bluuebunny/crossref_metadata_2025_split huggingface dataset:
How different is the Learning Environment of Public and Private Sector Medical Colleges in Lahore, Pakistan?
Authors: Shahzad Saadia , Gohar Wajid  
Published: March 2023

Background & Objective: Regular assessment of the Learning Environment (LE) of health professions education institutions is important for their continuous improvement and to keep the students motivated. Pakistan Medical & Dental Council (PM&DC) applies uniform standards of quality in all public and private sector medical colleges of the country. However, the learning environment of these colleges might be different due to differences in their geographic location, structure, utilization of resources, and modus operandi. This study was conducted to measure the learning environment in selected public and private sector medical colleges in the city of Lahore, Pakistan, using a pre validated instrument (Jhon Hopkins Learning Environment Scale).
Methods: This cross-sectional descriptive study was conducted on 3,400 medical students from six public and private sector medical colleges of Lahore, during November and December 2020. Data was collected through Google forms. Two stage cluster random sampling technique was used to draw the study sample. John Hopkins Learning Environment Scale (JHLES) was used for data collection.
Results: Overall JHLES mean score was 81.75 ±13.5. Public sector colleges had a significantly higher mean JHLES score (82.1) than private-sector colleges (81.1), with small effect size (0.083). Male students rated LE slightly higher than females (82.0 and 81.6 respectively).
Conclusion: JHLES a relatively simpler tool (28 items) than DREEM, can be used effectively in the context of Pakistani environment to measure the LE in medical colleges. Both, public and private sector colleges had high overall JHLES mean scores, with public sector colleges having a significantly higher score than private-sector colleges.
doi: https://doi.org/10.12669/pjms.39.3.6202
How to cite this: Shahzad S, Wajid G. How different is the Learning Environment of Public and Private Sector Medical Colleges in Lahore, Pakistan? Pak J Med Sci. 2023;39(3):757-763. doi: https://doi.org/10.12669/pjms.39.3.6202
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.
Genetic Polymorphism and serum levels of Insulin like Growth Factor-1 (Igf-1) in patients of rheumatoid arthritis
Authors: Fayyaz Iram , Khaliq Saba , Bano Farhat , Kaul Haiba 
Published: March 2023

Objectives: Insulin like growth factor-1(IGF-1), is a modulator of immunity and inflammation, it promotes the anabolic role of growth hormone (GH) on bone and skeletal tissue. Genetic polymorphism in IGF-1 gene is reported to affect the transcriptional efficiency affecting its serum level. In this study we aim: 1) To study the presence of 192bp polymorphism of IGF-1 gene in patients of rheumatoid arthritis (RA), 2) To study the association of 192 bp polymorphism of IGF-1 gene with serum IGF-1 levels and disease severity in patients of RA.
Methods: A cross-sectional study was carried out at University of Health Sciences (UHS), Lahore. Diagnosed RA cases who fulfilled the American College of Rheumatology (ACR) criteria were recruited from Fatima Memorial Hospital (FMH) and Behbud Rheumatology Clinics, Lahore during 2018–2019. Serum IGF-1 levels were determined by ELISA in blood samples of 200 RA patients and 200 healthy individuals. DNA was extracted and genetic polymorphism was determined.
Results: The serum IGF-1 level in RA group was significantly lower compared to healthy group. Our study shows presence of 192bp allele of IGF-1in 77% of the studied population. Carriers of 192bp allele of IGF-1 had a significantly higher serum level of IGF-1 as compared to non-carriers in the RA patients. Rheumatoid factor (RF) positive patients had a higher number of 192bp carriers in comparison to RF negative patients. Significant difference was also seen in severity of disease between carrier and non-carriers of 192bp allele with the disease being more severe in male carriers.
Conclusions: There is an association of IGF-1gene polymorphism with variation in serum IGF-1 levels and severity of RA.
doi: https://doi.org/10.12669/pjms.39.3.6561
How to cite this: Fayyaz I, Khaliq S, Bano F, Kaul H. Genetic Polymorphism and serum levels of Insulin Like Growth Factor-1 (Igf-1) in patients of rheumatoid arthritis. Pak J Med Sci. 2023;39(3):764-768. doi: https://doi.org/10.12669/pjms.39.3.6561
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.
Exploring areas of improvement in postnatal care services in a tertiary care hospital in Lahore
Authors: Mahmood Atiya , Eusaph Amna Zia , Javed Ayesha , Muzaffar Arooj 
Published: March 2023

Background and Objective: Poor postnatal care can increase morbidity and mortality. This study assessed the current deficiencies in quality of postnatal care provided to mothers in Lady Aitchison hospital, Lahore when compared to WHO standards and identifies the areas for quality improvement.
Methods: It is a descriptive cross-sectional study which employs quantitative method to collect and analyze the data. It was conducted to include ninety-six maternities attending the wards of Lady Aitchison Hospital, Lahore during January 2022 to February 2022. Consenting post-partum mothers were selected by random sampling and interviewed by using a structured proforma.
Results: Among 96 mothers, 56% were below 25 years of age, 39% had secondary education, with more than one child (71%) and 57% visited for the first time. Majority of mothers, were given medicine timely (82%) and found the attitude (85%) and information (83%) provided by the healthcare workers helpful. Their subjective satisfaction rate with staff was 90%. The main areas of concern were lack of proper examination guidelines and facilities, limited information to mothers regarding neonatal care and substandard interior of hospitals. The statistics on the detailed maternal and neonatal examination showed that it was left out in 30% to 50% patients. Information regarding the danger signs of mothers and neonates was not given in 69% and information on family planning was provided to only 28%. Contentment with the infrastructure of the hospital was subpar and it was suggested that the sanitary conditions of washrooms and the paraphernalia of the wards i.e., ACs and beds needed improvement.
Conclusions: This study suggests that in developing countries like Pakistan, majority of the patients were satisfied by the services of healthcare workers. The prime improvement area is the infra-structure of the hospital which can be upgraded to provide better quality facilities in terms of air-conditioning, washrooms and well-designed areas for extensive examination of breast, pelvis, abdomen and neonates. There is also need for introduction of standard guidelines for postnatal care.
doi: https://doi.org/10.12669/pjms.39.3.6780
How to cite this: Mahmood A, Eusaph AZ, Javed A, Muzaffar A. Exploring areas of improvement in postnatal care services in a tertiary care hospital in Lahore. Pak J Med Sci. 2023;39(3):732-736. doi: https://doi.org/10.12669/pjms.39.3.6780
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.
Natamycin versus natamycin combined with voriconazole in the treatment of fungal keratitis
Authors: Cai Jingjing , Yang Chengwen , Wei Qiuhong , Lian Huifang , An Lin , Zhang Rong 
Published: March 2023

Objective: To observe the therapeutic effect of natamycin combined with voriconazole in the treatment of fungal keratitis (FK).
Methods: This is a retrospective study. The subjects of this study were 64 patients with FK who were admitted to Baoding No.1 Central Hospital from February 2019 to July 2022. The enrolled patients were divided into control group (n= 32) and study group (n= 32) by the random number table method. The control group was treated with natamycin alone, and the study group was treated with natamycin combined with voriconazole. The total efficacy, time of disappearance of ocular symptoms, visual acuity level, keratitis severity score, corneal ulcer area, tear fungus index and incidence of adverse reactions were compared between the two groups.
Results: The total efficacy,of the study group was significantly higher than that of the control group. The disappearance time of corneal ulcer, photophobia, foreign body sensation and hypopyon in the study group was shorter than those in the control group. Keratitis severity score and (1,3)-β-D-glucan level in the study group were lower than those in the control group. The corneal ulcer area was narrowed in the study group than that of the control group, and the visual acuity level in the former group was higher than that of the latter group. Besides, there was no significant difference in the frequency of adverse reactions between the two groups.
Conclusion: Natamycin combined with voriconazole is safe and effective in the treatment of FK.
doi: https://doi.org/10.12669/pjms.39.3.6908
How to cite this: Cai J, Yang C, Wei Q, Lian H, An L, Zhang R. Natamycin versus natamycin combined with voriconazole in the treatment of fungal keratitis. Pak J Med Sci. 2023;39(3):775-779. doi: https://doi.org/10.12669/pjms.39.3.6908
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.
Effects of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) targeted combined chemotherapy on immune function, tumor markers and oxidative stress in patients with stage IV lung adenocarcinoma
Authors: Kun Yanxiao , Wu Jian , Chen Shaomu 
Published: March 2023

Objective: To investigate the effects of EGFR-TKI combined chemotherapy on immune function, tumor markers and oxidative stress in patients with stage-IV lung adenocarcinoma.
Methods: This retrospective observational study included 116 patients with stage-IV lung adenocarcinoma, treated in The First Affiliated Hospital of Soochow University from January 2021 to January 2022. According to the treatment records, 60 patients that received pemetrexed + cisplatin for four courses were set as a Control-group and 56 patients that received EGFR-TKI + pemetrexed + cisplatin for four courses were set as an Observation-group. Changes in immune function, tumor marker levels and oxidative stress level in the two groups were analyzed and compared.
Results: After the treatment, levels of CD3+, CD4+, IgG and IgM in the Control-group were significantly lower than those before the treatment. EGFR-TKI + pemetrexed + cisplatin resulted in levels of CD3+, CD4+, IgG and IgM higher than before the treatment, and compared to the Control-group (p<0.001). After the treatment, the levels of NSE, serum CEA, serum CA125, CYFEA21-1 in both groups were significantly lower than those before treatment, and lower in the Observation-group (p<0.001). After the treatment, VEGF and MMP9 levels in both groups were significantly lower than those before treatment, and markedly lower in the Observation-group (p<0.001).
Conclusion: Compared with systemic chemotherapy, EGFR-TKI targeted combined chemotherapy for stage-IV lung adenocarcinoma is associated with enhanced immune function of patients. It more effectively inhibits the growth and proliferation of tumor cells and reduces the level of oxidative stress.
doi: https://doi.org/10.12669/pjms.39.3.7397
How to cite this: Kun Y, Wu J, Chen S. Effects of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) targeted combined chemotherapy on immune function, tumor markers and oxidative stress in patients with stage IV lung adenocarcinoma. Pak J Med Sci. 2023;39(3):742-746. doi: https://doi.org/10.12669/pjms.39.3.7397
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.
The Effect of Government Policy Management on the Quality of Health Services
Authors: Rahmadhani Wulan , Laelatul Qomar Umi , Dorji Sangay 
Published: March 2023

Background: Quality of health services is a tool to measure the patient’s satisfaction with medical services in accordance with standard operating procedures and medical service standards. It is based on the potential of available resources, facilities, and infrastructure of Pusat Kesehatan Masyarakat (Puskesmas) or hospitals that are efficient, effective, safe, and in accordance with norms, ethics, law, as well as the socio-cultural environment while respecting and adapting to the capabilities and limitations of the government and society. Good quality of services in a health service affects the health service. This research aims to analyze, synthesize, summarize, and compare the results of studies about the influence of government policy management on the quality of health services in Puskesmas. Method: This literature review was conducted by searching the literature in Google Scholar, Prayer, and Garuda with the keywords of Government Policy, Health Service Management, and Quality of Health Services. This study reviewed 6 articles as reference sources. Results: This study showed the influence of government policy management on the quality of health services at Puskesmas. Conclusion: Policy management in a health service greatly influences the quality of health services and good service quality results in high patient satisfaction.
Systematic review of economic evaluations of varicella vaccination programmes
Authors: Anderson Robert , Kim Sungwook , Roberts Nia , Petrou Stavros 
Published: March 2023

Objectives
This study carried out a systematic literature review of economic evaluations of varicella vaccination programmes from the earliest publication to the present day, including programmes in the workplace and in special risk groups as well as universal childhood vaccination and catch up programmes.

Methods
Articles published from 1985 until 2022 were sourced from PubMed/Medline, Embase, Web of Science, NHSEED and Econlit. Eligible economic evaluations, which included posters and conference abstracts, were identified by two reviewers who scrutinised each other’s selections at both title and abstract and full report stages. The studies are described in terms of their methodological characteristics. Their results are aggregated by type of vaccination programme and the nature of the economic outcome.

Results
A total of 2575 articles were identified of which 79 qualified as economic evaluations. A total of 55 studies focused on universal childhood vaccination, 10 on the workplace and 14 on high risk groups. Twenty-seven studies reported estimates of incremental cost per quality-adjusted life year (QALY) gained, 16 reported benefit-cost ratios, 20 reported cost-effectiveness outcomes in terms of incremental cost per event or life saved and 16 reported cost-cost offset results. Most studies of universal childhood vaccination reported an increase in overall costs to health services, but often a reduction in cost from a societal perspective.

Conclusions
The evidence surrounding the cost-effectiveness of varicella vaccination programmes remains sparse with contrasting conclusions in some areas. Future research should particularly aim to encompass the impact of universal childhood vaccination programmes on herpes zoster among adults.
Синдром Яїл: проникаюче ножове поранення лицевого скелета: ілюстрований опис клінічного випадку і огляд літератури “Massaad J, Olszewski R. Jael’s syndrome: knife blade impacted in the facial skeleton: an illustrated case report and a review of literature
Authors: Vares Yan , Vares Yarema 
Published: March 2023

Мета: здійснити опис клінічного випадку проникаючого поранення, нанесеного за допомогою ножа, з подальшим його застряганням в структурах лицевого скелета
Опис випадку: ми здійснюємо опис вихідної ситуації, процесу видалення стороннього тіла та післяопераційного періоду за допомогою двовимірних та тривимірних зображень з комп’ютерних томограм, а також клінічних фотографій.
Висновок: ми описали історичні аспекти проникаючих ножових поранень лицевого скелета, звертаючи особливу увагу на біомеханіку таких ушкоджень, а також здійснили огляд літератури, що описує шляхи та наслідки лікування таких травм.
Svordomar och lärdomar
Authors: Pulls Sofia 
Published: March 2023

Swearing and Learning: The Importance of Swear Words in Ulf Stark’s Rymlingarna and Oskar Kroon’s Överallt och ingenstans
This study investigates the uses and functions of swear words in children’s literature, analyzing Ulf Stark’s Rymlingarna (The Runaways, 2018) and Oskar Kroon’s Överallt och ingenstans (Everywhere and Nowhere, 2020). In both novels there are characters swearing recurringly, even though swear words are usually not frequently used in literature for young children. A starting point for the article is that the swear words seem to be important in the stories, that the function is not only to underline emotions, or create realism, but also to contribute to the themes of the books. First, the functions of swearing in language and literature are presented, and similarities with functions of humor are pointed out. The study shows that the use of swear words affects both what is being told, and how; they contribute simultaneously to the aesthetics and pedagogy of the novels. Through swear words, characters and close relationships are portrayed. Norms are challenged, and swearing is sometimes part of gaining agency and creating a room of one’s own for the characters. This also means that swearing affects subjectivity and how different characters come to understand themselves and others in the world. Finally, the swear words can be seen as connected to the theme, which in both novels discusses how we can continue to live, through grief and loss of loved ones.
Electrophysiological activity from over the cerebellum and cerebrum during eye blink conditioning in human subjects
Authors: Todd Neil P. M. , Govender Sendhil , Keller Peter E. , Colebatch James G. 
Published: March 2023

AbstractWe report the results of an experiment in which electrophysiological activity was recorded from the human cerebellum and cerebrum in a sample of 14 healthy subjects before, during and after a classical eye blink conditioning procedure with an auditory tone as conditional stimulus and a maxillary nerve unconditional stimulus. The primary aim was to show changes in the cerebellum and cerebrum correlated with behavioral ocular responses. Electrodes recorded EMG and EOG at peri‐ocular sites, EEG from over the frontal eye‐fields and the electrocerebellogram (ECeG) from over the posterior fossa. Of the 14 subjects half strongly conditioned while the other half were resistant. We confirmed that conditionability was linked under our conditions to the personality dimension of extraversion‐introversion. Inhibition of cerebellar activity was shown prior to the conditioned response, as predicted by Albus (1971). However, pausing in high frequency ECeG and the appearance of a contingent negative variation (CNV) in both central leads occurred in all subjects. These led us to conclude that while conditioned cerebellar pausing may be necessary, it is not sufficient alone to produce overt behavioral conditioning, implying the existence of another central mechanism. The outcomes of this experiment indicate the potential value of the noninvasive electrophysiology of the cerebellum.
Crystal structure of tetrapropylammonium guanidinium 4,4′-sulfonyldibenzoate monohydrate, C27H44N4O7S
Authors: Lin Na , Sun Ruiqin , Li Xiaofang 
Published: March 2023

Abstract
C27H44N4O7S, monoclinic, P21/n (no. 14), a = 10.216(3) Å, b = 18.133(5) Å, c = 17.036(5) Å, β = 98.371(3)°, V = 3122.2(16) Å3, Z = 4, R
gt(F) = 0.0435, wR
ref(F
2) = 0.1333, T = 296(2) K.
Radiation fabrication of hybrid activated carbon and functionalized terpolymer hydrogel for sorption of Eu(III) and Sm(III) ions
Authors: Elbarbary Ahmed M. , Sharaf El-Deen S. E. A. , Abu Elgoud E. M. , Sharaf El-Deen G. E. 
Published: March 2023

Abstract
In this work, a hybrid composite of activated carbon (AC) functionalized with terpolymer hydrogel of polyvinyl alcohol/polyacrylamide/polyacrylic acid (PVA/PAAm/PAA) was prepared by γ-irradiation and used efficiently for sorption of Eu(III) and Sm(III) ions from aquatic solutions. Sewage sludge from the wastewater treatment plant was used to prepare AC, then activated by zinc chloride (ZnCl2) and thermal treatment at 550 °C. The modification of AC by functionalized terpolymer has successfully occurred mainly to limit its precipitation and to increase its adsorption capacity which allowed capable interaction with the metal ions. Different advanced techniques were used to investigate the structure and properties of (PVA/PAAm/PAA)/AC composite before and after the sorption process. Using 20 kGy is sufficient to get gel fraction of 87.5% and equilibrium swelling was 39.1 g/g. The (PVA/PAm/PAA)/AC composite hydrogel showed a pHpzc at pH ∼3. FTIR and EDS confirmed the successful integration of the functional groups and constituent elements of AC into terpolymer hydrogel components. XRD results confirmed the typical diffraction peaks of AC in the composite and the calculated average crystallite size was 167.4 nm. The SEM morphology of AC appeared as grains distributed well into the composite. The effect of synthesized AC, PVA/PAAm/PAA and (PVA/PAAm/PAA)/AC sorbents were tested to uptake of Eu(III) and Sm(III) ions. The highest uptake was noticed for (PVA/PAAm/PAA)/AC composite and it was selected for studying the parameters affecting the sorption process such as pH, shaking time, initial concentration, and adsorbent dosage. Results of the experimental data showed that Langmuir isotherm and Pseudo-second-order kinetic models fit well the sorption process of both Eu(III) and Sm(III) ions with maximum sorption capacities of 173.24 and 160.41 mg/g and uptake percentage of 82.3% and 83.4%, respectively at the optimum conditions of pH 4, 180 min, 100 mg/L metal concentration and 0.01 g adsorbent mass. The thermodynamic parameters indicated endothermic and spontaneous nature of the sorption process. Additionally, the as-prepared composite afford high selectivity and uptake capacity for Eu(III) and Sm(III) ions at pH 4 even in the presence of competing cations; Cd(II), Co(II), Sr(II) and Cs(I). The (PVA/PAAm/PAA)/AC composite was used efficiently as a unique and selective adsorbent for the sorption of Eu(III) and Sm(III) ions.
The Effect of E-Commerce on Grocery Store Choice and Retail Competition
Authors: Etcheverry Clara 
Published: March 2023

Abstract
E-commerce continues its expansion, and most retail groups have opened online distribution channels in the French grocery market. Using purchasing data, I develop a store choice model and a supply model to estimate the effect of the online distribution channel on consumer welfare and retail competition. E-commerce leads to a small decrease in consumer surplus. Furthermore, only online leaders obtain more market shares and profits while the majority of retailers globally get lower market shares and profits with e-commerce.