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Objective: To determine the role of Neutrophil Lymphocyte Ratio as an inflammatory marker in Rheumatoid Arthritis. Study Design: Cross-sectional analytical study. Place and Duration of Study: Rheumatology Department, National Hospital and Medical Center, Lahore Pakistan, from Mar to Sep 2021. Methodology: After approval from Institutional Ethical Review Board, 160 patients diagnosed with rheumatoid arthritis, aged 21-80 years, were enrolled. Demographic information and medical history were obtained and divided into two groups: Active disease (DAS-28 score>3.2) and LDA/remission (DAS-28 score

Objectives: Smoking is a potent risk factor for coronary artery disease, but there is controversy about its protective nature in terms of prognosis in ST-elevation acute coronary syndrome patients undergoing primary percutaneous coronary intervention. So, the main objective of this study is to unfold this controversy in a South Asian population in terms of clinical angiographic parameters and its in-hospital outcomes. Methods: In this study, we included 1756 consecutive patients diagnosed with ST-elevation acute coronary syndrome undergoing primary percutaneous coronary intervention. Patients were classified into smokers and non-smokers, and the in-hospital mortality rate was compared. Multivariable logistic regression analysis was performed to evaluate the paradoxical role of smoking. Results: Smokers were younger (53.78 ± 11.16 years vs 56.43 ± 11.17 years; p

Vision Transformers (ViT) are commonly utilized in image recognition and related applications. It delivers impressive results when it is pre-trained using massive volumes of data and then employed in mid-sized or small-scale image recognition evaluations such as ImageNet and CIFAR-100. Basically, it converts images into patches, and then the patch encoding is used to produce latent embeddings (linear projection and positional embedding). In this work, the patch encoding module is modified to produce heterogeneous embedding by using new types of weighted encoding. A traditional transformer uses two embeddings including linear projection and positional embedding. The proposed model replaces this with weighted combination of linear projection embedding, positional embedding and three additional embeddings called Spatial Gated, Fourier Token Mixing and Multi-layer perceptron Mixture embedding. Secondly, a Divergent Knowledge Dispersion (DKD) mechanism is proposed to propagate the previous latent information far in the transformer network. It ensures the latent knowledge to be used in multi headed attention for efficient patch encoding. Four benchmark datasets (MNIST, Fashion-MNIST, CIFAR-10 and CIFAR-100) are used for comparative performance evaluation. The proposed model is named as SWEKP-based ViT, where the term SWEKP stands for Stochastic Weighted Composition of Contrastive Embeddings & Divergent Knowledge Dispersion (DKD) for Heterogeneous Patch Encoding. The experimental results show that adding extra embeddings in transformer and integrating DKD mechanism increases performance for benchmark datasets. The ViT has been trained separately with combination of these embeddings for encoding. Conclusively, the spatial gated embedding with default embeddings outperforms Fourier Token Mixing and MLP-Mixture embeddings.

Adults who have brain tumors face a serious and potentially fatal challenge since the tumors rapidly growing malignant cells can seriously impair their physiological ability. In clinical practice, imaging techniques such as MRI, PET, and CT scans are widely used to determine the size, kind, and location of tumors. The goal of this research is to create a Computer-Aided Diagnostic (CAD) system that can automatically segment and classify brain tumors utilizing T1W-CE Magnetic Resonance Imaging (MRI) of the brain. The CAD system will involve two primary tasks: tumor classification, which determines the type of tumor depicted in the image, and tumor segmentation, which involves accurately determine the tumor region from the surrounding healthy tissue. By automating these processes, the proposed system aims to enhance the accuracy and effectiveness of brain tumor diagnosis and treatment planning. The classification of brain tumors into multiple classes is recognized as a complex challenge within the field of medical imaging. This research article proposes a model named VS-BEAM that can be used efficiently for clinical decision-making. The proposed VS-BEAM (Voting Based Semi-Supervised Bayesian Ensemble Attention Mechanism) model has been examined for a brain tumor’s multi-class classification. The VS-BEAM model achieved the highest level of accuracy possible. The proposed work achieves maximum sensitivity, specificity, and diagnostic accuracy compared to existing models using T1W-CE MRI images. A convolutional autoencoder is utilized for extracting tumors from MRI images. The accuracy obtained from testing data of 264 brain tumors was 98.91%, indicating that the method is effective and can be used in the clinical context to assist in detecting larger or even smaller tumors.

Objective: to determine the frequency of joint hypermobility in paramedical students and staff at National Hospital Lahore. Study Design: Cross-sectional study. Place and Duration of Study: Department of Rheumatology, National Hospital and Medical Center, Lahore Pakistan, from Mar to Sep 2021. Methodology: Two hundred fifty paramedical students and staff of either gender, aged between 16 years to 35 years were enrolled. Localized Joint Hypermobility was defined as 4 scores on the Beighton Score Scale. Demographic information was obtained from each participant, and joint hypermobility was assessed by using the Beighton score. Results: Mean age of the study participnats was 26.6±4.6 years with 146(58.24%) females. Mean BMI was 23.9±4.0 kg/m2. Generalized Joint Hypermobility was seen in 51(20.4%), and 31(12.4%) had localized hypermobility. Out of 250 participants, 33 (13.2%) had musculoskeletal pain, while among 51 patients with generalized hypermobility, 12(23.5%) had musculoskeletal pain. Conclusion: One out of every five young healthy paramedics enrolled had generalized joint hypermobility. One-third of subjects had at least one clinically documented hypermobile joint. Almost every fourth person with generalized joint hypermobility has musculoskeletal pain compared to 1 in 10 persons without generalized hypermobility. Keywords: Beighton score scale, Generalized joint hypermobility, Localized joint hypermobility, Musculoskeletal pain.

A document’s keywords provide high-level descriptions of the content that summarize the document’s central themes, concepts, ideas, or arguments. These descriptive phrases make it easier for algorithms to find relevant information quickly and efficiently. It plays a vital role in document processing, such as indexing, classification, clustering, and summarization. Traditional keyword extraction approaches rely on statistical distributions of key terms in a document for the most part. According to contemporary technological breakthroughs, contextual information is critical in deciding the semantics of the work at hand. Similarly, context-based features may be beneficial in the job of keyword extraction. For example, simply indicating the previous or next word of the phrase of interest might be used to describe the context of a phrase. This research presents several experiments to validate that context-based key extraction is significant compared to traditional methods. Additionally, the KeyBERT proposed methodology also results in improved results. The proposed work relies on identifying a group of important words or phrases from the document’s content that can reflect the authors’ main ideas, concepts, or arguments. It also uses contextual word embedding to extract keywords. Finally, the findings are compared to those obtained using older approaches such as Text Rank, Rake, Gensim, Yake, and TF-IDF. The Journals of Universal Computer (JUCS) dataset was employed in our research. Only data from abstracts were used to produce keywords for the research article, and the KeyBERT model outperformed traditional approaches in producing similar keywords to the authors’ provided keywords. The average similarity of our approach with author-assigned keywords is 51%.

Modular multilevel converters (MMCs) have been conceived as an alternative in front-end converter applications to enhance the converter system’s reliability, minimize total harmonic distortion, and improve power quality. These converters utilize several DC-link capacitors and power electronic switches, along with switches operating with high switching frequencies, to attain the desired characteristics. Thereby, this paper systematically proposes a novel three-phase asymmetric hybrid modular multilevel converter (AHMMC) for front-end converters used in lower-medium-voltage applications. The AHMMC configuration is based on a three-phase converter connected to a per-phase series arrangement with a cascaded converter module (CCM). The study investigates the AHMMC and proposes a control scheme, which minimizes the voltage range on switches and maintains the current to its reference value. Furthermore, the study also introduces an active balancing of voltage across DC-link capacitors based on the phase opposition disposition PWM (POD-PWM) method. Our new configuration has features such as low switching loss, reduced DC-link voltage, a wider modulation range for the unity power factor (PF), and low voltage and current harmonic distortion. The simulation results are added to verify the performance of the new AHMMC topology and the usefulness of the modular control scheme. In addition, a low-voltage laboratory prototype based on customized control and power boards is built to validate the proposed converter and its control scheme in practice.

Computing software plays an essential role in almost every sector of the digital age, but the process of efficient software development still faces several challenges. Effective software development methodology can be the difference between the success and failure of a software project. This research aims to evaluate the overall impact of Agile Software Development (ASD) on the individual, organizational, software development, and project management dimensions. For this purpose, we surveyed several software development professionals from a variety of backgrounds (experience, location, and job ranks) to explore the impact of ASD on the IT industry of Pakistan. Our analysis of the collected information is two folds. First, we summarized the findings from our surveys graphically clearly show the opinions of our survey respondents regarding the effectiveness of the Agile methodology for software development. Secondly, we utilized quantitative measures to analyze the same data statistically. A comparison is drawn between the graphical and statistical analysis to verify the reliability of our findings. Our findings suggest the existence of a strong relationship between effective software development and the use of Agile processes. Our analysis shows that the job fit of software development professionals and ASD are critical factors for software development project success in terms of cost, quality, stakeholders satisfaction, and time. Although the study focuses on the IT industry of Pakistan, the findings can be generalized easily to other developing IT industries worldwide.

As a retailer between the energy suppliers and end users, the integrated energy service provider (IESP) can effectively coordinate the energy supply end and the energy use end by setting energy prices and energy management. Because most of the current research focuses on the pricing of electricity retailers, there are few studies on IESP energy pricing and management, which are still at the initial stage. At the same time, the existing research often does not consider the impact of demand response (DR) and uncertainties, such as natural gas and electricity wholesale prices, on the pricing of IESP. It is necessary to model the DR and uncertainties in the integrated energy system. Aiming at the inadequacy of the existing research and to address the energy pricing and management of IESP, this paper develops a two-stage stochastic hierarchical framework, which comprehensively considers the DR strategy of the user end, characteristics of the electricity/gas/heat storage and the uncertainties of electricity and gas wholesale prices. The proposed hierarchical model for energy pricing and management is a two-layer model: the upper layer is the problem of maximizing the benefits of IESP, and the lower layer is the problem of minimizing the energy cost of user agents. Through the complementary transformation, the linearization method and the strong duality principle in the optimization theory, the model is transformed into a mixed-integer linear programing (MILP) problem, which can be easily solved by the off-shelf commercial solver. Finally, the simulation results are provided to demonstrate the interactive operation between the IESP and user agent through energy prices setting, DR strategy and energy management.

Background: Diabetic-foot syndrome is a difficult & debilitating complication of inadequately regulated Diabetes Mellitus. Attributed to neural & vascular pathology, the condition is further potentiated by glycemic healing impairment. A wide array of microorganisms have been implicated & sensitivity-guided antibiotics are essential to save both limb as well as to minimize rampant microbial resistance. Present study aims to determine the culture & sensitivity pattern of bacteria in stated cohort of patients at a Surgical Unit. Materials & Methods: This prospective cohort study was conducted over a period of 1 year-duration at a tertiary-care-Hospital. All patients presenting with diabetic-foot who had not been subjected to empiric antibiotic-therapy were enrolled. Demographic & lesion-based variables were studied and the Culture & Sensitivity pattern was evaluated and statistically analyzed. Results:100 patients were included in the study,of which 80 were male (mean-age 60.8±12.7 years) & rest female (mean-age 58.4±11.3-years).35% cultures yielded no growth. Remaining cases showed following pathogens in descending order of incidence. Maximal sensitivity was also reported as mentioned. 1) Staphylococcus-aureus & Klebseilla-Pneumoenae– Piperacillin/Tazobactam,2) Pseudomonas-Aerugionas-Cefotaxime,3)E-coli–Amikacin& Sulbactam,4) Proteus -Gentamicin, 5) Streptococci– Amikacin and 6) Bacteroides – Cefoperazone & Aztreonam. Of 71 cases, 70 had aerobic-organisms isolates & only 1 had anaerobic-isolate. Conclusions: Six pathogens were identified in present study of which Staphylococcus-Aureus was the most prevalent as well as the most resistant. Streptococci & Gram-negative Organisms were observed in remaining cases. While formulation of an adequate antibiotic regime is rendered difficult by resistance & mixed infections, targeted antibiotic administration is decisively crucial to achieve optimal & timely outcome in diabetic foot.

Multiple energy carriers can be coupled as an Integrated Energy System (IES) through interconnection technologies. Unexpected risks will be transferred with the growing coupling of energy systems, mainly stemming from the uncertainties in different energy sectors. It is imperative to coordinate the operation of different energy systems to improve energy efficiency and ensure energy security. With the close integration of different energy systems, it is necessary to couple these different energy markets to achieve the holistic energy supply economy. On the other hand, uncertainties in the energy systems will bring the financial risk for the operator of IES. A risk-averse stochastic market clearing model for the IES is proposed to study the operating strategy aiming at minimizing the operation cost. While the financial risk imposed by the wind power uncertainties is restricted to a predefined level. Simulations results are provided to verify that the proposed model can improve market efficiency and handle the trade-off between cost and risk.

Melanoma is considered a fatal type of skin cancer. However, it is sometimes hard to distinguish it from nevus due to their identical visual appearance and symptoms. The mortality rate because of this disease is higher than all other skin-related consolidated malignancies. The number of cases is growing among young people, but if it is diagnosed at an earlier stage, then the survival rates become very high. The cost and time required for the doctors to diagnose all patients for melanoma are very high. In this paper, we propose an intelligent system to detect and distinguish melanoma from nevus by using the state-of-the-art image processing techniques. At first, the Gaussian filter is used for removing noise from the skin lesion of the acquired images followed by the use of improved K-mean clustering to segment out the lesion. A distinctive hybrid superfeature vector is formed by the extraction of textural and color features from the lesion. Support vector machine (SVM) is utilized for the classification of skin cancer into melanoma and nevus. Our aim is to test the effectiveness of the proposed segmentation technique, extract the most suitable features, and compare the classification results with the other techniques present in the literature. The proposed methodology is tested on the DERMIS dataset having a total number of 397 skin cancer images: 146 are melanoma and 251 are nevus skin lesions. Our proposed methodology archives encouraging results having 96% accuracy.

Improving a vehicle driver’s performance decreases the damage caused by, and chances of, road accidents. In recent decades, engineers and researchers have proposed several strategies to model and improve driving monitoring and assistance systems (DMAS). This work presents a comprehensive survey of the literature related to driving processes, the main reasons for road accidents, the methods of their early detection, and state-of-the-art strategies developed to assist drivers for a safe and comfortable driving experience. The studies focused on the three main elements of the driving process, viz. driver, vehicle, and driving environment are analytically reviewed in this work, and a comprehensive framework of DMAS, major research areas, and their interaction is explored. A well-designed DMAS improves the driving experience by continuously monitoring the critical parameters associated with the driver, vehicle, and surroundings by acquiring and processing the data obtained from multiple sensors. A discussion on the challenges associated with the current and future DMAS and their potential solutions is also presented.

Background: Hypoglycemia in neonates is associated with an increased risk of morbidity and mortality. The objective of this study was to determine the frequency and clinical characteristics of symptomatic hypoglycemia in neonates. Methodology: This cross-sectional study was conducted at Department of Pediatrics Neonatology, Lady Reading Hospital Peshawar, from April 2009 to March 2010. A total of 150 neonates with signs and symptoms of hypoglycemia were admitted. Gestational age, birth weight and clinical features were recorded on questionnaire. Blood glucose level was checked and any value less than 40mg/dl was considered as hypoglycemia. Data was analyzed by SPSS version 11. Results: Out of 150 symptomatic neonates, 44(29.3%) were found to be hypoglycemic. Hypoglycemia was more common in males 34(32.7%) as compared to females 10(21.7 %), p=0.04, and was more frequent in first seven days of life 40(31.7%) than late neonatal age 4(16.6%), p=0.04. Hypoglycemia was present in 12(34%) small-for-gestational age, 31(30%) appropriate-for-gestational age and 1(8.3%) in large-for-gestational age babies (p>0.05). Hypoglycemia was seen in 11(32.3%) preterm and 33(29%) term babies (p>0.05). Feeding difficulty was the most common symptom of hypoglycemia 32(72.7%) cases followed by jitteriness in 28(62.7%) cases. Conclusion: Symptomatic neonatal hypoglycemia is more common in male babies and in the early neonatal age. Blood glucose estimation is mandatory in neonates with signs and symptoms of hypoglycemia.

Objective: To determine the frequency of hypothyroidism in patients with pulmonary hypertension. Study Design: Observational Cross-sectional study. Setting: Department of Medicine, Sandeman Provincial Hospital, Bolan University of Medical & Health Sciences Quetta Pakistan. Period: March 2020 to March 2021. Material & Methods: Pulmonary Hypertension was defined as mPASP of ≥25 mm Hg at rest on transthoracic echocardiogram and hypothyroidism was labeled when TSH was high with low Free T4 and/or Free T3. Patients with congestive cardiac failure, pulmonary malignancy or pulmonary metastasis assessed by history and examination were excluded from the study. Using non-probability consecutive sampling, 186 patients of both genders, aged 20-65 years with pulmonary hypertension were included. Demographic information along with clinical variables noted, echocardiography was done and thyroid profile was sent for each patient. Results: Mean age was 41.2+11.2 years with 56 (30.1%) males and 130 (69.9%) females. The mean height, weight and BMI were 1.6+0.2 meters, 56.5+14.4 kilograms and 21.8+3.6 kg/m2 respectively. The mean mPASP was 40.2+7.1 mmHg. The mean serum TSH, free T3 and free T4 levels were 6.6+4.8 IU/L, 2.5+1.0 pmol/L and 1.1+0.4 pmol/L respectively. In our study, hypothyroidism was seen in 46 (24.7%) and was not significantly associated with age, gender, BMI or mPASP. Conclusion: Hypothyroidism was noted in about a quarter of the patients with pulmonary hypertension in this study. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of hypothyroidism in patients with pulmonary hypertension. Study Design: Observational Cross-sectional study. Setting: Department of Medicine, Sandeman Provincial Hospital, Bolan University of Medical & Health Sciences Quetta Pakistan. Period: March 2020 to March 2021. Material & Methods: Pulmonary Hypertension was defined as mPASP of >25 mm Hg at rest on transthoracic echocardiogram and hypothyroidism was labeled when TSH was high with low Free T4 and/or Free T3. Patients with congestive cardiac failure, pulmonary malignancy or pulmonary metastasis assessed by history and examination were excluded from the study. Using non-probability consecutive sampling, 186 patients of both genders, aged 20-65 years with pulmonary hypertension were included. Demographic information along with clinical variables noted, echocardiography was done and thyroid profile was sent for each patient. Results: Mean age was 41.2+11.2 years with 56 (30.1%) males and 130 (69.9%) females. The mean height, weight and BMI were 1.6+0.2 meters, 56.5+14.4 kilograms and 21.8+3.6 kg/m² respectively. The mean mPASP was 40.2+7.1 mmHg. The mean serum TSH, free T3 and free T4 levels were 6.6+4.8 IU/L, 2.5+1.0 pmol/L and 1.1+0.4 pmol/L respectively. In our study, hypothyroidism was seen in 46 (24.7%) and was not significantly associated with age, gender, BMI or mPASP. Conclusion: Hypothyroidism was noted in about a quarter of the patients with pulmonary hypertension in this study. [ABSTRACT FROM AUTHOR]

Objective: To determine frequency of hyponatremia in liver cirrhosis patients presenting with hepatic encephalopathy. Study Design: Descriptive Cross-sectional study. Setting: Department of Medicine, Sandeman Provincial Hospital, Bolan University of Medical and Health Sciences Quetta. Period: June 2020 to December 2020. Material & Methods: Cirrhosis was characterised on Ultrasound abdomen with altered liver parenchyma, shrunken liver and coarse echo texture. HE was defined as a spectrum of neuropsychiatric abnormalities diagnosed clinically with adequate history taking and physical examination. After taking informed consent from the patients' attendants, 172 patients of liver cirrhosis presenting with HE were enrolled. Detailed clinical history and examination along with investigations were done. Hyponatremia was defined as serum sodium level <135 mEq/L. Data was analyzed through SPSS Version 20.0. Results: There were 127 (73.8%) males and 45 (26.2%) females with mean age 46.61+9.31 years while mean BMI was 25.25+2.73 kg/m². Out of 172 patients, 18 (10.5%) had Child-Pugh Class A, 63 (36.6%) Child-Pugh Class B and 91 (52.9%) had Child-Pugh Class C. Hospital stay >3 days was seen in 47 (27.3%) while 125 (72.7%) had stay of >3 days. It was observed that 14 (8.1%) patients expired. Hyponatremia was found in 69 (40.1%). Conclusion: Hyponatremia was a common feature in liver cirrhosis patients presenting with hepatic encephalopathy. Furthermore a significant association of hyponatremia was seen with hospital stay and all-cause mortality. [ABSTRACT FROM AUTHOR]

Granulomatosis with polyangiitis (GPA) is an uncommon pauci-immune small-vessel necrotising granulomatous vasculitis mostly seen in age 45-60 years. We present the case of a formerly healthy 44 years old male presenting with dysuria and intermittent urinary retention for 8 months, not responding to empirical antibiotic therapy and TURP. A prostate biopsy showed necrotising granulomatous prostatitis. Urinalysis demonstrated persistent pyuria and haematuria, but cultures showed no growth. Subsequently he complained of fever, cough, dyspnoea and skin ulcers. CT of the chest showed multiple cavitatory lesions and pleural effusion. On work up, c-ANCA was positive and a diagnosis of granulomatosis with polyangiitis was established. This depicts a rarely seen presentation of prostatitis as the initial feature of GPA. [ABSTRACT FROM AUTHOR]

Objectives: This study was aimed to report the prevalence-pattern of hereditary and congenital anomalies (CA) in general population of Balochistan province of Pakistan, and to elucidate the familial/sporadic presentations and parental consanguinity of CA., Methods: In a multi-center cross-sectional study, patients with CA were ascertained from various district hospitals and public places throughout Balochistan from 2019 to 2023. Online Mendelian Inheritance in Man (OMIM) and International Classification of Diseases (ICD-10) databases were utilized for uniformity in classification. Descriptive statistics was employed., Results: A cohort of 1185 independent patients diagnosed with CA was recruited and the index males were 71%. The CA were classified into nine major and 118 minor entities. In the major categories, neurological disorders had the highest prevalence (n=317; 27%), followed by limb defects (n=161; 14%), blood-heart defects (n=159; 13%), neuromuscular anomalies (n=156; 13%), sensorineural/ear defects (n=140; 12%), eye/visual impairments (n=90; 8%), musculoskeletal defects (n=83; 7%), ectodermal defects (n=31; 3%), and others (48; 4%). Sixty one percent CA were sporadic in nature and 39% were familial; and parental consanguinity was observed in 51% cases. Several rare CA were witnessed., Conclusions: High preponderance of sporadic presentations in neuromuscular anomalies and musculoskeletal defects and low incidence of parental consanguinity in ectodermal defects and musculoskeletal defects may depict a significant etiological role of non-genetic/environmental factors such as prenatal exposures and maternal conditions. In this context, it is important to increase health education, enhance antenatal and perinatal care, and strengthen the health-care system in Balochistan to reduce the burden of CA., Competing Interests: Conflict of interest: None., (Copyright: © Pakistan Journal of Medical Sciences.)

An experiment was conducted to investigate the effect of different growing media on the growth and development of Dahlia (Dahlia pinnata). Seven different growing media including sand, silt, leaf mold, sand + silt, sand + leaf mold, silt + leaf mold and sand + silt + leaf mold, were used to check the growth and development of dahlia in pots. The over all best performance was recorded in media sand + silt + leaf mold for almost all the parameters; plant height (42.08 cm), stem thickness (1.93 cm), number of branches per plant (3.6), minimum days to flowering (91.66), number of flowers per plant (10.6), number of petals per flower (13), diameter of flower (8.8 cm) and vase life of flower (5 days). The media leaf mold alone also performed significantly well for all the parameters including the maximum 42.55 leaves per plant. Sand, when used alone as a growing medium showed the least response and provided unsatisfactory results for all the parameters.