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Synchronization of chaotic systems by means of the combination of drive‐response/master–slave systems have been widely utilized. In the current study, the author introduces the concept of internal synchronization (IS) that is based on the synchronization within the system among the subsystems. Furthermore, the two types of Internal Multi‐Switching Synchronization (IMSS): the first one based on single error while the other one is based on two errors, have been discussed. In order to demonstrate, the author chooses the Lorenz Chaotic System (LCS) and Lorenz Hyper Chaotic System (LHCS) together with the adaptive sliding mode control (SMC) technique in multi‐switching manner. In addition, the efficiency of the IMSS is illustrated using Mathematica. The computational part is the witness of the achievement of stability of the IS. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical effectiveness of Paracetamol with Ibuprofen as an antipyretic, fever relief and linked discomfort in children. Study Design: Comparative cross-sectional study. Place and Duration of Study: Combined Military Hospital, Abbottabad Pakistan from Apr to Nov 2019. Methodology: Children aged six months to five years, who reported fever between 38-41°C were included. Two temperature groups were developed, i.e., 37.8--38.9ºC and 39-41ºC with baseline temperatures of 38.60±0.56 for Paracetamol-Group and 38.58± 0.56ºC for Ibuprofen-Group. The prescriptions were given over to the parents with clarification about the dose of the medication. The medication had active and placebo forms. Information was gathered until saturation was done. Results: A total of 104 children were taken in the study. Of these, 77(74.08%) were females, and 27(24.96) were males. Comparing Ibuprofen-treated children with Paracetamol-Group, the final result showed that the extent of children's temperature management was greater in the Ibuprofen-Group 37(71%) than in the Paracetamol-Group 34(65%). Conclusion: Doctors, attendants and guardians wishing to use medications to treat children suffering from fever should be encouraged to use Ibuprofen first and to consider the relative risks and advantages of using Ibuprofen in addition to Paracetamol for fever. Comparatively, Ibuprofen is more effective than Paracetamol. [ABSTRACT FROM AUTHOR]

This study empirically examines the spillovers from global uncertainties to the sectoral indices of the Pakistan stock market (PSX). Furthermore, we select three major sectoral indices, i.e., the energy, financial, and material composite indices. These indices represent a massive capital volume of PSX. We utilize the data from 10 May 2002 to 27 June 2022 to examine the outbreak due to the global financial crisis (GFC) of 2007–2008 and the impact of the world's great pandemic, of COVID-19. Additionally, we applied a novel econometric estimation approach: quantile connectedness. We found that connectedness is strong in the case of highly positive changes (above the 20% quantile) and highly negative changes (below the 80% quantile). Additionally, the study also found that materials sector is the least connected at level of 1.58%. In contrast, the financial sector was a strong transmitter of spillovers during the entire study period at connectedness of 54.59%. Regarding graphical results, we found that economic policy uncertainty (EPU) and crude oil index (WTI) are net transmitters, especially during the financial crisis and COVID-19, whereas WTI transmitting impact was significantly dominant during GFC 2007–2008. Conversely, the index MSCI remains the recipient of the spillover during the entire study period, where the remitting effect was observed as dominant during the GFC, and COVID-19 outbreak. The energy sector was found to be more recipient during the GFC, with additional turn transmitters of the shocks after the COVID-19 pandemic. The study recommends that portfolio managers and individual investors consider the materials sector for their investment due to the least connectivity. Similarly, investors need to invest carefully in the financial sector because it is a net transmitter of spillovers to other sectors. [ABSTRACT FROM AUTHOR]

This paper mainly deals on the issue of a chaotic synchronization of a master and slave systems. It is generally the requirement of the synchronization that someone needs at least one to one master and slave systems. In the current study, the authors introduce the concept of a synchronization in which there is no need of slave/response system externally. Furthermore, the synchronization has been demonstrated here within a system among the subsystems of different orders. In addition, adaptive control is chosen for the synchronization among various combinations in multiswitching manner. For demonstration purpose, Lorenz Six Dimensional Hyper Chaotic System (L6DHCS) is chosen. There are three different kinds of possible switches presented by the authors formed within the considered system. The numerical simulations are carried out to validate the effectiveness of the analytical technique using Mathematica. [ABSTRACT FROM AUTHOR]

Abstract Background The internet is increasingly being used worldwide in imparting medical education and improving its delivery. It has become an important tool for healthcare professionals training but the data on its use by medical students in developing countries is lacking with no study on the subject from Pakistan. This study was, therefore, carried out with an aim to evaluate the pattern of internet access and utilization by medical students in Pakistan. Methods A structured pre-tested questionnaire was administered to a group of 750 medical students in clinical years studying at various public and private medical colleges in Lahore. The questions were related to patterns of internet access, purpose of use and self reported confidence in performing various internet related tasks, use of health related websites to supplement learning and the problems faced by students in using internet at the institution. Results A total of 532 medical students (70.9%) returned the questionnaire. The mean age of study participants was 21.04 years (SD 1.96 years). Majority of the respondents (84.0%) reported experience with internet use. About half of the students (42.1%) were using internet occasionally with 23.1%, 20.9% and 13.9% doing so frequently, regularly and rarely respectively. About two third of the students (61.0%) stated that they use internet for both academic and professional activities. Most of the participants preferred to use internet at home (70.5%). Self reported ability to search for required article from PubMed and PakMedinet was reported by only 34.0% of the entire sample. Students were moderately confident in performing various internet related tasks including downloading medical books from internet, searching internet for classification of diseases and downloading full text article. Health related websites were being accessed by 55.1% students to supplement their learning process. Lack of time, inadequate number of available computers and lack of support from staff were cited as the most common problems faced by students while accessing internet in the institution premises. There were significant differences among male and female students with respect to the place of internet use (p = 0.001) and the ability to search online databases for required articles (p = 0.014). Conclusions Majority of the medical students in this study had access to internet and were using it for both academic and personal reasons. Nevertheless, it was seen that there is under utilization of the potential of internet resources to augment learning. Increase in awareness, availability of requisite facilities and training in computing skills are required to enable better utilization of digital resources of digital resources by medical students.

Abstract Background There is a growing body of literature on the relationship of Hepatitis C virus infection (HCV) and type 2 diabetes mellitus (T2DM). However, there are certain gaps in literature and the data is inconclusive. This study was, therefore, carried out to determine the prevalence of HCV infection in diabetic patients and to elucidate the presence of any possible relationship between HCV and T2DM in this region. Methods Serologic testing for anti-HCV antibody was done on a sample of 3000 individuals with T2DM visiting Diabetes Clinic of Nishtar Medical College Hospital, Multan and 10,000 volunteer blood donors visiting blood bank of the same hospital during the study period using Accurate rapid immunochromatographic kits which was later confirmed by using Chemelex S.A third generation ELISA kit for positive cases. Data about various variables was collected from diabetic patients using a structured questionnaire after taking informed consent. Results Prevalence rate of 13.7% for HCV infection was recorded among subjects having T2DM with seropositivity rate of 4.9% among the control group of volunteer blood donors without diabetes. The patients with T2DM were more likely to have HCV infection as compared to the control group (OR = 3.03, 95%CI = 2.64-3.48, p = 0.001). Diabetic patients with age above 55 years had higher prevalence rate as compared to younger individuals. Male patients had significantly high seropositivity as compared to female patients (15.3% vs. 12.4%, p = 0.02). Those with duration of diabetes 11 years and above and the ones with good glycemic control had higher seroprevalence rates of 18.2% and 18.7% respectively. There was no statistically significant difference among subjects when the distribution of HCV was studied on the basis of marital status, locality, or family history of diabetes. Conclusions The results show that there is a strong association between HCV and T2DM in the region as evident from significantly higher prevalence of HCV infection in diabetics as compared to the control group in the present study.

Abstract Background The prevalence of anxiety and depressive disorders in cancer patients and its associated factors in Pakistan is not known. There is a need to develop an evidence base to help introduce interventions as untreated depression and anxiety can lead to significant morbidity. We assessed the prevalence of depression and anxiety among adult outpatients with and without cancer as well as the effect of various demographic, clinical and behavioral factors on levels of depression and anxiety in cancer patients. Methods This cross-sectional study was carried out in outpatient departments of Multan Institute of Nuclear Medicine and Radiotherapy and Nishtar Medical College Hospital, Multan. Aga Khan University Anxiety and Depression Scale (AKUADS) was used to define the presence of depression and anxiety in study participants. The sample consisted of 150 diagnosed cancer patients and 268 participants without cancer (control group). Results The mean age of cancer patients was 40.85 years (SD = 16.46) and median illness duration was 5.5 months, while the mean age of the control group was 39.58 years (SD = 11.74). Overall, 66.0% of the cancer patients were found to have depression and anxiety using a cutoff score of 20 on AKUADS. Among the control group, 109 subjects (40.7%) had depression and anxiety. Cancer patients were significantly more likely to suffer from distress compared to the control group (OR = 2.83, 95% CI = 1.89-4.25, P = 0.0001). Performing logistic regression analysis showed that age up to 40 years significantly influenced the prevalence of depression and anxiety in cancer patients. There was no statistically significant difference between gender, marital status, locality, education, income, occupation, physical activity, smoking, cancer site, illness duration and mode of treatment, surgery related to cancer and presence of depression and anxiety. Cancers highly associated with depression and anxiety were gastrointestinal malignancies, chest tumors and breast cancer. Conclusions This study highlights high prevalence rates of depression and anxiety in cancer patients. Younger age was associated with a higher likelihood of meeting criteria for psychological morbidity. The findings support screening patients for symptoms of depression and anxiety as part of standard cancer care and referring those at a higher risk of developing psychological morbidity for appropriate care.

The present study is based on the anti-synchronization of chaotic systems of different orders. The author studied the reduced-order anti-synchronization (ROAS) in order to observe the variations between the computational studies on Mathematica and Matlab. For demo purpose, circular restricted three body problem (CRTBP) and Lorenz chaotic systems of different orders are chosen. The study of ROAS has been carried out via a robust generalized active control technique under the effect of both unknown model uncertainties and external disturbances. In order to see the variations between the computational studies, a parallel simulation is carried out on Mathematica and Matlab at the same values of the parameters and initial conditions. [ABSTRACT FROM AUTHOR]

Background: To determine the rate of conversion of abstracts presented at conferences into full-text articles published in peer-reviewed journals in the field of pediatric critical care medicine (PCCM) in a developing country. Methods: We retrospectively reviewed PCCM abstracts from Pakistan presented at national and international pediatric and critical care conferences over 10 years (January 2010 to March 2020). Data included abstract characteristics, such as presentation (poster/oral), presenter (fellow/resident), time of meeting (month and year), type of meeting, study design and topic; and publication characteristics, such as journal name, time (month and year) and first author. The primary outcome was publication rate of PCCM abstracts presented in meetings and time (months) from presentation to publication. Results: A total of 79 PCCM abstracts were presented in 20 meetings during the study period. There were 65 poster presentations (82.28%), of which 63 (79.74%) were presented at international critical care conferences and all presenters were PCCM fellows. In total, 64 (81%) abstracts were descriptive observational studies (retrospective: 50, 63.29%) and prospective (14, 17.72%). Only one was an interventional randomized controlled trial. The publication rate of PCCM abstracts was 63.3% (50/79) and the mean time to publication was 12.39±13.61 months. The publication rate was significantly correlated to the year of publication (P<0.001). Conclusions: The PCCM abstract publication rate and mean time from presentation to publication was 63.3% and 12.39±13.61 months, respectively, in a developing country. [ABSTRACT FROM AUTHOR]

The present study deals with the synchronization of chaotic systems of different orders. The author investigates the reduced-order synchronization (ROS) problem for a circular restricted three body problem (CRTBP)-Lorenz chaotic systems that are of different orders. The study of ROS has been carried out via a robust generalized active control technique together with the effect of both unknown model uncertainties and external disturbances. Also for the chosen master-slave combination, a comparison of computational study between Mathematica and Matlab has been presented in order to observe the variations. Furthermore, it is discussed that ROS is a special case for multi-switching synchronization of different orders of chaotic systems. [ABSTRACT FROM AUTHOR]

Chaos synchronization is a procedure where one chaotic oscillator is forced to adjust the properties of another chaotic oscillator for all future states. This research paper studies and investigates the global chaos synchronization problem of two identical chaotic systems and two non-identical chaotic systems using the linear active control technique. Based on the Lyapunov stability theory and using the linear active control technique, the stabilizing controllers are designed for asymptotically global stability of the closed-loop system for both identical and non-identical synchronization. Numerical simulations and graphs are imparted to justify the efficiency and effectiveness of the proposed scheme. All simulations have been done by using mathematica 9. © 2014 Wiley Periodicals, Inc. Complexity 21: 379-386, 2015 [ABSTRACT FROM AUTHOR]

This paper addresses the chaos control and synchronization problems of a hyperchaotic system. It is assumed that the parameters of the hyperchaotic system are unknown and the system is perturbed by the external disturbance. Based on the Lyapunov stability theory and the adaptive control theory, suitable nonlinear controllers are designed for the asymptotic stability of the closed-loop system both for stabilization of hyperchaos at the origin and complete synchronization of two identical hyperchaotic systems. Accordingly, suitable update laws are proposed to estimate the fully uncertain parameters. All simulation results are carried out to validate the effectiveness of the theoretical findings. The effect of external disturbance is under our discussion. [ABSTRACT FROM AUTHOR]

The problem of chaos synchronization is to design a coupling between two chaotic systems (master-slave/drive-response systems configuration) such that the chaotic time evaluation becomes ideal and the output of the slave (response) system asymptotically follows the output of the master (drive) system. This paper has addressed the chaos synchronization problem of two chaotic systems using the Nonlinear Control Techniques, based on Lyapunov stability theory. It has been shown that the proposed schemes have outstanding transient performances and that analytically as well as graphically, synchronization is asymptotically globally stable. Suitable feedback controllers are designed to stabilize the closed-loop system at the origin. All simulation results are carried out to corroborate the effectiveness of the proposed methodologies by using Mathematica 9. [ABSTRACT FROM AUTHOR]

In this computational study, we synchronize the Circular Restricted Three Body Problem (CRTBP) with Lorenz Hyper Chaotic System (LHCS) using a Robust Adaptive Sliding Mode Controller (RASMC) together with uncertainties, external disturbances and fully unknown parameters. A simple suitable sliding surface, which includes synchronization errors, is constructed and appropriate update laws are used to tackle the uncertainties, external disturbances and unknown parameters. All simulations to achieve the synchronization for the implemented technique for the two non-identical systems under consideration are being done using Mathematica. © 2013 Wiley Periodicals, Inc. Complexity 18: 58-64, 2013 [ABSTRACT FROM AUTHOR]

Background: The internet is increasingly being used worldwide in imparting medical education and improving its delivery. It has become an important tool for healthcare professionals training but the data on its use by medical students in developing countries is lacking with no study on the subject from Pakistan. This study was, therefore, carried out with an aim to evaluate the pattern of internet access and utilization by medical students in Pakistan. Methods: A structured pre-tested questionnaire was administered to a group of 750 medical students in clinical years studying at various public and private medical colleges in Lahore. The questions were related to patterns of internet access, purpose of use and self reported confidence in performing various internet related tasks, use of health related websites to supplement learning and the problems faced by students in using internet at the institution. Results: A total of 532 medical students (70.9%) returned the questionnaire. The mean age of study participants was 21.04 years (SD 1.96 years). Majority of the respondents (84.0%) reported experience with internet use. About half of the students (42.1%) were using internet occasionally with 23.1%, 20.9% and 13.9% doing so frequently, regularly and rarely respectively. About two third of the students (61.0%) stated that they use internet for both academic and professional activities. Most of the participants preferred to use internet at home (70.5%). Self reported ability to search for required article from PubMed and PakMedinet was reported by only 34.0% of the entire sample. Students were moderately confident in performing various internet related tasks including downloading medical books from internet, searching internet for classification of diseases and downloading full text article. Health related websites were being accessed by 55.1% students to supplement their learning process. Lack of time, inadequate number of available computers and lack of support from staff were cited as the most common problems faced by students while accessing internet in the institution premises. There were significant differences among male and female students with respect to the place of internet use (p = 0.001) and the ability to search online databases for required articles (p = 0.014). Conclusions: Majority of the medical students in this study had access to internet and were using it for both academic and personal reasons. Nevertheless, it was seen that there is under utilization of the potential of internet resources to augment learning. Increase in awareness, availability of requisite facilities and training in computing skills are required to enable better utilization of digital resources of digital resources by medical students. [ABSTRACT FROM AUTHOR]

Background: There is a growing body of literature on the relationship of Hepatitis C virus infection (HCV) and type 2 diabetes mellitus (T2DM). However, there are certain gaps in literature and the data is inconclusive. This study was, therefore, carried out to determine the prevalence of HCV infection in diabetic patients and to elucidate the presence of any possible relationship between HCV and T2DM in this region. Methods: Serologic testing for anti-HCV antibody was done on a sample of 3000 individuals with T2DM visiting Diabetes Clinic of Nishtar Medical College Hospital, Multan and 10,000 volunteer blood donors visiting blood bank of the same hospital during the study period using Accurate rapid immunochromatographic kits which was later confirmed by using Chemelex S.A third generation ELISA kit for positive cases. Data about various variables was collected from diabetic patients using a structured questionnaire after taking informed consent. Results: Prevalence rate of 13.7% for HCV infection was recorded among subjects having T2DM with seropositivity rate of 4.9% among the control group of volunteer blood donors without diabetes. The patients with T2DM were more likely to have HCV infection as compared to the control group (OR = 3.03, 95%CI = 2.64-3.48, p = 0.001). Diabetic patients with age above 55 years had higher prevalence rate as compared to younger individuals. Male patients had significantly high seropositivity as compared to female patients (15.3% vs. 12.4%, p = 0.02). Those with duration of diabetes 11 years and above and the ones with good glycemic control had higher seroprevalence rates of 18.2% and 18.7% respectively. There was no statistically significant difference among subjects when the distribution of HCV was studied on the basis of marital status, locality, or family history of diabetes. Conclusions: The results show that there is a strong association between HCV and T2DM in the region as evident from significantly higher prevalence of HCV infection in diabetics as compared to the control group in the present study. [ABSTRACT FROM AUTHOR]

Background: The prevalence of anxiety and depressive disorders in cancer patients and its associated factors in Pakistan is not known. There is a need to develop an evidence base to help introduce interventions as untreated depression and anxiety can lead to significant morbidity. We assessed the prevalence of depression and anxiety among adult outpatients with and without cancer as well as the effect of various demographic, clinical and behavioral factors on levels of depression and anxiety in cancer patients. Methods: This cross-sectional study was carried out in outpatient departments of Multan Institute of Nuclear Medicine and Radiotherapy and Nishtar Medical College Hospital, Multan. Aga Khan University Anxiety and Depression Scale (AKUADS) was used to define the presence of depression and anxiety in study participants. The sample consisted of 150 diagnosed cancer patients and 268 participants without cancer (control group). Results: The mean age of cancer patients was 40.85 years (SD = 16.46) and median illness duration was 5.5 months, while the mean age of the control group was 39.58 years (SD = 11.74). Overall, 66.0% of the cancer patients were found to have depression and anxiety using a cutoff score of 20 on AKUADS. Among the control group, 109 subjects (40.7%) had depression and anxiety. Cancer patients were significantly more likely to suffer from distress compared to the control group (OR = 2.83, 95% CI = 1.89-4.25, P = 0.0001). Performing logistic regression analysis showed that age up to 40 years significantly influenced the prevalence of depression and anxiety in cancer patients. There was no statistically significant difference between gender, marital status, locality, education, income, occupation, physical activity, smoking, cancer site, illness duration and mode of treatment, surgery related to cancer and presence of depression and anxiety. Cancers highly associated with depression and anxiety were gastrointestinal malignancies, chest tumors and breast cancer. Conclusions: This study highlights high prevalence rates of depression and anxiety in cancer patients. Younger age was associated with a higher likelihood of meeting criteria for psychological morbidity. The findings support screening patients for symptoms of depression and anxiety as part of standard cancer care and referring those at a higher risk of developing psychological morbidity for appropriate care. [ABSTRACT FROM AUTHOR]

This study aimed to explore the influences of overcrowded classroom on the academic achievement of students at secondary school level in Khyber Pakhtunkhwa. Objective of the study was to explore the effect of overcrowded classroom on the academic achievement of students. Mixed method approach was applied for this research study. Sample of the study consisted of 600 10th grade students, 143 secondary school teachers and 30 principals selected through multistage cluster and simple random sampling technique. Quantitative data collected for the last five years result(2013-17) of 10th grade students from the Gazette book and also through self-developed questionnaires. Items of the questionnaire were developed on the basis of the problems of overcrowded classrooms with five point's Likert type rating scale. Qualitative data collected from the principals through interview. The results showed that there was a very weak correlation between the 10th grade students enrolled and their pass percentage in the SSC(A) exams for the years 2013-17. The study showed that there was much agreement between the views of teachers, students and principals on the issue. It was concluded from the current study that an overcrowded classroom can influences the student's academic achievement. The study confirmed that all the sampled secondary schools were lacking enough classrooms, teaching staffs and mostly the classrooms were overcrowded. It was recommended that class size may be of 35 students, shortage of teaching staffs and additional classrooms may be constructed to overcome the problem of overcrowded classroom. [ABSTRACT FROM AUTHOR]