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The need for thermal insulating building material due to increase in Urban Heat Island effect and the carbon footprint associated with concrete due to its binder, cement, has caused increase in utilization of waste by-products as supplementary cementitious materials (SCMs). Vast number of waste materials are available which could be potential substitutes of cement and help in developing eco-friendly concrete, however, conducting various tests on these would be costly and time-consuming. Therefore, computational simulation is a cost-effective and time-saving alternative for thorough time-consuming and expensive experimental studies. The aim of current work was to conduct the finite element simulation to assess the performance of eco-friendly lightweight foamed concrete incorporating two such waste products, Eggshell Powder (ESP) and Palm Oil Fuel Ash (POFA) being subject to thermal stress, heat transfer and parametric analysis and comparing the simulated results with data obtained from experimental work. Based on the results, it can be concluded that the surface temperature of the eco-friendly lightweight concrete panels decreased as the thickness of the panels increased. The finite element model by using ABAQUS software was validated with experimental results, and it was determined that the simulated results were within an acceptable range of 10% which could reduce to 2% if all panels with a set thickness of 50 mm. Therefore, computational model could help predict thermal stresses and heat transfer and provide fast-track thermal performance analysis of eco-friendly lightweight concrete incorporating various waste materials.

This research offered that the rice husk ash is served as replacement for cement ingredient such as 5%, 10% and 15% along with 10%, 20%, 30% and 40% of fine aggregates replaced with coal bottom ash in concrete. In this regard, total 180 concrete samples were prepared with mix proportion of 1:2:4 at 0.50 water/cement ratio and theses specimens were cured at 28 days. However, the main theme of this study is to perform the slump test, compressive strength, split tensile strength and water absorption of concrete including different proportions of rice husk ash as replacement for cement and fine aggregates replaced with coal bottom ash separate and combine. The outcome was detected that the workability and water absorption is dropped as the dosages of rice husk ash and coal bottom ash increases in concrete. Moreover, the compressive and split tensile strength is enhanced by 9.10% and 7.73% while the utilizing of 5% RHA along with 30% of fine aggregate replaced with coal bottom ash in concrete at 28 days consistently.

The disposal of solid waste in open environment is a serious alarming concern that needs immediate attention from the researchers. The hazardous solid agro-industrial wastes which include: wheat straw ash, rice husk ash, corn cob ash and sugarcane bagasse ash (SCBA), having pozzolanic properties, have a versatile use in concrete. The solid pozzolana enhances the various concrete properties by the reaction of silicates with calcium hydroxide in the presence of water, which in result generate a saturated zone of calcium silicate hydrate (CSH) gel. This C-S-H gel reduces the amount of calcium hydroxide C(OH)2 during the hydration process of cement. Very limited research works have been done on concrete by partially replacing cement with SCBA. This research work was focused on evaluating the properties of concrete by partially replacing cement with SCBA at 0, 5, 10, and 15 percentages. Compressive strength, Strength activity index, and water absorption of all mixes were examined. And it was observed that all SCBA mixes showed an increase in compressive strength and at 10% replacement the strength activity index was at a peak of 115.67%, but all the SCBA mixes showed a strength activity index greater than 75% which satisfied the standard specification. The water absorption test for all SCBA mixes showed a slight increase in water absorption.

The utilization of (HSC) high strength concrete in the construction industry is increasing all over the world because it reduces the cross-section of structural members and increases floor area. High strength concrete can be produced by using high cement content with low w/c ratio, mineral admixtures, and chemical admixture, and with suitable fiber. Nevertheless, in this research, HSC mix was achieved with the use of a special type BASF Master (M)/Polyheed 996 super-plasticizer based on polycarboxylic ether available in the market which reduced the w/c of concrete mixes, albeit attaining adequate workability. Compressive strength, up to 63 Mpa at 28 days, was achieved at slump value 178 mm by utilizing locally available materials like cement, sand, and coarse aggregates with a maximum 1.2% (by weight of cement) dosage of super-plasticizers. HSC has high workability, and to control the workability, different percentages of polyester fiber length 32 mm were also added to HSC. Polyester fiber controls the workability and improves the properties of HSC. There were four mixes designed with polyester fiber. The addition of polyester fiber content was 0.2%, 0.3%, 0.4%, and 0.5% (by weight of cement) in HSC, and the slump value were 153mm, 127mm, 102mm and 76mm respectively. It was observed that the usage of polyester fiber (0.2% to 0.5%) decreases workability by 14% to 57% of HSC. Therefore, it was concluded that increasing the percentage of fiber decreases the slump to the required value.

Silica fume is an industrial by-product that can be used as a partial replacement of cement to enhance the strength related properties of roller compacting concrete. In past, industrial wastes were used to dump on earth, river, and sea that creates a hazardous environment for aquatic life as well as for humans. Nowadays, the use of industrial by-products as cement replacement is popular in the construction industry because it protects the environment from hazards. In this research, the effect of silica fume as partial replacement of sulphate resisting cement is investigated on the compressive strength of roller compacting concrete. Total four types of mix proportions were casted using concert mix ratio as 1:2:4 to investigate the compressive strength of roller compacting concrete at 7 and 28 days of curing age. The sulphate resisting cement was partially replaced with silica fume by 0%, 5%, 10%, and 15% by weight of cement. The zero slump was maintained in all mixes. It was observed that the mix proportions containing 5% and 15% silica fume replacement showed maximum and minimum compressive strength of roller compacting concrete respectively.

Waste is available in an abundant form and goes to landfill without any use, creating threats to the environment. Recent and past studies have used different types of waste to stabilize soil and reduce environmental impacts. However, there is a lack of studies on the combined use of marble dust, rice-husk ash, and saw dust in expansive shale soil. The current study tries to overcome such a gap in the literature, studying the effect of marble dust, rice-husk ash, and saw dust on expansive shale’s compaction characteristics and permeability properties. According to unified soil classification and the AAHTO classification system, the geotechnical properties of natural soil are classified as clay of high plasticity (CH) and A-7-5. Several tests are performed in the laboratory to investigate the compaction characteristics and permeability properties of expansive shale. Moreover, permeability apparatus is used to investigate the permeability properties of soil. In addition, due to the accuracy of the apparatus, the conventional apparatus has been partly modified. The experimental results show that the addition of waste to the soil has significantly improved soil stabilization, increasing permeability and decreasing plasticity indexes. In addition, there is a gradual decrease in the dry density of soil and an increase in the permeability of stabilized soil. Based on the outcomes of the current study, it claims and concludes that these waste materials can be used as soil stabilizers or modifiers, instead of being dumped in landfill, which will provide a green, friendly, and sustainable environment. The current study recommends that future researchers use various wastes in the concrete and soil to improve their compaction and mechanical properties.

Carbon dioxide emissions from cement production have a significant impact on the environment. The huge energy consumption in the cement production process is also a problem. Pakistan is responding to a severe energy crisis. The price of cement is growing day by day. In addition, the use of waste for the disposal and recovery of natural concrete components can cause environmental degradation. Using waste not only reduces cement production, thereby lowering energy consumption, but also helps to protect the atmosphere. The aim of this research is to study the properties of concrete using silica fume as a partial replacement of cement and glass waste instead of fine aggregate. This research includes the study of workability, water absorption, compressive strength and split tensile strength. In this experimental study, 5%, 10% and 15% by weight of cement were replaced with silica fume, and fine aggregates were replaced with 10%, 20%, 30 and 40% by waste glass powder. A total of 20 mixtures in which one control mix, three mixes with addition of silica fume, four mixes with incorporating of glass powder and twelve mixtures with combined use glass powder and silica fume were prepared with 1:2:4 mix ratio at 0.5 water-binder ratios. According to the study parameters, replacing 10% cement with SF and 30% fine aggregate with glass powder is the best choice for optimum strength. Moreover, the utilization of glass powder and silica fume together significantly reduces the workability and water absorption of the composite concrete mixture.

The present study is based on a synthesis of facile, cheaper, well homogenized and highly stable Cerium Oxide nanostructures via chemical precipitation method. The synthesized nanoceria was subjected under different characterization tools. The UV–visible and FTIR study profile initially confirm the formation and existing functionalities in nanoceria. The XRD, SEM techniques were exploited the crystalline and untwined combined form rhombohedron shaped CeO2 nanoparticles respectively. While zeta sizer measurements explained well arranged, mono-dispersity, size and charge over the surface of nanoceria, which was calculated to be 17 nm with a desirable charge of + 6.37 mV. Finally, the well-prepared nanoceria nanoparticles were successfully applied as effective heterogeneous catalyst for 4-nitrophenol reduction. Under optimized conditions the nanoceria exhibited enhanced activity for 99% reduction of 4-NP within 60 s reaction time under greener microwave irradiation.

The construction industry is the largest manufacturing industry, which produces concrete and other related materials for construction of infrastructure around the world, after the food production industry. This industry requires a lot of natural resources like aggregates, limestone etc. to produce finished product such as concrete and cement. These natural resources are limited and have to deplete one day, so alternate to these resources are required. On the other hand, this industry produces a large amount of waste material that creates environmental pollution. Thus, recycling the waste as potential raw material and to produce a usable product is the need of present era for sustainable construction. This study presents the quantitative analysis of HSH (Human Scalp Hair) as fibers in cement concrete. This study aims to investigate the behaviour of concrete in terms of their mechanical properties when HSH are used as fibers. A detailed investigation on two types of concrete specimens i.e. cylindrical (150 mm diameter and 300 mm height) and prism (150 mm depth, width and 600 mm length) made with a different proportion of HSH as fibers and concrete mix ratios, was carried out. In this study, various proportions of HSH added in concrete that includes 0%, 1%, 2% and 3% by weight of OPC (Ordinary Portland Cement). All specimens were cast at two concrete mix ratios i.e. 1:2:4 and 1:1.5:3 with 0.50 W/C (Water-Cement Ratio). Moreover, specimens were tested in UTM (Universal Testing Machine) at 28 days curing age, for splitting tensile strength and flexural strength of concrete. It was observed from the experimental analysis that there is an improvement in mechanical properties of concrete at specific percentage of HSH and reduction of workability and density with increasing percentages of HSH.

BACKGROUND On December 3, 2020, district health authorities reported 15 suspected cases of gastroenteritis, including 4 deaths, from Village Bachal Soomro after a mourning ceremony. OBJECTIVE Field Epidemiology and Laboratory Training Program (FELTP) fellows investigated the suspected outbreak, with the objective to determine the magnitude of the outbreak and to evaluate associated risk factors. METHODS A retrospective cohort study was conducted on December 3, 2020, at Village Bachal Soomro. The complete cohort was traced back, and a pretested structured questionnaire was adopted to obtain demographic, clinical, and risk factor information. A case was defined as “any individual who attended the mourning ceremony at Village Bachal Soomro on December 3, 2020, and presented with any of the following symptoms: diarrhea, abdominal pain/cramps, and drowsiness.” Descriptive analysis followed by multiple logistic regression was performed. Different blood, stool, oropharyngeal swab, drinking water, and milk samples were sent for microbiological and chemical investigation. RESULTS Of 61 participants, 32 (52%) were males and the median age was 23 years (range 1-70 years). The overall attack rate was 72%, while the most affected age group was 10-19 years, with an attack rate of 85%. The majority of cases presented with diarrhea (47/61, 77%), followed by abdominal pain (44/61, 72%), vomiting (43/61, 70%), body ache (29/61, 48%), drowsiness (10/61, 16%), and fever (4/61, 7%). Among all food items, dessert had the highest food-specific attack rate of 90%. Among all risk factors, consumption of dessert (adjusted odds ratio [aOR] 61.3, 95% CI 6.1-613.1), water (aOR 23.9, 95% CI 2.0-276.7), and buffalo milk (aOR 7.9, 95% CI 1.22-51.8) were found to be significantly associated with the attack. Distribution of cases showed a common point source that was probably due to a single pathogen source. CONCLUSIONS Dessert was prepared 10-12 hours prior to meal intake, so the outbreak was probably caused by dessert prepared with contaminated milk and water, with enterotoxins of Staphylococcus aureus. Community awareness of personal hygiene, proper storage/preservation of food items, and provision of safe drinking water are suggested.

Aim: To determine the tuberculosis frequency in lung cancer patients. Study Design: Descriptive, cross-sectional study. Place and Duration of Study: Department of Pulmonology, Jinnah Postgraduate Medical Center, Karachi from 11th September 2017 to 10th March 2018. Methodology: One hundred and seventeen patients with lung cancer of age 30-60 years and both genders were enrolled. Patients with already taking anti-tuberculous therapy, previous history of tuberculosis, chest trauma and surgery were excluded. The relevant history, sputum or bronchial lavage sample was taken and presence or absence of pulmonary tuberculosis was noted. Results: Mean age was 50.31±6.43 years and majority of the patients 99 (84.62%) were between 46 to 60 years of age. Seventy five (64.10%) were male and 42 (35.90%) were females. Mean duration of disease was 17.97±4.67 days. Tuberculosis in patients with lung cancer was found in 24 (20.51%) patients whereas 93 (79.49%) patients have no tuberculosis. Conclusion: The frequency of tuberculosis in patients with lung cancer is quite high. Keywords: Tuberculosis, Lung cancer, Morbidity

Aim: To determine the accuracy of bronchoalveolar lavage in diagnosis of pleural tuberculosis among suspected cases of pleural tuberculosis using biopsy. Study design: Descriptive, cross-sectional. Place and duration of study: Department of Chest Medicine, JPMC, Karachi from 1st August 2017 to 31st January 2018. Methodology: One hundred and thirty six patients with cases of pleural tuberculosis of age 18-55 years and both genders were included. Patients with anti-tuberculosis drugs, pneumonia, tonsillitis, pharyngitis, obstructive pulmonary disease and platelet function disorders, thrombocytopenia or coagulation factors disorder were excluded. 30-50 ml of bronchoalveolar fluid was carried out through fiberoptic bronchoscopy. Three milliliters of 4% lignocaine was used as pre-medication and 3 ml of 2% lignocaine was used during bronchoscopy. Results: In BAL positive patients, 73 (true positive) had pleural tuberculosis and 9 (false positive) had no pleural tuberculosis on biopsy. Among 54, BAL negative patients, 5 (false negative) had pleural tuberculosis on biopsy whereas 49 (true negative) had no pleural tuberculosis on biopsy. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of BAL in diagnosis of pleural tuberculosis among suspected cases of pleural tuberculosis using biopsy as gold standard was 93.59%, 84.48%, 89.02%, 90.74% and 89.71% respectively. Conclusion: The diagnostic accuracy of bronchoalveolar lavage in diagnosis of pleural tuberculosis among suspected cases of pleural tuberculosis is quite high. Keywords: Pleural tuberculosis, Bronchoalveolar lavage, Sensitivity

Concrete structures get damaged over time, due to being subjected to various environmental exposures, improper design, management, and poor material durability. Portland cement mortars have been used as a repair material; however, it is both uneconomical and not eco-friendly due to high embodied carbon. Recently, polymer-modified binders have gained interest for their application in the repair of concrete structures. This research investigated the effectiveness of shrinkage-controlled polymer-modified binders (SC-PMB) in improving the bond strength of repaired structural concrete. The efficiency of the SC-PMB was investigated by performing a splitting tensile strength test on a concrete specimen prepared at two different mix ratios, i.e., 1:2:4 and 1:1.5:3 with 0.55, 0.50, and 0.475 water–cement (w/c) ratio. The fractured concrete samples were repaired with cement mortar (CM), cement paste (CP), polymer mortar (PM), and polymer paste (PP). It was observed that structural concrete repaired with polymer binders (PM and PP) showed greater performance in improving bond strength in tension. Particularly, structural concrete repaired with PP presented > 100% higher bond strength values in tension compared to CP, PM and CM.

This study describes the fresh and hardened properties of self-compacting concrete (SCC) with accumulation of metakaolin (MK). Soorh used as natural material which is calcined in an electric oven at 800 °C for 2 h to obtain metakaolin. A total of five mixtures have been developed, including varying MK contents (0–20% by weight of cement) and a water / binder ratio (W / B) of 0.38. The fresh properties were explored by slump flow, T50 flow, V-funnel, L-box, J-Ring sieve segregation test. Moreover, the hardened properties of concrete were performed for compressive, splitting tensile and flexural strength and permeability of SCC mixtures. The fresh concrete test results show that even if no viscosity modifier is required, satisfactory fresh concrete properties of SCC can be obtained by replacing the local MK content. At 15% replacement of cement with metakaolin maximum compressive, tensile and flexural strength is observed which is 10.39%, 10.19% and 7.07% more than that of control mix, respectively, and maximum reduction in water penetration depth which is 34% less than that of control mix is observed at 28 days age. It can be concluded from this study that 15% replacement of cement with local metakaolin is optimum.

Chronic kidney disease (CKD) is a world public health problem that is related with high morbidity and mortality. CKD patients can present with different skin manifestations, often benign with much impact on quality of patients life. Study Design: Case-series study. Setting: Nephrology Unit Civil Hospital Larkana. Period: From 1st January 2018 to 30th June 2018. Material and methods: 141 patients of ESRD on regular HD for at least 1 month. Patients were chosen randomly for evaluation of cutaneous changes regardless of their gender, age, sex and etiology of ESRD. General and dermatological examination of the skin, hair, nails, and oral mucosa was performed by consultant dermatologist. Data were analyzed by using IBM SPSS version 23.0. Descriptive analyses performed using mean with standard deviation and median with inter quartile ranges of quantitative data set. Count and percentages were reported for categorical data set. Results: In the present study there were one hundred and forty one patients. Out of them skin manifestations of patients, 87.9% had Xerosis, 31.9% found with skin hyper pigmentation, 9.2% had Subungal Hyperkeratosis, 24.1% had Uremic Pruirtis, 45.4% had Pallor, and 6.4% found with Bruises. There were 9.9% cases of Alopecia, 17.7% cases of half n half nail, 1.4% cases of half n half nail with alopecia, 9.2% cases of Koilionychia, 0.7% cases of Koilionychia with alopecia, 2.8% found with koilonychias and half n half nail, 2.1% with leuconycia and koilionychia, 15.5% with Leuconychia, 2.1% found with Leuconychia and alopecia, and 0.7% found with Leuconychia, koilonychia & alopecia in Hair and Nail changes. Conclusion: The range of skin manifestations vary in different studies. Although often benign with much impact on quality of patient’s life and life can be threatening. Early treatment of skin disorders can improve the quality of life.

This study investigates the moderating role of social support (i.e., supervisor, co-workers and the family) in the relationship between organizational injustice (i.e., distributive and procedural) and work interference with family (WIF; i.e., strain and behaviour based). Quantitative data were collected from employees working in public sector health-care organizations of Pakistan through survey questionnaires ( N = 255). This study finds significant effects of distributive and procedural injustice in engendering the negative experiences of strain- and behaviour-based WIF, in the employees of health-care organizations. The moderating effect of co-worker and family support provided mixed results. The supervisory social support was not found as a moderator. Findings of this study suggest that health-care organizations should pay serious attention to the ineffective work family policies and procedure to develop a family-friendly work environment. The supervisors should be given a role in work family policies and procedure development. The mitigating effect of co-workers’ support showed that the employees should be provided with proper knowledge on the policies and procedures of their organizations. The support of family members can also be either benign or harmful.

This experimental research was conducted to study the combined effect of agricultural by-product wastes on the properties of concrete. The coconut shell ash (CSA) was utilized to substitute cement content ranging from 0 to 20% by weight of total binder and sugarcane bagasse ash (SCBA) to substitute fine aggregates (FA) ranging from 0 to 40% by weight of total FA. In this regard, a total of 300 concrete specimens (cylinders and cubes) were prepared using 1:1.5:3 mix proportions with a 0.52 water-binder ratio. The study investigated the workability, density, permeability, and mechanical properties in terms of compressive and splitting tensile strengths. Additionally, the total embodied carbon for all mix proportions was calculated. It was observed that with an increase in CSA and SCBA contents, the workability, density, and permeability reduced significantly. Due to CSA and SCBA being pozzolanic materials, a gain in compressive and splitting tensile strengths was observed for certain concrete mixes, after which the strength decreased. The increase in embodied carbon of SCBA increased the total embodied carbon of concrete; however, it can be said that C15S40 which consists of 15% CSA and 40% SCBA is the optimum mix that achieved 28.75 MPa and 3.05 MPa compressive and tensile strength, respectively, a reduction of 4% total embodied carbon.

Objectives: The current study aimed to determine the Spontaneous Bacterial Peritonitis (SBP) risk due to increased use of Proton Pump Inhibitors (PPIs) among cirrhotic patients with ascites. Methods: This retrospective case-control study was conducted at Chandka Medical College & Hospital, Larkana from March 2013 to February 2014, involving 215 cirrhotic patients with ascites. Paracentesis was performed to distinguish cirrhotic patients with SBP and Polymorphonuclear Neutrophil (PMN) count ≥ 250 neutrophils/mm3 (cases) and non-SBP with PMN count < 250 neutrophils/mm3 (controls). The demographic details, history of PPIs use before admission and duration of Chronic Liver Disease (CLD) were inquired and statistical analysis was carried through SPSS Version 23.0. Results: Increased pre-hospital PPI intake was observed among cirrhotic patients with SBP (69.8%) as compared to those without SBP (48.8%; p = 0.014). The mean duration of PPI use was 19.16 ± 4.772 days, and it was more significant among older cirrhotic patients (p < 0.05). Increased duration of CLD was observed among PPI users, i.e. 20.47 ± 6.305 months vs. 18.95 ± 5.527 months among non-PPI users (p < 0.05). Conclusions: Our results show that cirrhotic patients with ascites consuming PPIs are more likely to develop SBP as compared to non-PPI users. doi: https://doi.org/10.12669/pjms.37.4.3476 How to cite this:Shaikh BA, Shaikh ZA, Shah AH, Kumar A. Determining the Risk of Spontaneous Bacterial Peritonitis due to increase use of Proton Pump Inhibitors among cirrhotic patients with ascites. Pak J Med Sci. 2021;37(4):1075-1079. doi: https://doi.org/10.12669/pjms.37.4.3476 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The carbon dioxide emissions from Portland cement production have increased significantly and Portland cement is the main binder used in self-compacting concrete, so there is an urgent need to find environmental friendly materials as alternative resources. In most developing countries, the availability of huge amounts of agricultural waste has paved the way for studying how these materials can be processed into self-compacting concrete as binder and aggregates compositions. Therefore, this experimental program was carried out to study the properties of self-compacting concrete (SCC) made with local metakaolin, coal bottom ash separately and combined. Total 25 mixes were prepared with four mixes as 5,10, 15 and 20% replacement of cement with metakaolin, four mixes as 10, 20, 30 and 40% of coal bottom ash as partial replacement of fine aggregates separately and 16 mixes prepared combined with metakaolin and coal bottom ash. The fresh properties were explored by slump flow, T50 flow, V-funnel, L-box, J-Ring sieve segregation test. Moreover, the hardened properties of concrete were performed for compressive, splitting tensile and flexural strength and permeability of SCC mixtures. Fresh concrete test results show that even if no viscosity modifier is required, satisfactory fresh concrete properties of SCC can be obtained by replacing the fine aggregate with coal bottom ash content. At 15% replacement of cement with local metakaolin is optimum and gave better results as compared to control SCC. At 30% replacement of fine aggregate is optimum and gave better results as compared to control SCC. In the combined mix 10% replacement of cement with metakaolin combined with 30% replacement of fine aggregate with coal bottom ash is optimum and gave better results as compared to control SCC.

Aim: To determine knowledge of hypoglycaemic symptoms & their self-management among pts with type II diabetes mellitus. Study Design: Descriptive, cross-sectional. Place and duration of study: OPD Clinic of Department of Medicine, Chandka Medical College Hospital Larkana from 23rd May 2019 to 22nd November 2019. Methodology: One hundred and thirty five patients with type II diabetes mellitus of age 35- 60 years were selected. Patients with type I DM and neuro-psychiatric illness were excluded. The symptoms of hypoglycemia and their responses to those symptoms were recorded. Results: The mean age of 47.07±6.04years and majority of the patients 83 (61.48%) were between 46-60 years of age. Seventy two (53.33%) were male and 63 (46.67%) were females. Mean duration of diabetes mellitus was 6.90±3.86 years. Adequate knowledge of hypoglycemic symptoms and their self-management among patients with type II diabetes mellitus was found in 62 (56.9%) patients. Conclusion: Hypoglycemic patients are significantly unaware of their condition and have a very low knowledge about hypoglycemia and its self-management. Keywords: Type II diabetes, Hypoglycemic symptoms, Knowledge

Concrete is frequently utilized infra-structural construction material all over the world. Cement is the main part of the concrete, during its manufacturing emission of gases such as carbon dioxide (CO2) from cement factories create greenhouse effect. In these days various natural pozzolanic materials are used as partial replacement of cement to enhance strength and durability and to reduction in consumption of cement consequently reduction in carbon dioxide (CO2) emission. The aim of this research is to investigate the effect of groundnut shell ash as a cement replacement material on workability and compressive strength of concrete. One mix of ordinary concrete and five mixes of modified concrete were prepared, where cement is replaced by groundnut shell ash from 3% to 15% by weight of cement, with 3% increment with 1:2:4 binding ratio mixed with 0.5 water/cement ratio. The workability and compressive strength of concrete was investigated. The obtained outcomes demonstrated that, groundnut shell ash as a cement replacement material have significant effect on compressive strength of concrete.

This research was performed to investigate the optimum conditions for developing pozzolanic ashes from organic wastes to be used as cement replacement materials. The organic wastes explored in the research are rice husk ash (RHA), wheat straw ash (WSA), and cow dung (CDA). When the organic waste is turned into ash, it develops a pozzolanic character due to the presence of silica. However, the presence of reactive silica and its pozzolanic reactivity depends on the calcination temperature, duration, and grinding. In this research, the organic wastes were calcined at three different calcination temperatures (300 °C, 400 °C, and 800 °C) for 2, 4, 6, and 8 h duration. The obtained ashes were ground for 30 min and replaced by 20% with cement. The samples containing ashes were tested for compressive strength, X-ray diffractometry (XRD), weight loss, and strength activity index (SAI). It was observed that the RHA calcinated at 600 °C for 2 h showed better strength. However, in the case of WSA and CDA, the most favorable calcination condition in terms of strength development was obtained at 600 °C for 6 h duration. The highest SAI was achieved for the mortar samples containing CDA calcinated at 600 °C for 6 h duration (CDA600-6H). The other two ashes (RHA and WSA) did not qualify as pozzolan according to the ASTM C618 classification. This was due to the presence of silica in crystalline form and lower surface area of the ash material. In this research, the ash was ground only for 30 min after calcination which did not contribute to an increase in the specific surface area and thus the pozzolanic activity. The materials ground for the higher duration are recommended for higher SAI.

Laurence-Moon-Bardet-Biedl syndrome (LMBBS), a rare autosomal recessive genetic disorder, results from consanguineous marriage. It is a congenital ciliopathy manifesting with primary and secondary characteristics. Primary clinical features include rod and cone dystrophy, polydactyly, central obesity, genital abnormalities, and mental retardation, often presenting as poor schooling skills. Secondary clinical features include developmental delay, speech deficit, brachydactyly/syndactyly, dental defects, ataxia, olfactory deficit, diabetes mellitus (DM), and congenital heart disease. Herein, we report a case of a 15-year-old male with clinical manifestations of LMBBS, namely learning disabilities, night blindness, hypogonadism, polydactyly, polysyndactyly, and obesity. Physicians must be familiar with this syndrome, for which an early diagnosis, multidisciplinary approach, and regular follow-ups can profoundly diminish morbidity and mortality in LMBBS patients.

Powdered cellulose etherified to primary, secondary, tertiary, and combination of primary and tertiary carbons contains halide or an epoxide compound obtains Methylcellulose, hydroxyethyl cellulose, hydroxypropyl cellulose, and hydroxypropyl methylcellulose (OH group replaced to OR) in presence of an alkali metal hydroxide in high pressure and thermal conditions, also produced to different grades where you played a viscosity parameter. Key Words: cellulose, alkali cellulose, etherfication.

Objective: To determine the impact of acne vulgaris on Self-esteem in adolescents and young adults. Study Design: Descriptive Cross-Sectional Study. Settings: Department of Dermatology, Civil Hospital, a tertiary care public sector health facility in Karachi. Duration: January 1, 2018 to June 30, 2018 (Six Months). Methodology: The study was conducted after informed consent; 158 patients diagnosed with acne vulgaris were evaluated for the impact it had on their self-esteem by using Rosenberg’s Self Esteem Scale (RSES). Chi square test was used to determine the correlation among different categorical variables. Results: Total 158 adolescent and young adults with acne vulgaris were included in the study, with 126 (79.7%) being females and 32 (20.3%) were males. The median age was 22.0 ± 4.62 years. Mean RSES score was 14.94 ± 0.141 and low self-esteem was reported in 67 (42.4%) participants. Conclusion: Acne vulgaris adversely effects self-esteem of patients, with one-third of the study population reporting low self-esteem. It was significantly low in females as compared to males.

Objective: To determine the frequency of cognitive impairment and it associated risk factors in patients presented with systemic lupus erythematosus. Study Design: Cross-sectional study Place and Duration: Department of Medicine, Chandka Medical College Hospital Larkana from 1st July 2018 to 31st December 2019. Methods: Ninety five patients of either gender presented with systemic lupus erythematosus were enrolled in this study. Patients detailed medical history, demographics including age, sex, education level, socioeconomic status and co-morbidities were recorded after taking informed written consent. Frequency of cognitive impairment was examined by Mini-mental state examination. Predictors of cognitive impairment were examined. Results: Seventy five (78.95%) were females while 20 (21.05%) patients were males. Fifteen (15.79%) patients were ages 60 years. Cognitive impairment was found in 22 (23.16%) patients. Among 22 cognitive impairment patients 17 (77.27%) had mild cognitive impairment and 5 (22.73%) had dementia. Cardiovascular disease, disease duration, low socio-economic status, and steroids use were the risk factors significantly associated with cognitive impairment (p-value Conclusion: The frequency of cognitive impairment in systemic lupus erythematosus patients was high. Diabetes mellitus, cardiovascular disease, low socio-economic status and hydroxychloroquine were the major risk factors associated with cognitive impairment. Keywords: Systemic lupus erythematosus, Cognitive impairment, Cardiovascular disease, Socioeconomic status, Diabetes mellitus, Steroids.

Renal manifestations of syphilis are variable, with membranous nephropathy being the most commonly described lesion. Rapidly progressive glomerulonephritis (RPGN) is rare and there is only one case report in the literature describing syphilis-associated crescentic glomerulonephritis. We report a rare case of RPGN secondary to latent syphilis, which resolved with penicillin treatment in the absence of immunosuppressive therapy. A 28-year-old Black male with a history of HIV was evaluated for severe acute kidney injury, nephrotic-range proteinuria, and active urine sediment. Serologies for glomerulonephritis were negative. Rapid plasma reagin and treponema pallidum particle agglutination assay were reactive, confirming syphilis diagnosis. Kidney biopsy revealed focal and segmental necrotizing and crescentic lesion. Patient received weekly benzathine penicillin (PCN) for 3 weeks, and renal function improved to baseline. This dramatic improvement happened with PCN alone, a finding which has not been previously reported. We recommend that syphilis be considered in the differential diagnosis of all patients with proteinuria or suspected glomerulonephritis.

Background On December 3, 2020, district health authorities reported 15 suspected cases of gastroenteritis, including 4 deaths, from Village Bachal Soomro after a mourning ceremony. Objective Field Epidemiology and Laboratory Training Program (FELTP) fellows investigated the suspected outbreak, with the objective to determine the magnitude of the outbreak and to evaluate associated risk factors. Methods A retrospective cohort study was conducted on December 3, 2020, at Village Bachal Soomro. The complete cohort was traced back, and a pretested structured questionnaire was adopted to obtain demographic, clinical, and risk factor information. A case was defined as “any individual who attended the mourning ceremony at Village Bachal Soomro on December 3, 2020, and presented with any of the following symptoms: diarrhea, abdominal pain/cramps, and drowsiness.” Descriptive analysis followed by multiple logistic regression was performed. Different blood, stool, oropharyngeal swab, drinking water, and milk samples were sent for microbiological and chemical investigation. Results Of 61 participants, 32 (52%) were males and the median age was 23 years (range 1-70 years). The overall attack rate was 72%, while the most affected age group was 10-19 years, with an attack rate of 85%. The majority of cases presented with diarrhea (47/61, 77%), followed by abdominal pain (44/61, 72%), vomiting (43/61, 70%), body ache (29/61, 48%), drowsiness (10/61, 16%), and fever (4/61, 7%). Among all food items, dessert had the highest food-specific attack rate of 90%. Among all risk factors, consumption of dessert (adjusted odds ratio [aOR] 61.3, 95% CI 6.1-613.1), water (aOR 23.9, 95% CI 2.0-276.7), and buffalo milk (aOR 7.9, 95% CI 1.22-51.8) were found to be significantly associated with the attack. Distribution of cases showed a common point source that was probably due to a single pathogen source. Conclusions Dessert was prepared 10-12 hours prior to meal intake, so the outbreak was probably caused by dessert prepared with contaminated milk and water, with enterotoxins of Staphylococcus aureus. Community awareness of personal hygiene, proper storage/preservation of food items, and provision of safe drinking water are suggested.

This research investigates the simple and conditional indirect effects of emotional and instrumental family related social support from coworkers on relationship and task family performance. Work to family enrichment is incorporated as mediator and family role salience as the conditional moderator. Primary data were collected through the Likert type of survey questionnaire from the employees working in banking sector of Pakistan (N = 401). It was found that emotional and instrumental family related social support from coworkers have significant effect on relationship and task family performance. Further, the effect of emotional support were more on relationship and the effect of instrumental were more on task family performance. Work to family enrichment was found as mediator in the relationship between social support types and family performance types. Family role salience was found as the conditional moderator in the indirect relationship between both types of social support and both types of family performance. This study will help managerial practitioners and researchers to understand the direct and conditional indirect effects of two specific types of social support (i.e., emotional and instrumental) on two specific types of family performance (i.e., relationship and task).

Purpose This study aims to examine the effect of psychological contract breach on organizational disidentification through the “affect-based” mediating mechanisms of trust and distrust. Design/methodology/approach Using a convenient sampling technique, cross-sectional data were collected from 281 doctors working in public sector health-care organizations in Pakistan. After initial data screening, a confirmatory factor analysis (CFA) was conducted to test the measurement models’ validity and reliability. The hypothesized relationships were tested using structural equation modeling (SEM) with AMOS. Findings The results of this study showed that psychological contract breach had significant direct and indirect positive effects through the mediating mechanism of distrust on organizational identification. However, trust was not supported as a mediator in that relationship. Research limitations/implications This study uses cross-sectional data. Other researchers should use longitudinal design with two or three time lags. This study uses a sample of doctors from different cities of Pakistan, as this is a global era, so results cannot be generalized; this opens the future avenue for other scholars to select a broad sample from multiple organizations like businesses and NGOs from different countries or to use it in different context. The authors have used single source (questionnaires) and quantitative method to collect data for this study, so there is a probability of self-report bias. As future is of mixed method, so future researchers should use mixed method for deep and thorough understanding of different selected phenomena. Practical implications Due to the experiences of breach of psychological contract, the doctors may either lose trust or may experience distrust which may further reduce their level of identification in an organization. Their contribution toward best interest of hospital decreases and their willingness to identify with their working place declines. Practically, the authors have compared that it is either the trust or distrust which can lead to organizational disidentification among doctors. Social implications The findings will help employers and hospital authorities to understand that doctors are the most important strategic element of every hospital. Having sound financial, physical and informational capital is incomplete and worthless if there is no “doctor”. Because they have to deal directly with patients, so in this case, they are most important and crucial. A doctor’s identification and their loyalty with high level of trust directly on employer and indirectly on hospital all contributes toward an organization’s long-term success, and ultimately for the success of society. Originality/value This study contributes to the existing literature on the consequences of employees’ psychological contract breach by simultaneously testing trust and distrust as the two competing affect-based mediating mechanisms between psychological contract breach and organizational disidentification.

Rapid industrialization over the past few decades has increased the disposal of waste materials in open-air landfills. The utilization of industrial wastes for the preparation of bricks can improve its functional characteristics and reduce the environmental pollution caused by landfill sites. This research investigated the effects of silica fume (SF) and fly ash (FA) on the structural and durability properties of burnt clay bricks (BCB) manufactured at the industrial kiln site. The SF and FA were added to the brick earth with a percentage variation of 2–10%. Results showed that the addition of 4% SF in brick earth increased the compressive strength of BCB by 27.55%, while 4% FA increased the compressive strength by 17.36%. Results also revealed that the addition of SF and FA reduced the weight of BCB, water absorption, and efflorescence while increased the structural efficiency. The incorporation of SF and FA resulted in variation of all dimensions of the burnt clay bricks. Nonetheless, the variation was observed within the range of testing standards.

The use of synthetic fiber and natural fiber for concrete production has been continuously investigated. Most of the materials have become popular for their higher flexibility, durability, and strength. However, the current study explores the engineering properties of cement concrete reinforced with nylon and jute fibers together. Varying proportions and lengths of nylon and jute fibers were utilized in the concrete mixture. Hence, the combined effects of nylon and jute fibers on workability, density, water absorption, compressive, tensile, flexural strength, and drying shrinkage of concrete were investigated. Results showed that concrete with 1% of nylon and jute fibers together by the volume fraction showed a maximum enhancement of the compressive strength, split tensile strength, and flexural strength by 11.71%, 14.10%, and 11.04%, respectively, compared to the control mix of concrete at 90 days. However, the water absorption of concrete increased with increasing nylon and jute fiber contents. The drying shrinkage of concrete decreased with the addition of nylon and jute fibers together after 90 days. Thus, the sparing application of both nylon and jute fiber as discussed in this study can be adopted for concrete production.

The purpose of this research is to investigate supervisory support as moderator between work family conflict (WFC) and turnover intentions in banking sector employees, working in Sindh province of Pakistan. Primary data were collected through Likert type survey questionnaire, targeting the 181 employees, working in commercial banks. The findings of this study shows the significant positive effect of work family conflict on turnover intentions of employees. Moreover, supervisory support was found as the significant moderator of the relationship between work family conflict and turnover intentions. The moderating effect of supervisory support significantly reduced the turnover intentions level of employees which they experienced due to work family conflict.

Pyroglutamic acid, an intermediate in glutathione metabolism, can lead to elevated anion gap metabolic acidosis as rare complication of acetaminophen therapy in adults. Acquired pyroglutamic acidosis has been observed primarily in settings associated with glutathione deficiency. Risk factors for glutathione deficiency include critical illness, chronic liver or kidney disease, advanced age, female gender, alcohol abuse, malnutrition, pregnancy, antiepileptic drugs, and chronic acetaminophen use. Diagnosis of pyroglutamic acidosis requires both the exclusion of common etiologies of increased anion gap metabolic acidosis and a high index of suspicion. Treatment involves discontinuation of acetaminophen, supportive care, and addressing risk factors for glutathione deficiency. The current report describes an ambulatory patient with multiple risk factors for glutathione deficiency, who developed recurrent pyroglutamic acidosis due to acetaminophen use with therapeutic blood levels of acetaminophen.

Objectives To evaluate the diagnostic accuracy of a short depression screening tool, the Saint Louis University (SLU) AMSAD depression scale, relative to the Geriatric Depression Scale–15 (GDS-15) and Montgomery-Asberg Depression Rating Scale (MADRS), and in relation to the Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5) criteria for major depressive disorder, in cognitively intact older adults. Design Cross-sectional. Setting Outpatient geriatric psychiatry clinic. Participants Fifty older adults (aged ≥65 years) without dementia. Measurements GDS-15, MADRS, SLU AMSAD, and DSM-5 criteria for major depressive disorder were administered. Results Total scores (continuous variables) for the GDS-15, MADRS, and SLU AMSAD correlated significantly with the DMS-5 criteria for major depressive disorder (MDD) [area under the curve (AUC) ≥ 0.93, sensitivity = 0.93, and specificity ≥ 0.80]. Optimal cutoffs were 9+ for GDS-15, 18+ for MADRS, and 7+ for SLU AMSAD. When score results were categorized according to their known cutoffs for mild, moderate, and severe depression, AUC values were again high (range = 0.82-0.89), with adequate levels of sensitivity (0.87-0.93) and specificity (0.71-0.86), distinguishing no or mild depression from moderate or severe depression in relation to the DSM-5 diagnostic criteria for MDD. Conclusions and Implications Strong diagnostic accuracy was shown for the 3 scales. The SLU AMSAD performed as well as the GDS-15 and slightly better than the MADRS. The superiority of the SLU AMSAD is supported by the fact that it encompasses only 5 simply worded, simply scaled items to be used in busy clinical settings.

The increase in volume of vehicles ultimately increases the number of waste tires. The proper disposal or reutilization of waste tires is a challenge. This study is aimed to utilize the steel fibers of waste tires as reinforcement in concrete. Concrete cylinders were cast with addition of different percentages of steel fibers (0-2%) and length (10-20 mm). The fresh and hard properties of concrete reinforced with different percentages of steel fibers and lengths were observed. It is seen that splitting tensile strength of concrete increased with increase in the length of fiber and with the increase in the percentage of fiber. The inclusion of the fibers in concrete causes the reduction in the workability of concrete.

Conference Abstracts

Generally, before the construction of any construction project, the subsoil investigations were carried out to evaluate the various geotechnical properties of soil like shear strength, permeability, etc. The sustainability of the projects largely depend upon the true prediction of the behaviour of the soil in long term and short term. However, due to the application of external loads, the stress induced on the soil increased and its effect remain high at shallow depths. This may cause the breaking of the soil particles particularly for coarse grained soils like gravel and sand. This chapter demonstrates the influence of induced stresses on the geotechnical characteristics of sand. The static normal stresses were induced in the range of 5–20 MPa with help of Universal Testing Machine (UTM). It is seen that with increase of static stresses the breaking of sand particles occurred. This possibly results in the decrease of permeability and shearing strength.

Subgrade is a most important part of a pavement structure, which should have a reasonable stiffness modulus and shear strength. CBR (California Bearing Ratio) test is performed to evaluate stiffness modulus and shear strength of subgrade soils. However, CBR test is laborious and time consuming, particularly when soil is highly plastic like Jamshoro soil. In order to overcome this limitation, it may be appropriate to correlate CBR value of soil with its index properties like grain size analysis, Atterberg limits, and compaction characteristics such as MDD (Maximum Dry Density) and OMC (Optimum Moisture Content). This paper expresses the correlations between CBR value of Jamshoro soil and its index properties. SLRA (Single Linear Regression Analysis) and MLRA(Multiple Linear Regression) based Models were utilized. It is seen that MLRA gave better correlations up to R 2 of about 0.984. It is observed that the Soaked CBR value can be predicted with confidence from LL (Liquid Limit), PI (Plasticity Index) and percent finer while the un-soaked CBR value can be obtained from LL, plasticity index and MDD.

This study investigated the main and conditional indirect effects of emotional and instrumental family related social supports from coworkers on person and task focused interpersonal citizenship behavior (ICBs). We incorporated work to family enrichment as mediator and family role salience as moderator in conditional indirect effect paths. Primary data were collected through the survey questionnaire in dyads from the employees and their immediate supervisors (N = 401). The results showed that the main and conditional indirect effects of emotional and instrumental family related social supports from coworkers were positive and significant on both ICBs (person and task focused). In comparison to instrumental support, the main effect of emotional support was more on person focused ICB. Whereas, in comparison to emotional support, the main effect of instrumental support was more on task focused ICB, as hypothesized. Work to family enrichment was found as mediator and family role salience as moderator in conditional indirect effect paths. This study establishes work family enrichment as a bridge in the social exchange process. The resources of emotional and instrumental family related support form coworkers’ engendered work to family enrichment, which in turn created the sense of obligation in the employees to reciprocate by performing person and task focused interpersonal citizenship behavior in the workplace. Further the employees high on family role salience experienced work to family enrichment more, due to support resources, and in turn reciprocated more interpersonal citizenship behaviors. Overall, this study contributed by examining a moderated mediation model, by testing work to family enrichment as mediator and family role salience as the boundary condition in relationship between two specific types of social support (i.e., emotional and instrumental) and two specific types of interpersonal citizenship behavior (i.e., person and task focused).

Introduction Despite its significant impact, geriatric depression remains both underdiagnosed and undertreated ( 1 ). In the absence of specific diagnostic criteria, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria currently represent the gold standard diagnostic tool for late-life depression. Given the fact that most elderly patients receive mental health care in primary care settings ( 2 ), there is an increasing need to develop practical diagnostic tools to be used by primary care practitioners. The Saint Louis University (SLU) AMSAD tool is a brief (5-item) questionnaire that was recently developed to screen for late-life depression. The 5 items reference appetite, mood, sleep, activity and death ideation using simple language and scaling. Previous research has supported its validity and reliability in cognitively intact older adults, in relation to the Geriatric Depression Scale (GDS)-15 and the Montgomery-Asberg Depression Rating Scale (MADRS) ( 3 ). However, few studies have examined the diagnostic accuracy of depression screening instruments in older adults. The objective of this study was to evaluate the accuracy and reliability of the SLU AMSAD regarding diagnosis of major depressive disorder (MDD) per DSM-5 criteria in a sample of older adults without major neurocognitive disorder. Methods A convenience sample of 50 patients, ≥ 65 years of age was enrolled through our specialized geriatric psychiatry outpatient clinic. Patients with a clinical suspicion/diagnosis of major neurocognitive disorder as reflected by a Saint Louis University Mental Status (SLUMS) score of Results Descriptive Analysis The sample had a mean (SD) age of 73.5 (7.1) years; 58% (n = 28) were women, 88% (n = 44) were Caucasian, and 86% (n = 43) had at least a high school level of education. The mean SLUMS score was 25.9 (2.9). For the depression measures, mean scores were 6.5 (4.5) for the GDS-15; 15.6 (11.4) for the MADRS; and 4.9 (3.2) for the SLU AMSAD. The SLU AMSAD evidenced adequate internal consistency reliability (alpha = .77). 30% (n = 15) of patients met DSM-5 criteria for MDD diagnosis. Diagnostic Accuracy and Correlations In the initial ROC analysis, total scores (continuous variables) for the GDS-15, MADRS, and SLU AMSAD were evaluated in relation to the DSM-5 designation of No MDD vs. MDD. AUC values were uniformly high (≥ .93), with correspondingly high levels of sensitivity (.93) and specificity (≥ .80). Optimal cut-offs were 9+ for GDS-15, 18+ for MADRS, and 7+ for SLU AMSAD. The SLU AMSAD was equivalent to GDS-15 and superior to MADRS in these analyses. ROC analyses using established categories for the depression measures were then executed. When score results were categorized as No vs. Any (Mild, Moderate, or Severe) Depression, AUC values ranged from .69-.79, with perfect sensitivity (1.0) but modest specificity (range = .37-.57). When score results were categorized as No-Mild vs. Moderate-Severe Depression, AUC values were again high (range = .82-.89), with adequate levels of sensitivity (.87-.93) and specificity (.71-.86). Moreover, total score correlations were nearly uniform across the depression measures (.69-.70). Scores categorized as No vs. Any (Mild, Moderate, or Severe) Depression yielded correlations with DSM-5 MDD that ranged from .39-.53; scores categorized as No-Mild vs. Moderate-Severe Depression yielded correlations ranging from .59-.75. When scores were categorized according to the optimal cut-off value, SLU AMSAD and GDS-15 had correlations of .75 with DSM-5 MDD, while the MADRS correlation was .68. Conclusions The results indicated strong diagnostic accuracy for all three depression scales in relation to the DSM-5, by ROC and correlational analyses. The SLU AMSAD performed at least as well as the GDS-15 (three times the length of the AMSAD) and slightly better than the much longer and complex MADRS. However, the clinical superiority of the SLU AMSAD for depression screening in the elderly, in relation to the other measures, is supported by the fact that it encompasses only 5 simply-worded, simply-scaled items. Thus, the SLU AMSAD emerges as a potentially strong candidate for depression screening in busy clinical settings, including primary care but also in the emergency department. This research was funded by No funding was received for this research.