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Objective: To find out the effect of inhaled Milrinone on pulmonary arterial pressure in patients undergoing cardiac surgery. Methods: A randomized controlled trial was done at Peshawar Institute of Cardiology in 78 patients who had preoperative pulmonary hypertension and had undergone cardiac surgery between the ages of 3 months and 60 years. Divided into 2, group 1 received Intravenous (IV) Milrinone and group 2 received Inhalational (IN) Milrinone. MANOVA was used to compare the difference between two groups across six dependent variables i.e., Heart rate (HR), systolic arterial pressure (SAP), Central venous pressure (CVP), Systolic pulmonary arterial pressure (SPAP), Diastolic pulmonary arterial pressure (DPAP) and Diastolic pulmonary arterial pressure (MPAP) at three stages; baseline, end of nebulization, and after cardiopulmonary bypass (labeled as stages 1,2 and3). Intraoperative complications like weaning from cardiac bypass (CBP) machine, use of vasopressor, insertion of intra-aortic balloon pump (IABP), and cardiopulmonary re-initiation were also observed in both the groups. Analysis of the data was done through SPSS-23. Results: In a total of 78 patients (39 in each group), an insignificant change was observed regarding the effects of IN Milrinone on HR, SAP, and CVP whereas significant effects of Inhaled Milrinone on SPAP, DPAP, and MPAP were observed (P-values

Cardiovascular (CV) diseases (CVD) are a major cause of long-term morbidity and mortality affecting life expectancy amongst cancer survivors. In recent years, because of the possibility of early diagnosis and the increased efficacy of neo-adjuvant and adjuvant systemic treatments (targeting specific molecular pathways), the high percentage of survival from breast cancer led CVD to become the first cause of death among survivors. Therefore, it is mandatory to adopt cardioprotective strategies to minimize CV side effects and CVD in general in breast cancer patients. Cancer therapeutics-related cardiac dysfunction (CTRCD) is a common group of side effects of chemotherapeutics widely employed in breast cancer (e.g., anthracycline and human epidermal growth factor receptor 2 inhibitors). The aim of the present manuscript is to propose a pragmatic multidisciplinary stepwise approach for prevention, early detection, and treatment of cardiotoxicity in patients with breast cancer.

Background and aim Mitral valve prolapse (MVP) is a common benign valvular disease though with an incidence of 0.2-1.9%/year of sudden cardiac death (SCD) related to complex ventricular arrhythmias in the form of arrhythmic MVP (AMVP). In MVP, first diagnostic approach is transthoracic echocardiography (TTE) that should be used to described morphological and functional valvular features and also the presence of mitral annular disjunction (MAD) which seems associated with AMVP. The aim of our study is to describe the association between advanced TTE markers of myocardial stretching such as global and focal longitudinal strain (GLS) and ventricular arrhythmias in MVP patients with and without MAD. Methods 88 patients with MVP were prospectively enrolled. All of them underwent 12-lead ECG and TTE including global and focal GLS of the left ventricle. In addiction, 40 had 24-hour Holter. Results MAD + patients were younger than MAD - (32.22±12.49 vs 41.64±15, p= 0.007) and mostly were females (30 females vs 9 males, p= 0.027). MAD + patients had higher burden of complex ventricular arrhythmias such as premature ventricular contractions (PVCs) with right bundle branch block (RBBB) morphology, bigeminy, non-sustained ventricular tachycardia (NSVT) and VT (Figure A). MAD + group had higher GLS (mean -21.5%±3% vs -20%±2.7%, p=0.0153) with notable difference in the inferior wall GLS (-19.4%±8% vs -16.4%±8%, p= 0.045), figure B. Conclusions Increased global and inferolateral GLS of left ventricle indicates longitudinal deformation in segments exposed to greater tension and mechanical stress by prolapsing leaflets and MAD which are associated with higher arrhythmogenic burden. Advanced echocardiographic techniques, such as global and segmental GLS could be considered as an advanced tool in the arrhythmic stratification of MVP patients.

Objectives: To develop and validate a survey to be used for determining the impact of pandemics on residents working in Surgical and allied disciplines in a teaching hospital. Materials and Methods: We developed a survey tool in Khyber Medical College Peshawar and reviewed it using the steps followed in AMEE guide 87. After face, content and construct validation, internal consistency and test-retest reliability were calculated by Cronbach alpha on standardized items and Pearson “r” respectively with the help of SPSS-25. Results: During the process, a 28-item survey tool was reduced to 16 items. The items were grouped under 5 sections named as preliminary data, Skills, Academic activities, impact over research activities and impact over examination preparations and schedules. The responses of all sections are in the Likert scale (with options from 4-6) while one section`s response is in “yes/no/unsure. The results of the Pilot study revealed Cronbach's alpha of 0.7 and Pearson "r" for test-retest reliability on all items as 0.7 to 1. Conclusion: IP-SRP survey is a new validated tool with good validity and reliability that can be used by healthcare professionals in times of pandemics, calamities, and natural disasters that strike the world population locally, regionally, or globally. Keywords: COVID-19 pandemic, the impact of Pandemic on the surgical residency program.

Mitral valve prolapse (MVP) is the most frequent valvulopathy with a prevalence of 1.2%-2.4% in general population and it is characterized by a benign course. Although it can be associated with some complications, ventricular arrhythmias (VA) and sudden cardiac death (SCD) as ultimate expressions, are the most worrying. The estimated risk of SCD in MVP is between 0.2% and 1.9% per year including both MVP patients with left ventricular (LV) dysfunction due to severe MR and MVP patients without significant MR. The latter ones constitute a particular phenotype called "malignant MVP" characterized by bileaflet myxomatous prolapse, ECG repolarization abnormalities and complex VAs (c-VAs) with polymorphic/right bundle branch block morphology (RBBB) and LV fibrosis of the papillary muscles (PMs) and inferobasal wall secondary to mechanical stretching visualized as late gadolinium enhancement (LGE) areas by cardiac magnetic resonance (CMR). In MVP, the first diagnostic approach is transthoracic echocardiography (TTE) that defines the presence of mitral annular disjunction (MAD) which seems to be associated with "arrhythmic MVP" (AMVP). From an ECG point of view, AMVP is characterized by frequent premature ventricular contractions (PVCs) arising from one or both PMs, fascicular tissue, and outflow tract, as well as by T-wave inversion in the inferolateral leads. The aim of the present paper is to describe TTE red flags that could identify MVP patients at high risk to develop complex arrhythmias as supported by the corresponding findings of LGE-CMR and anatomy studies. TTE could be a co-partner in phenotyping high-risk arrhythmic MVP patients.

Aims We hypothesized that the wide-awake local anaesthesia with no tourniquet (WALANT) technique is cost-effective, easy to use, safe, and reproducible, with a low learning curve towards mastery, having a high patient satisfaction rate. Furthermore, WALANT would be a suitable alternative for the austere and developing nation environments where lack of funds and resources are a common issue. Methods This was a randomized control trial of 169 patients who required surgery for closed isolated distal radius fractures. The study was performed between March 2016 and April 2019 at a public sector level 1 trauma centre. General anaesthesia was used in 56 patients, Bier’s block in 58 patients, and WALANT in 55 patients. Data were collected on pre-, peri-, and postoperative parameters, clinical outcome, hospital costs, and patient satisfaction. One-way analysis of variance (ANOVA) was used with a p-value of 0.05 being significant. Results Operations with WALANT proceeded sooner, and patients recovered faster, resulting in mean fewer missed working days (7.8 (SD 1.67)) compared with general anaesthesia (20.1 (SD 7.37)) or Bier’s block (14.1 (SD 7.65)) (p < 0.001). The WALANT patients did not develop complications, while the other patients did (p < 0.04). Clinical outcomes did not differ, nor did surgeon qualification affect clinical outcomes. Mean hospital costs were lower for WALANT ($428.50 (SD 77.71)) than for general anaesthesia ($630.63 (SD 114.77)) or Bier’s block ($734.00 (SD 37.54)) (p < 0.001). Patient satisfaction was also higher (p < 0.001). Conclusion WALANT for distal radius fractures results in a faster recovery, is more cost-effective, has similar clinical outcomes, and has fewer complications than general anaesthesia or Bier's block. This makes WALANT an attractive technique in any setting, but especially in middle- and low-income countries. Cite this article: Bone Joint Res 2020;9(7):429–439.

Early detection and treatment of cancer have led to a noticeable reduction in both mortality and morbidity. However, chemotherapy and radiotherapy could exert cardiovascular (CV) side effects, impacting survival and quality of life, independent of the oncologic prognosis. In this regard, a high clinical index of suspicion is required by the multidisciplinary care team in order to trigger specific laboratory tests (namely natriuretic peptides and high-sensitivity cardiac troponin) and appropriate imaging techniques (transthoracic echocardiography along with cardiac magnetic resonance, cardiac computed tomography, and nuclear testing (if clinically indicated)), leading to timely diagnosis. In the near future, we do expect a more tailored approach to patient care within the respective community along with the widespread implementation of digital health tools.

Several past studies have shown the use of glass fibre-reinforced polymer (GFRP) bars to alleviate the reinforced steel rusting issue in different concrete structures. However, the practise of GFRP bars in concrete columns has not yet achieved a sufficient confidence level due to the lack of a theoretical model found in the literature. The objective of the current study is to introduce a novel prediction model for the axial capability of concrete columns made with bars of GFRP. For this purpose, two different approaches, such as data envelopment analysis (DEA) and artificial neural networks (ANNs) modelling, are used on a collected dataset of 266 concrete column specimens made with GFRP bars from previous literature works. Eight parameters were used to predict the axial performance of GFRP-based RC columns. The proposed DEA and ANNs predictions demonstrated a good correlation with the testing dataset, having R2 values of 0.811 and 0.836, respectively. A comparative analysis of the DEA and ANNs models is undertaken, and it was found that the suggested models are capable of accurately forecasting the structural response of GFRP-made RC column structures. Then, a comprehensive parametric analysis of 266 GFRP-based columns was performed to study the effect of different materials and their geometrical shape.

Road safety has become a serious issue in both developed and developing countries, costing billions of dollars every year. Road accidents at nighttime especially in low illumination situations are common and severe and have gained a lot of attention. To improve visibility and avoid traffic accidents, a series of efforts have been made but the existing mechanism is facing continuous challenges and highlighting a need for smart highways with high efficiency, road safety, and strength. In this study, the use of radium polymer beads (RPB) is proposed to avoid road accidents. The effect of RPB was investigated by comparing the results of the beads’ surface and modified asphalt mixtures using the three-stage testing methodology. Utilizing the circular economy, RPB have been introduced as a solution to the problem. Results indicated that in the first phase, the addition of RPB on the mixture surface improved the mechanical performance of the road pavement and helped in avoiding road accidents due to their ability to absorb the light from the source and then reflect in the night. Moreover, the mechanical properties using Marshall stability standard parameters (stability 9 kN and flow 2–4 mm range) were fulfilled as a standard testing requirement. The proposed radium bead layer can reduce road accidents and provide a direction towards future smart highways by using new reflective materials in road construction.

Disaster is a state of serious disruptions in the functionality of any society or county Disasters pose serious economic or environmental impacts that surpass the capacity of the affected country or society to compete with the use of their assets Recently, Pakistan significantly prone to health disasters due to COVID-19 among developing South Asian countries The long-term impact of health disasters and other natural hazards put additional pressure mostly on the government's economic policy It forces the government to follow a constructive approach like a disaster relief-based approach rather than a conventional mitigation management formation to reduce the impact of disaster risk This study elaborates on the main issues associated with disaster preparedness as well as recovery of the economy and businesses of the country For Scientific risk performance analysis, open-source data from the National Institute of Disaster Management (NDMA) has been utilized to study the current situation of COVID-19 in Pakistan Results show Pakistan has been facing a highly vulnerable situation as more than three hundred and fifty thousand confirmed cases have been reported Poor health and technical management facilities have been exposed against COVID-19 as Pakistan has a low heath budget because of its declining GDP growth rate in the world This research will help in disaster preparedness and the development of a disaster risk management framework while designing strategies to deal with such pandemics in the future © 2021 The Author(s)

The utilization of waste industrial materials such as Blast Furnace Slag (BFS) and Fly Ash (F. Ash) will provide an effective alternative strategy for producing eco-friendly and sustainable concrete production. However, testing is a time-consuming process, and the use of soft machine learning (ML) techniques to predict concrete strength can help speed up the procedure. In this study, artificial neural networks (ANNs) and decision trees (DTs) were used for predicting the compressive strength of the concrete. A total of 1030 datasets with eight factors (OPC, F. Ash, BFS, water, days, SP, FA, and CA) were used as input variables for the prediction of concrete compressive strength (response) with the help of training and testing individual models. The reliability and accuracy of the developed models are evaluated in terms of statistical analysis such as R2, RMSE, MAD and SSE. Both models showed a strong correlation and high accuracy between predicted and actual Compressive Strength (CS) along with the eight factors. The DT model gave a significant relation to the CS with R2 values of 0.943 and 0.836, respectively. Hence, the ANNs and DT models can be utilized to predict and train the compressive strength of high-performance concrete and to achieve long-term sustainability. This study will help in the development of prediction models for composite materials for buildings.

Eco-friendly waste utilization helps in the development of sustainable infrastructures. Recently, researchers have focused on the production of road infrastructures using the circular economy concept of human safety. The objective of this study is to investigate and explore the utilization of optimum polymer waste content for the development of polymer-modified asphalt mixtures using response surface methodology (RSM). RSM based on Box–Behnken design (BBD) was employed to optimize experimental design and included three factors: X1, polymer type; X2, polymer contents; and X3, testing day. The optimized responses determined by the RSM were as follows: MS of 42.98 kN, MF of 5.08 mm, and MQ of 8.66 kN/mm, indicating a favorable and consistent precision in comparison with experimental values. Moreover, the Marshall characteristics of samples prepared with PE were quite improved compared to PET. In conclusion, the incorporation of such polymer wastes in road construction is a sustainable and cost-effective way of improving their engineering properties. This study will help in the development of sustainable road infrastructures supporting human safety and environmentally friendly practices.

This study presents the waste tire gasification in CO2 atmosphere aiming to produce higher H2 production. Therefore; the waste tire was gasified in horizontal tube reactor under different ranges of reaction temperature, heating rate, and residence time. Maximum H2 and gas yields of 46.28 mol % and 72.43 wt. % were obtained at higher temperature of 900 ℃, lower heating rate of 10 ℃/min, and lower residence time of 20 min. Tar and char products were decreased considerably from 15.34 to 4.24 wt. % and 35.23 to 23.25 wt. %, respectively. While, LHV and H2/CO molar ratio were ranged between 9.80-11.07 MJ/Nm3 and 1.41 to 2.18, respectively. Artificial neural network (ANN) model provided a strong relationship .i.e. the estimated regression coefficient (R2) values were obtained as; 0.90, 0.94, 0.93, and 0.96 for H2, CO, CO2, and CH4 respectively. The gasification was also carried out in thermogravimetric analyzer (TGA) under different heating rates hence; showed three different degradation stages. Kinetic parameters; activation energy (Ea), and R2 were estimated using Kissinger–Akahira–Sunose (KAS) model which were found to be 38.99 kJ/mol and 1.0 for stage 1, 63.01 kJ/mol and 0.94 for stage 2, and 84.73 kJ/mol and 0.91 for stage 3.

The increasing costs of virgin content, decreasing resources, and growing plastic waste have shifted the research momentum towards green and sustainable road pavements. Hence, in recent years, various researchers have worked on the utilization of different types of plastic wastes in asphalt concrete by replacing it with binder content. Under this premise, this study examines the effect of expanded polystyrene beads (EPS) as a replacement to the binder at seven different dosages ranging from 5% to 50%. The bitumen of 60/70 grade was utilized in this study. The fresh properties of polymer-modified bitumen were checked and compared to that of conventional specimens. The mechanical properties of all specimens were investigated in terms of Marshall Stability properties. The results indicated that the adding of PEB improves the stability of modified asphalt concrete. Furthermore, the addition of EPS by substituting bitumen content could be a promising way to reduce the environmental impact of bitumen, and will also help in economic infrastructure development.

Hypertrophic osteoarthropathy (HOA) was described by Friedreich in 1868. It is a rare condition with variable presentations including clubbing of the toes and fingers, arthralgia with edema, bilateral ptosis, thickening of the skin and leonine facies. Bone and periarticular tissue proliferation leads to expansive extremities. It is a distant effect disorder in various neoplasms (paraneoplastic syndrome); often associated with lung neoplasm. We report a case of a 36 year old Pakistani male smoker, presenting with bilateral joint pains, shortness of breath and grade 4 digital clubbing on general examination.

Introduction: In recent decades, interventional procedures in cardiac surgery have developed as widely used techniques of treating valvular dysfunctions and coronary artery diseases. Objectives: The main objective of the study is to find the endotracheal reintubation in post-operative cardiac surgical patient other than surgical bleeding. Material and methods: This descriptive study was conducted in Peshawar institute of cardiology during 2018 to 2019. The data was collected with the permission of ethical committee of hospital. The data was collected from those patients who were underwent cardiac bypass surgery in hospital. All demographical data related to age, gender and history of diseases was collected. Results: The data was collected from 122 patients, from these 22 patients were not extubated and none of them survived. The most common indication for surgery was myocardial revascularization (30.6%), followed by valve replacement (22.7%) and thoracic aortic aneurysm repair. Conclusion: It is concluded that reintubation after cardiac surgery is a marker for morbid postoperative period. The reintubation rate in patients undergoing cardiac surgery in our hospital was high.

Mitral valve prolapse (MVP) is the most common valvular disease with a prevalence of 2%. It has generally a benign course; however, recent findings suggested an association between MVP and complex arrhythmias and eventually cardiac arrest and for this reason, it is also called arrhythmogenic MVP. Subjects who experience this complication are in general young women, with thickened mitral leaflets or bileaflet prolapse not necessarily associated with severe mitral regurgitation (MR). The nature of the relation between MVP and cardiac arrest is not clearly understood. Actually, the challenging task is to find the cluster of prognostic factors including T-wave inversion, polymorphic premature ventricular contractions, bileaflet prolapse, MR severity, but most importantly, those parameters of hypercontractility, mitral annulus disjunction (MAD), and myocardial fibrosis using a multimodality approach. Transthoracic echocardiography is the first-line imaging modality for the diagnosis of MVP, but also for detecting MAD and hypercontractility, followed by cardiac magnetic resonance for tissue characterization and detection of myocardial and papillary muscle fibrosis, using either late gadolinium enhancement (at the basal segment of the inferolateral wall and papillary muscles) (macro-fibrosis), or diffuse fibrosis by T1 mapping (native and post contrast T1). Moreover, there are also preliminary data on positron emission tomography utilizing 18F-fluorodeoxyglucose as a tool for providing evidence of early myocardial inflammation. The objective of this review article is to provide the clinician with an overview and a practical clinical approach to MVP for risk stratification and treatment guidance.

Self-Compacting Concrete (SCC) is a unique kind of concrete that tends to consolidate in terms of its weight. In this study, the prime target is to investigate the durability properties of SCC developed using eco-friendly economical waste binding materials as partial replacement to costly cement. This circular economy concept will not only help in the development of green concrete but will also help to improve the climatic condition by reducing the use and production of cement. An economical design methodology has been applied to produce environmentally friendly construction material. This research focuses on the application of Alum Sludge (AS) and Brick Dust (BD) in Self-Compacting Concrete (SCC). Both materials are waste materials containing binding properties. Performance of SCC developed using these two materials was tested considering mechanical properties of concrete using the destructive testing technique. Results showed that BD and AS can be utilized for up to 12% and 9% of replacement of cement, respectively, to achieve equal or higher compressive, tensile, and flexural strength. The application of BD and AS has demonstrated a subsequent improvement of SCC’s mechanical properties, i.e., compressive, tensile, and flexural strength. This study will help the production of composite green materials with the help of eco-friendly and economical waste materials for sustainable infrastructure development.

The present investigation aims to propose a numerical model for assessing the complex damaging response of glass fiber-reinforced polymer- (GFRP-) reinforced concrete columns having hybrid fibers and confined with GFRP spirals (GFHF columns) under concentric and eccentric compression. Fiber-reinforced concrete (FRC) consists of polyvinyl alcohol fibers (PVA) and polypropylene fibers (PF). A total of six GFHF circular columns were constructed having a circular cross section of 250 mm and a height of 1200 mm. A commercial package ABAQUS was used for the finite element analysis (FEA) of the GFHF columns by using a modified concrete damage plastic (CDP) model for hybrid fiber-reinforced concrete (HFRC). The damaging response of GFRP bars was defined using a linear elastic model. The results depicted that the failure of GFHF columns occurred either in the upper or in the lower half portion with the rupture of GFRP longitudinal bars and GFRP spirals. The decrease in the pitch of GFRP spirals led to an improvement in the axial strength (AS) of GFHF columns. The eccentric loading caused a significant reduction in the AS of columns. The comparative study solidly substantiates the validity and applicability of the newly developed FEA models for capturing the AS of GFHF columns by considering the axial involvement of longitudinal GFRP bars and the confinement effect of transverse GFRP spirals. So, the suggested numerical model having a complex system of equations for HFRC can be used for the accurate analysis of HFRC members.

Polymer composites have been identified as the most innovative and selective materials known in the 21st century. Presently, polymer concrete composites (PCC) made from industrial or agricultural waste are becoming more popular as the demand for high-strength concrete for various applications is increasing. Polymer concrete composites not only provide high strength properties but also provide specific characteristics, such as high durability, decreased drying shrinkage, reduced permeability, and chemical or heat resistance. This paper provides a detailed review of the utilization of polymer composites in the construction industry based on the circular economy model. This paper provides an updated and detailed report on the effects of polymer composites in concrete as supplementary cementitious materials and a comprehensive analysis of the existing literature on their utilization and the production of polymer composites. A detailed review of a variety of polymers, their qualities, performance, and classification, and various polymer composite production methods is given to select the best polymer composite materials for specific applications. PCCs have become a promising alternative for the reuse of waste materials due to their exceptional performance. Based on the findings of the studies evaluated, it can be concluded that more research is needed to provide a foundation for a regulatory structure for the acceptance of polymer composites.

Numerous environmental issues arise as a result of a linear economy strategy: reserves become scarce and end up in landfills and as greenhouse gases. Utilizing waste as a resource or shifting towards a circular economy are among the effective strategies for addressing these issues. To track this shift, appropriate measures that concentrate on sustainable development while taking practical contexts into consideration are required. In this paper, we utilize plastic wastes as a replacement for bitumen for reuse aiming at a circular economy. The use of plastic waste materials, i.e., plastic bottles (PET) and gas pipes (PE) in asphalt materials as a bitumen modifier was studied through series of experimental lab test methods. Marshall samples were prepared using a conventional Marshall method containing five different percentages (0%, 5%, 10%, 15%, and 20%) of plastic content by total weight of bitumen. Samples were tested after 1 and 30 days and the result shows that the stability of plastic-modified asphalt concrete was increased after 30 days, while still meeting standard criteria with plastic contents up to 20%. Moreover, the addition of waste plastic in road construction is a very effective strategy for reusing plastic waste, which also provides economic and social benefits for a sustainable approach to road pavements.

To identify missing childhood Tuberculosis (TB) cases, “screeners” (hospital-based health workers trained to screen accompanying contacts of TB patients for symptoms) were introduced in eight tertiary care hospitals of Sindh, Pakistan in 2013. There was a 55% increase in childhood TB notifications in 2014 compared to 2012 in facilities with screeners (n = 8) compared to 40% increase in facilities without screeners (n = 22). This apparent association disappeared when stratified by presence of “trained pediatrician” whose introduction was associated with a massive increase in notifications while transfer was associated with a marked decrease. In conclusion, screeners were not associated with increase in pediatric TB case notifications.

The behaviour of asphalt concrete mixtures is difficult to understand due to its complex nature under different loading conditions and environmental factors. For prediction, there is a need to find mathematical relations between multiple inputs and outputs using a simple and precise way. Recently, artificial neural networks (ANNs) has been widely used to study the mechanical parameters of asphalt concrete materials and its applications in civil engineering fields. This study presents the application of ANNs method for prediction of Marshall stability of asphalt concrete developed with two different types of aggregates based on mineralogy under four different testing temperatures ranging between 25 °C and 60 °C. The ANNs model established with six input variables including temperature, aggregate type, ultrasonic pulse velocity–time and space volume, unit volume of dry air, and saturated surface dry weight. The proposed model developed using six neurons in hidden layer for the prediction of experimental data. The feasibility of the proposed model checked in terms of root mean square error (RMSE) and coefficient of determination (R2). The R2 values found within range during both training (0.909–0.999) and validation phase (0.886–0.997) depending on estimated parameters. Moreover, the influence of different aggregate type has been investigated under varying temperatures conditions using the proposed ANNs method. The proposed model has shown the potential to understand the mechanical behaviour of sustainable asphalt concretes accurately under various temperature conditions.

Self-Compacting Concrete (SCC) differs from the normal concrete as it has the basic capacity to consolidate under its own weight. The increased awareness regarding environmental disturbances and its hazardous effects caused by blasting and crushing procedures of stone, it becomes a delicate and obvious issue for construction industry to develop an alternative remedy as material which can reduce the environmental hazards and enable high-performance strength to the concrete, which would make it durable and efficient for work. A growing trend is being established all over the world to use industrial byproducts and domestic wastes as a useful raw material in construction, as it provides an eco-friendly edge to the construction process and especially for concrete. This study aims to enlighten the use and comparative analysis for the performance of concrete with added industrial byproducts such as Ground Granulated Blast Furnace Slag (GGBFS), Silica fumes (SF) and Marble Powder (MP) in the preparation of SCC. This paper deals with the prediction of mechanical properties (i.e., compressive, tensile and flexural Strength) of self-compacting concrete by considering four major factors such as type of additive, percentage additive replaced, curing days and temperature using Artificial Neural Networks (ANNs). This project has been supported by PIET.

There has been a recent concern among oncological clinicians and pathologists of our region regarding the disproportionate increase in the number of patients presenting with diffuse large B cell lymphoma (DLBCL). This prompted us to conduct a thorough, hospital-based epidemiological study in a major referral center of Pakistan. A total of 780 specimens were collected over last half decade from cases classified as adult Non Hodgkin's lymphoma (NHL). Out of these 780, 596 (76.4 %) were diagnosed as DLBCLs. The gender ratio was 2.3:1 (M:F) and the median age was 47.2 years, with an age range of 15-85 years. Nodal-NHLs constituted 42.2 % of all adult NHLs, with the cervical lymph nodes as the most frequent nodal site of presentation. The most frequent extranodal site was the gastro-intestinal tract (GIT), followed by the head and neck. In conclusion, we document an astonishingly high number of DLBCL amounting to an emerging epidemic in Pakistan, with a consideration of probable etiopathogenetic factors.