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Adjacent segment degeneration is commonly observed in patients after fusion surgery. Among the associated risk factors is the preoperative presence of adjacent disc degeneration (ADD). The risk factors and other spine phenotypes associated with preoperative ADD is critical to understand the pathological process and better prognosis postsurgery. Current study aims to assess and compare the magnetic resonance imaging (MRI) spinal phenotype of herniated level with and without ADD. Preoperative T2W sagittal lumbar MRI images of 155 lumbar disc herniated patients were analyzed for the presence of ADD (Pfirrmann grade III and above). The herniated disc level was assessed for the presence and absence of vertebral endplate (VEP) defects, Modic changes, and high intensity zone (HIZ). Mean age of patients was 38 ± 2 years, almost 62% were males. ADD was found in 57%, VEP defects were seen in 62% of the herniated level, 24.5% showed Modic changes, 3.8% showed spondylolishthesis, and 15.5% revealed HIZ. Age and other demographic factors did not have any significant effect on the presence of ADD, the patients with extruded and sequestered discs had more ADD (p = 0.02). VEP defects were significantly higher in levels with ADD (p = 0.02). Patients with ADD had significantly VEP defect scores (p = 0.01), Modic score (p = 0.002), HIZ score (0.02), and posterior bulge score (p < 0.001). Findings suggest that affected levels with VEP defects and severe grade of disc herniation have the greater likelihood of having ADD. Once developed this ADD may also affect the other spinal levels, and also can affect postoperative prognosis. [ABSTRACT FROM AUTHOR]

Objective: To estimate the incidence and risk factors of delirium in intensive care unit (ICU) of Sindh Institute of Urology and Transplantation (SIUT), Karachi. Study Design: Cross-sectional study. Setting: The ICU of SIUT, Karachi, Pakistan. Period: February 2023 to August, 2023. Methods: Patients over 18 years of age who were admitted to the ICU for more than 24 hours were analyzed. Patient with Richmond agitation sedation score (RASS >-2) were assessed for delirium using the confusion assessment method (CAM)-ICU method. Delirium subtypes were also evaluated. Domographic and clinical risk factors were evaluated for possible relationship with the existence of delirium. Results: Total 96 patient were enrolled in the study, 64 (66.7%) were male and 32 (33.3%) female. The mean age was 49.1±17.3 years. Mean RASS and CAM-ICU scores were 0.53±1.31 and 1.0±1.42 respectively. Delirium was present in 32 (33.3%) patients. It was noted that 45.4% patients had hypoactive delirium, 31.8% hyperactive delirium, and 22.7% mixed type. Patients aged 50 years or above had higher odds of delirium (OR: 0.41 [0.17-0.98], p=0.045), On multivariable regression model, BMI <25 Kg/m², coexistence of ischemic heart disease and chronic kidney disease, patients with septic shock, post-operative patients, need of sedation were significantly associated with higher odds of delirium. Conclusion: Delirium is a frequent condition in ICU patients, with a higher occurrence of hypoactive delirium. The leading risk factors associated with delirium were older age, ischemic heart disease, chronic kidney disease and use of sedative drugs. [ABSTRACT FROM AUTHOR]

This research aimed to investigate the measures required for the effective implementation of a semester system for undergraduate education in graduate and post-graduate colleges affiliated with the University of Malakand. The study mainly focused on physical requirements (lecture rooms, laboratories, library), human resource requirements (faculty members, staff), issues in the curriculum, and major issues in the assessment system from the perspectives of teachers of public sector colleges affiliated with the University of Malakand. A mixed-method research design was used for data collection. First, qualitative data was collected, and analyzed through thematic analysis, and then a questionnaire was developed for quantitative data analysis. The findings of the study showed that there were several issues in the implementation of the semester system in the affiliated colleges. These included lengthy courses, outdated content, irrelevant content, lack of space such as classrooms, science labs, etc, need for curriculum improvement, poor assessment system, lack of training for teachers, and lack of regular monitoring from management and the university side. Based on the results it is suggested that the implementation of the semester system in the colleges needs to be reviewed and improved for the affiliated colleges and to ensure quality education. [ABSTRACT FROM AUTHOR]

This investigation assessed the potential of cepharanthine (CEP), a compound from Stephania cepharantha Hayata, in mitigating atherosclerosis in a hyperlipidemic rat model. Using Wistar rats, four distinct diet and drug treatment groups were established: a high-fat high sucrose diet (HFHS), HFHS supplemented with intraperitoneal cepharanthine (HFHS-C) or oral atorvastatin (HFHS-A) from the 8th week, and a normal-fat diet (NFD). The study aimed to evaluate diet and drug impact on aortic histopathological changes over 16 weeks. Our results revealed significant atherosclerosis prevention in the aorta of the HFHS-C group, marked by preserved endothelial integrity, absence of inflammation, and lack of atherosclerotic plaques. Additionally, CEP demonstrated a crucial role in preventing the emergence of cholesterol clefts and foamy macrophages. These findings suggest that CEP effectively curbs atherosclerosis progression in hyperlipidemic rats, reducing arterial fat deposition and offering a potential natural preventative strategy against this disease. [ABSTRACT FROM AUTHOR]

The purpose of the study was to investigate the influence of teacher emotional intelligence on work discipline. 348 teachers working in 201 primary schools of district Mardan was the sample of the study. The findings of the study showed a significant relationship between the facets of emotional intelligence and work discipline however, overall no correlation between the facets of teacher emotional intelligence and work discipline of primary school teachers was found. Furthermore, the highest correlation between the use of emotions and regulation of emotions; and the lowest correlation between the facets of time management and teacher showing positive attitude towards students, were found. [ABSTRACT FROM AUTHOR]

This research paper tends to focuses girl's obstacles in access to get higher education. Girl's education portrays significant role in formulation of human resources as well the establishment of supportable and the development of sophisticated community. This research study inculcates to prospect and revolutionize girl's learner's aspirations and the various barriers with respect to higher education. The kind of research design proposed for this study was of qualitative nature so as to get deeper understandings as well strengthens the area of interest i.e. barriers in acquiring girls tertiary education. Data collection was carried out from students of two public girl's high schools and two higher secondary schools in district Nowshera. Source of data collection was based on semi structured interviews and responses were further elaborated keeping the level of saturation of the interviews. Once saturation level was reached, thematic analysis was implemented to analyze the data. Finding of this research study extracted significant obstacles that hinders girls access to higher education i.e. Pakhtun cultural constraints, Commitment with Family and Cultural Obstacles, Gender Discrimination a Barrier in Girls Higher Education, Early Marriage an Obstacle in Girls higher education, Scarcity of Girls Higher Educational Institutions, Cultural obstacles and financial issues. Findings of this research study produced profitable recommendations i.e. "Each and every individual is exceptional and distinctive and based on equity and justice every girls has the ethical consideration of acquiring quality education in order to formulate a more sophisticated and balanced society. [ABSTRACT FROM AUTHOR]

The intent of this study is to explore the role of head teacher in transforming reflective practices in government primary schools. Reflection is a high impact practice that develops teacher's pedagogical practices which ultimately develop and facilitates the development of new knowledge and skills. Reflective practices enable teachers to continually examine their own thoughts, perspectives, beliefs, and actions. Findings of this study revealed what sort of research is needed to train and prepare primary teachers to make instructional decisions regarding their classroom practices as a strategy of continuing Professional Development (CPD) Program. This study was based on the objective: To investigate the role of school head teacher in primary school teacher's reflection. The study follows qualitative research design and was based on exploratory single case study design. The instruments used for data collection were included semi structured interview, analysis of primary school teacher's reflective diaries and observational notes of participant teacher lessons in order to find out the complete process of reflective practice in the context of Government primary school. The participants of this study included teachers of grade 1 to grade 5 and the head teacher. For data analysis content analysis method was applied and thematic categories were developed for interpretations. The findings of this study revealed that reflective process create sophisticated teaching learning process as well better students learning outcomes. It was found that the head teachers accomplished central role in enhancing process of reflective practices. It is recommended that the head teacher needs to carry out planning and continuity of a process of reflective practice, arranging of seminars, formulating the goals of reflection for different purposes making an observation notes, communicating and cooperating with teachers and to support teachers' reflective practices. [ABSTRACT FROM AUTHOR]

Objective: To estimate fibromyalgia frequency among patients presenting with complaints of chronic fatigue and or generalised body pain for at least six weeks., Methods: The cross-sectional study was conducted at the Department of Internal Medicine, Indus Hospital, Karachi, between December 2016 and March 2018, and comprised patients of either gender presenting with complaints of chronic fatigue and or generalised body pain for at least six weeks. They were assessed for fibromyalgia according to the 2010 Fibromyalgia Diagnostic criteria questionnaire. The Data was analysed using SPSS 21., Results: Of the 267 patients, 197(73.8%) were females and 70(26.2%) were males. Fibromyalgia was detected in 149(55.80%) patients. The mean age of patients with fibromyalgia was 42.3±14.6 years and it was 38.9±13.7 years in patients without fibromyalgia (p<0.05). No significant association was found between gender and fibromyalgia (p>0.05)., Conclusions: All patients with generalised pain should be evaluated for fibromyalgia and a diagnosis made to reduce the cost of further referrals and investigations, and delay in the management of this debilitating disorder.