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Being one of the most common abdominal surgical procedures, numerous techniques have been adapted to decrease post-operative pain post cholecystectomy. However, the efficacy of intravenous (IV) lidocaine in managing post operative pain after LC is still controversial, according to many recent studies. This study aims to detect the effectiveness of IV lidocaine compared to other medications in managing post-operative pain. PubMed, Scopes, Web of Science and Cochrane Library were searched for eligible studies from inception to June 2023, and a systematic review and meta-analysis was done. According to eligibility criteria, 14 studies (898 patients) were included in our study. The pooled results of the included studies showed that the pain score after 6, 12 and 24 h after the surgery was significantly lower in those who received IV lidocaine as a painkiller (Visual Analogue Scale [VAS] 6H, mean difference [MD] = −1.20, 95% confidence interval [CI] = −2.20, −0.20, P = 0.02; I2 = 98%, VAS 12H, MD = −0.90, 95% CI = −1.52, −0.29, P = 0.004; I2 = 96% and VAS 24H, MD = −0.86, 95% CI = −1.48, −0.24, P = 0.007; I2 = 92%). In addition, IV lidocaine is associated with a significant decrease in the opioid requirement after the surgery (opioid requirements, MD = −29.53, 95% CI = −55.41, −3.66, P = 0.03; I2 = 98%). However, there was no statistically significant difference in the incidence of nausea and vomiting after the surgery between the two groups (nausea and vomiting, relative risk = 0.91, 95% CI = 0.57, 1.45, P = 0.69; I2 = 50%). Lidocaine infusion in LC is associated with a significant decrease in post operative pain and in opioid requirements after the surgery.

Abstract This study presents a computational analysis of fluid flow characteristics around two staggered arranged square cylinders using the Lattice Boltzmann Method (LBM). With Reynolds number (Re) fixed at 200, numerical simulations explore the influence of varying gap ratios (G) ranging from 0 to 10 times the cylinder size. Emphasis is placed on understanding the impact of cylinders spacing on flow structure mechanisms and induced forces. Investigation of fluid flow parameters includes vorticity behavior, pressure streamlines, and variations in drag and lift coefficients alongside the Strouhal number under different values of G. From the results, four distinct flow patterns emerge: single bluff body flow, flip flopping flow, modulated synchronized flow, and synchronized flow, each exhibiting unique characteristics. This study reveals the strong dependence of fluid forces on G, with low spacing values leading to complex vortex structures and fluctuating forces influenced by jet flow effects. At higher spacing values, proximity effects between cylinders diminish, resulting in a smoother periodic flow. The Strouhal number, average drag force and the rms values of drag and lift force coefficients vary abruptly at narrow gaps and become smooth at higher gap ratios. Unlike the tandem and side-by-side arrangements the staggered cylinders arrangement is found to have significant impact on the pressure variations around both cylinders. Overall, this research could contribute to a comprehensive understanding of staggered cylinder arrangements and their implications for engineering applications.

Summary:. Chronic expanding hematoma (CEH) is a rare entity that poses diagnostic and therapeutic challenges due to persistent growth, risk of recurrence, and potential for blood loss anemia. The most common etiologies of CEH are trauma or surgery. It is thought to occur due to irritant effects of blood breakdown products, causing bleeding from capillaries in chronic granulation tissue. Although treatment of CEH is variable, complete surgical excision of the hematoma and its pseudocapsule is the gold standard. We present a case of a 15-year CEH that was initially treated with limited evacuation of the hematoma and cavity decortication, resulting in recurrence. Ultimately, the patient was managed with complete excision of the pseudocapsule, closure of the cavity with quilting sutures, application of an absorbable hemostatic agent, and placement of a large drain, resulting in a successful outcome. This case highlights the efficacy of a comprehensive surgical plan in addressing CEH, emphasizing the importance of pseudocapsule excision in its entirety to prevent recurrence.

The aim of the current research is to highlight the time-dependent properties of laminar convective thermal transmission inside a semi-infinite pipe, with an emphasis on flow frequencies that impact inter-fluid momentum and energy. The implicit finite difference approach is used to solve two-dimensional mathematical model composed of nonlinear partial differential equations. The research includes forecasting thermal performance of time-dependent flow in a pipe over several parameter ranges relevant to the flow model. The obtained forecasts were emphasized graphically. The numerical solutions were separated into steady and unsteady components, with the steady component yielding findings that were then used to determine the time dependent surface shearness and energy shearness in the time dependent phase. The stable component of the investigation revealed that raising the buoyancy force parameter and the impact of viscous dissipation significantly improved the flow velocity pattern and heat distributions throughout the flow domain. While the amplitude of time dependent surface shearness varied somewhat across various buoyancy force parameter values, the amplitude of time dependent heat transmission rates varied significantly. This study sheds light on the interaction of several characteristics, such as buoyancy force effects and internal energy loss, on time-dependent thermal energy flow inside a semi-infinite pipe subjected to laminar convective flow. It is worth noting that the amplitude of the time dependent rate of heat transmission shows more noticeable variations with different values of the buoyancy force parameter, in contrast to the minute change in the amplitude of the time dependent surface sheerness.

Background: Urinary tract infection (UTI) is known to be the most frequent bacterial infection in the paediatric population. Objective: To determine the clinical profile and etiology of complicated urinary tract infection (UTI) in children. Methods: This cross-sectional study was done at the Department of Nephrology and Neonatology, National Institute of Child Health, Karachi from 1st January 2022 to 30th June 2022. In 241 children of either gender, (male and female) aged up to 15 years having structural or functional anomalies of the kidney and urinary tract or recurrent infection due to underlying kidney or urinary tract abnormalities were enrolled. Demographic and clinical characteristics along with laboratory parameters and etiological agents of complicated UTI were noted. Ultrasonography examination and dimercaptosuccinic acid (DMSA) renal scan (where indicated) were performed. Results: Of 241 children, 179 (74.3%) were male. The mean age was 3.08±3.63 years. Capillary refill time was prolonged in 78 (32.4%) children. Fever/chills, nausea/vomiting, urinary urgency, and dehydration were the most frequently noted clinical presentations reported in 232 (96.2%), 109 (45.2%), 91 (37.8%), and 89 (36.9%) children respectively. Ultrasonography findings were evident of bilateral moderative hydronephrosis in 60 (24.9%) children. E. coli followed by Pseudomonas and Klebsiella species were the most commonly found etiological agents noted in 98 (40.7%), 50 (20.7%), and 40 (16.6%) children respectively. Conclusion: The majority of the children with complicated UTIs were male. Fever/chills, nausea/vomiting, urinary urgency, and dehydration were the most frequently noted clinical presentations. The most commonly observed ultrasonography findings were bilateral moderative hydronephrosis.

This study investigates the impact of lotus seed powder and chocolate addition on the frozen yogurt formulated with goat milk. It’s hypothesized that it would be a low-fat, high-protein, mineral-rich, healthy alternative to market-available dairy frozen desserts. Four different treatments T1 (7% cocoa powder (CP), milk 90%, lotus seed powder (LSP) 3%), T2 (5% CP, 90% milk, 5% LSP) and T3 (3% CP, 90% milk, 7% LSP) were created using lotus seed and cocoa powder, while T0 (100% pure goat milk) was used as the control. The product underwent a comprehensive evaluation, including a thorough assessment of its physicochemical, phytochemical, mineral, and sensory profiles. Prepared yogurt showed an increase in lotus seed powder i.e. 3, 5, and 7% showed reduction in moisture 31.3, 31.5 and 33.7%, respectively. pH ranged from a minimum of 4.41 in T0 to 5.72 in T2. The phytochemical analysis revealed the mean value of TPC, TFC and DPPH of the product in the range of 41.3–87.6 mg/GAE g, 118–147 mg/GAE g, 86–95 µg/mL. The mineral contents ranged 1405–1430 mg/g for Ca, and 149–165 mg/g for Mg. Sensory evaluation of the product revealed that T2 received the highest score for flavor, texture, color, and overall acceptance of the prepared product. Thus, the addition of lotus seed and cocoa powder to goat milk frozen yogurt demonstrated great sensory and nutritional advantages, making it optional for creating a fresh dairy product with high added values.

Background: Urinary tract infections (UTIs) are some of the most common infections affecting women during pregnancy, which – if left untreated – may lead to severe consequences for both mother and infant health. Low socio-economic status and educational attainment levels, inappropriate personal hygiene practices – especially in rural women – may lead to an increased risk of developing UTIs. The present study aims to assess the knowledge, attitudes and practices of pregnant women – who are living in peripheral areas of the Chakwal district, Punjab, Pakistan – regarding UTIs, according to the Health Belief Model (HBM). Methods: A descriptive, cross-sectional study was carried out using a 91-item questionnaire, including six HBM domains. Data collection was performed with convenience sampling among pregnant women in hospitals between July and September 2021. Statistical analyses (descriptive statistics, χ2-tests) were carried out using IBM SPSS 25.0. Results: 98.4% (n = 243) of the respondents were married, 77.7% (n = 192) were housewives, 41.7% (n = 103) attended up to an intermediate college education, while 43.7% (n = 108) were in their first trimester. Majority of women (81.8%) had positive attitudes towards UTI-related knowledge-acquisition, and most of them (94.7%) had good hygiene practices; on the other hand, only around half of the participants (55.5%) had acceptable knowledge levels. Advanced age (p = 0.005) and higher educational attainment levels (p = 0.025) were associated with better attitudes, while higher income levels were associated with better knowledge (p

This study explores the synergistic effects of Resveratrol and Metformin on improving insulin sensitivity and ovulatory function in women with Polycystic Ovary Syndrome (PCOS). As a complex condition, PCOS is characterized by elevated androgen levels, menstrual irregularities, and the presence of ovarian cysts, with significant impacts on reproductive and metabolic health. Addressing this, our randomized, double-blind, placebo-controlled trial involved 100 women diagnosed with PCOS. Participants were divided into two groups, one receiving Metformin alone and the other a combination of Metformin and Resveratrol. Outcomes measured included insulin sensitivity, ovulatory cycles, metabolic and hormonal profiles, and inflammatory markers. Our findings revealed that combination therapy significantly improved ovulatory function, insulin sensitivity, and reduced inflammation compared to Metformin alone. These promising results indicate the potential of combined Resveratrol and Metformin treatment in managing both metabolic and reproductive aspects of PCOS, though further research is necessary to confirm these outcomes and clarify the mechanisms at play.

Abstract Objectives Intraoperative frozen-section evaluation is a valuable technique for detecting positive margins intraoperatively for oral squamous cell carcinoma. We conducted this study to determine the diagnostic accuracy of frozen section in detecting margin status and the effect of tumor grade and stage on diagnostic accuracy. Results A total of 251 biopsy-proven cases of oral squamous cell carcinoma were included in this study. The tissue specimen resected during surgery was sent to the laboratory for frozen section evaluation. The frozen section results were then compared with the permanent section results to determine the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. The mean age of the patients included in the study was 51.65 ± 10.03 years, with male predominance (55.4%). The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of frozen section were 88.81%, 94.84%, 95.20%, 88.10%, and 91.63%, respectively. We conclude that frozen section is a useful technique in determining the margin status intraoperatively in oral cancers, with high diagnostic accuracy. Moreover, certain clinical parameters such as age, gender, disease duration, and tumor stage and grade appear to affect the diagnostic accuracy of frozen section.

Let $ S $ be a polynomial ring over a field and $ I $ be an edge ideal associated with some classes of circulant graphs. We discussed the algebraic invariants, namely, regularity, projective dimension, depth, and the Stanley depth of $ S/I. $

Background: Information technology (IT) is a new way of teaching and learning. One of the promising media of information technology is e-Learning, which is used to enhance knowledge and skills among users. A student gains better and deep knowledge through a useful tool. This survey aimed to determine practices among medical students for e-Learning. Methods: This cross-sectional survey was conducted on 184 students amongst the 500 students currently enrolled in medical college. Data was collected using questionnaires and were analyzed through SPSS version 22. Chi-square was used for qualitative values. Results: Majority 90.80% (n=167) students were aware of e-Learning and were statistically high in first year students (p-value: 0.018). The student did not show statistically significant results for content learned through e-Learning with a p-value of 0.063. Different resources were used for e-Learning in which videos had the highest percentage (87.60%) and audios were used as the least resource for e-Learning (29.20%). Daily, 56% of the students use e-Learning for 1 hour or less and only 3% of the students used it for more than 4 hours. Conclusion: Majority of undergraduate medical students were aware of the use of e-Learning and most of them preferred e-Learning for their course work and studies showing a significant increase in understanding and use, compared to studies conducted earlier. Participants found e-Learning useful and effective tool in increasing knowledge and understanding of their subject. Keywords: e-Learning; Practices; Students.

Background and objective: Hashimoto’s thyroiditis is one of the common autoimmune thyroid diseases with increasing incidence in the general population. It has been suggested that a combination of genetic and environmental factors increase the risk of developing the disease. The current study aimed to find the association between HLA-DRB1*04 gene with Hashimoto's Thyroiditis among the Iraqi-Kurdish population in Erbil Province. Methods: The case-control study was conducted on 45 untreated patients with Hashimoto’s thyroiditis who have already been diagnosed and 45 control subjects. Blood specimens were taken from the subjects for gene detection purposes via conventional polymerase chain reaction. Sera specimens were used to run enzyme linked immunosorbent assay to measure the level of IFNγ. Results: The age of subjects ranged from 32 to 63 years with no significant difference between mean ±SE of cases (46.822±1.087 years) with the mean ±SE (47.044 ±1.162 years) of the control subjects (P = 0.999). The mean ±SE of free T3 and T4 levels was lower in cases in comparison to those of controls, while the mean ±SE of TSH level in cases was significantly higher compared to those of controls. Statistically there was a highly significant difference in the mean ±SE of free T3, free T4 and TSH levels between cases and controls (P

Background: Menstrual hygiene management plays a significant role in the achievement of sustainable development goals, including good health and well-being, quality education, gender equality, women’s empowerment, and sanitation. Even though the United Nations emphasizes menstrual hygiene management as a global public health and human rights issue, studies from different parts of the world have shown there is a lack of policies in this area that affects adolescent girls. Objective: The study aimed to assess the menstrual-related knowledge and practices of adolescent girls (10–18 years) attending urban and rural public schools of district Khairpur of province Sindh of Pakistan. Design: This research is an analytical cross-sectional study design. Methods: Adolescent girls ( n = 310), 159 girls from urban and 159 girls from rural schools, were enrolled. Data were collected through self-administered questionnaires. Knowledge was considered satisfactory if the participant scored ⩾12/20, and 10 and poor for

Nanoparticles (NPs) of metals and metal oxides have received increasing attention regarding their characteristic behavior in plant systems. The fate and transport of metal NPs and metal oxide NPs in plants is of emerging concern for researchers because they ultimately become part of the food chain. The widespread use of metal-based NPs (MBNPs) in plants has revealed their beneficial and harmful effects. This review addresses the main factors affecting the uptake, translocation, absorption, bioavailability, toxicity, and accumulation of MBNPs in different plant species. It appraises the mechanism of nanoparticle-plant interaction in detail and provides understanding of the estimation strategies for the associated pros and cons with this interplay. Critical parameters of NPs include, but are not limited to, particle size and shape, surface chemistry, surface charge, concentration, solubility, and exposure route. On exposure to MBNPs, the molecular, physiological, and biochemical reactions of plants have been assessed. We have filled knowledge gaps and answered research questions regarding the positive and negative effects of metal and metal oxide NPs on seed germination, callus induction, growth and yield of plant, nutritional content, antioxidants, and enzymes. Besides, the phytotoxicity, cytotoxicity, genotoxicity, and detoxification studies of MBNPs in plants have been outlined. Furthermore, the recent developments and future perspectives of the two-way traffic of interplay of MBNPs and plants have been provided in this comprehensive review.

The groundwater resources in different areas of Pakistan are heading towards depletion along with the deterioration of quality due to over-abstraction and urbanization. The main focus of this study is to map the current hydrostratigraphical and hydraulic conditions of the late Quaternary aquifers in the central part of Thal Doab of Punjab Plains. To achieve the target, a comprehensive approach was employed combining geophysical investigations using electrical resistivity surveys (ERS) and physiochemical analysis of groundwater specimens collected from the study area. Careful calibration of resistivity models was performed by comparing them with lithologs to ensure their accuracy. The current groundwater conditions were assessed through thirty vertical electrical soundings (VES) using the Schlumberger electrode configuration up to 300m of AB/2. The interpreted results revealed the presence of four to six geo-electric sublayers comprising the intermixing layers of clay, silt, sand, gravel, and kankar inclusions. These layers exhibited very low (230 Ω-m) resistivity zones at various depth intervals. The developed 2D/3D models of aquifer systems identify the promising areas of good/fresh quality groundwater in the regions characterized by medium to very high resistivity mainly within the sand with gravel layers. However, lower resistivity values indicate the presence of marginally suitable/fair and saline/brackish groundwater showing the existence of fine sediments such as clays/silts. Additionally, twenty groundwater samples were collected to assess various parameters including pH, TDS, arsenic, fluoride, iron, nitrate, and nitrite. The spatial distribution of these parameters was visualized using 2D maps. The suitability of the groundwater for drinking consumption was evaluated in accordance with WHO guidelines.

Brucellosis is a widespread zoonotic disease of veterinary and public health importance with considerably higher prevalence in developing/underdeveloped countries. This study reports the prevalence and risk determinants of brucellosis in small ruminants of peri-urban and rural areas of district Multan, Southern Punjab, Pakistan. For this purpose, sera samples (n = 392) of small ruminants were collected and subjected to preliminary screening using commercially available RBPT reagents followed by serodetection of brucellosis using multispecies i-ELISA kit (ID.vet, France). All the ELISA positive samples were confirmed by PCR using genus-specific primers, and frequencies of Brucella species in positive samples were enumerated using species-specific primers. Results indicated seropositivity rates of 9.69, 9.95, and 10.20% in study population using RBPT reagents of IDEXX-USA, ID.Vet-France, and VRI-Pakistan, respectively, with a statistically nonsignificant difference p>0.05. Results of ELISA showed an overall seroprevalence rate of 7.14% in target population with a slightly higher rate in sheep (7.65%) as compared to goat (6.63%) population (p=0.695; OR = 1.16, 95% CI = 0.53, 2.57). Results revealed that out of total positive samples, B. abortus was detected in 60.71% of seropositive samples and B. melitensis was detected in 14.28% of positive samples. It was revealed that risk factors including body condition scores, hygienic conditions of the housing facility, farming system, reproductive disorders, educational status of farmers, and awareness of farmers about brucellosis had significant association with brucellosis in small ruminants of study area p0.05 with brucellosis. In conclusion, brucellosis is prevalent in small ruminants of Multan, Pakistan. It is recommended to devise and implement effective control strategies with a major focus on raising awareness about brucellosis in farmers for the containment of infection in the region.

OBJECTIVES To assess the inter-rater reliability regarding the radiolucencies associated with a second molar adjacent to an impacted third molar. METHODOLOGY A cross-sectional comparative study was conducted in the College of Dentistry, Sharif Medical and Dental College, Lahore, in which dentists from four different specialities, namely; Oral Pathology, Endodontics, Prosthodontics and Oral and Maxillofacial surgery, were included as raters. 21 Orthopantomograms were assigned to each rater for assessing radiolucencies associated with a second molar adjacent to an impacted third molar. RESULTS The level of agreement regarding the radiolucencies associated with the second molar observed on the Orthopantomograms between rater 1 with rater 2 (κ=0.158., p=0.036) and rater 1 with rater 3 (κ=0.139, p=1.000) was very weak but was fair between rater1 and 4 (κ=0.271, p=0.200). CONCLUSION The only radiolucency that rater one observed was external root resorption. Rater 2 identified one case of radiolucency as dental caries and another as caries and periapical radiolucency that were identified by Rater 1 as external resorption; hence they had a weak agreement between Rater 1 and Rater 2 regarding the radiolucencies associated with second molars. Rater 3 identified radiolucencies owing to caries which were reported to be radiolucency due to external resorption by rater 1, and this agreement was weak. Most radiolucencies determined by rater 1 as external resorption were reported to be external resorption by rater 4, resulting in a fair agreement between rater 1 and 4.

Background: Paddy during various stages i.e. loading, transportation, storage, handling etc. occurs severe losses, which can be reduced by designing appropriate post-harvest machineries using physico-mechanical properties. Objectives: The study aimed to assess the variation in physico-mechanical properties of thirteen different paddy cultivars. Methodology: The study was carried out at the College of Engineering, Nanjing Agricultural University, China. Thirteen different freshly harvested paddy cultivars were collected from Nanjing. Collected paddy cultivars before experiment were cleaned removing extraneous materials. Paddy cultivars were sealed polythene bags, and were then kept in refrigerator at a temperature of 5 ºC for 7 days for uniform distribution of moisture. The required amount of samples from each cultivar was accordingly taken for evaluating their physical and mechanical properties. Results: The results when assessed were statistically different (p?0.05) from each other. The average values of different paddy cultivars for length, width, thickness, geometric mean diameter, arithmetic mean diameter, square mean diameter, equivalent diameter, surface area, volume, sphericity, aspect ratio, thousand kernel weight, bulk density, true density, porosity, hardness and toughness (for both horizontal and vertical orientations) were calculated to be 7.94mm, 3.32mm, 2.26mm, 3.84mm, 4.51mm, 2.56mm, 3.64mm, 46.53mm2, 29.74mm3, 0.49%, 0.42, 28.64 gm, 568.31 kg m-3, 1225.20 kg m-3, 54%, 46.09 N, 14.75 N, 16.06 mJ and 6.90 mJ respectively. Conclusion: A wide variation was observed for each parameter while comparing different paddy cultivars. This wide variation in result will negatively affect the performance of the equipment and machinery being used for post-harvest practices. The study concludes that it is essential for industries involved in equipment design and machinery production, as well as end-users responsible for their implementation, to take into account these substantial differences among cultivars when making their decisions.

Introduction: The personality trait of openness to experiences symbolizes the level of creativity, non-conformity, and adventurous aspects of an individual`s personality. Individuals with this personality trait as their predominant personality characteristic are very receptive to new ideas and concepts and are rarely reluctant to embark upon new avenues in life. These individuals are more open-minded and tend to investigate a broader perspective of situations. It is a known fact that such individuals have a very non-conservative method of information seeking as opposed to conservative people who are extremely cautious of the facts, they come across to avoid the risks. This study was designed to find out the impact of the personality trait of openness to experience on oral parafunctional habits. Material & Methods: A cross-sectional descriptive study was conducted at the College of Dentistry, Sharif Medical and Dental College, Lahore, over 5 months, from July to November 2021. Data was collected using a pre-validated parafunctional habits questionnaire and a ten-item personality inventory scale. Results: The difference in the personality trait score of openness to experience was non-significant with oral parafunctional habits of tooth grinding (p=0.28), tooth clenching (p=0.36), biting hard objects (p=0.86) and chewing gum (p=0.83), however, significant with the habit of nail biting (p=0.03). Conclusion: The personality trait was seen most prevalent in individuals who disagreed with having the habit of nail biting and teeth grinding and for those who strongly agreed to have the habit of tooth clenching. The personality trait was also most prevalent in individuals who agreed to have the habit of biting hard objects and those who neither agreed nor disagreed with having the habit of chewing gum.

Objective Maternal sepsis is the third leading cause of maternal mortality globally. WHO and collaborators developed a care bundle called FAST-M (Fluids, Antibiotics, Source identification and treatment, Transfer and Monitoring) for early identification and management of maternal sepsis in low-resource settings. This study aimed to determine feasibility of FAST-M intervention in a low-resource setting in Pakistan. The FAST-M intervention consists of maternal sepsis screening tools, treatment bundle and implementation programme.Design and setting A feasibility study with before and after design was conducted in women with suspected maternal sepsis admitted at the Liaquat University of Medical and Health Sciences hospital Hyderabad. The study outcomes were compared between baseline and intervention phases. In the baseline phase (2 months), the existing sepsis care practices were recorded, followed by a training programme for healthcare providers on the application of FAST-M tools. These tools were implemented in the intervention phase (4 months) to assess any change in clinical practices compared with the baseline phase.Results During the FAST-M implementation, 439 women were included in the study. 242/439 were suspected maternal infection cases, and 138/242 were women with suspected maternal sepsis. The FAST-M bundle was implemented in women with suspected maternal sepsis. Following the FAST-M intervention, significant changes were observed. Improvements were seen in the monitoring of oxygen saturation measurements (25.5% vs 100%; difference: 74%; 95% CI: 68.4% to 80.5%; p

Background:. Self-fulfilling prophecy bias occurs when a perceived prognosis leads to treatment decisions that inherently modify outcomes of a patient, and thus, overinflate the prediction performance of prognostic methods. The goal of this series of systematic reviews is to characterize the extent to which neuroprognostic studies account for the potential impact of self-fulfilling prophecy bias in their methodology by assessing their adequacy of disclosing factors relevant to this bias. Methods:. Studies evaluating the prediction performance of neuroprognostic tools in cardiac arrest, malignant ischemic stroke, traumatic brain injury, subarachnoid hemorrhage, and spontaneous intracerebral hemorrhage will be identified through PubMed, Cochrane, and Embase database searches. Two reviewers blinded to each other’s assessment will perform screening and data extraction of included studies using Distiller SR and following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will abstract data pertinent to the methodology of the studies relevant to self-fulfilling prophecy bias. Results:. We will conduct a descriptive analysis of the data. We will summarize the reporting of mortality according to timing and mode of death, rates of exposure to withdrawal of life-sustaining therapy, reasoning behind limitations of supportive care, systematic use of standardized neuroprognostication algorithms and whether the tool being investigated is part of such assessments, and blinding of treatment team to results of neuroprognostic test being evaluated. CONCLUSIONS:. We will identify if neuroprognostic studies have been transparent in their methodology to factors that affect the self-fulfilling prophecy bias. Our results will serve as the foundation for standardization of neuroprognostic study methodologies by refining the quality of the data derived from such studies.

Abstract Background Maternal sepsis is a life-threatening condition, defined by organ dysfunction caused by infection during pregnancy, childbirth, and the postpartum period. It is estimated to account for between one-tenth and half (4.7% to 13.7%) of all maternal deaths globally. An international stakeholder group, including the World Health Organization, developed a maternal sepsis management bundle called “FAST-M” for resource-limited settings through a synthesis of evidence and international consensus. The FAST-M treatment bundle consists of five components: Fluids, Antibiotics, Source identification and control, assessment of the need to Transport or Transfer to a higher level of care and ongoing Monitoring (of the mother and neonate). This study aims to adapt the FAST-M intervention and evaluate its feasibility in Pakistan. Methods The proposed study is a mixed method, with a before and after design. The study will be conducted in two phases at the Liaquat University of Medical and Health Sciences, Hyderabad. In the first phase (formative assessment), we will adapt the bundle care tools for the local context and assess in what circumstances different components of the intervention are likely to be effective, by conducting interviews and a focus group discussion. Qualitative data will be analyzed considering a framework method approach using NVivo version 10 (QSR International, Pty Ltd.) software. The qualitative results will guide the adaptation of FAST-M intervention in local context. In the second phase, we will evaluate the feasibility of the FAST-M intervention. Quantitative analyses will be done to assess numerous outcomes: process, organizational, clinical, structural, and adverse events with quantitative comparisons made before and after implementation of the bundle. Qualitative analysis will be done to evaluate the outcomes of intervention by conducting FGDs with HCPs involved during the implementation process. This will provide an understanding and validation of quantitative findings. Discussion The utilization of care bundles can facilitate recognition and timely management of maternal sepsis. There is a need to adapt, integrate, and optimize a bundled care approach in low-resource settings in Pakistan to minimize the burden of maternal morbidities and mortalities due to sepsis.

Abstract Background To address the issue of high maternal mortality, the Government of Pakistan initiated a community midwifery program in 2006 to provide skilled birth attendance to women living in rural areas. Despite a large investment in the community midwifery program, research evidence from rural districts of Pakistan suggests that the utilization of maternal and newborn services through community midwives is very low. This exploratory study aimed to understand the facilitators and barriers influencing community midwives’ services utilization in district Thatta. Methods A qualitative study was conducted in the rural district Thatta, Pakistan. Key-informant interviews (KIIs) were conducted with district officials of the Health department (Thatta), Maternal and Newborn Child Health Program, and Midwifery Association of Pakistan (MAP). In-depth Interviews (IDIs) were conducted with midwifery students who were currently enrolled in the midwifery program of the district; trained community midwives providing services in district Thatta, and trained community midwives not continuing their profession. IDIs were also conducted with community women to explore their views about the scope of midwifery practice and the factors influencing the utilization of community midwives’ services in district Thatta, Pakistan. Data were analyzed using qualitative thematic analysis. Results A total of 25 interviews (KIIs = 5; IDIs = 20) were conducted. Two overarching themes were identified: (I) community midwives’ skills and competencies; and (II) ownership and supportive supervision. The major hindering factors for community midwives’ service utilization included deficiencies in community midwives’ training particularly in clinical hands-on training, lack of ownership of community midwifery program, and lack of service structure by the CMWs regulatory body. Conclusion The study has identified serious gaps in the CMWs program at the level of training and supervision of midwives in Pakistan. The study has also identified factors related to the training of CMWs that could facilitate the program in the context of Pakistan and similar settings.

Congenital perineal grove (CPG) is a rare anorectal anomaly; only 65 cases have been reported in literature. Two cases who were referred for evaluation of a lesion in the perineum are reported here. The patients were diagnosed clinically as CPG in neonatal period and were initially managed conservatively. Surgery was required in one case as the lesion was persistent and symptomatic. A high index of suspicion is required for diagnosis of CPG to avoid parental anxiety and unnecessary diagnostic work-up and surgery. Surgery is required only in cases where the lesion persists or there is infection, pain, and ulceration. Keywords: Anorectal malformations, Perineal cleft, Perineal grove.

Background: Carrot due to its versatility in culinary uses is considered to be one of the most preferred vegetable. The carrot in Pakistan ranks third among winter vegetables, but due to adoption of improper postharvest techniques and storage, it leads to a great reduction in its quality. Objective: The study was carried out to assess the effect of different treatments on quality characteristics of carrot. Methodology: The study was carried out at the Laboratory of Farm Structures, Sindh Agriculture University Tandojam, Pakistan. Freshly harvested mature carrots free from damage and fungal attack were obtained from field. The carrot samples were subjected to different post-harvest treatments i.e. 40 ºC hot water dip for 2 minutes, 50 ºC hot water dip for 2 minutes, 0.4% concentration of calcium chloride (CaCl2) dip for 2 minutes and tap water. Results: The results revealed that moisture content and firmness decreased with increasing storage duration, whereas weight loss, fungal incidence and total soluble solids increased with increasing storage duration. The carrots treated with 0.4% concentration of CaCl2 dip for 2 minutes had maximum moisture content (78.32%) and firmness (4.12 lbs), with minimum weight loss (41.33%), fungal incidence (38.14%) and total soluble solids (10.43%), followed by 40 ºC hot water dip for 2 minutes, 50 ºC hot water dip for 2 minutes and tap water. Conclusion: The carrots treated with 0.4% concentration of CaCl2 dip for 2 minutes showed better quality characteristics at the end of storage. The adoption of this treatment should therefore be encouraged in the developing countries for extending the quality characteristics of carrots.

Abstract Background Introduction of Bare Metal Stents (BMS) was itself a revolutionary step in the history of the medical industry; however, Drug Eluting Stents (DES) maintained its superiority over BMS in every aspect from restenosis rate to late lumen loss. The reason behind the magnanimous position of the DES in the stent market is the degree of improvement with which it evolves. New and better stents come into the market every year, surpassing their predecessors by many folds. Literature review This review paper discusses the journey of DES with supporting clinical trials in detail. In the first generation, there were stainless-steel stents with thicker coatings. Although they had superior results compared to BMS, there was still room for improvement. Afterward came the second-generation stents, which had superior metal platforms with thinner struts and thin coatings. The drugs were also changed from Paclitaxel and Sirolimus to Zotrolimus and Everolimus. These stents performed best; however, there was an issue of permanent coating, which remained intact over the stent surface after complete drug elution and started to cause issues in longer-term studies. Hence, an improved version of DES was introduced to these permanent coatings called the third generation of drug eluting stents, which initially utilized biodegradable polymer and ultimately moved towards polymer free drug coatings. This generation has introduced a unique amalgam of technologies to achieve its polymer free coatings; however, researchers have numerous prospects of growth in this field. This review paper highlights the major coups of stent technology evolution from BMS to DES, from thick polymeric coatings to thin coatings and from durable polymers to polymer free DES. Conclusion In conclusion, though the medical industry promptly accepted BMS as the best treatment option for cardiovascular diseases; however, DES has provided even better results than BMS. In DES, the first and second generation has ruled the technology for many years and are still on the shelves. Still, the issues aroused due to durable polymer shifted the attention towards biodegradable drug eluting stents, the third generation growing rapidly. But the scientific community has not restricted themselves and is investigating bioresorbable stents that completely eliminate the polymer intervention in drug eluting stent technology.

Urinary tract infections (UTIs) are healthcare problems that commonly involve bacterial and, in some rare instances, fungal or viral infections. The irrational prescription and use of antibiotics in UTI treatment have led to an increase in antibiotic resistance. Urine samples (145) were collected from male and female patients from Lower Dir, Khyber Pakhtunkhwa (KP), Pakistan. Biochemical analyses were carried out to identify uropathogens. Molecular analysis for the identification of 16S ribosomal RNA in samples was performed via Sanger sequencing. Evolutionary linkage was determined using Molecular Evolutionary Genetics Analysis-7 (MEGA-7). The study observed significant growth in 52% of the samples (83/145). Gram-negative bacteria were identified in 85.5% of samples, while Gram-positive bacteria were reported in 14.5%. The UTI prevalence was 67.5% in females and 32.5% in males. The most prevalent uropathogenic bacteria were Klebsiella pneumoniae (39.7%, 33/83), followed by Escherichia coli (27.7%, 23/83), Pseudomonas aeruginosa (10.8%, 9/83), Staphylococcus aureus (9.6%, 8/83), Proteus mirabilis (7.2%, 6/83) and Staphylococcus saprophyticus (4.8%, 4/83). Phylogenetic analysis was performed using the neighbor-joining method, further confirming the relation of the isolates in our study with previously reported uropathogenic isolates. Antibiotic susceptibility tests identified K. pneumonia as being sensitive to imipenem (100%) and fosfomycin (78.7%) and resistant to cefuroxime (100%) and ciprofloxacin (94%). Similarly, E. coli showed high susceptibility to imipenem (100%), fosfomycin (78.2%) and nitrofurantoin (78.2%), and resistance to ciprofloxacin (100%) and cefuroxime (100%). Imipenem was identified as the most effective antibiotic, while cefuroxime and ciprofloxacin were the least. The phylogenetic tree analysis indicated that K. pneumoniae, E. coli, P. aeruginosa, S. aureus and P. mirabilis clustered with each other and the reference sequences, indicating high similarity (based on 16S rRNA sequencing). It can be concluded that genetically varied uropathogenic organisms are commonly present within the KP population. Our findings demonstrate the need to optimize antibiotic use in treating UTIs and the prevention of antibiotic resistance in the KP population.

The contactless estimation of the weight of a container and the amount of its content manipulated by a person are key pre-requisites for safe human-to-robot handovers. However, opaqueness and transparencies of the container and the content, and variability of materials, shapes, and sizes, make this estimation difficult. In this paper, we present a range of methods and an open framework to benchmark acoustic and visual perception for the estimation of the capacity of a container, and the type, mass, and amount of its content. The framework includes a dataset, specific tasks and performance measures. We conduct an in-depth comparative analysis of methods that used this framework and audio-only or vision-only baselines designed from related works. Based on this analysis, we can conclude that audio-only and audio-visual classifiers are suitable for the estimation of the type and amount of the content using different types of convolutional neural networks, combined with either recurrent neural networks or a majority voting strategy, whereas computer vision methods are suitable to determine the capacity of the container using regression and geometric approaches. Classifying the content type and level using only audio achieves a weighted average F1-score up to 81% and 97%, respectively. Estimating the container capacity with vision-only approaches and estimating the filling mass with audio-visual multi-stage approaches reach up to 65% weighted average capacity and mass scores. These results show that there is still room for improvement on the design of new methods. These new methods can be ranked and compared on the individual leaderboards provided by our open framework.

What are the effects of parenting styles on academic performance and how unequal are these effects on secondary school students from different gender and socioeconomic status families constitute the theme of this paper. A cross-sectional and purposive sampling technique was adopted to gather information from a sample of 448 students on a Likert scale. Chi-square, Kendall's Tau-c tests and hierarchical multiple regression analyses were used to determine the extent of the relationship among the variables. Chi-square and Kendall's Tau-c (Tc) test results established that the socioeconomic status of the respondent's family explained variation in children's academic performance due to parenting style; however, no significant difference was observed in the academic performance of students based on gender. Furthermore, hierarchal multiple regression analysis established that the family's socioeconomic status, authoritative parenting, permissive parenting, the interaction of socioeconomic status and authoritative parenting, and the interaction of socioeconomic status and permissive parenting were significant predictors (P

IntroductionThe World Health Organization and partners developed and evaluated a maternity-specific sepsis care bundle called 'FAST-M' for low-resource settings. However, this bundle has not yet been studied in Asia. Our study sought to evaluate the perceptions of healthcare providers about the implementation of the FAST-M intervention in Pakistan.Materials and methodsThe study was conducted at a public sector hospital in Hyderabad. We conducted three focus group discussions with healthcare providers including doctors, nurses, and healthcare administrators (n = 22) who implemented the FAST-M intervention. The Consolidated Framework for Implementation Research was used as a guiding framework for data collection and analysis. The data were analyzed using a thematic analysis approach and deductive methods.ResultsFive overarching themes emerged: (I) FAST-M intervention and its significance including HCPs believing in the advantages of using the intervention to improve clinical practices; (II) Influence of outer and inner settings including non-availability of resources in the facility for sepsis care; (III) HCPs perceptions about sustainability, which were positive (IV) Integration into the clinical setting including HCPs views on the existing gaps, for example, shortage of HCPs and communication gaps, and their recommendations to improve these; and (V) Outcomes of the intervention including improved clinical processes and outcomes using the FAST-M intervention. Significant improvement in patient monitoring and FAST-M bundle completion within an hour of diagnosis of sepsis was reported by the HCPs.ConclusionsThe healthcare providers' views were positive about the intervention, its outcomes, and long-term sustainability. The qualitative data provided findings on the acceptability of the overall implementation processes to support subsequent scaling up of the intervention.

Abstract In this article, we establish a new class of mixed integral fractional delay dynamic systems with impulsive effects on time scales. We investigate the qualitative properties of the considered systems. In fact, the article contains three segments, and the first segment is devoted to investigating the existence and uniqueness results. In the second segment, we study the stability analysis, while the third segment is devoted to investigating the controllability criterion. We use the Leray–Schauder and Banach fixed point theorems to prove our results. Moreover, the obtained results are examined with the help of an example.

Background: Fear-avoidance beliefs and signs specifically non-organics are considered the psychological factors that have been determined in playing a major role in the advancement of prolonged disability. The current study was directed to explore the prevalence of fear-avoidance belief in patients with neck and back pain seeking physiotherapy and identifying the superior level of fear-avoidance beliefs regarding work or bodily performances which causes chronicity and disability in patients. Methodology: An observational study was conducted at the Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences, Ojha Campus, Karachi-Pakistan, from 1st Dec 2019 to 29th Feb 2020. Standard Fear Avoidance Belief Questionnaire (FAB-Q) was used to assess the fear level. The queries determined from the questionnaire were distributed into two types; FABQ-work-related and FABQ-physical activity-related. Results: A total of 100 patients were included in the study, with a mean age of 45.76 ± 13.75 years. 39.0% patients reported neck pain, whereas 61.0% reported back pain. The prevalence of fear-avoidance belief related to physical activity was 90% and related to work was 91%. The results also showed a significant association between gender and work-related fear-avoidance belief with a p-value of 0.024 (≤ 0.05). Conclusion: It is concluded that neck and backache sufferers show a high prevalence of fear-avoidance behavior of physical pastime and work score, confining their daily activities and not taking part in any bodily activities due to fear.

Objective A maternal sepsis management bundle for resource-limited settings was developed through a synthesis of evidence and international consensus. This bundle, called ‘FAST-M’ consists of: Fluids, Antibiotics, Source control, assessment of the need to Transport/Transfer to a higher level of care and ongoing Monitoring (of the mother and neonate). The study aimed to adapt the FAST-M intervention including the bundle care tools for early identification and management of maternal sepsis in a low-resource setting of Pakistan and identify potential facilitators and barriers to its implementation.Setting The study was conducted at the Liaquat University of Medical and Health Sciences, which is a tertiary referral public sector hospital in Hyderabad.Design and participants A qualitative exploratory study comprising key informant interviews and a focus group discussion was conducted with healthcare providers (HCPs) working in the study setting between November 2020 and January 2021, to ascertain the potential facilitators and barriers to the implementation of the FAST-M intervention. Interview guides were developed using the five domains of the Consolidated Framework for Implementation Research: intervention characteristics, outer setting, inner setting, characteristics of the individuals and process of implementation.Results Four overarching themes were identified, the hindering factors for implementation of the FAST-M intervention were: (1) Challenges in existing system such as a shortage of resources and lack of quality assurance; and (2) Clinical practice variation that includes lack of sepsis guidelines and documentation; the facilitating factors identified were: (3) HCPs’ perceptions about the FAST-M intervention and their positive views about its execution and (4) Development of HCPs readiness for FAST-M implementation that aided in identifying solutions to potential hindering factors at their clinical setting.Conclusion The study has identified potential gaps and probable solutions to the implementation of the FAST-M intervention, with modifications for adaptation in the local contextTrial registration number ISRCTN17105658.

Molecular hydrogen is renowned as an odorless and colorless gas. The recommendations developed by China suggest that the inhalation of hydrogen molecules is currently advised in COVID-19 pneumonia treatment. The therapeutic effects of molecular hydrogens have been confirmed after numerous clinical trials and animal-model-based experiments, which have expounded that the low molecular weight of hydrogen enables it to easily diffuse and permeate through the cell membranes to produce a variety of biological impacts. A wide range of both chronic and acute inflammatory diseases, which may include sepsis, pancreatitis, respiratory disorders, autoimmune diseases, ischemia-reperfusion damages, etc. may be treated and prevented by using it. H2 can primarily be inoculated through inhalation, by drinking water (which already contains H2), or by administrating the injection of saline H2 in the body. It may play a pivotal role as an antioxidant, in regulating the immune system, in anti-inflammatory activities (mitochondrial energy metabolism), and cell death (apoptosis, pyroptosis, and autophagy) by reducing the formation of excessive reactive O2 species and modifying the transcription factors in the nuclei of the cells. However, the fundamental process of molecular hydrogen is still not entirely understood. Molecular hydrogen H2 has a promising future in therapeutics based on its safety and possible usefulness. The current review emphasizes the antioxidative, anti-apoptotic, and anti-inflammatory effects of hydrogen molecules along with the underlying principle and fundamental mechanism involved, with a prime focus on the coronavirus disease of 2019 (COVID-19). This review will also provide strategies and recommendations for the therapeutic and medicinal applications of the hydrogen molecule.

Introduction Drawing on the well-acknowledged evidence of community midwives services to address the issue of high maternal mortality, the Government of Pakistan initiated the Community Midwifery (CMW) programme in 2006 to provide skilled birth attendance to pregnant women living in rural areas. Despite a large investment in CMW programme, the availability of community midwives in rural areas following their training is a constant struggle. The concerns related to the training, support and acceptability of community midwives need to be studied in order to identify gaps in the provision of skilled maternal and newborn healthcare. Therefore, this study aims to explore factors influencing the utilisation of services provided by community midwives and their non-retention in district Thatta, Pakistan.Methods and analysis The study will use a qualitative exploratory research design. The data will be collected through semistructured interviews and an approach of purposive sampling for the selection of participants for interviews. The study will be conducted in one of the rural districts Thatta of Province Sindh, Pakistan. The data will be collected through key informant interviews (KIIs) and in-depth interviews (IDIs). The KIIs will be conducted with officials of the health department (Thatta), the provincial maternal and newborn child health programme, and the Midwifery Association of Pakistan. The IDIs will be conducted with midwifery students, community midwives working and not working in the district, and community women of district Thatta. Data will be analysed through qualitative data analysis software NVivo V.10 and the thematic analysis approach.Ethics and dissemination Ethical approval for this study has been obtained from the Aga Khan University Ethical Review Committee (2020-3391-11138). The results of the study will be disseminated to the scientific community, to policy-makers involved in CMW programme training and implementation, and to the research subjects participating in the study.

The herbal disinfection suspensions were tested on microorganisms isolated from the kitchen floor surface using the disc diffusion technique. Three plant extracts were prepared in an aqueous solvent, and their inhibitory zones were determined. Aak, Pomegranate, and dumb cane leaf extract mixture were used for making disinfectant. For E. coli, the plant combination disinfection 1, at a concentration of 1500 µl, revealed 15mm of zones. Maximum zones for disinfectant 2 were recorded at 750 µl, which was 12mm. At 3000 µl concentration, 16 mm zones were observed for disinfectant 3. At 1500 µl concentration, 15 mm of zones were seen for disinfectant 4. Zones of inhibition of S. aureus were reported to be 18 mm and 15 mm at 3000 µl for disinfectants 1 and 2. At 375 µl, 21 mm of zones were found for disinfectant 3. At 3000 µl concentration, 17 mm of zones were observed for disinfectant 4. Comparing E. coli and S. aureus may conclude that S. aureus has more potential inhibitory zones than E. coli. All of the disinfectants showed promising antibacterial activity against surface microorganisms. Keywords: Zones of inhibition, Disinfectant, Disk diffusion method, Microbes, Concentration.

Purpose: The purpose of this paper is to investigate the linkage between COVID-19 related experiences and the academic performance of university students. COVID-19, in general, has impacted the whole world financially, socially, and psychologically through its adverse effects in the form of closure of business, financial crisis, downsizing, psychological distress, etc. Evidence suggests the prevalence of COVID-19 related issues among university students who faced stressful conditions due to lockdown and isolation. Methodology: Drawing on the behavioral theory of plasticity, the present study adopted a two-wave methodology for data collection. We collected data with the help of structured questionnaires from students (n=1473) of an international university in Australia. We used the structural equation modeling (SEM) technique to test the moderated mediation model in Smart PLS3. Findings: Results indicated that COVID-19 related experiences were negatively associated with students’ academic performance and positively with online leisure crafting. Whereas online leisure crafting was positively associated with academic performance and partially mediated the COVID-19 related experiences and academic performance. Uncertainty avoidance significantly buffered the effect of COVID-19 related experiences on online leisure crafting. The findings supported the research framework of the study. Conclusion: This study helps make clear the ‘how’ and ‘why’ of the impact of COVID-19 related experiences on university students’ academic performance through the mediation of online leisure crafting and moderation of uncertainty avoidance. The implications for university management and policymakers are discussed.

The coronavirus disease 2019 (COVID-19) pandemic and its effects on an individual’s life have altered the consumer behavior. In the context of purchase and consumption, a shift from conventional to green purchase has been noticed. Although the factors underlying this shift were relatively unexplored, the study aimed to identify the factors that influenced a significant role in the green purchases during the outbreak and the relationship of these factors with green purchase behavior (GPB). Subsequently, this study investigates and interprets the role of fear of COVID-19 (FCV), psychological distress (PD), and mortality salience (MS) in predicting consumer’s GPB. This research adopted a quantitative methodology using data collected from 432 respondents in various cities across Pakistan. Smart-PLS 3 was used to evaluate the measurement model, structural model, and multi-group analysis (MGA). Despite having the negative psychological and physical impact of the pandemic, a significant proportion of customers have switched to healthier and sustainable products. This research revealed that the FCV, PD, and MS plays a substantial role in adopting GPB. All the direct relationships were positive and significant. In addition, MS and PD partially mediate the effect of FCV on GPB. Furthermore, the MGA revealed that the infected respondents were interested in purchasing green products than uninfected respondents due to their FCV; conversely, the PD and MS were higher in uninfected individuals than infected ones. However, there is a vast literature on GPB, but little has investigated the cumulative impact of FCV, PD, and MS on GPB.

Background: Obesity is a current major concern of young adults in Pakistan and it is also a global health issue. According to WHO obesity has increased by 2005-2015 from 1.6 billion and 40 million to 2.3 billion. Increased BMI (body mass index) depends on the amount of time a person spends in a sedentary lifestyle and decrease with increased PA(Physical Activity) without exception of gender. Objectives: The purpose of this study is to examine the relationship between physical activity obesity and overweight among university going students and to identify the interrelationship among these three parameters using IPAQ (International Physical Activity Questionnaire) Methodology: An observational cross sectional survey was conducted using non-probability purposive sampling method at 4 universities situated in Jamshoro, Sindh for a duration of six (06) months. This sample size was 382 and all enrolled students were included except females with known hormonal disorders which were excluded from the study. SPSS version 23 was used to analyze the data in tabular and graphic format. Written informed consent was obtained from all the participants. The study was approved by the ERC of BDMC, Mirpurkhas. Results: Three hundred and Eighty two students participated in this study which consisted of 219 males (57.3%) and 163 females (42.7%) with mean age 22.3 ± 1.8 years. The association of performance of exercise and BMI was significant (p value = 0.02). The BMI of the studied subjects was also significantly associated with number of hours spent sitting. (p value = 0.01). The association of total physical activity with BMI was also found to be significant. (p value = 0.01) Conclusion: this study shows that physical activity is inversely proportional to obesity and overweight, sitting time during work hours and lack of sports and leisure activity, less involvement in home and care activities more time spending in involving in social media playing video games are also can be considered as reasons of an increasing number of overweight and obesity. Keyword: Physical activity, BMI, Sedentary Life Style, Over-weight, Obese

Advocates of software engineering and software project management stated in the literature that creeping of scope is one of the most common causes for the failure of software projects. Also, advocates believed that it could occur in almost every software project, which leads to compromise in quality, delayed schedules, increase cost and decreased customer satisfaction. However, the lack of empirical evidence demands a comprehensive investigation to identify the factors of scope creep and to propose a conceptual framework to empirically evaluate the impact of scope creep on software project success. To determine the scope creep factors in this study, two exploratory methods, i.e. a Systematic Literature Review (SLR) and interview from experts are performed. Following the analysis of these methods, a conceptual framework is proposed. To empirically evaluate the proposed conceptual framework, data is collected through a survey method. Next, the collected data is analyzed through Partial Least Squares' Structural Equation Modelling (PLS-SEM). From the results, it is evident that the identified factors of scope creep are negatively associated with software project success. The results of empirical evaluation also second the findings of SLR. The outcome of the study may help the practitioners to understand the dynamics of factors, which undermine scope creep in software SMEs and to assist them in the development of effective control and mitigation strategies, therefore, to increase the project success rate.

Objective: To determine the overall prevalence of overactive bladder in Pakistan, and to determine the difference in prevalence in relation to gender. Method: The multicenter study was conducted from February 2017 to October 2018 at 11 institutions across the country, and comprised randomly selected healthy subjects of either gender who were assessed on the basis of symptoms defined by the International Continence Society for overactive bladder. Data was collected using a questionnaire based on the symptoms which was filled for the respondent by designated health workers. Data was analysed using SPSS 23. Results: Of the 1291 respondents, 632(49%) were males with a mean age of 37.8+14.4 years, and 659(51%) were females with a mean age of 38.3+13.7 years. The overall prevalence of overactive bladder was 82(6.4%). Among the males, it was 15(2.4%) and among the females 67(10.2%) (p=0.001). Urgency, frequency and nocturia were reported by 82(6.4%) respondents; 15(1.2%) males and 67(5.2%) females (p=0.001). Conclusion: The prevalence of overactive bladder was found to be low when assessed with strict application of the three classical symptoms of the condition. Continuous...

Surgical conditions are responsible for up to 15% of total Disability-Adjusted Life Years (DALY) lost globally. Approximately 4.8 billion people have no access to surgical care and this studies aim is to assess the surgical disease burden in children under the age of five years. We used Surgeons OverSeas Assessment of Surgical Need (SOSAS) and Pediatric Personnel, Infrastructure, Procedures, Equipment, and Supplies (PediPIPES) survey tools in Tando Mohammad Khan (TMK). A set of photographs of lesions were also taken for review by experts. All the data was recorded electronically via an android application. The current surgical need was defined as the caregiver's reported surgical problems in their children and the unmet surgical need was defined as a surgical problem for which the respondent did not access care. Descriptive analysis was performed. Information of 6,371 children was collected. The study identified 1,794 children with 3,072 surgical lesions. Categorization of the lesions by the six body regions suggested that head and neck accounted for the greatest number of lesions (55.2%) and the most significant unmet surgical need (16.6%). The chest region had the least unmet surgical need of 5.9%. A large percentage of the lesions were managed at a health care facility, but the treatment essentially consisted of mainly medical management (87%), and surgical treatment was provided for only 11% of lesions. The health facility assessment suggested that trained personnel including surgeons, anesthetic, or trained nurses were only available at one hospital. Basic procedures such as suturing and wound debridement were only performed frequently. This study suggests a high rate of unmet surgical need and a paucity of trained health staff and resources in this rural setting of Pakistan. The government needs to make policies and ensure funding so that proper trained staff and supplies can be ensured at district level.

Nanomaterials exist as potential biocompatible materials in nature and are being synthesized to provide extraordinary characteristics in various food industry sectors. Synthesis of biocompatible nanomaterials requires modification in the shape, density, and size of nanomaterials. Biocompatible nanomaterials are synthesized to reduce toxicity, decrease adverse effects in the gastrointestinal tract, and enhance immune response. Nanomaterials can target organs and tissues. Nanomaterials are found to be effectively compatible by interacting with functional foods and nutraceuticals. Applications of these nanomaterials are novel strategies in food industries such as food safety, food processing, food quality, food packaging, and food labeling. Various functions like detection of toxins and pathogens; production of biocompatible packaging; enhancement in color, flavor, and aroma; processing edible film, and sensing authenticity of food product are being accomplished with no toxicity. This review provides a systematic study on the biocompatibility of nanomaterials. It highlights the synthesis of biocompatible nanomaterials and advanced functions of these nanomaterials in the production area, processing industry, safety improvement, quality control, edible packaging films, biocompatibility, current developments, legislations and regulations for Nano-products, health and safety concerns, toxicity and public perceptions for use of nanomaterials.

Background: Global Health Estimates 2015 has shown IHD as second leading global cause of death and 3rd leading global cause for DALYs for 2015. The objectives of this study were to determine frequency, distribution and determinants of DM in adult acute coronary syndrome (ACS) population of D.I.Khan Division, Pakistan. Materials & Methods: This cross-sectional study was conducted in Departments of Ophthalmology & Community Medicine, Gomal Medical College, D.I.Khan, from February 1, 2017 to April 30, 2017. 331 cases were selected with margin of error 4.511%, 90%CL and 25% prevalence of DM in 73,438 adults assumed to have IHD. All indoor adult patients of ACS were eligible. Sex, age groups, and residence and presence of DM were variables. Frequency and distribution were analyzed by count and percentage. Hypotheses for distribution were substantiated by chi-square goodness-of-fit and of association by chi-square test of association. Results: Out of 331 patients with ACS, 225 (68.0%) were men and 106 (32.0%) women, 221 (66.8%) ≤60 years and 110 (33.2%) >60 years, and 210 (63.4%) urban and 121 (35.6%) rural. Frequency of DM was 79/331 (23.87%). Out of 79 patients with DM, men were 44 (13.29%), women 35 (10.57%), age group ≤60 years 57 (17.22%), >60 years 22 (6.65%), urban 53 (16.01%) and rural 60 (7.85%). Our prevalence of DM was lower than expected (p=.00214), our distribution by sex was similar to expected (p=.4993) while our distribution for age groups (p=.01209) and residence (p=.00005) were not similar to expected. Presence of DM was associated to sex (p=.011) but not to age groups (p=.0304) and residence (p=.5241). Conclusion: Prevalence of DM in adult ACS population of D.I.Khan Division, Pakistan was found lower than expected. The prevalence was more in men than women, more in younger age group (≤60 years) than older age group (>60 years) and more in urban than rural population. Our prevalence of DM was lower than expected, our distribution by sex was similar to expected while our distribution for age groups and residence were not similar to expected. The presence of DM was associated to sex but not to age groups and residence.

Bacteriocins are ribosomal-synthesized peptides or proteins produced by bacterial strains and can inhibit pathogenic bacteria. Numerous factors influence the potential activity of bacteriocins in food matrices. For example, food additives usage, chemical composition, physical conditions of food, and sensitivity of proteolytic enzymes can constrain the application of bacteriocins as beneficial food preservatives. However, novel bacteriocin nanoencapsulation has appeared as an encouraging solution. In this review, we highlight the bacteriocins produced by Gram-negative bacteria and Gram-positive bacteria including lactic acid bacteria that have shown positive results as potential food preservatives. In addition, this review encompasses the major focus on bacteriocins encapsulation with nanotechnology to enhance the antimicrobial action of bacteriocins. Several strategies can be employed to encapsulate bacteriocins; however, the nanotechnological approach is one of the most effective strategies for avoiding limitations. Nanoparticles such as liposomes, chitosan, protein, and polysaccharides have been discussed to show their importance in the nanoencapsulation method. The nanoparticles are combined with bacteriocins to develop the nano-encapsulated bacteriocins from Gram-negative and Gram-positive bacteria including LAB. In food systems, nanoencapsulation enhances the stability and antimicrobial functionality of active peptides. This nanotechnological application provides a formulation of a broad range of antimicrobial peptides at the industry-scale level. Nano-formulated bacteriocins have been discussed along with examples to show a broader antimicrobial spectrum, increase bacteriocins’ applicability, extend antimicrobial spectrum and enhance stability.

The significant increase in the rate of cesarean section is a major public health issue. The World Health Organization recommends C-section rates not to be greater than 10% and not lower than 5% as both the indicated limits can adversely affect maternal and newborn health. The rate of C-section deliveries is 22% according to recent Pakistan demographics and Health Survey of 2017-2018. This study contributes to the existing literature by examining the factors influencing high C-section rates in Pakistan. A narrative review of published literature between 2000 to 2020, on “factors influencing C-section rates in Pakistan” was done. The findings highlighted five factors that primarily influence utilization of C-section which include: 1. Accessibility to utilize C-section, 2. Association of C-section rates with socioeconomic profile, 3. Elective C-section, 4. Medical conditions as a cause of C-section, 5. C-section as a source of business. Pakistan like other Low middle income countries (LMICs) is facing the increased disease burden on its week and fragile health system. The over utilization of C-section rates has imposed additional burden on the health care system of Pakistan as well as increased economic and health resource liability on maternal care.