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Abstract South Asian universities play a crucial role in driving economic development through research and innovation. However, these institutions often face challenges that hinder their productivity in these areas. To address these challenges, this study aims to understand and examine the factors enhancing research and innovation productivity in universities across South Asian countries, specifically Bangladesh, India, Nepal, Pakistan, and Sri Lanka. Using panel data from 2009 to 2021, the study employs the newly developed dynamic common correlated effects (DCCE) approach by Chudik and Pesaran (2015a). The results revealed that the factors found to be enriching research productivity, though the impact is negligible, are patent rights, funding for tertiary education, information technology, and publications. However, tertiary school enrollment is not a significant factor. On the other hand, for innovation productivity, the influencing factors with a negligible impact are patent rights, funding for tertiary education, and information technology. In this case, neither tertiary school enrollment nor publications play a significant role. Furthermore, the research productivity of the universities in South Asian countries is negligibly stimulating the countries’ GDP per capita, while the innovation productivity of the universities is not. Moreover, examining these relations using models such as mean group (MG), pooled mean group (PMG), and augmented mean group (AMG) can produce misleading results due to cross-sectional dependence among the units. Nonetheless, PMG outperformed AMG, followed by MG. Policy recommendations were suggested based on the findings.

Abstract Institutions are pivotal in university governance, symbolizing stable organizational power reflective of governance capacity. The strategic organization of a university’s internal structures aims to align with its developmental goals. The effectiveness of these arrangements is evaluated by their congruence with the university’s characteristics and norms, aiming to enhance governance for growth and sustainability. Thus, the primary aim of this study is to determine whether this layout can strengthen the university’s governance ability, enhancing its prospects for survival and development. This study introduces a novel theoretical framework across the dimensions of time, space, and quantity, utilizing governance elements to assess the impact of institutional layouts on governance capabilities. Data were gathered through a self-developed survey questionnaire, with a total of 742 valid responses collected, and by employing a high-dimensional fixed-effects model, we found that the three-dimensional institutional layouts significantly impact governance capabilities, with effects varying by the institution’s affiliation. Furthermore, the mechanism analysis shows that university governance capabilities are also manifested through different configurations of governance elements under institutional layout, and are influenced by the responsiveness, collaboration, and expansion of the entire institutional system. Moreover, our analysis indicates a threshold effect in the tenure of institutional members, where both excessive and insufficient enthusiasm impact governance capabilities differently. This suggests the importance of a strategic institutional layout that aligns with the governance elements’ dynamics of timeliness, flexibility, distribution, and scarcity across time, space, and quantity. Achieving an optimal arrangement enhances the university’s governance efficiency significantly. In light of these findings, policy implications were proposed.

This study's context emphasizes the growing need for effective safety management in residential construction projects. Building Information Modeling (BIM) has been recognized as a potential solution for managing safety in various construction projects, but its adoption could have been more active due to several obstacles. This study identifies and validates the obstacles to implementing BIM-based safety management practices in residential construction projects. The research employed a two-step methodology comprising exploratory factor analysis (EFA) and structural equation modelling (SEM). The data was collected through an online design, construction, and management professional survey. The study reveals four significant obstacles: integration complexity, data quality and consistency, initial investment and cost, and regulatory and standardization. By identifying and validating the obstacles to the adaptation of BIM-based safety management practices, the findings make theoretical contributions to the literature. The small sample size from a limited geographic region and cross-sectional design are limitations. However, the findings provide important practical implications by highlighting key obstacles organizations must address to facilitate BIM adoption for safety management in residential construction. This quantitative study makes a theoretical contribution by validating and ranking key impediments to BIM for safety management in a new context.

Introduction Patient satisfaction is an integral part of healthcare quality, impacting treatment adherence, patient loyalty and healthcare utilisation. Parental satisfaction is particularly crucial as parents influence decision-making for their child’s healthcare.Objective The objective was to assess parental satisfaction levels (as measured by Patient Satisfaction Questionnaire-18 (PSQ-18)) related to paediatric healthcare services and identify specific factors significantly influencing parental satisfaction with paediatric healthcare services.Methodology This is a descriptive cross-sectional study that used a structured questionnaire based on the PSQ-18. The study was conducted in Faisalabad, Islamabad, Peshawar and Swat. Seven subscales measured satisfaction across various dimensions.Results We found 882 suitable responses indicating a diverse participant demographic, with the largest group in the 6–12 years age category. The overall mean parental satisfaction score was 2.0±0.5 (40.0%). Notably, financial aspects scored highest at 2.8 (55%), followed by accessibility and convenience at 2.0 (40.5%). However, lower satisfaction scores in the interpersonal relationship (1.8±0.5) and technical quality (1.8±0.5) domains were recorded. Sociodemographic analysis indicated age, education and occupation significantly influenced satisfaction. Conversely, factors such as gender, residence and the presence of chronic disease did not significantly impact satisfaction levels.Conclusion The study offers valuable insights into paediatric patient satisfaction in Pakistan, emphasising the need for targeted interventions and improvements in specific domains to enhance overall healthcare quality.

Background Pyrethroid-based mosquito repellents are widely used to control mosquito-borne diseases. Liquid mosquito-repellent vaporisers are effective modes of pyrethroid delivery but can also pose significant health risks if ingested or used improperly.Objective This systematic review was performed to assess the demographic distribution, clinical presentation, management strategies and outcomes in children resulting from accidental ingestion of liquid mosquito repellent vaporiser.Methods The study adheres to the reporting standards outlined in the PRISMA Statement for Systematic Reviews and was prospectively registered with PROSPERO (record # CRD42023413937) to enhance transparency and minimise reporting bias. A comprehensive search was conducted on PubMed, Scopus and Google Scholar using specific MeSH terms related to insecticides, mosquito repellents, pyrethroids, ingestion, poisoning, toxicity and prevention. The reference lists of the included studies were also reviewed for additional relevant articles. The inclusion criteria involved studies published in peer-reviewed journals between 2000 and 2023 that focused on children under 18 years old with a history of mosquito-repellent ingestion based on primary data.Results Twelve studies met the inclusion criteria; these were primarily case reports from India, China and the UAE. Male children were predominantly affected, and symptoms included vomiting, convulsions, cough and respiratory distress. Management primarily involved supportive and symptomatic measures, including atropine for salivation and antiepileptic drugs for seizures. Respiratory support was provided for respiratory complications.Conclusion Despite the known risks and diverse presentations of pyrethroid poisoning caused by liquid mosquito repellent vaporiser in children, the limited substantial evidence in the literature underscores the urgent need for comprehensive research to refine management approaches and enhance preventive measures.

Abstract This paper explores the question of whether parental migration is a significant source of human capital development or whether it is harmful to non-cognitive ability development. In light of this, a research question was raised: what is the effect of different statuses of parental migration on the non-cognitive abilities of left-behind children in rural China? To answer this research question, the study uses the China Education Panel Survey (CEPS) data wave-I and employs the Propensity Score Matching (PSM) method. The findings revealed that the decision of one or both parents to migrate hurts the non-cognitive abilities of the left-behind school-going children. The results imply that parental migration of one or both parents in rural China is detrimental to the non-cognitive abilities of the left-behind children (LBCs). Therefore, parents should stay or move with their children instead of leaving them with relatives or grandparents. Furthermore, the government must concentrate on removing obstacles to education, especially for migrants, by undertaking initiatives like expanding the number of schools for LBCs and waiving tuition fees. Moreover, the government needs to take action to improve the lives of LBCs and find solutions to their problems. Lastly, the authorities need to promote economic change to create a more balanced economy.

Since the beginning of this century, there has been evidence of a rise in educational funding among the South Asian Association for Regional Cooperation (SAARC). However, there has been a decline in recent years despite South Asia being a highly populated and poverty-ridden region. Thus, the present study comes to assess how well the countries are doing in relation to the effect of educational funding on national development indicators, namely economic growth, human capital development, and the unemployment rate among the SAARC countries in the 21st century using Panel Nonlinear Autoregressive Distributed Lag (PNARDL) model formulated in Salisu and Isah (2017). The findings revealed that the impact of educational funding on economic growth and the unemployment rate is an asymmetry in the long run and symmetry in the short run but on the human development index, it is an asymmetry in both terms. However, educational funding is influencing economic growth in the long run, but in the short run is not. Furthermore, educational funding influences human capital development in both terms, but in the long run is negligible. Moreover, educational funding is negligibly discouraging the unemployment rate in both terms.

Abstract Comprehensive medical evaluation is important for patients with SRS to identify associated medical conditions and provide timely interventions. Clinicians should remain vigilant for potential neurological manifestations in SRS patients.

Aisha Javed,1 Shah Rukh Abbas,1 Muhammad Uzair Hashmi,1 Noor Ul Ain Babar,2 Irshad Hussain2 1Department of Industrial Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, 44000, Pakistan; 2Department of Chemistry, Syed Babar Ali School of Science and Engineering, Lahore University of Management Sciences, Lahore, 54792, PakistanCorrespondence: Shah Rukh AbbasDepartment of Industrial Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, H-12, Islamabad, PakistanTel +92 3355449622; +92 51-9085-6125Email sabbas@asab.nust.edu.pkBackground: Mycobacterium tuberculosis’ rapid detection is still a formidable challenge to have control over the lethal disease. New diagnostic methods such as LED fluorescence microscopy, Genexpert, Interferon Gamma Release Assay (IGRA) are limited on efficacy spectrum owing to their high cost, time-intensive and laborious nature, in addition their low sensitivity hinders their robustness and portability. Electroanalytical methods are now being considered as an excellent alternative, being currently employed for efficient detection of the analytes with the potential of being portable. This report suggests label-free electrochemical detection of Mycobacterium tuberculosis (Mtb) via its marker, insertion sequence (IS6110).Methods: In this pursuit, graphene oxide-chitosan nanocomposite (GO-CHI), a biocompatible matrix, having a large electroactive area with an overall positively charged surface, is fabricated and characterized. The obtained GO-CHI nanocomposite is then immobilized on the ITO surface to form a positively functionalized electrochemical sensor for the detection of Mtb. DNA probe, specific for the IS6110, was electrostatically anchored on a positively charged electrode surface and the resistance of charge transfer was investigated for the sensitive and specific (complementary vs non-complementary) detection of Mtb by cyclic voltammetry and differential pulse voltammetry techniques.Results: The cyclic voltammetry was found to be diffusion controlled facilitating the absorption of analyte on the electrode surface. The label-free “genosensor” was found to detect a hybridization efficiency with a limit of detection of 3.4 pM, and correlation coefficient R2=0.99 when analysed over a range of concentrations of DNA from 7.86 pM to 94.3pM. The genosensor was also able to detect target DNA from raw sputum samples of clinical isolates without DNA purification.Conclusion: This electrochemical genosensor provides high sensitivity and specificity; thus offering a promising platform for clinical diagnosis of TB and other infectious diseases in general.Keywords: label-free detection, DNA genosensor, Mycobacterium detection, tuberculosis, graphene oxide nanocomposites, GO nanocomposites electrochemical sensing

In this study, we grew pristine and Ni-doped vertically aligned zinc oxide nanowires (NWs) on a glass substrate. Both the doped and pristine NWs displayed dominant 002 peaks, confirming their vertical alignment. The Ni-doped NWs exhibited a leftward shift compared to the pristine NWs. TEM measurements confirmed the high crystallinity of individual NWs, with a d-spacing of ~0.267 nm along the c-axis. Ni-doped NWs had a higher density, indicating increased nucleation sites due to nickel doping. Doped NW films on glass showed enhanced absorbance in the visible region, suggesting the creation of sub-gap defect levels from nickel doping. Magnetization vs. magnetic field measurements revealed a small hysteresis loop, indicative of soft ferromagnetic behavior. Current transient plots demonstrated an increase in current with an applied magnetic field. Two-terminal devices exhibited a photo response that intensified with magnetic field application. This increase was attributed to parallel grain alignment, resulting in enhanced carrier concentration and photo response. In the dark, transport properties displayed negative magnetoresistance behavior. This magneto-transport effect and enhanced photo response (under an LED at ~395 nm) were attributed to giant magnetoresistance (GMR) in the aligned NWs. The observed behavior arose from reduced carrier scattering, improved transport properties, and parallel spin alignment in the magnetic field.

According to the Phillips curve, there is an inverse relationship between inflation and unemployment. According to the Okun’s law, there is an inverse relationship between potential output growth and unemployment. The paper tries to check whether these interdependencies are seen in the Pakistan’s economy, thus testing the relevance of both dependencies for that economy. With this aim, the authors analyse the relationships between several macroeconomic variables, such as inflation rate, unemployment rate, GDP per capita growth rate, and population growth rate, using annual data of the period 1985–2017. By employing the respective simultaneous equation models (SEM) estimated with the indirect least square technique (ILS) and using various statistical tests, the authors conclude that the relationship postulated by the Phillips curve can be observed in the Pakistan’s economy, but the results of the examination do not confirm the occurrence of the relationship postulated by the Okun’s law.

Congestion control is an extremely important area within wireless sensor networks (WSN), where traffic becomes greater than the aggregated or individual capacity of the underlying channels. Therefore, special considerations are required to develop more sophisticated techniques to avoid, detect, and resolve congestion. The constrained resources of the WSN must be considered while devising such techniques to achieve the maximum throughput. Various approaches have been introduced in the past few years that include routing protocols aided with congestion detection and control mechanism, and dedicated congestion control protocols. In the former schemes, the congestion avoidance is performed by the sink node that causes topology reset and bulk traffic drop. As a consequence, the latter mentioned congestion control protocols addressing the congestion avoidance, detection, and resolution were introduced at the node level. In this paper, we explore mechanisms for controlling congestion in the WSNs and present a comparative study. The congestion control schemes are categorized as centralized with partial congestion control and distributed with dedicated congestion control.

Inductive Teaching Method (ITM) promotes effective learning in technological education (Felder & Silverman, 1988). Students prefer ITM more as it makes the subject easily understandable (Goltermann, 2011). The ITM motivates the students to actively participate in class activities and therefore could be considered a better approach to teach computer programming. There has been little research on implementing ITM in computer science courses despite its potential to improve effective learning. In this research, an existing computer programming lab course is taught using a traditional Deductive Teaching Method (DTM). The course is redesigned and taught by adopting the ITM instead. Furthermore, a comprehensive plan has been devised to deliver the course content in computer labs. The course was evaluated in an experiment consisting of 81 undergraduate students. The students in the Experimental Group (EG) (N = 45) were taught using the redesigned ITM course, whereas the students in the Control Group (CG) (N = 36) were taught using the DTM course. The performance of both groups was compared in terms of the marks obtained by them. A pre-test conducted to compare pre-course mathematical and analytical abilities showed that CG was better in analytical reasoning with no significant differences in mathematical abilities. Three post-tests were used to evaluate the groups theoretical and practical competence in programming and showed EG improved performance with large, medium, and small effect sizes as compared to CG. The results of this research could help computer programming educators to implement inductive strategies that could improve the learning of the computer programming.

Provisioning fault-tolerant scheduling in computational grid is a challenging task. Most of the existing fault tolerant scheduling schemes are either geared toward proactive or reactive. Proactive schemes emphasize on the reasons responsible for generating faults, whereas reactive mechanisms come into effect after failure detection. Unlike most existing mechanisms, we present a novel, dynamic, adaptive, and hybrid fault-tolerant scheduling scheme based on proactive and reactive approaches. In the proactive approach, the resource filtration algorithm picks resources based on resource location, availability, and reliability. Unlike most existing schemes, which rely on remotely connected resources, the proposed algorithm prefers to employ locally available resources as they might have less failure tendency. To cope with the frequent turnover problem, the proposed scheme calculates resource availability time based on various newly identified parameters (e.g., mean time between availability) and picks highly available nodes for task execution. Resource reliability is an indispensable consideration in the proposed scheme and is calculated based on parameters such as jobs success or failure ratio and the types of failures encountered. We employ an optimal resource identification algorithm to determine and select optimal resources for job execution. The performance of the proposed scheme is validated through the GridSim toolkit. Compared with contemporary approaches, experimental results demonstrate the effectiveness and efficiency of the proposed scheme in terms of various performance metrics, such as wall clock time, throughput, waiting and turnaround time, number of checkpoints, and energy consumption.

Literature is an appropriate mode for expression of thought andvision. Poetry is its most impressive and effective form of communication. It is the most beautiful and sensitive source to expresses the feelings, mood and experiences of the poet. In the literary sense the Ghazal is meant for romance and to project glamour of the feminine. The Ghazal emerged from the "tashbib" of the Arabic qasidah. In the beginning of Islam in Iran, the Islamic Arabic civilization and literature, penetrated Persian poetry. In Persian literature the Ghazal was introduced by a poet "Roodki" in the period of Samani. Roodki was also commended by a renowned poet "Unsri" in the era of Mehmood Ghaznvi. However this was the earlier period of qasidah. The Persian literature had a remarkable influence on Urdu Ghazal. Urdu Ghazal owes its thought, mood of expression, formation, theme, canvas, from Persian literature i.e the Ghazal. That is why the great poet like Mirza Ghalib felt proud of his Persian poetry and preferred it to his Urdu poetry.

Background: The aims of this study have been elaborated below: (1) to enumerate the common causes of acute abdominal emergencies by ultrasonography in paediatric patients; (2) to establish the diagnostic efficacy of ultrasonography in evaluation of acute abdominal conditions in children and to illustrate the associated ultrasonographic findings; (3) and, to discuss the role of ultrasonography in guiding the mode of intervention in these cases. Patients and Methods: This prospective study of ultrasonographic examination in 146 paediatric patients presenting with acute onset abdominal pain at the emergency/paediatric outpatient department section of Jawaharlal Nehru Medical College & Hospital, Aligarh, between June 2006 and December 2007, using 3.75 MHz and 8 MHz transducers of the ADARA (Siemens) machine. Results : Common causes of acute abdominal emergencies in pediatric patients as noted on ultrasonography included nonspecific pain (28%), abdominal abscess (21%), acute appendicitis (7%) and intussusception (7%). Ultrasonography was diagnostic in 45.2% cases and supportive in 12.3% of the cases. As for as the final outcome, ultrasonography prevented surgery in almost 20% cases and laparotomy was avoided in 7% of the patients as ultrasound guided interventions in the form of abscess aspiration were carried out. Conclusion: Ultrasonography evaluation of children with acute abdominal pain, helps in making significant changes in the management plan of the patients, and also reveals various clinically unsuspected diseases.

Data Grids deal with geographically-distributed large-scale data-intensive applications. Schemes scheduled for data grids attempt to not only improve data access time, but also aim to improve the ratio of data availability to a node, where the data requests are generated. Data replication techniques manage large data by storing a number of data files efficiently. In this paper, we propose centralized dynamic scheduling strategy-replica placement strategies (CDSS-RPS). CDSS-RPS schedule the data and task so that it minimizes the implementation cost and data transfer time. CDSS-RPS consists of two algorithms, namely (a) centralized dynamic scheduling (CDS) and (b) replica placement strategy (RPS). CDS considers the computing capacity of a node and finds an appropriate location for the job. RPS attempts to improve file access time by using replication on the basis of number of accesses, storage capacity of a computing node, and response time of a requested file. Extensive simulations are carried out to demonstrate the effectiveness of the proposed strategy. Simulation results demonstrate that the replication and scheduling strategies improve the implementation cost and average access time significantly.

Recently, wireless sensor network (WSN) applications have seen an increase in interest. In search and rescue, battlefield reconnaissance, and some other such applications, so that a survey of the area of interest can be made collectively, a set of mobile nodes is deployed. Keeping the network nodes connected is vital for WSNs to be effective. The provision of connectivity can be made at the time of startup and can be maintained by carefully coordinating the nodes when they move. However, if a node suddenly fails, the network could be partitioned to cause communication problems. Recently, several methods that use the relocation of nodes for connectivity restoration have been proposed. However, these methods have the tendency to not consider the potential coverage loss in some locations. This paper addresses the concerns of both connectivity and coverage in an integrated way so that this gap can be filled. A novel algorithm for simultaneous-node repositioning is introduced. In this approach, each neighbour of the failed node, one by one, moves in for a certain amount of time to take the place of the failed node, after which it returns to its original location in the network. The effectiveness of this algorithm has been verified by the simulation results.

Introduction: The complex biopsychosocial pathways linking maternal mental health with preterm birth (PTB) are not well understood. This study aimed to explore allostatic load (AL) as a mediator and perceived chronic stress as a moderator in the pathway linking maternal mental health and PTB., Methods: A cohort study of pregnant women (n = 1,567) recruited at clinic visits within 10-19 weeks of gestation was assessed for maternal mental health (i.e., pregnancy-related anxiety, state anxiety, depressive symptoms) and perceived chronic stress. Blood pressure and levels of cortisol, total cholesterol, C-reactive protein, and glycosylated hemoglobin were used to create a composite measure of AL., Results: AL had the most significant effect on PTB (odds ratio (OR) = 1.84, 95% CI = 1.26-12.67, p = 0.001), while systolic blood pressure emerged as the only significant individual marker using variable selection (OR = 22%, 95% CI = 1.06-1.40, p < 0.001) in multiple logistic regression analysis. A mediation analysis revealed that maternal mental health did not have a significant direct effect on PTB (p = 0.824), but its indirect effect mediated by AL was significant (z = 2.33, p < 0.020). Low and high levels of perceived chronic stress, relative to the mean, moderated this indirect effect (z = 3.66, p < 0.001)., Conclusions: AL has a significant direct influence on PTB and mediates the effect of maternal mental health on PTB; however, the indirect effect of AL is indistinguishable between women with higher or lower levels of perceived chronic stress than normal., (© 2024 S. Karger AG, Basel.)

Purpose: Global health researchers have a responsibility to conduct ethical research in a manner that is culturally respectful and safe. The purpose of this work is to describe our experiences with recruitment and retention in Pakistan, a low-middle-income country., Description: We draw on two studies with a combined sample of 2161 low-risk pregnant women who participated in a pilot (n = 300) and a larger (n = 1861) prospective study of psychological distress and preterm birth at one of four centers (Garden, Hyderabad, Kharadar, Karimabad) of the Aga Khan University Hospital in Karachi, Pakistan., Assessment: Challenges we encountered include economic hardship and access to healthcare; women's position in the family; safety concerns and time commitment; misconceptions and mistrust in the research process; and concerns related to blood draws. To mitigate these challenges, we developed culturally acceptable study incentives, involved family members in the decision-making process about study participation, partnered with participants' obstetrician-gynecologists, accommodated off site study visits, combined research visits with regular prenatal care visits, and modified research participation related to blood draws for some women., Conclusion: Implementation of these mitigation strategies improved recruitment and retention success, and we are confident that the solutions presented will support future scientists in addressing sociocultural challenges while embarking on collaborative research projects in Pakistan and other low-middle-income countries., (© 2024. The Author(s).)

Introduction: The prevalence of gestational diabetes mellitus (GDM) is on the rise in low-income and middle-income countries, such as Pakistan. Therefore, the development of a risk score that is simple, affordable and easy to administer is needed. Our study aimed to develop a Non-INvaSive Pregnancy RIsk ScoRE (INSPIRE) for GDM screening in Pakistani pregnant women based on risk factors reported in the literature., Methods: Using a cross-sectional study design, we enrolled 500 pregnant women who attended antenatal clinics at one tertiary and two secondary care hospitals in Karachi between the 28th and 32nd weeks of gestation. We randomly divided data into derivation (n=404; 80%) and validation datasets (n=96; 20%). We conducted interviews to collect information on sociodemographic factors and family history of diabetes, measured mid-upper arm circumference (MUAC) and reviewed the medical records of women for obstetric history and oral glucose tolerance test (OGTT) results. We performed a multivariable logistic regression analysis to obtain coefficients of selected predictors for GDM in the derivation dataset. Calibration was estimated using Pearson's χ2 goodness of fit test while discrimination was checked using the area under the curve (AUC) in the validation dataset., Results: Overall, the GDM prevalence was 26% (n=130). INSPIRE was based on six predictors: maternal age, MUAC, family history of diabetes, a history of GDM, previous bad obstetrical outcome and a history of macrosomia. INSPIRE achieved a good calibration (Pearson's χ2=29.55, p=0.08) and acceptable discrimination with an AUC of 0.721 (95% CI 0.61 to 0.83) with a sensitivity of 74.1% and specificity of 59.4% in the validation dataset., Conclusion: We developed and validated an INSPIRE that efficiently differentiates Pakistani pregnant women at high risk of GDM from those at low risk, thus reducing the unnecessary burden of the OGTT test., Competing Interests: None declared., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. Published by BMJ.)

Background: Diabetes mellitus (DM) is well known for related micro and macrovascular complications. Uncontrolled hyperglycemia in diabetes mellitus leads to endothelial dysfunction, inflammation, microvascular impairment, myocardial dysfunction, and skeletal muscle changes which affect multiple organ systems. This study was designed to take an extensive view of cardiorespiratory dynamics in patients with type 2 DM., Methods: One hundred healthy controls (HC) and 100 DM patients were enrolled. We measured and compared the breathing patterns (spirometry), VO2 max levels (heart rate ratio method) and self-reported fitness level (international fitness scale) of individuals with and without diabetes. Data was analyzed in SPSS v.22 and GraphPad Prism v8.0., Results: We observed restrictive spirometry patterns (FVC <80%) in 22% of DM as compared to 2% in HC (p = 0.021). There was low mean VO2 max in DM as compared to HC(32.03 ± 5.36 vs 41.91 ± 7.98 ml/kg/min; p value <0.001). When evaluating physical fitness on self-reported IFiS scale, 90% of the HC report average, good, or very good fitness levels. In contrast, only 45% of the DM shared this pattern, with a 53% proportion perceiving their fitness as poor or very poor (p = <0.05). Restrictive respiratory pattern, low VO2 max and fitness level were significantly associated with HbA1c and long-standing DM., Conclusion: This study shows decreased pulmonary functions, decreased cardiorespiratory fitness (VO2 max) and IFiS scale variables in diabetic population as compared to healthy controls which are also associated with glycemic levels and long-standing DM. Screening for pulmonary functions can aid optimum management in this population., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Abbas et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Cancer outcomes are poor in resource-limited countries owing to high costs and insufficient pathologist-population ratio. The advent of digital pathology has assisted in improving cancer outcomes, however, Whole Slide Image scanners are expensive and not affordable in low-income countries. Microscope-acquired images on the other hand are cheap to collect and can be more viable for automation of cancer detection. In this study, we propose LCH-Network, a novel method to identify the cancer mitotic count from microscope-acquired images. We introduced Label Mix, and also synthesized images using GANs to handle data imbalance. Moreover, we applied progressive resolution to handle different image scales for mitotic localization. We achieved F1-Score of 0.71 and outperformed other existing techniques. Our findings enable mitotic count estimation from microscopic images with a low-cost setup. Clinically, our method could help avoid presumptive treatment without a confirmed cancer diagnosis., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (©2024 AMIA - All rights reserved.)

Background: We determined whether dimensions of psychosocial distress during pregnancy individually and collectively predicted preterm birth (PTB) in Pakistani women as it may be misleading to extrapolate results from literature predominantly conducted in high-income countries., Methods: This cohort study included 1603 women recruited from four Aga Khan Hospital for Women and Children in Sindh, Pakistan. The primary binary outcome of PTB (i.e., livebirth before 37 completed weeks' gestation) was regressed on self-reported symptoms of anxiety (Pregnancy-Related Anxiety (PRA) Scale and Spielberger State-Trait Anxiety Inventory Form Y-1), depression (Edinburgh Perinatal Depression Scale (EPDS)), and covariates such as chronic stress (Perceived Stress Scale) assessed with standardized question and scales with established language equivalency (Sindhi and Urdu)., Results: All 1603 births occurred between 24 and 43 completed weeks' gestation. PRA was a stronger predictor of PTB than other types of antenatal psychosocial distress conditions. Chronic stress had no effect on the strength of association between PRA and PTB and a slight but non-significant effect on depression. A planned pregnancy significantly lowered risk of PTB among women who experienced PRA. Aggregate antenatal psychosocial distress did not improve model prediction over PRA., Conclusions: Like studies in high-income countries, PRA became a strong predictor of PTB when considering interactive effects of whether the current pregnancy was planned. Women's resilience and abilities to make sexual and reproductive health decisions are important to integrate in future research. Findings should be generalized with caution as socio-cultural context is a likely effect modifier. We did not consider protective/strength-oriented factors, such as resilience among women., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: All authors except, NF, declare no conflict of interest. NF, Senior Biostatistician, was paid through the CIHR Project Grant and Startup Grant, Faculty of Health, York University. This does not alter our adherence to PLOS ONE policies on publication of this article. Data are available on reasonable request. Please contact Dr. Shahirose Sadrudin Premji (shahirose.premji@queensu.ca) for more information, collaborations, or data access inquiries. We do not have permission from the Pakistani participants to share individual level data. They have given informed consent on the basis that only aggregate date would be published. Hence, data are available on reasonable request as stated above and I have provided the contact information., (Copyright: © 2023 Lalani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: Contributing factors to COVID-19 vaccination intention in low-income and middle-income countries have received little attention. This study examined COVID-19-related anxiety and obsessive thoughts and situational factors associated with Pakistani postpartum women's intention to get COVID-19 vaccination., Design: Cross-sectional study administering a survey by a telephone interview format between 15 July and 10 September 2020., Setting: Four centres of Aga Khan Hospital for Women and Children-Garden, Kharadar, Karimabad and Hyderabad-in Sindh Province, Pakistan., Participants: Women who were enrolled in our longitudinal Pakistani cohort study were approached (n=1395), and 990 women (71%) participated in the survey, of which 941 women who were in their postpartum period were included in the final analysis., Primary Outcome Measure and Factors: COVID-19 vaccine intention, sociodemographic and COVID-19-related factors, Coronavirus anxiety, obsession with COVID-19 and work and social adjustment were assessed. Multiple multinomial logistic regression analysis was used to identify factors associated with women's intentions., Results: Most women would accept a COVID-19 vaccine for themselves (66.7%). Only 24.4% of women were undecided about vaccination against COVID-19, and a small number of women rejected the COVID-19 vaccine (8.8%). Women with primary education were less likely to take a COVID-19 vaccine willingly than those with higher education. COVID-19 vaccine uncertainty and refusal were predicted by having no experience of COVID-19 infection, childbirth during the pandemic, having no symptoms of Coronavirus anxiety and obsession with COVID-19. Predictors for women's intention to vaccinate themselves and their children against COVID-19 were similar., Conclusion: Understanding the factors shaping women's intention to vaccinate themselves or their children would enable evidence-based strategies by healthcare providers to enhance the uptake of the COVID-19 vaccine and achieve herd immunity against Coronavirus., Competing Interests: Competing interests: SK and NF were supported to work as research team members through the Canadian Institutes of Health Research Project Grant and Startup Grant., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Retinitis pigmentosa (RP) belongs to pigmentary retinopathies, a generic name for all retinal dystrophies with a major phenotypical and genotypical variation, characterized by progressive reduction of photo-receptor functionality of the rod and cone. Global prevalence of RP is ~ 1/4000 and it can be inherited as autosomal dominant (adRP), autosomal recessive (arRP) or X- linked (xlRP). We designed this study to identify causative mutations in Pakistani families affected with arRP., Methods: In 2019, we recruited two unrelated Pakistani consanguineous families affected with progressive vision loss and night blindness from Punjab region. Clinical diagnosis confirmed the; bone spicule pigmentation of the retina, and an altered electroretinogram (EGR) response. Proband and healthy individual from each family were subjected for whole-exome sequencing (WES). Various computational tools were used to analyze the Next Generation Sequencing (NGS) data and to predict the pathogenicity of the identified mutations., Results: WES data analysis highlighted two missense homozygous variants at position c.T1405A (p.S469T) in PLCE1 and c.T11C (p.V4A) in HPS1 genes in proband of both families. Healthy individuals of two families were tested negative for p.S469T and p.V4A mutations. The variant analysis study including molecular dynamic simulations predicted mutations as disease causing., Conclusion: Compound effect of mutations in rarely linked PLCE1 and HPS1 genes could also cause RP. This study highlights the potential application of WES for a rapid and precise molecular diagnosis for heterogeneous genetic diseases such as RP., (Copyright © 2022 Babar et al. Published by Tehran University of Medical Sciences.)

Various pathophysiologic mechanisms may account for lupus-induced myocardial injury. Understanding the distinctions in the underlying disease process helps recognize variable clinical presentations and implement appropriate therapies. This report describes lupus-induced myocardial injury in three men less than 40 years old with diverse pathophysiologic mechanisms and presentations including acute myopericarditis with microvascular obstruction, acute coronary syndrome (ACS) and chronic myocarditis with systolic heart failure. Cardiovascular magnetic resonance (CMR) helped define the mechanism of disease, which included evidence of coronary microvascular obstruction in a patient without epicardial coronary artery disease. These findings highlight the cardiovascular effects of lupus, reveal coronary microvascular obstruction as potential consequence of acute myocarditis, and demonstrate the application of CMR in assessing the extent of disease., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Breast neoplasms are becoming more common in the last few years. Among these masses, metastasis to the breast is rare. Extra-gestational choriocarcinoma is extremely rare among breast neoplasms. We intend to present a case of a 30-year-old female with complaints of breast and axillary lumps. She had a history of a previously treated uterine trophoblastic tumor. Subsequently, she underwent a trucut biopsy of the breast mass and the axillary node, revealing metastatic choriocarcinoma., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Aleem et al.)

In the last decade, neuromodulation via baroreflex activation therapy (BAT) and vagus nerve stimulation (VNS) has emerged as an innovative approach for the treatment of heart failure with reduced ejection fraction (HFrEF). A review of the literature was conducted to examine the latest efficacy and safety data on neuromodulation for the treatment of HFrEF. Two independent researchers searched the PubMed, clinicaltrials.org, and the Cochrane databases for the most recent data on BAT and VNS published between 2013 and 2019. A total of nine studies were identified. BAT and VNS therapy consistently improved subjective heart failure parameters including New York Heart Association class and Minnesota Living with Heart Failure Questionnaire. Improvements in objective cardiac parameters such as left ventricular ejection fraction (LVEF) were less consistently seen; however, where present, ranged from +3% to +6%, in line with improvements seen after other guideline directed therapy such as left ventricular assist device (LVAD). Benefits of BAT showed a predilection for patients without cardiac resynchronization therapy (CRT) and efficacy of VNS therapy varied with device type. The clinical application of BAT and VNS was found to be limited due to low-powered data, inconsistencies in study design, short-term follow-up and lack of diversity in patient recruitment. Well-powered studies with consistent design, longer follow-up and diverse populations are warranted before BAT and VNS can be incorporated into heart failure guidelines and clinical practice., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that would influence the work reported in this paper., (Copyright 2022, Babar et al.)

Objective: To assess the adherence level of obstetricians towards postpartum diabetes screening guidelines., Methods: The quasi-experimental pre- and post-intervention study was conducted from May 2014 to April 2015 at Aga Khan Hospital for Women-Karimabad, Karachi, and comprised all obstetricians practicing at the time. All the booked women with gestational diabetes delivered in the 6 months before refresher lecture (group 1) and those delivering in the 6 months following the intervention (group 2) were included. Data was analysed using SPSS 19., Results: Of the 550 cases, 275(50%) each were in groups 1 and 2. All pregnant women had live-birth. The intervention made it thrice likely (95% confidence interval: 7.83) that a physician advised postpartum oral glucose tolerance test. Caesarean section increased the chances of getting test advice almost 4 times (95% confidence interval: 1.70, 9.10) compared to women who delivered vaginally. Women managed on insulin with / without metformin were 4 times likely to being advised the test compared to women managed on diet (confidence interval: 1.00, 17.09). Full-time employees advised 7 times more than the visiting obstetricians (confidence inter val: 1.33, 35.16)., Conclusions: It is time for more strategic planning regarding patient education the benefits of detection of abnormal glucose tolerance in early postpartum period.

The objective of our study was to determine the frequency of methicillin resistance in coagulase negative Staphylococcus (CoNS) and to determine its in-vitro antimicrobial susceptibility to various other routinely used antibiotics. It was a cross sectional study conducted at the department of Microbiology, Army Medical College, Rawalpindi, Pakistan from June 2011 to May 2012. The organisms were identified on the basis of colony morphology, Gram staining, catalase, DNAase and slide/tube coagulase tests. The organisms were considered to be methicillin resistant when the diameter of zone of inhibition was less than 25mm around 30μg cefoxitin disc. Antibiotic sensitivity was determined using the Modified Kirby-Bauer disc diffusion method. From a total of 337 CoNS, 201 were methicillin resistant and were included in the study. All were resistant to Penicillin, followed by Erythromycin (93•1%), Ciprofloxacin (77%), Co-trimoxazole (74•8%), Gentamicin (68•3%), Clindamycin (51•06%), Tetracycline (44•6%), Fusidic acid (40%), Rifampicin (39•5%), Chloramphenicol (19•3%), Linezolid (2%), Minocycline (1•1%), and Vancomycin (0%). More than half of CoNS were methicillin resistant. Vancomycin is the only drug to which all of the MRCoNS were sensitive, with more than 98% of the isolates being sensitive to Linezolid and Minocycline.

Purpose: To develop methods to delineate the relationship between endothelial cell toxicity and tissue fixation (toxicity/fixation) using sodium hydroxymethylglycinate (SMG), a formaldehyde releaser, and riboflavin-UVA photochemical corneal cross-linking (CXL) for therapeutic tissue cross-linking of the cornea., Methods: Eleven fresh cadaveric rabbit heads were used for ex vivo corneal cross-linking simulation. After epithelial debridement, the tissue was exposed to 1/4 max (9.8 mM) or 1/3 max (13 mM) SMG at pH 8.5 for 30 minutes or riboflavin-UVA (CXL). The contralateral cornea served as a paired control. Postexposure, cross-linking efficacy was determined by thermal denaturation temperature (Tm) and endothelial damage was assessed using calcein AM and ethidium homodimer staining (The Live/Dead Kit). Confocal laser scanning fluorescence microscopy was used to generate live/dead cell counts using a standardized algorithm., Results: The ΔTm after CXL, 1/3 SMG, and 1/4 SMG was 2.2 ± 0.9°C, 1.3 ± 0.5°C, and 1.1 ± 0.5°C, respectively. Endothelial cell damage was expressed as the percent of dead cells/live + dead cells counted per high-power field. The values were 3 ± 1.7% (control) and 8.9 ± 11.1% (CXL) (P = 0.390); 1 ± 0.2% (control) and 19.5 ± 32.2% (1/3 max SMG) (P = 0.426); and 2.7 ± 2.4% (control) and 2.8 ± 2.2% (1/4 max SMG) (P = 0.938). The values for endothelial toxicity were then indexed over the shift in Tm to yield a toxicity/fixation index. The values were as follows: 2.7 for CXL, 14 for 1/3 max, and 0.1 for 1/4 max., Conclusions: Quarter max (1/4 max = 9.8 mM) SMG effectively cross-linked tissue and was nontoxic to endothelial cells. Thus, SMG is potentially a compound that could achieve both desired effects.

Purpose: Current literature contains scant information regarding the extent of enzymatic collagen cross-linking in the keratoconus (KC) cornea. The aim of the present study was to examine levels of enzymatic lysyl oxidase-derived cross-links in stromal collagen in KC tissue, and to correlate the cross-link levels with collagen fibril stability as determined by thermal denaturation temperature (Tm)., Methods: Surgical KC samples (n = 17) and Eye-Bank control (n = 11) corneas of age 18 to 68 years were analyzed. The samples were defatted, reduced (NaBH4), hydrolyzed (6N HCl at 110°C for 18 hours), and cellulose enriched before analysis by C8 high-performance liquid chromatography equipped with parallel fluorescent and mass detectors in selective ion monitoring mode (20 mM heptafluorobutyric acid/methanol 70:30 isocratic at 1 mL/min). Nine different cross-links were measured, and the cross-link density was determined relative to collagen content (determined colorimetrically). The Tm was determined by differential scanning calorimetry., Results: Cross-links detected were dihydroxylysinonorleucine (DHLNL), hydroxylysinonorleucine, lysinonorleucine (LNL), and histidinohydroxylysinonorleucine in both control and KC samples. Higher DHLNL levels were detected in KC, whereas the dominant cross-link, LNL, was decreased in KC samples. Decreased LNL levels were observed among KC ≤ 40 corneas. There was no difference in total cross-link density between KC samples and the controls. Pyridinolines, desmosines, and pentosidine were not detected. There was no notable correlation between cross-link levels with fibril instability as determined by Tm., Conclusions: Lower levels of LNL in the KC cornea suggest that there might be a cross-linking defect either in fibrillar collagen or the microfibrillar elastic network composed of fibrillin.

Objective: To determine the frequency of Vancomycin Resistant Enterococcus (VRE) in a tertiary care hospital of Rawalpindi, Pakistan., Study Design: Observational, cross-sectional study., Place and Duration of Study: Department of Microbiology, Army Medical College, Rawalpindi, from May 2011 to May 2012., Methodology: Vancomycin resistant Enterococcus isolated from the clinical specimens including blood, pus, double lumen tip, ascitic fluid, tracheal aspirate, non-directed bronchial lavage (NBL), cerebrospinal fluid (CSF), high vaginal swab (HVS) and catheter tips were cultured on blood agar and MacConkey agar, while the urine samples were grown on cystine lactose electrolyte deficient agar. Later the antimicrobial susceptibility testing of the isolates was carried out using the modified Kirby-Bauer disc diffusion method on Mueller Hinton agar., Results: A total of 190 enterococci were isolated. Of these, 22 (11.57%) were found to be resistant to vancomycin. The antimicrobial sensitivity pattern revealed maximum resistance against ampicillin (86.36%) followed by erythromycin (81.81%) and gentamicin (68.18%) while all the isolates were 100% susceptible to chloramphenicol and linezolid., Conclusion: The frequency of VRE was 11.57% with the highest susceptibility to linezolid and chloramphenicol.

Objectives: To assess the various recruitment strategies used by medical researchers and their response rates., Methods: The observational study, part of a larger retrospective cohort, was done at the Aga Khan University Hospital, Karachi, Pakistan, from May 2008-December 2010, covering a period from 1999 to 2005. We used a multi-mode contact approach for including participants in the study. This comprised an invitational letter that described the study sent along with a mail-back, postage-paid envelope and multiple phone calls for recruitment of participants. The response to each mode was noted and described as frequency and percentage., Results: There were 1335 participants eligible for recruitment in the study. Of them, 1247 (93.4%) were sent mailouts to which only 84 (6.7%) responded. Besides, 1133 participants,whose phone numbers were available, were called. Overall, the number of people that we were able to contact was low. The response to postage paid mail was very poor whereas the majority of participants were contacted via phone calls. Out of such participants, 257 (19.25%) agreed to participate at the very first call and our results suggest that more than three calls made very little contribution to the consent rate., Conclusion: Recruiting subjects from contact information available in the medical records may not be the best method. Multiple and innovative approaches are required for approaching potential participants and requesting them to participate in a study.

Anemia is a global problem of immense public health significance. Iron deficiency anemia is the most common nutritional disorder seen all over the world, more in the developing countries, particularly, affecting young children of 6-24 months of age, adolescents, women of reproductive age group and pregnant/ lactating women. Basic approach in prevention of IDA should include education and associated measures to increase the dietary intake of iron, dietary modification to enhance the iron absorption, fortification of food articles, in addition to control the infection and worm infestations. Supplemenldelim 1, of medicinal iron is key to success which can be achieved by daily or intermittent (biweekly/weekly) administration of oral iron to the target group. Reduction of nutritional anemia should receive top priority through proper planning by using better utilization of existing health infrastructure.

Background: Lipid-cell tumors are rare, functioning ovarian neoplasms. They have not been reported in women with von Hippel-Lindau syndrome, an autosomal-dominant tumor-suppressor gene mutation that is associated with renal cell carcinoma, and other vascular tumors., Cases: Two women with von Hippel-Lindau syndrome and kidney tumors were evaluated for secondary amenorrhea, hirsutism, and complex adnexal masses seen on computed tomography. The first patient had known renal cancer and bilateral adnexal masses, one with central necrosis. Because metastatic renal cell cancer could not be excluded on frozen section, bilateral salpingo-oophorectomy was performed. The second patient underwent right salpingo-oophorectomy after human chorionic gonadotropin testing confirmed that the ovarian tumor produced testosterone. Final pathology in both cases revealed testosterone-secreting lipid cell tumors., Conclusion: Lipid cell ovarian tumors should be considered in women with von Hippel-Lindau presenting with adnexal mass, amenorrhea, and hirsuitism.

von Willebrand disease (VWD) is the most common congenital bleeding disorder and is caused by a quantitative or qualitative abnormality of von Willebrand factor (VWF). Ristocetin cofactor (RCoF) assay is used to evaluate VWF activity, but it does not assess collagen-binding activity. Normal values of RCoF and VWF antigen vary with ABO blood group type. The collagen-binding assay (CBA) measures VWF activity; however, its relationship with ABO blood group has not been completely explored. We performed CBA on plasma samples from 131 healthy volunteers to determine if CBA values correlated with blood type. Individuals with blood group O had a mean CBA value of 94 +/- 28%, which was significantly different from the mean of 117 +/- 33% in persons with non-O blood groups (P = 0.0001). Thus, CBA values appear to correlate with ABO blood type in a manner similar to RCoF., (Copyright 2002 Wiley-Liss, Inc.)