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Drought is an inevitable environmental stress that drastically hampers the growth, productivity, and quality of food crops. Exogenous sodium nitroprusside and spermidine have decisive functions in the growth enhancement of plants; nevertheless, their specific role in mediating stress responses to improve drought tolerance in sunflowers at the reproductive stage (terminal drought) remains largely unknown. In the present study, we explored the positive effects of sodium nitroprusside and spermidine on physiological responses to increase in sunflower yield during periods of terminal drought. Initially, various doses (50, 100, 150, 200, 400 μM) for each sodium nitroprusside or spermidine were foliar sprayed to improve water content, chlorophylls, and biomass accumulation in sunflower seedlings under control (100% FC) and drought (60% FC) conditions. Optimized rates (100 μM for sodium nitroprusside) and (100 μM for spermidine) were further tested alone and in combination to assess drought tolerance potential and their ultimate impact on yield under drought stress. Drought exposure caused a marked reduction in relative water content (26%) and chlorophyll a (31%) and b (35%) contents; however, sodium nitroprusside and spermidine at 100 μM significantly improved the growth of sunflower (13%). Furthermore, combined use of sodium nitroprusside and spermidine at 100 + 100 μM markedly improved the achenes per head (16%), 1000-achene weight (14%), and ultimately grain (28%) and oil (21%) yields of sunflowers under drought stress. A strong association was found between the 1000-achene weight and the achene yield of sunflower. Hence, combined sodium nitroprusside and spermidine upregulate water balance and chlorophyll contents to increase sunflower yield under terminal drought., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

The removal of toxic dye pigments from the environment is of utmost importance since even trace amounts of these pollutants can lead to harmful impacts on ecosystems. Heterogeneous photocatalysis is a potential technique for eliminating microbiological, inorganic, and organic pollutants from wastewater. Here, we report the band gap alteration of ZnO by making its composites with CuSe to enhance photocatalytic activity. The purpose is to develop metal oxide nanocomposites (ZnO/CuSe) as an effective and efficient material for the photodegradation of methyl blue. The photocatalysts, ZnO nanorods, CuSe, and ZnO/CuSe nanocomposites of different weight ratios were synthesized by the simple and cost-effective technique of precipitation. UV-Vis spectra verified that the ZnO/CuSe photocatalyst improved absorption in the visible region. The optical bandgap of ZnO/CuSe nanocomposites reduced from 3.37 to 2.68 eV when CuSe concentration increased from 10 to 50%. ZnO/CuSe composites demonstrated better photocatalytic activity than ZnO when exposed to UV-visible light. The pure ZnO nanorods could absorb UV light and the nanocomposites could absorb visible light only; this was attributed to the transfer of excited high-energy electrons from ZnO to CuSe., (© 2023. The Author(s).)

Background: Amid COVID-19, soon after the closure of academic institutions, academia was compelled to implement teaching and assessments virtually. The situation was not the same for all countries. This transition was much more challenging in low-resource settings like Pakistan, where the students were geographically distant with minimal connectivity. A private university in Pakistan instituted a systematic approach for ensuring quality assurance and reliability before launching online assessments amid the COVID-19. The purpose of this study was to reflect on the phased transition to online/remote assessments to facilitate continuous student learning through distance modalities during the pandemic., Method: To assist faculty in re-designing their assessments, a workshop was conducted which was based on the modified Walker's nine principles. The principles coded as "ACTFAiREST 2" were introduced to ensure that the faculty understands and adapts these principles in designing online assessments. The faculty modified and re-designed their course assessments, from face to face to online modality and submitted their proposals to the Curriculum Committee (CC). To guide the process of approving modified and re-designed assessments, a checklist was adapted. All the pre and -post workshop assessment proposals were analyzed using a content analysis approach to ensure the alignment of course learning outcomes with the assessments., Results: A total of 45 undergraduate courses' assessment proposals were approved by the CC after deliberations ensuring their applicability in a virtual environment. From the analysis of the course outlines and assessment proposals submitted to the CC, faculty made four key changes to their assessment tasks in the light of ACT FAiREST 2 principles (a) alternative to performance exams; (b) alternative to knowledge exams; (c) change in the mode of assessment administration; and (d) minimizing the overall assessment load., Conclusion: This transition provided an impetus for the faculty from a low resource setting to build momentum towards improved and innovative ways of online teaching and assessments for future nursing education to adapt to the new normal situation. This development will serve as a resource in similar contexts with planned and evidence-based approaches for enhancing faculty readiness and preparedness for online/remote assessments., (© 2022. The Author(s).)

Background: Pakistan's neonatal mortality rate has the highest proportion in the South Asian region and it is higher in the rural areas as compared to the urban areas. Poor resuscitation techniques and lack of basic newborn resuscitation skills in birth attendants are contributing factors towards neonatal deaths. Based on the significant outcomes of the Helping Baby Breath (HBB) training, similar training was implemented for Community Midwives (CMWs) in a low-resource setting in Gujrat, Pakistan, to improve their knowledge and skills. The training evaluation was conducted and participant feedback was obtained through both qualitative and quantitative methods. The findings of the quantitative assessment of the training evaluation will be published elsewhere. This paper presents the qualitative evaluation of the training., Objective: The objective of the study was, to determine the perceptions of HBB trained CMWs about the effectiveness of the HBB training, and the challenges faced in the implementation of HBB skills for newborn resuscitation, at their work settings., Methodology: The qualitative descriptive design was used in this study. The purposive sampling technique was chosen to recruit midwives and key informants as participants of the training. Interviews were conducted by using a semi-structured interview guide. The study included a total of five interviews: two focus group interviews for CMWs (10 in each group), and three individual interviews of key informants., Findings: The content analysis of the qualitative data yielded three themes: the effectiveness of training, challenges, and suggestions. The findings revealed that the HBB training was effective for the CMWs in terms of its usability, regarding improvement in newborn resuscitation knowledge and skills. Moreover, it enhanced confidence and satisfaction in CMWs. However, less volume of patients was a challenge for a few CMWs with regard to practicing their skills., Conclusion: Due to the inadequate number of patients and fewer opportunities of practice for several CMWs, they required such training frequently, in order to maintain their competency. The CMWs also recommended that HBB training should be part of the Midwifery program curriculum. Moreover, similar training was also recommended for other healthcare providers working in low-resource settings, including doctors and nurses., Competing Interests: Declaration of Competing Interest All authors declare that there is no conflict of interest., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Birth asphyxia is one of the significant causes of neonatal deaths in Pakistan. Poor newborn resuscitation skills of birth attendants are a major cause of neonatal mortality in low resource settings across the globe. This study aimed to evaluate the effectiveness of the Simulation-Based High-Frequency training of the Helping Babies Breathe for Community Midwives (CMW), in district Gujrat, Pakistan., Method: A pre-post-test interventional study design was used. The universal sampling technique was employed to recruit 50 deployed CMWs in the entire district of Gujrat. The pre-tested module and tools of Helping Babies Breathe (2nd edition) were used in the intervention. Using the High Frequency training approach, three one-day training sessions were conducted for CMWs at an interval of 2 months. During the 2 months interval, participants were monitored and supported to practice their skills at their birthing centers. Knowledge and skills were assessed before and after each session. The McNemar and Cochran's Q tests were applied for data analysis. Participants' feedback was also obtained at the end of each training, which was analyzed through descriptive statistics., Results: Data from 34 CMWs were analyzed as they completed all three training sessions and assessments. The results were statistically different after each training session for OSCE B (p-value < 0.05). However, for knowledge and OSCE A, significant improvement was observed after training sessions 1 and 2 only. Pairwise comparison showed that pre-assessment at training 1 was significantly different from most of the repeated measures of knowledge, OSCE A, and OSCE B. Moreover, the learners appreciated the overall training in terms of organization, content, material, assessment, and overall competency. Additionally, due to a small sample size of the CMWs, and a short time of the intervention, significant differences in morbidity and mortality outcomes could not be detected., Conclusion: The study concluded that a series of training and continuous supportive supervision and facilitation enhances Helping Babies Breathe (HBB) knowledge retention and skills. The study recommends, periodic, structured and precise HBB trainings, with ongoing quality monitoring activities through blended learning modalities would help sustain and scale-up the intervention., (© 2021. The Author(s).)

Background: Transgender and gender nonconforming (TGNC) people are a marginalized set of the population that continues to experience health care inequalities. This study aimed to assess oral health parameters including Candida growth and intensity among TGNC adults., Methods: This cross-sectional study recruited two subgroups: 40 transgender and 40 control adults. Consented participants were interviewed and clinically examined. Data using the WHO oral health assessment forms were obtained. Samples for Candida growth and intensity analysis were collected from the dorsum surface of the tongue., Results: 27.5% of the transgender group was HIV seropositive. Oral nicotine stomatitis and leukoplakia are reported to be the most prevalent intra-oral lesions showing a prevalence of 27.5% and 20%, respectively. The dental and periodontal health parameters of the transgender group were worse than those of the control group. The intensity of Candida colonies was significantly higher in the test group (p = 0.014)., Conclusion: Poor oral health and significant oral mucosal disorders were reported in transgender adults that have shown a higher rate of behavioral risk factors such as tobacco and alcohol consumption. Further longitudinal studies in different world regions are warranted to understand the barriers to good oral health in transgender adults and how to implement effective prevention and management strategies., (© 2021. The Author(s).)

Majority of Pakistani soils are deficient in phosphorus. Phosphorus is usually applied in form of synthetic fertilizer. However integrated use of P from synthetic and organic sources can be more profitable and beneficial on sustainable basis. Field trials were conducted at research farm University of Poonch, Rawalakot, AJK, Pakistan for two consecutive years to check the comparative effects of synthetic fertilizer and organic manures applied alone and in combinations on the phosphorus use efficiency (PUE), wheat yield and yield components. Shafaq-06 cultivar of wheat was used as test cultivar. Ten treatments were included: (I) Control (P0) without application of fertilizer; (II) SSP @ 60 kg/ha (P60SSP); (III) SSP @ 90 kg/ha (P90SSP); (IV) SSP @ 120 kg/ha (P120SSP); (V) PM @60 kg/ha (P60PM); (VI) PM @90 kg/ha (P90PM); (VII) PM @120 kg/ha (P120PM); (VIII) SSP @30 kg/ha + PM @30 kg/ha (P30SSP+30PM); (IX) SSP @45 kg/ha + PM @45 kg/ha (P45SSP+45PM); (X) SSP @60 kg/ha + PM @60 kg/ha (P60SSP+60PM) which were laid out under the Randomized Complete Block Design. Significantly higher values for yield of grain (2397 kg/ha) was recorded with PM + SSP @ 60 kg P2O5 ha-1 each. Likewise, FPUE, PIR of wheat and AFPUE was quite higher with combined use of PM and SSP i.e. P60SSP+60PM treatment. Additionally, increase in PUE, wheat yield and yield components associated with combined treated plot would help to minimize the use of high cost synthetic mineral fertilizers and represents an environmentally and agronomically sound management strategy., Competing Interests: The authors have declared that no competing interests exist.

Horse purslane (Trianthema portulacstrum L.) is an important weed of soybean crop capable of causing significant yield reduction. Therefore, this study assessed the impact of horse purslane and other weeds' infestation on the productivity of soybean. Ten treatments, i.e., weed-free throughout the growing season, horse purslane-free till 20, 40 and 60 days after emergence (DAE), all weeds-free till 20, 40 and 60 DAE, weedy-check (excluding horse purslane), weedy-check (horse purslane alone) and weedy-check (all weeds) were included in the study. Data relating to density and dry weight of recorded weed species, and yield and related traits of soybean were recorded. Overall, infestation percentage of horse purslane was 33.10 and 51%, whereas dry weight was 12 and 44 g m-2 during 1st and 2nd year, respectively. The highest dry weight of all weed species was recorded at 45 DAE in weedy-check all weeds treatment during both years. The lowest relative density and frequency of horse purslane were recorded in the treatment where it was controlled until 20 DAE during 2018 at 30 DAE, whereas the same treatment recoded the lowest density of horse purslane at 45 DAE during 2019. The relative frequency of horse purslane was non-significant for weedy-check horse purslane and weedy-check all weeds treatments during 2018, whereas former treatment had higher relative frequency of horse purslane in weedy-check all weeds than the later during 2019. Yield and related traits significantly differed among different treatments used in the study. The treatment all weeds controlled until 40 DAE recorded higher number of pods per plant, 1000-seed weight and seed yield during both years. The yield reduction in weedy-check treatments was; weedy-check all weeds > weedy-check all weeds except horse purslane > weedy-check horse purslane only. It is concluded that horse purslane was not the sole weed interfering soybean fields and weed flora consisted of false amaranth [Digera muricata (L.) Mart.] and purple nut sedge (Cyperus rotundus L.). Hence, if the soybean fields in northern irrigated plains of Pakistan are infested with horse purslane or heavily infested with horse purslane or other weeds, these should be controlled in initial 40 DAE to improve soybean productivity., Competing Interests: The authors have declared that no competing interests exist.

Understanding the impact of irrigation and fertilizer on rabbiteye blueberry (Vaccinium virgatum) physiology is necessary for its precision planting. Here, we applied varied irrigation and fertilizer under completely randomized experimental design to see its impact on the physiological characteristics and bush growth of rabbiteye blueberries. A comprehensive evaluation of the membership function was used to establish the best water-fertilizer coupling regimes. Rabbiteye blueberry enhanced the net photosynthetic rate, stomatal conductance and transpiration rate of leaf and improved its photosynthetic capacity at maximum level of irrigation water and fertilizer application (F3W4). The high fertilizer-medium water treatment (F3W3) increased leaf-soluble protein contents. The medium fertilizer-medium water treatment (F2W3, F2W2) increased leaf- soluble sugar, superoxide dismutase, and chlorophyll contents; decreased the malondialdehyde content; and enhanced leaf resistance and metabolism. It also promoted the growth of flower buds and new shoots. Combined membership function and cluster analyses revealed that the optimal water and fertilizer conditions for promoting rabbiteye blueberry plant growth were the medium fertilizer-medium water [(NH4)2SO4:Ca(H2PO4)2:K2SO4 at 59:10:20 g plant-1; 2.5 L water plant-1], medium fertilizer-medium-high water [(NH4)2SO4:Ca(H2PO4)2:K2SO4 at 59:10:20 g plant-1; 3.75 L water plant-1], and high fertilizer-medium-high water [(NH4)2SO4:Ca(H2PO4)2:K2SO4 at 118:20:40 g plant-1; 3.75 L water plant-1] treatments. The findings of this study could be used in improving the precision and efficacy of rabbiteye blueberry planting in Guizhou, China. Such an approach can increase the productivity and profitability for local fruit farmers., Competing Interests: The authors do not have any conflicts of interest.

Soil salinity disrupts the physiological and biochemical processes of crop plants and ultimately leads to compromising future food security. Sodium nitroprusside (SNP), a contributor to nitric oxide (NO), holds the potential to alleviate abiotic stress effects and boost tolerance in plants, whereas less information is available on its role in salt-stressed lentils. We examined the effect of exogenously applied SNP on salt-stressed lentil plants by monitoring plant growth and yield-related attributes, biochemistry of enzymes (superoxide dismutase (SOD), catalase (CAT), and peroxidase (POD)) amassing of leaf malondialdehyde (MDA) and hydrogen peroxide (H 2 O 2 ). Salinity stress was induced by NaCl application at concentrations of 50 mM (moderate salinity) and 100 mM (severe salinity), while it was alleviated by SNP application at concentrations of 50 µM and 100 µM. Salinity stress severely inhibited the length of roots and shoots, the relative water content, and the chlorophyll content of the leaves, the number of branches, pods, seeds, seed yield, and biomass per plant. In addition, MDA, H 2 O 2 as well as SOD, CAT, and POD activities were increased with increasing salinity levels. Plants supplemented with SNP (100 µM) showed a significant improvement in the growth- and yield-contributing parameters, especially in plants grown under moderate salinity (50 mM NaCl). Essentially, the application of 100 µM SNP remained effective to rescue lentil plants under moderate salinity by regulating plant growth and biochemical pathways. Thus, the exogenous application of SNP could be developed as a useful strategy for improving the performance of lentil plants in salinity-prone environments.

To assess comparative losses of Trianthema portulacastrum (HP) relative to other weeds, the experiment was set during consecutive summer seasons 2018 and 2019 at the Research Farm MNS-University of Agriculture, Multan, Pakistan. Experiment consisted three replications which were laid out under randomized complete block design. Experiment consisted of ten treatments viz: weeds free (whole season), HP free till 20 Days after emergence (DAE), HP free till 40 DAE, HP free till 60 DAE, all weeds free 20 DAE, all weeds free 40 DAE, all weeds free 60 DAE, weedy check (all weeds), weedy check except HP and weedy check containing only HP. During 2018 in all weeds weedy check, maximum HP relative density (33.33%) was observed while in 2019, plot where weeds were controlled from growing till 20 DAE showed (80%) relative density at 30 DAE. HP maximum frequency (66.67%, 77.78%) and relative frequency (66%, 100%) was recorded at 45 DAE in plots where HP was kept controlled till 20 DAE and all weeds kept controlled till 20 DAE, respectively. Maximum number of grains per cob (738, 700.68), 1000 grain weight (306.66, 271.51 g) and grain yield (6150, 8015 kg hec -1 ) were recorded in plots which were kept all weed free till 60 DAE. As the competition period of weeds increased over 40 DAE, it substantially reduced yield of maize. Keeping the plots HP free till 40 DAE in the maize fields with HP as the major dominating weed, likely increase in maize grain yield is up to 30% compared to the fields where HP left un attended throughout the growing season. However, if maize field is infested with a mix of weeds with more than one dominating weeds including HP, compared to weedy situation the whole season, 30% higher grain yield can be obtained if all weeds are kept controlled till 40 DAE. Hence it can be concluded that whether the farmers face heavy HP infestation only or the mix of weeds as dominating weeds, in either case farmer should control weeds within first 40 days in maize field for better grain yield., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Objective: The study aimed to determine the maternal and newborn outcomes of Community Midwives' (CMWs') services in Pakistan as recorded in the provincial Management Information System (MIS) of the government's Maternal Newborn and Child Health (MNCH) program of Sindh province., Methodology: A descriptive retrospective design was used to examine the monthly reports of CMWs, stored in the MNCH-MIS, for the period of January 2013 to December 2015. A total of 200 CMWs were randomly selected from 23 districts of the Sindh province. The outcomes of the CMWs' services were analyzed, using descriptive statistics., Results: The analysis of data of 23 districts revealed that a total of 103,836 antenatal care were attended by 200 CMWs who were selected for the study. For intranatal care, 23,296 cases were registered, of which 78.3% (n = 18, 233) returned to these CMWs at the time of delivery. During the period, 17,849 were live births. The still birth rate was calculated to be 13.4/1000, the abortion rate was 7.3 per 1000 pregnant women, newborn mortality rate was 12.4/1000 live births, and the maternal mortality ratio was 142.5/100,000 live births. Moreover, the low birth weight newborns were 9% of the total live births., Conclusion: This study indicates that although the outcomes for CMWs are better than for some other cadres in Pakistan, they are still inadequate compared to midwives trained to the international standards. The outcomes presented in this study are in line with the challenges of CMWs survival reported in the earlier studies. This strongly indicate need for improvement in CMWs pre-service and in-service education to meet the international quality standards set by ICM., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: in 2012 the Aga Khan University in Karachi, Pakistan opened the country's first bachelor's degree program in midwifery for women who held diplomas in nursing and midwifery. The principal aims were to prepare midwives who would be competent to provide full-scope practice. For quality assurance, the programme was continuously monitored and assessed. As part of this ongoing evaluation process we sought in-depth feedback from the first graduates about their student experiences., Objective: this study aimed to explore the experiences of the first graduates of a Bachelor of Science in Midwifery (BScM) program to deepen our understanding of their views of the program's strengths and difficulties and to obtain their suggestions for change., Design and Methods: This qualitative descriptive exploratory study used universal sampling to collect data from all 21 of the first graduates of the BScM Program. Data collection involved focus group discussions using a semi structured interview guide and content analysis. The study was approved by Institutional Ethics Review Committee., Findings: three main themes emerged from the data: (1) Competence acquisition, (2) Attitude transformation, and (3) Strengths and limitations of the program., Conclusions: the study findings highlighted that the degree program in midwifery had a positive impact on graduates' perceptions of their knowledge, skills, attitudes and ability to implement evidence-based midwifery practice. The graduates regarded the university's environment, teaching-learning strategies, preceptorship model, self-directed learning and exposure to diverse clinical settings as major facilitators in achieving competence., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The aim of this note is to assess the common clinical features of paediatric multiple sclerosis (PMS) in Pakistan. For this purpose, 150 MS patients with the age range of (1-72) years and mean age (34.2±11.09) years were studied during the period 2010 to 2015 from MRI centers of Pakistan. We found 15 paediatric MS cases which had clinical course relapsing-remitting MS (11), secondary-progressive MS (3) and primary-progressive MS (1). Revised McDonald criteria 2010 of MRI was used to disseminate lesions in space and time. Sensory symptoms were found 27% in PMS patients and contributed brain area of corpus callosum, brain stem, periventricle, basal ganglia, white matter and cerebellum. Optic neuritis was the second clinical feature and its prevalence was reported 20% in paediatric patients. In conclusion, Paediatric multiple sclerosis is predicted 10 % with mean age 11.2 years in Pakistan. Sensory and optic neuritis are suggested the common clinical features of paediatric multiple sclerosis in Pakistan.

Objectives: Squamous cell carcinoma is the most common oral cancer. Radiotherapy with concomitant chemotherapy is an ideal treatment modality largely used for oral cancers, which precipitates many side effects, of which the most challenging and debilitating side effect is xerostomia. This study aimed to evaluate the efficacy of bethanechol in patients with xerostomia following chemoradiation therapy for oral cancer., Materials and Methods: Fifty patients with xerostomia postchemoradiation therapy, aged between 30 and 65 years, were selected based on selection criteria. Thirty patients in the study group were administered 25 mg bethanechol three times daily (TDS) and 20 patients in the control group with placebo capsules. The subjective symptoms of oral dryness were periodically evaluated at baseline, at the end of 1 st , 2 nd and 3 rd weeks using a self-reported questionnaire. Salivary analysis such as whole resting saliva and whole stimulated saliva (WSS) volumes, amylase, pH and sodium potassium ratio were evaluated before and 3 weeks after bethanechol and placebo therapy., Results: Twenty-four (80%) patients in bethanechol group and only 2 (10%) patients in control group showed subjective improvement in oral dryness at the end of 3 rd week. A significant difference was found between two groups in whole resting and stimulated saliva volume, pH and amylase. However, there was no statistically significant difference in sodium potassium ratio with insignificant adverse effects after 3 weeks of bethanechol therapy., Conclusions: 25 mg bethanechol (TDS) has shown subjective improvement in oral dryness in 24 (80%) patients with significant improvement in whole resting and WSS volumes, pH and salivary amylase with insignificant adverse effects., Competing Interests: There are no conflicts of interest.

Osteoma is an uncommon benign neoplasm composed of mature bone. Growth is slow and continuous and located principally in the cranio-maxillo-facial region, and can be central (endosteal) or peripheral (periosteal). Osteomas can be solitary or multiple masses, and they are generally asymptomatic. We discuss a case of ivory osteoma of the mandible in a 35-year-old female, which was present at the left body of the mandible since she was 10 years old, and was gradually increasing in size. The osteoma was removed surgically through an intraoral approach, and no recurrence was observed., (© 2011 Blackwell Publishing Asia Pty Ltd.)