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Abstract Background Patent ductus arteriosus is one of the most common cardiac conditions affecting the neonates. Considering the lack of studies done on this topic in healthcare settings in Khyber Pakhtunkhwa province, this study aims to find out the comparative effectiveness of paracetamol and ibuprofen in management of PDA in our healthcare setting to conclude a better management option for the condition. Objective To find and compare the effectiveness of paracetamol and ibuprofen in the closure of patent ductus arteriosus in preterm neonates. Methodology This randomized controlled trial was conducted in the Department of Nursery and Neonatal Intensive Care Unit, Khyber Teaching Hospital, Peshawar, Pakistan, from 10th April 2024 to 10th October 2024. A total of 256 neonates of both genders with patent ductus arteriosus were included. Group A received oral paracetamol, and Group B received oral ibuprofen. The effectiveness of the treatments was evaluated at the end of the treatment period. Results The age range in this study was from 48 to 96 h, with a mean age of 71.79 ± 13.10 h in Group A and 73.40 ± 11.81 h in Group B. Efficacy was observed in 107 (83.6%) patients in Group A compared to 90 (70.3%) patients in Group B, showing a statistically significant difference (P = 0.011). Conclusion Our study has concluded that paracetamol is more effective than ibuprofen in closing patent ductus arteriosus. The trials were retrospectively registered at NIH Trial Registry (NCT06601114) https://clinicaltrials.gov/study/NCT06601114 dated 15/09/2024.

The primary objective of this article is to examine the effect of discrete heating on MHD double-diffusive convection and thermal radiation of ternary hybrid nanofluid flow heat and mass transfer in a vertical cylindrical annulus along with Arrhenius activation energy and chemical reaction. In this study, the cavity inner wall has two distinct flush-mounted heat sources, while the outer wall is isothermally cooled at a lower temperature. The top and bottom walls are thermally insulated. The ensuing equations that govern the physical framework are solved using the implicit Crank-Nicholson finite difference technique. As the heater advances upward, the flow intensity decreases, leaving a part of the fluid static at the bottom of the cylinder. Because more heat induces high buoyant flow in the annulus, the absolute value of axial velocity and wall temperature rises as the length of the heat source rises. Enhancing the values of activation energy parameter drops the Arrhenius energy function, elevating the pace of the generative chemical process and hence the concentration. Increasing the thermal radiation parameter lowers the surface heat flux while enhancing the nanofluid temperature. The Brownian motion parameter corresponds to the random motion of nanoparticles in a fluid, and this irregular movement augments the collision of nanoparticles with fluid particles, causing the particle's kinetic energy which leads to thermal energy and hence increases temperature. Also, the heat and mass transfer characteristics are forecasted and analyzed by considering the Levenberg–Marquardt backpropagating artificial neural network technique.

The aim of this research work is to estimate and analyze the solution of rheological chemical reactive Carreau nanofluid (CNRFM) induced by exponentially extended surface (EES) subject to variable physical attributes by using stochastic analysis on Levenberg Marquardt backpropagation neural networks (SALMBNNs). The non-linear Partial Differential Equations (PDEs) are transformed by using the similarity transformation variables into their corresponding ODEs. The reference values are created with ARK (adaptive Runge-Kutta) scheme. The ensuing results are explained for the variable viscosity, Weissenberg number (material number), Brownian movement factor, LRF (local rotation factor), LN (Lewis number) and activation energy with chemical reaction in addition. Numerical calculations of different physical quantities are approximated with artificial intelligence based SALMBNNs from dataset created with ARK method. The convergence, accuracy, and efficiency of the proposed stochastic analysis on Levenberg Marquardt backpropagation neural network (SALMBNNs) are established and endorsed through iterative learning curves at each incremental step in epoch, statistical instance distribution studies of error-histograms, analysis of adaptive controlling parameters of SALMBNNs, and evaluation of regression metric.

Our study delves into the dynamics of a convective Magneto-Hydrodynamic Bioconvective Nanofluid model (MHD-BCNFM) flowing over a convectively heated stretched sheet. To accomplish this, we utilize the distinctive capabilities of the Supervised Stochastic Approach for Computational Analysis (SSACA). By integrating similarity transformations, we convert the partial differential equations (PDEs) governing the system into coupled ordinary differential equations (ODEs). We generate the dataset for our approach using the Adam numerical technique specifically tailored for the (MHD-BCNFM). Achieving this involves systematic modulation of parameters such as λ, bioconvection Péclet number Pe, Bioconvection constant σ, Brownian motion parameter Nb, and thermophoresis parameter Nt. ''Moreover, we utilize a reference dataset to compute numerical values of various physical quantities in the (MHD-BCNFM) employing SSACA-based Artificial Intelligence methods. The effectiveness of our devised SSACA approach is demonstrated by a negligible mean squared error, ranging from approximately 10−8 to 10−10. Histograms exhibit a maximum error range of 10−5, closely aligning with optimal correlation/regression measures. Outstanding performance metrics in terms of Mean Squared Error (MSE) are attained at levels such as l 9.93E−12, 1.07E−11, 6.28E−10, 1.43E−11, 2.09E−09, 3.65E−11, 2.97E−11, and 2.80E−13 against 320, 430, 209, 85, 356, 295, 66, and 136 epochs. A comparative study between the proposed and reference datasets underscores the authenticity and precision of SSACA, supported by error analyses ranging from E-05 to E-09 across all scenarios.

This study investigates fluid flow and natural convection heat transfer in a parallelogram-shaped cavity with a porous medium under non-uniform temperature condition. The bottom wall is heated with a non-uniform temperature, the side walls are cooled, and the upper wall is adiabatic. The governing equations, along with corresponding boundary conditions, are formulated in dimensionless stream function and vorticity using the extended Darcy model for the porous medium. The equations are solved by employing the finite difference method. The study presents outcomes for isotherms, streamlines, and Nusselt numbers across range of parameters, including the Rayleigh number (104≤Ra≤108), Darcy number (10−1≤Da≤10−6), Prandtl numbers (Pr=0.71,1,7.1), fluid porosity (ϵ=0.8), and inclination angles (30∘≤ϕ≤90∘), about flow and heat transfer characteristics. The results indicate that an increase in Ra, Pr, and ϕ, along with a decrease in Da, leads to an enhancement in the strength of vortexes. It is observed that for constant Ra⁎=RaDa, Rate of heat transfer increases with an increase in Ra and a decrease in Da. The maximum value observed is 10.15. Also rate of Heat transfer increases with the increase in angle and maximum rate of heat transfer is observed at ϕ=90∘.

Thermal management is very important in engineering applications to improve the systems’ performance and to reduce the environmental impact. This research works to establish the convective heat transfer coefficient (CHTC) of new improved ternary hybrid functionalized nanofluids with CuO, Fe2O3, and SiO2 nanoparticles in polymeric fluid. The investigations are aimed at the use of the state-of-the-art AI techniques for predicting and simulating the heat transfer processes in radiated channels as well as incorporating the effects of viscous dissipation and radiation. A new computational process tools up Python, Mathematica, and MATLAB to solve the transformed system of PDEs a LMNNA. These results support the qualitative understanding regarding flow rate dependency on R but dependency of flow rate on γ. Likewise, temperature profiles increase with increase in Eckert number (Ec) and Prandtl ratio (Pr) but decreases as radiating parameter (Rd) increases. The use of AI in creating the simulations is more accurate for prediction than traditional numerical methods with an improved MSE of up to 10−14 through the Python model. With focus on technological advancements in the field of thermal heat, these studies show great promise of THF in enhancing rate of heat transfer-issues which complete several energy storage systems, cooling techniques in aeronautics as well as electric vehicle operational convenience via thermal layout.A synergetic composition of three distinct nanomaterial oxides of Copper, Iron and Silicon in engine oil, contributes unique thermophysical character in thermal management. Advance computational technique with combination of AI with Python, Mathematica and Matlab (AIPMM) employing Levenberg Marquardt Neural Network Algorithm (LMNNA), is used for solving a transformed system of ODEs, which was obtained from the system of PDEs of present model. Dataset generated from Python and Mathematica is filtered and embedded into LMNNA for evaluation and comparison of results.Temperature and flow rate profile are analyzed against variations in sundry characteristics. The profile of flow rate shows it increases with fluidity parameter R and decreases with increasing deviation parameter γ. Temperature outline shows it enhances with Eckert Ec and Prandtl Pr ratio but decreases with increase in radiating parameter Rd.

Owing to enhanced features of nanomaterials, various applications of such materials have been suggested in the thermal systems, heat exchanges, electronic cooling systems, coolant processes, energy production etc. Following to such motivated applications, the objective of current analysis is to presents the bioconvective double stratification flow of Sutterby nanofluid due to bidirectional moving surface. The thermal interpretation of problem is subject to utilization of radiative effects, activation energy and heat source. The observations for heat, mass and microorganism's assessment are performed by using the convective boundary conditions. Shooting numerical simulations are performed for modeled problem. It is noticed that heat transfer enhances due to thermal stratification parameter. An increment in mass transfer is subject to larger values of mass stratification Biot number. The claimed results offer significance in controlling the heating and cooling processes, thermal devices, energy generation, manufacturing developments, solar systems etc.

This article explores the enhancement of thermal exchange in a dissipative Triple-nanoparticle (Al2O3+CuO+Cu) hybrid fluid over a stretchable wavy cylindrical surface with slip effect, incorporating Python bvp algorithm with artificial intelligence AI analysis of numerical results. The stochastic AI analysis gives the enhanced and optimized results with predictive modeling, incorporating randomness of influencing parameters and nonlinear turbulent behavior of model. The model has significant importance and application in noise reducing and drag reduction devices or structures. Moreover, the presented geometrical structure is useful in enhancing thermal conduction characteristic. The intricate interplay of constituent nanoparticles and their effect on complex heat transfer in drag optimization devices is the main focus of this study. Mathematical Model of PDEs of this flow problem is converted into system of ODEs by similarity transformations with introducing dimensionless parameters. Numerical solutions of the emerged system are obtained by Python bvp solver algorithm and graphical solutions by Python are presented. To expedite the solution process and enhance the accuracy of prediction, advanced AI algorithm, such as neural network and machine learning technique is adopted. Numerical dataset obtained from Python is embedded for further AI analysis by using Levenberg Marquardt Feed-forward Algorithm (LMFA) with 10 computing neurons and 4 output layers representing results for 4 parametric variations.A rise in the fluid flow speed is observed with higher of value yield stress or Newtonian-behavior i.e. of Casson parameter a1 and stretching parameter λ for the sheet, but shows a decline with enhancing turbulence s2. Temperature profile show a descending behavior with inclination of Eckert ratio Ec, and Prandtl ratio of momentum-thermal diffusivity.

Background: Human Papilloma Virus (HPV) is found in the oral tobacco chewers with precancerous lesions such as submucous fibrosis (SMF), leukoplakia and erythroplakia. Trismus is a common symptom seen in patients with SMF and oral cancers. In Pakistan the risk of oral cancers has been raised up to 8.5 to 10 times due to increase in tobacco chewers in the recent years. Objective: To determine the frequency of oral HPV infection in chewable tobacco users with trismus living in the lowincome areas of Karachi. Methods: Camps were set up in 5 different areas of Karachi. In each camp, 100 people were examined for oral lesions by experienced volunteers. Oral rinse (40ml) was taken after gentle brushing over the lesions. DNA was extracted and PCR was performed using Gp5+/Gp6+ consensus primers. The results were analyzed on SPSS version 17.0. Results: Out of 187 subjects with trismus, 157 (84%) were males and 30 (15.51%) were females with average age of 28.7 years (12 -70 years). Gutka, Naswar, Chalia and Paan users were 45.45%, 37.56%, 12.83% and 6.95% respectively. Mild trismus was found in 113 (60.43%) subjects followed by moderate trismus in 52 (27.81%) and severe trismus in 22(11.76%). Out of total 36 (19%) HPV positive subjects, 27(14.44%), 7(3.74%) and 2(1.07%) had mild, moderate and severe trismus respectively. 150 controls tested negative for HPV. Conclusion: The frequency of HPV in oral cavity was high in subjects with trismus suggesting risk of oral squamous cell carcinoma. HPV in subjects with moderate to severe trismus should be tested in blood because it is difficult to get suitable oral sample. Key Words: Trismus, Human Papilloma Virus, Submucous Fibrosis (SMF), Chewable Tobacco.

Passive cooling of photovoltaics (PV) using phase change materials (PCM) may be extremely effective owing to their enormous implicit specific heat. However, the low rate of heat transfer, high solar radiation, and ambient temperature drop its efficiency by 0.45%/ᵒC. Only such a small fraction of solar irradiance is turned into electrical energy by PV cells; most of the irradiation is transformed into heat; hence, cells start operating above ambient temperature. Therefore, the exterior heat of photovoltaic panels is controlled by applying artificial cooling to enhance their efficiency. The current research aims on the significant benefits of using PCM to reduce panel surface temperature in terms of boosting energy efficiency and maintaining thermal comfort. This study demonstrates a successful design of PV controlled-temperature module using phase change materials for hot climate, especially for south Asian regions. The surface temperature of solar panels has been reduced using computational analysis and experimental study on paraffin wax. In this work, Paraffin wax used, which reduced the panel surface temperature by 5-7ᵒC, generating a 29% increase of the modified PV panel relative efficiency compared to its standard value.

Abstract Background: The occurrence of native coronary artery vasospasm after coronary artery bypass grafting (CABG) is a rare phenomenon with potentially catastrophic outcomes. The absence of a clear understanding of contributing factors and an undetermined occurrence rate underscores the importance of coronary angiography as the primary diagnostic tool for this condition. Case Presentation: We present the case of a 70-year-old Asian male with a 14-year history of diabetes mellitus, seven years of Giant Cell Arteritis (GCA), and Ischemic Heart Disease (IHD). The patient experienced severe native coronary artery vasospasm following conventional CABG, prompting intervention through coronary angiography. Management & Results: The patient underwent coronary angiography, revealing multivessel coronary artery vasospasm. Intracoronary administration of nitroglycerin and diltiazem was initiated promptly. The swift identification and treatment of vasospasm were instrumental in preventing severe myocardial injury. Conclusion: Coronary artery vasospasm post-CABG poses a significant threat, emphasizing the need for early identification and intervention. The successful management presented in this case underscores the importance of timely recognition and the administration of vasodilators in mitigating potential myocardial damage. This report contributes to the growing understanding of this rare but critical complication, highlighting the necessity for vigilance in post-CABG patient care.

Inflammatory myofibroblastic tumors of the bladder (IMTB) are rare neoplasms that can occur in children. These tumors have uncertain malignant potential and can present similarly to bladder sarcomas. It is important to differentiate between IMTB and bladder sarcomas using a careful immunohistochemical approach. We report a case of IMTB in a 12-year-old girl who presented with presyncope and gross hematuria. IMTB was diagnosed through immunohistochemical analysis, and clinical improvement was observed after resection of the tumor.

The study of nanofluids has remarkable uses for researchers because of their fascinating implications in medication delivery, biotechnology, aerodynamic procedures, food privilege, nanotechnology, cool atomic reactors, chemotherapy, next generation film collectors and many more. Currently, the bioconvection technology is measured as a necessary procedure with suppressed compensation in bio-fuel, bio-technology, medical sciences, enzymes, bio-reactors, petroleum chamber machinery, nano-drug delivery, etc. The foremost plan of this exploration is to evaluate the influence of magnetohydrodynamics 3-dimensional flow of tangent hyperbolic nanofluid with gyrotactic motile microorganism through a linear stretching surface. Furthermore, the impressions of mixed convection, Joule heating along with viscous dissipation are as well a part of our research. The analytical expression of tangent hyperbolic liquid flow provides the governing non-linear partial differential equations; a proper transformation is used to transmit this system of equations in ordinary differential equations. To find out the numerical solution, the dimensionless equations are determined by means of BVP4C technique in MATLAB. The influences of miscellaneous substantial parameters on temperature, concentration along with motile microorganisms are accomplished by means of graphs. It can be observed that the heat transfer profile of tangent hyperbolic nanoliquid escalates by increasing the approximations of Eckert number, heat sink/source and power law index factor. A conflicting behavior is observed for Brownian motion parameter, stretching rate parameter along with Schmidt number in concentration profile. Furthermore, Peclet number and bioconvection Lewis number have decreasing impacts for microorganism profile. These nano fluid models with gyrotactic microorganisms are implemented in biodiesel fabrication, heat control systems, food factories, biomechanics, biomedical engineering, thermal exchangers, waste water treatment plant aero dynamical systems, and fundamental sustainable energy resources.

The design variables are optimized to improve the overall performance of wireless power transfer (WPT) coils or couplers. However, failure to consider their uncertainties and tolerances will lead to variations in the performance targets of a WPT system and mass-scale production of couplers cannot afford performance variation from one coupler to another. Therefore, this article proposes a stochastic-based optimization method to incorporate the uncertainties and tolerances of design variables into the optimization process to realize a robust WPT coupler. The proposed robust optimization methodology is compared with the existing deterministic optimization methodology to achieve reduced transmitter and receiver side current harmonics, maximum efficiency, and minimum leakage magnetic field. The results demonstrate that the design resulting from the robust optimization has 1.59% and 1.66% fewer harmonics distortion in the receiver and transmitter side currents compared to the deterministic optimization, along with coil-to-coil efficiency of 96.5% and leakage field of 7.4 μT measured 650 mm from the center of the coupler. Moreover, the fabricated coupler from robust optimization has a superior efficiency profile under load variations.

Coupler parameters, such as transmitter inductance (LTx), receiver inductance (LRx), and the coupling coefficient (k) or mutual inductance (M), vary with the misalignments. Their variations must be quantified and incorporated into the design and optimization stage as they impact performance indices such as efficiency and leakage magnetic field. Most of the solutions proposed in the literature compromise the performance of the coupler in search of a misalignment-tolerant design. Therefore, this article presents a method to incorporate the misalignments into the design and optimization process of an inductive power transfer (IPT) coupler by utilizing robust optimization, where misalignments are considered as noises or disturbances or uncertainties to a perfectly aligned coupler. The optimized designs resulting from this method will not compromise the performance of the coupler in search of a misalignment-tolerant design. Effectiveness of the proposed robust optimization method is experimentally verified with a 3.7 kW hardware prototype.

Character of activation energy and nanofluids has a prominent significance in the field of oil reservoir, chemical engineering, geothermal engineering, heat exchanger, food processing, heat and mass transportation and cooling devices. The aim of current study is to present the mathematical modeling and numerical solutions of three dimensional flow of Sutterby nanofluid past a bidirectional moving surface under the influences of mixed convection, binary chemical reactions, viscous dissipation and activation energy. Boundary layer theory is abduced to model the physical problem in the form of partial differential equations. The obtained partial differential system is metamorphosed into ordinary differential system by operating appropriate conversion. Fehlberg Runge Kutta scheme is applied to derive the numerical simulations of reduced non-dimensional differential model. It is gripping to explore that fluid velocities f′(η) and g′(η) have opposite behavior due to the enrichment of Sutterby fluid parameter β₁. Additionally, higher approximation of chemical reaction parameter and activation energy parameter has reverse trends on nanoparticle concentration.

The main purpose of this study is to present the mathematical modeling of steady three dimensional boundary layer flow of incompressible non-Newtonian Cross nanofluid over a bidirectional stretching surface. The Buongiorno nanofluid model and Cattaneo-Christov heat flux model are also assumed in present work. It is considered that bidirectional stretching sheet is embedded in Darcy-Forchheimer porous media. Additionally, the motion of fluid flow is induced due to the bidirectional stretching surface. Boundary layer theory is invoked to model the basic partial differential equations of current study. The modeled partial differential equations are reduced to ordinary differential equations with the assistance of appropriate transformation and then solved numerically through Runge Kutta Fehlberg scheme along shooting method. The ranges of involved physical parameters in present study can be explained as 0≤βT≤0.08,0≤βC≤0.25,0≤Fr≤6.0,0≤β≤4.0,0≤We₁≤1.0,0≤We₂≤1.5,0≤Nt≤0.4,0.1≤Nb≤1.2,0≤n≤2,0≤δ≤1.2,0.7≤Pr≤6.2,1≤Sc≤7. It is engrossing to reveal that surface mass transfer rate is an aggrandizing function of concentration relaxation parameter but reverse behavior is noticed for enrich thermal relaxation parameter. Additionally, fluid velocities f′(η) and g′(η) reduce due to the improvement of Forchheimer number and porosity parameter. Furthermore, magnitudes of the surface drag forces along x− and y− directions grow for larger approximation of Weissenberg numbers.

This work reported to investigate convective flow of non-Newtonian fluid effect on an exponentially stretchable surface. Effect of nanoparticle is considered in heat and mass equation. The transformation technique utilized on dimensionless equations is converted to non-dimensionless equations are solved thought numerical approach Bvp4c. Influence of approatiate analysis of velocities, heat and mass transport are scrutinized through figures. Furthermore, the comparative analysis of drag forces, Nusselt number and Sherwood number are evaluated over and done with tabulated values. It is give details that the temperature field strengthens with intensification in thermophoresis and random diffusions. Similarly, rises in thermophoresis effect parameter both temperature and concentration profile increasing.

Abstract Background Caffeine is a routinely prescribed pharmacological active compound in neonatal intensive care units (NICU) for treating apnea of prematurity (AOP), which also decreases the risk of bronchopulmonary dysplasia and cerebral palsy in neonates. Caffeine-induced excessive calcium loss can promote the development of metabolic bone disease (MBD) in preterm neonates. This study aimed to evaluate the effect of the caffeine regimen on the development of osteopenia of prematurity (OOP), using serum alkaline phosphatase (serum-ALP) concentrations as a surrogate marker at the 4th week of life. Methods This retrospective cohort study was conducted including neonates of

A theoretical analysis of electro-osmosis peristaltic flow of generalized Newtonian fluid bounded in a complex wavy divergent channel is performed. There are many complex rheological generalized Newtonian fluids, out of which Ellis fluid model is considered to approximate the fluid present within the channel. The flow equations are modelled using balances of mass and momentum while the body force term is introduced using well known Poisson equation. An analytical solution to the governing flow equations is presented and the closed form expressions for longitudinal velocity, flow rate and stream function are developed. The numerical solution of pressure rise is obtained via NIntegrate build in command of Mathematica 12.3. Influence of diverse rheological and electrical parameters on flow characteristics are analysed via plots.

Chalcogenide nanoparticles and their morphologies have contributed to the most prominent nano-chemistry field under their ease of fabrication and assorted appositeness. Herein, we demonstrate the two antithetic pathways viz., single source (S-S) and multisource (M-S) precursors to fabricate nanomaterial. The motive of the stated research work was to identify any alteration in morphologies of the resulting product by shifting the fabrication pathways. Wherefore, to deduct the results, photocatalytic activity (covered by full-spectrum versus four contrasting dyes) and battery application (electrochemical discharge/charge at voltage limits of 0.01 – 3.0 V against Li/Li+) of both materials have been executed. The nanomaterial gathered from the S-S protocol has an immense exterior area that acknowledges the photocatalytic activity rather than the product obtained from the M-S protocol.

A recent advancement in fluid dynamics is the consideration of nanofluids which has an extraordinary thermal conductivity characteristics and upsurge heat transfer in fluids. This paper examines the heat and mass transfer properties of a steady 3D movement of a sutterby nanomaterial on a bidirectional stretching plane. Nanoparticle mass flow and convective boundary conditions are deliberated. In addition, the effect of heat generation/absorption and non-linear thermal radiation is explored. Moreover, the latest proposed model of the nanofluid has been pondered which involves controlling the nanoparticle volume element at the wall submissively relatively than dynamically. We introduced a similarity transformation to change the equations of boundary layer to a self-similar system after that processed analytically with the help of the bvp4c scheme. The outcomes of several control parameters on heat and mass transfer properties are shown among graphs then scrutinized. The systematic outputs of the Nusselt number are premeditated via tables. We observed that by increasing the estimates of the Lewis number (Le) indicates a reduction in the concentration field as well as the thickness of the equivalent boundary layer. Similarly, it is seen that the concentration field decreases rapidly according to the Brownian motion parameter as compared to the Lewis number (Le).

Objective: To assess the attitude of resident and consultant Prosthodontists towards clinical decision-making in complete denture prosthodontics Study Design: A cross-sectional study. Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi, from Nov 2019 to Jan 2020. Methodology: Fifty trainee and consultant prosthodontists from all over the country were included in the study. A questionnaire consisting of 10 questions aimed at assessing the approach towards clinical decision-making in complete denture prosthodontics was circulated among the study subjects using Google Forms. Data was analyzed using SPSS version 24. Results: Around 20 (40%) prosthodontists regarded patient’s personal values and preferences to be “very important” in clinical decision-making in contrast to their own values. Most of the clinicians 47 (94%) believed their patients were quite satisfied with them and around 31 (62%) prosthodontists believed that “choice of the best treatment results from negotiation between patients and clinicians after they have shared technical information as well as their values and preferences about the options”. No significant difference was observed in choice of response between males and females or between prosthodontists with varying clinical experience for any of the questions asked (p>0.05). Conclusion: Prosthodontists participating in the present study demonstrated a positive attitude towards shared decisionmaking in complete denture prosthodontics. No differences were observed between males and females in terms of attitude towards shared decision-making practices.

Cardiovascular diseases are among the top leading causes of death worldwide. Most of the time, the patients present with no symptoms, or some symptoms resemble other diseases. This makes most cases challenging for physicians and healthcare workers to diagnose. Besides this, most of the time, not diagnosing the patient on time or delay in the start of intervention is the main cause of death in cardiovascular diseases. Proper history and examination can play a crucial role in this part. History taken in properly can help in reaching the diagnosis. Apart from this, it also helps in the start of empirical therapy. This is where most clinicians are lacking. Waiting for the labs is still time-wasting in other health issues, but it can be killing in cardiac patients. Thus the cardiologist needs to start with a good history and then go on with examinations. Then confirm their findings with the proper labs. This narrows down the diagnosis and saves a lot of time. History-taking is the most important clinical step in the management of patients. But most of the time, it is underrated, and most clinicians rely on labs rather than these basic skills. This article thus reviews the importance of history-taking in diagnosing patients with cardiovascular diseases. Besides this, it also addresses how a good history should be taken to narrow down the diagnosis and reach the proper diagnosis within time to save a patient's life.

Introduction: Deep venous thrombosis (DVT) is a coagulation disorder that is on the rise due to lifestyle changes. Patients with DVT are at risk for developing a life-threatening complication, pulmonary embolism which urges the importance of its early diagnosis. The Gold standard modality for its early diagnosis is invasive which is Venography. Other modalities like compression ultrasound and duplex imaging are noninvasive but operator-dependent and not routinely available during evening and night shift hours. D-Dimer is a simple, noninvasive, cost-effective, and easily available diagnostic test that can be helpful in diagnosis. The objective of this study is to compare the sensitivity of D-Dimers with Doppler ultrasound for the diagnosis of deep venous thrombosis. Materials and Methods: A cross-sectional comparative (validation) study in which 65 admitted patients with a high risk of DVT on Well’s criteria for clinical diagnosis were enrolled by non-probability convenience sampling from March to August 2018. Both D-Dimer and Doppler ultrasounds were performed on all suspected patients of DVT. Results: Amongst 65 cases, 60 (92.3%) had positive Dimer results compared to 65 (100.0%) with the Doppler ultrasound. The difference between the two diagnostic modalities was statistically significant (p-value = 0.02). The sensitivity of D-dimers was 92.3% however specificity, PPV, and NPV were 0% as none of the cases was negative on ultrasound Doppler. Conclusion: The D-dimer test is a conveniently performed, cost-effective test with a sensitivity of more than 90% in the current study and can be useful for Emergency and critical care departments.

Objective: To evaluate the relationship between inner canthal distance and maxillary anterior teeth width with respect to age, gender and ethnicity. Study Design: Cross sectional study. Place and Duration of Study: Altamash Institute of Dental Medicine, Karachi, from Aug 2019 to Jan 2020. Methodology: One hundred participants from both genders with full permanent dentition, no interdental space or pathology and facial symmetry were included in this study. The measurements were carried out with digital Vernier caliper. SPSS-25 was used for statistical analysis. Results: The mean ± SD of inner canthal distance and width of maxillary anterior teeth were 2.99cm ± 0.46 and 3.82cm ± 0.35 respectively. A significant difference was found between gender (p=0.037) and inner canthal distance. The maxillary anterior teeth width and inner canthal distance varies amongst different ethnicities (p=0.01). The inner canthal distance does not vary with advancing age (p=0.87) whereas width of maxillary anterior teeth varies (p=0.04). A weak correlation value of 0.47 was found between inner canthal distance and maxillary anterior teeth width. Conclusion: This research suggests that there is a weak relationship between inner canthal distance and maxillary anterior teeth width. Therefore, a multiplication ratio of 1.27 is advised to get combined mesiodistal width of maxillary anterior teeth. Additionally, the value of both differs in various local ethnicities. Inner canthal distance does not vary with age though has significant gender disparities while maxillary anterior teeth width remains constant.

In the presented study, a novel application of intelligent numerical computing solver based on neural networks backpropagated with the Levenberg-Marquard scheme (NN-BLMS) is presented to interpret the chemical reactions and activation energy in unsteady 3D flow of Eyring-Powell magneto-nanofluidic system for convective heat and mass flux scenarios. The original nonlinear coupled PDEs representing the Eyring-Powell magneto-nanofluidic model (EPMNM) is transformed to an equivalent nonlinear ODEs system by exploiting similarity variables. A dataset for the proposed NN-BLMS is generated for different scenarios of EPMNM by variation of radiation, temperature ratio parameter, heat generation, Brownian motion and thermophoresis parameters by using Adam numerical method. The training, testing, and validation processes of NN-BLMS are performed to determine the approximate solution of EPMNM for different cases and comparison with reference results to verify the correctness of the proposed NN-BLMS. The performance of the proposed NN-BLMS to effectively solve the EPMNM is endorsed through mean squared error, histogram studies and regression analysis. The close matching of the proposed and reference results based on error analysis form level 10−05 to 10-07 validates the correctness of the proposed methodology.

In this present communication, we proposed the mathematical model for non-Newtonian liquid (Ree-Eyring model) towards a stretched surface. The Buongiorno model is used in the modelling of flow problem subject to magnetohydrodynamics, entropy generation, nonlinear thermal radiation, homogeneous-heterogeneous reactions, Brownian motion, Joule heating and thermophoresis diffusion. Convective boundary conditions are implemented at the stretched surface. With the assistance of rheological expression of Ree-Eyring model, we construct the governing flow expressions. The energy equation is developed via Brownian diffusion, nonlinear thermal radiation, Joule heating and thermophoresis. Two different types of species (homogeneous-heterogeneous reactions) are considered for the analysis of mass transport. The flow is solely induced due to a nonlinear stretched surface. The electrical conducting and chemically reactive fluid is considered for the analysis towards a stretched surface. The appropriate transformations are implemented to transform governing PDEs into a set of coupled ODEs. Shooting method has been applied to get the solutions of obtained highly non-linear ODEs. The thermodynamics second law is employed to model and calculate total entropy rate. Impact of influential variables on the flow field (velocity), gradient of velocity, temperature, gradient of temperature, concentration and entropy generation rate are studied. The engineering quantities like velocity, temperature gradients are numerical discussed in tabular form. Furthermore, the entropy rate and Bejan number show contrast impact versus larger Brinkman number.

Abstract Aim: To assess the prevalence of depression among the transgender population and analyze the relationship of socio-demographic factors with depression. Study design: Cross-sectional study Place and duration of study: Twin cities (RWP and Islamabad). 3 months Subjects and Methods: The sample population comprised of one hundred and forty two transgender people of Rawalpindi and Islamabad. Beck depressive inventory II (BDI-II) was used to record the presence and severity of the depressive symptoms. Depressive symptoms were categorized as mild, moderate and severe. Relationship of the age, smoking, family income, illicit substance use and education was studied with the presence of depressive symptoms among these transgender population of twin cities of Pakistan. Results: A total of 142 transgender people were included in the final analysis. Mean age of the study participants was 39.55 ± 6.18. Out of these, 45.1% had no depressive symptoms while 31.7% had mild, 12.7% had moderate and 10.6% had severe depressive symptomatology. After applying the binary logistic regression we found that presence of depressive symptoms had significant association with illicit substance use among the target population. Conclusion: This study showed a high prevalence of depressive symptoms among the transgender population of twin cities of Pakistan. Use of illicit substances like tobacco, cannabis, opiates and alcohol should be discouraged and those using these should be routinely screened for the presence of other mental health issues in order to timely diagnose and treat them. Key words: depression; socio-demographic factors; trans-genders

Hemosuccus pancreaticus is a rare but potentially torrential and life-threatening cause of acute upper gastrointestinal bleeding. It is described as an intermittent hemorrhage from the major duodenal papilla via the main pancreatic duct. Peripancreatic pseudoaneurysm following chronic pancreatitis is a common underlying etiology. However, gastroduodenal artery pseudoaneurysm-related hemosuccus pancreaticus remains exceedingly rare in the etiological spectrum of upper gastrointestinal bleeding. We hereby delineate a rare case of hemosuccus pancreaticus associated with gastroduodenal artery pseudoaneurysm in a patient who initially presented with abdominal pain and hematochezia. He was successfully managed with coil embolization without recurrence or sequelae. Furthermore, we conducted a search of the MEDLINE (PubMed and Ovid) database for relevant studies on hemosuccus pancreaticus published between inception and September 15, 2021. The available clinical evidence on causes, presentation patterns, diagnosis, and management was analyzed and summarized. This article highlights the rarity, the intermittent nature of hemorrhage, and the lack of a standardized diagnostic approach for this elusive disease. Clinicians should remain cognizant of hemosuccus pancreaticus, especially in patients presenting with symptoms and signs of intermittent gastrointestinal bleeding and abdominal pain. Prompt diagnosis carries paramount importance in saving patients from repeat hospital admissions and disease-associated morbidity and mortality. Conventional angiography with coil embolization may constitute an effective treatment strategy.

Obstructive sleep apnea syndrome is a conceivably hazardous ailment. Most end up with non-reversible surgical techniques, such as the maxillomandibular advancement (MMA) procedure. MMA is an amazingly obtrusive treatment, regularly connected to complexities and facial change. Computational fluid dynamic (CFD) is broadly utilized as an instrument to comprehend the stream system inside the human upper airways (UA) completely. There are logical inconsistencies among the investigations into the utilizations of CFD for OSAS study. Thus, to adequately understand the requirement for OSAS CFD investigation, a systematic literature search was performed. This review features the necessary recommendations to accurately model the UA to fill in as an ideal predictive methodology before mandibular advancement surgery.