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Zarmina Islam,1 Parvathy Mohanan,2 Wajeeha Bilal,1 Taleen Hashmi,1 Zainab Rahmat,1 Ikran Abdi,3 Mehr Muhammad Adeel Riaz,4 Mohammad Yasir Essar5 1Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan; 2Medical University Sofia, Sofia, Bulgaria; 3Faculty of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan; 4Punjab Medical College, Faisalabad, Pakistan; 5Kabul University of Medical Sciences, Kabul, AfghanistanCorrespondence: Mohammad Yasir EssarKabul University of Medical Sciences, Kabul, Afghanistan, Tel +992 117118300, Email Yasir.essar@gmail.comAbstract: Pakistan is currently facing two outbreaks, dengue and COVID-19; both have strained its healthcare system resulting in multiple concerns including the co-diagnosis of two. Due to poor healthcare capacity, low vaccination rate, increasing COVID-19 variants, socioeconomic disparities, and misinformation, it is inevitable that implications will prove to be damaging to both healthcare workers and civilians. Among these challenges, it is important to note the need for stronger epidemiological surveillance for both COVID-19 and dengue and the implementation of public health measures without endangering sources of livelihood. To sustain this, cooperation between WHO and Pakistan’s government must continue through smart lockdowns, dengue awareness campaigns, and double laboratory procedures.Keywords: dengue, COVID-19, Pakistan, healthcare infrastructure

Introduction In the last one decade, per oral endoscopic myotomy (POEM) has been found to be an effective minimally invasive approach for the treatment of esophageal achalasia cardia and was lately shown to be noninferior to laparoscopic Heller's myotomy in a randomized controlled trial.

This study deals with unraveling the diagenesis-induced porosity evolution in a mixed clastic-carbonate sequence of the Middle Permian Indus Basin, Pakistan. Multiple data sets including outcrop, petrography, cathodoluminescence, scanning electron microscopy (SEM), mineralogy, and geochemical isotopic compositions were integrated to establish a link between porosity evolution and diagenesis. The spatial thickness and facies variations of the strata at outcrop scale are inherently controlled by the underlying bathymetry of the basin with deepening westward trend. The low values of δ18O of the target strata, relative to average values of the Permian carbonate, hints to diagenetic alteration in the strata. The data sets used in this study reveal modification of the strata in four environments, that is, i) early marine diagenesis indicated by micritization, pervasive dolomitization and isopachous fibrous cements, followed by ii) meteoric dissolution, and iii) shallow burial diagenetic processes including the precipitation of blocky cement, compaction of skeletal and non-skeletal allochems, and stylolites, and iv) a deep burial environment, characterized by pressure solution, and micro-fractures. The clastic intervals host subangular to subrounded quartz grains, floating textures, and almost complete absence of deleterious clay minerals, consequently resulting in the preservation of primary porosity. The primary porosity of carbonate intervals is preserved in the form of intercrystalline and intracrystalline porosity. The secondary porosity evolved through various diagenetic phases in the form of fractures and dissolution. The diagenetic solution mediated by organic matter in carbonates may have experienced both bacterial decomposition and thermochemical sulfate reduction, precipitating sulfides within the pores. The plug porosity/permeability analyses generally suggest high porosity in the siliciclastic unit, and carbonates with wackestone fabric while lower values were observed for the inner shelf pure carbonate facies. However, both intervals show very low permeability values probably due to isolated moldic pores and intense micritization. Therefore, clastic intervals may provide an opportunity to serve as a moderate reservoir; however, the carbonate intervals possess very low permeability values and could generally be considered as low-moderate reservoir potential.

With the expansion in recent power systems, the boost in renewable energy resources with multiple interconnections, overloading of existing power networks, increased load growth, and equipment failures, power system transient instability issues have exponentially increased. Transient stability in power systems is of particular importance even while performing the steady state analysis of a power system. Power system transient stability assessment is mandatory regularly for power system operation and has a major impact on power system planning. Potential risks of blackouts and failures in power systems can be avoided or minimized with the prompt prediction of transient instability. This research work presents a predictive approach for power system transient instability. The case study is a 735kV, 29-bus, 7-powerplant network involving precise modeling of generators. In particular, the proposed method is represented by different machine learning models through extraction and regression, in which the variables of the power-generating units are used as primary sources/features. Data cleaning and sorting out techniques are being used for refining data. Feature extraction has also been implemented for further cleansing of the data. The result is in the form of concrete and robust classifier models that can overcome power systems’ instability concerns through prompt prediction.

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Abstract In this paper, we present the palynostratigraphy, petrography, scanning electron microscopy (SEM) and X-ray diffraction (XRD) investigations to evaluate hydrocarbon reservoir potential of the Jurassic clastic-carbonate mixed sequence of the Kala Chitta Range, northwest Pakistan. The chronostratigraphic sub-divisions of the diverse lithologies within the sequence were made by using palynostratigraphy. The clastic dominated sequence of Datta Formation was assigned Toarcian-Bajocian age, while the Shinawari Formation was deposited during the Bajocian-middle Bathonian. The carbonate shoal facies of the Samana Suk Formation showed late Bathonian-Tithonian time of deposition. The primary and secondary porosities augmented by the plug porosity and permeability data suggest that the sandstone of Datta Formation is an excellent reservoir. The dominance of diverse matrix within the Shinawari Formation occluded the primary porosity. However, based on dissolution and dolomitization, the Shinawari Formation is categorized as a moderate reservoir. The dominance of various types of matrix and cement with superimposed burial diagenesis has occluded the primary porosity within the Samana Suk Formation. However, the diagenetic dissolution and dolomitization during the telogenetic stage were supported by the SEM and bulk geochemical data. Such diagenetic overprinting has significantly enhanced the reservoir potential of the unit.

Abstract The present study is focused on formation evaluation of the Lockhart Limestone in two wells (Meyal-05P and Meyal-10P) located in Northern Deformed Potwar Zone of the Potwar sub-basin, Pakistan. The geological formations ranging from Triassic to Pliocene have been drilled in these wells. The formation evaluation of the Lockhart Limestone mainly involves reservoir potential evaluation, interpretation of depositional environment and transgressive–regressive sequences using petrophysical logs. In either wells, the reservoir characterization is steered by various petrophysical parameters including calculation of volume of shale, porosity, permeability and hydrocarbon saturation. The thickness of the Lockhart Limestone is 50 m and 77 m in the Meyal-05P and Meyal-10P wells, respectively. In Meyal-05P and Meyal-10P wells, the average petrophysical parameters values and ranges are given as follows: volume of shale 48% and 20%; density porosity 1–5.6% and 1–31.7%; neutron porosity 1–23% and 1–42.9%; sonic porosity 1–29% and 1–39%; effective porosity 5% and 1–21%; and hydrocarbon saturation 92.21–99.8% and 97–99.6%. The petrophysical parameters indicate that the Lockhart Limestone of Meyal-10P well is quantitatively better reservoir than that of the Meyal-05P. In Lockhart Limestone of either wells, the permeability is

Abstract Introduction Plasmodium vivax was traditionally thought to be benign; however, nowadays it presents with a myriad of systemic complications like cerebral malaria, acute respiratory distress syndrome, acute kidney injury, acute pancreatitis, hepatic dysfunction, and disseminated intravascular coagulation, which were earlier attributed only to Plasmodium falciparum malaria. Here we report a case of a middle-aged man who presented with disseminated intravascular coagulation manifesting as symmetrical peripheral gangrene. What makes this case more interesting is that the malaria isolated was Plasmodium vivax instead of Plasmodium falciparum. Such findings were previously reported, but this is the first case where the patient was managed conservatively with antimalarial drugs without the need for amputation, which focuses on the very important role of early diagnosis and timely management. Case presentation A 44-year-old Indian man from north India presented with history of fever of 2 days’ duration with severely painful cold extremities. No pulse could be recorded on examination. A diagnosis of symmetrical peripheral gangrene was made. During the etiological evaluation, Plasmodium vivax malaria was found leading to disseminated intravascular coagulation causing this complication. He was started on artesunate and lumefantrine combination therapy and he recovered completely without the requirement of amputation. Conclusion This case highlights the non-benign nature of Plasmodium vivax and its emerging complications. Also it correlates symmetrical peripheral gangrene with Plasmodium vivax malaria. It also emphasizes the importance of timely diagnosis and intervention to reduce mortality and morbidity.

In the original publication of the article.

The surface coating is one of the novel approaches to enhance the performance and durability of the mechanical components by decreasing the wear and friction among two interacting bodies. In this study, tribological and mechanical properties of titanium nitride (TiN) coatings were investigated on the AISI 52100 bearing steel deposited by low-temperature physical vapor deposition system. Surface morphology and elemental composition of the TiN coating were analyzed by scanning electron microscope and energy-dispersive X-ray spectrum, respectively. Substrate surface roughness and coating thickness of TiN were varied for correlative analysis among adhesion, mechanical, and tribological properties. Scratch and tribo tests were performed for evaluating the adhesion and tribological properties, respectively. Samples having the substrate surface roughness (0.2 ± 0.05 µm) and the coating thickness of more than 2.83 µm presented relatively better adhesion, wear resistance, and lower coefficient of friction of the TiN coating.

Piston ring and cylinder liner (PRCL) interface is a major contributor to the overall frictional and wear losses in an IC engine. Physical vapor deposition (PVD) based ceramic coatings on liners and rings are being investigated to address these issues. High temperature requirements for applications of conventional coating systems compromise the mechanical properties of the substrate materials. In the current study, experimental investigation of tribo-mechanical properties is conducted for various titanium nitride (TiN) coated PRCL interfaces in comparison with a commercial PRCL system. Low-temperature PVD based TiN coating is successfully achieved on the grey cast iron cylinder liner samples. Surface roughness of the grey cast iron cylinder liner substrates and the thickness of TiN coating are varied. A comprehensive comparative analysis of various PRCL interfaces is presented and all the trade-offs between various mechanical and tribological performance parameters are summarized. Coating thickness between 5 and 6 micrometres reports best tribo-mechanical behaviour. Adhesion and hardness are found to be superior for the TiN coatings deposited on cylinder liner samples with higher roughness, i.e., ~ 5-micron Ra. Maximum 62 % savings on the COF is reported for a particular PRCL system. Maximum 97% saving in cylinder liner wear rate is reported for another PRCL system.

The VIoT (Visual Internet of Things) connects virtual information world with real world objects using sensors and pervasive computing. For video surveillance in VIoT, ChD (Change Detection) is a critical component. ChD algorithms identify regions of change in multiple images of the same scene recorded at different time intervals for video surveillance. This paper presents performance comparison of histogram thresholding and classification ChD algorithms using quantitative measures for video surveillance in VIoT based on salient features of datasets. The thresholding algorithms Otsu, Kapur, Rosin and classification methods k-means, EM (Expectation Maximization) were simulated in MATLAB using diverse datasets. For performance evaluation, the quantitative measures used include OSR (Overall Success Rate), YC (Yule’s Coefficient) and JC (Jaccard’s Coefficient), execution time and memory consumption. Experimental results showed that Kapur’s algorithm performed better for both indoor and outdoor environments with illumination changes, shadowing and medium to fast moving objects. However, it reflected degraded performance for small object size with minor changes. Otsu algorithm showed better results for indoor environments with slow to medium changes and nomadic object mobility. k-means showed good results in indoor environment with small object size producing slow change, no shadowing and scarce illumination changes.

This research addresses the issue of tire waste management and natural aggregate resource depletion. It investigates use of commercially produced recycled tire rubber as replacement for fine and coarse aggregate in non-structural concrete. Two replacement levels of 10% and 20% were considered for fine aggregate with 0% or 10% of coarse aggregate. The study employed a mix proportion of 1:5:4 (cement: fine aggregate: coarse aggregate) with a water-to-cement ratio of 0.25, which is normally utilized in concrete block manufacturing in Oman. The mixes were tested for their thermal conductivity, water absorption and compressive strength. The behavior of mixes exposed to 100 and 200°C was also studied and the samples were later tested for compressive strength. The results showed improvements in compressive strength after exposure to heat. Thermal conductivity was reduced as the percentage replacement increased for both fine and coarse aggregate. During heat exposure, the temperature rise was faster in rubberized mixes, and the compressive strength of all mixes improved after the exposure to heat. Water absorption and void content increased with increase in replacement percentage. The compressive strength did not show a clear trend with the replacement and this is due to the sensitivity of the stiff mix used in the study and its inherent lean nature. The results indicate that the lean nature of the mix makes it insensitive to small replacement investigated in this research.

Background: Total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC) has shown promise in achieving pathologic complete response (pCR) and enabling organ preservation through watch-and-wait (WW) strategies. However, implementation of WW protocols in diverse patient populations and safety-net hospitals faces unique challenges. The objective of this study is to evaluate TNT outcomes and identify barriers to WW implementation in a predominantly Hispanic safety-net hospital in South Texas., Methods: A retrospective review was conducted of 40 LARC patients treated with TNT at an academic tertiary referral center in South Texas between 2018 and 2023. Patient demographics, disease characteristics, and pCR rates were analyzed. A survey of multidisciplinary providers assessed perceived institutional and patient-related barriers to WW implementation., Results: The cohort was 70% Hispanic, with a median age of 54 years. Most patients had advanced disease at diagnosis (57.5% T4, 65% N2). The pCR rate was 18.5% (5/27) among patients undergoing surgery. Re-review of MRIs for pCR patients revealed that 2/5 had minimal residual disease. The provider survey identified MRI quality variability, lack of dedicated treatment coordinators, and concerns about patient compliance and financial barriers as key obstacles to WW implementation., Conclusions: Despite advanced disease presentation in a predominantly Hispanic population, TNT achieved pCR rates comparable to international trials. Institutional and patient-level barriers to WW were identified, informing the development of a tailored WW protocol for this unique patient population., (© 2024 Wiley Periodicals LLC.)

Competing Interests: The authors have no competing interests to declare that are relevant to the content of this article.

Sugar and nitrogen metabolisms help plants maintain cellular homeostasis, stress tolerance, and sustainable growth in drought conditions. Melatonin, a potent antioxidant and signaling molecule, appears to mitigate the negative impacts of drought on plants. This study aimed to investigate the potential role of foliar-applied melatonin in ameliorating drought-induced alterations in leaf sugar and nitrogen metabolisms' enzyme activities during cotton flowering and boll formation. To date, no study has examined drought-induced sugar and nitrogen metabolisms' enzyme activity changes in cotton treated with foliar melatonin. Drought levels (FC1 = 75 ± 5%, FC2 = 60 ± 5%, and FC3 = 45 ± 5%) were maintained between 3 and 35 days after flowering (DAF), and melatonin (M) concentrations (0, 25, 50, and 100 μmol L -1 ) were applied at 3 and 21 DAF in a completely randomized design. M100 concentrations at low FC levels significantly enhanced leaf sugar and N-metabolic enzyme activities, such as sucrose synthase (65.56%) and glutamine synthetase (55.24%), compared to plants not treated with melatonin; peaking between 7 and 21 DAF and declining gradually with crop growth. Moreover, the M100 concentrations at all FC levels, particularly FC3, significantly increased the relative expression of GhSusB, GhSusC, SPS1, and SPS3 genes, indicating that melatonin improves leaf sugar and N-metabolism enzymatic activities under drought stress. Therefore, applying M100 concentrations to cotton foliage under FC3 conditions during reproductive stages improves leaf water status, sugar, and N-metabolism enzyme activities, demonstrating melatonin's potent anti-stress, osmoregulatory, and growth-promoting properties in overcoming drought stress in cotton crops. Future research into the molecular mechanisms of melatonin-mediated sugar and nitrogen metabolism enzyme activities in cotton leaves may lead to biotechnological methods to improve drought resilience in cotton and other crops., (© 2023 Scandinavian Plant Physiology Society.)

Cell death is a natural mechanism for biological clearance for the maintenance of homeostasis in a dynamic microenvironment of the central nervous system. Stress and various factors can lead to imbalance between cellular genesis and cell death leading to dysfunctionality and a number of neuropathological disorders. Drug repurposing can help bypass development time and cost. A complete understanding of drug actions and neuroinflammatory pathways can lead to effective control of neurodegenerative disorders. This review covers recent advances in various neuroinflammatory pathways understanding, biomarkers, and drug repurposing for neuroprotection., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: In malaria-stricken regions, malaria continues to be one of the primary causes of mortality for children. The number of malaria-related fatalities has drastically decreased because of artemisinin-based pharmacological regimens., Methods: Two independent researchers did a comprehensive literature search using PubMed/MEDLINE and Google Scholar from its inception to September 2022., Results: After evaluating RTS, S/AS01 for its safety, effectiveness, and feasibility, the European Medicines Agency (EMA) issued a favorable conclusion. It was suggested that the RTS, S malaria vaccine be used extensively by the World Health Organization on October 6, 2021. The successful pilot program testing the malaria vaccine in Ghana, Kenya, and Malawi served as the basis for this proposal., Conclusion: Several challenges need to be addressed to ensure the success of vaccination programs. From the acceptability perspective, issues such as inadequate community engagement, concerns about side effects, and issues with the delivery and quality of healthcare services can affect the acceptance of the vaccine. From the feasibility standpoint, factors such as lack of transportation or long distances to healthcare facilities and the perception of completion of the vaccination calendar can affect the feasibility of the vaccine. Lastly, the availability of the vaccine is also a major concern as it may not be readily available to meet the demands., (© 2023 The Authors. Immunity, Inflammation and Disease published by John Wiley & Sons Ltd.)

Over the years, several developing countries have been suffering from high infant and child mortality rates, however, according to the recent statistics, Pakistan falls high on the list. Our narrative review of copious research on this topic highlights that several factors, such as complications associated with premature births, high prevalence of birth defects, lack of vaccination, unsafe deliveries, poor breastfeeding practices, complications during delivery, sudden infant death syndrome (SIDS), poor socioeconomic conditions, and a struggling healthcare system, have influenced these rates. Bearing in mind the urgency of addressing the increased infant and child mortality rate in Pakistan, multiple steps must be taken in order to prevent unnecessary deaths. An effective initiative could be spreading awareness and education among women, as a lack of education among women has been indirectly linked to increased child mortality in Pakistan across many researches conducted on the issue. Furthermore, the government should invest in healthcare by hiring more physicians and providing better supplies and improving infrastructure, especially in underdeveloped areas, to decrease child mortality due to lack of clean water and poor hygiene. Lastly, telemedicine should be made common in order to provide easy access to women who cannot visit the hospital.

Healthcare workers (HCWs) have faced an increased amount of mental health struggles amidst the COVID-19 pandemic. However, those in conflict-based settings with fragile healthcare systems meet additional challenges. This study reviews violence, conflict and mental health among HCWs in five countries: Syria, Palestine, Yemen, Afghanistan and Lebanon. Our study reports that HCWs are targeted by violence, bombings, mistreatment and different forms of abuse, including verbal and physical. With the additional burdens of the pandemic including prolonged working hours, limited resources and insufficient humanitarian aid, the healthcare workers fall victim to increased levels of burnout and mental illnesses. The situation leads to dire consequences on their personal lives and professional development, compelling them to quit their job or country all together. Although healthcare workers remain resilient in these conflict-based settings, immediate interventions are required to prevent violence against them and cater to their rapidly declining mental health., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Pakistan has not benefited significantly from telemedicine, despite the promise that it could overcome many of the barriers impeding maternal healthcare delivery in emerging markets. Due to a lack of a regulatory framework and a lack of government interest, new companies in Pakistan have a hard time establishing healthcare projects that will be cost-effective and innovative. A review of telemedicine adoption in the past and present for improving maternal healthcare standards is presented in this article. Furthermore, a discussion of the challenges associated with digital health adoption is provided, as well as possible and feasible policies for making the use of digital health in maternal health more effective., Competing Interests: None declared., (© 2022 The Authors.)

Maternal mortality is a major concern in various countries across the globe and particularly Pakistan. Regardless of the fact that the maternal mortality rate is steadily decreasing over time, Pakistan still faulters below the progress necessary to reach its set goals. Challenges such as lack of skilled staffing, the facilities to house them, lack of education as well as social constraints are proving to be significant obstacles for the healthcare system of Pakistan and its attempts to reduce the maternal mortality rate. Furthermore, the rural environments of the country, poverty constraints, and general ignorance continue to exacerbate the factors previously listed. In order to address these issues, the government needs to work alongside international organizations to acquire funding to build new facilities, particularly in rural areas, train skilled staff, educate on the benefits of antenatal and delivery care, and provide additional funding to subsidize the care itself for those in need. This with further research done in order to assess the effectiveness of various programs and the progress over time will make an impact on reducing the maternal mortality rate in Pakistan., Competing Interests: None declared., (© 2022 The Authors.)

Objective: To assess the burnout among the healthcare workers during the fourth wave of COVID-19., Methods: In this cross-sectional study, burn out was measured in health care professionals using the MBI scale inventory during the fourth wave of COVID-19. Age, gender, marital status, having children, hospital, job type, experience, and workload, as well as the severity of burnout in each subscale, were all measured. We used the chi-square test to detect the difference between the level of burnout and other demographic variables, and a multiple logistic regression test was used to define the predicted correlation between the high level of burnout and the risk factors. Odds ratios and corresponding 95% confidence intervals (CI) were reported. A p-value of less than 0.05 indicated a statistically significant outcome., Results: Out of 776 healthcare workers who participated in our study, 468 (63.2%), 161 (21.7%) and 112 (15.1%) participants experienced low, moderate and high levels of emotional exhaustion, respectively. For the depersonalization subscale, 358 (48.3%), 188 (25.4%) and 195 (26.3%) people suffered from low, moderate, and high levels of depersonalization, respectively while 649 (87.6%), 40 (5.4%) and 52 (7.0%) respondents had low, moderate and high levels in the personal accomplishment subscale, respectively., Conclusion: During the fourth wave of COVID-19, the healthcare workers reported increased level of burnout overall possibly due to the long term physical and mental impacts that the pandemic has had over the time. Moreover, healthcare workers in Pakistan were more prone to burnout as compared to other countries., Competing Interests: None declared., (© 2022 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Tuberculosis (TB), a global health concern is also a leading cause of mortality and morbidity across Pakistan affecting a major proportion of the population. The absence of an integrated system to control the spread of TB has led to a rise in multidrug resistant strains of TB (MDR-Tb) which do not exhibit any sensitivity towards the first line therapy for TB. Such adverse circumstances call for effective planning strategies to mitigate the health hazards of MDR-TB. This article briefly highlights the challenges encountered by the already burdened healthcare system and suggests relatively inexpensive approaches to tackle the ongoing crisis associated with MDR-TB on a national scale., Competing Interests: None., (© 2022 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Public health remains a major concern in Pakistan, with communicable diseases including HIV/AIDS, hepatitis B, and C, and tuberculosis the leading cause of morbidity and mortality. Several factors contribute to the country's high risk of infectious disease epidemics, including overcrowded cities, unclean drinking water, inadequate sanitation, poor socioeconomic conditions, and low vaccination coverage. Due to the absence of a comprehensive surveillance strategy and mechanism, it has been difficult to manage infectious disease outbreaks effectively. The article offers insights into the various challenges faced by public and private healthcare sectors to control the spread of communicable diseases and proposes solutions to prevent crippling of the overburdened healthcare system on a national scale., Competing Interests: None., (© 2022 The Authors.)

While monkeypox virus (MPXV) remained endemic in central and western African countries, a sudden unusual spike of global cases among non-endemic countries is an enigma for scientists. With 257 cases reported as of 26th May 2021, a multi-country outbreak of monkeypox has been declared in countries including the UK, EU/EEA states, and North America. Even though the likelihood of transmissibility of MPXV is limited compared to COVID-19, yet a coordinated multidisciplinary effort is required to prevent any further global expansion. Few appropriate responsive approaches to contain the infection could be; limiting the contact with potential animal reservoirs, isolation of confirmed cases, using PPEs to prevent human-human transmission, awareness activities, and administration of pre and post prophylactic vaccination. In this review, we have discussed the previous and current outbreaks of MPXV along with the abrupt actions that are needed to address the situation.