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Pakistan’s linguistic diversity and communication challenges are documented evidence of the country’s policy makers and practitioners for a decade’s plan of cultural harmony, regional stability, and linguistic autonomy. Besides, regional language users, national identity persuaders, and national integration into the global objectives of access to information for growth and good is made possible through the medium of communication. Its practice was seen in educational decisions in the past and its struggle for a nationwide networking is being witnessed in the period of COVID-19. The study is the result of almost 15 years old motivation to highlight the issues relevant for a phonological description of Goan Karachiites (GKs) speech of English. However, the framework is updated to absorb recent trends of global integration and communication challenges for a result-oriented academic deliberation. Its QUAL QUAN methods application is derived from phonological underpinnings to witness the divergence of English pronunciation of the GKs from Received Pronunciation (RP). The GKs English was reportedly non-RP, but intelligible on systemic phonological grounds.

Aims Successful cardiac resynchronization therapy (CRT) shortens the pre-ejection period (PEP) which is prolonged in the left bundle branch block (LBBB). In a combined animal and patient study, we investigated if changes in the pulse arrival time (PAT) could be used to measure acute changes in PEP during CRT implantation and hence be used to evaluate acute CRT response non-invasively and in real time. Methods and results In six canines, a pulse transducer was attached to a lower limb and PAT was measured together with left ventricular (LV) pressure by micromanometer at baseline, after induction of LBBB and during biventricular pacing. Time-to-peak LV dP/dt (Td) was used as a surrogate for PEP. In twelve LBBB patients during implantation of CRT, LV and femoral pressures were measured at baseline and during five different pacing configurations. PAT increased from baseline (277 ± 9 ms) to LBBB (313 ± 16 ms, P < 0.05) and shortened with biventricular pacing (290 ± 16 ms, P < 0.05) in animals. There was a strong relationship between changes in PAT and Td in patients (r2 = 0.91). Two patients were classified as non-responders at 6 months follow-up. CRT decreased PAT from 320 ± 41 to 298 ± 39 ms (P < 0.05) in the responders, while PAT increased by 5 and 8 ms in the two non-responders. Conclusion This proof-of-concept study indicates that PAT can be used as a simple, non-invasive method to assess the acute effects of CRT in real time with the potential to identify long-term response in patients.

Sara Alnasser,1 Maryam Alharbi,1 Ahmad AAlibrahim,2 Ali Aal ibrahim,3 Osama Kentab,2 Wajdan Alassaf,2 Muna Aljahany1 1Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 2Department of Emergency, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 3College of Medicine, Sulaiman Al Rajhi University, Bukairiyah, Saudi ArabiaCorrespondence: Muna Aljahany, Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, Saudi Arabia, Email msaljahany@pnu.edu.saObjective: We studied the extent and reasons for non-urgent emergency department (ED) visits in a single university hospital, their predictors, and patient outcomes to propose solutions suitable for Middle Eastern healthcare systems.Design: We conducted a retrospective review of electronic medical records, including all non- and less-urgent ED visits with complete triage records (levels 4 and 5 triage based on the Canadian Triage and Acuity Scale (CTAS) over one year. The data on patient demographics, visit characteristics, and patient disposition were analyzed using SPSS software.Setting: The study was conducted in the ED at King Abdullah Bin Abdul-Aziz University Hospital (KAAUH), a Saudi university hospital located within the campus of Princess Nourah Bint Abdulrahman University.Participants: A chart review was carried out for 18,880 patients with CTAS 4 or 5 visiting the KAAUH ED between July 2020 and July 2021. Additionally, a total of “ 11,857” patients with missing triage acuity or CTAS levels 1, 2, or 3 were excluded from the study.Results: The majority (61.4%) of the 30,737 ED visits were less-urgent or non-urgent. The most common reasons for non-urgent visits were routine examination/investigation (40.9%), medication refilling (14.6%), and upper respiratory tract infection/symptoms (9.9%). Most visits (73.4%) were during weekdays and resulted in the prescription of medication (94.2%), laboratory tests (62.8%), sick leaves (4.7%), radiology examinations (3.6%), and a visit to primary healthcare clinics (family medicine) within a week of the emergency visit (3.6%).Conclusion: Less- and non-urgent ED visits often did not need any further follow-ups or admission and represented a burden better managed by a primary healthcare center. Policymakers should mitigate unnecessary ED visits through public awareness, establish clear regulations for ED visits, improve the quality of care in primary healthcare centers, facilitate booking for outpatient department appointments, and regulate the systems of payment coverage/insurance and referral by other organizations.Keywords: emergency department, triage, non-urgent visits

An effective healthcare sector essentially relies on a strong primary healthcare system. The primary healthcare system governs all major aspects of preventive healthcare and family planning services including immunization, hygiene, communicable disease prevention, sanitation, etc. In addition to this, a major bottleneck limiting the quality of healthcare at secondary and tertiary health facilities is the very high patient footfall that these hospitals. The primary healthcare facilities are designed to be the first tier of facility that a patient falls onto, and hence is either treated there or referred to higher level facilities by screening and limiting patient flow to next levels. Supporting this tier hence helps reduce burden on secondary and tertiary facilities of patients that could have been treated at primary facilities and hence exponentially improve the quality of health services in these lager hospitals. The document discusses some of the major issues faced by the primary healthcare sector in Punjab. These issues were studied and analyzed in detail at South Punjab Health Department, which is an arm of the provincial health department governing 11 districts of Southern Punjab – districts where socio-economic conditions are generally much poorer than the rest of Punjab. This document discusses the initiative of Sehat Ghar, its model, potential to ensure basic health services delivery to the local population and its direct & indirect contribution to tackle major issues of primary healthcare in Punjab.

The gendered social structure of any general population anticipates an essential action in the charming and confined status of women, as women contain half of the world's done individuals yet not considered as proportionate to the male or controlled piece of society. Political fortifying of women is positively not the primary consideration in making women socially, purposely, or monetarily self-administering. Or then again, perhaps, it is vital for the explanation and progress of society. The mother anticipates an essential movement in the supporting of kids, as near women acknowledge a fundamental action in the advancement of society. Strengthening of women makes women free monetarily, at any rate, the political fortifying of women accumulates her self-governing politically in taking her choice to choose an option as exhibited by her consent, making her stable to challenge races, pick her self-overseeing in essential power and planning practices in help and progress of society. Women' delineation in Local Government raises the voices of conventional women from ground level.

Pronouns are few and fixed, but used frequently in language and their forms and functions have been reviewed in the past. The qualitative study theoretically underpinned by various linguistic philosophers is a teacher’s reflection about the use of English pronoun we in ninety-six extended written responses of English language learners studying two disciplines of knowledge in a public institution of higher education in Karachi. The data were collected from ninety-six participants in 2018, analyzed in 2019 and drafted in 2020. The occurrence of the royal we in the sentences of the participants was reportedly too low to connect it with exclusive-we. However, its deictic use was a frequent representation of togetherness. The study’s usefulness lies with further investigations into this linguistic behavior of the pronoun among its users.

Progressive disease that is Diabetes is a chronic disorder that is characterized by elevated blood glucose levels. The global prevalence of this disorder has nearly doubled among adults. Diabetes Mellitus (DM) and thyroid diseases are the most common endocrine disorders in clinical practice. Several studies have shown that diabetes mellitus is associated with an increased incidence of thyroid disorders. The main aim of this study was to assess the prevalence of thyroid diseases in patients with Diabetes. Therefore, this information can guide physicians to detect and treat this problem better. This cross-sectional study was conducted at the outpatient clinics in King Fahad General Hospital in Jeddah, Saudi Arabia. The prevalence of thyroid disease among all patients with Diabetes was 31.2%. The frequency of patients without or denied any previous thyroid disease was 27.9%. The most frequent thyroid disorder was subclinical hypothyroidism, occurring in 4.2% of patients with type I DM and 35.9% with type II DM. We concluded that screening for thyroid disease among diabetic patients is essential and should be performed routinely due to the high prevalence of new cases diagnosed and the possibility of developing risk factors, such as hypertension and dyslipidemia, arising from undiagnosed thyroid dysfunction.

This article analyses the law and procedure of extradition in Pakistan with special reference to Extradition Act 1972. Extradition is a surrender of an accused or convicted person from one state to other state on its request. It is also considered as a system by which one state delivers an accused person to another state on her demand. Moreover, extradition is also used as a tool and considered to be one of the stages to secure international criminal justice system. Furthermore, the focus of the study is to discuss the interpretation of Extradition Act 1972 by the superior courts in their decisions. This study reveals that there are some lacunas in Extradition Act 1972 i.e., there is no provision which safeguards the fugitive offenders from cruel, torture and other inhumane treatment in the requesting state, it does not guarantee the fair trial of the offender in demanding state, additionally, this Act does not provide any right of appeal against the order of surrender. Resultantly, this paper finds that Extradition Act 1972 provide less safeguard to the fugitive offender and did not guarantee the fair trial in the requesting state.

Objectives: To analyze the clinical profile, etiologies and outcome of seriously ill patients admitted in Pediatric Intensive Care Unit (PICU). Study Design: Cross Sectional study. Setting: PICU of Nishtar Medical Hospital, Multan, Pakistan. Period: January 2018 to December 2018. Material & Methods: During the study period, a total of 150 children, aged 1 to 12 years, with better prognosis and post-surgical cases requiring intensive care were registered. Age, gender, cause for hospitalization (clinical, surgical or emergency), length of PICU stay, diagnosis and outcome were recorded for all patients. Results: During the year of the study, 83 (55.3%) children were noted to be male. The mean age was 56.9+12.5 months. Mechanical ventilation was done in 62 (41.3%) patients. Major indications for admission to the PICU were respiratory disorders (21.5%), followed by sepsis (11.4%) and meningitis (8.1%). Majority, 80 (53.3%) patients improved and were shifted to ward and later discharged while 27 (18.0%) expired. Conclusion: Most of the children admitted in the PICU were male, aged below 5 years. Most common indication for admission in the PICU were respiratory disorders followed by sepsis and meningitis.

Objective: To determine the frequency of delayed development in newborns with hypoxic ischemic encephalopathy (HIE) stage 2 presenting to Nishtar Hospital Multan. Study Design: Descriptive Case Series. Setting: Department of Pediatrics, The Children’s Hospital and The Institute of Child Health, Multan. Period: August 2019 to February 2020. Material & Methods: Children with birth asphyxia (HIE stage 2) admitted in NICU were registered. The basic demographic information including name, age, sex, address and telephone number was recorded in a specifically designed proforma. Children were followed up at 3 months and developmental milestones were recorded in the proforma. Results: Mean age of newborns was 17.15±15.95 hours and mean weight was 2.88±0.28 kg. There were 55 male newborns (67.9%) and 26 female newborn babies (32.1%). Male to female ratio was 2.1:1. Frequency of delayed development of the beabies in our study was 34.6% while 53 babies (65.4%) had normal development assessed through milestones achieved at 3 months. Milestones achieved at 3 months were; head control in 54 newborns (66.7%), lifts head and chest above couch in prone position in 50 newborns (61.7%), head above line of body on ventral suspension in 55 newborns (67.9%), follows light through an arc of 180 degrees/defensive blink in 21 newborns (25.9%), turns to nearby voice in 38 newborns (46.9%), happy response to mother’s face when feeding in 63 newborns (77.8%). Conclusion: Frequency of delayed development of the newborns with stage-2 HIE in our study was high.

Alnasser S, Alharbi M, AAlibrahim A, et al. Int J Gen Med. 2023;16:221–232. The authors advise that the Funding section on page 231 is incorrect. The revised Funding statement is as follows: Funding Princess Nourah bint Abdulrahman University Researchers Supporting Project number (PNURSP2023R141), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.The authors apologize for any inconvenience caused to the readers.

Objective:This study assesses the attitudes (willingness) and preparedness of non-frontline physicians across different specialties in the Kingdom of Saudi Arabia (KSA) toward the management of hospitalized coronavirus disease (COVID-19) patients.Methods:This cross-sectional study conducted between April 15, 2020, and May 5, 2020, included 6209 physicians working in KSA. An electronic questionnaire was designed and validated for the assessment of 3 categorical outcome variables, namely, attitudes, confidence, and knowledge levels. Pearson’s chi-square test was used for comparing the distribution of the proportions of these 3 categorical variables.Results:Most participants (63.2%) were willing and prepared to treat COVID-19 patients. A significantly large proportion of participants specializing in anesthesiology (78.2%) had higher knowledge levels, followed by those from plastic surgery (71.1%), pediatrics (69.7%), and obstetrics and gynecology (69.1%) (P < 0.0001). Lower confidence levels were found for airway management skills (38.1%), particularly among dermatologists and radiologists.Conclusion:Higher knowledge levels about personal protective equipment (PPE) use and confidence in airway management skills were proportionally related to the level of willingness to participate in COVID-19 patient management. There is an urgent need to train doctors from certain specialties on PPE use and airway management to enable their frontline support of severely ill COVID-19 patients.

Background: Simulation-based basic airway management training may enhance the learner's competence and offer practitioners the opportunity to practice infrequently applied skills in cases with difficult airway management. Here, we aimed to examine the effectiveness of implementing the American College of Surgeons/ Association for Surgical Education (ACS/ASE) simulation-based Basic Airway Management module in the current medical school curriculum in PNU. Methods: This is a quasi-experimental study in which 44 students were enrolled in the training course; the instructors comprised six practicing physicians and technicians from the anesthesia and emergency departments. The students were divided among six groups for a 20-minutes hands-on training. Cognitive assessment and performance rating scale were conducted after the introduction of the module. An independent t-test was applied to analyze the pre- and post-test training scores for the cognitive assessment and performance rating scale. Statistical significance was set at p < 0.05. Results: There was a significant improvement in the post-training cognitive assessment scores, especially for basic maneuvers to establish the airway in a restrained and unrestrained driver, and in a patient with neck hematoma. A significant difference was also observed in pre- and post-training procedural steps, product characteristics, and global rating score. Conclusions: The ACS/ASE surgical skills curriculum for basic airway skills training is a feasible and effective approach for teaching basic airway management skills to medical students in PNU and other local universities.

Introduction:During the world-wide coronavirus disease 2019 (COVID-19) outbreak, there is an urgent need to rapidly increase the readiness of hospitals. Emergency departments (EDs) are at high risk of facing unusual situations and need to prepare extensively in order to minimize risks to health care providers (HCPs) and patients. In situ simulation is a well-known method used in training to detect system gaps that could threaten safety.Study Objectives:One objective is to identify gaps, test hospital systems, and inform necessary modifications to the standard processes required by patients with COVID-19 presenting at the hospital. The other objective is to improve ED staff confidence in managing such patients, and to increase their skills in basic and advanced airway management and proper personal protective equipment (PPE) techniques.Methods:This is a quasi-experimental study in which 20 unannounced mock codes were carried out in ED resuscitation and isolation rooms. A checklist was designed, validated, and used to evaluate team performances in three areas: donning, basic and advanced airway skills, and doffing. A pre- and post-intervention survey was used to evaluate staff members’ perceived knowledge of ED procedures related to COVID-19 and their airway management skills.Results:A total of 20 mock codes were conducted in the ED. Overall, 16 issues that posed potential harm to staff or patients were identified and prioritized for immediate resolution. Approximately 57.4% of HCPs felt comfortable dealing with suspected/confirmed, unstable COVID-19 cases after mock codes, compared with 33.3% beforehand (P = .033). Of ED HCPs, 44.4% felt comfortable performing airway procedures for suspected/confirmed COVID-19 cases after mock codes compared with 29.6% beforehand. Performance of different skills was observed to be variable following the 20 mock codes. Skills with improved performance included: request of chest x-ray after intubation (88.0%), intubation done by the most experienced ED physician (84.5%), and correct sequence and procedure of PPE (79.0%).Conclusion:Mock codes identified significant defects, most of which were easily fixed. They included critical equipment availability, transporting beds that were too large to fit through doors, and location of biohazard bins. Repeated mock codes improved ED staff confidence in dealing with patients, in addition to performance of certain skills. In situ simulation proves to be an effective method for increasing the readiness of the ED to address the COVID-19 pandemic and other infection outbreaks.

An abnormal systolic motion is frequently observed in patients with left bundle branch block (LBBB), and it has been proposed as a predictor of response to cardiac resynchronization therapy (CRT). Our goal was to investigate if this motion can be monitored with miniaturized sensors feasible for clinical use to identify response to CRT in real time. Motion sensors were attached to the septum and the left ventricular (LV) lateral wall of eighteen anesthetized dogs. Recordings were performed during baseline, after induction of LBBB, and during biventricular pacing. The abnormal contraction pattern in LBBB was quantified by the septal flash index (SFI) equal to the early systolic shortening of the LV septal-to-lateral wall diameter divided by the maximum shortening achieved during ejection. In baseline, with normal electrical activation, there was limited early-systolic shortening and SFI was low (9 ± 8%). After induction of LBBB, this shortening and the SFI significantly increased (88 ± 34%, p < 0.001). Subsequently, CRT reduced it approximately back to baseline values (13 ± 13%, p < 0.001 vs. LBBB). The study showed the feasibility of using miniaturized sensors for continuous monitoring of the abnormal systolic motion of the LV in LBBB and how such sensors can be used to assess response to pacing in real time to guide CRT implantation.

Background: Miniaturized accelerometers incorporated in pacing leads attached to the myocardium, are used to monitor cardiac function. For this purpose functional indices must be extracted from the acceleration signal. A method that automatically detects the time of aortic valve opening (AVO) and aortic valve closure (AVC) will be helpful for such extraction. We tested if deep learning can be used to detect these valve events from epicardially attached accelerometers, using high fidelity pressure measurements to establish ground truth for these valve events. Method: A deep neural network consisting of a CNN, an RNN, and a multi-head attention module was trained and tested on 130 recordings from 19 canines and 159 recordings from 27 porcines covering different interventions. Due to limited data, nested cross-validation was used to assess the accuracy of the method. Result: The correct detection rates were 98.9% and 97.1% for AVO and AVC in canines and 98.2% and 96.7% in porcines when defining a correct detection as a prediction closer than 40 ms to the ground truth. The incorrect detection rates were 0.7% and 2.3% for AVO and AVC in canines and 1.1% and 2.3% in porcines. The mean absolute error between correct detections and their ground truth was 8.4 ms and 7.2 ms for AVO and AVC in canines, and 8.9 ms and 10.1 ms in porcines. Conclusion: Deep neural networks can be used on signals from epicardially attached accelerometers for robust and accurate detection of the opening and closing of the aortic valve.

Objective: The emergence of the novel coronavirus disease 2019 (COVID-19) has resulted in precautionary measures by governments worldwide to contain the spread of the virus. However, the degree of compliance toward personal precautionary measures has varied, despite the urgent need to contain the pandemic. This study aimed to assess the level of compliance toward personal protective precautions during and after the lockdown among residents of Riyadh, Saudi Arabia. Methods: We conducted a cross-sectional study with 1,108 residents using an online survey to collect sociodemographic data, compliance with personal protective measures, and other factors during and after the lockdown. Statistical Package for Social Sciences (SPSS) version 26 (IBM SPSS Statistics, Armonk, NY) was used for data analysis. Results: During the lockdown, 35.5% of respondents were “very compliant,” whereas 30.1% were “less compliant.” Additionally, compliance levels in those who depended on official sites as their primary source of information were significantly higher than those who depended on their family, friends, and social media. Approximately 39.76% of those who were “very compliant” intended on getting vaccinated against COVID-19, while 28% of those with high compliance did not intend on getting vaccinated. Further, compliance levels were high in participants who were not in direct contact with COVID-19 cases as well. Conclusion: This study highlights the importance of maintaining the level of compliance toward personal precautionary measures against COVID-19 even after lockdown release to prevent further waves. This study showed that compliance toward personal protective measures was high for those who did not have direct contact with COVID-19 positive people after lockdown, those planning for inoculation, and those insuring applications of precautionary measures by their children. Additionally, higher compliance was noted in participants who sought information from official sites.

Denture-induced stomatitis is the most common pathogenic reaction of denture-bearing mucosa, caused by Candida albicans. Miswak is naturally available oral hygiene tool and have been showed to have antifungal activity against Candida albicans in oral cavity. Aim: The aim of the study was to compare the antifungal efficacy between commercial cleaner (Corega) and Miswak extract ( Salvadora persica) against Candida albicans on heat cured Polymethyl methacrylate (PMMA) acrylic denture base resin. Materials and methods: Forty-eight samples of heat cured PMMA acrylic denture base resin were fabircated in the study. The sterile acrylic resin specimens were immersed in standardized cell suspension of Candida albicans and incubated for 60 min at 370°C for cell adhesion and 2 h at 370°C for biofilm formation. After 24 h biofilm was evaluated by cell viability (CFUs) on SDA and cell counting of Candida albicans under light microscope at 400× magnification. The fungicidal effect of commercial cleaner and Miswak extract on Candida albicans biofilm was then evaluated by colony-forming units on SDA and cell counting under light microscope at 400× magnification. Results: Screening test agar disk-diffusion assay showed mean inhibitory zone of 3 mm for commercial cleaner as compared to Miswak extract, which showed mean inhibitory zone of 2 and 1 mm for different concentrations. Broth microdilution method showed 31 mg/ml MIC and 62.5 mg/ml Minimal Fungicidal Concentration (MFC) values for commercial cleaner as compared to Miswak extract that showed 125 mg/ml MIC and 250 mg/ml MFC values against Candida albicans. A significant difference ( p < 0.05) was observed between pre and post treatment of both commercial cleaner and Miswak extract, for CFUs and cell count for Candida albicans. Conclusion: Commercial denture cleaner (Corega) showed better antifungal ( C albicans) activity than Miswak extract ( Salvadora persica) on heat cured PMMA acrylic denture base resin.

Introduction Global longitudinal strain is recommended by the European Society of Cardiology to detect subclinical left ventricular (LV) dysfunction, but is markedly load-dependent. Myocardial work was recently introduced as a clinical tool to study LV function by pressure-strain analysis. Since myocardial work incorporates afterload, it is assumed to be less afterload-dependent than strain, but the relationship with afterload is incompletely understood. Hypothesis Myocardial work is a better tool than strain, to measure myocardial function during elevated afterload. Methods In eleven anesthetized dogs, LV volume and longitudinal strain were measured by sonomicrometry, and pressure by micromanometry. Myocardial work was calculated by pressure-strain analysis. Additionally, stroke work was calculated as the area of the pressure-volume loop. Afterload was instantly increased by aortic constriction using a pneumatic cuff around the ascending aorta. Measurements were performed at baseline, during moderate- and marked afterload elevations. Results Table 1 summarizes the results. LV pressure (LVP) successively increased with moderate and marked afterload elevation, while longitudinal strain was successively reduced. Myocardial work and stroke work, on the other hand, increased with moderate afterload elevation, but was then reduced at marked afterload increase (Figure 1 and Table 1). Stroke volume and ejection fraction corresponded to strain and were reduced with afterload elevation. Conclusions Longitudinal strain and myocardial work have qualitatively different responses to increased afterload. While moderate changes in afterload cause reductions in strain that can be falsely interpreted as reductions in contractility, myocardial work increases as it incorporates the increased workload at moderately elevated afterload. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The Norwegian Health Association

تتناول هذه الدراسة موضوع (الأوقاف والهدايا في العراق خلال العصر العباسي) لدمجها في أهمية الأوقاف والهدايا في المجتمع العربي الإسلامي حيث ساهمت في الحفاظ على العديد من العادات والتقاليد الاجتماعية التي تعكس القيم الإنسانية المتجسدة في الإسلام. الشخصية العربية. تحتوي هذه الدراسة على مجموعة من أنواع الأوقاف والهدايا خلال فترة البحث. ويشمل ما تم تعميمه بين فئات المجتمع مثل النقود النقدية ، والهراوات ، والعبيد من رباط السندات وبوندميدس ، وأردية الشرف والملابس ، والجوهر والعطور ، والكتب المؤلفة ، والأطعمة والفواكه..

Pain is a subjective complaint that comprises a vast majority of emergency department (ED) visits. Owing to its subjectivity, pain reporting is prone to variations that could impact patient care. We aimed to determine the extent of differences in pain rating-scores between patients and their physicians in the ED and impact on patient satisfaction.A prospective cross-sectional sample of eligible patients was recruited from two centers in Saudi Arabia. Pain scorings were performed using validated online questionnaires during patients' ED stay.Pain rating scores by physicians was lower than that by patients (6.3 ± 2.0 versus 7.0 ± 3.1, p = 0.004). Additionally, severe pain rating (8-10 rating) was given less frequently by physicians compared with that by patients (26.0% versus 48.1%, p = 0.004). Comparing the ratings by physicians with those by patients, underestimation was observed in 70.1%, overestimation in 16.9%, and matching rating in 13.0% cases. The most frequent analgesic medication administered was paracetamol (79.2%), followed by diclofenac (26.0%), morphine (10.4%), and ketorolac (9.1%). The medications were administered mainly intravenously (87.0%) and, to a lesser extent, intramuscularly (31.2%). Majority of patients (62.5%) reported not to have sufficient pain relief after treatment.Most physicians tend to underestimate the level of pain perceived by their patients, which often leads to under-treatment and lower patient satisfaction. The present study revealed a significant difference in pain ratings between patients and physicians.

Aim: To determine the frequency of necrotizing enterocolitis in preterm infants Place and duration of study: It is a descriptive cross-sectional study in Pediatric Medicine Department, Nishtar Hospital Multan from March, 2021 to August, 2021 Methodology: The preterm neonates were called for follow up every week for 4 weeks to diagnose Necrotizing enterocolitis. Results; Out of 174 cases, 101 (58%) were males while 73 (42%) were females. Necrotizing enterocolitis (NEC) was noted in 61 (35.1%) while NEC in breastfeeding infants was 14/74 (18.9%) and in formula feeding infants NEC was 47/100 (47%). Conclusion; High frequency of necrotizing enterocolitis was observed in this study among formula fed preterm infants as compared to breastfed preterm infants. Keywords; Breastfeeding, formula feeding, Necrotizing enterocolitis

Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EU’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie Background There is no consensus on which haemodynamic marker should be used to quantify acute response to cardiac resynchronization therapy (CRT) during implantation of the device. CRT has been shown to acutely reduce left ventricular (LV) end systolic as well as end-diastolic volume (EDV), precluding the use of preload dependent markers such as LV maximum pressure rise (dP/dtmax). Purpose As resynchronization will abolish the uncoordinated regional early systolic contractions of the LV, it will shorten the time to maximal pressure rise and aortic valve opening. For this reason, the purpose of this study was to investigate if duration from the time-point of ventricular pacing to dP/dtmax is less preload dependent and a better marker of acute response to CRT than dP/dtmax by comparing how the 2 markers reflected LV function during different CRT configurations. Methods LV pressure by micromanometer and volume by sonomicrometry were measured in 6 anaesthetized canines with left bundle branch block. Transient caval constrictions were performed to vary preload. Preload dependency of the 2 markers was compared by normalizing their values and calculating their relations to EDV. In 4 of the animals, biventricular pacing was performed at 3 different pacing sites with variations in atrioventricular delays that provided a range of response to CRT. To correct for acute changes in preload by CRT, stroke volume (SV) at identical EDV found from transient caval constrictions, were assessed and used as reference to grade improved LV function. Linear regression analysis was used to assess the correlation of both the duration of the preejection phase and dP/dtmax with SV. Results The duration of the preejection phase varied less with changes in preload compared to dP/dtmax: the slopes of their relation to EDV were -0.6 ± 0.7 %/ml and 4.8 ± 2.1 %/ml (p = 0.004), respectively. Turning CRT on, acutely reduced EDV from 74 ± 16 to 69 ± 17 ml (p Conclusions The duration of the preejection phase correlated with changes in LV function induced by CRT while dP/dtmax performed poorly as preload was changed. Hence, the novel timing parameter was less preload dependent and may be a better marker for assessing acute response to CRT. Abstract Figure.

Objectives This study aimed to describe the development and implementation of a separated pathway to check and treat patients with a suspected/confirmed coronavirus disease 2019 (COVID-19) in the emergency department (ED) at King Abdullah bin Abdulaziz University Hospital in Riyadh. Methods We conducted a retrospective, descriptive longitudinal study from March to July 2020 by analyzing data of all confirmed cases of COVID-19 among ED visitors and healthcare workers in King Abdullah bin Abdulaziz University Hospital. Results During the study period, a total of 1,182 swab samples were collected for testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), of which 285 (24.1%) tested positive. Of the 285 cases of confirmed SARS-CoV-2 infection, 18 were healthcare workers and 267 were patients. As a result of using the respiratory pathway for COVID-19 patients, the hospital managed to limit transmission of SARS-CoV-2 not only between patients but also between patients and healthcare workers, while also containing the pandemic. There were no cases of nosocomial SARS-CoV-2 infection recorded among the patients who visited the ED or the flu clinic. All confirmed cases were community acquired and patients were cared for under constrained measures. Conclusions Implementing infection control measures and restricting those with respiratory symptoms to the ED pathway prevented nosocomial spread of SARS-CoV-2 infection in the ED.

In December 2019, a pneumonia of unknown etiology was detected in Wuhan, China. This outbreak was then declared an international public emergency in January 2020 by the World Health Organization (WHO), and the announcement activated disaster management plans worldwide. This global crisis created several challenges for the health-care sector. This study reviews the challenges faced by a middle-sized urban academic hospital that are likely present to some extent in all health-care sectors, regardless of their existing disaster plans and policies. While preparing this Saudi academic hospital with a capacity of 192 beds for the emerging pandemic, obstacles arose despite its extensive prior disaster planning and training. Specifically, these challenges were related to health-care workers, supplies, and patient care. We review the actions taken to overcome and resolve these difficulties and provide future planning suggestions for each area to potentially assist other hospitals in their disaster planning and preparedness.

The purpose of this paper is to highlight the importance and effectiveness of investigation in the Criminal Justice System of Pakistan. The study provides the historical background of the Police system of Pakistan, which is primarily responsible for the investigation of crime in the Criminal Justice System of Pakistan. The study also examines and highlights the poor standards of Police Investigation and its impact on the Criminal Justice System of Pakistan. The study describes and analyzes the different statutes and laws in Pakistan which regulate the process of the criminal investigation in Pakistan. The researcher collected data through interviews from the 10 Defense Lawyers (who are representing accused in trial courts) in District Multan. Data is also collected through interviews from the 10 Public Prosecutors (who are prosecuting the accused on behalf of State in trial courts) from District Multan. The finding of the study reveals that the current system of the police investigation is faulty and outdated. In the end, this study recommends how to improve the standards of investigation in the Criminal Justice System of Pakistan

IntroductionUnacceptable practices of health care providers during disasters have been observed because they work outside the scope of their daily practices and have inadequate training. A greater need for the involvement of health professionals in disaster management has been noted in Saudi Arabia. This study evaluates the efficacy of a training course in prehospital major incident management for health care providers in Saudi Arabia.MethodsAn interactive course for general principles in prehospital major incident management was developed with domains and core competencies. The course was designed according to the local context and was based on international standards. It was piloted over four days at the Officers Club of the Ministry of Interior (Riyadh, Saudi Arabia) and was sponsored by Mohammed Bin Naif Medical Center, King Fahd Security College in Riyadh, Saudi Arabia. The participants (n=29) were from different disciplines from main government health facilities in Riyadh. They completed a pre-test and a post-test.ResultsThe overall score was 55.1% on the pre-test and 68.4% on the post-test (Wilcoxon test for paired samples, P Conclusion:Conducting inter-disciplinary and competency-based disaster medicine courses for health care providers can augment appropriate disaster preparedness for major incidents in Saudi Arabia.BajowNA,AlAssafWI,CluntunAA.Course in prehospital major incidents management for health care providers in Saudi Arabia.Prehosp Disaster Med.2018;33(6):587–595.

Objectives: Uterine serous (USC) and clear cell carcinoma (CC) are aggressive variants of endometrial cancer (EC), comprising only 20% of all cases, but accounting for a disproportionately high number of EC related deaths. The molecular profile of USC and CC is distinct from that of other EC, displaying alternations in TP53 and HER2/neu. Human epidermal growth factor receptor 2/neu (HER2) is a key player in singling for cancer cell growth, survival and proliferation. Recent data demonstrates a survival benefit with the use of trastuzumab, a monoclonal antibody against HER2, in combination with chemotherapy for HER2 expressing USC. However, the clinical implications of HER2 status on prognosis remain unclear. Methods: A multicenter retrospective analysis of patients with USC and CC was conducted from 2000 - 2019. Inclusion criteria were patients who had undergone comprehensive surgical staging/tumor debulking with archival tissue available for HER2 assessment via immunohistochemistry (IHC). HER2 positive was defined as IHC score of 3+. Platinum sensitivity was defined as recurrence >6 months from last platinum-based therapy. Differences in the frequencies of stage, race, chemosensitivity and sites of disease recurrence were identified using Pearson's chi-square test. Progression free survival (PFS) and overall survival (OS) analysis was performed using Kaplan-Meier estimates. Multivariate analysis (MVA) was performed using Cox proportional hazards model. Results: HER2 status was evaluated in 56 patients. Histology included 44 (79%) USC, 9 (16%) CC and 3 (6%) mixed serous-clear cell. 11 (19.6%) were positive for HER2; 18.2% USC, 22.2% CC and 33.3% mixed histology. Of these 56 patients, 50 had follow-up information available for review and were included in final analysis. The mean age was 67-years and the majority of patients were African American (88%). Stage distribution included 38% stage I, 8% stage II, 18% stage III and 36% stage IV. 29 (58%) patients recurred during the study period, 7 (70%) of the HER2 positive and 22 (55%) of the HER2 negative cohort (p=0.390). The most common location of recurrence was the abdomen followed by the pelvis and extra-abdominopelvic sites. There was no difference in the stage (p=0.471), race (p=0.323) or distribution of recurrence sites (p=0.813) between HER2 positive and negative tumors. Platinum sensitivity was significantly improved in HER negative (65%) vs. HER2 positive tumors (30%) (p=0.044). For the entire cohort, the median PFS was 21 months and the median OS was 29 months. The median PFS and OS did not differ significantly based on HER2 status (p=0.229 and p=0.255, respectively). However, there was a clinically relevant trend towards improved PFS (26 vs. 7 months) and OS (35 vs. 14 months) in HER2 negative vs. positive tumors. On MVA, platinum sensitivity (p Download : Download high-res image (140KB) Download : Download full-size image Conclusions: In addition to being a tool to guide targeted therapy, HER2 is a valuable prognostic marker in USC and CC. Expression is associated with significantly lower platinum sensitivity and inferior survival compared to tumors not expressing HER2.

Objectives: Wilms tumor gene 1 (WT1) expression is a hallmark of ovarian serous carcinoma (OSC) and considered to be diagnostic marker of these tumors, differentiating them from uterine serous carcinoma (USC), traditionally thought to rarely express WT1. However, recent data indicates a significant percentage of USC may express WT1, limiting its use as a differentiating marker between these two tumors. Additionally, the clinical implications of WT1 positivity in USC remain unclear. Methods: A multicenter retrospective analysis of patients with USC was conducted from 2000 - 2019. Inclusion criteria were patients who had undergone comprehensive surgical staging/tumor debulking with archival tissue available for WT1 assessment via immunohistochemistry (IHC). Platinum-sensitive patients were defined as those recurring >6 months from last platinum-based chemotherapy. Differences in the frequencies of stage, race, chemosensitivity and sites of disease recurrence were identified using Pearson's chi-square test. Progression free survival (PFS) and overall survival (OS) analysis was performed using Kaplan-Meier estimates. Multivariate analysis (MVA) was performed using Cox proportional hazards model. Results: WT1 status was evaluated in 61 patients with USC. 13 (21.3%) were positive for WT1 by IHC. Of these 61 patients, 56 had follow-up information available for review and were included in final analysis. The mean age was 67-years and the majority of patients were African American (97%). Stage distribution included 32% stage I, 5% stage II, 25% stage III and 38% stage IV. The majority of patients were designated as platinum-sensitive (63%). 36 (64%) patients recurred during the study period, 8 (62%) of the WT1 positive and 28 (65%) of the WT1 negative cohort. The most common location of recurrence was the abdomen followed by the pelvis and extra-abdominopelvic sites. There was no difference in the stage (p=0.158), race (p=0.227) or distribution of recurrence sites (p=0.581) between WT1 positive and WT1 negative tumors. Platinum-sensitivity was significantly improved in WT1 positive (92.3%) vs. WT1 negative tumors (55.8%) (p=0.016). For the entire cohort, the median PFS was 20 months and the median OS was 29 months. The median PFS and OS did not differ significantly based on WT1 status (p=0.544 and p=0.759, respectively). However, we did observe a trend towards improved PFS among WT1 positive tumors (21 vs. 16 months, respectively). On MVA, stage (p Download : Download high-res image (147KB) Download : Download full-size image Conclusions: WT1 positivity is observed in over 20% of USC, limiting its utility to differentiating OSC and USC. Additionally, WT1 status holds prognostic significance as expression was associated with improved platinum-sensitivity and a clinically significant 5-month improvement in PFS.

This report describes the medical coverage provided for 10KSA, a charity event held in Saudi Arabia for breast cancer awareness. More than 10,000 women attended the event. A total of 41 attendees sought medical care; four patients (9.8%) presented directly to the clinic and 37 patients (90.2%) presented to the first aid units, mostly for check-ups. This report may be helpful for care providers arranging medical coverage for future events with similar challenging situations (women only, distant location).AlAssafWI. EMS coverage of a female-only event with 10,000 attendees: preparation and implementation in one week. Prehosp Disaster Med. 2017;32(6):694–698.

Measurements of the left ventricular (LV) pressure trace are rarely performed despite high clinical interest. We estimated the LV pressure trace for an individual heart by scaling the isovolumic, ejection and filling phases of a normalized, averaged LV pressure trace to the time-points of opening and closing of the aortic and mitral valves detected in the individual heart. We developed a signal processing algorithm that automatically detected the time-points of these valve events from the motion signal of a miniaturized accelerometer attached to the heart surface. Furthermore, the pressure trace was used in combination with measured displacement from the accelerometer to calculate the pressure–displacement loop area. The method was tested on data from 34 animals during different interventions. The accuracy of the accelerometer-detected valve events was very good with a median difference of 2 ms compared to valve events defined from hemodynamic reference recordings acquired simultaneously with the accelerometer. The average correlation coefficient between the estimated and measured LV pressure traces was r = 0.98. Finally, the LV pressure–displacement loop areas calculated using the estimated and measured pressure traces showed very good correlation (r = 0.98). Hence, the pressure–displacement loop area can be assessed solely from accelerometer recordings with very good accuracy.

Objectives: To investigate the effects of nutraceuticals on key processes associated with atherosclerosis in vitro and in vivo. Background: Atherosclerosis is an inflammatory disease of the vasculature in which macrophages play key roles at all stages and represent promising therapeutic targets. Unfortunately, current therapies against atherosclerosis are not fully effective and associated with other issues such as adverse side effects. In addition, there have been many failures on pharmaceutical agents identified from drug discovery programs. Nutraceuticals represent promising alternatives in the prevention and treatment of atherosclerosis but requires a thorough understanding of their actions together with the underlying mechanisms. The purpose of this study was to address this with emphasis on key macrophage processes associated with atherosclerosis. Methods: A combination of macrophage cell lines and primary cultures were used with gene expression analysed by atherosclerosis profiler arrays and real time quantitative PCR. Foam cell formation was investigated by following the uptake of fluorescently labeled modified LDL, intracellular lipid profiling and cholesterol efflux assays. Inflammasome activation was evaluated by following the release of interleukin (IL)-1beta using an ELISA and ROS production using a kit from Abcam. The effects in vivo were analysed in C57BL/6 mice fed a high fat diet. Results: The studies focused on polyphenols, flavanols and omega-6 polyunsaturated fatty acids. These either inhibited or had no effect on several key macrophage processes associated with atherosclerosis such as pro-inflammatory gene expression, the uptake of modified LDL, macropinocytosis, ROS production and the activation of the inflammasome. In addition, where analysed, the nutraceutical inhibited several atherosclerosis-associated markers in mice fed a high fat diet. The mechanisms underlying such actions will be presented. Conclusions: The studies provide new insights into the beneficial actions of nutraceuticals in atherosclerosis.

Introduction/Objective A liposarcoma is a tumor derived from primitive mesenchymal cells undergoing adipose differentiation. Liposarcomas are uncommon in childhood, representing only about 2% of childhood sarcomas. Among liposarcomas, is a very rare subtype, the so-called ‘pleomorphic myxoid liposarcoma’ which has extensive myxoid changes and scattered pleomorphic cells. Here we report an autopsy case of an extensively metastatic pleomorphic myxoid liposarcoma. Methods A 12 year-old, African-American boy presented in the ED with ascites and shortness of breath, who later expired despite resuscitation. Autopsy finding showed a primary lesion in the left superior orbital fissure with diffuse metastasis to liver, replacing most of the liver parenchyma (liver weigh 8500 g). Metastatic foci are also present in gallbladder, pancreas, large intestine, bilateral lungs, and inner and outer surfaces of cranium. Histologically, tumor at all sites shows similar morphology, revealing scattered pleomorphic lipoblasts and a myxoid background with arborizing vasculature. Lipoblasts show indented and distorted nuclei and cytoplasmic vacuoles. Immunohistochemically the tumor cells are immunoreactive for p16 (diffusely and strongly) (Figure, D) and S100 (weakly) and negative for AE1/AE3, myogenin, synaptophysin, GFAP, EMA, and CD34. FISH was negative for MDM2 and t(12;16)(q13;p11.2) FUS-DDIT3 rearrangement, ruling out conventional myxoid liposarcoma. Conclusion This case shows the aggressive nature of a poorly studied entity in an uncommon age group and emphasize the need to study childhood liposarcomas in more detail.

Easy to use devices for the rapid detection of toxic metal ions in drinking water is essential for improving monitoring, identification and management of water resources. In 2014, over 100,000 residents of Flint, Michigan, were exposed to high levels of lead in their drinking water, leading to serious environmental and health issues. The problem faced by Flint is a perfect example of the need for a portable device for on-site detection system that can sense the presence of high concentrations of toxic metal ions in the environment in natural pH with no sample pretreatment. In this work, an easy to use method for metal ion detection in natural water samples was developed. Preconcentration of ions at the electrode surface was achieved by optimizing a nanostructured layer consisting of gold nanoparticles and a conductive polymer, which improved detection sensitivity and selectivity withing limits that cover the EPA levels for metal ion exposure. The method was demonstrated for the detection of As, Pb and Hg in natural waters, using anodic stripping voltammetry (ASV). Several parameters were optimized in order to achieve the highest detection sensitivity, including pH, ionic strength and deposition time. Local water samples were tested for heavy metal ion content and validated using lab-based methods, including atomic absorption spectroscopy (AAS) and ICP-MS. This methodology was applied onto the surface of low-cost screen-printed electrodes which are easy to use and portable.

Automatic speech recognition is the area of research concerning the enablement of machines to accept vocal input from humans and interpreting it with the highest probability of correctness. There are several techniques to implement speech recognition models. One of the emerging techniques is using neural networks with deep learning for speech recognition. Arabic is one of the most spoken languages and least highlighted in terms of speech recognition. This paper serves as a brief review on the available studies on Arabic speech recognition. In addition, it sheds some light on the services and toolkits available for Arabic speech recognition systems’ development.

A miniaturized accelerometer attached to the heart has been used for monitoring functional parameters such as early systolic velocity and displacement. Currently, processing of the accelerometer signal for derival of these functional parameters depends on determining start systole by detecting the ECG R-peaks. This study proposes an alternative method using only the accelerometer signal to detect start systole, making additional ECG recordings for this purpose redundant. A signal processing method for automatic detection of start systole by accelerometer alone was developed and compared with detected R-peaks in 15 pigs during 5 different interventions showing a difference of 30 ± 17 ms. Furthermore, the derived early systolic velocity and displacement using only accelerometer measurements correlated well (r 2 =0.91 and 0.82, respectively) with minor differences compared to the current method using ECG R-peaks as time reference. The results show that an accelerometer can be used to monitor cardiac function without the need to measure ECG which can simplify the monitoring system.

Background: Primary menstrual pain is a well-known gynecological disorder among adult females including nursing undergraduate students. Nursing students tend not to seek medical treatment. As a result, this affects their quality of academic life and also absenteeism rate is increased. Objectives: To evaluate the prevalence of menstrual pain and its effect on sickness absenteeism on nursing student. Methods: This is a descriptive survey research design study by means of using a validated and modified questionnaire. Questionnaire information regarding menstrual pain severity, history and absenteeism were included. The research took place in the collage of nursing at the largest University in the world, Princess Nourah Bint Abdelrahman University, Riyadh, Saudi Arabia. A total of 100 single, female, unmarried undergraduate nursing students (Year 1, 2, 3, 4) were recruited by personal invitation during lectures. Result: The prevalence of menstrual pain was 92%. Most of the nursing students 27% had menstrual pain of moderate grade 5 - 6 and 38% of nursing students did not take pain medication for it. Lecture and collage absenteeism due to menstrual pain was present in 9% and 30% respectively. Finally, there was no significant correlation between menstrual pain and age of menarche, age and height. Conclusion: Menstrual pain is widely common prevalent among nursing undergraduates. As a result, it affects the quality of students’ day-to-day life routine. The majority of nursing students’ rarely seeks medical treatment. Providing health and patient education to improve awareness on managing menstrual period might help in avoiding students’ absence from classes.

As Ebola has spread beyond West Africa, the challenges confronting health care systems with no experience in managing such patients are enormous. Not only is Ebola a significant threat to a population’s health, it can infect the medical personnel trying to treat it. As such, it represents a major challenge to those in public health, emergency medical services (EMS), and acute care hospitals. Our academic medical center volunteered to become an Ebola Treatment Center as part of the US effort to manage the threat. We developed detailed policies and procedures for Ebola patient management at our university hospital. Both the EMS system and county public health made significant contributions during the development process. This article shares information about this process and the outcomes to inform other institutions facing similar challenges of preparing for an emerging threat with limited resources. The discussion includes information about management of (1) patients who arrive by ambulance with prior notification, (2) spontaneous walk-in patients, and (3) patients with confirmed Ebola who are interfacility transfers. Hospital management includes information about Ebola screening procedures, personal protective equipment selection and personnel training, erection of a tent outside the main facility, establishing an Ebola treatment unit inside the facility, and infectious waste and equipment management. Finally, several health policy considerations are presented. (Disaster Med Public Health Preparedness. 2015;9:558–567)

Scalable data is the demand of many of the emerging technologies. In order to target scalability, query processing plays an important role. The target is to achieve the maximum performance in terms of less execution time and more output. This could be achieved with any selected data and implementing advanced algorithms in any platform. This paper has worked in ArcMap in order to handle data of maps through different layers. Map reduction in size eases the process of query processing and generates the resultant records much faster. In addition, query category contributes to scalability as well. Classifying a compound query into a simple one adds positive impact on the results. Query payload and cost are controlled by maintaining execution time of the query and enhancing retuned records per command. This is helpful in analyzing different map layers for selected area of interest. Scalable map data is selected, analyzed with different map layers and results are obtained of processed queries that clearly indicates the successful achievement of scalability of the data through controlled process of query handling in smart and efficient way.

In recent years the need for informal home care in European countries is growing quickly due to increased life expectancy and demographic change. Informal caregivers have to overcome many obstacles ranging from a lack of adequate training to misjudging their physical and psychological abilities. The aim of this project is to create a low cost wearable device, which unobtrusively measures the physical stress load on caregivers. Two parameters with the most impact on performance and well-being of the caregiver have been identified: (i) fatigue and (ii) back-stress. Based on the measurements, an alert is issued if caregivers are not performing a task correctly, or if they are overexerting themselves. This paper discusses the design of such device and description of an initial prototype, its advantages and possible further development and applications.

This paper presents the design of a low cost and portable EMG circuit for signal acquisition and signal processing of surface EMG along with motor control and drive circuitry. The proposed circuitry was successfully tested on a prosthetic arm. The paper discusses various approaches that were tested and highlights the best possible approach. The highlighted approach is best for acquiring a high fidelity EMG signal, increase its SNR and process the signal into a form best suited for motor control via a microcontroller. The paper further discusses the use of various types of surface electrodes and the variety of components that can be used in the circuitry depending upon their availability in the local market and their economic aspect.