bluuebunny/crossref_metadata_2025 huggingface dataset:
Stress Distribution Investigation at the Tapered Sandwich Endings
Authors: Löffelmann František
Published: June 2019

One of the typical sandwich ending is tapered transition to a solid laminate, which causes significant stress distribution changes. The reviewed articles show that tapered area causes increase in the shear stress in the core, increase of the axial forces in the facesheets and local bending at the fork point, at points of the tapering angle change, and at ply drop positions. Most of the studies gave attention to the endings without reinforcing. During Erasmus+ internship at KTH 2D model of the tapered ending with reinforcing plies, various geometry and resin filler in the core tip was investigated to see the influence on the stress distribution. It was found that tension load case is not as critical as bending load case. Increasing of the solid laminate thickness, adding plies and inserting a short resin or adhesive filler into the core tip area lead to significant stress reduction, whereas in the transition point, from tapering to constant thickness sandwich, increasing radius is more efficient than reinforcing plies in regard to reduce stress concentration.
Role Conflict, Self Efficacy, Employees’ Performance and Organizational Performance
Authors: Fahmi Hadi Kurnia , Musnadi Said , Nadirsyah Nadirsyah
Published: June 2019

AbstractObjective – This study aims to analyze the influence of role conflict and self-efficacy towards employees’ performance and its implications on organizational performance at Inspectorate of Nagan Raya District, Aceh, Indonesia. Design/methodology – The sample of this study is 120 auditors. The data was collected through questionnaire and analyzed using Structural Equation Model (SEM). Results – The study found that role conflict and self-efficacy have positive and significant influence on employees’ performance and inspectorate performance at Nagan Raya District. Meanwhile employees’ performance mediates the effect of role conflict and self-efficacy towards inspectorate performance at Nagan Raya District.
IFRSs Adoption and its Influence on Financial Perfor-mance of Listed Consumer Goods Companies in Nigeria
Authors: Balogun Shittu Aliu , Abiodun Sanyaolu Wasiu , Asamu Job-Olatunji Kehinde
Published: June 2019

AbstractObjective – This study examined the effect of IFRS adoption on financial performance of Listed Consumer Goods Companies in Nigeria. Design/methodology – The study selected 10 out of all the 28 Listed Consumer Goods Companies in Nigeria. Ex post facto research design was adopted and regression analysis through the aid of Eviews 9 was employed in analyzing the effect of IFRS adoption on performance of the selected listed companies. Results – The findings revealed that IFRS adoption has significant positive effect on return on total asset, IFRS adoption has negative insignificant effect on interest coverage ratio, significant positive effect on basic earnings power ratio and that IFRS adoption has negative insignificant effect on leverage. Based on the findings, the study concluded that IFRS adoption has joint significant effect on Return on asset, on Basic earnings power and on Interest coverage while the reverse was the case for financial leverage. Research limitations/implications – This study is limited in the context of consumer goods companies only. Future studies can extend the result of this study by investigating other industry in identifying the implication of IFRS adoption in their businesses.
Knowledge Management Practices of Universities in Bangladesh: Lecturers’ Perception
Authors: Akter Kaniz Marium , Banik Subrata
Published: June 2019

AbstractObjective – Aim of this study is to focus on the knowledge management practices of universities in Bangladesh. The study attempts to identify the level of four knowledge management dimensions that includes knowledge discovery, knowledge accumulation, knowledge sharing, and knowledge application. Design/methodology – A questionnaire survey was conducted to collect the primary data from 108 university lecturers in Bangladesh. The knowledge management practices of the universities in Bangladesh were recognized by utilizing a close-ended questionnaires that is adapted from the Becerra-Fernandez and Sabherwal’s Knowledge Management Process (2010). Results – Results indicated that three knowledge management dimensions are moderately practiced by the Bangladeshi universities. However, knowledge accumulation was the dominant dimension in comparison with others, where knowledge sharing was the least dominant dimension of knowledge management. Research limitations/implications – The study will facilitate the authorities of higher educational institutions to develop plans and strategies for practicing the knowledge management in the highest level. It is essential for creating a sound knowledge-based culture in the universities. Further research is recommended increasing the sample size and finding the impact of knowledge management on the organizational performance using SEM Model.
A rare case of bacterial infective endocarditis caused by Streptococcus alactolyticus
Authors: Cekmen Nedim , Baysan Oben , Disbudak Emine , Gunt Ceren
Published: June 2019

Background: Streptococcus alactolyticus is a rarely isolated bacterium, which classified under DNA cluster IV of the S. Bovis/S. equinus complex. Infections, especially infective endocarditis, caused by Strep. alactolyticus are very rare in humans.

Case Report: We describe a case of Strepotoccocus alactolyticus bacteriemia complicated by infective endocarditis. A 64-year-old male with a previous history of coronary artery bypass grafting applied to our cardiology outpatient clinic with complaints of dyspnea, fever, confusion and an apical holosystolic murmur. He was admitted to the intensive care unit. Transthoracic and transesophageal echocardiography showed the presence vegetation on the aortic valve. S. alactolyticus was detected on serial blood cultures. The patient was first treated with intensive antimicrobial therapy, and then underwent mitral and aortic valve replacements with uneventful follow-up.

Conclusion: Streptococcus alactolyticus infective endocarditis has only been reported previously in one patient. More information is certainly needed for diagnosis and treatment of patients infected with Streptococcus alactolyticus.

Key words: Streptococcus alactolyticus, endocarditis
Time to Reflect on the Role of Motor Control in Low Back Pain
Authors: Hodges Paul W. , van Dieën Jaap H. , Cholewicki Jacek
Published: June 2019

The articles in this special issue on low back pain are the outcome of work undertaken by a series of working parties established during the meeting, “State-of-the-Art in Motor Control and Low Back Pain: International Clinical and Research Expert Forum,” held in Chicago in October 2015. This multidisciplinary meeting provided an opportunity for discussion of key issues that interconnect motor control, pain, and the spine. What started as a relatively straightforward objective to summarize the field subsequently developed into an extensive process of literature review and discussion that culminated in the commentaries and articles presented in this special issue. We hope that the up-to-date information and in-depth insights into pain, motor control, and rehabilitation provide novel insights and a clear trajectory for future work and form the foundation for ongoing lively discussion. J Orthop Sports Phys Ther 2019;49(6):367–369. doi:10.2519/jospt.2019.0104
Can the Neck Contribute to Persistent Symptoms Post Concussion? A Prospective Descriptive Case Series
Authors: Kennedy Ewan , Quinn Dusty , Chapple Cathy , Tumilty Steve
Published: June 2019

Background

Persistent symptoms post concussion can arise from a range of sources, including the neck. There is little description of neck assessment findings in people with persistent symptoms post concussion.

Objectives

To assess people with persistent symptoms following a concussion and determine whether the neck has also been injured, and to evaluate the potential of the neck to contribute to their symptoms.

Methods

A consecutive series of participants (n = 20) referred for neck assessment were prospectively recruited by 2 providers of a multidisciplinary concussion service for people with persistent symptoms. Data were collected at initial assessment and on completion of neck treatment, which included standard questionnaires (Rivermead Post Concussion Symptoms Questionnaire, Neck Disability Index, Dizziness Handicap Inventory); patient-reported measures of headache, dizziness, and neck pain; physical examination findings; and details of comorbidities.

Results

Participants were evaluated at a mean of 7.5 weeks post concussion (median, 5 weeks). On neck assessment, 90% were considered by the clinician to have a neck problem contributing to their current symptoms. Multiple findings were consistent with this view, including moderate-to-severe Neck Disability Index scores (mean ± SD, 33.4 ± 9.5 points), frequent neck pain (85%), frequent moderate-to-severe pain on occiput-C4 segmental assessment (85%), a positive flexion-rotation test (45%), and muscle tenderness (50%–55%).

Conclusion

Multiple findings were indicative of concurrent neck injury, particularly involving the upper cervical spine. These neck-related findings are important to recognize, as they have the potential to contribute to persistent symptoms post concussion and may respond to neck treatment. This study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616001183471). J Orthop Sports Phys Ther 2019;49(11):845–854. Epub 1 Jun 2019. doi:10.2519/jospt.2019.8547
Relevansi Teori Belajar Behaviorisme Terhadap Pendidikan Agama Islam
Authors: Pratama Yoga Anjas
Published: June 2019

Teori belajar behaviorisme dapat digunakan untuk membantu proses pembelajaran. Namun diketahui bahwa banyak percobaan dalam teori behaviorisme dilakukan dengan menggunnakan hewan sehingga menimbulkan pertanyaan, apakah teori belajar behaviorisme sejalan dengan ajaran agama Islam dan dapat digunakan dalam Pendidikan Islam. Penelitian ini merupakan penelitian kepustakaan yang dianalisis dengan menggunakan teknik analisis konten. Hasil dari penelitian ini adalah ditemukan adanya relevansi antara teori belajar behaviorisme terhadap pendidikan Islam, sebagai berikut: (1) Teori belajar behaviorsime dapat digunakan untuk membantu proses pembelajaran pendidikan Islam (2) Teori belajar behaviorsime merupakan teori belajar yang sejalan/berkaitan dengan ajaran agama Islam (3) Adanya pengkondisian (clasical conditioning), pengulangan dan penguatan dalam teori behaviorsime yang juga digunakan dalam pembelajaran pendidikan Islam (4) Teori belajar behaviorsime menurut Edward Lee Thorndike mengandung empat hukum, yaitu: law of radiness (hukum kesiapan), law of exercise (hukum latihan), law of effect (hukum latihan), dan law of attitude (hukum sikap), yang sejalan/berkaitan dengan proses pembelajaran pedidikan Islam.

Kata Kunci: Relevansi, Teori Belajar Behaviorisme, Pendidikan Islam
ẢNH HƯỞNG CỦA MỘT SỐ YẾU TỐ KỸ THUẬT ĐẾN CÔNG THỨC PHỐI CHẾ NƯỚC GIẢI KHÁT GIÀU POLYPHENOL TỪ DỊCH CHIẾT LÁ TÍA TÔ
Authors: Quốc Bảo Võ Văn , Huy Nguyễn Vũ Bá
Published: June 2019

Mục đích của nghiên cứu này nhằm góp phần hoàn thiện quy trình sản xuất nước giải khát từ dịch chiết giàu polyphenol từ lá tía tô. Trong nghiên cứu này, chúng tôi khảo sát một số yếu tố như lượng đường, acid citric,  ascorbic acid, carrageenan và lượng dịch chiết bổ sung ảnh hưởng đến quy trình sản xuất nước giải khát, cũng như khảo sát thời gian thanh trùng để bảo quản sản phẩm. Để thiết lập được công thức phối chế, chúng tôi bổ sung : 12% đường, 0,15% acid citric, 0,05% ascorbic acid, 0,04% carrageenan và lượng dịch chiết là 4%. Ngoài ra, để đảm bảo sản phẩm an toàn vi sinh thực phẩm sau khi sản xuất và đến tay người tiêu dùng, chúng tôi tiến hành thanh trùng ở 80°C trong thời gian 10 phút.
Aluminium High Pressure Die Casting Application on Rear Frame Rails
Authors: ÖZBAY İbrahim , AYDINER Tamer , YİLMAZOGLU Gürkan , CELİK Hafize , AKSEL Levent , YENİ Harun , BAYRAMOGLU Metehan , AYDOGMUS Erdem
Published: June 2019

Due to the highly competitive environment in automotive industry and environmental restrictions, car manufacturers tend to use higher mechanical properties but better performance in lightweighting instead of traditional structural materials such as steel. Aluminium alloys are a good example of this application since they are 3 times lighter than steel. Aluminium is proposed to use in car body structure design because of its high performance of durability, and in addition with proper geometry and heat treatment the mechanical properties will be also valid for structural parts.  Using casting as a process enables to make topology optimization and having more complex shapes that has better strength but less weight with respect to sheet metal stamping.Rear rail reinforcement support bracket is one of the most suitable component of body in white, where topologically optimized aluminium die casted part could be applied. In a conventional reinforcement support bracket, more than one steel stamped parts are used to have desired performance of stiffness and durability which results in much more complex structures in terms of design, formability and assembly. In this study, a new part designed and produced by high pressure casting method to obtain the same performance of current solution. Additionally to obtain better mechanical properties different heat treatments have been tested and the optimum heat treatment cycle has been determined. The new design has been compared to current one with virtual validation tools and the results have been given as comparison.
Vehicle Loading Conditions’ Influence Over Front Lighting Requirements and Dipped Beam Vertical Leveling Control Method
Authors: RODOPLU Ahmet , ÖZBEK Hatice , ÇİL Caner
Published: June 2019

This study evaluates the effects of the vehicle body
inclination changes on the cut-off (the transition between the lighter and
darker portions of the beam) vertical position of dipped beam which is one of
the main functions of the headlamp. The functionality of headlamp vertical
aiming system and its importance for the driving safety are examined. In case
of any change on the vehicle, which effects to the vehicle inclination values, a
control method is defined in order to check suitability of cut-off vertical
position for every loading conditions defined by regulations. In addition, the calculations
are formulated to find required vertical aiming values in order to keep the
cut-off position in the range of minimum to maximum values defined by the
regulations are formulated.

It is concluded that after heavy accessory/configuration
changes, major modifications, or new version of model aplications on the vehicle
make necessary to be checked availability of actual cut-off vertical positions
and output values of the headlamp aiming software. In case of aiming software
update necessities, new values based on regulated loading conditions can be
defined by following formulations.
A Study for Detecting Flow Lines on The Aesthetic Plastic Parts During Design Phases as Using Material Flow Analysis Programs
Authors: KÜÇÜKOĞLU Ayça , VARGELCİ Sinan , ACAR Atanur
Published: June 2019

In
today’s competitive business environment the automotive industries aim to
increase the usage of the plastic materials in automobile components in order
to reduce weight of the vehicles. Although the plastic materials provide a
considerable savings on vehicle weight, these materials have some problems to
be solved. One of the difficult problems encountered in the production of
plastics is the flow lines on plastics because of its unpredictable behavior.
As a result, considered problem faced by automobile companies often spend
plenty of time and money is an issue to resolve. In this study the source of
plastic flow lines on automotive external aesthetical parts are investigated by
using material flow analysis programs. According to conventional methodologies;
weld lines, temperature differences, filling times, clamping forces, shrinkages
parameters are examined deeply before tooling face especially to eliminate
aesthetical problems. But in this case we observed an unordinary situation such
as flow lines on front bumper visible surfaces after tooling phase and
therefore we searched a new approach to simulate this flow lines on the
material flow analysis program. Flow directions and flow velocity are
comprehensively examined step by step during filling analysis. As a result of
the analysis the geometric factors that affect the balance of flow and brings
turbulence are detected. After the root cause analysis for plastic deformation
the potential techniques are researched to find best solution.  Analysis are repeated in the same conditions
that are considered to be made for all geometric changes.  The experiment results are comparatively
analyzed and the solution approach that have the best flow balance is selected.
Assessing Students� Speaking Skills at 2nd Semester Students of English Study Program IAIN Curup
Authors: Desfitranita Desfitranita , Senjahari Bayu
Published: June 2019

Speaking skill in English language learning is sometimes difficult for learners. Some students in second semester in IAIN Curup at English study program experienced errors in daily communication. This research tried to disclose what errors that the students did, to what extent the errors occurred. Qualitative approach was considered appropriate in this research because it did not try to generalize the findings but to deepen the case. Observation and open-ended Interview were applied to gather the data. As the instruments, field notes and voice recorder were utilized. The result shows that the students made errors in the four categories namely error in the using of be + adjectives, misplace be present time and past time, missing verbs and error in applying preposition. Errors occurred in the circumstances of choosing sentence verbs time signal and the lack of awareness in placing be for a sentence. Keywords: Speaking errors, grammar, sentence construction
The Effect of Fix Up Strategy in Enhancing Students� Reading Comprehension in IAIN Curup
Authors: Suhermanto Hadi
Published: June 2019

This study aimed to find out whether there is any effect of fix-up strategy on students reading comprehension at second semester English Study Program students in IAIN Curup. This study employed a quasi experimental research design. The sample of this study was second semester English Study Program students in IAIN Curup. It consisted of 60 students. The instrument on this research was reading test which was aimed to measure students reading comprehension. The reading test consists of 30 multiple choice questions for pre-and post-test. The finding of this research showed that the t-count value was 3,905 more than t-table value, it means that H0 was rejected and hypothesis H1 that stated there was any effect of applying fix-up strategy on the students reading comprehension at second semester English Study Program students in IAIN Curup was accepted. Fix-up strategy was proved to be effective to be used in teaching reading since there was a significant difference of students meanscore after doing the treatment by using fix-up strategy. Key words: Reading Comprehension, Fix-Up Strategy
Comparison of intra-articular injection therapy to physiotherapy techniques in management of shoulder impingement syndrome.
Authors: Saeed Hafiz Salman , Asif Muquduss , Iqbal Muhammad Sajjad , Fayyaz Iqra
Published: June 2019

Background: Shoulder impingement syndrome is umbrella term that covers rotator cuff syndrome, tendinitis of muscles of rotator cuff and bursitis in shoulder region. Usually this syndrome is treated conservatively. The treatment options are corticosteroid injections, medical treatment and physical therapy, of which, the most common are injection therapy and physical therapy. Injection therapy is carried out by orthopedic surgeons. However, which treatment is most effective in terms of symptoms relieving and cost effectiveness, yet conflicting. Study Design: Randomized Controlled Trial. Setting: Independent University Hospital, Faisalabad. Period: 1stJuly 2017 to 30thJune 2018. Methods: Comparing effects of two treatments for shoulder impingement syndrome; sub armorial steroid injection, the control group and manual physical therapy, the treatment group. Primary outcomes were Shoulder Pain and Disability Index (SPADI), to measure endpoint differences. Secondary outcomes included changes in Global Rating of Change (GRC) scale and Numeric Pain Rating Scale (NPRS) scores. Trial was conducted in one clinical setup. The collected data was analyzed by Statistical Package of Social Sciences (SPSS 20.00). Results: At baseline of group physical therapy 19(95%) reported severe and 1(5%) moderate level of pain, at numeric rating pain scale. At post treatment of group injection therapy 19(95%) reported severe and 1(5%) moderate level of pain, at numeric rating pain scale. At follow up of group injection therapy 19(95%) reported severe and 1(5%) moderate level of pain, at numeric rating pain scale. At follow up of treatment physical therapy all patients mild level of pain, at numeric rating pain scale. Conclusion: Injection therapy treatment is more effective in improving shoulder impingement syndrome in terms of pain and function than that of physical therapy treatment.
The good teacher attributes – a cross sectional study on teaching evaluation at rehman medical college, Peshawarq
Authors: Raza Ali , Zainab Hajira
Published: June 2019

Introduction: The role of teacher is crucial to a college’s/ university success. Teaching evaluation when done properly enhances teacher’s professional practice as well as aids in professional development. There is a clearer link between student learning standards and teacher preparation standards, as teaching evaluation is relevant to every segment of the educational system. This is a controversial area involving technical, psychological, political, ethical and educational complexities. The purpose of this study is to present qualities of a good teacher as are evaluated by Higher Education Commission (HEC) teaching evaluation survey. Study Design: Cross sectional study. Setting: Rehman Medical College, Peshawar. Period: April to October 2017. Methodology: The survey was conducted by quality enhancement cell. The senior faculty i.e assistant professor and above of respective subjects were evaluated by the students. The survey was done from year 1 to year 4 MBBS. The total number of responses for all subjects were 2190. Results: Year wise and subject wise analysis was done using ANOVA and chi-square tests. Both tests showed no difference between the perception of students year wise and subject wise. However, individual item analysis showed certain difference which were more due to the teachers’ influence on the students. The disagreement level for Biochemistry as compared to other subjects was consistently high which desires further probation. Conclusion: Although it’s a very difficult area and involves controversy. Individual to individual feedback can improve the situation. Regular professional development workshops will develop teachers professionally.
Oral hygiene awareness in orthodontic patients; A cross sectional survey
Authors: Ilyas Muhammad , Khalid Muhammad Usman , Qurat-Ul-Ain Arif Syeda , Ashraf Sobia
Published: June 2019

Aim and Objectives: To evaluate the current status of oral hygiene awareness in patients undergoing active orthodontic treatment and to educate them how they can improve and maintain their oral health throughout orthodontic treatment to minimize the risk of dental caries, plaque deposition, gingivitis and localized enamel decalcification. Study Design: Prospective survey. Setting: Orthodontic Department, Punjab Dental Hospital Lahore, Pakistan. Period: 06 months 1st August 2018 to 31st January 2019. Methods and Materials: A structured questionnaire was distributed to 100 patients undergoing active orthodontic treatment at orthodontic department of Punjab Dental Hospital Lahore, Pakistan in an effort to assess the level of awareness and practical measures taken by patients to maintain and improve their oral health during orthodontic treatment. Conclusion: This survey revealed that most of the patients are aware and practising oral hygiene measures during their orthodontic treatment and dentist should repeat all these instruction on every visit.
Surgical intervention in ectopic pregnancies
Authors: Rasool Memon Fouzia , Poothavelil Mini , Memon Samreen
Published: June 2019

Objectives: To find out the negative laparoscopy rate for suspected ectopic pregnancy. Study Design: Retrospective cohort study. Setting: Electronic medical record databases in North Cumbria University Hospital, Carlisle, United Kingdom. Period: August 2014 to August 2018. Material and Methods: The data of total 150 laparoscopies performed for ectopic pregnancy management was collected for gestational age at presentation, symptoms, serial beta human chorionic gonadotrophic hormone (HCG) levels, ultrasound findings, time interval for diagnosis, time to surgery and histology. Results: One hundred and fifty patients (52 under 5 weeks and 98 over 5 weeks’ gestation) were incorporated into this study. The primary presenting symptoms were pain and vaginal bleeding. Suboptimal rise in serial beta HCG (performed 48 hours apart) was seen in 69 patients (46%) while other 81 patients (54%) had confirmed ectopic on USS and were offered surgical management after the scan. One hundred forty for women (96%) went for surgical management and one patient had conservative management as she was asymptomatic with low HCG(less than 1000IU) at the first visit and rapid drop in serial BHG results. Fifty three women (35%) had surgery on the same day when they had ectopic pregnancies seen on USS, 63 (42%) went to theatre for surgery between 0-6 days, while 34 patients (23%) had surgery between 7-14 days of USS. All women were operated through laparoscopic route and tubal ectopic pregnancies were confirmed at laparoscopy. There was no negative laparoscopy in our study period. Conclusion: Judicious and timely surgical intervention made it possible to treat every case through laparoscopic route with zero negative laparoscopy rate.
Diagnostic accuracy of saline infusion sonohysterography for evaluation of uterine cavity abnormalities in patients with abnormal uterine bleeding
Authors: Zafar Humaira , Naz Mubashra , Fatima Umber
Published: June 2019

Objectives: The objective of this study was to evaluate the diagnostic accuracy of saline infusion hysterosonography for detection of uterine cavity abnormalities using Hysteroscopy as the gold standard. Study Design: Analytical Quasi Experimental study. Setting: Obstetric and Gynaecology Department Madina Teaching Hospital Faisalabad. Period: July 2017 to December 2017. Materials and Methods: Sixty patients presented with abnormal uterine bleeding were included in the study. Transvaginal ultrasound, SIS and hysteroscopy performed for evaluation of the uterine cavity for any abnormality. Results: SIS helped in detection of intacavitary abnormalities in 39 out of 60 patients indicating sensitivity of 88. 64 % and specificity of 100 % as hysteroscopy confirm the findings in all the patients. The NPV is 76 % and PPV of 100 % taking hysteroscopy as gold standard. The diagnostic accuracy of saline infusion sonography is 91%. Conclusion: The addition of SIS to TVS significantly improved the sensitivity and specificity for detecting intracavitary pathology. It can be used as an alternative procedure whenever hysteroscopy is not available.
Frequency of helicobacter pylori stool antigen in individuals with dyspeptic symptom
Authors: Tareen Khalid Ahmed , Awan Riaz Hussain , Nayab Seema , Awan Khadim Hussain , Awan Faqir Muhammad
Published: June 2019

Objectives: To evaluate the frequency of H. pylori stool antigen in individuals with dyspepsia. Study Design: Cross sectional study. Setting: Liaquat National Hospital, Karachi. Period: July-2017 to 31st December-2017). Patients and Methods: The individuals with dyspeptic symptoms for ≥3 months durations were included and explored for H. Pylori infection by H. Pylori stool antigen while the result were analyzed and frequencies and percentages were calculated. Results: The mean ± SD for overall population was 36.29±8.57 years while the frequency of H. pylori was recorded as 38.57% (54/140) patients respectively. Conclusion: H. pylori infection usually observed in dyspeptic individuals and should be screened for eradication therapy.
Students’ perception regarding skill lab training in medical education
Authors: Imran Shezadi Sabah , Ramzan Musarat , Zahra Fatima Tuz , Kausar Farhana , Khan Benish , Ahmed Asifa , Andleeb Ayesha , Ashraf Faiza
Published: June 2019

Introduction: Clinical skills refer to the skills required for a clinician to manage a complete patient encounter. Clinical skill laboratories provide the facility to medical students and medical staff to learn the clinical skills before applying them on patients. Objectives: To evaluate perception of medical students regarding skill lab training. Study Design: Cross -sectional study. Study Setting: Wah Medical College. Period: January 2017 to June 2017. Study Subject: Students of Final Year M.B.B.S. Sample Size: 114 students. Sampling Technique: Convenient sampling. Data Collection Procedure: With informed consent of participants, questionnaires were filled by students themselves. Questionnaire was comprised of two parts; first part comprised of demographic data, second part comprised of 18 questions to determine perception of medical students about skill lab training. The responses of 18 questions were measured on four-point Likert scale from strongly disagree to agree. Data Analysis: Data was analyzed by using SPSS version 19, frequencies and percentages were calculated. The Chi square- goodness of fit test for one sample was applied on various levels of agreement. The p value of less than 0.05 was considered as significant. Results: The mean age of 114 students was 23.4 years with minimum age of 21 years and maximum of 26 years. Male students were 45(39%) and 69(61%) were female students. Out of 114 medical students108 (94.8%) students preferred to practice in skill lab before performing it on patient and they also had an opinion that the mentor must be friendly and helpful during teaching. Among them 107 (93.9%) students desired that procedures in the skill lab should be performed by the mentors first in front of students and 103 (90.4%) students thought that training of practical skills improve their learning. Out of them 94(82.5%) students believed that skill lab training increased their motivation to become a doctor, 102 (89.5%) students thought that skill lab practice provides a feeling of security for learning process and 100 (87.7%) students had an opinion that it should be a compulsory part of medical curriculum and even it should be started from the first year of the medical education. P value of level of agreement of all the variables regarding perception about skill lab training was found to be < 0.001 which was statistically significant. Conclusion: The students believed that skill lab training is very useful for them and they preferred to practice on manikin before dealing with the patients.
Carotid plaque and type 2 diabetes mellitus
Authors: Bashir Farhat , Nageen Ayesha , Kidwai Saera Sohail , Ara Jamal
Published: June 2019

Atherosclerosis is the basic cause of macrovasular complications of diabetes mellitus. It affects all parts of the circulatory tree. An easy and reliable method of diagnosing atherosclerosis is Carotid Doppler ultrasonography. Increased Carotid Intima-Medial thickness (CIMT) and presence of carotid plaque is an important predictor of ischemic heart disease and cerebrovascular accidents. The purpose of this study was to find the association of carotid plaque with cardio-metabolic risk factors in type 2 diabetes mellitus. Study Design: Cross-sectional study. Setting:  Medical Out-patient Department of Creek General Hospital, Karachi. Period: One year from June 2015 to May 2016. Subjects and Methods: The study population included 119 cases of type 2 diabetes mellitus. All subjects underwent Carotid Doppler ultrasonography. The demographic, anthropometric, clinical and laboratory data was collected and analyzed through SPSS ver.20.0. The relationship of carotid plaque with different atherosclerotic variables was assessed by Student’s t-test and Chi-square test. P-value of <0.5 was considered significant. Results: Out of 119 patients with type 2 diabetes mellitus, 18.5% had a carotid plaque. The presence of plaque was associated with duration of diabetes, presence of hypertension, BMI, diastolic blood pressure, total cholesterol, triglyceride levels and CIMT. Conclusion: We need to focus on management of the multiple metabolic abnormalities associated with diabetes mellitus in order to prevent atherosclerosis and its associated cardiovascular disease.
Prevalence of depression among type2 diabetes mellitus in Pakistani population
Authors: Naeem Abid , Shuaib Muhammad , Hassan Abid Subtain-Ul- , Abid Muhammad Huzaifa , Imran Muhammad
Published: June 2019

Introduction: Diabetes is a very prevalent problem in Pakistan. Depression along with diabetes affects not only quality of life but compliance and management of patient. Various studies have found high prevalence of depression among T2DM depression. In our study we shall determine the prevalence of depression among T2DM patients in Pakistan. Period: May 2017 to December 2017. Objectives: The objective of this study was to find out the prevalence of depression in Type2 diabetes mellitus patients. Study Design: A cross-sectional study. Setting: Jinnah Post Graduate Medical Centre Karachi. Results: Mean PHQ- Score is 10.83±5.6. 81.9% had PHQ Score > 4. According to PHQ-9 scale, 18.1% (n=30) had no depression, 26.5% (n=44) had moderately severe depression and 3.6% (n=6) had severe depression. In our study females had more severe depression in comparison with male (5.2% vs. 0%). Conclusion: Depression is very common in Pakistan among Type 2 Diabetic patients. Antidepressant has key role to break the vicious cycle of depression and type2 diabetes mellitus diabetes.
Clinical experience with flap reconstruction of post tumor excision head & neck defects
Authors: Adeel Imran , Ali Ghazanfar , Tariq Irem Zoya
Published: June 2019

Introduction: Soft tissue reconstruction of defects after excision of head & neck malignancies is one of the difficult tasks for plastic surgeons and it has always been a challenge for plastic surgeons to seek options which are safe & with less morbidity and good functional and aesthetic outcomes.1 Multiple options are available for reconstruction purpose, ranging from simpler options in the form of primary closure and skin grafting, to more complex reconstruction with flaps. Flap coverage is more reliable over simpler options, in terms of functional and aesthetic outcome for the management of head and neck malignancies.2 Objectives: The purpose of this study is to determine the role of different types of flaps for the soft tissue reconstruction in the management of head and neck malignancies, and reliability of local flap coverage in the management of head and neck malignancies. Material and Methods:…  Study Design: Retrospective case series. Setting: This study was conducted at the department of Plastic and Reconstructive Surgery, Shaikh Zayed Postgraduate Medical Institute, Lahore. Period: 5 years from 2009 to 2013. Subject and Methods: A total of 63 patients, with diagnosis of head and malignancies, were studied retrospectively over a period of 5 years from June 2009 to June 2013. Age ranged from 18 to 80 years (mean: 59.17 years). There were 30 males (47.61%) and 33 females (52.38%). Soft tissue reconstruction was done with different types of local and distant flaps. Results: A total of 65 different types of flaps were done for the reconstruction purpose. Local flaps were done in 42 (68%) cases, regional flaps were done in 15 (23%) cases and in 6 (9%) cases, free tissue transfer was done. In two cases more than one flap were used for reconstruction. Neck dissection was done in 13(21.74%) of the cases. Good results were achieved in all cases with respect to functional and aesthetic outcome. Conclusion: Despite of the intricate anatomy of head and neck region and the challenging reconstruction, flap reconstruction is a reliable option with good functional and aesthetic outcome and most of the soft tissue reconstruction can be achieved with different local flaps, depending on the extent of soft tissue defect.
Pattern of clinical and hematological profile in patients diagnosed as megaloblastic anemia in a tertiary care centre
Authors: Khan Muhammad Ihtesham , Munir Asif Hussain , Fatima Syeda Hina
Published: June 2019

Objectives: To determine the pattern of clinical presentation, pattern of cytopenias, and haematological parameters of megaloblastic anemia in our setup. Study Design: Cross Sectional Descriptive study. Setting: Pathology Department, Khyber Teaching Hospital, Peshawar. Duration: January 2016 to December 2016 (one year period). Material and Methods: A total of 337 patients underwent bone marrow biopsy during the study period, out of which 46 patients were diagnosed as having megaloblastic anemia on bone marrow aspirate and B12 levels. The clinical features and hematological parameters of these patients were recorded in a proforma and the results were drawn accordingly. All cell counts were done on automated counter machine. Results: Out of 337 patients referred to pathology department for bone marrow aspiration, about 45 cases had megaloblastic anemia. These 45 cases were included in the study. Age of the study sample ranged from 1 year to 90 years (mean 32.2 years ± 12.1 SD). There were 35 (78%) males and 10 (22%) females, with male to female ratio of 3.5:1. Commonest clinical feature was generalized weakness and loose motion, while commonest physical sign was pallor, which were seen in 36 (80%), 36 (80%) and 40 (88%) cases respectively. About 28 (62%) patients had pancytopenia, 9 (20%) patients had bicytopenia (low hemoglobin and platelet count), and 8 (18%) cases had isolated anemia. Low Hb was present in all the 45 (100%) patients. Both the mean hemoglobin level and platelet count were reduced (7.4g/dL and 128x109/L. respectively) while mean white cell count in study sample was normal (mean 5.0x109/L). Conclusion: Megaloblastic anemia may presents as anemia, bicytopenia or pancytopenia. The cytopenias are important feature of megaloblastic anemia. Generalized weakness, and lethargy are the common clinical presentation, while pallor is common physical finding. Patients presenting with a constellation of generalized weakness, pallor and pancytopenia should be suspected of megaloblastic anemia and should be investigated accordingly.
Frequency of dyslipidemia in young overweight and obese students (age 10-16 years) in private schools of swat
Authors: Nazli Rubina , Fatima Sadia , Farooq Nazish , Ullah Ihsan , Haider Jamila , Zubair Aqsa
Published: June 2019

Objectives: The objective of the current study was to estimate the frequency of pediatric dyslipidemia in overweight and obese students of private schools in Swat. Study Design: Questionnaire based cross-sectional study. Setting: Three private schools of district Swat. Period: 6 months. Method: Study analysis was done in Research laboratories of Biochemistry Department, Institute of Basic medical Sciences (IBMS), Khyber Medical University Peshawar. Well-designed questionnaires were used for screening of 99 out of 1374 students, including both girls and boys. Anthropometric measurements were taken. Blood samples were collected for the analysis of serum lipids using an Automated Cobas Analyzer. SPSS version 20, Student’s t test and Logistic regression method was used for statistical analysis. Results: The prevalence of dyslipidemia was measured to be 42.4%. A significantly direct association was found between the rate of dyslipidemia and BMI. Highly significant P values were found for serum lipids in obese children as compared to overweight children thus showing strong association between the biochemical Parameters and BMI. Even though rate of dyslipidemia was measured to be a little higher in boys as compared to girls, no statistically significant gender differences were found in serum lipid levels. Conclusion: Reduce long-term complications in adulthood is possible through controlling the serum lipid levels of children and adolescents.
Efficacy of photodynamic therapy in the treatment of cutaneous leishmaniasis
Authors: Aftab Khan Mahvish , Aftab Sehrish , Shams Nadia , Ullah Khan Rahmat
Published: June 2019

Introduction: A limited number of case reports have studies the efficacy of Photodynamic Therapy (PDT) in management of Cutaneous Leishmaniasis (CL). Topical PDT is an innovative mode of therapy that works on principle of selective uptake of photosensitizing agent by CL lesions. Current study was conducted to determine efficacy of topical photodynamic therapy of CL. Study Design: Descriptive cross sectional study. Setting: Dermatology outdoor clinic PIMS Islamabad. Period: July 2015 to Jan 2016. Materials & Methods: Total 75 patients (>12 years) of either gender with biopsy proven CL lesions were included after ethical approval.  Pregnant or lactating women, those with sensitivity to light or photo sensitizer were excluded. The selected cases were administered once a week sessions of topical 5-ALA PDT therapy. This therapy was continued till 4 weeks and efficacy was observed at 6th week; efficacy labeled as yes if there was no erythema with resolution of papules, plaques or nodules, surrounded by normal healthy skin clinically and the histo-pathological smears revealing absence of amastigotes, otherwise labeled as non-effective. Results: Mean age was 24.37+7.43 years. There were 44(58.67%) females and 31(41.33%) males. Mean duration of disease was 40.29+11.73 days and mean size of lesion was 19.69+9.88 mm. Effective PDT outcome was seen in 67(89.33%) patients at 6th week of therapy. Conclusion: This study concluded that topical photodynamic therapy is an effective method for treatment of Cutaneous Leishmaniasis.
Frontal bone fractures; an analysis at liaquat university hospital hyderabad
Authors: Shams Salman , Hamid Ali Muhammad , Ghafar Shaikh Abdul , Kumar Anand
Published: June 2019

Objectives: To analyze the pattern and presentation of frontal bone fractures at tertiary care hospital. Setting & Period: Department of Oral & Maxillofacial Surgery & Neurosurgery Liaquat University hospital Hyderabad. Study was conducted from 2012 to 2017. Study Design: Prospective study. Methodology: 62 patients of frontal bone fractures with age range of 21 to 60 years. Clinical diagnosis was done by plain radiograph PA view of face and 3D CT scan of face. The parameters used to classify the patients were age and sex, etiology and site of trauma, presence of associated craniomaxillofacial fractures. Results: Males were involved more than females. Peak age range was found between 31 to 40 years (50%) followed by 41 to 50 years (26.92%). RTA was the most common etiological factor involved followed by assault. Fractures of anterior table were most frequently seen (59.61%). Most frequently associated craniomaxillofacial involved was naso-orbito ethmoid fracture. Conclusion: This study concludes that RTA is the most contributing factor of frontal bone fracture. Fractures involving anterior table fracture are frequently seen, these fractures rarely occur in isolation and mostly seen with NOE type of craniomaxillifacial trauma.
Effect of haloperidol on centrilobular vein and portal triad of liver in the albino rats during intrauterine life
Authors: Tufail Shazia , Ibrahim Sobia , Suhail Muhammad Usman
Published: June 2019

Haloperidol is first generation antipsychotic used to treat psychosis. Its usage during pregnancy benefits psychotic mother and is indispensable for treating psychiatric emergency situations. Objectives: To evaluate the effects of haloperidol on development of centrilobular vein and portal triad of liver given to albino rats during intrauterine period. Study Design: Experimental study. Setting: PPGMI Animal House, Lahore. Period: July to September 2017. Materials & Methods: Pregnant female rats were randomly divided into three groups A,B and C ,15 rats in each group. Group B & C were given haloperidol in a dose of 0.4mg/kg and 0.8mg/kg body weight by intraperitoneal route whereas group A was considered as control group. Hysterotomy was done on 21st day of gestation and pups were removed. Pups of group A, B and C were designated as A1, B1 and C1. They were grossly examined for any abnormality and liver was removed after dissection. Slides were made and stained to evaluate changes in detailed histological study of centrilobular veins and portal triads. Results: Comparison of centrilobular vein and portal triad of group B1 and C1 with control A1 revealed that there is significant congestion seen in centrilobular veins of group B1 and C1 with P value ≤ 0.001 and signs of inflammation are present in experimental groups where were significant as compared to control group A1 with P value ≤ 0.001. Conclusion: Haloperidol, given during intrauterine life is responsible for initiating cell injury sequelae in the developing liver of fetal albino rats and must be given with caution if necessary.
Effect of haloperidol on centrilobular vein and portal triad of liver in the albino rats during intrauterine life
Authors: Khalid Muhammad , Rasheed Javaria
Published: June 2019

Background: Acute poisoning in children is the third most common emergency with significant economical burden. Objectives: This study was carried out to elucidate the clinical and demographic pattern and outcome of acute poisoning in children at local University Hospital of South Punjab. Study Design: Retrospective study. Setting: Pediatric Medicine Department of Nishtar Medical University, Multan. Study Period: January 1st – December 31st 2016. Materials and Methods: This one year hospital based study included 74 children up to 12 years admitted with acute poisoning. The data was extracted from clinical charts. Clinical, demographic and outcome data was extracted and analyzed. Mean and standard deviation are calculated for continuous variables and frequencies with percentages for categorical variables. The data is presented in tables and figures. Results: A total of 74 children with poisoning were admitted during study period (total admission–3107) giving annual incidence of 2.38 %. Males predominated (n=49, 66 %) the study population. Fifty four percent (n=40) of the children were in 13 – 59 months age group. Majority of the children were admitted due to accidental poison ingestion (n=65, 87.8%), through emergency (n=68, 92%) department, brought from urban areas (n=38, 51.4%), and within 1 hour of exposure (n=41, 55.4%). Most common poisons ingested were pesticides (n=29, 39%), kerosene oil (n=13, 17.57%) and Paraphenylene diamine (Kala pathar) (n=11, 14.86%). Most common system specific symptoms belonged to cardiovascular system (54 %) followed by nervous system (51 %) and respiratory system (42 %). Median hospital stay of the poisoning cases was 2 days (min. 1, max. 17). Poisoning associated mortality rate was 16.2 % (n=12). Kala pathar ingestion was the only significant factor associated with mortality (p-value 0.04). Conclusion: Accidental ingestion of non – pharmacological agents at home is most common in children < 5 years of age at our set – up. Mortality rate due to acute poisoning is high in children. Parents education for safe placement of poisoning agents, set – up of regional poison control centers and healthcare workers training on management of such cases will help curtailing this problem.