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Shariah screening discards the firms that belong to impermissible business sectors (or sin industries) and follow capital structure with high debt and current assets. This study tests whether the firms passing Shariah screening have better (or worse) governance quality as compared to firms not subjected to Islamic screening. The screened firms may have lesser governance quality as they cannot use debt to discipline managers or achieve optimal capital structure. On the contrary, they may be better governed as these firms get higher presence of institutional investors and better analyst coverage. This paper provides comparison of governance quality of Shariah compliant (SC) firms in United States by using proprietary dataset of Dow Jones US Indices. The screened firms offer ground for a natural experiment as they pass negative ethical screening and meet financial criteria for the inclusion in the index. The findings suggest that the SC firms have lesser governance quality than Shariah Non-Compliant firms. The lower level of governance can be attributed to lower Size, lower Profitability, higher Dividend Payout, higher Total Risk and lower Free Cash Flow. Various robustness tests are performed to validate the findings and the results remained robust. These findings provide useful insights about the governance mechanism of SC firms that are emerging as an important alternative investment class in the last two decades.

Aim This study aimed to determine the potential prophylactic efficacy of probiotic individually and/or in combination with anti-coccidial drug on the performance and immunity of broilers under an induced coccidial infection over a 28-day of experimental trial. Methods One hundred and eighty 1-day-old Cobb broiler chicks were randomly divided into five groups, included control group (CG), control positive group (CPG), probiotic-treated group (Prob), diclazuril-treated group (Dic), and probiotic + diclazuril-treated group (Prob + Dic). On day 21 of age, all birds, except group CG, were orally inoculated with 1 ml of tap water containing 25,000 Eimeria tenella sporulated oocysts. Results Our results showed that the probiotic treatment did not influence pre-challenge body weight, feed intake and feed conversion ratio (FCR). During the post-challenge period, chickens in groups probiotic and diclazuril individually and in combination exhibited higher body weight and lower (better) FCR, reduced oocyst shedding (throughout the day four, five, six and seven post-infection), cecal lesions and mortality compared with control positive chickens. Moreover, Compared to CPG group, Prob + Dic group showed increased (p < 0.05) serum levels of interleukin-10 (IL-10) and immunoglobulin M (IgM) and decreased the concentrations of interferon gamma (IFN-γ). On the other hand, individual treatment with probiotic exhibited highest serum levels of IL-10 and IgM, while diclazuril alone increased the blood concentrations of IL-10 and decreased the levels of IFN-γ compared to control positive group; however, there was no significant effect of Prob on IFN-γ, Dic on IgM and all groups on interleukin-17. Conclusion In conclusion, supplementation of probiotic, with and/or without anti-coccidial drug, enhances immunity and inhibits the negative effects of Eimeria infection. Significance and Impact of the Study This study reveals the anti-coccidial mechanisms of probiotic in the presence and absence of anti-coccidial drug in preventing the coccidia infection.

Smart electronic materials ‘nanographene’ stated, its significant authentication has undergone massive improvements and has emerged as a ‘material of the century’ in materialize fields of ‘Chemical Biology’ and ‘Materials Chemistry’. ‘Graphene’ as a wonder material has been proposed to possess a high surface area (∼2600 m2 g−1), high portability of charge carriers and excellent mechanical qualities. Moreover, the long-extend π-conjugation of graphene is an essential photocatalytic property enabling wide ranging biosensor activities. Herein, critical review article reflects well known yet a brand-new novel material ‘nanographene’ and its versatile integrations, utilized for substantial enrichment of desired properties. Target cost-effectiveness, plasticity, and environment-friendliness of melt mixing/compounding fabrication strategy employed to utilize in-vivo, in-vitro, and in- situ, pharmaceutical, nano-imaging protocols. Owing to nanographene’s wide range expansion, summarized latest breakthroughs in Materials Science as well as Biomedical utilizations including cancer nanotechnology, drug delivery, tissue manufacturing, scaffold, photo-thermal therapy, antimicrobial activities, made up of exploring the significant opportunities and key challenges in this novel emerging field.

Supply chain disruption refers to a breakdown, often caused by an unforeseen incident or risk, in a supply chain's production or distribution process. Contemporary supply chains are globalized, complex, and extended, exhibiting an increased vulnerability to a multitude of risks and disruptions. However, the current trend of real-time data exchange through smart technologies, also known as industry 4.0, provides significant opportunities to reshape the conventional business operations and effectively cope with unanticipated supply chain breakdowns. Yet, limited attention has been paid to the role played by industry 4.0 technologies in mitigating supply chain risks and any resulting disruptions. By bringing together these inter-related yet often separate concepts, we devise a novel model that addresses this knowledge gap. In this article, we empirically test our model on a sample of 302 responses received from senior managers of the Australian food processing industry. We found that supply–demand mismatch, process risks, and transportation risks are currently the major sources of supply chain disruptions. Specifically, supply–demand mismatch appears to be the most severe and attention seeking risk, followed by process and transportation risks. We also reveal that industry 4.0 technologies significantly mitigate supply–demand mismatch and process risks and any resulting supply chain disruptions. Contrary to our expectations, however, the impact of industry 4.0 technologies on transportation risks is found to be positive but nonsignificant. This is the first empirical article to assess the extent to which the three critical supply chain risks may undermine firm performance and to explore the moderating effect of industry 4.0 technologies. We draw managers’ attention to the detrimental impact of supply chain disruptions and the significance of industry 4.0 technologies in dealing with adversities.

This paper addressed the prediction of heart sicknesses from hazard elements through a decision-making tree. We introduced the facts mining technique in public fitness to extract high-degree knowledge from raw data, which facilitates predicting heart diseases from risk factors and their prevention. The existing work intends to introduce a new risk element in heart diseases using novel data mining strategies. Latest actual international affected person’s information (e.g., smoking, area of residence, age, weight, blood stress, chest pain, low-density lipoproteins (LDL), high-density lipoproteins (HDL), block arteries became accrued by way of the use of questionnaire through direct interview technique from patients. Novel two-variable decision trees are constructed for coronary heart illness records primarily based on chance factors and ranking of risk elements. The results show a correct prediction of cardiovascular disease (CVD) from the risk factor if records on chance factors are available as direct results of this study, tobacco, loss of physical exercise, and weight-reduction plan play a vital role in predicting heart diseases, which is the most important reason for mortality in developing countries, especially in my country.

Glucocorticoid use is the most common cause of secondary osteoporosis. Poor skeletal health related to glucocorticoid use is thought to involve inhibition of the Wnt/β-catenin signaling pathway, a key pathway in osteoblastogenesis. Sclerostin, a peptide produced primarily by osteocytes, is an antagonist of the Wnt/β-catenin signaling pathway, raising the possibility that sclerostin is involved in glucocorticoids’ adverse effects on bone. The aim of this study was to determine whether an acute infusion of cosyntropin (i.e. ACTH(1–24)), which increases endogenous cortisol, increases serum sclerostin levels as compared to a placebo infusion. This study was performed using blood samples obtained from a previously published, double-blind, placebo-controlled, randomized, cross-over study among healthy men and women who received infusions of placebo or cosyntropin after being supine and fasted overnight (ClinicalTrials.gov NCT02339506). A total of 17 participants were analyzed. There was a strong correlation (R2 = 0.65, P < 0.0001) between the two baseline sclerostin measurements measured at the start of each visit, and men had a significantly higher average baseline sclerostin compared to women. As anticipated, cosyntropin significantly increased serum cortisol levels, whereas cortisol levels fell during placebo infusion, consistent with the diurnal variation in cortisol. There was no significant effect of cosyntropin as compared to placebo infusions on serum sclerostin over 6–24 h (P = 0.10). In conclusion, this randomized, placebo-controlled study was unable to detect a significant effect of a cosyntropin infusion on serum sclerostin levels in healthy men and women.

A multivariate risk score model was proposed by Sieira et al in 2017 for sudden death in Brugada syndrome; their validation in 150 patients was highly encouraging, with a C-index of 0.81; however, this score is yet to be validated by an independent group. A total of 192 records of patients with Brugada syndrome were collected from 2 centers in the United Kingdom and retrospectively scored according to a score model by Sieira et al. Data were compiled summatively over follow-up to mimic regular risk re-evaluation as per current guidelines. Sudden cardiac death survivor data were considered perievent to ascertain the utility of the score before cardiac arrest. Scores were compared with actual outcomes. Sensitivity in our cohort was 22.7%, specificity was 57.6%, and C-index was 0.58. In conclusion, up to 75% of cardiac arrest survivors in this cohort would not have been offered a defibrillator if evaluated before their event. This casts doubt on the utility of the score model for primary prevention of sudden death. Inherent issues with modern risk scoring strategies decrease the likelihood of success even in robustly designed tools such as the Sieira score model.

Present study was aimed to explore the impact of ginger and peppermint in adolescents suffering with primary dysmenorrhea. For that purpose, 150 adolescents, aged 13-22 years, with regular menstruation suffering with moderate to severe dysmenorrhea (scoring 3-5 on pain scale) and preferably not taking any medication were enrolled and randomly divided into three groups i.e. control, ginger and peppermint. Baseline data was collected with help of self-administered questionnaire. To determine comparative analgesic effect of ginger and peppermint, capsules were formulated, and each group received total number of 15 capsules in a month (3 capsules/day for consecutive 5 days). Compared with baseline data, ginger was found more effectual than peppermint in releasing dysmenorrhea i.e. observed scoring in case of ginger was reduced from mean value of 4.13 ± 0.63 to 2.10 ± 1.52 (p = 0.001). Similarly, ginger intervention exhibited gradual betterment of 10% in symptoms of dysmenorrhea but also affected blood pressure positively (p < 0.05). However, blood hemoglobin and serum calcium levels acted as independent variables in ginger and peppermint groups (p > 0.05), not affected by any mode of intervention. It was concluded that ginger exhibited superior impact in lowering pain as compared to peppermint and control groups.

Failure caused by corrosion in industries are the major cause of breakdown maintenance. Acoustic emission during the accelerated corrosion testing is a reliable method for corrosion detection, however, classification of these acoustic emission signals by machine learning techniques is still in its infancy. Proposed approach uses a hybrid technique that combines the detection of corrosion through acoustic emission signals from accelerated corrosion testing with machine learning techniques to accurately predict the corrosion severity levels. Laboratory based experimentation setup was established for accelerated corrosion testing of mild steel samples for different time spans and mass loss of samples were recorded. Acoustic emission signals were acquired at high frequency sampling rate with Sound Well AE sensor, NI Elvis kit and NI Labview software. AE mean, AE RMS, AE energy, and kurtosis were selected as distinct features as they represent a linear relationship with the corrosion process. For multi-class problem, five Corrosion severity levels have been made based on mass loss occurred during accelerated corrosion testing for which Naive Bayes, BP-NN and RBF-NN showed accuracy of 90.4%, 94.57%, and 100% respectively.

With the rise in popularity of structured reports in radiology, we sought to evaluate whether free-text CT reports on pancreatic ductal adenocarcinoma (PDAC) staging at our institute met published guidelines and assess feedback of pancreatic surgeons comparing free-text and structured report styles with the same information content. We retrospectively evaluated 298 free-text preoperative CT reports from 2015 to 2017 for the inclusion of key tumor descriptors. Two surgeons independently evaluated 50 free-text reports followed by evaluation of the same reports in a structured format using a 7-question survey to assess the usefulness and ease of information extraction. Fisher’s exact test and Chi-square test for independence were utilized for categorical responses and an independent samples t test for comparing mean ratings of report quality as rated on a 5-point Likert scale. The most commonly included descriptors in free-text reports were tumor location (99%), liver lesions (97%), and suspicious lymph nodes (97%). The most commonly excluded descriptors were variant arterial anatomy and peritoneal/omental nodularity, which were present in only 23% and 42% of the reports, respectively. For vascular involvement, a mention of the presence or absence of perivascular disease with the main portal vein was most commonly included (87%). Both surgeons’ rating of overall report quality was significantly higher for structured reports (p

BACKGROUND: Haematuria is the most common urinary finding that bring children to the attention of the paediatric nephrologists. It can be caused by glomerular & non-glomerular diseases. The main causes of Haematuria are urinary tract infections, trauma to abdomen, acute post streptococcal glomerulonephritis and congenital hydronephrosis. OBJECTIVE: The objective of this study was to identify the distribution of factors in children with haematuria in age group of 1 to 14 years METHODS: A total of 84 admitted patients of haematuria, who fulfill the inclusive criteria,were enrolled in this study after consent from their parents. Each patient was evaluated through history, examination and investigated. Urine sample of each patient was analyzed for a microscopic examination. Investigations / imaging were performed in clinical laboratory of LGH / PGMI, Lahore. The collected information was entered into SPSS version 20, and analyzed. RESULTS: There were 47(44.05%) male and 37(55.95%) female patients in this study. The mean age of patients was 8.69 ± 3.63 years.We found 14 patients (16.66%) has urological anomalies,6 boys have posterior urethral valves.2 girls and one boy has vesicoureteral reflux.One boy and one girl has ureterovesical junction obstruction,one boy has hypospadias and 2 girls , ureteropelvic junction obstruction.History of recent bladder catheterization was seen in 5(5.59%), urinary tract infection 17(20.23%) and 14 patients has urological anomalies(16.66%). CONCLUSION: According to this study ,most common factors causing haematuria was urinary tract infection 17(20.23%) , acute poststreptococcal glomerulonephritis 16(19.04%) and congenital urological anomalies 14(16.66%).Renal stones were found in 10(11.90%).

Objectives: To determine the prevalence of violence among medical doctors in public sector hospitals of Karachi relating to physical violence, psychological violence (verbal and bullying/mobbing), sexual harassment and racial harassment). Methods: A cross-sectional study was carried out in three public sector hospitals in Karachi (JPMC, Civil Hospital and Sindh Government Lyari General Hospital Karachi). Medical doctors of any age and gender who worked in outpatient departments, wards, and emergency departments were eligible to participate in the study. A validated WHO-designed questionnaire was used, with questions about exposure to violence, the source and types of violence, and socio-demographic information. In descriptive statistics, frequencies and percentages were reported for all categorical variables. The Chi-square and Fisher's exact tests were used to investigate the relationship between workplace violence and other types of violence. Results: 350 questionnaires were distributed to qualified medical doctors in total. Only 300 of them responded, for an 85.7 percent response rate. The majority of respondents were under the age of 40, and male gender was slightly more exposed to violence. The majority of the doctors were subjected to verbal abuse as well as bullying and mobbing. Conclusion: It was then concluded that any type of violence was common in doctors aged >35 years and male gender was more exposed to any violence as compare to female gander. The main type of violence was verbal violence in our study, whereas racial harassment and sexual harassment was also seen.

Background and Aim Device assisted enteroscopy is the cornerstone for small bowel evaluation. However, the data are limited in pediatric patients. In this study, we aim to evaluate the safety and utility of single balloon enteroscopy (SBE) in children. Methods The data of children (≤18-years) who underwent SBE from November 2010 to July 2020 was analyzed, retrospectively. The safety and diagnostic yield of SBE were assessed. Results 189-SBE procedures (males 117, mean age 15.1 ± 2.76, range 3–18 years) were performed in 174-children. The indications for SBE were chronic abdominal pain in 119 (68.4%), gastrointestinal bleed 17 (9.8%), chronic diarrhea 17 (9.8%) and vomiting 13 (7.5%). Antegrade, retrograde and combined SBE were performed in 98 (51.8%), 77 (40.7%), 7 (3.7%) children, respectively. The mean length of small bowel intubation in antegrade and retrograde SBE groups were 168.9 ± 58.6 cm and 120.7 ± 52.1 cm, respectively. Overall, a positive finding was seen in 117 (67.2%) cases. The most common findings were ileal and jejunal ulcers with or without strictures in 76 (64.9%) children. A total of 18 therapeutic enteroscopic procedures were performed. There were no major adverse events. Conclusion SBE is a safe and effective procedure for the evaluation and management of small bowel diseases in children.

Epigastric pain can have multiple etiologies including myocardial infarction, pancreatitis, acute aortic syndromes, gastroesophageal reflux disease, esophagitis, peptic ulcer disease, gastritis, duodenal ulcer disease, gastric cancer, and hiatal hernia. This document focuses on the scenarios in which epigastric pain is accompanied by symptoms such as heartburn, regurgitation, dysphagia, nausea, vomiting, and hematemesis, which raise suspicion for gastroesophageal reflux disease, esophagitis, peptic ulcer disease, gastritis, duodenal ulcer disease, gastric cancer, or hiatal hernia. Although endoscopy may be the test of choice for diagnosing these entities, patients may present with nonspecific or overlapping symptoms, necessitating the use of imaging prior to or instead of endoscopy. The utility of fluoroscopic imaging, CT, MRI, and FDG-PET for these indications are discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Chronic kidney disease (CKD) is a complex disease which affects approximately 13% of the world’s population. Over time, CKD can cause renal dysfunction and progression to end-stage kidney disease and cardiovascular disease. Complications associated with CKD may contribute to the acceleration of disease progression and the risk of cardiovascular-related morbidities. Early CKD is asymptomatic, and symptoms only present at later stages when complications of the disease arise, such as a decline in kidney function and the presence of other comorbidities associated with the disease. In advanced stages of the disease, when kidney function is significantly impaired, patients can only be treated with dialysis or a transplant. With limited treatment options available, an increasing prevalence of both the elderly population and comorbidities associated with the disease, the prevalence of CKD is set to rise. This review discusses the current challenges and the unmet patient need in CKD.

Objective: To ensure family spacing in our low socio-economic class. Study Design: Quasi-experimental study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Jan 2018 to Dec 2019. Methodology: Two hundred females using oral contraceptive pills for spacing of children coming to Pak Emirates Military Hospital were selected. The problems of using contraceptive pills were identified. Out of these 87 women agreed to choose an intrauterine copper device (IUCD). Results: Out of 200 women 87 converted from oral contraceptive pills to intrauterine copper device use. Most of them faced daily dosage problems 168 (84%). Nausea was encountered by 123 (61.5%) women and later settled in 89 (44.5%) women. About 31 (15.5%) were worried about the chances of uterine perforation and 56 (28%) were worried about lost intrauterine copper device resulting in laparotomy. About 65 (32.5%) were afraid of infection, backache and vaginal discharge. About 91 (45.5%) women thought to have gastric problems with the intrauterine copper device. About 71 (81%) agreed to have a spacing of children for about five years and removal whenever desired. Conclusion: Intrauterine contraception is a very safe and efficient method for contraception as compared to oral pills. If expertise is, available it should be used and couples should be fully educated for its safety.

Background: The goal of this research was to use the Quality by Design (QbD) approach to develop orally disintegrating tablets of Montelukast sodium, a leukotriene receptor antagonist used to treat asthma. Characterizing the reference product, defining the quality target product profile (QTPP), identifying critical quality attributes (CQAs), and performing initial testing are all parts of the QbD approach and relating the critical material attributes (CMAs) and critical process parameter (CPP) to drug product CQAs, as a result to develop the design space and defining control strategy. Method: Montelukast sodium tablets were designed using direct compression technique. Formulation were designed by using (DOE software v 13.2) 23 full factorial design in which three variables namely croscarmellose sodium (CCS), microcrystalline cellulose (MCC) and magnesium stearate were varied at two levels by considering one center point. Results: The disintegration time and in vitro dissolution were considered as responses and the prepared tablets have been evaluated for various quality control tests. Formulation F5 was considered as optimized as it showed minimum disintegration time and maximum drug release profile. Conclusion: The CMAs classified as high or medium risk in the initial risk assessment were mitigated to low risk based on the experimentation. Finally, a control strategy was defined giving better control over drug product development.

PurposeThis study looked at the impact of a community-based public health campaign on hypertension and diabetes mellitus awareness and prevention, as well as student experiential learning in a campaign conducted by pharmacy students.Design/methodology/approachA convenience sampling cross-sectional pre–post survey was done to assess disease awareness and knowledge among those who attended the health campaign. The data analysis includes a total of 230 participants with complete data. After the campaign, the pharmacy students used self-assessment to reflect their learning experience.FindingsMost participants were unaware of their blood pressure and blood glucose readings, but they reported improved awareness of diseases and prevention of hypertension and diabetes after the health campaign. Although most participants correctly identified the common signs and symptoms of hypertension, few could associate it with overweight. Most participants were unaware of the 5 g per day salt intake limit for controlling hypertension before the campaign. Most participants were less aware that diabetes is associated with impaired vision, peripheral neuropathy, renal and heart diseases. Students expressed increased confidence in leadership, teamwork and communication abilities after the campaign based on self-assessment.Practical implicationsA health campaign enhances the disease knowledge of the general public. It has been suggested that experiential learning be encouraged in the pharmacy curriculum.Originality/valueThis study adds to the knowledge on the roles of community-based health campaigns and the value of pharmacy students’ involvement in experiential learning.

To investigate the safety and efficacy of glaucoma XEN stent implantation and examine the effect of undergoing combined phacoemulsification and XEN versus XEN implant alone. A retrospective case note review of patients who underwent XEN implantation by a single surgeon over a 24-month period was performed. Outcomes included changes in IOP and medication use after XEN implant insertion as well as complications post-surgery. Subgroup analysis was also performed, separating phaco-XEN (phacoemulsification and XEN implantation) and stand-alone XEN implantation. 186 XEN implant procedures were included in this study from a total of 143 patients. Intraocular pressure changes with time were as follows: preoperative 18.1 mmHg (± 5.77), 6 months 13.2 mmHg (SD ± 3.9), 12 months 13.7 mmHg (SD ± 5.6) and 24 months 12.6 mmHg (SD ± 3.1). For visits up to 12 months, comparison from preoperative IOP was significant at the

In this paper, a miniaturized bandstop frequency selective surface (FSS) with high angular stability is presented. Each FSS element consists of four sets each consisting eight octagonal concentric interconnected loops. The four sets are connected with each other through outermost octagonal loop. The unit size is miniaturized to 0.066 λ0 at the resonant frequency of 1.79 GHz. The proposed configuration achieves excellent angular stability (only 0.025 GHz resonant frequency deviation is observed upto 83° oblique angles). The working mechanism of FSS is explained with the help of equivalent circuit model (ECM), electric field distribution, and corresponding surface current distribution. A prototype of the designed bandstop FSS is fabricated to verify the simulated frequency response. The experimental results are consistent with the simulation results. Simple geometry, low profile, high angular stability, and compact cell size are prominent features of the proposed structure.

Stock markets worldwide have witnessed high volatility during the year 2020 owing to the eruption of Covid-19. Due to the world’s unprecedented economic challenges, this study could potentially guide financial advisors and individual investors in dealing with pandemics. An association between investors’ perception toward the intensity of Covid-19 and heuristic biases is analyzed using the responses of 290 stock investors of National Capital Region (NCR), India. The data are validated through Cronbach’s alpha, and the model fit is analyzed using EFA. Confirmatory factor analysis (CFA) is employed to investigate the relationship between Covid-19 and heuristic biases. Covid-19 does not have any influence on the overconfidence of investors. A significant positive relationship is found between Covid-19 and the remaining three heuristics, i.e., availability, anchoring, and representativeness. The present study analyzes the association between Covid-19 and specific investors’ bias only and should not be interpreted for causality. The study has the potential to guide investors in understanding the errors they are making while investing during the pandemic and the ways to deal with them. The study could provide insights to the financial advisors in understanding their customers. The implications of the study may include inputs of the errors committed by them during the pandemic. Despite the fact that an enormous amount of literature exists in the field of investors’ sentiment, a scarcity of literature is available that measures the relationship between heuristic biases and the perceived impact of the pandemic. The current study attempts to fill this gap in the literature.

Practical data detectors must achieve low error-rate at low-complexity for massive multiple-input multiple-output (MIMO) wireless systems. Since near-optimal minimum mean square error (MMSE) detection exhibits high computational complexity for such wireless systems, various iterative methods as well as their enhanced variants have been proposed. The efficiency of iterative approaches, however, is not satisfying due to slow convergence rate and reduced accuracy. This paper proposes a novel semi-iterative data detection algorithm for massive MIMO systems that simultaneously achieves a large improvement in convergence and accuracy with respect to the corresponding iterative method. We provide a general three-term recurrence expression for semi-iterative detection and incorporate it with Richardson method as a show case. To further improve the convergence rate of the proposed technique, a new trace-diagonal based low-complexity initial method is developed. A sufficient condition for convergence of the proposed method is also provided. We analyze the associated complexity of semi-iterative detector, and provide numerical results which demonstrate that the proposed detector is superior to recently introduced iterative detectors in terms of both the error-rate performance and computational complexity.

Rehabilitation needs are increasing globally due to population growth, aging population, high survival rates for people with disability, and severe health conditions. In the past few years, new telecommunication-based practices, including various forms of e-rehabilitation have gained attention all over the world, including the Kingdom of Saudi Arabia (KSA). Telerehabilitation is an alternative way of delivering rehabilitation services in which information and communication technologies are used to expedite communication between the health care professional and the patient at a distant location. It can be beneficial to people in rural areas, especially individuals in isolated communities. At present, the COVID-19 pandemic has forced speedy adoption of telerehabilitation due to restricted traditional in-person visits all over the world, including KSA; however, no telerehabilitation guidelines are available in the country. Since specialized rehabilitation services are limited to main cities of the country, the provision of care by reaching out the underserved areas using telemedicine technology is deemed important. These guidelines were established collaboratively by panel of various rehabilitation experts with input from other practitioners in the field and strategic stakeholders. It will facilitate rehabilitation clinicians practicing in KSA providing consultation, counseling, education, assessment, monitoring, therapy, or follow-up to a patient remotely using telemedicine communication technologies. This document includes administrative, clinical, and technical guidelines, which are aimed to standardize telerehabilitation practice across the country. The core principles are based on standards set forth by American Telemedicine Association and are guided by telemedicine policy in KSA. Additionally, ethical considerations of telerehabilitation practice pertinent to Saudi culture and health care system are elaborated as well. This document serves as a general guide for the provision of telerehabilitation services and do not describe a specialty-specific clinical practice guideline.

Neuroinflammation leads to neurodegeneration, cognitive defects, and neurodegenerative disorders. Neurotrauma/traumatic brain injury (TBI) can cause activation of glial cells, neurons, and neuroimmune cells in the brain to release neuroinflammatory mediators. Neurotrauma leads to immediate primary brain damage (direct damage), neuroinflammatory responses, neuroinflammation, and late secondary brain damage (indirect) through neuroinflammatory mechanism. Secondary brain damage leads to chronic inflammation and the onset and progression of neurodegenerative diseases. Currently, there are no effective and specific therapeutic options to treat these brain damages or neurodegenerative diseases. Flavone luteolin is an important natural polyphenol present in several plants that show anti-inflammatory, antioxidant, anticancer, cytoprotective, and macrophage polarization effects. In this short review article, we have reviewed the neuroprotective effects of luteolin in neurotrauma and neurodegenerative disorders and pathways involved in this mechanism. We have collected data for this study from publications in the PubMed using the keywords luteolin and mast cells, neuroinflammation, neurodegenerative diseases, and TBI. Recent reports suggest that luteolin suppresses systemic and neuroinflammatory responses in Coronavirus disease 2019 (COVID-19). Studies have shown that luteolin exhibits neuroprotective effects through various mechanisms, including suppressing immune cell activation, such as mast cells, and inflammatory mediators released from these cells. In addition, luteolin can suppress neuroinflammatory response, activation of microglia and astrocytes, oxidative stress, neuroinflammation, and the severity of neuroinflammatory diseases such as Alzheimer's disease, Parkinson's disease, multiple sclerosis, and TBI pathogenesis. In conclusion, luteolin can improve cognitive decline and enhance neuroprotection in neurodegenerative diseases, TBI, and stroke.

The objective of the current study was to assess the impact of internet gaming disorder on self-appraisal. Moreover, role of gender as a moderator on the relationship between internet gaming disorder and self-appraisal among university students was also explored. A sample of 300 students was collected through purposive sampling technique, from different universities of Islamabad and Rawalpindi. The participant’s age range was 18-28 years. Self-report measures i.e., Internet Gaming Disorder Scale-short form (Pontes & Griffiths, 2015) and Core Self Evaluation Scale (Judge, Erez, Bono, & Thoresen, 2003) were administered. Results yielded that internet gaming disorder negatively predicted self-appraisal among university students. Moreover, gender worked as a significant moderator on the relationship between internet gaming disorder and self-appraisal. The independent sample t-test showed that males reported a higher level of internet gaming disorder as compared to females. Males showed less self-appraisal as compared to females. This study will help to identify the effects of internet gaming disorder on self-appraisal among university students. Furthermore, intervention plans can also be developed for students by decreasing their gaming activity and increasing their self-appraisal and bringing them back to their normal life.

Symphysis is an anatomical part of mandible that includes lower incisors and anterior chin. Mandibular symphysis is a contributing factor of facial harmony for esthetics and is a determinant for lower incisor position in orthodontic treatment planning for border line cases. This cross-sectional study was carried out in Orthodontics department, Fatima Memorial Hospital College of Medicine and Dentistry Lahore on a sample size of 90 cases using 95% confidence level. Non probability consecutive sampling technique was used. Symphyseal dimensions were measured on lateral cephalogram. Data collected was entered and analyzed in computer program SPSS version 20. Quantitative outcomes like symphysis dimensions, symphysis width, vertical pattern, and ANB were subjected to ANOVA of significance. Independent T-test was used to make the comparison between males and females on the basis of variables. Results of this study suggested thatC-C’ varies significantly between males and females, whereas the differences in symphysis width LA, and LP between males & females are statistically insignificant (P>0.05). Bone anterior to lower incisor apex varies significantly among various facial profiles with hypo divergent males exhibiting wider chin than normo divergent and hyper divergent subjects. Sexual dimorphism in symphysis width was seen among genders. Keywords: Facial harmony, lower incisor position

Amaç: Otizm spektrum bozukluğu (OSB), erken çocukluk dönemlerinde sosyal etkileşim ve iletişim becerilerinde yetersizlik, kısıtlı ilgi alanı ve stereotipik davranış örüntüleri ile karakterize nörogelişimsel önemli bir bozukluktur. Bu çalışmanın amacı OSB tanısı almış çocuğu olan ebeveynlerin aşılar hakkında genel bilgilerini ölçme, aşıya karşı tutumlarını belirleme, aşı karşıtlığının oranı ve nedenlerini saptamaktır. Gereç ve Yöntem: Çalışma, OSB tanılı çocukları olan ebeveynlerden birisi ile, yüz yüze görüşmek sureti ile, anket yaparak gerçekleştirilmiştir. Bulgular: Elde edilen verilere göre; kontrol grubu ile karşılaştırıldığında, otizmli çocukları olan ebeveynlerin; aşılar hakkındaki bilgi düzeylerinin, ve aşı reddi tercihlerinin daha yüksek olduğu, aşıların içeriklerinden daha çok şüphe duydukları, özellikle canlı virus aşılaması ile otizmin başlaması arasında, zamansal ilişki olduğuna inandıkları belirlenmiştir. Sonuç: OSB tanılı çocukların rutin çocuk-ergen psikiyatristleri tarafından, rutin kontrollerinde; ailelerin aşılar hakkındaki düşünceleri, kaygıları ve kaçınmaları değerlendirilmelidir.

Third space or submucosal space is a potential space which on expansion allows the endoscopist to execute a multitude of therapeutic procedures for various gastrointestinal diseases like achalasia, subepithelial tumors, Zenker’s diverticulum, and refractory gastroparesis. Third space was first utilized for performing endoscopic myotomy in cases with achalasia cardia about a decade ago. Since then, the field of submucosal endoscopy has witnessed an exponential growth. The present review focuses on recent advances in the field of third-space endoscopy. With regard to per-oral endoscopic myotomy (POEM) in achalasia cardia, several recent studies have evaluated the long-term outcomes of POEM, compared endoscopic myotomy with pneumatic dilatation (PD) and surgical myotomy, and evaluated the outcomes of short- versus long-esophageal myotomy. In addition, the utility of multiple dose antibiotic prophylaxis to prevent infections after POEM has been questioned. Overall, the results from these studies indicate that POEM is a durable treatment modality, equally effective to Heller’s myotomy and superior to PD. With regard to gastric-POEM (G-POEM), recent studies suggest only modest efficacy in cases with refractory gastroparesis. Therefore, quality studies are required to identify predictors of response to optimize the outcomes of G-POEM in these cases. Another third-space endoscopy procedure that has gained popularity is endoscopic division of septum in cases with esophageal diverticula including Zenker’s POEM and epiphrenic diverticula POEM (Z-POEM and D-POEM, respectively). The technique of diverticulotomy using the principles of submucosal endoscopy appears safe and effective in short term. Data on term outcomes are awaited and comparative trials with flexible endoscopic myotomy required. Per-rectal endoscopic myotomy (PREM) is the most recent addition to third space endoscopy procedures for the management of short-segment Hirschsprung’s disease. Limited data suggest that PREM may be a promising alternative surgery in these cases. However, quality studies with long-term follow-up are required to validate the outcomes of PREM.

Purpose of review Third space endoscopy (TSE) or submucosal endoscopy provides with the opportunity for minimally invasive management of various gastrointestinal disorders. TSE is a relatively new field and the knowledge on its utility continues to advance. The purpose of this review is to provide with updated evidence on the efficacy and utility of TSE in gastrointestinal motility disorders including achalasia and refractory gastroparesis. Recent findings Peroral endoscopic myotomy (POEM) is a safe procedure with emerging evidence on its durability as well. Major technical variations do not appear to impact the outcomes of POEM. Recent randomized trials suggest superiority of POEM over pneumatic dilatation and noninferiority over Heller's myotomy in idiopathic achalasia. With regard to gastric POEM (G-POEM), recent evidence confirms its efficacy in refractory gastroparesis. Although effective, the long-term outcomes of G-POEM are not well known. In addition, the criteria for patient selection remain elusive. Summary TSE has emerged as a new frontier in the endoscopic management of gastrointestinal motility disorders. While short-term outcomes are encouraging, the durability of TSE remains to be seen in achalasia as well as refractory gastroparesis. Insights regarding patient selection and predictors of outcomes may help optimizing the results of gastric POEM in refractory gastroparesis.

This paper presents a new compact, high gain and multiband planar bowtie slot antenna. The antenna structure comprises of dielectric substrate, copper conducting sheet, fillet triangular-shaped slots, and a chamfered metallic ground plane. The proposed antenna model is fed with the 50 Ω standard grounded coplanar waveguide (GCPW) feedline. The designed antenna is low profile with compact dimensions of 0.379λ×0.186λ×0.012λ at 2.39 GHz frequency. Stable multi-resonant behavior of frequencies is obtained with the material selection, slots dimensions and position. Moreover, the parametric study has been carried out in order to validate the frequency tuning mechanism and impedance matching control. The novelty of designed antenna lies in high performance features which have been achieved with ultra-compact (0.039λ×0.022λ) modified triangular shaped metallic ground plane. The proposed antenna is fabricated and experimentally verified. The antenna key features in terms of return loss, surface current distribution, peak gain, radiation efficiency and radiation patterns have been analyzed and discussed. The designed radiator exhibits the excellent performance including strong current density, peak realized gain of 6.3 dBi, 95% radiation efficiency, wide fractional bandwidth of 39.5% and good radiation characteristics at in-band frequencies. The simulation and measured results are in good agreement and hence make the proposed antenna a favorable candidate for the advanced heterogeneous wireless communication applications.

Purpose This paper aims to focus on the influences of the COVID-19 pandemic on business-to-business (B2B) firms’ relationship initiation and customer relationship management in an under-explored and unique context of high-tech industrial microenterprises. The authors analyze the challenges posed by the COVID-19 pandemic in the specific context of B2B relationship initiation and customer relationship management dynamics by examining Finnish B2B industrial microenterprises. Design/methodology/approach The paper uses exploratory in-depth case studies undertaken in three Finnish industrial microenterprises to analyze the influences of the COVID-19 pandemic on their new business relationship initiation and relationship management with the current customers. Findings The case firms quickly adjusted to the “new normal” and used a number of technological resources, including online meetings and three-dimensional demonstrations, among others. A key reason for this quick adjustment was them being microenterprises. However, despite this, lack of access to customer sites remained a hindrance as their products need to fit certain production processes, which cannot be done without physical visits. Furthermore, the development of trust with new customers, especially those based in emerging markets, was challenging due to the lack of physical meetings and site visits. Research limitations/implications The research highlights the challenges posed by the COVID-19 pandemic to B2B relationships and gives an account of the changing dynamics of relationship initiation and customer relationship management amid technological and societal disruptions. It also highlights the continued role of personal relationships and psychical meetings in such relationships. As such, the research informs B2B research that examines the role of personal relationships in B2B marketing. Practical implications The study offers industrial microenterprise executives insights into how to face and tackle COVID-19 driven challenges in B2B customer relationship management and how to integrate technological tools in relationship management practices while understanding where face-to-face meetings are indispensable. Originality/value The study demonstrates areas in which virtual tools can and cannot be substitutes for conventional means of B2B relationship initiation and customer relationship management across developed and emerging markets. It also highlights the specificities of industrial microenterprises and their business development and customer relationship management dynamics mechanisms, a research area that has been rather ignored by prior studies.

Nowadays traditional techniques of living and earning are being transformed to modern smart technologies, taking their inspiration from the emerging trends. Agriculture and its supply chain are also one of the major domains of research that need attention for its growth especially in developing countries like Pakistan. Food safety and its supply are drawing the world's attention towards its importance and people are focusing on it because of health hazards. This research, presents a Combo smart model with a novel scheme for the transformation of traditional agriculture to smart agriculture, taking into consideration both blockchain and Internet of Things ( IoT) characteristics. The system proves to be reliable, automatic, open, and biological food tracks built with the features of Blockchain IoT devices. This system provides equal opportunity to all stakeholders involved in the agricultural food supply chain; even they are not familiar with each other and may not trust. IoT devices are added to the smart model to reduce human interference for data recording and verification. For validation purposes, the proposed scheme is compared to our own scheme, which uses only IoT devices deployed in the monitoring field without a blockchain.

Background: Malaria is communicable disease that exists worldwide and is a cause of morbidity and mortality. Our objectives were to determine the prevalence and distribution of malaria by sex, age groups and species in year 2019 in suspected malarial population of District D.I.Khan, Pakistan.Materials Methods: This cross-sectional study was conducted in Department of Community Medicine, Gomal Medical College, D.I.Khan, Pakistan from October 1, 2020 to October 31, 2020. The data for malaria was retrieved from office of Frontier Primary Healthcare, D.I.Khan for 2019. A sample of 108,849 was calculated from population at risk of 1,306,655, with 0.258154 margin of error, 99% CI and 13.843% assumed prevalence of malaria. Sex, age groups, species and presence of malaria were our four nominal variables. Prevalence and distribution were described by count and percentage with 95% confidence intervals. Four hypotheses for prevalence and distribution were verified by chi-square goodness of fit test.Results: Out of a sample of 108,849 suspected malarial cases, 9,568 (8.79%, 95%CI, 8.62-8.95%) were positive. Out of 9,568 positive cases, 5,406 (4.97%) were men and 4,162 (3.82%) women, 1,062 (0.98%) in age group up to 5 years and 8,506 (7.81%) in age group 5 years and 9,121 (8.38%) were Plasmodium vivax, 437 (0.40%) were Plasmodium falciparum and 10 (0.009%) were mixed malarial infections. Our prevalence of malaria 8.79% was lower to 13.843% expected (p=.00001). Our distribution across sex (p=.00001), age groups (p=.03231) and species (p=.00001) were not similar to expected.Conclusion: The prevalence of malaria in year 2019 in suspected malarial population of District D.I.Khan, Pakistan was 8.79%. The prevalence was lower than expected for our population. The prevalence was higher for men, older age group (5 years) and for Plasmodium vivax. The prevalence for men was higher than expected for men and vice versa for women. The prevalence for age group up to 5 years was higher than expected for age group up to 5 years and vice versa for age group 5 years. The prevalence for Plasmodium vivax was higher than expected for Plasmodium vivax and vice versa for Plasmodium falciparum and mixed cases.

The objective of this qualitative study was to explore how the medicine sales staff responded to presumptive COVID‐19 patients in Pakistan. The data were obtained from the medicine sales staff working at drug retail outlets of Bahawalpur, Punjab, Pakistan, through in‐depth face‐to‐face interviews using a semi‐structured interview guide. A two‐step sampling strategy was used, including purposive and convenient sampling techniques. Sample size was determined by applying the saturation point criteria. A total of 17 interviews were audio‐recorded, transcribed verbatim and analysed using the thematic analysis. Analysis of data yielded six themes and seven sub‐themes. The themes included (1) knowledge about various aspects of COVID‐19, (2) practices of sales staff in response to COVID‐19 pandemic, (3) attitude of sales staff towards COVID‐19 pandemic, (4) services offered to presumptive COVID‐19 patients, (5) challenges encountered during pandemic and (6) suggestions to improve delivery of pharmacy services by sales staff. In Pakistan, non‐pharmacist sales staff had superficial knowledge about COVID‐19. Presumptive COVID‐19 patients were provided with only basic pharmacy services. Professional training is advised among pharmacy sales staff as a short‐term solution to improve their knowledge. As a long‐term goal, the availability of pharmacists at drug retail outlets is warranted.

Background and objectives During Corona Virus Disease-19 (COVID-19) pandemic, it has been estimated that approximately 10% of health care professionals (HCPs) have been diagnosed contacting COVID-19. Aerosol-generating procedures have led to change in safety practices among HCPs. We thus evaluated the efficacy of the endoscopic safety measures among HCPs posted in the endoscopy unit. Methods In this retrospective analysis, all endoscopic procedures performed over a period of 4 months, from 1 April to 31 July 2020 were included. We noted indications and number of COVID-positive procedures as well as comprehensive screening of HCPs posted in our endoscopy unit. The aim of the study was to evaluate the incidence and outcome of COVID-19 among HCPs. Results Three thousand four hundred and sixty procedures were included in the analysis. Indications were divided as urgent (n = 190, 5.49%), semi-urgent (n = 553, 16%) and non-urgent group (n = 2717, 78.52%). Thirty-four procedures (0.98%) were done on diagnosed COVID-19 patients. The most common indications were gastrointestinal bleed (n = 12/34, 35.30%) followed by biliary sepsis (n = 9/34, 26.5%). Among the HCPs, the incidence of symptomatic COVID-19 was 6.58% (n = 5/76). All HCPs recovered with excellent outcomes. A comprehensive screening showed 7.90% (n = 6/76) HCPs having Immunoglobulin G (IgG) antibody in their sera. Conclusion Addition of safety measures in endoscopy leads to low risk of transmission among HCPs.

Contains fulltext : 238998.pdf (Publisher’s version ) (Open Access) BACKGROUND: Pancreatic duct disruption or disconnection is a potentially severe complication of necrotizing pancreatitis. With no existing treatment guidelines, it is unclear whether there is any consensus among experts in clinical practice. We evaluated current expert opinion regarding the diagnosis and treatment of pancreatic duct disruption and disconnection in an international case vignette study. METHODS: An online case vignette survey was sent to 110 international expert pancreatologists. Expert selection was based on publications in the last 5 years and/or participation in development of IAP/APA and ESGE guidelines on acute pancreatitis. Consensus was defined as agreement by at least 75% of the experts. RESULTS: The response rate was 51% (n = 56). Forty-four experts (79%) obtained a MRI/MRCP and 52 experts (93%) measured amylase levels in percutaneous drain fluid to evaluate pancreatic duct integrity. The majority of experts favored endoscopic transluminal drainage for infected (peri)pancreatic necrosis and pancreatic duct disruption (84%, n = 45) or disconnection (88%, n = 43). Consensus was lacking regarding the treatment of patients with persistent percutaneous drain production, and with persistent sterile necrosis. CONCLUSION: This international survey of experts demonstrates that there are many areas for which no consensus existed, providing clear focus for future investigation.

Background: Staphylococcus aureus (SA) is a major etiological pathogen causing multiple infections and broadly known as a serious public health challenge faced due to antibiotic resistance. It is the need of time that infection prevention and control strategies; and antibiotic stewardship policies have to be employed conjointly to minimize the extended rise of antibiotic resistance. Objectives: To determine the frequency and sensitivity patterns of Staphylococcus aureus in tertiary care setting. Study Design: Descriptive study Place & Duration of Study: Pathology Laboratory of tertiary care center from 1st March’ 2020 till 28th February’ 2021. Materials & Methods: A total 643 Staph. aureus isolated from various clinical specimens received in a tertiary care hospital; were processed and identified by culture, staining and bench tests. Sensitivity testing was done by Disc Diffusion method. Resistance to cefoxitin(30µg) was labelled as Methicillin Resistant Staphylococcus aureus (MRSA). Constitutive and Inducible Clindamycin resistance was also evaluated. (CLSI, 2020-21). Results: During the study period 125 (19.44%) MRSA were recovered. Statistically, gender distribution regarding MRSA was significant, most of SA was recovered from blood (53.68%), while 46.31% from pus and wound swabs. The frequency of MRSA from Surgical and allied wards was higher (52.63%) than Medicine and allied wards (47.36%). Sensitivity to vancomycin, linezolid and tigecycline was noted 100% by all the isolates. Sensitivity to clindamycin and Doxycycline was 68.42% and 64.81% respectively; while resistance to erythromycin, ciprofloxacin and trimethoprim/sulfamethoxazole was 73.68%, 60% and 57.89%, respectively. Conclusion: The hazardous infections due to Staphylococcus aureus are worrisome in the present therapeutic scenario. A levelheaded prescription of sensitive antibiotics has to be ensured to minimize the rising frequency of resistant strains of SA.

Background: One important and often ignored aspect in treatment of patients of chronic kidney disease (CKD) is screening for eye disorders. There is a need for continuous monitoring and examination, with cooperation from an ophthalmologist, of all dialysis patients with increased risk of vision loss like patients with coexisting diabetes and hypertension. It is not very common to find vision disorders or other anatomical defects of eye which can be directly attributed to kidney diseases. In general, eye disease is found as incidental finding during screening of patients with kidney diseases. Aim: To evaluate the frequency of eye changes in patients of chronic kidney disease. Methods: It was a Cross-sectional descriptive study performed in Department of Medicine and Nephrology Indoor, Fatima Memorial Hospital Lahore. The total duration was 6 months after approval of the project i.e. from 26-12-2019 to 25-06-2020. All patients admitted in the hospital under department of Medicine or Nephrology from 13 to 70 years of age diagnosed as a case of Chronic Kidney Disease as per the Glomerular Filtration Rate (GFR) were recruited for the study. Results: Total cases were 213, 44(20.65%) were from the age group of 13-40, 169(79.35%) were in 41-70 years age group, mean±Standard deviation(SD)was 47.82±8.55years, 114(53.52%) male, 99(46.48%) females, 129(60.56%) had diabetes mellitus, 141(66.19%) had hypertension, mean duration of disease was calculated as 14.23±4.99 months, 41(19.24%) retinal disorder, 79(37.08%) had cataract while 93(43.66%) had no eye disorder, out of 41 cases of retinal disorders, 17(41.46%) had hypertensive retinopathy while 24(58.53%) had diabetic retinopathy. Conclusion: There is a high prevalence of cataract and retinal disorders in chronic kidney disease patients. However our study was limited to single center, more extensive studies with a bigger sample size are needed to validate our results. Keywords: Chronic kidney disease, Eye disorders, Retinal disorders, Cataract, End stage renal diseases

Purpose Mer tyrosine kinase-retinitis pigmentosa (MERTK-RP) causes a primary defect in the retinal pigment epithelium, which subsequently affects rod and cone photoreceptors. The study aims to identify the most appropriate MERTK-RP biomarkers to measure disease progression for deciding the optimum therapeutic trial intervention time. Materials and methods Patients' data from baseline (BL) and last follow-up (LFU) were reviewed. Best corrected visual acuity (BCVA), spectral domain-optical coherence tomography (SD-OCT), ultra-widefield fundus autofluorescence (UWF-FAF) patterns, kinetic perimetry (KP), and electroretinography (ERG) parameters were analyzed. Results Five patients were included with the mean age of 17.7 ± 14.4 years old (6.7-42.3) at BL and mean BCVA follow-up of 8.4 ± 5.1 years. Mean BCVA at BL and LFU were 0.84 ± 0.86 LogMAR and 1.14 ± 0.86 LogMAR, respectively. The BCVA decline rate was 0.05 ± 0.03 LogMAR units/year. Ellipzoid zones (EZ) were measurable in eight eyes with mean BL length of 1293.75 ± 421.07 µm and reduction of 140.95 ± 69.28 µm/year and mean BL CMT of 174.2 ± 37.52 µm with the rate of 11.2 ± 12.77 µm declining/year. Full-field ERG (ffERG) and pattern ERG (pERG) were barely recordable. UWF-FAF showed central macular hyper-autofluorescence (hyperAF). KP (III4e and V4e) was normal in two eyes, restricted nasally in four eyes, superior wedge defect in two eyes and undetectable in two eyes. The four restricted nasally KPs became worse, while the others stayed almost unchanged. Conclusions This cohort showed early visual loss, moderately rapid EZ reduction and macular hyperAF. EZ, CMT, and BCVA were consistently reduced. Relative rapid decline in these biomarkers reflecting visual function suggests an early and narrow timespan for intervention.

Purpose In the COVID-19 pandemic, students were subjected to high pressure when they were forced to move to distance learning in a lockdown environment. Such a drastic move for communities living in groups with solid relationship ties comes at a price. This study aims to investigate the acceptance of distance learning amongst Omani higher education institutions (HEI) students during COVID-19 lockdown. Design/methodology/approach This is a quantitative research based on an online survey designed to study participants’ acceptance of distance learning during COVID-19 lockdown. Findings A sample of 757 Omani students was selected, of which 81.2% were female. About 60% of the students’ Age lies 15–20 years. The highest percentage (38.8%) of students belongs to the College of Arts and Humanities. A total of 80% of the students reported a moderate level of information technology skills, and also more than 80% of the students had never attended eLearning calls. Most of the students affirm the eLearning acceptance (students’ willingness to use eLearning tools for the tasks they are designed for), eLearning usefulness (using eLearning would enhance students’ performance), eLearning ease of use (the degree to which a student believes that using eLearning tools are free from effort), learning from home during COVID-19 and eLearning effectiveness (student’s satisfaction and the benefits student will gain from learning via online platforms). Multiple regression analysis confirms that more than 81% of the variation in the eLearning acceptance was explained by eLearning usefulness, eLearning ease of use, learning from home during COVID-19 and eLearning effectiveness independent variables. Moreover, these independent predictors have a positive association with eLearning acceptance. Originality/value This research intends to fill the gap in Omani HEI students’ acceptance of distance learning during the COVID-19 pandemic.

Objectives Low back pain is the most widespread musculoskeletal ailment and a common cause of disability worldwide. Conventional medicine typically treats low back pain with a combination of physical therapy; activity modification and rest; pain-relieving and anti-inflammatory medications which are associated with huge socioeconomic implications and adverse drug reactions. In contrast Ḥijāma, Dalk and Bukhūr are ancient medical techniques recommended in the management of musculoskeletal disorders with little or no adverse effects. To evaluate the safety and effectiveness of Ḥijāma bi’l Shart (wet cupping), followed by Dalk (Massage) with Roghan Dafli and Bukhūr (medicated steam) with Tukhm Soya (Anethum graveolens Linn) in patients of Waja al-Zahr (Non-specific Low back pain). Methods Patients of either gender in the age group of 18–50 years with low back pain persisting for four weeks or more as chief complaint were recruited in the trial. The study was GCP compliant. The duration of the protocol therapy carried out was 14 days. Results Ninty two patients of NSLBP were screened, of which 34 who fulfilled the inclusion criteria and were willing to participate in the study were recruited. Three participants were lost to follow-ups due to personal reasons and 31 patients completed the trial during the study period. Overall therapeutic response observed in this study was 97% while 3% of the patients did not respond to intervention. Conclusions The study findings imply that there is a credible evidence to ensure that the regimens intervened are safe and effective in ameliorating the symptoms of Waja al-Zahr.

Objectives To validate the concept of abadāl-i-adwiya (drug substitution) by evaluation of physicochemical standardization and hepatoprotective activity of Aristolochia rotunda & its substitute, Curcuma Zedoaria in albino Wistar rats. Methods Physicochemical standardization by estimation of moisture content, ash values and extractive values were carried out using standard methods. Hepatotoxicity was induced in albino Wistar rats using CCl4 1 mL/kg s. c. on alternate day for 14 days. Group I was served as Plain control and Group II as Negative control. Group III was administered silymarin 50 mg/kg p. o. while Group IV received HAE of A. rotunda 89.64 mg/kg p. o., and Group V was administered HAE of C. Zedoaria 45.73 mg/kg p. o. At the end of the study, serum bilirubin, AST (SGOT), ALT (SGPT) and ALP were estimated. The histopathology of liver was also carried out. Results The physicochemical parameters of both test drugs viz. moisture content, total ash, acid insoluble ash and water soluble ash were found within normal limit. The total serum bilirubin, direct bilirubin, AST (SGOT), ALT (SGPT) levels were significantly decreased in Test groups A and B when compared to the Negative and Standard controls. The microscopic examination of liver collected from animals of Group IV and Group V revealed significant recovery from hepatic toxicity compared to the Negative control. Conclusions The study experimentation has revealed that C. Zedoaria may be used as a substitute for A. rotunda in the treatment of liver diseases. However, the outcome has to be further corroborated with phytochemical evaluation and clinical trials of both the drugs. Furthermore, the concept of drug substitute in Unani system of medicine is also validated in the light of above study.

The current pandemic caused by SARS-CoV-2 has led to a massive change in every aspect of our lives. It has grossly affected the healthcare system, business and world trade, disruption of movement and supply of essential goods and has crippled the global economy. Although few vaccines have been approved for the control of disease, targeted therapy options for this virulent disease still remain limited and elusive. Exhaustive search for potent therapeutic candidate is in progress, for which herbal armory are also being explored. Medicinal plants and their products play a vital role in alleviating various diseases and have been reported to exhibit a wide range of biological activities. Plant-based drugs with antiviral, anti-inflammatory and immunomodulotry activities were hypothetically considered as potential drugs to prevent and mitigate the prevailing situation caused by SARS-CoV-2. Arq Ajīb ‘a Unani formulation’ presents compelling approach in treating numerous diseases. The ingredients of Arq Ajīb and their phytocompounds have been reported for wide-ranging pharmaco-biological activities including antiviral, anti-inflammatory, immunomodulotry, anti-allergic, antitussive and bronchodilatory activities. Scientific data available on the formulation ingredients and their phytocompounds indicates that the formulation may have a significant role in augmenting the immune status of individual, protecting them from infection and providing symptomatic relief to patients affected with COVID-19. Hence, it may be considered as a potential drug for the development of novel therapeutic candidate for SARS-CoV-2 infection. This multi-faceted review highlights the therapeutic significance and pharmacological actions of Arq Ajīb and its ingredients to demonstrate the plausible role of the formulation in combating COVID-19. Keywords: Arq Ajīb, COVID-19, Pudina, Ajwain, Camphor, Unani formulation

Dosimetric Evaluation & Verification Of External Beam 3-D Treatment Plans In Humanoid Phantom have been carried out. In this study male anthromorphic phantom, model no.702 D, manufactured by Atom Ltd has been used. The plan was delivered to phantom and TLD- 100 was placed in cavities to evaluate and verify the dose delivered by implementing 3D treatment plans. TLD 100 was calibrated using SIEMENS PRIMUS PLUS Linear Accelerator with calibrated 6 MV X ray beam. We chose phantom skull, abdomen and pelvis region for making treatment plans and then doses by treatment plans have been verified by TLDs. 4%, 3.5% and 3% variation in the results was found for skull, pelvis and abdomen region respectively which is within the safe limit of accuracy i-e from 3% to 5 %. Before working with TLDs, it has also been found that thermoluminescent dosimeters were showing the linear response and results are reproducible for the dose range from 50 cGy to 200 cGy. This study has been performed at Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN) during the year 2010-2011.

This study maps the landslide susceptibility along the China–Pakistan Economic Corridor (CPEC) route using multiple landslide causative factors. A decisive statistical approach and the Geographic Information System (GIS) were used to map the route’s susceptibility. The study area comprises a 236 km section of the Karakoram Highway, located in a region subjected to repeated landslides. The maps of different causative factors, including topographical, geological, and hydrological factors, were generated through GIS using data obtained from various sources. The causative factors were weighted according to their potential for developing a landslide event in a pairwise matrix of a multi-criteria decision-making approach. The analytical hierarchy process was applied to get the Consistency Index that governed the whole rating process. The weights of the landslide causative factors were used for generating the study area’s final landslide susceptibility map. The results indicated that about 38% of the study area falls under the category of high and very high susceptibility. The outcomes of this study could be valuable in the identification of the parameters at a given area or region that are more prominently influencing the happening of landslides, in this way permitting the more viable preventive measures to be taken.

Background Minimal access surgery is associated with improved cosmetic and other short-term outcomes. Conventionally, an abdominal incision is made for specimen extraction. We assessed the feasibility of specimen extraction through one of the natural orifices and analyzed its impact on short-term outcomes. Methods A prospectively collected data were reviewed on consecutive patients who underwent natural orifice specimen extraction (NOSE) after laparoscopic colorectal surgery. The results were compared with a matched group who had transabdominal extraction (TAE) of the specimens. A systematic literature review was performed to compare our results. Results The combined median operating time for right and left colectomies was significantly higher in the NOSE group as compared with TAE group (260 vs. 150). There was no mortality in either group and no conversions to TAE in the NOSE group. No local metastasis or major iatrogenic injuries were reported at the time of retrieval. The results were comparable to those of a meta-analysis of randomized controlled trials. Conclusion The results of NOSE are comparable to those of TAEs. The absence of a minilaparotomy for specimen extraction may lead to a speedy recovery and better cosmesis.