system. The Gulf crisis was an embodiment to clarify the features of this system. .

    The crisis in the Gulf was an opportunity for the Moroccans to manage this complex event and to use it for the benefit of the Moroccan situation. Therefore, the bilateral position of the crisis came out as a rejection, a contradiction and a supporter of political and economic dimensions at the external and internal levels. On the Moroccan situation, and from these points came the choice of the subject of the study (the dimensions of the Moroccan position from the Gulf crisis 1990-1991), which shows the ingenuity of Moroccans in managing an external crisis and benefiting from it internally.
The international and regional conflict in the Middle East and its impact on the Arab region (The model of the Arab spring)
Authors: Hamad Attiah Saddam Marerr
Published: March 2019

The international conflict in the Middle East was one of the first civilizations that arose in this land. Life was born in the East, and humanity knew the meaning of the sun in this geographical area called the Middle East. This conflict preceded the oil explorations because of the strategic location of this region.
Children of war in Iraq princes of future wars Study on the rights of Iraqi children
Authors: Mohamed Ahmed Ali
Published: March 2019

The importance of studying the impact of wars on civilians in general and children, especially with the increasing number of victims and the transformation in the nature of wars and armed conflicts, which is now more deadly children, including fighters.

The human and material bleeding caused by decades of successive wars in Iraq will require more decades to recover from its effects and repercussions. The war has left millions of dead, orphans and street children, as well as millions of people with disabilities and mental disorders. In the face of inadequate government policies, armed groups and militias have succeeded in investing in these millions of children into projects of killers, martyrs and militia leaders.

   The exit of Iraq from the cycle of war and violence depends on the removal of childhood from this vicious circle that transform the victims of today to the princes of the wars of tomorrow
Diplomacy of science, technology and innovation Report of the Spanish Foreign Ministry and a brochure on its official page
Authors: Fadel Thaer Tahir
Published: March 2019

In a rapidly changing world where new global challenges are striking their wings all over the world, it is recognized in the modern world that CTI is one of the engines of social and economic development and the drive for globalization. It will be more effective in the future. One of the solutions to these changes lies in science, technology and innovation. Science, technology and innovation are an engine for the task of economic development, but at the same time pose new challenges, as they contribute to the restructuring of the present world in the foreseeable future. In the same context, science, technology and innovation have a growing size in all areas of modern society, and this is manifest in the current international relations and the international presence of a country and its image in the world. The ability to bring about scientific and technological developments, innovation or attract talent are fundamental aspects of soft power and public diplomacy, and represent a framework for the state.
Future Prospects for the Experience of Administrative Decentralization in Iraq
Authors: Abd Almajmai Suhail Ali , Ahmaid Hazem Sabah
Published: March 2019

Future Prospects for the Experience of Administrative Decentralization in Iraq The experience of administrative decentralization is an important experiment for all levels of countries because it works according to consistent and interrelated steps in order to reach supportive solutions that contribute to the development of this experience. Therefore, it requires effective and influential institutions in the behavior of the majority as well as the principle of transparency and issue. Administrative decentralization is available in all its dimensions if applied in Iraq in the future.
What Does It Mean to Be a Citizen? A Comparative Study of Teachers' Conceptions in Spain and Chile
Authors: Martínez-Rodríguez Rosendo , Sánchez-Agustí María , Muñoz-Labraña Carlos
Published: March 2019

The aim of our research has been to analyse the conceptions of citizenship held by history teachers in secondary schools in Spain and Chile, while at the same time relating these to their perceptions of the socio-political and socio-economic contexts of their countries. The study compares the conceptions of teachers from these two countries which share a similar recent history and have both experienced strong movements of popular protest and political detachment. The methodology was qualitative and made use of semi-structured interviews. The study analysed dialogues from 70 teachers, 35 in each country. The initial results indicate a predominance of moral and participatory conceptions of citizenship, to the detriment of legal or identity-based conceptions. The controversial political, social and economic context of both countries within which the interviews were conducted is a key factor to understanding the teachers' perspectives on their conceptions and the meaning of these.
KAJIAN PENGARUH GELOMBANG TERHADAP KERUSAKAN PANTAI MATANG DANAU KABUPATEN SAMBAS
Authors: . Umar
Published: March 2019

Abstrak Pantai Desa Matang Danau adalah pantai yang berhadapan langsung dengan Laut Natuna. Laut Natuna memang memiliki gelombang yang cukup besar yang merambat dengan arah dominan dari barat. Pantai Matang danau bermaterial berupa pasir bercampur lempung. Pantai ini sudah cukup lama mengalami aberasi akibat gelombang dan arus sejajar pantai. Pada penelitian ini dicoba melakukan perhitungan dan simulasi model CGWAVE untuk memperkirakan arah datang dan besarnya gelombang dari laut dalam menuju pantai. Dari pemodelan tersebut diketahui bahwa arah datang gelombang tidak tegak lurus dengan pantai sehingga timbul arus sejajar pantai yang akan mempengaruhi pergerakan sedimen sepanjang pantai. Gelombang pecah juga cukup dekat dengan garis pantai sehingga mengakibatkan rawan terhadap abersi. Kata-kata kunci: pantai, gelombang, abrasi
Aplikasi Debit Aliran Menggunakan Koefisien Dasar Dengan Didasarkan Bentuk Konfigurasi Dasar Saluran
Authors: Wibowo Hari
Published: March 2019

Kekasaran dasar saluran sangat berpengaruh pada karakteristik aliran, terutama dalam menghitung kecepatan dan debit aliran. Kekasaran dasar saluran dinyatakan dalam koefisien kekasaran. Koefisien kekasaran saluran yang digunakan dalam aliran seragam adalah nilai koefisien kekasaran Manning (n). Banyak penelitian yang dilakukan untuk mendapatkan nilai koefisien kekasaran Manning. Pengunaan koefisien kekasaran Manning saat ini hanya didasarkan n tabel. Sedangkan nilai n tabel Manning hanya disarankan untuk saluran kondisi baik. Penerapan n tabel Manning pada saluran alami memberikan hasil yang kasar, karena keadaan aliran lebih banyak tergantung pada faktor yang tidak diketahui. Diantaranya adanya bentuk konfigurasi dasar, dan penelitian sebelumnya belum ada yang memperhitungkannya. Tujuan penelitian adalah untukmendapatkan suatu rumusan empiris nilai koefisien kekasaran Manning saluran alam berdasarkan modifikasi koefisien kekasaran Manning, yang berkaitan butiran dasar dan bentuk dasar yang ada dilapangan. Metode yang akan dilaksanakan berupa pengambilan data lapangan dalam upaya mencari hubungan bentuk bentuk dasar saluran terhadap koefisien kekasaran dasar material non kohesif. Aplikasi penerapan rumusan akan dilakukan pada studi kasus Sungai Jawi dan Parit Tokaya di kota Pontianak.Kata kunci: Kekasaran dasar, bentuk dasar, koefisien kekasaran Manning
El derecho al olvido digital: una brecha entre Europa y Estados Unidos
Authors: Moreno Bobadilla Ángela
Published: March 2019

El derecho al olvido digital se ha convertido en tema de capital importancia, como consecuencia del impacto que Internet está teniendo sobre la vida privada de los ciudadanos. En este contexto, el presente artículo[1]  analiza las diferentes formas de protección de este derecho emergente en los sistemas codificados y en los sistemas del common law, para dar cuenta de las dispares realidades que se están conformando en ambos Continentes, en donde se trata de equilibrar el derecho a la información con el derecho al olvido en una era donde la memoria digital no olvida ni perdona

 

*Artículo realizado en el marco del Proyecto Fondecyt de Iniciación N° 11180172 "Aspectos fundamentales para la configuración y el desarrollo del derecho al olvido digital en Chile".
Characteristics Analysis of Dual Bell Nozzle using Computational Fluid Dynamics
Authors: Akib Yeasir Mohammad , Kabir Asif , Hasan Mahdi
Published: March 2019

Space exploration and space tourism have now become a raging competition among the developed nations. For this reason, different types of advanced rocket nozzles with prospective privileges are introduced. Altitude adaptive dual bell nozzle will soon replace the conventional nozzles for the first stage rocket launcher. Indeed, this nozzle has auto adaption capability based on altitude. The major feature of a dual bell nozzle is the two bell-shaped contours separated by an inflection point. This nozzle has left rooms for researchers to test different flight conditions and transition characteristics. In this paper, a dual bell nozzle contour has been developed in MATLAB and analysed for different thermodynamic parameters. ANSYS Fluent is used in analysing flow through the nozzle. Shadowgraph imaging technique is used for measuring density gradient and compared it with fluent results. The simulations were performed by using the k-epsilon turbulence model.
Sustainable Machining Processes through Optimization of Process Parameters
Authors: Ogedengbe Temitayo Samson
Published: March 2019

Machining processes are a vital part of manufacturing activities in major industries that contributes to the growth of the economy. They mostly require high amount of electrical energy to power the various support modules installed on machine tools. Carrying out machining activities with a view to reducing energy consumption will therefore result in a lowered cost of production for manufactured products. Previous studies on some energy-saving methods adopted by researchers and the limitations faced in the reduction of energy consumption have been discussed. In this work, the effect of process parameters in the conservation of energy during machining processes was experimented. Results shows that much energy could be saved by optimizing parameters before machining.
Application of the Bees Algorithm for Constrained Mechanical Design Optimisation Problem
Authors: Kamaruddin Shafie , Abd Latif Mohd Arif Hafizi
Published: March 2019

Optimisation is a technique or procedure to find the optimal or feasible solution whether it is to minimise or maximise by comparing other possible solutions until the best solution is found. Nowadays, many optimisation algorithms have been introduced due to the advancement of technology such as Teaching Learning Based Optimisation (TLBO), Ant Colony Optimisation (ACO), Particle Swarm Optimisation (PSO) and the Bees Algorithm. The Bees Algorithm is considered as one of the best optimisation algorithms because it has been successfully solved different type optimisation problem from in various field. It is inspired by the foraging behaviour of honey bees in nature. This study applies the Bees Algorithm to minimise the mass of disc clutch brake in its design. To find the optimal solution for the multiple disc clutch design, the Bees Algorithm will be used and expected to give better result compared to other optimisation algorithms that already have been used.
Comparative Analysis of Machining Stainless Steel using Soluble and Vegetable Oils as Cutting Fluids
Authors: Ogedengbe Temitayo Samson , Awe Peter , Joseph Ojotu Ijiwo
Published: March 2019

In this study, the performance of groundnut oil as an alternate cutting fluid was compared with that of soluble oil during machining of stainless steel. The temperature at the cutting zone, surface roughness and the chip formation were monitored under the two cutting conditions (soluble oil and vegetable oil). The machining parameters used were cutting speed (75 – 135 rev/min), feed rate (0.01 – 0.05 mm3/mm) and depth of cut (0.01 – 0.08 mm). The experiment was designed using Taguchi orthogonal array of Minitab 18 which generated a 9 run machining parameter mix for the experimentation. The Physiochemical properties of the various fluids were also analyzed to determine the properties and constituent elements of the cutting fluids. The actual machining of the stainless steel bar was done using a Colchester mastiff lathe machine. Results show that feed rate and cutting speed had the most significant effect on surface roughness during machining of stainless steel both with groundnut oil and soluble oil. Soluble oil was a better coolant but poorer in lubrication as vegetable oil reduced surface roughness more when used. Surface roughness value improved from 9.21μm during machining with soluble oil to 3.84μm during machining with groundnut oil which represented a 58.3% improvement. Hence, vegetable oil is therefore recommended as good alternative cutting fluid to soluble oil during machining of stainless steel.
Consumming iron tablet is not enought; A perspective from Midwife
Authors: Yani Lasiyati Yuswo , Yani Lasiyati Yuswo
Published: March 2019

Iron is a mineral that is needed by the body that serves to synthesis hemoglobin. Iron requirement during pregnancy as a result of increased maternal blood supply. Proper iron consumption behavior will affect the levels of hemoglobin during pregnancy. From the literature, the study found six behavior of iron consumption in pregnant women. First Add the amount of food intake. Second Diversity of food intake. Third increase in iron absorption. The four serve the food appropriately. The five regularities of Fe tablet consumption. Last Drink the Fe tablet in the right way. Pregnant women should receive proper counseling on how to properly add blood tablets, as the absorption of tablets plus blood is affected by reinforcing and inhibiting factors. Tablets added blood are easily absorbed if the acidic conditions are in the duodenum and jejunum.
The Improvement of Cognitive Function and Decrease the Level of Stress in the Elderly with Brain Gym
Authors: Azizah Lilik Marifatul , Martiana Tri , Soedirham Oedojo
Published: March 2019

The decline in cognitive function in the elderly, which is part of the aging process can result in long-term memory problems and information processes, so it is often regarded as a stressor that causes stress and perceived as an adverse threat. Brain gym can improve memory, decreased emotional stress and the clearer mind. The aim of the study analyzed the effectiveness of brain gym in improving cognitive function and decreased the level of stress of elderly. Pre-experimental study of one group pretest-posttest design with 35 samples selected by simple random sampling. The frequency of Brain Gym exercise twice a week with duration of every 15 minutes and done in four weeks. Measurement of stress level using DASS, while Cognitive function with MMSE. Data analyzed using Wilcoxon signed rank test. The results showed improvement of cognitive function in elderly and decreased stress level after brain gym (p = 0.001 and p = 0.009 at α = 0.05). Brain gyms are more effective at lowering stress levels than older cognitive function improvements that require longer and more intense time to improve concentration and elderly memory.

 

Keywords: Brain Gym, Kognitif, Stress, Elderly
HYPNOTHERAPY DECREASES STRESS IN ELDERLY HYPERTENSION
Authors: Kastubi Kastubi , Minarti Minarti , Saudah Noer
Published: March 2019

Stress stimulates the sympathetic nervous encouraging the heart and cause an increasing blood pressure. Efforts to reduce hypertension pharmacological and non-pharmacological. Non-pharmacological experiment of which is hypnosis. The research objective was to analyze the decrease of stress to elderly hypertensive therapy with hypnotherapy. The research design used experimental pretest - Posttest with Control Group. The population were all the elderly with hypertension in the elderly health care center PacarKeling , and Kemayoran Surabaya with 35 elderlies. Number of sample 15 intervention group, 15 control group. The sampling technique used Simple Random Sampling. Variable intervention was therapeutic applications of hypnosis to elderly hypertensive. The dependent variable was the stress in elderly hypertensive. The statistical test used paired t-test. It showed changes in stress to the control group -7.33, while the experminent group amounted to 14.60. Results can reduce stress in the group treated with hypnotherapy an average decrease of 14.6. Results showed that there were differences in the level of stress control and experiment groups with significant value of p = 0.000 (p <0.05), The effect of hypnotherapy was also shown in the systolic blood pressure change between control and experiment groups showed a mean difference of ranks. In the control group 20.8, while in the experimental group 10.2. Mann Whitney test results obtained by the significant value of p = 0.000 (p <0.05) in mean systolic blood pressure differences between control and experiment groups. Hypnotherapy can reduce stress and blood pressure in the experiment group. Causes of stress on the individual such as physical pain, and the outside factor could be due to family problems, economic. Suggestions that hypnosis can be used as a new experiment method stress problem in the elderly
SOCIAL SUPPORT RELATIONSHIP WITH SELF CONCEPT IN HIV / AIDS PATIENTS
Authors: Sudarsih Sri , Setiawan Yusarief
Published: March 2019

A positive self-concept in people with HIV / AIDS is needed. This is because the various problems that occur in people with HIV / AIDS both physical and psychological problems. The concept of self has the role of helping the sufferer achieve his life goal, one way that can be used is through social support from. The purpose of this research is to know the relationship of social support with self concept of HIV / AIDS patient. Independent variable is social support and dependent variable that is self concept. The design of the study used correlation analytic design with cross sectional design. The sample is 26 respondents. The sampling technique uses non probability sampling type consecutive sampling. The instrument uses a questionnaire consisting of a questionnaire to measure social support and to measure self-concept. The Stabilistic Test uses the Fisher's Exact Test. Result of research got most respondent have social support that is 15 respondent (57,7%), most of respondent have positive self concept that is 16 respondent (61,5%). The result p (0,032) and Î± (0,05) which means there is relationship of social support with self concept in patient of HIV / AIDS. The higher the social support the more positive the self-concept, the lower the social support will produce negative self-concept. Counseling for families about social support for people with HIV / AIDS will increase family knowledge so it is expected to develop patient self-concept.
COMPLICATED INGUINAL HERNIAS;
Authors: Akhtar Naveed , Ul-Hassan Syed Shams- , Sabir Muhammad , Ashraf M. Nauman
Published: March 2019

Background: Herniorrhaphy and hernioplasty are the two most common modalities used with different degree of success and complication rates in the treatment of inguinal hernia. Several studies show that use of mesh is superior to the non-mesh operations in inguinal hernia surgery.It is generally believed that the use of biomaterials should be limited to non-infected surgical fields.Now the concept regarding use of mesh in complicated hernias is changing as shown by many studies. Current study is being planned to observe the outcomes of the mesh hernioplasty in treatment of complicated inguinal hernias in emergency so that in future appropriate and safe technique may be suggested for repair of complicated hernias in emergency setting. Objectives: To compare the outcome of hernioplasty and herniorrhaphy in emergency for the treatment of complicated (Irreducible/obstructed) inguinal hernias regarding wound infection and hospital stay. Material & Methods:… Study Design: Randomized control trial. Setting: Surgical ward, Sheikh Zayed Hospital, Rahim yar khan. Period:09 months from 01-01-2016 to 30-09-2016. Sample Size: A total of 64 patients with 32 patients were included in each group, with confidence level of 95% and power of 80% and anticipated mean level of hospital stay in group 1 of 5±3.4 days versus 3±2.1 days in group 2. Sampling Technique: Non-probability, consecutive sampling. Results: In this study there were total 64 cases with 32 in each group. The mean age was 41.69±11.06 years and the mean duration of hernia obstruction was 12.83±4.97 hours. There was no significant difference in terms of age, duration of hernia and hernial obstruction between both groups. Seroma was seen in 5 (7.81%) out of 64 cases while wound infection was seen in 8 (12.50%) of cases. Seroma was seen in 2 (6.25%) out of 30 cases in herniorrhaphy as compared to 3 (9.38%) out of 32 cases with hernioplasty with p value of 0.64. Wound infection was seen in equally 4 (12.50%) out of 32 cases in both groups with p value of 1.0. Duration of hospital stay was 4.66±1.36 in patients with herniorrhaphy as compared to 4.53±1.37 days with hernioplasty with p value= 0.82. There was no significant difference in terms of age groups, duration of hernia and its obstruction between both groups regarding seroma. There was also no significant association among any of the confounding factors regarding the wound infection and length of the hospital stay between the both groups. Conclusion: We can perform hernioplasty as compared to herniorrhaphy for complicated inguinal hernia with similar complications and better success rates in the same emergency setting.
ANTIMICROBIAL SUSCEPTIBILITY;
Authors: Gul Javeria , Javed Iffat , Mushtaq Sohaila , Anwar Muhammad Saeed
Published: March 2019

Background: The emergence and spread of antibiotic resistant bacteria causing infection is a great health issue for clinicians. The problem of multidrug resistant (i.e. resistant to at least three groups of antimicrobial) is becoming more and more threatening. The rate of resistance among Gram negative bacteria especially non fermenters are increasing to all available antibiotic groups. Objectives: The aim of study was to detect the pattern of antimicrobial susceptibility in non-fermenter Gram negative bacilli (NFGNB) in a tertiary care hospital (Postgraduate Medical Institute, Lahore). Study Design: Descriptive study. Settings: The study was conducted in Pathology Department, Postgraduate medical institute (PGMI), Lahore. Study Period: Six months from August 2014 to December 2014. Material and Methods: Non-fermenter Gram negative bacteria were collected from various clinical specimen including blood, pus, urine, fluid aspirates and respiratory tract in a period of six months in pathology department, PGMI. All non-fermenter Gram negative isolates were identified up to species level by standard laboratory procedures using API (Analytical profile index) 20 NE (non-enterobacteriaceae). Antimicrobial susceptibility testing of non-fermenter Gram negative isolates were performed by modified Kirby Bauer disk diffusion method as recommended in CLSI. Results: Out of the total 51 samples the most commonly isolated NFGNB were Acinetobacterbaumanni and Burkholderiacepacia (16 each) followed by Pseudomonas aeruginosa (7), Pseudomonas luteola (5), Stenotrophomonasmaltophilia (4), Pseudomonas fluorescens (2) and Pseudomonas stutzeri(1). Conclusion: The study showed that rate of multidrug resistance increased in non-fermenter Gram negative organisms.
MANDIBULAR ANGLE FRACTURE;
Authors: Kumar Anand , Hussain Shah Syed Fida , Ali Muhammad Hamid , Hassan Syed Ghazanfar
Published: March 2019

Objectives: To compare the outcome of treatment of mandibular angle fracture by using intra oral, vs. transbuccal approaches in terms of complications. Setting: Oral & Maxillofacial surgery department, Faculty of dentistry Liaquat University of Medical & Health Sciences, Jamshoro/ Hyderabad. Duration: 1st March 2017 to 31st August 2017. Design: Randomized controlled trail. Subject and Methods: 180 patients consuming bilateral mandible angle fracture were involved in this study. 90 randomly allocated patients were managed with transbuccal approach and 90 managed by intra oral approach. Follow up was continued for each patient after every one week for 8 weeks. Results: The average age of the patients was 35.09±5.96 years. Rate of infection, malocclusion, scar formation, facial nerve injury and non-union was significantly low in transbuccal approach as compare to intra oral approach. Conclusion: In conclusion, transbuccal approach was preferred over the intra oral approach due to easy usage, negligible requirement for plate twisting, and enablement of plate engagement in the neutral mid-point zone.
SUBCLINICAL HYPOTHYROIDISM;
Authors: Memon Abdul Salam , Kumar Bheesham , Talpur Altaf Ahmed , Junejo Afzal
Published: March 2019

Objectives: Analysis of thyroid function test, C-reactive protein (CRP) and lipids profile in subclinical hypothyroidism (SCH) as indicators of vascular atherosclerotic disease. Study Design: Cross sectional (case control) study. Place and Duration: Department of Surgery, Liaquat University of Medical and Health Sciences Hospital from January 2016 to July 2017. Materials and Methods: Subjects for this study were selected by inclusion and exclusion criteria. Sampling technique was non-probability purposive sampling. A case of SCH was defined as Thyroid stimulating hormone (TSH) > 6.2 (μIU /ml) with normal T4 and T3 free levels. 5 ml venous blood was collected from peripheral vein. Blood was centrifuged to extract sera for the detection of serum TSH, T4 and T3, and CRP. 12 hours fasting was mandatory for blood lipid detection. Data was analyzed on software SPSS 22.0 (P-value ≤0.05) at 95% confidence interval (P-value ≤0.05). Results: Cases showed high TC, TAG and LDLc with low HDLc compared to controls (P<0.05). Serum TSH was elevated in cases compared to controls (P=0.0001). Serum CRP in controls was noted as 2.75±1.12 ng/ml compared to 9.41±1.58 ng/ml in cases (P=0.0001). Pearson`s correlation shows serum CRP was negative correlated with serum T3 (r= -0.180, P=0.074), and serum T4 (r= -0.2250, P=0.025), but positive correlated with serum TSH (r= 0.626, P=0.0001). Conclusion: Subclinical hypothyroid is associated with dyslipidemia and raised C-reactive protein and both may be interpreted as indicators of vascular atherosclerotic disease.
NUTRITIONAL STATUS;
Authors: Batool Farah , Kausar Samina , Khan Shaier , Ghani Mansoor , Margrate Meshal
Published: March 2019

Background: Malnutrition is one of the major public health concerns in developing countries. In Pakistan more than 38% of the children are under weight and stunted. Malnutrition in children has been found associated with nutritional knowledge of mothers. The current study has been conducted to assess the nutrition status of children from 6 months to 5 years of age. Objectives: To determine the association of child’s nutritional status to immunization and maternal nutritional knowledge. Study Design: Cross sectional descriptive study design was used. Setting: Mustafa Abad, District Kasur, Pakistan. Period: April to June 2018. Methods: Convenient sampling technique was used. For data collection a self-structured questionnaire was used. Nutritional status of children was measured in term of stunting, wasting and under-weight, according to the WHO’s criteria of malnutrition. Data were entered in SPSS version-20 and analyzed. Results: There was significant association (p-value <0.05) between child’s nutrition status with mothers’ nutritional knowledge. The majority of the mothers with adequate knowledge had children with normal nutrition status whereas the children whose mothers had poor nutritional knowledge were presented with stunting. The immunization coverage of this area was good as it was 99%. Conclusion: Malnutrition is prevalent in our children at alarming level. There is a need to improve the nutritional knowledge of mothers because it has a definite association with nutritional status of children under the age of five years.
LAPAROSCOPIC CHOLECYSTECTOMY;
Authors: Abbasi Fatima , Ahmed Saeed
Published: March 2019

Objectives: To compare the outcomes of early versus delayed laparoscopic cholecystectomy in acute calculus cholecystitis. Study Design: Randomized control study. Setting: Surgical Unit of Rawal Medical and Dental Hospital, Islamabad. Period: February 2015 to January 2016. Subjects and Methods: 100 patients with acute cholecystitis between the ages 20 years to 60 years were divided into early and late group of 50 patients each. Informed consent was taken. Data was entered into a pre designed performa. Analysis of data was done using spss version 17. T test was applied on quantitative data and chi 2 on qualitative data. p–value of less than 0.05 was taken as significant. Early group had laparoscopic cholecystectomy within 72 hours while late group had surgery 6-8 weeks after the acute attack. Results: There was increased operating time in the early group which was statistically significant (p-value 0.046). There was slightly increased rate of conversion to open cholecystectomy, increased hospital stay and intra and post operative complications but none of them were statistically significant. Also pain scores and analgesic requirements had no major difference in both groups. Conclusion: Early laparoscopic cholecystectomy is a reasonably safe and cost effective alternative to interval cholecystectomy. Although some complications are more common in early cholecystectomy mainly due to difficult anatomy of calot’s triangle like conversion to open, gall bladder perforation and wound infection, none of them proved to be statistically significant.
CAUSES OF DEATH;
Authors: Awan Ejaz Ahmed , Seenharo Zafar Ali , Salim Memon Mohammad Ismail
Published: March 2019

Objectives: The purpose behind this study was to determine the pattern of the causes of death in adult males - a perspective on autopsy. Study Design: Cross sectional study. Period: 2015 to 2016. Setting: Peoples Medical College Hospital, Nawabshah, Shaheed Benazirabad, Sindh, Pakistan. Material and Methods: 73 male patients, whose autopsy were performed through a convenience non-purposive sampling technique to ascertain the causes of death among dead bodies brought at Peoples Medical College Hospital, Nawabshah, Shaheed Benazirabad, Sindh, Pakistan for the purpose of autopsy. Autopsy was performed with consent taken from the family members and hospital administration. Questionnaire was used to collect the limited relevant data and used SPSS version 17 for data entry and analysis. Results: Mean age of patients whom autopsy were performed was 37.12 years among them minimum age was 10 year and maximum age recorded was 75 years. Among all, 31 (42.46%) cases were from rural area while 42 (57.53%) cases were from urban area. Overall the most common pattern of death was firearm injury (27.39%) and most of them (17.80%) belongs to younger group (10 – 40 years) of males and the same cause of death was also the most common (9.58%) among older group (≥41 – 75 years). Conclusion: Most of the autopsies were performed from urban areas among them most common cause of death was firearm injury in both younger and older group of people.
MUSCULOSKELETAL DISORDERS;
Authors: Ali Zahid , Chishty Hira , Farwa Anosha , Fletcher Noshi Maria , Ali Syed Muhammad
Published: March 2019

Introduction: Dental surgeon are most susceptible to develop the musculoskeletal disorders due to different working habits, repetitive tasks and uncomfortable physiological posture and mental stresses. Dentist and other health professionals often cannot avoid prolonged static postures. In optimal seated postures, major part of human body and muscles are contracted statically and there is little movement of the vertebral joints this may result in physiological changes that can lead to neck, shoulder and back pain or musculoskeletal disorders. The aim of the study was to determine the frequency of musculoskeletal disorders among dental surgeons practicing in different areas of Karachi city. Study Design: Cross sectional study. Setting: Private Dental Clinics in the city of Karachi. Period: March 2017 to May 2017. Material & Methods: The survey was conducted among 242 Dental Surgeons practicing in different districts of Karachi. The questionnaire was concerned with demographic details, work duration and acquired specialization, organization and methods of work in the surgery. Results: Out of 242 questionnaire 107 were male and 135 female and 70% of the responders were from age group 25-35 years. Around 38.60% were serving the profession from less than 5 years and 28.83% had an experience of 5 to 10 years. Most of the dentist work 6 days a week and 5 to 8 hours a day. 42% dentist preferred both standing and sitting position. About 55.81% have acquired their preferred mode of vision according to position. Shoulder had more incidence of involvement (36.27%), followed by lower back (34.41%) and Neck (22.32%). Majority of them (40.1%) marked intensity of pain as moderate and described it as discomfort (42.4%) and aching (39.2%). Majority were taking paracetamol as pain killer and 53.6% agreed to the fact that their pain aggravates upon repetitive movements. Conclusions: The present study showed high prevalence of musculoskeletal disorders among dentist, so there should be preventing aims delivered during undergraduate curriculum and structure base workshop should be programmed to explain the consequences of prolonged and bed posture dentistry.
GASTROINTESTINAL BLEEDING;
Authors: Jaffary Mujtaba , - Nida , Ahmad Khan Saeed
Published: March 2019

Background: Gastrointestinal bleeding (GIB) among patients with critical illness is one of the leading sources of mortality and morbidity. The prevalence of GIB differs from 15-50 percent during first 24 hours stay in intensive care unit. Mechanical ventilation is a most leading risk factor of GIB among patients admitted in ICU (intensive care unit). Objectives: The objective of the study is to know the prevalence and risk factors associated with gastrointestinal bleeding among mechanically ventilated patients. Study Deign: Retrospectively study. Setting: Ch Rehmat Ali Memorial Trust Hospital, Lahore. Period: 1st October 2017 to 31st March 2018. Materials and Method: A group of 120 patients in intensive care unit who received mechanical ventilation for a period of 48 hours or above were included. Results: Among 56 patients with gastrointestinal bleeding, mean age was 49.2±12.1, mean length of ICU stay was 29.2±16.6 and mean duration of ventilation was 30.2±20.5. Among 64 patients with no gastrointestinal bleeding, mean age was 51.9±15.0, mean length of ICU stay was 12.7±6.8 and mean duration of ventilation was 13.5±7.9. There were 12 (21.1%) mortalities among patients with gastrointestinal bleeding and 10 (15.6%) mortalities among patients with no gastrointestinal bleeding. Conclusion: Study concluded that length of ICU stay, duration of ventilation, renal failure, liver failure and mortalities were more among patients with gastrointestinal bleeding.
CURATIVE HEALTH SEEKING BEHAVIOUR;
Authors: Zahra Taskeen , Rashid Almas , Ilyas Aneela , Sohail Aamna , Baig Shahbaz
Published: March 2019

Introduction: Health seeking behavior (HSB) is a sequence of complicated decisions that is based on socio-cultural and economic determinants. 17% of under 5 mortality in the Pakistan is due to diarrhea and around 11% of them die from pneumonia every year. Care givers are mostly parents whose HSB needs extensive study in-order to reduce childhood mortality from preventable diseases such as diarrhea and acute respiratory infection (ARI). Objectives: The following article reviews Pakistan Demographic and Household Survey (PDHS) 2012-2013 data to study the prevalence of diarrhea and ARI among under-5 children in Pakistan, to determine the HSB among under-five during their illness and to study the association of socio-economic profile with parents’ HSB. Study Design: Cross sectional descriptive study. Setting and Period: Children under-five years living with their parents as sampled by the 2012-13 PDHS were used to estimate the prevalence of diarrhea and ARI in preceding two-weeks. Material and Methods: After reviewing, the primary data of PDHS survey 2012-2013, dimensions of HSB, namely illness, medical care sought and provider (type and place), were examined in adjusted analysis for diarrhea or ARI when reported. Variables like socio-cultural capital including wealth index (for socio-economic profile) of parents were computed. Results: Out of 7064 children, 56% were less than 25 months, 25 % reported for diarrhea and 90.8% of them soughed treatment. Out of 35 % of those who had ARI, in the two-week period, 93.2% soughed treatment, 33.7% of it was informal, while for diarrhea it was 20.2%. In both illness’ treatment sought formally, was more from private health care provider. Conclusion: Wealth index was found to play an important role in HSB. Along with parental occupation, education and place of residence, it influences inequities in HSB. Child sex had no role in HSB for diarrhea and ARI.
INDUCTION OF LABOUR;
Authors: Hafeez Sana , Akhter Musrat , Siddique Shazia , Jabeen Salma
Published: March 2019

Background: Increased risk for the baby and higher perinatal mortality are related to birth after 42 weeks. To find out whether a delivery occurs within a span of 24 hours, assessment of cervix through Transvaginal ultrasonography (TVS) and Bishop’s Score are two methods. Objectives: To find out the accuracy of transvaginal ultrasound and Bishop’s Score for cervical length assessment to know the success of induction of labor in primigravidas at term. Setting: Department of Obs and Gynae of Civil Hospital, Bahawalpur. Study Design: Cross sectional study. Period: Nov 1st 2016 to April 30th 2017. Material and Methods: Total 220 females were included through non probability, purposive sampling. Females underwent vaginal examination and Bishop Score was noted and case was labeled as positive or negative. TVS and cervical length was measured and case was labeled as positive or negative. After that, PGE1 50 ug was used and females were waited for labor to be started and normal delivery occurrence. Data was entered and analyzed using SPSS version 16.0. Results: The mean bishop score of females after induction was 6.78±2.66. There were 171 (78%) females who had bishop score >5 while 49 (22%) had bishop score <5. The mean cervical length of females after induction was 26.40±3.69mm. There were 154 (70%) females who had cervical length <27mm while 66 (30%) had cervical length >27mm. The mean induction to delivery interval was 23.01±4.66hours. There were 130 (59%) females who delivered within a period of 24 hours while 90 (41%) delivered after 24 hours. The calculated specificity, sensitivity, positive predictive value, negative predictive value along with diagnostic accuracy of Bishop score were 31%, 84%, 64%, 57% and 62% respectively. The calculated specificity, sensitivity, positive predictive value, negative predictive value along with diagnostic accuracy of cervical length were 59%, 90%, 76%, 80% and 77% respectively. Conclusion: Cervical length assessment on TVS had more accuracy than bishop score in primigravidas presenting at term for induction of labor helping avoidance of post-term pregnancy.
CHEMOTHERAPY INDUCED NAUSEA AND VOMITING;
Authors: Tahir Muhammad , Khokhar Muhammad Abbas , Ilyas Sadaf , Qamar Samina
Published: March 2019

Background: Ginger has long been used as an antiemetic herb in various systems for traditional medicine. However, lack of data on its utility in preventing chemotherapy induced vomiting prevents us from reaching any definite statement. Objectives: To determine the effect of prophylactic use of ginger in decreasing the delayed chemotherapy induced vomiting, when added as an add on therapy to the standard antiemetic treatment in patients receiving highly emetogenic chemotherapy. Study Design: Randomized control trial. Setting: Department of Medical Oncology, Jinnah Hospital Lahore. Period: July 2014 and January 2016. Materials and Methods: A total of 90 patients were selected and randomly allocated into two groups, A and B, having 45 patients each. Patients in both groups received highly emetogenic chemotherapy regimens. For prophylaxis of CINV, Group A received olanzapine based standard antiemetic regimen and cap ginger 500 mg per oral TID 3 days prior to chemotherapy and 3 days after chemotherapy and Group B received olanzapine based standard antiemetic regimen only. Observation for frequency and grade of delayed chemotherapy induced vomiting in all cases was done at day 8 of chemotherapy. Results: The mean age of the patients in group A (intervention group) is 44.5±12.8 years and that in group B (standard group) is 41.4±13.9 years. 29 (64.4%) patients in the intervention group had no vomiting at all as compared to the 19(42.2%) patients in standard group. Mild/Grade 1 vomiting was experienced in 6 (13.3%) patients in the intervention group as compared to 9 (20.0%) patients in the standard arm. There was also a significant reduction in moderate/grade 2 vomiting in intervention arm 7 patients (15.5%) as compared to 11 patients ( 24.4%) in control arm. There was also significant reduction in the severe vomiting that is grade 3 and 4 in group A with the use of ginger capsulesas grade 3 vomiting was observed in only 6.6%versus 15.5% ptients, while none had grade 4 vomiting in group A compared to one patient (2.2%) in group B. Conclusion: Significant decrease in delayed chemotherapy induced vomiting was achieved in patients who were treated with standard antiemetic regimen plus ginger than those treated with standard antiemetic regimen alone, in patients receiving highly emetogenic chemotherapy. So the addition of ginger to standard antiemetic regimens is a safe, less expensive and effective additional treatment option.
INTER-TROCHANTERIC FRACTURES;
Authors: Alam Farhad , Jabeen Mudassar
Published: March 2019

Introduction: Hip fractures are a leading cause of death and disability among elderly. Approximately half of these injuries are intertrochanteric fractures and the incidence is continuously increasing. These fractures are the most common injuries around the hip region and are more common in elderly people. Different types of implants were tried at different times for internal fixation of these fractures, of which dynamic hip screw has remained the most popular one. But with the advent of some newer implants, the efficacy of dynamic hip screw is being questioned. Objectives: To determine the results of dynamic hip screw as a method of internal fixation in closed stable as well as unstable intertrochanteric fractures of femur in adults. Design: Descriptive case series. Setting: The study was conducted in orthopedic department Allied Hospital Faisalabad. Period: 11months (from 26th, march, 2015 to 25th Feb, 2016). Subjects and Methods: Sixty cases of intertrochanteric fractures were included and operated for internal fixation with dynamic hip screw under fluoroscopic guidance. Pre, per and post-operative findings during hospital stay and follow-up period were recorded. Results: We had a total 60 cases, 20 patients in group A stable intertrochanteric fractures and 40 patients in group B unstable intertrochanteric fractures. We have reported the follow up study up to 20 weeks. There were 10 (50%) male and 10 (50%) female in group A. In group B 27 (67.5%) males and 13 (32.5%) females. The youngest pt was 25 years in group A and 16 years in group B. The mean age in group A was 59.10 and st/deviation 16.942. In group B mean age was 54.85 and st/ deviation 14.123. Infection rate in group A was 5%. In group B superficial infection was 5% and deep infection was 2.5%. Nonunion in both groups was 5%. The failure rate was 5% in group A and 20% in group B. Conclusion: The use of Dynamic hip screw with aside plate is associated with good results and acceptable complication rate. Dynamic hip screw is implant of choice in both stable and unstable intertrochanteric fractures.