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The study examines the impact of brand personality on brand loyalty. It also explores the mediating role of self-congruence and brand trust on the relationship between brand personality and brand loyalty. With today’s competitive environment, it has become increasingly challenging and important for companies to increase the customer retention. To trespass and achieve the highest point in the competition, companies have been rigorously looking for customs to make powerful brand relations with the customers. This study concludes that due to brand personality the consumer become loyal towards brand and purchase products from the specific brand. The act of self-congruence on brand personality increases the brand loyalty, when the personality of the brand matches the personality of the consumer, this enhances self-congruence and trust of the consumers on trust which will lead to increase in the loyalty of consumers towards brand. On the basis of results implications, limitations and future directions of the study were conferred.

The current research examines the influence of spiritual leadership on green creativity via the mediating mechanism of green knowledge-sharing by supporting social learning theory. Leaders with spiritual traits can create green knowledge sharing that leads to green employee creativity. Rationally, this research follows the mechanism of post-positivism. Therefore a quantitative methodology is applied. Time-delayed survey administration and deductive approach are applied for theory development. Multilevel data is collected from 405 employees working in Pakistani universities and hospitals. Multilevel pathway analysis is implemented by using Mplus. Our research established a statistically positive influence of spiritual leadership on green knowledge-sharing, which increases green creativity. Our study provides various practical and managerial consequences where organizations can intentionally emphasize and concentrate on employees' green creativity to save the environment through employees' implementation of green ideas.

Objective: To determine the orthodontic treatment need indices in the adolescents. Study Design: Cross-sectional study. Place and Duration of Study: Orthodontics Department, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Dec 2019 to Feb 2020. Methodology: A total of 144 subjects were selected. The orthodontic treatment need was determined using the Index of Orthodontics Treatment Needs (IOTN) and Dental Aesthetic Index (DAI). Dental casts were made for each subject and rated against DAI. Measurements against all ten components of DAI were undertaken based on the patient's occlusal morphology.Intraoral photographs and casts were used to determine the aesthetic and dental health components of IOTN. Results: According to Index of Orthodontics Treatment Needs- Aesthetic Component, high severity and orthodontic treatment need were observed 18(12.5%). Index of Orthodontics Treatment Needs-Dental Health Component showed a high severity and treatment need 55(38.1%), while DAI revealed a high severity and treatment need 106(73.61%) subjects. Kappa analysis exhibited no significant association between IOTN-DHC Index and AC Index (κ=0.089, p=0.158) and only a slight agreement between IOTN-DHC and DAI (κ=0.18, p=0.005). Conclusion: While using DAI and IOTN, the perception of orthodontic treatment needs is assessed differently. Indices exhibited low agreement for high treatment need cases and high agreement for low treatment need cases.

Background: The orthodontist and patients prefer the usage of mini-screw anchorage due to its feasibility of insertion and removal, which necessitates minimum patient cooperation, and cost-effectiveness. Aim: The aim of the study is to access the mean perception of pain using a visual analogue scale after placing the mini-screws in orthodontic patients. Methods: Using convenient sampling technique, this cross-sectional study was held at Armed Forces Institute of dentistry, Rawalpindi and Shahida Islam Dental College, Lodhran for six-months duration from July 2022 to December 2022. A total of 80 patients took part in the study. On a 10-millimeter visual analogue scale (VAS), where 10 signifies "the severe pain presumable" and 0 signifies "no pain," they were asked to rate their anticipated level of pain Results: A total of 80 patients were selected for this study with the mean age of 21.1± 2.8. The majority of subjects (60%) were female, and the posterior maxilla (48.8%) and posterior mandible (30%) were mostly implanted with mini-screws. Mostly, patients described pain on the 1st day of mini-screws insertion with mean VAS was 4.10± 1.65 and on 7th day; minimum pain was experienced with VAS of 2.9±1.09. There was a significant variation (p ≤0.01) in the VAS score between the sexes, with women exhibiting a higher VAS score (39 ± 52.7) compared to men (35 ± 47.3). Conclusion: Mini screws can more precisely carry out difficult tooth movements than the traditional anchorage used in standard orthodontic treatment. Keywords: Pain, mini-screws placement, mean pain perception and visual analogue scale.

Background: The success of orthodontist treatment lies in the satisfaction and expectation levels of the patients. There is a need to explore factors which determine the expectation and satisfaction levels of the patients. Objective: The study aimed to analyze the satisfaction level and expectations of orthodontic patients with their orthodontic treatment. Study design: This cross-sectional and observational study was conducted at dentistry department of Islamic International Medical and Dental College Islamabad. The duration of the study was six months from Jan 2022 to June 2022. Material and Methods: The 210 patients that visited orthodontic department of the hospital were selected for analysis. Among those 210 patients, there were 170 females and 40 males. The participants were fully aware of the study and written consent was taken from the patients. The satisfaction level was analyzed. It was observed that there were 16% participants that were unsatisfied. There were 176 patients that were satisfied with the orthodontic treatment they were given. There was no significant co-relation found between people of different age groups (p=0.5). The study was carried out to find features like ethics, behavior and the degree of orthodontist that did the treatment. The comparisons of groups with the orthodontic treatment was carried out and the satisfaction of the patients post-treatment. Results: It was observed that 16% participants were unsatisfied it included 7 males and 27 females. Among the 210 patients that participated there were 176 patients that were satisfied with the orthodontic treatment they were given. There was no significant co-relation found between people of different age groups (p=0.5). There were 70% patients that reported that they had no problem during the treatment. And there were 30% patients that felt problems. There were many problems described by the patients. Conclusion: The study reported that majority of the patients significantly met their expectations of the treatment. There was no orthodontic treatment linked factor that had significant association on the satisfaction of the patients. Keywords: Orthodontic patients, satisfaction level and degree of orthodontist.

BACKGROUND: The proliferation of ICT has transformed customers’ buying patterns. The organic consumption patterns based on online consumers’ reviews were reviewed through moderated mediation model. This research paper examines the mediating role of consumer attitude in the relationship between online consumers’ reviews and organic consumption. It further examines, if perceived irritation moderates this effect. METHODS: Data were collected from 287 respondents who were experienced in online buying of organic products. Applied the PROCESS macros in IBM SPSS Statistics 23 to assess latent hypothesized relationships. IMPLICATIONS: These results have urged marketers to reconsider their strategies to treat modern consumers and scheming more artistic web pages braced with social feedback mechanism to stream organic consumption. CONCLUSIONS: The results supported that online consumers’ reviews positively influences organic consumption of Chinese. However, this effect is stronger when perceived irritation of webpages is low.

Introduction: Graduates of physiotherapy educational and training programs should be expected to work as a competent clinician. Studies carried out in different parts of the world show contradicting results. This study was designed to evaluate the competencies of physical therapy interns in patients' management skills. Material & Methods: A cross-sectional study was carried out from July, 2019 to December, 2019 on fifty two physical therapy interns who were working in different clinical settings. The sampling technique used for this survey was purposive sampling. Twenty clinical physical therapists assessed competencies of these interns using the modified version of Clinical Internship Evaluation Tool. SPSS version 20 was used for data analysis. Results: Clinical physiotherapists who assessed the competencies of the physiotherapy interns stated that the profeciency of all (n = 52, 100) participants in relation to patients management skills was satisfactory for their current educational level. Thirteen (25%) of the respondents had thinking that examination is an area of concern and more than a half (53.8%, n=28) mentioned that examination is an area of strength and 21.2% (n=11) of them gave no response about examination. Questions related to examination revealed that majority (n=45, 86.5%) respondents think that they obtain accurate history. Similarly, majority (n=47, 90.4%) of participants responded that they determine diagnosis for physical therapy management of the patients. On a scale from 0 to 10, the interns were compared to a competent clinician who is able to skillfully manage patients in an efficient manner to achieve effective patient/client outcome. About 44.2% (n=23) of the respondents gave 4 out of 10 rating, 51.9% (n=27) of them gave 5 number and 3.8 (n=2) of them were awarded 6/10 number of clinical competences. Conclusion: We concluded from the study that almost all the physical therapy interns were competent in regards to in-patients management skills.

Objective: To determine the accuracy of digitally/computer-traced cephalograms compared to hand-traced cephalograms in terms of differences in mean angular and linear cephalometric measurements.Study Design: Observational (cross-sectional comparative).Place and Duration of Study: The study was carried out at the Orthodontics Department of Armed Forces Institute of Dentistry (AFID), Rawalpindi, Pakistan, from June 2020 to December 2020.Materials and Methods: One hundred and twenty patients aged 12 – 24 years undergoing treatment at the department were randomly selected. Cephalograms were recorded by a digital cephalographic system, keeping the distance between film and object at 5 feet and exposure time at 80 KV/0.5 sec. Both hard and soft copies were obtained. Hand tracings were done using the hard copy with a 0.5 mm lead pencil on 0.003-inch matte acetate paper. Digital tracings were performed using the soft copy of the same digital cephalometric system in the Viewbox software version 4.0. Linear and angular measurements were recorded. Data were analyzed using SPSS version 24. Descriptive statistics were calculated. For comparison between two methods, i.e., vs Computerized tracing, an independent sample t-test was applied while the p-value was kept ≤0.05.Results: No statistically significant difference was observed between cephalometric measurements obtained via the two methods for any of the linear or angular measurements.Conclusion: Computerized cephalometric analysis is reliable and time-effective, and its accuracy is comparable to manual analysis.

Continuous increase in population has resulted in increased demand for building material. Bricks are the major building material and are a fast-growing industrial sector in many countries such as Pakistan, China, India, and Bangladesh. Despite its integral role, it is among the top three factors that cause the emission of harmful pollutants that not only affect our climate and human health but also effecting agriculture sectors to a great extent. Brick kilns emit gases like SO2, CO, Black Carbon, CO2, NOx, PM, etc., that affect our biotic and abiotic components of the ecosystem. So, the objective of this paper is twofold. Firstly, it has been focused on the pollutants emissions from brick kilns, their effects on climate and agriculture sectors. Secondly, the possible techniques have been discussed that can be used to reduce or eliminate its harmful impacts. It was found that the pollutant emissions from brick kilns like SOx, NOx, CO2, CO, unburnt hydrocarbons, Particulate matter, heavy metal, and various other compounds have a significant effect on the surrounding environment, climate and agriculture field in the vicinity of brick kilns. If the proper technology for reducing pollutants will not be installed in the brick kiln, there might be a serious disadvantage of climate and especially in the agriculture field in the vicinity of brick kilns.

PurposeThe purpose of this paper is to examine the impact of consumers’ attitudes towards organic food on online impulse buying behaviour as well as the moderating effect of three website features (visual, information and navigation design) on this relationship.Design/methodology/approachSurvey data were collected via an online survey using social media platforms. A total of 653 online questionnaires were collected (response rate = 72.5 per cent) and analysed by applying exploratory and confirmatory factor analyses. The proposed hypotheses were tested through structural equation modelling.FindingsSocial media forums, ratings and reviews shape Chinese consumers’ attitudes towards organic food and positively influence their online impulse buying in this market. Website features are critical for disseminating information on organic food. Informative webpages featuring product quality and certification have a greater moderating effect on purchase. Information cues such as nutritional content; production and processing methods, and environmentally friendliness also influence consumers’ attitudes and thus impulse buying decisions.Practical implicationsMarketers should reconsider their tactics for dealing with modern consumers, as webpages should be user-friendly and visually appealing with a social learning mechanism to drive organic food consumption.Originality/valueThis study bridges a gap in the literature on social commerce initiatives for developing consumers’ attitudes towards organic food and online impulse buying. Further, it proposes measures that can enhance organic consumption and contributes to the literature on the importance of social factors, resulting in enhanced knowledge on the online impulse buying of organic food.

Background: Patients associated with VAP having mortality rates range from 20to 50% and this may extend up to 70% when multi-resistant and invasive pathogens accountablefor infection, however, VAP is also interrelated with noteworthy rate of morbidity, extendedperiod of stay in ICU, protracted MV, and augmented hospitalization cost. Objectives: To reviewthe risk factors, incidence and transience rate of mortality for ventilator-associated pneumonia.Design: Prospective and cross sectional way. Period: From April 2016 to December 2016.Setting: Different Tertiary Care Institutes of Karachi, Pakistan. Method: A structured datacollection form was prepared to record the information and validated using spearman correlationcoefficient and Cronbach’s α value. Value of α = 0.902 and p = 0.913 have revealed the suitabledegree of reliability and uniformity. Data was collected with respect to gender, age, antibioticutilization record, and main diagnosis outcomes. Microbiological basis of ventilator-associatedpneumonia was assessed using patient lab record for rate and seclusion of organism. Results:In this study a detail of significant virulence factor articulated by these microorganisms hasbeen depicted. Statistically insignificant differences were observed among the groups withrespect to clinical and demographic characteristics like mean age, gender, infection severityscores (SOFA, MODS, CPIS and APACHE II), immune status of patients and type of the casesincluding surgical or clinical scenario. 39.3% patients developed early onset while 60.6% ofcohort was observed with late onset of VAP. Conclusion: The precise microbial source of VAPare numerous and diverse. The realistic challenge at the present time is to portray the authenticapproximate of the clinical consequences associated with VAP. Henceforth such investigationsmay be supportive in origination of the most favorable institutional antimicrobial strategy toreduce the associated complications of this threat.

Background: Patients associated with VAP having mortality rates range from 20to 50% and this may extend up to 70% when multi-resistant and invasive pathogens accountablefor infection, however, VAP is also interrelated with noteworthy rate of morbidity, extendedperiod of stay in ICU, protracted MV, and augmented hospitalization cost. Objectives: To reviewthe risk factors, incidence and transience rate of mortality for ventilator-associated pneumonia.Design: Prospective and cross sectional way. Period: From April 2016 to December 2016.Setting: Different Tertiary Care Institutes of Karachi, Pakistan. Method: A structured datacollection form was prepared to record the information and validated using spearman correlationcoefficient and Cronbach’s α value. Value of α = 0.902 and p = 0.913 have revealed the suitabledegree of reliability and uniformity. Data was collected with respect to gender, age, antibioticutilization record, and main diagnosis outcomes. Microbiological basis of ventilator-associatedpneumonia was assessed using patient lab record for rate and seclusion of organism. Results:In this study a detail of significant virulence factor articulated by these microorganisms hasbeen depicted. Statistically insignificant differences were observed among the groups withrespect to clinical and demographic characteristics like mean age, gender, infection severityscores (SOFA, MODS, CPIS and APACHE II), immune status of patients and type of the casesincluding surgical or clinical scenario. 39.3% patients developed early onset while 60.6% ofcohort was observed with late onset of VAP. Conclusion: The precise microbial source of VAPare numerous and diverse. The realistic challenge at the present time is to portray the authenticapproximate of the clinical consequences associated with VAP. Henceforth such investigationsmay be supportive in origination of the most favorable institutional antimicrobial strategy toreduce the associated complications of this threat.

Introduction: The extraction of permanent teeth for orthodonticreasons has been a hot topic of debate in the past and continues to be of interesteven today. There is a considerable controversy concerning extraction as a treatmentadjunct which sometimes reaches to the intensity of sacred beliefs. Objective: Theaim of this study was to report the frequency of tooth extraction and its pattern inPakistani orthodontic patients. Study Design: Descriptive cross-sectional. Setting: ArmedForces Institute of Dentistry (AFID), Rawalpindi. Period: 1st July 2012 to 30th June 2014. Material& Methods: The study sample consisted of 489 patients reporting to the orthodonticdepartment at AFID. Patients between the age of 7 – 21 years were selected. Patientsbeing treated with the extraction of permanent teeth (excluding third molars) wereincluded in this study. Data was analyzed using SPSS version 24. Descriptive statisticswere calculated. Results: A total of 296 patients did not require any extraction. Theremaining 193 patients required and experienced extraction of permanent teeth aspart of their orthodontic treatment plan resulting in an over-all extraction frequencyof 39.5%. Most of the extracted teeth were first premolars especially from the upperarch. Association of extraction status (extraction vs non-extraction) with gender wasfound to be statistically insignificant (p = 0.393). Conclusion: There is a moderatefrequency of extraction in the orthodontic patients with less than half of the totalpatients requiring extraction as part of their treatment.

Purpose Conflicts are inevitable in organizations and are a significant challenge for frontline managers (FLMs). This study aims to investigate the relationship between the leadership styles of FLMs and relationship conflicts (RLCs), with the indirect intervention of emotion regulation (ER) and five conflict-handling styles (CHSs). Design/methodology/approach Research data were obtained from 243 FLMs in the Pakistan textile industry. SPSS 23 and PROCESS macros software were used to test and verify hypotheses regarding leadership styles, ER, CHSs and RLC. The authors conducted 5,000 bootstrap replications to verify mediation. Findings Leadership styles are significantly associated with RLC. A high degree of ER can negatively moderate RLCs through transformational leadership (TFL) and transactional leadership (TCL) styles and positively moderate RLCs through a laissez-faire leadership (LZF) style. Among CHSs, a compromise style mediates the relationship between RLC and the TFL and LZF styles, and a domination style mediates the relationship between RLC and the TCL style. Practical implications FLMs should be trained to overcome workplace interpersonal conflicts. Appropriate cognizance of a conflict before it occurs is a requisite skill. FLMs must be able to use all five given CHSs. Originality/value This study identifies the association of leadership styles with CHSs and ER to manage RLC in a non-Western context. The study enhances understanding of the use of the ER factor with the different CHSs of FLMs.

In Computer Aided Diagnosis (CAD) tools, vertebra localization and detection are the essential steps for the diagnosis of cervical spine injuries. The accurate localization leads to accurate treatment, which is more challenging in case of poor contrast and noisy radiographs. This paper targets c-spine radiographs for the localization of vertebra using different vertebra templates, vertebra detection at each level using two different clustering techniques and gives a comparison between them. Moreover it separates the regions for each individual c-spine. It takes the poor contrast x-ray as input, enhance the contrast and detect the edges of enhanced image. After the edge detection, manually selected Region of Interest (ROI) helps in getting the edges of area covering C3 – C7 only. These edges along with 4 different template models of vertebra are used for the localization by Generalized Hough Transform (GHT). The results obtained are analyzed visually for the best localization template. Then, on voted points obtained after pruning, two clustering techniques Fuzzy C Means and K-Means are applied separately, to form clusters and centroids for each vertebra. Another part of this paper is to separate vertebra regions. For this, intervertebral points are calculated and then along these points, centroids are rotated using Affine Transformation. It gives parallel lines to vertebrae and joining them gives region for each vertebra. The comparison and testing of proposed technique has been performed using dataset ‘NHANES II’ publicly accessible at ‘The National Library of Medicine’, total 150 cervical spine scans are used securing accuracies 93:76%, 84:21% and 83:1% for FCM, K-Means and region separation, respectively.

Among the Health care associated infection (HCAI) Surgical Site Infection(SSI) is one of the most common complications occur after surgery and increases mortalityand morbidity rate. The objective of this study is to identify the common causative organisminvolved in postoperative wound infections along with their sensitivity and resistivity patterns.Study Design: Prospective cross sectional study. Setting: Tertiary Health Care setup inKarachi, Pakistan. Period: Six month from April 2016 till September 2016. Method: A total of100 patients are included in this study that underwent various surgical procedure. Result: Inthis study E. coli isolated from 32% of cases followed next in frequency by S.aureus in 16%,Coagulase negative Staphylococci in 14 %.the other less common pathogen involved Klebsiella,P. aeuroginosa, Enterococcus & Acinetobacter, Enterobacter, Streptococcus group D. AmikacinIimipenem and Meropenem is found to be of more Sensitive against E. Coli while Ampicillin andco trimaxazole showed higher resistivity against E. coli or other various organism. Teicoplannand vancomycin and linzolid have shown absolute sensitivity to various pathogens. Penicillinis found to be highly resistant against Coagulase negative Staphylococci. Conclusion: E.coli is the most common pathogens involved in Post-surgical Infection Amikacin, imipenem,Meropenem, Teicoplann, vancomycin. linzolid is found to be more Sensitive against variousorganism isolated in our study. Acinetobacter are highly resistant to various drugs while P.aeuroginosa have also shown optimal sensitivity pattern against various groups of antibiotics.Present study signifies the adaptation of antibiotic combination in rational way for prophylacticuse and the exploitation of a synchronized system of surgical wound management and cure.

Drug-drug interaction (DDI) is a specific type of adverse event, which developsdue to multiple regimen therapy, and that may lead to significant hospitalization and death.Clinical and economic impact of drug interactions are increasingly accredited as a chiefconcern in critical care. Potentiating effects of DDIs in intensive care units are far more criticaldue to complex medications regimen, high risk severely ill population and associated metabolicand physiological disturbances which can impede drug effects. Pharmacist contribution isclassified as clarification of drug order, appropriate drug information provision, and advice forsubstitute treatment. A multidisciplinary approach is very necessary in developing a pharmacotherapeuticregimen designed to optimize patient outcome and minimize any potential dugdrug interactions. This review encompasses the prevalence, categorization, significance interm of patient safety and prescription efficacy, clinical and economic burdens, national andinternational data comparisons related to drug-drug interactions.

The solution for safe and rational medication use to improve patient care aswell as to enhance public health status is Pharmacovigilance (PV). Optimal care of patientand appropriate medication utilization in secure way with respect to various conditions is animperative function of pharmacovigilance system. PV mainly involves in the adverse drugreactions (ADRs) identification, system of reporting, scrutinizes the effectiveness of treatment,reduces the adverse consequences to utmost level and guarantees the patient wellbeing.The safety of drug is highly essential factor when it comes from the healthcare provider to thepatient. For a drug to be successful in market, it is crucial for it to be efficacious as well as safeand secure for the patients. Hence, adherence toward pharmacovigilance activities and systemis now based on a paradigm change from care to safety.

While antecedents of impulsive buying behavior have been addressed by existing literature, the current study investigates the impulse buying of organic food through indirect effect of social appeal and media richness of website on relationship between consumer attitude and online impulse buying behavior. In total, 270 individuals from Beijing, China were approached and in response 197 valid responses were collected. Data were collected in the span of two months (September and October, 2018) through online questioannaire placed on Wechat, a famous social media platform. Results revealed a significant moderation of social appeal as social communities and forums influence consumer attitude in both cognitive and affective extents. A websites with highly media richness can increase impulsive decisions and can convert intentions into buying. Results instigate professionals of virtual marketing to review schemes to deal modern consumers by developing websites with social learning mechanism, user-friendlier and visually appealing to push organic intake.

Evolution of social media provides a great opportunity for marketers to investigate social factors that influence customer’s engagement in electronic Word-of-Mouth (eWOM) via social networks. Given the collaborative nature of Social Networking Sites (SNSs) such as WeChat, Weibo, and QQ. This study investigates how social factors relate to eWOM in SNSs. The homophily and tie strength are found as important antecedents of eWOM in SNSs environment. The results confirm that the homophily have positive direct influence on eWOM. In addition to that, the homophily have positive indirect impact on eWOM, through mediation of the tie strength. This study represents a unique effort to focus on the combined direct and indirect effects of the homophily on eWOM. The implications for practitioners and marketers are discussed.

 Abstract—In global software development partitioning of work into tasks and proper allocation of those tasks to sites are important factors to maximize the benefit of GSD and to cope with its challenges as well. This paper presents a mathematical model based on minimizing the cost and time and load balancing in global software development. It uses multi level clustering technique to reduce the inter-communication cost and optimally assign tasks to the sites. Primarily clustering is done for work division and secondly clustering is done at time of allocation of tasks. Task and site attributes are also considered during clustering. This model is implemented using MATLAB tool and task allocation example is used to compare its performance with other task allocation.

The purposefulness of this study is to investigate the relationship between leadership styles of frontline managers (FLM) and interpersonal conflict, with direct and indirect intervention of emotional intelligence (EI). Research data were obtained from 211 frontline managers from banking sector of Pakistan. SmartPLS 2.0, a second-generation structural equation modeling technique was used to test and verify hypotheses. Results indicate that leadership styles are significantly associated with interpersonal conflict. Using High EI can negatively moderates interpersonal conflicts through transformational and transactional leadership style. However, the least preferred style of FLM is laissez-faire style and found to be insignificant with interpersonal conflict. This research provides imperious insight towards significance of FLM in banking industry. They should be trained to overcome interpersonal conflicts; appropriate cognizance of a conflict before it erupts and escalates can be an exquisite skill. This investigation contributes to the literature by identifying association of leadership styles with EI to cater interpersonal conflict in a non-western context. Current study enhances mindfulness of FLM by practicing emotional intelligence factor with leadership styles to overcome interpersonal conflict.

Irrational, over and misuse of antibiotics arise as global concern in both hospital and community settings and lead to adverse events including antimicrobial resistance, associated health problems, amplified hospitalization stay and cost. Hence, Drug Utilization Evaluation (DUE) studies are designed to evaluate and improve the prescribing, administration and the rational use of medications. The present study was designed to assess the pattern of antimicrobial drug utilization in in-patients cohort of tertiary care setup in Karachi, Pakistan. This cross sectional observational study was conducted in retrospective manner. World health organization (WHO) guidelines and criteria are considered to evaluate the appropriateness of drug use in various disease conditions. ATC/DDD system was applied to determine the study outcome. High frequency of antibiotics utilization found in respiratory tract infections of both lower (LRTI) 16.8% (n=42) and upper (UTI) 13.2% (n=33). The estimated total number of drug units administered per month was greater with cefixime (46) and ciprofloxacin (45) both. DDD/100 bed days drug utilization of antibiotics was higher with ciprofloxacin, cefexime and meropenem (47, 46 and 29.25) correspondingly. In conclusion, the current investigation signifies extensive scope for progress in prescribing trend. Drug adherence to customary guidelines of disease management and constraint policies to endorse judicious drug use may be considered vital in healthcare setup.

Drug-drug interactions (DDIs) are extremely significant concern, particularly in sensitive population including pediatric and geriatric. Propensity for the development of DDIs is high in patients admitted at intensive care units (ICU). This study was conducted to evaluate the DDIs incidence, facts and measures in ICU. From a total of 150 cases studied for ICU patients, with the mean age of 56.37±12.45 years, 55.33% were male and the rest were female 44.66%. The demographic information like age, gender and main diagnosis details of study participants that were extracted from the patients' clinical record. A statistically significant association between the drug interaction and the number of drugs prescribed per prescription was observed (p0.0001). Concerning the onset of outcome, 52% of DDIs distinguished as delayed onset of effect (past 24 hours) and 35% were categorized as rapid onset (within 24 hours). Despite the facts regarding patient safety and minimizing DIs error, polypharmacy is still frequent in critically ill patients admitted in ICU attributed high risk of adverse reactions due to use of multiple interventions to treat severity of disease condition. Such studies may be used to develop an effective tool for the diagnosis and management of DDIs.

Among the well-known Health care-associated infections (HAIs), surgical site infections (SSIs) contribute to considerable high mortality and morbidity rate, substantial prolongation in hospitalization period and extra expenses in terms of treatment cost. This study was aimed to evaluate the predictive variables associated with surgical site infections, and their clinical consequences. This was a prospective, cross sectional study conducted in the surgical department of tertiary care setting in Karachi, Pakistan. Each patient was followed up from the time of admission until time of the discharge postoperatively for 30 days. A total of 554 surgical procedures were performed and 81 SSIs were identified. The predictor variable/risk factors significantly associated with the presence of SSI were age, gender, BMI, ASA score, co-morbid condition, surgical wound class, emergency surgeries, duration of surgery, type of anesthesia, prosthetic implant, pre operative length of stay and pre operative blood transfusion. Outcomes of such studies may be utilized in the design of a multi factorial practice to get better patient's safety and clinical outcomes.

Drug utilization pattern is premeditated to evaluate appropriateness of drug usage. The current study was performed in a multifaceted tertiary care setting in qualitative and cross sectional manner between January to June 2016. In the present study, the proportion and rate of antibacterial prescribing was found to be comparable to other studies conducted in the recent past. The standard integer of remedial moieties per encounter was also found to be elevated when compared to the analogous investigations carried out in various regions of the world at secondary and tertiary care levels. Patient medical charts were retrieved and retrospectively analyzed to extract relevant data. Demographic variables, gender, age, hospital stay, residing ward were taken into consideration. Whereas other variables for ciprofloxacin, meropenem and amikacin were studied with respect to initial/final diagnoses, administered dose, duration of treatment, dosing interval, frequency of administration, microbial culture/sensitivity test and multiple therapeutic regimen. Outcome measures composed of clinical outcome with respect to therapeutic success or failure. An approximation range of 48-59 % of one additional antibiotic and 30-36 % with two or more drugs was found to be for ciprofloxacin, meropenem and amikacin in selected patient’s cohort during their hospitalization period. Prophylactic, empiric and specific use of ciprofloxacin, meropenem and amikacin were in order of 17-39, 12-22 and 30-43 %. Study results highlighted the need for educational intercessions, development of robust and standard utilization guidelines for antibiotics, which could help overcome irrational practice.

Dengue a majorly imperative arthropod-borne infection of viral origin has stroked the humans Worldwide. It has been estimated that about 2.5 billion inhabitants are at threatened by this infection around the globe. Dengue fever has become pandemic-prone viral disease prevailing all over subtropical and tropical regions. Majorly four characteristics of closely related serotypes of dengue are DENV-1, DENV-2, DENV-3 and DENV-4. Dengue fevers pass on by the bite of an infected female Aedes aegypti mosquito. The topmost ailments include; internal bleeding, Dengue Hemorrhagic Fever (DHF) which may lead to Circulatory Shock Syndrome (CSS), high temperature, cold like illness, urticaria, severe joint pain, thrombocytopenia and heme-concentration. From the recent years, this "break-bone fever" has become out breaking viral disease in Pakistan because Urbanization provided the ideal environment for these mosquitoes which includes presence of stagnant water in indoor drainage holes, contaminated water for drinking, poverty, immune compromised individuals and insufficient medical facilities. Such causative factors embrace viral disease that brings about high rate of mortality and morbidity. But nowadays, rational prescribing and the facilities provided by pharmaceutical care has become necessary element of health care for achieving definite outcomes that can improve a patient's quality of life.

The clinical and economic features of Ventilator-Associated Pneumonia (VAP) are quite unclear, with an extensive array of values and contradictory results. The real challenge in this connection is to present the real estimate of the clinical and associated economic consequences of VAP. In developing countries like Pakistan, it is important to formulate an optimal institutional antimicrobial policy that can be used as a guide for empirical/prophylactic and specific therapies of antibiotics in VAP with more rational approach to lessen the rates of mortality and morbidity, decline the length of treatment and hospitalization and the significant impact in prevention of development of multidrug resistant strains and cost reduction.

This paper aims to investigate the relationship of team leader's emotional intelligence (EI) with indirect intervention of five conflict-handling styles on interpersonal conflict. Totally, 213 out of 300 team leaders completed a paper-based questionnaire with 71% return rate. SPSS 23 and PROCESS MACRO to test mediation, 5,000 times bootstrapping with cross-sectional research design was used. Results show that EI is negatively and significantly associated with interpersonal conflict. High EI team leaders are better able to address interpersonal conflict. Furthermore, integrating style mediated relationship between EI and interpersonal conflict. This study provides a broad insight for leader's EI abilities and conflict management techniques. It contributes to the literature by identifying significance of EI for team leader and its effects on interpersonal conflict through five handling styles in a non-western context. This study enhances understanding of conflict situations and appropriate style selection to cater interpersonal conflict in telecom industry of Pakistan.

While existing literature has addressed the antecedents of impulsive buying behaviour, this research study investigates the impulse buying of organic food through mediating effect of social appeal on the relationship between consumer attitude and online impulse buying behaviour and whether this mediated relationship is moderated by website personality. In total, 600 respondents were asked to fill online survey questionnaire, however, 423 valid responses were collected in Beijing, China. Data were collected in a period of three months from October-December 2017 by survey questionnaire placed on frequently used social media platform like Wechat, QQ and Sina Weibo. Results revealed a significant full mediation in a positive relationship. This mediating effect of social appeal is further moderated by website personality. Results instigate online marketing professionals to review their tactics to deal with modern consumers by developing websites with social learning mechanism, user-friendlier and visually appealing to push organic intake.

Products of Non-steroidal anti-inflammatory drugs (NSAIDs) are principally and most widely utilized due to their multipurpose actions, i.e., analgesic anti pyretic and anti-inflammatory effect. Beside their therapeutic effect their toxic effect based on their selectivity of cyclooxygenase (COX) enzyme. While cardiovascular toxicities associated with NSAIDs are mainly related with COX-2 selective inhibitor and primarily dependent on their dose time and duration. Variability in therapeutic response and susceptibility to toxicity is well recognized and can be manageable if considerable precautions implement.

Objective: To signify the risk factors, treatment complexities, economical and clinical scenarios related to Surgical Site infection (SSIs). The second most common health care associated infection is the Surgical Site infection, which may increase morbidity and mortality rate among surgical patient and produce a greater influence on length of stay during hospitalization, readmission and economic cost. Method: A methodical literature investigation was conducted to recognize the extent of studies in relation to SSI. Procedural details of SSI, quality attributes in term of various components of SSI were assessed. Results: The incident rate reported in different countries shows divergent variation because of the numerous systems integrated in the epidemiological control of Hospital acquired Infection. Staphylococcus aureus is most frequent pathogen associated with SSI. Increased treatment cost is mostly associated with additional length of hospitalization and supplementary diagnostic testing’s, extra medication/antibiotic utilization and maybe any other minor surgical procedure in certain conditions. Conclusion: This Literature review elaborates the risk factors, classification, economical and clinical scenario and also demonstrates the treatment challenges in various perspectives.

Objectives To analyze the factors leading to obesity in school children and to assess the role of Physical therapist in health education in schools Methods It was a cross sectional study and factors leading towards obesity among school - going children aged 13 - 16 years were analyzed. A total of 300 students were selected from different schools of Karachi through Convenience sampling technique. Data entry was done on SPSS version 20 and frequencies and percentages were taken as descriptive statistics for categorical variables. Results 300 participants were included in the study where girls were 53.7%and boys were 46.3%. It was found that majority 40% of the children come under the category of normal BMI while 37% were overweight and obese. In addition, 55% of the children had a positive family history of obesity. It was also interesting to find out that 46% students were not participating in any physical activity and 45% schools didn’t even had the PT period in their schedule. Furthermore, 91% students were consuming regularly. Conclusions Our study concluded that the major risk factor of obesity in 13-16 years children is lack of physical activity. However, usage of junk food is also increasing in this age group. Furthermore genetic predisposition cannot be ignored. It was further noticed that most of our children are having less sleep than recommended which itself has a very strong relation with weight gain.