bluuebunny/crossref_metadata_2025_split huggingface dataset:
Etiologies and outcome of lower gastrointestinal bleeding in patients presenting to a tertiary care Children’s Hospital
Authors: Talib Muhammad Abu , Aziz Muhammad Tariq , Suleman Hassan , Khosa Ghazi Khan , Joya Saima Jabeen , Hussain Ibrar 
Published: January 2021

Objective: To determine etiology and outcome of children with lower gastrointestinal bleeding (LGIB).
Methods: This was a prospective study conducted at the Department of Pediatric Gastroenterology and Hepatology, Children’s Hospital and The Institute of Child’s Heath, Multan, Pakistan, from July 2019 to March 2020. A total of 148 cases presented with bleeding per rectum and underwent colonoscopy, were included. Children of both genders and aged three month to 15 years were included. Detailed history, clinical examination, laboratory studies, colonoscopy and histopathology were done in all cases. Study information like demographics, complaints, general clinical examination, colonoscopy and histopathological findings were recorded.
Results: Overall, mean age was noted to be 7.20±1.83 years. Abdominal pain was reported in 41 (27.7%), diarrhea 36 (24.3%), fever 12 (8.1%) and constipation in 4 (2.7%). Pallor was noted among 68 (45.9%), weight loss 39 (26.3%) and tachycardia 31 (20.9%). Colonoscopy revealed juvenile colonic / rectal polyps, infectious colitis and solitary rectal ulcer (SRU) as the most common etiologies found among 58 (39.2%), 20 (13.5%) and 19 (12.8%) cases respectively. Juvenile polyps and non-specific colitis were the commonest histopathological findings seen in 55 (37.2%) and 20 (13.5%) cases respectively. Colonoscopic polypectomy was used to remove all juvenile polyps.
Conclusion: LGIB is presentation of various underlying causes. Children with LGIB commonly present with abdominal pain. Juvenile polyps were the most frequent cause of LGIB among children flowed by non-specific colitis. Most of the children having LGIB were diagnosed and treated successfully, few are in remission and very few were found resistant to treatment.
doi: https://doi.org/10.12669/pjms.37.2.2676
How to cite this:Talib MA, Aziz MT, Suleman H, Khosa GK, Joya SJ, Hussain I. Etiologies and outcome of lower gastrointestinal bleeding in patients presenting to a tertiary care Children’s Hospital. Pak J Med Sci. 2021;37(2):556-560. doi: https://doi.org/10.12669/pjms.37.2.2676
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.
Comparison of within 7 Day All-Cause Mortality among HDU Patients with Modified Early Warning Score of ≥5 with those with Score of <5
Authors: Sahikh Majid Ahmed , Punshi Avinash , Talreja Mohan Lal , Rasheed Tazeen , Bader Nimrah , Zuberi Bader Faiyaz 
Published: January 2021

Objective: To compare 7-Day All-Cause Mortality among HDU Patients with Modified Early Warning Score of ≥5 with Those with Score of <5.
Methods: All patients of age more than 18 years, of either gender admitted in HDU of Medical Unit-II, CHK between September 2019 to February 2020 were included. MEWS was calculated for each patient at time of admission. Patients with MEWS score of ≥5 were allocated to Group-A and those with score of <5 were allocated to Group-B. Patients were followed for seven days and outcome status of alive, expired or discharged was noted.
Results: Total of 336 patients were selected out of which 168 patients was inducted in Group-A and 168 patients in Group-B. MEWS Score in patients who expired was significantly higher (Mdn=11) than in those who survived (Mdn=4), p <.001. 7-day mortality in Group-A was 62 (39.9%) while in Group-B was 40 (23.8%). ROC was plotted of MEWS Score for mortality, it showed significant area under curve of 68.4% (p <0.001, 95% CI = 0.62 to 0.75). MEWS Score of 3.5 showed sensitivity of 89.2% and specificity of 65%.
Conclusion: Our results show that MEWS has a positive trend to predict mortality. MEWS score of 3.5 is suggested cut off based on ROC in our study.
doi: https://doi.org/10.12669/pjms.37.2.2832
How to cite this:Shaikh MA, Punshi A, Talreja ML, Rasheed T, Bader N, Zuberi BF. Comparison of within 7 Day All-Cause Mortality among HDU Patients with Modified Early Warning Score of ≥5 with those with Score of <5. Pak J Med Sci. 2021;37(2):515-519. doi: https://doi.org/10.12669/pjms.37.2.2832
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.
Nurturing Grit among Medical Students
Authors: Mirza Tayyeba Iftikhar , Yasmeen Rahila , Mahboob Usman 
Published: January 2021

Objective: To identify the learning strategies used by the medical students with high Grit for design and implementation of a three months course, to assist the medical students having low Grit.
Methods: A mixed-method study with explanatory sequential design was followed by an intervention to improve Grit amongst first year students at Foundation University Medical College from March to August 2019. Non-probability convenience sampling was used in the Phase-I. In Phase-II, through purposive sampling, students with high score on GRIT were interviewed. The interview questions were validated and piloted for clarity. All interviews were recorded, transcribed verbatim, and thematic analysis was done. The themes generated were used to design an intervention, which was implemented as a part of the curriculum for less Gritty students to see whether it can enhance Grit in them.
Results: A total of 133 students participated out of which, 23(17%) had a high, whereas 10(7.5%) had a low level of Grit. Five themes generated from the transcripts, namely Planning, Metacognitive skills, Mastery learning, Cognitive strategies, and Self-regulation, that led the development of an intervention abbreviated as “RESET-P-GOALS”. A Wilcoxon signed-rank test showed that the intervention did elicit a statistically significant change in the Grit score in students having low Grit (Z = -2.8, p= 0.005).
Conclusion: Good planning, Mastery learning and self-regulation are the reasons for success of Gritty students. The learning strategies with the name “RESET-P- GOALS” are effective in enhancing Grit in students with less score on Grit.
doi: https://doi.org/10.12669/pjms.37.2.2999
How to cite this:Mirza TI, Yasmeen R, Mahboob U. Nurturing Grit among Medical Students. Pak J Med Sci. 2021;37(2):531-535. doi: https://doi.org/10.12669/pjms.37.2.2999
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.
Evaluation of risk factors for Suicide Attempts in Turkey’s East: A Five-Year Study
Authors: Börk Turgay , Türkoğlu Abdurrahim , Ateşçelik Metin , Tokgözlü Ömer 
Published: January 2021

Objectives: Suicide attempt has different risk factors for each community. In the study we aimed to reveal the causes of suicide attempt in Turkey’s Eastern part and to make suggestions to prevent suicide.
Methods: For this study, 130 patients who were admitted to the Emergency Department of the University Hospital due to suicide attempt between January 2013 and December 2017 were included. Our University Hospital is the largest hospital in the East of Turkey. The data were obtained from hospital records and files of judicial investigations. Clinical progress records were obtained from the hospital archive. Investigation files were received from local judicial units.
Results: Fifty six percent of the patients (n = 73) were female. 48% of female cases (n = 35) were married. There was major depressive disorder in 34% (n = 44) of the cases. Medicine taking was the most frequent suicide method with 63% (n = 82). The main reason for suicide was parental conflicts for female cases; and psychiatric and financial problems for males.
Conclusion: Family therapy for married individuals would reduce suicide attempts in females. Psychiatric history is an important risk factor and it should be ensured that these patients are followed up regularly by the health institutions and their relatives. To prevent drug abuse, there should not be too much medicine in homes. If medicine is available at home, it should be kept in a safer environment.
doi: https://doi.org/10.12669/pjms.37.2.3092
How to cite this:Bork T, Turkoglu A, Atescelik M, Tokgozlu O. Evaluation of risk factors for Suicide Attempts in Turkey’s East: A Five-Year Study. Pak J Med Sci. 2021;37(2):572-575. doi: https://doi.org/10.12669/pjms.37.2.3092
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.
Ingestion of Cylindrical Battery and Medical Treatment
Authors: KOŞAR Mehmet Nuri , GÖRGÜLÜ Özkan 
Published: January 2021

Due to their chemical properties, accidental or suicidal ingestion of batteries into the digestive system can cause fatal complications; Treatment should not be delayed and close monitoring is required. A 26-year-old male patient is treated by the psychiatry department with diagnoses of antisocial personality disorder and depressive adjustment disorder. He consulted with the complaint of ingesting cylindrical AA battery for suicidal purpose. In our case, the cylindrical AA battery in the duodenum was removed from the rectum at the end of the third day without any complications. However, the continuous movement of the cylindrical AA battery with lactulose treatment in the gastrointestinal tract and the support of this movement with abdominal radiographs can reduce the risk of fatal complications. When planning the battery treatment in the gastrointestinal tract, the location of the battery and whether it is mobile should be determined. While obstruction of oesophagus by batteries requires emergency surgical treatment, batteries that remained fixed in the stomach for longer than 48 hours need to be treated with surgical or endoscopic methods.
doi: https://doi.org/10.12669/pjms.37.2.3225
How to cite this:Kosar MN, Gorgulu O. Ingestion of Cylindrical Battery and Medical Treatment. Pak J Med Sci. 2021;37(2):595-597. doi: https://doi.org/10.12669/pjms.37.2.3225
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.
Predictive value of DWI-FLAIR Mismatch in patients with Ischemic Stroke and receiving Endovascular treatment beyond Time Window
Authors: Cao Shan , Dong Hui 
Published: January 2021

Objective: To investigate the efficacy and safety of endovascular treatment in patients having acute ischemic stroke with over-time window under DWI-FLAIR mismatch.
Methods: From January 2018 to January 2020, 80 patients who met the research criteria in the First Central Hospital of Baoding, China were selected. According to the time of onset, they were divided into test group and control group, with 40 cases in each group. Forty patients in the test group were beyond time window (6~24h) and the MRI showed a DWI-FLAIR mismatch. Forty patients in the control group were within the time window (< 6h). All patients received endovascular treatment (EVT). The mRS, NIHSS and infarct volume of patients in the test group were compared and analyzed before and 30 and 90 days after treatment, as well as the indicators of both groups of patients before and after treatment, to determine therapeutic effect in patients receiving EVT beyond time window. Meanwhile, the recanalization of the blood vessel and the incidence of cerebral hemorrhage of patients in both groups were compared to determine the safety in patients receiving EVT beyond time window under DWI-FLAIR mismatch.
Results: The mRS, NIHSS and infarct size in the test group were significantly improved before and 30 and 90 days after treatment (p<0.05). The test group showed no significant difference in mRS, NIHSS and other indicators when compared with the control group (p>0.05). There was no significant difference in the rate of recanalization of the blood vessel and intracranial hemorrhage after treatment between both groups (p>0.05).
Conclusion: DWI-FLAIR mismatch can be used as an objective imaging basis for intravascular interventional therapy in patients with stroke with over-time window and large vessel occlusion. It has the advantages of short examination time, non-invasiveness, no need for contrast agents, simple implementation, clear guidance.
doi: https://doi.org/10.12669/pjms.37.2.3293
How to cite this:Cao S, Dong H. Predictive value of DWI-FLAIR Mismatch in patients with Ischemic Stroke and receiving Endovascular treatment beyond Time Window. Pak J Med Sci. 2021;37(2):466-471. doi: https://doi.org/10.12669/pjms.37.2.3293
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.
Telemedicine: A New Frontier in Clinical Practice
Authors: Asad Munazza , . Nooresahar , Sabzwari Saniya R. 
Published: January 2021

The COVID-19 pandemic has highlighted the important role of telemedicine as a tool for safe healthcare delivery across the world. While its use was more common in the developed world, the developing world has also adopted this strategy. It is important to develop a clear process and contextual guidance for effective use of this strategy for better patient-doctor interaction and its role in teaching/learning of trainees.
doi: https://doi.org/10.12669/pjms.37.2.3592
How to cite this:Asad M, Nooresahar, Sabzwari SR. Telemedicine: A New Frontier in Clinical Practice. Pak J Med Sci. 2021;37(2):588-590. doi: https://doi.org/10.12669/pjms.37.2.3592
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.
Association of serum chemerin with calcium, alkaline phosphatase and bone mineral density in postmenopausal females
Authors: Tariq Saba , Tariq Sundus , Shahzad Muhammad 
Published: January 2021

Objectives: To investigate the association of serum chemerin with calcium, alkaline phosphatase and bone mineral density in postmenopausal non-osteoporotic and osteoporotic females.
Methods: This cross-section analysis was carried out at the orthopedic department of Madina Teaching Hospital, Faisalabad, Pakistan, in the year 2017-2019. Postmenopausal females were divided into two groups according to their bone mineral density (BMD). All osteoporotic females had a T-score of -2.5 or less. Data were analyzed on SPSS-24.
Results: A total of 140 women were included in our study (80 osteoporotic and 60 non-osteoporotic). Non significant difference in age and BMI was observed between osteoporotic and non-osteoporotic subjects (p=0.152) and (p=0.291) respectively. There was a significant difference found in total BMD, serum chemerin levels between osteoporotic and non-osteoporotic subjects p<0.001 in both parameters. No significant correlation of serum chemerin was found with serum calcium, serum alkaline phosphatase and BMD in postmenopausal osteoporotic females (p=0.907), (p=0.318) (p=0.664) respectively. A significant negative correlation was found between serum alkaline phosphatase levels and total BMD in postmenopausal osteoporotic females (p=- 0.039). Linear regression analysis of serum alkaline phosphatase levels with total BMD showed no association between BMD and serum alkaline phosphatase levels (p=0.869).
Conclusion: There is no association of serum chemerin with calcium, ALP and bone mineral density in non-osteoporotic and osteoporotic postmenopausal females.
doi: https://doi.org/10.12669/pjms.37.2.3907
How to cite this:Tariq S, Tariq S, Shahzad M. Association of serum chemerin with calcium, alkaline phosphatase and bone mineral density in postmenopausal females. Pak J Med Sci. 2021;37(2):384-388. doi: https://doi.org/10.12669/pjms.37.2.3907
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.
Burning of Brides in South Asia
Authors: Sultan Tehreem 
Published: January 2021

doi: https://doi.org/10.12669/pjms.37.2.4053
How to cite this: Sultan T. Burning of Brides in South Asia. Pak J Med Sci. 2021;37(2):608. doi: https://doi.org/10.12669/pjms.37.2.4053
Virtual orthopaedic teaching during COVID-19: Zooming around Scotland
Authors: MacDonald DRW , Neilly DW , McMillan TE , Stevenson IM ,   SCORE Collaborators,   On behalf of the SCottish Orthopaedic Research collaborativE (SCORE) @SCOREortho
Published: January 2021

Introduction The restrictions associated with the COVID-19 pandemic and lockdown have resulted in a switch from face-to-face formal teaching for Scottish orthopaedic trainees to virtual teaching. The aim of this study was to determine the availability and acceptability of this online teaching as reported by trainees themselves. Methods A 20-question web-based survey was distributed to orthopaedic trainees in all four training regions in Scotland. A total of 71 respondents completed the survey. Results The average amount of formal teaching available to trainees increased during the COVID-19 lockdown, with significantly more respondents stating that they received ≥4 hours of teaching per week ( p=0.012). The average amount of consultant-led teaching also increased since lockdown, with significantly more trainees saying they received 2–3 hours ( p=0.017) or ≥4 hours ( p<0.0001) of teaching per week. There was no significant difference in the proportion of teaching opportunities that respondents were able to attend before and during lockdown but the barriers to attending teaching changed. Online teaching was highly acceptable to trainees, with 94% of those surveyed rating teaching quality and relevance as 8, 9 or 10 out of 10. The vast majority (96%) of respondents felt that virtual teaching should continue to be a part of formal trainee teaching in their region. Conclusions The switch from face-to-face to online formal teaching since the COVID-19 pandemic has resulted in increased availability of formal teaching to Scottish orthopaedic trainees. The virtual teaching received has been highly acceptable to trainees.
Self-reported confidence and experience of dentists entering oral and maxillofacial dental core training
Authors: Ali Awais 
Published: January 2021

Introduction The aim of this study was to explore the experience and self-reported confidence of UK dentists before starting dental core training (DCT) roles in oral and maxillofacial surgery (OMFS). Methods An anonymous electronic voluntary questionnaire was distributed to all foundation dentists in the North West region. The survey was open to participants for two months, from August to September 2019. The data were analysed using Google Forms and Microsoft Excel®. Results A total of 20 respondents completed the survey. Participants reported some experience and exposure in OMFS in 85% of responses. Three-quarters (75%) of those surveyed were either ‘not very confident’ or ‘not confident at all’ about the upcoming role. All participants stated they would benefit from attending specific continuing professional development events or study days focusing on transitioning to an OMFS job in a hospital. Conclusions The self-reported confidence levels of North West dentists in performing general duties and practical elements of OMFS are low. Further targetted training is advised for DCTs who are transitioning from a dental to an OMFS role.
Factors related to pain management adequacy in patients receiving palliative care: data from a tertiary hospital in Indonesia
Authors: Shatri Hamzah , Agung Ratih Arianita , Abdullah Vera , Elita Dina , Putranto Rudi , Adli Mizanul , Irawan Cosphiadi 
Published: January 2021

BACKGROUND Adequate pain management must be applied to improve the quality of life, particularly in patients receiving palliative care. Thus, this study aimed to determine the factors related to pain management adequacy in patients receiving palliative care.
METHODS This cross-sectional study included all patients sent for consultation to the palliative care team complaining of pain in Cipto Mangunkusumo Hospital, Jakarta, Indonesia from 2016 to 2018. All data such as gender, age, employment status, disease type, primary cancer location, pain intensity, analgesic drug treatment duration, and the presence of anxiety and depression were retrieved from medical records. Pain management adequacy was evaluated using the pain management index. Logistic regression included all variables with p<0.25 related to pain management adequacyin bivariate analysis.
RESULTS Out of 175 patients with pain, 85.7% reported having adequate pain management. Pain was more adequately treated in patients with employment (p = 0.001), milder pain intensity (p<0.001), those using opioids (p<0.001), and those who did not experience anxiety (p = 0.05). Factors related to pain management adequacy were opioid use (OR = 3.23, 95% CI = 1.71–6.13) and milder pain (OR = 11.15, 95% CI = 3.89–31.99).
CONCLUSIONS Most of the patients received adequate pain management which related to opioid use and milder pain.
Acute pediatric peritoneal dialysis: impact of an opt-out model and adaptable methods in a hospital in Nigeria
Authors: Alao Michael Abel , Ibrahim Olayinka Rasheed , Abiola Olajide Olusegun , Gbadero Daniel Adedosu , Asinobi Adanze Onyenonachi 
Published: January 2021

BACKGROUND Despite efforts to scale peritoneal dialysis (PD) uptake, access is still limited in Sub-Saharan Africa, including Nigeria. Thus, this study evaluated access to PD, cost-effectiveness, complications, and in-hospital mortality rate following the adoption of a local opt-out model approach for all children with acute kidney injury (AKI) that required PD. METHODS This work was a retrospective review of 33 children with AKI that required dialysis between December 2014 and November 2016. PD was carried out using locally adaptable consumables in place of commercially produced consumables. All patients that required renal replacement therapy (RRT) were offered an option to opt-out irrespective of their financial status. Patients’ relevant data were retrieved from the case notes and analyzed. RESULTS The median age was 7 years (range 3–12). 23 patients (70%) were males. Of the 33 patients that required RRT, 29 had PD. The children had an access rate of 88% (95% CI = 76.77–99.03). The access rate was not related to gender (p = 1.000), age group (p = 0.240), or socioeconomic status (p = 0.755). Complications were pericatheter leakage of fluid (n = 7, 24%), catheter malfunction (n = 5, 17%), abdominal wall edema (n = 3, 10%), scrotal edema (n = 2, 7%), and peritonitis (n = 1, 3%). In-hospital mortality was 3/29 (10%; 95% CI = 2.2–27.3). Cost analysis revealed that the cost of consumables was reduced by 88.5%. CONCLUSIONS An opt-out model with the use of locally adaptable consumables improved PD access (88%) with a low in-hospital mortality rate.