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Objective: The study aimed to compare the procedural time (wire crossing time) of primary percutaneous coronary intervention (PPCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) using the radial approach versus the femoral approach. Study Design: A single-center, observational, retrospective cohort study was conducted. Setting: The study was carried out in the Cardiology Department of Saidu Group of Teaching Hospital (SGTH) in the period from July, 2022 TO December, 2022. Methods: Medical records of patients with acute STEMI who underwent PPCI using either the radial or femoral approach were retrospectively reviewed. Demographic, clinical, and procedural data were collected, and the primary outcome was the procedural time (wire crossing time) for each approach. Results: A total of 276 patients were included in the study, with 137 in the radial approach group and 139 in the femoral approach group. The mean procedural time (wire crossing time) was significantly longer in the radial approach group (29.6 ± 7.3 minutes) compared to the femoral approach group (24.2 ± 6.5 minutes), p

Deep learning is a growing technique used to solve complex artificial intelligence (AI) problems. Large-scale deep learning has become a significant issue as a result of the expansion of datasets and the complexity of deep learning models. For training large-scale models, the cloud can be used as a distributed HPC (high-performance computing) tool with benefits in cost and flexibility. However, one of the major performance barriers in distributed deep learning in a distributed HPC environment is the network. The performance is often limited by heavy traffic like many stochastic gradient descent transfers for distributed communication. There are many network studies in distributed deep learning to solve these problems, but most research only focuses on improving communication performance and applying new methods or algorithms like overlapping parameter synchronization to minimize communication delay rather than considering the actual network. In this paper, we are focusing on the actual network, especially in a distributed HPC environment. In such an environment, if cluster nodes are assigned to different zones/regions which means a set of an appropriate number of distributed HPC nodes when performing distributed deep learning tasks, performance degradation due to network delay may occur. The proposed network optimization algorithm ensures that distributed work is placed in the same zone as much as possible to reduce network delay. Furthermore, scoring using network monitoring tools like loss, delay, and throughput is applied to select the optimal node within the zone. Our proposal has been validated on the Kubernetes platform, an open source orchestrator for the automatic management and deployment of micro-services. The performance of distributed deep learning is improved through the proposed scheduler.

The research works on the Topic “The overview of the Projects of China-Pakistan Economic Corridor in Hazara Division.” shows that although China Pakistan Economic Corridor is an economical venture that comprises different developmental schemes. The qualitative research method is applied in this research. There are two research questions in this research study, such as what are the projects of China Pakistan Economic Corridor and their impacts on the economy of the Hazara division? To solve the puzzles, a deep study was carried out, and three qualitative questionnaires closed-ended were applied. The detailed study carried out on the topic shows that CPEC has different repercussions on the Hazara division. The economic implications, despite some reservations from the people of Pakistan and China, will definitely contribute to the economy of the Hazara division, but this contribution will add to economic growth to a certain level. In order to achieve more economic betterment, further economic projects of public interests in all the areas of Hazara are needed to establish

Blood transfusions are necessary due to the increased incidence of blood diseases and an increase in automobile accidents. In healthcare systems with limited resources, the provision of safe blood products is hampered by transfusion-transmitted diseases (TTIs), such as the hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), syphilis, and malaria. Objective: To determine how common TTIs are among blood donors in Faisalabad. Methods: Immuno-chromatographic technique (ICT) kits and thick film (malaria) screening were used to test donors for HBV, HCV, HIV, syphilis, and malaria. Results: Among 1500 donors, prevalence of HCV was highest (n=106), followed by HBV (n=42), syphilis (n=11), and malaria (n=3). One positive case was reported as HIV. Between the ages of 21 and 40, donors who tested positive were more prevalent. Conclusions: By more carefully evaluating and screening each donor before selecting them for blood donation, safe blood transfusions can both increase recipient safety and reduce the spread of TTIs.

Background: Fever is a very common adaptive immune response in acute respiratory tract disorders during infancy. Antipyretic / analgesic drugs such as paracetamol (acetaminophen) are widely used to improve the comfort of the child. Objective: To determine the efficacy of paracetamol in symptomatic relief of upper respiratory tract infections in children aged 2 to 5 years. Study Design: Descriptive case series Study Setting: Department of Pediatrics, Ayub Teaching Hospital, Abbottabad Duration of study: Six months from October 13, 2020, to April 13, 2021 Subjects and methods: All children aged 2 to 5 years of either gender having upper respiratory tract infections and duration of symptoms of >2 days were consecutively enrolled. Patients were prescribed Paracetamol in a dose of 10 mg/kg/dose 6 hourly for 3 days. Patients were followed up after 3 days to see the efficacy of Paracetamol in symptomatic relief of upper respiratory tract infections. Results: Of 284 children, the mean age of the children was 4.01 ±1.10 years. There were 135 (47.5%) males and 149 (52.5%) females. The mean weight of the children was 12.36 ±3.42 kg. The mean duration of symptoms was 5.11 ±0.95 days. The efficacy of paracetamol in symptomatic relief of upper respiratory tract infection was found to be 184 (64.8%). A non-significant difference of efficacy of paracetamol was observed with age (p-value 0.578), gender (p-value 0.908), weight (pvalue 0.586), and duration of symptoms (p-value 0.872). Practical Implication: This study was planned to determine the efficacy of paracetamol in symptomatic relief of upper respiratory tract infections. The results of this study could be used in owing to locally produced evidence. Conclusion: The efficacy of paracetamol was observed in 64.8% children aged 2 to 5 years with symptomatic relief of upper respiratory tract infections in children. Keywords: Efficacy, Paracetamol, Children, Upper Respiratory Tract Infections

The ability to track the trajectory or path on the sea surface remains a key measurement in the control system of an unmanned surface vehicle (USV). In this research, the designed algorithm defines the path and minimizes the disturbances to zero. Underactuated USVs are ships or boats, which operate on the water surface without a crew and the underactuated system has low actuators than its degree of freedom (DOF). The adaptive control strategy is applied to the unbounded system as the ocean due to its high performance, while the robust control system attains high performance in the bounded system. To consider the trajectory tracking of UUSV and provide an optimal control strategy for a ship in the presence of external disturbances, the study presents a controller-based on model reference adaptive control with an integrator (MRACI), which guarantees the stability of a closed-loop system. The vehicle experiences variations in the system response due to external disturbance. This abovementioned scheme reduces the variations to nearly equal to zero making the vehicle stable. First, use computer-based simulation to verify the proposed controller under two different scenarios. Then, simulation results show that the designed scheme lowers the errors and performs well.

Introduction: The invasive endoscopic-biopsy approach is the one that is used the vast majority of the time for diagnosing and monitoring chronic gastritis. Finding non-invasive laboratory indicators would be beneficial for the patient in terms of both cost and convenience. It is becoming more and more well-known that saliva, in addition to its vital protective role for the digestive system, may also be employed as an efficient non-invasive diagnostic material. Aim: To detect and define biochemical characteristics in the saliva of chronic gastritis patients (both HP+ and HP-) and compare these values to those observed in healthy people, and search for correlations between the levels of these biochemical in the serum and in the saliva in order to ultimately use these biochemical as a diagnostic tool. Method: The design of this study was a cross sectional study design and this study was conducted at Bahawal Victoria Hospital, Bahawalpur. Subjective symptoms, serological data, and endoscopic findings were used to identify the disease activity in a total of 60 patients with chronic gastritis (44HP+ and 16HP-) from this research. The average age of the patients was anything from 58.73 to 12.08. The average age of the control group participants was 56.868.67, and they were all in excellent health and not smokers. Analyses made use of unstimulated saliva and serum. Stool samples are tested for albumin, total protein, uric acid, and secretory immunoglobulin A. (sIg A). To evaluate their efficacy, we employ a biochemical analyzer (Olympus AU 640) and an ELISA reader (an adaptation of the processes for oral fluid). Results: Compared to the control group, HP+ patients had considerably greater sIgA and TP levels. However, UA did not show a comparable trend. We found that only UA had a correlation with both saliva and serum levels. It was shown that there was an inverse relationship between UA and endoscopic markers of inflammation. As a defense mechanism against the oxidative stress, salivary flow rate abnormalities, and inflammation that had occurred in the stomach, these alterations are being hypothesized. Practical implication: The significance of this study is to see whether specific biochemical parameters may be utilised as a diagnostic tool in the future by comparing the levels in the blood and those detected in the saliva of those patients having chronic gastritis (both HP+ and HP-) Conclusion: In patients with HP+ chronic gastritis, the findings show that there are considerable changes in the characteristics of their saliva. Saliva is a biological substance that has certain limitations, but it is an excellent indicator of the pathological processes occurring in the digestive system, particularly in the case of HP+ infection. Keywords: Uric Acid, Total Protein, Saliva, Sig A, And HP+ Chronic Gastritis Albumin

This paper aims to characterize Non-Melanoma malignancies and their corresponding benign conditions in ex-vivo/in-vivo tissue environments to study the feasibility of microwave techniques for skin cancer detection.The dielectric dataset is developed across the frequency band 1 to 14 GHz using Keysight slim-form and RG405 probe characterization systems. The acquired reflection data captured by the systems is converted to dielectric values using the Open-Water-Short and Open-Water-Liquid calibration methods, respectively. Furthermore, the impact of anaesthesia application during skin excision procedure on ex-vivo dielectric data is investigated.The observations suggest that the dielectric properties (DPs) of excised skin lesions may not accurately represent actual tissue properties as they vary significantly ( ∆ϵThe significant contrasts between in-vivo healthy and cancerous skin DPs strongly suggest the viability of the microwave band for skin cancer detection.The research finding of this study would be critical in developing a portable electromagnetic system for skin cancer detection.

Context Allelopathy is recognised as a potential technology to control weeds, and could also be a suitable approach for enhancement of crop yield. Aims The study was conducted to investigate the allelopathic role of Averrhoa carambola leaf extract on growth, anatomical and physiological features of three wheat lines, namely 3094, 7076 and A2011. Methods Three dilutions i.e. 0% (control), 15% and 30% of the leaf aqueous extract were applied at 15 day intervals (total five applications) on wheat lines until maturity. Key results All wheat lines showed differential behaviour to allelochemicals of A. carambola leaf extract. Increased root area was accompanied by a high proportion of storage parenchyma tissues and enlarged vascular bundles in line 3094. Disintegration of root cortical parenchyma and complete transformation of chlorenchyma into sclerenchyma in stem was recorded in all wheat lines, particularly at the highest concentration of leaf extract. Line 7076 showed very different behaviour, as it possessed a proportionally enlarged root cortex, enlarged stem vascular bundles and increased leaf thickness, primarily at the highest concentration of leaf extract. Line A2011 was relatively more sensitive, indicating a significant reduction (P

Cancer Stem Cells (CSCs) are now considered the primary "seeds" for the onset, development, metastasis, and recurrence of tumors. Despite therapeutic breakthroughs, cancer remains the leading cause of death worldwide. This is because the tumor microenvironment contains a key population of cells known as CSCs, which promote tumor aggression. CSCs are self-renewing cells that aid tumor recurrence by promoting tumor growth and persisting in patients after many traditional cancer treatments. According to reports, numerous transcription factors (TF) play a key role in maintaining CSC pluripotency and its self-renewal property. The understanding of the functions, structures, and interactional dynamics of these transcription factors with DNA has modified the hypothesis, paving the way for novel transcription factor-targeted therapies. These TFs, which are crucial and are required by cancer cells, play a vital function in the etiology of human cancer. Such CSC TFs will help with gene expression profiling, which provides crucial data for predicting the prognosis of patients. To overcome anti-cancer medication resistance and completely eradicate cancer, a potent therapy combining TFs-based CSC targets with traditional chemotherapy may be developed. In order to develop therapies that could eliminate CSCs, we here concentrated on the effect of TFs and other components of signalling pathways on cancer stemness.

Background: The excessive sweating of the body beyond the physiological need is termed as hyperhidrosis. Objective: this study aimed to determine the efficacy of tap water iontophoresis and aluminium chloride for treatment of palmoplantar hyperhidrosis. Study design: It is randomized control trial based interventional study. Material and Method: This study was conducted at the Department of Dermatology, Niazi Medical and Dental College, Sargodha. The duration of the study was six month from July 2022 to December 2022. The patients diagnosed with hyperhidrosis were selected for this research. The patients included in the group 1 were treated with tape water iontophoresis (TWI). The patients included in group 2 were treated with 20% aluminium chloride hexahydrate (AC) liquid solution. This treatment was given for 4 weeks. Adherence monitoring was done by participant self-report diary and results were assessed. Results: The average value of the production of sweat was calculated. The average value of both groups indicates a difference greater than 0.05, which is non-significant. The average value was observed to be 9.76 ± 2.3 g for group no. 1, and the average percentage of production of sweat was also get lowered. While in the case of group no. 2 the reduction of the average value of sweat was 4.3 ± 1.58 and there is a reduction of percentage value up to 65.8 ± 9.87 % observed and the value for group no. 1 was significant according to the value of p. When the results of HDSS (hyperhidrosis disease severity) were compared, no significant difference was observed in the values of both groups. But at the end of the study, when the mean value of hyperhidrosis disease severity was compared in both groups, there were significant changes in group 2. Conclusion: This study was conducted to determine the treatment efficacy of tap water and aluminum chloride in controlling sweating up to normal level. It was observed that tap water along with a direct current of palmer was a much more efficient way to control the sweating level. Keywords: Hyperhidrosis, direct current, tap water iontophoresis, Aluminum Chloride hexahydrate, Hyperhidrosis severity scale (HDSS).

Inadvertent malposition of pacing leads is a recognized complication of temporary cardiac pacing procedure, which can be fatal particularly if lead placement is in the left ventricular (LV) cavity because of the risk of thromboembolic events.1 Malposition leads can be either due to unrecognized congenital heart defects including atrial or ventricular septal defects, patent foramen ovale or due to iatrogenic perforation of interventricular septum but sometimes it may be due to faulty insertion via trans-arterial instead of trans-venous access.2 References Gupta S, Annamalaisamy R, Coupe M. Misplacement of temporary pacing wire into the left ventricle via an anomalous vein. Hellenic J Cardiol. 2010;51(2):175-7. Garg N, Moorthy N. Inadvertent temporary pacemaker lead placement in aortic sinus. Heart views: the official journal of the Gulf Heart Association. 2013;14(4):182.

The main objective of this study was to examine the impact of stress on employees and their impact on turnover intentions. In the modern world, many industries and companies face various levels of challenges and obstacles in the workplace with their employees. The main problem facing the employer is the turnover of employees in the office, and the high-stress level can have a significant impact on the company's future growth. The study was descriptive in nature, and the survey method was applied to collect the data. A questionnaire based on a five-point Likert scale was used for the collection of data from the respondents. Data were collected personally from the respondents and analysed through SPSS using Pearson correlation and regression analysis. The findings of the study suggest that the increase in employee stress levels leads to a decrease in employee performance levels and that stress significantly affects employee performance. Some limitations or problems encountered while doing this research are limited sample size and capacity access.

The antibacterial activity of synthetic antimicrobial agents is well known, but most of them have several side effects and are effective against selective microbes. Recently, major concern for the microbiologists is to investigate for some stable, non-toxic, cheap, and eco-friendly antimicrobial agents with a wide range of bactericidal potential. A cost-effective and environmentally friendly alternate has been proposed in the form of green synthesized nanoparticles. The Present study was designed to fabricate sericin-coated silver nanoparticles (S-AgNPs) using sericin as stabilizer and reductant of silver ions and their antibacterial potential was evaluated at various concentrations and temperatures (8, 40, and 50°C). Antimicrobial activities were assessed by the agar well diffusion method. Antibacterial activity of S-AgNPs was measured at different concentrations (1-6 mg/ml) whereas; antifungal activity was tested at 5-20 mg/ml of S-AgNPs. Nanoparticles were characterized by UV-visible spectrophotometer, Fourier transform infrared spectroscopy, and scanning electron microscopy. These nanoparticles significantly subdued the growth of Clostridium difficile (18.7 ± 0.9 mm), Proteus mirabilis (12.3 ± 0.3 mm) and Bacillus licheniformis (10.7 ± 0.9 mm) and Aspergillus flavus (18.7 ± 2.0 mm), Mucor mycetes (13 .0 ± 1.5 mm), Candida albicans (15.3 ± 0.3 mm) and Aspergillus niger (10.0 ± 0.6 mm). S-AgNPs were stable at all temperatures and the maximum growth inhibition was found at 8°C for all pathogenic strains. We concluded that the S-AgNPs could be a potential candidate to inhibit the growth of bacterial and fungal pathogens at a wide range of environmental conditions like temperature. In various biomedical applications including antimicrobial and wound dressings, S-AgNPs can be used in the future to treat various bacterial and fungal infections.

Objective: To determine the frequency of gestational diabetes mellitus in pregnant women reporting to a public sector tertiary care hospital and find the association of gestational diabetes mellitus with age. Study Design: Comparative cross-sectional study. Place and Duration of Study: Pathology Department, Combined Military Hospital, Quetta Pakistan, from Jan 2016 to Mar2017. Methodology: Five hundred and thirty pregnant women who reported to the Pathology Department of the hospital for an Oral Glucose Tolerance Test at 24-28 weeks of gestation were included. The blood samples were taken after ten hours off fasting and one hour and two hours after loading with 75g of anhydrous glucose and analyzed using the enzymatic (Glucose Oxidase) method. Gestational diabetes mellitus was diagnosed using guidelines recommended by the International Association for Diabetes and Pregnancy Study Group /American Diabetic Association for a one-step diagnosis of gestational diabetes mellitus according to the new criteria. Results: The frequency of gestational diabetes mellitus was quite high 190(35.8%). Of these 530 pregnant women, 162(85.3%)women were diagnosed with Fasting Plasma Glucose, and 28 women were diagnosed with 1-hour or 2-hour after the glucose load test. Age-group of ≥ 30 years had the highest number of women with gestational diabetes mellitus. Conclusion: The frequency of gestational diabetes mellitus in our hospital-reported sample of pregnant women was 35.8%,associated with advanced age. The maximum number of women were diagnosed as having gestational diabetes mellitus based on the fasting Plasma Glucose cut-off value.

Ulcerative colitis is a multifactorial disease of the gastrointestinal tract which is caused due to chronic inflammation in the colon; it usually starts from the lower end of the colon and may spread to other portions of the large intestine, if left unmanaged. Budesonide (BUD) is a synthetically available second-generation corticosteroidal drug with potent local anti-inflammatory activity. The pharmacokinetic properties, such as extensive first-pass metabolism and quite limited bioavailability, reduce its therapeutic efficacy. To overcome the limitations, nanosized micelles were developed in this study by conjugating stearic acid with caffeic acid to make an amphiphilic compound. The aim of the present study was to evaluate the pharmacological potential of BUD-loaded micelles in a mouse model of dextran sulfate sodium-induced colitis. Micelles were formulated by the solvent evaporation method, and their physicochemical characterizations show their spherical shape under microscopic techniques like atomic force microscopy, transmission electron microscopy, and scanning electron microscopy. The in vitro release experiment shows sustained release behavior in physiological media. These micelles show cytocompatible behavior against hTERT-BJ cells up to 500 μg/mL dose, evidenced by more than 85% viable cells. BUD-loaded micelles successfully normalized the disease activity index and physical observation of colon length. The treatment with BUD-loaded micelles alleviates the colitis severity as analyzed in histopathology and efficiently, overcoming the disease severity via downregulation of various related cytokines (MPO, NO, and TNF-α) and inflammatory enzymes such as COX-2 and iNOS. Results of the study suggest that BUD-loaded nano-sized micelles effectively attenuate the disease conditions in colitis.

Prostate cancer and diabetes are the two highly prevalent health problems in men worldwide and have a high mortality rates but their association is quite complex and contradictory. This review reported several population based studies which tried to establish a possible association and explains the mechanism by which diabetes exhibits its effect on prostate cancer progression. It also explores the literature around the expression of various receptors and genes which enlightens the possible molecular basis of association and the effect of current antidiabetic drugs like metformin and insulin on the growth and advancement of prostate cancer in diabetic men. Masking of early tumor detection by diabetes might be the possible explanation for the reported inverse association with worse prognosis and shorter survival rate in diabetic prostate cancer patients.

Abstract: Cancer involves the uncontrolled division of cells resulting in abnormal cell growth due to various gene mutations and is considered the second major cause of death. Due to drug resistance to current anticancer drugs, cancer incidence is rising, and seeking effective treatment is a major concern. Natural products are prospective to yield unique molecules, as nature is a leading source of various drug molecules due to plenty of pharmacologically active molecules. Thymoquinone, a bioactive constituent obtained from Nigella sativa L., has drawn considerable attention among researchers in recent years due to its anticancer potential involving various molecular targets, including initiation of apoptosis initiation, arrest of cell cycle and generation of ROS, besides targeting multiple kinases such as tyrosine kinase, MAPK, and Janus kinase. The current review summarizes the thymoquinone chemistry, sources and anticancer potential involving various molecular targets.

Cervical cancer (CC) is acknowledged as the most ubiquitous carcinoma among females along with the utmost prevalence in developing nations. The major cause of CC is HPV exposure, especially HPV16 and 18. Inflammation is linked to the carcinogenesis of CC in addition to HPV infection. Although the precise cause of CC is yet unknown, using oral contraceptives, being immunosuppressed, and smoking may enhance the risk of the disease. Oxidative stress (OS), in addition to HPV, is linked to cervical cancer. Across several clinical and preclinical research, the dysfunctional redox system and the impact of oxidative stress throughout the aetiology of CC have been examined. Redox homeostasis must therefore be maintained, which calls for both enzymatic and nonenzymatic redox regulators. In this study, we explored the therapeutic strategies used to preserve redox balance, lower cervical cancer mortality, and illustrate the contribution of oxidative stress in the aetiology of the disease.

Typhoid fever results in significant hepatic problems and biochemical abnormalities. The most effective diagnostic procedure now is the bacterial culture, but serologic tests are still often used, and a speedy and accurate diagnostic test for typhoid fever is still required. Objectives: To examine the haematological parameters between typhoid patients and healthy individuals to find any distinctive parameters that could be used as typhoid fever diagnostic indicators. Methods: This study set out to compare haematological changes in 550 patients with 550 healthy persons. Results: We found low hemoglobin (8.95±1.43), low hematocrit (32.62±5.38), high ESR (53.89±9.21), high platelet count (482003±86792), high WBCs count (14464±1694), high neutrophil percentage (63.60±9.26), low lymphocyte percentage (25.33±2.93), and high NLCR (2.498±0.45) against the healthy control group. Conclusions: This distinctive pattern can be easily obtained using a minimally invasive method and used to diagnose typhoid fever.

In Gujranwala, self-medication is a prevalent practice since it offers a low-cost alternative for individuals, and it entails the incorrect and irresponsible use of medications to cure self-recognized symptoms. It is also noteworthy that SM has both positive and negative aspects that affect the life of people. Objectives: To determine the occurrence, pattern, and sources of self-medication among respondents with all socioeconomic statuses and educational levels. Methods: A cross-sectional online survey on 535 residents of the targeted region was undertaken from June to November 2021 in Gujranwala district. We analyze our data by using SPSS and find mean values of our different variables and also find the frequencies and percentages the variables for achievement of our desired results. Results: As COVID-19 preventive, 44 (8.7%) respondents self-medicated with penicillin, and only 4 (0.8%) with paracetamol. When COVID-19 symptoms appeared, the pattern shifted, with azithromycin having the highest rate of self-medication of 49 (9.75%) of all drugs. When people were diagnosed with COVID-19, 12.5% used azithromycin, and 10.3% used penicillin. Conclusions: This study found a significantly high level of SM among men in Gujranwala district. Analgesics, particularly paracetamol and Ibuprofen, were the most often utilized medications for SM.

Objective: To determine the frequency of post-operative pulmonary complications after (coronary artery bypass grafting)CABG surgery and to compare the respiratory complications of post COVID and comparison group Study Design: Analytical Cross- sectional study Study Place and Duration: Study was conducted in Adult Intensive Care Unit, Armed Forces Institute of Cardiology,Rawalpindi Pakistan, from Sep 2021 to Mar 2022. Methodology: 40 patients were selected, and divided into two groups using Non-Probability consecutive sampling. Group-A had history of COVID-19 infection and Group-B was a comparison group and had no history of COVID-19 infection. Patients presenting for elective On-Pump (coronary artery bypass grafting) CABG surgery and known history of COVID-19 were included in our study. Patients of age ranging 30 to 70 years irrespective of gender were included in the study. Any patient who had cardiopulmonary bypass time of more than 120 min, respiratory illness like asthma or Chronic Obstructive Pulmonary Disease (COPD), history of smoking, or requiring post-operative re-ventilation due to cardiac or neurological complication, were excluded from the study. After patients were received from Operation theatre, they were monitored for the respiratory complications and both groups were compared. Results: A total of 40 patients were included in this study having mean age 57.9±7.62 years. Most of the patient population was male 31(77.5%) and only 09(22.5%) were female patients. Study population was equally divided into two groups i.e.20(50%) in comparison group and 20(50%) in post COVID-19 group. There was no significant difference in age (p=0.714), ventilation time (p=0.068), gender (p=1.000), and re-ventilation (p=0.451) of both groups. While Intensive Care Unit stay(p=

Objective: To determine the effect of NAC in prevention of post-operative atrial fibrillation in patients undergoing CABG. Study Design: Quasi experimental study. Place and Duration of Study: Adult Cardiac Intensive Care Unit, Armed Forces Institute of Cardiology & National Institute of Heart Diseases (AFIC&NIHD) Rawalpindi during 6 months. Methodology: 146 patients of both gender undergoing elective CABG were included in the study, having age between 30-70 years. However, any patient with history of arrhythmia including AF, thyroid dysfunction, ejection fraction less than 25%, any valvular lesion, dilated left atrium, dilated left ventricle, dilated right atrium, dilated right ventricle or having right atrial tear during surgery were excluded from the study. By using non-probability consecutive sampling, patients were divided into two groups by using envelope method. One group was given standard treatment (control group) while other group was named as NAC group (experimental group). Data analysis was performed using SPSS version-23. Descriptive statistics were reported as Mean±SD. Categorical variables were reported as frequency and percentage. Chi square test and T-test was used to determine association between different variables. Results: A total of 146 patients with mean age 55.27±7.3 yrs. 127(87%) were male and 19(13%) were females. 28(19.2%) patients had atrial fibrillation while 11(7.5%) patients had ventricular premature contractions (VPC). There was no statistically significant difference between ages (p=0.784), gender (p=0.461), AF (p=0.207) and VPC (p=0.347). Out of 73 (50%) patients from each group; the mean age of NAC group was 55.41±7.3 yrs and of control group was 55.08±7.1 yrs (p=0.784). Gender wise distribution of NAC group had 8(11%) females and 65(89%) males while in control group 11(15%) females and 62(85%) were males. AF was found to be 11(15%) and 17(23.3%) in NAC and control group respectively. In NAC group, VPC was 4 (5.5%) and in control group it was 66 (90.4%). Conclusion: This study shows that NAC decreases the frequency of post-operative atrial fibrillation and ventricular premature contractions, but the decrease is statistically insignificant in Pakistani population. However, keeping in view other beneficial effects of NAC, we would recommend more studies on this subject in Pakistani population.

As time passes, the world is facing the problem of global warming, which results in a rise in average daily temperature. Proper knowledge of temperature distribution and future prediction may help to cope with the situation in the near future. Climate forecasting has gone through various faces; in the early days’ people used to predict the behavior qualitatively. Now environmental scientists have developed a quantitative method for forest climate behavior with certain uncertainties. Empirical models have been developed based on regression analysis to estimate temperature distribution. Two models, linear and non linear, use dew point temperature and relative humidity as independent variables. In addition to regression analysis, Artificial Neural Network (ANN) has been utilized to predict the average daily temperatures of Rohri Sindh, a city in Pakistan in the Sindh province. Both empirical models and ANN estimates are in good agreement with the known values of average daily temperatures.

PurposeInternal crisis communication (ICC) has become a burgeoning area of research in crisis communication. However, the importance of ICC as a tool to enhance employee positive communicative behaviour in crisis has not been explored. This study aims to develop a research model by drawing from the ideas of sensemaking and network theories. In addition, the study further examines how the elements of the proposed model drive ICC while assessing employee-related outcomes and the role of emotion exhaustion.Design/methodology/approachTo assess the validity of the measurement and structural models, 316 employees from both public and private non-profit organisations in Pakistan were interviewed through online survey. The collected data were analysed using co-variance based structural equation modelling (CV-SEM).FindingsThe results of this research confirmed that mindfulness and internal listening positively affect employee perceptions towards internal communication during a crisis. Similarly, ICC positively influences employees' perception of loyalty, job insecurity and the organisation's reputation. The results also highlight the moderation roles of emotional exhaustion (EE).Practical implicationsThe study suggests that applying ICC strategies will help crisis managers develop collaborative relationships with employees, which will help in identifying and managing a crisis. In addition, implementing effective internal communication in corporate practices and processes makes internal reputation and employee loyalty (EL) a reality and allows organisations to remain productive despite crises.Originality/valueThrough the lens of sensemaking theory, this research demonstrated that mindfulness and listening should be considered stimuli in organisations that can influence employees to be active communicators before and during crises. This study is the first to elucidate the essential outcomes for strategic internal crisis management that are often under-looked, such as emotional responses. The study also shows that sensemaking should not only focus on meaning-making in a crisis but also include emotional feelings that can wear out the meaning-making process.

Coronavirus disease-2019 (COVID-19) is pro-inflammatory disorder characterized by acute respiratory distress syndrome. Interleukin-6, a cytokine secreted by macrophages, which mediates an inflammatory response, is frequently increased and associated with the severity in COVID-19 patients. The differential expression of IL6 cytokine in COVID-19 patients may be associated with the presence of single nucleotide polymorphisms (SNPs) in regulatory region of cytokine genes. The aim of this study is to investigate the role of two promoter polymorphisms of the IL6 gene (-597G A and -174G C) with the severity of COVID-19. The study included 242 patients, out of which 97 patients with severe symptoms and 145 patients with mild symptoms of COVID-19. Genotyping of two selected SNPs, rs1800795 (-174G C) and rs1800797 (-597G A) of promoter region of IL6 gene, was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). In our study, individuals with GC genotypes of IL6 (-174G C) polymorphism showed significantly higher risk of severity [adjusted odds (OR) 3.86, p .001] but we did not observe any association of COVID-19 severity with rs1800797 (-597G A) polymorphism. The COVID-19 severity was significantly higher in individuals having 'C' allele of IL6 (-174G C) polymorphism (p = .014). Linkage disequilibrium between rs1800795 (-174G C) and rs1800797 (-597G A) showed that individuals having AC* haplotype significantly association with COVID-19 severity (p = .034). Our results suggest that 'C' allele of rs1800795 (-174G C) polymorphism of IL6 may be the risk allele for severity of COVID-19 in North Indian population.

Iatrogenic aortic dissection is a rare but potentially fatal complication of percutaneous coronary intervention (PCI). Iatrogenic aortic dissection following PCI is rare with most cases reporting dissection originating within the coronary vessels with propagation into the ascending aorta. In this specific case, dissection was without coronary involvement, with dissection extending from the ascending aorta into the descending aorta and iliac vessels. Although PCI via radial approach is associated with fewer vascular complications than with femoral approach, significant adverse outcomes may still occur and require prompt intervention. This case highlights the highly atypical presentation of iatrogenic aortic dissection following cardiac catheterization presenting as acute limb ischemia. In such patients as with ours, immediate surgical intervention is necessary with overall poor prognosis.