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Motivation To examine the hypothesis that obesity with metabolic syndrome, compared to simple obesity, has distinct molecular signatures and metabolic pathways. Methods We analyzed a cohort of 39 patients with obesity that includes 21 subjects with metabolic syndrome, age-matched to 21 subjects with simple obesity. We measured in whole blood samples 754 human microRNAs (miRNAs), 704 metabolites using unbiased mass spectrometry metabolomics, and 25,682 transcripts, which include both protein coding genes (PCGs) as well as non-coding transcripts. We then identified differentially expressed miRNAs, PCGs, and metabolites and integrated them using databases such as mirDIP (mapping between miRNA-PCG network), Human Metabolome Database (mapping between metabolite-PCG network) and tools like MetaboAnalyst (mapping between metabolite-metabolic pathway network) to determine dysregulated metabolic pathways in obesity with metabolic complications. Results We identified 8 significantly enriched metabolic pathways comprising 8 metabolites, 25 protein coding genes and 9 microRNAs which are each differentially expressed between the subjects with obesity and those with obesity and metabolic syndrome. By performing unsupervised hierarchical clustering on the enrichment matrix of the 8 metabolic pathways, we could approximately segregate the simple obesity strata from that of obesity with metabolic syndrome. Conclusions The data suggest that at least 8 metabolic pathways, along with their various dysregulated elements, identified via our integrative bioinformatics pipeline, can potentially differentiate the patients with obesity from those with obesity and metabolic complications.

Eighty one percent of adolescents aged 11–17 years are inadequately physically active worldwide. Physical activity (PA) recommendations for high school children have not been studied previously in schools in the Qatar region. The objectives of the study were: (i) to assess the level of compliance of the recommended PA and to assess if there are any gender differences; and (ii) to analyze the recommended step count compliance during school and non-school days. An observational cross-sectional study was conducted. Twenty-nine children (12 boys and 17 girls) aged 13–17 years (15.24 ± 1.46) took part in this study. Participants wore Fitbit Charge 5 wrist bands for three weeks to collect various digital biomarkers including moderate-to-vigorous physical activity (MVPA) and step counts (tracking during out-of-school time and school time). Based on this study, high school children in the two Qatar region schools did not meet the MVPA and steps/day recommendation by the established agencies: 38% of the total study group met the recommended 60 min/day of activity (50% boys, 29% girls). Gender differences were also observed in PA levels and steps per day: for non-school days, 17% met the recommended 10,000 steps/day (25% boys, 12% girls). There was a pattern of greater PA performance and steps during the weekdays as opposed to the weekend, but these values showed no robust evidence in favor of H1 or statistical significance for step counts. However, the evidence was robust in favor of H1 (difference between weekend and weekday) due to a statistically significant difference for meeting the 60 min/day activity. While further studies are required to establish if this is a general trend in Qatari schools, this pilot study does highlight the need to design more effective programs and messaging strategies to improve PA levels in the high school population.

Background: Inadequate child feeding practices lead to malnutrition, higher under-five mortality rates and adverse effects on quality of life. This study aimed to assess the breastfeeding and complementary feeding practices of mothers as well as the influence of various sociodemographic factors on them in local families of Lahore. Methods: This is a cross-sectional, descriptive study. It was conducted in CMH (Combined Military Hospital), Lahore in 2018. It comprises a sample of 203 mothers with children of at least two years of age, from various urban areas of Lahore. The subjects were selected on the basis of the inclusion criteria. Mothers with psychiatric illnesses and children with congenital anomalies were excluded from the study. Mothers were approached in the paediatric outpatient departments of four tertiary care hospitals of Lahore. Responses were recorded using a modified version of the Action Contre La Faim (ACF) questionnaire. Independent sample t-test and chi-square test were applied for analysis of the data. Results: Early initiation of breastfeeding within one hour from birth was observed in 83.3% children. Most children were administered colostrum (69.5%). The rate of exclusive breastfeeding for the first six months was 45.3%. A child was being breastfed 8.21 ± 6.67 (mean ± SD) times a day. Maternal educational status, total number of adults in a household, and access to free healthcare were identified as important factors influencing the practice of breastfeeding. Porridge, khichdi, eggs, fruit and yoghurt were the most frequently used complementary foods. Conclusions: A high rate of an early start of breastfeeding and a low rate of exclusive breastfeeding for at least six months were predominant in our population. Administration of colostrum was observed in approximately two-thirds of the study participants. Education of the mother, type of the family system (nuclear or combined), and access to free healthcare strongly influence the breastfeeding practices.

BACKGROUND In 2021 alone, diabetes mellitus, a metabolic disorder primarily characterized by abnormally high blood glucose (BG) levels, affected 537 million people globally, and over 6 million deaths were reported. The use of noninvasive technologies, such as wearable devices (WDs), to regulate and monitor BG in people with diabetes is a relatively new concept and yet in its infancy. Noninvasive WDs coupled with machine learning (ML) techniques have the potential to understand and conclude meaningful information from the gathered data and provide clinically meaningful advanced analytics for the purpose of forecasting or prediction. OBJECTIVE The purpose of this study is to provide a systematic review complete with a quality assessment looking at diabetes effectiveness of using artificial intelligence (AI) in WDs for forecasting or predicting BG levels. METHODS We searched 7 of the most popular bibliographic databases. Two reviewers performed study selection and data extraction independently before cross-checking the extracted data. A narrative approach was used to synthesize the data. Quality assessment was performed using an adapted version of the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. RESULTS From the initial 3872 studies, the features from 12 studies were reported after filtering according to our predefined inclusion criteria. The reference standard in all studies overall (n=11, 92%) was classified as low, as all ground truths were easily replicable. Since the data input to AI technology was highly standardized and there was no effect of flow or time frame on the final output, both factors were categorized in a low-risk group (n=11, 92%). It was observed that classical ML approaches were deployed by half of the studies, the most popular being ensemble-boosted trees (random forest). The most common evaluation metric used was Clarke grid error (n=7, 58%), followed by root mean square error (n=5, 42%). The wide usage of photoplethysmogram and near-infrared sensors was observed on wrist-worn devices. CONCLUSIONS This review has provided the most extensive work to date summarizing WDs that use ML for diabetic-related BG level forecasting or prediction. Although current studies are few, this study suggests that the general quality of the studies was considered high, as revealed by the QUADAS-2 assessment tool. Further validation is needed for commercially available devices, but we envisage that WDs in general have the potential to remove the need for invasive devices completely for glucose monitoring in the not-too-distant future. CLINICALTRIAL PROSPERO CRD42022303175; https://tinyurl.com/3n9jaayc

Aim: To determine the hemodynamic response during insertion of laryngeal mask airway versus conventional intubation. Study design: Randomized controlled trial. Place and duration of study: Department of Anaesthesia, Jinnah Postgraduate Medical Centre, Karachi from 9th June 2016 to 10th December 2016. Methodology: One hundred and fifty-eight patients were enrolled, and they were divided in two groups; Group A (laryngeal mask airway) and patients falling in group B (conventional method). Baseline haemodynamic parameters were noted, and all patients were induced with propofol 2mg.kg 1. In group B, succinylcholine 1.5mg.kg-1 was used to facilitate intubation. After induction appropriate size endotracheal tube or laryngeal mask airway were inserted for airway control. For first five minutes after intervention, analgesics and any other stimulation were avoided, in order to prevent any haemodynamic alteration. All airway interventions were done by anaesthesiologist who had more than 5 years post fellowship experience. Mean arterial pressures were recorded. Initial haemodynamic parameters were measured when the patient enter the operating room and then second reading taken just after induction of anaesthesia, third reading recorded one minute and fourth reading 5 minutes after the intervention (i.e., after passing either endotracheal tube or laryngeal mask airway). Results: The average mean arterial pressure during process of intubation of patients in Group laryngeal mask airway group was 105.21±5.90 while in conventional group the average mean arterial pressure was 102.21±4.29 with P-value=0.001. Conclusion: Intubation through intubating laryngeal mask airway is accompanied by minimal cardiovascular responses than those associated with direct laryngoscopic tracheal intubation, so it can be used for patients in whom a marked pressor response would be deleterious. Keywords: Intubating laryngeal mask airway, Conventional laryngoscopy, Hemodynamic responses, Airway morbidity

Background Anxiety and depression are the most common mental disorders worldwide. Owing to the lack of psychiatrists around the world, the incorporation of artificial intelligence (AI) into wearable devices (wearable AI) has been exploited to provide mental health services. Objective This review aimed to explore the features of wearable AI used for anxiety and depression to identify application areas and open research issues. Methods We searched 8 electronic databases (MEDLINE, PsycINFO, Embase, CINAHL, IEEE Xplore, ACM Digital Library, Scopus, and Google Scholar) and included studies that met the inclusion criteria. Then, we checked the studies that cited the included studies and screened studies that were cited by the included studies. The study selection and data extraction were carried out by 2 reviewers independently. The extracted data were aggregated and summarized using narrative synthesis. Results Of the 1203 studies identified, 69 (5.74%) were included in this review. Approximately, two-thirds of the studies used wearable AI for depression, whereas the remaining studies used it for anxiety. The most frequent application of wearable AI was in diagnosing anxiety and depression; however, none of the studies used it for treatment purposes. Most studies targeted individuals aged between 18 and 65 years. The most common wearable device used in the studies was Actiwatch AW4 (Cambridge Neurotechnology Ltd). Wrist-worn devices were the most common type of wearable device in the studies. The most commonly used category of data for model development was physical activity data, followed by sleep data and heart rate data. The most frequently used data set from open sources was Depresjon. The most commonly used algorithm was random forest, followed by support vector machine. Conclusions Wearable AI can offer great promise in providing mental health services related to anxiety and depression. Wearable AI can be used by individuals for the prescreening assessment of anxiety and depression. Further reviews are needed to statistically synthesize the studies’ results related to the performance and effectiveness of wearable AI. Given its potential, technology companies should invest more in wearable AI for the treatment of anxiety and depression.

Background: Fentanyl-induced cough is a common difficulty encountered at induction of anesthesia. Various interventions both pharmacological and non-pharmacological have been used to prevent this side effect including dexamethasone and propofol. Aim: To compare the effectiveness of dexamethasone and propofol to prevent fentanyl-induced cough at the induction of general anesthesia. Study design: Randomized controlled trial. Place and duration of study: Department of Anaesthesiology, Surgical ICU & Pain Management, Dow University of Health Sciences and Civil Hospital Karachi from 16th September 2011 to 15th March, 2012. Methodology: One hundred patients who underwent elective surgical procedure were selected. Patients were randomized in two groups of 50 patients each; Group D was given intravenous dexamethasone; whereas patients of group P received intravenous propofol as the premedication before induction. The main outcome measure was effectiveness of both drugs to prevent fentanyl-induced cough. Results: Majority of patients (40%) were between 20-30 years of age group with mean age was 35.80±10.14 years. Males were more than females. Intravenous dexamethasone was significantly effective (90%) than intravenous propofol (70%) [p=0.012]. Conclusion: Intravenous dexamethasone is effective in reducing fentanyl-induced cough in comparison to propofol. Keywords: Dexamethasone, Propofol, Fentanyl-induced cough (FIC)

To develop a machine-based algorithm from clinical and demographic data, physical activity and glucose variability to predict hyperglycaemic and hypoglycaemic excursions in patients with type 2 diabetes on multiple glucose lowering therapies who fast during Ramadan.Thirteen patients (10 males and three females) with type 2 diabetes on 3 or more anti-diabetic medications were studied with a Fitbit-2 pedometer device and Freestyle Libre (Abbott Diagnostics) 2 weeks before and 2 weeks during Ramadan. Several machine learning techniques were trained to predict blood glucose levels in a regression framework utilising physical activity and contemporaneous blood glucose levels, comparing Ramadan to non-Ramadan days.The median age of participants was 51 years (IQR 49-52); median BMI was 33.2 kg/mXGBoost, a machine learning AI algorithm achieves high predictive performance for normal and hyperglycaemic excursions, but has limited predictive value for hypoglycaemia in patients on multiple therapies who fast during Ramadan.

Background: There are currently no treatment algorithms specifically for early peri-prosthetic joint infection (PJI) after hemiarthroplasty for hip fracture. Commonly, debridement, antibiotics, and implant retention (DAIR) is attempted as first-line management, despite lack of evidence supporting this strategy in this patient group. The purpose of this study was to evaluate outcomes of DAIR for early PJI after hemiarthroplasty for hip fracture in our unit. Methods: The departmental database from December 2008 to January 2019 was searched to identify all patients in our unit who were treated for early PJI after hemiarthroplasty for hip fracture. Data for included patients were collected from electronic healthcare records and analyzed. Primary outcome measure was treatment success, defined as patient survival to discharge, with eradication of infection and implant retention. Results: Twenty-six patients were identified and included in the study. Mean age was 84.7 years. All except one patient were American Society of Anesthesiologists (ASA) class 3 or 4. All patients were McPherson host grade B or C. Twenty-three of 26 patients underwent DAIR and three of 26 proceeded directly to excision arthroplasty. Debridement, antibiotics, and implant retention was successful in three of 23 patients (13%) after a single procedure, with success in two additional patients after a second procedure, giving overall success rate of five of 23 patients (22%). Conclusions: Debridement, antibiotics, and implant retention has a high failure rate in treating early PJI after hemiarthroplasty for hip fracture. These patients are generally elderly and frail with multiple host and wound compromising factors. Debridement, antibiotics, and implant retention should not be recommended as first-line management for the majority of these patients, for whom getting it right the first time is of vital importance to avoid consequences associated with failed surgical procedures. Further multicenter studies that also explore alternate treatment strategies are required to devise an algorithm specifically for hip fracture patients, to aid decisions on treatment and improve outcomes.

The use of constrained Total Hip Replacements (THR) is controversial due to lack of definite indications and potentially high failure rates because of mechanical loosening or component failure. A review was performed to assess a departmental use of a single constrained acetabular component over a ten years period.Patient demographics, operative indications, complications and patient follow-up were recorded. Post-operative Oxford Hip Scores (OHS) were obtained via a combination of New Zealand Joint Registry interrogation and telephonic questioning. Cup version and inclination angles were obtained from standardised anteroposterior radiographs using established techniques.Forty-four constrained components (in 39 patients) were implanted between 2005 and 2014. The mean age was 78 years with mean ASA 2.7 and mean follow-up 37.2 months (range 13-116). The mean post-operative OHS was 36 (SD 9.25), and there were 4 failures (3 dislocations and 1 peri-prosthetic fracture). The 3 dislocations had either cup ante version (AV) or inclination angles (IA) outside the data set interquartile range (AV 13-24°, IA 40-50°). The cup inclination was significantly lower (p0.01) in patients with pain on sitting. At post-operative follow-up, 14/39 patients had died from unrelated causes, with only 1 patient surviving beyond 6 years.Constrained acetabular components offer a solution to hip instability in a difficult group of patients. This study has shown good medium-term outcomes of a single component type in a predominantly frail group of low demand patients. Despite constraint, correct cup placement (particularly inclination) remains important to prevent dislocation or poor reported outcome.

Approximately 350 million patients of hepatitis B and 170 million patients of Hepatitis C are present worldwide according to WHO. Many risk factors are involved in the transmission of theses deadly viral infections but blood transfusion in Beta thalassemic patients is working with two faces, one as remedy and the other is key risk factor in the spread of silent killers. Thalassemia patients registered in Combine Military Hospital (CMH) Rawalakot and Sheikh Khalifa Bin Zayed Al-Nahyan Hospital, Muzaffarabad Azad Jammu and Kashmir Pakistan were studied for the viral hepatitis B and C prevalence. A total of 303 (including 164 males and 139 females) individuals, aged between 1 and 12 years were studied. All the understudy participants were interviewed through questionnaire method. After taking written consent from each participant or guardian, 5 ml of blood was collected from each participant and brought to the working laboratory for HBV and HCV screening through ICT kit method. All ICT positive samples were further confirmed through ELISA. Individuals 25(8.2%) were found positive for both hepatitis B surface Antigen (HBsAg) and Anti hepatitis C antibody (Anti-HCV antibody) after initial screening with no coinfection of both diseases. Out of 25 total infected individuals, 05(1.6%) were found HBsAg positive and 20(6.6%) were found anti-HCV positive. All the ICT positive individuals were further confirmed by quantitative Enzyme Linked Immunosorbent Assay (ELISA) and 23(7.6%) individuals were confirmed for both hepatitis B and C including 05(1.6%) HBsAg positive as well as 18(5.9%) anti-HCV antibody positive individuals. We can conclude that 8.2% prevalence of hepatitis B and C among thalassemic patients is an alarming health concern which directly indicates to pay attention for ensuring 100% safe blood transfusion.

Neck of femur fractures are the most prevalent type of injury in elderly trauma patients. Both intra and extra capsular type of fractures are equally distributed in the given population. Traditionally, Extra capsular fractures are fixed with Dynamic Hip screw or Intra medullary nailing based on the type of fracture. NICE (National Institute of Clinical Excellence) recommends fixing 31-A1 and 31-A2 fractures with DHS (Dynamic Hip Screw) whereas AO recommends fixing 31-A1 with DHS and 31-A2.1 subtype with DHS and 31-A2.2 and 31-A2.3with IMN (Intra medullary nail). In regional trauma centre 178 patients, 125 females and 53 males with extra capsular neck of femur fractures fixed were selected in a retrospective study. The data was spanning over a period of 1 year. Fractures were classified as per AO classification by two registrars. The implant selection was analysed in terms of the short term out come to find out the cost effectiveness of one over the other. The quality of reduction was assessed as per standard criteria and consideration of lateral femoral wall thickness was taken into account to assess the stability of fracture. The study found more risk of peri prosthetic fractures associated with Intra medullary nailing as compared to Dynamic Hip screw and more risk of Varus collapse was found to be associated with DHS as compared to IM Nail. Moreover, despite of Nail being costly as compared to DHS, the study did not reveal its superiority in terms of inpatient hospital stay. In appropriately selected patient DHS provides results in terms of hospital stay, revision rate and wound complications comparable to IM Nail in the short term justifying its use in the above-mentioned fracture patterns as per the standard National Institute of clinical Excellence guidelines.

Despite growing concerns over pathological internet usage, studies based on validated psychometric instruments are still lacking in Pakistan. This study aimed to examine the psychometric properties of the Internet Addiction Test (IAT) in a sample of Pakistani students. A total of 522 students of medicine and dentistry completed the questionnaire, which consisted of four sections: (a) demographics, (b) number of hours spent on the Internet per day, (c) English version of the IAT, and (d) the Defense Style Questionnaire-40. Maximum likelihood analysis and principal axis factoring were used to validate the factor structure of the IAT. Convergent and criterion validity were assessed by correlating IAT scores with number of hours spent online and defense styles. Exploratory and confirmatory factor analysis reflected the goodness of fit of a unidimensional structure of the IAT, with a high alpha coefficient. The IAT had good face and convergent validity and no floor and ceiling effects, and was judged easy to read by participants.

Road accidents cannot be stopped despite providing the best possible roads and intersections, however there are ways to reduce the impact of road accidents on road-users and the vehicles plying on the road.The incidence of accidental deaths has shown an increasing trend during the period 2005 - 2015 with an increase of 54.3 in the year 2015 as compared to 2005 increase in the rate of accidental deaths during the same period was 25.5.A total of 4,00,517 accidental deaths were reported in the country during 2015 (5,535 more than such deaths reported in 2014) showing an increase of 1.4 as compared to 2014. However, the average rate of Accidental Deaths has remained same 32.6 in 2014 and 2015.In the stretches we studied the road accidents are increasing rapidly .We studied accidental records of various police-stations ,identified the black-spots of accidents and then analyzed the geometric features of those spots whose observation is given in this paper .The identification of such points provides us ease to work on some section of road which is most prone to accidents .We analyzed the geometric deficiencies and they recommended ways to reduce their affects. The findings indicated that large radii right-turn curves were more dangerous than left curves, in particular, during lane changing maneuvers. However sharper curves are more dangerous in both left and right curves. Moreover, motorway carriageways with no or limited shoulders have the highest CR when compared to other carriageway width. Proper traffic guidance and control system to guide road users ensuring safe movement of vehicles has been recommended and some of the facilities such as pedestrian crossings and median openings, acceleration and deceleration lanes were re-designed in order to improve the safety of the road and minimize the accidents.

Introduction: Despite growing concerns over pathological use of the Internet, studies based on validated psychometric instruments are still lacking in Pakistan. The present study aimed to examine the psychometric properties of Young’s Internet Addiction Test (IAT) in a sample of the Pakistani population. We examined the validity, internal consistency, readability and floor and ceiling effects of IAT scores.Methods: This cross-sectional study was conducted at CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan from 1 March 2015 to 30 May 2015. A total of 522 medical and dental students completed the questionnaire, which consisted of three sections: (a) demographics and percentage grades in annual examinations, (b) a categorical question to record the estimated number of hours spent on the Internet per day, and (c) the English version of the IAT. All data were analyzed in SPSS v. 20. Principal axis factor analysis was used to validate the factor structure of the IAT in our study sample. An alpha coefficient > .7 was sought in the reliability analysis. Histograms and the values of skewness and kurtosis were analyzed for floor and ceiling effects. In addition, readability of the IAT was assessed as the Flesch Reading Ease score and Flesch-Kincaid Grade level function. Results: A total of 522 medical and dental students participated in the survey. Most respondents were female medical students enrolled in preclinical years of their degree program. Median age (min-max) of the respondents was 20 years (17-25 years). A single-factor model for IAT score explained 33.71% of the variance, with a high alpha coefficient of .893. In addition, the IAT had good face and convergent validity and no floor and ceiling effects, and was judged easy to read by participants. Conclusion: The English version of the IAT showed good psychometric properties in a sample of Pakistani university students. A single-factor model for assessing internet addiction showed good reliability and was found suitable with our study sample.