Mamdouh Maher, A. M. Elsawah (Ahmed Elsawah), Islam Ebid, Mohamed Elsayed, Mohamed Akkad, Ahmed Abdelhalim, Mohamed Sabry Elhadainy
Purpose: International guidelines recommend that haemodialysis access is provided by an arteriovenous fistula (AVF), which enables frequent, reliable access to the circulation, but there are no guidelines to suggest whether these AVFs need to be ligated after kidney transplantation. Cardiovascular morbidity and mortality remain high in recipients of a kidney transplant, the persistence of a patent arteriovenous fistula (AVF) after transplantation may contribute to ongoing maladaptive cardiovascular remodelling. The ability to reverse this maladaptive remodelling by ligation of this AVF is unknown. We conducted this trial to evaluate the effect of AVF ligation on cardiac structure and function in stable kidney transplant recipients. Also we studied the ability of preoperative echocardiographic and non-invasive hemodynamic measurements, including the effects of acute temporary occlusion of the fistula, to predict postoperative left ventricular diameter and mass reduction, by the closure of the fistula. Materials and Methods: Nonrandomized controlled trial. kidney transplant recipients (>12 months after transplantation with stable graft function) were divided into 2 groups. The first referred for surgical arteriovenous fistula closure. The second group didn’t receive Fistula closure (control). Standard echocardiographic parameters, heart rate, and blood pressure were assessed preoperatively (fistula closure) at baseline. These measurements were repeated 6 months after surgical closure. Findings: Seventeen kidney transplant patients were prospectively studied with 11 case and 6 controls with no fistula closure. Surgical fistula closure decreased left ventricular end-diastolic diameter and mass indexes (29.9_2.4to 27.4_2.1 mm/m2, P<0.001, and 141_37 to 132_39 g/m2, P<0.05, respectively), whereas no changes were seen in controls after a similar delay. Postoperative left ventricular end-diastolic diameter and mass reductions correlated best with the increases in total peripheral resistance (r_0.85, P<0.0001) and mean arterial blood pressure (r_0.64, P_0.006), respectively. Conclusions. Surgical closure of arteriovenous fistula reduces left ventricular diameter and mass in kidney transplant recipients. The best predictors of those morphological changes are the rise in blood pressure and total peripheral resistance induced by temporary occlusion of the fistula. Implications to Theory, Practice and Policy: Surgical closure of persistent AV fistula after renal transplantation to correct LV geometry and improve symptoms in terms of exertional dyspnea and palpitations.
{"title":"Changes in Cardiac Structure and Function Following Fistula Ligation in Kidney Transplant Recipients (Cohort Study)","authors":"Mamdouh Maher, A. M. Elsawah (Ahmed Elsawah), Islam Ebid, Mohamed Elsayed, Mohamed Akkad, Ahmed Abdelhalim, Mohamed Sabry Elhadainy","doi":"10.47672/ajhmn.1669","DOIUrl":"https://doi.org/10.47672/ajhmn.1669","url":null,"abstract":"Purpose: International guidelines recommend that haemodialysis access is provided by an arteriovenous fistula (AVF), which enables frequent, reliable access to the circulation, but there are no guidelines to suggest whether these AVFs need to be ligated after kidney transplantation. Cardiovascular morbidity and mortality remain high in recipients of a kidney transplant, the persistence of a patent arteriovenous fistula (AVF) after transplantation may contribute to ongoing maladaptive cardiovascular remodelling. The ability to reverse this maladaptive remodelling by ligation of this AVF is unknown. We conducted this trial to evaluate the effect of AVF ligation on cardiac structure and function in stable kidney transplant recipients. Also we studied the ability of preoperative echocardiographic and non-invasive hemodynamic measurements, including the effects of acute temporary occlusion of the fistula, to predict postoperative left ventricular diameter and mass reduction, by the closure of the fistula. \u0000Materials and Methods: Nonrandomized controlled trial. kidney transplant recipients (>12 months after transplantation with stable graft function) were divided into 2 groups. The first referred for surgical arteriovenous fistula closure. The second group didn’t receive Fistula closure (control). Standard echocardiographic parameters, heart rate, and blood pressure were assessed preoperatively (fistula closure) at baseline. These measurements were repeated 6 months after surgical closure. \u0000Findings: Seventeen kidney transplant patients were prospectively studied with 11 case and 6 controls with no fistula closure. Surgical fistula closure decreased left ventricular end-diastolic diameter and mass indexes (29.9_2.4to 27.4_2.1 mm/m2, P<0.001, and 141_37 to 132_39 g/m2, P<0.05, respectively), whereas no changes were seen in controls after a similar delay. Postoperative left ventricular end-diastolic diameter and mass reductions correlated best with the increases in total peripheral resistance (r_0.85, P<0.0001) and mean arterial blood pressure (r_0.64, P_0.006), respectively. \u0000Conclusions. Surgical closure of arteriovenous fistula reduces left ventricular diameter and mass in kidney transplant recipients. The best predictors of those morphological changes are the rise in blood pressure and total peripheral resistance induced by temporary occlusion of the fistula. \u0000Implications to Theory, Practice and Policy: Surgical closure of persistent AV fistula after renal transplantation to correct LV geometry and improve symptoms in terms of exertional dyspnea and palpitations.","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"46 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139010849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdul Mateen, Rukhsar Amanat, Haider Ali, Hurab Khalid, Akram Ali, A. Rehman, Samia Khaliq
Purpose: Diastasis recti abdominis (DRA) denotes an anomalous separation of the rectus muscles throughout their longitudinal axis, devoid of fascial irregularities. The current study sought to determine the prevalence of DRA and its potential association with pelvic floor muscular strength and urinary incontinence in the gynaecological population of Faisalabad. This was a cross-sectional study. Materials and Methods: A Convenient sampling technique was used for collecting data. A sample of 100 females from government hospitals of Faisalabad was taken. Study was conducted in Faisalabad from February 2018 to May 2018. Inclusion criteria of the research was, immediate postpartum ladies, females aged 18 to menopausal age, and females who had normal vaginal birth. Manometric techniques were employed to quantify the strength of the pelvic floor muscles (PFMS), with outcomes represented in cmH2O. The incidence of urinary incontinence (UI) was ascertained by querying patients regarding any manifestations postpartum. The extent of diastasis recti abdominis (DRA) was gauged utilizing fingerbreadth assessments of the rectus abdominis muscles. This particular measurement spanned a distance of 4.5 cm both superior and inferior to the umbilicus, aligned with the linea alba. Findings: Results were analyzed through SPSS version 26. Diastasis recti abdominis was found to be present in 57% of the females. 7% of the women had very weak pelvic floor muscle, 38% had weak, 50% had moderate strength and 5% had good strength of pelvic floor muscles. Out of 100, urine incontinence was found in 59% females. There was no statistically significant correlation observed between diastasis recti abdominis muscle and either urinary incontinence or pelvic floor muscle strength, with a p-value exceeding 0.05. Implications to Theory, Practice and Policy: Incorporate routine DRAM screening for postpartum gynecological patients. Educate women about DRAM, its risk factors, and prevention strategies. Promote postpartum exercises and physical therapy to strengthen abdominal muscles and pelvic floor. Provide nutritional counseling to address obesity, a risk factor for DRAM. Implement a multidisciplinary approach involving gynecologists, physiotherapists, and nutritionists. Conduct additional research on the long-term consequences of DRAM and effective interventions. Conduct awareness campaigns targeting both healthcare providers and the public to increase DRAM awareness.
目的:腹直肌分离(DRA)是指直肌在其纵轴上的异常分离，没有筋膜不规则。目前的研究旨在确定DRA的患病率及其与盆底肌肉力量和尿失禁在费萨拉巴德妇科人群中的潜在关联。这是一项横断面研究。材料与方法:采用简便的抽样技术进行数据采集。从费萨拉巴德政府医院抽取了100名女性样本。研究于2018年2月至2018年5月在费萨拉巴德进行。本研究的纳入标准为:刚产后的妇女、18岁至绝经年龄的妇女和正常阴道分娩的妇女。采用压力测量技术量化盆底肌肉(PFMS)的强度，结果用cmH2O表示。通过询问患者的产后表现来确定尿失禁的发生率。利用腹直肌的指宽评估来测量腹直肌(DRA)移位的程度。这种特殊的测量跨越了脐上下4.5厘米的距离，与白线对齐。结果:通过SPSS version 26对结果进行分析。57%的女性有腹直肌转移。7%的女性盆底肌肉非常弱，38%的女性盆底肌肉弱，50%的女性盆底肌肉强度中等，5%的女性盆底肌肉强度良好。在100例患者中，59%的女性出现尿失禁。腹直肌转移与尿失禁或盆底肌力的相关性均无统计学意义，p值均大于0.05。对理论、实践和政策的启示:纳入产后妇科患者的常规DRAM筛查。教育妇女关于DRAM、其危险因素和预防策略。提倡产后锻炼和理疗，加强腹肌和盆底。提供营养咨询，解决肥胖问题，这是患DRAM的风险因素。实施包括妇科医生、物理治疗师和营养学家在内的多学科方法。对DRAM的长期后果和有效干预措施进行进一步研究。针对医疗保健提供者和公众开展宣传活动，以提高对DRAM的认识。
{"title":"Association of Diastasis Recti Abdominis with Pelvic Floor Muscle Strenth and Urine Incontinence in Gynecological Population","authors":"Abdul Mateen, Rukhsar Amanat, Haider Ali, Hurab Khalid, Akram Ali, A. Rehman, Samia Khaliq","doi":"10.47672/ajhmn.1672","DOIUrl":"https://doi.org/10.47672/ajhmn.1672","url":null,"abstract":"Purpose: Diastasis recti abdominis (DRA) denotes an anomalous separation of the rectus muscles throughout their longitudinal axis, devoid of fascial irregularities. The current study sought to determine the prevalence of DRA and its potential association with pelvic floor muscular strength and urinary incontinence in the gynaecological population of Faisalabad. This was a cross-sectional study. \u0000Materials and Methods: A Convenient sampling technique was used for collecting data. A sample of 100 females from government hospitals of Faisalabad was taken. Study was conducted in Faisalabad from February 2018 to May 2018. Inclusion criteria of the research was, immediate postpartum ladies, females aged 18 to menopausal age, and females who had normal vaginal birth. Manometric techniques were employed to quantify the strength of the pelvic floor muscles (PFMS), with outcomes represented in cmH2O. The incidence of urinary incontinence (UI) was ascertained by querying patients regarding any manifestations postpartum. The extent of diastasis recti abdominis (DRA) was gauged utilizing fingerbreadth assessments of the rectus abdominis muscles. This particular measurement spanned a distance of 4.5 cm both superior and inferior to the umbilicus, aligned with the linea alba. \u0000Findings: Results were analyzed through SPSS version 26. Diastasis recti abdominis was found to be present in 57% of the females. 7% of the women had very weak pelvic floor muscle, 38% had weak, 50% had moderate strength and 5% had good strength of pelvic floor muscles. Out of 100, urine incontinence was found in 59% females. There was no statistically significant correlation observed between diastasis recti abdominis muscle and either urinary incontinence or pelvic floor muscle strength, with a p-value exceeding 0.05. \u0000Implications to Theory, Practice and Policy: Incorporate routine DRAM screening for postpartum gynecological patients. Educate women about DRAM, its risk factors, and prevention strategies. Promote postpartum exercises and physical therapy to strengthen abdominal muscles and pelvic floor. Provide nutritional counseling to address obesity, a risk factor for DRAM. Implement a multidisciplinary approach involving gynecologists, physiotherapists, and nutritionists. Conduct additional research on the long-term consequences of DRAM and effective interventions. Conduct awareness campaigns targeting both healthcare providers and the public to increase DRAM awareness.","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"42 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138593614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Over the years, plants have been used in treatment of various health ailments. Morus alba also known as White Mulberry is a deciduous tree which belongs to family Moraceae. Mulberry is rich in antioxidants such as hydrophobic flavonoids, polyphenols, carotenoids, vitamin A, C and E. Materials and Methods: This study analyses the central nervous system activities including memory enhancement, learning abilities, changes in behavior, cognition, anxiety and depression. These effects will be studied on experimental mice, which will be distributed in control and test groups. Aqueous fruit extract prepared by Maceration extraction will be given to test group in three different doses per oral over a time period of 30 days, whereas control will be given water for injection for same duration. Findings: Afterwards, changes in aforementioned effects will be observed to determine the pharmacological effects of taken fruit. The obtained results suggest an antidepressant like effect of mulberry in the initial two weeks of dosing. Afterwards it shows anxiolytic effect at higher doses. Implications to Theory, Practice and Policy: All these tests can be repeated weekly while dosing the animals daily for 90 days for chronic toxicity analysis. Furthermore, we can add a brain biopsy/histopathology to evaluate the changes in chemical neurotransmitters.
{"title":"Morus alba; A Ray of Hope for Psychiatric Illnesses","authors":"Dr. Afshan Siddiq, Sidra Mohiuddin Soofi","doi":"10.47672/ajhmn.1671","DOIUrl":"https://doi.org/10.47672/ajhmn.1671","url":null,"abstract":"Purpose: Over the years, plants have been used in treatment of various health ailments. Morus alba also known as White Mulberry is a deciduous tree which belongs to family Moraceae. Mulberry is rich in antioxidants such as hydrophobic flavonoids, polyphenols, carotenoids, vitamin A, C and E. \u0000Materials and Methods: This study analyses the central nervous system activities including memory enhancement, learning abilities, changes in behavior, cognition, anxiety and depression. These effects will be studied on experimental mice, which will be distributed in control and test groups. Aqueous fruit extract prepared by Maceration extraction will be given to test group in three different doses per oral over a time period of 30 days, whereas control will be given water for injection for same duration. \u0000Findings: Afterwards, changes in aforementioned effects will be observed to determine the pharmacological effects of taken fruit. The obtained results suggest an antidepressant like effect of mulberry in the initial two weeks of dosing. Afterwards it shows anxiolytic effect at higher doses. \u0000Implications to Theory, Practice and Policy: All these tests can be repeated weekly while dosing the animals daily for 90 days for chronic toxicity analysis. Furthermore, we can add a brain biopsy/histopathology to evaluate the changes in chemical neurotransmitters. ","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"96 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138596096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dr. Rabia Shaheen Khan, Babar Ali, Zulaikha Saif, Dr Hafiza Aroosa, Dr Memoona Aslam, Sheeza Ali Rubab, Shahbaz Khizar
Purpose: De Quervain's Tenosynovitis is inflammation of extensor pollicis brevis and abductor pollicis longus tendons that run from the side of the wrist to the base of the thumb. To see the frequency of De Quervain’s Tenosynovitis and work related risk factors in carpenters of Punjab, Pakistan
Methodology: It was a cross-sectional study. Sample size of the research was 492. Study was conducted at the province Punjab, Pakistan. Inclusion criteria of the study were carpenters of age between twenty to fifty years having experience of more than 2 years. Data was collected to the selected population, through convenient sampling technique. Duration of the study was 8 months. Outcome measures of the study were Finkelstein test, Visual analogue scale and a structured questionnaire. The collected data was analyzed by using SPSS version 25.
Findings: Out of 492 participants, De-Quervain's Tenosynovitis was found to be present in 46% of carpenters Punjab. 25.6% of the participants had moderate, while 22.3% had extreme discomfort in lower back. 19.91% reported not to have an enough space for work. 55.69% didn’t take adequate breaks while working. 69.91% reported to have no back rest while working, 63% reported not use any wrist support or brace while working and 35.36% reported not to have any proper training for this work.
Conclusion: De Quervain’s Tenosynovitis is prevalent in carpenters of Punjab, Pakistan. Work-related discomfort was found in various regions of body including eyes, neck, shoulders, arms, wrist and hand. Contributing work-related risk factors for De Quervain's Tenosynovitis among carpenters encompass insufficient training, absence of wrist support, and inadequate breaks during work.
{"title":"Work-Related Risk Factors Contributing to De-Quervain's Tenosynovitis among Carpenters in Punjab","authors":"Dr. Rabia Shaheen Khan, Babar Ali, Zulaikha Saif, Dr Hafiza Aroosa, Dr Memoona Aslam, Sheeza Ali Rubab, Shahbaz Khizar","doi":"10.47672/ajhmn.1635","DOIUrl":"https://doi.org/10.47672/ajhmn.1635","url":null,"abstract":"Purpose: De Quervain's Tenosynovitis is inflammation of extensor pollicis brevis and abductor pollicis longus tendons that run from the side of the wrist to the base of the thumb. To see the frequency of De Quervain’s Tenosynovitis and work related risk factors in carpenters of Punjab, Pakistan
 Methodology: It was a cross-sectional study. Sample size of the research was 492. Study was conducted at the province Punjab, Pakistan. Inclusion criteria of the study were carpenters of age between twenty to fifty years having experience of more than 2 years. Data was collected to the selected population, through convenient sampling technique. Duration of the study was 8 months. Outcome measures of the study were Finkelstein test, Visual analogue scale and a structured questionnaire. The collected data was analyzed by using SPSS version 25.
 Findings: Out of 492 participants, De-Quervain's Tenosynovitis was found to be present in 46% of carpenters Punjab. 25.6% of the participants had moderate, while 22.3% had extreme discomfort in lower back. 19.91% reported not to have an enough space for work. 55.69% didn’t take adequate breaks while working. 69.91% reported to have no back rest while working, 63% reported not use any wrist support or brace while working and 35.36% reported not to have any proper training for this work.
 Conclusion: De Quervain’s Tenosynovitis is prevalent in carpenters of Punjab, Pakistan. Work-related discomfort was found in various regions of body including eyes, neck, shoulders, arms, wrist and hand. Contributing work-related risk factors for De Quervain's Tenosynovitis among carpenters encompass insufficient training, absence of wrist support, and inadequate breaks during work.","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135271413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Anterior knee pain begins when the kneecap does not move freely and bumps into the bottom portion of the thigh bone. This can be the result of the patellofemoral joint being out of alignment or the kneecap being in an abnormal position. The muscles on the front and back of your thigh are tight or weak. Patellofemoral pain syndrome (PFPS) is the term used to describe a common knee condition that causes pain in the front of the knee, near the patellofemoral joint. To determine the prevalence and functional limitations associated with anterior knee pain among female.
Methodology: An analytical cross-sectional study was conducted in the district Gujranwala. The sample size was 237. General female population of age 20 to 40 was included in this study. Convenient sampling technique was used. A Kujala scores (anterior knee pain scale) was used for data collection. The total scores of the questionnaire were 100. Participants with score less than 84 were positive anterior knee pain and those who had score more than 84 were negative anterior knee pain results.
Findings: Results shows that out of 237 participants 42 female with percentage 17.7% having positive results of ANP (anterior knee pain) and 195 females with percentage 82.3% have negative results of ANP.
Conclusion: This survey concluded that the 17.7% of the subjects were positive for ANP according to ANPQ. It was more common in young females. The daily physical activities are impacted by ANP. The majority of respondents who received positive scores struggled with knee flexion and experienced pain that affected their overall performance.
{"title":"Prevalence and Functional Limitations Associated with Anterior Knee Pain among Females","authors":"Maham Abbas, Faiza Asghar, Farooq Islam, Asim Raza","doi":"10.47672/ajhmn.1632","DOIUrl":"https://doi.org/10.47672/ajhmn.1632","url":null,"abstract":"Purpose: Anterior knee pain begins when the kneecap does not move freely and bumps into the bottom portion of the thigh bone. This can be the result of the patellofemoral joint being out of alignment or the kneecap being in an abnormal position. The muscles on the front and back of your thigh are tight or weak. Patellofemoral pain syndrome (PFPS) is the term used to describe a common knee condition that causes pain in the front of the knee, near the patellofemoral joint. To determine the prevalence and functional limitations associated with anterior knee pain among female.
 Methodology: An analytical cross-sectional study was conducted in the district Gujranwala. The sample size was 237. General female population of age 20 to 40 was included in this study. Convenient sampling technique was used. A Kujala scores (anterior knee pain scale) was used for data collection. The total scores of the questionnaire were 100. Participants with score less than 84 were positive anterior knee pain and those who had score more than 84 were negative anterior knee pain results.
 Findings: Results shows that out of 237 participants 42 female with percentage 17.7% having positive results of ANP (anterior knee pain) and 195 females with percentage 82.3% have negative results of ANP.
 Conclusion: This survey concluded that the 17.7% of the subjects were positive for ANP according to ANPQ. It was more common in young females. The daily physical activities are impacted by ANP. The majority of respondents who received positive scores struggled with knee flexion and experienced pain that affected their overall performance.","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"234 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135809056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dr. Rabia Anwar; PT, Aamir Shahzad, Hurab Khalid, Areej Akmal Bajwa, Zulaikha Saif, Fatima Iftikhar, Mir Arif Hussain
Purpose: Lateral epicondylitis, also referred to as "tennis elbow," is a painful condition resulting from the inflammation of tendons situated along the exterior of the elbow, which serve to connect the muscles of the forearm. The primary aim of this study was to assess and compare the therapeutic effects of phonophoresis with naproxen versus ultrasound therapy in managing pain levels and enhancing grip strength in individuals suffering from lateral epicondylitis
Methodology: This quasi-experimental study comprised a sample size of 42 participants, selected through convenient sampling methods over duration of 8 months. The inclusion criteria stipulated that individuals of both genders, aged between 31 and 50 years, experiencing chronic pain in the elbow and forearm for a period exceeding 3 months, and exhibiting a positive response to the Mill's test, were eligible for participation. The participants were divided into two groups, each consisting of 21 subjects. Out of the 42 patients, 21 were assigned to Group 1, which received baseline therapy along with Phonophoresis utilizing naproxen, while the remaining 21 were allocated to Group 2, which received baseline therapy in conjunction with therapeutic ultrasound. Both groups had received baseline treatment of stretching and strengthening exercises. Four sessions of interventions were given per week, for four weeks. Intensity of pain was assessed by Visual analogue scale (VAS) before and after the treatment of 4 week and grip strength was measured by handheld dynamometer. There were two drop outs in group 1 and three in group 2. The collected data was analyzed and interpreted by using SPSS software of version 24.0
Findings: Among the 42 participants (with 21 in each group), 67% of patients in Group 1 were male, while 33% were female. In Group 2, 42.9% were male, and 57.1% were female. For Group 1, the median grip strength value before treatment was 60.00, which significantly decreased to 20.00 after treatment. Similarly, in Group 2, the median grip strength value before treatment was 70.00, and it also decreased significantly to 20.00 after treatment. The pre-treatment mean grip strength in Group 1 was 36.46±8.82, which increased to 50.59±11.33 after 4 weeks of treatment. In Group 2, the pre-treatment mean grip strength was 31.12±4.87, and it increased to 52.02±9.70 after treatment. A statistically significant difference was observed in both groups when comparing pre- and post-treatment grip strength values (p<0.001). However, the between-group analysis comparing Group 1 and Group 2 showed no statistically significant difference (p>0.05)..
Recommendations: Based on the study's findings, both phonophoresis with naproxen and therapeutic ultrasound are effective in managing pain and improving grip strength for lateral epicondylitis patients. Clinicians should consider incorporating these treatments into their therapeutic regimens for such patients. Future research should consider lar
{"title":"Comparative Efficacy of Phonophoresis with Naproxen and Ultrasound Therapy on Pain and Grip Strength in Lateral Epicondylitis","authors":"Dr. Rabia Anwar; PT, Aamir Shahzad, Hurab Khalid, Areej Akmal Bajwa, Zulaikha Saif, Fatima Iftikhar, Mir Arif Hussain","doi":"10.47672/ajhmn.1633","DOIUrl":"https://doi.org/10.47672/ajhmn.1633","url":null,"abstract":"Purpose: Lateral epicondylitis, also referred to as \"tennis elbow,\" is a painful condition resulting from the inflammation of tendons situated along the exterior of the elbow, which serve to connect the muscles of the forearm. The primary aim of this study was to assess and compare the therapeutic effects of phonophoresis with naproxen versus ultrasound therapy in managing pain levels and enhancing grip strength in individuals suffering from lateral epicondylitis
 Methodology: This quasi-experimental study comprised a sample size of 42 participants, selected through convenient sampling methods over duration of 8 months. The inclusion criteria stipulated that individuals of both genders, aged between 31 and 50 years, experiencing chronic pain in the elbow and forearm for a period exceeding 3 months, and exhibiting a positive response to the Mill's test, were eligible for participation. The participants were divided into two groups, each consisting of 21 subjects. Out of the 42 patients, 21 were assigned to Group 1, which received baseline therapy along with Phonophoresis utilizing naproxen, while the remaining 21 were allocated to Group 2, which received baseline therapy in conjunction with therapeutic ultrasound. Both groups had received baseline treatment of stretching and strengthening exercises. Four sessions of interventions were given per week, for four weeks. Intensity of pain was assessed by Visual analogue scale (VAS) before and after the treatment of 4 week and grip strength was measured by handheld dynamometer. There were two drop outs in group 1 and three in group 2. The collected data was analyzed and interpreted by using SPSS software of version 24.0
 Findings: Among the 42 participants (with 21 in each group), 67% of patients in Group 1 were male, while 33% were female. In Group 2, 42.9% were male, and 57.1% were female. For Group 1, the median grip strength value before treatment was 60.00, which significantly decreased to 20.00 after treatment. Similarly, in Group 2, the median grip strength value before treatment was 70.00, and it also decreased significantly to 20.00 after treatment. The pre-treatment mean grip strength in Group 1 was 36.46±8.82, which increased to 50.59±11.33 after 4 weeks of treatment. In Group 2, the pre-treatment mean grip strength was 31.12±4.87, and it increased to 52.02±9.70 after treatment. A statistically significant difference was observed in both groups when comparing pre- and post-treatment grip strength values (p<0.001). However, the between-group analysis comparing Group 1 and Group 2 showed no statistically significant difference (p>0.05)..
 Recommendations: Based on the study's findings, both phonophoresis with naproxen and therapeutic ultrasound are effective in managing pain and improving grip strength for lateral epicondylitis patients. Clinicians should consider incorporating these treatments into their therapeutic regimens for such patients. Future research should consider lar","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"98 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135927921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Adhesive capsulitis is a condition in which the tissues of the shoulder joint become tight and impede movement. It is characterized by gradual loss of both active and passive glenohumeral joint motion, resulting in fibrosis, scarring and contractures of the joint capsule. Patient with adhesive capsulitis usually have difficulty in performing overhead activities, as well as routine duties such as combing their hair, dressing themselves, and throwing a ball. The objective of this study was to determine the effectiveness of proprioceptive neuromuscular facilitation (PNF) stretch vs muscle energy technique (MET) on pain and disability in patients with adhesive capsulitis.
Methodology: Study Design: This research employed a rigorous single-blinded randomized controlled trial design to investigate the comparative effectiveness of two manual therapy techniques in the management of adhesive capsulitis. The study was conducted in accordance with established ethical guidelines and principles. Participant Selection: A total of 30 participants, aged between 30 and 60 years, were recruited for this study. The selection process adhered to specific inclusion and exclusion criteria to ensure the homogeneity of the participant group. Inclusion criteria encompassed individuals in the 2nd and 3rd stages of adhesive capsulitis, both males and females, those with comorbid conditions such as diabetes and hypertension, and individuals experiencing painful restrictions in active and passive glenohumeral or periscapular motion. It was essential that participants had the ability to understand Punjabi or Urdu and were willing to participate. Exclusion criteria included individuals with a history of post-traumatic immobilization, cognitive impairment, previous surgery or arthroscopy, cervical pathology, neoplasm/tumor, or reflex sympathetic dystrophy. Informed Consent: Before the commencement of the study, informed consent was obtained from all participants. The participants were fully informed of the study's objectives, procedures, and potential risks and benefits. The rights of voluntary participation and the option to withdraw from the study at any time were emphasized. Participant data were anonymized and kept confidential throughout the research process to safeguard privacy. Randomization: To minimize bias, participants were randomly assigned to two distinct treatment groups, Group A and Group B. The randomization process was conducted using a computer-generated method, ensuring that each participant had an equal chance of being assigned to either group. Interventions: The study employed two distinct manual therapy techniques for the treatment of adhesive capsulitis. Group A received proprioceptive neuromuscular facilitation (PNF) stretching, while Group B underwent the Spencer muscle energy technique (MET). Both interventions were administered over a duration of one month. Baseline Treatment: In addition to the primary interventions, all participants re
{"title":"Comparative Effectiveness of Proprioceptive Neuromuscular Facilitation Stretch Vs Spencer Muscle Energy Technique on Pain and Disability in Patients with Adhesive Capsulitis","authors":"Tamjeed Ghaffar, Mehak Fatima, Chaman Zahra, Ayesha Yousaf, Iqra Wahid, Asma Ghafoor","doi":"10.47672/ajhmn.1631","DOIUrl":"https://doi.org/10.47672/ajhmn.1631","url":null,"abstract":"Purpose: Adhesive capsulitis is a condition in which the tissues of the shoulder joint become tight and impede movement. It is characterized by gradual loss of both active and passive glenohumeral joint motion, resulting in fibrosis, scarring and contractures of the joint capsule. Patient with adhesive capsulitis usually have difficulty in performing overhead activities, as well as routine duties such as combing their hair, dressing themselves, and throwing a ball. The objective of this study was to determine the effectiveness of proprioceptive neuromuscular facilitation (PNF) stretch vs muscle energy technique (MET) on pain and disability in patients with adhesive capsulitis.
 Methodology: Study Design: This research employed a rigorous single-blinded randomized controlled trial design to investigate the comparative effectiveness of two manual therapy techniques in the management of adhesive capsulitis. The study was conducted in accordance with established ethical guidelines and principles. Participant Selection: A total of 30 participants, aged between 30 and 60 years, were recruited for this study. The selection process adhered to specific inclusion and exclusion criteria to ensure the homogeneity of the participant group. Inclusion criteria encompassed individuals in the 2nd and 3rd stages of adhesive capsulitis, both males and females, those with comorbid conditions such as diabetes and hypertension, and individuals experiencing painful restrictions in active and passive glenohumeral or periscapular motion. It was essential that participants had the ability to understand Punjabi or Urdu and were willing to participate. Exclusion criteria included individuals with a history of post-traumatic immobilization, cognitive impairment, previous surgery or arthroscopy, cervical pathology, neoplasm/tumor, or reflex sympathetic dystrophy. Informed Consent: Before the commencement of the study, informed consent was obtained from all participants. The participants were fully informed of the study's objectives, procedures, and potential risks and benefits. The rights of voluntary participation and the option to withdraw from the study at any time were emphasized. Participant data were anonymized and kept confidential throughout the research process to safeguard privacy. Randomization: To minimize bias, participants were randomly assigned to two distinct treatment groups, Group A and Group B. The randomization process was conducted using a computer-generated method, ensuring that each participant had an equal chance of being assigned to either group. Interventions: The study employed two distinct manual therapy techniques for the treatment of adhesive capsulitis. Group A received proprioceptive neuromuscular facilitation (PNF) stretching, while Group B underwent the Spencer muscle energy technique (MET). Both interventions were administered over a duration of one month. Baseline Treatment: In addition to the primary interventions, all participants re","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"31 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136018839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Implementation science is the broader aspect of corporate social responsibility (CSR) translating healthcare education to clinical research and practice for public health and patient safety encompassing the hierarchy of evidence-based medicine (EBM), hence, serving as an integrative method of combing CSR towards healthcare corporate governance. This paper aims to model EBM under principles of valid contract formation as compliance to CSR theories of promoting positive health outcomes of patient safety leading to financial success and lessening the risks of mortality cases.
Methodology: The elements of valid contract formation and sources of errors are the systematic plan for behavioral guidance of EBM practice. These determinants are crucial in refining the clinical judgment of medical experts together with other healthcare professionals in support with high-ranking databases of research publication, resulting to a greater impact of positive health outcomes of patient safety under “judicious” application of CSR. These principles of contract law are integrated for “measuring” the EBM’s financial success towards healthcare corporate governance.
Findings: EBM is a scientific approach to handle medical cases and reports towards patient safety under clinical judgment of medical expert and healthcare team in corroboration with reliable sources of databases for medical research and review for reducing death rates in healthcare setting. SELECT Criteria Mechanism elucidated EBM as implementation science integrating CSR for behavioral compliance to healthcare corporate governance. First, the modeling of CSR as method to comply with EBM delineates the elements formed for valid contract formation in producing an “ethical” standard as responsibility for optimal patient safety as bargained promise under acceptance of the clinical team. Second, the illustration of the healthcare corporate governance in EBM practice as theory “measures” the reduction of healthcare expenditures from the exhibited means of diminishing mortality cases. Therefore, implementation science serves as an initiation for remediation process of reducing risks of death cases.
Recommendation: Implementation science is very important in EBM practice in treating ways of lessening the probability of mortality cases under “ethical” or “judicious” patient safety guidelines as corporate social responsibility. Hence, it is recommended to develop systems for behavioral guidance in a more organized plan of targeting death reduction cases towards financial intelligence as fulfillment in implementation science.
{"title":"The Implementation Science of Financial Intelligence in Evidence-Based Medicine Using Select Criteria Mechanism as Treatment Process towards Healthcare Corporate Governance","authors":"Zharama Llarena","doi":"10.47672/ajhmn.1623","DOIUrl":"https://doi.org/10.47672/ajhmn.1623","url":null,"abstract":"Purpose: Implementation science is the broader aspect of corporate social responsibility (CSR) translating healthcare education to clinical research and practice for public health and patient safety encompassing the hierarchy of evidence-based medicine (EBM), hence, serving as an integrative method of combing CSR towards healthcare corporate governance. This paper aims to model EBM under principles of valid contract formation as compliance to CSR theories of promoting positive health outcomes of patient safety leading to financial success and lessening the risks of mortality cases.
 Methodology: The elements of valid contract formation and sources of errors are the systematic plan for behavioral guidance of EBM practice. These determinants are crucial in refining the clinical judgment of medical experts together with other healthcare professionals in support with high-ranking databases of research publication, resulting to a greater impact of positive health outcomes of patient safety under “judicious” application of CSR. These principles of contract law are integrated for “measuring” the EBM’s financial success towards healthcare corporate governance.
 Findings: EBM is a scientific approach to handle medical cases and reports towards patient safety under clinical judgment of medical expert and healthcare team in corroboration with reliable sources of databases for medical research and review for reducing death rates in healthcare setting. SELECT Criteria Mechanism elucidated EBM as implementation science integrating CSR for behavioral compliance to healthcare corporate governance. First, the modeling of CSR as method to comply with EBM delineates the elements formed for valid contract formation in producing an “ethical” standard as responsibility for optimal patient safety as bargained promise under acceptance of the clinical team. Second, the illustration of the healthcare corporate governance in EBM practice as theory “measures” the reduction of healthcare expenditures from the exhibited means of diminishing mortality cases. Therefore, implementation science serves as an initiation for remediation process of reducing risks of death cases. 
 Recommendation: Implementation science is very important in EBM practice in treating ways of lessening the probability of mortality cases under “ethical” or “judicious” patient safety guidelines as corporate social responsibility. Hence, it is recommended to develop systems for behavioral guidance in a more organized plan of targeting death reduction cases towards financial intelligence as fulfillment in implementation science.","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"47 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135462016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zainab Sarfraz, Dr. Gulraiz Enderyas, Dr. Farooq Islam, Prof Asim Raza Thakur
Purpose: To compare hamstring tightness in individuals with and without plantar fasciitis
Methodology: 369 individuals (male and female) was evaluated This, cross-sectional study included individuals with, and without plantar fasciitis. Data will be collected from hospitals in DHQ Wazirabad, THQ Gujranwala, Aziz Bhatti Gujrat. Non probability convenient sampling technique was used. Goniometer was used for measuring range of motion for active knee extension. The data was collected under the rules and regulations of ethical committee of University of Lahore.
Findings: This study's findings show that 50.27 percent of subjects had plantar fasciitis whereas 49.73 percent did not. Active knee extension test was used to determine whether participants had tight hamstrings. The results show that among the 49.73% of participants who did not have plantar fasciitis, 37.23% had negative results, while 12.50% had positive results. In contrast, among the 50.27% of participants who did have plantar fasciitis, 11.14% had negative results, while 39.13% had positive results.
Conclusion: The study's goal was to determine if hamstring tension contributes to the development of plantar fasciitis. According to the current study, individuals with and without PF had their hamstring tightness evaluated. An active knee extension test was used to measure the tightness of the hamstrings. Following the completion of the current study, it was shown that patients with plantar fasciitis show higher hamstring tightness than individuals without plantar fasciitis.
Recommendations: For study, it is recommended to gather data from several cities so that the conclusions may be generalized. Future research should examine additional risk factors for plantar fasciitis. The reasons of hamstring tightness should be addressed to reduce the chance of developing plantar fasciitis.
{"title":"A Comparative Study to Assess Hamstring Tightness in Individuals with and without Plantar fasciitis","authors":"Zainab Sarfraz, Dr. Gulraiz Enderyas, Dr. Farooq Islam, Prof Asim Raza Thakur","doi":"10.47672/ajhmn.1621","DOIUrl":"https://doi.org/10.47672/ajhmn.1621","url":null,"abstract":"Purpose: To compare hamstring tightness in individuals with and without plantar fasciitis
 Methodology: 369 individuals (male and female) was evaluated This, cross-sectional study included individuals with, and without plantar fasciitis. Data will be collected from hospitals in DHQ Wazirabad, THQ Gujranwala, Aziz Bhatti Gujrat. Non probability convenient sampling technique was used. Goniometer was used for measuring range of motion for active knee extension. The data was collected under the rules and regulations of ethical committee of University of Lahore.
 Findings: This study's findings show that 50.27 percent of subjects had plantar fasciitis whereas 49.73 percent did not. Active knee extension test was used to determine whether participants had tight hamstrings. The results show that among the 49.73% of participants who did not have plantar fasciitis, 37.23% had negative results, while 12.50% had positive results. In contrast, among the 50.27% of participants who did have plantar fasciitis, 11.14% had negative results, while 39.13% had positive results.
 Conclusion: The study's goal was to determine if hamstring tension contributes to the development of plantar fasciitis. According to the current study, individuals with and without PF had their hamstring tightness evaluated. An active knee extension test was used to measure the tightness of the hamstrings. Following the completion of the current study, it was shown that patients with plantar fasciitis show higher hamstring tightness than individuals without plantar fasciitis.
 Recommendations: For study, it is recommended to gather data from several cities so that the conclusions may be generalized. Future research should examine additional risk factors for plantar fasciitis. The reasons of hamstring tightness should be addressed to reduce the chance of developing plantar fasciitis.","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135513874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To find out the association of shoulder impingement syndrome with BMI in younger adults with reporting shoulder pain.
Methodology: This analytical cross-sectional study was carried out involving 18 to 39 years of male and female. Data was collected from Gujarat city (City Hospital, Gujrat Hospital, and THQ Hospital). This study was completed in 4 months after approval of synopsis. And total 233 males and females were evaluated. 18 to 39 years of males and females and who are willing to participate were included. Using a self-administered questionnaire, data was collected on demographic information (age, gender, occupation, height, weight, and BMI), as well as information specific to shoulder impingement syndrome.
Findings: Total patients were 233.There were 19 patients who were underweight overall or 8.2%.There were 12 underweight individuals with positive Neer's Test results, and their proportion was 9.0%.There were 7 underweight patients with negative Neer's Test results, and their proportion was 7.0%.75 patients were overall healthy, and their proportion was 32.2%.There were 28 healthy patients with positive Neer's Test results, and their proportion was 21.1%.The percentage of healthy patients with a negative Neer's Test was 47, or 47.0%.There were 93 patients overall who were overweight, making up 39.9% of the total.There were 58 overweight individuals with positive Neer's Test results, and their proportion was 43.6%.Neer's Test results for overweight individuals who were 35 and whose percentage was 35.0% were negative. A total of 46 patients were obese, making up 19.7% of the total.There were 35 obese individuals with positive Neer's Test results, and their proportion was 26.3%.There were 11 obese individuals with negative Neer's Test results, and their proportion was 11.0%.
Conclusion: This study reveals that the prevalence of shoulder impingement is associated with overweight or obese patients. The ratio of shoulder impingement was high in females. My result was significant.
Recommendations: For study, it is recommended to gather data from several cities so that the conclusions may be generalized. In order to prevent people from developing shoulder impingement, obesity risk factors should be addressed.
{"title":"Association of Shoulder Impingement Syndrome with BMI in Younger Adults with Reporting Shoulder Pain","authors":"Haseeba Maryam, Enderyas Enderyas, Farooq Islam, Asim Thakur","doi":"10.47672/ajhmn.1618","DOIUrl":"https://doi.org/10.47672/ajhmn.1618","url":null,"abstract":"Purpose: To find out the association of shoulder impingement syndrome with BMI in younger adults with reporting shoulder pain.
 Methodology: This analytical cross-sectional study was carried out involving 18 to 39 years of male and female. Data was collected from Gujarat city (City Hospital, Gujrat Hospital, and THQ Hospital). This study was completed in 4 months after approval of synopsis. And total 233 males and females were evaluated. 18 to 39 years of males and females and who are willing to participate were included. Using a self-administered questionnaire, data was collected on demographic information (age, gender, occupation, height, weight, and BMI), as well as information specific to shoulder impingement syndrome.
 Findings: Total patients were 233.There were 19 patients who were underweight overall or 8.2%.There were 12 underweight individuals with positive Neer's Test results, and their proportion was 9.0%.There were 7 underweight patients with negative Neer's Test results, and their proportion was 7.0%.75 patients were overall healthy, and their proportion was 32.2%.There were 28 healthy patients with positive Neer's Test results, and their proportion was 21.1%.The percentage of healthy patients with a negative Neer's Test was 47, or 47.0%.There were 93 patients overall who were overweight, making up 39.9% of the total.There were 58 overweight individuals with positive Neer's Test results, and their proportion was 43.6%.Neer's Test results for overweight individuals who were 35 and whose percentage was 35.0% were negative. A total of 46 patients were obese, making up 19.7% of the total.There were 35 obese individuals with positive Neer's Test results, and their proportion was 26.3%.There were 11 obese individuals with negative Neer's Test results, and their proportion was 11.0%.
 Conclusion: This study reveals that the prevalence of shoulder impingement is associated with overweight or obese patients. The ratio of shoulder impingement was high in females. My result was significant.
 Recommendations: For study, it is recommended to gather data from several cities so that the conclusions may be generalized. In order to prevent people from developing shoulder impingement, obesity risk factors should be addressed.","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136032819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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