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Cell phone elbow is the pinching of ulnar nerve behind the elbow resulting in tingling or numbness within the hand when using a cell phone, sleeping with your elbows bent, or holding your arms bent and by your head for long period of time. Objective: To find out the prevalence of cellphone elbow among mobile phone users and its associated impairments and functional limitations. Methods: A cross-sectional study was conducted during October 2021 to April 2022. Data were collected from different Punjab colleges and universities: NUR International University, Riphah International University, The University of Lahore, University of Faisalabad, Niazi College of Physical Therapy and Fatima Memorial Hospital and College. Participants were recruited through convenience sampling from 17-50 years of age with positive Tinel sign test. Data collection were done by using the Numeric Pain Rating Scale and Boston Carpal Tunnel Syndrome Questionnaires. Results: Out of 250 subjects 33.2% were having noticeable symptoms associated with prolong phone usage. Among them 39.6% experienced numbness and tingling. Hand pain is reported in 32.8% and 27.6% experienced pain on ulna side of elbow. Conclusions: The prevalence of cell phone elbow was 33.2%, higher than the previous studies. This research advice the cell phone users to minimize their mobile usage, avoid prolonged calls, use hands alternately to avoid strain on one hand, use hands-free and ear pods while taking calls

Morbid obesity is a major health problem worldwide and the Roux-en-Y gastric bypass (RYGB) is a popular surgical treatment. A 40 year old woman, 17 years post RYGB presented with concurrent symptomatic gastric ulcers and acute pancreatitis. The diagnosis was difficult and after failed medical therapy, surgery was required. The gastric remnant is not easily accessible by endoscopy thus; detecting PUD in this excluded segment is difficult. As a result, alternative methods, such as exploratory laparotomy or pediatric endoscopy may be required to effectively diagnose the gastric remnant.

Cardiovascular diseases are among the top leading causes of death worldwide. Most of the time, the patients present with no symptoms, or some symptoms resemble other diseases. This makes most cases challenging for physicians and healthcare workers to diagnose. Besides this, most of the time, not diagnosing the patient on time or delay in the start of intervention is the main cause of death in cardiovascular diseases. Proper history and examination can play a crucial role in this part. History taken in properly can help in reaching the diagnosis. Apart from this, it also helps in the start of empirical therapy. This is where most clinicians are lacking. Waiting for the labs is still time-wasting in other health issues, but it can be killing in cardiac patients. Thus the cardiologist needs to start with a good history and then go on with examinations. Then confirm their findings with the proper labs. This narrows down the diagnosis and saves a lot of time. History-taking is the most important clinical step in the management of patients. But most of the time, it is underrated, and most clinicians rely on labs rather than these basic skills. This article thus reviews the importance of history-taking in diagnosing patients with cardiovascular diseases. Besides this, it also addresses how a good history should be taken to narrow down the diagnosis and reach the proper diagnosis within time to save a patient's life.

Lectin-like oxidized low-density lipoprotein (ox-LDL) receptor 1 (LOX-1) is a vital scavenger receptor involved in ox-LDL binding, internalization, and subsequent proatherogenic signaling leading to cellular dysfunction and atherosclerotic plaque formation. Existing data suggest that modulation of ox-LDL - LOX-1 interaction can prevent or slow down atherosclerosis. Therefore, we utilized computational methods such as multi-solvent simulation and characterized two top-ranked druggable sites. Using systematic molecular docking followed by atomistic molecular dynamics simulation, we have identified and shortlisted small molecules from the NCI library that target two key binding sites. We demonstrate, using surface plasmon resonance (SPR), that four of the shortlisted molecules bind one-on-one to the purified C-terminal domain (CTLD) of LOX-1 receptor with high affinity (K

Neonatal conjunctivitis is an important cause of ocular morbidity with infectious and noninfectious origins. Common practice in the United States is to administer prophylactic antibiotic ointment at birth; however, prophylaxis is ineffective for some causes. Moreover, recognition of the etiologies that threaten systemic complications to the neonate is critical in providing timely and appropriate treatment. This review summarizes the clinical features, etiology, and treatment recommendations of various forms of neonatal conjunctivitis.

Purpose The purpose of this paper is to examine the optimal leverage ratio, speed of adjustment, and which factors contribute to achieving the target of selected telecom companies in a partial adjustment framework from 2008 to 2017. Further is to analyze the likelihood of bankruptcy of sample companies by Altman Z-Score model and to suggest which theory of capitals structure is better in explaining leverage strategies and judicious mix of debt and equity structure of the selected telecom companies. Design/methodology/approach This paper chooses a partial adjustment model and uses the generalized method of moments technique to identify the variables that influence the target leverage ratio and the factors that influence the speed at which the target leverage is adjusted. Second, the Altman Z-score model is used in this paper to research the financial status of telecom companies using financial instruments and techniques. Findings For Indian telecom firms, firm-specific variables such as profitability, NDTS and Z-score lead to greater debt adjustment towards optimal level target leverage. The paper also highlights new paradigms in the Indian telecom sector, stating that top market leaders such as Bharti Airtel, BSNL, Idea, Vodafone and R.com, among others, should focus on debt reduction and interest payments, as well as implement new strategies to solve the crisis and change financial policies. Research limitations/implications It mainly focuses on firm-specific variables because the firm-specific variables affect the leverage framework. The country-specific variables are not taken into the study. These results may be unique to telecom companies due to some peculiarities existing in the telecom sector in India. Although other sectors, both national and international level, can be taken into consideration. Practical implications This paper has ramifications for corporate executives, investors and policymakers in India, for example, in terms of considering different transition costs while changing a telecom company’s financing decisions. Originality/value To the best of the authors’ knowledge, this is the first paper of its kind to look at both financial and econometric tools to assess financial performance using the Altman Z-Score model, as well as decide leverage strategies and the pace with which they can be adjusted to target leverage in the context of Indian telecom companies.

Due to innumerable applications of nanofluid in heat transfer phenomena as well as engineering processes, the research on this innovative fluid over conventional fluid got popularity among researchers. Here, we have considered a non-Darcy porous surface medium for generalized Eyring–Powell fluid model under thermophoretic as well as Brownian movements. No mass flux phenomena along with heat sink-source and activation energy aspects are scrutinized; characteristics of random motion of fluid and thermophoresis diffusion characteristics for generalized Eyring–Powell fluid are examined briefly. The system of nonlinear PDEs is reduced to nonlinear ODEs by using the similarity variable technique; the numerical scheme bvp4c is used along with shooting technique. The physical aspects like flow of fluid, temperature profile, concentration for variation of concerned parameters have been computed and demonstrated pictorially with the help of graphs. It is observed that the velocity of nanofluid declines by increasing values of the power law index ([Formula: see text] and Eyring–Powell liquid parameters. Augmented values of Brownian moment, thermophoresis parameter as well as heat source rise with increase in temperature of nanofluid. The concentration profile of generalized Eyring–Powell nanofluid deteriorates for higher values of Schmidt number. Moreover, the transportation rate of heat declines against Pr, while it rises by increasing values of [Formula: see text].

PurposeThe study investigates the impact of bank market competition and concentration on the bank default-risk using the data for 36 Indian scheduled commercial banks from 1999 to 2017.Design/methodology/approachThe study adopts the dynamic panel generalised method of moments (GMM) and panel quantile models to obtain the results.FindingsBank market competition and concentration foster financial fragility in terms of high default-risk. This implies that concentration does not mean a lack of competition in the Indian banking market. The findings from the quantile model reveal that the stated relationships become weaker under the tails of the conditional distribution of the risk measure.Research limitations/implicationsThe authors recommend that non-structural measures (Lerner index and H-statistic) should be preferred over the concentration measures (HHI and CR3) to characterise bank market competition in India. Based on the evidence of persistence in the bank risk variable, from the methodological perspective, dynamic panel data models are better choices for bank-level analyses compared to the conventional panel data models.Practical implicationsTo improve the health of banks, price competition should be reduced among them. This objective should be achieved by creating new avenues to increase the banks' non-interest income parallelly with the consolidation of the market.riginality/valueFirst, it tries to answer whether concentration implies a lack of competition for a banking system like India. Second, the quantile regression technique enables us to understand the varying nature of the impact of market competition on bank risk at different locations on the latter's conditional distribution. Earlier studies have not looked at these aspects in the Indian context.

The exceptional increase in antibiotic resistance in past decades motivated the scientific community to use silver as a potential antibacterial agent. However, due to its unknown antibacterial mechanism and the pattern of bacterial resistance to silver species, it has not been revolutionized in the health sector. This study deciphers mechanistic aspects of silver species, i.e., ions and lysozyme-coated silver nanoparticles (L-Ag NPs), against

Background: Pregnancy is the period during which a fetus develops inside the uterus or womb of a female. Low back pain is common during pregnancy, and it can have serious effects on physical, mental, emotional health during daily activities of living. Job routine commitments in working women may have impact on the level of low back pain during. Objective: To compare the low back pain in working and non-working pregnant females. Methodology: This was a descriptive cross-sectional study. The data was collected through validated Oswestry Disability Questionnaire and numeric pain rating scale from 121 pregnant females, 25 working and 96 non-working females, between the ages of 20 to 40 years with having low back pain working or non-working from Fatima Memorial Hospital, Lahore from October 2020 to March 2021 using non-probability convenience sampling. Statistical analysis was performed using SPSS 25.0 software. Result: The mean age of the study is 27.91. Independent t-test showed statistically non-significant difference between back pain of working (n=25, M=5.76, SD=0.413) and non-working (n=95, M=5.78, SD=.186) females, t(120)=.080, p=.936. the 95% confidence interval was -.0798 to 0.865. so, it failed to reject the null hypothesis. Also, there was no statistically significant difference between disability of working (n=25, M=12.68, SD=.8.112) and non-working (n=95, M=15.27, SD=8.350) females. t(120)=-1.390, p=.167. the 95% confidence interval was -6.282 to 1.100. so, it failed to reject the null hypothesis Conclusion: The findings of study concluded that both working and non-working females have a statistically non-significant, equal level of pain and disability due to low back pain during pregnancy. Keywords: Pregnancy, Low Back Pain, Working Women, Non-Working Women, Housewife, Female Job

Sweet syndrome is an uncommon disorder of unknown etiology and characterized by skin and systemic inflammation. Classic Sweet syndrome is not associated with malignancy or drug exposure and typically involves elderly females. A 67-year-old female with a past medical history of multiple sclerosis and chronic kidney disease presented with worsening erythema of bilateral lower extremities, and diffuse, tender pustular lesions in her extremities, eye lids, nares, oral commissures, and tongue. A biopsy revealed marked neutrophilic inflammation suggestive of Sweet syndrome and she was started on high dose methylprednisolone which immediately improved her condition. As with most progressive inflammatory diseases, early recognition and early treatment improves the prognosis. This case is unusual because of mucosal involvement at presentation. Classic Sweet syndrome can often be diagnosed by exclusion after failed treatment for either infectious or autoimmune disorders.

The present study empirically examines the factors accounting for inflation in India in an open economy framework by utilizing the bounds testing approach to cointegration for the 2006: Q3-2019: Q4 period. The findings reveal the existence of a long-run relationship with the household survey-based inflation expectation, real output, narrow money aggregate and interest rate as important determinants of inflation. The study concludes that inflation is well explained by a combination of structural and monetary factors. Notably, the significance of inflation expectation as an important explanatory variable corroborates the utilization of inflation forecast by the RBI as an intermediate target in the flexible inflation targeting framework. In this backdrop, it is imperative for RBI to conduct a high frequency inflation expectations survey of households to account for frequent information updation on the part of certain groups of households.

The magnetic coupler is the heart of an inductive power transfer (IPT) system, which facilitates wireless power transfer through its air gap. The couplers are designed to maximize efficiency, power density, power transfer distance, and misalignment tolerance while minimizing leakage flux, weight, cost, and volume. The coupler design process becomes complex due to the nonlinear behavior of magnetics, sophisticated geometrical structures, and mandatory design limitations imposed by standards, such as SAE J2954/1, IEC 61980-1:2015, and ISO 19363:2020. Initially, this article reviews the advancements in coil design methodologies and their structures over the last few decades to identify the ongoing challenges and trends. The impacts of the power electronics system, industrial standards, material selection, numerical and analytical modeling methods, and thermal modeling on the coil design process are identified to formalize the design procedure. A coil design example based on finite element analysis (FEA) tools is presented to identify the drawbacks of the existing design and optimization process. A sensitivity analysis, 3-D-Pareto plots, and optimal design selection by considering misalignment variations are proposed to improve the multiobjective optimization process. A generalized guideline for coil design is proposed, which highlights the essential design stages of an IPT coupler. Current trends are identified, and future directions are proposed.

Background: Mandibular fracture, also known as fracture of the jaw, is a sudden discontinuity through the mandibular bone. In the treatment of un-favorable mandibular angle fractures, 3D plating system was analogous to double miniplates Osteosynthesis. Over the last century, the indicators for closed vs. open reduction have shifted considerably. Objective: To compare the outcome of conventional miniplates versus 3-D miniplates for reduction of mandibular fractures Material & Methods Study Design: It was randomized control trial Setting: Department of Oral & Maxillofacial Surgery, Mayo Hospital, Lahore Duration: 6 months i.e. from 24-04-2017 to 24-10-2017 Data collection: 70 mandibular fracture patients were enrolled. The patients were split into two groups. Group A is treated with 3D plates technique and group B treated with conventional mini plate technique. After surgery patients were evaluated for plate failure or and at 1 month for occlusal discrepancy. All the data was entered and put in SPSS version 21. Results: In this study the mean age of the group A patients was 29.29±1.802 years whereas the mean value of age in group B patients was 35.69±11.65 years, male/female ratio of the patients was 1.05:1. Plate was successfully inserted in 100% patients by 3D mini-plate technique. The occlusal discrepancy was noted in 8(11.43%) patients (p-value=0.005). Conclusion: 3-D mini-plates for reduction of mandibular fractures is significantly more efficacious than to conventional mini-plates method Keywords: 3-D mini-plates, Conventional, Mandibular Fractures

The main goal of the current article analyzed the influence of MHD flow of micropolar fluid via exponentially curved stretching surface. Heat transfer analysis is discussed with the impact of thermal radiation and Joule heating. For mathematical model curvilinear (u, v, r and s) is taken for governing flow problem. Viscous dissipation is also considered. Exponential similarity variables are used to transform partial differential equations to ordinary differential system. (ODEs). Numerical techniques have been used to solve the nonlinear ODEs. Effect of various physical variables like material parameter $$(K_{1} = 0.1, 0.2, 0.3, 0.4, 0.5)$$ , radius of curvature ( $$\delta = 1,2,3,4,5$$ ), magnetic parameter ( $$M = 0,0.1, 0.2, 0.3, 0.4$$ ), radiative parameter ( $$R_{d} = 1.0,2.0,3.0,4.0,5.0$$ ), heat generation parameter (Q = 0, 0.1, 0.2, 0.3, 0.4), surface friction, couple stress and surface temperature on the flow of velocity, temperature field and microrotation velocity has been examined through graphs. A good agreement of the present work has been noticed with a previous published result.

Most non-intrusive induction motor (IM) efficiency estimation methods rely on the machine slip to compute the output power and the efficiency. To achieve the overall non-intrusive nature of the entire process, it is vital to utilize a reliable and non-intrusive rotor speed measurement technique in order to obtain the slip of an in-service motor. A number of rotor speed estimation techniques have been proposed in literature. This article focusses on the review and analysis of different techniques in terms of intrusiveness, relative accuracy, sensitivity and computational overhead particularly when the IM is fed by an inverter supply. An experimental accuracy and sensitivity analysis of some motor current and vibration-based techniques is carried out to check the accuracy trends reported in literature and the robustness of these techniques. Potential techniques for non-intrusive rotor speed estimation of inverter-fed induction motors are recommended.

Background Caffeine is a routinely prescribed pharmacological active compound in neonatal intensive care units (NICU) for treating apnea of prematurity (AOP), which also decreases the risk of bronchopulmonary dysplasia and cerebral palsy in neonates. Caffeine-induced excessive calcium loss can promote the development of metabolic bone disease (MBD) in preterm neonates. This study aimed to evaluate the effect of the caffeine regimen on the development of osteopenia of prematurity (OOP), using serum alkaline phosphatase (serum-ALP) concentrations as a surrogate marker at the 4th week of life. Methods This retrospective cohort study was conducted including neonates of Results From the total of 268 participants, 52 (19%) developed OOP, mostly female (61.5%). In the high ALP group, the serum-ALP levels were significantly higher than in the low-ALP group (725.0 ± 143.8 vs 273.6 ± 55.0 units/L, p p Conclusion The daily and cumulative doses of caffeine and smaller GA are associated with the development of OOP in this study cohort. Clinical randomized control studies are needed to validate the outcomes and determine the range of safest and most effective caffeine doses for treating AOP in preterm neonates.

Immune thrombocytopenic purpura (ITP) is an autoimmune disorder caused by autoantibodies against platelet antigens resulting in platelet destruction and inhibition of platelet production. Occasionally, an inciting event such as a virus or vaccination can precipitate ITP. Several cases of ITP have been reported after the BTN162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) SARS-CoV-2 (COVID-19) vaccines. All reported cases of post-vaccination ITP have resolved with medical therapy until this case.A man in his mid-20s developed bleeding from ITP 2 weeks after receiving the second dose of the Pfizer SARS-CoV-2 vaccine. All inpatient medical treatment attempts failed. On hospital day 40, a splenectomy was performed and he ultimately recovered and was discharged.Awareness of potential vaccination side effects is a fundamental element of refining and improving patient safety. This case illustrates that given the right circumstances, serious refractory ITP can develop in response to the second dose of the Pfizer SARS-CoV-2 vaccine.

Objective: To evaluate the relationship between inner canthal distance and maxillary anterior teeth width withrespect to age, gender and ethnicity. Study Design: Cross sectional study. Place and Duration of Study: Altamash Institute of Dental Medicine, Karachi, from Aug 2019 to Jan 2020. Methodology: One hundred participants from both genders with full permanent dentition, no interdental space or pathology and facial symmetry were included in this study. The measurements were carried out with digital Vernier caliper. SPSS-25 was used for statistical analysis. Results: The mean ± SD of inner canthal distance and width of maxillary anterior teeth were 2.99cm ± 0.46and 3.82cm ± 0.35 respectively. A significant difference was found between gender (p=0.037) and inner canthaldistance. The maxillary anterior teeth width and inner canthal distance varies amongst different ethnicities(p=0.01). The inner canthal distance does not vary with advancing age (p=0.87) whereas width of maxillaryanterior teeth varies (p=0.04). A weak correlation value of 0.47 was found between inner canthal distance andmaxillary anterior teeth width. Conclusion: This research suggests that there is a weak relationship between inner canthal distance and maxillary anterior teeth width. Therefore, a multiplication ratio of 1.27 is advised to get combined mesiodistal width of maxillary anterior teeth. Additionally, the value of both differs in various local ethnicities. Inner canthal distance does not vary with age though has significant gender disparities while maxillary anterior teeth width remains constant.

A fuel with parameters such as high energy density, lower viscosity, and freezing point is desirable to be used in missile aircrafts jets at higher altitudes. In this regard, exotetrahydrodicyclope...