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The human being is the noblest of all the creations by Allah Rabbul-Izzat. Allah gave special commands to humans which made differences over other species, the hygiene practice is one of them. The researches on toilets, defecation, urination and self-cleansing may be supposed as unthinkable subjects in daily discussions, but these topics are important for health and hygiene perspectives. Designers and manufacturers are busy making aesthetically attractive, ergonomically and anthropometrically defined toilet seats. But there is a need for some adjustments in the size and design of modern toilet seats as per the hygiene perspective. This paper presents a conceptual design framework aimed, increasing the level of hygiene and introduced the three-dimensional designs of sitting and squatting types of toilet seats with some amendments as compared to modern designs, concerning hygiene perspective. The present conceptual design of toilet seats can become the integration of human hygiene practice. In this study, Solidworks Designing Software was used for three-dimensional designs. This framework study dedicates to Iranian society.

BackgroundIndoor air quality has been shown to influence asthma control and outcomes. Air purifiers and high-efficiency particulate air filtration devices can improve indoor air quality by reducing the indoor levels of air pollution and allergens. However, the influence of this improved indoor air quality on asthma control remains unclear; hence, randomized controlled trials are needed to further elucidate this phenomenon. ObjectiveThis study aims to investigate the effect of reducing the levels of allergens and pollutants in the bedroom and living room through the use of Dyson air purifiers (Dyson Pure Cool) on asthma control. MethodsThis is an 18-month long, investigator-led, randomized, double-blinded, placebo-controlled, single-center trial. Subjects will be randomized in a 1:1 ratio to active or placebo Dyson filters. The primary outcome is the change in the scores of Asthma Control Questionnaire 6 and Asthma-specific Quality of Life Questionnaire from baseline. Secondary outcomes include changes in lung function (forced expiratory volume in one second, forced expiratory volume in one second/forced vital capacity ratio, and midexpiratory flows), peak expiratory flow measurements, airway hyperresponsiveness (assessed by methacholine bronchial challenge), fractional exhaled nitric oxide, and indoor air pollutant levels. The sample size will be 50 subjects, and all subjects will have a confirmed diagnosis of mild persistent to moderate persistent asthma along with an Asthma Control Questionnaire 6 score of >1.5. ResultsThis study was approved by the West Midlands Research Ethics Committee (18/WM/0277). The study results will be published in peer-reviewed scientific journals; presented at relevant scientific conferences; and shared in plain English with participants in our newsletters, in our clinics, and via the David Hide Asthma and Allergy Research Centre website. Our trial began in September 2019 and is expected to end in August 2021. ConclusionsThis is a double-blinded, placebo-controlled, randomized, investigator-led study to investigate the efficacy of a novel air purifier in improving asthma control in adults. The trial period of 18 months will facilitate the collection of robust data and will therefore generate clear signals. However, this extended trial duration may lead to patient withdrawal. Furthermore, this trial is conducted at a single center and in a location with a homogenous cohort of people, which may affect translatability. Nonetheless, it is hoped that the findings of this trial may help further inform clinicians regarding the utility of this novel device as an adjunct in asthma care. Trial RegistrationClinicalTrials.gov NCT04729530; https://clinicaltrials.gov/ct2/show/NCT04729530 International Registered Report Identifier (IRRID)DERR1-10.2196/28624

Birthweight has been found to associate with later-life health outcomes. Here the authors perform a meta-analysis of epigenome-wide association studies of 8,825 neonates from 24 birth cohorts in the Pregnancy And Childhood Epigenetics Consortium, identifying differentially methylated CpGs in neonatal blood that associate with birthweight.

Background: In today's society, a huge population is facing intellectual health problems. Therapeutic expense of such problems leads people into a financial burden. Inspite of squandering cash on pharmaceutical prescription, it is better to take benefit from laughter therapy. It is a part of human behavior, which helps human clarify their intentions in social interaction. The aim of this study was to determine the effects of laughter on cognition. Methodology: This uncontrolled experimental study was conducted on 80 participants, recruited on convenience bases. All 18-30 years aged subjects with no chronic psychological disorder were included. While patients with a chronic psychological disorder were excluded from the study sample. Participants were divided into 3 groups: 26 participants in Group A, 33 participants in Group B and 21participants in Group C. Cognition skills were assessed by using Montreal Cognitive Assessment (MoCA) score before and after laughter therapy session of about 25 mins. The collected data was then analyzed using SPSS version 21. Results: All the groups showed improvement in MoCA score after laughter therapy. Group A MoCA score after therapy was 22.70. Group B MoCA score after therapy was 25.10. Group C MoCA score after therapy was 25.42.By mean analysis, we figured out that there is a greater change of cognition seen in members of Group C than in Group B and change in Group B is greater than in Group A. Conclusion: It was concluded that laughter improves cognition and regulates neurotransmitters. Moreover, it has great influence in daily life and puts a great impact on memory and cognitive skills.

The selection of stimulus contents for neurofeedback has direct implications on the efficacy of neurofeedback therapy. In particular, a suitable selection of stimulus contents facilitates the achievement of sustainability during neurofeedback sessions, which has been considered challenging during clinical practice. To further elaborate this point, this research investigates the efficacy of different neurofeedback stimulus contents (audio, video, and games) for stress mitigation. The effectiveness of the contents was measured by statistically comparing quantitative electroencephalogram (QEEG) features, such as alpha power and alpha asymmetry before and after neurofeedback sessions. In addition, the topographic maps of activities were constructed for a visual description. In this study, 29 study participants were recruited, and the EEG data were recorded during multiple neurofeedback sessions. ANOVA and post hoc testing verified the statistical significance of the results of the various stimulus contents, whereas a t-test verified the significance of stress mitigation because of neurofeedback. The results indicate that games exhibit higher effectiveness than audio and video contents for stress mitigation. In addition, the topographic analysis demonstrates the efficacy of neurofeedback training for stress mitigation. In conclusion, the effects of neurofeedback therapy could be enhanced while selecting suitable stimulus contents for neurofeedback protocols.

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), the causative agent for the Coronavirus Disease 2019 (COVID-19) pandemic, has sparked a medical emergency worldwide. With the rise in COVID-19 infections and an eventual increase in hospitalized critically ill patients, a trend of bacterial, fungal, and viral superinfection has been noted. One important agent of co-infection identified is Candida auris. Due to its multidrug-resistant nature and easy transmissibility, C. auris is difficult to manage in COVID-positive patients. Patients with comorbidities, immunosuppressive states, intubated and on ventilators are more likely to contract the fungal infection. Therefore, it is essential to the first screen, diagnose, and isolate patients with C. auris infection and manage and treat them while preventing the spread of the disease. Failure to recognize and prevent its spread may lead to an eventual epidemic or even a pandemic during the current COVID-pandemic, which the exhausted healthcare system can most definitely not handle. This systematic review investigates the prevalence of C. auris, its pathophysiology, diagnosis, prevention, and treatment during the COVID-19 pandemic.

In recent times, organisations in a variety of businesses, such as healthcare, education, and others, have been using the Internet of Things (IoT) to produce more competent and improved services. The widespread use of IoT devices makes our lives easier. On the other hand, the IoT devices that we use suffer vulnerabilities that may impact our lives. These unsafe devices accelerate and ease cybersecurity attacks, specifically when using a botnet. Moreover, restrictions on IoT device resources, such as limitations in power consumption and the central processing unit and memory, intensify this issue because they limit the security techniques that can be used to protect IoT devices. Fortunately, botnets go through different stages before they can start attacks, and they can be detected in the early stage. This research paper proposes a framework focusing on detecting an IoT botnet in the early stage. An empirical experiment was conducted to investigate the behaviour of the early stage of the botnet, and then a baseline machine learning model was implemented for early detection. Furthermore, the authors developed an effective detection method, namely, Cross CNN_LSTM, to detect the IoT botnet based on using fusion deep learning models of a convolutional neural network (CNN) and long short-term memory (LSTM). According to the conducted experiments, the results show that the suggested model is accurate and outperforms some of the state-of-the-art methods, and it achieves 99.7 accuracy. Finally, the authors developed a kill chain model to prevent IoT botnet attacks in the early stage.

Introduction: Pre-Eclampsia (PE) is the common multisystem disorder which complicates the pregnancies 3-8% and a major cause of morbidity and mortality throughout the world. Aim: To determine the correlation of placental growth factor with PE in mid trimester of pregnancy at Liaquat University of Medical and Health Sciences Jamshoro. Materials and Methods: This Case-Control study was performed at Pathology Department with Department of Obstetrics and Gynaecology, Liaquat University of Medical and Health Sciences (LUMHS) Jamshoro/Hyderabad, during 12 months, from 6th February, 2017 to 5th February 2018. Pregnant women with mid trimester were enrolled in the study. Group A included females with PE, while Group B were normotensive females of same gestation. Their blood sample were collected and stored at -80°. Level of placental growth factor was measured on Elecsys system. Data was analysed via Statistical Package for the Social Sciences (SPSS) version 20. Results: Total 384 PE females were selected and 50 females without hypertension were studied as control. Mean age of patients was 27.46±3.91 years. No significant variance was seen between mean of gestational age of patients and normal pregnant females; p-value 0.346. Mean of placental growth factor was insignificantly decreased 35.21±31.68 pg/mL among patients in contrast to normal women as 47.23±56.13 pg/mL, p=0.081. A negative correlation was found between blood pressure and placental growth factor, r-values -0.004 and -0.001, respectively. Conclusion: It was concluded that serum placental growth factor was the poor marker for PE, as it showed weak negative correlation with PE.

Background: A virtuous understanding of Electrocardiogram is an indispensable ability and essential skill required in doctors. This study assessed the understanding of the electrocardiogram and acute management of myocardial infarction among emergency doctors, general practitioners, medical officers, house officers and postgraduate students. Methods: A cross sectional survey was conducted for 7 months on n=312 doctors working in tertiary care public and private hospitals and as General practitioners in Karachi, Pakistan. Convenience sampling technique was used. Participants were asked to interpret a 12 lead electrocardiogram attached to questionnaire and write down their findings and diagnoses. They were then asked about its acute management. ANOVA and Chi square was applied for making inferences from the acquired data. p value of less than 0.05 was taken as significant. Approval was taken from the Ethical Review board. Results: Knowledge was assessed on basis of designation, 84.6% of the emergency doctors correctly interpreted the ECG while 75.4% of general physicians read it correctly. House officers and medical officers had the lowest scores in ECG interpretation. Years of experience demonstrated inverse results with >5 years experience at the lowest scores for interpretation of ECG and MI management. Interpretation scores of ECG were significantly high (p value 0.03) in participants who attended workshops compared to those who did not. Conclusion: Emergency doctors had better scores when it comes to ECG interpretation and management of MI. Frequent workshops and cardiology rotations should be mandatory for health care professionals to improve essential skill and knowledge of acute management of myocardial infarction.

Automatic License Plate Detection (ALPD) is an integral component of using computer vision approaches in Intelligent Transportation Systems (ITS). An accurate detection of vehicles’ license plates in images is a critical step that has a substantial impact on any ALPD system’s recognition rate. In this paper, we develop an efficient license plate detecting technique through the intelligent combination of Faster R-CNN along with digital image processing techniques. The proposed algorithm initially detects vehicle(s) in the input image through Faster R-CNN. Later, the located vehicle is analyzed by a robust License Plate Localization Module (LPLM). The LPLM module primarily uses color segmentation and processes the HSV image to detect the license plate in the input image. Moreover, the LPLM module employs morphological filtering and dimension analysis to find the license plate. Detailed trials on challenging PKU datasets demonstrate that the proposed method outperforms few recently developed methods by producing high license plates detection accuracy in much less execution time. The proposed work demonstrates a great feasibility for security and target detection applications.

Super-pixels represent perceptually similar visual feature vectors of the image. Super-pixels are the meaningful group of pixels of the image, bunched together based on the color and proximity of singular pixel. Computation of super-pixels is highly affected in terms of accuracy if the image has high pixel intensities, i.e., a semi-dark image is observed. For computation of super-pixels, a widely used method is SLIC (Simple Linear Iterative Clustering), due to its simplistic approach. The SLIC is considerably faster than other state-of-the-art methods. However, it lacks in functionality to retain the content-aware information of the image due to constrained underlying clustering technique. Moreover, the efficiency of SLIC on semi-dark images is lower than bright images. We extend the functionality of SLIC to several computational distance measures to identify potential substitutes resulting in regular and accurate image segments. We propose a novel SLIC extension, namely, SLIC++ based on hybrid distance measure to retain content-aware information (lacking in SLIC). This makes SLIC++ more efficient than SLIC. The proposed SLIC++ does not only hold efficiency for normal images but also for semi-dark images. The hybrid content-aware distance measure effectively integrates the Euclidean super-pixel calculation features with Geodesic distance calculations to retain the angular movements of the components present in the visual image exclusively targeting semi-dark images. The proposed method is quantitively and qualitatively analyzed using the Berkeley dataset. We not only visually illustrate the benchmarking results, but also report on the associated accuracies against the ground-truth image segments in terms of boundary precision. SLIC++ attains high accuracy and creates content-aware super-pixels even if the images are semi-dark in nature. Our findings show that SLIC++ achieves precision of 39.7%, outperforming the precision of SLIC by a substantial margin of up to 8.1%.

Background: If people dearth something regarding their senses, they mold their brain in accordance with the environs. Researches indicate vision is not always a necessity for the ramification of the brain's cortical organization. Our real endeavor is to channel people if an individual lacks something the brain rewires in a way that the lacking becomes unrecognizable and their other capabilities improve. Methodology: This was a cross-sectional study conducted on 80 subjects of age 15-30 years at Liaquat National School of Physiotherapy. Group A comprised of 40 congenitally blind subjects from Dar-ul-sukun and Ida Rieu School for blind and deaf while group B consisted of 40 sighted subjects. Senses of both groups were assessed by smelling, graphesthesia, two-point discrimination, auditory acuity test, foot tap test and sixth sense test. Collected data was analyzed on SPSS version 20 by applying independent sample t-test. Result: The results showed that the scores of group A outweighed that of group B as all the tests showed a significant mean difference with p-value

Background: Addiction is the behavior of a human in which they depend fully on the substance. According to the World Health Organization (WHO) 2015, over 1.1 billion people smoked tobacco whereas; over 2.14 billion people used social networks. The objective of this study is to assess that is there any similarity between the addiction level of smoking and social network usage. Methodology: This is a Cross-sectional study in which 80 participants were selected on a convenience based sampling of age 18-25 which were divided into group A (social media users) and group B (smokers). Inclusion criteria for Group A were Social network user since 5 years with user I.Ds on more than 2 social network sites and check notifications every minute however group B includes smokers who were smoking since last 5 years (1 packet per day) with no known co-morbid. All participants were asked to fill the questionnaire constructed on the basis of the Bergen Addiction Scale (BAS). Blood pressure measurement and time required to complete the cognitive task was also recorded. Data analysis was done using SPSS version 21. Result: Results showed 30% mild addictors, 30% moderate addictors and 40% severe addictors in group A while 40%, 22.5% and 37.5% in group B, respectively. According to mean withdrawal effects on cognitive skills, 97.6% participants in group A were able to complete task within assigned time before cessation and after cessation only 57% participants were able to do so, while in group B 94% were able to complete task before cessation and only 72% of participants were able to do so after cessation. Lastly, the mean BP reading checked in group A before cessation was 114.54/82.34mmHg and after cessation, it increased to 122.47/90.34mmHg whereas in group B, before cessation the mean BP reading was 118.32/84.88mmHg and after cessation it was 121.42/88.63mmHg. Conclusion: It is concluded that the addiction status of social media users and smokers is almost similar. This leads to the outcome that social network abuse is as harmful as smoking on focus, concentration, cognitive skills and increment of anxiety and BP.

Subsea pipeline corrosion is considered as a severe problem in offshore oil and gas industry. It directly affects the integrity of the pipeline which further leads to cracks and leakages. At present, subsea visual inspection and monitoring is performed by trained human divers; however, offshore infrastructures are moving from shallow to deep waters due to exhaustion of fossil fuels. Therefore, inhospitable underwater environmental conditions for human diver demand imaging-based robotic solution as an alternate for visual inspection and monitoring of subsea pipelines. However, an unfriendly medium is a challenge for underwater imaging-based inspection and monitoring activities due to absorption and scattering of light that further leads to blur, color attenuation, and low contrast. This paper presents a new method for subsea pipeline corrosion estimation by using color information of corroded pipe. As precursor steps, an image restoration and enhancement algorithm are developed for degraded underwater images. The developed algorithm minimizes blurring effects and enhances color and contrast of the images. The enhanced colors in the imaging data help in corrosion estimation process. The image restoration and enhancement algorithm are tested on both experimentally collected as well as publicly available hazy underwater images. A reasonable accuracy is achieved in corrosion estimation that helped to distinguish between corroded and non-corroded surface areas of corroded pipes. The qualitative and quantitative analyses show promising results that encourage to integrate the proposed method into a robotic system that can be used for real-time underwater pipeline corrosion inspection activity.

Objective: The purpose of this study was to explore the efficacy of knee osteoarthritis treatment with Maitland technique over general exercises in aged female patients. Methodology: A Cross sectional experimental study was performed on 80 osteoarthritic female patients of age between 45-60 years which were randomly selected from LNH. They were divided into 2 groups of 40 patients each. Group A received Maitland technique application while Group B received general knee ROM ex’s. All participants have received 24 sessions of Maitland and general exercises. Data has been collected and analyzed on SPSS 20through assessment form used by Physiotherapist via pre-and post-evaluation of Visual Analogue Scale, Muscle Power, Muscle Tone and Range of Motion. Results: The results revealed that Group A having visual analogue scale score =5.4 ±0.9, while Group B having visual analogue scale score=6.25±1.4, the muscle power was 5.0±4.8 in group A, while in group B it was4.05 ±0.58, Geno-Flexion of group A was 129.5±5.2, Geno-Flexion of group B was 121.57±10.9. The results of all tests were significant with the P-value < 0.05 of Group A as compared to B. Discussion: During the OA of knee joint the decrement of a proteoglycan content of cartilage and the disintegration of collagen fibers occurs, which leads to rise in water content so there will be loss of osmotic pressure. The net result will be the degradation of cartilage, as proteoglycan has protective effects on collagen fibers. Conclusion: It was concluded that Maitland technique relieved more effectively the symptoms of knee osteoarthritis in females than general exercises.

Introduction: One of the mainstays of chemotherapy in acute myeloid leukemia (AML) is induction with a goal to achieve morphological complete remission (CR). However, not all patients by this remission criterion achieve long-term remission and a subset relapse. This relapse is explained by the presence of measurable residual disease (MRD).Methods: We accrued 451 consecutive patients of adult AML (from March 2012 to December 2017) after informed consent. All patients received standard chemotherapy. MRD testing was done at post-induction and, if feasible, post-consolidation using 8- and later 10-color FCM. Analysis of MRD was done using a combination of difference from normal and leukemia-associated immunophenotype approaches. Conventional karyotyping and FISH were done as per standard recommendations, and patients were classified into favorable, intermediate, and poor cytogenetic risk groups. The presence of FLT3-ITD, NPM1, and CEBPA mutations was detected by a fragment length analysis-based assay.Results: As compared to Western data, our cohort of patients was younger with a median age of 35 years. There were 62 induction deaths in this cohort (13.7%), and 77 patients (17.1%) were not in morphological remission. The median follow-up was 26.0 months. Poor-risk cytogenetics and the presence of FLT3-ITD were significantly associated with inferior outcome. The presence of post-induction MRD assessment was significantly associated with adverse outcome with respect to OS (p = 0.01) as well as RFS (p = 0.004). Among established genetic subgroups, detection of MRD in intermediate cytogenetic and NPM1 mutated groups was also highly predictive of inferior outcome. On multivariate analysis, immunophenotypic MRD at the end of induction and FLT3-ITD emerged as independent prognostic factors predictive for outcome.Conclusion: This is the first data from a resource-constrained real-world setting demonstrating the utility of AML MRD as well as long-term outcome of AML. Our data is in agreement with other studies that determination of MRD is extremely important in predicting outcome. AML MRD is a very useful guide for guiding post-remission strategies in AML and should be incorporated into routine treatment algorithms.

Background: Most researches on Gastrointestinal (GI) disorders are conducted in secondary health care settings, yet majority patients present at a primary health care level. Functional dyspepsia (Idiopathic or non ulcer dyspepsia) constitutes a tremendous workload in primary care. This study aims to assess the knowledge of general practitioners regarding functional dyspepsia. Methods: Data was collected through a cross sectional study in 2016, targeting 18 towns of Karachi. Multistage sampling technique was employed. A total of n=250 general practitioners were inducted in the study. Data was collected through self administered questionnaire developed from the ROME III guidelines of functional dyspepsia. Descriptive analysis was carried out through SPSS 21. Results: From the total n=250 general practitioners only 17.5% were able to correctly identify the correct definition of functional dyspepsia. Less than 1% knew that ROME III guidelines are being followed for management of functional dyspepsia. The diagnostic criterion for functional dyspepsia was known to only 15% general practitioners. Only two alarm signs were identified by the participants of the study. Conclusion: The average number of patients seen by General Practitioners is high yet their knowledge is weak and practices are not according to the standard guidelines

Biomarkers play an essential role in the management of patients with invasive cancers. Pancreatic ductal adenocarcinoma (PDC) associated with poor prognosis due to advanced presentation and limited therapeutic options. This is further complicated by absence of validated screening and predictive biomarkers for early diagnosis and precision treatments respectively. There is emerging data on biomarkers in pancreatic cancer in past two decades. So far, the CA 19-9 remains the only approved biomarker for diagnosis and response assessment but limited by low sensitivity and specificity. In this article, we aim to review current and future biomarkers that has potential serve as critical tools for early diagnostic, predictive and prognostic indications in pancreatic cancer.

Electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) have temporal and spatial characteristics that may complement each other and, therefore, pose an intriguing approach for brain-computer interaction (BCI). In this work, the relationship between the hemodynamic response and brain oscillation activity was investigated using the concurrent recording of fNIRS and EEG during ankle joint movements. Twenty subjects participated in this experiment. The EEG was recorded using 20 electrodes and hemodynamic responses were recorded using 32 optodes positioned over the motor cortex areas. The event-related desynchronization (ERD) feature was extracted from the EEG signal in the alpha band (8–11) Hz, and the concentration change of the oxy-hemoglobin (oxyHb) was evaluated from the hemodynamics response. During the motor execution of the ankle joint movements, a decrease in the alpha (8–11) Hz amplitude (desynchronization) was found to be correlated with an increase of the oxyHb (r = −0.64061, p < 0.00001) observed on the Cz electrode and the average of the fNIRS channels (ch28, ch25, ch32, ch35) close to the foot area representation. Then, the correlated channels in both modalities were used for ankle joint movement classification. The result demonstrates that the integrated modality based on the correlated channels provides a substantial enhancement in ankle joint classification accuracy of 93.01 ± 5.60% (p < 0.01) compared with single modality. These results highlight the potential of the bimodal fNIR–EEG approach for the development of future BCI for lower limb rehabilitation.

Insomnia is a sleep disorder in which the subject encounters problems in sleeping. The aim of this study is to identify insomnia events from normal or effected person using time frequency analysis of PSD approach applied on EEG signals using channel ROC-LOC. In this research article, attributes and waveform of EEG signals of Human being are examined. The aim of this study is to draw the result in the form of signal spectral analysis of the changes in the domain of different stages of sleep. The analysis and calculation is performed in all stages of sleep of PSD of each EEG segment. Results indicate the possibility of recognizing insomnia events based on delta, theta, alpha and beta segments of EEG signals.

Objective: To assess the knowledge, attitude and practices of mothers regarding risk factors for diarrhea and its management in children under five years of age living in rural districts of Pakistan. Materials and Methods: A cross-sectional study was conducted in two union councils of Dadu and Badin Districts of Sindh in 2014. The sample size from each Union council was n=450. Cluster sampling technique was utilized for selection of households in both of the Union Councils. Personal interviews were conducted from mothers by trained data collectors on pretested questionnaire. Descriptive analysis was done on SPSS version 20. Results: 46% in Badin and 44% under 5 children in Dadu had suffered an attack of acute diarrhea in the last three months. Regarding the signs of dehydration, 36% mothers identified that absence of tears as a principal sign of dehydration in Badin, while 41% in Dadu identified lethargy as the chief sign. Contaminated water and stale food was identified as a cause of diarrhea by most participants in both districts. 48% in Badin and 41% in Dadu identified hand washing the most important method for prevention against diarrhea. When management of diarrhea was taken into account for majority 50% mothers it was through ORS. Conclusion: Knowledge on diarrhea and its treatment and prevention was found to be bleak in our survey among rural residents of Sindh. Results displayed poverty besides illiteracy, improper water and sanitation facilities and unhygienic practices serving as barricades dragging down health indicators similar to other rural parts of the country.

Background: Thromboangiitis obliterans (Buerger′s disease) is a nonatherosclerotic inflammatory disorder primarily involving small and medium sized vessels, mainly arteries of the extremities. As the disease progresses, it could cause gangrene and amputation of limbs, eventually leading to persistent pain and disability. Settings and Design: A prospective, randomized, single-blinded comparative study. Materials and Methods: Fifty patients of Buerger′s disease planned for amputation below the knee were divided randomly into two equal groups of 25 each. Patients of both groups were advised to stop smoking. Lumbar (chemical) sympathectomy was carried out in patients of study group 1 week before amputation. The severity of postamputation stump pain was assessed using visual analog scale (VAS) and requirement of analgesics on weekly basis for 12 weeks. The incidence of phantom limb pain and overall quality of life was also evaluated using Short Form-36 (SF-36) scale. Results: VASs and requirement of analgesics were significantly less in patients who underwent lumbar sympathectomy as compared to patients of control group. The quality of life as reflected by SF-36 score was also significantly better in the study group. However, there was no significant difference in the incidence of phantom limb pain in the two groups. No major complications were reported following lumbar sympathectomy. Conclusions: Lumbar sympathectomy significantly decreases the severity of postamputation stump pain of lower limbs and thus improves the overall quality of life in patients of Buerger′s disease.

Several real-time visual monitoring applications such as surveillance, mental state monitoring, driver drowsiness and patient care, require equipping high-quality cameras with wireless sensors to form visual sensors and this creates an enormous amount of data that has to be managed and transmitted at the sensor node. Moreover, as the sensor nodes are battery-operated, power utilization is one of the key concerns that must be considered. One solution to this issue is to reduce the amount of data that has to be transmitted using specific compression techniques. The conventional compression standards are based on complex encoders (which require high processing power) and simple decoders and thus are not pertinent for battery-operated applications, i.e., VSN (primitive hardware). In contrast, compressive sensing (CS) a distributive source coding mechanism, has transformed the standard coding mechanism and is based on the idea of a simple encoder (i.e., transmitting fewer data-low processing requirements) and a complex decoder and is considered a better option for VSN applications. In this paper, a CS-based joint decoding (JD) framework using frame prediction (using keyframes) and residual reconstruction for single-view video is proposed. The idea is to exploit the redundancies present in the key and non-key frames to produce side information to refine the non-key frames’ quality. The proposed method consists of two main steps: frame prediction and residual reconstruction. The final reconstruction is performed by adding a residual frame with the predicted frame. The proposed scheme was validated on various arrangements. The association among correlated frames and compression performance is also analyzed. Various arrangements of the frames have been studied to select the one that produces better results. The comprehensive experimental analysis proves that the proposed JD method performs notably better than the independent block compressive sensing scheme at different subrates for various video sequences with low, moderate and high motion contents. Also, the proposed scheme outperforms the conventional CS video reconstruction schemes at lower subrates. Further, the proposed scheme was quantized and compared with conventional video codecs (DISCOVER, H-263, H264) at various bitrates to evaluate its efficiency (rate-distortion, encoding, decoding).

Mental stress has been identified as a significant cause of several bodily disorders, such as depression, hypertension, neural and cardiovascular abnormalities. Conventional stress assessment methods are highly subjective and tedious and tend to lack accuracy. Machine-learning (ML)-based computer-aided diagnosis systems can be used to assess the mental state with reasonable accuracy, but they require offline processing and feature extraction, rendering them unsuitable for real-time applications. This paper presents a real-time mental stress assessment approach based on convolutional neural networks (CNNs). The CNN-based approach afforded real-time mental stress assessment with an accuracy as high as 96%, the sensitivity of 95%, and specificity of 97%. The proposed approach is compared with state-of-the-art ML techniques in terms of accuracy, time utilisation, and quality of features.

Objective: To study the phenomena of weight misperception and to assess the intentions of weight management in the adult population of Karachi, Pakistan. Factors which lead to weight loss efforts will also be identified. Methods: A cross-sectional study was conducted with a total of 450 male and female adults aged 20 to 60 years. Data was collected through purposive sampling technique. All participants had their weight and height measured and filled a questionnaire asking about perceived weight status. Data was analyzed using SPSS version 20. Chi square was used to form associations, with P value of less than 0.05 being taken as significant. Results: Based on body mass index (BMI), 13.3% of the participants were underweight, 54.9% were of normal weight, 25.3% were overweight and 6.4% were obese. Misperception was prevalent in 37.8% (40.3% in females versus 33.1% in males) of the subjects. 28% overestimated their weight and 9.3% underestimated their weight. About 46.7% of underweight, 17.6% of overweight and 31.7% of obese participants were not making any efforts about the discrepancy in their weight. 28% were trying to lose and 28.7% were trying to control their weight. The highest rated reason for this weight consciousness was ‘feeling better about myself’. Conclusion: There was more weight misperception in females than males with a tendency of overestimation in females and underestimation in males. More females were trying to lose weight and more males were trying to gain it. A significant number of participants were making efforts that were not in correspondence with their weight status. Satisfaction about self was rated to be more important than health concerns.

Atypical breakpoints and variant APL cases involving alternative chromosomal aberrations are seen in a small subset of acute promyelocytic leukemia (APL) patients. Over 7 different partner genes for RARA have been described. Although rare, these variants prove to be a diagnostic challenge and require combination of advanced cytogenetic and molecular techniques for accurate characterization. Heterogeneity occurs not only at the molecular level but also at clinico-pathological level influencing treatment response and outcome. In this case series we describe the molecular heterogeneity of APL seen in a single tertiary referral centre with a focus on seven variant APL cases from a single tertiary cancer center in India over a period of two and a half years. We discuss five cases with PLZF-RARA fusion and two novel PML-RARA variants, including a Bcr3 variant involving fusion of PML exon4 and RARA exon3 with an additional 40 nucleotides originating from RARA intron2, another involving exon 6 of PML and exon 3 of RARA with addition of 126 nucleotides, which mapped to the central portion of RARA intron 2 To the best of our knowledge this is the first of kind case series from India

An explicit content detection (ECD) system to detect Not Suitable For Work (NSFW) media (i.e., image/ video) content is proposed. The proposed ECD system is based on residual network (i.e., deep learning model) which returns a probability to indicate the explicitness in media content. The value is further compared with a defined threshold to decide whether the content is explicit or nonexplicit. The proposed system not only differentiates between explicit/nonexplicit contents but also indicates the degree of explicitness in any media content, i.e., high, medium, or low. In addition, the system also identifies the media files with tampered extension and label them as suspicious. The experimental result shows that the proposed model provides an accuracy of ~ 95% when tested on our image and video datasets.

Objectives: To assess knowledge and attitude about malaria and dengue, its spread, symptoms and prevention among the population of Dadu and Badin district of Sindh province. Study Design and Methods: A cross sectional baseline survey was conducted in rural areas of Dadu and Badin districts of Sindh in 2014. Cluster sampling technique was utilized for selection of 900 households from two union councils. Personal interviews were conducted by trained data collectors on pretested questionnaire. Data was entered on SPSS version 20. Descriptive analysis was conducted. Results: Only 22.4% in Dadu and 34.4% of Badin residents heard about dengue fever. Merely13% from both districts knew about bleeding in dengue fever. Only 17.9% in Dadu and 25% in Badin opined that malaria occurred post rainfall. Only3.5% in Dadu and 2.9% in Badin had the perception that malaria incurred after floods. In Badin only 3% had ever sprayed inside their homes compared to 7% in Dadu in past one year. In Badin 84% were using mosquito nets as prevention while in Dadu 66%. Only 3.5% in Dadu and 6.2% were covering water buckets as a precautionary measure against mosquitoes. Conclusion: In the present survey, situation is alarming as there are gross deficiencies in knowledge and attitudes pertaining to malaria and dengue while preventive practices are negligible.

Objective: To assess the patterns seen in population visiting tertiary care facilities in Karachi Method: This cross-sectional study was conducted in 2013 an two tertiary care hospitals of Karachi. A totalof 398 participants were enrolled in the study through convenience sampling technique. Hypochondriasis wasassessed using Illness Attitude Scale (IAS) by Kellner. Data was analyzed using SPSS version 20. Differencein mean scores among different groups was taken out through Independent sample t test andANOVA, associations were taken out using chi-square test. P value less than 0.05 was taken as significant. Results: Out of the total participants, 53.8% were suffering from hypochondriasis. When categorized bygender, males were 45.8% and females 62.9% (p value 0.001). When categorized by marital status, it wasfound that 58.6% of married participants were hypochondriac whereas only 37.1% singles were hypochondriac(P value 0.001).Age group between 25-35 years had the maximum number of hypochondriacs (30%). Conclusion: The pattern of distribution of hypochondriasis was found out to be similar with that of otherstudies. Females are predominantly more hypochondriac as compared to males

Purpose: The purpose of this study was to analyse the outcome of salvage surgery in the management of anal canal cancer. Methodology: All patients with a diagnosis of anal canal carcinoma from 2006 to 2015 were studied. Basic demographic data were recorded. Treatment modalities used were recorded for all patients. Long-term surgical outcomes were recorded. Median survival in months was recorded. All data were recorded in the SPSS ver. 20. Results: A total of 62 patients were included in the study. Median age was 51. 38 patients had SCCa on histology and 24 had an adenocarcinoma. 52% of patients had a T4 lesion. Chemoradiotherapy (CRT) was offered to 59 (95%) patients as the first line of therapy. 12 (19%) patients had a complete response. 37 (60%) patients had a partial and 10 (16%) patients had no response to chemoradiation. Salvage surgery was offered to 27 patients. Of these, 21 had a curative resection. Six had irresectable disease and underwent a colostomy only. Median overall survival for all patients was 46 months with a 5-year survival of 55%. Patients with partial response who were offered salvage surgery the 5-year survival were 40%. For patients with no response or progressive disease after chemoradiation therapy, the 5-year survival was 20%. Conclusion: Long-term survival can be achieved in majority of patients who undergo radical salvage surgery after failed CRT for carcinoma of the anal canal. Key words: Adenocarcinoma, anal canal, chemoradiotherapy, surgery

Introduction. Cholecystoduodenal fistulas represent the most common type of bilioenteric fistulas while choledochoduodenal fistulas account for only 1–25% of cases. Bilioenteric fistula cases are associated with cholelithiasis and are rarely associated with duodenal peptic ulcers. Here we present the first case of Bouveret syndrome secondary to choledochoduodenal fistula complicating peptic duodenal ulcer managed successfully via endoscopic mechanical lithotripsy. Case. 86-year-old male with a medical history significant for coronary artery disease and stage 3 colorectal cancer status after resection and chemoradiation presented with intractable sharp abdominal pain worse postprandially for one week in duration, associated with early satiety, anorexia, and 5 lbs weight loss in one week. CT abdomen showed possible choledochoduodenal fistula and a distended stomach. An esophagogastroduodenoscopy (EGD) was performed revealing a large 2.5–3 cm stone lodged in the duodenal bulb at the base of duodenal ulcer with a fistula opening beneath it. The stone was extracted in 2 pieces via mechanical lithotripsy. Endoscopic ultrasound of the CBD revealed Rigler’s triad. Conclusion. Bouveret syndrome is mostly associated with cholecystoduodenal fistula and has high mortality and morbidity due to underlying comorbid conditions and elderly age. Patients are not always fit for surgical management, and endoscopic management is not always successful.

This paper proposes an intrusion detection technique based on DBN (Deep Belief Network) to classify four intrusion classes and one normal class using KDD-99 dataset. The proposed technique is based on two phases: in first phase it removes the class imbalance problem and in the next, it applies DBN followed by FFNN (Feed-Forward Neural Network) to build a prediction model. The obtained results are compared with those given in [9]. The prediction accuracy of our model shows promising results on both intrusion and normal patterns

Devices in a visual sensor network (VSN) are mostly powered by batteries, and in such a network, energy consumption and bandwidth utilization are the most critical issues that need to be taken into consideration. The most suitable solution to such issues is to compress the captured visual data before transmission takes place. Compressive sensing (CS) has emerged as an efficient sampling mechanism for VSN. CS reduces the total amount of data to be processed such that it recreates the signal by using only fewer sampling values than that of the Nyquist rate. However, there are few open issues related to the reconstruction quality and practical implementation of CS. The current studies of CS are more concentrated on hypothetical characteristics with simulated results, rather than on the understanding the potential issues in the practical implementation of CS and its computational validation. In this paper, a low power, low cost, visual sensor platform is developed using an Arduino Due microcontroller board, XBee transmitter, and uCAM-II camera. Block compressive sensing (BCS) is implemented on the developed platform to validate the characteristics of compressive sensing in a real-world scenario. The reconstruction is performed by using the joint multi-phase decoding (JMD) framework. To the best of our knowledge, no such practical implementation using off the shelf components has yet been conducted for CS.

Objective: To study the types and presentation of hand injuries in children. Method and Materials: A prospective study was done at the emergency department of Jinnah Postgraduate Medical Centre from 24th October, 2014 to 30th December, 2014 (a duration of six weeks). The data was collected on 50 out-patient children but we also followed the in-patient to find the outcome of their injuries. A self-designed questionnaire was administered and was filled by the parents of the participants. The questionnaire was explained in a one to one meeting by our volunteers. The volunteers were encouraging and friendly. Results: The most common reason of hand injury in our settings was due to road traffic accidents (34%); followed by the second reason, a fall of an object on the hand. In most of the cases, 68% of the participants involved the right hand whereas in 32% of the participants, the left hand was involved. The most common bone to be fractured in children was the scaphoid with the 1st metacarpal bone. Conclusion: The goal of the study was to find out the various modes of presentation and types of the hand injuries in the accident and emergency department and to emphasize the regions commonly injured during a hand trauma. Better understanding of the type and manner of hand injuries will lead the physicians to emphasize on the areas more commonly injured and take suitable measures for their treatment accordingly. The rising number of hand injuries and knowledge about their pattern encourages the authorities to take suitable action and measures for its prevention and treatment which has been an area of neglect.

Objective: To assess the risk factors for falls in geriatric population of aged 60 and above Method: A cross-sectional study was conducted from September to December 2012 on geriatric population of age 60 and above. A total of 100 participants were selected through consecutive sampling technique. Personal interviews were conducted. Chi-square test was applied as the test of significance for finding association between falls and risk factors. P value less than 0.05 was taken as significant. Results: A total of 100 participants were included in the study, male and female ratio was 2:3. A large portion of participants had a history of fall as 45% said they had also fallen previously while the remaining 55% gave no history of fall. Fractures were the outcome of 51% of the falls that were included into this study. Majorityfractures observed were in the lower limb (59%), Majority of the participants, 51% gave slipping or tripping over some object as the reason of their fall only one third 33% were in the affirmative that physiotherapists can bring a change in their lifestyle. The time of fall as mentioned by the participants was for the majority in the morning as 56% falls occurred before noon. Conclusion: Approximately fifty percent of the falls had resulted in fractures especially of the lower limb. Lifestyle modifications that can help in minimizing the risk of falls should be incorporated in daily life to avert harmful consequences.

Objective: To assess the frequency of Spondylolisthesis among patients of Chronic Low Back Pain in Karachi Method: This cross-sectional study was conducted from April 2012 to December 2012. Patients were selectedfrom four Hospitals consisting of two private and two government tertiary care hospitals. A total of 313 patientsconfirmed through MRI as suffering from low back pain were selected through purposive sampling technique. Data was analyzed using SPSS version 20 and associations were assessed using chi-square test. Results: Out of the total 313 participants, 211 were diagnosed as suffering from Spondylolisthesis. Middle agegroup had significant association with spondylolisthesis. Housewives 57% (21) were found to be associatedwith Grade 3 Spondylolisthesis. Weight had a significant effect on the preponderance of spondylolisthesis as46.9% (99) obese had these findings on their MRI. Duration of pain greater than 1 year had significant associationwith spondylolisthesis, 85.3% (180) participants had these findings on their MRI (P value 0.000). Similarlyradiating pain was found to be more prevalent in spondylolisthesis as 80.6% (170) participants with spondylolisthesis as their finding complained of radiating pain Conclusion: In our survey majority of patients suffering from chronic low back pain had Spondylolisthesis(67.4%). Future studies should focus on measures that specify the risk factors of Spondylolisthesis and targettowards its intervention.

Background: Scrotal ultrasound, though reliable in distinguishing between intratesticular and extratesticular lesions and characterizing them as cystic and solid, cannot distinguish benign from malignant pathology. Although fine needle aspiration cytology (FNAC) has proved to be of great diagnostic importance in testicular lesions, its scope in extratesticular lesions is largely unexplored. Aim: To evaluate extratesticular scrotal lesions cytologically and compare it with their clinical, radiological, and histological findings. Materials and Methods: Sixty five patients with extratesticular scrotal lesions were assessed clinically, radiologically, and cytologically. Histopathology was done in 45 cases where surgical exploration was undertaken. All the data were then analyzed and correlated. Results : Extratesticular lesions accounted for 72.2% of the scrotal swellings. Of these, the epididymis is most commonly involved (61.5% cases) with the commonest type of lesion being cystic (49.3% cases). Ultrasonography preferably with color doppler is highly useful for the evaluation of the scrotum. Apart from distinguishing extratesticular from testicular and cystic from solid lesions, it has an important role in identifying individual lesions, thus reducing the list of differential diagnosis. Fine needle aspiration cytology contributed to a definitive diagnosis in 47.7% cases. It helps classify cystic masses on the basis of their contents and defines the etiology of chronic inflammatory lesions, apart from corroborating with the clinico-radiological diagnosis. Histological evaluation was possible only in cases where surgery was performed and helps further define the diagnosis. Conclusion : Fine needle aspiration cytology is essentially non-traumatic and easy to carry out and should be a technique of choice for the study of scrotal pathology, main advantage being avoidance of delays in diagnosis.

The timing of introduction of solid food on the subsequent development of food allergy is under debate and the role of concurrent breastfeeding is unclear. The aim of the present study was to investigate the role of solid food introduction whilst concurrently breastfeeding on food allergy outcome, with a specific focus on cows’ milk allergy. Prospectively collected infant feeding data from a birth cohort were analysed. Participants with histories suggestive of food allergy underwent diagnostic food challenges. Children with food allergy were matched to control participants for age and sex. Mann–Whitney U tests, χ2, Fisher exact tests and logistic regression calculations were undertaken. A total of thirty-nine food-allergic children and seventy-eight matched controls were identified, including twenty-two cows’ milk-allergic children and forty-four matched controls. The control group introduced solid food earlier than the food-allergic group (P

ABSTRACT: OBJECTIVES: To know causes of obstructive jaundice. To see co-relation of USG and ERCP findings. SETTINGS AND DURATION: This descriptive study was conducted at radiology department of Madinah Teaching Hospital and stGastroentrotology department of Madinah Teaching Hospital, Faisalabad from 1 November 2014 in patients coming from peripheral areas of Faisalabad. STUDY DESIGN: Descriptive study. PROJECT SUMMARY (200-250WORDS) OBJECTIVES: To determine the findings in ultrasound and ERCP in patients of obstructive jaundice. Obstructive jaundice (means when serum bilirubin level in greater than 50µmol/dL (3mg/dL). METHODOLOGY: Descriptive study was performed in Madinah Teaching Hospital to diagnose causes of obstructive jaundice. The study was performed by USG and ERCP in 55 patients having sign and symptoms of obstructive jaundice. RESULTS: Study shows that most of the patients having obstructive jaundice have mainly benign CBD causes and only 3 patients have malignant CBD causes. One patient has CA head of pancreas. Among these study cases 30 out of 55 have prolonged history of Cholelithiasis for 5-7years. 52/55 patients have same findings on USG and ERCP. So results are true positive in 52/55 patients.

Rheumatoid arthritis is a chronic inflammatory disease primarily manifesting with symptoms of joint pain. It also involves multiple organ systems in the body, including the lungs. Interstitial lung disease (ILD) is the most common form of pulmonary involvement in rheumatoid arthritis (RA). Without the typical symptoms such as chronic joint pain, establishing the diagnosis of RA could be quite challenging and a high index of suspicion is thereby required to diagnose ILD in patients with RA, thereby delaying treatment and increasing morbidity and mortality. We report a case of a 67-year-old Hispanic male with no previous history of rheumatoid arthritis or symptoms of typical joint pain who comes to the hospital only with the chief complaints of progressive worsening of shortness of breath for a duration of 6 months and was eventually diagnosed with ILD of the usual interstitial pneumonia variant with serologies positive for rheumatoid arthritis.

Neonatal mortality associated with preterm birth can be reduced with antenatal corticosteroids (ACS), yet 36.0 weeks GA. In phase 1, UH measurements were collected prospectively in the Democratic Republic of Congo, India and Pakistan, using distinct tapes to address variation across regions and ethnicities. In phase 2, we tested accuracy in 250 pregnant women with known GA from early ultrasound enrolled at prenatal clinics in Argentina, India, Pakistan and Zambia. Providers masked to the ultrasound GA measured UH. Receiver operating characteristics (ROC) analysis was conducted.1,029 pregnant women were enrolled. In all countries the tapes were most effective identifying pregnancies between 20.0-35.6 weeks, compared to the other GAs. The ROC areas under the curves and 95% confidence intervals were: Argentina 0.69 (0.63, 0.74); Zambia 0.72 (0.66, 0.78), India 0.84 (0.80, 0.89), and Pakistan 0.83 (0.78, 0.87). The sensitivity and specificity (and 95% confidence intervals) for identifying pregnancies between 20.0-35.6 weeks, respectively, were: Argentina 87% (82%-92%) and 51% (42%-61%); Zambia 91% (86%-95%) and 50% (40%-60%); India 78% (71%-85%) and 89% (83%-94%); Pakistan 63% (55%-70%) and 94% (89%-99%).We observed moderate-good accuracy identifying pregnancies ≤ 35.6 weeks gestation, with potential usefulness at the community level in low-middle income countries to facilitate the preterm identification and interventions to reduce preterm neonatal mortality. Further research is needed to validate these findings on a population basis.

In tolerance towards metal uptake, there is a need to evaluate the performance of vetiver grass for metal removal to reduce water impurity. This study was aimed to evaluate contaminant removal by vetiver grass at varying root length and plant density and determine the metal uptake in vetiver plant biomass. Pollutant uptake of vetiver grass was conducted in laboratory experiment and heavy metal analysis was done using acid digestion and Atomic Absorption Spectrometry. Findings indicated that the removal of heavy metal was decreased in seven days of the experiment where iron shows the highest percentage (96%; 0.42 ppm) of removal due to iron is highly required for growth of vetiver grass. Removal rate of heavy metals in water by vetiver grass is ranked in the order of Fe>Zn>Pb>Mn>Cu. Results also demonstrated greater removal of heavy metals (Cu, Fe, Mn, Pb, Zn) at greater root length and higher density of vetiver grass because it increased the surface area for metal absorption by plant root into vetiver plant from contaminated water. However, findings indicated that accumulation of heavy metals in plant biomass was higher in vetiver shoot than in root due to metal translocation from root to the shoot. Therefore, the findings have shown effective performance of vetiver grass for metal removal in the phytoremediation of contaminated water.

Radial basis function neural networks are used in a variety of applications such as pattern recognition, nonlinear identification, control and time series prediction. In this paper, the learning algorithm of radial basis function neural networks is analyzed in a feedback structure. The robustness of the learning algorithm is discussed in the presence of uncertainties that might be due to noisy perturbations at the input or to modeling mismatch. An intelligent adaptation rule is developed for the learning rate of RBFNN which gives faster convergence via an estimate of error energy while giving guarantee to the l2 stability governed by the upper bounding via small gain theorem. Simulation results are presented to support our theoretical development.