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Abstract The important mechanical parameters and their hierarchy in the growth and folding of the human brain have not been thoroughly understood. In this study, we developed a multiscale mechanical model to investigate how the interplay between initial geometrical undulations, differential tangential growth in the cortical plate, and axonal connectivity form and regulate the folding patterns of the human brain in a hierarchical order. To do so, different growth scenarios with bilayer spherical models that features initial undulations on the cortex and uniform or heterogeneous distribution of axonal fibers in the white matter were developed, statistically analyzed, and validated by the imaging observations. The results showed that the differential tangential growth is the inducer of cortical folding, and in a hierarchal order, high-amplitude initial undulations on the surface and axonal fibers in the substrate regulate the folding patterns and determine the location of gyri and sulci. The locations with dense axonal fibers after folding settle in gyri rather than sulci. The statistical results also indicated that there is a strong correlation between the location of positive (outward) and negative (inward) initial undulations and the locations of gyri and sulci after folding, respectively. In addition, the locations of 3-hinge gyral folds are strongly correlated with the initial positive undulations and locations of dense axonal fibers. As another finding, it was revealed that there is a correlation between the density of axonal fibers and local gyrification index, which has been observed in imaging studies but not yet fundamentally explained. This study is the first step in understanding the linkage between abnormal gyrification (surface morphology) and disruption in connectivity that has been observed in some brain disorders such as Autism Spectrum Disorder. Moreover, the findings of the study directly contribute to the concept of the regularity and variability of folding patterns in individual human brains.

Introduction: Anal fissure is an elongated ulcer in lower anal canal which presents with severe perianal pain during and after defecation with red streaks of blood. Chronic anal fissure is a fissure for more than six weeks with a skin tag (sentinel tag). Surgical options include Lord's dilatation of anus, lateral internal sphincterotomy (LIS) and posterior anal flap. Aims & Objectives: To compare LIS and Lord's operation in cases of chronic anal fissure in terms of occurrence of incontinence. Place and duration of study: Department of General Surgery, Ayub Teaching Hospital Abbottabad from September 2018 to March 2019. Material & Methods: This quasi-experimental study was carried on 92 patients with anal fissure. By convenience (non- probability) sampling patients were divided into two equal groups of 46 patients as group A for LIS and group B for Lord's dilatation. Data was collected on a structured proforma and analyzed using SPSS 20. Results: Flatus incontinence was observed in 1 (1.1%) fecal incontinence was in 11 (12.0%). Flatus incontinence occurred in 1 (1.1%) patient of group A while no flatus incontinence was reported in patients of group B. Fecal incontinence is observed in 10 (10.9%) patients with group A while 1(1.1%) of patients in group B had fecal incontinence. The result was significant with chi square value 9.614 and p value 0.008. Conclusion: Lord's dilatation is a better procedure than Lateral internal sphincterotomy in terms of fecal incontinence.

Abstract As a complex hydrological problem, rainfall-runoff (RR) modeling is of importance in runoff studies, water supply, irrigation issues, and environmental management. Among the variety of approaches for RR modeling, conceptual approaches use physical concepts and are appropriate methods for representation of the physics of the problem while may fail in competition with their advanced alternatives. Contrarily, machine learning approaches for RR modeling provide high computation ability however, they are based on the data characteristics and the physics of the problem cannot be completely understood. For the sake of overcoming the aforementioned deficiencies, this study coupled conceptual and machine learning approaches to establish a robust and more reliable RR model. To this end, three hydrological process-based models namely: IHACRES, GR4J, and MISD are applied for runoff simulating in a snow-covered basin in Switzerland and then, conceptual models’ outcomes together with more hydro-meteorological variables were incorporated into the model structure to construct multilayer perceptron (MLP) and support vector machine (SVM) models. At the final stage of the modeling procedure, the data fusion machine learning approach was implemented through using the outcomes of MLP and SVM models to develop two evolutionary models of fusion MLP and hybrid MLP-whale optimization algorithm (MLP-WOA). As a result of conceptual models, the IHACRES-based model better simulated the RR process in comparison to the GR4J, and MISD models. The effect of incorporating meteorological variables into the coupled hydrological process-based and machine learning models was also investigated where precipitation, wind speed, relative humidity, temperature and snow depth were added separately to each hydrological model. It is found that incorporating meteorological variables into the hydrological models increased the accuracy of the models in runoff simulation. Three different learning phases were successfully applied in the current study for improving runoff peak simulation accuracy. This study proved that phase one (only hydrological model) has a big error while phase three (coupling hydrological model by machine learning model) gave a minimum error in runoff estimation in a snow-covered catchment. The IHACRES-based MLP-WOA model with RMSE of 8.49 m3/s improved the performance of the ordinary IHACRES model by a factor of almost 27%. It can be considered as a satisfactory achievement in this study for runoff estimation through applying coupled conceptual-ML hydrological models. Recommended methodology in this study for RR modeling may motivate its application in alternative hydrological problems.

Objective: To determine the frequency of hand-foot syndrome and associated factors among patients receiving Capecitabine for the management of cancer in a tertiary care setting. Study Design: Cross-sectional study. Place and Duration of Study: Oncology Department Combined Military Hospital, Rawalpindi Pakistan from Dec 2020 to May2021. Methodology: One hundred patients with malignant conditions taking Capecitabine for more than two weeks were included in the study. A detailed relevant dermatological examination was carried out on all the patients to diagnose hand-foot syndrome based on the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0 Grading of Hand-Foot Syndrome. Results: Out of 100 cancer patients using Capecitabine for more than two weeks included in the study. Sixty-eight showed the presence of hand-foot syndrome, while 32 did not show any features of hand-foot syndrome. Combination treatment was statistically significantly associated with hand-foot syndrome among the patients included in our study (p-value

Background. Pharmaceutical care services offered by pharmacists rationalize drug therapy, improve patient quality of life, and save patients’ lives. This study was designed to optimize patient drug therapy through pharmaceutical care services offered by a pharmacist in consultation with other health care providers (HCPs) at a tertiary care hospital. Methods. This descriptive study was conducted to assess the role and effectiveness of pharmacists in optimizing drug therapy outcomes. The study was carried out at an internal and pulmonary medicine unit of a tertiary care hospital in Srinagar, Jammu and Kashmir, India, with a total of 50 health care providers (HCPs) (24 doctors, 16 nurses, and 10 pharmacists). A total of 182 patients (males and females) of all age groups were recruited into the study over a period of nine months. Patient-specific pharmaceutical care plans initiated by the pharmacist based on drug therapy-related needs and problems were used to address and optimize drug therapy outcomes in consultation with other HCPs. Results. A total of 388 drug-related problems (DRPs) with an average of 2.29 DRPs per patient were identified, for which 258 pharmaceutical care plans as interventions were proposed, out of which 233 (90.31%) were accepted and implemented. Preassessment and postassessment by HCPs on services rendered by the pharmacist showed a positive change in attitude among HCPs with respect to their endorsement and acceptance of the pharmacist’s services in providing direct patient care. Conclusions. Pharmaceutical care services offered by pharmacists helped in optimizing drug therapy and patient care.

Objective: To find out the echo abnormalities in a south Asian cohort on maintenance hemodialysis in a tertiary care hospital. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Combined Military Hospital Abbottabad, from Feb 2022 to Apr 2022. Methodology: 57 adult patients on maintenance hemodialysis had a non-contrast transthoracic echocardiographic study recording parameters of left and right ventricular systolic and diastolic function. Results: We had 57 patients. 71.9% (n=41) were male, and females 28.1% (n=16), diabetics 47.4 % (n=27), hypertensives 84.2%(n=48), smoking 28.1% (n=16); 15.8%(n=9) had some form of ischemic heart disease. Left ventricular hypertrophy was noted in 78.9% (n=45) of the entire patient population. 84% (n=48) of hypertensive patients had LVH. Overall, 82% (n=47) of hypertensive patients had some degree of diastolic dysfunction compared to non-hypertensive patients (p

Objective: To detect residual RV dysfunction on a right ventricle focused Transthoracic Echocardiography (TTE) in COVID-19 infection survivors with lung involvement. Study Design: Analytical Cross sectional study design. Place and Duration of Study: Combined Military Hospital Abbottabad Pakistan, Feb 2022 to Apr 2022. Methodology: 87 patients who had suffered from and survived COVID-19 infection with definite involvement on CT scans of the chest were studied after discharge. Echocardiography was done to determine the RV anatomical and functional parameters to determine the relationship between extent of lung involvement and transthoracic echocardiographic parameters.Data was entered in Microsoft excel and exported to SPSS v 23 for analysis. Results: The initial sample size was of 87 patients. Due to suboptimal ECHO studies 7 cases were excluded. Males represented 62.5% (n=50) and females 37.5% (n=30). The ages ranged from 27 to 80 years, mean 53.08±12.77 years. Based on the CT severity score severe infections were 61.3 %(n=49) and mild 38.8% (n=31). The CTSS ranged from 6 to 30 with a mean of (17.74±7.13). In our study we found that on TTE, there was a statistically significant difference in 2 of the anatomical parameters; RVOT PLAX (RVOT diameter in Parasternal long axis view) [27.4 vs 28.3; p=0.02], RVOT-Dis (Distal RVOT dia) [22.8 vs 24; p=0.01]. In addition, there was a statistically significant difference in all the functional parameters of RV function TDI S vel (Systolic Tissue Doppler Velocity of the Tricuspid Annulus by Tissue doppler imaging) [7 vs4.9; p

Background: Alexithymia is a symptom that most psychosomatic patients experience and can affect their performance, psychological state, and the severity of their physical symptoms. Therefore, we aimed to determine the effectiveness of group therapy based on acceptance and commitment on the severity of fatigue and depression with the moderating role of alexithymia in patients with multiple sclerosis (MS) in Tehran. Methods: In this research, a semi-experimental pre-test post-test design was used with three months of follow-up. Using convenience sampling, 40 patients with MS were randomly assigned to two experimental and control groups. Before and after the intervention and three months later in the follow-up phase, all participants responded to fatigue severity, depression, and alexithymia questionnaires. The intervention consisted of ten 90-minute group therapy sessions based on acceptance and commitment, which was performed only for the experimental group. Results: Analysis of covariance indicated a significant difference between the mean scores of fatigue severity, depression, and alexithymia in the experimental and control groups in post-test and follow-up stages. Conclusion: Group therapy based on acceptance and commitment with the moderating role of alexithymia effectively reduced the severity of fatigue and depression in patients with MS.

Background: Considering the prevalence of migraine and its detrimental effects on functioning, physical health, and quality of life as well as its psychosocial and social risks. The purpose of this study was to compare the effectiveness of mindfulness-based stress reduction treatment with treatment based on acceptance and commitment to the severity of pain and health-related quality of life in migraine patients. Methods: In this study, a semi-experimental design used with pre-test, post-test, a 3-month follow-up, and a control group. Using purposive sampling and considering the inclusion criteria, 45 patients with migraine diagnosis selected from among those referring to the neurology department of Imam Hossein hospital in Tehran. They were then randomly assigned to two experimental groups and a control group. The first experimental group received group therapy based on mindfulness (n = 15; 90-minute sessions), the second experimental group received acceptance and commitment based intervention (n = 15; 90-minute sessions), and the control group (n = 15) received no intervention. All subjects responded to pain intensity and health-related quality of life questionnaires before the intervention (pre-test), after the intervention (post-test), and 3 months after the intervention (follow-up). One-way ANOVA analyzed the collected data. Results: The findings showed that mean scores for the 2 experimental groups were significantly different from the control group in the post-test and follow-up phases in terms of severity of pain and health-related quality of life, while the mean scores for the two experimental groups did not differ significantly. The results emphasize the importance of these interventions for chronic diseases and offer new horizons in clinical interventions. Conclusion: The results of this study showed that mindfulness-based stress reduction therapy and acceptance and commitment therapy could positively affect the severity of pain and health-related quality of life in migraine patients, and any of them can be used to improve the variables mentioned above.

This paper reviews the burgeoning literature on three gases that have major impacts in biology. NO, CO and H2S are now co-classified as endogenous gasotransmitters with profound effects on mammalian physiology and, potentially, major implications in therapeutic applications. All are well known to be toxic yet, at tiny concentrations in human and cell biology; they play key signaling and regulatory functions. Looking over the bulk of this article only physiological and pathophysiological aspect of NO has been included. [ABSTRACT FROM AUTHOR]

To reduce the problem of sedimentation in open channels, calculating flow velocity is critical. Undesirable operating costs arise due to sedimentation problems. To overcome these problems, the development of machine learning based models may provide reliable results. Recently, numerous studies have been conducted to model sediment transport in non-deposition condition however, the main deficiency of the existing studies is utilization of a limited range of data in model development. To tackle this drawback, six data sets with wide ranges of pipe size, volumetric sediment concentration, channel bed slope, sediment size and flow depth are used for the model development in this study. Moreover, two tree-based algorithms, namely M5 rule tree (M5RT) and M5 regression tree (M5RGT) are implemented, and results are compared to the traditional regression equations available in the literature. The results show that machine learning approaches outperform traditional regression models. The tree-based algorithms, M5RT and M5RGT, provided satisfactory results in contrast to their regression-based alternatives with RMSE = 1.184 and RMSE = 1.071, respectively. In order to recommend a practical solution, the tree structure algorithms are supplied to compute sediment transport in an open channel flow.

The tomato leaf miner (TLM), Tuta absoluta (Meyrick), is an invasive tomato pest found worldwide. Sustainable control strategies aimed at increasing biological control approaches and decreasing chemical inputs are required, due to the tendency to develop insecticide resistance. In this study, the lethal and sublethal effects of four chemical insecticides (abamectin, indoxacarb, chlorantraniliprole, and spinosad) and the sublethal effects of the entomopathogenic fungus Metarhizium anisopliae (Metschnikoff) on a widespread TLM egg parasitoid, Trichogramma brassicae Bezdenko, were estimated. Concentration mortality response bioassays enabled the estimation of lethal concentrations of the tested insecticides for the parasitoids, with chlorantraniliprole having the lowest LC50 and indoxacarb the highest. The LC25 and LC50 of the tested insecticides on the TLM were sprayed on eggs and then offered at three time intervals to the parasitoids. The fertility and other life table parameters of the individuals emerging from the treated eggs were estimated. All of the chemical insecticides, but not the fungus, had harmful effects on T. brassicae. The insecticide applications caused a 3.84-5.17 times reduction in the net reproductive rate (R0) compared with the control. No parameters were affected by spraying the fungus in the 0h treatment, but effects were recorded at 24 and/or 48h, except for the gross reproduction rate (GRR). The value of the intrinsic rate of increase (rm) also decreased to 0.528-0.617 after the insecticide treatments. The doubling time (DT) increased in all treatments compared to the control. Nevertheless, the generation time (T) was only very slightly affected. In addition, in the combination experiments, M. anisopliae showed a remarkable synergism with T. brassicae in controlling TLM eggs. These results indicate that low levels of lethal effects on key biological control agents should be considered in the choice of insecticides to be included in sustainable TLM control packages.

Holt–Oram syndrome is a rare genetic autosomal dominant disorder which affects the upper limbs and heart. It is also known as “heart–hand” syndrome or “atriodigital dysplasia.” The present article describes the clinical and radiological images of the features of Holt–Oram syndrome in two patients.

A rare case of a large pseudoaneurysm at the anastomotic site of internal iliac artery with the graft renal artery in a case of renal transplant is presented with a vision of documenting this condition and making clinicians familiar with this rare postsurgical complication in patients of renal transplant.