bluuebunny/crossref_metadata_2025 huggingface dataset:
Efecto de la suplementación con zumo de remolacha sobre el resultado obtenido en un test máximo incremental y en dos test de valoración de potencia del tren inferior en triatletas amateurs.
Authors: Miralles-Mayol María , Raya-González Javier , Rodríguez-Fernández Alejandro , Castillo Daniel
Published: December 2021

El objetivo fue analizar los efectos de la suplementación con zumo de remolacha (ZR) sobre el rendimiento deportivo en triatletas amateur, medido mediante un protocolo de media sentadilla bilateral y unilateral, y con una prueba de salto con contramovimiento (CMJ), en situación de fatiga. Doce triatletas amateurs participaron en este estudio aleatorizado, a doble ciego y con un diseño cruzado compuesto por dos sesiones de evaluación que consistían en un test incremental hasta la extenuación ejecutado entre dos CMJ y dos pruebas de media sentadilla con 30 y 40 kg de manera bilateral y unilateral. La intervención nutricional consistía en ingerir 140 mL de ZR o placebo 2,5 h antes de la prueba. La suplementación con ZR mejoró el consumo máximo de oxígeno (VO2max) absoluto (p = 0,033) y relativo (p = 0,011) obtenido en la prueba incremental en comparación con placebo (4,12 ± 0,70 vs. 3,72 ± 0,90 ml·kg·min-1 y 54,82 ± 7,72 vs. 44,48 ± 15,84 ml·kg·min-1). Por otro lado, no se encontró una interacción significativa (p > 0,05, n2p = 0,03-0,30) para ninguna de las variables estudiadas en relación con el rendimiento bilateral y unilateral en media sentadilla ni CMJ entre la condición (placebo y ZR) y el tiempo (antes, PRE y después, POST). Estos resultados ponen de manifiesto que la suplementación con ZR ayuda a exhibir un mayor VO2max en triatletas amateurs pero no reduce la fatiga en comparación con la condición de placebo.
Transformation of the groundwater composition in coastal zone of the Ivankovo reservoir during 20 years
Authors: Lapina Elena , Lapina Larisa , Kudryashova Vera
Published: December 2021

The Ivankovo reservoir is an important source of drinking water for the city of Moscow. The water quality status of aquifers around the reservoir is important for its safety, as groundwater inflow into the reservoir is considerable. The chemical composition of the shallow groundwater around the Ivankovo reservoir is studied. The study is based on long-term monitoring (1999–2019) of both surface and groundwater quality. The aim of the paper is to identify changes in groundwater quality over this period and to determine their causes. The results show that over this 20 year-period, the groundwater quality in the study area shifted from HCO3–Ca to HCO3–Ca-Mg type, proven by statistical methods. The median values of the total dissolved solids (TDS) decreased by 13% in summer and by 17% in winter. It is shown that the ongoing processes of transformation of the groundwater chemical composition are mainly due to climate change, and atmospheric precipitation in the spring-winter period is a possible source of the Mg2+ ion entering the groundwater table. Among other components, concentrations of chlorides and sulfates underwent the largest change, the median values of which have decreased by two or more times, which is caused by both the dilution of the groundwater by melt water and a decrease in the anthropogenic load.
Analysis of the condition of karst springs included in the National Groundwater Monitoring Network
Authors: Damyanova Evelina
Published: December 2021

Approximately 20% of the monitored points in the National Groundwater Monitoring Network (NGMN) of Bulgaria are karst springs. The number of monitored karst springs is changing over time for various reasons and currently there are 33 springs monitored continuously and 53 on monthly basis. The monitoring points are distributed over 39 karst basins around the whole country. There are between 1 and 5 monitored springs per karst basin and no monitoring points in 23 karst basins. The present analysis includes the determination of some of the main statistical characteristics of karst springs and it is based on the monitoring data series. The obtained data allow us to make some conclusions of the nature of their water regime. Based on the analysis, some suggestions and recommendations are made with regard to improvements in the monitoring of karst springs in Bulgaria.
PERFORMANCE BASED PROFESSIONAL DEVELOPMENT OF IN-SERVICE TEACHERS
Authors: Sidra Rizwan
Published: December 2021

Developing countries all over the world are struggling to improve their education system to achieve sustainable development standards. Pakistan being a developing country is no different; the two major issues related to education are quality and quantity and both are imperative in our current situation where we are up against the challenges of low literacy and poor quality of education. The government has taken up the challenge of low quality of education by investing in teacher education in the form of various reforms which are designed to enhance the teaching quality and provide standards of acceptability across the country. In this regard professional standards in 2009 were launched across the country for teachers. The latest concept of teaching is no more transfer of knowledge rather it is the transformation of knowledge in an organized manner. This organized knowledge transformation requires detailed planning and multiple strategies of delivery; this concept took the fourth place in the professional standards as “Instructional Planning and Strategies”. This standard has three dimensions one of which is “Performance” with eight indicators that can be used to measure this dimension. This article focuses on the performance of in-service teachers teaching at secondary level gauged on the defined indicators of performance in instructional planning & strategies stated in the professional standards. The population was teachers already teaching at secondary level from all the four provinces and Islamabad, according to multistage sampling technique 400 teachers were selected and further their 80 head teachers were also included for the purpose of triangulation. The findings showed that currently in-service teachers required training at varying degree on all the indicators of performance which provided the basis for priority wise training recommendations according to the defined indicators. The challenge of quality teaching in the country can be addressed if the teachers perform according to the prescribed standards.
IMPACT OF ONLINE EDUCATION’S COMPATIBILITY ON STUDENT’S SATISFACTION IN UNIVERSITIES OF PAKISTAN BY USING TAM MODEL
Authors: Uzma Haleem, Dr. Muhammad Asim, Salman Manzoor
Published: December 2021

The outbreak of COVID-19 has created a pandemic situation across every corner of the world. It has brought a great and unpredictable change in the lifestyle of the human race extended from one part to another part of the world. The significant unavoidable change in our lives is the shift from physical to online activities, especially in the education system. Moving from the physical education system to an online education system must not be easy for everyone. Particularly, in the territories with incompetent technology infrastructure or low- computer literacy rates like those of Pakistan. The current research work is an attempt to identify and investigate factors affecting students’ satisfaction in the online learning environment in Pakistan. It is quantitative research and data was collected by distributing a well-structured questionnaire among students in different universities in Karachi. This data was run using Smart PLS3 software. Results for Average of Variation Explained (AVE) showed that the model used for the research is a quality model whereas path co-efficiencies have also supported the hypothesis I and 11. The outcomes revealed that technology compatibility and online learning self-efficacy both strengthen the online learning compatibility in Pakistan and thereby, significantly impact students’ satisfaction.
ROLE OF CASE SCENARIOS IN IMPROVING EFFECTIVENESS OF LARGE GROUP LECTURE FORMAT: DATA FROM UNDERGRADUATE MEDICAL STUDENTS
Authors: Maria Safdar, Zahid Farooq Baig, Attia Sheikh
Published: December 2021

Teaching practices are being modified over time to more student centered approaches to improve the learning. Lecture being the corner stone of the teaching, need techniques to improve its effectiveness thus emphasizing “learning” rather than “teaching.” One of the main problems with long lectures is the low attention span of students. This study was undertaken to assess the role of adding case scenarios to the lectures, thus improving its learning outcomes. It is a descriptive study conducted in 3 rd year and 4th year students at CMH Multan Institute of Medical Sciences (CIMS) from 1st October 2018 to 1st April 2019. The focus of this study was to know impact of case scenarios in improving learning of the students in a lecture. During study period, on average two lectures per months of department of medicine, were taken with addition of case scenarios. The outcome measurement of this technique was done by two methods, feedback by the students and peer review from colleagues. There were a total of 61 participants who gave feedback on the lecture. Analysis of feedback performa revealed that almost 64% of students had a low attention span after 20 minutes into a well prepared and interesting lecture. Fifty to 90 percent of students agreed or completely agreed that adding aids like videos, graphics, algorithms or case scenarios etc improved the learning of students. More than ninety percent of participants completely agreed or agreed that the case scenarios are relevant, provide sufficient information, improve learning outcome and serve the purpose. The second part of the data collection was peer review; five colleagues attended the lectures during this period and in addition to filling feedback performa, gave valuable reviews on this. All the peers supported the idea of using case scenarios during lectures. We can conclude that adding case scenarios to the large group lecture format makes it more interactive, improved attention span and keeps attention of students which is difficult to achieve in a class of almost hundred.
ANALYSIS OF PUNJAB TEXTBOOK OF GENERAL SCIENCE IN CONTEXT OF ENVIRONMENTAL EDUCATION AT 8TH GRADE
Authors: Nazir Haider Shah, Nadia Nazir, Mahek Arshad
Published: December 2021

The current research was carried out to analyze the content and to assess teachers’ perception regarding content of general science textbook at the elementary level for grade 8th in the environmental education context. For content analysis general science recommended by Punjab Textbook has been taken. For getting teachers perception, five-point Likert scale was utilized which consisted of 27 statements under the consideration of three components of Palmer’s teaching and learning model a) education about the environment b) education in or from the environment c) education for the environment. The outcomes of the research showed that activities of the content related to environment are more emphasizing towards psychomotor domain instead of equally focusing all domains. On the other hand, teachers’ perception indicate that more improvement is needed in textbook in relation to providing opportunities to boost the skills, knowledge, attitudes among students in order to protect the environment. For instance, an environmental day can be organized in which awareness, knowledge, skills related to environment are provided
THE ROLE OF LOCAL GOVERNMENT SYSTEM IN SOUTH ASIA: A CASE STUDY OF PAKISTAN
Authors: Dr. Shehla Tehseen
Published: December 2021

Pakistan is a democratic country in the region of South Asia, but it has been deprived of political backdrop from its independence from the British Empire in 1947, notably in the field of local self-government. Pakistan's history demonstrates that inconsistency in civilian norms hampered the establishment of a robust democratic culture at all levels of government. The military has repeatedly swallowed the civil-military political romance. Each military commander instituted local self-government; General Ayyub instituted the Basic Democratic System in his dictatorship, and General Zia instituted local government as well; their primary goal was to legitimate their own authority and that of the military. However, the decentralisation changes in Pakistan may be traced back to the last military takeover led by General Musharraf in 1999. Under General Musharraf's leadership, recent decentralisation measures in Pakistan have been examined in this article. We emphasise the most important features of this reform and examine its growth in the context of history to better recognize the probable causes for the current decentralisation of power. In Pakistan, the history of local government reforms is particularly intriguing as, on request of a non-representative centre, each of the top three reform efforts has been executed using a "top-down" strategy for the reform process. It should be noted that each of these reforms is an add-on to the broader constitutional reengineering agenda that is designed to centralise the political authority of a non-representative centre further. In these cases, we would propose that the design of local government reforms is endogenous rather than exogenous for centralization purposes of the non-representative centre. Pakistan's analysis aims to provide understanding into the good economics of why non-representative governments were keen to promote local decentralisation, which has been dismay formerly
EDUCATIONAL PLANNING AND POLICY MAKING IN PAKISTAN (FROM 1947 TO 1980)
Authors: Zeb-un-Nisa, Dr. Ghulam Mustafa, Anwar Ali
Published: December 2021

Pakistan appeared on the globe of the world as an independent country in 1947 after the British rule ended in India. At the time of independence, Pakistan inherited an educational system that was launched by a foreign government before hundred years ago. This system was established on economic, cultural, social, and political notions that were totally dissimilar from the ideologies of independent nations. During the colonial period, specific development in the education system has been observed. However, this development was mostly restricted to Indian areas. The areas consisted of Pakistan were surprisingly backward in all fields as well as in education. 85% of the population of Pakistan was illiterate at the time of independence. The literacy rate was much low in underdeveloped regions such as Baluchistan and the share of rural women in literacy rate was almost zero. A reviewing study of the history of educational planning and policymaking in Pakistan during the period of 1947 to 1980 was commenced which demonstrates that fixing of goals and targets, unsuccessfulness in the achievement of these goals, and fixing of new tasks with demonstrative willingness is an ongoing activity. The policymakers have been playing this game on countless public expenses from the past more than 70 years. Different forms of governments whether military or civilians, socialist or Islamic, elected or otherwise have done slight alterations in the style of playing of this game. The outcomes have been similar in all instances. The purpose of the study is to learn the salient features of educational planning and policies in Pakistan from 1947 to 1980. The analysis shows the lack of political commitment towards education or literacy. This paper recommends that the targets of educational policies can be acquired through the implementation of a proper mechanism for the execution and constant monitoring of these policies.
PAK-AFGHAN TIES A HISTORICAL OVERVIEW
Authors: Farhana Kosar
Published: December 2021

Tensions between Afghanistan and Pakistan have existed for a long time and can be traced back to five key factors: security interest considerations, cross-border ties and connectivity, geopolitical dynamics, national sovereignty concerns, and regional and international relations. These forces will have an influence on the long-term stability prospects in Afghanistan and the surrounding area if they work together. A tight eye will be kept on the battlefield, given the possibility of escalation following the withdrawal of the US and foreign forces. As the relationship between Afghanistan and Pakistan deteriorates, it is possible that any remaining hopes for a negotiated settlement would be jeopardised. Once the fighting has been brought to a halt or a new administration has been established, bilateral relations will have an influence on the security, political, and economic dynamics of the region throughout the medium to long term. Having a strong relationship with Pakistan can help to promote stability and progress. However, because of the hatred on both sides, which has been heightened by the conflict, the inverse consequence is more likely. The most promising path forward for Afghanistan and Pakistan in terms of expanding their cross-border connections for the benefit of regional peace and the well-being of their populations is to acknowledge and attempt to resolve one another's security and sovereignty concerns in a peaceful and constructive manner through dialogue.
IS THE SHANGHAI COOPERATION ORGANIZATION MAKING A “NATO OF THE EAST”?
Authors: Muhammad Naveed Akhtar ,Dr. Faisal Javaid
Published: December 2021

Shanghai Cooperation Organization (SCO) is the largest regional origination in which Russia and China are founding members and recently Iran’s bid for full membership has been approved during the 21st summit of the SCO. These countries are against American hegemony and covertly and overtly demonstrate their concerns. SCO has been conducting military exercises regularly since 2002. Improving Strategic partnership between China and Russia, the presence of Iran, and military exercises of the SCO are matters of concern for the West. Some western scholars labeled it as “NATO of the East” and assessed it as an emerging military bloc. According to official documents and statements, SCO is a political and security organization based on cooperation and partnership and follows a non-interference policy. Does SCO contain components of a military alliance? Is SCO a military bloc or on the way to becoming in the future? This paper evaluates the SCO according to the theoretical concept of a military alliance besides comparative analysis of the SCO with NATO.
INDIVIDUAL AND CONFLICT: A SOCIOLOGICAL ANALYSIS OF PERSONAL CHARACTERS LEADING TO CONFLICT FORMATION AMONG THE PAKHTUNS OF KHYBER PAKHTUNKHWA, PAKISTAN
Authors: Riaz Ahmad , Dr. Adnan Khan
Published: December 2021

Development of society and its inhabitants is negatively affected by prevailing conflicts. Although, enormous research and theoretical work regarding macro level factors leading to conflict formation is available, still, research is needed to investigate the problem at individual level. The current study aims at finding out personal characters resulting in conflict formation. For this cross sectional qualitative study, data were collected from participants through interview guide. As, totality of the personality characters of individual cannot be negative or anti-social, therefore, the current study aimed at finding out negatively interacting characters which frequently ends in conflict formation. The study found that, incongruous modes of interaction, egocentrism, bad attitude, negative personal tendencies, ideological differences, psychological problems, and personality disorder; were the most common characters of personality that not only had negative effects on cognitive abilities of individuals rather jolt negative energies in their behavior and led to conflict formation. Furthermore, the study suggests that many conflicting situations in our daily lives could be avoided if we leash these negative personality characters and keep focusing on reforming and redirecting our behavior. For this purpose, further research is needed to find out ways and techniques which could replace negative personality characters by positive ones to ensure peacebuilding.
New Silk Road Implications of Economic Development in Central Asia
Authors: Prof. Dr. Muhammad Ahmed Qadri , Sundus Qureshi
Published: December 2021

The New Silk Road (NSR), one of China's most ambitious economic plans, was unveiled by President Xi Jinping in 2013 and is intended to act as the Central Asian component of the Eurasian Belt and Road Initiative (Belt Road) (BRI). By enhancing and expanding China's security arc westward, as well as developing them as a transportation corridor connecting China to Europe, Beijing is able to consolidate its current economic investments while also launching new projects in Central Asia and South Asia, as well as attracting new investment from other countries. The NSR, touted by China as simply a development project, is loaded with wide-ranging security implications. China's infrastructure security and investment concerns in Central Asia are examined in this research, which examines the interplay between these two issues. China's non-state retaliation (NSR) in Central Asia is investigated in three ways: With its securitization push, the Silk Road Initiative not only consolidates the power of the Central Asian regimes; it also grants China an important position managing safeguards; and it allows the ultra-rich to move between the lure of Chinese investments and the appeasement of popular fears about China's growing influence. According to this report, NSR aid and investment from China has received an overall favourable reaction in the area, with some countries concerned about the consequences of the project on their sovereignty and security, as well as the promise of connection and prosperity (a "win-win" situation). A look at China's growing security and economic commitment in Central Asia and the tight Sino-Russian friendship, as well as the areas of collaboration and complementarity between the two countries, is included in the article's concluding paragraphs.
ROLE OF FEMALE PARLIAMENTARIANS IN POLITICAL AND SOCIAL CHANGE IN PAKISTAN
Authors: Nawaz Ahmed , Habiba Mushtaq , Jamil Ahmed
Published: December 2021

This article attempts to elucidate the female parliamentarian’s role in social and political change in Pakistan by looking at it through the lens of the country’s historical progress. With an emphasis on historical evolution and current situation, the article also discusses social constraints that have made it difficult for women to engage in the political system in the past. Women’s political engagement should be enhanced in the future, and an assessment of these concerns may produce some helpful ideas. In this study article, researchers have examined employing a qualitative research approach which is also called market research method that focuses on acquiring data through open-ended and conversational dialogue. These qualitative research approaches allow for in-depth and additional probing and questioning of respondents based on their responses, where the researchers also seek to understand their purpose and sentiments. The study also finds that Women’s political empowerment across the country is limited by social and cultural standards, as well as by their economic dependency on the male counterparts of their household. Women’s engagement is also limited by low literacy rates and the segregation of men and women in social positions. There will be no meaningful impact on women’s engagement in the public life particularly political life, until there is a progressive adjustment in societal standards, which should begin at the grassroots level and work its way up. For starters, women must be granted greater social and economic autonomy.
DOMESTIC PROBLEMS FACED BY FEMALE MINORITIES IN SOUTH EASTERN COUNTRIES SPECIFICALLY PAKISTAN
Authors: Komal Ahmed
Published: December 2021

This study is about domestic problems faced by female minorities in South Asian countries specifically Pakistan. The study focused on racial, caste and religious minorities, focused on domestic issues like forceful change of religion and other domestic problems. There is no disputing the reality that men are given preferential treatment over women in a variety of situations. The questionnaire of this research revealed some critical results regarding domestic problems faced by the female minorities in Pakistan. The research revealed that verbal violence is more dominant among the forms of domestic violence faced by minority women and that women do face these problems because they belong to a minority.
A CASE STUDY OF RADICALIZATION OF ISLAM IN PAKISTAN DURING AFGHAN JIHAD 1979-89
Authors: Masood Ahmed Riaz
Published: December 2021

Back in August 1947, Pakistan emerged as sixth Muslim populated country on the map of the world with the claim to spread the peaceful message of Islam throughout the world but during cold war 1947-91, when the Americans and Russians intervened in the decaying politics of Afghanistan, Pakistan also came forward to help its Muslim neighbor to ward off the Russians. Thus, this period encouraged the Taliban to form their government in Afghanistan and helped the Americans to push the Russians out of their country but such a move radicalized Islam in Pakistan. The country drifted into extremism though it was already slightly extremist but during Afghan Jihad the ruling elite and Military also move in that direction. It was after that period, the country adopted the Taliban version of Islam which brought inequality in society, it was that version of Islam which created gender inequality, it was that version of Islam which brought an end to religious freedom, it was that version of Islam which brought an end to the practice of tolerance, forbearing and forgiving, it was that version of Islam which says that Islam spread through the use of sword/force, it was that version of Islam which gave an identity to militant organizations and yes it was that version of Islam which gave birth to the evil of suicide bombings. This article will portray the period during Afghan Jihad which radicalized Islam in Pakistan and analyzes the causes for its acceptance in Pakistan and then suggest solutions to de-radicalize the existing version.
Transformation digitale et achat public : procédures dématérialisées, cas de l’Université Hassan II – Casablanca –
Authors: GHYATI Soufiane , KASBAOUI Tarik
Published: December 2021

La commande publique représente une part importante des dépenses publiques : entre 15% et 17% du PIB du Maroc. La dématérialisation de la procédure des marchés publics se présente comme seule et unique solution devant les entités publiques pour renforcer leur efficacité en termes d’engagements et d’émissions. La dématérialisation de la procédure des achats des Universités va permettre d’améliorer leur efficacité et à participer à l’atteinte des objectifs de bonne gouvernance dans la gestion de la chose publique.
Dans le cadre de cette recherche, nous allons adopter une méthode d’étude qualitative basée sur un entretien en profondeur. Cette étude aura comme objectif d’étudier la fonction des achats au sein de l’Université Hassan II – Casablanca et de proposer une démarche qui intègre la digitalisation comme étant une variable importante du développement de cette fonction. L’administration dudit guide au niveau de 19 établissements, nous a permis de collecter les réponses de 13 établissements, soit un taux de couverture de la population cible de 68,42%.
Đặc trưng truyền thuyết về các danh nhân văn hóa vùng Đồng bằng sông Cửu Long
Authors: Đỗ Thị Hồng Hạnh
Published: December 2021

Nội dung bài viết nêu lên những đặc điểm mang tính đặc trưng của cốt truyện và việc tổ chức các yếu tố tự sự của truyền thuyết về các danh nhân văn hóa vùng Đồng bằng sông Cửu Long. Việc xác định những đặc điểm mang tính đặc trưng của truyền thuyết về các danh nhân văn hóa vùng Đồng bằng sông Cửu Long được thực hiện bằng việc so sánh với các truyền thuyết cùng tiểu loại ở vùng Đồng bằng sông Hồng.
Análise linguística no contexto escolar em diferentes perspectivas
Authors: Pinton Francieli Matzenbacher , Volk Romário , Schmitt Rosana Maria
Published: December 2021

Esta coletânea busca reunir investigações que, em alguma medida, discutam questões relativas à análise linguística mesmo que, em algum momento, estejam mais próximas de um discurso de renovação gramatical. Nesse sentido, podemos entender os capítulos aqui reunidos como um mosaico teórico e metodológico que aponta caminhos diversificados quanto ao objeto da prática de análise linguística. Nessa esteira, os capítulos focalizam desde aspectos referentes aos saberes dos professores em formação inicial sobre a análise linguística até a sua recontextualização em materiais didáticos e documentos oficiais. As perspectivas são múltiplas, visto que os pesquisadores se posicionam de diferentes lugares teóricos e focalizam diferentes níveis de análise em suas reflexões.
Reverse Triage and People Whose Disabilities Render Them Dependent on Ventilators
Authors: Emmerich Nathan , McConville Pat
Published: December 2021

The COVID-19 pandemic has occasioned a great deal of ethical reflection both in general and on the issue of reverse triage; a practice that effectively reallocates resources from one patient to another on the basis of the latter having a more favourable clinical prognosis. This paper addresses a specific concern that has arisen in relation to such proposals: the potential reallocation of ventilators relied upon by disabled or chronically ill patients. This issue is examined via three morally parallel scenarios. First, the standard reallocation of a ventilator in accordance with reverse triage protocols; second, the reallocation of a personal ventilator from a chronically ill patient ordinarily reliant on it; and, third, the reallocation of a personal ventilator owned by a financially privileged individual but who is not ordinarily reliant on it. This paper suggests that whilst property rights cannot resolve these scenarios in a satisfactory manner, it may be possible to do so if we draw on the resources of phenomenology. However, in contradistinction to a recent paper on this topic (Reynolds et al. 2021), we argue that ethical claims to ventilators are not well grounded by the overly demanding notion that they are embodied objects. We suggest that the alternative phenomenological notion of homelikeness provides for a more plausible resolution of the issue. The personal ventilators of individuals who commonly rely upon them become part of their ordinary, everyday or homelike being. They are a necessary part of the continuation or maintenance of their basic state of health or wellbeing and the reallocation of such objects is unethical.
Keywords: Phenomenology, COVID-19, Pandemic, Triage, Reverse triage, Ventilation, Chronic illness, Allocation of resources
Fostering hope and resilience amidst intractable ethical dilemmas brought about by the COVID-19 pandemic
Authors: Alvarez Allen , Dyrnes Stabell Espen , Koksvik Gitte , Thorseth May
Published: December 2021

This special issue of Etikk i Praksis – Nordic Journal of Applied Ethics features four articles that address a number of urgent ethical issues that arise in the COVID-19 pandemic.
Acute viral myositis: case report
Authors: Pezzin Felipe Sarlo , Perovani Camila de Melo , Ribeiro Luana Marques , Pereira Julya Leite de Assis , Gratival Caroline Lopes , Leme Fabiana Penedo , Lee Soo Yang
Published: December 2021

Context: Benign Acute Childhood Myositis (BACM) is a self-limited syndrome of acute myalgia prevalent in calf with impaired walking after Upper Respiratory Tract Infection. This report analyze the clinical condition and investigation of BACM case, by medical record. Case report: C.L.F.A., male, 12 years, in use of clobazam, sodium divalproate, topiramate and lamotrigine, started low back pain. One day after, presented headache, fever and nasal congestion. Reported convulsive febrile episodes. At following morning received Upper Respiratory Tract Infection diagnoses. Next day, maintained symptoms and developed thrombocytopenia. Discharged due to suspicion of dengue. After 24 hours, returned with improved thrombocytopenia, also with leukopenia. At 5th day, started pain in lower limbs and impaired walking. Due to muscle symptoms worsening and increased creatinophosphokinase, hospital admission were indicated. Laboratory tests found increased in creatinekinase (10,180 U/L), CKMB (129,6 U/L), leukopenia (2800/mm3 ) and thrombocytopenia (174,000 / mm3 ). Anti-HIV, anti- leptospirosis, dengue, Chikungunya and anti-HCV tests resulted negative. At the 6th hospitalization day, he was discharged virtue of muscle symptoms, leukocytosis and creatinekinase levels favorable progression. Conclusions: BACM has excellent prognosis and self-limited course, so outpatient care is feasible. The diagnosis is clinical. If neurological deficits, modified urine tests and rash, or symptoms duration longer than one week, differential diagnoses must be researched. Measure creatinekinase is important if pain or walking disability after viral episode. Early intervention avoids complications.
Predictors of unfavorable outcome and in-hospital mortality after ischemic stroke
Authors: Boas Gustavo Di Lorenzo Villas , Tramonte Maiara Silva , Carvalho Ana Claudia Pires , Fornazari Ana Elisa Vayego , Minicucci Marcos , Modolo Gabriel Pinheiro , Ferreira Natalia Cristina , Lopes Laura Cardia Gomes , Bazan Rodrigo
Published: December 2021

Background: stroke is the second leading cause of death and disability worldwide. The most significant factors for early mortality are age, severity of stroke (NIH stroke scale), atrial fibrillation (AF) and hypertension. Objective: elucidate the factors correlated with unfavorable outcome and mortality after ischemic stroke. Design/Setting: retrospective descriptive study conducted at the Botucatu Medical School Hospital. Methods: this study included 515 stroke patients, aged at least 18, admitted to ICU and stroke-unit between January/2017-December/2018. Baseline data, comorbidities and risk factors were collected and relation to unfavorable outcome and in-hospital mortality were evaluated. Unfavorable outcome was defined as dependency (modified Rankin Scale mRs 4–5). Results: overall, in-hospital mortality rate was 15% (77) and unfavorable outcome 36.7% (189). The patients average age was 69.18±13.08, and NIHSS at admission 9.27±8.41. NIHSS at admission and pre-morbid mRs were independently associated with unfavorable outcome, as each NIHSS point was responsible for 22% outcome increase. Both higher NIHSS and AF were independently associated with in-hospital mortality, increasing the death risk 19% and 3.5 times respectively. Conclusion: the main factor associated with overall in-hospital mortality and unfavorable outcome was stroke severity.
Subacute combined degeneration of spinal cord vs Miller-Fisher syndrome: a diagnostic challenge
Authors: Silva Júnior Mário Luciano de Mélo , Souza Roberta Lorena de Farias , Vilanova Marcos Vinícius de Souza , Carvalho Marcos Holmes
Published: December 2021

Context: Ataxic syndromes in the emergency department have a vast differential diagnosis, including immune, nutritional, and other etiologies. Case report: Man, 67yo, alcoholic, but previously healthy, came to ED due to complaints of falls and progressive dysesthesia in lower limbs which started 7 days from admission. He denied other toxic exposures or infectious history, except covid-19 one month before the current symptoms. Physical examination revealed mild hoarseness, left hemipalate paresis, tactile and position sense hypoesthesia, no sensory level, absence of profound reflexes; right hypotonia, global ataxia, and he was unable to walk. Neuroaxis MRI was normal. CSF obtained at D10 had 2 lymphocytes/mm3, 96mg/dL of proteins and no other abnormalities. Hb=13g/ dL, VCM=103fL, B12=424pg/mL, LDH and homocysteine were high. Negative anti-HTLV and -transglutaminase; covid-19 rapid test was positive, but rt-PCR was negative. ENMG revealed moderate sensory-motor axonal polyneuropathy. We hypothesized that the main differential diagnoses were subacute combined degeneration of spinal cord (although high level of protein in CSF) and Miller-Fisher syndrome (although ophthalmoparesis was absent). Considering that there was no motor nor respiratory symptoms, we did not offer pulse therapy and opted for B12 vitamin replacement. The patient had a favorable response to therapies and was able to walk at two weeks of treatment. Conclusions: We did not define the etiology of this case, however, it is important to keep B12 deficiency in mind (even when it is into the lab reference range) and to pay attention to post-viral atypical manifestations, mostly in the context of the current covid-19 pandemic.
Evolution of hospitalizations due to TBI according to the etiology of trauma in SUS Brazil 2010 – 2019
Authors: Oberg Luciana Maria Capurro de Queiroz , Sousa Regina Marcia Cardoso de
Published: December 2021

Introduction: Traumatic brain injury (TBI) is the main determinant of morbidity, mortality and disability for trauma victims, being considered a serious public health problem because it mainly affects individuals of productive age. The etiology of trauma differs according to the age group affected: falls in age extremes and external causes – especially traffic accidents – in young people and adults, constituting the main mechanism of trauma as a whole. Recent studies show that the epidemiology of TBI in the United States is changing: falls have been ahead of traffic accidents as the main mechanism of trauma, especially in the age group above 85 years of age, accompanied by the general reduction in TBI due to traffic accidents. Objective: To describe the evolution of the incidence of hospitalizations due to TBI and trauma mechanisms in the SUS between 2010 and 2019. Methods: Descriptive, cross-sectional study that analyzed hospital morbidity due to TBI in Brazil and the mechanism of trauma, from 2010 to 2019. General hospitalization data were obtained from SIH/ SUS. The ICD10 codes used were those referring to TBI: “Fracture of the skull and bones of the face” and “Intracranial trauma”. Descriptive statistics were used for data analysis. Data were collected in February 2021. Results: There was an increase in the incidence of TBI in all age groups in the period studied. Traffic accidents, despite all prevention actions, remain an important etiology in young people, adults and the elderly. There is a significant increase in the incidence of TBI and falls in the elderly and very elderly population. Conclusion: When compared to the evolution of the TBI profile in the United States, there was also an increase in incidence and etiology “falls” in the elderly and very elderly in Brazil. However, traffic accidents still represent an expressive mechanism of trauma related to TBI.
The impact of epigenetics on the development of neurodegenerative diseases
Authors: Faria Gustavo Hugo de Souza
Published: December 2021

Introduction: Neurodegenerative diseases affect thousands of people in Brazil and have been increasing in frequency with the aging population. However, little is known about the molecular mechanisms and biomarkers of these diseases, which leads to a medical approach based on symptomatic and unresolving characteristics. Epigenetics, including DNA methylation, histone modifications, and changes in regulatory RNAs, emerges as a tool for prevention of neurodegenerative diseases. Objectives: To review studies that discuss the role of epigenetics in the development of neurodegenerative diseases. Methodology: This study involved an integrative review of papers published from 2016 to 2021 by searching PubMed and Scopus. Results: The studies showed that there is evidence that epigenetic mechanisms interfere with the development of major neurodegenerative diseases. Huntington’s disease presents an altered gene from birth, but transcriptional dysregulation is characteristic of the pathology that may be correlated to the age of disease onset in the cortex. In Parkinson’s disease dysregulation of expression of a specific protein is believed to play a central role in the disease and occurs through aberrant methylation that controls activation or suppression. In relation to Alzheimer’s disease, it has been found that deregulated DNA methylation and demethylation is linked to the onset and progression of the disease. In addition, these epigenetic factors are interfered with by diet, aging, and exercise. Conclusions: Investment in epigenetic studies is needed to understand possible markers of neurodegenerative diseases, for early diagnosis and the formation of epidrugs with the ability to treat.
The Non-motor Effects of Deep Brain Stimulation of the Subthalamic Nucleus in Patients with Motor Disorders Caused by Parkinson’s Disease
Authors: Oliveira Júnior Rocymar Rebouças , Lira Ana Carolina Soares de , Lemos Nilson Batista , Carvalho Lucas Sávio Fernandes , Guimarães Maria Júlia Plech , Correia Marialice Pinto Viana , Barroso Luciana Karla Viana
Published: December 2021

Introduction: Parkinson’s disease is a disease caused by the degeneration of dopaminergic neurons in the substantia nigra, and is characterized by a triad of symptoms: bradykinesia, muscle rigidity and rest tremors; which worsen progressively, leading the patient to resort to surgical treatment to ensure a better drug response. However, surgical intervention has proven to be efficient not only to alleviate Movement Disorders, but also to control the nonmotor symptoms of the disease. Objective: To evaluate the non-motor effects of Deep Brain Stimulation (DBS) in patients who do not respond adequately to drug treatment. Methods: This is a literature review conducted by searching the electronic databases Lilacs, Scielo, Medline and Pubmed from 2011 to 2021, using the descriptors “parkinsonism”, “deep brain stimulation”, “non-motor” and “depression”. Articles and specimens from the American and Brazilian literature on the topic were considered relevant. Results: The studies showed that patients who underwent the surgical procedure showed evolution of neurophysiological and psychosocial aspects, such as improved sleep quality, reduced risk of dementia, improved mood and minimized anxiety. In this sense, it is necessary to pay attention to the stage of Parkinson’s Disease evolution that the patient is in, in order to start the surgical treatment before it no longer has the expected expressive effects. Conclusion: It is expected, therefore, a significant improvement in the quality of life of patients undergoing PCT, which is not restricted to motor gains.
Hemorrhagic transformation predictors in ischemic stroke patients from a Stroke Unit
Authors: Abreu Fernanda Ferreira de , Mendez Vinícius Bessa , Silva Ivã Taiuan Fialho , Cajaíba Alice Monteiro Soares , Jesus Pedro Antonio Pereira de
Published: December 2021

Background: Hemorrhagic transformation (HT) is an aggravating factor to patients with ischemic stroke. For patients’ best care, it’s essential to know its predictors. Objective: To describe HT in patients with ischemic stroke. Design and setting: Prospective cohort with ischemic stroke patients from a Stroke Unit, admitted between 2017 to 2019. Methods: All patients performed a brain computer tomography (CT) scan on arrival and 24-hours later. Patients with or without HT were compared for predictors. Results: 363 patients were included, with a mean age of 63,14 (±13,92), 53,1% were male and 9,9% (n= 38) had HT. Thrombolysis didn’t increase the risk of HT [(55,3% vs 42,5%); p= 0,132]. Patients with atrial fibrillation [(31,6% vs 12,6%); p= 0,002], and cardioembolic etiology according with TOAST classification [(57,6% vs 21,7%); p< 0,001] had higher risk of HT. Patients with HT had lower ASPECTS scores on their initial CT [8 (6-9) vs 9 (8-10); p< 0,001] and higher NIHSS scores [12 (9-15) vs 8 (5-12); p< 0,001]. Cardioembolic strokes [OR= 4,67; (IC95% 2,01-10,84)] and higher NIHSS [OR= 1,11; (IC95% 1,01-1,22)] were independently associated with HT after multivariate adjustments, considering ASPECTS and thrombolysis. Conclusion: Cardioembolic etiology and higher NIHSS score were independently associated with HT. It’s essential to know HT predictors due to worse outcomes associated with its occurrence.
Relationship between cognitive performance and physical activity in community-dwelling older adults
Authors: Alves Aline Martins , Silva Luiza Alves da , Martins Tatiana Carvalho Reis , Luchesi Bruna Moretti
Published: December 2021

Introduction: The aging process can result in the decline of cognitive function. Some factors may be beneficial for cognitive functioning in aging, such as physical activity. Objective: To analyze the relationship between physical activity and cognitive performance in community-dwelling older adults. Methods: Cross-sectional and quantitative study, carried out in 2018/2019, with 491 older adults (≥60 years), registered in Primary Healthcare Units in Três Lagoas-MS. The older adults were divided into two groups: physically active (>150 minutes of moderate physical activity or >75 minutes of vigorous activity/week - n=320) and inactive (n=171), according to the International Physical Activity Questionnaire. The Mini-Mental State Examination (MMSE) was also applied. T and chi-square tests were used to analyze the relationship between variables. Results: The physically active group were mostly women (60.8%), with an average of 69.7±6.9 years of age and 4.2±3.5 years of schooling. In the inactive group, the majority were women (59.7%), with 71.4±8.2 years of age and 4.0±4.2 of schooling. The groups were similar in terms of sex and education, but the inactive group was older (p=0.029). The active older adults had a mean of 23.7±3.8 points in the MMSE, and the inactive group, 21.9±4.6, with a significant difference (p <0.000), ndicating that the active group had a better cognitive performance. Conclusion: There is a relationship between being physically active and having a better cognitive performance. Physical activity in old age is related to benefits in several areas and must be incorporated into public health promotion and disease prevention policies.
Gait disorders in the Autism Spectrum Disorder (ASD): an integrative review
Authors: Muniz Débora de Moura , Caliari Vitória de Ataide , Vasconcelos Ana Elisa Chaves de , Rodrigues Matheus Duarte , Medeiros Fabíola Lys de
Published: December 2021

Introduction: Human gait is defined by the sequence of repetitive movements of the lower limbs that leads the body forward, providing postural stability. In Austist Spectrum Disorder (ASD), in addition to social and linguistic impairment, this movement dynamic may be altered. Objectives: To characterize gait changes in individuals with ASD. Design and setting: Integrative review of the literature, University of Pernambuco, Recife. Methods: We reviewed articles indexed in the databases: MEDLINE/Pubmed, SciELO and Google Scholar. The descriptors “Autism Spectrum Disorder” and “Gait Disorders, Neurologic” were used, according to DeCS / MeSH. Articles in Portuguese and English that contemplated the objectives of the review, published between 2011-2021 were selected. Results: 13 articles were included. It was shown that children with ASD, compared to neurotypical (NT), showed atypical gait, using different strategies to load the body and mitigate the impact of movement. Alterations included: toe walking; increased hip flexion and stance phase; greater pelvic anteversion; reduced gait speed; shorter steps; greater asymmetry; difficulties walking in a straight line; less distribution of plantar pressure and wide-based gait. They also have greater variability in joint movement. Finally, we noticed that there is a scarcity of clinical studies that analyze biomechanical and neurophysiological data together, and a lack of uniformity in the methodological criteria.