bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation and surgical outcome of Adrenal Incidentalomas: Surgical Outcome of Adrenal Incidentalomas
Authors: Ali Mazhar , Biyabani Syed Raziuddin , Cowasji Zain , Aziz Wajahat 
Published: November 2023

Objective: To observe the presentation, radiological and endocrine evaluation, and management of incidentally discovered adrenal masses at our institution.
Study Design: Retrospective
Place and duration: Study was conducted at Agha Khan University Hospital Karachi from July 1988 and December 2011.
Methodology: Case records of patients undergoing adrenalectomy from July 1988 to December 2011 were reviewed. Patients with known or suspected adrenal disease prior to imaging were excluded. The clinical presentation, demographic data, preoperative workup and preoperative clinical diagnosis was reviewed and compared with the final histopathological diagnosis.
Results: Out of 56 patients undergoing adrenalectomy, 23 had an adrenal incidentalomas (AI) which includes 14 males and 9 females. The mean age was 40 (± 14) years. Mean size of the adrenal mass was 6 (± 6) cm. Incidenataloma was detected on ultrasound in 12 patients, CT scan in 10 patients, and MRI in 1 patient. Twenty patients (87 %,) underwent biochemical evaluation, including urinary Vanillylmandelic acid (VMA) level in 15, serum cortisol in 10 and aldosterone level in 7.
Conclusion: Complete metabolic workup in essential in all patients with incidentally detected adrenal mass. Although malignancy is a valid concern in >4cm adrenal mass, the possibility of subclinical functioning adrenal adenoma or pheochromocytoma should not be ignored.
Frequency of anemia in patients with pulmonary TB presenting at Nishtar Hospital Multan
Authors: Shahzad Alam khan  , Ramzan Faisal , Noshad javed  , Hamad Arshad  , Sadam Hussain  , Muhammad Usman Zaffar  
Published: November 2023

Objective: The present study aimed to determine the frequency of anemia in patients with pulmonary TB presenting at Nishtar Hospital Multan and its classification as per the severity and morphological characteristics.
Methods: This retrospective cross-sectional study was conducted at Nishtar Hospital Multan. A total of 109 TB patients were enrolled and underwent physical and systemic examination. Blood samples were collected to estimate complete blood counts (CBC), liver and renal function tests (LFT; RFT), serum albumin, and C - reactive protein (CRP) levels. Abdominal ultrasound was performed when suspected of any organomegaly. Hemoglobin was estimated using an automated analyzer (SYSMEX-SP100) and repeated manually among doubted cases. Before inclusion, written informed consent was obtained from all patients before inclusion, and the collected data was analyzed using SPSS version 22.0.
Results: The female majority (54%) in the studied sample, with a mean age of 38 ± 15.3 years, and most belonged to low socioeconomic status (80%). Moreover, 43% were from Multan, 30% from D.G. Khan, and the remaining were from Khanewal, Layyah, and Vehari districts. Anemia was found in 82.56% of the enrolled TB patients. Most patients were moderately weak (Hb < 10 g/dl > 7 g/dl), and microcytic anemia was found in more than 80% of the anemic patients. CRP level was raised in 70% of these patients, and there was hypoalbuminemia in 80%. Furthermore, females were more anemic than males.
Conclusion: In our study, anemia was prevalent in TB patients, specifically microcytic anemia. Hence, TB patients must be monitored for dietary deficiencies and inflammatory modulators to avoid such complications
Trend and Reasons of Women Towards the Choice for Place of Delivery: Evidence from Mics 2017-18 Punjab, Pakistan
Authors: Zeeshan Muhammad , Isaac Shahzad  , Shazia Hayat  
Published: November 2023

Objective: To assess the attitudes and reasons of women towards the choice for place of delivery as per the data from the Multiple Indicators Cluster Survey (MICS) 2017-18, Punjab, Pakistan.
Material and methods: Observational Study conducted at 36 districts of the Punjab, 2017-18A total of 53,840 households were drawn as the sample size from 2,692 sample clusters, out of which 1,893 were rural clusters and 799 were urban clusters. From 53,840 households, 52,765 households occupied and 51,660 were successfully interviewed. Therefore, the response rate was 97.9%. According to survey results, 79,510 women had been eligible for interview of age group 15-49 years. Out of which 74,010 women were interview successfully with the response rate 93.1%. Further, out of these 74,010 women, there were 26,980 women who had ever or currently married, and out of these women 15,656 women gave birth in the last two years. In our study, we considered the place of delivery as an outcome variable and wanted to identify the associated socio-demographic and socioeconomic characteristics that were expected to be responsible for shifting the trend from the public to the private sector for delivery. To check the association and for statistical testing of hypothesis, Chi-square test for association was applied. We also applied multinomial logistic regression to identify the predictors for the place of delivery by using SPSS. P-value ?0.05 was considered as significant.
Results: Majority of the women (43.5%) delivered their babies in the private sector while (29.7%) of women delivered their babies in public sector hospitals, and (26.4%) women prefered home delivery. In the comparison of area of residence, urban women compared to rural women were more likely to choose public sector hospitals for their deliveries OR=1.02 (0.94-1.09) 95% CI, p=0.000, for home deliveries OR=1.293 (1.154-1.45) 95% CI, p=0.000 and for other OR=2.341 (1.196-4.582)95% CI, p=0.013. In the comparison of regions of Punjab, the women of South and Central Punjab were more likely to choose private sector hospitals for delivery, OR=1/0.535=1.87 (0.478-0.600)95% CI, p=0.000 and OR=1/0.624=1.61 (0.564-0.690)95% CI, p=0.000, respectively. The women who get antenatal care had 2.84 times more chances, as compared to the women who did not get antenatal care visits, to deliver in the private sector OR=0.353 (0.213-0.538)95% CI, p=0.000. About the model fitting, chi-square value=3527.06, Cox & Snell=0.202 and p=0.000 suggested that the predictors in the model had a significant effect.
Conclusion: Overall women prefer to undergo childbirth process in private sector hospital while women of urban area prefer public sector hospital. It may be related to facilities present in private sector hospitals or it may due to the fact that public healthcare facilities are not accessible to everybody especially in rural areas. In modern era, still many women prefer home delivery.
Pattern of Factors Associated with Obesity in Young Adults of Ischemic Heart Disease
Authors: Tariq Abbas  , Badar  , Zarlish Qazi Muhammad , Momin Rasheed  , Kashif Ali Hashmi  , Hira  
Published: November 2023

Abstract:
Objectives: The objective of studying the pattern of factors associated with obesity in young adults with ischemic heart disease is to identify the various factors that contribute to the development of obesity in young adults that leads to ischemic heart disease in the population. By understanding the associated factors, healthcare providers can develop effective strategies for preventing and treating obesity in young adults with ischemic heart disease, which may ultimately help reduce their risk of heart disease and improve their overall health outcomes.
Methodology: To better understand the pattern of risk factors responsible for obesity in young adults, we have conducted a cross-sectional in outpatient department (OPD) of Ch. Pervaiz Elahi Institute of Cardiology Multan. A non-purposive sampling technique was used. We have measured height, weight, body mass index BMI and collected data about their lifestyle, hypertension, diabetes and smoking status.
Results: Out of 458 patients, after dichotomizing the BMI variable into >30 BMI as obese and <30 as non-obese, we studied the incidence of obese patients overall and the presence of different risk factors in the obese population. In the obese group, the significant risk factor in our sample population had either a sedentary lifestyle comprising 19.2% or Hypertension (19.6%).
Conclusions: It has been concluded from the study that sedentary lifestyle is the most common risk factors in obesity among young adults. The incidence of hypertension in young adults is also significant.
Comparison of Nebulized vs Systemic Corticosteroids for Management of Children Presenting with Acute Exacerbation of Asthma
Authors: Zaffar MUhammad Usman , Waqas Ahmad  , Nadeem Iqbal  
Published: November 2023

Objective: is to compare the effectiveness of nebulized and systemic corticosteroids for management of acute exacerbation of asthma in children.
Methodology: This randomized control trial was conducted at emergency department of Agha Khan University Hospital, Karachi in 6 months duration from 1st July 2021 to 30th December 2021. A total of 90 patients were emrolled in study and divided into two groups I and II. In group I nebulized corticosteroids were administered and in group II systemic corticosteroids were administered. Final outcomes were assessed after 2 weeks post treatment follow up.
Results: Comparison of disease reduction (pre-treatment) of both the groups was shown in table II. Oscillometric Resistances at 1st day, 7th day and 14th day were almost equal in both the groups, (p>0.010). The mean length of stay of group I and group II was 1.75±0.56 days and 3.62±1.44 days, respectively, (p<0.001). most of the patients of group I were satisfied as compare to group II, 42 (93.3%) and 34 (75.6%), respectively, (<0.001).
Conclusion: Use of nebulized steroids and systemic steroids can both be effective in the treatment of acute exacerbation of asthma, but their specific roles and benefits may vary depending on the individual patient's condition and the severity of the exacerbation. Specific outcomes of hospital stay and severity of disease are much better in inhaled steroids as compare to systemic steroids.
Influence of Timing of Surgery on Surgical Outcomes of Elderly Hip Fractures
Authors: Ahmad Umair , Muhammad Naqash Khan  , Gauhar Nawaz Khan  , Hassan Raza Khosa  , Syed Zohaib Haider  , Shahid Javed  
Published: November 2023

Objective: To determine the effect of timing of surgery on surgical outcomes of hip fractures in elderly patients.
Methods: This Cross Sectional study including 150 elderly patients who presented in Indus RTEH campus Muzaffargarh and underwent surgical management for hip fractures was conducted from 1st January-2021 to 30th Dec-2022. The patients were labeled to have early surgery if they underwent surgery within 24 hours of surgery and delayed surgery if they underwent surgery after 24 hours of fracture. Details regarding surgical procedure, duration of surgery and intraoperative blood loss was determined for each patient. The patients were followed for 30 days after surgery. Occurrence of pressure sores, cardiovascular events, implant complications was determined. 30-day operative mortality was also noted.
Results: Mean age of patients was 72.8±7.9 years in early and 74.3±8.2 years in delayed group. Majority patients were females with frequency of 70.6% (53) in early and 76% (57) in delayed group (p-value 0.67). Bed sores occurred in 1 (1.3%) patient in early group and in 5 (6.7%) patients in delayed group with p-value 0.09. UTI occurred in 4 (5.3%) patients in early group versus in 9 (12.0%) patients in delayed group (p-value 0.14). Length of stay was significantly prolonged in delayed group; 7.5±2.3 days versus 6.1±1.8 days in early group, p-value 0.001. 30 days mortality rate was 7 (9.3%) in early group versus 9 (12.0%) in delayed group, p-value 0.59.
Conclusion: Early surgical intervention in elderly patients with hip fractures is beneficial as it significantly lower the risk of post-operative complications and results in early discharge of patient from the hospital.
Relationship Between Social Media Use and Professional Identity Development Among Undergraduate Nursing Students
Authors: Hafsa bibi  , Victoria Samar  , Syed Azmat Hussain shah  , Irum Qureshi  , Sabiha Sarwar  , Farzana Parveen  
Published: November 2023

Objective: To assess the relationship between social media usage by undergraduate nursing students and the development of their professional identity.
Methodology: Cross-sectional study was conducted at people’s Nursing School, LUMHS, Jamshoro during the period of May 15,2023 to June 10,2023. A questionnaire was adopted form Muna Alharbi et.al, study conducted at Saudi Arabia, was distributed to 162 students to collect data. Descriptive analysis, including frequencies, percentages, and medians, was performed, along with non-parametric tests to examine relationships in the questions.
Results: Out of 162 participants, the majority had high or very high professional identity levels (48.8% and 37.0% respectively). Those who used social media for education had higher professional identity scores (p = 0.001), and participants with more years of study also had higher scores (p = 0.028). Hours of social media use (3 to 5.5 hours) were significantly related to professional identity scores (p=0.029).
Conclusions: Social media has a positive impact on the development of professional identity among undergraduate nursing students. However, nursing education has been slow to integrate social media into curricula. Students need guidance on using social media for professional growth.
Frequency of intraoperative hypotension after the induction of anesthesia in hypertensive patients with preoperative angiotensin converting enzyme inhibitors
Authors: Shuja Syed Zaidan , Lubna Naz  , Atique ur Rehman orakzai  , Muhammad Fahad Farooq  , Maqsood Ahmed Siddiqui  , Jawad Hameed  
Published: November 2023

Objective: is to evaluate the intraoperative hypotension after anesthesia induction in controlled hypertensive patients who have been taking ACE inhibitors preoperatively.
Methodology: Prospective study conducted at department of anesthesia and ICU Jinnah Postgraduate Medical Institute, Karachi, Pakistan from 1st march 2021 to 28th February 2022. Before the surgery, the patient's mean arterial pressure and blood pressure (systolic, diastolic) were recorded in the preoperative holding area. During the surgery, the primary anesthesia team maintained an intraoperative monitoring chart. After the surgery, patient was shifted to recovery room, patient was monitored for blood pressure, for at least 10 minutes after the shifting from operation theater.
Results: There were 73.1% males and 26.9% females, 57.7% patients had hypotension. The mean age, BMI and duration of anesthesia of the patients was 54.07±6.85 years, 26.52±4.45 kg/m2 and 82.19±3.16 minutes, respectively. There were 74.7% patients had hypotension and on antihypertensive drugs other than ACE inhibitor and hypotension was occurred in 74.5% of patients who are using ACE inhibitors as antihypertensive drugs (p>0.050).
Conclusion: Higher incidence of intraoperative hypotension in patients with controlled hypertension who are taking ACE (Angiotensin-Converting Enzyme) inhibitors. So, controlled hypertension with ACE inhibitors is a significant risk factor for intraoperative hypotension.
Keywords: Intraoperative hypotension, ACE inhibiotrs, Hypertensive, Anesthesia, Antihypertensive
Recensioner
Authors: Kuusela Tommy , Lövkrona Inger , Gustavsson Anders , Jönsson Håkan , Ternhag Gunnar , Svensson Birgitta , Sandgren Patrik , Steinrud Marie 
Published: November 2023

Recensioner av

Tora Wall: Folktrons väsen. Encyklopedi
Folktro. En besjälad värld. Huvudredaktörer Kurt Almqvist och Lotta Gröning
Kågeträskdagboken. En västerbottnisk dagbok 1891–1901 med kommentarer. Volym 2. Ann-CatrineEdlund (huvudredaktör), Lars-Erik Edlund & Ulf Lundström under medverkan av Birgitta Bjurman
Ulrica Söderlind: Cajsa Wargs kokkonst. Fyra gastronomer, mat, dryck och tillagning under svenskt 1700- tal
Gustaf Ankarcrona och bilden av Dalarna som svenskt ideal. Johan Knutsson (red.)
Manligt mode. En okänd historia. Ingrid Giertz-Mårtenson (red.)
Leif Runefelt: Några ögonblicks förundran. Marknaden för ambulerande underhållning i Sverige 1760–1880
Margareta Petersson: Kärlek, kvinnoroller och koloniala drömmar. Familjen Stephens livsöden på och bortom Huseby bruk
NEW PRODUCT DESIGN AS PART OF THE DIGITAL FACTORY CONCEPT
Authors: Regodić Dušan 
Published: November 2023

The concept of digital production represents the basis for the development of a digital production system, i.e. a digital factory. The digital factory represents the integration of the virtual and real factory. Inside the virtual factory, products, processes and resources are modeled on the basis of real data, which are then tested, improved and optimized through the application of digital production tools. Finally, when the results of the virtual factory are verified and all possible irregularities are removed, they can be applied in the real factory.
The primary goal of this paper is to present the process of designing a new product. The design process is an integral part of the modern digital factory concept. The concept requires full integration of product data, as well as systems for design, planning and production, including the design of technological processes.
The aim of this paper is to solve the problem of the budget coefficient of aerodynamic drag force of axisymmetric aircraft without wings. The problem is interesting because it provides a simple calculation of the axial aerodynamic coefficient of drag force for different airspeed. Ruling allows for easier comparison of the components of aerodynamic force coefficient of drag when changing airspeed and experimental values ​​from wind tunnel. The dependences of aerodynamic coefficients of aerodynamic parameters and shape aerodynamic configuration.The application of the proposed solutions will accelerate the flow of information theoretical researches aerodynamics of the aircraft. The accuracy in determining the values ​​of aerodynamic coefficients is one of the key factors for the assessment of flight "rapidly rotating" axisymmetric bodyes.
NEOLIBERAL INSTITUTIONALISM OF THE EUROPEAN CENTRAL BANK: AN ANALYSIS OF BANKING SUPERVISION REGULATION
Authors: Ristić Kristijan 
Published: November 2023

The contemporary world financial crisis is characterized by complexity in global effects, which has not been recorded in economic history so far. The crisis originated in the financial sphere, but it spread to the entire real sector and the world economy as a whole. The question is often asked: was the crisis orchestrated or the result of tectonic disturbances in the functioning of the modern neoliberal credit-market system. Entering into the analysis of the world crisis, it is indisputable that the imposed neoliberal and monetarist model experienced its complete collapse, which fundamentally shook the pillars of neoliberal capitalism. Neoliberalism "opened up" national economies and made them vulnerable to the penetration of Western capital, and unprecedented exploitation through the virtual clapboard and dollar, as national and world money without a real basis and cover. With worthless paper, everything was bought around the world and broke the "disobedient, Basically, it is about the creation of "peripheral states and economies in the interest of large financial capital.
In the paper, we analyze the scope of financial regulations, primarily banking supervision, with the aim of assessing possible limitations and effects as well as implications for the financial systems of countries on the way to European integration.
Optimized MobileNetV3: a deep learning-based Parkinson’s disease classification using fused images
Authors: Pechetti Sukanya , Rao Battula Srinivasa 
Published: November 2023

Background and Objective
Parkinson’s disease (PD) is a progressive neurological condition that manifests motor and non-motor symptoms. Early in the course of the disease, PD patients frequently experience vocal difficulties. In the beginning, preprocessing procedures were used with multi-focus image fusion to enhance the quality of input images. It is essential to diagnose and treat PD early to ensure that patients live healthy and productive lives.

Methods
Tremors, rigidity in the muscles, slow movement, difficulty balance, and other psychological symptoms are some of the disease’s symptoms. One of the critical mechanisms supporting PD identification and assessment is the dynamics of handwritten records. Several machine-learning techniques have been researched for the early detection of this disease. Yet the main problem with most of these manual feature extraction methods is their poor performance and accuracy.

Results
This cannot be acceptable when discovering such a chronic condition. For this purpose, a powerful deep learning model is suggested to help with the early diagnosis of Parkinson’s disease. Therefore, we proposed MobileNetV3-based classification. To enhance the classification performances even more, the MobileNetV3-based approach was optimized by the Improved Dwarf Mongoose Optimization algorithm (IDMO).

Conclusion
The Pyramid channel-based feature attention network (PCFAN) chooses the critical features. The efficiency of the approaches is tested using the PPMI and NTUA datasets. Our proposed approach obtains 99.34% accuracy, 98.53% sensitivity, 97.78% specificity, and 99.12% F-score compared to previous methods.
Exploring the Impact of Varying Nitrogen Levels and Cutting Management on Fodder Yield and Nutritional Quality in Fodder Pearlmillet (Pennisetum glaucum L.)
Authors: Shashikala T. , Naaiik Rvt. Balazzii , Kumar T. Sukruth 
Published: November 2023

A Field experiment was conducted at AICRP on Forage Crops and Utilization, ARI, Rajendranagar, Hyderabad during kharif 2021. The treatments consisted of four fodder pearl millet varieties (TSFB 15-4, TSFB 15-8 ,Moti bajra and Moti bajra ), two nitrogen levels (80 and 120 kg N ha-1) and two cutting management practices (C1: Two cuts: 1st at 60 DAS, 2nd cut at 50% flowering) (C2: Three cuts: 1st at 50 DAS, 2nd cut at 35 days after 1st cut and 3rd cut at 50% flowering) laid out in randomized block design with factorial concept, with Factor (A) as varieties, Factor (B) as nitrogen levels and Factor (C) as cutting management with three replications. The soil was sandy loam in texture with pH of 7.0 low in available nitrogen, medium in available phosphorus and available potassium. The results revealed that TSFB 15-8 recorded significantly higher green fodder (769.8 q ha-1) and dry fodder (191.7 q ha-1) yields. The variety TSFB 15-8 was also shown highest crude protein content (6.0%), crude protein yield (13.8 q ha-1) and higher nitrogen uptake (190.2 kg ha-1). Application of nitrogen 120 kg N ha-1 significantly recorded maximum green fodder yield (716.1 q ha-1),dry fodder yield,crude protein content (6.1%), crude protein yield (14.7 q ha-1) and nitrogen uptake (207.1kg ha-1). But as the nitrogen application increases the ADF and NDF contents decrease. The higher ADF and NDF contents recorded highest at 80 kg N ha-1 and lowest at 120 kg N ha-1. Three cuts for green fodder recorded highest crude protein content (6.5%), crude protein yield (13.9 q ha-1) and nitrogen uptake (228.0 kg ha-1) over two cuts for green fodder. Variety TSFB 15-8 with nitrogen level of 120 kg N ha-1 at C2 found suitable and economical for cultivation in southernTelangana zone.