bluuebunny/crossref_metadata_2025_split huggingface dataset:
A numerical solution by alternative Legendre polynomials on a model for novel coronavirus (COVID-19)
Authors: Hashemizadeh Elham , Ebadi Mohammad Ali 
Published: September 2020

AbstractCoronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. This paper provides a numerical solution for the mathematical model of the novel coronavirus by the application of alternative Legendre polynomials to find the transmissibility of COVID-19. The mathematical model of the present problem is a system of differential equations. The goal is to convert this system to an algebraic system by use of the useful property of alternative Legendre polynomials and collocation method that can be solved easily. We compare the results of this method with those of the Runge–Kutta method to show the efficiency of the proposed method.
Spatiotemporal variability and trends in rainfall and temperature in Alwero watershed, western Ethiopia
Authors: Alemayehu Arragaw , Maru Molla , Bewket Woldeamlak , Assen Mohammed 
Published: September 2020

Abstract
Climate analysis at relevant time scales is important for water resources management, agricultural planning, flood risk assessment, ecological modeling and climate change adaptation. This study analyses spatiotemporal variability and trends in rainfall and temperature in Alwero watershed, western Ethiopia. Our analysis is focused on describing spatial and temporal variability of rainfall in the study area including detection of trends, with no attempt at providing meteorological explanations to any of the patterns or trends. The study is based on gridded monthly rainfall and maximum and minimum temperature data series at a resolution of 4 × 4 km which were obtained from the National Meteorological Agency of Ethiopia for the period 1983–2016. The study area is represented by 558 points (each point representing 4 × 4 km area). Mean annual rainfall of the watershed is > 1600 mm. Annual, June–September (Kiremt), March–May (Belg) rainfall totals exhibit low inter-annual variability. Annual and October-February (Bega) rainfalls show statistically significant increasing trends at p = 0.01 level. May and November rainfall show statistically significant increasing trends at p = 0.01 level. March shows statistically significant decreasing trend at p = 0.1 level. The mean annual temperature of the watershed is 25 °C with standard deviation of 0.31 °C and coefficient of variation of 0.01 °C. Mean annual minimum and maximum temperatures show statistically non-significant decreasing trends. Bega season experienced statistically significant deceasing trend in the maximum temperature at p = 0.01 level. The year-to-year variability in the mean annual minimum and maximum temperatures showed that the 2000s is cooler than the preceding decades. Unlike our expectations, annual and seasonal rainfall totals showed increasing trends while maximum and minimum temperatures showed decreasing trends. Our results suggest that local level investigations such as this one are important in developing context-specific climate change adaptation and agricultural planning, instead of coarse-scale national level analysis guiding local level decisions.
Ramp lesions: a systematic review of MRI diagnostic accuracy and treatment efficacy
Authors: Moreira José , Almeida Margarida , Lunet Nuno , Gutierres Manuel 
Published: September 2020

Abstract
Purpose
We conducted a systematic review of the published literature to assess the accuracy of Magnetic Resonance Imaging (MRI) in establishing the presence of ramp lesions (RLs) in Anterior Cruciate Ligament (ACL) deficient knees and the clinical efficacy of the surgical repair of RLs.

Methods
A comprehensive search of the MEDLINE, Web of Science and Scopus databases was performed according to PRISMA guidelines. Studies assessing MRI diagnostic accuracy for RLs or the clinical effect of RL repair in participants with ACL injuries were included. Diagnostic accuracy measures were pooled and plotted in forest plots. Preoperative and at last follow-up treatment efficacy outcome measures were extracted and plotted in forest plots, for graphical comprehension.

Results
Sixteen studies met the criteria and were included. The diagnostic analysis showed a pooled sensitivity, specificity, positive and negative likelihood ratios of 65.1% (95% CI, 59.73 to 70.42), 91.6% (95% CI, 89.14 to 94.05), 2.91 (95% CI, 2.38–3.55) and 0.53 (95% CI, 0.44–0.64), respectively, with high heterogeneity (I2 above 80%) for all measures. Treatment analysis showed improved Lysholm Knee Score, IKDC score and laxity difference between the knees in all studies after meniscal suture repair. A separate analysis showed no differences between repair of smaller, stable, RLs with meniscal sutures and repair with abrasion and trephination only.

Conclusion
Although the results present considerable heterogeneity, MRI seems to demonstrate moderate accuracy in the diagnosis of RLs in patients with ACL tear and the surgical repair of RLs can be associated with improved overall outcomes.
Chest wall reconstruction with an anatomically designed 3-D printed titanium ribs and hemi-sternum implant
Authors: Goldsmith Ira , Evans Peter Llewelyn , Goodrum Heather , Warbrick-Smith James , Bragg Thomas 
Published: September 2020

Abstract
Background
Chest wall resection following wide local excision for bone tumor results in a large defect. Reconstructing this defect is complex and requires skeletal and soft tissue reconstruction. We describe the reconstruction of a large skeletal defect with a three-dimensional (3-D) printed custom-made, anatomically designed, titanium alloy ribs and hemi-sternum implant.

Method
To design the implant manual bone threshold segmentation was performed to create a 3-D virtual model of the patient’s chest and the tumor from sub-millimeter slice computed tomography (CT) scan data. We estimated the extent of resection needed to ensure tumor-free margins by growing the tumor by two cm all around.. We designed the implant using an anatomical image of the ribs and right hemi-sternum and then fabricated a 3D model of them in titanium metal using TiMG 1 powder bed fusion technology. At surgery the implant was slotted into the defect and sutured to the ribs laterally and hemi-sternum medially.

Results
Histology confirmed clear all around microscopic margins. Following surgery and at 18 month follow up the patient was asymptomatic with preserved quality of life and described no pain, localized tenderness or breathlessness. There was no displacement or paradoxical movement of the implant.

Conclusion
Our techniques of CT segmentation, editing, computer aided design of the implant and fabrication using laser printing of a custom-made anatomical titanium alloy chest wall ribs and hemi-sternum for reconstruction is feasible, safe and provides a satisfactory result. Hence, a patient specific 3-D printed titanium chest wall implant is another useful adjunct to the surgical approach for reconstructing large chest wall defects whilst preserving the anatomical shape, structure and function of the thorax.
Zebrafish Nedd8 facilitates ovarian development and the maintenance of female secondary sexual characteristics via suppression of androgen receptor activity
Authors: Yu Guangqing , Liu Xing , Zhang Dawei , Wang Jing , Ouyang Gang , Chen Zhu , Xiao Wuhan 
Published: September 2020

ABSTRACT
Nedd8 is a ubiquitin-like protein that covalently conjugates to target proteins through neddylation. In addition to cullin-RING ligases, neddylation also modifies non-cullin proteins to regulate protein activity, stability and localization. However, the roles of NEDD8 remain largely unknown in vivo. Here, we found that loss of nedd8 in female zebrafish led to defects in oogenesis, disrupted oocyte maturation and stimulated growth of the breeding tubercles (BTs) on the pectoral fins. The BTs are normally present in males, not females. However, the loss of one copy of ar can partially rescue the phenotypes displayed by nedd8-null female zebrafish. Further assays indicated that Nedd8 conjugates to Ar and Ar is neddylated at lysine 475 and lysine 862. Moreover, Nedd8 conjugation efficiently suppressed Ar transcriptional activity. Lysine 862 (K862) of Ar is the key site modified by neddylation to modulate Ar transcriptional activity. Thus, our results not only demonstrated that Nedd8 modulates ovarian maturation and the maintenance of female secondary sexual characteristics of female zebrafish in vivo, but also indicated that androgen signaling is strictly regulated by nedd8.
Risk of Lymph Node Metastasis and Feasibility of Endoscopic Treatment in Ulcerative Early Gastric Cancer
Authors: Ren Ming-Han , Qi Xing-Si , Chu Yu-Ning , Yu Ya-Nan , Chen Yun-Qing , Zhang Peng , Mao Tao , Tian Zi-Bin 
Published: September 2020

Abstract
Background
When the risk of lymph node metastasis (LNM) is considered minimal in patients with early gastric cancer (EGC), endoscopic submucosal dissection (ESD) is an effective alternative to radical resection. This study aims to estimate the feasibility of ESD for EGC with ulceration.

Patients and Methods
We retrospectively reviewed data from 691 patients who underwent gastrectomy for EGC with ulceration. Subsequently, a stratification system for lesions was created based on the expanded ESD criteria, and the associations between the subgroups and the rate of LNM were analyzed.

Results
LNM was confirmed in 16.5% (114/691) of patients. Univariate analysis demonstrated that age, sex, tumor size, macroscopic features, depth of invasion, tumor differentiation, Lauren type, lymphovascular invasion (LVI), and perineural invasion were associated with LNM. Multivariate analysis showed that LVI [odds ratio (OR) = 16.761, P < 0.001], SM1 invasion (OR = 2.159, P = 0.028), and SM2 invasion (OR = 3.230, P < 0.001) were independent risk factors for LNM. LNM occurred in undifferentiated mucosal tumors, with ulceration being 1.7% (2/116) when the lesion was smaller than 20 mm. Further stratification revealed that among lesions < 30 mm in size, undifferentiated tumors with SM1 invasion had a higher rate of LNM and a lower disease-free survival rate than differentiated tumors with SM1 invasion and tumors limited to the mucosal layer.

Conclusions
Depth of invasion and LVI were strongly associated with LNM in ulcerative EGC. Endoscopic resection may be applicable for undifferentiated mucosal ulcerative EGC < 30 mm in size, and additional investigation is needed to evaluate its safety.
Budesonide/Fomoterol in combination with Montelukast in the treatment of Bronchial Asthma
Authors: Dai Xiaoxia , Feng Tao , Zhang Xuejuan , Li Kaishu 
Published: September 2020

Objective: To analyze the clinical effect of budesonide/fomoterol combined with montelukast in the treatment of chronic persistent asthma.
Methods: Ninety-four patients with asthma who came to our hospital for treatment from April 2017 to April 2019 were randomly divided into control group and observation group, with 47 patients in each group. The control group was treated with budesonide/formoterol, and the observation group was treated with montelukast on the basis of the control group. The treatment effect of the two groups was observed and compared.
Results: The total efficacy rate of the observation group was significantly higher than that of the control group (P<0.05); the daytime symptom score and nighttime symptom score of the observation group were significantly higher than those of the control group (P<0.05). The pulmonary function indexes of the two groups after treatment were significantly higher than that before treatment, and the improvement of the observation group was more significant (P<0.05); the FeNO and EO levels of the observation group after treatment were superior to those of the control group, and the difference was statistically significant (P<0.05).
Conclusion: Budesonide/formoterol powder inhalation combined with montelukast can effectively improve the lung function, reduce the level of inflammatory factors, and accelerate the regression of symptoms in the treatment of chronic persistent asthma. It is worth clinical application.
doi: https://doi.org/10.12669/pjms.36.7.2018
How to cite this:Dai X, Feng T, Zhang X, Li K. Budesonide/Fomoterol in combination with Montelukast in the treatment of Bronchial Asthma. Pak J Med Sci. 2020;36(7):1688-1692. doi: https://doi.org/10.12669/pjms.36.7.2018
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
An epidemiological study of prevalence and comorbidity of non-clinical Dyslexia, Dysgraphia and Dyscalculia symptoms in Public and Private Schools of Pakistan
Authors: Ashraf Farzana , Najam Najma 
Published: September 2020

Objective: Dealing with Dyslexia, Dysgraphia and Dyscalculia symptoms is a major challenge for teachers and school psychologists while addressing students’ issues. The present study was designed to examine the prevalence and comorbidity of specific learning disabilities (SLD) symptoms such as dyslexia, dysgraphia and dyscalculia in public and private schools of Lahore, Pakistan.
Methods: This cross-sectional study was conducted in four schools of Lahore from June, 2019 to December 2019. We examined 666 participants (boys= 384, girls= 282) from two public (n=409) and two private (n=257) schools of Lahore with a mean age of 13 years (SD±1.44). Participants were assessed on Learning Disabilities Checklist (LDC) along with a demographic sheet. The data were analyzed by using descriptive statistics (frequencies and percentages) and inferential analyses of Chi Square test of association and Cohen’s Kappa by using SPSS version 24.
Results: Findings indicated that 39% participants showed SLD symptoms, 33% dyslexia, 48% dysgraphia and 45% dyscalculia symptoms. Significant co-morbidities were seen, such as 30% for dyslexia and dysgraphia symptoms, dyslexia and dyscalculia 26% and dysgraphia and dyscalculia as 36%. Variations in SLD, dyslexia, dysgraphia and dyscalculia symptoms were also seen across gender and schools with significant higher prevalence in public schools.
Conclusion: High prevalence of SLD symptoms and comorbidity in students was found which is alarming, particularly in public sector schools in Pakistan. SLD and dyslexia were higher for boys, whereas girls scored high on dysgraphia and dyscalculia. Therefore, there is great need of introducing screening measure of assessment of SLD and management strategies to deal with these issues.
doi: https://doi.org/10.12669/pjms.36.7.2486
How to cite this:Ashraf F, Najam N. An epidemiological study of prevalence and comorbidity of non-clinical Dyslexia, Dysgraphia and Dyscalculia symptoms in Public and Private Schools of Pakistan. Pak J Med Sci. 2020;36(7):1659-1663. doi: https://doi.org/10.12669/pjms.36.7.2486
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Subjective quality of multiple choice questions used in undergraduate courses in orthopedics and other specialties
Authors: Husnain Amina , Khan Asif , Khan Mohammad Umer , Hussain Faisal Nazeer 
Published: September 2020

Background and Objective: Multiple Choice Questions (MCQs) can sample broad domains of knowledge efficiently and reliably. The MCQs of lower order C1(Cognitive Level1=Recall of knowledge) do not fulfill this purpose and those of higher cognitive order C2 (Cognitive Level2=Interpret) &C3(Cognitive Level3=Analyze) are better at assessing the problem solving capabilities of the student. Every good educational activity must be supported by quality examination to complete the objectives of a curriculum. The objective of the study was to evaluate MCQs presently being used in internal examinations of medical colleges in Lahore.
Methods: Papers consisting of MCQs from Orthopedics other specialties were collected in June 2019 from different medical colleges of Lahore and reviewed by a senior medical teacher without blinding and without his knowing the scores the students had been awarded before. Question statement, clinical scenarios, options and other mistakes were assessed in each item on predetermined criteria. Cognitive level of the item was determined if it was asking for a recall/identify/ analyze response. The results were tabulated and compared in two groups i.e. Miscellaneous and Orthopedics.
Results: Most of the items(total=589) in both groups were of C1 cognitive level though Orthopedics (229) were slightly better (χ2 = 49.882 P-Value = 0.000 (Statistically Significant). Miscellaneous group (360) was better in quality in making clinical scenarios (χ2 = 29.952 P-Value = 0.000 (Statistically Significant) and writing a question statement without confusion. Options were better written in both groups. A good percentage of items needed to be corrected for mistakes in spellings, grammar and segregation into under graduate level.
Conclusions: The cognitive level of assessment tool s MCQs is quiet low in both groups especially clinical scenario construction can be improved. Mistakes in spellings, grammar and conceptual mediocrity is common in both groups.
doi: https://doi.org/10.12669/pjms.36.7.2864
How to cite this:Husnain A, Khan A, Khan MU, Hussain FN. Subjective quality of multiple choice questions used in undergraduate courses in orthopedics and other specialties. Pak J Med Sci. 2020;36(7):1618-1622. doi: https://doi.org/10.12669/pjms.36.7.2864
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Assessment of episodes of pneumonia and diarrhea in vaccinated and unvaccinated children under 60 months of age
Authors: Bham Shireen Qassim , Saeed Farhan , Khan Muhammad Athar , Khan Rashid Naseem 
Published: September 2020

Objective: To assess the episodes of pneumonia and diarrhea in vaccinated and unvaccinated children under 60 months of age.
Methods: This descriptive cross-sectional study was carried out at Darul Sehat Hospital and SESSI, Karachi in the Department of Pediatrics from 1st November 2018 to 3rd February 2019. An interview based questionnaire was administered and selection of participants was done by convenience sampling. Total of 196 participants were selected for interview.
Results: Total 196 participants were interviewed which included mothers of children between the age group of 1- 60 months. The questions were entered on the questionnaire after taking consent from the mothers. Among them, males were 98 (52.7%) and females were 88(47.3%). One hundred seventy two (88.7%) children were vaccinated for pneumococcal and rotavirus whereas unvaccinated children were 22(11.3%). There was an incidence of 66(63.5%) for loose watery diarrhea. In vaccinated children, grading of diarrhea was found to be severe cases as 30 (34.9%), moderate cases as 27 (31.4%) and mild cases as 29(33.7%). For unvaccinated children, severe cases were 12 (66.7%) and for mild and moderate cases were (11.1%) and 04(22.2%) respectively with p value of 0.035. As compared to their unvaccinated counterparts, the frequency of severe pneumonia was far less than cough and cold in vaccinated children (p<0.001)
Conclusion: There is significant reduction in cases of severe pneumonia in children receiving pneumococcal vaccine as compared to children receiving Rota vaccine there is moderate reduction in cases of severe diarrhea. The overall coverage of Pneumococcal and Rota vaccines was higher in our sample population. Efforts should be made to increase the awareness of Rotavirus vaccination in order to have better coverage in future.
doi: https://doi.org/10.12669/pjms.36.7.2996
How to cite this:Bham SQ, Saeed F, Khan MA, Khan RN. Assessment of episodes of pneumonia and diarrhea in vaccinated and unvaccinated children under 60 months of age. Pak J Med Sci. 2020;36(7):1596-1600. doi: https://doi.org/10.12669/pjms.36.7.2996
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Pakistani Student Nurses’ perceptions of their hospital’s health professionals’ attitudes and suggested ways to improve patient care – An untainted view
Authors: Safdar Sachal Aqeel , Zafar Humaira , Ahmad Jawwad , Qayyum Rashid , Nasim Sajid , Safdar Chaudhry Aqeel 
Published: September 2020

Background & Objectives: Feedback brings a fresh perspective and improvement in any organization. Health professionals (HPs) lose insight of the gaps in medical care. The views of student nurses can help improve systems. The objective of this study was to assess the views of our student nurses and how they perceive the way the doctors and HPs work in our hospital and comment on training, attitudes, care pathways, teamwork, and what needed to be improved.
Methods: A proforma based qualitative study was carried out at the Nurses’ Training Centre of PAF Hospital and Fazaia Medical College, Islamabad, from January to March 2020. After approval, a semi-structured proforma with open and closed ended questions was administered, in English and Urdu. The results were analyzed by comparative numbers and percentages for each question and descriptive responses were grouped in recurring themes and analyzed for content and their constructive value.
Results: Out of 85 nursing cadets, the proforma could be administered to 61(M=38(62.3%) and F=23(37.7%). Most were FSc with 26% graduates. Majority of the female students’ main reason for joining was to serve humanity, unlike most males. According to gender many responses were interestingly different. Majority of females thought male doctors were better (86%). Only 36% said the doctors were sincere in care of patients. Most thought that we needed to improve patient counseling. Most thought the seniors treated them unfairly, but bullying was negligible. They wanted the senior HPs to improve their attitudes and ensure adequate equipment in the wards. They were worried about personal security from patients and relatives. Dedicated mental health services to deal with stress of witnessing every day misery and death was suggested.
Conclusions: Doctors need to improve their counseling skills and should talk more to the patients and their relatives. They should acknowledge the nursing students and improve teamwork. Belittling them in front of others harms their self-efficacy. Simple corrections like punctuality, ownership of their patients and improvement of equipment and systems can improve patient care.
doi: https://doi.org/10.12669/pjms.36.7.3110
How to cite this:Safdar SA, Zafar H, Ahmad J, Qayyum R, Naseem S, Safdar CA. Pakistani Student Nurses’ perceptions of their hospital’s health professionals’ attitudes and suggested ways to improve patient care – An untainted view. Pak J Med Sci. 2020;36(7):1671-1677. doi: https://doi.org/10.12669/pjms.36.7.3110
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.