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BackgroundWe aimed to identify factors associated with a significant reduction in SLE disease activity over 12 months assessed by the BILAG Index.MethodsIn an international SLE cohort, we studied patients from their 'inception enrolment' visit. We also defined an 'active disease' cohort of patients who had active disease similar to that needed for enrolment into clinical trials. Outcomes at 12 months were; Major Clinical Response (MCR: reduction to classic BILAG C in all domains, steroid dose of ≤7.5 mg and SLEDAI ≤ 4) and 'Improvement' (reduction to ≤1B score in previously active organs; no new BILAG A/B; stable or reduced steroid dose; no increase in SLEDAI). Univariate and multivariate logistic regression with Least Absolute Shrinkage and Selection Operator (LASSO) and cross-validation in randomly split samples were used to build prediction models.Results'Inception enrolment' (n = 1492) and 'active disease' (n = 924) patients were studied. Models for MCR performed well (ROC AUC = .777 and .732 in the inception enrolment and active disease cohorts, respectively). Models for Improvement performed poorly (ROC AUC = .574 in the active disease cohort). MCR in both cohorts was associated with anti-malarial use and inversely associated with active disease at baseline (BILAG or SLEDAI) scores, BILAG haematological A/B scores, higher steroid dose and immunosuppressive use.ConclusionBaseline predictors of response in SLE can help identify patients in clinic who are less likely to respond to standard therapy. They are also important as stratification factors when designing clinical trials in order to better standardize overall usual care response rates.

ABSTRACT Previous studies exploring the relationship between dietary potassium and magnesium intake and the risk of type 2 diabetes mellitus (T2DM) have yielded inconsistent results. Objective The present study was designed to compare the effect of magnesium, potassium and both (potassium and magnesium combined) on cholesterol levels and quality of life (QoL) among patients with T2DM. Methods A randomised controlled trial (single blinded) was conducted at The University of Lahore and Lahore Medical Research Center (LMRC). The sample size was 290 patients with T2DM, who were divided into four groups: Group I (T1) that received control/placebo; Group II (T2) and Group III (T3) received magnesium and potassium supplements, respectively; and Group IV (T4) received both magnesium and potassium supplements. Blood samples were taken from all patients before and after 60 days of supplementation to determine the levels of K+, Mg2+ and cholesterol using a chemistry analyzer (photometer 5010 v5+). Results There was a decrease in mean cholesterol levels in all groups after the treatment, with the largest reduction (224.9 ± 61.92 to 163.4 ± 48.38) seen in the T3 group, that received potassium supplements. A significant increase in the social QoL, indicated by a p value change from 0.06 before medical intervention to 0.000 after medical intervention, was observed. p value was significant (

BackgroundThe high prevalence of Type 2 diabetes mellitus(T2DM) in Pakistan is a challenge to the existing healthcare system. This is the first comprehensive review of the status of glycemic control, diabetes knowledge, treatment adherence, complications and financial burden faced by the diabetic patient population of the country.MethodsWe searched PubMed, Web of Science and Scopus for studies on diabetes control, knowledge, treatment adherence, prevalence of complications and cost in Pakistan published in English from 2000 to 2024. We hand-searched Google Scholar for additional papers and included a total of 45 studies in our review.ResultsThe review shows that poor glycemic control prevails among diabetic patients ranging from 44.7% to 86.4% along with half of the patients have poor diabetes knowledge (46.0% -70.0%). Treatment adherence level in diabetic patients varies widely in different studies, frequently reported complications are retinopathy (14.5%-43.0%), nephropathy (14.0%-31.0%) and neuropathy (10.8%-59.6%); and the disease poses a great deal of economic burden.ConclusionMost of the studies were observational. Glycemic control and knowledge among individuals with T2DM in Pakistan are inadequate, leading to a high prevalence of complications that impose significant health and economic burdens. Further longitudinal studies generating evidence of lifestyle modifications as primary and secondary prevention strategies against diabetes in the Pakistani population can form a strong foundation for awareness campaigns and policy revisions.

BackgroundAcquired spontaneous intestinal perforation or SIP occurs most commonly in the extremely premature infant population. As the incidence is rising, understanding modifiable factors such as common medication exposures becomes important for individualizing care.MethodsThe primary outcome was SIP in premature infants with exposure to indomethacin, ibuprofen, or acetaminophen. The systematic review and meta-analysis were conducted following the Cochrane methodology and PRISMA guidelines.ResultsThe point estimates of three RCTs showed an increase in the risk of SIP with indomethacin exposure compared to no medication, the pooled estimate was not statistically significant. There is no statistically significant association between the risk of SIP for indomethacin with treatment use over prophylactic use and when holding feeds. Ibuprofen conferred less risk than indomethacin, and its route of administration did not alter the risk profile. There was not enough evidence to draw conclusions about the risk of SIP and acetaminophen exposure.ConclusionIn studies of infants exposed to either indomethacin or ibuprofen in the last 40 years, the incidence of SIP is still commonly within 2–8%. Moving forward modifiable factors such as medication exposure will help guide care to minimize risk where possible.Systematic Review Registrationhttps://www.crd.york.ac.uk/, PROSPERO (CRD42017058603).

IntroductionIndividuals with neurological conditions (e.g., stroke, spinal cord injury, multiple sclerosis) may experience challenges to their mobility. While the individual needs for persons with neurological conditions may vary, thus making intervention development more difficult, identifying key personalization or tailoring variables may help to customize interventions. However, the process to personalize treatments has not been well described. It is also unclear how adaptive intervention design includes the perspective of those with lived experience. Co-design methods may be a way to be transparent about intervention development to meet the needs of persons with mobility impairments while ensuring the resulting intervention is relevant and applicable to those who will be participating. The purpose of the present article is to describe a co-design process to facilitate the development of personalized mobility programming for persons with mobility impairments.MethodsDevelopment of a set of personalized mobility programming for individuals with mobility impairments was conducted following an adaptive intervention design approach with a co-design component. A series of working groups and individual sessions with key interest groups (e.g., persons with lived experience, fitness instructors, front-line clinicians, students) were conducted in order to develop the personalized mobility programming based on the needs and preferences described during various working groups.ResultsTwo sets of working groups and three individual one-to-one sessions were conducted with a total of 14 participants (n = 6 persons with lived experience, n = 4 research team members, n = 2 physiotherapists, n = 2 occupational therapists, n = 1 registered kinesiologist). From the information gathered during the working groups a set of four personalized mobility programs were developed: (1) cognitive cardio class, (2) functional strength class, (3) mobility circuit group, and (4) an open gym. Participants also discussed the onboarding process, how to effectively track participant goals throughout the programming and personalization variables.DiscussionThe current paper provides a guideline for future work that aims to develop programming that is personalized to the needs of the persons with mobility impairments due to various neurological conditions. The strengths of this approach include the collaborative nature of the program development, while the main limitations were logistical in nature (e.g., scheduling, engaging all working group members).

Background Bolus thermodilution and intravenous adenosine are established methods for coronary microcirculatory assessment. Yet, its adoption remains low, partly due to procedural time and patient discomfort associated with intravenous adenosine. We investigated differences between intracoronary and intravenous adenosine using bolus thermodilution in terms of microcirculatory indices, procedural time, and side effects associated with adenosine in patients with myocardial ischemia and nonobstructive coronary arteries. Methods and Results In this prospective, observational study, 102 patients with suspected myocardial ischemia and nonobstructive coronary arteries underwent measurements of mean transit time, coronary flow reserve, index of microcirculatory resistance, procedure time and patient tolerability with low‐dose intracoronary adenosine, high‐dose intracoronary adenosine (HDIC), and intravenous adenosine. HDIC induced greater hyperemia compared with low‐dose intracoronary IC adenosine and intravenous adenosine with a shorter hyperemic mean transit time, P

BackgroundDiabetic retinopathy (DR) is a leading cause of blindness globally. The gold standard for DR screening is stereoscopic colour fundus photography with tabletop cameras. VistaView is a novel smartphone-based retinal camera which offers mydriatic retinal imaging. This study compares the diagnostic accuracy of the smartphone-based VistaView camera compared to a traditional desk mounted fundus camera (Triton Topcon). We also compare the agreement between graders for DR screening between VistaView images and Topcon images.MethodologyThis prospective study took place between December 2021 and June 2022 in Pakistan. Consecutive diabetic patients were imaged following mydriasis using both VistaView and Topcon cameras at the same sitting. All images were graded independently by two graders based on the International Classification of Diabetic Retinopathy (ICDR) criteria. Individual grades were assigned for severity of DR and maculopathy in each image. Diagnostic accuracy was calculated using the Topcon camera as the gold standard. Agreement between graders for each device was calculated as intraclass correlation coefficient (ICC) (95% CI) and Cohen's weighted kappa (k).Principal findingsA total of 1428 images were available from 371 patients with both cameras. After excluding ungradable images, a total of 1231 images were graded. The sensitivity of VistaView for any DR was 69.9% (95% CI 62.2-76.6%) while the specificity was 92.9% (95% CI 89.9-95.1%), and PPV and NPV were 80.5% (95% CI 73-86.4%) and 88.1% (95% CI 84.5-90.9) respectively. The sensitivity of VistaView for RDR was 69.7% (95% CI 61.7-76.8%) while the specificity was 94.2% (95% CI 91.3-96.1%), and PPV and NPV were 81.5% (95% CI 73.6-87.6%) and 89.4% (95% CI 86-92%) respectively. The sensitivity for detecting maculopathy in VistaView was 71.2% (95% CI 62.8-78.4%), while the specificity was 86.4% (82.6-89.4%). The PPV and NPV of detecting maculopathy were 63% (95% CI 54.9-70.5%) and 90.1% (95% CI 86.8-92.9%) respectively. For VistaView, the ICC of DR grades was 78% (95% CI, 75-82%) between the two graders and that of maculopathy grades was 66% (95% CI, 59-71%). The Cohen's kappa for retinopathy grades of VistaView images was 0.61 (95% CI, 0.55-0.67, pConclusionThe VistaView offers moderate diagnostic accuracy for DR screening and may be used as a screening tool in LMIC.

In the majority of sample surveys, the variable of interest might have sensitive characteristics. Since we frequently get unrealistic responses from respondents during interviews as employing the direct method is not seen logical in these situations. To tackle this difficulty, the randomized response technique is good substitute for the direct method. The respondent is reassured that there would not be any issues will your response when using the randomized response technique as it protects privacy and secrets. In this paper, we propose a novel quantitative three-stage randomized response technique. Using simulation with R software, we prove that the results obtained from the proposed method are ideal. We suggest ratio and product type estimators by using the auxiliary information to enhance the efficiency of estimators. It is demonstrated that these estimators are superior for the conventional ones in special situations and in applied task, the use of auxiliary variable improves the estimation of the average cheating of Shahid Chamran university of Ahvaz students. The main objective is to increase the average sensitive reaction by utilizing the auxiliary variable.

This study investigates the genomic features and probiotic potential of Lactiplantibacillus plantarum HMX2, isolated from Chinese Sauerkraut, using whole-genome sequencing (WGS) and bioinformatics for the first time. This study also aims to find genetic diversity, antibiotic resistance genes, and functional capabilities to help us better understand its food safety applications and potential as a probiotic. L. plantarum HMX2 was cultured, and DNA was extracted for WGS. Genomic analysis comprised average nucleotide identity (ANI) prediction, genome annotation, pangenome, and synteny analysis. Bioinformatics techniques were used to identify CoDing Sequences (CDSs), transfer RNA (tRNA) and ribosomal RNA (rRNA) genes, and antibiotic resistance genes, as well as to conduct phylogenetic analysis to establish genetic diversity and evolution. The study found a significant genetic similarity (99.17% ANI) between L. plantarum HMX2 and the reference strain. Genome annotation revealed 3,242 coding sequences, 65 tRNA genes, and 16 rRNA genes. Significant genetic variety was found, including 25 antibiotic resistance genes. A phylogenetic study placed L. plantarum HMX2 among closely related bacteria, emphasizing its potential for probiotic and food safety applications. The genomic investigation of L. plantarum showed essential genes, including plnJK and plnEF, which contribute to antibacterial action against foodborne pathogens. Furthermore, genes such as MurA, Alr, and MprF improve food safety and probiotic potential by promoting bacterial survival under stress conditions in food and the gastrointestinal tract. This study introduces the new genomic features of L. plantarum HMX2 about specific genetics and its possibility of relevant uses in food security and technologies. These findings of specific genes involved in antimicrobial activity provide fresh possibilities for exploiting this strain in forming probiotic preparations and food preservation methods. The future research should focus on the experimental validation of antibiotic resistance genes, comparative genomics to investigate functional diversity, and the development of novel antimicrobial therapies that take advantage of L. plantarum's capabilities.

Background: Globally, there is significant variation in the out-of-hospital cardiac arrest (OHCA) survival rate. Early links in the chain of survival, including bystander cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator at the scene, are known to be of crucial importance, with strong evidence of increased survival rate with good neurological outcomes. The data from the Middle East are limited and report variable rates of bystander CPR and survival. It is crucial to get prospective, reliable data on bystander response in these regions to help plan interventions to improve bystander response and outcomes. ObjectiveThis international collaborative study aims to describe the characteristics, including bystander interventions and outcomes, of OHCAs brought to hospitals enrolled in the study from Abu Dhabi, United Arab Emirates; Doha, Qatar; and Muscat, Oman. It also aims to describe the strength of the association between bystander response and OHCA outcomes, including the return of spontaneous circulation, survival to hospital admission, survival to discharge, and good neurological outcome at discharge in the local context of low bystander CPR rates. MethodsThis multicenter, prospective, noninterventional observational study (Bro. Study) will be conducted at the emergency departments of 4 participating tertiary care hospitals in 3 countries. The data will be collected prospectively according to the Utstein style (a set of internationally accepted guidelines for uniform reporting of cardiac arrests) on demographic variables (age, sex, nationality, country, participating center, and comorbidities), peri–cardiac arrest variables (location, witnessed or not, bystander CPR, use of automated external defibrillator, time of emergency medical services arrival, initial rhythm, number of shocks, and time of prehospital CPR), and outcome variables (return of spontaneous circulation, survival to discharge, and neurological outcome at discharge and 3 months). Univariate and multivariate analysis with logistic regression models will be used to measure the strength of the association of bystander interventions with outcomes using SPSS (version 22). ResultsData collection began in November 2023 and will continue for 2 years, with publication expected by early 2026. ConclusionsBystander response to an OHCA is critical to a favorable outcome. The reliable, baseline bystander CPR data will be a cornerstone in the team’s next planned projects, which are to qualitatively identify the barriers to bystander CPR, conduct a scoping review of community interventions in the Gulf and other Asian countries, and design and implement strategies to help improve the bystander CPR rate in the community. International Registered Report Identifier (IRRID)DERR1-10.2196/58780

BackgroundDevelopment of anti-drug antibodies (ADAs) and neutralizing antibodies (NAbs) to monoclonal antibodies may adversely impact pharmacokinetics, efficacy, and/or safety.ObjectiveTo describe incidence, titer, and persistence of dupilumab ADAs and NAbs, and their effects on pharmacokinetics, efficacy, and safety in patients with atopic dermatitis (AD).MethodsThis analysis included seven phase 3 randomized, placebo-controlled (N=2,992) and two long-term open-label extension (N=2,287) trials of subcutaneous dupilumab in adults and pediatric patients with moderate-to-severe AD. ADA, NAb, and dupilumab concentration in serum were assessed using validated immunoassays. ADA impacts on efficacy (EASI) and safety were assessed.ResultsTreatment-emergent ADAs were observed in up to 8.6% (aged ≥18 years), 16.0% (12-17 years), 5.3% (6-11 years), and 2.0% (6 months to 5 years) dupilumab-treated patients. Among dupilumab-treated patients, ≤3.7% had persistent responses,

Objective: To compare the effectiveness of Transversus Abdominis Plane (TAP) block vs Local Infiltration for pain management techniques in patients undergoing laparoscopic lower abdominal surgeries. Methodology: This cross-sectional study was conducted at the Department of Surgery, Lahore General Hospital, from March to May, 2024. It involved a total of 110 patients, divided into two groups of 55 each, between the ages of 20 to 60 years, diagnosed with indirect inguinal hernia by ultrasound. Chronic smokers, drug addicts, intravenous drug abusers, patients with a history of previous surgeries, with known drug allergies and with complicated hernia were excluded from this cross-sectional study. The Numerical Rating Scale (NRS) was used to see the pain variation and effectiveness of both techniques at 6, 12, 18 and 24 hours. Results: The mean age in the TAP Block Group was 32.0 ± 9.92 years, and the mean age in the Local Wound Infiltration Group was 34.21 ± 10.01 years. There were 108 (98.18%) male and 2(1.81%) female cases with a higher male-to-female ratio. The results indicated that the TAP Block group consistently required fewer rescue analgesic doses than the local wound Infiltration group at all postoperative time points. At 6 hours, 23.63% of patients in the TAP Block group needed additional analgesia, compared to 38.18% in the Wound Infiltration group, though this difference was not statistically significant. However, at 12, 18, and 24 hours, the TAP Block group showed a significantly lower need for rescue analgesia, with p-values of 0.002, and 0.008, respectively. Conclusion: In managing postoperative pain of Inguinal Hernia Repair, TAP Block is superior to Wound Infiltration of local anesthetic agent. After TAP Block NRS remains fewer and a smaller number of rescue doses are needed as compared to Wound infiltration.

Background: Ascites is common in advanced gastrointestinal cancers with peritoneal metastases (PM) and negatively impacts patient survival. No study to date has specifically evaluated the relationship between ascites, PM and survival outcomes in metastatic colorectal cancer (mCRC) and metastatic gastric cancer (mGC). Objectives: This study aims to investigate and elucidate the relationship between malignant ascites, PM and survival outcomes in both mCRC and mGC patients. Design: This is a retrospective analysis of prospectively collected clinical trial data of mCRC and mGC patients with PM. Methods: We performed two pooled analyses, firstly of two Italian randomized trials enrolling patients with mCRC eligible for systemic therapy (TRIBE2; VALENTINO), and secondly of gastric cancer and peritoneal metastasis (GCPM) patients who underwent bi-directional therapeutic treatment comprising systemic and peritoneal-directed therapies. Results: Of 900 mCRC patients, 39 (4.3%) had PM with malignant ascites. Compared to the group without PM, median progression-free and overall survival were significantly inferior in the ascites group (hazard ratio (HR) for progression-free survival (PFS) 1.68, 95% confidence interval (CI): 1.21–2.35, p = 0.007; HR for overall survival (OS) 2.14, 95% CI: 1.57–3.01, p

Thermal performance of building materials is often improved by introducing air voids through foaming. However, this typically results in a reduction in compressive strength. To address this issue, an experimental study was conducted to develop thermally efficient geopolymer blocks using three grades of crumb rubber (CR), without compromising compressive strength. Tests such as compressive strength, tensile strength, thermal conductivity, water absorption, and porosity were carried out to assess the performance of these blocks in comparison to conventional geopolymer blocks. The CR-incorporated geopolymer blocks demonstrated low thermal conductivity, ranging from 0.63 to 0.43 W/mK, along with a reduced environmental impact and carbon footprint. Importantly, they exhibited high compressive strength, ranging from 25 to 52 MPa, which exceeds the required strength for first-class bricks (12 MPa). A computational conjugate heat transfer analysis was also carried out to evaluate the strength of heat transferred through the solid media to the internal fluid media. It contributes to the advancement of environmentally conscious building materials, emphasizing the potential benefits of crumb rubber-incorporated geopolymer composites as a novel material for building construction purpose.

Summary: Background: Coronary angioplasty and stent insertion is a first line treatment for patients with coronary artery disease, however it is complicated in the long-term by in-stent restenosis (ISR) in a proportion of patients with an associated morbidity. Despite this, currently there are no effective treatments available for the prevention of ISR. Repeat percutaneous revascularisation carries increased risks of major adverse cardiovascular events and a higher incidence of stent failure. In this study we report the efficacy of dietary inorganic nitrate in the prevention of ISR in a prospective, double-blind, randomised controlled trial. Methods: NITRATE-OCT is a double-blind, randomised, single-centre, placebo-controlled phase II trial. 300 patients who were planned to undergo percutaneous coronary intervention (PCI) and drug eluting stent (DES) implantation for stable angina were randomised on a 1:1 basis to receive a daily dose of either dietary inorganic nitrate or placebo for 6 months. Block randomisation was used and patients stratified according to diabetes status. The patients then underwent quantitative coronary angiography (QCA) at baseline and at 6 months and optical coherence tomography at 6 months to quantify ISR. The primary endpoint was the QCA quantified decrease of in-stent/in-segment diameter from the baseline measure at 6 months i.e., in-stent and in-segment late-lumen loss (LLL). The study is registered with ClinicalTrials.gov, number NCT02529189. Findings: From November 1st 2015 and March 31st 2020, NITRATE-OCT enrolled 300 patients with angina, with 150 each randomised to receive 70 mL of nitrate-containing beetroot juice or placebo (nitrate-deplete) juice for 6 months. Procedural characteristics were similar between the groups. The primary endpoint was available in 208 patients: 107 and 101 in the nitrate and placebo groups, respectively. There was a statistically significant effect of inorganic nitrate on both primary endpoints: in-stent LLL decreased by 0.16 mm (95% CI:0.06–0.25; P = 0.001) with mean = 0.09 ± 0.38 mm in the inorganic nitrate group versus 0.24 ± 0.33 mm in the placebo group; (P = 0.0052); and in-segment LLL decreased by 0.24 mm (95% CI:0.12–0.36; P

An eco-friendly synthetic route was developed for the formation of nickel oxide (NiOaq and NiOet) nanoparticles (NPs) by treating Ni(NO3)2.6H2O with aqueous/ethanolic extracts of Elettaria cardamomum leaves; the same reaction was performed in the presence of graphene oxide (GO) to produce NiOaq@GO and NiOet@GO nanocomposites (NCs), respectively. The NMs were characterized by XRD, FT-IR, SEM, EDX, UV–visible spectroscopy, and TGA-DSC analysis. They were also subjected to electrochemical investigations and photocatalytic degradation of crystal violet (CV) dye. XRD analysis revealed the average crystallite sizes of 8.84–14.07 nm with a face-centered cubic form of NiO NPs and a hexagonal structure of their nanocomposites with GO. FT-IR spectroscopy confirmed the presence of Ni-O vibrations at 443-436 cm−1. SEM images confirmed the spherical morphology of NiO NPs while NiOaq@GO NCs contained randomly aggregated, thin, and wrinkled graphene sheets. NiOaq and NiOet have shown particle sizes of 27.7–30.63 nm which were decreased to 19.33–26.39 nm in their respective NiOaq@GO and NiOet@GO NCs. EDX spectra verified the homogeneous distribution of elements (Ni, O, C) on the surface of the particles. The synthesized NCs have shown smaller band gaps (NiOaq@GO = 3.74 eV; NiOet@GO = 3.34 eV) as compared to their respective NPs (NiOaq = 5.0 eV; NiOet = 3.89 eV). TGA/DSC data was used to find the thermal stabilities, glass transition temperatures, and enthalpies. Cyclic voltammetry measurements exhibited distinct oxidation and reduction peaks. NCs exhibited better potential as electrode materials for supercapacitor applications as compared to their respective NPs. NiOet@GO exhibited the best electrochemical performance and photocatalytic degradation efficiency of CV dye. After 120 min exposure to sunlight, the degradation coefficient of CV was observed to be 82.93, 86.34, 89.99, 90.27 and 81.65 % in the presence of NiOaq, NiOet, NiOaq@GO, NiOet@GO and GO, respectively.

Background: COPD and Asthma are a burden to our society and in a city like Jamshoro having industries and power plants in close vicinity, this becomes a greater concern. The objective of this cross-sectional study was to evaluate the relationship between air quality indices (AQIs) and exacerbations in chronic obstructive respiratory diseases such as asthma and COPD, prevalent among the general population in Jamshoro. Methods: This cross-sectional study, conducted from August 2023 to February 2024 at LUMHS, Jamshoro (ERC approval: 14287/23/081), used purposive sampling to recruit 300 adults with asthma or COPD. Air quality data (PM10, PM2.5, NO2, SO2) were collected, and respiratory outcomes were measured via spirometry and a validated questionnaire. Pearson’s correlation and multiple regression analyzed the association between air quality and exacerbations. Ethical approval and informed consent were obtained. Results: There was a significant inverse relationship between PM10, NO2, and FEV1 (r = -0.45, p < 0.01; r = -0.40, p < 0.01). Chi-square analysis indicated a strong association between AQI categories and exacerbation rates (χ² = 25.6, df = 3, p < 0.001). Multiple regression showed that PM10 and NO2 were significant independent predictors of respiratory exacerbation (β = 0.049, p < 0.01; β = 0.038, p < 0.01). Conclusion: The study underscores the adverse respiratory health consequences of poor air quality in Jamshoro and recommends the implementation of effective air quality management policies.

Objectives. Antimicrobial resistance (AMR) poses a significant threat to global public health, with substantial mortality rates attributed to AMR-related infections. Pediatric populations face heightened vulnerability due to prevalent antimicrobial misuse. This study aimed at addressing the significant threat of antimicrobial resistance (AMR) and its associated mortality rates. Methods . This retrospective cross-sectional multicentric study investigated antibiotic prescribing patterns in pediatric wards of 4 secondary care hospitals affiliated with Aga Khan University Hospital. The study utilized the WHO Access, Watch, and Reserve (AWaRe) classification framework. Data from 6934 encounters were analyzed. Results . Antibiotics were prescribed in 78.1% of encounters, with intravenous administration being predominant (98.6%). Ceftriaxone was the most prescribed antibiotic agent (45.8%), and third-generation cephalosporins constituted the most prevalent antibiotic class (54.4%). Pneumonia exhibited the highest prescription rate (99.9%), with Watch group antibiotics being predominantly prescribed (>80%) across hospitals. Conclusion . These findings underscore the urgency for targeted interventions to optimize prescribing practices and mitigate resistance.

Peatlands are vital in the global carbon cycle, acting as significant sinks for carbon and releasing methane (CH4) and carbon dioxide (CO2) into the atmosphere. However, the complex interactions between environmental factors and the microbial communities responsible for these greenhouse gas emissions remain insufficiently understood. To address this knowledge gap, a pilot-scale mesocosm study was conducted to assess the impact of different terminal electron acceptors (TEAs), including sulfate (SO42−), humic acid (HA), and goethite, on CH4 and CO2 emissions and microbial community structures in peatlands. Our results revealed that the addition of TEAs significantly altered the CH4 and CO2 emissions. Specifically, the addition of SO42− nearly doubled CO2 production while substantially inhibiting CH4 emissions. The combined addition of SO42− and HA, as well as HA alone, followed a similar pattern, albeit with less pronounced effects on CH4. Goethite addition resulted in the highest inhibition of CH4 among all treatments but did not significantly increase CO2 production. Community composition and network analysis indicated that TEAs primarily determined the structure of microbial communities, with each treatment exhibiting distinct taxa networks. Proteobacteria, Acidobacteria, Chloroflexi, and Bacteroidetes were the most abundant phyla across all mesocosms. The presence of methanotrophs, including Methylomirabilales and Methylococcales, was linked to the inhibition of CH4 emissions in these mesocosms. This study provides novel insights into the spatial variability of microbial diversity and density in peatlands under various TEAs, emphasizing the role of methanogenesis and CO2 fluxes in carbon cycling. Our findings enhance the understanding of carbon cycling in microbe-rich environments exposed to TEAs and highlight the potential for future studies to investigate the long-term effects of TEAs on microbial communities, enzymes, and carbon storage.

The present work investigates the mechanical properties of a composite material composed of multi-walled carbon nanotubes (MWCNTs), nano-aluminum powder (NAP), and glass fibers (GF) for five different compositions. The study further investigated how MWCNTs contribute to maintaining the mechanical properties of nanocomposites when exposed to elevated temperatures, up to 180 °C. The evaluation of impact strength revealed that the nanocomposite, composed of 2 % MWCNTs, 15 % NAP, and 10 % GF, demonstrated the greatest impact strength. At room temperature, the composite containing 2 % MWCNTs, 5 % NAP, and 20 % GF exhibited the highest ultimate tensile strength (UTS). Conversely, at elevated temperatures reaching up to 180 °C, the highest UTS was observed in the composition with 2 % MWCNTs, 10 % NAP, and 15 % GF. The hardness of the nanocomposite was influenced by its composition; at room temperature, the maximum hardness was observed in the mixture containing 2 % MWCNTs, 20 % NAP, and 5 % GF. In contrast, at elevated temperatures, the composition with 2 % MWCNTs, 5 % NAP, and 20 % GF exhibited the highest hardness. Overall, the study found that incorporating GF and NAP improved the mechanical properties of the composite. These results indicate that the composite's performance could be further optimized for specific applications through the addition of filler materials.

Significance: The thermal analysis of nanofluid in a vertical cylinder (artery) in a magnetized environment holds significant implications in physiological and thermal regulation networks. This research is significant in biomedical engineering with applications like medical diagnostics and treatment strategies. Motive: This study investigates the thermal behavior of a magnetized blood-based ternary Carreau nanofluid flowing through a vertically bounded artery with quadratic convection. Velocity and heat transfer analysis is conducted within the artery, utilizing thermal radiation and quadratic convection in a magnetized setting. The base fluid consists of blood, augmented with three nanoparticles: CuO, Al2O3, and TiO2. The investigation centers on examining the properties of blood nanofluid, arterial geometry, and thermal dynamics. Methodology: The physical model generates a set of partial differential equations (PDEs) and similarities mechanism is utilized to fetch its non dimensional form in terms of ordinary differential equations (ODEs). Furthermore, numerical outcomes are obtained with Matlab function bvp4c and obtained data set is trained through robust scheme Levenberg-Marquardt neural network (LMNN) procedure to predict the solution. Findings: Velocity of blood is reduced with increased values of wiessenberg number, magnetic parameter and mixed convection parameter and velocity increases for Second-order convection parameter. Temperature profile decreases with curvature parameter, mixed convection parameter and permeability parameter.

Oleogel significantly affects the product's sensory properties, texture, and shelf life. The goal of this study was to create oleogel by combining corn oil and sunflower oil and utilizing beeswax as a structural agent. A variety of physicochemical analyses were done to evaluate the quality of oleogel, including peroxide value, iodine value, saponification value, fatty acid, rheological parameters and firmness. Different percentages of oleogel, ranging from 0% to 75%, were used to substitute margarine in cookies. The cookies' quality was evaluated using proximate analysis, color analysis, texture analysis, calorific value, and sensory analysis. The study yielded substantial results by finding the ideal margarine-to-oleogel mix ratio, allowing for the manufacturing of high-quality cookies with a greater degree of unsaturation. Cookies with oleogel showed higher levels of unsaturation and better properties, making them the preferred option among consumers.

Introduction: Accepting the levels of professionalism that are currently in place not only provides a baseline for promoting development through educational and professional growth approaches, but also helps to make improved professionalisation possible by focusing on individual and professional-related factors. The objective of the current study in my thesis was to evaluate the professionalism and guiding principles of the physical therapists at RCRS, Lahore. Objective: to assess the professionalism of candidates pursuing a postgraduate degree in physical therapy. Methodology: A cross-sectional investigation was conducted. Before taking part in the study, each participant signed a written informed consent form. Data were gathered using a closed-ended professionalism rating questionnaire. 50 postgraduate students from Riphah International University's Lahore campus were included in the sample.. Results: The average age of the participants in the study was 24.0600 (SD±.956). Honesty and Integrity 82% of participants (n=41) Reliability and Responsibility 74% of participants (n=37) Respect for Patients 86% of participants (n=43) Respect for Others 72% of participants (n=36) Attendance and Approach to Learning 60% of participants (n=30) Compassion and Empathy 68% of participants (n=34) Communication and Collaboration 68% of participants (n=34) Self Awareness and Knowledge of Limits 56% of participants (n=28) Altruism and Advocacy 76% of participants (n=38) Health 86% of participants (n=43) Conclusion: It was concluded that an overall levels of professionalism among post graduate students of physical therapists were unsatisfactory.

Abstract Background Otitis media (OM) is the most frequent and complex middle ear condition with multifactorial etiology including genetic predisposition. OM depicts a variable clinical spectrum, leading to speech, developmental delay, and hearing loss. Here, we report the clinical and genetic findings of chronic suppurative otitis media (CSOM) segregating in a six‐generation consanguineous Pakistani family PKOM08. Methods Clinical evaluations, including audio and tympanometry, were conducted to assess OM manifestation and their impact on hearing function. Exome sequencing was performed to identify potential genetic variants underlying CSOM in the study participants. Results Clinical evaluation of participating individuals revealed varying degrees of disease severity, with mild to moderate hearing loss. All the affected individuals had CSOM with no other apparent comorbidity. Whole exome followed by Sanger sequencing revealed two rare heterozygous variants [c.1867C>T, p.(Pro623Ser) and c.11015G>A, p.(Arg3672Gln)] of BSN gene in most of the affected individuals of family PKOM08. BSN encodes a scaffold bassoon protein involved in synaptic vesicle trafficking. The identified variants replaced evolutionary conserved amino acid residues in the encoded protein and are predicted to impact the ionic interactions in the secondary structure. Conclusion A deep intronic variant of BSN has been previously implicated in the etiology of childhood ear infections. Our study further supports a link between BSN‐impaired function and ear infection and CSOM in children.

Pakistan is faces significant challenges in meeting its energy demand and consumption needs for consumers. This country's energy production from primary sources such as petroleum and natural gasses is incompetent in fuel-use and hence unable to meet feasibility cost. With an increasing population, Pakistan's energy consumption per capita has been steadily rising. This behaviour is leading to critical energy issues, especially in remote rural areas. This trend in rising energy costs and demand factors are similar to those in the energy markets in the South and South-East Asia. The primary energy sources in Asia continent, including fossil fuels, are insufficient supply to meet this growing demand in production and thus resulting in frequent electricity blackouts. Consequently, renewable energy sources such as solar photovoltaic (PV) and wind power have substantially started to produce energy and to provide a huge portion of Pakistan's daily energy needs apart in conventional energy currently. However, these sources are not yet as reliable, conventional energy bases have a challenge for sustainable energy production. As a result, renewable energy factors nonetheless initial started have effectively stabilized energy consumption, particularly for green electricity with net-zero carbon emissions. The aim of this study is to evaluate the feasibility and cost-effectiveness of integrating a microgrid hybrid system with combined (solar PV/wind power) renewable energy as well as conventional fossil fuel generators. This evaluation focuses on predicting energy production and its costs using Hybrid Optimization of Multiple Energy Resources (HOMER) software, and to enhance the electricity standards at NUST (National University for Sciences and Technology), Pakistan. The proposed methodology of microgrid hybrid system, when evaluated using HOMER software, shows a significant improvement in energy stability and cost efficiency. Moreover, this proposed system can reduce reliance on fossil fuels by a substantial percentage, enhances the predictability of energy production, and optimizes its energy consumption. These can achieve better performance metrics in terms of reliability, cost, and environmental impact; feasible solution for Pakistan and the developing countries. This proposed methodology offers a novel approach by integrating renewable energy sources with conventional generators to create a balanced and efficiency factor by microgrid system. This hybrid system goals as an investigation is to optimize this energy production, reduce carbon emissions, and provide a more stable and cost-effective energy supply.

Sewage water is extensively used for irrigation, serving as a valuable resource for plant growth to enhance agricultural productivity. However, this practice also results in a significant accumulation of heavy metals in the soil, posing potential environmental and health risks. A study was designed to evaluate the combined effect of amendments on heavy metal immobilization in soil and improved growth and yield in pea plants. For this, the soil for each treatment was mixed with biochar (BC) (1% w/w), polyacrylamide (PAM) (0.5% w/w), and also applied in combination. Pea plants were irrigated with tap water (TW), sewage water (SW), and tap + sewage water (TW + SW). A factorial design was applied to analyze data statistically. The combined application of the biochar and polymer showed a positive response by significantly enhancing the plant growth parameters (39%–84%), physiological attributes (67%–69%), and reducing Cd (56%) and Cr (65%) concentration in soil applied with SW and TW + SW. Moreover, treatment with a combined application of BC and PAM significantly reduced Cd concentrations by 43% in roots, 50% in shoots, and 91% in grains. Similarly, Cr concentrations were reduced by 51% in roots, 51% in shoots, and 94% in grains compared to the control. Overall, the study results indicate reduced bioaccumulation and health risks associated with potentially toxic elements (PTEs), supporting the application of the polymer and biochar for irrigating pea plants with TW + SW. Leveraging the combined benefits of polymer and biochar amendments appears to be an effective strategy to remediate PTE-contaminated soil, thereby increasing plant growth and yield.

Countries should focus on the improvements to achieve sustainable development goals. However, taking these actions create some operational costs. Thus, it is appropriate for rising nations to prioritize sustainable development objectives. Due to this condition, more critical sustainable development goals should be identified. Accordingly, this study evaluates green energy-oriented sustainable development goals for emerging economies. Within this context, a model is generated by considering the golden cut and bipolar q-rung orthopair fuzzy sets (q-ROFSs). The novelty of this study is to identify key green energy-oriented sustainable development goals for the improvement of emerging economies by an original model based on the golden cut and bipolar q-ROF decision making approach. All results are similar, indicating the proposed model's validity and coherency. It is concluded that increasing renewable energy is the most significant target with a weight of 0.235 regarding green energy-oriented sustainable development. Cooperation and efficiency are other significant issues for this condition, with weights of 0.198 and 0.196. It is also identified that Turkey and Mexico are the most successful countries in reaching green energy-oriented sustainable development goals. Increasing the share of renewable energy in total energy production and consumption is important for emerging countries. For this situation, governments should provide subsidies for renewable energy investors to provide a cost advantage. In this context, issues such as tax cuts and loans with low-interest rates can increase the motivation of clean energy investors.

There is growing interest in the use of electrospun polymeric nanofibers in drug delivery systems due to their remarkable surface-to-volume ratio, which enhances the processes of drug loading, specific cell binding and proliferation. The preferred polymers for drug delivery must be biocompatible and biodegradable. Gum tragacanth is one of the materials of choice for drug delivery. This work aimed at cross-linking the tragacanthin, the water-soluble fraction of gum tragacanth, with glutaraldehyde, synthesis of the cross-linked nanofibers and evaluating their properties to encapsulate and deliver a drug using caffeine as a model drug in the first place. The nanofibers were then loaded with cisplatin and evaluated against HepG2 cell line. The drug-loaded nanofibers (dia. 0.841 μm) were prepared by electrospinning using glutaraldehyde as the cross-linker and glycerol as a plasticizer and characterized by scanning electron microscopy, Fourier transform-infrared spectroscopy, electronic spectroscopy, 1HNMR, powder X-ray diffraction analysis, and thermogravimetric analysis. They released the encapsulated drugs in a sustained manner at pH 7.4 over 4.5 days (∼275 h with ∼80 % release) following Higuchi (cisplatin) and Hixon-Crowell (caffeine) kinetics. In a cytotoxicity assay against HepG2 cell line the cisplatin-loaded nanofibers exhibited enhanced activity compared to that with the standard cisplatin and in the caspase activity assay it activated caspase 3 to a higher extent and 8 and 9 to double the extent (4-fold) of cisplatin, suggesting a higher apoptotic activity by the nanoformulation than the standard cisplatin. Thus, nanoformulation appeared to be a potential candidate for treating hepatocellular carcinoma as an implant.

Agricultural productivity is highly correlated with climatic variations, including drought events. This study is aimed at performing a comprehensive assessment of agricultural drought conditions in the Köppen–Geiger climate zones in Bangladesh, based on the temperature condition index (TCI), vegetation condition index (VCI), and vegetation health index (VHI). The zones are classified as follows: temperate dry winter with a hot summer zone, tropical savannah zone, and tropical monsoon zone. The range of VHI is optimized based on its correlation with TCI and VCI. The correlation among the stratified drought indices is also examined to quantify and measure the strength and direction of the linear relationships between them. Moreover, Mann–Kendall test is conducted to assess the statistical trends in the spatiotemporal propagation of droughts across different climate zones. The balanced correlation approach for VHI reveals that vegetation health is governed by the temperature conditions. Certain variations in the drought intensity, frequency, and duration are observed across climatic zones in earlier years while the recent years are noted with less droughts. Normal or no drought conditions are noticed mostly in the tropical monsoon zone through VCI and VHI. The correlations among the drought classes indicate that VHI is more strongly correlated with TCI than with VCI, while NDVI exhibits stronger correlations with VCI than with either VHI or TCI. The Mann-Kendall test revealed that VCI has significant downward trends in drought categories and an upward trend in normal conditions, whereas VHI and TCI displayed inconsistency in statistical trends. By extensively exploring the agricultural drought conditions within specific climate zones, this study offers valuable insights for agronomists and stakeholders involved in climate resilience planning and agricultural development in Bangladesh.

In statistical inferences, the estimation of population parameters using information obtained from a sample is an important method. This involves choosing an appropriate sampling method to collect data. An efficient sampling method used for data collection is Ranked Set Sampling (RSS). In this study, we investigate the reproducibility of four well-known mean estimators under RSS using parametric predictive bootstrapping. These estimators are called conventional, ratio, exponential ratio, and regression estimators. Reproducibility is the ability of a statistical technique to obtain results similar to those based on the original experiment if the experiment is repeated under the same conditions. We conduct a simulation study to compare the reproducibility of mean estimators for varying sample sizes when sampling is based on perfect and imperfect rankings. We consider data on abalone in our simulations to demonstrate real-world applications. This study concludes that the regression estimator is the best reproducible estimator, while the conventional estimator is the worst in this regard.

Grain legumes, serving as vital sources of starch, protein, and oil, play a pivotal role in ensuring food security. However, global climate change poses an enhanced risk to legume production by elevated temperatures. The reproductive process, determining grain yield, is highly sensitive to heat stress, primarily affecting pollen and ovule infertility and reducing fertilization rates. Consequently, this leads to smaller seeds and reduced yield due to impaired grain setting and abortion. This review outlines the reproductive responses to heat stress in both male and female development and fertilization processes, while also examining heat-tolerant physiological and molecular mechanisms. Looking ahead, the development of heat-resistant genomes can be pursued by improving physiological processes through molecularly linked genetic engineering approaches to cope with these challenges posed by global warming.

Reliable estimates of how human activities may affect wildlife populations are critical for making scientifically sound resource management decisions. A significant issue in estimating the consequences of management, development, or conservation measures is the need to account for a variety of biotic and abiotic factors, such as land use and climate change, that interact over time altering wildlife habitats and populations. The snow leopard Panthera uncia (Schreber, 1775), as a vulnerable species, is extremely sensitive to indirect impacts of climate change. Given that it is highly difficult undertaking conservation measures on the entire range of snow leopards, identifying hotspots for conservation is necessary. This study was conducted in Bagrot and Haramosh valleys, in the Trans-Himalayan region, to evaluate the impacts of climate and human pressure on snow leopard habitat. Hybrid classification of Landsat satellite data for 2010 and 2020 was performed to elucidate land use changes that suggested a decrease in permanent snow by 10 % and 3 % in Haramosh and Bagrot while an increase in settlements cover by 16 % and 23 %, respectively. Life zone comparison for 2010 and 2020 using the Holdridge life zone (HLZ) classification system disclosed a change from three life zones to five life zones in Haramosh, and four life zones to five life zones in Bagrot, caused by a temperature increase of 2°C to 3°C, indicating that the area is becoming more and more suitable for settlements and less favorable for snow leopards. This study underlines again that mountainous regions are more vulnerable to the impacts of climate change. Warming weather is making survival more difficult for snow leopards. Although they are resilient to the direct effects of climate change, indirect impacts like avalanches, flash floods, urbanization, and human-wildlife conflict make them more vulnerable and threaten their survival. Thus, we recommend establishing further protected areas, better controlling illegal wildlife trade, and conducting genetic studies to understand impacts on snow leopards and rangeland management, livelihood improvement, and human-wildlife conflict reductions.