Thematic Progression: A Comparative Analysis of Social Science Research Articles Written by Pakistani and British Research Scholars

Cohesion plays a crucial role in shaping the texture of a text through appropriate thematic choices. Recognizing the issue of cohesion, the researcher conducted a present study to address this problem. The study focused on analyzing social science research articles authored by Pakistani and British research scholars, employing thematic terminologies and emphasizing the textual metafunction. The objectives were twofold: first, to explore and compare the thematic meanings expressed in Pakistani and British social science research articles, and second, to elucidate the functional interpretation of the identified themes. The researcher conducted a qualitative analysis of the data in three steps: (1) dividing the text into clauses, (2) identifying theme components, and (3) tagging the components according to their types and sub-types of themes. The results revealed that the prominent sub-types of themes were the unmarked topical theme (UMT), finite, continuatives, and conjunctions in the topical, interpersonal, and textual themes, respectively. The topical themes served as noun groups, while the textual themes connected new information with prior information. The qualitative analysis focused on studying the patterns of cohesion, leading the researcher to thematic progression and explaining the relationship between theme and rheme within a text. This relationship and its interpretation demonstrated that cohesion relies on thematic choices. Furthermore, the study found that British research articles exhibited greater cohesion compared to Pakistani research articles

Efficacy and safety of atorvastatin and rosuvastatin in ischemic heart disease patients: A prospective study

Purpose: To compare the safety and efficacy of two commonly used statins namely; atorvastatin and rosuvastatin, and determine the efficiency of CoQ10 in the reversal of statin-induced myopathy. Methods: An investigational study design was adopted using randomized trials involving patients suffering from ischemic heart disease and receiving either atorvastatin or rosuvastatin. The study was conducted at Punjab Institute of Cardiology, Lahore, Pakistan during the period, November 2016 - February 2017. A total number of 95 male and female patients, between the ages of 40 and 80 years, were selected. Their blood samples were analyzed for lipid profile, total cholesterol, serum high-density lipoprotein-cholesterol (HDL-C), serum triglycerides, low-density lipoproteins-cholesterol (LDL-C) and total cholesterol/HDL-C ratio. Results: Gender and dose showed significant correlation with creatine phosphokinase (CPK) levels, (p = 0.001) and (p > 0.001), respectively. The patients using rosuvastatin 20 mg had a higher risk of developing myopathy than those treated with atorvastatin 40 mg (p = 0.023), while atorvastatin 20 mg patients were more prone to induce myopathy than 10 mg (p = 0.001) recipients. Atorvastatin 20 mg produced higher CPK levels than rosuvastatin 10 mg (p = 0.002). A substantial increase in CPK levels was found with rosuvastatin 20 mg and atorvastatin 20 mg usage (p > 0.001). It was observed that rosuvastatin 20 mg significantly increased the risk of myopathy compared to atorvastatin 10 mg (p > 0.001). However, rosuvastatin 20 mg/day considerably reduced the blood cholesterol as compared to atorvastatin 10mg/day (p = 0.001). CPK levels reduced significantly following treatment with CoQ10 (p = 0.022). Conclusion: Rosuvastatin users are more prone to the risk of myopathy, myalgic symptoms and rise in CPK levels than atorvastatin users, and these effects are dose related. CoQ10 is effective in lowering CPK levels and reversing myalgia

Adequate Visits, Inadequate Service: Comprehensiveness of ANC in Samarinda & Balikpapan, East Kalimantan

Introduction: With reference to the recommended essential antenatal services in Indonesia, this study assessed the provision of essential minimum care to pregnant women who attended government primary healthcare centres. Methods: Using a structured questionnaire, exit interviews were conducted with 182 pregnant women in their third trimesterfollowi ng receipt ofANC at primary health care centres intwo cities of East Kalimantan province, Indonesia. Results: For those who attended the government health care centres, access toANC intenns of number of visits and the timing of the visits were quite close to the national recommendations. At the government health centres a majority, however, did not receive the full set of even basic antenatal care components. The research also pointed that despite attending the government health centre for four or moreANC visits many women used the ANC services provided by the private doctors as well. Concluslon: The ANC at the government primary care facilities lacks comprehensiveness, and quality improvement measures are necessary if these services are to contribute to better health of mother and babies. The health departments and those involved in managing national safe motherhood initiatives should not besatisfied with the infonnation that a large number of pregnant women may now be accessing ANC from skilled health care providers

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors

Background: Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants.Method: Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records\u27 review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays.Findings: The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals.Conclusion: There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped

Concordant versus discordant ultrasound guided breast biopsy results: How they effect patient management?

Background: To determine concordant or discordant breast biopsy results and see their effect on patient management and outcome.Material and methods: This descriptive analytical study was conducted at the department of Diagnostic Radiology Aga Khan University Hospital Karachi Pakistan from January to December 2013. All patients fulfilling our selection criteria were included. A concordant result was defined when the imaging and pathology results concluded same diagnosis and a discordant result when they did not match. All histopathology results were reviewed and a decision was made regarding concordant/discordant biopsy results and recommendations given for further management of all patients.Results: A total of 282 patients underwent core biopsy of lesions in the breast. The mean age was 47.87 ± 13.99 years. Out of 282 lesions biopsied, 172 were concordant malignant and 105 were concordant benign. Two lesion out of 282 were borderline or high risk, one case was discordant benign and 2 cases discordant malignant. The appropriate management for all cases was recommended after radiology-pathology correlation.Conclusion: Cautious Radiology-Pathology co relation is indispensable in addition to appropriate post biopsy management for managing a successful core breast biopsy program. This practice identifies a substantial number of false negative results of core biopsy by identifying discordant results avoiding delays in diagnosis of breast cancer

Speech language pathologists’ self-report on counselling

Objective: To determine the level of understanding among speech language pathologists regarding counselling. Method: The cross-sectional study was conducted online from July 2020 to January 2021, and comprised speech language pathologists of either gender working in public or private institutions or clinics of Punjab, Sindh and KPK. Data was collected using the Self-report on counselling and interpersonal communication skills’ questionnaire. The collected data was analysed using SPSS 22. Results: Of the 190 subjects, 176(92.6%) were females and 14(7.4%) were males. Majority 173(91.1%) were aged 25-35 years, and 173(91.1%) belonged to the Punjab province. Majority 175(92%) of the respondents reported satisfaction about their own counselling skills, while 168(88.4%) also expressed the need for inclusion of more courses and training to develop counselling and interpersonal communication skills. Conclusion: With experience, professional counselling skills improve and awareness about the need to incorporate counselling training also increases. Key Words: Counselling, Pakistan, Programme, Self report

PREVELANCE OF METFORMIN-INDUCED GASTROINTESTINAL PROBLEMS

Metformin is used as an anti-diabetic drug among oral hypoglycemic drugs, which produces many gastrointestinal problems. Study aims to investigate the effect of metformin induced gastrointestinal problems and its prevalence. A cross-sectional study design was adapted using convenience sampling technique, at different Diabetic Centers of Lahore and Faisalabad, Pakistan from, June-2017 to November-2017. A total of 300 male and female patients participated in the study between 26 to 85 years and diagnosed with type-II diabetes. Data was directly collected from the patients and prevalence of metformin-induced gastrointestinal intolerance was determined by the symptoms of the patients. Data was analyzed by SPSS version 21. Results showed a significant difference between gender and symptoms (p=0.029). Moreover, the gastrointestinal problems were found to be dose related. A significant difference existed between patients who were taking 500mg and those taking 850 mg of metformin (p=0.006), patients who were taking 500mg and those taking 1000mg of metformin (p=0.000) and patients who were taking 850mg with those taking 1000mg of metformin (p=0.022). The prevelance of metformin-induced gastrointestinal symptoms was 45.8%. Most commonly occurring symptoms were, constipation (41.35%) followed by dyspepsia (27.89%), abdominal pain (26.92%), bloating and heart burn (25%), indigestion (15.38%), anorexia (11.54%), diarrhea (6.58%), flatulence (7.69%), nausea (6.73%) and vomiting (2.88%). It was concluded that gastrointestinal intolerance was more in females as compared to males. The gastrointestinal problems increased with the increase in dose. The side effects occurred were irrespective of the age and the most common gastrointestinal symptom was found to be constipation

Clinical utility of routine investigations and risk factors of end-organ damage in asymptomatic severe hypertension

Asymptomatic severe hypertension is defined as systolic blood pressure of ≥ 180 mmHg or diastolic blood pressure of ≥ 120 mmHg without signs and symptoms of end-organ damage or dysfunction. Literature shows that around 5% of the patients with severe asymptomatic hypertension had acute hypertension-related end-organ damage. This study aimed to determine the clinical utility of routine investigations and risk factors of end-organ damage in patients presented to the emergency department with asymptomatic severe hypertension. This single-center, cross-sectional study was conducted at the emergency department of the Aga Khan University Hospital, Karachi, Pakistan, from January 2018 to December 2020. All adult patients (age ≥ 18 years) presented to the emergency department with a systolic blood pressure of ≥ 180 or diastolic blood pressure of ≥ 120 mmHg without any signs and symptoms of end-organ damage (e.g., chest pain, unilateral limb or facial weakness, or hemiplegia, altered mental status, shortness of breath, decreased urine output, and sudden-onset of severe headache) were included. Routine investigations were analyzed to detect end-organ damage, including complete blood count, basic metabolic panel, urine detailed report, electrocardiogram, and troponin-I. Multivariable binary logistic regression was applied to identify the risk factors of end-organ damage considering the significant p value of ≤ 0.05. A total of 180 patients were presented to the emergency department with asymptomatic severe hypertension during the study period. Among the total patients, 60 patients (33.3%) had abnormal investigation findings; out of them, new-onset end-organ damage was diagnosed in 15 patients (8.3%). The most common end-organ damage was the kidney (73.3%) followed by the heart (26.6%). The multivariable binary logistic regression showed that age of more than 60 years, past medical history of diabetes, ischemic heart disease, and cerebrovascular accident were significantly associated with a higher risk of end-organ damage (p \u3c 0.05). The study identified a higher prevalence of abnormal routine investigations and acute end-organ damage in emergency department patients with asymptomatic severe hypertension compared to high-income countries and suggested a lower threshold for end-organ damage screening in these patients. The current recommendations of foregoing further workup in patients with asymptomatic severe hypertension may need modification for emergency departments in low-middle-income countries if similar associations are replicated in other setting

Peripheral mRNA Expression and Prognostic Significance of Emotional Stress Biomarkers in Metastatic Breast Cancer Patients

Emotional stress is believed to be associated with increased tumor progression. Stress-induced epigenetic modifications can contribute to the severity of disease and poor prognosis in cancer patients. The current study aimed to investigate the expression profiles along with the prognostic significance of psychological stress-related genes in metastatic breast cancer patients, to rationalize the molecular link between emotional stress and cancer progression. We profiled the expression of selected stress-associated genes (5-HTT, NR3C1, OXTR, and FKBP5) in breast cancer including the stress evaluation of all participants using the Questionnaire on Distress in Cancer Patients–short form (QSC-R10). A survival database, the Kaplan–Meier Plotter, was used to explore the prognostic significance of these genes in breast cancer. Our results showed relatively low expressions of 5-HTT (p = 0.02) and OXTR (p = 0.0387) in metastatic breast cancer patients as compared to the non-metastatic group of patients. The expression of NR3C1 was low in tumor grade III as compared to grade II (p = 0.04). Additionally, the expression of NR3C1 was significantly higher in patients with positive estrogen receptor status. However, no significant difference was found regarding FKBP5 expression in breast cancer. The results suggest a potential implication of these genes in breast cancer pathology and prognosis