bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Survey of Growth Hormone Stimulation Test Efficacy for Workup of Short Stature in a Referral Laboratory
Authors: Munir Muhammad Usman , Aamir Muhammad , Haroon Zujaja Hina , Kirmani Sobia Irum , Yasir Afshan , Habib Hunain 
Published: May 2023

Objective: To assess growth hormone (GH) stimulation test efficacy in short stature workup for establishing GH deficiency.
Study Design: Cross-sectional survey.
Place and Duration of Study: Diagnostic Endocrine Section, Department of Chemical Pathology & Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, from Aug 2020 to Jan 2021.
Methodology: The study was conducted on 129 individuals aged 2-16 years. History, axiological data and biochemical parameters were assessed to establish GH deficiency for short stature workup.
Results: Out of 129 individuals, 76(59%) boys and 53(41%) girls reported GH stimulation tests. 81(62.3%) children were in <3rd percentile, 29(22.3%) in <5th percentile, 9(6.9%) in <10th percentile and 5(3.8%) in <25th percentile. Among the group with bone age difference >2 years, 34(82.9%) fell in <3rd percentile. GH Stimulation test post-Levo Dopa was performed in 102(78.46%) patients. 49(37.4%) patients responded inadequately to the GH stimulation test. The adequate response to the GH Stimulation test improved as the percentile declined from the 50th to the 3rd percentile.
Conclusion: GH stimulation test results can only partially rely upon though their importance remains in combination with other short-stature workup parameters for ruling out growth hormone deficiency.
Clinical Association of Thyroid Eye Disease with Disease Severity and Thyroid Functional Status-an Experience of a Tertiary Care Hospital, Karachi
Authors: Rani Bharta , Ahsan Tasnim , Aijaz Wasfa , Imran Paras , Fouzia Qasim Saeeda , Jabeen Rukhshanda 
Published: May 2023

Objectives: To determine the occurrence and severity of thyroid eye disease regarding thyroid function in patients with autoimmune thyroid disease (AITD).
Study Design: Cross-sectional study.
Place and Duration of Study: Endocrinology Clinics, Jinnah Postgraduate Medical Centre (JPMC) and Medicell Institute of Diabetes Endocrinology & Metabolism (MIDEM) Karachi Pakistan, from Jan to Dec 2020.
Methodology: Patients with AITD or the presence of eye disease were included in the study. Socio-demographic, clinical and laboratory parameters, including thyroid function tests (TFTs), thyroid autoantibodies (TRAb, Anti-TPO, Anti-Tg), presence or absence of eye disease and its severity according to NOSPECS, were documented on a predefined proforma.
Results: A total of 220 patients with a mean age of 35.58±13.52 years and female predominance were included. Hyperthyroid, Hypothyroid and Euthyroid states were found in 125(56.82%), 43(19.5%) and 6(2.7%) of patients, respectively. Eye disease was found in 59(26.81%) patients. The mean NOSPECS score for patients with Grave’s Orbitopathy (GO) for males was 2.56±1.08, and for females, 2.59±1.01. Females had a greater number of TED-related signs and symptoms as compared to men (p=0.01). NOSPECS severity score of TED significantly correlated with fluctuating TFTs and overactive thyroid state (p<0.0001).
Conclusion: Patients with TED commonly presented with proptosis, lid retraction, and restricted movements. The severity of GO was significantly related to older age, female gender, smoking, fluctuating TFTs and hyperthyroidism. Endocrinologists and Ophthalmologists should both work in collaboration for appropriate management.
Unmasking of Pre-Existent Hyperglycemia and its Association with Ventilation in COVID-19 Patients: Experience at a Tertiary Care Hospital
Authors: Ali Waqar , Malik Uzma , Waheed Khadija , Khalid Usman , Arshad Waqas , Fatima Anam 
Published: May 2023

Objective: To determine the relationship between pre-existent hyperglycemia among patients with COVID-19 pneumonia requiring oxygen supplementation.
Study Design: Cross-sectional study
Place and Duration of Study: COVID-19 isolation wards, High Dependency Units, and Intensive Care Units of Mayo Hospital Lahore Pakistan, from Apr to May 2021.
Methodology: Eighty-one patients with hyperglycemia but without a prior diagnosis of diabetes mellitus were selected for this study. The data was collected from COVID PCR positive patients admitted to the isolation ward and intensive care unit at Mayo Hospital, Lahore. All the patients admitted during a 2-month duration from April to May 2021.
Results: A Total of 81 patients were included, of which 54(66.7%) were males. On the basis of HbA1c, 68(84%), 12(14.8%) and 1 (1.2%) patient(s) were diagnosed diabetic, pre-diabetic and non-diabetic respectively. Of the four patients requiring mechanical ventilation, 3(75%) were diabetic, and 1(25%) was pre-diabetic. Of patients who required non-invasive ventilation, 68(84.4%), 12(14.2%) and 1(1.3%) were diabetic, pre-diabetic and non-diabetic, respectively.
Conclusion: There is a significant burden of undiagnosed diabetes mellitus and pre-diabetes among patients with severe COVID-19 who require oxygen supplementation or admission to high-dependency units. Therefore, all patients should undergo thorough testing to exclude underlying diabetes mellitus.
Impact of Thymic Response in COVID-19 Pneumonia on Disease Severity and Mortality-As Assessed on CT-Chest
Authors: Zafar Saerah Iffat , Nasir Hina , Slehria Atiqur Rehman , Zafar Nadeem , Shahiryar Alina 
Published: May 2023

Objective: To determine the effect of thymic response to COVID-19 pneumonia on imaging and its impact on disease severity and outcome.
Study Design: Cross-sectional study.
Place and Duration of Study: Armed Forces Institute of Radiology and Imaging (AFIRI), Rawalpindi Pakistan, from Mar to Jul 2020.
Methodology: A total of 1620 COVID-19 patients above the age of 18, of either gender, were included in the study. Their findings on High-Resolution CT (HRCT) chest were recorded and graded according to the CT severity score (CTSS) out of a total of 40; less than or equal to 19 was taken as mild while >20 scores were considered as severe disease. The thymic response was assessed by imaging appearance on CT and was graded from 0-3 as follows: fatty, predominantly fatty, mixed density (fat and soft density), and soft density. Fatty replacement implied thymic involution, while soft density depicted a reactivation of thymic tissue after a disease process depictive adequate thymic response.
Results: A significant difference in thymic response was observed in patients of different age groups (p<0.001), with the younger age group demonstrating thymic reactivation/ response in the majority (170/244, 69.7%). CT severity score and mortality were significantly higher in older patients demonstrating poor thymic response to COVID pneumonia.
Conclusion: Response of the thymus to acute viral infection by Sars COVID-19 is impaired as age progresses; this accounts for greater disease severity, morbidity and mortality in older patients.
Development and Validation of Caregiver Social Isolation Scale
Authors: Shafiq Sameera , Anwaar ul Mustafa Muhammad 
Published: May 2023

Objective: To develop an indigenous Caregiver Social Isolation Scale (CSIS) in Urdu for caregivers of mental and physical disorders in Pakistan.
Study Design: Mixed method study.
Place and Duration of Study: Department of Psychology, University of Gujrat, Pakistan, from Jan to Jun 2021.
Methodology: An item pool of 48 was generated based on a thematic analysis of structured interviews with six experts and nine caregivers. The content validity was evaluated by three PhDs in Psychology and two Physicians. The reliability calculated on thirty participants for a tryout was 0.95. Item total correlation of item tool was in the acceptable range. A pilot study was done on three hundred individuals. The value of the KMO was 0.952, which showed the adequacy of the data, with the value of Bartlett’s test significant. No item was deducted. The reliability of 48 items on 300 individuals was 0.976, with two factors. First, for the validity of CSIS, data was collected from 120 individuals with standardized Ryff’s psychological well-being scale, Scale of Social Support and Delong Loneliness Scale. Second, confirmatory factor analysis was conducted on 200 caregivers of children with cleft lip and palate.
Results: Exploratory factor analysis yielded two factors, mental agony and lack of social cohesion, with 48 items. Model fit indices of CFA on caregivers......
Conclusion: CSIS is a reliable and valid scale for assessing the social isolation experiences of caregivers of either mental or physical diseases in Urdu.Keywords: Cleft lip, Cleft palate, Caregiver social isolation scale, Exploratory factor analysis.
Comparison of the Diagnostic Accuracy of Doppler Cerebroplacental Ratio Versus Standard Fetal Biometry for Fetal Growth Restriction
Authors: Aziz Sadaf , Humayun Pareesae , Altaf Mariam , Khan Yasser , Andrabi Syed Atif Hussain , Aziz Mubashrah 
Published: May 2023

Objective: To assess the diagnostic accuracy of the Doppler Cerebroplacental ratio for fetal growth restriction keeping fetal biometry as the reference standard.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Radiology, Combined Military Hospital, Multan Pakistan, from May to Oct 2020.
Methodology: Two hundred and fifty-six-singleton pregnancies ≥ 30 weeks were included and underwent fetal biometry, including estimated fetal weight (EFW) by trans-abdominal ultrasound. The umbilical artery and middle cerebral artery resistive indices were evaluated using Doppler ultrasound, and Cerebroplacental ratio (CPR) was calculated. The presence or absence of fetal growth restriction (FGR) was noted using cut-off EFW of 10th centile and CPR of 1.0.
Results: Cerebroplacental ratio showed FGR in 145(56.64%) patients. Fetal biometry showed FGR in 141 (55.08%) patients,whereas 115(44.92%) patients revealed none. Of 145 CPR-positive patients, 127(87%) were true positive, while 18(12%) were false positive. Among 111 CPR-negative patients, 14(0.12%) were false negative, while 97(87%) were true negative. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the Cerebroplacental ratio were 90.07%, 84.35%, 87.59%, 87.39% and 87.50%, respectively.
Conclusions: Doppler Cerebroplacental ratio is sensitive for diagnosing fetal growth restriction; however, its role as a stand alone test needs further evaluation and may be enhanced with other tools such as estimated fetal weight.
Neutrophil Lymphocyte Ratio as Screening Tool for Neonatal Sepsis in Developing Countries
Authors: Naseer Nauman , Sheikh Taimur Khalil , Zulfiqar Sughra , Bashir Huma , Haroon Sadaf , Jahangir Junaid 
Published: May 2023

Objective: to recognize an alternate method for screening neonatal sepsis in patients while considering the sensitivity and accuracy of the diagnosis.
Study Design: Cross sectional study.
Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Jun to Dec 2021.
Methodology: Patients admitted to the Neonatal Intensive Care Unit of the Combined Military Hospital were included in the study. Demographic data, including age, weight, gender, and gestational age, were recorded. In addition, a statistical comparison of total leucocyte count, absolute neutrophil and lymphocyte counts, neutrophil-lymphocyte ratio, and C-reactive protein test was carried out for the cases and controls.
Results: It was evident from the results that a significant correlation between the neutrophil-lymphocyte ratio and neonatal sepsis exists. The mean NLR in non-septic individuals was (1.8±1.3) and in septic individuals, it was (2.9±1.9). The p-value was 0.001. Furthermore, ROC showed that at an NLR value of 1.6, sensitivity was 0.594 and 1-specificity 0.295.
Conclusion: Neutrophil lymphocyte ratio was an efficient screening tool for determining sepsis in neonates, with comparable results to the C-reactive protein test.
Association of Umbilical Cord Lactate Levels and Capillary Ph with Hypoxic-Ischemic Encephalopathy in Neonates Born with Intrapartum Asphyxia
Authors: Hassan Shah Syed Awais Ul , Qadir Ehsan , Ahmed Zeeshan , Shahid Farah , Alam Samina Shams 
Published: May 2023

Objective: To estimate the association of umbilical cord lactate levels and pH with Hypoxic-Ischemic Encephalopathy in neonates born with intrapartum asphyxia.
Study Design: Comparative cross-sectional study.
Place and Duration of study: Pediatrics Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from February 2021 to April 2022.
Methodology: The study was conducted on neonates born with suspicion of intrapartum asphyxia at our hospital. Umbilical cord lactate levels and capillary pH were performed within the first 30 minutes of birth. Then, neonates were admitted to the neonatal intensive care unit and followed up for three days to look for the presence and severity of Hypoxic-Ischemic Encephalopathy (HIE). Association was ascertained between raised lactate levels and negative base deficit with HypoxicIschemic Encephalopathy.
Results: A total of 1000 neonates were included in the final analysis. From 1000 neonates with intrapartum asphyxia, 790(79%) did not develop any grade of hypoxic-ischemic encephalopathy within the first three days of birth, while 210(21%) developed either Grade-I, II or III encephalopathies. Raised serum lactate and base deficit were significantly associated with the presence and severity of hypoxic-ischemic encephalopathy in neonates born with intrapartum asphyxia (p-value<0.001).
Conclusion: Both umbilical artery lactate levels and capillary pH performed within the first 30 minutes of birth were associated with the presence and severity of Hypoxic-Ischemic Encephalopathy in neonates included in our study. These results favour lactate levels as a predictor of Hypoxic-Ischemic Encephalopathy.
Evaluation of Intraoperative and Post-Operative Benefits of Supraorbital Keyhole Approach for Anterior Circulation Aneurysm Surgery
Authors: Ejaz Memoona , Mushtaq Junaid , Khan Habibullah , Bangash Khurshid Ali , Farooq Umer , Tashfeen Ahmed , Ahmed Ali , Ahmed Zeeshan 
Published: May 2023

Objective: To evaluate the intraoperative and post-operative benefits of the supraorbital keyhole approach for anterior circulation aneurysm surgery.
Study Design: Cross-sectional analytical study
Place and Duration of Study: Neurosurgery Department, Combined Military Hospital (CMH), Rawalpindi Pakistan, from Mar 2021 to Apr 2022.
Methodology: Forty patients came for anterior circulation aneurysm surgery during the above said period in the hospital who met the inclusion and exclusion criteria of the study. Ambulation time against all patients was 24 hours. Patients were treated with clipping. After surgery, patients were followed till the resolution of complications.
Results: Of 40 cases, 21(52.5%) were males, and 19(47.5%) were females. The average age of the patients was 51.97±9.73 years. The aneurysm location of patients was not associated with the gender of the patient, with a p-value of 0.115. Similarly, the average age of the patient was not significantly different for the patients' aneurysms location with a p-value of 0.106. Satisfaction appearance was claimed in all 40(100%) cases after surgery. The research study showed no complications in 18(45%) patients out of 40 after treatment, with a p-value of 0.041.
Conclusion: Supraorbital keyhole approach for anterior circulation aneurysm surgery is better regarding intraoperative tissue trauma and post-operative cosmetic outcome. The patient and all post-operative complications will be cured within six months after surgery.
Comparison of Patient Outcomes Before and After the Vascular Surgery Fellowship Program at Tertiary Care Hospital
Authors: Khan Raoon , Arif Anum , Bhatti Ahsin Manzoor , Faisal Mohammad Jamal , Iqbal Maryam 
Published: May 2023

Objective : To assess the outcomes in managing patients with chronic kidney disease (CKD) requiring vascular access before and after, a formal vascular surgery fellowship program (VSFP) was introduced in a tertiary care hospital in Punjab.
Study Design : Pilot quasi-experimental study.
Place and Duration of Study: Department of Vascular Surgery and Nephrology at Combined Military Hospital (CMH) ,Lahore Pakistan, from Feb to Oct 2020.
Methodology: Patients meeting the inclusion criteria of ages between 20 to 70 years, either gender and undergoing dialysis due to chronic renal failure were recruited in the study. Data was collected at the initial phase when a VSFP was absent and later when it was present. Outcome variables were current dialysis access, waiting time for permanent dialysis access and failure rate about the duration of chronic renal failure.
Results: A total of 226 patients were recruited in the study. In both pre-vascular surgery fellowship program time (pre-VSFPT) and post-vascular surgery fellowship program time (post-VSFPT), the predominant functional dialysis access at the time of the interview was arterio-venous fistula (AVF). However, they were much higher in the post-VSFPT, i.e., 46(54.1%) as compared to 96 (68.1%) (p= 0.069). In addition, in pre-VSFPT, 24 (28.2%) patients had a “Never Created” AVF status at the time of the interview as compared to 21(14.9%) in post-VSFPT, which was statistically significant.
Conclusion: The establishment of a fellowship program not only benefits the trainee but it improves patient care significantly. This study highlights the improvement in all the benchmarks of the formation
Skeletal Maturity Assessment using Mandibular Canine Calcification Stages
Authors: Nasir Zainab Bint-e- , Jan Abdullah , Khalid Zahra , Tariq Qurat ul ain , Zia Ramsha , Arshad Neha 
Published: May 2023

Objective: To determine the correlation between cervical vertebral maturation stages on a lateral cephalo-gram and Dimerijan canine calcification stages on an Orthopan-tomogram for assessment of skeletal maturity
Study Design: Cross-sectional study.
Place and Duration of Study: Orthodontics Department, Armed Forces Institute of Dentistry (AFID), Rawalpindi Pakistan, from Dec 2021 to Apr 2022.
Methodology: The subjects of either gender, aged 9 to 16 years, in good physical, mental and oral health were included in the study. Two radiographs, a lateral cephalogram and Orthopantomogram, were taken for each patient. Hassel and Farman and Demirjian stages were used to asses skeletal maturity and canine classification, respectively.
Results: The mean age of the sample was 13.29±1.86 years. The Hassel and Farman CVM stages on a lateral cephalometric radiograph and Dimerijan canine calcification stages on a panoramic radiograph showed a significant positive correlation (r= 0.785, p= 0.000)
Conclusion: There is a high correlation between CVM stages by Hassel and Farman and Dimerijan canine calcification stages to assess skeletal maturity. Therefore, any of these radiographs can be employed to assess the skeletal maturity status of the patient without exposing the patient to additional radiographic radiation.Keywords: Cervical vertebral maturation (CVM) stages, Canine calcification stages, Dental maturity, Skeletal maturity.
Comparison of Intravenous Tramadol vs Intravenous Morphine in Attenuation of Hemodynamic Stress response to Laryngoscopy and Endotracheal Intubation in Laparoscopic Cholecystectomy
Authors: Khan Basit Mehmood , Ayub Farrukh , Shoukat Sundas , Naseer Syed Khurram , Hayat Umer , Zafar Junaid 
Published: May 2023

Objective: To compare the efficacy of intravenous Tramadol and intravenous Morphine in attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation in laparoscopic cholecystectomy.
Study Design: Quasi-experimental study
Place and Duration: Department of Anesthesia, Combined Military Hospital, Mardan Pakistan, from Jun 2021 to Jun 2022.
Methodology: A total of 136 patients were involved in the research. These patients were divided via a lottery method into two groups i.e., Group-T (Tramadol) and Group-M (Morphine) with 68 patients in each group. Patients aged 20-50 years planned for laparoscopic cholecystectomy with American Society of Anesthesiologists (ASA) Grade I or Grade II were included in the study.
Results: Out of a total of 136 patients with equal distribution of 68(50%) patients in each group. Patients with ASA– I Grade from Group–T and Group-M were 52(76.5%) and 41(60.1%), respectively; however, ASA–II Grade patients were 16(23.5%) from Group–T and 27(39.7%) from Group–M. In this study, intravenous Tramadol was effective in 48(70.5%) out of 68 patients, while intravenous Morphine was effective in 60(88.24%) patients, with a p-value of 0.01.
Conclusion: This study concluded that intravenous Morphine is more effective in attenuating hemodynamic stress response to laryngoscopy and endotracheal intubation in laparoscopic cholecystectomy than intravenous Tramadol.
Sol Brain, Pre-Operative Magnetic Resonance Spectroscopy and Surgical Biopsy Yield
Authors: Bangash Khurshid Ali , Yousaf Nasrin , Ilyas Sohail , Mahmood Rashid , Parveen Ishrat , Yousaf Ajmal , Khushdil Arshad , Nathaniel Sharoon 
Published: May 2023

Objective: To ascertain the positive predictive value (PPV) of magnetic resonance spectroscopy (MRS) in diagnosing neoplastic intracranial masses by taking histopathology as a benchmark.
Study Design: Cross-sectional study.
Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Jan 2019 to Jun 2021.
Methodology: After approval from the Ethical Review Committee, 64 patients with neoplastic intracranial mass lesions on MRI were incorporated into the study. Patients with a history of brain surgery done previously, breastfeeding females, claustrophobia, already diagnosed type of tumour, and contraindication to MRI were excluded. MR Spectroscopy was performed, and findings were correlated with histopathology.
Results: Of 64 patients, 39(60.94%) were males, and 25(39.06%) were females. Magnetic Resonance Spectroscopy (MRS) supported the diagnosis of neoplastic brain lesions in all 64 patients. Histopathology confirmed malignant brain lesions in 59 cases, whereas 05 cases had benign lesions. PPV of MRS in the diagnosis of neoplastic brain lesions was 92.19%.
Conclusion: This study concluded that MRS is a non-invasive option having a very good PPV in determining neoplastic brain lesions.
Peran Dinas Tenaga Kerja Dan Transmigrasi Provinsi DIY Dalam Upaya Mengurangi Angka Pengangguran Pada Era Tatanan Baru di Kota Yogyakarta
Authors: Dwi Maelana Herman Wahyu , Najib Khoiri , Nugroho Himawan Agung 
Published: May 2023

During the COVID-19 pandemic, the unemployment rate increased because companies reduced the number of employees. The Labor and Transmigration Office of the DIY Province takes a role in reducing unemployment rate in Kota Yogyakarta. The purpose of this study is to explain the role of the Labor and Transmigration Office of DIY Province in an effort to reduce unemployment in the era of the new normal in the city of Yogyakarta. The research data was collected through observation, interviews, document studies and literature studies.
The role of the Labor and Transmigration Office of DIY Province, as a result of this research, is to create programs and activities for the community of Kota Yogyakarta so that the community has certified knowledge and abilities, namely the Workforce Certification Activity Program, Apprenticeship Program, Business Assistance Program for Educated Independent Workers ( TKMT) and Technical Guidance for Accreditation and Instructor Accreditation of Job Training Institutes (LPK) and Job Training Centers (BLK).