bluuebunny/crossref_metadata_2025 huggingface dataset:
ЦЕРКОВЬ И ИДЕНТИЧНОСТЬ РУСИНОВ УГОРСКОЙ РУСИ В XIX – НАЧАЛЕ ХХ ВЕКА
Authors:   Российский государственный социальный университет, Шевченко Кирилл
Published: February 2024

Аннотация Статья анализирует положение и эволюцию греко-католической церкви на территории исторической Угорской Руси, которая до 1919 г. являлась составной частью Венгрии. Если до середины XIX в. значительная часть греко- католического духовенства стремилась способствовать культурно-национальному развитию угорских русинов, то со второй половины XIX в. греко-католическая церковь превратилась в эффективный инструмент национальной политики Будапешта, способствуя мадьяризации русинов. Деятельность униатского духовенства была направлена на ассимиляцию русинов Угорской Руси. В первую очередь это проявилось в сфере образования и в церковной сфере.
ZNAČAJ STARE SRBIJE U UTVRĐIVANjU SRPSKOG IDENTITA
Authors:   Institute for political Studies, Belgrade, Serbia, Šuljagić Sanja
Published: February 2024

U ovom radu je upotrebom komparative i analitičko- sintetičke metode objašnjen istorijski značaj područja „Stare Srbije“ za formiranje srpskog narodnog i državnog identiteta, odnosno značaj područja ,,prave Srbije”, kako ga je istoričar Miloš Milojević nazivao u svojim delima. U sklopu analize značaja ,,Stare Srbije” za utvrđivanje srpskog identiteta prikazan je istorijski i geopolitički presek i pravni elementi nastali na području „Stare Srbije“, koji su uticali na formiranje srpskog identiteta kroz istoriju.
"Orchestrated" A painting motivated by the essence of love
Authors: Tabi Crentstil
Published: February 2024

The man, portrayed with strength and confidence, has his arm lovingly draped over the woman's shoulders. His touch is both protective and affectionate, symbolizing his devotion to her. His hand rests gently on her shoulder, conveying a sense of comfort and reassurance. The woman, depicted with grace and elegance, leans into the man's touch, her face adorned with a serene expression. Her eyes reflect a deep sense of trust and adoration, as she gazes affectionately at her partner. Her body language suggests a sense of ease and contentment, as if she feels safe and cherished in his embrace. Surrounding the couple, the background is a subtle blend of muted colors, allowing the couple to remain the focal point of the artwork. The absence of any specific setting or context emphasizes the timeless and universal nature of their love.
Urethral calculi: An uncommon but important cause of urinary retention in females
Authors: ASAH-OPOKU Kwaku
Published: February 2024

Urinary retention is a stressful situation that requires appropriate and prompt management [1]. When it occurs, it leads to anxiety, pain and lower abdominal discomfort [1]. When it is long-lasting, the backpressure of urine that results from the obstruction can lead to hydroureters and hydronephros is, which can lead to kidney injury. Urethral obstruction in females is caused by previous incontinence surgery, urethral stricture and external obstruction of the urethra, such as from pelvic tumours like uterine fibroids and cervical cancer, among others [2]. Urethral obstruction from urethral stones has an incidence of 1 -2% and is reported to be very rare in females due to their comparatively short and straight urethra[3-5]. Kyei [6], in this edition of the HSIJ, has clearly illustrated, using medical imaging, a case of urethral obstruction in a nulliparous lady caused by urethral obstruction from a calculus. This is instructive and provides several learning points.

In terms of history, the young lady had no previous history that would point towards a urinary tract calculi, such as previous pelvic pain and haematuria, except for the two-day history of the frequency of micturition. Examination revealed a distended bladder. This may be a pointer to an obstructive uropathy. However, because urethral calculus is an uncommon cause in females, it is likely to be missed. Without paying close attention to examining the urethra, one can miss out on the diagnosis of pelvic examination. Investigations such as an abdominopelvic ultrasound scan and CT scan are helpful in the diagnosis of urethral obstruction from a stone as well as helping to assess the other parts of the urinary tract for more stones and also obtaining information regarding pelvic tumours causing urethral obstruction. Clinicians need to have the possibility of the diagnosis in mind to be able to clinch it at the examination. This is because, in spite of all the progress made in medical care in Ghana, some health centres may still lack or have faulty radiological equipment. Making the diagnosis early helps to relieve the obstruction early and helps to alleviate the uncomfortable symptoms of pain and anxiety. It also reduces the risk of urethral damage from a locally impacted stone and damage to the kidneys caused by backpressure from the obstructed urine. A urethral examination should, therefore, constitute an important part of the patient clinical evaluation in cases of urinary retention.
Swallowing difficulty among stroke patients at a primary-care facility and its association with their nutritional risk
Authors: STEELE-DADZIE Rebecca K , AGBEYAKAH Awo S.D. , STEELE-DADZIE Allen , ASANTE Matilda
Published: February 2024

Background: Swallowing difficulty is common in stroke patients and is associated with prolonged inadequate food intake. This eventually leads to malnutrition and dehydration and contributes appreciably to stroke complications and mortality rates. The associated nutritional risk is often undetermined.

Objective: To determine the prevalence of swallowing difficulty among stroke patients and its association with their dietary intake and nutritional risk.

Methods: The study design was cross-sectional, involving 57 stroke inpatients recruited from the Polyclinic, Korle-Bu Teaching Hospital. Swallowing difficulty and dietary intake were assessed using the water swallowing test and 24-hour recall interviews respectively. Nutritional risk was determined using the Nutritional Risk Screening tool (NRS-2002). Data were analysed using SPSS version 21.0 at a 95% confidence interval. Significance was set at p < 0.05.

Results: Mean age was 64.3 ± 15.9 years. The majority (57.9%) had swallowing difficulty with an 8-fold higher nutritional risk compared to those without swallowing difficulty [R2= 0.754; OR= 8.40; p = 0.010 (CI = 2.177 -32.128)] after adjusting for age, gender, education and occupation. Median daily energy intake was significantly lower in the former [628kcal; (483-1003)] compared to the latter [(1,017kcal; 600-1586); p = 0.025].

Conclusion: More than half of the participants had swallowing difficulty with a significantly higher nutritional risk and lower daily energy intake. Early routine assessment of nutritional risk, followed with timely appropriate interventions, is strongly advocated as part of standard operating procedures for stroke management in primary care to reduce stroke complications and mortality
Risk of hypertension in adult patients on antiretroviral therapy: a propensity score matching analysis
Authors: NARTEY Edmund T , TETTEH Raymond A , ANTO Francis , SARFO Bismark , KUDZI William , ADANU Richard M
Published: February 2024

Background: Hypertension is a major risk factor that contributes to cardiovascular diseases in adults with HIV infection. Although a relationship exists between antiretroviral therapy (ART) and components of the metabolic syndrome, it is unclear whether HIV or anti retrovirals are explanatory risk factors for hypertension in Persons Living with HIV (PLWH). The present study used propensity-scored-matching (PSM) analysis to estimate ART's average treatment effect (ATT) on blood pressure and hypertension in PLWH.

Objective: The present study used PSM analysis to estimate the average treatment effect of ART on blood pressure and hypertension in patients attending the HIV clinic at the Korle-Bu Teaching Hospital (KBTH) in Accra.

Methods: A hospital-based comparative cross-sectional study was conducted at the HIV Clinic of the Korle-Bu Teaching Hospital in Accra, Ghana. A simple random sampling technique was used to recruit 59 ART-exposed and 59 ART-naïve study participants. The ATT was estimated using the kernel matching or weighting strategy with a bandwidth of 0.06,and standard errors were bootstrapped with 150 replications.

Results: The prevalence of hypertension in the ART-exposed and ART-naive study participants in the final propensity score-matching sample was 42.4% (95% CI, 36.2-48.8) and 17.0% (95% CI, 9.3-28.9) respectively and the estimated ATT was 26.2% (p<0.001) indicating a statistically significant difference between the ART-exposed group and the ART-naive group. The estimated ATT on systolic blood pressure was 12.0 mmHg (95% CI, 5.7-18.3; p<0.001) and that on diastolic blood pressure was 6.1 mmHg (95% CI, 1.3-10.8; p=0.012)

Conclusion: A plausible causal link is reported between ART and hypertension. Significant ATT of ART suggests increases in blood pressure values represent a transition from association to causation. This transition could be a significant step in policy formulation in taking preventive action against hypertension and its complications among PLWH.
Pathological gambling is an underestimated risk factor for pilfering and suicide in Ghana: a case report
Authors: Majeed Niena Samira , Dei-Asamoa Richard , Agorinya Joel , Appiah-Pippim Sheila , Marfo Alberta Nsiah-Asamoah , Twum Winnifred L , Dellor Dzifa , Apio Edna , Fiagbe Delali Kudzo
Published: February 2024

Background: Gambling is a game of chance that involves putting money or something of value at risk to gain something better. Currently, in Ghana, sports betting is a growing public health concern. We present a case report of a 29-year-old accountant who presented with a year duration of recurrent suicidal thoughts, two years of depressive symptoms, and a four-year history of pilfering due to obsessive internet gambling. His symptoms were successfully managed at the Psychiatry Department of Korle-Bu Teaching Hospital. Pathological gambling is an underestimated risk factor for theft, depression, and suicide in Ghana. However, most people are unaware that it is a psychiatric condition that is manageable in the hospital. Advocacy, education, and publicity of pathological gambling as a psychiatric condition are needed to create awareness in the general public.
Orbital tuberculosis mimicking an ocular malignancy: a case report
Authors: TAGOE Lily G , Mainsah Valerie Shamwun , Asare Afrane Adwoa Kumiwa , Gbadamosi Hafisatu , Edusei Lawrence , Acquah Serwaa , Renner Lorna Awo , Segbefia Catherine Idara
Published: February 2024

Background: Tuberculosis (TB), a multi-systemic disease caused by Mycobacterium tuberculosis, is associated with a high burden of morbidity and mortality worldwide. The diagnosis of TB in children is challenging, particularly when it presents in rarer sites such as the eye. We present a case of a female Ghanaian toddler with a right orbital mass which mimicked an orbital malignancy and was confirmed as TB on histopathology. This case report highlights the need for a high index of suspicion for TB among children who present with orbital masses, especially in TB-endemic regions.
Optimasi Proses Penyalutan Tablet dengan Penambahan Extended Fin untuk Meningkatkan Kualitas Produk dan Efisiensi Produksi
Authors: Riyanto Agus , Akbar Ali
Published: February 2024

Dalam pengertian umum obat Tablet adalah bentuk sediaan padat mengandung bahan obat dengan atau tanpa bahan pengisi. Tablet kempa dibuat dengan memberikan tekanan tinggi pada serbuk (bulk) granul menggunakan cetakan baja. Tablet inti (core) yang akan disalut haruslah memenuhi persyaratan tertentu, karena selama proses penyalutan akan terjadi gerakan dan bantingan tablet inti secara terus menerus selama beberapa waktu. Extended fin yaitu sebagai sirip tambahan yang berfungsi ketika produk sudah dimasukkan ke dalam coating pan dan diputar, maka saat proses coating tidak mungkin produk yang bersentuhan langsung dengan dinding coating pan akan terjadi gesekan dan mengakibatkan reaksi yang terjadi pada saat proses film coating. Untuk itulah maka dipasang extended fin untuk mengurangi gaya gesek yang terjadi antara produk dan dinding mesin coating pan. Dengan adanya penambahan extended fin mengurangi gesekan antara obat dan dinding mesin sehingga waktu proses coating produk tidak terjadi reaksi akibat terlalu banyak gesekan dengan dinding mesin dan juga dari hasil kehalusan, kemengkilapan, dan kesolidan warna juga sangat baik. Hal ini memberikan penyelesaian tentang problem yang selama ini terjadi yang membuat persentase hasil produksi berkurang.
Who is The Most Popular Presidential Candidate in Indonesia Election Based on Google Trend
Authors:   Program Vokasi Universitas Katolik Parahyangan, Indonesia, Natalius Barus Dianta Hasri
Published: February 2024

Social media plays a significant role in contemporary political marketing. Social media channels provide legislators and party officials a direct avenue to engage with individuals, allowing for efficient communication, campaigning, and the establishment of relationships. Likewise, the act of aligning oneself with certain political groups and actively participating in discussions and interactions with political figures, such as candidates or representatives, is a widespread practice on social media platforms. Political brands have not yet capitalized on the possibilities of social media to develop online relationships, unlike commercial brands. However, they persist in depending on traditional techniques of political advertising on social media channels. According to the study's results, Jokowi remains a very popular political figure with the ability to have a substantial impact on Prabowo Gibran, the presidential contender associated with him. Prabowo Gibran personally achieved this by effectively promoting these earnings via various internet platforms. Conversely, AMIN is the rival that has the highest level of enduring appeal. They exhibit no discernible indications of either rising or diminishing their popularity, which means they remain the contender with the highest level of popularity. Ganjar Mahfud is the least popular contender of the three contestants. This is plausible since Jokowi, who really expressed his support for Prabowo Gibran, has a passive impact on the issue.
Islam dan Modernitas: Analisa Dialog Kemanusiaan Perspektif Ali Hassan Zaidi
Authors: Irawan Dedi
Published: February 2024

This paper seeks to build a paradigm of social science approach that is relevant to Islam in the modern era. Modernization in Indonesia is currently towards the 5.0 era, which in the author's opinion is still essentially debatable. Meanwhile, the dialogue referred in this paper is an offer thats enable accepted by Muslim and non-Islamic communities. According to Ali Hassan Zaidi, dialogue has the universal quality, which can be used to appreciate each other even though distance separates both of them. In the first part, the author tries to explain the problems of modernity, as well as its influence on humans in general, and specifically on Islamic society. The second part, seeking the common ground between these problems with the theory of dialogue developed by Ali Hassan Zaidi. This type of research is qualitative-descriptive research using data collection methods, namely library research. By explaning these two problems, the author hopes to build a clear and more relevant paradigm. It is strengthened by the analysis of the sociological theory of dialogue developed by Ali Hassan Zaidi. Then with the conclusion that humanitarian dialogue is a solution to solve the social problems of Islamic society.
Perkembangan Nuklir dalam Pandangan Islam: Analisis Manfaat, Mudarat, Pahala dan Dosa
Authors: Khoirulloh Hilmi , Irfan Ahmad , Setiady Dicky
Published: February 2024

Pemanfaatan energi nuklir semakin berkembang pesat seiring dengan adanya perkembangan teknologi. Dalam pemanfaatannya, nuklir mempunyai dampak khususnya bagi kehidupan manusia dan lingkungan. Tujuan penelitian ini adalah untuk mengetahui manfaat dan mudarat dari pemanfaatan energi nuklir menurut pandangan Islam. Penelitian ini dilakukan dengan metode kualitatif melalui pendekatan deskriptif analitik. Peneliti menggunakan teknik pengumpulan data melalui proses identifikasi masalah dan menganalisis secara kritis serta mendalam berbagai referensi ilmiah yang relevan pada penelitian ini serta menafsirkan ayat-ayat Al-Qur’an berkaitan dengan pahala dan dosa bagi orang berilmu yang memanfaatkan energi nuklir sesuai dengan kepentingan, baik secara manfaat maupun mudarat. Hasil penelitian ini menunjukkan bahwa dalam proses pemanfaatan energi nuklir, pasti membawa manfaat dan mudarat bergantung pada kepentingan orang-orang yang mengelolanya. Orang yang mengembangkan pemanfaatan energi nuklir untuk memberikan dampak baik bagi kehidupan manusia dan lingkungan akan mendapatkan pahala serta bagi yang menyalahgunakannya akan mendapatkan dosa dari Allah SWT. Oleh karena itu, penelitian ini membahas tentang perkembangan nuklir ditinjau dari pandangan Islam, baik secara manfaat dan mudaratnya bagi kehidupan umat manusia serta lingkungan, juga balasan berupa pahala yang didapatkan untuk orang-orang yang mengembangkannya bagi kesejahteraan umat dan dosa bagi orang yang menyalahgunakan energi nuklir untuk kepentingan merusak kehidupan manusia dan lingkungan.
Respon Anak Punk Terhadap Stigma Sosial Masyarakat Melalui Komunitas Tasawuf Underground
Authors: Saragih Hendra Maujana , Agustiani Nella , Lestari Dewi
Published: February 2024

AbstrakRespon Anak Punk Stigma Sosial Masyarakat Melalui Komunitas Tasawuf Underground. Skripsi Program studi Sosiologi Fakultas Ilmu Sosial dan Ilmu Politik Universitas Nasional, Jakarta. Penelitian ini didasarkan atas sebuah maraknya fenomena sosial dimana adanya keberadaan punk yang semakin berkembang di masyarakat. Pandangan negatif sudah melekat pada diri punk terutama punk yang berada di jalanan yang biasa disebut punk street. Bagi masyarakat luas punk dianggap sebagai perilaku yang menyimpang yang identik dengan sebuah hidup bebas, seks bebas, narkoba, minum-minuman beralkohol yang mengakibatkan anak punk ini membuat kekacauan di lingkungan masyarakat pada kenyataannya juga punk tidak sepenuhnya dapat diterima masyarakat luas hal tersebut dipengaruhi oleh citra yang dibangun media dan yang mereka yang bergaya punk tetapi tidak mengetahui arti makna punk yang sebenarnya. Tujuan dari penelitian yang ingin dicapai yaitu untuk mengetahui bagaimana bentuk respon anak punk terhadap stigma sosial dari masyarakat dalam mengikuti kegiatan-kegiatan di komunitas Tasawuf Underground. Adapun hasil penelitian ini menggunakan metodologi penelitian metode kualitatif deskriptif untuk menjelaskan secara teliti dan dalam serta menggambarkan bagaimana bentuk respon anak punk terhadap stigma sosial dari masyarakat dalam mengikuti kegiatan-kegiatan di komunitas Tasawuf Underground, dari hasil penelitian ini dapat menjawab dari permasalahan yang ada mengacu pada teori Peter L Berger dan Thomas Luckman bahwa konstruksi sosial terbentuk melalui dialektika momen eksternalisasi, objektivasi, dan internalisasi maka dapat dianalisis bahwa konstruksi sosial pada masyarakat luas dibentuk oleh dialektika tersebut, bagi pihak-pihak komunitas punk terkhususnya anak punk jalanan, mereka mengalami proses eksternalisasi berupa perolehan kebudayaan dan norma sosial. Dengan hadirnya Komunitas Tasawuf Underground dengan tujuan untuk memberdayakan anak punk jalanan sendiri itu karena ingin mengikis stigma negatif yang terlanjur disematkan oleh masyarakat dengan memperdalam agama dan juga melakukan kegiatan-kegiatan positif lainya, dan memberikan inspirasi untuk masyarakat umum dan pemerintah untuk sama-sama memperbaiki permasalahan sosial ini dengan cara yang lebih manusiawi lagi, dengan menjadi kan mereka sahabat dan dibina dengan baik, yang sejatinya mereka ingin lagi kembali masuk kedalam kehidupan masyarakat.Kata Kunci: Respon; Anak Punk ; Stigma Sosial ; Masyarakat
Medical brain drain, a critical challenge to Pakistan's healthcare sector
Authors: Amna Ahmed  , Aribah  , Muhammad Ibrahim
Published: February 2024

Madam,
Medical brain drain describes a condition where highly skilled healthcare workers leave their country of origin to work overseas in search of better working conditions, higher pay, or more opportunities for career advancement leading to deprivation of medical professionals and a loss of expertise and talent (1). Unfortunately, the exodus of skilled individuals from Pakistan is jeopardises country's intellectual assets and demands immediate attention.
Skilled healthcare workers shortage is worsening in Pakistan due to the high number of talented professionals migrating for better career opportunities in the foreign land. According to the Bureau of Emigration and Overseas Employment in 2022 alone, approximately 765,000 Pakistanis, including 2,500 physicians, left the country, highlighting the severity of the situation (2)
The medical profession is highly regarded in Pakistan and attracts a significant number of people. Despite this, Pakistan is among the 57 countries that lack sufficient human health resources to fulfil its healthcare requirements and objectives. The country is confronted with a considerable discrepancy in the ratio of doctors to patients which stands at 1:1300, significantly below the ratio of 1:1000 recommended by the World Health Organization (WHO) (3)
The degradation of the healthcare system, shortage of residency positions and lower salaries during a period of high inflation, coupled with cultural biases and undervaluation of professions like nursing have led to a shortage of healthcare staff. Moreover, societal expectations for women to prioritize their domestic duties contribute to the disproportionate number of female doctors leaving the medical field. This further burdens the healthcare system by increasing the workload for the remaining healthcare professionals (4)
Brain drain hampers economic growth and innovation by robbing the nation of its skilled professionals and their expertise. This issue can be addressed by adopting a comprehensive approach such.  Improving the healthcare infrastructure and working conditions, increasing residency positions and salaries and providing better job opportunities could help retain competent doctors. Encouraging research on brain drain can aid policymakers in developing tailored policies based on the country's needs. These measures can help Pakistan build a robust healthcare system and provide quality medical services to its people.
Resilience and academic performance: exploring the link in dental students
Authors: Fizzah Ali  , Rehan Ahmed Khan  , Mahwish Arooj
Published: February 2024

This study aims to assess the correlation between the resilience level of dental students (preclinical and clinical years) and its effects on their academic performance.
It is a correlational research study that was carried out on second, third, and final-year dental students at Lahore Medical & Dental College, Lahore. Academic resilience was judged by using the academic resilience scale (ARS-30). The correlation between resilience and academic performance was established by applying the bivariate Pearson correlation.
The mean age of the students was 21.49±1.39 years. Among 196 dental students from different years, 132(67.35%) were females and 64(32.65%) were males. A strong positive correlation was observed between the academic performance and resilience of dental students, i.e. r=0.774. From the results, it can be concluded that there is a positive correlation between academic resilience and academic performance among dental students.
Keywords: Resilience, Dental students, Academic performance.
The potential of methylene blue in treating septic shock – is it worth a shot?
Authors: Salva Shariq  , Khawaja Areej , Khowaja Nima
Published: February 2024

Shock is a circulatory failure that results in insufficient oxygen supply to cells. Septic shock is the most common variety in patients admitted to the Intensive Care Unit (ICU) and is a fatal condition that accounts for a considerable number of deaths in the ICU. [1, 2]. Treatment of septic shock consists of a triad that comprises hemodynamic resuscitation via crystalloid, vasopressor infusion and antibiotic delivery within the first hour of recognition [2]. Despite the evidence that these measures help reduce mortality, the percentage of death remains greater than 40%, necessitating the requirement for alternative treatment strategies [2]. Research shows that methylene blue significantly increases mean arterial pressure (MAP) and systemic vascular resistance (SVR).Furthermore, treatment with methylene blue aids in the tapering of vasopressors [3]. In a recent single-centre randomised control trial including patients suffering from septic shock, Ibarra-Estrada et al. Investigated the effect of early adjuvant methylene blue on time to vasopressor discontinuation. They discovered that in comparison to the control group, patients who were administered methylene blue had decreased time to vasopressor discontinuation with no adverse but rather had a shorter length of ICU and hospital stay [4]. Another trial by R. Ismail et al. involving preterm neonates with refractory septic shock reported similar findings where methylene blue led to a significant rise in arterial blood pressure, reducing the need for norepinephrine [5]. In addition, pooled data from a systematic review and meta-analysis shows that the use of MB in conjunction with vasopressors dramatically reduced mortality in patients with vasodilatory shock.
These findings suggest that methylene blue has favourable outcomes in treating septic shock. Due to limited data, more research is required to compare the efficacy of methylene blue in different types of shock states and in different subgroups such as neonates, adolescents, adults and the elderly population. At this stage, more evidence regarding the short-term and long-term benefits and possible side effects of using methylene blue is also required, to allow physicians to be able to incorporate it in regular treatment protocols when practicing evidence-based medicine. Newer studies could help shed some light on appropriate dosing regimens and discover populations that would reap the most benefits from its use. Accurate conclusions, drawn via systematic reviews and meta-analyses including newer large-scale multi-centred clinical trials might be just what is needed to enhance the already existing treatment regimens for shock.
Krukenburg tumour: Role of 18F-FDG PET/CT in identifying the primary site
Authors: Sharjeel Usmani  , Sarah Murad  , Fareeda al Kandari  , Muneera Al Maraghy
Published: February 2024

Krukenberg tumours are a rare form of metastatic tumours of the ovary. They primary site is usually the gastro-intestinal system with the most common being gastric cancer. We present the case of a 35-year-old female coming in with a large pelvi-abdominal mass for investigation. This pelvic mass showed mild to moderate metabolic activity. 18F-FDG PET-CT was able to identify the primary gastric carcinoma. Subsequent histopathology confirmed this to be gastric adenocarcinoma with metastases to the ovary. Keywords: 18F-FDG PET-CT, metastatic gastric carcinoma, Krukenburg tumour.
Predictors of clinical outcomes in patients with sepsis: a retrospective study from a tertiary care hospital in Pakistan
Authors: Angez Meher , Jassani Sahar , Abbas Manzar , Akbar Inaara , Russell Seth Martin  , Ainan Arshad
Published: February 2024

Objective: To assess associations between various clinic-demographic factors and clinical outcomes among patients treated for sepsis.
Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of all patients aged >18 years diagnosed with sepsis from January to December 2019. Multivariable logistic regression was used to evaluate independent associations between predictors and outcomes. Data was analysed using R packages.
Results: Of the 1,136 patients, 621(54.6%) were male and 515(45.3%) were female. The overall mean age was 59.05±16.91 years. Female gender (odds ratio: 1.029; 95% confidence interval: 1.03-1.64) to be an independent predictor of septic shock, while hypertension (odds ratio0.75; 95% confidence interval: 0.59-0.95) emerged as a protective factor. Chronic kidney disease (odds ratio: 1.539; 95% confidence interval: 1.14-2.07) was an independent predictor of prolonged length of stay, while older age appeared to be protective (odds ratio: 0.98; 95% confidence interval: 0.98-0.99). Mortality was associated with a significantly lower odds of Escherichia coli on culture (odds ratio: 0.26; 95% confidence interval: 0.12-0.54).
Conclusion: Independent associations were found between specific patient characteristics and adverse clinical outcomes.
Key Words: Sepsis, Septic shock, Mortality, Morbidity.
Impact of Covid -19 on expanded program on Immunisation in District Dir lower Khyber Pakhtunkhwa
Authors: Abdullah  , Salsbeel Khan  , Iqra Hamid Khan  , Tahira Ashraf
Published: February 2024

Objectives: To study the impact of coronavirus disease-2019 on Expanded Program on Immunisation in a rural setting.
Method: The descriptive, cross-sectional study was conducted in five union councils of District Dir Lower, in the Khyber Pakhtunkhwa province of Pakistan. Data was collected from March to August 2020, which was a period of lockdowns in the wake of the coronavirus disease-2019, and then from March to August 2021. The sample comprised children aged <2 years. Data was analysed using SPSS 25.
Results: Of the 330 children, 210(63.6%) were boys, and 120(36.4%) were girls, and all 330(100%) were located in rural areas. First-phase data showed that the maximum coverage rate of immunisation was 258(78.2%) noted in OPV1(Oral Polio Vaccine) Penta1(Pentavalent vaccine), PCV10-1 (Pneumococcal pneumonia), and Rota 1(Rota Vaccine), and the least vaccination rate was 68.2% for Measle-1. In the second phase, 23% incline was noted in Measles-2 vaccination, followed by 16.3% in OPV2, Penta 2, PCV10-2 and Rota 2, 16% in Measles-1, 14% in OPV-3, Penta-3, PCV10-3, Rsota-3 and IPV, 11.5% in OPV-1, Penta-1, PCV10-1, and Rota-1, and 10.6% in OPV-0 and BCG-0.
Conclusions: Immunisation programme was affected by lockdowns during the active phase of the coronavirus disease-2019 pandemic.
Key Words: COVID-19, Immunisation, Coronavirus, Pandemic, Vaccination.
Paraganglioma of the urinary bladder- a case report
Authors: Hassan Muzammil , Quereshi Abdul Hafeez
Published: February 2024

It is very uncommon to discover Paragangliomas in the urinary bladder. These tumours originate from the sympathetic nerves which supply chromaffin cells in the bladder wall. They can be classified as functional or non-functional. If functional, the most common presentations are with hypertensive crisis or post-micturition syncope. A silent paraganglioma of the bladder can be easily misdiagnosed which can result in severe peri-operative morbidity. We present a case of a male patient who was being managed for hypertension for 2-3 years. He presented at The Indus Hospital, Karachi on 7th August 2022 with gross painless haematuria. An ultrasound scan revealed an echogenic lesion arising from base of the urinary bladder, which was treated via Transurethral Resection of Bladder Tumour (TURBT). Histopathological report revealed Paraganglioma of the Bladder. He was later scheduled for Partial Cystectomy (PC) and has been doing well ever since.
Caudal duplication syndrome: a rare entity
Authors: Kanwal Saadia , Batool Shazia , Naqvi Shamoona , Israr Naila , Akhtar Samina , Zia Saadia
Published: February 2024

The rare caudal duplication syndrome is a spectrum of anomalies primarily involving partial or complete duplication of organs comprising the gastrointestinal, genitourinary and distal neural tube systems. These findings are considered to be a result of aberrant embryogenesis. We hereby report a case of an adult female with complete duplication of the genital and urinary systems (urethra and bladder), hindgut and lower end of vertebral column with no functional impairment. She presented in her first pregnancy at 36 weeks gestation, in labour. To the author's knowledge this is the first case of caudal duplication syndrome with pregnancy from Pakistan.
Key Words: Caudal duplication, Genitourinary, Gestation, Hindgut.
Impact of perceived social support on psychological resilience: a comparison between medical and surgical postgraduate residents
Authors: Amreen  , Anosha Arshad  , Kanza Majid  , Mishall Baig Ahmed  , Sarah Misbah
Published: February 2024

Objective: To identify the predictable relationship and differences between perceived social support and psychological resilience among medical and surgical postgraduate residents.
Method: The analytical cross-sectional study was conducted from July to September 2021 at Dr Ruth K.M. Pfau Civil Hospital, Karachi, and comprised postgraduate medical and surgical residents of either gender. Data was collected using validated self-administered questionnaires. Data was analysed using SPSS 22.
Results: Of the 200 residents, 100(50%) were medical residents and 100(50%) were surgery residents. Besides, 161 (80.5%) were females and 39(19.5%) were males. The overall mean age was 27.57+2.13 years. Mean perceive social support score was 62.53+15.41 and mean score for psychological resilience was 70.40+13.73. Perceived social support was a significant predictor of resilience (p=0.0001). Medical residents scored significantly higher (p=0.034) on perceived social support compared to residents from surgery departments. Marital status, residency year, and birth order in the family significantly differed with reference to perceived social support and resilience (p<0.05).
Conclusion: There was a favourable role of perceived social support in building resilience among postgraduate residents.
Key Words: Social support, Psychological resilience, Internship and residents, Teaching hospital.
The outcomes of nutritional therapy in patients with non-alcoholic fatty liver disease (NAFLD): pitfalls in getting fit from fat
Authors: Shaikh Sabhita Shabir , Afnan Badder Hina , Nasim Sumaira , Ahmed Farooqi Waqas , Darbari Ahsan Ali , Shabbir Alveena
Published: February 2024

Objectives: To evaluate the outcomes of nutritional intervention on non-alcoholic fatty liver disease parameters, and to determine the reasons for non-compliance with nutritional therapy.
Method: The interventional study was conducted from May 2020 to October 2022 at the National Institute of Liver and Gastrointestinal diseases, Dow University Hospital, Ojha Campus, Karachi, and comprised patients of either gender aged 18-65 years who had been diagnosed with non-alcoholic fatty liver disease based on abdominal ultrasound. Anthropometrics, physical activity level, and biochemical markers were evaluated at baseline and 6 months after the intervention that involved nutritional assessment, counselling and guidance related to dietary modification and optimisation of physical activity level. The effect of the intervention was evaluated by improvement in liver enzymes, biochemical parameters, anthropometric indices and any change in the level of physical activity.  The reasons for noncompliance were also recorded. Data was analysed using SPSS 22.
Results: Out of 118 subjects enrolled, 61(51.69%) completed the study. Most patients were females 81(68.6%), married 25(21.2%) and housewives 64(54.2%). There were 16(26.2%) subjects who had 3-10kg weight reduction. The reduction in serum cholesterol and triglyceride levels was not significant (p>0.05). Also, no significant change was observed in the level of physical activity compared to the baseline (p>0.05). Overall, 27(44.3%) patients showed compliance with treatment. The main reasons for noncompliance were lack of time 21(34.4) and knee joint pain 5(8.2%).
Conclusion: Lifestyle modification can be beneficial for weight-loss in the management of non-alcoholic fatty liver disease. However, awareness of its importance and willingness in initiating real-life practical steps with subsequent adherence to dietary therapy was found lacking in the sample studied.
Key Words: Fatty liver, Non-alcoholic steatohepatitis, Diet therapy, Nutrition, Physical activity.
Perceptions and use of evidence-based revision methods among undergraduate medical students
Authors: Ashfaq Qurat-Ul-Ain , Ejaz Taymmia , Baloch Maria Hasan , Asghar Imam Kamil
Published: February 2024

Objectives: To assess awareness, perceptions and use related to evidence-based revision methods by undergraduate medical students.
Method: The descriptive cross-sectional study was conducted in three medical colleges of Rawalpindi-Islamabad, Pakistan, from December 01, 2019, to January 31, 2020, after approval from the ethics review committee of Army Medical College, Rawalpindi. The sample comprised undergraduate medical students of either gender. Data was collected online using a 10-item standardised questionnaire. Students were asked about the revision methods they used routinely and their perceptions of conventional and evidence-based revision methods. Data was analysed using SPSS 23.
Results: Of the total 136 respondents, 92(67%) were females and 44(32.3%) were male students. The response from pre-clinical and clinical years was 67 (50.7%) and 69(49.2%), respectively. Highlighting was the most widely used revision method among students (70 students, 51%), followed by re-reading important points (65 students, 47.7%). 126 students (92%) had the opinion that conventional revision methods were effective learning tools. Only 52 students (38.2%) were aware of the term ‘evidence-based revision methods’. Digital tools based on principles of evidence-based revision were used by a minority of students which included use of online question banks by 21 students (15.4%), osmosis by 40 students (29.4%), sketchy pharma by 35 students (25%), flashcards by 19 (14%) and picmonic by only 3 (2.2%). More than 80% (114 students) responded that they wanted evidence-based revision methods to be incorporated into curriculum, and 85% (116 students) said they would like to have a workshop on these techniques.
Conclusion: Most medical students were not aware of and were not using evidence-based revision methods, and relied on conventional revision tools. They were, however, eager to learn about newer revision strategies.
Key Words: Medical education, Undergraduate, Learning strategies, Evidence-based revision methods, Active recall.
Aeromonas hydrophila induced necrotizing fasciitis following laparoscopic cholecystectomy
Authors: Taimoor Khalid Janjua  , Saba Siddique  , Mohammad Faisal Ibrahim  , Muhammad Nadeem Khurshaidi
Published: February 2024

Necrotizing fasciitis [NF] is a multifaceted disease of the muscle fascia and body tissues which demands the earliest intervention. Past reviews have documented very few cases of Aeromonas Hydrophila [AH] induced NF following abdominal surgery. AH can cause fatal NF as seen in a 72 year old female patient reported at Liaquat National Hospital &Medical College; a tertiary care center in Karachi, Pakistan on 2nd April, 2022. She had a known comorbidity of hypertension and presented with the chief complaint of symptomatic gallstones for which she underwent Laparoscopic Cholecystectomy (LAPCHOL). She developed NF of the lower abdomen post-operatively. Following uneventful Laparoscopic Cholecystectomy our patient presented to the ER two days later with severe lower abdominal pain and overlying cellulitis. Fasciotomy revealed extensive myonecrosis with necrotizing soft tissue infection.
---Continue
Pneumopericardium in a child – “halo sign” on chest x-ray: A Case Report
Authors: Sadaf Alina , Rashid Aqeela , Omer Sadia
Published: February 2024

A 5 year old boy with acute lymphoblastic leukemia on chemotherapy presented with chest pain and vomiting for two days after an elective procedure under general anesthesia. His chest x-ray was remarkable for a prominent halo sign, an air gap surrounding the heart indicating a large pneumopericardium. Although the pneumopericardium could not be appreciated on an echocardiogram, the child developed clinical signs of cardiac tamponade. Attempts to evacuate the pneumopericardium were unsuccessful leading to death.
Keywords: Pneumopericardium, Halo sign.
Concordance of clinical, histopathologic and direct Immunofluorescence findings in patients with intraepidermal immunobullous disorders
Authors: Erum Ashraf  , Shareef Faryal
Published: February 2024

Objective: To determine the concordance among clinical, histopathological and immunofluorescence as diagnostic methods for intraepidermal immunobullous disorders.
Method: The prospective cross-sectional study was conducted at the Institute of Skin Diseases, Karachi, from December 2020 to December 2022, and comprised adult patients of either gender presenting with complaints of bullae, vesicles, pustules and crusts on the skin or mucous membrane. Diagnostic findings of each patient as obtained by clinical assessment, microscopy and direct immunofluorescence were compared. Data was analysed using SPSS 19.
Results: Of the 81 patients, 41(50.6%) were males and 40(49.4%) were females. The overall median age was 35 years (interquartile range: 23 years), with 66(75%) patients aged 19-55 years. The predominant body site involved was the trunk 49(60.5%), followed by mucosa 26(32.1%). Clinical diagnosis detected 80(98.7%) cases, compared to 76(93.8%) by microscopy and 81(100%) by direct immunofluorescence.
Conclusion: Direct immunofluorescence was found to be the gold standard for a confirmatory diagnosis of intraepidermal immunobullous disorders, especially when clinical and histopathology findings were inconclusive.
Key Words: Intraepidermal immunobullous disorders, Pemphigus vulgaris, Histopathology, Direct immunofluorescence.
Effects of interval training on hemodynamic variables after coronary artery bypass graft: a meta-analysis
Authors: Zehra Fatima , Aslam Sehrish , Saeed Mehjabeen
Published: February 2024

Objective: To assess the combined impact of interval training programme on haemodynamic variables, specifically blood pressure and heart rate, in patients having undergone coronary artery bypass graft surgery.
Methods: The meta-analysis was conducted from October to December 2022, and comprised search on PubMed, MEDLINE, Web of Science, PeDro, EMBASE, Science Direct, Cochrane Central Register of Controlled Clinical Trials, Google Scholar and Scopus electronic databases by two researchers independently for literature published between 2009 and 2020 related to the effects of interval training on coronary artery bypass graft patients. Meta-analysis was then performed to analyse the effects of an interval training on systolic blood pressure, diastolic blood pressure, and heart rate. The meta-analysis was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.
Results: Of the 122 studies initially located, 7 were related to the effects of different forms of interval trainings and their impact on systolic and diastolic blood pressure of the patients, and 5 studies analysing the effects of interval trainings on heart rate. Interval training showed mild improvement in decreasing SBP compared to control groups. Standardized mean difference suggested an effect size of -0.226 in random effect model (I2=52.01; p=0.064). Similarly, a small effect size of 0.136 (I2=39.19%, p=0.14) was observed for diastolic blood pressure. Also, there was a small effect size of 0.155 (I2= 28.08, p=0.23) observed for heart rate.
---Continue
Cytogenetic abnormalities associated with reproductive failure in Pakistani population: experience of a tertiary care hospital
Authors: Faiza Naz  , Nazneen Perveen  , Syed Zulfiqar Ali Naqvi  , Sobia Rafiq
Published: February 2024

Constitutional chromosomal abnormalities play a significant role in causing reproductive anomalies in individuals of reproductive age. With the rapid advancement of genome engineering techniques, it has now become possible to cure different genetic disorders. However, very limited data is available regarding the prevalence of such aberrations in the Pakistani population. Considering this factor, this retrospective analysis was undertaken to elucidate the type and prevalence rate of such abnormalities in our population. A total of 241 individuals, who were referred to the Liaquat National Hospital, from January 2017 to December 2021, with a history of infertility or miscarriages, were evaluated using the standard GTG banding technique. The results revealed a notably high percentage 44(18.2%) of chromosomal abnormalities in our population. Surprisingly, the frequency of these anomalies was observed to be higher in males than in females.
---Continue
Pancreaticoureteric fistula following penetrating abdominal trauma: A Case Report
Authors: Hamza Bashir  , Nouman Muhammad , Khan Muhammad Arsalan
Published: February 2024

Pancreaticoureteric Fistula (PUF) is a very rare complication secondary to penetrating abdominal trauma involving the ureter and pancreatic parenchyma. Pancreatic injuries carry high morbidity due to the involvement of surrounding structures and are difficult to diagnose due to their retroperitoneal location. A case of a patient is reported at Civil Hospital, Hyderabad who presented with a history of firearm injury and missed pancreatic duct involvement on initial exploration that eventually led to the development of Pancreaticoureteric Fistula. He was managed via percutaneous nephrostomy (PCN) for the right ureteric injury and pancreatic duct (PD) stenting was done for distal main pancreatic duct injury (MPD).
Key Words: Pancreatic injury, Pancreaticoureteric Fistula, Penetrating abdominal trauma.
Assessment of tear film parameters in females with refractive errors using a single device: an observational study
Authors: Alanazi Mana Alafri , Alanazi Shahad Abdulrazzaq , Baashen Mashaaer Abdulwahhab , Almutairi Meznah Saud , El-Hiti Gamal Abdel-Rehman
Published: February 2024

This observational study aimed to evaluate the use of a single portable device to assess the non-invasive tear break-up time (NITBUT), tear meniscus height (TMH), and lipid layer patterns (LLP) in young females with refractive errors (REs). The study was conducted at the College of Applied Medical Science (Female campus), Riyadh, Saudi Arabia between January 5, 2021 to May 15, 2021. Forty young females, with mean age of 23.0± 4.3 years with REs (2.53 ± 2.05 D) and 40 females, mean age 23.8± 4.5 years with healthy eyes were recruited. The tests were administered in the following order: Ocular Surface Disease Index (OSDI), followed by NITBUT, TMH, and LLP. Significant differences (via Mann–Whitney U test) were noted in the median ocular surface disease index (OSDI; p<0.001), NITBUT (p = 0.035), TMH (p = 0.009), and LLP (p<0.001) scores between the study and control groups.
---Continue