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Objective: This study was aimed to investigate TB patients adherence and treatment outcomes among internally displaced patients in comparison with adjacent settled areas. Methods: The study was designed as an observational cross-sectional study among the TB patients of internally displaced populations (IDPs) of North Waziristan Agency (NWA) and adjacent settled areas of Bannu and Lakki Marwat (NIDPs). Based on the study inclusion and exclusion criteria 330 patients fullfilled the inclusion criteria and were assigned equally to both IDPs and NIDPs study groups. Odds ratio (OR) with 95% confidence interval was calculated and p-values, 0.05 were considered statistically significant. Results: The treatment outcomes with the status of “cured” and “completed treatment” were better among NIDPs as compared to IDPs. Patients with treatment outcome status of “defaulted treatment”, “without documentary evidence, and “failure” were high in IDPs as compared to NIDPs. Adherence to TB treatment was better among NIDPs (50.9%) as compared to IDPs (39.4%). The patients showing non-adherence to TB treatment were more among IDPS (27.3%) than NIDPs (10.9%). Conclusion: Overall results of this study revealed a poor adherence to the TB treatment medications with an odds ratio of 0.286, (p

Prophylactic use of antibiotics before surgery is evidence-based practice for prevention of surgical site infections (SSIs).To investigate adherence to and surgeons' perception of antibiotic prophylaxis guidelines.A two-phase, cross-sectional prospective study conducted in two teaching hospitals. Phase 1: 6-month audit of prescriptions to investigate adherence rate to evidence-based guidelines. The important information was collected from medical charts through a predesigned proforma. Phase 2: self-administration questionnaire was used to investigate the surgeons' perception. Descriptive statistics, independent-sample Kruskal-Wallis test and multivariate linear regression analysis were performed using SPSS version 21.0.A total of 866 eligible surgical cases (acute appendectomy; n = 418; 48.2%), laparoscopic cholecystectomy (n = 278; 32.1%) and inguinal hernia (n = 170; 19.7%) were investigated. Surgical antibiotic prophylaxis was prescribed in 97.5% of procedures. Out of these, 9.5% adhered to guidelines with respect to correct choice, 40% for timing, and 100% for dose and route (optimal value 100%). Most patients received ceftriaxone (n = 503; 59.5%) as prophylactic antibiotic. The questionnaire (good internal consistency; α ≥ 0.7) was filled out by 200 surgeons. More than half (69%) of participants thought that antibiotics were overused. Most surgeons perceive that poor adherence to treatment guidelines is due to poor awareness, underestimation of infection, lack of consensus, and disagreement with guidelines recommendations.Surgeons have positive perception that antibiotics should be used according to guidelines recommendations. However, we found poor treatment adherence to antibiotic prophylaxis guidelines.مراجعة استعمال المضادات الحيوية الوقائية ومدى امتثال الجراحين للمبادئ التوجيهية القياسية في الإجراءات الجراحية المعتادة في منطقة البطن.ذاكر خان، نافيد أحمد، شايستا ظفار، عاصم الرحمن، فايز الله خان، محمد صقلان، سُهيل قامران، حاضر رحمن.يُعتبر استعمال المضادات الحيوية على سبيل الوقاية قبل الجراحة من الممارسات المُسنَدة بالبيّنات للوقاية من حدوث عدوى المواضع الجراحية.هدفت هذه الدراسة إلى تحرّي مدى الامتثال للمبادئ التوجيهية الخاصة باستعمال المضادات الحيوية الوقائية ومنظور الجراحين في هذا الشأن.أُجريت دراسة استباقية مقطعية على مرحلتين في اثنين من المستشفيات الجامعية. المرحلة 1: مراجعة الوصفات الطبية التي حُررت على مدار 6 أشهر لتحري معدل الامتثال بالمبادئ التوجيهية المُسنَدة بالبيّنات. وجُعت المعلومات المهمة من المخططات الطبية للمرضى باستخدام استمارة مُصمَّمة مسبقاً لهذا الغرض. المرحلة 2: استخدام استبيان يُستكمل ذاتياً لتحرِّي منظور الجراحين في هذا الشأن. وقد استُخدم الإصدار 21.0 من برنامج SPSS لإجراء إحصاءات وصفية، واختبار كروسكال واليس القائم على العينات المستقلة، وتحليل الانحدار الخطي المتعدد المتغيرات.بلغ مجموع الحالات الجراحية التي تصلح للخضوع لهذه الدراسة 866 حالة، تراوحت بين استئصال الزائدة الدودية الملتهبة التهاباً حاداً (العدد=418؛ 48.2٪)، واستئصال المرارة بالمنظار (العدد= 278؛ 32.1٪)، والفتق الأُربي (العدد=170؛ 19.7٪). وقد وُصفت المضادات الحيوية الوقائية في 97.5٪ من الإجراءات الجراحية. ومن بين هذه الإجراءات الجراحية، كانت نسبة الامتثال للمبادئ التوجيهية من حيث الاختيار الصحيح، والتوقيت، والجرعة والمسار 9.5٪، و 40٪، و 100٪ على التوالي (القيمة المُثلى 100٪). وتلقى معظم المرضى دواء سيفترياكسون (العدد= 503؛ 59.5٪)، بوصفه أحد المضادات الحيوية الوقائية. وقد أجاب عن الاستبيان 200 جراح (اتساق داخلي جيد؛ α ≥ 0.7). ورأى أكثر من نصف الجراحين المشاركين في الاستبيان (69 ٪) أن هناك زيادة في استعمال المضادات الحيوية. كما رأى معظم الجراحين أن السبب وراء ضعف الامتثال بالمبادئ التوجيهية للعلاج يرجع إلى ضعف الوعي، وعدم تقدير الحجم الحقيقي للعدوى، وغياب التوافق في الآراء، والاختلاف مع التوصيات الخاصة بالمبادئ التوجيهية.لدى الجراحين منظور إيجابي بشأن ضرورة استعمال المضادات الحيوية وفقاً لما ورد في التوصيات الخاصة بالمبادئ التوجيهية، لكن لوحظ ضعف الامتثال للمبادئ التوجيهية الخاصة بالعلاج بالمضادات الحيوية الوقائية.Audit de l’antibioprophylaxie et de l’observance des lignes directrices standard par les chirurgiens dans les actes courants de chirurgie abdominale.L’usage prophylactique des antibiotiques préalablement à un acte chirurgical est une pratique fondée sur des données probantes, qui permet de prévenir les infections du site opératoire (ISO).Étudier l’observance des lignes directrices en matière d’antibioprophylaxie et le point de vue des chirurgiens sur cette pratique.Une étude prospective transversale en deux phases, a été menée dans deux hôpitaux universitaires. Phase 1 : Audit des ordonnances sur six mois, afin d’évaluer le taux de d’observance des lignes directrices fondées sur des données probantes. Les informations importantes ont été recueillies à partir des dossiers médicaux au moyen d’un formulaire conçu à cet effet. Phase 2 : un auto-questionnaire a été utilisé pour étudier le point de vue des chirurgiens. Des statistiques descriptives ont été produites, un test de Kruskal-Wallis sur échantillons indépendants et une analyse de régression linéaire multivariée ont été réalisés à l’aide du logiciel SPPS, version 21.0.Au total, 866 cas chirurgicaux répondant aux critères de l’étude ont été examinés : appendicectomies aiguës, (n = 418, soit 48,2 %), cholécystectomies laparoscopiques, (n = 278, soit 32,1 %) et hernies inguinales (n = 170, soit 19,7 %). Une antibioprophylaxie chirurgicale a été prescrite dans 97,5 % des interventions. Parmi ces dernières, le respect des lignes directrices était de 9,5 % pour le choix de l’antibiotique, de 40 % pour le moment de l’administration et de 100 % pour la dose et la voie d’administration, la valeur optimale étant 100 %. La majorité des patients ont reçu de la ceftriaxone (n = 503, soit 59,5 %) comme antibiotique prophylactique. Le questionnaire a été rempli par 200 chirurgiens, avec une cohérence interne satisfaisante (α ≥ 0,7). Plus de la moitié (69 %) des participants estimaient que les antibiotiques étaient surutilisés. La majorité des chirurgiens pensent que l’observance médiocre des lignes directrices de traitement est due à un manque de sensibilisation, à une sous-estimation de l’infection, à l’absence d’un consensus et à un désaccord avec les recommandations de ces lignes directrices.Les chirurgiens approuvent l’usage des antibiotiques conformément aux recommandations des lignes directrices de traitement. Cependant, notre étude révèle une observance médiocre de ces textes dans les traitements d’antibioprophylaxie.

Background: Foreign body ingestion by children is a commonly encountered problem and accounts for a significant emergency visits among pediatric population. Although these ingested foreign bodies pass spontaneously and uneventfully, a subset of such bodies may become trapped in the digestive tract, eventually leading to significant injury. Most of these bodies are radio-opaque and detectable radiologically, but some radio-lucent may become a diagnostic dilemma and subtle management issue. Case Report: We report a case of a one-year girl who presented after accidental ingestion of foreign body with signs and symptoms of acute intestinal obstruction. Initially we were unable to diagnose the cause, but later the radiological investigation suspected a mesenteric cyst. After failure to respond to conservative measures she underwent exploratory laparotomy, and a jelly ball was removed from the gut. The patient had uneventful post-operative recovery and was kept on follow-up for three months without any complication. Conclusion: These patients do not respond to conservative measures and need surgery on an emergency basis. It is likely that if left untreated may have caused Intestinal perforation and irreversible shock. Radiolucent foreign bodies are difficult to diagnose and need high level of suspicion. Need of the hour is to educate the parents to be extra vigilant as “prevention is better than cure”.

Globally, every year, millions of surgical procedures are carried out and most of the patients experience surgical site infections (SSIs) after surgery. This general overview is aimed to find SSI incidence, risk factors, and treatment-related factors in the current scenario of literature searched. Articles from scientific databases such as Google Scholar, Medline, PubMed, and ScienceDirect were searched and extracted with keywords SSI’, surgery’, surgical infection’, wound infection’, Risk factors SSI’, Antibiotics, and Treatment. The incidence rate of SSIs is on rise in developing countries due to limited reporting which is alarming for patient safety. Various surgery-related guidelines might be helpful in the reduction of SSI incidence. A full assessment of patients before surgery are needed through various available parameters; especially, rational use of antibiotics may minimize the risk of misuse. Healthcare-associated infections need much attention and awareness as the situation is much alarming.

Surgical site infections (SSIs) are among the common problems associated with paediatric surgeries and significantly contribute to postsurgical morbidity and mortality. This study was conducted to assess antimicrobial prophylaxis practices and compliance rates with international guidelines in common paediatric surgical procedures. A retrospective cross-sectional study was conducted in paediatric patients aged

Background: appropriate prescribing of antimicrobial prophylaxis (AP) is a main strategy of the antimicrobial stewardship programme. Aim: to investigate the prescribing practices of antimicrobial prophylaxis and adherence to recommended protocols in older patients in the surgical wards at a 600-bed teaching hospital in Islamabad, Pakistan. Method: researchers selected 240 surgical procedures retrospectively for patients aged 65 years and older admitted to four surgical specialties (abdominal, orthopaedic, urological and neurosurgery) during 1 year. The different parameters of antimicrobial prescription were compared with international clinical practice guidelines. Findings: There were more ‘clean’ surgical wound procedures (n=104; 43.3%) than ‘clean contaminated’ (n=97; 40.4%) and most of these were elective surgical procedures (n=226; 94%). The indication, selection, route, dose, and timing of antimicrobial were found to have adhered with the standard guidelines in 89.6%, 32.5%, 100%, 100% and 55.3% of cases, respectively (optimal value 100%). A statistically significant difference was observed between antimicrobial practices and surgical procedures (P< 0.001). The commonly prescribed antimicrobials were ceftriaxone followed by cefazolin. Conclusion: about 89% of participants who underwent surgical procedures received antimicrobials. The selection of therapeutic agent, the timing and use of broad-spectrum antimicrobial were the common problems in our setting.

Objectives: To investigate the utilization pattern of Surgical antibiotic prophylaxis (SAP) for the prevention of surgical infections in most common abdominal and orthopedic surgical procedures. Methods : A prospective observational and non-intervention study was conducted at two teaching hospitals (PIMS and SIH) in Islamabad, Pakistan. Prescriptions records were reviewed to assess the utilization pattern of SAP during the nine-month duration. Data regarding most common surgical procedures, antimicrobial utilization, dose, route and administration timing of SAP were extracted for analysis. Observed practices were compared with standard treatment guidelines. Results : Out of total 1512 surgical procedures about, 56.9% (n=860) of patients performed abdominal followed by 652 (43.1%) orthopedic surgical procedures. A total of 212 (14%) surgical procedures were completely correct in all steps. SAP were given in 1474 (97.5%) of surgical procedures. In 712 of the participants (48.3%) were given Ceftriaxone following by Cefazolin (n=247, 16.7%). Abdominal surgeries were majorly managed with Ceftriaxone (59%) while the orthopedic surgeries managed with Ceftriaxone (31.3%) and Cefazolin (30%). Appropriate choice of SAP was observed in (n=275; 18.6%) procedures and about half (n=719, 49%) received antibiotics within optimal timing. The appropriate choice/selection of SAP according to the guidelines was greater in orthopedic surgical procedures (n=212; 14.8%) than abdominal surgeries (n=63; 4.3%); p≤0.001. Compliance with respect to timing was significantly lower in an orthopedic surgical procedure (n=301) as compared to abdominal surgeries (n=418); p≤0.001. Similarly, a statistically significant difference observed between PIMS and SIH with respect to SAP practices; p≤0.001. Conclusions : Inappropriate choice, the timing of administration and combination of SAP were observed in the current study. J Microbiol Infect Dis 2019; 9(3):104-111.

This study was conducted to investigate the antibiotic utilization pattern and patient care indicators according to the World Health Organization (WHO) methodology. An observational prospective and prescription-based study was conducted in the surgical outpatient department (SOD) and emergency department (ED) in two teaching hospitals during 3 months. Prescription of patients was investigated through random systematic sampling technique and desired information was collected through pre-design pro forma. Observed practices were evaluated according to WHO criteria. The categorical data were presented as percentages and the chi-squared test was used to make comparisons through SPSS V-22.0. A total of 586 prescriptions (hospital-A = 279; hospital-B = 307) were collected from the SOD and ED over the study period. There were more male patients (398; 67.9%) compared with female with an average age of 43.5 years (ranged 16–95). All the prescriptions contained antibiotics (100%) and the prescription having at least one injectable antibiotic were 300 (51.4%). Generic prescribing was observed in 13.5% of prescriptions and 96% of antibiotics were prescribed from the National Essential Medicine List/formulary. The mean time consumed and noted during a consultation and dispensing was found to be 8 min and 157.8 s, respectively. Furthermore, only 48% of the patients knew about the correct dosage schedule of the antibiotic prescription. Cephalosporins (mostly ceftriaxone and cefuroxime) were the most frequently prescribed class of antibiotics. The over-prescribing of antibiotics, low generic prescribing, lack of patients’ knowledge, a short consultation, and dispensing times were the major identified problems.

Muhammad Nasir Kalam,1 Muhammad Fawad Rasool,2 Faleh Alqahtani,3 Imran Imran,4 Asim Ur Rehman,1 Naveed Ahmed1 1Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45320, Pakistan; 2Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan; 3Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia; 4Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, PakistanCorrespondence: Naveed AhmedDepartment of Pharmacy, Quaid-i-Azam University, Islamabad, 45320, PakistanTel +92 (51) 90644180Email natanoli@qau.edu.pkMuhammad Fawad RasoolDepartment of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, PakistanTel +923008639046Email fawadrasool@bzu.edu.pkAim: The study was aimed to understand the underlying causes for the differences in propranolol pharmacokinetics (PK) between healthy and cirrhosis populations by using a systematic whole-body physiologically based pharmacokinetic (PBPK) model-building approach for suggesting model informed propranolol dosing in liver cirrhosis patients with different stages of disease severity.Methods: A whole-body PBPK model was developed by using population simulator PK-Sim® by using reported physicochemical and clinical data for propranolol in healthy and liver cirrhosis populations. The model evaluation was done by visual verification and comparison of PK parameters using their observed/predicted ratios (Robs/pred).Results: The developed model has effectively described the disposition of propranolol after intravenous and oral application in healthy and liver cirrhosis populations. All the model predictions were comparable to the observed clinical data and the Robs/pred for all the PK parameters were within a 2-fold range. A significant increase in plasma concentration of propranolol and decrease in drug clearance was observed in progressive stages of liver cirrhosis. The developed model after evaluation with the reported clinical PK data was used for suggesting model informed propranolol dosing in different stages of liver cirrhosis based on systemic unbound drug concentration.Conclusion: The developed PBPK model has successfully described propranolol PK in healthy and cirrhosis populations after IV and oral administration. The evaluated PBPK propranolol-cirrhosis model can have many implications in predicting propranolol dosing in liver cirrhosis patients with different stages of disease severity.Keywords: PBPK, propranolol, cirrhosis, dose adjustments, drug therapy

Globally, surgical site infections are one of the common infections which lead to a large amount of mortality and morbidity in postsurgical care. The risk for surgical site infection is multidimensional which includes mainly; patient, surgery, and hospital-related factors. This study is aimed to determine the burden of SSIs along with contributed risk factors. A prospective observational cross-sectional study was conducted in one of the largest public-sector hospitals in Pakistan. A total of 412 patients were recruited in the study with full consent and monitored for 30 days after surgery with direct and indirect surveillance. Overall, in seven different surgical procedures the incidence (29.8%) rate of SSI was observed; in appendectomy ( n = 17, 4.1%), exploratory laparotomy ( n = 51, 12.6%), laparoscopic cholecystectomy ( n = 12, 2.90%), mesh repair ( n = 17, 4.01%), thyroidectomy (5, 1.2%), transurethral resection of the prostate ( n = 11, 2.6%), and transurethral resection of the bladder (10, 2.4%). The average SSI rate in every single procedure was about 18 (4.27%) per surgical procedure out of 123 (29.85%) SSI cases. Types of SSI identified were superficial, deep incisional and organ/space ( n = 76, 18.4%, n = 23, 5.5%, and n = 24, 5.7%). Incidence of SSIs during admission, at readmission, and post-surveillance cases were ( n = 50, 12.1%, n = 25, 6.0% and n = 48, 11.6%). Associated risk factors found contributed to the incidence of SSI ( p

Background and Objectives Liraglutide, an analog of human glucagon-like peptide 1 (GLP-1), has been approved for the treatment of type 2 diabetes mellitus in Pakistan since 2016. It is a GLP-1 receptor agonist that has shown promising results in terms of not only glycemic control but also weight loss. Our study aimed to provide evidence regarding the safety and effectiveness of liraglutide in Pakistan and to look at the adherence rate and treatment satisfaction of patients using liraglutide. Methods This is an observational retrospective study that recruited patients who were treated with liraglutide. Data were collected at the first visit and follow-up. Morisky Green Levine Adherence Scale and Treatment Satisfaction Questionnaire for Medication (TSQM-9) were used for the determination of adherence and satisfaction with the treatment. Results A total of 70 patients were recruited in the study, The mean difference in weight, body mass index, glycated hemoglobin (HbA1C), systolic blood pressure, and diastolic blood pressure from baseline to follow-up was -5.36 kg, -2.14 kg/m2, -1.76%, -12.38 mmHg, and 5.55 mmHg, respectively. Nausea was the main side effect reported. TSQM-9 scores were compared from baseline, and it was found that patients are satisfied with the treatment and its effectiveness. Conclusions Our study has demonstrated the effectiveness of liraglutide as a monotherapy or combination therapy in the Pakistani population. Liraglutide led to reduction in HbA1C and weight. This is associated with high treatment satisfaction rate and adherence rate. Thus, liraglutide remains an effective though expensive treatment option in a country like Pakistan.

At present, several drug molecules have been used for the treatment of rheumatoid arthritis (RA). However, the utilization of these compounds through the oral and parenteral route is limited due to low bioavailability, rapid metabolism, poor absorption, first-pass effect, and serious adverse effects. A transdermal delivery system is an appealing option in this scenario, as it possesses the proficiency to overcome drawbacks associated with the oral and parenteral route. With the innovation of several enhancement strategies, many therapeutic agents have been administered transdermally, proposing an exceptional approach to treat RA. The present article provides an insight into the etiology and pathophysiology of RA. The challenges of the transdermal route and the strategies to improve those problems are described. The current advances in increasing the transdermal efficiency of the therapeutics against RA are discussed. Limitations and advantages regarding the state of the art transdermal delivery system and future outlook are also summarized.

Background: A judicious utilization of antibiotic prophylaxis and postoperative analgesics are an effective strategy to prevent surgical site infections and pain, respectively. Aims: The aim of this study was to assess prescription practices and guidelines adherence of antibiotics and analgesics in total knee replacement (TKR) surgery. Setting and Design: A cohort observational pilot study was conducted for a period of 2 months at two tertiary care teaching hospital (government hospital = GH and private hospital = PH) in Islamabad, Pakistan. Subjects and Methods: All the individuals aged ≥18 who underwent TKR surgery with no previous surgery and infection (n = 300) were included during the study period. The patient medication profile was analyzed through various indicators. International evidence-based guidelines were used as a reference to analyze current treatment practices. Statistical Analysis Used: Descriptive statistics such as frequencies, percentages, averages, standard deviation, and Chi-square test was used for interpretation of data in SPSS V-22.0. Results: Preoperative prophylactic antibiotics were prescribed in 94% (n = 283) cases. Of these, 61.5% adhered according to guidelines with respect to correct choice, 64.6% for timing, and 100% for the route (optimal value 100%). The prescribing behavior with respect to antibiotic choice and timing was different among GH and PH hospitals (P = 0.001). Cefazolin was the most commonly prescribed preoperative and postoperative antibiotic, followed by cefuroxime. With respect to analgesics, paracetamol and tramadol were frequently used in TKR patients. One hundred and seventy six (58.6%) patients received analgesics according to the guidlines recommendations, and 7.8% (n = 23) received more than one analgesic in their postoperative prescription. Conclusion: The low compliance rate with guidelines was observed. The choice and timing of antibiotic, selection of analgesics, and its multiple usage were main identified problems.

Objective Diabetes mellitus is a major health problem in developing countries. There are various insulin therapies to manage diabetes mellitus. This systematic review evaluates various insulin therapies for management of diabetes mellitus worldwide. This review also focuses on recent developments being explored for better management of diabetes mellitus. Research design and method We reviewed a number of published articles from 2002 to 2016 to find out the appropriate management of diabetes mellitus. The paramount parameters of the selected studies include the insulin type & its dose, type of diabetes, duration and comparison of different insulin protocols. In addition, various newly developed approaches for insulin delivery with potential output have also been evaluated. Results A great variability was observed in managing diabetes mellitus through insulin therapy and the important controlling factors found for this therapy include; dose titration, duration of insulin use, type of insulin used and combination therapy of different insulin. Conclusion A range of research articles on current trends and recent advances in insulin has been summarized, which led us to the conclusion that multiple daily insulin injections or continuous subcutaneous insulin infusion (insulin pump) is the best method to manage diabetes mellitus. In future perspectives, development of the oral and inhalant insulin would be a tremendous breakthrough in Insulin therapy.

Cancer has been the most deleterious disease since few decades and its prevalence is increasing day by day. Scientists have developed many novel carrier systems to modify the delivery of anticancer...

Background: Most of the people have poor knowledge and inability to administer liquid medications properly which can lead to medication errors and poor health outcomes as laymen and even health care professionals hardly know about the differences among teaspoon (5ml), tablespoon (15ml) and other measuring devices which have great differences in volumes. Objective: To assess knowledge attitude and practice of measuring devices in the population of district east (Gulshan Iqbal and Jamshed Town) Karachi. Methods: A descriptive survey was conducted and total 98 participants were interviewed and information’s were collected on designed questionnaires proforma. Results: In current results cough syrup were used (74.40%), antacids (12.24%) and (20.40%) multivitamins syrups with different measuring measuring devices such as teaspoons (61.22%), table spoons (33.67%) and other oral cups, syringes and dropper (7.14%) and (25.51%) people had experienced with wrong doses and suffered from ADR’s. Conclusion: Awareness and consciousness about appropriate dosing is important in the use of oral liquid medication, the current study was planned to examine the dosing accurateness of measuring devices used for liquid oral medications above an extensive series of dosing volumes. Key Words: ADR’s, Teaspoons, Tablespoons, Pharmacist, Pakistan.

This paper presents the Internet of Things (IoT) based Grocery Management System consisting of Smart Refrigerator and Smart Cabinet. Oftentimes people forget about the food left in their refrigerator and cabinets. This food is thrown away after some time and thus food wastage is increased. Many people find it difficult to go to grocery shopping due to physical disabilities or busy schedules. These problems are addressed by our proposed system. With the help of the system, user can see what is inside the refrigerator and cabinet over the web. By knowing how much food is left in the refrigerator and cabinet, food wastage is drastically reduced. Moreover, when the food items are finished inside refrigerator and cabinet, our system places an automatic online order with the permission of user to replenish the finished food items. Thus, the proposed system makes the life easier for people who cannot go to grocery shopping. In contrast to previous similar refrigerators, our smart refrigerator uses cameras instead of sensors such as weight and IR sensors. Thus, the system provides more accurate and information-rich results without using extensive wiring as required by previous approaches. Many businesses also face problems when they do not know how much of their goods are sold in which stores. So, they have to hire workers to get this data. Using our proposed system, they will instantly know about the data of their products and can plan their sale promotions accordingly.

A block chain is referred to as a growing list of records which are linked using cryptography. It is simple and open ledger that records all the transactions in block structures. These block structures are bound with each other by using Quantum Cryptographic protocols. The block chain is democratic system in which concerned parties get access by using a key to perform transaction. The well-known type of Quantum Cryptography protocol is Quantum Key Distribution (QKD). With the help of QKD our Crypto-currency system is secured when passage in between transmitting end and receiving end shouldn't be intrude by third party. Secrecy of the system depends upon different factors like efficient and optimized key rate, secure carrier of modulating signal. In this work the transparency and immunity of block chain based crypto-currency system is analyzed with simulation of six state QKD Protocol. The generation of key rate is observed to ensure the path for production of better crypto-currency system. A Mathematical model is used to obtain the desire constraints so that linear relationship can be achieved. At application level this study contributes to the implementation of crypto-currency system through six state QKD protocol.

Background:Nobel laureate Sir James Black’s molecule, propranolol, still has broad potential in cardiovascular diseases, infantile haemangiomas and anxiety. A comprehensive and systematic review of the literature for the summarization of pharmacokinetic parameters would be effective to explore the new safe uses of propranolol in different scenarios, without exposing humans and using virtual-human modeling approaches.Objective:This review encompasses physicochemical properties, pharmacokinetics and drug-drug interaction data of propranolol collected from various studies.Methods:Clinical pharmacokinetic studies on propranolol were screened using Medline and Google Scholar databases. Eighty-three clinical trials, in which pharmacokinetic profiles and plasma time concentration were available after oral or IV administration, were included in the review.Results:The study depicts that propranolol is well absorbed after oral administration. It has dose-dependent bioavailability, and a 2-fold increase in dose results in a 2.5-fold increase in the area under the curve, a 1.3-fold increase in the time to reach maximum plasma concentration and finally, 2.2 and 1.8-fold increase in maximum plasma concentration in both immediate and long-acting formulations, respectively. Propranolol is a substrate of CYP2D6, CYP1A2 and CYP2C19, retaining potential pharmacokinetic interactions with co-administered drugs. Age, gender, race and ethnicity do not alter its pharmacokinetics. However, in renal and hepatic impairment, it needs a dose adjustment.Conclusion:Physiochemical and pooled pharmacokinetic parameters of propranolol are beneficial to establish physiologically based pharmacokinetic modeling among the diseased population.

In this research, we are analyzing the simultaneous wireless information and power transfer (SWIPT) system with one relay node, assuming the relay follows the amplify and forward (AF) protocol of system. In this paper we have discussed the two types of hardware architectures for energy harvesting from radio frequency; time switching and power splitting. Our simulation results shows the effect of change of fading severity of channel path and change of different noises on performance of data and energy harvesting rate of system.

This paper implements three-way nested design to mark moving objects in a sequence of images. Algorithm performs object detection in the image motion analysis. The inter-frame changes (level-A) are marked as temporal contents, while the intra-frame variations identifies critical information. The spatial details are marked at two granular levels, comprising of level-B and level-C. The segmentation is performed using analysis of variance (ANOVA). This algorithm gives excellent results in situations where images are corrupted with heavy Gaussian noise ~N(0,100). The sample images are selected in four categories: ‘baseline’, ‘dynamic background’, ‘camera jitter’, and ‘shadows’. Results are compared with previously published results on four accounts: false positive rate (FPR), false negative rate (FNR), percentage of wrong classification (PWC), and an F-measure. The qualitative and quantitative results prove that the technique out performs the previously reported results by a significant margin.

This study aimed to evaluate the perception of surgical teams (doctors) towards surgical site infections (SSIs). A cross-sectional study was carried out in a tertiary care hospital in Pakistan. The questionnaire was completed by 85 surgical team doctors (n = 110) (response rate ? 77%). The respondent perception of SSIs was found significant. Patient hospitalization, care of the patient in the ward, intrinsic and extrinsic factors, assessment of malnutrition, a therapy protocol, inappropriate parameters, criteria of KUNIN, pathological examination, the total length of stay, and rational antibiotics prophylaxis (95% CI p < 0.05) are considered responsible variables for the incidence of SSIs. The obesity and the factors related to the ventilation of operating room (95% CI p < 0.05) are counted insignificant for SSI. The internal consistency for the questionnaire’s scale and each factor subscale was good fit (overall = 0.8, each, ? ? 0.07). Surgeons’ perspective has shown that the associated risk factors and treatment outcomes of surgical patients may have a direct association with the incidence of SSIs. © 2019, Association of Surgeons of India.

Speckle noise in ultrasound (US) medical images is the prime factor that undermines its full utilization. This noise is added by the constructive / destructive interference of sound waves travelling through hard- and soft-tissues of a patient. It is therefore generally accepted that the noise is unavoidable. As an alternate researchers have proposed several algorithms to somewhat undermine the effect of speckle noise. The discrete wavelet transform (DWT) has been used by several researchers. However, the performance of only a few transforms has been demonstrated. This paper provides a comparison of several DWT. The algorithm comprises of a pre-processing stage using Wiener filter, and a post-processing stage using Median filter. The processed image is compared with the original image on four metrics: two are based on full-reference (FR) image quality assessment (IQA), and the remaining two are based on no-reference (NR) IQA metrics. The FR-IQA are peak signal-to-noise ratio (PSNR) and mean structurally similarity index measure (MSSIM). The two NR-IQA techniques are blind pseudo-reference image (BPRI), and blind multiple pseudo-reference images (BMPRI). It has been demonstrated that some of these wavelet transforms outperform others by a significant margin.

An audit of the antibiotic prophylaxis in surgical procedures is the basic area of antimicrobial stewardship programme. The current research aimed to evaluate the adherence-proportion of the pre-operative antibiotic prophylaxis (PAP) practices in common elective surgical procedures. It was an eight-month (January 2017 to August 2017) observational cross-sectional patients’ treatment record-based study conducted at two tertiary care teaching hospitals of Islamabad, Pakistan. We investigated the three most commonly performed elective general surgical procedures at the hospitals in adults aged > 18 years with no previous infection or surgery. The required data were extracted from the medical charts. Current prescribing practices were compared with the standard prescribing guidelines. A total of 660 (Government Hospital (GH), n = 330 and Private Hospital (PH), n = 330) procedures were observed. The most commonly performed elective general surgical procedures were laparoscopic cholecystectomy 307/660 (46.5%), followed by direct inguinal hernia 197/660 (29.8%) and total thyroidectomy 156/660 (23.6%). Non-use of PAP was observed in 64/660 (9.7%) cases. PAP was given to 90.3% (n = 596/660) cases (300/330 (90.9%) patients in GH and 296/330 (89.7%) in PH; P = 0.599). Based on the existing guidelines, the choice of antibiotics was correct in only 4.2% (25/596) patients (10/300; 3.3% cases at GH and 15/296; 5% at PH). The appropriate use of antibiotics was significantly greater in direct inguinal hernia (n = 19/193; 9.8%) cases compared with that in total thyroidectomy (n = 4/152; 2.6%) and laparoscopic cholecystectomy (n = 2/251; 0.8%) cases; P = 0.001. Compliance to the timing was only 51% (n = 304/596) of the total patients received PAP which was significantly lower in GH 97/300 (32.3%) as compared with that in PH 207/296 (69.9%); P = 0.001. Administration timing of antibiotics was observed to be more appropriate in total thyroidectomy (n = 79/152; 51.9%) cases than in laparoscopic cholecystectomy (n = 130/251; 51.8%) and direct inguinal hernia (n = 95/193; 49.2%) cases; P = 0.001. The route and dose were appropriate in accordance with the guidelines in all cases (100%). Most of the patients received ceftriaxone, a third-generation cephalosporin that is no longer recommended by the latest international guidelines. The current analysis revealed an alarmingly poor adherence rate with the guidelines in the three elective surgical procedures at both hospitals. To improve the situation, training and awareness programs about the antimicrobial stewardship interventions on the institutional level may be valuable.

Recent era has brought upon a major global food shortage due to the climatic changes in the world. So in order to deal with this issue of global food shortage households must need to grow a reasonable deal of vegetables and other crops using artificial greenhouses. An artificially controlled greenhouse yields more crops per square meter compared to open field cultivation since the microclimatic parameters that determine crop yield are continuously examined and controlled to ensure that an optimum environment is created. This research paper addresses and tries to resolve a few issues that are faced by plants caretakers using the engineering approach so that he/she could remain satisfied even when he/she is physically away for a long duration of time because the automated system will take care of everything in the absence. This automated system works using sensors and actuators, which are controlled by a microcontroller and monitor and manage every environmental parameter required for the good growth of plants.

Science and technology have always been the vitals of human’s struggle, utilized exclusively for the development of novel tools and products, ranging from micro- to nanosize. Nanotechnology has gained significant attention due to its extensive applications in biomedicine, particularly related to bio imaging and drug delivery. Various nanodevices and nanomaterials have been developed for the diagnosis and treatment of different diseases. Herein, we have described two primary aspects of the nanomedicine, i.e., in vivo imaging and drug delivery, highlighting the recent advancements and future explorations. Tremendous advancements in the nanotechnology tools for the imaging, particularly of the cancer cells, have recently been observed. Nanoparticles offer a suitable medium to carryout molecular level modifications including the site-specific imaging and targeting. Invention of radionuclides, quantum dots, magnetic nanoparticles, and carbon nanotubes and use of gold nanoparticles in biosensors have revolutionized the field of imaging, resulting in easy understanding of the pathophysiology of disease, improved ability to diagnose and enhanced therapeutic delivery. This high specificity and selectivity of the nanomedicine is important, and thus, the recent advancements in this field need to be understood for a better today and a more prosperous future.

The design of a controller significantly improves if internal states of a dynamic control system are predicted. This paper compares the prediction of system states using Kalman filter and a novel approach analysis of variance (ANOVA). Kalman filter has been successfully applied in several applications. A significant advantage of Kalman filter is its ability to use system output to predict the future states. It has been observed that Kalman filter based predictive controller design outperforms many other approaches. An important drawback of such controllers is however that their performances deteriorate in situations where the system states have no correlation with the output. This paper takes a hypothetical model of a helicopter and builds system model using the state-space diagram. The design is implemented using SIMULINK. It has been observed that, in situations where the states are dependent on system output, the ANOVA based state prediction gives comparable results with that of Kalman filter based parameter estimation. The ANOVA based parameter prediction however outperforms Kalman filter based parameter prediction in situations where the output does not directly contribute in a particular state. Rigorous testing is performed on four internal states to prove the validity of ANOVA based predictive parameter estimation technique.

The denial of service (DOS) attack is a known problem in computer networks. This paper reviews DOS attack at the Application layer using session initiation protocol (SIP). Most of the existing solutions are based on adaptive threshold, cumulative sum, and Hellinger distance (HD). The HD uses number of INVITE messages for prediction of the possible flooding attack. A limitation of these approaches is that they all need training phase before actually being tested in the real situation. The proposed method proposes a completely different solution where transport layer protocol based on UDP is used to block the stream of undesired packets. This approach is novel and found to be working in various situations. The algorithm is rigorously tested using the network simulator NS2.

In order to manage a project and bring it to a successful completion, its project manager must have a complete understanding of the methods being used for the management of different parts of the project. Managers prefer specific project methodology/framework, while resist and face difficulties for an opportunity to manage another project with different methodology or a framework as they don't know how much commonality exists between the preferred and the new required methodology/framework. The crux of this paper is to present an understanding for managers and their organizations which can really augment their overall performance by having an understanding of different dynamics of different project management methodologies/frameworks and then use this understanding intelligently either by combining different powerful features or simply by knowing the equivalency with competitors which are using other project management methodologies/frameworks. This paper can be a good resource for the project managers having difficulty in deciding which and why a particular project management methodology/framework should be opted. To parameterize the scope of this paper, five important project management methodologies/frameworks were compared with PMBOK, which is a growing and established project management methodology. Finally a conclusion with a generic project management approach has been suggested.

A wireless network provides a significant advantage over the traditional wired network. The primary advantage is in the convenience, and in quick to deploy arrangement in at places with limited supports. This additional benefit is however not easy to realize without looking in to several points that requires more stringent analysis. One of the significant factor due to its very nature, wireless communication more prone to an unauthorized access by a user who happens to be in the vicinity, and is able to break in the security barriers. Most of the authentication mechanisms that use shared key mechanism carry the risk of loosing key during key distribution, or during authentication process. During this the highest amount of risk is present at the access points. The current wireless networks are based on 802.11b wired equivalent privacy (WEP) protocol that is based on shared key authentication. The protocol was originally designed keeping requirements of a wired network. This works fine under normal conditions, but in special circumstances it fails to provide data security. This research proposes a new approach that is based on public & private key encryptions. Once a session is established, a key is generated of that particular session. This session key shall be used through out the communications. The proposed approach is implemented on a simulator. This approach, in our finding applies more stringent requirements that are much harder to break by an intruder

This paper proposed a systematic approach to select a mathematical model for an industrial heating system by adopting system identification techniques with the aim of fulfilling the design requirement for the controller. The model identification process will begin by collecting real measurement data samples with the aid of MATLAB system identification toolbox. The criteria for selecting the model that could validate model output with actual data will based upon: parametric identification technique, picking the best model structure with low order among ARX, ARMAX and BJ, and then applying model estimation and validation tests. Simulated results have shown that the BJ model has been best in providing good estimation and validation based upon performance criteria such as: final prediction error, loss function, best percentage of model fit, and co-relation analysis of residual for output.