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AIM To carry out cross-culture adaptation and validation of the English version of Rheumatoid Arthritis Knowledge Assessment Scale (RAKAS) in patients with rheumatoid arthritis (RA). METHODS A cross-sectional study was conducted for 2 months in 2 tertiary care hospitals in Karachi, Pakistan. Sample size was calculated based on item-subject ratio. The translation was carried out using standard procedures for translation and cross-culture adaptation. The validation process included estimation of discrimination power, item difficulty index, factorial, convergent, construct and known group validities and reliability. Reliability of the scale was estimated using Kuder-Richardson Formula 20 and a value of σ2 ≥ 0.6 was acceptable. SPSS v23, Remark Classic OMR v6 software and MedCalc Statistical Software v16.4.3, were used to analyze the data. The study was approved by the relevant ethics committee (IRB#NOV:15). RESULTS The mean score was 7.68 ± 2.52 (95% CI: 7.31-8.05) for 177 patients. The σ2 = 0.601, that is, >0.6, test-retest reliability ρ = .753, P

The fingerprint presentation attack is still a major challenge in biometric systems due to its increased applications worldwide. In the past, researchers used Fingerprint Presentation Attack Detection (FPAD) for user authentication, but it suffers from reliable authentication due to less focus on reducing the ‘error rate’. In this paper, we proposed an algorithm, based on referential image quality (RIQ)-metrics and minutiae count using neural network, k-NN and SVM for FPAD. We evaluate and validate the error rate reduction with different machine learning models on the public domain, such as LivDet crossmatch dataset2015 and achieved an accuracy of 88% with a neural network, 88.6% with k-NN and 88.8% using SVM. In addition, the average classification error (ACE) score is 0.1197 for ANN, 0.1138 for k-NN and 0.1117 for SVM. Thus, the results obtained show that it was achieved a reasonable accuracy with a low ACE score with respect to other state-of-the-art methods.

Prune belly syndrome (PBS) is a rare congenital malformation of unknown etiology characterized by a triad of deficient abdominal wall musculature, undescended testicles and urinary tract malformations. Most of the patients have pulmonary, cardiac, skeletal and gastrointestinal tract anomalies. Lack of abdominal muscles leads to constipation due to inability to perform Valsalva maneuver, which helps push the stool out of the rectum during the defecation. Additionally, frequent respiratory tract infections, persisting constipation and urinary tract infections lead to the development of malnutrition in children. We report this case to raise the awareness of low socioeconomic and low-resource medical settings that malnutrition could be existed or caused by PBS. We also encourage the expansion of pediatric surgery and family medicine training to increase the number of specialist (family medicine) to report and refer PBS in earlier phase, while working in rural areas and remote provinces.

This research aims at the detection of the tumor clusters, found in the brain and classifying the type of tumor using Convolutional Neural Network (CNN) using MR Images of the patient. The proposed technique/mechanism consists of several phases, namely, Acquisition, Refining, Segmentation, and finally the Classification. The image refining process includes several sub-processes such as Noise Removal and Edge Detection. Further, based upon the input of the end-user, the class variance value gets calculated from the extracted features for segmentation and gets stored in a matrix called the convolutional pattern. The developed system classifies the type of tumor that either it is malignant or benign using Neural Network and Deep Learning Algorithms. The Idea of this project is to understand how we can develop industry grade, doctor acceptable, and diagnosable correct; an engineered mechanism for evaluating tumor presence in the subject so that faster and better measures can be taken to provide a good cure to the patient at the early stage.

The current novel corona (COVID-19) disease has threatened the health and safety of millions of people in the world due to its rapid, widespread outbreak and potential harms. Observing the trend and estimating the future prevalence of an epidemic is crucial for governments in allocating healthcare resources in public and regulating the economic activities in the country. To observe the trend and forecast the future prevalence of the COVID-19 epidemic in the world, researchers are currently using different statistical and mathematical-based models. In this study, we analyzed the trend pattern of COVID-19 and its future prevalence in Afghanistan. We employed time series models (ARIMA model) to existed COVID-19 epidemic data of Afghan patients collected from 22 March to 24 June 2020. Three ARIMA models with the lowest AIC values were developed and selected to forecast the cumulative number of registered, recovered, and death cases of COVID-19 for the next two months in Afghanistan. Predicted results from our models reveal that the number of registered, recovered, and death cases of COVID-19 may have an exponential growth until the end of August. According to our models' predictions, the cumulative number of registered, recovered, and death cases of COVID-19 can reach up to 61086, 45228, and 2302 at the end of August, respectively. We believe that this study’s results can potentially help the government of Afghanistan make effective strategies for controlling and preventing the spread of COVID-19 pandemic in the country.

Purpose The aim of this study was to gather data from female students studying in both health and non-health colleges at Imam Abdulrahman Bin Faisal University and report the prevalence, reasons, and determinants of dietary supplements use. Methods A month-long cross-sectional study was conducted in health and non-health colleges affiliated to Imam Abdulrahman Bin Faisal University in Dammam, Saudi Arabia. Convenient sampling was employed, and the data was gathered through an online survey using the English and Arabic versions of the Dietary Supplement Questionnaire (DSQ). The data was analyzed using SPSS version 23 and Medcalc. The study was approved by an ethics committee. Results Data from 545 participants was collected. The overall prevalence of dietary supplement use was 32.7% (95% CI: 29.06%– 36.51%). The prevalence was 29.77% (95% CI: 25.29%– 34.56%) among students at all health colleges combined and, it was 37.50% (95% CI: 31.36%– 43.96%) among students at all non-health colleges. Most students used a brand product, spent a monthly cost of SAR 286 (USD 76.3) on supplements and agreed that supplements were good for health (N = 392, 71.9%). Students from non-health- colleges agreed that dietary supplements are good for health in greater numbers as compared to non-health college students (p < 0.001). Students aged ≥ 20 years, studying in a non-health college and up to 3rd year of study, were more 2 times more likely to agree that dietary supplements are good for health. Conclusion Supplements were commonly used among female students at this university however, it was quite low as compared to students from other local and regional universities. Prevalence was higher in non-health colleges as compared to health colleges and the most commonly used supplements were brand products and, multivitamins, used for general health and well-being. This highlights the inclination of students towards supplement use.

Purpose: This study aimed to evaluate the concurrent validity of the Arabic version of the General Medication Adherence Scale (GMAS) using two validated scales namely Adherence to Refills and Medications Scale (ARMS) and Medication Adherence Rating Scale (MARS) in Saudi patients with non-communicable diseases. Methods: A cross sectional study was conducted for 2 months in out-patient departments at a tertiary care hospital in Khobar, Saudi Arabia. The study collected data from patients with chronic illnesses through convenience sampling. Pearson correlation (ρ) was conducted to report concurrent validity of GMAS. A correlation coefficient value ≥ 0.5 with p-value SAR 10,000, i.e., USD 2666.2 (56.4%). The mean adherence scores obtained from MARS, ARMS and GMAS were 7.09, 19.9, and 27.4. The correlation (ρ) between GMAS and MARS scores was 0.65, and between GMAS and ARMS scores was −0.79, p

The hormonal luminal-A is the most pre-dominant sub type of breast cancer (BC), and it is associated with a high level of cyclin D1 in Saudi patients. Tamoxifen is the golden therapy for hormonal BC, but resistance of cancer cells to tamoxifen contributes to the recurrence of BC due to many reasons, including high levels of AIB1 and cyclin D1. Overcoming drug resistance could be achieved by exploring alternative targetable therapeutic pathways and new drugs or combinations. The objective of this study was to determine the differentially enriched pathways in 12 samples of Saudi women diagnosed with luminal-A using the PamChip peptide microarray-based kinase activity profiling, and to compare the activity of HAA2020 and dinaciclib with tamoxifen in singles and combinations in the MCF7 luminal-A cell line. Our results of network and pathway analysis of the 12 samples highlighted the importance of VEGFR and CDKs in promoting luminal-A breast cancer. The activation of VEGF signaling via VEGFR-2 leads to activation of PI3K/AKT kinases and an increase of cell survival, and leads to activation of Hsp90, which induces the phosphorylation of FAK1, resulting in cytoskeleton remodeling. PLC-gamma 1 is also activated, leading to FAK-2 and PKC activation. Notably, the G1/S cell cycle phases and phosphorylation processes contribute to the top seven tumorigenesis processes in the 12 samples. Further, the MTT combination of HAA2020 and dinaciclib showed the best combination index (CI), was more clonogenic against MCF7 cells compared to the other combinations, and it also showed the best selectivity index (SI) in normal MRC5 cells. Interestingly, HAA2020 and dinaciclib showed a synergistic apoptotic and G1 cell cycle effect in MCF7 cells, which was supported by their synergistic CDK2, cyclin D1, and PCNA inhibition activities. Additionally, the combination showed VEGFR-2 and Hsp90 inhibition activities in MCF7 cells. The results show the significance of targeting VEGFR-2 and cyclin D1 in Saudi luminal-A breast cancer patients, and the effect of combining HAA2020 and dinaciclib on those targets in the MCF7 model. It also warrants further preclinical and in vivo investigations for the combination of HAA2020 and dinaciclib as a possible future second-line treatment for luminal-A breast cancers.

Hydatid cyst is a parasitic infection mostly caused by Echinococcus granulosis. The most frequent sites of the cyst are liver and lungs. Occurrence in the head and neck region is extremely rare. Only a few cases of hydatid cyst located in head and neck have been reported in the literature. The diagnosis of such isolated neck hydatid cyst is challenging due to the presence of simulating and more common cystic pathological conditions in the neck. Despite the fact that imaging techniques are sensitive in diagnosing cystic lesions, sometimes they cannot accurately identify etiology of the lesion. Here we are reporting a case of isolated primary hydatid cyst of the neck.

Almonds are nutrient-rich nuts. Due to their high level of consumption and relatively high price, their production is targeted for illegal practices, with the intention of earning more profit. The most common adulterants are based on superficial matching, and as an adulterant, the apricot kernel is comparatively inexpensive and almost identical in color, texture, odor, and other physicochemical characteristics to almonds. In this study, a near-infrared hyperspectral imaging (NIR-HSI) system in the wavelength range of 900&ndash, 1700 nm synchronized with a conveyor belt was used for the online detection of added apricot kernels in almonds. A total of 448 samples from different varieties of almonds and apricot kernels (112 &times, 4) were scanned while the samples moved on the conveyor belt. The spectral data were extracted from each imaged nut and used to develop a partial least square discrimination analysis (PLS-DA) model coupled with different preprocessing techniques. The PLS-DA model displayed over a 97% accuracy for the validation set. Additionally, the beta coefficient obtained from the developed model was used for pixel-based classification. An image processing algorithm was developed for the chemical mapping of almonds and apricot kernels. Consequently, the obtained model was transferred for the online sorting of seeds. The online classification system feedback had an overall accuracy of 85% for the classification of nuts. However, the model presented a relatively low accuracy when evaluated in real-time for online application, which might be due to the rough distribution of samples on the conveyor belt, high speed, delaying time in suction, and lighting variations. Nevertheless, the developed online prototype (NIR-HSI) system combined with multivariate analysis exhibits strong potential for the classification of adulterated almonds, and the results indicate that the system can be effectively used for the high-throughput screening of adulterated almond nuts in an industrial environment.

Methods that combine targeted techniques and chemometrics for analyzing food authenticity can only facilitate the detection of predefined or known adulterants, while unknown adulterants cannot be detected using such methods. Therefore, the non-targeted detection of adulterants in food products is currently in great demand. In this study, FT-IR and FT-NIR spectroscopic techniques were used in combination with non-targeted chemometric approaches, such as one-class partial least squares (OCPLS) and data-driven soft independent modeling of class analogy (DD-SIMCA), to detect adulterants in almond powder adulterated with apricot and peanut powders. The reflectance spectra of 100 pure almond powder samples from two different varieties (50 each) were collected to develop a calibration model based on each spectroscopic technique, each model was then evaluated for four independent sets of two varieties of almond powder samples adulterated with different concentrations of apricot and peanut powders. Classification using both techniques was highly sensitive, the OCPLS approach yielded 90&ndash, 100% accuracy in different varieties of samples with both spectroscopic techniques, and the DD-SIMCA approach achieved the highest accuracy of 100% when used in combination with FT-IR in all validation sets. Moreover, DD-SIMCA, combined with FT-NIR, achieved a detection accuracy between 91% and 100% for the different validation sets and the misclassified samples belong to the 5% and 7% adulteration sets. These results suggest that spectroscopic techniques, combined with one-class classifiers, can be used effectively in the high-throughput screening of potential adulterants in almond powder.

ObjectiveThe aim was to validate the Urdu version of General Medication Adherence Scale (GMAS) in patients with rheumatoid arthritis disease.MethodsA 2-month (March–April 2019) cross-sectional study was conducted in randomly selected out-patients with rheumatoid arthritis. The sample size was calculated using item-subject ratio of 1:20. The scale was evaluated for factorial, concrete, concurrent, and known group validities. Concrete validity was established by correlating scores of EQ-5D quality of life scale and GMAS adherence score. Concurrent validity was established by correlating the GMAS adherence score with pill count. Analyses for sensitivity were also conducted. Cut-off value was determined through receiver operator curve (ROC), and test–retest method was used to analyze internal consistency and reliability. Data were analyzed through IBM SPSS, IBM AMOS, and MedCalc software. The Urdu version of EQ-5D quality of life questionnaire was used with permission from developers (#ID20884). The study was approved by an ethics committee (#NOV:15).ResultsA total of 351 responses were analyzed. The response rate was 98%. Reliability was in acceptable range, i.e., Cronbach α = 0.797. Factorial validity was established by calculation of satisfactory fit indices. Correlation coefficients for concrete and concurrent validities were ρ = 0.687, p < 0.01 and ρ = 0.779, p < 0.01, respectively. Known group validity was established as significant association of adherence score with insurance and illness duration (p < 0.05) that were reported. Sensitivity of the scale was 94%. Most patients had high adherence (N = 159, 45.3%).ConclusionThe Urdu version of GMAS demonstrated adequate internal consistency and was validated. These results indicate that it is an appropriate tool to measure medication adherence in Pakistani patients with rheumatoid arthritis.

With the ever increase in social media usage, it has become necessary to combat the spread of false information and decrease the reliance of information retrieval from such sources. Social...

Introduction: Traumatic brain injury (TBI) is a major cause of death and disability throughout the world. Commonly used predictors of outcome both individually or in combination include age, Glasgow Coma Scale score, pupillary reactivity, early hypoxia, and hypotension. Most of the studies previously done to examine risk factors for mortality in severe TBI were done in the setting of polytrauma. Aims and Objectives: The aim and objective of this study was to do an in-depth analysis of various factors associated with the management and outcome of patients with isolated TBI admitted in an Intensive Care Unit (ICU). Materials and Methods: A total of seventy adult patients who were admitted to Intensive Critical Care Unit (ICU) with isolated TBI were selected during a 12-month period from January 2016 to December 2016. This is a prospective analytical study and parameters studied included age, sex, cause of admission classified by type of trauma, premorbid functional status, acute and chronic comorbidities, brain noncontrast computed tomography scan data, Glasgow Coma Scale (GCS), hemodynamic status, respiratory status, and mechanical ventilation, blood gases, serum electrolytes, serum glucose, hemoglobin, leukocyte and platelet counts, renal function, and urinary output. Results: The study population consisted of 46 (65.7%) males and 24 (34.2%) females. The mean age was 35.5 years (range, 18–65 years). The most common mode of trauma was road traffic accident (43.6%) followed by fall from height (35.7%). Statistically insignificant relationship (P < 0.05) was seen with sex and mode of injury among survivors and nonsurvivors; however, 61.9% of patients with age ≥40 years died (P < 0.005). Among clinical parameters at admission to ICU, low GCS, hypotension (mean arterial pressure ≤80 mmHg), hypoxia (pO2 ≤60 mmHg, spO2 ≤90 mmHg), and nonreacting pupils were significantly associated with increased mortality (P < 0.05). Conclusion: Isolated TBI still continues to have a good amount of morbidity and mortality which perhaps can be reduced by strict adherence to guidelines of management.

Semantic similarity is defined as the closeness of two concepts, based on the likeliness of their meaning. Most semantic similarity is applied uses ontology. This research are uses ontology as a case study due to their efficiency, scalability, lack of constraints and the availability of large ontologies. Ontology-based semantic similarity is used in two situations. The semantic similarity in a single ontology and when multiple ontologies are involved. In this research focus on single ontology where use MeSH datasets as a case study. Semantic similarity single ontology means similarities are compared from the same ontology. The importance of information in the biomedical field, semantic similarity measures have been of great interest.

Crossed renal ectopia (CRE) is a rare congenital anomaly in which both kidneys reside in one side. It could be detected incidentally or during the late stage when the kidney is functioning poorly or even being non-function. We report a case of 12 years old child with symptoms of right flank pain and dysuria due to urinary tract infection (UTI). We performed routine laboratory tests (blood and urine) along with whole abdominal Ultrasonography (US) and abdomenopelvic CT-Scan. Both kidneys were located in the right side joining in the upper and lower poles with both ureters draining separately in urinary bladder. No any other anomalies related to the kidneys (congenital obstruction and cystic anomalies) and other organ system were detected. We treated UTI appropriately and discharged the patient with advice.

Introduction: Dengue fever is arboviral infection transmitted from infected personto non-infected one by mosquitoes Aedes Aegypti or Aedes albopectis. All four serotypes (DEN-1, DEN-2, DEN-3 & DEN-4) can cause the clinical manifestations of disease. Dengue infectioncan cause acute febrile illness, dengue hemorrhagic fever (DHF) and dengue shock syndrome(DSS). About 50-100 million cases of dengue fever reported annually worldwide in which 0.5million may need admission. Overall mortality of dengue fever is 3%. The diagnosis of dengueis established by classical clinical features along with specific investigations like PCR, detectionof dengue NS1 antigen or IgM or IgG antibodies in the blood of infected person. Dengue isendemic in most part of our country and can become epidemics on and off. Objectives: Tostudy the pattern and mortality of Dengue fever during epidemic and post epidemic years inSwat. Setting: This study was conducted in Medical Department of Saidu Group of TeachingHospital, Swat. Period: Aug 2013 to November, 2016. Patients and method: Patients sufferingfrom acute febrile illness with features suggestive of Dengue fever were included in the study.Clinical criteria for initial diagnosis directed the subsequent diagnostic work up. Dengue wasconfirmed in these patients by either Dengue NS1 or Ig M antibodies in their blood. Writtenconsent for participation in study was taken from all the included patients. Formal permissionwas taken from Institutional Review Board of the institution to perform this study. The clinical andlaboratory data were recorded on a proforma and analyzed using SPSS 20. Results: Among5569 patients, 3834 (68.85 %) were male and 1735 (31.15%) were female. The mean age ofthe patients was 30 years SD 15.20. The most common age group that suffered with Denguefever was the adult age group (13-30 years). Dengue Hemorrhegic Fever was diagnosed in2543 (45.6%) patients and 50 (0.89 %) had features of DSS. A total 5018 (90.1 %) patients werecompletely cured while 37 (0.66 %) patients died. The overall mortality was 0.66%. Patientswith Dengue fever presented to the hospital though out the year but more than 50% of caseswere reported in the month of September. Conclusion: Adult age group and male gender ismost commonly affected by Dengue fever. Dengue fever was endemic in Swat valley and it canbecome cyclic epidemic in post epidemic years. Dengue fever can claim so many preciouslives if proper preventive measures were not taken in future.

Gastroschisis is a congenital abdominal wall defect with incidence of 1 in 4000 live births. The primary goal of treatment is to reduce bowel back to the abdominal cavity with minimizing risk of injury to the bowel or increased intra-abdominal pressure. The problem with completely reducing the viscera in gastroschisis is related to the status of the bowel, especially when bowel loops are edematous and matted together. The main treatment options are primary closure or delayed closure with use of a silo. Here we are reporting a case of successful reduction of herniated viscera in a gastroschisis patient using surgical latex gloves as a silo in the absence of standard silos.

Stability enhancement of output power and frequency in grid connected wind farms are major challenges nowadays. A model of a grid connected wind farm consisting of a fixed speed wind turbine based induction generator (IG) connected to the transmission line with an energy capacitor system (ECS) in parallel has been considered in this research work to analyze the output characteristics. ECS consists of converters, inverters along with electric double layer capacitor (EDLC). Choice of line power reference is one of the major factors for stable output power and frequency of the wind farm. In this paper simple low pass filter (LPF) method has been applied to generate line power reference for ECS. It has been revealed from the outcome of the research that line power reference and frequency of the output power obtained is more stable using LPF method. Furthermore, LPF method requires a shorter charging-discharging time and smaller storage capacity. Moreover, a control system is proposed which employs a lead lag compensator for smoothing the output power much more even during fault conditions. PSCAD/EMTDC software is used for simulation purposes.

Acute diarrhea is the fourth-ranking cause of death in children under the ageof 5 years. after neonatal causes, malaria, and acute respiratory infections. Objectives: Todetermine the role of Saccharomyces boulardii in the treatment of acute diarrhea. Design:Comparative study. Period: Six months, Mar to Aug 2013. Setting: Pediatric Unit II- LiaquatUniversity Hospital Jamshoro/ Hyderabad. Patients and methods: It consisted of 100 patients,of acute diarrhea with age between 3 months to 5 years reported to pediatric unit and fulfilledthe inclusion criteria. Cases were given low osmolar ORS, Zinc & Saccharomyces boulardii250mg twice daily for three days and controls were given low osmolar ORS and Zinc. P-value≤0.05 was considered as significant. Results: The results showed that 51 patients were maleand 49 patients were female. 27 male patients were in control and 24 were in case group. 23female patients were in control and 26 were in case group. The overall mean age of studysubjects was 26.73±12.65 months. Among reported patients most of the patients 84% werereported on 1st day. All reported patients had a complaint of loose motion with 73% also hadvomiting. All patients had watery loose motion. The mean duration was 4.20±1.70 days withthe mean frequency of 9.82±6.16 times. Among the patients 96 patients were hospitalized and97 patients were given I/V fluid. Among reported patients 10 were without dehyderation, 8 hadsome dehyderation, and 82 had severe dehyderation. 52 had acceptability of probiotics. Theresults were evaluated according to 1st, 2nd, and 3rd day post intervention. Among 50 patientsof case group, 18 patients were compliance. 49 patients had decrease in duration. The sameresults were observed in the decrease in frequency. Consistency was improved in 39 patients.The duration of hospitalization was reduced in 36 patients. It was observed that improvement inthe duration, frequency, and consistency was mostly observed on 2nd day of post intervention.Conclusions: The role of S. boulardii as a good biotherapeutic agent allowing to prevent and/ortreat several grastrointestinal diseases. In comparison to probiotic bacteria, the use of probioticyeast is beneficial when the treatment is combined to antibiotherapy.

AIMS AND OBJECTIVES: To evaluate the results of closed interlocking intramedullary nailing without reaming in the treatment of open fractures of t he tibial shaft and study the difficulties (complications) encountered during the operative study. To compare the efficacy of interlocking intramedullary nailing without reaming in treating open fractures of tibia, Time required for the union of fracture, Range of motion of ankle and knee joint, Rate of malunion and mal rotation and Pain at the knee joint. RESULTS: The average age of patient is 32 years,83.33% are males, road traffic accidents account for majority(79.16%),right side involved in 58.33%,gustillo type II and type I compound fractures are common, full range of movements is seen in 66.67% by 12 weeks and union occurred in 95.83% by 9 months. Thirteen (54.17%) patients had excellent results, six (25%) patients had good results, four (1 6.67%) patients had fair results and one (4.16) patient had poor result. CONCLUSION: Unreamed interlocking intramedullary nailing with the help of image intensifier seems feasible in open diaphyseal fractures of tibia with the advantages of minimal blood l oss, low risk of infection, early mobilisation , earlier soft tissue coverage , Promotes early union , minimal hospital stay and early returns to activities

Wind energy is an important source of electrical power in recent years. d summarize the content of the paper. Its main advantage comes from the fact of being a renewable and environmental-friendly energy. Permanent magnet synchronous generators (PMSG) applied to wind energy conversion system (WECS) using variable speed operation is being used more frequently in wind turbine application. Variable speed systems have several advantages over the traditional method of operating wind turbines, such as the reduction of mechanical stress and an increase in energy capture. To allow the variable speed operation of the PMSG WECS a conventional three-phase bridge rectifier (BR) with a bulky capacitor associated with a voltage source current controlled inverter (VS-CCI) is used. This paper presents a comparative simulation study between three different approaches applied to harmonic mitigation in PMSG WECS. The studied techniques are single-switch three-phase boost rectifier and three-phase boost type PWM rectifier.

The DSP (Digital Signal Processing) has many advantages over the analog processing. Therefore, with the recent advent of technology most of the signal processing tasks have been transferred from the analog to the digital domain. The ADCs (Analog to Digital Converter) provide a liaison between the real world analog signals and the digital processors. Therefore, ADCs become an elementary part of almost all modern electronic systems. This work focuses on the development of a simple Flash ADC for students demonstration purpose. In this context, a 5-Bit Flash ADC is implemented. Being designed for illustration purpose, the ADC has easily accessible inputs and outputs to each module. In order to keep the system cost effective with an ease of reimplementation. The low cost and easily market available discrete analog components are employed. The digital part is kept configurable with the help of a FPGA (Field Programmable Gate Array) based implementation. The digital circuit implementation is done via Verilog, a HDL (Hardware Description Language). The system implementation is described. Testing results are also presented. These results assure a proper functionality of the designed ADC.

Background: Congenital heart diseases (CHD) are relatively common with a prevalence ranging from 3.7 to 17.5 per 1000 live births. Little is known about genetic link with respect to congenital heart disease. Iroquoise (Irx) homeobox genes have been widely studied and their expression in both developing and adult heart. Author tried to study the role of irx4 and irx5 genes in structural congenital heart disease, keeping the focus on study reported by Cheng Z et al.Methods: Author studied reported mutation site sequences in 25 various congenital heart disease patients and control healthy relatives of patients. It is a unique study and there has not been such a study reported in literature till date. Besides comparison with healthy related controls, author took cardiac tissue biopsy in patients while doing corrective cardiac surgery. However, blood samples were taken from controls due to ease of feasibility.Results: Although, there were no sequence variations in the studied exon regions, but author got a base pair sequence change at 6 bp intron region, which is near the exon splice site in irx4 gene. Besides two ASD patient’s male children (one child each) had ASD prompting us to believe some role of sex linkage. However later needs pedigree analysis and sex chromosome studies for further analysis.Conclusions: Gene sequence in the Kashmiri population is unique. There is possibility of role of irx genes in CHD. ASD might have sex linkage in some.

Flavonoids have been demonstrated to provide health benefits in humans. Baicalein (5,6,7-trihydroxyflavone) is a phenolic flavonoid compound derived mainly from the root of Scutellaria baicalensis Georgi, a medicinal plant traditionally used in oriental medicine. Baicalein is widely used in Korean and Chinese herbal medicines as anti-inflammatory and anticancer therapy. However, the molecular mechanisms of its activity remain poorly understood and warrant further investigation. This study was performed to investigate the anticancer effect of baicalein on HCT116 human colon cancer cells and the tumor preventing capacity of baicalein on colitis-associated cancer in mice. In in vivo experiments, we induced colon tumors in mice by azoxymethane (AOM) and dextran sulfate sodium (DSS) and evaluated the effects of baicalein on tumor growth. Baicalein treatment on HCT116 cells resulted in a concentration-dependent inhibition of cell growth and induction of apoptotic cell death. The induction of apoptosis was determined by morphological changes and cleavage of poly(ADP-ribose) polymerase. Baicalein also suppressed the activation of NF-κB through PPARγ activation. These results indicate that the anti-inflammatory effects of baicalein may be mediated through PPARγ activation. Finally, administration with baicalein significantly decreased the incidence of tumor formation with inflammation. Our findings suggest that baicalein is one of the candidates for the prevention of inflammation-associated colon carcinogenesis.

An effortless and efficient protocol was developed for the synthesis of N,N′-diarylsubstituted formamidines under environment-friendly conditions. Ultrasonic energy was employed to obtain the desired products in excellent yields with high purity under solvent-free and catalyst-free conditions. Products were purified by the crystallization technique to avoid excess utilization of organic solvents.

Determine the safety and efficacy of On pump beating heart repair of Atrial Septal Defect (ASD) with regard to postoperative neurocognitive function and to determine myocardial oxygen extraction during the procedure. The prospective study included 70 consecutive patients with Secondum ASD randomly assigned to two groups Beating Heart Group (Gp1) and Arrested Heart Group (Gp2) each having 35 patients. Gp1 patients underwent beating heart ASD with normothermic bypass without cross-clamping the aorta. Gp2 patients had conventional surgery with normothermic bypass and cardioplegic arrest. All patients were evaluated preoperatively (D0) and postoperatively on 10th day (D10) and 6 months (D6mths) for neurocognitive functions. We also compared myocardial oxygen extraction and total costs incurred. On pump beating heart repair of secondum ASD without aortic cross clamp reduces cardiopulmonary bypass time min0 vs (39.4 ± 13.2 vs 58.6 ± 15.4, p = 0.000) and total cost in rupees (26733.4 ± 3117.8 ; 31357.1 ± 1748.8, p = 0.029). There was no neurologic deficit observed in any of our patients postoperatively. Preoperative and postoperative neurocognitive functions in either group did not show any significant intergroup or intragroup deterioration. Myocardial oxygen extraction in Vol%, though significantly more in Gp1 than in Gp2(10.2 ± 2.6 ; 7.9 ± 2.0, p = 0.000) was however comparable to that seen in normal healthy beating heart. There were no mortalities The technique is safe in protecting neurocognitive functions. This technique offers simple, effective, and safe alternative to cardioplegic techniques and may be safely used in majority of ASD repairs.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to induce apoptosis in a variety of cancer cells, including colon, prostate, breast and leukemia. Among them, aspirin, a classical NSAID, shows promise in cancer therapy in certain types of cancers. We hypothesized that aspirin might affect the growth of liver cancer cells since liver is the principal site for aspirin metabolism. Therefore, we investigated the effects of aspirin on the HepG2 human hepatocellular carcinoma cell line in vitro and the HepG2 cell xenograft model in BALB/c nude mice. We found that treatment with aspirin inhibited cell growth and induced apoptosis involving both extrinsic and intrinsic pathways as measured by DNA ladder formation, alteration in the Bax/Bcl-2 ratio, activation of the caspase activities and related protein expressions. In vivo antitumor activity assay also showed that aspirin resulted in significant tumor growth inhibition compared to the control. Oral administration of aspirin (100 mg/kg/day) caused a significant reduction in the growth of HepG2 tumors in nude mice. These findings suggest that aspirin may be used as a promising anticancer agent against liver cancer.

Pleuropulmonary blastoma (PPB) is a rare intrathoracic neoplasm of early childhood that occurs in the lung or visceral pleura. We present a case of a 5-year-old boy with a cough, left-sided chest pain and progressive dyspnea on exertion. The patient had had an operation for a congenital lung cyst of the left lower lobe, six months prior to the present admission. A CT showed a heterogeneously enhancing mass lesion filling the left hemithorax. CT-guided fine needle aspiration cytology of the mass was inconclusive. En bloc resection of the mass along with left lower lobe, the involved ribs and left diaphragm was performed. The diaphragmatic defect was repaired using prolene mesh. Histopathology of the resected specimen showed solid and cystic areas consistent with type II PPB. The patient received adjuvent chemotherapy and was doing well 23 months after surgery. Radical resection of the tumor followed by adjuvent chemotherapy provides the only hope of salvaging cases of type II or type III PPB.

Background The indications and the outcome of surgery for pulmonary aspergilloma remain highly controversial. This retrospective observational study was conducted to study the clinical profile, indications, post-operative complications and long term outcome of patients having pulmonary aspergilloma. Methods From January 2000 to October 2008, 52 patients underwent surgery for pulmonary aspergilloma at our tertiary care institute. Results The group consisted of 32 males and 20 females with a mean age of 39.3 ± 11.2 years. The most common indication for surgery was hemoptysis (96.15%). The underlying lung diseases were tuberculosis (75%), bronchiectasis (5.76%), and lung abscess (5.76%). In one patient (2%), concomitant ruptured lung hydatid cyst and an aspergilloma was present. The procedures performed were lobectomy ( n = 43), bilobectomy ( n = 3). pneumonectomy ( n = 3), segmental resection ( n = 3). The post-operative mortality was 1.92% (one patient). Overall complications occurred in 12 (23.07%) patients. The complications included prolonged air leak ( n = 6), bleeding ( n = 3), empyema ( n = 1), repeated pneumothorax ( n = 1), and wound dehiscence ( n = 1). The mean follow-up period was 38 ± 18.6 months. There was no recurrence of disease or hemoptysis. Conclusion Pulmonary aspergilloma is common in developing countries like India in which there is high prevalence of pulmonary tuberculosis. Surgical resection of pulmonary aspergilloma is effective in preventing recurrence of symptoms including hemoptysis. We recommend early surgical resection of symptomatic aspergilloma with reasonable complications. Pre-operative preparation of the patients, meticulous surgical technique and post-operative chest physiotherapy reduces the rate of complications. Complications may still occur and are largely related to the underlying lung pathology; however, the long term outcome is good.

Background: Right ventricular (RV) dysfunction is a significant cause of morbidity and mortality after surgical correction of RVOT obstruction including tetralogy of Fallot (TOF). Transatrial repair avoids a ventriculotomy (in contrast to the transventricular approach) emphasizing maximal preservation of RV structure and function. We have adopted this technique as less traumatic for the right ventricle. This study evaluates the early surgical results of our approach.Methods: Between January 2005 to January 2014, 77 consecutive patients with RVOT obstruction were referred to our unit for surgical therapy. Of these, 14 were unsuitable for repair and underwent aortopulmonary shunting. In the remaining 63 patients (mean age of 2.67±0.38 years), complete transatrial/transpulmonary repair was performed. Previously placed shunts (four patients) were taken down. In all cases, subpulmonary resection and ventricular septal defect (VSD) closure were accomplished transatrially. In 51 patients, the main pulmonary artery was augmented with an autologous pericardial patch.Results: There were 7 (9%) deaths in this series. No patient required permanent pacemaker. Median ICU and hospital stay were 91 hours and 14 days, respectively. At median follow up of 54 (mean 51±12) months, all patients are asymptomatic, with no significant residual lesion.Conclusions: Transatrial/transpulmonary repair of TOF is associated with remarkably low morbidity and mortality in our early experience.

Aim of this study Korean red ginseng (KRG, Panax ginseng C.A. Meyer Radix rubra) has been used to treat various diseases including cancer. However, the molecular mechanisms responsible for KRG extract induced apoptosis and telomerase inhibition remain unclear. Materials and methods The hot water extract from KRG was used to evaluate the mechanism of induction of apoptosis in U937 human leukemia cells and its effects on cyclooxgenase-2 (COX-2) and telomerase activity. Results KRG extract treatment to U937 cells resulted in growth inhibition and induction of apoptosis in a concentration-dependent manner as measured by hemacytometer counts, MTT assay, fluorescence microscopy, agarose gel electrophoresis and flow cytometry analysis. The increase in apoptosis was associated with the down-regulation of antiapoptotic Bcl-2, Bcl-XL, and IAPs family members, and the activation of caspase-3. KRG extract treatment also decreased the expression levels of COX-2 and inducible nitric oxide synthase. Furthermore, KRG extract treatment progressively down-regulated the expression of human telomerase reverse transcriptase, a main determinant of the telomerase enzymatic activity, with inhibiting the expression of c-Myc in a concentration-dependent manner. Conclusions These results provide important new insights into the possible molecular mechanisms of the anticancer activity of KRG extract.

Background: The UK average for inpatient stay for patients over 65 is 6-13 days (King9s Fund 2012). Barnsley Hospital is a 500-bed hospital in North West England with a busy acute medical unit (AMU) consisting of 8 acute medical wards. A system of inpatient respiratory review for AMU patients has been recently introduced. Aims: The aim was to review specialist respiratory input in Barnsley Hospital AMU and to assess the impact on diagnosis, management and discharge of inpatients. Methods: Patients admitted to Barnsley Hospital AMU from October 2013 to June 2014 who had received a specialist respiratory review were included. Data from patient notes was assessed for demographics, presenting complaint and comorbidities. Changes in diagnosis following review, formulation of specialist management plans and duration till discharge were also noted in these patients. Results: 806 patients (out of 4768) received received specialist respiratory input over the audit period. Average age was 69 years (range 17-101). 221 (38%) presented with exacerbation of COPD and 176 (31%) with pneumonia. The remainder comprised chiefly of shortness of breath and acute asthma. The most common co-morbidities were COPD (42%) and hypertension (17%). Respiratory review resulted in a change in diagnosis in 45% of patients. 77% received specialist management plans. 50% of reviewed patients were discharged in in ≤3 days. Conclusions: In an audit looking at inpatient admissions in a busy acute medical unit, inpatient respiratory review was important for accurate diagnosis, specialist-designed management plans and early discharge compared with the national average.

Tumors of fibrous tissue origin (Fibromatosis) in chest and mediastinum have been rarely reported in the literature1,2,3,6,7,9. Bilateral pleural and mediastinal fibromatosis extending to neck along the tissue planes has not been reported in the English literature. Most are benign but 10-20% can undergo malignant transformation6. These tumors are initially asymptomatic but later on present with compressive symptoms as the size grows. The possibility of this rare entity should always be considered in patients with intrathoracic and/or mediastinal tumors. We present 2 cases who were difficult diagnostic problems.

Metastatic malignancies to the hand, although rare, usually develop from lung, breast, and kidney tumors. Very rarely the origin is the gastrointestinal system. Metastases to the bones of the hand can cause pain, swelling, soft tissue ulceration, and osteolytic destruction. We present a patient with metastatic tumors to all digits of both hands 2.5 years after being operated on for esophageal carcinoma. The patient underwent amputation of the left little finger followed by systemic chemotherapy. The histopathological diagnosis was consistent with that of the primary tumor. This case is being presented for being the rarest of its kind and may even be the first of its nature in the world's literature as an extensive search has not shown another of its kind to date.

Objective To determine the sensitivity and specificity of single-tube osmotic fragility (SOFT) and its different methods as screening test for thalassemia trait. Methods A cross-sectional study was conducted at Omair Sana Foundation. A total of 400 participants were included in the study. Three hundred were known thalassemia carriers (parents with at least one child with thalassemia major), while 100 were healthy blood donors. SOFT was performed on all 400 participants. Serum iron, ferritin, and DNA tests were performed on 100 participants (donors). ARMS technique was used for detecting thalassemia mutations. Results Sensitivity and specificity of SOFT (venous method) were found to be 99.6% and 86%, respectively, while with EDTA method, sensitivity was 95% and specificity was 96%. For venous and EDTA methods, positive predictive values were 95.5% and 98.6%, respectively, while negative predictive values were 98.8% and 86.6%, respectively. Use of EDTA and storage had an effect on the results. Sensitivity of SOFT was 95% at 5 min, while it decreased to 87% with EDTA method at 240 min. Sensitivity of SOFT for iron deficiency anemia was found to be 14%. Conclusion SOFT can be used as screening test for thalassemia trait in a cost-effective way. Moreover, we also found that SOFT should be performed on venous blood without adding preservatives (EDTA) that can interfere with the results.

Pakistan’s exports evolve broadly in line with total world imports. Accordingly, Pakistan’s share in world imports was remarkably stable during the last 20 years, ranging between a minimum of 0.12 percent in 1980 and a maximum of 0.18 percent in 1992. In 1999-2000, the share was 0.15 percent. This would suggest that Pakistan’s export performance was not worse than that of the world on average. Compared to regional competitors, however, the performance was unimpressive, especially when compared to China and Thailand throughout the 1980s and 1990s or compared to Bangladesh, India, and Sri Lanka during the 1990s. All these countries succeeded in achieving sustainable market share increases in total world imports (Figure 1). In light of the growing awareness about the importance of exports in the overall economy of Pakistan and in view of the unimpressive export performance of Pakistan vis-a-vis other countries in the region it would be interesting to study the export performance of Pakistan and analyse the possible reasons for this poor performance and see whether it is due to demand deficiency or is it something to do with the supply side of the issue. There are, of course, many factors that determine the export performance of a country. Analysis of the determinants of export performance, using time series data in regression models encounter difficulties in defining and quantifying explanatory variable sets. The conceptual and practical difficulties involved in specifying, for example, the degree and structure of protection accorded to the domestic industry. However, time series analysis has generally been considered more persuasive than decomposition techniques.

It is proposed that the use of ultrasound irradiation is the major reason for the efficiency of the simple one-pot reaction of aromatic amines with triethyl orthoformate to afford formamidines and benzimidazole derivatives.

In the present paper we have tried to examine Pakistan’s experience with exports and growth by constructing several measures of diversification and structural change in Pakistan’s exports from a dis-aggregated data over a period of 27 years (1972-73 to 1997-98). Then using these measures we have tested a number of relationships among the structure of exports, export growth, aggregate growth, and world growth. By looking at the evolution and structural change of exports by sectors over the long run, we find a number of interesting results. First, the degree of export diversification increased sharply from 1979 and continued till 1985. After 1985, and with the return of the democracy in the country. There was a marked reduction in the export diversification and it went back to pre-1979 level. Secondly, a crude association of ‘traditionality’ with primary products and ‘non-traditionality’ with manufactured exports fails to represent Pakistan’s experience. As Pakistan emerged from an import substitution period into a period of structural change and free trade, its true comparative advantage was more visibly expressed, thus some manufactured exports declined while some primary products grew. Third, the shortrun dynamics of diversification and structural change show a marked pattern. Most change in the composition of exports has taken place during periods of boom in the domestic economy but when the world economy was experiencing a relatively recessionary period. The analysis of export-growth relationship rejects the hypothesis of export-led growth. Instead our results reveal that growth leads exports in case of Pakistan. The Mohammad Akbar is Associate Professor at the Applied Economics Research Centre, University of Karachi. Zareen F. Naqvi is Senior Economist at the World Bank, Islamabad. Authors’ Note: The views expressed in this paper are of the authors and not of the organisations where they are employed.

This paper presents field experiences with metal oxide varistor surge arresters (MOVAs). Observations on their breakdown mechanism are summarized. Results of laboratory and field study of several makes of MOVAs of different ratings used in electric transmission systems are presented. This includes on-site measurements of internal leakage currents of healthy units and laboratory examination of failed units. Based on the above studies, several possible measures to minimize MOVA’s failure are suggested.

TO THE EDITOR: A transfusion reaction (TR) is any untoward event that occurs during or after blood transfusion and is not related to the patient’s underlying illness. It has been estimated that about 10% of all transfusions carry the risk of an adverse event [1]. Both, infectious and non-infectious TRs are associated with significant mortality and morbidity [2]. The frequency of TR is estimated to be 0.5 to 2.9 per 1,000 blood units [3,4,5,6]. However, the actual TR incidence is frequently underestimated; therefore, every hospital should have a hemovigilance program aimed at effectively reporting and analyzing TR in order to improve transfusion patient safety [5].

This paper presents an empirical analysis of how foreign direct investment impact on the export performance of pharmaceutical firms in India. The hypothesis is examined using panel data analysis. The results show that foreign ownership has a negative impact on export performance. Unlike other industries, it is observed that in pharmaceutical industry foreign owned firms export less and focus more on domestic demand and host country specific advantages. Our findings provide rich source of information to policy makers, researchers and the management of both foreign and domestic owned firms.

Combined therapy with multiple drugs is a common practice in the treatment of cancer, which can achieve better therapeutic effects than a single drug, and can reduce the side effects as well as drug resistance. This study aimed to determine whether aspirin (ASA) shows synergism with doxorubicin (DOX) in HepG2 human hepatocellular carcinoma cells in vitro and in a HepG2 cell xenograft model in BALB/c nude mice. When treated in combination, DOX (0.25 nmol/ml) and ASA (5 µmol/ml) produced strong synergy in growth inhibition, cell cycle arrest and importantly, apoptosis in vitro in comparison to single treatments. Moreover, ASA (100 mg/kg/day orally) and DOX (1.2 mg/kg biweekly ip) induced synergistic antitumor activity in the HepG2 cell xenograft model in nude mice. Therefore, the combination of ASA and DOX could be used as a novel combination regimen which provides a strong anticancer synergy in the treatment of hepatocellular carcinoma.

Background There is a lot of controversy about the best surgical treatment for esophageal carcinoma. Methods In this retrospective study, 382 patients with carcinoma of the mid-to-distal esophagus underwent transthoracic or transhiatal esophagectomy. Early morbidity and mortality were compared. Principal endpoints were disease-free survival (DFS) and overall survival (OS). Results A total of 177 patients underwent transthoracic esophagectomy, and 205 patients underwent transhiatal esophagectomy. Demographic characteristics and characteristics of the tumor were similar in the two groups. Perioperative and postoperative morbidity was higher after transhiatal esophagectomy. In-hospital mortality was also higher after transhiatal esophagectomy. The median follow-up was 4.3 years. Estimated 3-year DFS rates were 44.63 and 31.21%, whereas the 3-year OS rates were 57.06 and 41.46% for the transthoracic and transhiatal groups, respectively (statistically significant). Also, the estimated 5-year DFS rates were 26.55 and 21.46%, whereas the 5-year OS rates were 32.76 and 30.24% for the transthoracic and transhiatal groups, respectively (statistically not significant). Conclusions Transhiatal esophagectomy was associated with higher perioperative and postoperative morbidity and in-hospital mortality than transthoracic esophagectomy. The DFS and OS were higher in the transthoracic group and were statistically significant at 3 years but statistically insignificant at 5 years.