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Aim: Hypertension, a prevalent chronic condition, significantly contributes to cardiovascular diseases worldwide. Effective management of hypertension is highly dependent on patient adherence to prescribed medications, as the correct dose at the right time can lead to desirable therapeutic results. This study aims to analyze medication adherence among hypertensive patients in Islamabad and Rawalpindi through an open survey. Methods: A prospective cross-sectional study was conducted from 17th March 2024 to 30th May 2024, targeting hypertensive populations in Islamabad and Rawalpindi. 246 patients were recruited using a sample size formula, and a General Medication Adherence Scale (GMAS) questionnaire was used to collect data. All the tests were conducted as two-sided, with a significance level of P < 0.05 using Python. Results: Among 246 participants (mean age 57.1 years), most were married, literate, and living with families, 63% were from Islamabad, and 78.9% were employed. The study found high adherence in behavior-related areas but low adherence due to costs. Gender showed a statistically significant correlation (P = 0.03) by independent t-test. At the same time, ANOVA tests revealed that educational level (P = 0.02), monthly income (P = 0.001), family support (P = 0.04), and medication costs (P = 0.001) significantly impacted adherence, while factors like social status, employment status, and smoking did not have a considerable influence. Conclusions: 72.4% of patients adhered to their prescribed therapy, and 27.6% did not highlight a critical issue that requires urgent intervention. Variables like gender, educational status, social status, occupation, and living with family are strongly associated with adherence. Common problems include taking multiple medications, lack of awareness about the importance of adherence, and financial constraints.

Background: Intraocular foreign body is an important complication of ocular trauma, especially open globe trauma. It can cause a range of complications leading to severe visual impairment to permanent blindness. They are removed via Pars Plana Vitrectomy using either forceps, endomagnet, or both. Various management techniques and their impact on final visual outcomes are identified in this study. Objective: To study the various factors influencing the final visual outcome in cases of intraocular foreign bodies treated via pars plana vitrectomy and surgical removal of the foreign body. Study type, settings & duration: This retrospective descriptive study was conducted at the Department of Ophthalmology, Allied Hospital, Faisalabad from June 2019 to December 2020. Methodology: About 57 consecutive patients presenting to the Ophthalmology department, Allied Hospital Faisalabad with intraocular foreign bodies were included in this study. All the patients included, underwent pars plana vitrectomy and surgical removal of an intraocular foreign body. The final best-corrected visual acuity of patients was recorded on follow-up visits. Results: The mean age of the participants was 29, 54 (94.7%) were males while only 3 (5.3%) were females. Final visual acuity was significantly poor in patients with foreign bodies involving the retina (p-value: 0.001) and in patients who underwent pars plana vitrectomy and surgical removal of the intraocular foreign body later than 7 days after the trauma p ~0.012 (p

Numerous harmful phenolic contaminants are discharged into water that pose a serious threat to environment where two of the most important purification methodologies for the mitigation of phenolic contaminants are adsorption and photocatalysis. Besides cost, each process has drawbacks in terms of productivity, environmental impact, sludge creation, and the development of harmful by-products. To overcome these limitations, the modeling and optimization of water treatment methods is required. Artificial Intelligence (AI) is employed for the interpretation of treatment-based processes due to powerful learning, simplicity, high estimation accuracy, effectiveness, and improvement of process efficiency where artificial neural networks (ANNs) are most frequently employed for predicting and analyzing the efficiency of processes applied for the mitigation of these phenolic contaminants from water. ANNs are superior to conventional linear regression models because the latter are incapable of dealing with non-linear systems. ANNs can also reduce the operational cost of treating phenol-contaminated water. A correlation coefficient of >0.99 can be achieved using ANN with enhanced phenol mitigation percentage accuracy generally ranging from 80 % to 99.99 %. Using ANN optimization, the maximum phenol mitigation efficiencies achieved were 99.99 % for phenol, 99.93 % for bisphenol A, 99.6 % for nonylphenol, 97.1 % for 2-nitrophenol, 96.6 % for 4-chlorophenol and 90 % for 2,6-dichlorophenol. In numerous ANN models, Levenberg-Marquardt backpropagation algorithm for training was employed using MATLAB software. This study overviews their employment and application for optimization and modeling of removal processes and explicitly discusses the important input and output parameters necessary for better performance of the system. The comparison of ANNs with other AI techniques revealed that ANNs have better predictability for mitigation of most of the phenolic contaminants. Furthermore, several challenges and future prospects have also been discussed.

A simplified synthetic approach involving sulfonylation followed by amino group alkylation produced new 2-aminothiazole derivatives. UV/Vis, infrared, and NMR spectroscopies confirmed their structures. Compounds 36, 22, 34, and 35 showed strong inhibition against Jack bean and Bacillus Pasteurii urease, with IC50 values from 14.06 to 20.21 μM/mL. Compounds 20, 26, 21, 29, 30, 31, and 32 exhibited potent inhibitory effects against α-glucosidase and α-amylase, with IC50 values between 20.34 and 37.20 μM/mL. Compounds 33, 26, and 27 demonstrated potent DPPH scavenging, with IC50 values around 34.4–39.2 μM/mL. FMO analysis showed compounds 21, 22, 24, and 25 having parallel aromatic ring systems due to π cloud interactions, while compounds 32 and 38 had distinct electronic density distributions. Compound 22 had HOMO and LUMO energy gaps of 5.805 eV, with bromo and fluoro substitutions in compounds 21 and 24 slightly increasing the gaps to 6.089 eV and 6.078 eV, respectively. Nitro groups in compounds 25 and 32 reduced the gaps to 0.384 eV and 1.187 eV. All compounds demonstrated high gastrointestinal absorption, non-permeability to the blood-brain barrier, and optimal skin permeation (Log Kp between −5.83 and −6.54 cm/s). Compounds 22, 24, and 38 had promising QED scores of 0.719, 0.707, and 0.860, respectively, with synthetic accessibility scores from 2.057 to 2.517. ADMET predictions indicated minimal toxicity, cardiovascular safety, and significant inhibitory potential for CYP enzymes. Strong in silico binding affinities (binding energies −5.75 to −7.63 kcal/mol) and metabolic stability suggest these derivatives are promising candidates for further drug development.

Background: Blood culture-negative endocarditis (BCNE) is a diagnostic challenge, therefore our objective was to pinpoint high-risk cohorts for BCNE. Methods: The study included adult patients with definite endocarditis. Data were collected via the Infectious Diseases International Research Initiative (ID-IRI). The study analysing one of the largest case series ever reported was conducted across 41 centers in 13 countries. We analysed the database to determine the predictors of BCNE using univariate and logistic regression analyses. Results: Blood cultures were negative in 101 (11.65 %) of 867 patients. We disclosed that as patients age, the likelihood of a negative blood culture significantly decreases (OR 0.975, 95 % CI 0.963–0.987, p

Background: This study aimed to identify factors that influence the mortality rate of patients with coronavirus disease (COVID-19)-associated pulmonary aspergillosis (CAPA). Methods: In this cross-sectional study, data from 23 centers across 15 countries, spanning the period of March 2020 to December 2021, were retrospectively collected. The study population comprised patients who developed invasive pulmonary aspergillosis while being treated for COVID-19 in the intensive care unit. Cox regression and decision tree analyses were used to identify factors associated with mortality in patients with CAPA. Results: A total of 162 patients (males, 65.4 %; median age: 64 [25th–75th: 54.0–73.8] years) were included in the study, of whom 113 died during the 90-day follow-up period. The median duration from CAPA diagnosis to death was 12 (25th–75th: 7–19) days. In the multivariable Cox regression model, an age of ≥65 years (hazard ratio [HR]: 2.05, 95 % confidence interval [CI]: 1.37–3.07), requiring vasopressor therapy at the time of CAPA diagnosis (HR: 1.80, 95 % CI: 1.17–2.76), and receiving renal replacement therapy at the time of CAPA diagnosis (HR: 2.27, 95 % CI: 1.35–3.82) were identified as predictors of mortality. Decision tree analysis revealed that patients with CAPA aged ≥65 years who received corticosteroid treatment for COVID-19 displayed higher mortality rates (estimated rate: 1.6, observed in 46 % of patients). Conclusion: This study concluded that elderly patients with CAPA who receive corticosteroids are at a significantly higher risk of mortality, particularly if they experience multiorgan failure.

ABSTRACT BACKGROUND: Treating patients with multi-morbidities have always been more difficult when compared to patients with no co-morbid conditions. Hence data from this study will empower us in exhibiting effective plans in the management of multi-morbidities with sepsis in our region. Objective: To determine the association of multi-morbidities with sepsis in adult patients admitted in a tertiary care hospital. Materials and Method: This is a case-control study conducted in the Medicine Wards and Intensive Care Unit of a tertiary care hospital in Karachi during the period of May 2018 to October 2018. Results: In this study, 52 patients were enrolled. The mean age of patients was 59.35 ± 6.17. Socioeconomic Status showed significant association (p-value 0.034). The Mean SOFA Score was 2.13 ± 1.86. The Odds of having cancer [OR: 3.10 (0.10 - 80.1), p-value 0.50] and other multimorbidities like rheumatoid arthritis [OR: 3.30 (0.30 - 33.6), p-value 0.32] in cases of sepsis respectively were more than in controls but the data was not statistically significant. The Mean Length of Hospital Stay was 4.71 ± 2.08. Conclusion: An association of multimorbidities in patients with sepsis could not be determined and requires to be researched further.

Abstract The growing freshwater scarcity has caused increased use of membrane desalination of seawater as a relatively sustainable technology that promises to provide long-term solution for the increasingly water-stressed world. However, the currently used membranes for desalination on an industrial scale are inevitably prone to fouling that results in decreased flux and necessity for periodic chemical cleaning, and incur unacceptably high energy cost while also leaving an environmental footprint with unforeseeable long-term consequences. This extant problem requires an immediate shift to smart separation approaches with self-cleaning capability for enhanced efficiency and prolonged operational lifetime. Here, we describe a conceptually innovative approach to the design of smart membranes where a dynamic functionality is added to the surface layer of otherwise static membranes by incorporating stimuli-responsive organic crystals. We demonstrate a gating effect in the resulting smart dynamic membranes, whereby mechanical instability caused by rapid mechanical response of the crystals to heating slightly above room temperature activates the membrane and effectively removes the foulants, thereby increasing the mass transfer and extending its operational lifetime. The approach proposed here sets a platform for the development of a variety of energy-efficient hybrid membranes for water desalination and other separation processes that are devoid of fouling issues and circumvents the necessity of chemical cleaning operations.

Salmonella Typhi infection in a patient in Pakistan initially responded to standard treatment but failed to respond to subsequent treatment. The first strain was susceptible to carbapenems and azithromycin; subsequent strains harbored the NDM-5 gene. Treatment with a combination of intravenous meropenem and colistin was successful. Carbapenem-resistant Salmonella Typhi emergence will hinder treatment.

Aim. The present study was carried out to evaluate the wound healing potential of crude Hydroalcoholic fruit extracts of Grape (Vitis vinifera L.) and Pomegranate (Punica granatum L.) in experimental animals.

This research utilizes the innovative fractional-order Archimedean spiral moth–flame optimization (FO-AMFO) technique to address the issues of the optimal reactive power dispatch (ORPD) problem. The formulated fitness function aims to minimize power losses and determine the ideal flow of reactive power for the IEEE 30- and 57-bus test systems. The extensive functions of the fractional evolutionary computing strategy are utilized to address the minimization problem of ORPD. This involves determining the control variables, such as VAR compensators, bus voltages, and the tap setting of the transformers. The effective incorporation of reactive compensation devices into traditional power grids has greatly reduced power losses; however, it has resulted in an increase in the complexity of optimization problems. A comparison of the findings indicates that swarming fractional intelligence using FO-AMFO surpassed the state-of-the-art competitors in terms of minimizing power losses.

We explored the self-reported antibiotic stewardship (AS), and infection prevention and control (IPC) activities in intensive care units (ICUs) of different income settings. A cross-sectional study was conducted using an online questionnaire to collect data about IPC and AS measures in participating ICUs. The study participants were Infectious Diseases–International Research Initiative (IDI-IR) members, committed as per their institutional agreement form. We analyzed responses from 57 ICUs in 24 countries (Lower-middle income (LMI), n = 13; Upper-middle income (UMI), n = 33; High-income (HI), n = 11). This represented (~5%) of centers represented in the ID-IRI. Surveillance programs were implemented in (76.9%−90.9%) of ICUs with fewer contact precaution measures in LMI ones (p = 0.02); (LMI:69.2%, UMI:97%, HI:100%). Participation in regional antimicrobial resistance programs was more significantly applied in HI (p = 0.02) (LMI:38.4%,UMI:81.8%,HI:72.2%). AS programs are implemented in 77.2% of institutions with AS champions in 66.7%. Infectious diseases physicians and microbiologists are members of many AS teams (59%&50%) respectively. Unqualified healthcare professionals(42.1%), and deficient incentives(28.1%) are the main barriers to implementing AS. We underscore the existing differences in IPC and AS programs’ implementation, team composition, and faced barriers. Continuous collaboration and sharing best practices on APM is needed. The role of regional and international organizations should be encouraged. Global support for capacity building of healthcare practitioners is warranted.

The term infantile seborrhoeic dermatitis is used to describe as apparently particularly eczematous or psoriasiform eruption seen in infants, having a fondness for the scalp and flexures, and can be compared with atopic dermatitis. This is a very common problem in neonates. We reported a 20th-day-old male neonate brought to us with his mother having complaints of yellowish greasy scales with thick greenish crust on them. Lesions were present on the scalp and the face.

Organic electronics requires dynamic materials, however, most of them have small strokes and operate at high temperatures. Here, the authors describe organic crystal that repeatedly expands and contracts nearly half its length around room temperature.

Background: Pharmaceutical care (PC) is the new way of practicing the pharmacist's rule; practicing the PC will improve the quality of life of the patient by providing advices and counseling such as following up the patient after taking the medicines. Objective: Evaluating the knowledge, attitude, practice, and perceived barriers of community pharmacists in Qassim, Saudi Arabia, toward the provision of PC. Materials and Methods: A cross-sectional study consisting of a questionnaire was conducted to gather data from pharmacy professionals working in community pharmacies in Qassim region of Saudi Arabia between September 2019 and May 2020. A sample of 130 pharmacists were given the questionnaire by the investigator. Results: The respondents showed a positive knowledge as 60% think that the medications should be dispensed to patients only, and 95.4% of the respondents are willing to counsel and offer advice to the patients. For attitude, there was also a positive response as 92.3% agreed that primary responsibility of community pharmacists is for providing PC. For practicing, a positive response was also found as 94.6% of the respondents do collect medication history from the patient, while 68.5% of the respondents follow up the patient's progress and assured that desired outcomes have been achieved. For barriers, lack of space and privacy were the most agreed barriers by the respondents with 63%. Conclusions: Community pharmacists have shown good knowledge, attitude, and practice in relation to the provision of PC in our study and major barrier we found in our study that lack of privacy in the pharmacy in which the patients will not be willing to express or explain their health or drug-related problems comfortably.

Abstract Background Malaria is still major problem in developing countries, such as Pakistan. Besides fever, body ache and vomiting it can present with acute kidney injury, proteinuria, hematuria and cerebral manifestations which are more common with falciparum malaria. Neurological manifestations are rare presentation of malaria and should be consider in patients who are admitting with features of neuropathy and stroke. Case presentation We describe an unusual case of falciparum malaria, complicated by acute kidney injury who developed Polyneuropathy and intra-arterial thrombosis in middle cerebral artery territory. Our patient recovered his renal functions during admission and recovered his power and sensation in his limbs as well after 1 month. Conclusion Malaria cause neurological manifestations including axonal and sensory neuropathy, cerebral venous and arterial thrombosis, PMNS, cerebellar signs and symptoms, psychosis, etc. With prompt diagnosis and early treatment they can be cure and regain their motor and sensory functions to normal level.

Titanium dioxide (TiO2) has been investigated for solar-energy-driven photoelectrical water splitting due to its suitable band gap, abundance, cost savings, environmental friendliness, and chemical stability. However, its poor conductivity, weak light absorption, and large indirect bandgap (3.2 eV) has limited its application in water splitting. In this study, we precisely targeted these limitations using first-principle techniques. TiO2 only absorbs near-ultraviolet radiation; therefore, the substitution (2.1%) of Ag, Fe, and Co in TiO2 significantly altered its physical properties and shifted the bandgap from the ultraviolet to the visible region. Cobalt (Co) substitution in TiO2 resulted in high absorption and photoconductivity and a low bandgap energy suitable for the reduction in water without the need for external energy. The calculated elastic properties of Co-doped TiO2 indicate the ductile nature of the material with a strong average bond strength. Co-doped TiO2 exhibited fewer microcracks with a mechanically stable composition.

Appropriate drug information is vital for the correct use of drugs in pharmaceutical practice. Providing patients with educational advice on prescribed medication and on proper medication administration has become an essential part of the pharmaceutical care process. The objectives of this study were to identify patients’ knowledge of prescribed medications, their desire for more information, and the sources of medication information in a population from Qassim, Saudi Arabia, using a cross-sectional descriptive study. Our target population consisted of adult patients with chronic illnesses receiving drugs at outpatient pharmacies. Nineteen pharmacies were selected based on convenience. After collecting their prescriptions, patients were asked to take part in the study by interviewers as they were leaving the pharmacies. The questionnaire used was pretested on 18 patients and then modified accordingly. questions investigated participants’ knowledge of drug information, their wish for more information, and their sources of drug information, other than clinicians. Descriptive analysis was used to describe patients’ physical details. The effect of sex, education, diagnosis, number of drugs, and age on knowledge of the purpose of drugs and the need for additional information were tested using Chi-square test. A total of 270 patients were interviewed, of whom 29.7% reported not knowing the purpose of at least one of their medications, and only reading a portion of the PILs. Of the patients sampled, 56.7% said they read the side effects section of the PIL, 43.3% reported reading the uses, while 27% read the contraindications. The drug -interactions section was the least read, with only 18.9% reporting reading it. A total of 57% of the patients reported that they needed more information about their medications. Highly educated patients reported using the PIL, social media, family and friends, TV, and newspapers as sources of drug information at significantly higher rates than patients with lower levels of education. Healthcare professionals should assess patient comprehension and the need for additional drug information, especially among patients with low levels of education. Additionally, healthcare professionals should consider other information sources used by their patients.

Fiber-optics based on organic crystals could have potential for unique telecommunications applications but typically transmit visible wavelengths. Here the authors present mechanically robust organic crystals with favourable optical properties across the main telecommunication bands in the near-infrared.

Abstract Hematite (Fe2O3) is one of the best candidates for photoelectrochemical water splitting due to its abundance and suitable bandgap. However, its efficiency is mostly impeded due to the intrinsically low conductivity and poor light absorption. In this study, we targeted this intrinsic behavior to investigate the thermodynamic stability, photoconductivity and optical properties of rhodium doped hematite using density functional theory. The calculated formation energy of pristine and rhodium doped hematite was − 4.47 eV and − 5.34 eV respectively, suggesting that the doped material is thermodynamically more stable. The DFT results established that the bandgap of doped hematite narrowed down to the lower edge (1.61 eV) in the visible region which enhanced the optical absorption and photoconductivity of the material. Moreover, doped hematite has the ability to absorb a broad spectrum (250–800) nm. The enhanced optical absorption boosted the photocurrent and incident photon to current efficiency. The calculated results also showed that the incorporation of rhodium in hematite induced a redshift in optical properties.

Objective: The aim of this study was to investigate maternal serum levels of an angiogenic factor called Placental Growth Factor (PLGF) at different ages of pregnancy in gestational hypertensive women residing in Raiwind Lahore, Pakistan. Methods: The analytical cross-sectional study was conducted at the Department of Obstetrics and Gynecology Sharif Medical City Hospital, Lahore from January 2015 - April 2015. Serum levels of PLGF were measured and compared between 22 control normotensive subjects (Group A) and 18 gestational hypertensive (Group B). Moreover, comparison was also made among different gestational weeks groups (I, II and III). Results: Serum PLGF levels were raised in gestational hypertensive (Group B) compare to normotensive (Group A) [366 (185-695) vs. 156 (132-319) ng/L], (P= 0.024). Serum PLGF levels were 156 (132-319) in gestational hypertensive individuals and 366 (185-695) ng/L in normotensive individuals. Serum levels PLGF of 18 -28 (I), 29-35 gestational weeks (II) were raised [425 (197-452) vs. 163 (91-332)], [546 (309-1519) vs. 137 (86-147)]. While in last 36- 40 weeks group (III) levels were decreased [216 (136-881) vs. 315 (185-612)] in comparison of normotensive subjects. Conclusion: It is concluded from this research that placental–derived angiogenic biomarker PLGF plays a significant role in gestational hypertension. The pattern of the PLGF marker in various intervals of pregnancy may provide information for the management of hypertension in pregnancy.

A 32-year-old woman presented with moderate effort intolerance, hemoptysis and cyanosis.She was found to have pulmonary arteriovenous malformations (PAVM) in the right lower lobe along with severe rheumatic calcific mitral stenosis. She underwent hybrid intervention, initially transcatheter fistula closure with CERA 24 mm Vascular Plug followed by mitral valve replacement. Her saturation normalized following intervention. She remained well in short term follow up.

Due to the drastic increase in the research publications, numerous research articles are available electronically on different online digital libraries. Some research articles or papers are not retrieved during online searches due to their classification issues. The adequately structured research articles are relatively easily approachable as compared to semi-structured and unstructured research articles, and sometimes the reader does not get accurate results on different digital libraries as the research articles are not classified properly. Neglecting the semi-structured and unstructured published research not only causes gap deficiency but also affects the results of the proposed techniques and citations for other articles. Usually, researchers missed semi-structured and unstructured research articles during their online search. Classification techniques have been applied to structured articles and no significant work has been performed towards the classification of semi-structured and unstructured research articles. Therefore, this research focuses on the classification of semi-structured research articles using different supervised classification techniques so that the most accurate and large amount of relevant research results will be achieved. For experimentation, a labeled dataset was used for the classification of semi-structured papers. The dataset we used for experimentation is comprised of manually gathered research articles from Santos repository dataset and labeling them accordingly. The current study used four different supervised classification techniques such as Support Vector Machine (SVM) classifier, Naïve Based classifier, K Nearest Neighbor classifier, and Decision Tree classifier. The comparison was performed between these supervised classification techniques to see which classifier gives better accuracy. The unit of measures or parameters selected to compare these classifiers are: accuracy, recall, precision, and f-score. The evaluation was performed on the basis of results and comparison in the experimentation. Experimental results of classifiers K-neighbor are better than other classifiers SVM, Decision Trees and Naive Bayes

Recent developments in mobile and wireless networks have paved the way for them to become a fabric of society and the economy. The ever-increasing penetration rate of mobile telephony and wireless broadband data access, and the ubiquity of WiFi are just a few examples of this phenomenon. While multihop wireless networks (e.g., WiMax, LTE-A, ad hoc, sensor, and mesh networks) offer many advantages, such as enhanced capacity, extended communication range, deployment, and operational flexibility, they usually lack provisioning for network robustness and do not, in general, withstand network equipment failures. Network failures may have drastic effects on network performance and hinder network operation. The capability of a network to deliver data successfully in a timely manner and continue its services despite the presence of failures and attacks is referred to as survivability, which is an important system design and operational characteristic that must be provisioned.

Intracranial hemorrhage (ICH) can lead to death or disability, which requires immediate action from radiologists. Due to the heavy workload, less experienced staff, and the complexity of subtle hemorrhages, a more intelligent and automated system is necessary to detect ICH. In literature, many artificial-intelligence-based methods are proposed. However, they are less accurate for ICH detection and subtype classification. Therefore, in this paper, we present a new methodology to improve the detection and subtype classification of ICH based on two parallel paths and a boosting technique. The first path employs the architecture of ResNet101-V2 to extract potential features from windowed slices, whereas Inception-V4 captures significant spatial information in the second path. Afterwards, the detection and subtype classification of ICH is performed by the light gradient boosting machine (LGBM) using the outputs of ResNet101-V2 and Inception-V4. Thus, the combined solution, known as ResNet101-V2, Inception-V4, and LGBM (Res-Inc-LGBM), is trained and tested over the brain computed tomography (CT) scans of CQ500 and Radiological Society of North America (RSNA) datasets. The experimental results state that the proposed solution efficiently obtains 97.7% accuracy, 96.5% sensitivity, and 97.4% F1 score using the RSNA dataset. Moreover, the proposed Res-Inc-LGBM outperforms the standard benchmarks for the detection and subtype classification of ICH regarding the accuracy, sensitivity, and F1 score. The results prove the significance of the proposed solution for its real-time application.

Lateral angular dermoid may have associated bony defects which must be recognized before surgery. High-resolution 3-D CT scans and MRIs define these lesions very clearly. Total excision with attention to the bony defect is usually curative. CSF leak from the operative wound at the surgery or in the post-operative period signifies the intracranial connection or dural adhesion unnoticed by the Ophthalmologist before surgery.

One nation with the highest risk of climate catastrophes is Pakistan. Pakistan’s geographical nature makes it susceptible to natural hazards. Pakistan is facing regional differences in terms of climate change. The frequency and intensity of natural hazards due to climate change vary from place to place. There is an urgent need to recognize the spatial variations in natural hazards inside the country. To address such problems, it might be useful to map out the areas that need resources to increase resilience and accomplish adaptability. Therefore, the main goal of this research was to create a district-level map that illustrates the multi-hazard zones of various regions in Pakistan. In order to comprehend the geographical differences in climate change and natural hazards across Pakistan, this study examines the relevant literature and data currently available regarding the occurrence of natural hazards in the past. Firstly, a district-level comprehensive database of Pakistan’s five natural hazards (floods, droughts, earthquakes, heatwaves, and landslides) was created. Through consultation with specialists in related areas, hazard and weighting factors for a specific hazard were specified based on the structured district-level historical disaster database of Pakistan. After that, individual and multi-hazard ratings were computed for each district. Then, using estimated multi-hazard scores, the districts of Pakistan were classified into four zones. Finally, a map of Pakistan’s multi-hazard zones was created per district. The study results are essential and significant for policymakers to consider when making decisions on disaster management techniques, that is, when organizing disaster preparedness, mitigation, and prevention plans.

Objective: To determine the correlation between mean serum C-reactive protein (CRP) level and mean lesion volume in acute ischemic stroke. Study Design: Cross sectional study. Place and Duration of Study: This study was conducted at Department of Neurology and General Medicine Combined Military Hospital, Quetta, Pakistan, from Jan 2016 to Jul 2016. Methodology: A total of 50 patients of both genders fulfilling the inclusion criteria were included in the study using non-probability consecutive sampling technique after taking informed consent. All patients were subjected to CT scan and infarct volume was calculated. Meanwhile blood samples were collected for CRP levels. Results: 21 (42%) were between 18-50 years of age while 29 (58%) were between 51-80 years of age. Mean age was 52.46 ± 13.33 years, 31 (62%) were male and 19 (38%) were females, mean serum CRP level of the patients was 37.56 ± 30.78 mg/L, mean lesion volume in acute ischemic stroke cases as 7.5 ± 3.59, Pearson correlation coefficient of mean lesion volume and serum CRP in acute ischemic stroke was calculated r=0.9162 (p-value 0.01). Conclusion: Correlation between CRP levels and infarction volume on CT scan in Acute Ischemic Stroke was found to be positive, therefore it may be used as a routine screening tool for estimation of infarct volume.

Objective: To determine the efficacy of atorvastatin in reducing proteinuria in patients of chronic kidney disease. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital Multan, from Jan 2014 to Jun 2014. Material and Methods: Seventy patients of both genders with documented chronic kidney disease (GFR 15ml/min) for at least 3 months duration were included by non-probability consecutive sampling. Age of the patients and reduction in proteinuria from the baseline after using atorvastatin was noted. The data were analyzed by using SPSS v 19. Descriptive statistics like mean ± SD, percentages and frequencies were calculated for age and efficacy of atorvastatin. The data collected for study was statistically analyzed using chi-square test. Results: The overall efficacy of atorvastatin was 31.43%. Twenty two out of 70 subjects had significant reduction in proteinuria i.e.>0.25 gm/24 hrs from baseline after statin use. A significant statistical association was not seen in the efficacy of atorvastatin between males and females, p-value being >0.05. Conclusion: A notable number of patients had improvement in their 24 hours proteinuria after the use of atorvastatin. Therefore atorvastatin use may be beneficial in all patients of chronic kidney disease as it will reduce progression of the disease and prevent rate of decline in renal functioning.

Molecular crystals can be bent elastically by expansion or contraction on opposite faces, or plastically by delamination into slabs that glide along slip planes. Here the authors report crystals that can be bent plastically while undergoing a mechanically induced phase transition without delamination.

Prosthetic valve endocarditis with aortic root abscess is a serious condition requiring urgent surgical intervention. We present a case caused by an infected Bentall mechanical valve conduit after cardiac surgery in a patient who was referred for a suprasternal pulsatile mass. The patient also had 1 episode of sentinel haemorrhage.

Chemiluminescence is known in solution, but has remained undetected in macroscopic crystalline solids so far. Here the authors demonstrate direct transduction of heat into light by thermochemiluminescence in a centimeter-size lophine hydroperoxide crystal.

With the advent of wireless sensor networks and their deep integration with the world have enabled users worldwide to achieve benefits from location-based services through mobile applications, the problems such as low bandwidth, high network traffic, and disconnections issues are normally extracted from mobile services. An efficient database system is required to manage mentioned problems. Our research work finds the probability of user’s next locations. A mobile user (query issuer) changes its position when performing a specific mobile search, where these queries change and repeat the search with the issuer position. Moreover, the query issuer can be static and may perform searches with varying conditions of queries. Data is exchanged with mobile devices and questions that are formulated during searching for query issuer locations. An aim of the research work is achieved through effectively processing of queries in terms of location-dependent, originated by mobile users. Significant studies have been performed in this field in the last two decades. In this paper, our novel approach comprise of usage of semantic caches with the Bayesian networks using a prediction algorithm. Our approach is unique and distinct from the traditional query processing system especially in mobile domain for the prediction of future locations of users. Consequently, a better search is analyzed using the response time of data fetch from the cache.

According to World Health Organization (WHO), the leading cause of fatalities and injuries is rear-ending collision in vehicles. The critical challenge of the technologically rich transportation system is to reduce the chances of accidents between vehicles. For this purpose, it is especially important to analyze the factors that are the cause of accidents. Based on these factors’ results, this paper presents a driver assistance system for collision avoidance. There are many factors involved in collisions in the existing literature from which we identified some factors which can affect the accident occurrence probability. However, with advancements in the technologies of autonomous vehicles, these factors can be controlled using an onboard driver assistance system. We used MATLAB’s Fuzzy Inference System Tool to analyze the categories of accident contributing factors. Fuzzy results are validated using the VOMAS agent in the NetLogo simulation model. The proposed system can inform the vehicle’s automated system when chances of an accident are higher so that the vehicle may take control from the driver. The proposed research is extremely helpful in handling various kinds of factors involved in accidents. The results of the experiments demonstrated that multi-factor-enabled vehicles could better avoid collision as compared to other vehicles.

Disaster management organizations such as fire brigades, rescue teams, and emergency medical service providers have a high priority demand to communicate with each other and with the victims by using mission-critical voice and data communications [item 1) in the Appendix]. In recent years, public safety agencies and organizations have started planning to evolve their existing land mobile radio system (LMRS) with long-term evolution (LTE)-based public safety solutions which provides broadband, ubiquitous, and mission-critical voice and data services. LTE provides high bandwidth and low latency services to the customers using internet protocol-based LTE network. Since mission critical communication services have different demands and priorities for dynamically varying situations for disaster-hit areas, the architecture and the communication technologies of the existing LTE networks need to be upgraded with a system that has the capability to respond efficiently and in a timely manner during critical situations.

Background:Candida auris has emerged globally as a multi-drug resistant yeast and is commonly associated with nosocomial outbreaks in ICUs. Methods: We conducted a retrospective observational multicentre study to determine the epidemiology of C. auris infections, its management strategies, patient outcomes, and infection prevention and control practices across 10 centres from five countries. Results: Significant risk factors for C. auris infection include the age group of 61–70 years (39%), recent history of ICU admission (63%), diabetes (63%), renal failure (52%), presence of CVC (91%) and previous history of antibiotic treatment (96%). C. auris was commonly isolated from blood (76%). Echinocandins were the most sensitive drugs. Most common antifungals used for treatment were caspofungin (40%), anidulafungin (28%) and micafungin (15%). The median duration of treatment was 20 days. Source removal was conductedin 74% patients. All-cause crude mortality rate after 30 days was 37%. Antifungal therapy was associated with a reduction in mortality (OR:0.27) and so was source removal (OR:0.74). Contact isolation precautions were followed in 87% patients. Conclusions:C. auris infection carries a high risk for associated mortality. The organism is mainly resistant to most azoles and even amphotericin-B. Targeted antifungal therapy, mainly an echinocandin, and source control are the prominent therapeutic approaches.

Background: Hypertension is a major public health problem worldwide and a key factor for chronic kidney disease (CKD). Detection and treatment of CKD is of paramount importance. Albuminuria is one of the earliest screening markers recommended in patients at increased risk for CKD. Objective: We conducted this study to determine the prevalence of persistent albuminuria (PA) in newly diagnosed hypertensive subjects and to study its associated risk factors. Methods: A total of 173 (72%) of 240 subjects among 1340 newly diagnosed hypertensive subjects from an ongoing community-based cohort study who had been screened once for the presence of albuminuria were retested for the presence of PA in this study. Urinary albumin concentration (UAC) in mg/L and albumin-to-creatinine ratio (ACR) in mg/g creatinine were determined in a spot morning urine sample by nephelometry. Results: The prevalence of PA signifying CKD was 9.3% with 95% confidence interval (CI) of 7.8–10.8% by UAC and 8.1% by ACR method (95% CI: 6.6–8.4%). Subjects with PA had mean age of 56.4 ± 11.4 years and 50% were males. Factors independently associated were male gender (odds ratio [OR], 1.92 (95% CI: 1.24–2.97)) and age less than 55 years with positive family history of kidney disease (OR, 15.51; 95% CI: 7.35–32.97). Among measurable variables, high cholesterol levels (p = 0.001), and progressively higher levels of systolic blood pressure (p < 0.001) were associated with risk of PA. Conclusion: Hypertensive kidney damage is already present in a significant number of newly diagnosed hypertensives suggesting late detection of hypertension.

Mobile Ad Hoc Cloud (MAC) enables the use of a multitude of proximate resource-rich mobile devices to provide computational services in the vicinity. However, inattention to mobile device resources and operational heterogeneity-measuring parameters, such as CPU speed, number of cores, and workload, when allocating task in MAC, causes inefficient resource utilization that prolongs task execution time and consumes large amounts of energy. Task execution is remarkably degraded, because the longer execution time and high energy consumption impede the optimum use of MAC. This paper aims to minimize execution time and energy consumption by proposing heterogeneity-aware task allocation solutions for MAC-based compute-intensive tasks. Results of the proposed solutions reveal that incorporation of the heterogeneity-measuring parameters guarantees a shorter execution time and reduces the energy consumption of the compute-intensive tasks in MAC. A system model is developed to validate the proposed solutions' empirical results. In comparison with random-based task allocation, the proposed five solutions based on CPU speed, number of core, workload, CPU speed and workload, and CPU speed, core, and workload reduce execution time up to 56.72%, 53.12%, 56.97%, 61.23%, and 71.55%, respectively. In addition, these heterogeneity-aware task allocation solutions save energy up to 69.78%, 69.06%, 68.25%, 67.26%, and 57.33%, respectively. For this reason, the proposed solutions significantly improve tasks' execution performance, which can increase the optimum use of MAC.

Objective: To observe the post-operative anatomical and visual results of primary vitrectomy alone versus vitrectomy plus encircling scleral buckle (SB) for the treatment of rhegmatogenous retinal detachment (RRD). Study type, settings and duration: An analytic and comparative study, conducted in Department of Ophthalmology, Allied Hospital, Faisalabad from March 2017 to September 2018. Methodology: This study was carried out on 50 Patients of RRD with inferior breaks at the Vitreo-Retina center of Eye Department Allied Hospital, FMU, Faisalabad. Each patient was informed and briefed about the study and enrolled after written informed consent .The study patients were divided into two groups named as group I and II, each having 25 patients of rhegmatogenous retinal detachments. The patients in Group I underwent pars-plana vitrectomy alone with silicon oil (SO) injection as internal tamponade and the patients in group II underwent PPV with 360o encircling scleral buckle (SB) and silicon oil (SO) injection as additional internal tamponade. All the cases were operated by single surgeon and with the same vitrectomy machine (Pulsar- II).The essential post-operative parameters were single operation success rate(SOSR) after retinal reattachment. Each patient was followed for 3 months with an interval of 2 weeks between each visit. Results: Single operation success rate (SOSR) in group I was 76% (19 out of 25 patients) and in group II it was 80% (20 out of 25 Patients). The retinal re-detachment occurred in 24% (6 out of 25 patients) in group I and 20% ( 5 out of 25 patients) in group II. Conclusion: Both the surgical procedures had good results as group II had 80% Single operation success rate (SOSR) and group 1 had 76% SOSR .This study showed almost same post -operative results in both groups.

Four edible fruits from Vitis vinifera, Punica granatum, Citrus aurantium and Opuntia ficus indica from Algeria were analyzed in order to determine the total polyphenol, total flavonoid and flavonol contents using classical spectrophotometric methods. The antioxidant activity was established by three different single-electron-transfer-based assays (ABTS radical cation, FRAP, and DPPH assays) and one hydrogen-atom-transfer based assay (ORAC). Among the four fruits tested, the Vitis vinifera hydroalcoholic extract showed the highest antioxidant capacity with all methods. The results indicated that the antioxidant activity and the total phenolic content of the selected plants are significantly different (p < 0.001).

We report a case of a type B aortic dissection with an aneurysm treated by the replacement of the proximal descending thoracic aorta via the reversed elephant trunk technique. A 48-year-old asymptomatic man was diagnosed with a type B aortic dissection, moderate aortic regurgitation, and a good biventricular function in March 2012. Four years later (April 2016), a contrast-enhanced computed tomography examination revealed an aneurysmal dilatation in the patient’s descending thoracic aorta with a thrombosis in the proximal part of the false lumen, which warranted surgical repair. He underwent type B aortic dissection repair through the left posterolateral thoracotomy. Three months after the surgery, the patient developed a type A aortic dissection with severe aortic regurgitation, which was successfully managed via a Bentall procedure with arch replacement facilitated by the reversed elephant trunk technique performed during the initial surgery through thoracotomy. At 2 years follow-up, the patient was doing well with a normal left ventricular function.

Complex cyanotic congenital heart diseases with left isomerism are sometimes associated with atrioventricular nodal conduction disturbances that may need permanent pacing. Surgical palliation in such anatomy connecting the superior vena cava to the pulmonary artery precludes a transvenous access for an endocardial pacing lead to the ventricles. Epicardial leads in these patients fail if the pacing thresholds are very high. We report transhepatic permanent ventricular lead implantation for a young boy with heterotaxy complicated by complete heart block.

Recent advancements in integrated circuits, wireless communication, and MicroElectroMechanical Systems (MEMS) technology has enabled low power, nano-technology wireless sensor nodes strategically deployed on the human body to be used by different applications, such as health monitoring, assisted living, and telemedicine. This new area of research is known as Body Area Networks (BANs) [1], [2]. BAN applications cover a wide area such as sports, entertainment, military, ubiquitous health care, and many other areas. BAN has multiple opportunities of interdisciplinary research where researchers from different areas of science and technology jointly put their efforts to improve the human body monitoring and performance. Due to these joint efforts, BAN is now evolving into Body Area Nano Networks (BANNs) as well [3], [4]. The BANNs are further extended with Internet of Nano Things and Internet of Bio-Nano Things technologies.

Background: Conventional methods of closure of ventricular septal defects involve placement of sutures 4-5 mm from the posterior inferior margin. This study compares the conventional method with an alternative technique wherein sutures are placed along the edge of the defect thereby “excluding” the conduction system and the tensor apparatus of the tricuspid valve from the suture line. Materials and Methods: Between January 2013 and January 2016, 409 consecutive patients were retrospectively reviewed and divided into two matched groups. Group A (n = 174) underwent closure using the alternative technique and Group B (n = 235) with the conventional technique. Patients with isolated ventricular septal defects (VSDs) (n = 136) were separately analyzed as were infants within this subset. Results: Immediate postoperative results were similar with no statistically significant differences in either group in terms of incidence of residual defects or postoperative tricuspid regurgitation. There was however a significantly increased incidence of post operative complete heart block (CHB) among patients in the conventional group (P = 0.02). Incidence of temporary heart block that reverted to sinus rhythm was also more in the conventional method group (Group B) (P = 0.03) as was right bundle branch block (P ≤ 0.05) in all the subsets of patients analyzed. Conclusion: Surgical closure of VSDs can be accomplished by placing sutures along the margins or away with comparable results. The incidence of CHB, however, seems to be less when the “excluding” technique is employed.

OBJECTIVE: This study aims to determine the frequency of organophosphate poisoning outcomes at tertiary care hospital at Nawabshah. DESIGN: Descriptive Study. SETTING: Intensive Care Unit at Peoples University of Medical and Health Sciences for Women, Nawabshah. MATERIAL AND METHOD: A retrospective study of 387 patients of organophosphate poisoning admitted in Intensive Care Unit at Peoples University of Medical and Health Sciences for Women, Nawabshah, catering all cases from urban and rural areas, during the years January 2013 to December 2015. The Intensive Care Unit is fully equipped with all modern equipment to treat cases of poisoning. The record of the patients were reviewed and the data was entered in proforma for further analysis. The variable considered were gender, age and yearly outcome was presented as frequencies and percentage whereas age was presented as mean ±SD. RESULTS: A total of 387 cases organophosphate poisoning were reported in our hospital between 2013 and 2015. The age of study population in our study was 26.14 ±10.086 years with predominance of males (62.5%). The highest number of cases (42.1%) were reported during 2013 with the least (23.3%) in 2014. Moreover, 275 (71.1%), 105 (27.1%) and 7 (1.8%) cases were cured, expired and referred during the period of three years i.e. 2013 to 2015. CONCLUSION: Organophosphate poisoning cases were more common among males. Youth is predominant population for organophosphate poisoning which draws immediate attention for public health policy makers, by educating the public through print and electronic media specially television with dramatize shots.

Background:To detect the prevalence rate of bacterial infection among urinary isolates and to determine the antimicrobial susceptibility pattern. Methods In this descriptive study 300 urine samples were collected for culture and sensitivity. After documenting pus cells, inoculation was done on required medias. Growth so obtained was interpreted as one organism grows into one colony hence called colony forming unit (CFU). The number of colonies formed were counted representing number of organisms present in the inoculum of urine taken and a total count was calculated for I ml of urine. Growth of bacterial count ≥ 105 CFU/ml was considered significant. The significant growth obtained was processed for standard biochemical tests of identification and in vitro sensitivity pattern(by the standard disc diffusion method). Zones of inhibition were measured and interpreted by the recommendations of clinical and laboratory standards. Results:- Total 250 (50%) samples of both males and females were positive. Females showed higher prevalence rate of UTI than males. Gram negative bacteria were found in high prevalence rate than gram positive bacteria. The common organisms were Escherichia coli, Klebsiella pneumonae, Staphylococus saprophyticus, Proteus mirabilis, Staphylococus aureus and Pseudomonas aeroginosa.. In vitro antibiotic susceptibility tests reveal that gram negatives bacteria were sensitive to imipenum, nitrofurantoin and norfloxacin. Gram positive isolates were sensitive to nitrofurantoin, amoxicillin / clauvanic acid, and ampicillin. Conclusion:-There is a need for constant monitoring of susceptibility of specific pathogens in different populations to commonly used anti-microbial agents.

Background: Gitelman’s syndrome (GS) is a rare autosomal recessive renal tubular disorder that is characterized by episodic clinical manifestations and persistent biochemical abnormalities. The disorder manifests in adolescent or adult age and is characterized by transient episodes of muscle weakness and tetany. Its diagnosis requires a high index of suspicion and skillful interpretation of laboratory investigations. Case Presentation: We herein present a case of a 20-year-old female patient who presented with generalized muscle weakness and mild renal insufficiency. Laboratory investigations revealed mild azotemia, high anion gap acidosis, hypokalemia, hypomagnesemia, and hypocalciuria. She recovered her renal functions and muscle power with appropriate management and is doing well seven months after her first presentation to our hospital. Conclusions: This case highlights the need to create high index of suspicion among the general practitioners about this syndrome and an early referral of such patients to nephrologists for an accurate diagnosis and appropriate management.

Background: Tetralogy of Fallot (TOF) with subarterial ventricular septal defect (VSD) is more common among Asians than Caucasians. Compared with the regular subaortic VSD postoperative right ventricular outflow obstruction is more common because of the sub-pulmonary extension of the defect. The objective of this study is to analyze the surgical implications and outcomes of patients with TOF - subarterial VSD in the current era. Patients and Methods: In all, 539 consecutive operated patients with TOF from May 2005 to September 2012 were retrospectively reviewed. Eighty-five patients had subarterial VSD. Seventy-nine of these underwent intracardiac repair. Preoperative clinical, echocardiographic features, operative and postoperative variables were assessed. Results: The median age at surgery was 6 years and the median weight was 14 kilograms. The male to female ratio was 1.7:1. TOF with subarterial VSD was associated with frequent use of transannular patch (74.6%). The early mortality was 2.5%. Follow up was 92% complete with a mean duration of 20 months with actuarial survival of 97.3% at 5 years. Two patients required reoperation for significant right ventricular outflow tract obstruction (RVOTO) at one year and three years, respectively. Conclusions: Intra cardiac repair for TOF with subarterial VSD has low perioperative mortality and morbidity. Transannular patch augmentation of the right ventricular outflow tract (RVOT) is required in a significant proportion of these patients. Precise suturing of the VSD patch, adequate infundibular resection and lower threshold for a transannular patch placement ensures a smooth early postoperative recovery.