Incivility, Role-Conflict, and Emotional Exhaustion in Teaching Profession: The Moderating Role of Gender

This study examined the effect of incivility and role conflict on emotional exhaustion of teaching staff. Incivility was determined in terms of discouretous and neglecting behavior of family memebrs at home while immediate supervisors at workplace. Role-conflict refers to the interferences of family members during office hours. The study further examined the moderating role of gender in each proposed effect. For empirical analysis, primary data were collected from regular teachers of public sector universities of AJ&K through mailed questionnaires. To examine the proposed direct effects, Structural equation modeling (SEM) was applied in AMOS 24. Feasible measurement model was identified and selected with the help of confirmatory factor analysis (CFA). The study further applied PROCESS macro of Hayes (2013) in SPSS 24 to examine the moderating role of gender. The results show a positive effect of family incivility, family-workplace conflict, and supervisors’ incivility on emotional exhaustion of respondents. Interestingly, the moderating role of gender was not observed for all three cases. On the basis of these findings, different policy implications were presented and discussed.&nbsp

The Outcome of Unreamed Interlocking Nail for the Management of Open Fractures of Tibial Shaft: An Observational Case Series

Objective: This observational case series was designed to see of early debridement and unreamed interlocking nail have emerged as a better modality in the management of open fractures of the shaft of the tibia.Materials and Methods: This descriptive case series study was conducted at the Department of orthopedics, Wah general Hospital Rawalpindi for a period of 6 months. Through non-probability purposive sampling, 60 cases of open fracture of the tibia were included. Unreamed interlocking nail was inserted in all the sixty patients and each nail was statically locked with one screw proximally and one screw distally. Patients were followed regularly i.e on the 1st then 10th, 20th, 30th post-operative day then monthly for 9 months in OPD, and data for union and infection were recorded. Results: The mean age for all patients was 32.82 ± 8.87years. There were 49 (81.7%) male and 11 (18.3%) female patients involved in this study. There were 27 (45%) patients who presented with Gustilo Anderson type I fracture, 23 (38.3%) had Gustilo Anderson type II and 10 (16.7%) had Gustilo Anderson type IIIA. We observed that there were 17 (28.3%) patients who had a transverse fracture, 22 (36.7%) had an oblique fracture, 8 (13.3%) had a spiral fracture and 13 (21.7%) had comminuted fracture. Union occurred within 5 months in 50 (83.3%) patients, 9 (15 %) showed delayed union while 1 (1.7%) patient had non-union after a course of follow-up. Infection was also observed in follow-up in only 8 (13.3%) cases while 52 (86.7%) cases did not show any sign of infection. Conclusion: Unreamed interlocking nailing is quite enough to manage the patients presenting with an open tibial fracture in terms of a higher union rate with low infection and non-union rate

COMPARISON OF SUSTAINED PRESSURE VS ISCHEMIC COMPRESSION ON TRIGGER POINTS IN CHRONIC MYOFACIAL PAIN MANAGEMENT

ABSTRACT OBJECTIVE: To determine the effect of different trigger points approaches in improving chronic myofascial pain. METHODS: This randomized controlled trial was conducted in Railway General Hospital, Rawalpindi, Pakistan from July-December 2016. Patients were randomly divided into two treatment groups through lottery method, in which 37 male participants who full filled the inclusion criteria (persistent pain >6 months, gradual onset of pain and impaired level of activity) were randomly allocated to sustained pressure (Group A) and ischemic compression (Group B) treated groups. Both groups received eight treatments sessions. They were evaluated at baseline and after 8th visit through Numeric Pain Rating Scale (NPRS) and Chronic Pain Acceptance Questionnaire (CPAQ). RESULTS: Within the group-A the pre and post-treatment mean for NPRS were 5.05±1.17 and 2.63±0.955 (p <0.001). Pre and post-treatment CPAQ activity engagement values were 32.00±2.42 and 41.74±2.53 (p <0.001). Pre and post-treatment CPAQ pain willingness values were 29.42±3.04 and 32.63±2.91 (p <0.001). Pre and post-treatment CPAQ sum was 61.42±3.67 and 73.84±3.64 (p 0.05). Pre and post treatment values for CPAQ sum were 64.61±2.42 and 75.72±1.12 (p<0.001). CONCLUSION: Improvement in pain relief was observed in both groups but there was no significant improvement in pain relief between ischemic compression and sustained pressure groups

Accuracy of procalcitonin levels for diagnosis of culture-positive sepsis in critically ill trauma patients: A retrospective analysis

Background: Abdominal trauma and intra-abdominal sepsis are associated with significant morbidity and mortality. Microcirculation in the gut is disrupted in hemorrhagic and septic shock leading to tissue hypoxia, and the damaged gut acts as a reservoir rich in inflammatory mediators and provides a continual source of inflammation to the systemic circulation leading to sepsis. Sepsis is defined as the presence (probable or documented) of infection together with a systemic inflammatory response to infection. Blood culture is commonly considered to be the preferred approach for diagnosing sepsis, although it is time-consuming, that is, reports are normally available only after 12-48 hours. Procalcitonin levels (PCT) have recently emerged as a promising biomarker in the diagnosis of sepsis. The aim of the present study is to determine the diagnostic accuracy of PCT levels in predicting sepsis in critically ill trauma patients.Methodology: This was designed as a validation study conducted in the Indoor Department of General Surgery, Liaquat National Hospital, Karachi. The sample size was calculated by taking the estimated frequency of sepsis in suspected patients at 62.13%, expected sensitivity of PCT at 70.83%, and specificity at 84.21% and the desired precision level of 12% for sensitivity; the calculated sample size was 96. The non-probability consecutive sampling method was used to recruit participants who were diagnosed with sepsis on clinical assessment. Blood culture samples were sent for the enrolled patients and a final diagnosis was made on the blood culture report. PCT levels were measured in these suspected patients on the same day of sending blood culture. Diagnostic accuracy of PCT size was measured using the receiver operating characteristic (ROC) curve. ROC curve was formulated for PCT levels against culture-proven sepsis to determine the ideal cut-off value of PCT levels. Two different cut-offs were determined to obtain the highest sensitivity and highest specificity accordingly.Results: A total of 97 individuals met the inclusion criteria with a mean age of 34.89 ± 10.52 years. Mean PCT levels were 0.96 ± 0.59, with a gender predilection towards females (p \u3c 0.001). No age difference was documented among gender (p = 0.655). The mean duration of intensive care unit stay was 11.73 ± 3.56 days. Culture-proven sepsis was identified in 67.0% of the study participants with a higher PCT level (p \u3c 0.001). Among the 52.6% males included in the study, half were reported to have culture-positive sepsis, but among the 47.4% females culture was positive in 87% (p \u3c 0.001). ROC revealed PCT was predictive for culture-positive sepsis at a cut-off value 0.47 ng/mL (p \u3c 0.001), with a sensitivity of 92.3%, specificity of 68.7%, positive predictive value (PPV) of 85.7%, and negative predictive value (NPV) of 81.5%. By increasing the cut-off value to 0.90 ng/mL at area under the curve of 0.816, the specificity increased to 81.3% and sensitivity became 66.2%, with a PPV of 87.8% and NPV of 54.2%.Conclusion: Our study determined two cut-values for PCT to predict sepsis, one with the highest sensitivity and the other with better specificity. Other than that, higher PCT levels were significant in female trauma patients. We conclude that PCT is a reliable marker for culture-proven diagnosis of sepsis and may aid physicians/surgeons to promptly manage patients accordingly

Liver lesions in children post-oncologic therapy: Review of case reports and institutional observation

Purpose: Focal nodular hyperplasia (FNH), a benign hepatic tumor with ill-defined etiology, has been increasingly reported in children treated for extra-hepatic malignancies. Serial imaging or biopsy may be needed when survivors present with liver lesions. This study aims to review the literature, compare them with our institution’s cohort and propose a less invasive diagnostic imaging modality for FNH utilizing Magnetic resonance imaging (MRI) with gadoxetate disodium. Methods: We reviewed 13 case reports/series published over the last 20 years and compared them to our retrospective review of 16 childhood cancer survivors (CCS) found to have liver lesions on various imaging studies. Several patients underwent biopsy for diagnosis. Results: No specific generalizations could be made in terms of which specific chemotherapeutic agents cause FNH. Seven out of 11 patients underwent radiotherapy and/or hematopoietic stem cell transplant. Additionally, 36% (4/11) had been treated for neuroblastoma. From the literature review, the use of MRI with gadoxetate disodium was difficult to evaluate. Imaging was mainly accomplished using ultrasound, computerized tomography and MRI with gadolinium. The results were often indeterminate and resulted in biopsy in 6 cases in our institution. In contrast, 5 patients underwent initial MRI with gadoxetate disodium, which confirmed the diagnosis of FNH. Conclusion: CCS have an increased risk of developing liver lesions. Consistent with previously published literature, patients exposed to radiotherapy or cytoreductive agents used for hematopoietic stem cell transplants appeared to be at higher risk. A significant proportion (36%, 4/11) of our patients with FNH was previously treated for neuroblastoma. With the introduction of MRI with gadoxetate disodium, imaging may be a viable alternative to biopsy.

Military strategies of the Islamic Republic of Iran against American military threats

Purpose: The main purpose of this research is to examine the military threats of the United States and present the military strategies of the Islamic Republic of Iran against them.Method: The type of research is applied, and the necessary information is obtained from the study of documents, interviews with experts and questionnaires, and a descriptive method with a mixed approach has been used. The overall statistical population of the research is 70 people and the sample size is consistent with the statistical population and all the numbers have been determined. In order to collect and analyze data, in addition to taking samples from library studies and conducting expert interviews, using document analysis and elite analysis methods, descriptive and inferential statistics methods have also been used.Results: The number of 7 main strategies was calculated based on 73 selected research factors (19 strength factors, 9 weakness factors, 10 opportunity factors and 35 threat factors) relying on the provided partial strategies.Conclusion: The result of the vector on the axis of Cartesian coordinates indicates that the competition of the Islamic Republic of Iran is more focused on strengths than opportunities