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INTRODUCTION: Residual tumor cellularity (RTC) and pathologic complete response (pCR) after neo-adjuvant chemotherapy (NAC) are prognostic factors associated with improved outcomes in breast cancer (BC). However, the majority of patients achieve partial pathologic response (pPR) and no clear correlation between RTC patterns and outcomes was described. Our aims were to define predictive factors for pCR and compare different outcomes of patients with pCR or pPR and with different RTC patterns. MATERIALS AND METHODS: Baseline and post-NAC demographics, clinicopathological characteristics, post-operative data, survival and recurrence status were recorded from our institutional database. A multivariable analysis was performed using a logistic regression model to identify independent predictors of pCR. Disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) analyses were performed using the Kaplan-Meier method. RESULTS: Overall, of the 495 patients analyzed, 148 (29.9%) achieved pCR, 347 (70.1%) had pPR, and the median RTC was 40%. Multivariable analysis identified 3 independent factors predictive of pCR: tumor stage before NAC (cT1-2 84.5% versus cT3-4 15.5%), BC sub-type (HER2-positive 54.7% versus triple-negative 29.8% versus luminal-like 15.5%), and vascular invasion (absence 98.0% versus presence 2.0%). We found statistically significant longer DFS, DDFS, and OS in patients with pCR and with RTC

Quality is essential in today’s competitive market to ensure customers are happy; recent research shows that about 90% of customers think quality is just as important as price when purchasing. Total quality management (TQM) has been a boon to the economies of many countries. Different tools and methods are used in TQM to give customers the best quality. However, there are some challenges that manufacturing organizations face when implementing these tools. Much research has been done on MSME sector, so far as label manufacturers are concerned, there has yet to be any research on a national or international level. In this study, we found 66 barriers to programs to improve quality in the label printing industry. We have used fuzzy MICMAC analysis and total interpretive modeling (TISM) to make a structural model. Our research paper provides an easy-to-use methodology and critically analyses the biggest obstacles to the successful application of TQM in the flexographic printing industry. Our research identified ten issues with the implementation of TQM in this industry. The paper has identified the interdependencies of the above variables. The findings of this research will aid in future planning, particularly in E-commerce and the pharmaceutical industry, where proper label printing is crucial.

In the present world, there has been a great amount of improvement in medical services through technology and science. Developed methods and treatments are invented, and thousands of lives are also saved. Day by day, new doors of innovation and inventions are being opened in this sector. But in spite of these developments, there is also a black dot in that improvement which is adding to the health issues of the population, called "Medical Negligence". It's the breach of “duty of care" standard on part of the medical personnel in charge, having liability to fulfil the standard and eventually leading to the occurrence of "medical negligence ". The determination of liability in cases of “medical negligence", is a complex one. In this regard, this paper opts to discuss the determination of the liability of the medical personnel in question of medical negligence as well as the legal consequence of such medical negligence as violation of basic human rights under International Human Rights Law.

Background: Rheumatic fever (RF) and rheumatic heart disease (RHD) are the leading causes of early cardiovascular morbidity and mortality especially in developing world. Recently more emphasis is given on the role of echocardiography for diagnosis of these diseases. Objective: Recent and reliable data and studies on RF and RHD are very limited in Bangladesh. Therefore, this study was done to diagnose rheumatic fever and rheumatic heart disease among clinically suspected patients. Methods: This cross-sectional study was conducted from February to June 2021 in National Center for Control of Rheumatic Fever and Heart Disease, Dhaka. A total of 250 patients irrespective of age and sex with complaints of joint pain and clinically suspected of RF and RHD were enrolled. Laboratory investigations including CBC with ESR, ASO titer, CRP, ECG and echocardiography were done. Results: Among the suspected patients, acute rheumatic fever without carditis was diagnosed in 10 (4%) patients and 15 (6%) had rheumatic heart disease with recurrent RF and carditis. Rheumatic fever with carditis were diagnosed in 63 (25.2%) patients; among whom 19 (7.6%) had clinical carditis and 44 (17.6%) were diagnosed as subclinical carditis. Acute rheumatic fever was diagnosed only within 5-20 years of age patient and 60% patients of RHD were found in 21-30 age groups. About half (49.20%) of the patients of rheumatic fever with carditis were between 11 to 15 years of age. Several abnormalities of heart valves were detected by Echocardiography; 78.2% of the patients of RF and RHD had mitral regurgitation and all the mitral stenosis cases were detected in patients with RHD. Combination of mitral regurgitation with aortic regurgitation and mitral regurgitation with mitral stenosis was also present. Conclusion: The findings of the study indicate that RF and RHD are not negligible in our country. Though the result does not indicate the prevalence or incidence; however, it highlights the need of systematic large-scale study with inclusion of echocardiography to find the prevalence of rheumatic fever and rheumatic heart disease in Bangladesh. Bangladesh Medical Res Counc Bull 2022; 48: 83-89

Background: Severe acute malnutrition (SAM) is a major cause of morbidity and mortality in children around the world. It is critical to identify the factors that contribute to mortality to reduce SAM related mortality. This study aimed to analyze the risk factors of mortality in hospitalized children with SAM. Methods: This case-control study was conducted in the SAM unit, department of pediatrics, institute of child and mother health, Matuail-1362, Dhaka, from January 2021 to December 2021. Data analysis was conducted using SPSS version 22. Univariate analysis was done to determine factors affecting mortality, and multivariate logistic regression was used to determine significant independent risk factors. Results: Mean age of the study subject was 6.38±3.45 months and 10.90±10.00 months in the case and control groups respectively. So, death was more common in younger children. The percentage of death was more (61.5% vs 54.6%) in males. Mortality was more common in family income

Purpose: Over the last ten years, social media gradually gained an increasingly active and relevant role in social and economic and corporate contexts. Particularly, social media plays a key role in accounting issues such as corporate strategy, corporate disclosure towards stakeholders, balance sheet and reporting. Thus, social media has become the easiest and most immediate way for companies to make execution of strategies and disclosure information and in general manage several accounting issues. In this scenario, this paper has the purpose to investigate the relationship between accounting and social media to draft emerging research paths and future avenues of research understanding what role social media is playing in companies and their value. Design/Methodology/Approach: We adopted the structured literature review (SLR) to draft emerging issues and future avenues in this field. This methodology contributes to identifying research trends and future research directors (Di Vaio et al.,2021; Secundo et al.,2020; Popay et al.,2006; Jesson and Lacey., 2020). Investigating relevant literature, we selected the range of keywords to compose the research query, we validated our results on Scopus database using the operator “TITLE-ABS-KEY”. In Line with our purpose we limited research query only to “final” documents published in “English” between 2018 and 2022. We conducted a not grey analysis identifying 206 articles about the theme of accounting and social media.Findings: Our analysis provides results on emerging issues and avenues in this research stream. Emerging issues are directed towards the relationship among accounting and social media, the effect of social media on the company system, how social media can serve a strategic level in the company, the role of social media in the organizational system, how social media are regarded by investors and so on. Originality/value: Our research contributes to increase the study on accounting and social media to offer readers a renewed perspective of study drafting the future research avenue.

Propranolol and Carvedilol are the currently used medications for main prophylaxis of variceal bleeding. Objective: To investigate the efficacy of carvedilol vs propranolol for prevention of variceal hemorrhage in liver cirrhosis patients. Methods: This prospective comparative study was carried out on 196 cirrhotic patients in the Gastroenterology Department of Lady Reading Hospital, Peshawar in collaboration with Pharmacology department of Khyber Medical University, Peshawar from July 2018 to June 2020. Patients with no prior history of primary variceal prophylaxis treatment and variceal bleeding were enrolled. All the patients were categorized into two groups: Group-I (Carvedilol) and Group-II (propanol). Frank hematemesis, melena, and endoscopic assessment was used for the evaluation of variceal bleeding. Results: Of the total 196 liver cirrhosis patients, Group-I and Group-II had 102 (52%) and 94 (48%) respectively. Ultrasonography found splenomegaly in 88% of cases and moderate to severe ascites in 42.6% of the patients investigated. The success rate of carvedilol and propanol group was 76% and 64.8% respectively. The side-effects and complication rate were significantly lower in Group-I than Group-II. The prevalence of variceal bleeding was 16.7% (n=17) and 11.7% (n=11) respectively. Conclusions: Carvedilol is an excellent treatment alternative for prevention of variceal bleeding than propranolol in terms of side-effects and complications rate.

Decades of ambidexterity research have gained huge scholarly attention from diverse research areas like marketing, organizational learning, innovation management, supply chain management, strategy, and entrepreneurship. However, it has been observed that past studies do not provide a quantitative assessment of ambidexterity determinants applicable to small and medium firms. In response, this study attempts to address this gap by providing an extensive list of eight determinants that are significantly related to Small and Medium Enterprise (SME) ambidexterity. We employed Random effects meta-analytical procedure to examine the combined effect sizes of each determinant. The analysis was based on 37 empirical publications from 2004 to 2021, involving 8422 SME observations and 48 correlations. The findings of the meta-analysis revealed that all the considered determinants such as Knowledge management, Entrepreneurial orientation, Formalization, Market orientation, Networking, Technological capability, Organization context, and Environmental dynamism are heterogeneous, and they all exert a significant positive impact on ambidexterity.

Hepatitis C is the major source of cirrhosis, HCC and chronic liver disease and is one of the major reasons for liver transplant and remain undiagnosed in large number of high-risk populations. Objectives: To assess the frequency of occult hepatitis C virus infection in the spouses of hepatitis C virus positive patients. Place and Duration: This Cross-sectional study was held in the Hepatitis clinic of gastroenterology ward of Lady Reading Hospital, Peshawar from 21st September 2020 till 20th March 2021 after approval from hospital ethical committee. Methods: Total 164 patients aged 20 to 60 years of both genders who were hepatitis C virus positive and whose spouses were healthy and asymptomatic were selected for this study. Frequency of occult hepatitis C infection in healthy spouse was determined. Data was analyzed and entered using SPSS 23. Results: In this analysis, total 164 patients were selected with mean age of 38.6±11.7 years. Among spouse history of previous surgery was present in 41.5%, history of blood transfusion in 47.6%, history of dental treatment in 73.2% and history of drug use in 54.9% sampled population. Frequency of occult hepatitis C infection was present in 7.3% healthy spouses. Conclusion: Hepatitis C infection is common in spouses of hepatitis C infection. All individuals presenting in OPD should be advised for spouse screening. Keywords: Occult, HCV, Intra-spousal transmission, intravenous drug use

This study focuses on identifying inherent skills in women and the need for women to develop vocational skills. Awareness of various government schemes and the benefits of being a skilled woman is highlighted. An empirical study has been made to collect information and statistical data. A strength, weakness, opportunity, and threat (SWOT) analysis is carried out. The findings are promising. Skill development teaches women about power from within, decision-making power, control over financial, physical, and knowledge-based assets, and power with ability. Homemakers will soon become breadwinners, and vice versa, depending on suitability and necessity. These days are not far. A skill-armed woman is a home to a self-sustaining life. Equipping women with employable vocational skills in India can certainly lead to an “equal skill, equal pay” scenario.

Excavations in Rome have long focused on the early city; only recently has attention turned to the archaeology of the medieval and later periods. Here, the authors present a rare sixteenth-century context, dating to a time when European cities contended with repeat epidemics and implemented measures to control the spread of disease. A contextual approach to the assemblage leads to its identification as a ‘medical dump’ of clinical equipment, including glass urine flasks and ‘single-serve’ ceramics, many of the latter specifically produced for the Ospedale dei Fornari. Drawing on Renaissance medical treatises, the authors argue that this material represents the disposal of potentially infected objects, shedding light on urban waste-management practices.

Objectives: To compare the efficacy of intravenous Labetalol and intravenous Hydralazine in reduction of blood pressure in patients with severe pre-eclampsia. Methodology: This comparative study was conducted at the Department of Obstetrics and Gynecology at Ziauddin University Hospital, Karachi from1st June 2019 to 30th June 2020. Total 208 pregnant women having severe pre-eclampsia (systolic pressure ≥160 mmHg and diastolic pressure ≥110mmHg) were included in study. Group A received I/V Labetalol. Group B received I/V Hydralazine. Efficacy of drugs was observed by reduction in blood pressure and the number of doses administered. Data was analysed using SPSS version 26. Results: Systolic blood pressure reduction in Labetalol group was significantly lower than in hydralazine group (105.5 ±11.3 vs. 115.8 ±17.1, p≤ 0.001). Diastolic blood pressure reduction was also lower in labetalol group than in hydralazine group (p= 0.03). Number of dosage of drugs in Group A (Labetalol) was 3.2 ±1.2 vs. Group B (Hydralazine) was 4.4±1.4, p =0.006). Conclusion: The results of this study show that Labetalol is more effective as compared to Hydralazine in terms of reducing the systolic and diastolic blood pressure and number of doses (Drugs) for in patients with severe preeclampsia. Keywords: Preeclampsia; bolus dose; Hydralazine; Labetalol.

OBJECTIVES To determine and compare the efficacy of Uterovaginal packing versus uterine balloon tamponade to control postpartum haemorrhage due to uterine atony unresponsive to medical treatment. METHODOLOGY This comparative prospective cross-sectional study was conducted in Hayatabad Medical Complex, OBG department. A total of 140 patients were categorised into two groups, group A underwent Uterovaginal packing and group B underwent uterine balloon tamponade. All women of 18 to 40 years with a history of delivery after 28 weeks of gestation, who developed primary postpartum haemorrhage due to uterine atony, unresponsive to medical treatment were included in the study. Women with a history of delivery before 28 weeks of gestation, secondary postpartum haemorrhage, genital tract trauma, retained placental tissue and membranes, placenta previa, morbidly adherent placenta, febrile illness and uterine structural lesion were excluded from the study. Efficacy was labelled if there was no ongoing blood loss after the procedure with concomitant hemodynamic stability. All information was recorded in a predesigned proforma, and data were analysed using SPSS version 22.RESULTS Our study included 140 women; 113 had a normal vaginal delivery, and 27 underwent cesarean section. Among cases with normal vaginal delivery, 45 women had Uterovaginal packing, and 68 had uterine balloon tamponade, while among cases of cesarean sections, 25 women had uterovaginal packing and 2 had uterine balloon tamponade. The efficacy of Uterovaginal packing was 90%, and that of uterine balloon tamponade was 87.1%, with no significant difference statistically (p- 0.51). Overall efficacy of both procedures was 88.6%.CONCLUSION All orthodontic and non-orthodontic treatment group participants required oral hygiene instructions and had periodontal treatment needs (TN1). The patients requiring scaling and prophylaxis and Oral hygiene instructions (TN 2) were more in the orthodontic treatment group than the non-orthodontic treatment group. A higher percentage of patients requiring complex treatment (deep scaling, root planning and complex surgical procedures), scaling and prophylaxis and Oral hygiene instructions (TN3) belonged to the non-orthodontic treatment group.

Abstract: Presence of N-heterocyclic ring systems as promising features in the molecular skeleton of FDA approved drugs, underlie the remarkable contributions of these heterocyclic nuclei in the field of medicine. Despite instability risks associated with COVID pandemic, the US FDA approved 50 drugs (36 NMEs and 14 biological products) in the year 2021. The active ingredients of 32 drugs out of these 36 NMEs (almost 89%) contain saturated, partially unsaturated and/or aromatic N-heterocyclic moieties in their molecular assemblies, hence dominating the medicinal approvals. While 27 molecules (75% of these NMEs drugs) are prominent small NMEs. Herein, we have considered profiling of those FDA approved 27 small-molecule drugs which are decorated with N-heterocycles as privileged scaffolds. These drugs are grouped on the basis of a number of N-heterocycles present in their structural framework. The spectrum of these drugs in terms of their structural features and medicinal importance is summarized in this review. Also, the pertinent analyses of their drug-likeliness conferring some general pharmacokinetic principles is highlighted.

The frequency of catastrophic natural disasters is rising, and much emphasis is being given to the Humanitarian Supply chain (HSC). The main goal of relief efforts is to get enough emergency supplies to the area hit by the disaster as quickly as possible. The decision of where to locate warehouses that will store relief supplies presents a significant obstacle for humanitarian relief organizations as they work to enhance their capacity for providing aid and their rescue plan. A non-optimal location could make the search and rescue efforts harder. More importantly, it has been seen that when these kinds of geographical sites are evaluated, social and environmental issues are not considered. This research paper aims to make humanitarian networks more accountable by determining the ideal warehouse site and considering both traditional and sustainable factors. A framework for selecting warehouses to keep relief goods was devised using the Multi-Criteria Decision Making (MCDM) approach. Best-Worst and TOPSIS (“Technique for Order Performance by Similarity to the Ideal Solution”) methods were used to rank the potential locations based on Cost, Logistics, Environmental, and Social Criteria. A research study has been done in the State of West Bengal (District Arambagh).

Petrochemical workers are exposed to many noxious substances present in their work places. The most dangerous effects are due to benzene which is mostly found in petrochemical vapours. The study was carried out in the Pathology department, Govt Medical College, Amritsar. 100 Petrol pump workers from different areas of the city were included as study group and 50 individuals from various departments in Government Medical College, Amritsar, were included as control group. Whole blood samples of the subjects were taken and analysed for complete blood count, liver function tests and renal function tests. The results showed statistically signicant increase in values of hematocrit, MCV, RDW, MPV, AST, ALT, ALP, GGT, Blood Urea, S. Creatinine, S. Uric Acid, Random blood sugar and statistically signicant decrease in values of MCH, MCHC, Platelet count, TSP, DSP with increased duration of exposure and in comparison to controls. However, there is seen statistically signicant increase in Hb, red blood cell count in initial years of exposure with subsequent decrease in their value after increased duration of exposure. There is seen neutropenia and lymphocytosis with PBF examination showing macrocytic RBC picture with no signicant difference in values of TLC, mid cell counts, PDW, PCT, S. Bilirubin (total and direct), S. Na+, PT, PTI with increased duration of exposure. The results of above parameters indicates that exposure to gasoline compounds over a long period of time may be the causative factor of hematotoxicity, hepatotoxicity and nephrotoxicity.

Episcleritis is an inflammatory condition that affects episcleral tissue underlying the sclera and conjunctiva.1,2 It is a recurrent and mild self-remitting surface disease. Its etiology is unknown but may be associated with systemic diseases.3–5 It has been recognized for over a century as sub-conjunctivitis or subconjuctivitis phlegmatous. The condition is unilateral in two thirds of cases and bilateral in one third. Two major clinical types are noticed diffuse and nodular. The case outlined Nodular episcleritis and its clinical diagnosis and management. The condition was mild and didn’t progress to a more severe disorder. An episcleral nodule adjacent to the cornea is very rare.

Corrosive substances are defined as chemicals which cause injury upon coming in contact with living tissues such as the skin, gastrointestinal tract, respiratory tract and eyes. These include acids, alkalis, oxidizing agents, hydrocarbons among others. Objective: To determine the frequency and difference in the frequency of upper gastrointestinal stricture formation following corrosive ingestion in the gastroenterology unit of Lady Reading Hospital, Peshawar. Methods: This cross- sectional study was held in the Gastroenterology unit of Lady Reading Hospital, Peshawar from 16th July, 2019 to 16th Jan, 2019. Detailed history was taken from the patient and the container of the chemical ingested was examined to find out the duration since ingestion, amount of chemical ingested, and the type of chemical ingested (acid or alkali). Results: Mean and SD for age was 35 ± 5.55. Mean and SDs for duration since ingestion. Mean and SDs for amount of corrosive ingestion was 24 ± 1.54. 50 (34.48%) patients were recorded in 10-25 years’ age group and 95 (65.51%) patients were recorded in 26-40 years’ age group. 97 (66.89%) patients were male, and 48 (33.10%) patients were female. 41 (28.27%) patients had acidic corrosion and 104 (71.72%) patients had alkali corrosion. As per frequencies and percentages for stricture formation, 57 (39.31%) patients had stricture formation. Conclusions: Although the mortality and morbidity of corrosive gastric injuries is high, the key to improve the survival is early identification of perforation, maintenance of nutrition and control of sepsis.

Introduction: Over the past few years, the population of Pakistan has become much aware of the need of weight loss and healthy lifestyle. We evaluated the cholesterol profiles to observe how keto diet and low-calorie diet influence the basic lipid profile of females. Aims: The aim of this study was to compare the cholesterol and triglyceride levels in adult non pregnant females taking ketogenic versus low calorie diet for a one month Methodology: The design of this study was a cross sectional study design. This study was conducted in lady reading hospital Peshawar and the duration of this study was from January 2022 to February 2022. 60 non pregnant females of age between 35-45 years with BMI ranging between 30-34.9 were included in the study. 30 were on low calorie diet, 30 were on keto diet. The serum cholesterol and triglyceride levels were calculated on day 1 and day 30 of the study. Results: The serum chloesterol levels were significantly reduced in individuals taking low calorie diet as compared to keto diet over a period of thirty days. After few weeks, anthropometric and body composition measurements revealed a significant reduction significant decrease in glucose and insulin blood levels were observed, together with a significant improvement of body weight. There was a significant, slightly decrease of LBM. A significant decrease of triglycerides, total cholesterol and LDL were observed along with a rise in HDL levels. The LH/FSH ratio, LH total and free testosterone, and DHEAS blood levels were also significantly reduced. Estradiol, progesterone and SHBG increased. The Ferriman Gallwey Score was slightly, although not significantly, reduced. Practical Implication: to determine the effects of a ketogenic diet (KD) in women age with a diagnosis of PCOS. We hypothesized that a modified KD (KEMEPHY diet) would lead to an improvement in body weight, plasma cholesterol, triglycerides, hyperinsulinemia, and hormonal outcomes Conclusion: Low calorie diet was significantly better than ketogenic diet in reducing serum cholesterol and triglyceride levels in individuals on a 30-day diet plan of respective type. Our results suggest that a ketogenic diet may be considered as a valuable nonpharmacological treatment for Polycystic ovary syndrome. Longer treatment periods should be tested to verify the effect of a ketogenic diet on the dermatological aspects of Polycystic ovary syndrome. Keywords: Cholesterol, Ketogenic Diet, Serum, Lifestyle, Low Calorie, Nutritionist

The title compounds, C32H35NO2, (I), and C30H29Br2NO2, (II), differ by the presence of a bromine atom instead of a methyl atom in the para position of two benzene rings of compound (II). The two compounds have a structural overlap r.m.s. deviation of 0.27 Å. The pyran and seven-membered cycloheptene rings in both structures adopt boat and boat-sofa conformations, respectively. Intra- and intermolecular C—H...O hydrogen bonds are responsible for the consolidation of the crystal packing of both molecules. In addition to this, weak C—H...π interactions are also observed. The intermolecular interactions were quantified and analysed using Hirshfeld surface analysis.

Giant African land snails (Achatina fulica; GALS) are a highly invasive herbivore and pose serious threats to native species and that could disrupt ecosystems. Various botanical extracts have been used as molluscicides to control mollusks for pest management. We aimed to identify the effects of neem (Azadirachta indica) and titepati (Artemisia vulgaris) to reduce GALS activities and survival using solutions of fresh neem leaf and titepati leaf, bark, and root. We found a fast movement in the GALS only in the extraction groups while the lethargic movement was lower in mulching method. A significant association of control groups with different extraction groups along with mulching treatment (p

Background: When cirrhosis and ascites are present, a very common bacterial infection known as spontaneous bacterial peritonitis (SBP) often develops. This condition must be early diagnosed and treated to reduce morbidity and mortality. Objective: To assess the frequency of Spontaneous Bacterial Peritonitis in Liver Cirrhosis patients with Ascites. Methodology: This cross sectional study was carried out at the department of gastroenterology, Lady Reading Hospital Peshawar. The duration of study was two years from January 2018 to December 2019. Spontaneous bacterial peritonitis was diagnosed as positive when the ascitic fluid bacterial culture was positive. Ascitic fluid was taken in aseptic condition and send to the hospital diagnostic laboratory for the culture test. All the information’s were recorded in a proforma designed for this research. Data was analyzed by using SPSS version 24. Results: In the current research, totally 150 liver cirrhosis patients with ascites were enrolled. The male patients in our study were 87 (58%) while female patients were 63 (42%). The mean age of the participants (SD) was 48 (4.95) years. The frequency of Spontaneous Bacterial Peritonitis was 60 (40%).

The construction projects are rising in Pakistan to overcome the flow of traffic on the main road of big cities. Karachi is the metropolitan city of Pakistan facing uncontrolled growth and urbanization, which leads to an increase in the demand for urban transport facilities. The study focuses on the assessment of the environmental impacts of the Tariq Road underpass construction site. The data was collected with the help of community consultation using analytical methods. It includes public chat, site visits, interviews, questioners, and the samples collection of environmental components. The results show that the most common hazards were related to excavation, working practice variation, and personal protective equipment (PPEs). Faulty and unmaintained machinery with the lack of proper barrier producing noise and air pollution.

Background: One of the most prevalent functional gastrointestinal illnesses is irritable bowel syndrome (IBS), which causes a variety of gastrointestinal symptoms, including changed bowel habits and stomach pain or discomfort, without an underlying basis. Objective: To assess the frequency of celiac disease in patient with irritable bowel syndrome. Methodology: This cross sectional study was carried out at the department of gastroenterology, Lady Reading Hospital Peshawar. The duration of study was two years from January 2018 to December 2019. The serological tests for celiac disease like IgA anti TTG and IgG anti TTG was determined. Biopsies were taken on upper gastrointestinal endoscopy. Data was collected in a specialized proforma for our research. All the data collected was analyzed by employing IBM SPSS version 23. Results: In our study, a total of 240 patients with irritable bowel syndrome were enrolled. Gender wise distribution shows that there were 132 (55%) male patients while the female patients were 108 (45%). The mean age of patients (SD) was 26.72 (± 2.27) years. The frequency of celiac disease based on serological testing was 20 (8.33%). The frequency of celiac disease based on histological findings was 15 (6.25%).

Background CDK4/6 inhibitors (CDK4/6i) in combination with endocrine therapy (ET) have a well-established role in the management of hormone receptor-positive (HR+)/HER2- metastatic breast cancer (MBC). The benefit of continuing CDK4/6i beyond progression in combination with a different ET has not been confirmed. Preclinical data suggest synergy between CDK4/6i and PD-L1 inhibition. The PACE trial prospectively evaluates whether continuation of the CKD4/6i palbociclib beyond progression on prior CDK4/6i and aromatase inhibitor (AI), with a change in ET to fulvestrant, improves outcomes beyond change to fulvestrant alone, as well as explores the activity of the palbociclib, fulvestrant, and avelumab triplet. Methods PACE is a multicenter randomized open-label investigator-initiated phase II trial, open at 11 U.S. sites. Eligible patients (pts) had HR+/HER2- evaluable MBC with prior progression on AI and any CDK4/6i after > 6 months (mo) of therapy in the MBC setting, or during/within 12 mo in the adjuvant setting, with no more than 1 prior line of chemotherapy for MBC. Pts were randomized 1:2:1 to fulvestrant alone (F); fulvestrant and palbociclib (F+P); or fulvestrant, palbociclib, avelumab (F+P+A), with tumor assessments every 8 weeks. Blood for circulating tumor DNA (ctDNA) analysis was collected at baseline, at times of tumor assessments, and at progression. The primary objective was to evaluate progression-free survival (PFS) with F+P vs F; secondary objectives included PFS with F+P+A vs F, objective response rate (ORR) in all arms, and safety. A sample size of 220 patients was planned to provide 80% power to detect an improvement in PFS with HR 0.6154 with F+P vs F (6.5 vs 4 mo; α(1)=0.05). Results A total of 220 pts were randomized from 9/2017-2/2022 (F: n=55, F+P: n=111, F+P+A: n=54); median age 57 years (range 25-83), 85% non-Hispanic (7.7% non-Hispanic black), 8.6% Hispanic, 6.4% unknown. 40% had de novo MBC, 60% had visceral disease, and 14% bone-only disease. 16% had 1 prior line of chemotherapy for MBC, 90% had received prior palbociclib, 4.5% ribociclib, 4.1% abemaciclib, 1.4% palbociclib and ribociclib. Pts entered the trial after a median 19 mo of prior CDK4/6i plus AI (interquartile range 12-31 mo). A total of 10 (5%) pts received protocol therapy as first line ET for MBC, 169 (77%) as second line, and 41 (17%) as beyond second line. 88% entered the trial directly after progression on CDK4/6i. After a median follow-up of 24 mo, 18 pts remained on protocol treatment. PFS was not improved with F+P vs F (median 4.6 vs 4.8 mo; HR=1.11, 90% CI 0.79-1.55; 2-sided p=0.62). Median PFS was 8.1 mo with F+P+A (HR=0.75 vs F, 90% CI 0.50-1.12; 2-sided p=0.23). ORR was 7.3% (90%CI 1.5-13.0) with F, 9.0% F+P (4.5-13.5%) and 13.0% F+P+A (5.4-20.5%). No new safety signals have been observed. Analysis of ctDNA panel sequencing encompassing 70 genes from 184 baseline samples, including correlation with known and hypothesized resistance genes, will be presented. Conclusions For ER+/HER2- breast cancer, combining palbociclib with fulvestrant beyond progression on prior CDK4/6i and AI did not significantly improve PFS compared with using fulvestrant alone. The observed longer PFS when a PD-L1 inhibitor was added to fulvestrant plus palbociclib is an intriguing signal in this ER+ population. Translational studies of blood and tumor tissue are ongoing and will be presented. Citation Format: Erica L. Mayer, Yue Ren, Nikhil Wagle, Reshma Mahtani, Cynthia Ma, Angela DeMichele, Massimo Cristofanilli, Jane Meisel, Kathy D. Miller, Trevor Jolly, Elizabeth Riley, Rubina Qamar, Priyanka Sharma, Sonya Reid, Natalie Sinclair, Meredith Faggen, Caroline Block, Naomi Ko, Ann Partridge, Wendy Y. Chen, Michelle K. DeMeo, Victoria Attaya, Amanda Okpoebo, Yuan Liu, Eric Gauthier, Harold Burstein, Meredith Regan, Sara Tolaney. GS3-06 Palbociclib After CDK4/6i and Endocrine Therapy (PACE): A Randomized Phase II Study of Fulvestrant, Palbociclib, and Avelumab for Endocrine Pre-treated ER+/HER2- Metastatic Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr GS3-06.

N/a.

Staphylococcus aureus is commensal and human pathogen both. The bacterium is one of the most common causes of food borne infections also in all over the world. C. copticum (Ajwain) is an aromatic spice used as a medicinal plant from ancient time for treating different human diseases including infectious diseases. The highest anti-staphylococcal activity in terms of inhibition zone was recorded 18.5 mm whereas 14.5 mm as lowest. The MIC range of ethanolic extract was evaluated amid 1.56 mg/ml to 3.12 mg/ml. The C. copticum (seed) extract might be useful as anti-staphylococcal agent as well as natural food preservative.

El Programa de Monitores Ciudadanos de Control (PMCC) es una estrategia de control social desarrollada por la Contraloría General de la República (CGR) que incorpora a los ciudadanos en el proceso de fiscalización de las obras públicas que desarrollan los gobiernos subnacionales. Este programa inició su implementación a mediados del año 2018, sin embargo, a casi tres años de su implementación se desconoce cuál ha sido la influencia de esta estrategia en la creación de valor público. Partiendo de esa problemática, nuestra investigación ha analizado la implementación del PMCC en el caso específico de La Libertad - Perú, durante los años 2018 y 2019; de cuyo resultado se ha determinado que el programa tiene legitimidad en el entorno político y existe una percepción de confianza de parte de la población, sin embargo, no está generando la adopción de acciones correctivas o preventivas esperadas frente a las situaciones de incumplimiento detectadas, de parte de la mayoría de titulares de las entidades; así tampoco tuvo incidencia en la generación de servicios de control por parte de la CGR. En tal sentido, se encuentra pendiente orientar algunos componentes de este programa a fin de que continúe mereciendo la confianza ciudadana, aportando a la mejora de los servicios hacia el ciudadano, y creando valor público.

Background Hyperlinear palms are described as a feature of loss-of-function (LoF) variants in filaggrin (FLG). Objectives To explore the phenotype of participants (age < 31 years) with atopic eczema of Bangladeshi ancestry from East London and investigate which factors best associate with LoF FLG variants. Methods A cross-sectional study with participants recruited between May 2018 and December 2020. Patterns of palmar linearity were categorized and modelled with the Eczema Area and Severity Index (EASI), transepidermal water loss (TEWL), skin hydration (SH) and LoF FLG variants. Results There were 506 complete cases available. Five palm patterns were noted. The ‘prominent diamond’ pattern associated best with EASI [marginal effects (ME) 2.53, 95% confidence interval (CI) 1.74–3.67], SH (ME 0.85, 95% CI 0.78–0.96) and TEWL (ME 1.32, 95% CI 1.11–1.62). Using five palm patterns had some ability to discriminate LoF FLG variants [area under the receiver operator characteristic (AUROC) 76.32%, 95% CI 71.91–80.73], improving to 77.99% (73.70–82.28) with the addition of SH. In subgroup analysis with only fine perpendicular/prominent diamond patterns the AUROC was 89.11% (95% CI 84.02–94.19). Conclusions This was a single-centre study design with humans classifying clinical patterns. The stability of temperature and humidity was not guaranteed across TEWL and SH measurements despite using a climate-controlled room. Palm patterns associate with EASI and TEWL. The fine perpendicular/prominent diamond patterns are markers to detect the absence/presence of LoF FLG variants, respectively.

Objectives: To collect all studies on acute kidney injury, even with their limitations, done in South Asia to draw a picture about the types of acute kidney injury prevalent in the region. Method: The meta-analysis was conducted in June 2022 and comprised search on PubMed, Medline, Cochrane Library and Google Scholar databases for studies on acute kidney injury done in South Asia regardless of time limit, and published in the English language. Combinations of key words used were ‘community acquired acute kidney injury’ or ‘acute renal failure’ with using individual names of ‘different countries’ in South Asia. Data was extracted and analysed. Results: Of the 31(67.4%) studies subjected to detailed analysis, 17(54.83%) had been done in India, 10(32.25%) in Pakistan, 2(6.45%) in Nepal, and 1(3.22%) each in Bangladesh and Sri Lanka. Overall, there were 16,584 patients with acute kidney injury. There were 16(51.61%) studies focussing on community-acquired acute kidney injury, while 15(48.38%) also included hospital-acquired acute kidney injury. Also, 17(54.83%) studies were prospective and 14(45.16%) were retrospective. Pattern of defining and classifying acute kidney injury varied in the studies. Need for renal replacement was not mentioned universally. Complete recovery reported varied 40-80% and mortality 2.2-52% in the studies analysed. Conclusions: The number of acute kidney injury patients was considerable. Despite variations in definitions, study designs and outcomes, the meta-analysis provides useful information about the pattern of presentation and major causes of community-acquired acute kidney injury in South Asia. Key Words: Acute kidney injury, Community-acquired, South Asia, Meta-analysis.

A través del uso de la tecnología, la escolarización se aceleró como resultado a la pandemia del COVID-19. El objetivo del estudio fue interpretar el desarrollo de la conciencia ambiental desde la mirada docente. El estudio se construyó bajo el enfoque cualitativo con diseño hermenéutico a nivel interpretativo. Se utilizó una guía de entrevistas semiestructurada, que se aplicó a seis docentes que cumplían con los requisitos previos para el estudio. Los hallazgos incluyeron proporcionar a la comunidad educativa información para contribuir al desarrollo de la conciencia ambiental, tener un conocimiento completo sobre la conciencia ambiental y utilizar técnicas para fomentar un sentido de valor y amor por el planeta tierra. A modo de cierre, es necesario fomentar la conciencia ambiental ya que es un proceso que requiere la comprensión y el dominio de una variedad de ideas, así como de componentes estratégicos, buen comportamiento y responsabilidad ambiental.

Introduction: Using acetic acid to inspect the vaginal canal is a simple screening procedure done with the naked eye. During a speculum examination, the cervical transformation zone is painted with acetic acid 3% to 5% or vinegar. It is a simple, cost-effective screening tool that can be used in poor developing countries with high rates of invasive cervical cancer mortality because acetic acid coagulates nuclear proteins, resulting in white discoloration of the transformation zone in CIN and early invasive cancer. Objective: This study aims to measure the effectiveness of a simple and economical screening test, visual inspection with acetic acid (VIA), for diagnosing cervical intraepithelial lesions in comparison to the gold standard of histopathology using a study population of women attending a gynecology outpatient department. Study Design: The study used a cross-sectional design to validate the findings. Study Area: This study was conducted in the Obstetrics & Gynecology Department, Women and Children Teaching Hospital, Dera Ismail Khan. Study Duration: This study took place between November 2018 and April 2019. Materials and Methods: The study included 414 women with abnormal vaginal bleeding. Under a good light source, a lubricated Cusco's speculum was introduced into the vagina to evaluate the cervix for gross abnormalities. A cotton swab was used to apply 3% acetic acid to the cervix and acetowhite changes were observed for one minute. Positive results were considered when distinct acetowhite areas were detected, while negative results were considered when light, faint, or doubtful aceto-white areas were detected. Results: There was a range of age from 18 to 40 years in this study with a mean age of 30.772 years and a mean weight of 71.644 kilograms. For diagnosis of cervical intraepithelial lesions, acetic acid visual examination has shown a sensitivity of 84.38%, specificity of 97.11%, diagnostic accuracy of 95%, PPV of 84.38%, and NPV of 97.11% (p=0.000). Practical implication: The purpose of this study is to compare the efficacy of a simple and inexpensive screening test, visual inspection with acetic acid (VIA), to the gold standard of histopathology in a study group of women attending a gynecological outpatient service. Cervical cancer is a leading cause of death among women in developing countries, where access to advanced diagnostic tools is limited. If VIA proves to be an effective screening tool, it could be widely implemented in low-resource settings to improve early detection and treatment of cervical cancer. Conclusion: VIA is considered an appropriate screening alternative for a large population. In contrast to cytology-based programs, it is highly sensitive, low-cost, and yields immediate results. Keywords: Cervical Cancer; Visual Inspection with Acetic Acid; Screening

During the Syrian conflict, ongoing since 2011, Palmyra became notorious for the destruction and looting of its Roman-period remains, giving rise to many narratives of what Palmyra’s future should bring, often without attention to how we have come to know its past. This article explores that past through a key period—the French Mandate—when European archaeologists categorically reshaped the site, culminating in the relocation of the site’s population from mudbrick houses in and around the Temple of Bel to a new, military-built town north of the original. We examine the site immediately prior to that transformation through contemporary archaeological diaries from 1924 to 1928, written by Danish archaeologist Harald Ingholt. Through his diaries, it is possible to reconstruct the complexity of knowledge production at the site, which disrupts the authorized discourses of archaeological discovery with important consequences for how we understand the contribution of local inhabitants to scientific knowledge.

Feed management in shrimp culture aims to improve the quality of shrimp organisms. The application of the feeding regime in shrimp culture has been developed to determine the best formulation of diet in order to maximize growth rate and survival rate of shrimp by increasing feed efficiency and minimizing waste. The application of the feeding regime is closely related to the understanding of the physiological and morphological aspects of shrimp from the larval stage to the adult stage. The success of the application of feed management with the application of the feeding regime will be a solution to the problem of the high costs of feed needed in shrimp culture. The best formulation of diet in shrimp culture in the N6-P3 stage is microalgae, at the M1-PL10 stage is zooplankton, and in the juvenile-adult shrimp stage is artificial feed. Microalgae can significantly increase the survival rate and growth rate of shrimp at the hatchery stage. This article aimed to examine the effect of the application of feeding regime using different diet formulations to produce the highest growth performance of shrimp in shrimp culture based on the morphological and physiological aspects of shrimp.

In the absence of any structural aetiology, irritable bowel syndrome is a condition of gastrointestinal motility and sensation that is defined by persistent abdominal pain and irregular bowel movements. It is the communal reasons for gastroenterology consultations. Therefore, knowledge of the relative frequency of these symptoms in our population will enable healthcare practitioners to tailor their management to the symptom patterns of our population. Objective: To determine the frequency of different clinical presentations/symptoms (frequent stools, looser stools, infrequent stools, harder stools, abdominal pain) of irritable bowel syndrome in patients presenting to the outpatient department of Lady Reading Hospital, Peshawar. Place and Duration: In Gastroenterology outpatient department of Lady Reading Hospital, Peshawar for six months duration from 25th June, 2019 to 25th December, 2019. Study Design: A Cross-sectional Study. Methods: In this study a total 192 patients were observed. The patients were given a questionnaire containing questions about their clinical presentation including present and past symptoms. These questions were including details of how frequently they need to pass stools, consistency/form of stools (graded according to Bristol Stool Chart) as well as presence or absence of pain.

The present study assessed if salivary crystallization pattern (ferning pattern formed as a result of the higher levels of salt content in the dried sample) could be used for estrus detection and for diagnosis of pregnancy/non-pregnancy in dairy cows. Saliva and blood samples were collected from non-pregnant cycling cows (Sahiwal breed; n = 20) on alternate days from the day of estrus till next estrus. Then, all the cows were inseminated and saliva and blood sampling were continued further for a period of 22 d post-insemination. Pregnancy diagnosis was carried out on day 45 post-insemination and eight cows were found to be pregnant. The salivary crystallization pattern and estradiol:progesterone ratio during estrous cycle and during pregnancy were compared among these cows. Six types of salivary crystallization patterns were discerned; distinct patterns such as branch-like, fern-like, fir-like and combinations of these. Fern-like pattern was observed in all the cows on the day of estrus (first measurement day) and furthermore, all of the cows that subsequently became pregnant had fern-like salivary crystallization pattern at the time of insemination. Saliva of all the pregnant cows showed branch-fir type of crystallization pattern on day 16 post-breeding while only 50% of non-pregnant cows showed this pattern on day 16 of estrous cycle. The appearance of fern-like pattern was positively and significantly related to estradiol:progesterone ratio (r = 0.86; P < 0.001). The findings were validated on a separate group of cycling cows (n = 32). We can conclude that salivary crystallization pattern might serve as a non-invasive and cost effective and easy-to-use cow-side tool for estrus detection and early pregnancy/non-pregnancy diagnosis in cows upon validation on a larger sample size.