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Background: Baroreflex sensitivity is a negative feedback mechanism that is responsible for buffering or maintaining blood pressure in its normal range. The literature indicates that baroreflex sensitivity naturally declines with age, leading to a higher risk of developing hypertension. Objective: To measure the frequency of sensitivity and determine its association with physical activity among the elderly. Methodology: This cross-sectional correlational survey was carried out at Fauji Foundation Hospital and Shifa Eye Trust Hospital in Rawalpindi over six months, from February to July 2019. The sample size was calculated using Raosoft. Healthy elderly participants aged above 60 years, both sedentary, and active elderly participants were included and the Physical Activity Readiness Questionnaire (PAR-Q) was used as a pre-screening tool to exclude high-risk populations. The International Physical Activity Questionnaire (IPAQ) categorized physically active to sedentary participants. Baroreflex sensitivity was assessed via the Valsalva maneuver. Pre and post-values of Blood pressure, pulse, Oxygen saturation, and Valsalva Maneuver were obtained. Results: Out of 201 participants, according to IPAQ categories, 139(69.2%) participants were vigorously active, 48(23.9%) were moderately active and 14(7.0%) were not active (Sedentary). The Spearman ’s-Rho test was applied to find the correlation among all variables, which showed that only pulse and physical activity had a significant association between each other. Conclusion: The study concluded that there was no significant association between physical activity and baroreflex sensitivity except pulse. Keywords: Baroreflex, Elderly, Valsalva’s Maneuver.

Background: Vitamin D deficiency is a worldwide epidemic health problem. Variable results are available with few studies favouring and others denying the association of Vit D deficiency and Hypertension. Material and Methods: An Epidemiological prospective Cross-sectional 3 year observational study was conducted to determine the point prevalence of vitamin D deficiency among hypertensive patients in comparison to age , sex matched, healthy controls among urban and rural population of the Jammu region and also to evaluate the correlation between vitamin D deficiency and hypertension.Group1 ( n = 856) patients of Hypertension with any co-morbid profile with or without complications presenting in tertiary care Medical college. Group 2 (n= 1006) healthy subjects. Results: The study included 1862 patients (856 cases and 1006 controls) with male-to-female ratios of 1.62:1 and 1.13:1, respectively, Prevalence rates of vitamin D sufficiency (>30 ng/mL), insufficiency (20-30 ng/mL), and the deficiency (

“Health is not just about taking medicines; it's about embracing a lifestyle that promotes well-being and vitality." In the realm of osteoporosis management, bisphosphonates have long stood as stalwart defenders against bone loss. These drugs, known for their efficacy in increasing bone density and reducing fracture risk, have been a cornerstone of osteoporosis treatment for decades. However, recent years have seen the emergence of a new concept: the bisphosphonate drug holiday. This strategic interruption in medication administration has sparked debates and discussions among healthcare professionals and patients. A drug holiday, as it pertains to bisphosphonates and osteoporosis, involves a deliberate pause in the continuous use of these medications. This approach aims to mitigate certain risks associated with long-term bisphosphonate therapy, such as atypical fractures and osteonecrosis of the jaw. By exploring the rationale behind drug holidays, we can better understand their potential benefits, drawbacks, and the evolving landscape of osteoporosis management.

Abstract Due to the ongoing challenges posed by climate change and environmental degradation, developing nations are pursuing initiatives to mitigate carbon emissions at net zero and achieve sustainability objectives. To attain these objectives, it is necessary to shift from conventional energy sources to green energy sources. This research paper examines the dynamic role of the green energy market and green energy pricing in sustainable pathways for attaining net-zero emissions in South Asian countries including India, Malaysia, Pakistan, and Bangladesh. The study utilizes the dynamic Autoregressive Distributed Lag simulations (DARDLS) technique and panel data spanning from 1990 to 2018. The findings reveal a positive correlation between the green energy market and sustainable development in the short run, with reverse effects in the long run. Furthermore, there is an inverse relationship between green energy prices, net-zero emissions, and sustainable development emissions in the short run, which strengthens over time. Based on the results, the study suggests that South Asia is a region that is especially susceptible to the impacts of climate change. Therefore, the governments of these countries should consider implementing favourable policies to support sustainable development, including providing financial assistance, offering subsidies for green energy technology, reducing tariffs, and establishing strong sustainability frameworks and government regulations.

Background: compromised hamstring flexibility is a risk factor to sports-related injuries, as muscular tightness is believed to reduce athletic performance. Different muscle energy techniques and friction massage are commonly practiced by manual therapists to improve hamstring flexibility. Objectives: To compare the effectiveness of muscle energy technique and friction massage in hamstring tightness among young athletes in Pakistan Methodology: A randomized controlled trial was conducted at Helping Hand Institute of Rehabilitation Sciences (HHIRS), Mansehra, and Neurological Orthopaedic and Sports Injury Services Mansehra (NOSIS). A total of n=60 young athletes between 18-25 years with hamstring tightness and limited straight leg raise range of motion (

Introduction: Cutaneous adverse drug reactions (CADRs) are the most common type of drug sensitivity reactions, with a varied and diverse range of morphologies. Therefore, it is essential to be aware of them for diagnosis and prevention. Aim: To assess the cutaneous adverse drug reaction (CADR) profile of patients from the tertiary care teaching hospital in North India. Methods: A prospective, observational study was conducted over 6 months in the Department of Pharmacology & Therapeutics, Jammu in collaboration with the Dermatology department, SMGS Hospital, Jammu after obtaining permission from the institutional ethical committee. Patients with drug rash, of either sex and all age groups were included in the study. The WHO-UMC scale and Naranjo algorithm scale were used to determine the causality assessment. Details regarding drug intake, morphology of eruption, offending drugs, drug rechallenge/ dechallenge history, and treatment given to the patients were assessed. Results: Out of 100 patients enrolled, 42% had an exanthematous drug eruption, while 21% had fixed drug eruptions. Most reactions were caused by antimicrobials 64% followed by non-steroidal anti-inflammatory drugs (NSAIDs) in 15% of patients, with 9% experiencing severe cutaneous adverse drug reactions (SCADRs), like Stevens- Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), caused by antituberculous drugs. Conclusion: The study findings show that reporting adverse drug reactions (ADR) can help identify the drugs most commonly associated with dermatological reactions. This leads to better patient treatment through early identification and management of these reactions.

Cardiac patients need cardiac rehabilitation (CR) as part of their post-hospital care, but there are significant global variations as CR is administered and designed. For improved patient outcomes following myocardial infarction (MI) or coronary artery bypass grafting (CABG), comprehensive cardiovascular rehabilitation (CR) programs are essential in developed nations. These programs include structured exercise plans, instruction on modifiable cardiovascular risks, and psychological therapy. Even though CR lowers rates of morbidity and death, there is not sufficient standardization or application of CR worldwide. German CR programs, for instance, prioritize offering comprehensive residential care for a shorter three-week duration than programs in other Western countries[1]. This illustrates how different CR strategies can exist even in nations with comparable healthcare systems. Exercise tolerance, quality of life, and clinical outcomes are all improved by CR, according to research, especially in patients with heart failure and low ejection fraction (HFrEF)[2]. Even in low- and middle-income countries (LMICs), where there are limited healthcare resources and poor utilization rates, there are still disparities in access to CR. Understanding outcomes, quality, and service delivery requires national registries; yet little is known about the number, kinds, and elements of these registries in relation to cardiac rehabilitation. The use of national and international registries to define cardiac rehabilitation and establish quality enhancement standards is still in its early stages, but it has the potential to make cross-country comparisons easier[3]. Cardiac rehabilitation (CR) programs are not widely available in Low-Middle Income Countries (LMICs), and overall, these treatments are not sufficiently offered to meet the growing burden of cardiovascular disease (CVD) in these regions. It is also shown that the CR service utilization rates in LMICs are not up to optimal levels. Numerous CR challenges plague both high-income and low-income nations, but LMICs are more disadvantaged because of their lack of resources, inadequate health systems, and affordability issues[4]. Similarly, despite evidence connecting cardiac rehabilitation to lower mortality among PCI patients in the US, an international analysis focused on the consistently low rates of referral to cardiac rehabilitation after PCI. After PCI, only about 60% of patients receive a referral for cardiac rehabilitation, which is still below ideal levels[5]. It is not possible to attribute the significant disparity in referral rates amongst medical facilities to variations in insurance coverage. These results highlight the possible need for hospital-level measures targeted at improving the rates of cardiac rehabilitation referrals after percutaneous coronary intervention. Globally, only a few nations have CR programs, and LMICs face more challenges when it comes to providing services. This demonstrates the urgent need for coordinated initiatives to boost CR competence and availability through innovative delivery strategies, efficient referral networks, and favorable health policies[6, 7]. Likewise, cardiovascular disease (CVD) is avoidable and pushes for middle-income nations to adopt cardiac rehabilitation (CR) more widely. To reduce additional death and morbidity after CVD events, these components include initial assessment, management of lifestyle risk factors (such as diet, tobacco use, and mental health), medical risk factors (such as blood pressure, lipids, and blood pressure), self-management education, and assistance with returning to work. To cut expenses, the evaluation recommends alternate delivery sites such primary care, community, and home. Furthermore, suggestions are offered for situations in which a non-physician, such as an allied health professional or community health worker, serves as the primary provider of critical care[8]. Consequently, considering the benefits of cardiac rehabilitation, the purpose of this review was to emphasize how important it is to put cardiac rehabilitation into practice after procedures like PCI, CABG, and other heart surgeries. This calls for the creation of possibilities for cardiac rehabilitation specialists to maximize their contributions to the well-being of patients undergoing such surgeries in the community, as well as the facilitation of more efficient referral processes. Ensuring high-quality rehabilitation services is essential. Finally, research on Pakistan indicates that while following some elements of standard cardiac rehabilitation after myocardial infarction may improve health-related quality of life, there are still issues with providing thorough and consistent cardiac rehabilitation throughout Phases II, III, and IV as well as sufficient psychosocial support. These issues stem from a lack of funding as well as barriers to receiving cardiac rehabilitation referrals and services.

Abaloparatide is a synthetic peptide analog of human parathyroid hormone-related protein (PTHrP). In 2017, the FDA approved its use in postmenopausal women with osteoporosis at high risk for fracture. Abaloparatide demonstrated a beneficial effect on BMD compared to teriparatide for postmenopausal women with osteoporosis and the prevalence of hypercalcemia in the abaloparatide is less than that of teriparatide. Abaloparatide significantly increased BMD at non-vertebral sites and significantly decreased the risk of major osteoporotic fractures compared with teriparatide. Patients who are intolerant or have failed to respond to traditional osteoporosis therapy are often prescribed abaloparatide.

Introduction: Temporomandibular Joint (TMJ) dysfunction is second most frequent cause of orofacial pain after dental pain. TMJ dysfunction and disorders of cervical region greatly affect the routine activities and lifestyle and lower the person’s ability to interact socially and work independently. The objective of current study was to determine the prevalence of TMJ dysfunction and its association with neck pain among university students. Material & Methods: Participants from different universities in Faisalabad were selected using convenient sampling. Out of 1513 students, 1338 who met inclusion criteria were included in this study. The participants were asked to respond to a self-structured questionnaire that contained the Fonseca's Anamnestic Index (FAI) and Neck Disability Index (NDI). SPSS version 21 was used for data analysis. Results: A total of 58% of the subjects were having mild to moderate level of temporomandibular dysfunction while 41% of the student’s reported absence of neck pain. Study revealed that the headache was most common problem (61.5%) among university students and least common problem (16.5%) was moving jaw to the sides. Moderate and severe TMJ dysfunction were associated with severe and complete levels of NDI with p

Aging is a natural process and not a disease that all living organisms go through, as they grow older and accumulate cellular damage over time. The desire to maintain a beautiful, youthful appearance crosses all racial, cultural, and economic boundaries. A component of beauty may include a retained youthfulness despite advancing age, by the appearance of smooth, even skin complexion and the absence of wrinkles, and skin laxity.

We hereby report a first case of substance abuse, where regular insulin by intravenous route has been misused to augment the cocaine abuse to derive sedation, euphoria, and a state of semi-consciousness leading to medication error in the form of extensive thrombophlebitis/cellulitis necrotising fasciitis. The said case report is important to create awareness among the drug regulatory authorities regarding this new face of substance abuse, which can prove potentially fatal among abusers warranting necessary regulatory action.

Background: Social media is frolicking as an utmost priority in today's livelihood, and it is such a milieu today to see people browsing and surfing social networking sites, reading blogs, or chatting by using laptops, mobile phones, or other sophisticated devices anywhere and at any time and enjoying with their favorite social apps – Facebook, WhatsApp, YouTube, etc., Aim: The aim of the study is to assess the knowledge, attitude, and practices of social media usage and addiction among dental students. Materials and Methods: A cross-sectional study was done among 360 students of a dental teaching institute in Uttar Pradesh, India. A questionnaire was prepared which had three sections - related to demographic details and usage and frequency of social media apps based on “Social Media Addiction Scale,” developed by Arslan A and Kırık. These were used as the data collection tool to measure social media addiction among dental students. Responses were recorded in 5-point Likert scale – strongly agree, agree, neutral, disagree, and strongly disagree. Data were analyzed by SPSS version 23. Results: Out of total 360 participants, 276 (76.70%) were female while 84 (23.30%) were male. 238 (66.11%) were undergraduates (UGs) followed by 122 (33.89%) postgraduates (PGs). A significantly higher number of UGs were engaged with their patients in personal conversation on social media platform, while a significantly higher number of PGs believed that social media had a positive effect on dentistry. Questions on social media addiction scale by Arslan A and Kırık revealed that out of total study participants, 48.7% of UGs agree on the belief that new media technologies change human life, whereas 39.4% of PGs agree on the same and the result was statistically significant (P ≤ 0.05). Conclusion: Social media networking sites and apps have attracted students in its digital web and hold strong position with new horizons whether in comprehensive or educational, interacting, entertainment, or spending leisure time.

Recent technological advancements demand IEPM for sustainable energy development through the induction of advanced computational techniques. However, the applicability and outcomes of such modeling tools vary due to underlying limitations in addition to gaps within the energy sector. This study uses a three-pronged approach to determine the potential of IEPM in shaping sustainable energy systems, particularly for Pakistan. Findings suggest that the main hindrances in sustainable electricity generation in Pakistan are over dependence upon thermal fuel mix and partial achievement of national energy policy targets. A review of the public sector plans, researches, and historical energy mix of Pakistan affirms that all efforts are targeted towards least cost electricity production without considering social and environmental impacts. All past studies projected energy supply and demand to ascertain future implications, but no one suggested sustainable alternatives for meeting national energy targets. Findings of this study necessitate upon development of a fair, consistent, long-term and sustainable IEP with clear policies to overcome sectoral bottlenecks and attain a high growth trajectory. A review of modeling tools, their applications and limitations, carried out in this study, suggests the adoption of the LEAP model for realistic IEP for Pakistan. This considered LEAP’s strengths in terms of energy-environment nexus, strong-accounting and scenario-building, bottom-up/top-down approach, user-friendliness, and spatial-temporal flexibility.

Introduction: Biopsy is the gold standard for Oral Potentially Malignant Disorders (OPMD) diagnosis. Chemiluminescence provides promising complementary alternative diagnostic adjunct for its simple non invasive collection and technique and to screen large populations. Aim: To summarise and compare the existing evidence on diagnostic accuracy of chemiluminescence in detecting OPMD. Materials and Methods: The systematic review and meta-analysis protocol was registered at the international prospective register of systematic reviews (PROSPERO- CRD42022306061) and performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Diagnostic Test Accuracy (PRISMA-DTA) checklist. PubMed, Google Scholar, EBSCOhost were searched from 2000 to 2021 to identify the screening potential of chemiluminescence for OPMD. True positive, false positive, true negative, false negative, sensitivity, and specificity values were extracted or calculated if not present for each study. Quality of selected studies was evaluated based on Quality Assessment for Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Meta-analysis was performed in Meta-Disc 1.4 software and Review Manager 5.3 using a bivariate model parameter for the sensitivity and specificity and summary points. Summary Receiver Operating Curve (SROC), confidence region, and prediction region were calculated. Results: Twenty-four studies were included for qualitative synthesis and out of that, 14 were included for meta-analysis. Sufficient data for meta-analysis was available only for leukoplakia, oral lichen planus (OLP) and oral submucous fibrosis (OSMF). Sensitivity and specificity were calculated with Area Under Curve (AUC). For leukoplakia, chemiluminescence had sensitivity and specificity of 75% and 98% with 0.74 AUC. For OLP, it was 78% and 60% with 0.70 AUC. For oral submucous fibrosis it was 89% and 76% with 0.69 AUC. Conclusion: Chemiluminescence overall had good sensitivity and specificity values along with good AUC. This strongly supports the fact that it can be used as an alternative diagnostic adjunct to biopsy for various OPMD.

The study aimed to determine the relationship between physical activity and eating behaviours among the physical therapy students of various physical therapy institutes of Rawalpindi/Islamabad during the Covid-19 pandemic. The study was conducted from September 2020 to February 2021. It was a cross sectional co-relational survey of a total of 209 physical therapy students, and the sampling technique was purposive sampling. Eating Attitude Test (EAT-26) Questionnaire and International Physical Activity Questionnaire (IPAQ) were used as the data collection tools. Healthy young students of 18-26 years of age, of both genders, were included and students with major functional limitations were excluded from the study. The results showed that 87 (41.6%) participants had normal EAT-26 scores whereas 122 (58.4%) had abnormal EAT-26 scores. ---Continue

Madam, Stroke is a leading cause of death and disability around the globe and particularly in low- and middle-income countries, and this burden is increasing. (1) Its incidence in Pakistan, is also increasing daily and shares a significant burden by contributing to an exponential expenditure of resources, finances, community manpower, health services and overall economy. (2) Overall disability burden can be reduced remarkably, if early recovery prediction can be formulated for stroke parameters such as upper limb impairment, swallowing, Shoulder Abduction and Finger Extension (SAFE) score, Motor Evoked Potential (MEP) status, National Institute of Health Stroke Scale (NIHSS) scoring. Existing relevant evidences for the early prediction of stroke recovery, reported the use of blood biomarker as an objective indicator. And among them, some serve as a guide in decision-making for clinical practice, such as: Brain natriuretic peptide (BNP), D-Dimer, and have potential in improving the diagnosis and the management of patients with stroke. MRI findings have also made an accurate prognosis about behavioral outcomes after stroke based on the severity of cognitive impairments. (3) For predicting recovery after stroke, various algorithms approaches have also been done since last 10 years and among Predict Recovery Potential (PREP2), (GRAVo) and (PRESS) models of prediction, studies have supported that the PREP2 algorithm was regarded as potentially valid. To date, only one approach has combined biomarkers within the first few days after stroke to make predictions for individual patients. The Predict Recovery Potential (PREP) algorithm predicts upper-limb functional outcomes by combining biomarkers, neurophysiological and neuroimaging measures to make a prognosis. PREP2 algorithm is probably the easiest approach to operationalize among predictive models and serves as a benchmark for predicting motor recovery after stroke. (4) So, till now, there is no consensus among both clinicians and scientists on how to apply a specific predictive model in clinical routine or research protocols, in which biological and psycho-social factors can be collectively incorporated with Artificial intelligence. Hence these steps are mandatory to be implemented in predictive models considering all the factors mentioned above- and including other factors like cost, knowledge, interface development, resources, time and expertise of both scientists and clinicians. ---Continue

Banana Bunchy top virus (BBTV) is a multipartite circular single strand DNA virus that belongs to genus Babuvirus and family Nanoviridae. It causes significant crop losses worldwide and also in Pakistan. BBTV is present in Pakistan since 1988 however, till now only few (about twenty only) sequence of genomic components have been reported from the country. To have insights into current genetic diversity in Pakistan fifty-seven genomic components including five complete genomes (comprises of DNA-R, -U3, -S, -M, -C and -N components) were sequenced in this study. The genetic diversity analysis of populations from Pakistan showed that DNA-R is highly conserved followed by DNA-N, whereas DNA-U3 is highly diverse with the most diverse Common Region Stem-loop (CR-SL) in BBTV genome, a functional region, which previously been reported to have undergone recombination in Pakistani population. A Maximum Likelihood (ML) phylogenetic analysis of entire genomes of isolates by using sequence of all the components concatenated together with the reported genomes around the world revealed deeper insights about the origin of the disease in Pakistan. A comparison of the genetic diversity of Pakistani and entire BBTV populations around the world indicates that there exists a correlation between genetic diversity and recombination. Population genetics analysis indicated that the degree of selection pressure differs depending on the area and genomic component. A detailed analysis of recombination across various components and functional regions suggested that recombination is closely associated with the functional parts of BBTV genome showing high genetic diversity. Both genetic diversity and recombination analyses suggest that the CR-SL is a recombination hotspot in all BBTV genomes and among the six components DNA-U3 is the only recombined component that has extensively undergone inter and intragenomic recombination. Diversity analysis of recombinant regions results on average one and half fold increase and, in some cases up to four-fold increase due to recombination. These results suggest that recombination is significantly contributing to the genetic diversity of BBTV populations around the world.

Banana bunchy top disease (BBTD), caused by a Banana Bunchy Top Virus (BBTV), is the most devastating viral disease of bananas. The genome of multipartite BBTV is about 1 Kb in size and comprises six circular single-stranded (ss) DNA components, namely DNA-R, C, S, M, U3, and N. Gene expression in multipartite DNA viruses is highly flexible due to variations in the copy number and transcript levels of individual genomic components. This enables them to adapt to changing conditions and maintain optimal fitness. In the current study, the copy number of each genetic component of BBTV and its transcript level were determined in the leaf, midrib, and root tissue of the infected banana plant. The results of the study showed that DNA copies (copies/ng) were higher in midrib (11,105 ± 10,704.42), followed by leaf (6902.91 ± 1651.14), and were lowest in root (23.49 ± 9.21) tissues. In contrast, the transcript level was highest in the root (312.45 ± 106.69) and lowest in the midrib (0.72 ± 0.16). This suggests that BBTV independently regulates the transcriptional level of each DNA component. The distribution of BBTV in different tissues assists the identification of significantly higher viral load tissues for early and sensitive disease diagnosis, which will be beneficial for better disease management.