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The rapid increase in population accelerates the rate of change of Land use/Land cover (LULC) in various parts of the world. This phenomenon caused a huge strain for natural resources. Hence, continues monitoring of LULC changes gained a significant importance for management of natural resources and assessing the climate change impacts. Recently, application of machine learning algorithms on RS (remote sensing) data for rapid and accurate mapping of LULC gained significant importance due to growing need of LULC estimation for ecosystem services, natural resource management and environmental management. Hence, it is crucial to access and compare the performance of different machine learning classifiers for accurate mapping of LULC. The primary objective of this study was to compare the performance of CART (Classification and Regression Tree), RF (Random Forest) and SVM (Support Vector Machine) for LULC estimation by processing RS data on Google Earth Engine (GEE). In total four classes of LULC (Water Bodies, Vegetation Cover, Urban Land and Barren Land) for city of Lahore were extracted using satellite images from Landsat-7, Landsat-8 and Landsat-9 for years 2008, 2015 and 2022, respectively. According to results, RF is the best performing classifier with maximum overall accuracy of 95.2% and highest Kappa coefficient value of 0.87, SVM achieved maximum accuracy of 89.8% with highest Kappa of 0.84 and CART showed maximum overall accuracy of 89.7% with Kappa value of 0.79. Results from this study can give assistance for decision makers, planners and RS experts to choose a suitable machine learning algorithm for LULC classification in an unplanned urbanized city like Lahore.

Objective: To determine the frequency of SOX10 expression in patients with triple-negative breast cancer. Study Design:Descriptive cross-sectional study. Place and Duration of Study: Armed Forces Institute of Pathology, Combined Military Hospital, Rawalpindi, 01Dec 202 1 to 30 Sep 2022. Materials and Methods: This study was conducted on 185 patients diagnosed with triple-negative breast cancer. Patients with any size, stage and grade of breast cancer that were negative for the presence of estrogen and progesterone receptors, as well as HER2, were included. Those who were chemo-experienced, had received radiation to the breasts or had relapsed were excluded. Immunohistochemistry was performed using staining with a SOX10 antibody on patients' tissue samples for SOX10 expression, which was quantified. Data was analyzed using SPSS 26.0, and comparison was made between patients who were SOX10 positive versus those who were SOX10 negative with regards to disease characteristics. Results: The mean age of our sample population was 51.65 ± 9.81 years. SOX10 was positive in 138 (74.6%) cases, with patchy positivity seen in 55 (29.7%) samples, while focal and diffuse involvement was seen in 67 (36.2%) and 16 (8.7%) cases respectively. Higher SOX10 positivity was seen with advancing age, (p=0.014), larger tumour size, (p

Madam, Heart failure (HF) is a multifaceted clinical syndrome arising from a functional or structural cardiac condition that hampers the adequate filling or expulsion of blood into the systemic circulation. It is estimated that heart failure affects around 26 million people globally and significantly adds to healthcare expenditures on a worldwide scale1. Furthermore, in 2016, approximately 16 percent of deaths in Pakistan were due to heart related disorders. This number grew to 29 percent in 20222. HF can greatly diminish the functional capability of a patient and heighten the risk of mortality. Therefore, it is essential to accurately diagnose and proficiently manage this condition to improve the quality of life of the patient. Spironolactone, the first mineralocorticoid receptor antagonist (MRA) to be developed, is prescribed for the management of hypertension, primary hyperaldosteronism, and peripheral oedema linked to cardiac failure3. When HF occurs and cardiac output decreases, it stimulates the renin-angiotensin-aldosterone system (RAAS) which in turn causes salt and water reabsorption and thus increases venous return to the heart which further contributes to congestive heart failure and heart fails to pump the additional fluid and pooling occurs. Here MRAs are very affective as they inhibit the function of aldosterone and hence fluid retention does not occur. Unfortunately, the beneficial effects of spironolactone do not occur without substantial adverse effects. Firstly, spironolactone is associated with sexual adverse events due to its affinity for androgen and progesterone receptors. There have been reports of male patients experiencing gynecomastia and breast pain. Secondly, spironolactone has been classified as potassium sparing diuretic hence hyperkalemia (defined as serum K+ > 5.5 mEq/L) is a common side effect3. Hyperkalemia can manifest as muscle weakness or paralysis, metabolic acidosis, cardiac conduction abnormalities, and life-threatening cardiac arrhythmias4. These cardiac arrythmias can have serious consequences, including cardiac arrest and stroke. In conclusion heart failure, if not treated immediately, can be fatal. Spironolactone is a drug used for management of heart failure; however, it has some detrimental effects on the cardiovascular system such as development of serious cardiac arrythmias. Hyperkalemia, due to potassium sparing nature of MRAs, is the primary cause of these life-threatening effects thus it is recommended to assess serum potassium levels and renal function of a patient with heart failure before prescribing spironolactone. Moreover, patients who are being treated with spironolactone should be periodically monitored to prevent any casualty.

Objective: To determine the frequencies of different types of granulomas in patients suffering from cutaneous leishmaniasis. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Armed Forces Institute of Pathology, Combined Military Hospital, Rawalpindi, Dec 2021 to Oct 2022. Materials and Methods: This study was conducted on 290 patients suffering from cutaneous leishmaniasis. Patients aged between 18 and 70 years of both genders were included, while those who had already received treatment for leishmaniasis, or suffered frommucocutaneous or visceral leishmaniasis were excluded. All patients underwent a punch biopsy, tissue which was stained with hematoxylin and eosin, and then studied for the presence of granulomas and Parasitic Index. PCR was done to confirm species of Leishmania causing disease. Data was analyzed using SPSS 26.0. Results: Our study population had a median age of 38.00 (16 - 63) years, with a male majority: 185 (63.8%). Granuloma formation was seen in 185 (63.8%) patients: 121 (41.7%) had a tuberculoid granuloma and 13 (4.5%) had suppurative granulomas, while 51 (17.6%) had caseating ones. L. Tropica was the most seen organism accounting for 255 (87.9%) cases, L. Major was the infective organism in 26 (9.0%) patients, while L. Infantum was found in 9 (3.1%) cases. Factors such as gender (p=0.273), age of the patient (p=0.901), disease duration (p=0.366), site of lesion (p=0.669), type of skin lesion (p=0.490), parasite index (p=0.297) and species of Leishmania (p=0.870) did not have any significant association with the development of non-caseating granulomas. Conclusion: Chronic granulomatous inflammation is a common finding on histopathology in cutaneous leishmaniasis and vigilance is required to avoid confusion with other endemic granulomatous skin conditions.

Hydrothermal carbonization (HTC) has recently emerged as a promising technology for converting diverse forms of waste with a high moisture content into value-added products such as biofuel, biochar, and activated carbon. With an increasing demand for sustainable and carbon-neutral energy sources, HTC has attracted considerable attention in the literature. However, a successful transition from laboratory-scale to large-scale industrial applications entails notable challenges. This review critically assesses the upscaling of hydrothermal carbonization processes, emphasizing the challenges, innovations, and environmental implications associated with this transition. The challenges inherent in upscaling HTC are comprehensively discussed, including aspects such as reactor design, process optimization, and the current treatment technology for process water. This review presents recent innovations and technological advancements that address these challenges and explores integrated solutions to enhancing hydrothermal carbonization’s scalability. Additionally, this review highlights key companies that have developed and implemented HTC plants for commercial purposes. By overcoming the obstacles and achieving advancements in the upscaling of hydrothermal carbonization, this review contributes to the ongoing efforts to realize the full potential of HTC as a sustainable and scalable biomass conversion technology and proposes future directions.

The excessive pumping of groundwater during the dry season in Pakistan is identified as a significant concern for groundwater sustainability. Farmers encounter difficulties in efficiently managing irrigation, and adopting the outputs of Irrigation Advisory System (IAS) to improve irrigation practices. Upgrading the existing IAS can help to identify the regions with over-irrigation issues and optimize outreach efforts. To solve these issues, we define the new concept of integrating Gravity Recovery and Climate Experiment (GRACE) total water storage anomalies (TWSA) and Landsat 8 imageries, which can enhance the IAS efficiency by accurately identifying regions facing groundwater depletion by estimating actual crop water consumption through application of the Simple Algorithm For Evapotranspiration Retrieving (SAFER) on Landsat 8 data and Penman-Monteith (PM) method was used to calculate crop water demand using meteorological forcing data from Global Land Data Assimilation System (GLDAS) over the five selected districts of Punjab during the dry seasons of year 2013–2020. Comparing actual water consumption (SAFER evapotranspiration (ET)) with in-situ groundwater depth, strong correlations were found between them that are supporting the use of Landsat 8 data for irrigation monitoring. Further, compared SAFER ET was with PM ET to calculate the percentage of over/under irrigated regions, and the results revealed that most of the selected districts were over-irrigated, indicating the potential for excessive irrigation water savings. Our results show that the integration of GRACE TWSA and Landsat 8 data enhance the efficiency of operational IAS and can lead to potential savings of 81% (equivalent to 155 million m3) of groundwater during the dry season in the Central Punjab, Pakistan. Satellite data integration globally enhances IAS implementation, aiding regions with unsustainable dry season irrigation. This empowers farmers to optimize agriculture through precise IAS outputs.

Background: Breast cancer (BC) is a major health concern in the BRICS-plus, a group of developing nations consisting of Brazil, Russia, India, China, South Africa, and 30 other Asian countries, with nearly half of the world's population. This study aims to identify potential risk factors contributing to the burden of BC by assessing its epidemiological and socio-demographic changes. Methods: Data on BC outcomes were obtained from the 2019 Global Burden of Disease Survey. The age-period-cohort (APC) modeling technique was used to evaluate the nonlinear impacts of age, cohort, and period on BC outcomes and reported risk attributable mortality and disability adjusted life years (DALYs) rate changes between 1990 and 2019. Results: In 2019, there were 0.90 million female BC cases and 0.35 million deaths in the BRICS-plus region, with China and India having the largest proportion of incident cases and deaths, followed by Pakistan. Lesotho experienced the highest annualized rates of change (AROC: 2.61%; 95%UI: 1.99–2.99) in the past three decades. Birth cohorts' impact on BC varies greatly between the BRICS-plus nations, with Pakistan suffering the largest risk increase in the most recent cohort. High body mass index (BMI), high fasting plasma glucose (FPG), and a diet high in red meat contributed to the highest death and DALYs rates in most BRICS-plus nations in 2019, and there was a strong negative link between SDI and death and DALYs rate. Conclusions: The study found that the burden of BC varies significantly between BRICS-plus regions. Thus, BRICS-plus nations should prioritise BC prevention, raise public awareness, and implement screening efficiency measures to reduce the burden of BC in the future, as well as strengthen public health policies and initiatives for important populations based on their characteristics and adaptability.

Pseudomonas aeruginosa is a significant pathogen in healthcare-associated infections, particularly in immunocompromised and cystic fibrosis patients. This study aimed to assess the antibiotic susceptibility of 111 P. aeruginosa isolates from various clinical specimens collected between May 2023 and April 2024 at Integral Institute of Medical Sciences and Research, Lucknow. Isolates were identified using standard microbiological techniques and antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method according to CLSI guidelines. The study focused on multidrug-resistant (MDR), extensively drug-resistant (XDR) and pan-drug-resistant (PDR) classifications based on resistance patterns. The prevalence of P. aeruginosa was 16.5%, with 54% of isolates from males and 46% from females. The highest isolation rate was from pus samples (49.5%), followed by sputum (18%) and urine (15.3%). The majority of isolates came from the Department of Surgery (19.8%) and inpatient cases (52.3%). Resistance was highest to ceftazidime (57.7%) and imipenem (51.4%), while piperacillin-tazobactam showed the lowest resistance (19%). MDR isolates were most frequently found in pus samples (50%), while urine samples had the highest PDR rate (33.3%). These findings highlight the increasing antibiotic resistance in P. aeruginosa, with significant MDR and PDR rates, particularly in pus and urine samples. This study underscores the need for stringent antibiotic stewardship to mitigate resistance and develop effective treatment strategies. [ABSTRACT FROM AUTHOR]

Background: On 16th January 2021, India began the world’s largest vaccination program for COVID-19. Healthcare workers were the first group to be offered the vaccine, however, vaccine hesitancy emerged as a barrier. Vaccine hesitancy refers to a delay in acceptance or refusal of vaccination despite the availability of vaccination services. It was listed as one of the ten threats to global health by WHO. The aim of this study was to determine the rate of vaccine acceptance and reasons for vaccine hesitancy among UG (undergraduate) medical students of Bihar. Our study was necessary because UG medical students do not contribute directly to the frontline of healthcare but are exposed to multiple cases of COVID-19 during clinical teachings and they are also the future of any country’s healthcare system. Material and Methods: A cross-sectional study was carried out on the UG medical students of Bihar using an anonymous online survey. The survey link was sent electronically via WhatsApp. All the questions of the survey were closed-ended, in the form of multiple-choice questions and tick boxes. The data was analyzed on SPSS software. Results: Out of 394 responses received, 205 (52.03%) were males, 384 (97.46%) belonged to the age group of 18-25 years. In the bivariate model, attributes like the male sex, being well informed about the vaccines, being at high risk of exposure, and the belief that vaccination can overcome the pandemic were associated with a higher likelihood of accepting the vaccine. Participation of professors in vaccination was the most common source of motivation (209/357; 58.5%) in vaccine acceptors, while insecurity about the efficacy of the vaccines (16/37; 43.2%) was the most common reason among vaccine deniers. Conclusion: We recorded a high vaccine acceptance rate of 90.6% in our study. Further, 78.4% of vaccine deniers believed that they would have accepted the vaccine if they were provided appropriate information on the vaccines prior to the vaccination. Therefore, we reach a conclusion that prevaccination orientation sessions aimed at UG medical students will significantly help in addressing their vaccine hesitancy. [ABSTRACT FROM AUTHOR]