bluuebunny/crossref_metadata_2025 huggingface dataset:
ACUTE MYOCARDIAL INFARCTION
Authors: Majeed Babar Muhammad Zafar , Majid Abdul , Iqbal Javed
Published: September 2021

Objectives: To determine Post streptokinase TIMI flow grade (rate) in infarctrelated artery (IRA) in ST elevated myocardial infarction patients. Study Design: A nonrandomizedprospective study. Period: Dec-2014 to Dec-2015. Setting: Sheikh Zayed MedicalCollege and Hospital Rahim Yaar Khan. Methods: 113 patients were selected to see poststreptokinase TIMI flow grade in infarct related artery (IRA). The data was analyzed using SPSSVersion 20. Descriptive statistics was used to see and analyze the data. Results: Mean ageof patients was 50.43±9.81 years. There was more males (87.61%) as compared to females(12.39%). After thrombolyzation with streptokinase 23.01% patients were with TIMI grade 0/1(failed perfusion), 45.13% (51) patients with TIMI grade 2 (partial perfusion) and 31.86% patientswith TIMI grade 3 (full perfusion) in infarct related artery. In our study TIMI flow improved tograde 2/3 (partial to complete perfusion) in 76.99% patients. There were 11.73% patients withTIMI 0/1 with 50% ST segment resolved, 8.85% patients with TIMI 0/1 with persisted 50% STsegment, 32.74% patients with TIMI 2 with 50% ST segment resolved, 11.5% (13) patients withTIMI 2 with 50% ST segment persisted, 32.74% patients with TIMI 3 with 50% ST segmentresolved and 4.42% patients with TIMI 3/1 with 50% ST segment persisted. Post streptokinasethere was no coronary artery thrombus in 91.07 % patients. While 6.25% patients had thrombusin left coronary artery and 2.84% patients had right coronary artery thrombus. Conclusion:Thrombolyzation with streptokinase improves perfusion in infarct related artery and increasesTIMI flow grade in STEMI patients. It reduces the risk of recurrent myocardial infarction byrestoration of blood flow in infarct related artery.
FAILED SPINAL ANESTHESIA
Authors: Ikram Mobeen , Samee Abdul , Amir Muhammad , Imdad Muhammad
Published: September 2021

Objectives: To determine the frequency of failed spinal anesthesia in patientsundergoing caesarean section in a teaching hospital in Pakistan. Study Design: It was a cross– sectional study. Setting: Department of Anesthesia and Pain Management PAF HospitalSargodha. Period: January 2015 to May 2015. Methodology: A total of 293 pregnant patientsundergoing caesarean section under spinal anesthesia were included. After prehydration andessential monitoring, all patients were given spinal anesthesia with 25 G spinal needle at L3-L4 or L4-L5 level by 2nd year resident anesthesiologist under indirect supervision using 1.5 mlof hyperbaric spinal injection. Failure to achieve adequate block was managed by differentmodalities like sedation, analgesia with ketamine, repeat spinal anesthesia or to proceed withgeneral anesthesia. Results: Out of total of 293 patients, failed spinal occurred in 9 patients(3.07%). Out of these 9 patients, 02 patients (22.22%) were elective caesarean sections while07 cases (77.77%) were emergency caesarean sections. Conclusion: The chances of failedspinal anesthesia are more in emergency caesarean sections as compared to elective casesand failure rate of spinal anesthesia in PAF teaching hospital Sargodha is 3.07% which is slightlyhigher than 3%
CONGENITAL FOOT ANOMALIES;
Authors: Hussain Imam , Osama Muhammad , Malik Reem Javed
Published: September 2021

Background: Congenital foot anomalies affect a large number of childrenthroughout the world. Rehabilitation of these anomalies is expensive and time consuming.There are many factors responsible for these anomalies. Incidence of these anomalies variesin different areas of the world. The aim of this study is to determine the frequency of congenitalfoot anomalies among children reporting at Chal foundation, Swabi, Pakistan. Study Design: Across sectional descriptive study. Setting: Chal Foundation, Swabi, Pakistan. Period: October2012 – October 2014. Methodology: Sample was selected using the convenience samplingtechnique. A total of 1141 patients visited the center, out of which 408 cases of congenitalfoot anomalies. Patient demographics including name, age, gender and district along withdiagnosis and side involvement was noted, and analyzed on SPSS v21.0. Results: A sampleof 408 patients was taken from which 70.3% were males and 29.7% were females. The meanage of the patients was 4.47 years at the time of visit. Only 5.9% cases were reported within thefirst year after birth. Right side foot anomaly was observed in 23.8% cases and 20.3% caseshad left side foot anomaly. Bilateral anomaly was observed in 55.9% cases. Among the 408cases, the most often reported was CTEV, observed in 79.7% cases. The second most commonanomaly was pes planus, observed in 8.8% cases. Conclusion: Congenital foot anomalies arecommon musculoskeletal anomalies affecting a large number of children, the most prevalentof which is CTEV. Unfortunately few people seek management in time either due to lack offacilities or awareness. Prevalent cousin marriages in the society may also play an influentialrole in increased risk of such anomalies to occur. Many of these anomalies can be managedconservatively with physical therapy and orthotics if reported in due time. Attention should bepaid on educating people regarding identification and timely management of such conditions.
MICROALBUMINURIA;
Authors: Zakria Muhammad , Sarfraz Muhammad , Ahmad Touseef
Published: September 2021

Objectives: To determine the frequency of microalbuminuria in patientswith acute ischemic stroke. Study Design: Cross-sectional study. Setting: Medical floor,Independent University Hospital, Marzipura, Faisalabad. Study Duration: Two years, from 1stOctober 2013 to 30th September 2015. Materials and Methods: 95 patients of ischemic stroke,with or without diabetes mellitus and hypertension were tested for early morning urine albuminto creatinine ratio, after excluding patients with raised serum creatinine, urinary tract infection,congestive heart failure and menstruation. A urinary albumin to creatinine ratio of 30 to300 μg/mg was considered as MA. Results: Out of a total of 95 patients, MA was present in 46(48.4%)and absent in 49(51.6%) patients. Out of 33 diabetic patients, MA was present in 18(54.5%)patients while out of 62 non-diabetics 28(45.2%) had MA. Out of 55 hypertensive patients,MA was present in 27(49.1%) while out of 40 non-hypertensives 18(45.0%) had MA. Among14 patients having both diabetes mellitus and hypertension, 8(57.1%) were having MA. Outof 20 patients without both diabetes and hypertension, 8(40.0%) had MA. Conclusion: Giventhe high frequency of microalbuminuria in patients with ischemic stroke, microalbuminuria is auseful modifiable factor in addition to conventional risk factors in identifying those at increasedrisk of ischemic stroke.
POST-PCI CLINICAL OUTCOME;
Authors: Asghar Naeem , Nazim Muhammad , Ahmad Shakeel
Published: September 2021

Introduction: The incidence of creatine kinase-myocardial band (CK-MB)isoenzyme elevation after percutaneous coronary intervention (PCI) ranges from 11% to 35%,including low-level elevations with no associated signs or symptoms as well as large non–Qwaveand Q-wave myocardial infarction. Whereas the deleterious effect on survival of largeperiprocedural myocardial infarctions have been well documented. Large periproceduralmyocardial infarctions, such as those caused by occlusion of a large side branch, flow-limitingdissection, or distal embolization of a large thrombus, would be undesirable and associatedwith worse subsequent cardiac outcomes. Objectives: To correlate the clinical outcomeafter PCI with cardiac biochemical markers. Study Design: Observational follow-up study.Setting: Faisalabad Institute of Cardiology, Faisalabad. Duration of Study with Dates: Sixmonths (February, 2014 to August, 2014). Patients and Methods: Two hundred patients withsymptoms of myocardial ischemia proceeding for percutaneous coronary intervention wereenrolled in the study. After taking history and clinical examination, the patients divided into twogroups: group I and group II. Group I comprised one hundred and fifty patients having normalcardiac enzymes and group II comprised fifty patients having raised cardiac enzymes. Results:Out of 50 patients with raised cardiac enzymes 42 (84%) were males and 8 (16%) were females,multi vessel coronary disease (58%), multi vessel PCI (54.3%). Periprocedural complicationsdissection (6%), side branch compromise (14%), slow flow (10%), no reflow (2%), sub-acutestent thrombosis (4%) occurred in group II as compared to slow flow (1.4%) and sub-acutestent thrombosis (0.7%) in group I. In hospital mortality (2%) in group II while no mortality ingroup I. On thirty day follow up 32% patients became symptomatic among which 6% developednon ST elevation MI in group II while only 1.4% patients had symptoms of angina in group I.6% patients needed repeat target lesion revascularization in group II and only 0.7% in groupI. Conclusion: Patients with raised cardiac enzymes had worse clinical outcome in terms ofmortality, myocardial infarction and repeat target lesion revascularization than normal cardiacenzymes.
PRE DIALYSIS PATIENTS;
Authors: Ali Syed Hidayet , Das Bagwan , Taj Agha , Kumar Santosh , Kumar Besham
Published: September 2021

Introduction: Chronic kidney disease (CKD) is an alarmingly increasingcondition from day to day andit is assumed that malnutrition is co-existent in patients withchronic renal failure (CRF). Malnutrition also occurs in pre-dialysis patients. Such patientshave reduced body weight, depleted fat (energy) stores, loss of somatic protein (low musclemass) and low levels of different plasma proteins like pre-albumin albumin, transferrin, andothers. Objective: To ascertain the frequency of malnutrition in dialysis independent patientsof chronic kidney disease. Setting: Department of nephrology, Jinnah Postgraduate MedicalCentre Karachi. Duration of study: 6 month from 1 June 2013 – 1 December 2013. Studydesign: cross sectional study. Subjects and methods: Patients with chronic kidney disease(GFR <60ml/min/1.73m2) on conservative management irrespective of cause and sex werestudied. All Patients with CKD stage 3 and onwards i. ecreatinine clearance less than 60ml/min/1.73m2for more than 6 months were considered. Descriptive analysis of these patientswas done by: Calculating mean ± SD for age and duration of disease. Male to female ratiowas calculated. Frequency of malnutrition in undialysed patients was calculated. The effectmodifier of age, gender, duration of disease was controlled through stratification. Chi squaretest was applied and p value ≤0.05 was taken as significant. Result: Out of 137 patients, 80were males and 57 were females and the mean age of patients was 58 ±5.8. Mean duration ofdisease was 5.2 ±1.05. Moderate malnutrition cases were 58(42.3%) while severe malnutritionwas observed in 32(23.35%) cases. Conclusion: Patients of chronic kidney disease were foundto be at risk of malnutrition.
BLOOD BAG;
Authors: Chaudhary Hammad Tufail
Published: September 2021

Transfusion of blood products is one of the key aspects of hospital care. Amongthe risk of blood transfusions, bacterial contamination of the blood bags is not so uncommon.Sources of bacteria can be several. Majority of the times the source of bacteria is the arm of thedonor. Second important cause of bacterial contamination of blood transfusion, is bacteria inthe blood stream of the donor. Donor is usually selected with strict selection criteria. Detailedhistory is usually taken. Diversion is another method used to reduce the bacterial contaminationof blood bags. Temperature is also important parameter for the growth of bacteria. RBCs arestored at 4 ˚C and platelets are stored at 22˚C. For the ideal bacterial detection techniques,it is important that they can detect the bacteria as early and as low as possible. At the time ofcollection of sample for viral screening, number of bacteria might be too low to be detected.
DRUG-DRUG INTERACTIONS (DDIs);
Authors: Qureshi Ali , Ghoto Muhammad Ali , Dayo Abdullah , Arain Mudassar Iqbal , Parveen Rabia , Mangi Altaf
Published: September 2021

Introduction: Drug-drug interaction refers to an altered or impaired responseof drug as a resultant of the other drug’s activity. However, recently advancement in field oftherapeutics has leaded the therapy toward more rational and logical trend in order to improvethe patients’ health with respect to cost effectiveness. Objective: To assess the various levels ofDDIs in Prescriptions at public sector teaching hospital of Hyderabad, Pakistan. Study Designand Settings/Methodology: A descriptive observational questionnaire based study has beenconducted by collecting initially 250 random prescriptions of various patients prescribed withmultiple drugs. Tertiary care hospital OPD and In-patient wards were visited for a period of06 months. The Prescriptions (℞) so collected were analyzed and assessed individually fordrug interactions using Standard drug interaction software i.e.. Lexi-comp’s Lexi-Interact, DrugInformation Handbook, Hansten and Horn’s drug interactions. Results: For this study, a total 250Prescriptions were collected. It was observed that 30 (12%) prescriptions contained with singlemedication, 10 (4%) prescriptions were unreadable, 210 (84%) prescriptions were containedmore than one medication. Moreover, 210 (84%) poly-pharmacy prescriptions focused keenly.Subsequently, 51 (24%) prescriptions ensured the prevalence of DDIs and 159 (76%) were Non-DDIs prescriptions. Similarly, 13 ℞ contained four or more than four drugs, 32 ℞ contained threedrugs and 06 prescriptions contained two drugs correspondingly. Conclusion: It was clearlyconcluded that the most potential reason of DDIs are Poly pharmacy. So it is of utmost needto enhance the health care policies in overall healthcare system in order to antagonize DDIsassociated morbidity and mortality among society.
FETAL OUTCOME;
Authors: Memon Afsheen , Abdullah Sheikh Aisha , Kamal Anisa
Published: September 2021

Objectives: To compare the effect of nuchal cord versus without cord aroundthe neck on mode of delivery and fetal outcome. Study design: Case control comparativestudy. Period: 1st August 2013 to 31st March 2014. Setting: Gyn /Obs Department at Sir SyedHospital Karachi. Material and Methods: A comparative study was carried out on 2 groupsof parturient ladies. The study group comprised of those ladies who at the time of delivery(vaginal delivery/caesarean-section) had clinically cord around the neck while the other group(control) did not have nuchal cord. Duration of labour, mode of delivery were noted. Perinataloutcome was measured in terms of Apgar score and NICU admission. High risk pregnancieswere excluded from the study. Result: Incidence of nuchal cord at the time of delivery was22.7%. A high rate of caesarean delivery observed in study group as compared to controlgroup (70 % vs 40%) (P value 0.00006). Fetal heart rate irregularities & meconium stainedliquor finding was not significantly different in two groups (p< 0.161) & (p<0.169) respectively.Similarly fetal outcome measured in terms of Apgar score at 1 & 5 min & NICU admissionwas also not significantly different between the two groups. Conclusion: A significant highrate of caesareans section rate was observed in the study group mainly due to fetal distress(FHR irregularities). This means cord around the neck is a risk factor & needs extra monitoringspecially through intermittent CTG monitoring during labour so that fetal distress can be pickedup early & emergency caesarean section can be performed to avoid fetal compromise.
NASWAR;
Authors: Ali Sarah , Khan Wazir Muhammad Ali Rahman , Qadir Samie
Published: September 2021

Objectives: To explore what naswar (smokeless tobacco) users know aboutthe effects of naswar on their oral and general health. Methods: This cross sectional surveywas undertaken in the city of Peshawar, Pakistan. Sample size of 96 participants based on 95%C.I with interval width of 10% was used for this study. Only male naswar users were included.Keeping in mind the resources and time constraints the participants were purposely sampled.All the participants were consented before being included in the sample. Survey tool whichincluded open, closed and semi structured questions was self-administered. Findings: 42.7%(95% CI: 32.8-52.6%) of the respondents considered naswar, either harmless or resultingin minor side effects. There was lack of awareness of the existence of oral and lung canceramong a significant proportion (41% with 95% CI: 31.8-58.5%) of participants. In response toa question about harmful effects of naswar use, vast majority of the respondents mentionedone or the other form of oral (non serious) or tooth problems. Only 10.41% (95%CI: 4.3-16.5%)mentioned its association with cancer and none mentioned about the risk of cardiovasculardisease. Conclusion: Our survey appears to indicate that level of awareness of naswar usersin Peshawar is poor. We recommend to the government of NWFP to make an effort to educatethe people about the harmful effects of naswar use.
CHRONIC LOW BACK PAIN;
Authors: Ali Sehrish , Sajjad Abdul Ghafoor , Keramat Keramat Ullah , Darian Haider
Published: September 2021

Background: Worldwide prevalence of chronic low back pain is 19.6% in thoseaged between 20-59 years and more prevalent in women. Routine physiotherapy appears to beeffective in reducing pain and improving functional outcome in chronic low back pain patients.Lumbar stabilization exercises are trending in the management of chronic low back pain thoughit is not known whether addition of these exercises produce better results as compared to routinephysiotherapy alone. Objectives: The objective of this study was to determine the effect of thelumbar stabilization exercises on pain, ROM and functional disability in the management ofchronic low back pain. A randomized control trial. Period: February 2016 to July 2016. Setting:Rehab & Research Center, Pakistan Railway General Hospital. Methodology: 42 chronic lowback pain patients (02 drop outs, one from each group). The participants were recruited throughpurposive sampling technique. Random allocation was done through coin toss method into twogroups Lumbar Stabilization Exercise (LSE) group (n=20) and Conventional Physiotherapy(CPT) group (n=20). Tools used to collect data were NPRS, Modified ODI, Goniometer (LumbarFlexion, Extension and Side bendings) and MMT (Trunk Flexors and Extensors). The data wasanalyzed (n=40) at baseline and later after 2 weeks of intervention (8 sessions) on IBM SPSS-20. Results: 28 females and 12 males participated in the study with mean age of 38.88 ±12.69.After 02 weeks of intervention both treatment groups showed improvement in decreasing painand improving functional status. LSE group had significant gains in NPRS p=0.001, ModifiedODI p=0.001, ROM Extension p= 0.027, ROM Right side bend p= 0.024 and MMT Flexion p=0.031 as compared to CPT group. Conclusion: Lumbar stabilization exercises in addition toconventional physiotherapy are found more effective in chronic low back pain managementas compared to conventional physiotherapy alone in terms of reducing pain and functionaldisability.
PROTECTIVE EFFECT OF ZINC;
Authors: Anjum Kaukab , Ali Asma , Shahid Uzma
Published: September 2021

Background: Nutrition is an important determinant of bone health. Micronutrients,other than calcium has been paid less attention to-date in the prevention and treatment of bonediseases. Objective: To evaluate the protective effect of zinc on high salt induced gross changesin humerus and femur of rats. Study design: Analytical control randomized trial. Place andduration of study: Islamic International Medical College, Rawalpindi, hosted the research withthe cooperation of National Institute of Health; Islamabad. The study was approved by Ethicalreview committee of Riphah international university before its initiation. It took six months tocomplete the research (Sep 2015-March 2016). Material and methods: Forty five adult femaleSprague Dawley, 10-12 weeks old rats were used in the study. Three groups were made, eachhaving fifteen rats. Control group C (N=15) received laboratory diet without any alteration.Experimental group A (N=15) were served with high salt diet (8%NaCl) whereas experimentalgroup B (N=15) animals were given high salt diet augmented with zinc (50mg/kg/day).Allgroups were given the diet for eight weeks. Animals were weighed at the start and end ofstudy after which they were sacrificed. Left humeri and femora of all rats were obtained. Weightand mid shaft diameters of bones were recorded. The results were compiled after comparisonamongst all the groups. Results: Marked gross changes were witnessed in experimentalgroups. These changes were of greater severity in high salt diet group as compared to the zincsupplemented group in which reverse beneficial effects were noticed. After zinc administration,there was substantial increase in the weight of animals and bones with concurrent increase inmid shaft diameters. Conclusion: Zinc has a Protective role against high salt induced damageon the gross parameters of bones.
NARROW THERAPEUTIC INDEX DRUGS;
Authors: Ali Huma , Zafar Farya , Shaukat Ahmed , Alam Shazia , Ali Umer , Shareef Huma , Mallick Neelam , Shafiq Yusra , Hasnain Hina , Naveed Safila , Raza Naqvi Ghazala
Published: September 2021

Introduction: There are several clinically significant outcomes of drug-druginteractions (DDIs) which have been classified as one of the serious forms of adverse drugreactions that may lead to prolongation of hospital stays along with severe cases of mortality andmorbidities. It may cause due to the selection of two or more interacting drugs to be prescribedto patient. Objectives: Therefore it is indispensable to attain a collective level of therapeuticdecision making so that any potential DDIs can be minimized that ultimately turn out to be safeand beneficial to patient. Study Design: The current study is based upon surveys to evaluateutilization of medications that have a narrow therapeutic range with high incidence to developDDIs and to access the knowledge, attitude as well as practice of using such drug productsin relation to these facts, though very few such studies have been identified, yet the relevantdata is insufficient locally. The study design was selected to be qualitative and cross sectional.Period: January 2016 till August 2016 in Karachi, Pakistan. Settings: The questionnaire waswell constructed for physicians, pharmacists as well as nurses who were selected as theparticipant of the study and a former consent from the respondents was obtained. Method:Coefficient of spearman correlation & Cronbach’s α values were calculated in order to validatethe questionnaire (α = 0.927 and p = 0.918). The information based on practice along withdemographics of study participant was included as first segment of questionnaire while theirknowledge regarding drug interactions was included as second part. Mean scores werecalculated and responses were analysed by ANOVA in relation to the knowledge of membersrelating to drug interactions of vancomycin, warfarin and valproic acid. Results: Mean scores ofperception were found in order of 1.590.16, 1.549.02 and 2.020.83 for physicians, pharmacistsand nurses. No significant differences were observed between physicians and pharmacistscohorts in identifying the drug interactions whereas noteworthy variations were observed inthe group of nurses (p < 0.05). Conclusion: Such investigations are vital in their prospect tohighlight the importance for the design, implementation and monitoring of an effectual toolfor the guidance of various healthcare members involved in identification and management ofDDIs. Furthermore, results also signify the need of sophisticated support systems for valuableclinical judgments.
MAGNETIC RESONANCE IMAGING;
Authors: Ashraf Yasma , Iqbal Irum , Khatoon Shafaat
Published: September 2021

Perianal fistula is defined as an abnormal communication channel between analcanal and perianal skin. Among all the imaging tools Magnetic resonance imaging (MRI) isof choice in the diagnosis and management of perianal fistulas. Objectives: “To determinethe diagnostic accuracy of MR imaging in detection of perianal fistulas and comparing it withper operative findings”. Peroperative findings are taken as gold standard. Place and Durationof Study: This study was carried out in Diagnostic Radiology, Pakistan Institute of MedicalSciences (P.I.M.S) Islamabad, over a period of nine months from 01-02-2012 to 31-10-2012. Forthis collaboration was made with the Department of General Surgery P.I.M.S and Departmentof gynecology (MCH center) PIMS and gastroenterology Department. Patients and Methods:A total of 95 patients were included in study having perianal fistulas on clinical examination.MRI was performed in the patients and T1-weighted fast spin echo (T1W FSE) images weretaken before and after gadolinium injection. Fat suppressed T2-weighted fast spin echo (T2WFSE) images were obtained in all three planes including transverse, sagittal and coronal. Allthe scans were viewed by a single consultant radiologist to avoid observer bias. Results: Outof 95, 81 patients (85.3%) were male and 14 (14.7%) were female. Sensitivity, specificity andaccuracy of magnetic resonance imaging (MRI) was 96.2%, 75.0% and 92.6%, respectively.Positive predictive value was 95.0% and negative predictive value was 80.0%. Conclusion: ourstudy proves that among imaging modalities MRI is of choice for preoperative assessment ofperianal fistulas. It provides highly accurate, noninvasive and relatively very less time consumingmeans of performing pre-operative evaluation, specially the complex, branching fistulas. Thisdiagnostic accuracy not only helps in surgical cure but avoids recurrence and post-operativecomplications like fecal incontinence
PROSTATE CANCER;
Authors: Ali Shah Syed Imran , Ghani Mansoor
Published: September 2021

Background: Androgen deprivation therapy (ADT) with luteinizing hormonereleasing hormone agonists (LHRHa) is a major treatment modality for prostate cancer (PC),particularly advanced disease. LHRHa induced hypogonadism promotes bone loss, leading toosteoporosis and heightened fracture risk. Most previous studies on skeletal impact of LHRHaemployed bone mineral density (BMD) testing. Serum bone-specific alkaline phosphatase(BSAP), an established bone biomarker, is reflective of changes in skeletal metabolism whichprecede BMD changes. In postmenopausal women, serum BSAP has been associated withfracture risk irrespective of BMD. Setting: Charing Cross Hospital, London, United Kingdom.Methods: We assessed early changes in serum BSAP levels of patients with non-metastaticPC (n=9) undergoing LHRHa therapy. Serum testosterone and estradiol concentrations werealso measured. Samples were taken at baseline before the start of treatment and three monthsafterward. Comparisons were made with blood samples taken at similar time points for agematchedcontrols without PC (n=9). Results: No significant difference in BSAP levels wasseen between groups (p=0.242). Testosterone and estradiol levels were significantly reducedfollowing treatment (p=0.000). No correlation was observed between serum BSAP and serumtestosterone (R=0.187, p=0.276) or serum estradiol (R=0.055, p=0.75). Conclusions:Changes in serum BSAP levels may not be evident as early as 3 months following ADT withLHRHa. The study was limited by the small sample size and use of serum BSAP only whichis one of the many bone markers. A larger study using multiple bone markers is warranted todetermine early effects of LHRHa treatment on bone metabolism.
SPINAL DYSRAPHISM;
Authors: Ujala Bushra , Bano Saeeda , Mehreen Asma , Bukhari Hassan
Published: September 2021

Introduction: MRI plays an important role in characterising spinal dysraphisms.The reason behind this is quality of MRI showing very high contrast resolution of soft tissuesand the ability to detect fat in the lesion.T2 weighted images provide excellent contrastbetween the sub-arachnoid spaces and neural tissue while evaluating spinal dysraphisms.Objectives: To determine the frequency of rare disorders of spinal dysraphism in view of MRIfindings of spinal dyspharism patients. Study Design: retrospective. Duration: the study wasconducted from 1st September 2015 to 30th November 2015. Settings: Radiology department,Allied hospital Faisalabad. Methods: A total of 20 consecutive pediatric age group patientspresented with clinical suspicion of spinal dysraphism were included. MRI L/S spine was carriedout on 1.5Tesla Philips and diagnosis of various disorders of spinal dysraphism was made.Conclusion: MRI is the first choice examination for the detection of occult spinal dysraphism.Its timely diagnosis improving surgical & medical outcome as well as better & long term careof patients with spinal dysraphism. Majority of patients in the current study had tethered cord(75%), myelomeningocele (20%), myelocele (10%), lipomyelocele (10%) Dermal sinus tract(10%) & diastematomyelia (10%) followed by associated spinal lipomas (5%), caudal agenesis(5%) & anterior meningocele (5%).
ANTENATAL HEALTH CARE;
Authors: Asim Muhammad , Siddiqui Saira , Malik Nazia , Nawaz Waseem , Ali Farman
Published: September 2021

Background: Prenatal and postnatal health care utilization services areimperative strategy to decrease maternal morbidity and mortality. One in 38 Pakistani womendies from pregnancy related causes as compared to 1 in 230 women in Sri Lanka. Objectives:The objective of the present study is to know about the pattern and trends of utilization ofantenatal and postnatal health care services by mothers in Pakistan. Study design: Descriptivesystematic literature review. Material and methods: The relevant literature was systematicallysearched through different key words related to antenatal and postnatal health care utilizationservices in Pakistan through different online research engines to accomplish this study.Results: Twenty five research articles were included in this review article. It was found thatlast two decades, we cannot achieve the optimum progress towards antenatal and postnatalhealth care utilization services. The problem is much severe in rural areas of across the country,where a number of socio-cultural and program factors hinders women to utilize the basic healthservices. Mother’s education, household income, autonomous at household decision makingand birth order are the significant factors that to utilize the antenatal and postnatal care inPakistan. Conclusion: There should be need to aware the mother about the importance ofprenatal and postnatal visits. In rural areas, government should give some economic incentivefor prenatal and postnatal visits. Furthermore, government should take necessary steps totackle the problem by providing the easy access to the health care facilities.
FORECASTING THE DEVELOPMENT OF THE NUCLEAR INDUSTRIAL COMPLEX
Authors: Drobot Sergiy
Published: September 2021

The article is devoted to the development of an approach to forecasting the level of development of the nuclear industrial complex of Ukraine. The main purpose of this work is to forecast the level of development of the nuclear industry of Ukraine on the basis of the formed system of indicators that characterize both quantitative and qualitative changes in its operation. General scientific and special research methods, methods of analytical equalization, correlation and regression analysis, and scenario approach were used in the work, which in general allowed to fulfill the purpose of forecasting the level of development of the nuclear industrial complex of Ukraine. Statistical material on the indicators of attraction and use of production means, investment and innovation resources as the main sources of development of the nuclear industrial complex is collected and systematized. Growth rates that characterize quantitative and qualitative changes by sources of development are calculated; on this basis, an integrated assessment of the development of the nuclear industrial complex of Ukraine is given, its type is determined. An approach to forecasting the development of the nuclear industrial complex has been developed. Based on the developed approach, forecasting of development indicators was carried out. The forecast calculations have shown that in the forecast period it is possible to ensure further development with a focus on innovation, due to the increase of generalized indicators of development by its individual sources and the integrated indicator of development as a whole. The results of forecasting can create a basis for making sound management decisions in the field of managing the development of the nuclear industry.
Significance of Stone Waste in Strength Improvement of Soil
Authors: Kumar Amit , Devi Kiran , Singh Maninder , Soni Dharmender Kumar
Published: September 2021

The evolution of industries is essential for the economic growth of any country; however, this growth often comes with exploitation of natural resources and generation of wastes. The safe disposal and utilisation of industrial wastes has become essential for sustainable development. A possible approach would be to utilize these wastes in construction industries. The stone industry is one such flawed industries that generates waste in dust or slurry form; this leads harmful impacts on human beings, animals, and surrounding areas which, in turn, can lead to soil infertility. In the present study, stone waste was examined for its influence on maximum dry density (MDD), optimum water content (OMC) and unconfined compressive strength (UCS) of soil experimentally. Stone waste was used at 0%, 4%, 8%, 12%, 16% and 20% by weight of soil and UCS tests were conducted at maturing periods of 7, 14 and 21 days. Test results reported that the incorporation of stone waste improved the compressive strength value significantly. Maximum dry density was enhanced; however, optimum water content was reduced with the use of stone waste in soil due to its fine particles. Linear regression equations were also derived for various properties.
Orange Peel Extract Mediated Silver Nanofluid as Corrosion Inhibitor for X80 Steel in Simulated Oilfield Scale Dissolver
Authors: Ituen Ekemini , Dim Chukwudurom , BoEKOM Ekerete
Published: September 2021

Silver nanofluid was prepared by bio-reduction reaction between orange peels extracts (OPE) and silver nitrate and characterized by spectroscopic and microscopic techniques. Colloidal nanoparticles of sizes between 40 – 50 nm and spherical shape were obtained. The nanofluid was applied as anticorrosion additive to inhibit corrosion of X80 steel in simulated oilfield scale dissolver solution (1.0 M HCl) at various temperatures. The nanofluid (OPE-AgNPs) was 98.9 % and 84.3 % efficient at 30 ºC and 60 oC respectively as determined by weight loss measurement. In comparison with OPE, OPE-AgNPs shows better corrosion inhibition and higher resistance to thermal degradation. Some kinetic and thermodynamic models were used to characterize the inhibition process. OPE-AgNPs could be optimized and used as alternative anticorrosion additive for scale dissolution liquor in the industry.
Stromal and Tumor Glioma-Derived Cells with Similar Characteristics have Differences in α-Smooth Muscle Actin Expression and Localization
Authors: Tolkunova Elena N
Published: September 2021

Gliomas are solid brain tumors composed of tumor cells and recruited heterogenic stromal component. The study of the interactions between the perivascular niche and its surrounding cells is of great value in unraveling mechanisms of drug resistance in malignant gliomas.   In this study, we isolated the stromal diploid cell population from oligodendroglioma and a mixed population of tumor aneuploid and stromal diploid cells from astrocytoma specimens. The stromal cells expressed neural stem/progenitor and mesenchymal markers showing the same discordant phenotype that is typical for glioma cells. Moreover, some of the stromal cells expressed CD133. For the first time, we demonstrated that this type of stromal cells had the typical myofibroblastic phenotype as the α-SMA+ cells formed α-SMA fibers and exhibited the specific function to deposit extracellular matrix (ECM) proteins at least in vitro. Immunofluorescent analysis showed diffuse or focal α-SMA staining in the cytoplasm of the astrocytoma-derived, A172, T98G, and U251MG glioma cells. We could suggest that α-SMA may be one of the main molecules, bearing protective functions. Possible mechanisms and consequences of α-SMA disruptions in gliomas are discussed.
Realia-Mediated Instruction: An Effective Tool for Improving Young Learners' Vocabulary Skills
Authors: Bhatti Muhammad Safdar , Habibie Alvons , Noreen Shaista , Hussain Sabir , Bajwa Shahla
Published: September 2021

A foreign language teacher often employs realia to strengthen pupils' association between words and objects. The current study investigates real-life activities that improve vocabulary learning in the English language and the impact of realia on improving students' vocabulary learning performance. It was an experimental study with only post-test design. Forty students participated in the study. The data were collected and analyzed statistically. The results revealed that vital activities used for vocabulary development were menu selection, game recognition, picture identification, activity identification, magazine adds understanding, and identification of cities and map reading, respectively. It was evident that the experimental group performed better when compared with the control group. The study suggested that students may focus their attention, stimulate their interest, give them real impact, make them aware, and modernize their language learning through vocabulary improvement.
Perancangan Sistem Pendukung Keputusan Pemilihan Supplier di PT. Alfindo Dengan Metode Analytical Hierarchy Process (AHP)
Authors: Wulandari Ninik
Published: September 2021

PT. Alfindo merupakan perusahaan yang bergerak di bidang contractor, fabrikasi, manufacturing, general trading, and labour supply. PT. Alfindo tidak memproduksi barang sendiri melainkan membutuhkan supplier dalam proses pengadaan barang. Namun, dalam proses pemilihannya PT. Alfindo masih mengalami kesulitan dalam memilih supplier yang terbaik, perusahaan juga belum memiliki kriteria khusus dalam melakukan penilaian terhadap supplier, serta membutuhkan waktu yang lama dalam proses pemilihannya. Penelitian ini bertujuan untuk menghasilkan suatu rancangan aplikasi yang dapat digunakan untuk pemilihan supplier, dan dapat membantu dalam memberikan evaluasi terhadap supplier berdasarkan kriteria yang dimiliki perusahaan, diantaranya harga, kualitas, pelayanan, waktu pengiriman, dan responsibilitas, serta dapat mengefisienkan waktu dalam pembuatan laporan. Penelitian dilakukan dengan metode observasi, wawancara, dan studi pustaka. Penelitian dilakukan di PT. Alfindo Banten Sukses Bersama. Sistem dirancang dengan menggunakan metode Analytical Hierarkhi Process (AHP) sebagai perhitungannya dan menggunakan Unified Modelling Language (UML) sebagai model perancangannya. Adapun software yang digunakan untuk membangun sistem ini adalah menggunakan Hypertext Preprocessor (PHP) dengan MySQL Server sebagai database-nya. Dari penilitian yang telah dilakukan maka dihasilkan sebuah sistem pendukung keputusan pemilihan supplier di PT. Alfindo dengan metode Analytical Hierarkhi Process (AHP), untuk membantu dalam proses pemilihan supplier terbaik sebagai pemasok barang-barang atau spare part alat kebutuhan industri yang dibutuhkan konsumen
Rancang Bangun Sistem Informasi Pengingat Jadwal Pembayaran Angsuran Berbasis Sms Gateway
Authors: Desmira Desmira , Singgih Nur
Published: September 2021

SMS adalah teknologi untuk mengirim pesan. Sistem pengingat jadwal pembayaran angsuran dengan mengirim SMS (Short Message Service) yang masih menggunakan sumber daya manusia atau manual sangat tidak efektif dan tidak efisien, karena berpotensi besar tidak tepat waktu, kurang cepat, waktu pelayanan yang terbatas, dan menambah beban kerja bagi perusahaan. Pelayanan untukmengingatkan jadwal angsuran pelanggan akan jauh lebih efektif dan efisien dengan menggunakan komputer atau otomatis. Model implementasi pengingat jadwal angsuran berbasis SMS Gatewaymemungkinkan komputer dapat mengirimkan SMS kepada pelanggan sebelum tanggal jatuh tempo angsuran dan memberikan informasi yang dibutuhkan pelanggansecara otomatis selama 24 jam non stop. Perangkat lunak yang digunakan untuk sebagai SMS Gateway adalah Gammu.
Sistem Rekomendasi Penjualan Alat Musik Modern Menggunakan Metode Simple Additive Weighting
Authors: Sugiyani Yani , Rizkiyanto Adji
Published: September 2021

Alat musik adalah suatu alat instrument yang dibuat dan dimodifikasikan untuk suara yang berirama. alat musik berbagai macam jenis, dan jika ingin melakukan pembelian terkadang kita bingung untuk menyesuaikan kriteria produknya.  Keberhasilan suatu perusahaan dagang dalam melaksanakan misinya tidak terlepas dari peran strateginya, ragam dan jumlah barang jasa yang dipasok bergantung pada jenisnya. Perusahaan dagang yang memiliki barang yang modern dengan harga terjangkau pastinya akan terbantu untuk sistem penjualan, lalu dengan sistem promosi di dunia maya  dan ditampilkan sistem rekomendasi konsumen pastinya perusahaa akan terus meningkat penjualannya. Dalam suatu perusahaan dagang perlu adanya sistem pendukung keputusan, karena untuk memberikan alternatif dalam pengembangan penjualan,   dan juga perlunya rancangan rekomendasi konsumen untuk membantu ide-ide dari konsumen yang berupa website. Sistem ini dikembangkan menggunakan perancangan aplikasi E-commerce melalui program Hypertext Processor sebagai bahasa pemogramannya, dan MysQL sebagai database. Dalam hal ini penulis menggunakan metode Simple Additeve Weigthing  (SAW), metode ini dipilih karena memiliki cara-cara untuk meperbandingkan nilai bobot pada kriteria barang. sehingga keputusan yang diambil dapat lebih obyektif. Metode SAW adalah penjumlaha  terbobot dengan konsep dasar mencari penjumlahan terbobot dari rating kinerja pada setiap alternatif pada semua atribut.
Perancangan Sistem Pendukung Keputusan Pemberian Kredit Pemilikan Rumah (KPR) Dengan Metode Simple Additive Weighting
Authors: Tanto Tanto
Published: September 2021

Kredit merupakan suatu fasilitas keuangan yang memungkinkan seseorang atau badan usaha untuk meminjam uang untuk membeli produk dan membayarnya kembali dalam jangka waktu yang ditentukan. PT.Bank Tabungan Negara (BTN) KCP Serang merupakan memiliki beberapa kegiatan perusahanan salah satunya adalah Kredit Pemilikan Rumah (KPR). Dalam  proses pengajuan KPR, pihak Bank mengalami kesulitan menentukan calon nasabah yang berhak menerima KPR dan proses pengajuan KPR yang dilakukan oleh calon nasabah membutuhkan proses dan waktu yang cukup lama. Dari hal tersebut dibutuhkan suatu sistem pendukung keputusan pemberian KPR di Bank BTN KCP Serang. Sistem pendukung keputusan adalah sistem yang dapat membantu seseorang dalam mengambil keputusan yang akurat dan tepat sasaran. Salah satu metode yang digunakan dalam SPK adalah simple additive weighting (SAW). SAW merupakan metode yang paling banyak digunakan dalam memecahkan permasalahan, seperti dalam SPK penentuan kelayakan nasabah penerima KPR. Metode SAW pemberian KPR memiliki beberapa kriteria yang menjadi dasar pengambilan keputusan antara lain character, capacity, capital, collateral dan condition. Hasil penelitian ini adalah membuat aplikasi sistem pendukung keputusan pemberian KPR untuk memberikan kemudahan dalam pengambilan keputusan pemberian KPR.
Methods of resource room management for teachers of learning disabilities in English language in light of some variables
Authors: Khasawneh Mohamad Ahmad Saleem
Published: September 2021

This study aimed at identifying the methods of managing the resource room for teachers of English language learning disabilities in the light of some variables. The study population consisted of all (60) teachers of English language learning disabilities in the upper basic stage in Irbid Governorate. The sample of the study consisted of (30) female and male teachers. The study used the descriptive methodology, for which a questionnaire was developed to collect and test data. The results of the study showed that the democratic method ranked first with a mean score of (4.13) and a standard deviation of (0.59), and the autocratic method came in the second rank with a mean score of (2.30) and a standard deviation of (0.57). The laissez-faire method came in the last rank with a mean score of (1.96), and a standard deviation of (1.96).
English foreign language teaching anxiety of Indonesian pre-service teachers of undergraduate internship program
Authors: Sari Huyi Intan , Anwar Choiril
Published: September 2021

Anxiety is a topic mostly investigated in the field of foreign language education. Unfortunately, the main focus of the studies on the aforementioned topic has primarily been provided in relation to anxiety suffered by students not teachers. Anxiety in speaking English while teaching has been proven to be a separate obstacle to the success of the language teaching and learning. This still happens to teachers who even have years of teaching experience. This study aims to investigate the English language teaching anxiety as experienced by the pre-service teacher at the department. The FLTA questionnaire consisting of 27 out of 45 items was adopted to collect data. Since this study was carried out during the COVID-19 pandemic, the questionnaire was distributed to the participants via email. The analysis was then made by implementing the qualitative descriptive approach and simple quantification to support the description. The results show that there were five factors of anxiety occur during the program. They were teaching inexperience, self-perception of language proficiency, fear of negative evaluation, lack of student�s interest, and difficulty with time management. These findings are expected to become a reference for the efforts of developing an internship preparation program.
Situating east Indonesia's EFL Learners attitudes toward the extensive listening practices
Authors: Su Yosefina Rosdiana , Fatmawati Fatmawati , Guna Stanislaus , Jemadi Fransiskus , Mat Yovita Narsi , De'e Ronaldus
Published: September 2021

Learning English as a foreign language is very challenging for both teachers and students in Flores, East Nusa Tenggara of Indonesia. The challenges are primarily caused by their lack of exposure to the authentic environment of English. In dealing with this phenomenon, the appropriate listening practices expect to help the learners to obtain and construct their knowledge of English as well as to acquire more comprehensible input. This article reports an investigation on the EFL learners� attitudes toward the extensive listening practices. It applied mixed-method research procedures involving 55 students of the English language and education program of Universitas Katolik Indonesia Santu Paulus Ruteng. The data were collected through a survey coupled with Focus Group Discussions with 15 participants. This research revealed that the learners' attitudes are identified into two main categories called positive and negative attitudes. In this case, 38 % of the participants have positive attitudes toward extensive listening practices and 62% of the participant reflected the negative attitude toward the extensive listening practices. Learners with a positive attitude had a very strong awareness of the significance of listening skills in L2 learning. To improve their listening skills, they develop their listening practices outside the classroom consistently. Meanwhile, learners with negative attitudes were categorized as dependent learners who practiced their listening skills during the listening course only. This group of learners was less aware of the significance of listening skills in L2 learning and their listening practices were highly dependent on the teachers' instruction. It showcased that both of the learners� internal and external factors were strongly contributed to this poor extensive listening practices.� The EFL teachers are then strongly suggested to strengthen the learners� awareness on the significance of Listening Skills in L2 learning as well as design more instructed extensive listening practices outside the classroom.�