bluuebunny/crossref_metadata_2025_split huggingface dataset:
Agile Management in Health Professions Education with Respect to Waterfall Life Cycle
Authors: Javed Rabbia , Fatima Fozia , Shabnam Nadia , Qamar Khadija , Fatima Sobia , Gul Ambreen 
Published: December 2022

Objective: To determine the practice of waterfall life cycle functions in the health profession department of medical institutes by keeping in view the demographic factors of health professions managers.
Study Design: Cross-sectional survey.
Place and Duration of Study: Medical Institutes of Rawalpindi and Islamabad Pakistan, from Feb to Jul 2021.
Methodology: 46 managers were taken as a sample through a systematic random sampling technique. A self-developed questionnaire was used, and it contained 21 items. Mean and standard deviation were used to measure the practices of waterfall agile management, and t-test and ANOVA were used to test the effect of gender and experiences.
Results: Managers were not fully confident about the practices of water fall life cycle functions in their respective organization (Mean=3.08 ± 1.19). Gender has no significant effect on required analysis (p=0.861); design stage (p=0.625); test (p=0.222); deployment (p=0.718) and development (p=0.432) while monitoring and evaluation had significant effect (p=0.042). Similarly, managers’ experience has significant effect on required analysis (p=0.013); test (p=0.001); deployment (p≤0.001) and development (p=0.002) while it has no significant effect on design stage (p=0.062) and monitoring and evaluation (p=0.060) in medical institutes.
Conclusion: Health profession managers were neutral about the practices of the waterfall life cycle of agile management in their respective medical institutes.
Outcome of Probing and Syringing in Congenital Nasolacrimal Duct Obstruction in Children Under Local Anesthesia
Authors: Sharif Nusrat , Munir Muhammad Sajid , Arshad Muhammad , Nazir Shahid , Sadiq Muhammad Usman , Rehman Rabya 
Published: December 2022

Objectives: To evaluate the success rate of probing and syringing for congenital nasolacrimal duct obstruction in children under local anaesthesia.
Study Design: Cross-sectional study.
Place and Duration of Study: Ophthalmology Department, Niazi Medical Dental College, Sargodha Pakistan, from Jul 2018 to Dec 2019
Methodology: Forty-five children were included in the study, of which five had bilateral epiphora. Children of 8-12 months of age were included in this study. Probing and syringing were done under topical local anaesthesia. In this study, special modified straight 25D lacrimal probe cannula was used. Post-operative steroids and antibiotics were given to all the children for two weeks.
Results: Forty Children (45 Eyes) of 8-12 months of age (less than one year) were included in this study. Single successful probing was achieved in 40 eyes (88.88%). Probing was repeated in five cases. Repeated successful probing was achieved in 3 eyes (60%) as the remaining two eyes (40%) where success was not achieved had a bone abnormality which needed an ENT examination and further intervention like Dacryocystorhinostomy (DCR) with close intubation.
Conclusion: Topical local anaesthesia is a good alternative to general anaesthesia as it is not available, particularly in remote areas of Pakistan. It saves the children from the hazards of general anaesthesia and is a good choice for children who are not fit for general anaesthesia.
Association of Malabsorption and Anaemia in Adults in Tertiary Care Hospital
Authors: Hussain Altaf , Hafeez Muhammad , Naveed Muhammad , Shah Syed Umer , Khan Muhammad Shahid , Cheema Ahmed Ammar 
Published: December 2022

Objective: To determine the association of malabsorption in celiac disease with anaemia and other sociodemographic factors at a tertiary care hospital in Pakistan.
Study Design: Cross sectional study
Place and Duration of Study: Department of General Medicine Military Hospital Rawalpindi from Jul to Dec 2019.
Methodology: A total of 300 adults were included in the study, 150 cases were patients with the diagnosis of celiac disease, and the other 150 were controls without celiac disease. Celiac disease was diagnosed based on biopsy findings by a consultant gastroenterologist. Defined was defined based on haemoglobin levels. In addition, the relationship between age, gender, anaemia, and the presence of comorbidities was assessed with the presence of celiac disease among the adults included in the study.
Results: Out of 300 cases and controls, 116 (38.7%) patients were males, and 184 (61.3%) were females. One hundred and forty-eight (49.3%) did not show the presence of anaemia, while one hundred and fifty-two (50.7%) showed the presence of anaemia. we found a statistically significant difference in cases and controls regarding the presence of comorbidities and the presence of anaemia (p<0.05).
Conclusion: Patients with celiac disease showed a greater frequency of anaemia as compared to those who were not having celiac disease. Therefore, patients with celiac disease are at high risk for developing anaemia, or patients with anaemia should be screened for malabsorption problems. In addition, patients with celiac disease were also at high risk for acquiring other systemic disorders.
Survival Outcomes in the Patients of Ovarian Epithelial Carcinomas Treated with Fertility-Sparing Surgery: A Study from a Developing Country
Authors: Azhar Musa , Khan Shafquat Ali , Hamdani Syed Abdul Manan , Yasmeen Tahira , Yasmeen Samia , Awan Umme-e-Kalsoom , Syed Aamir Ali , Siddiqui Neelam 
Published: December 2022

Objective: To assess the outcomes of fertility-sparing surgery in patients with ovarian epithelial carcinoma treated at our centre.
Study Design: Retrospective longitudinal study.
Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore Pakistan, from Jul 2001 to Aug 2015.
Methodology: We studied 31 patients with ovarian epithelial carcinoma who underwent fertility-sparing surgery at Shaukat Khanum Memorial Hospital. The detail regarding patients and tumour characteristics, along with outcomes of the intervention, was obtained from secondary data kept in the electronic hospital information system.
Results: A total of 132 patients with ovarian epithelial carcinoma were identified; 31 patients underwent fertility-sparing surgery (Stage-IA, n=19; Stage-IC, n=12). By histopathology, 14(45.0%) had mucinous cystadenocarcinoma, 7(22.6%) serous adenocarcinoma, 6(19.4%) endometroid, and 4(12.9%) with clear cell pathology. The mean duration of follow-up was 52.6±2.3 months (18-118 months) after fertility-sparing surgery. Five-year recurrence-free survival was 81.0%. (Three-year=89.0%), using the Kaplan-Meier graph. Three patients had successful pregnancies, with one having a twin pregnancy.
Conclusion: Fertility-sparing surgery should be considered for children of early-stage epithelial ovarian carcinoma patients as it preserves fertility and endocrine function while avoiding recurrence.
Chronic HCV Infection–Comparison of Awareness Regarding Mode of Transmission in Educated and Uneducated Patients Presenting in Gastroenterology/ Medical Clinics in Various Hospitals of Sindh Province
Authors: Khan Rao Zaid Ali , Khan Rao Saad Ali , Khan Uzair Ali , Alam Laima , Naqvi Syed Rehan Asghar , Naqvi Syed Zohair Asghar 
Published: December 2022

Objective: To compare the awareness regarding the mode of transmission in educated and uneducated patients presenting to OPDs of five hospitals in Sindh province.
Study Design: Cross-sectional survey.
Place and Duration of Study: Five Combined Military Hospitals, of Sindh province; Badin, Chhor, Hyderabad, Malir and Pano Aqil, Pakistan, from April to July 2022.
Methodology: Patients presenting to the five Combined Military Hospitals were included through non probability consecutive sampling technique. The questionnaire was reviewed by two medical education experts for content validity and piloted among ten patients before being tested.
Results: A total of 121 participants were included in the study. Participants had better knowledge regarding sharing of shaving equipment (p=0.008), unsafe blood transfusions (p<0.001), using contaminated surgical instruments in surgeries (p<0.001) and dental extractions (p=0.005) and sharing of needles (p<0.001) as potential sources of HCV spread. The disparity was quite clear by comparing the ratio of correct responses given by educated participants with uneducated.
Conclusion: Our general public lacks basic information regarding modes of transmission of HCV, and the low level of education in the masses is one of the most important reasons.
Frequency of Cap+1 Mutation in Beta Thalassemia and its Associated Haematological Features
Authors: Iqbal Muhammad Ijaz , Robert Helen Mary , Khan Nabeela , Mahmood Asad , Haider Ali 
Published: December 2022

Objective: To study the frequency of Cap+1 mutation and associated hematological parameters in suspected beta thalassemia patients.
Study Design: Analytical cross-sectional study.
Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology (AFIP) Rawalpindi from Aug 2017 to Aug 2018.
Methodology: 960 patients suspected to have beta thalassemia were inducted into the study. After detailed history and examination basic hematological parameters (Hemoglobin, Mean Corpuscular Volume, Mean Corpuscular Hemoglobin) were analyzed using automated analyzer (Sysmex XE-5000). Molecular genetic analysis by conventional PCR was carried out for CAP+1 mutation. Genomic DNA purification kit (Gentra system USA) was used for extracting DNA from whole blood in order to study the molecular genetics for Cap+1 mutation. Primers were designed for detection and analysis of normal and mutant DNA.
Results: The frequency of Cap+1 mutation was observed in 3.2 ± 1.7% (31/960) in all suspected cases of beta thalassemia with a normal range of Hemoglobin (12.4 ± 1.1 g/dl), Mean Corpuscular Volume (86.4 ± 2.1fl/red cell) and Mean Corpuscular Hemoglobin (29 ± 1.7pg/cell).
Conclusion: Cap+1 mutation is a silent mutation and its diagnosis remains a challenge because of its normal clinical presentation and normal to mildly deranged basic hematological parameters. Detection of CAP+1 at molecular level has revolutionized the thalassemia prevention program in Pakistan.
The Detection of BRAF-V600E Mutation in Hairy Cell Leukaemia by Polymerase Chain Reaction and Study of its associated Clinicohaematological Parameters
Authors: Iqbal Muhammad Ijaz , Robert Helen Mary , Khan Nabeela , Mahmood Rafia , Khurshid Ayesha , Khan Saleem Ahmed 
Published: December 2022

Objective: To contemplate the occurrence of a rare mutation (BRAF V600E) in the patients having Hairy cell leukemia in our setting, which wouldserve asuseful analytic and diagnostic criteria.
Study Design: Analytical cross sectional study.
Place and Duration of Study: Armed Forces Institute of Pathology Rawalpindi Pakistan, from Oct 2017 to Oct 2018.
Methodology: A sample of 36 patients with a suspicion of Hairy cell leukemia were included in this investigation. Complete blood counts, bone marrow examination (trephine biopsy and aspiration), cyto-chemistry and staining of the patients suspected to have Hairy cell leukemia was performed. PCR was done for detection of BRAF V600E mutation.
Results: 29 (80.5%) cases showed a positive BRAF mutational analysis and 7 (19.4%) cases showed a negative result.
Conclusion: Almost all the cases of classic Hairy cell leukemia had BRAF V600 E mutation.Isolating this mutation can be used as a regular tool in detection of disease and monitoring disease progression and relapse.
Thyroid Dysfunction During Combined Pegylated Interferon Alpha and Ribavirin Therapy in Patients of Chronic Hepatitis C-Virus Infection
Authors: Mumtaz Maher Aadil , Uttra Khurshid Muhammad , Ali Imtiaz , Ali Karamat , Zaheer Qasim , Akram Ammad 
Published: December 2022

Objective: To determine frequency of thyroid dysfunction among patients of chronic hepatitis C receiving combined pegylated interferon alpha and ribavirin therapy.
Study Design: Cross sectional study.
Place and Duration of Study: Department of Medicine, Military Hospital Rawalpindi, from Jan to Jul 2017.
Methodology: One hundred and twenty patients, aged 18–60 years from both genders, with established hepatitis C were included; while the patients with decompensated liver disease, previous antiviral treatment, pre-existing thyroid, autoimmune or severe cardiopulmonary disease and on immuno-suppressants or steroids were excluded. After formal informed consent, they were prescribed 24 weeks pegylated interferon alpha-2 (3 million units subcutaneously thrice weekly) and oral ribavirin (1000–1200 mg daily) therapy. After 12 weeks, serum thyroid stimulating hormone, free thyroxine and triiodothyronine levels were determined by chemiluminescence technique.
Results: Out of 120 patients, 100 (83.33%) were males and 20 (16.67%) were females with male to female ratio of 5:1. Mean thyroid stimulating hormone levels at baseline and 12 weeks were 2.86 ± 1.03uiu/ml and 2.16 ± 0.79 uiu/ml respectively. Mean triiodothyronine levels at baseline and 12 weeks were 3.27 ± 1.31pg/ml and 2.69 ± 1.01 pg/ml respectively. Mean thyroxine levels at baseline and 12 weeks were 1.26 ± 0.38 pg/ml and 1.07 ± 0.53 pg/ml respectively. Frequency of thyroid dysfunction was found in 40 (33.33%) patients.
Conclusion: Frequency of thyroid dysfunction among hepatitis C patients receiving combined pegylated interferon alpha and ribavirin therapy is quite high.
Comparison of Stool Antigen Test with Histopathology of Endoscopic Gastric Biopsies for Detection for Helicobacter Pylori; A Hospital-Based Study
Authors: Zubair Muhammad , Nawaid Muhammad Amir , Afridi Nabeel Khan , Baig Bilal , Hanif Muhammad , Mahmoud Tamer Mohamed , Gabalunos Helman Sansaet 
Published: December 2022

Objective: The objective of this study is to evaluate the diagnostic accuracy of H. pylori Stool Antigen (HpSA) test keeping histopathology as gold standard.
Study Design: This is a cross sectional observational study.
Place and Duration: This study was performed from Jan 2015 to Mar 2020 at Najran Armed Forces Hospital, kingdom of Saudi Arabia.
Methodology: Total 151 patients in whom HpSA was done were included in the study. They were followed for their results of histopathology on gastric biopsies.
Results: Among 151 patients 85(56.3%) were females and 66 (43.7%) were males. Mean age was 40 years. Forty three (28.5%) patients were positive for both HpSA and on histology, Fifteen (9.9%) patients were positive on HpSA test but negative on histology. Twenty two (14.6%) patients were negative on HpSA but they were positive on histology. Seventy one (47%) patients were negative both on HpSA and histology. The sensitivity and specificity were 66.1% and 82.5% respectively. Positive predictive value (PPV) was 74.1% and negative predictive value (NPV) was 76.3% for HpSA. Diagnostic accuracy for this test was 75.5%.
Conclusion: Keeping in view the low sensitivity and diagnostic accuracy HpSA test cannot be used as screening tool in all patients, however it can be used for clinical correlation in setups where other diagnostic tests are not available due to the simplicity of its use, low cost and easy repeatability
Renal Abnormalities in Young Healthy Individuals on Screening Ultrasonography of Kidneys
Authors: Saqib Rizwan , Bangash Tajamul Hussain , Ahmed Sajad , Asim Niaz Muhammad Muttahhar , Sabir Ghulam , Fatima Sughra 
Published: December 2022

Objective: To determine the prevalence of renal abnormalities in young healthy individuals on screening ultrasonography of kidneys.
Study Design: Cross sectional study
Place and Duration of Study: Combined Military Hospital, Hyderabad from Sep 2019 to Mar 2020.
Methodology: 2050, Young asymptomatic healthy individuals of 15-24 years age, coming to radiology department for screening ultrasound of kidneys were included in the study. The examination was performed with standard convex probe of 3.5MHz on Aloka Pro sound SSD-3500 Ultrasound machine by experienced radiologist. Both kidneys were scanned with patient in supine and lateral positions. The images were taken in both longitudinal and transverse sections.
Results: Out of 2050 cases included in the study, 112 (5.46 %) had renal abnormalities, 81 (3.95 %) had renal calculi, hydronephrosis was found in 14 (0.68%) cases, out of which ten were due to calculi, 9 (0.44%) individuals had abnormalities of size, shape and position and renal cysts were found in 7 (0.34%) cases with six simple and one septated cyst, while only 1 (0.05%) case had bilaterally echogenic kidneys.
Conclusion: The overall prevalence of renal abnormalities was 5.46% with calculi comprising the major abnormality. Early detection with ultrasound screening can prevent further damage to the kidneys in young asymptomatic healthy individuals. It is recommended to perform screening ultrasonography of kidneys, ureters and bladder in young candidates before induction in services.
Macular Thickness Decreases with Age in Normal Eyes: A Study On Macular Thickness Map Protocol on the Oct
Authors: Tahir Tooba Bint , Muzzaffar Waqar , Faheem Mahum , Ashraf Ammarah 
Published: December 2022

Objective: To evaluate the normal macular thickness and how it varies with age in the eyes of healthy subjects using macular map protocol on Spectral-Domain Optical Coherence Tomography (SD-OCT).
Study Design: Cross-sectional study.
Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jun 2020 to Sep 2021.
Methodology: Our study included one thousand seven hundred and four eyes (1704) of healthy subjects. They underwent imaging with macular thickness map protocol using Topcon Spectral-Domain Optical Coherence Tomography (SD-OCT). According to the macular thickness map, protocol macular area was subdivided into nine ETDRS fields. Measurement of macular thickness and its variations with age were determined. Pearson correlation was applied to identify the relationship between age and macular thickness of layers.
Results: Our study revealed a negative relationship which was statistically significant between macular thickness and age for all the ETDRS regions. Results showed a mean macular thickness of 274.90 ± 15.18. The female gender was found to have greater macular thickness than males (p-value 0.002).
Conclusion: This study concluded a significant decrease in macular thickness with age. This is the first normative study using Topcon SD-OCT and macular map protocol for macular thickness measurement done in the Pakistani population.
Diagnostic Accuracy of Ultrasound and MRI for Diagnosis of Adenomyosis Taking Histopathology as Gold Standard
Authors: Anwar Javed , Tariq Mehwish , Amin Nabila , Gul Bibi , Niaz Ayesha , Nawaz Khurram Haq 
Published: December 2022

Objective: To determine the diagnostic accuracy of Magnetic Resonance Imaging (MRI) and ultrasonography to detect adenomyosis, keeping histopathology as the gold standard.
Study Design: Cross-sectional study.
Place and Duration of Study: Radiology and Gynecology departments of the Combined Military Hospital, Quetta Pakistan, from Aug 2019 to Aug 2021.
Methodology: One hundred sixty-two patients were enrolled in this study after taking written and informed consent. After taking history, all patients were assessed by Magnetic resonance imaging and transvaginal ultrasonography. The magnetic resonance imaging and transvaginal ultrasound findings were noted on a predesigned proforma. All the patients underwent a hysterectomy, and a Biopsy specimen was sent for histological confirmation of adenomyosis. The accuracy of diagnosis was assessed in both initial modalities.
Results: A total of 162 patients were enrolled in the study. The mean age of the females and junctional zone diameter (JZmax) in mm on MRI was 38.56 years and 12.54.9 mm. In terms of parity, 32 (19.8%) females were nulliparous, 68 (42%) females had low multi-parity, and 62 (38.2%) females had high multi-parity. On magnetic resonance imaging, adenomyosis was present in 112 (69.1%) females. On transvaginal ultrasound, it was present in 97 (59.9%) females, and on histopathology, it was present in 105 (64.8%) females, out of which 36 (34%) had diffuse adenomyosis and 32 (30.8%) had focal adenomyosis. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Magnetic resonance imaging was 86.7%, 36.9%, 81.3%, 71.8% and 78.4% respectively and of transvaginal ultrasound it was 65.7%, 50.9%,.............
Geophysical measurements of the southernmost microglacier in Europe suggest permafrost occurrence in the Pirin Mountains (Bulgaria)
Authors: Georgieva Gergana , Tzankov Christian , Kisyov Atanas 
Published: December 2022

Abstract. There are no large glaciers in the territory of Bulgaria, but small patches of snow
and firn have been observed in the high mountains at the end of summer. Perennial
snow patches and microglaciers are considered indicators of permafrost occurrence.
The results from the first detailed geophysical investigations of the Snezhnika
glacieret, considered to be the southernmost microglacier in Europe, situated in
the Golyam Kazan cirque, Pirin Mountains, Bulgaria, are presented in the paper.
Ground-penetrating radar (GPR) and 2D electrical resistivity tomography (ERT)
were used to estimate the thickness of the microglacier as well as its subsurface
structure. Measurements started in 2018 and continued over the next 2 years in
order to assess changes in its size and thickness. The mean thickness of Snezhnika
is about 4–6 m, reaching 8 m or probably more in some areas. ERT measurements
of the deeper parts of the microglacier beds show high electrical resistivities
reaching over 60 000 Ωm at a depth of 4–10 m. An anomaly at this depth
is likewise distinguishable on the GPR profiles. These anomalies are interpreted
as permafrost areas and were consistently observed on the ERT and GPR profiles
in the 2 years of the study. These results imply for the first time the
existence of permafrost in the Pirin Mountains and in Bulgaria.
The collapse of the Cordilleran–Laurentide ice saddle and early opening of the Mackenzie Valley, Northwest Territories, Canada, constrained by 10Be exposure dating
Authors: Stoker Benjamin J. , Margold Martin , Gosse John C. , Hidy Alan J. , Monteath Alistair J. , Young Joseph M. , Gandy Niall , Gregoire Lauren J. , Norris Sophie L. , Froese Duane 
Published: December 2022

Abstract. Deglaciation of the northwestern Laurentide Ice Sheet in
the central Mackenzie Valley opened the northern portion of the deglacial
Ice-Free Corridor between the Laurentide and Cordilleran ice sheets and a
drainage route to the Arctic Ocean. In addition, ice sheet saddle collapse
in this section of the Laurentide Ice Sheet has been implicated as a
mechanism for delivering substantial freshwater influx into the Arctic Ocean
on centennial timescales. However, there is little empirical data to
constrain the deglaciation chronology in the central Mackenzie Valley where
the northern slopes of the ice saddle were located. Here, we present 30 new
10Be cosmogenic nuclide exposure dates across six sites, including two
elevation transects, which constrain the timing and rate of thinning and
retreat of the Laurentide Ice Sheet in the area. Our new 10Be dates
indicate that the initial deglaciation of the eastern summits of the central
Mackenzie Mountains began at ∼15.8 ka (17.1–14.6 ka),
∼1000 years earlier than in previous reconstructions. The
main phase of ice saddle collapse occurred between ∼14.9 and
13.6 ka, consistent with numerical modelling simulations, placing this event
within the Bølling–Allerød interval (14.6–12.9 ka). Our new dates
require a revision of ice margin retreat dynamics, with ice retreating more
easterly rather than southward along the Mackenzie Valley. In addition, we
quantify a total sea level rise contribution from the Cordilleran–Laurentide
ice saddle region of ∼11.2 m between 16 and 13 ka.