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Objective: Pakistan bears most of the burden of drug-resistant typhoid, challenging its healthcare systems with substantial cost. This study’s purpose is to investigate resistance in community-acquired salmonella typhi to guide its evidence-based empiric treatment. Material & Methods: This study used retrospective data from the microbiology laboratory, Khyber Teaching Hospital, Peshawar (September 2022-March 2023). Data of routine diagnostic samples for typhoid was retrieved from the database. Kirby– Bauer disk diffusion method was employed to determine the sensitivity of S. Typhi against a panel of 21 selected antibiotic discs (not exclusively for each isolate). Results: Among 1742 suspected patients, 239 (13.92%) were positive for S. Typhi with 212/238 (89.1%), 227/233 (97.4%), and 196/239 (82.0%) isolates resistant to chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole, respectively. High resistance (88.0% to ciprofloxacin) was detected against fluoroquinolones. Third-generation cephalosporins also showed poor activity with 144/158 (91.1%) and 120/136 (88.2%) resistance towards ceftriaxone and cefixime, respectively, except for cefoperazone/sulbactam (2/123, 1.6%). Among 157 tested isolates, 3 (1.9%), 9 (5.7%), and 123 (78.3%) were labeled as non-resistant, MDR, and XDR strains, respectively. XDRs were less resistant to azithromycin (1/114), piperacillin/tazobactam (1/123), carbapenems (0/123), and tigecycline (0/123). Conclusion: XDR S. Typhi was observed as the dominant strain in Peshawar regions for which azithromycin is still the drug of choice. With emerging resistance, azithromycin safety should be ensured through antibiotic stewardship principles. An interesting finding was the enhanced activity of cefoperazone/sulbactam, suggesting future studies. Alternative options are expensive antibiotics which can be used as a last resort. [ABSTRACT FROM AUTHOR]

Since 2013, the leading SAT solvers in SAT competitions all use inprocessing, which, unlike preprocessing, interleaves search with simplifications. However, inprocessing is typically a performance bottleneck, in particular for hard or large formulas. In this work, we introduce the first attempt to parallelize inprocessing on GPU architectures. As one of the main challenges in GPU programming is memory locality, we present new compact data structures and devise a data-parallel garbage collector. It runs in parallel on the GPU to reduce memory consumption and improve memory locality. Our new parallel variable elimination algorithm is roughly twice as fast as previous work. Moreover, we augment the variable elimination with the first parallel algorithm for functional dependency extraction in an attempt to find more logical gates to eliminate that cannot be found with syntactic approaches. We present a novel algorithm to generate clausal proofs in parallel to validate all simplifications running on the GPU besides the CDCL search, giving high credibility to our solver and its use in critical applications such as model checkers. In experiments, our new solver ParaFROST solves numerous benchmarks faster on the GPU than its sequential counterparts. With functional dependency extraction, inprocessing in ParaFROST was more effective in reducing the solving time. Last but not least, all proofs generated by ParaFROST were successfully verified. [ABSTRACT FROM AUTHOR]

A field experiment on the effect of zinc and molybdenum application on the yield of lentil was carried out at The University of Agriculture Peshawar during the Rabi season of 2021. The experiment was carried out in a randomised complete block design with three replications. Four levels of molybdenum (0, 1, 2 and 3 kg ha-1) and 0.5% zinc foliar spray at different intervals of lentil crop (control, 50 days after sowing, 100 days after sowing, 50 days after sowing + 100 days after sowing) were tested in the experiment. The results revealed that 3 kg ha-1 of molybdenum enhanced plant height (55 cm), nodules plant-1 (25), branches plant-1 (7), days to flowering (107) and maturity (159), dry matter of leaves at the flowering stage (64 g m-2), dry matter of leaves at the maturity stage (113 g m-2), dry matter of branches at the physiological maturity stage (304 g m-2), dry matter of pods at the maturity stage (439 g m-2), pods plant-1 (92), seeds pod-1 (2.0), 1000-seed weight (31 g), biological yield (3207 kg ha-1), and seed yield (1002 kg ha-1). Zinc foliar spray (0.5%) at 50 days after sowing + 100 days after sowing of lentil crop improved the dry matter of leaves at the flowering stage (62 g m-2), days to first flowering (109), days to physiological maturity (157), dry matter of leaves at the physiological maturity stage (111 g m-2), dry matter of pods at the physiological maturity stage (435 g m-2), pods plant-1 (91), 1000 seed weight (32 g), biological yield (3236 kg ha-1) and seed yield (1026 kg ha-1). Lastly, scatterplots revealed a significant correlation of grain and biological yield with their components. It is concluded that molybdenum application at a rate of 3 kg ha-1 and 0.5% zinc foliar spray at 50 days after sowing + 100 days after sowing of the lentil crop increased seed yield and is thus recommended for the Peshawar region. [ABSTRACT FROM AUTHOR]

Innovative structures called piano key weirs are used in hydraulic engineering to regulate flow. This study intends to investigate the effects of changes in the geometry of the piano key weir, namely the number of cycles, on discharge performance. The study looked at how a piano key weir's discharge capacity would change as the number of cycles changed. In this work, a series of controlled laboratory tests were carried out in which several piano key weir models were examined at various heads in the range of 0.042m to 0.078m. The findings showed that some modifications to the geometric parameters can have a substantial effect on the PKW's discharge efficiency. The piano key weir's discharge rates increased as the number of cycles was reduced, showing that fewer cycles enable better flow control and water management capabilities. Furthermore, the value of discharge capacity of PK weir with number of cycles 3 was found to be 3.36% and 5.95% greater than PK weir with number of cycles 4 and 5 respectively. The research's conclusions offer useful information for engineers and professionals working on water resource projects, assisting them in making wise choices when putting piano key weirs to use in practical situations. [ABSTRACT FROM AUTHOR]

This research discusses the asphalt mix design with electronic waste aggregates. Plastic is increasing day by day and it is an environmental hazard. Its disposal is a very serious issue. Electronic Waste can cause adverse effects on the environment. To deal with this problem we used Electronic Waste as a replacement for natural aggregates. In this research we used electronic waste in place of natural aggregates upto15%. We prepared 6 samples with 0,5,10 and 15% E-waste and performed Marshall Stability and Flow test. We also performed Bulk Specific gravity test. The Marshall Stability value at 0% is 1262.53kg, 5% is 1256.4kg, 10% is 1230.32kg and 15% is 1204.24. The Flow value at 0% is 7.5mm, 5%is 7.86mm, 10% is 8.1mm and 15% is 8.5mm. The bulk specific gravity at 0% is 2.324, 5% is 2.236, 10% is 2.091 and 15% is 2.027. The Marshall Stability and bulk specific gravity decrease with an increase in E-Waste% while Flow value increase with increase in E-Waste%. [ABSTRACT FROM AUTHOR]

Background: Air pollution, a global concern with an annual emission of 600 million tons of pollutants, poses a significant health threat, particularly in cities like Peshawar. Our objectives were to study the nature and distribution of particulate matter (PMs) in the air of fourteen sites in Peshawar city and assess its association with respiratory symptoms and peak flow. Materials & Methods: This study selected 14 sites in Peshawar for air sampling. Air quality was assessed for PM 1-10, Cadmium, and lead in milligrams/m3 of the air through a device called High volume Air sampling system (PM 10-4200 AFC, HI-Q Environmental Health Services, San Diego, California USA). By systematic random sampling, one hundred and eighteen individuals were questioned on these 14 sites for their demographic details and respiratory symptoms through a structured questionnaire. The researchers measured the peak flow through a portable Mini-Wright peak flow meter. SPSS version 20 conducted the statistical analysis. The chi-square test and Pearson's correlation test were applied. The criterion standard for the p-value was less than 0.05. Results: In a study involving 118 individuals from diverse professions in Peshawar, evaluated air pollutant levels, particularly PM1-10, lead, and Cadmium, exceeded WHO recommendations. The active cough was the predominant symptom in 55% (n=66) of the study sample. In contrast, 54% exhibited lower-than-predicted peak flow values, clinical symptoms like cough, impaired exercise tolerance, and exposure to pets correlated with reduced peak flow. Positive correlations were found between peak flow and age and inverse correlations with symptom duration. Conclusion: Particulate matter in the air of Peshawar city is higher than the upper limits recommended by the WHO. This bad air quality in Peshawar affects its residents through active coughing and low peak flow readings, amongst many other respiratory problems. [ABSTRACT FROM AUTHOR]

BACKGROUND: Muscle energy technique (MET) is found to be effective for the management of neck pain and in addition to the muscle specific approach, clinicians may also adopt movement specific approach for METs. However, the literature is deficient in terms of comparison of muscle specific and movement specific METs in the management of mechanical neck pain. OBJECTIVE: To compare the effects of muscle specific and movement specific METs in the management of mechanical neck pain. METHODS: A single blind parallel design randomized controlled trial was conducted on 66 participants with mechanical neck pain ranging from 40–80 mm on visual analogue scale (VAS), aged between 19–44 years with pain and limitation on cervical motion. Once included, the participants were randomly allocated to two groups, namely the muscle specific MET group and the movement specific MET group. Outcome measures included VAS, Neck Disability Index (NDI) and cervical range of motion (ROM). RESULTS: No significant differences (p > 0.05) were observed, neither immediately nor after 5 days, between muscle specific and movement specific MET in terms of VAS, NDI and ROM. However, a significant difference (p < 0.05) was observed in both groups in terms of pre- and post-analysis for all outcome variables. CONCLUSIONS: Both muscle specific and movement specific METs are effective in the management of mechanical neck pain, with no significant differences between the two treatment techniques. [ABSTRACT FROM AUTHOR]

An editorial is presented on the challenge of language barriers faced by researchers, particularly in non-English speaking countries, hindering effective communication and publication of scientific findings. It reports that while Artificial Intelligence (AI) emerges as a comprehensive solution to these problems, there are concerns about its long-term implications and misuse, leading to the development of policies regulating its use in scientific writing.

Introduction: Throughout their academic careers, medical and dental students face challenges that cause varying levels of stress, affecting their academic performance and quality of life (QoL). Our study aims to ascertain the effect of academic stress and the educational environment on the QoL and academic performance of medical and dental students, encompassing the perspectives of both students and healthcare professionals. Methods: A mixed-method research was conducted from February to May 2022, comprising students from a medical and dental college in Pakistan. During Phase 1, the students participated in the cross-sectional survey and completed the WHO Quality of Life Scale (WHOQOL-BREF), Academic Stress Scale, and Dundee Ready Educational Environment Measure (DREEM) Inventory questionnaires. Academic performance was evaluated through last year's annual assessment results of the students. During Phase 2 of the study, interviews with healthcare professionals who had experience as the students' counsellors were conducted. Results: The mean age of the sample (n = 440) was 22.24 ±1.4 years. The Cronbach Alpha reliability of the DREEM inventory was 0.877, that of the Academic Stress Scale was 0.939 and the WHOQOL scale was 0.895. More than half of the students (n = 230, 52.3%) reported better QoL and the majority perceived a positive educational environment (n = 323, 73.4%) and higher academic stress (n = 225, 51.1%). Males had significantly more academic stress (p<0.05). Those who perceived a positive educational environment and better QoL had better academic performance (p<0.05). Academic performance was positively and significantly correlated with QoL and academic stress (p = 0.000). In qualitative analysis, 112 codes were generated which converged into 5 themes: challenging educational environment, psychological need and support, individual differences, relationship and family life, and adjustment issues. Conclusion: Medical and dental students encounter a myriad of challenges, along with significant academic stress, which detrimentally affects their academic performance, despite perceiving a positive educational environment. Conversely, a better QoL is associated with improved academic performance. [ABSTRACT FROM AUTHOR]

The long-time dynamics of a quiescent finite-size three-dimensional air filament in a static liquid is studied using three-dimensional numerical simulations. The two ends of the air filament retract under the effect of surface tension and form bulges. A long filament with the aspect ratio Γ = 30 is considered to trigger the end-pinching regime of the filament rupture. The study focuses on the effect of the Ohnesorge number, which relates viscous forces to inertia and surface tension forces. Depending on the value of the Ohnesorge number, two or three successive ruptures of the filament are observed. Wavy structures form at the interface of the air filament after the first rupture and lead to a subsequent breakup in the middle of the filament or in several places depending on the corresponding Ohnesorge number. The size distribution of the bubbles generated is provided and shows an average diameter twice as large as the initial diameter of the air filament. Microbubbles are generated, and their number is shown to increase when the Ohnesorge number decreases. [ABSTRACT FROM AUTHOR]

Aim: There is limited data on clinical outcomes of delayed cardioversion (DCV) compared with early cardioversion (ECV) in paroxysmal atrial fibrillation (AF) patients. Methods: We utilized data from National Inpatient Sample (2015–2020) and propensity-score matched analysis to determine adjusted odds ratio (aOR) of major clinical outcomes, including 17,879 AF cases: 9725 and 8154 underwent ECV and DCV, respectively. Results: Compared with ECV, DCV was associated with higher odds of acute heart failure (AHF; aOR 1.79 [1.67–1.92]; p < 0.01), median length of stay (4 vs 2 days; p < 0.01) and cost of hospitalization ($33,410 vs $21,738; p < 0.01) with no significant difference in inpatient mortality and other cardiovascular and neurological outcomes. Conclusion: Compared with ECV, DCV was associated with more AHF and resource utilization. [ABSTRACT FROM AUTHOR]

PURPOSE: Knee Osteoarthritis is a common degenerative joint disease associated with significant walking-related disability. Impaired gait mechanics can lead to an increase in energy expenditure and impaired energy recovery, causing an increase in perceived fatigue resulting in functional decline. However, despite the association of performance fatigability with negative health outcomes and walking-related disability, it is still not well understood in patients with knee osteoarthritis. METHODS: The study conducted a cross-sectional comparison between 20 participants with knee osteoarthritis (OA) classified as grade III or less on the Kellgren classification, and a control group of 20 healthy individuals matched in age, weight, height, body mass index (BMI) and gender. A six-minute walk test (6MWT) was used as an outcome measurement tool, and distance, gait velocity, and walking-related performance fatigability were calculated. SPSS version 21 was used to analyze the data, and the normality of the data was determined using the Shapiro-Wilk test. For normally distributed data, the independent t-test was employed, while the non-normally distributed data was analyzed using the Mann-Whitney U test. RESULTS: No significant differences (p > 0.05) were observed between healthy controls and participants with knee OA in terms of age, weight, height, and BMI. However, significant differences (p < 0.05) were observed in total distance covered in 6 minutes, distance covered in each minute, gait velocity and walking-related performance fatigability. Persons with knee OA demonstrated greater fatigability and lesser gait velocity and distance covered during the 6MWT. CONCLUSION: Individuals with knee OA exhibited greater fatigability and lower gait velocity and distance covered during the 6MWT. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular comorbidities increase the risk of transplant‐associated complications. However, the impact of atrial fibrillation (AF) as an independent risk factor remains limited. Methods: The National Inpatient Sample (NIS) database was queried using the International Classification of Diseases codes to identify patients admitted for allogeneic stem cell transplant (ASCT). The patients were then subclassified into with and without AF. Subsequently, a multivariate logistic regression model was constructed to account for patient demographics, comorbidities, and hospital characteristics to evaluate the impact of AF on the primary outcome of interest: all‐cause mortality, and secondary outcomes of interest that included common hospitalization complications. Results: The data for 77 157 cases of ASCT were collected between 2002 and 2019. Among these 5086 (6.6%) cases had concurrent AF. Multivariate logistic regression revealed patients undergoing ASCT with AF had almost a three times higher risk of all‐cause mortality (odds ratio = 2.99 [95% confidence interval: 2.73–3.28]; p <.01). AF patients also had a higher risk for cardiac arrest, cardiogenic shock, acute kidney injury, and need for hemodialysis (all p <.01). Conclusion: AF causes a higher risk of death and cardiovascular complications among patients undergoing ASCT. This signifies the importance of pretransplant consultation and optimization for cardiovascular comorbidities to improve hospitalization outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine the effects of fasting on weight and eventually on Body Mass Index (BMI) in medical students of a Public Sector Medical College Methods: It was a prospective analytical study conducted in a Public Sector Medical College in Peshawar City from 28th March to 20th May 2022 (1443 Hijri). Convenience Sampling was used and 115 students (58 male and 57 female) of 1st Year MBBS to Final Year MBBS were enrolled. Four readings of weight were taken, one before, two during, and one after Ramadan. A well-structured self-administered questionnaire was used to inquire about basic demographic characteristics, sleep patterns during Ramadan and normal routine, and family history of obesity. The collected data were analyzed through SPSS software and a repeated measures ANOVA test was used for drawing statistical conclusions. Results: A slight increase in the mean weight was observed during the second week of Ramadan while a loss of 0.4 kg occurred during the fourth week of Ramadan, F (1, 81) = 1777.55; p < 0.0001. The same pattern was observed for BMI, F (1, 81) = 2705.18; p < 0.0001. However, the weight and the BMI were regained in two to three weeks following Ramadan. Conclusion: Ramadan offers a non-hazardous way of weight loss. Further studies across different geographical locations with larger sample sizes should be conducted to identify and quantify the association between weight and fasting and also to identify potential confounders. [ABSTRACT FROM AUTHOR]

Myocarditis and pericarditis have been reported after COVID-19 vaccine administration in children and adolescents, raising the concern about their possible association with these vaccines. The objective was to explore the incidence, clinical presentation, and association of myocarditis and pericarditis with COVID-19 vaccines in children and adolescents. We conducted a systematic literature search on three databases, that is, Cochrane, MEDLINE/PubMed, and EMBASE from inception till March 2022. A total of three case reports, four case series, and six observational studies were included in the review. For case reports and case series, the mean age of the patients was 17.4 years, with 96.9% being male. Chest pain (n = 31, 93.9%), fever (n = 18, 54.5%), myalgias (n = 15, 45.4%) and headache (n = 9, 27.2%) were the most common presentations. Out of 33 patients, 32 (96.9%) of patients received Pfizer-BioNTech whereas only one (3.03%) received Moderna (mRNA 1273). Clinical investigations revealed ST elevation (n = 32, 97%), and elevated CRP (n = 9, 27.2%) and cardiac troponin (n = 29, 87.8%). The pooled incidence of myocarditis and pericarditis from observational studies was (0.00063%) and (0.000074%) %, respectively. Myocarditis and pericarditis in children and adolescents after the COVID-19 vaccines were more prevalent among males and more commonly observed after the second dose of Pfizer. Though the overall incidence was low, however, the clinicians should consider myocarditis and pericarditis as probable diagnosis when encountering young patients, with a history of vaccine administration, presenting with suggestive findings. [ABSTRACT FROM AUTHOR]

The present work aims to describe in detail the petrophysical properties of the Bahariya Formation (Abu Sennan field) through processing the core sample data and finding out the possible relations between permeability and other reservoir parameters such as porosity, specific internal surface, formation factor, and nuclear magnetic resonance to obtain reliable permeability prediction model of the Upper Cretaceous formation. The core samples have a length range of 2–4 cm with a diameter of 2.54 cm. Many petrophysical reservoir parameters were measured, such as permeability, porosity, density, formation factor, and special measurements such as spectral induced polarization, nuclear magnetic resonance, and specific internal surface. The samples cover a wide range of porosity (11.82–23.68 %) and permeability (0.06–133.65 mD). The porosity-permeability relationship indicates the increase of the permeability with porosity increase for the studied samples. The reservoir quality index ranges from 0.02 to 0.78 μm. The flow zone indicator ranges from 0.09 to 3.39 μm where pore throat radius (R35) ranges from 0.10 to 7.40 μm. The reservoir quality index (RQI) and flow zone indicator (FZI) cross-plot show a better understanding of the formation evaluation. The hydraulic flow units are (0.09 μm < FZI ≤ 3.39 μm) and RQI < (1 μm). NMR longitudinal relaxation time T1 range is 1.21–175 ms, NMR transversal relaxation time T2(100) range is 0.70–91.77 ms, and T2(600) range is 0.74–75.86 ms. Models that incorporate porosity and NMR relaxation times will be more accurate and suitable for permeability prediction. Using multiple regression to determine the exponents of the power-law equation and replacing the porosity with the formation factor can improve the permeability prediction for the samples under investigation. The utilizing of NMR in predicting the permeability through a robust model considers an additional value for the Upper Cretaceous rocks in Egypt. [ABSTRACT FROM AUTHOR]

A primary goal of zoos is to educate their visitors about global conservation efforts. Studying visitors' perceptions and attitudes towards captive and wild endangered species helps target conservation messaging. This is especially important in countries, such as Pakistan, where hunting and human–wildlife conflict pose the greatest threats to species. While there have been some studies about Pakistan's rural communities' perceptions, few studies have examined the perceptions of Pakistan's zoo visitors. We present data from exit surveys (n = 304) collected at three of the largest zoos in Pakistan (Lahore: an established zoo, Peshawar: a newly built zoo, and Jungle Kingdom: a theme park and zoo). Zoo location was a significant predictor for a range of attitudes, suggesting that the way a zoo presents itself strongly impacts visitor perceptions. Perceptions of learning were influenced by high biodiversity appreciation but a low confidence in knowledge about animals. Support for keeping animals in captivity was most likely when animal welfare was perceived as good and amongst respondents who valued biodiversity. Zoo-goers, regardless of location, demonstrated high levels of interest in animals and environmental concerns. However, the primary visit motivator was spending time with family and friends. [ABSTRACT FROM AUTHOR]

Background: Lower eyelid bags, tear trough deformity and lax eye lid skin are a few aging conditions for which people seek plastic surgeon's consultation. These cosmetic concerns can be effectively addressed by lower lid blepharoplasty but this procedure alone may predispose patient to lid malpositioning and ectropion later. Including the Kuhnt Szymanowski technique with lower lid blepharoplasty, in which wedge resection of lateral posterior lamella is done, can reduce ectropion formation specially in patients with lid distraction of more than 6mm away from the globe. Objective: The objective of our study is to reduce the chances of ectropion formation and scleral show specially in elderly patients undergoing lower eyelid blepharoplasty for the correction of lower eyelid laxity and to evaluate patient's outcome. Methods: This is a retrospective case series with 2 years duration from January 2019 to December 2020. All patients with lid distraction > 6mm were operated and bilateral lower lid blepharoplasty and Kuhnt Szymanowski technique was performed under L.A. Mean duration of follow-up was 6 months post-operatively and patients' surgical outcomes were assessed. Results: In our study, total 20 patients were included. Total number of eye surgeries performed were 40. Majority of patients were female (64%) were female. None of the patients (0%) reported ectropion formation post-operatively. Conclusion: In our experience, Kuhnt Szymanowski technique addresses lower eyelid laxity effectively. This technique when added in selected group of patients, reduces chances of temporary or permanent ectropion, hence reduces morbidity and redo procedures. [ABSTRACT FROM AUTHOR]

This study undertakes a numerical investigation of the dynamics of a finite-size air filament surrounded by a denser fluid medium with a range of viscosity. The two edges of the filament retract due to its surface tension effects. It is shown that if the aspect ratio is small, the filament recoils in a single bubble while for large aspect ratios, the filament ruptures at its two ends. Between these two limits, the filament can escape from pinch-off through the reopening of the neck and/or breakup in the middle region. The air filament pinch-off is accompanied by the formation of a thin air thread, which subsequently breaks up into microbubbles. Viscous effects of the external fluid do not show a significant impact on the fate of large or small aspect ratio filaments but instead control the shape of the bulge and the neck region close to breakup. Before breakup, the bulge adopts a prolate shape for Ohnesorge numbers smaller than 0.01, while an oblate shape is obtained for Ohnesorge numbers larger than 1. A spherical shape is obtained between these two limits. For small Ohnesorge numbers, the neck region exhibits a reflection symmetry perpendicular to the filament axis while for large Ohnesorge numbers, a thread of air forms and connects the bulge to the filament. The radius of the neck is shown to decrease as a power-law function of the time before breakup with the exponent of 0.5 for small Ohnesorge numbers and 1 for large Ohnesorge numbers. [ABSTRACT FROM AUTHOR]

BACKGROUND: Even though studies have reported impaired postural stability (PS) and risk of fall in non-specific low back pain (LBP), evidence is relatively scarce in terms of discogenic LBP or in persons with degenerative disc disorders of the lumbar spine. OBJECTIVE: To determine the differences in terms of PS, fall risk and sensory integration of balance in persons with discogenic LBP as compared to healthy controls. METHODS: A cross sectional comparative study was conducted on 60 participants, out of which 30 had discogenic LBP and 30 were healthy controls. The variables of interest included PS, fall risk score (FRS) and clinical test of sensory integration of balance (CTSIB), and the data was collected using Biodex Balance SystemTM SD, with higher scores signifying poorer outcomes. RESULTS: Persons with discogenic LBP scored significantly (p < 0.05) higher in terms of overall PS index [Mean difference = 2.33 (95% CI 1.38, 3.28)], anteroposterior PS index [Mean difference = 1.87 (95% CI 0.84, 2.90)] and mediolateral PS index [Mean difference = 0.82 (95% CI 0.43, 1.21)], FRS [Mean difference = 2.92 (95% CI 2.36, 4.8)] and CTSIB [Mean difference = 1.67 (95% CI 1.28, 2.06)] as compared to healthy controls. Both healthy controls and persons with discogenic LBP revealed higher anteroposterior postural stability index as compared to mediolateral postural stability index (p < 0.001). CONCLUSIONS: Persons with discogenic low back pain exhibit greater risk of fall and poorer postural stability and sensory integration of balance as compared to healthy controls. It is suggested that fall risk, postural stability and sensory integration of balance should be considered as outcome measures in clinical management of such patients. [ABSTRACT FROM AUTHOR]

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We address the problem of timing-based localization in wireless networks, when an unknown fraction of data is corrupted by non-ideal propagation conditions. While timing-based techniques can enable accurate localization, they are sensitive to corrupted data. We develop a robust method that is applicable to a range of localization techniques, including time-of-arrival, time-difference-of-arrival and time-difference in schedule-based transmissions. The method is distribution-free, is computationally efficient and requires only an upper bound on the fraction of corrupted data, thus obviating distributional assumptions on the corrupting noise. The robustness of the method is demonstrated in numerical experiments. [ABSTRACT FROM AUTHOR]

BACKGROUND: Neck is one of the most common sites of musculoskeletal symptoms, and muscle shortening and weakness is observed to be a common cause of neck pain and disability. OBJECTIVE: To compare the immediate and short term effects of static stretching (SS), autogenic inhibition (AI) and reciprocal inhibition (RI) muscle energy techniques (MET) on isometric muscle strength in the management of mechanical neck pain. METHODS: A randomized controlled trial was conducted on 78 participants with neck pain randomly allocated to SS, AI-MET and RI-MET groups. All the participants received Trans Cutaneous Electrical Nerve Stimulation (TENS), hot pack and unilateral postero-anterior glide, followed by 3–5 repetitions of either SS, AI-MET or RI-MET for five consecutive sessions. Numeric pain rating scale (NPRS) and Modified Sphygmomanometer Dynamometry (MSD) were used as outcome measurement tools. One way ANOVA and repeated measures ANOVA were used for inter-group and intra-group comparison. RESULT: In terms of MSD scores, a significant difference (p < 0.05) was observed between the groups. Both AI-MET and RI-MET were found to be comparatively more effective than SS, however AI-MET was found to be the most effective. CONCLUSION: AI-MET is more effective than SS and RI-MET in terms of improving isometric muscle strength in patients with mechanical neck pain. [ABSTRACT FROM AUTHOR]

Objective: To evaluate outcome of diagnostic kidney biopsy in patients with renal allograft dysfunction at a tertiary care hospital. Study Design: Retrospective observational study. Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Jan 2014 to Jan 2020. Methodology: A consolidate registry review was carried to formulate this study. The registry data exists at our center containing information about the graft dysfunction (manifesting as proteinuria, deranged urea and creatinine or urine sediment abnormalities) and other major indications which warrant probing with biopsy. The histopathological diagnosis of these biopsies is confirmed from the nephro-pathology registry before finalization of diagnosis. Results: A total of 94 diagnostic kidney biopsies were performed in patients with graft dysfunction. Out of 94 biopsies, 80 (85.1%) patients were male while 14 (14.9%) were female patients. The most frequent single cause for graft dysfunction was Cell Mediated Rejection (n 12, 24.5%) followed by Interstitial Fibrosis and Tubular Atrophy/Acute Tubular Injury. The most common cause among the glomerulonephritis was Membranoproliferative Glomerulonephritis (n 3, 6.1%) followed by others. The most common cause for mixed pathology remainedcell mediated rejection with Interstitial fibrosis and tubular atrophy (n 8, 17.8%). Conclusion: Cell mediated rejection is thecommonest pathology responsible for renal allograft dysfunction both as a single lesion as well as part of mixed pathology. [ABSTRACT FROM AUTHOR]

Stress and burnout have been soaring among doctors. It does not only have deleterious effects during working hours but also impact personal lives of the doctors. The primary focus of this study is to gauge level of burnout among surgical residents working in two major tertiary care hospital of Karachi, Pakistan. Methods: This was a cross sectional study comprising of 118 candidates who completed the questionnaire based on demographics variables, professional details and Maslach Burnout Inventory (MBI), which scores the burnout level on the basis of three components namely emotional exhaustion, depersonalization and personal accomplishment. The duration of study was one month starting from 1st January to 31st January 2019. Residents working in Department of General Surgery were part of inclusion criteria. Consultants and medical students met the exclusion criteria. Data was analysed by SPSS-23. Results: Mean MBI score was 57.15 with mean scores of Emotional Fatigue, Personal Fulfilment and Depersonalization were 22.42, 19.89 and 14.81 respectively. In terms of emotional fatigue, female residents (49.2%) were more likely to suffer than their male counterpart (50.8%) (p=0.018). Married residents (37.3%) tend to have higher mean personal fulfilment scores (p=0.02). Residents who were living alone (31%) have higher mean depersonalization score (p=0.02). With respect to personal factors, higher MBI scores were observed among doctors who were married, worked about 75–90 hours and remain sleep-deprived and those who were not able to sustain their families financially. Conclusion: On the basis of higher MBI scores in married, sleep deprived residents who were working for extensive hours and felt financial constraints, there is an extensive need of comprehensive support groups, humane number of working hours, improved salary packages, de-stressing activities like sports etc. to ameliorate the mental health of resident physicians and enhance their productivity. [ABSTRACT FROM AUTHOR]

Introduction: Refractory or chronic subdural hematomas (cSDH) constitute a challenging entity that neurosurgeons face frequently nowadays. Middle meningeal artery embolization (MMAE) has emerged in the recent years as a promising treatment option. However, solid evidence that can dictate management guidelines is still lacking. Methods: We conducted a systematic review and meta-analysis (MA) in compliance with the PRISMA guidelines to evaluate the efficacy and safety of MMAE compared with conventional treatments for refractory or cSDH. Databases were searched up to March 2019. Using a random-effects model, meta-analyses of proportions and risk difference were conducted recurrence, need for surgical rescue, and complications. Results: Eleven studies (177 patients) were included. Majority (116, 69%) were males with a weighted mean age of 71 + −19.5 years. Meta-analysis of proportions showed treatment failure to be 2.8%, need for surgical rescue 2.7%, and embolization-related complications 1.2%. Meta-analysis of risk-difference between embolized and non-embolized patients showed a 26% (p < 0.001, 95% CI 21%–31%, I2 = 0) lower risk of hematoma recurrence in MMAE. Similarly, in the embolized group, the need for surgical rescue was 20% less (p < 0.001, 95% CI = 12%–27%, I2 = 12.4), and complications were 3.6% less (p = 0.008, 95% CI 1%–6%, I2 = 0) compared to conventional groups. Conclusions: Although MMAE appears to be a promising treatment for refractory or cSDH, drawing definitive conclusions remains limited by paucity of data and small sample sizes. Multicenter, randomized, prospective trials are needed to compare embolization to conventional treatments like watchful waiting, medical management, or surgical evacuation. More extensive research on MMAE could begin a new era in the minimally invasive management of cSDH. [ABSTRACT FROM AUTHOR]

Background: Damage control resuscitation forms the cornerstone of management in trauma surgery. Several blood products have been widely used for preoperative transfusions prior to emergency surgeries and for hemorrhage control in trauma. Prothrombin complex concentrate (PCC) is now being introduced as an essential component of damage control resuscitation. Summary: We did a comparative descriptive analysis of several single and multi-institutional clinical trials and retrospective cohort studies. The primary focus of these studies was a comparison between PCC and other transfusion modalities including recombinant factor VIIa, fresh-frozen plasma, and fibrinogen based on several vital parameters. The parameters included rapid international normalized ratio reversal, hospital length of stay, cost-effectiveness, mortality rate, and rate of thromboembolic complications. Key Points: Although still awaiting its approval from the FDA for use in traumatic coagulopathy, 4-factor PCC has shown far more convincing results in contrast to former transfusion modalities, even 3-factor PCC. However, more prospective extensive clinical trials on national levels are needed to compare its effectiveness to 3-factor PCC and gather promising recognition in the trauma care fraternity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cervical radiculopathy is a relatively common musculoskeletal disorder resulting in a significant social and occupational impact. Manual therapy is thought to provide relief in cervical radiculopathy; however, evidence is lacking regarding the comparison of different manual therapy concepts. OBJECTIVE: To determine the effects of Maitland's oscillatory mobilization as compared to Kaltenborn's sustained stretch mobilization in the management of cervical radiculopathy. METHODS: A randomized controlled trial was conducted at Fauji Foundation Hospital comprising of 46 patients randomized into oscillatory and sustained stretch mobilization groups. Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI) and cervical range of motion (ROM) were used as outcome variables. RESULTS: No significant differences were observed at base line between the two groups (P > 0.05) except for ROM in extension and left side bending (P < 0.05). In terms of pre and post treatment comparison, P value of less than 0.05 was observed for both groups, indicating both treatments to be effective in isolation. However, post treatment comparison between both groups showed oscillatory mobilization to be superior to sustained stretch mobilization (P < 0.05) in the management of cervical radiculopathy except for the outcomes of pain and side bending. CONCLUSION: Both oscillatory and sustained stretch mobilization techniques are found to be effective in the management of cervical radiculopathy in terms of pain, range and disability. However, oscillatory mobilization is found to be superior in terms of functional ability and range of motion. [ABSTRACT FROM AUTHOR]

Background and Objective: The SARS-CoV-2 vaccines of Sinopharm and Pfizer have been reported to vaccinate more than 7.3 billion people across the globe. However, the protection offered by these mRNA vaccines wanes with time, which is why the third dose of a different or same vaccine may become necessary. The objective of this study was to compare the levels of immunoglobulin G (IgG) in the post-vaccination phase in the local population after two doses with Sinopharm and Pfizer vaccination. Methods: A cross-sectional study was conducted at the Combined Military Hospital (CMH) Medical College and Institute of Dentistry, Lahore, Pakistan. A total of 100 adult participants who were completely vaccinated with either Sinopharm or Pfizer, at least 6 weeks before, were included in the study after taking informed consent. Blood samples were collected and SARS-COV-2 virus IgG antibody levels were estimated using enzyme-linked immunosorbent assay (ELISA). The collected data were analyzed while taking a p value < 0.05 as significant. Results: The mean age of the participants was 20.18 ± 1.29 years. Mean antibody titers, six weeks post-vaccination were 5453.73 ± 609.15 units per milliliter (U/ml) and 10786.86 ± 1525.49 U/ml in Sinopharm and Pfizer groups, respectively. The difference was statistically significant (p = 0.0004). Conclusion: Antibody response was considerably higher in Pfizer-vaccinated individuals in comparison to Sinopharm in the local population from Pakistan. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the impact of screen time with digital eye strain (DES), visual acuity, and near point of accommodation (NPA). METHODS: This cross-sectional study was conducted at Khyber Medical College Peshawar, Pakistan. This study included 244 students of 3rd year to 5th year MBBS, who consented to participate. A Snellen chart and Royal Air Force (RAF) rule were used to assess the visual acuity, and NPA. Chi-Square, Pearson Correlation, and multiple regression analyses were conducted using SPSS software. RESULTS: Out of 244 participants, 181 (74.1%) reported at least one symptom of digital eye strain. Headache (n=87; 35.6%) and eye pain (n=64; 26.22%) were the most common reported symptoms. Refractive error was reported in 98 (40.16%) students, including myopia (n=86; 35.25%), hyperopia (n=12; 4.92%), and astigmatism (n=12; 4.92%). Mobile (n=244; 100%) and Laptop (n=212; 86.90%) were the main electronic gadgets used by participants. Headache, eye pain, tearing of the eyes, eye redness, and itching of the eyes were significantly associated with screen time (p<0.05). Headache, blurred vision, itching of eyes, and eye pain were significantly associated with refractive error (p<0.05). Multiple regression analysis explains a 32.9% variance in the digital eye strains. CONCLUSION: This study reveals a concerning 74.1% prevalence of DES among medical students in Peshawar, Pakistan, emphasizing the impact of prolonged screen time on ocular health. Our study reveals a significant link between screen time and DES, with headache and eye pain being the prevalent symptoms. Associations between symptoms, screen time, and refractive errors emphasize the relevance of these factors. [ABSTRACT FROM AUTHOR]

BACKGROUND: Neural mobilization is an effective technique in the management of cervical radiculopathy (CR). However, the difference between active versus passive upper extremity (UE) neural mobilization techniques in the management of cervical radiculopathy is not well established. OBJECTIVE: To determine the role of active versus passive UE neural mobilization in females with cervical radiculopathy. METHODS: A double blind randomized controlled trial was conducted at Shifa International Hospital from Sep 2016 to Feb 2017, and 44 females were included and randomized into 2 groups, receiving 12 treatment sessions in total. Group A received active whereas Group B received passive UE neural mobilization, along with cervical traction and Unilateral Posterior Anterior (UPA) glide regardless of the group. Numeric pain rating scale (NPRS), Neck Disability Index (NDI) and cervical range of motion (ROM) were used as outcome measurement tools. Non-parametric tests of significance were used for inter group and intra group comparison (Mann-Whitney U test and Wilcoxon test). RESULTS: A statistically significant difference was observed between pre and post NPRS, NDI and ROM scores after 4 weeks of treatment for both groups (p < 0.05). However, no significant differences were observed in post treatment scores of active and passive neural mobilization groups (p > 0.05). CONCLUSION: Both active and passive neural mobilization is effective in the management of cervical radiculopathy. One of the interventions is not superior to the other. [ABSTRACT FROM AUTHOR]

Background: Duplication of the vas deferens, a rare congenital anomaly of the pelvic anatomy, is often an incidental finding during surgeries involving the spermatic cord, such as inguinal hernia repair, varicocelectomy, orchidopexy, and vasectomy. Case Report: A 25-year-old male presented to our surgical outpatient clinic with bilateral swelling in the inguinal region. A diagnosis of bilateral inguinal hernia was established. While performing spermatic cord dissection during hernioplasty, a duplicated vas deferens was revealed within the left spermatic cord. Doppler ultrasonography confirmed the absence of waveforms in both vasa deferentia, differentiating them from adjacent vessels. The hernia repair was performed without complications. Conclusion: Our case highlights the importance of radiologists' and surgeons' ability to recognize a duplicated vas deferens to avoid possible iatrogenic injury. [ABSTRACT FROM AUTHOR]