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Background: Hypospadias is a congenital anomaly, exclusive to the male population involving male external genitalia. Incidence varies in different populations and ethnic groups. Objective: To determine the frequency of fistula formation after two staged Bracka’s technique in the management of hypospadias cripples in patients of different age groups. Methodology: Setting: Department of Plastic and Reconstructive Surgery, Shaikh Zayed Hospital, Lahore. Duration of Study: From January 2011 to June 2014. Study Design: Descriptive case series. Sampling Technique: Non-probability: purposive sampling. Study subjects: Patients with age 1 to 60 years, diagnosed as case of hypospadias cripples diagnosed clinically (patients having a persistent functional complication after initial repair). The data was entered into SPSS version 22 and analyzed through it. Fistula formation was presented as frequencies and percentages. Results: The mean age was 8.26±5.67. The majority of the patients, 71 (84%) were less than 10 years of age (84%), 6 patients (7%) were between 10-20 years of age, while 8 patients (9%) were more than 20 years of age. Only 9 patients (11%) had a fistula and most of the patients 76 (89%) had no fistula. There was 1 (1%) patient who had fistula less than 10 years of age, 2 (3%) patients had fistula between 10-20 years of age while 6 (7%) patients had fistula more than 20 years of age. Conclusion: It is concluded that the early intervention in cases of hypospadias cripples results in lesser complications and lesser functional problems as compared to increasing age at the time of presentation.

Financial decision making is affected by financial literacy, having its implications spread across communities, countries and the societies in general. The importance and fragility of financial literacy has been the subject of previous studies. However, current study dived deep into public and private universities to find their contribution. Longitudinal survey approach employed withmultistage stratified random sampling technique, clustered to respondents' demographics. Financial literacy is evaluated based on simplicity, relevance, brevity and capacity of differentiation. Finding reveals that the students of the private sector became more capable of processing financial information after studying finance courses. Similarly, students having finance courses before joining universities were more financially literate as compared to others. Irrefutably, the study recommends improvement in curriculum design, teaching methodology and assessment. Higher educational institutions must improve curriculum and improvise teaching pedagogies. The findings of the study have paved the road for the dissemination of financial literacy for the growth of individuals, society and the economy Keywords: Financial literacy, Financial fragility, Financial well being, Academia.

The coastal / maritime tourism is an important segment in a multi-trillion dollars and multivariate global tourism industry. It offers one of the new avenues and fastest growing areas for significant role in global economies. Various countries such as Maldives, Indian State of Kerala, Singapore and Thailand etc. have focused on maritime tourism with good governance practices evolved over period of time to earn substantial revenues from it. Pakistan has also immense maritime tourism potential with diversified natural, religious, and cultural tourism resources. But Pakistan’s maritime tourism is considered very weak due to various issues. With qualitative research, this paper attempts to explore and suggest solutions for the development of maritime tourism sector of Pakistan by analysing the tourism governance of global success stories and evaluating the nationwide potential and challenges. Arguments are developed that the factors behind the success stories of Maldives & Kerala state in India can act as guidance for taking initiatives on the proposed potential sites in order to uplift the maritime tourism sector in Pakistan. It is anticipated that the effective implementation of this paper’s recommendations would be instrumental in gearing up Pakistan’s Maritime economy.

Background Epilepsy is a neurological disorder that presents with recurrent seizures associated with erratic brain activity which can be measured through EEG in addition to other neurological investigations. However, EEG may show abnormal patterns and waveforms while the patient is having a seizure which is crucial for making an accurate diagnosis. Objective This study aims to evaluate the spectrum of EEG findings in newly diagnosed epileptic patients as part of a neurological investigation. Material and methods This cross-sectional study was carried out at the Department of Paediatric Neurology, the Children's Hospital, and the Institute of Child Health, Lahore for six months. A sample of 122 patients was enrolled in this study with an age range of >1 month and

With an assorted sample of customers from various banks of Pakistan, the authors tried to establish relationship of investor’s demographic traits and personality type with financial risk tolerance during the choice of investment. Results provide sustenance for the projected hypotheses such as investor’s age, income, financial knowledge, family size, occupation and academic qualification has association with financial risk tolerance capability.Investors doing service in an organization tolerate more risk as compare to the investor having their own business. However, Investors marital status and gender has no effect on financial risk tolerance. Investor either married or unmarried showed similar attitude toward financial risk tolerance. Empirical results also provide evidence that investors having type A personality are more financial risk taker as compare to type B personality.

In the suburbs of big cities, the vegetables are commonly irrigated with effluents due to paucity of good quality water. These effluents are loaded with toxic or heavy metals which may cause environmental or health hazard. Present study was performed in pots experiments to investigate the impacts of different effluents on the growth, yield and heavy metals concentration of turnip (Brassica rapa). Pots were arranged in a completely randomized design (CRD) with six treatments replicated four times. The treatments included 10% effluents of sugar mill, sewage water, soap factory, ghee mill, slaughterhouse and control. Data on weight of root plant-1 (g), root length, root diameter, yield ha-1 and heavy metals (Fe, Pb, Zn, Ni, Cd) concentrations in roots were recorded and analyzed statistically. Results revealed that highest yield and related traits were recorded with sewage water followed by slaughterhouse wastage and sugar mill effluent. Application of sewage water enhanced 11.2% yield while the increment with slaughterhouse wastage and sugar mill effluent was 7.8% and 2.3%, respectively. Heavy metal concentrations were increased with all types of effluents. The transfer factors showed that accumulation of metals was in the order of Pb > Cd > Zn > Fe > Ni.

Southern Lower Indus basin is an oil and gas prone basin, which is important for producing hydrocarbon in Pakistan. Due to limited Rock-Eval pyrolysis data availability in the prospective shale gas basin, the organic facies geochemical characteristics study is a challenging task for researchers. The primary objective of this study is an evaluation of the Lower Goru Formation organic facies hydrocarbon potential by geochemical data and its subsurface facies distribution study by well tops and seismic data. The study area is situated at the Southern Lower Indus basin of Pakistan that is considering the prospective shale gas basin with immense unconventional hydrocarbon potential. In the present study, Rock-Eval pyrolysis data analysis along with the integration of both seismic and well tops data were conducted for investigation of source rock generation potential of organic facies variability within the Lower Goru Formation. The geochemical approaches used in the current study show that the Lower Goru Formation encountered in, bears fair to excellent total organic carbon (TOC) content values of 0.50–3.60% in Well-A and 0.10–4.69% in Well-B. Additionally, the results of Rock-Eval pyrolysis data show that interbedded shales of the Lower Goru Formation contain different types of kerogen (III, II–III, and II) with variable generation potential of oil and gas.

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Background: Tension type headache is claimed to be one of top ten disabling conditions in the world. The purpose of the study was to determine the effects of muscle energy technique on pain, range of motion at cervical spine and disability related to tension type headache. Methods: A randomized control trial was conducted on 48 participants of both genders whose age was 18 to 40 years with complain of tension type at Rehabilitation and Injury Management Department of Medcare International Hospital Gujranwala, from July to December 2019. Participants were randomly selected and allocated into two groups (experimental and control group). The experimental group received both muscle energy technique and myofascial release technique on trapezius and sternocleidomastoid of both sides. The intervention was applied for 6 weeks (3 sessions per week). Assessments were done at baseline, 4th week and 6th week. Numeric pain rating scale (NPRS), Headache disability inventory (HDI), headache impact test (HIT) and cervical range of motion with the help of Inclinometer were tools for assessment. Data analysis was done using SPSS (version 21). Results: The mean age of experimental group was 26.5±5.42 and control group was 27.7±5.70. The experimental group was shown significant improvement in terms of pain and flexion and side flexion range of motion with p-value ≤0.05. Conclusion: It is concluded that muscle energy technique is effective treatment for tension type headache; it is associated to decreased range of motion at cervical spine and disability related to TTH. Trial registration: IRCT20190121042445N2, Registered 07-02-2021.

Human diets with functional ingredients showed promising role in management of diseases of modern age like hyperglycemia and hyperlipidemia and even cancer. The study designed to elucidate role of honeybee propolis for management of hyperglycemia and hyperlipidemia states through animal modeling system. Hydroalcoholic extract of propolis was used for development of functional drink with standard recipe and addition of specified dose of extracts (400mg/500mL). Animals were grouped into three studies including study-I fed on regular diet, study-II fed on sucrose enrich diet and study-III fed on diet enriched with cholesterol and monitored to evaluate the results. Various parameters like feed consumption, liquid intake of animals measured regularly whereas body weight recorded at the end of each week of study. At the end of the study animals were analyzed for different blood indicators like blood lipid indices (cholesterol, LDL, HDL concentration and triglyceride contents)), glucose concentration and insulin contents as well. The maximum feed and drink intake were examined in animals, fed with control diet whereas a non substantial mode of intake was recorded in rest of two groups of animals. The consumption of honeybee propolis based drink reduced cholesterol (6.63% to 10.25%) and LDL (9.96% to 11.23%), whilst a sharp increase in HDL level was ranged as 4.12 to 4.49% among animal groups fed with high cholesterol and high sucrose diet. Blood glucose level was decreased by 10.25% and 6.98% however 6.99% and 4.51% increase were observed in plasma insulin level in both studies, study-II and study-III correspondingly. The overall findings of the study showed that drinks prepared using propolis of propolis found effective for management of hyperglycemia and hypercholesterolemia in present animal modelling system.

Water is extremely important for human survival and economic development globally. The largest province of Pakistan, Balochistan, is facing drought conditions, water scarcity and quality issues, which has badly affected community livelihood and health. The agriculture sector contributes over 26% gross domestic product (GDP) of the country and engages 44% of the total labour force. Due to the steep slope, the limited surface is ephemeral. So, groundwater is the only option for various activities in 90% area of the province while 10% area has waterlogging and extremely bad-quality groundwater issues. Major reasons for limited research work on water issues across the province were because of security, political and socio-economic issues. Previous studies depict that groundwater quality in the entire province contains a high concentration of various contaminants and pathogens. Pakistan Economic Survey revealed in a study that over 50 million people across the country do not have access to safe water, and over 0.25 million children died due to polluted water. More than 72% of the rural population in Balochistan depends on dug wells and streams for drinking water. This review paper covers various anthropogenic factors that contaminate groundwater and surface water, uses and available overall water resources in the province. Previous studies indicate the public in Balochistan is facing health issues from contaminants such as arsenic, fluoride, pathogenic, etc. in drinking water. In this article, spatial maps show the spatial variation of pollutants, water table and geological formations. Balochistan can be divided into two regions, south and north, containing different climate and water availability conditions. Basin wise water monitoring system could be the best option to sustain water resources, and low delta crops reduce stress on groundwater. The stakeholders and active community participation and serious effects could help to overcome water issues.

Visual identification of gunmen in a crowd is a challenging problem, that requires resolving the association of a person with an object (firearm). We present a novel approach to address this problem, by defining human-object interaction (and non-interaction) bounding boxes. In a given image, human and firearms are separately detected. Each detected human is paired with each detected firearm, allowing us to create a paired bounding box that contains both object and the human. A network is trained to classify these paired-bounding-boxes into human carrying the identified firearm or not. Extensive experiments were performed to evaluate the effectiveness of the algorithm, including exploiting full pose of the human, hand-keypoints, and their association with the firearm. The knowledge of spatially localized features is key to the success of our method by using multi-size proposals with adaptive average pooling. We have also extended a previously existing firearm detection dataset, by adding more images and tagging in the extended dataset the human-firearm pairs (including bounding boxes for firearms and gunmen). The experimental results $({78.5 AP}_{hold})$ demonstrate effectiveness of the proposed method.

Background: The recommended intake of fortified milk can substantially decrease the children’s ailment, increase growth rate and appears an economically beneficial strategy in the general Pakistani population aged over 6-24 months. Objective: The aim of this study is to determine the influence of fortified milk on children's health in Pakistan. Study Design: Randomized controlled trial. Settings: Department of Economics, GC University, Faisalabad-Pakistan. Duration: April 2019 to August 2019. Sample Size: Consisted of 100 individuals. Sampling Technique: Snowball technique was used to collect data. Data Analysis: Pretest and posttest data were analyzed with the help of t-test, paired sample t-test, and cross-tabulation. Results: It was found that there was a significant difference between the mean difference in age, height ratio of participants from their pretest and post-test scores. Conclusion: Fortified milk brings positive changes in growth of children in terms of weight & height. Suggestions: The mass should have awareness regarding fortified complementary foods.

Objective: This study was carried out to determine whether the rate of abnormal placentation is increasing in concurrence with the cesarean section and to assess risk factors and outcomes with multidisciplinary team interventions and anesthetic practices. Study design: Prospective cohort study. Material & Methods: A study was conducted in the department of anaesthesia from January 2014 to December 2017. All candidates under the spectrum of placenta accreta were observed for maternal age, parity, mode of anesthesia, blood loss, and outcome. Results: Out of 109 patients, the preoperative diagnosis of PAS was made up of 100 (91.74%) and intraoperative diagnosis of 9 (08. 26%) patients. According to the mode of anesthesia, 100 (91.74%) patients received GA, and 09 (08.26%) patients received spinal anesthesia. In 06 (05.49%) patients, spinal was converted to GA. Perioperative CPR was done in 05 (04.58%) cases. Out of 109 cases, 83 survived uneventfully, and 21 developed complications. 05 patients expired in the following days. (01 immediately postoperative period, 02 in 1st 24 hours and 02 in 1st 48 hours. Conclusion The rate of placenta accreta increased in conjunction with cesarean deliveries; the most important risk factors were previous cesarean delivery, placenta previa, and advanced maternal age and outcomes improved in a multidisciplinary team intervention.

Objective To compare the dynamic hip screw with proximal femoral nail for the treatment of Arbeitsgemeinschaft fur Osteosynthesefragen type A2 and A3 per trochanteric fractures of femur. METHODS The randomised controlled single-blind study was conducted at the Mayo Hospital, Lahore, Pakistan, from September 2015 to September 2017, and comprised patients aged 40-75 years with Arbeitsgemeinschaft fur Osteosynthesefragen type A2 and A3 per trochanteric fracture. The patients randomised into two equal groups. In Group A, patients were treated by closed reduction and internal fixation with dynamic hip screw, while those in Group B were treated by closed reduction and internal fixation by proximal femoral nail. Follow-up was done at 2nd, 6th and 12th weeks, and at 6th, 9th and 12th month post-operatively. Variables evaluated were frequency of union, surgical time, approximate amount of blood loss and complications. The functional assessment was done by using Harris hip score. SPSS 20 was used for data analysis. RESULTS Of the 68 patients, there were 34(50%) in each group. The mean age of patients in Group A was 60.88±12.49 years and in Group B it was 59.32±2.39 years. The mean surgery time in Group A was 58.71±7.84 minutes and in Group B 35.35±5.48 minutes (p

The objective of the study was to evaluate different types of cancer and its chemotherapy in various ethnic groups of Pakistan. Ethnic groups includes, Pukhtoons, Punjabis, Sindhis, Muhajirs, Siraikis, Memoons, Hazaras, Hindkos, Baltis, Gilgitis, Kashmiris, and Afghanis. The data was collected from well reputed hospitals located in the different provinces of Pakistan. The collected data was taken from 15 hospitals where around 8500 patients visited during 2010 to 2017. From the visited patients, 8356 were analyzed for their ethnicity, age and sex while, 144 patients (male 77 and female 67) were excluded from analysis due to incomplete information or loss of follow-up. Among 8356 patients, 3762 were male (45%) whereas, 4594 were female (55%). The chemotherapy was carried out as per National Comprehensive Cancer Network guidelines (NCCN- guidelines). The most common five prevalent cancer among these ethnic groups were Head and Neck, Blood, Respiratory, Genito-urinary and Breast cancer. The most common cancer in female was breast cancer while, head and neck cancer was more prevalent in male. It can be concluded that the prevalence of cancer in Pakistan is very alarming, which may be due to lack of awareness, illiteracy, lack of national cancer control programs, and economics issues.

Depression and anxiety are the most common disorders among all age groups. Several antidepressant drugs including benzodiazepine, antidepressant tricyclics, azapirone, noradrenaline reuptake inhibitors, serotonin selective reuptake inhibitors, serotonin, noradrenaline reuptake inhibitors, and monoamine oxidase inhibitors have been used to treat these psychiatric disorders. However, these antidepressants are generally synthetic agents and can cause a wide range of side effects. The potential efficacy of plant-derived alkaloids has been reviewed against various neurodegenerative diseases including Alzheimer’s disease, Huntington disease, Parkinson’s disease, schizophrenia, and epilepsy. However, data correlating the indole alkaloids and antidepressant activity are limited. Natural products, especially plants and the marine environment, are rich sources of potential new drugs. Plants possess a variety of indole alkaloids, and compounds that have an indole moiety are related to serotonin, which is a neurotransmitter that regulates brain function and cognition, which in turn alleviates anxiety, and ensures a good mood and happiness. The present review is a summary of the bioactive compounds from plants and marine sources that contain the indole moiety, which can serve as potent antidepressants. The prospects of naturally occurring as well as synthetic indole alkaloids for the amelioration of anxiety and depression-related disorders, structure-activity relationship, and their therapeutic prospects have been discussed.

Chiastic structure which is also called chiastic pattern is widely used as a literary technique in narratives and stories. It is usually a motif creating recurring element because it is symbolically significant in the story. Chiastic structures in various forms can also been observed in Quran, Hebrew Bible and New Testament. This paper explores the Chiastic patterns present in Chapter 43 of Quran and their relevance to the main themes presented in the chapter. The paper concludes that the themes presented in the chapter are similar to the pillars of Muslim faith and therefore their recurrence happens through these patterns. The paper also recommends that other chapters of Quran may be studied to find out the important themes which are explained through chiastic patterns.

The recent developments in the Internet of Things (IoT) paradigms have significantly influenced human life, which made their lives much more comfortable, secure and relaxed. With the remarkable upsurge of the smart systems and applications, people are becoming addicted to using these devices and having many dependencies on them. With the advent of modern smart healthcare systems, and significant advancements in IoT enabled technologies have facilitated patients and physicians to be connected in real-time for providing healthcare services whenever and wherever needed. These systems often consist of tiny sensors and usually run on smart devices using mobile applications. However, these systems become even more challenging when there is a need to take intelligent decision making dynamically in a highly decentralized environment. In this paper, we propose a Belief-Desire-Intention (BDI) based multi-agent formalism for ontology-driven healthcare systems that perform BDI based reasoning to take intelligent decision making dynamically in order to achieve the desired goals. We illustrate the use of the proposed approach using a simple case study with the prototypal implementation of heart monitoring applications.

Aim: The purpose of this viewpoint is to summarize the advantages and constraints of the tools and strategies available for reducing the annual incidence of tuberculosis (TB) by implementing the World Health Organization (WHO) End TB Strategy and the linked WHO TB Elimination Framework, with special reference to Oman. Methods: The case-study was built based on the presentations and discussions at an international workshop on TB elimination in low incidence countries organized by the Ministry of Health, Oman, which took place from September 5 to September 7, 2019, and supported by the WHO and European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Results: Existing tools were reviewed, including the screening of migrants for latent TB infection (LTBI) with interferon-gamma release assays, clinical examination for active pulmonary TB (APTB) including chest X-rays, organization of laboratory services, and the existing centres for mandatory health examination of pre-arrival or arriving migrants, including examination for APTB. The need for public-private partnerships to handle the burden of screening arriving migrants for active TB was discussed at length and different models for financing were reviewed. Conclusions: In a country with a high proportion of migrants from high endemic countries, screening for LTBI is of high priority. Molecular typing and the development of public-private partnerships are needed. (C) 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. Funding Agencies|WHOWorld Health Organization; ESCMID; Qiagen; Cepheid; Advanced Healthcare Solutions; PfizerPfizer; MSD; QIAGEN Sciences Inc.

Globally, claims and disputes are an unfortunate reality in construction projects. Recent statistics reveal that construction claims in the UK increased by 21% in 2018 compared to other countries such as India (8%), Mexico (3%), Ireland (2%), and Cyprus (2%). Though, construction industry is known for array of standard forms of contract and administrative tendencies; unsubstantiated claims and chronic disputes remain prevalent in the sector. Yet, there is little research on preventive approach to unsubstantiated claims that ultimately lead to disputes. The study advocates the use of Systematic and Technical Appraisal (STA) to prevent unsubstantiated claims and disputes in the construction industry. The study research method is based on qualitative research technique and use of case studies. The research question is: does systematic and technical appraisal of construction claims help prevent unsubstantiated claims and disputes in the UK construction industry? The study population sample is drawn from experienced industry stakeholders including clients, contractors, consultants, experienced quantity surveyors and cost managers in addition to use of construction case studies. Initial findings reveal that claim management processes in the construction sector are far-off from perfection. Other findings reveal that robust systematic and technical claim appraisal process has potential to prevent unsubstantiated claims; which in most cases lead to disputes. The study is part of an on-going PhD study to seek to develop an effective claim management system for the UK construction industry.

Background: Neuromobilization (NM) includes neurophysiological parameters that vary between clinicians. This randomized controlled trial aimed to investigate the NM on the outcomes of participants with shoulder impingement syndrome (SIS) following treatment sessions (base line to follow up). Study design: Single blinded randomized control clinical trial. Methods: Patients (80) with shoulder impingement syndrome (SIS) were asked to participate in this trial. At the first session, participants were randomly assigned to either control group (40) or experimental group (40). After the baseline assessment routine physiotherapy was executed for both groups, while NM was provided to experimental group. Pain and functional disability score were evaluated on baseline, post treatment and after follow up. Pain was considered as primary out come and functional disability score as secondary outcome. Improvement was evaluated at post treatment and follow up. Differences in outcome between groups were evaluated with clinical improvement. Results: The experimental group compared with control group at 11th week had lower mean pain score 2.15(1.66-2.64) vs 4.90(4.41-5.40); between group difference, 1.82; 95% (CI), -2.38 to -1.25; P ˂ 0.001 and Partial ƞ2=0.33, similarly functional disability score 28.58(27.32-29.83) vs 20.10(18.84-21.36); between group difference ,5.62; 95%CI,(4.32-6.92); P˂ 0.001 and Partial ƞ2=0.49. Over all pain and functional disability score were improved among experimental group relative to control group at 11th week. Conclusion: In an experimental setting, the delivery of neuromobilization leads to significantly different outcomes in participants than in control group. Studies are still required to explore the mechanisms underlying neuromobilization effects. Trial registration: IRCT20190121042445N1, Registered 19 February 2019. Key words: shoulder impingement, neuromobilization, functional disability.

Evaluation of shale gas hydrocarbon potential of Talhar Shale member of Lower Goru Formation, by using well logs data only, has been a challenging task in Southern Lower Indus Basin Pakistan. This paper is helpful to evaluate shale gas potential of source rock by using well log data. We have introduced and applied Empirical and Graphical method to resolve this task and have derived geochemical parameters from well logs data. The way mentioned is fastand the cheapest. Talhar Shale has kerogen typeIII and type II which has potential to produce, mainly, oil and gas. Talhar Shale is of Montmorillonite clay type. So, Talhar Shale has better sorption property. Empirical formulas are used to derive parameters, using well logs of Porosity, Density and Uranium. Porosity and Volume of Kerogen, calculated from density log, gives average values of 11.8% and 11.4%. Level of Maturity Index (LMI), derived by log, average value is 0.54 which indicates that it is on early stage of maturity. Vitrinite reflectance is between 0.5-0.55% as calculated by graphical method and empirical formula. Talhar Shale with main products of oil and gasis onset of oil generation,;could be a good potential source in the study area.

Objective: to determine the frequency of microalbuminemia in type IIdiabetic patients and to compare lipid profile in type II diabetic patients with and withoutmicroalbuminuria. Settings: Department of Medicine, Allied Hospital, Faisalabad. Durationof study: From: January 2015 to December 2015. Results: In our study, mean age was53.18+9.32 years, 43.90% (n=151) were male and 56.10% (n=193) were females, frequencyof microalbuminuria in type II diabetes mellitus was recorded in 32.56%(n=112). Conclusion:the frequency of microalbuminemia in type II diabetic patients is higher while the frequencyof hypertriglyceridemias, increased LDL-C and decreased HDL-C in Type II diabetic patientsis significantly higher in patients with microalbuminuria when compared them withoutmicroalbuminuria..

Objective To determine and compare the distribution of oestrogen and progesterone receptors (ER and PR) expression between normal kidneys and chronic pyelonephritis. Study design Comparative-descriptive study. Place and duration of study King Faisal Specialist Hospital and Research Centre, and Alfaisal University, Riyadh, Saudi Arabia, between January 2017 and December 2018. Methodology: Renal specimens, including 41 chronic pyelonephritis, and 21 healthy specimens were examined. ER/PR expression was determined immunohistochemically, termed focal if 50%. The intensity of staining was labelled weak (pale), moderate or strong. Results Majority of samples showed presence of diffuse ER (82.9% diseased; 71.4% healthy) and focal PR (53.7% diseased; 76.2% healthy), mostly with strong intensity. ER and PR distribution whether focal or diffuse, correlated with each other in 41.9%. All proportions comparisons showed p values greater than 0.05. Conclusion There was a trend of diffuse renal stromal expression of ER and PR in chronic pyelonephritis as compared to healthy specimens. However, the difference did not reach statistical significance. Key Words: Oestrogen receptor, Progesterone receptor, Chronic pyelonephritis, Renal cancer, Renal stroma.

To compare the effectiveness of Rush pin with long arm cast and dynamic compression plate in the management of diaphyseal fracture of radius and ulna in adults.The randomised control study was conducted at the Mayo Hospital, Lahore, Pakistan, from December 2012 to December 2015, and comprised diaphyseal fracture of radius and ulna cases aged 15-45 years of either gender. The patients were divided randomly into two groups. Group A was managed with open reduction and internal fixation with Dynamic Compression Plate, while group B was managed with closed reduction and internal fixation with Rush pin and long arm cast. Groups were compared for age, gender, Orthopaedic Trauma Association fracture type distribution, surgery time, amount of blood loss, union achieved, time to union and functional outcome in terms of Grace-Eversmann criteria and the Disabilities of the Arm, Shoulder and Hand score. The complications in the two groups were also noted. SPSS 20 was used for data analysis.Of the 60 patients, 30(50%) each were in groups A and B. In group A, there were 23(76.67%) males and 7(23.33%) females, while in group B, there were 26(86.67%) males and 4(13.33%) females. The mean age in group A was 30.33} 4.26 years (range 21-37 years), and in group B it was 28.60}7.69 years (range 15-45 years). There was significant short time to union in group B compared to group A (p0.0001). Frequency of union and functional outcome were not significantly different between the groups (p0.05).Functional outcome and frequency of union was not significantly different between the groups, but there was a statistically significant earlier union in cases managed with Rush pin and long arm cast than those managed with open reduction and internal fixation with Dynamic Compression Plate.

Seemingly, a formidable ethical challenge to financial reporting is the phenomenon of fallacious and discretional financial reporting as currently in practice. Such untruthful reporting intensified during the first decade of the 21st century when many of the personnel got involved to increase their personal benefits and the result was a wide-spread financial fiasco in the form of MCI WorldCom, Enron, Well Fargo, and Tesco accounting scandal, to mention a few. Most of the scandals were cause by false reporting, withholding information about financial troubles, revenue and earnings inflation, discretional revenue and expense recognition, use of off-balance-sheet items, artificial increase of cash flow and profits, backdating of sales contracts and accounting for vendors allowances and financing. The research in hand is an attempt to discuss such issues in the light of ethical and moral values that are not only recommended teachings of Islam, but also accepted business ethics in the civilized world. Islamic ethical guidelines for business encompass discipline and rules as enjoined in the divine sources of Shar¯ı‘ah - Qur’¯an and Sunnah (sayings of or the approved actions by the holy Prophet Muhammad PBUH). Implementation of these guidelines to make financial reporting ethical should be acceptable to the entire world, at personal, organizational, and society levels for broad based benefits of the mankind.

Automatic detection of firearms is important for enhancing the security and safety of people, however, it is a challenging task owing to the wide variations in shape, size, and appearance of firearms. Also, most of the generic object detectors process axis-aligned rectangular areas though, a thin and long rifle may actually cover only a small percentage of that area and the rest may contain irrelevant details suppressing the required object signatures. To handle these challenges, we propose a weakly supervised Orientation Aware Object Detection (OAOD) algorithm which learns to detect oriented object bounding boxes (OBB) while using AxisAligned Bounding Boxes (AABB) for training. The proposed OAOD is different from the existing oriented object detectors which strictly require OBB during training which may not always be present. The goal of training on AABB and detection of OBB is achieved by employing a multistage scheme, with Stage-1 predicting the AABB and Stage-2 predicting OBB. In-between the two stages, the oriented proposal generation module along with the object aligned RoI pooling is designed to extract features based on the predicted orientation and to make these features orientation invariant. A diverse and challenging dataset consisting of eleven thousand images is also proposed for firearm detection which is manually annotated for firearm classification and localization. The proposed ITU Firearm dataset (ITUF) contains a wide range of guns and rifles. The OAOD algorithm is evaluated on the ITUF dataset and compared with current state-of-the-art object detectors, including fully supervised oriented object detectors. OAOD has outperformed both types of object detectors with a significant margin. The experimental results (mAP: 88.3 on AABB & mAP: 77.5 on OBB) demonstrate the effectiveness of the proposed algorithm for firearm detection., Accepted for Publication in Neurocomputing

Since the first case was reported in 1981, the Indonesian government and civil society have implemented many initiatives to respond to the HIV/AIDS epidemic. From an historical perspective, the country now has the means to rapidly diagnose cases of HIV infection and provide antiretroviral therapy. The concern expressed by international health agencies about a potential major HIV epidemic in the country has not been confirmed, as evidenced by a slowing down of the number cases. The threat from non-sterile needle sharing has been relatively well controlled through harm-reduction programmes; however, drug trafficking remains a challenge. It has reached worrying levels and involves law enforcement units at the forefront of the battle. In parallel, the level of condom use in high-risk behaviour groups seems unsuccessful in reducing infection rates, especially among heterosexuals. The lack of information and the high mobility of the groups at risk of acquiring HIV infection have created tremendous challenges for outreach programmes. Heterosexual transmission represents the most important route of transmission in the country. When reflecting on the country's 2014 Millennium Development Goals, condom use during high-risk sex only reaches 43.5%, and only 21.3% of young people have a comprehensive knowledge about HIV/AIDS. The 2030 Millennium Development Goal Agenda offers an opportunity to catch up on goals that still need to be achieved. Therefore, efforts are underway to try to halt the epidemic by 2030 and also to ensure that all high-risk populations are included in this effort.

Given the anticipated 1000 times growth of tele-traffic, the conception of efficient spectrum management and sharing mechanisms becomes essential for 5G networks due to the scarcity of spectral resources. To meet this ambitious goal, we propose an SDN-based synergistic spectrum sharing technique, the harmonized SDN-enabled approach (HSA), which relies on distributed input reporting on spectrum availabilities in 5G heterogeneous networks. Conventional spectrum sharing mechanisms, particularly those using cognitive radio techniques, rely heavily on spectrum sensing and adaptive transmission-aided communications devices. However, this device-level spectrum sharing might lead to inaccurate sharing decisions due to the widely fluctuating signal quality observed by each device. Moreover, the network becomes vulnerable to malicious devices that report false sensing data to gain unfair access to the spectrum. These problems are further compounded by the fact that operational cellular networks have a somewhat rigid architecture relying on vendor-specific configuration interfaces, hence restricting the operators to have, at best, only indirect control of the network’s operation and resources. In addressing these challenges, we adopt a synergistic approach that integrates the distributed sensing devices, cellular base stations, and SDN controller into an intrinsically amalgamated network. To alleviate any potential controller scalability and latency concerns, HSA harmonizes the network’s operation by distributing the local decision making and network-wide policy making tasks among the base stations and the SDN controller, respectively. The article outlines the detailed network architecture and also presents an efficient resource management algorithm.

Selenium (Se) is an essential micronutrient for animal and humans; however, its essentiality in plants is yet to be established. Nevertheless, its beneficial role is reported in crop plants particularly under biotic and abiotic stresses. Selenium adopts uptake/transport pathways in plants similar to that of sulfate and/or phosphates; it may replace sulfur at cellular level to synthesize important macromolecules including amino acids, specific structural and functional proteins and/ or potentially toxic non-specific proteins and other seleno-compounds. The toxic compounds and non-specific proteins may cause severe cellular toxicity either by altering structure and functions of important biomolecules (proteins, and enzymes) and/ or by producing reactive oxygen species (ROS) and reactive nitrogen species (RNS). Selenium deficiency in human beings may cause immune system disorders, impaired fertility, cardiovascular diseases, diabetes, inflammatory disorders and last but not the least many types of cancer. Keeping in view widespread deficiency of Se and associated health risks, it is necessary to adopt practices to improve Se content of human diet. Biofortification of Se in plants is one of the good strategies to combat occurrence of Se deficiency in humans while addressing the potential issues related to its economic viability and social acceptability. The current manuscript critically discusses the Se existence in the environment, essentiality for humans, uptake and translocation in plants, physiological toxicity mechanisms and beneficial role in plant cycle while biofortification strategies are also elaborated especially conventional approaches and recent modifications in Se enrichment of food crops. Moreover, it also emphasizes the issues regarding economics of Se biofortification and its social acceptance. Keeping in view the importance of Se for life, its human health consequences and economic feasibilities, appropriate biofortification strategies may serve better to eradicate its hidden hunger rather than its artificial supplementation.

Organizational health is a modern and wide-ranging phenomenon that essential to endure long term achievements of an organization. The main objective of the current research study, to examine the effects of customer feedback on organizational health when employee empowerment works as a moderator. For this significant purpose, data was collected by respondents via using five Point Likert-scale techniques. The current research study has taken 750 total sample size from population to do expose hide phenomenon. We have used Factor Wise Reliability approach to test questions reliability; Descriptive Statistics verified whether data normalized or not; Pearson correlation to check the variables association-ship; Multiple linear regression technique to quantify per-point and overall fraction between dependent and independent variables; and finally linear regression moderation equation also conclude in methodological part for examines the moderation effect. The result indicates that Customer Feedback and organizational health both have been positively associated with each other. Besides, employees empowerment makes more strengthen the relationship of customer feedback and organizational health. In the light of outcome of current study, the manager should be aware about employees empowerment and customer feedback that are an order to sustain old customers and attract new customers for the Fast Food Industry. This research study has released new and different path for empirical investigation among organizational health, customer feedback and employees empowerment.

The basic aim of any education system is the development of overall personality of a child but major focus of school education remains on the intellectual development of students. Mathematics is a compulsory subject in the school curriculum and is very effective in cognitive development, but, it does so if taught and assessed properly. SSC exams are very important for students as they are gauged on the basis of their results in these exams. Due to the importance of these exams, the major focus of teaching/learning process in the schools remains on achieving the highest possible grades in the exams. It is therefore, very important to have a deep investigation of the exam papers in order to know weather the items of these papers are measuring essential mathematical skills or not. To achieve the purpose, this study has scrutinized the papers of SSC (Grade-10) for the years 2014/2015, set by Board of Secondary Education Karachi. Items used in these papers were examined and categorized according to the levels of Mathematical Assessment Task Hierarchy (MATH) taxonomy. These items were then compared with the items of GCE (O-Level) mathematics papers, serving as benchmark papers in this study, to highlight the shortcomings. The results of the study revealed that the items of SSC papers are highly biased towards A1 (Factual Knowledge) and A2 (Routine Procedures) categories of the taxonomy. The study concluded that these items assess knowledge of facts and algorithms only and do not measure essential mathematical skills (involvement of higher levels of thinking processes) of students. As, the papers of board exams highly affect teaching/learning process, it is recommended to improve the items of papers so that essential mathematical skills can be measured. The study recommends focusing on application and problem solving skills rather than the capacity of memorization because with this practice thinking habits can not be inculcated among students which are necessary to compete with other nations in this era of globalization.

OBJECTIVE To compare the success of treatment between thumb spica cast with "methylprednisolone acetate injection" versus thumb spica cast alone for the treatment of de Quervain's disease as functional outcomes, complications and patient compliance. METHODS A single blinded randomized controlled trial using a probability sampling technique was conducted from January 2014 to h February 2017at the Orthopaedic Unit II, King Edward Medical University / Mayo Hospital, Lahore. A total of 134 patients of both genders, between 30-60 years of age presented with wrist pain and diagnosed de Quervain's disease, were included in the study. Patients were randomly divided into two group by the computer allocation method. Patients in Group-A received thumb spica cast with methylprednisolone acetate and xylocaine injection while patients in Group-B were treated with thumb spica cast alone. The outcome variable was frequency of successful treatment which was noted and compared among the groups. RESULTS Amongst the total 134 patients, the age of the patients ranged from 30 to 60 years with a mean of 37.16±5.15 years. Most of the patients were aged between 30 40 years (78.8%) followed by 41-50 years (21.2%). There were 38 (28.4%) male and 96 (71.6%) female patients in the study group with a male to female ratio of 1:2.5. In group-A mean VAS and Quick DASH score before treatment and after the treatment was statistically significant (p-value

Acute lung injury (ALI) is clinically characterized by excessive inflammation leading to acute respiratory distress syndrome (ARDS), having high morbidity and mortality both in human and animals. Ginsenoside Rb1 (Rb1) is a major primary bioactive component extracted by Panax ginseng, which has numerous pharmacological functions such as anti-cancer, anti-inflammatory, and antioxidant. However, the anti-inflammatory effects of Rb1 in Staphylococcus aureus (S. aureus)-induced ALI in mice have not been investigated. The aim of the current study was to determine the anti-inflammatory influence of Rb1 on S. aureus-induced ALI in mice, and to explore its possible underlying principle mechanisms in RAW 264.7 macrophage cells. The results of physical morphology, histopathological variation and wet-to-dry weight ratio of lungs revealed that Rb1 significantly attenuated S. aureus-induced lung injury. Furthermore, qPCR results displayed that Rb1 inhibited IL-1β, IL-6 and TNF-α production both in vivo and in vitro. The activation of Toll-like receptor 2 (TLR2) by S. aureus was inhibited by application of Rb1 as confirmed by results of immunofluorescence assay. The expression of NF-kB and MAPK signaling proteins revealed that Rb1 significantly attenuated the phosphorylation of p65, ERK, as well as JNK. Altogether, the results of this experiment presented that Rb1 has ability to protect S. aureus-induced ALI in mice by attenuating TLR-2-mediated NF-kB and MAPK signaling pathways. Consequently, Rb-1 might be a potential medicine in the treatment of S. aureus-induced lung inflammation.

Acute lung inflammation is one among the top of infectious diseases. It is a pulmonary dysfunctional disease. It breaks the physiological coordination in the structures and functions of respiratory system. There are a few effective treatments to minimize the mortality of acute lung inflammation. It was induced by Staphylococcus aureus (S. aureus) via nasal instillation of mice. The common ivy (Hedera helix) is the most significant medicinal plant and considered as a traditional medicinal plant. The most active ingredient in the extract of ivy plant was Hederacoside-C (HDC). The purpose of this study was to investigate its anti-inflammatory effects on induced acute lung inflammation in vivo and (RAW 264.7 cells) in vitro and to elucidate its anti-inflammatory mechanisms. HDC was administered intraperitoneally 1 h after infection until 24 h. The dose was repeated every 8 h for three successful doses. Mice treated with HDC significantly reduced the pulmonary edema, white blood cells, wet-dry ratio (W/D) and myeloperoxidase (MPO) activity. HDC attenuated protein expression levels of MAPKs including p38, ERK, JNK and NF-κB including p65 and IκB-α pathways analyzed by ELISA. HDC also suppressed the protein expressions of TLR2 & TLR4 detected by Western blot. HDC also downregulated the gene expression of pro-inflammatory cytokines including IL-6, IL-1β and TNF-α, but upregulated the gene expression of an anti-inflammatory cytokine IL-10 analyzed by qRT-PCR. In conclusion, our results stated that HDC could inhibit the S. aureus induced acute lung inflammation and it may be a potential therapeutic drug against acute lung inflammation.

In this paper, we design an integrated protocol that jointly optimizes the performance of the physical, medium access control (MAC), and network layers. Our goal is to minimize total network energy consumption while delivering a minimum required signal-to-noise ratio (SNR) at each intended receiver within the network. At the MAC layer, we develop a cooperative automatic repeat request (ARQ) system, in which the relay nodes assist the source with its retransmission attempts. A complete analytic framework for the cooperative system is developed. Using this framework, we find the optimum transmission energy at the physical layer. To demonstrate the effectiveness of the proposed scheme in minimizing energy consumption, we propose two cooperative routing algorithms at the network layer. The proposed algorithms utilize the derived cooperative link cost as a basic building block. Through analysis and simulations, it is shown that over a single hop, cooperative transmission can achieve energy savings of up to 73%, as compared with noncooperative transmission. The simulation results also demonstrate that the proposed routing algorithms can achieve significant energy savings while using fewer hops, as compared with the baseline cooperative and noncooperative routing algorithms.

Acute pulmonary embolism (PE) is usually a complication secondary to migration of a deep venous clot or thrombi to lungs, but other significant etiologies include air, amniotic fluid, fat, and bone marrow. Regardless of the underlying etiology, little progress has been made in finding an effective pharmacologic intervention for this serious complication. Among the wide spectrum of PE, massive PE is associated with considerable morbidity and mortality, primarily due to severely elevated pulmonary vascular resistance leading to right ventricular failure, hypoxemia, and cardiogenic shock. We currently have limited therapeutic options at our disposal. Inhaled nitric oxide (iNO) has been proposed as a potential therapeutic agent in cases of acute PE in which hemodynamic compromise secondary to increased pulmonary vascular resistance is present, based on iNO's selective dilation of the pulmonary vasculature and antiplatelet activity. A systematic search of studies using the PubMed database was undertaken in order to assess the available literature. Although there are currently no published randomized controlled trials on the subject, except a recently publish phase I trial involving eight patients, several case reports and case series describe and document the use of iNO in acute PE. The majority of published reports have documented improvements in oxygenation and hemodynamic variables, often within minutes of administration of iNO. These reports, when taken together, raise the possibility that iNO may be a potential therapeutic agent in acute PE. However, based on the current literature, it is not possible to conclude definitively whether iNO is safe and effective. These case reports underscore the need for randomized controlled trials to establish the safety and efficacy of iNO in the treatment of massive acute PE. The purpose of this article is to review the current literature in the use of iNO in the setting of PE given how acute PE causes acute onset of pulmonary hypertension.

Background & objective Low back pain is a frequent problem faced by the majority of people at some point in their lifetime. Exercise therapy has been advocated an effective treatment for chronic low back pain. However, there is lack of consensus on the best exercise treatment and numerous studies are underway. Conclusive studies are lacking especially in this part of the world. Thisstudy was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy exerciseprovided in patients with nonspecific chronic mechanical low back pain. Methods This is single blinded randomized control trial that was conducted at the department of physical therapy Orthopedic and Spine Institute, Johar Town, Lahore in which 120 subjects with nonspecific chronic low back pain participated. Subjects with the age between 20 to 60 years and primary complaint of chronic low back pain were recruited after giving an informed consent. Participants were randomly assigned to two treatment groups A & B which were treated with core stabilization exercise and routine physical therapy exercise respectively. TENS and ultrasound were given as therapeutic modalities to both treatment groups. Outcomes of the treatment were recorded using Visual Analogue Scale (VAS) pretreatment, at 2nd, 4th and 6th week post treatment. Results The results of this study illustrate that clinical and therapeutic effects of core stabilization exercise program over the period of six weeks are more effective in terms of reduction in pain, compared to routine physical therapy exercise for similar duration. This study found significant reduction in pain across the two groups at 2nd, 4th and 6th week of treatment with p value less than 0.05. There was a mean reduction of 3.08 and 1.71 on VAS across the core stabilization group and routine physical therapy exercise group respectively. Conclusion Core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in patients with non-specific low back pain.

Objective To compare the radiological outcome of two cannulated screws versus three cannulated screws in fixation of fractures of neck-of-femur in adults. Study design An experimental study. Place and duration of study Department of Orthopedic Surgery and Traumatology, Mayo Hospital, Lahore from September 2013 to September 2015. Methodology A total of one hundred and twenty adults, age ranging from 14-49 years, with all Garden's types fracture of neck-of-femur, were inducted through Accident and Emergency Department after a written informed consent. Patients were randomly divided into two treatment groups. Group A underwent two cannulated screws fixation, while Group B underwent three cannulated screws fixation. Radiological union was checked at the 12th postoperative week. Results The median age was 36 years with interquartile range of 1.5 (p=0.895). There were 54 (90%) males and 06 (10%) females in GroupA; while 55 (91.7%) males and 05 (8.3%) females in Group-B (p=0.752). In the 12th postoperative week, radiological union was evident in 107 (89.2%) patients. The frequency of radiological union at 12th postoperative week was 98.3% in Group A and 80.0% in Group B (p Conclusion Frequency of radiological union of two cannulated screws fixation was found to be significantly higher than three cannulated screws fixation in adults with fracture of neck-of-femur.

In 2014, the average employment of hired workers in California crop and livestock agriculture, counting all occupations, rose by 10% to 410,900. However, although the state reports the number of jobs on farms regularly, it does not report the number of workers who fill these jobs. We analyzed all Social Security numbers reported by farm employers in 2014 and found two workers for each average or year-round equivalent farm job, making the total number of farmworkers employed in agriculture 829,300, or twice average employment. Approximately 83% of farmworkers had their maximum earnings with an agricultural employer in 2014, and almost 80% of those primary farmworkers were employed by crop support firms (392,000) or fruit and nut farms (154,000). Over 60% of all workers had only one farm employer, followed by 27% with two or more farm employers, and 35% were employed in Kern (116,000), Fresno (96,000) and Monterey (82,000) counties. These data show that California has a remarkably stable farm workforce: most farmworkers are attached to one farm employer, often a labor contractor who moves them from farm to farm.

The achievable secrecy rate of a dual-hop amplify-and-forward relaying system, in the presence of an eavesdropper, is investigated based on the different values of the wireless links' signal-to-noise ratios (SNRs). It is shown that when the direct link to the eavesdropper is in a better condition than the direct link to the destination, but the relaying link for the destination is better than the relaying link for the eavesdropper, under specific conditions for the links SNRs, it is possible to achieve the secrecy rate for a limited range of the relay power. On the other hand, when the direct link to the destination is better than the direct link to the eavesdropper, under certain conditions for the links' SNRs, it is not always beneficial to employ the relay, since there exists a limited range of relaying power for which secrecy rate is not achievable. Finally, it is shown that the source transmit power has no impact on the secrecy rate achievability. Simulation results confirm the theoretical analysis carried out in this letter.

We have human-environment relations inseparable since the creation of mankind. Being a developing country, Pakistan is striving to make developments in all the respective fields which alleviate our hot raising socio- economic issues. But beside the infrastructural and economic growth our environment is also getting polluted leaving behind several drastic and severe environmental crises and one of the adverse repercussions is environmental pollution. The extreme effects of environmental pollution cannot be neglected and through proper and genuine laws and policies implementations we can cope up such issues. This study reveals the history of environmental laws and policies and their implementations in Pakistan. Pakistan has a wide range of laws related to environment but the practice shows there is some problem which hinders to achieve the desired targets. This study mainly includes two main factors of pollution; water pollution and air pollution and their effects on population of Pakistan. Air pollution is top of the list for environmental protection agencies all over the world and same in Pakistan which is acting as a destructive bump for the economic growth of Pakistan. Moreover abruptly elevating health issues are one of the consequences of such factors of environmental pollution. This study also debates some survey of World Health Organization (WHO) and Health institute of USA about the number of people affected by these issues all over the world and in Pakistan. At the end there are concluding remarks concerning the environmental laws and policies in Pakistan, its implementation, current environmental situation with some suggestions and recommendations.