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Abstract Insulin resistance (IR) is a well-recognized covariate of Polycystic Ovarian Syndrome (PCOS) with varying burden and risk factors among populations. The relationship of insulin secretory defect or ISD with PCOS is less understood. The presence of IR and ISD as well as their covariates have been explored in the present case-control study among young adult to early middle-aged, normal weight to obese, Bangalee women with PCOS. A number of 158 PCOS [age 23 (15–34) years, Median (Range)] and 126 Non-PCOS [24 (19–34) years] females were recruited purposively with PCOS diagnosed following Modified Rotterdam Criteria 2003. Hormones were measured by CLIA method and lower abdominal ultrasonography was done by trained personnel. IR and ISD were assessed by homeostasis model assessment with 75th percentile values of HOMA-IR (2.4) and HOMA%B (143) in Non-PCOS group considered as the cut-off values. Hyperandrogenism (HA) was measured by calculating Fasting Androgen Index (FAI). HOMA-IR was high among 52% of PCOS and 28% of Non-PCOS women. Body Mass Index (BMI) and HA were independently associated covariates of IR (p

Heat pipes have the potential to benefit from nanofluid flow between coaxial cylinders. Heat is effectively transferred from one place to another by means of heat pipes. Heat pipes can be used for electronics cooling, spacecraft thermal management, and heat recovery systems by adding nanofluids, which enhances the heat pipe's thermal conductivity and heat transfer capability. This work aims to discover an approximate solution for the flow of a trihybrid nanofluid (THNF) consisting of graphene, copper, and silver between two coaxial cylinders in magneto-hydrodynamics, taking into account the broad variety of applications. The nanomaterial is tested in a system with a fixed inner cylinder and a rotating outer cylinder. It contains graphene, copper, silver, and kerosene oil as the base fluid. For examining the flow characteristics, magnetic field is applied along radial direction of the cylinder, while inner cylinder is fixed, and outer cylinder is rotating. Moreover, temperature of the outer cylinder is higher than the lower cylinder. The objective of this study is to develop a mathematical model of the problem and solve the governing equation numerically using the MATLAB built-in routine called bvp4c. Additionally, we identify the most effective physical parameter to optimize the heat transfer rate using Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS). Using a variety of factors, we calculate fluid velocity, skin friction, temperature, and Nusselt number graphically. According to the study, higher Brinkman numbers (Br) and magnetic parameter (M) characteristics lead to higher temperatures. Furthermore, Fuzzy TOPSIS shows that alternative A11 (ϕ=(0.9,1.0,1.0),M=(0.5,0.7,0.9),Br=(0.9,1.0,1.0)) has the maximum heat transfer rate, while another A8 (ϕ=(0,0,0.1),M=(0,0,0.1),Br=(0,0,0.1)) has the lowest.

Nanoparticles have numerous applications and are used frequently in different cooling, heating, treatment of cancer cells and manufacturing processes. The current investigation covers the utilization of tetra hybrid nanofluid (aluminium oxide, iron dioxide, titanium dioxide and copper) for Crossflow model over a vertical disk by considering the shape effects (bricks, cylindrical and platelet) of nanoparticles, electro-magneto-hydrodynamic effect and quadratic thermal radiation. The present study is devoted to present the mathematical formulation of the tetra-hybrid nanofluid flow in a porous channel with stretching/shrinking walls. The present inspection model is derived from given partial differential equations (PDEs) and then transformed into a system of ordinary differential equations (ODEs) by incorporating similarity variables. The transformed ODEs are solved using the bvp4c methodology, which yields numerical results. From the obtained results it is observed that the maximum amount of C f x happens when there is slightly increase in M with stretched wall that is λ ∈ [ 0 , 2 ] . A high radiation value indicates a considerable contribution from radiative heat transfer, whereas stretching and shrinking increase and reduce the size of the boundary. The combined impact caused an increase in the Nusselt number. The graphical and tabular representations are used to explain the physical behaviour of various model parameters. Previous outcomes are also contrasted with the current outcomes.

Introduction: Breakthrough infection by SARS-COV-2 virus among vaccinated individuals has been reported from all over the world and it has created a substantial challenge in designing strategies to live with the virus in the post-pandemic era. Factors affecting the extent and nature of breakthrough infection are still not fully understood and those are known to vary depending on host and agent factors. Health Care Workers (HCWs), especially in hospital settings, are front-liners in combating the epidemic and, consequently, they are more vulnerable to breakthrough infection by SARS-COV-2. Like most of the countries of the world, Bangladesh went through several waves of COVID-19 and the last (3rd wave) was the widespread Omicron wave during the winter of 2022. HCWs in Bangladesh have been disproportionately affected by the virus. Under this context, the aim of the present study was to explore breakthrough infection (BTI) and its host-related covariates among HCWs of a COVID-dedicated city-based hospital during the Omicron wave in Bangladesh. Materials and methods: An observational cross-sectional study was conducted on 267 HCWs of the Narayanganj Tertiary (300-bed) hospital during February–March 2022 which coincided with the terminal part of the 3rd wave. Data were collected by trained Field Assistants using Interviewer-administered Data Collection Forms with Questionnaires as instruments. Previous COVID-19 status (any time after the onset of the pandemic and within last 3 months) was explored by the history of specific symptoms as well as by the confirmatory rtPCR test reports from DGHS approved laboratories Anti-nucleocapsid antibody (Anti-N-Ab) in venous blood samples, assayed by a chemiluminescent ELISA technique, was used as a seroprevalence-based marker of breakthrough infection during the preceding few months. Data were analyzed by bivariate as well as multivariate statistics using the IBM-SPSS software. Results: The median age (range) of the HCWs was 38 (21–65) years; Body Mass Index (BMI, kg/m2) 25 (15–49); and Waist-Hip Ratio (WHR) was 0.92 (0.46–1.21). The male subjects had significantly higher median age (p = 0.01) and higher WHR (p = 0.001) as compared to the female subjects. As per the BMI category, subjects with overweight and obesity constituted 83.3 % of the male subjects as compared to 61.6 % of the female subjects (p = 0.001). The time lapse between receiving of 3rd dose and blood sampling was significantly higher among females compared to males (median days 60 vs 49, p

Objective: To determine the efficacy of intravenous Magnesium Sulphate in attenuating the hemodynamic response, Systolic Blood Pressure, in hypertensive patients undergoing laryngoscopy and endotracheal intubation compared with a Control Group. Study Design: Quasi-experimental study. Place and Duration of Study: Anesthesia Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Apr to Oct 2018. Methodology: A total of 110 diagnosed patients of hypertension, taking anti-hypertensive medication, between 30–65 years of age, belonging to either gender, and undergoing elective surgery were enrolled. Patients were given intravenous Magnesium Sulphate (30 mg/kg) in 20 ml normal saline over a period of 03 minutes before induction of general anesthesia while control Group was given 20 ml of normal saline (placebo). Systolic Blood Pressure for both Groups was recorded on a performa by an observer two minutes after intubation. Results: The mean age of patients in treatment Group was 43.95±8.39 years and in control Group, 43.84±8.36 years. Out of 110 patients, 41(37.27%) were males and 69(62.73%) were females. The efficacy of MgSO4 was 16(29.09%) and in control Group, it was 04(7.27%) with p-value of 0.003(

There has been a lot of interest in alternative fuels due to the depletion of petroleum supplies and growing environmental concerns. Biodiesel is made from renewable resources and is one of the many practical and beneficial fuel substitutes for fossil fuels. Recent advancements in nanotechnology have made it feasible to use nanoparticles as fuel additives for internal combustion engines. An earlier study suggested that these compounds might enhance engine performance. There has been a concern that this may increase the particulate matter emitted with the exhaust which adversely affects the air quality. The size-distribution of unregulated particulate matter (PM) emitted with exhaust gases is examined in this work. Under various load conditions, PM exhaust emissions were examined while keeping the engine running at a constant 1350 rpm. A nanoparticles of 50 parts per milligram of Aluminum oxide Al2O3 and Iron oxide Fe2O3 into the jatropha biodiesel / diesel fuel blend. When the engine is fueled with blend of diesel, biodiesel, and nanoparticles ternary fuel, it created fewer particulate matter emissions than the diesel/biodiesel binary blend which contains no nanoparticles. In comparison to pure diesel fuel, the diesel/biodiesel blend binary combination produced 10–15 % less PM1, PM2.5, PM7, and PM10 emissions which is very critical to air pollution problem with the fine/very fine particles.

Heat pipes are heat transfer devices that carry heat from one point to another efficiently. The thermal conductivity and heat transfer performance of the heat pipe can be increased by integrating nanofluids, making them appropriate for applications such as electronics cooling, spacecraft thermal management, and heat recovery systems. The suggested work is being carried out for the approximate solution of tri-hybrid nanofluid (copper (Cu), silver (Ag) and graphene oxide (GO)) flow between two horizontal coaxial cylinders. The inner cylinder is rotating with constant velocity and the outer cylinder is fixed. Moreover, the flow is under the influence of magnetic field. The system of governing partial differential equations is converted into a set of non-linear ordinary differential equations by incorporating the suitable similarity transformation and then solved numerically by employing Runga-Kutta 4th order technique. Response surface methodology (RSM) is also incorporated in order to optimize the heat transfer rate by the various combinations of the physical parameters involved in the study. The study revealed that the temperature of the nanofluid increased by raising the strength of the Reynolds number and melting parameter. From optimization technique RSM it came to know that the heat transfer rate reached its peak value when the strength of the Reynolds number and concentration of the nanoparticle of the fluid is higher than normal.

This study investigates the effect of increasing urbanization on the demand for petroleum products, which are limited natural resources. The study evaluated the use of biodiesel and clove oil as additives in diesel fuel to reduce carbon deposition on engine parts and noise emissions. Three fuel samples were tested: B30 (30 % biodiesel and 70 % diesel), clove oil at 3000 parts per million (PPM), and D100 diesel fuel. Endurance tests were conducted at a constant load and revolution per minute (RPM) to analyze carbon deposition on engine parts as well as noise emission levels at constant and variable RPM. It was found that biodiesel blended fuel had higher carbon deposition formation compared to diesel fuel, with a deposition rate of 77.48 % for B30 and 71.84 % for D100. In contrast, when clove oil was added to biodiesel, engine part deposition was decreased compared to diesel fuel, with a deposition rate of 47.71 % for clove oil. Furthermore, the study analyzed noise emissions at four positions (left, right, back, and top) using the three fuel samples. Clove oil showed lower noise emissions compared to diesel, indicating that it can help reduce noise pollution.

The power electrical devices are being continuously trimmed down and must disperse a greater amount of heat flux, overheating has become a significant issue. Ferrofluids, also known as magnetic nanofluids, consist of solid magnetic nanoparticles that exhibit superior thermal conductivity compared to their underlying fluids, which can be either aqueous or oil based. This facilitates increased rates of convective heat transfer, but more importantly, it allows for external flow modification using a magnetic field. This work is unique in that it analyses hybridized ferrofluid flow over a shrinking/stretching surface with radiative magnetization and significant magnetic force. The governing equations were solved using the bvp4c function in MATLAB, after being transformed into ordinary differential equations (ODEs) by using similarity transformations. The system acquires a bimodal solution, and stability analysis validates the physical and dynamic stability of the first solution. The local skin friction coefficient, the local Nusselt number, the temperature and velocity profiles, and the substantial influence of governing effects are all studied and graphically displayed. The key findings are the values of Nux1Rex are decreasing for both second and first solutions as values of φCoFe2O4 are increasing. An increasing trend for the values of RexCf is observed for both second and first solutions as values of φCoFe2O4 increases. The results compareded with the results reported in literature and found a significant agreement.

Background Type 2 diabetes mellitus (T2DM) is a global public health crisis impacting low-income and middle-income countries such as Bangladesh. While self-management is encouraged for individuals with T2DM, there is a significant lack of knowledge regarding the factors of facilitators, barriers and expectations associated with T2DM self-management in Bangladesh. This research aims to investigate the potential elements that support, impede and are anticipated in the effective practice of self-management for T2DM in rural areas of Bangladesh.Methods and analysis This study will use an exploratory qualitative approach. 16 focus group discussions, 13 in-depth interviews and 9 key informant interviews will be conducted among multilevel stakeholders, including people with T2DM, their caregivers, healthcare providers, health managers/administrators and policy planners. Interviews will be audio-recorded, transcribed, translated and analysed using thematic analysis.Ethics and dissemination This research project has been approved by the Monash University Human Research Ethics Committee (project reference number: 39483) and the Ethical Review Committee of the Centre for Injury Prevention and Research, Bangladesh (Memo: CIPRB/ERC/2023/14). Research findings will be disseminated in peer-reviewed journals and conference presentations. Published reports will include group data. Individual data privacy will be strictly maintained.

The enhanced thermal efficiency exhibited by Casson nanofluids offers significant practical applications across various industrial and engineering sectors. This study focuses on the mathematical investigation of the steady magnetohydrodynamic (MHD) boundary layer flow of Casson nanofluid through a stretched/shrinking cylinder, taking into account the effects of suction and thermal radiation. The governing partial differential equations (PDEs) have been subjected to a similarity transformation, resulting in a set of nonlinear ordinary differential equations (ODEs). These ODEs were solved numerically utilizing the code of bvp4c in the software of Matlab which offers high accuracy (4th order). The employed nanofluid model incorporates the effects of Brownian motion and thermophoresis. The present study illustrates the graphical depictions of the impacts of different governing parameters, namely Hartmann (M) number, curvature (γ) parameter, Brownian motion (Nb) parameter, mass suction (S) parameter, thermal radiation (Rd) parameter, and thermophoresis (Nt) parameter, on heat transfer, flow, and mass transfer characteristics. Comprehensive determination and visual presentation of the coefficient of skin friction, local Nusselt number, and local Sherwood number were conducted for a range of estimates of applied parameters. Based on our examination, it has been determined that dual similarity solutions are present within a specific range of mass suction parameters. The relationship between the Casson parameter and various fluid dynamic properties, such as skin friction coefficient, heat transfer rate, and mass transfer rates, has been found to exhibit a decreasing trend. Furthermore, the stability analysis discovered that the first solution exhibits linear stability, whereas the second solution displays linear instability. Additionally, the motivation behind this study is to enhance industrial performance through the optimization of thermal power generation systems, thereby increasing their overall efficiency.

Abstract This study focuses on the issue of lots resubmission in inspection processes, which often arises when the initial inspection of a lot is suspected, marked as held, or not accepted. To address this problem, a novel variables sampling plan based on the coefficient of variation is proposed. The objective is to determine the sampling plan parameters that minimize the average sample number while satisfying the two-points of operating characteristic curve. Practical considerations are taken into account by providing tabulated values for the inspection sample size and acceptance criteria of the proposed plan. These tables incorporate various combinations of quality levels, considering commonly used producer's risk and consumer's risk. Furthermore, a comparative analysis between the proposed plan and a single sampling plan is conducted to highlight the advantages of the new approach. To illustrate the practical implementation of the proposed plan, an example is presented.

A numerical study was carried out on dual solutions of rotating stretching/shrinking surfaces to explore the influence of convective boundary conditions, viscous dissipation, thermal radiation, and heat sources/sinks on 3-D hybrid nanofluid flow. Hybrid nanofluids have great potential for a variety of applications due to their unique properties and versatility. It is improved the effectiveness of heat transfer rates. The main objective of this study is to investigate the influence that certain parameters on the temperature and velocities profiles against the parameters, including the volume fraction of copper, suction effect, viscous dissipation, thermal radiation, Biot number and rotating parameter. Further, the impact of the suction effect and shrinking sheet on reduced heat transfer and skin friction is also considered against the volume fraction of copper. The nonlinear partial differential equations are transformed into a collection of ordinary differential equations by including linear similarity variables. The generated combination of higher order nonlinear ODEs is solved via a boundary value algorithm called bvp4c, which executes on the MATLAB computing tool. The findings confirmed the existence of two branches (dual solution) with varied quantities of copper volume fraction according to the shrinking surface and suction effect. Additionally, as the Biot number, Eckert number, thermal radiation, and copper volume fraction all increase in strength, the rate at which heat flows in both solutions also increases. However, the heat transfer rate declined as increased the suction effect. Besides, when a positive and negative increment is applied to the rotational parameter, both solutions suffer an increase in both velocities. In summary, unique solutions are obtained S

The investigation into the flow of sodium alginate-alumina/copper hybrid nanofluids toward a power law form stretching/shrinking sheet while taking into account the effect of suction was carried out numerically. Sodium alginate-alumina/copper hybrid nanofluids have been of great interest in recent years due to their potential applications in various fields. Hybrid nanofluid is currently being used to enhance the efficiency of heat transmission rates. The primary objective of this research is to analyze the influence that certain characteristics, such as those pertaining to magnetic M, shrinking parameter ϵ, thermal radiation R, and thermal slip factor βT parameters, have on temperature and velocity profiles. Furthermore, as part of this investigation, the local skin friction as well as the Nusselt number according to the copper solid volume fraction φCu against shrinkage ϵ and suction γ effect were explored. In order to convert the nonlinear partial differential equation into a system of ordinary differential equations, appropriate similarity variables have to be incorporated into the transformation process. Ordinary differential equations are resolved with the help of the MATLAB bvp4c solver program, which is used in the conclusion phase. The study identified two approaches to shrinking ϵ sheet and suction γ zone with varying parameter values for copper volume fractions φCu. No solution was obtained in the range of when ϵ

BackgroundPosterior cerebral circulation ischemic stroke (PCS) comprises up to 25% of all strokes. It is characterized by variable presentation, leading to misdiagnosis and morbidity and mortality. We aim to describe PCS in large multiethnic cohorts.MethodsA retrospective review of a large national stroke database from its inception on the 1st of January 2014 till 31 December 2020. Incidence per 100,000 adult population/year, demographics, clinical features, stroke location, and outcomes were retrieved. We divided the cohort into patients from MENA (Middle East and North Africa) and others.ResultsIn total, 1,571 patients were identified. The incidence of PCS was observed to be rising and ranged from 6.3 to 13.2/100,000 adult population over the study period. Men were 82.4% of the total. The mean age was 54.9 ± 12.7 years (median 54 years, IQR 46, 63). MENA patients comprised 616 (39.2%) while others were 954 (60.7%); of these, the majority (80.5%) were from South Asia. Vascular risk factors were prevalent with 1,230 (78.3%) having hypertension, 970 (61.7%) with diabetes, and 872 (55.5%) having dyslipidemia. Weakness (944, 58.8%), dizziness (801, 50.5%), and slurred speech (584, 36.2%) were the most commonly presenting symptoms. The mean National Institute of Health Stroke Score (NIHSS) score was 3.8 ± 4.6 (median 3, IQR 1, 5). The overall most frequent stroke location was the distal location (568, 36.2%). The non-MENA cohort was younger, less vascularly burdened, and had more frequent proximal stroke location (p

This study employs the Tiwari and Das model to numerically evaluate the heat-transfer properties of a magnetized Casson sodium alginate-copper/alumina hybrid nanofluid flow over a permeable moving surface, taking into account the effects of viscous dissipation. Sodium alginate-alumina/copper hybrid nanofluids have garnered significant attention in modern society because of their potential uses in a variety of different industries. The key goal of the study is to examine the effect of the Casson parameter and copper solid volume fraction for skin friction coefficient and Nusselt number against velocity ratio parameter. Additionally, in the present study, velocity and temperature profiles for velocity ratio parameter, suction effect, magnetic parameter, Eckert number, and Prandtl number are also included. Using the bvp4c technique, the PDEs are converted into a set of non-linear ODEs with the use of suitable similarity variables. Dual approaches for controlling parameter using varied Casson fluid parameter and copper solid volume fraction quantities have been identified. Unique solutions, no solutions, and dual solutions exist in specific ranges of parameters. Consequently, beyond the critical values, no solution exists. The rate of heat transfer strengthened as the capacity of the Eckert number augmented. The temperature profile also diminished when the Prandtl number improved. The appearance of the boundary layer separation extension resulted from incorporating the copper solid volume fraction. Finally, stability analysis reveals that the first solution is stable, and the second solution is unstable.

Diabetes mellitus (DM) poses a significant challenge to public health. Effective diabetes self-management education (DSME) interventions may play a pivotal role in the care of people with type 2 diabetes mellitus (T2DM) in low- and middle-income countries (LMICs). A specific up-to-date systematic review is needed to assess the effect of DSME interventions on glycaemic control, cardiometabolic risk, self-management behaviours, and psychosocial well-being among T2DM across LMICs. The MEDLINE, Embase, CINAHL, Global Health, and Cochrane databases were searched on 02 August 2022 and then updated on 10 November 2023 for published randomised controlled trials (RCTs) and quasi-experimental studies. The quality of the studies was assessed, and a random-effect model was used to estimate the pooled effect of diabetes DSME intervention. Heterogeneity (I2) was tested, and subgroup analyses were performed. Egger's regression test and funnel plots were used to examine publication bias. The risk of bias of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trial (RoB 2). The overall assessment of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. A total of 5893 articles were retrieved, and 44 studies (n = 11838) from 21 LMICs met the inclusion criteria. Compared with standard care, pooled analysis showed that DSME effectively reduced the HbA1c level by 0.64% (95% CI: 0.45% to 0.83%) and 1.27% (95% CI: -0.63% to 3.17%) for RCTs and quasi-experimental design studies, respectively. Further, the findings showed an improvement in cardiometabolic risk reduction, diabetes self-management behaviours, and psychosocial well-being. This review suggests that ongoing support alongside individualised face-to-face intervention delivery is favourable for improving overall T2DM management in LMICs, with a special emphasis on countries in the lowest income group.

Vegetables are renowned for their nutritional value, as they are rich sources of dietary fiber, minerals, and vitamins offering a wide range of health benefits. They also possess antioxidative properties that contribute to overall well-being. The aim of this study was to evaluate the contamination of heavy metals like Arsenic (As), Cadmium (Cd), Chromium (Cr), Copper (Cu), Iron (Fe), Manganese (Mn), Nickel (Ni), and Zinc (Zn) in the agriculture soil and most frequently consumed vegetables including; Sweet Potato (Ipomoea batatas), Turnip (Brassica rapa), Onion (Allium cepa), Carrot (Daucus Carota), Garlic (Allium sativum), Radish (Raphanus sativus), Lotus (Nelumbo nucifera), Potato (Solanum tuberosum), Beetroot (Beta vulgaris), and Ginger (Zingiber officinale) collected from various sites of District Ghotki, Sindh. The agriculture soil and vegetable samples were digested, and heavy metal levels were determined using Atomic Absorption Spectrophotometer (AAS). The Zn content was found higher in all vegetable samples. Cu, Fe, Mn, and Zn concentrations were found within the permissible levels of the Food and Agriculture Organization and World Health Organization (WHO/FAO). However, the concentrations of As, Cd, Cr, and Ni were found higher than the permissible limit suggested by WHO/FAO. Hazard index (HI), target hazard quotient (THQ), daily intake of metals (DIM), and estimated daily exposure to heavy metals (EDEM) were also measure. The hazard index (HI) values of As for all the vegetable samples were greater than 1, indicating potential health risks to those consuming these vegetables.

Hybrid nanofluids are widely used to improve the efficiency of a thermal system in many aspects of engineering and science. Therefore, the current work is design to investigate the heat transfer of Cu-Fe3O4 nanoparticles in water base Maxwell fluid flow over a cone, which is kept in a porous medium. Additionally, the fluid experiences magnetic field and thermal radiation effects. As a result, the impacts of volume fraction, porosity, magnetic field, and thermal radiation are properly taken into account. It is observed that increasing temperature time relaxation with constant temperature fractional derivative decreases the thermal gradient, whereas increasing temperature fractional derivative parameter with constant time relaxation increases the thermal gradient. Moreover, adding 1% Cu-Fe3O4 increases the heat transfer rate of the fluid up to 1.13% and 1.24% when Rd=0 and Rd=0.2, respectively. On the other hand, the heat transfer rate of Maxwell fluid decreases up to 0.5% in the presence of a magnetic field specifically considering M=2 without thermal radiation.

Suspending particles of tiny solid in a fluid used to transport energy can enhance its thermal conductivity and heat transport properties. Our main goal of this examination is to study the radiative unsteady two-dimensional (2D) flow on a continuously diminishing, horizontal sheet. with suction for the hybrid water-based nanofluid and an aligned field of magnetic, including the combined suction, magnetic, and velocity slip conditions effect. The Tiwari & Das model of nanofluid equations is used, which takes into consideration the solid volume percentage. Equations of similarity are derived by employing the transformations of similarity, and the associated equations have been simplified numerically by employing the bvp4c method in MATLAB software for a variety of values of the nanoparticle volume fraction, the unsteadiness, and the wall mass suction in water. It is discovered that, within the given the unsteadiness parameter range, two solutions exist. Moreover, it is found that the fluid velocity slows down in 1st solution as volume fraction of copper nanoparticles rises but speeds up in the second solution at first before slowing down again. Using a temporal stability analysis, it is found that only one of the dual branches is stable over the long run, while the other is unstable.

Here in, heat transfer characteristics of a magnetized Casson sodium alginate-alumina/copper hybrid nanofluid flowing through the permeable moving plane are investigated considering the effects of thermal radiation and Joule heating with Tiwari and Das model. The primary objective of the present study is to investigate the influence of the velocity ratio parameter on the solid volume fraction and the Casson parameter. In addition, the velocity and temperature profiles used in the current study illustrate the effects of the velocity ratio parameter R, solid volume fraction, suction effect, magnetic field, Joule heating, and thermal radiation. To apply the three-stage Lobatto IIIa with boundary value problems (bvp4c) approach to implement the appropriate similarity variables to transform the partial differential equations (PDEs) into a system of nonlinear ordinary differential equations (ODEs). It has been determined that there are two branch solutions for the velocity ratio parameter against using the Casson parameter and copper volume fraction values. Non-unique branch at R Rci. As the Eckert number and radiation grew, the rate of heat transmission surged. The increase of Casson hybrid nanofluid parameter values caused to drop the skin friction in both upper and lower branch.

Continuous monitoring and improving the production process is a crucial step for the entrepreneur to maintain its position in the market. A successful process monitoring scheme depends upon the specification of the quality being monitored. In this paper, the monitoring of temperature is addressed using the specification of moving average under uncertainty. We determined the coefficients of the proposed chart utilizing the Monte Carlo simulation for a different measure of indeterminacy. The efficiency of the proposed chart has been evaluated by determining the average run lengths using several shift values. A real example of weather-related situation is studied for the practical adoption of the given technique. A comparison study shows that the proposed chart outperforms the existing chart in monitoring temperature-related data.

Background: Marker gene polymorphisms linked with the renin-angiotensin-aldosterone system (RAAS) have been broadly studied in diabetic nephropathy (DN) patients considering that RAAS is a potential drug target to slow down kidney disease progression. Objectives: The aim of the present study was to determine the link between M235T and T174M variants of angiotensinogen (AGT) gene and DN. Methods: A total of 93 patients with DN, mean age of 56±8 years, systolic blood pressure (SBP) of 141±14, and diastolic blood pressure (DBP) of 84±7 mm Hg (mean±SD) were investigated, among whom 59 patients had a family history of type 2 diabetes mellitus. A total of 96 healthy subjects served as the control group with no family history of diabetic nephropathy (FHDN) and type 2 diabetes mellitus, a mean age of 47±10 years, SBP of 126±11, and DBP of 76±6 mm Hg. PCR–restriction fragment length polymorphism was employed for genotyping M235T and T174M molecular variants. Results: Genotype frequencies of the variants M235T (χ2=2.038, P=0.361) and T174M (χ2=2.952, P=0.229) did not show any statistically significant association with type 2 diabetic nephropathy (T2DN) compared to the control. Based on FHDN and family history of diabetes mellitus (FHDM), the frequency of genotypes of M235T marker (P=0.360) in FHDN, and (P=0.886) FHDM; T174M marker (P=0.641) in FHDN, and (P=0.425) FHDM also did not show any statistically significant association with T2DN compared to the controls. Conclusion: M235T and T174M variants were not associated with DN in a Bangladeshi population.

The purpose of the current article is to numerically and theoretically examine the flow of two-dimensional (2D) steady Hiemenz with the transfer of heat of carbon nanotubes (CNTs) hybrid base C2H6O2+H2O (Ethylene glycol + water) nanofluid across a linear shrinking/stretching surface. The equations of Navier–Stokes have been converted into equations of self-similar applying suitable transformations of similarity variables, and then numerically resolved using the three-stage Labatto-three-A formula. In addition, an endeavor is made to extend the behavior of asymptotic of the solution to massive stretching. The comparison between the found asymptotic solutions and previously reported numerical results is rather impressive. Observations indicate that equations of self-similar display double solutions within the restricted shrinking parameter range. There exists one solution for every case of stretching. In the first solution, the impacts of nanoparticle solid volume fraction and shrinking parameters on velocity and thermal fields exhibit an increasing trend. Consequently, the linear analysis of temporal stability has been performed to establish the most fundamentally viable option. The smallest eigenvalue sign determines whether a solution is unstable or stable for the purposes of stability analysis. The analysis of stability demonstrates that the first solution describing the primary flow is stable.

Alternative fuels have garnered significant attention due to the depletion of petroleum sources and growing environmental concerns. Biodiesel, a renewable fuel, holds potential as a viable substitute for fossil fuels. Recent advancements in nanotechnology have made nanoparticle fuel additives for internal combustion engines feasible. Previous research has shown that these additives can enhance engine performance. In this experimental study, we investigated the effects of incorporating aluminium oxide nanoparticles (Al2O3) into a JB30 fuel blend (30% Jatropha biodiesel + 70% diesel) to assess potential performance improvements and reduced noise emissions. Our tests employed a 4-stroke, single-cylinder diesel engine operating at a constant speed of 1350 rpm. The JB30 blend was subjected to a 50 ppm dose of Al2O3 nanoparticles using an ultrasonicator. Results indicate that brake-specific fuel consumption (BSFC) improved for the DF70JB30 blend and further improved for the DF67JB30 blend with Al2O3 nanoparticles. Compared to pure diesel fuel, the brake thermal efficiency (BTE) increased by 3.77% for DF70JB30 and by 3.82% for DF67JB30Al2O3. Noise emissions, a crucial factor influenced by the fuel type, were lower for all blended fuels compared to pure diesel fuel (DF). The addition of nanoparticles also contributed to a reduction in the combustion pressure rise rate, resulting in decreased combustion noise. Based on these findings, it can be concluded that both the binary blend DF70JB30 and the ternary blend DF67JB30Al2O3 can be used in diesel engines without necessitating any adjustments. However, DF67JB30Al2O3 demonstrated superior outcomes when compared to DF70JB30.

Abstract Following to improved thermal impact of hybrid nanomaterials, wide range applications of such materials is observed in the thermal engineering, extrusion systems, solar energy, power generation, heat transfer devices etc. The hybrid nanofluid is a modified form of nanofluid which is beneficial for improving energy transfer efficiency. In current analysis, the solid nanoparticles aluminium ( $$\phi_{{{\text{Al}}_{2} {\text{O}}_{3} }}$$ ϕ Al 2 O 3 ) and copper ( $$\phi_{{{\text{Cu}}}}$$ ϕ Cu ) have been mixed with water to produce a new hybrid nanofluid. The investigation of a steady two-dimensional mixed convection boundary layer flow of the resultant hybrid nanofluid on a vertical exponential shrunk surface in the existence of porous, magnetic, thermal radiation, velocity, and thermal slip conditions is carried out. Exponential similarity variables are adopted to transform the nonlinear partial differential equation into a system of ordinary differential equations which has been then solved by employing the shooting method in Maple software. The obtained numerical results such as coefficient of skin friction $$f^{\prime \prime } \left( 0 \right)$$ f ″ 0 , heat transfer rate $$- \theta^{\prime } \left( 0 \right)$$ - θ ′ 0 , velocity $$f^{\prime } \left( \eta \right)$$ f ′ η and temperature $$\left( {\theta \left( \eta \right)} \right)$$ θ η distributions are presented in the form of different graphs. The results revealed that duality exists in solution when the suction parameter $$S \ge S_{ci}$$ S ≥ S ci in assisting flow case. Due to non-uniqueness of solutions, a temporal stability analysis needs to be performed and the result indicates that the upper branch is stable and realizable compared to the lower branch.

Abstract In this article, an enhanced X-bar control chart using generalized multiple dependent state (GMDS) sampling under neutrosophic statistics is presented. The joint advantages of GMDS sampling and the neutrosophic statistics have been recycled for the efficient monitoring of the average quality characteristic of any production process. The efficiency of the proposed chart has been evaluated using the average run length values under different ranges of the parameters under study. The comparison of the proposed chart with the existing control chart has been discussed. The comparison shows that the proposed chart is better than the existing chart. Results reveal the superiority of the proposed neutrosophic-based GMDS sampling chart. In addition, an example has also been included for the practical implementation of the proposed methodology.

Objective: To compare our experience with the LigaSure small jaw device and Harmonic scalpel in total thyroidectomy regarding operative time and major complications associated with surgery. Study Design: Prospective comparative study. Place and Study Duration: General Surgery Department, Pak Emirates Military Hospital, Rawalpindi and Combined Military Hospital, Kohat Pakistan, from Oct 2017 to Apr 2020. Methodology: This study included 150 patients diagnosed with simple/toxic multinodular goitre, thyroid carcinoma, and diffuse thyroid enlargement. Eighty-one patients were randomly assigned to the LigaSure Group and 69 to the Harmonic Group who underwent total thyroidectomy. Mean operative time and major complications like blood loss, hematoma, hypocalcemia, recurrent laryngeal injury, and surgical site infection were compared. Results: Median (IQR) operative time of the LigaSure small jaw device was 55.00(11) minutes, and that of the Harmonic scalpel was 60.00 (11) (p

Objectives Understanding the knowledge, attitudes and practices (KAP) of COVID-19 within distinct populations may aid further public health messaging. This study’s aims were to explore KAP towards COVID-19 in rural Bangladesh and identify any potential links to sociodemographics, existing clinical conditions and sources of information.Design Cross-sectional community-based study.Setting Participants were recruited from 18 villages using multistage cluster random sampling.Methods Data were collected through face-to-face interviews, from June to November 2021, using a structured questionnaire. Data included sociodemographics, clinical conditions, sources of information and KAP of COVID-19 questions. Χ2 test, multiple logistic regression and correlation analyses were performed.Results A total of 1603 participants were included with mean ages of 42.3±14.2 years, ranging from 18 to 60 years. Of these, 51% were male, 42.2% had secondary education and 45% had comorbidities. Television was the main source of COVID-19 information (55.8%). The overall correct response rate of KAP questions was 90%, 78% and 59%, respectively. In stepwise multiple logistic regression, good knowledge was associated with higher education (adjusted OR (AOR): 4.61, 95% CI: 2.40 to 8.85, p

Through a vertically shrinking sheet, a two-dimensional magnetic nanofluid is numerically analyzed for convection, heat generation and absorption, and the slip velocity effect. In this research, Al2O3–Cu/water composite nanofluid is studied, where water is deemed the base liquid and copper (Cu) and alumina (Al2O3) are the solid nanoparticles. Modern composite nanofluids improve heat transfer efficiency. Using the Tiwari-Das model, the current study examines the effects of the solid volume fraction of copper, heat generation/absorption, MHD, mixed convection, and velocity slip parameters on velocity and temperature distributions. Introducing exponential similarity variables converts nonlinear partial differential equations (PDEs) to ordinary differential equations (ODEs). MATLAB bvp4c solver is used to solve ODEs. Results showed dual solutions for suction with 0%–10% copper nanoparticles and 1%–500% heat generation/absorption. As copper (Cu) solid volume percentage increases from 0% to 10%, reduced skin friction f″(0) boosts in the first solution but falls in the second. When Cu is added to both solutions, heat transport −θ′(0) decreases. As heat generation/absorption increases 1%–500%, −θ′(0) decreases in both solutions. In conclusion, solution dichotomy exists when suction parameter S≥Sci in assisting flow case, while no fluid flow is possible when S

Globally, chronic kidney disease (CKD) is one of the major public health concerns. CKD and renal failure are reported to be high in the areas with higher salinity, however, the association is still unclear. We aimed at assessing the association of degree of groundwater salinity with CKD among diabetic populations of two selected areas in Bangladesh. This cross-sectional analytic study was carried out among 356 diabetic patients aged 40–60 years in high groundwater salinity exposed Pirojpur (n = 151) and non-exposed Dinajpur (n = 205), the southern and northern districts of Bangladesh, respectively. The primary outcome was the presence of CKD (via estimated glomerular filtration rate

Background: Mobile Health i.e. m-Health Education (MHE) and Traditional Health Education (THE) interventions are both used for education of diabetic patients. However, it is not yet reported which one is the most effective. This study was designed to compare the effectiveness of these two types of intervention on adherence to the seven dimensions of diabetes' self-management in a peripheral district of Bangladesh. Methods: A randomized controlled trial was conducted in Thakurgaon district, in Bangladesh, with two intervention arms (-MHE and THE- and one control group. All groups received an initial educational session including the control group. During the educational session pictorial materials was used and patients received a logbook to register their different activities related to diabetes. The intervention was conducted over a period of 12 months. MHE group received additionally a monthly reminder and monitoring through mobile phone calls. THE group received a monthly home visit reminder and monitoring through personal visits. 330 adult diabetics patients were included in each group. Data were collected by face-to-face interview using a semi-structured questionnaire at baseline and endline. Adherence to the seven self-management dimensions was measured and compared in the different groups before and after the intervention using analysis of co-variance (ANCOVA) and logistic regression technique. Findings: Study participants took place from January 2016 to June 2017. Among the 990 included patients, 86 were lost to follow-up. Both MHE and THE groups showed significant (p

To reduce the environmental pollution caused by cement manufacturing and to save both the economy and resources, it is required to use alternative waste materials of pozzolanic nature to partially replace cement in the construction industry. Among different cement replacement materials being used now-a-days, marble dust is the one on which limited research has been done especially on the performance of structural members likeRC slabs. In this paper, marble dust has been used in different ratios as partial replacement of cement in concrete mix. RC one-way slabs as well as plain concrete standard samples were cast to determine their mechanical properties i.e. compressive, tensile and flexural strengths, stiffness, first and ultimate load, crack patterns, modulus of elasticity, maximum deflection and durability etc. It was found that by increasing the dosage of marble dust in plain concrete samples, workability was decreased. Compressive and tensile strengths of concrete increased up to 7.5% replacement but decreased on further replacement. The permeability of concrete decreased with the addition of marble dust up to 10% replacement, then it increased. The behaviour of one-way slabs showed an increase in the first crack load and ultimate failure capacity. Moreover, decrease in the deflection of slabs was observed with the increasing replacement of cement with marble dust. The resistance of concrete against corrosion of steel reinforcement also increased due to less migration of chloride ions. Ultrasonic Pulse Velocity (UPV) tests showed improved homogeneity and stiffness of concrete structurewith the replacement of cement by marble dust.

Objective The objective of this study was to evaluate the acceptance and uptake of COVID-19 vaccines in rural Bangladesh.Design This was a cross-sectional study conducted between June and November 2021.Setting This study was conducted in rural Bangladesh.Participants People older than 18 years of age, not pregnant and no history of surgery for the last 3 months were eligible to participate.Primary and secondary outcomes The primary outcomes were proportions of COVID-19 vaccine acceptance and roll-out participation among the rural population. The secondary outcome was identification of correlates which contributed to COVID-19 vaccine acceptance and roll-out participation. Χ2 tests and multivariable logistic regression analyses were performed to identify relevant correlates such as sociodemographic factors, clinical conditions and COVID-19-related factors.Results A total of 1603 participants were enrolled. The overall COVID-19 vaccine acceptance was very high (1521/1601, 95%), and half of the participants received at least one dose of the COVID-19 vaccine. Majority of participants wanted to keep others safe (89%) and agreed to the benefits of COVID-19 vaccines (88%). To fulfil the requirement of online registration for the vaccine at the time, 62% of participants had to visit an internet café and only 31% downloaded the app. Over half (54%) of participants were unaware of countries they knew and trust to produce the COVID-19 vaccine. Increased age, being housewives, underweight and undergraduate education level were associated with vaccine acceptance, while being female, increased age and being overweight/obese were associated with vaccine uptake. Trust in the health department and practical knowledge regarding COVID-19 vaccines were positively associated with both vaccine acceptance and uptake.Conclusion This study found a very high COVID-19 vaccine acceptance in rural Bangladesh. Policymakers should support interventions aimed at increasing vaccine and general health literacy and ensure ongoing vaccine supply and improvement of infrastructure in rural areas.

Objective: To evaluate the effect of verbal and audiovisual methods of dental health education on knowledge, practice of old school-going children. Study Design: Prospective longitudinal study. Place and Duration of Study: Islamia collegiate Middle School for Boys, Peshawar Pakistan, from Dec 2019 to Feb 2020. Methodology: The study population consists of 272 middle school children aged 10-13 years. After collecting baseline data which consists of a questionnaire regarding knowledge and attitude about oral hygiene followed by recording plaque score,and gingival score, students were randomly allocated into three groups. Group-1 participants received verbal dental health education through charts and pamphlets about oral health, hygiene, and tooth brushing demonstrations. Group-2 received verbal and audio-video sessions about oral hygiene. Group-3(Control-Group) received no intervention. After the intervention,knowledge attitude and plaque score gingival score was assessed. Results: A statistically significant positive change in dental knowledge and practice score was found in the AudiovisualGroup as compared to the Verbal-Group. Post-intervention mean plaque score of the participants was lowered more in the Audiovisual-Group than in the Verbal-Group. In addition, the post-intervention mean gingival score of the participants was lowered more in the audiovisual group than in the verbal group. Conclusion: Short-term oral health education programs, including A-V aids, may be useful in improving oral hygiene and gingival health.

Objective: To compare the effectiveness of beclomethasone dipropionate with flunisolide given twice daily in terms of improvement in symptom score after 14 days of treatment in allergic rhinitis patients. Study Design: Quasi-Experimental Study. Place and Duration of Study: The study was carried out at the Department of ENT, PAF Hospital E-9 Islamabad, Pakistan, from January 2021 to July 2021. Materials and Methods: All patients of age 20-60 years of either gender having allergic rhinitis were included in the study. Allergic rhinitis was defined as any patient with a history of running nose with seasonal changes or exposure to allergens diagnosed by a consultant ENT surgeon. Patients with a history of smoking, asthma, having deviated nasal septum and inferior turbinate hypertrophy, patients already treated with Beclomethasone dipropionate or flunisolide, patients having an acute upper respiratory infection, and pregnant females were excluded from the study. A consecutive sampling technique was applied for the selection of participants. Patients were randomly divided into two groups: Group-A was given beclomethasone dipropionate, and Group-B Group-B was given flunisolide. The daily dose during treatment was 0.1 mg of beclomethasone dipropionate (50 ugs per puff) two-time each medicine daily. And dose of flunisolide nasal solution (flunisolide nasal spray 0.025%) flunisolide 50 micrograms in each nostril twice daily were 2 sprays (50 ugs) in each nostril 2 times a day: Treatment was continued for two weeks in each group. The symptoms score was estimated at baseline and after two weeks of intervention. Data were analyzed with the help of SPSS version 20. Results: The mean age of the study participants was 41.17+8.58 years in beclomethasone dipropionate and 41.85+8.52 years in flunisolide. Efficacy of flunisolide was significantly higher in terms of improvement in symptom score after 14 days of treatment in patients of allergic rhinitis compared to beclomethasone dipropionate (85% vs 79.58, p=0.035). Conclusion: Flunisolide inhaler is more effective when compared with beclomethasone dipropionate for treating allergic rhinitis.

Abstract Water pollution is one of the most dangerous problems which is commonly ignored in our country. Pakistan ranks very low in the world, regarding drinkable water. Both surface and underground water are contaminated with toxic metals and pesticides and arsenic (μg/L) were found to be 50. The quality parameters set by the WHO are persistently violated. The water quality is seriously affected by improper disposal of industrial, domestic waste and agrochemicals. These pollutants are responsible alone, or along with other factors for a variety of health problems. This article discusses drinking water being supplied in Sahiwal (Pakistan) to students living in the hostel along with an emphasis on the major pollutants, their effects and consequent health problems. The data presented in this article have been collected in Sahiwal. The water samples were collected from the main supply and the blood samples were of the consumers of that water.

Objective: To determine the effects of intra articular platelet rich plasma (PRP) injection on level of pain of knee joint in patients with knee osteoarthritis. Study Design: Prospective observational study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Aug 2018 to Jan 2019. Methodology: Forty patients with pain due to knee osteoarthritis for intra-articular injection were included in this observational clinical trial after informed consent and fulfilling inclusion criteria. After measuring pain by numerical rating scale, patients received intra articular platelet rich plasma (10ml) therapy in affected knee under fluoroscopy. Using the Numerical rating scale level of pain was evaluated and recorded for each patient at different intervals. Results: There was dramatic improvement in pain score after first and second injection of platelet rich plasma. There was 33.33% improvement at 3rd week, 54.32% at 6th week and 71.60% at 6th month. Conclusion: Platelet rich plasma is safe, cost effective and minimally invasive in reducing pain scores and functional limitation in knee osteoarthritis.

Objective: To determine the efficacy of transforaminal epidural steroid injection (TFESI) using conventional versus Kambin’s triangle approaches in patients of lumbar radiculopathy. Study Design: Quasi experimental study. Place and Duration of Study: Department of Pain Medicine, Combined Military Hospital Rawalpindi Pakistan, from Oct 2019 to Apr 2020. Methodology: Eighty patients suffering from lumbar radiculopathy fulfilling the inclusion criteria were included in this study and were randomly assigned to undergo transforaminal epidural steroid injection using either conventional approach (group C) or the Kambin’s triangle (group K) approach. Pain scores and patient satisfaction levels were recorded at 4 and 8 weeks after the procedure. Results: In both groups, the pain score (group C pre-procedure NRS =7.28 ± 1.26 vs post-procedure NRS = 2.14 ± 0.81, group K pre-procedure NRS = 7.33 ± 1.16 vs post-procedure NRS=2.70 ± 0.94) and patient satisfaction improved 4 and 8 weeks after the procedure. The pain score (p-value=0.21) and patient satisfaction score (p-value=0.88) however were not significantly different between groups. Conclusion: This study demonstrated that using conventional or Kambin’s approach exhibits no difference in decreasing pain score or patient satisfaction level.

An experiment was conducted to assess the yield potential and Water Use Efficiency (WUE) of Canola crop grown under sprinkler and basin irrigation techniques on a clay loam soil. The experiment was designed by the Principles of Randomized Complete Block Design (RCBD) with two treatments, viz. T1 (sprinkler irrigation method) and T2 (basin irrigation method), replicated four times. Marginal quality water with Electrical Conductivity (ECw) of 1.83 dS/m and pH of 8.2 was used for irrigation. The crop yield obtained under T1 and T2 treatments were 1,407.9 and 1,123.8 kg ha-1, respectively; 20% more yield was observed under T1 treatment. In the given order of treatments (T1 and T2), the Canola crop used 3,605 and 4,453 m3 ha-1 of irrigation water, hence, 19% water saving was achieved by T1 treatment. The WUE attained under T1 and T2 treatments were 0.39 and 0.25 kg m-3 respectively; therefore, 35.8% WUE was enhanced under T1 treatment. While comparing the agronomic parameters of the crop under the two procedures, all the observed parameters (plant height, number of branches plant-1, number of pods plant-1, pod length, number of seeds pod-1 and biomass plant-1) were superior in case of T1 treatment than T2 treatment. The soil Electrical Conductivity (ECse), Sodium Absorption Ratio (SAR), and Exchangeable Sodium Percentage (ESP) increased, and pH decreased under both the treatments, however, the maximum increase in ECse, SAR and ESP, and maximum decrease in pH occurred under T2 treatment. Statistical analysis showed that the crop yield, irrigation water use, WUE, ECse, pH, SAR, ESP, and all the agronomic parameters differed significantly (p < 0.05) under the two treatments.

Abstract Aims/Introduction We aimed to assess the health‐related quality of life (HRQoL) and identify its predictors among type 2 diabetes patients of Bangladesh. Materials and Methods This nationwide cross‐sectional study assessed HRQoL among 1,806 type 2 diabetes patients using the EuroQol‐5 Dimensions Questionnaire (EQ‐5D‐5L), and the responses were further translated into a single summary crosswalk index score using the UK time trade‐off value set. The predictors were determined using multinomial logistic regression analysis. Results The mean EQ‐5D‐5L index score was 0.62 (standard deviation 0.25), and men scored better than women. More than half of the study participants (53.4%) were ranked as “average” HRQoL. Overall, 64% of respondents had a “problem” at least in one of the dimensions of the EQ‐5D‐5L, and the burden of reported “problems” was higher among women (70%). Among the five dimensions, the highest reported “problem” was 79.8% for anxiety/depression, 77.7% for pain/discomfort and 60.1% for mobility. However, younger participants (aged 1) were being men, living in a rural area, married, literate, a monthly income >19,488 BDT, absence of comorbidity and had a duration of diabetes ≤5 years. Conclusions The majority of Bangladesh’s type 2 diabetes patients had an “average” HRQoL based on the EQ‐5D‐5L index score. In broad terms, the identified predictors were sex, place of residence, marital status, literacy, monthly income, comorbidity and duration of diabetes.

With the increase of density and complexity of high performance integrated circuits and systems, including many-core chips and system-on-chip (SoC), it is becoming difficult to meet the power delivery and regulation requirements with off-chip regulators. The off-chip regulators become a less attractive choice because of the higher overheads and complexity imposed by the additional wires, pins, and pads. The increased I2R loss makes it challenging to maintain the integrity of different voltage domains under a lower supply voltage environment in the smaller technology nodes. Fully integrated on-chip voltage regulators have proven to be an effective solution to mitigate power delivery and integrity issues. Recently, there has been a surge of interest among the academic and industrial research communities to explore and design different types of on-chip voltage regulators. This survey presents a brief overview of the on-chip power delivery system and the classification and working principles of on-chip voltage regulators. The main focus of this review paper is to provide a comprehensive study of two of the most promising on-chip voltage regulators - (i) the low-drop-out (LDO) regulator and (ii) the switched-capacitor (SC) regulator. This article elaborates on the design specifications, optimization techniques, advantages, and limitations of LDO and SC type on-chip voltage regulators.

Background: Knowledge about diabetes is the cornerstone of self-management, which is crucial for diabetes care. Improving patients’ knowledge and self-management toward their condition can achieve better control, delay complications, and improve their quality of life. However, there are great variations in the level of knowledge from population to population and this needs to be explored in different ethnic and sociocultural groups for designing appropriate preventive strategies. Due to lack of adequate studies in Bangladesh, this study aimed at assessing diabetes-related knowledge, its determinants and examined which subgroups of patients have the largest knowledge deficits. Materials and Methods: This cross-sectional study was carried out among 504 study participants with type 2 diabetes in the outpatient clinic of the Bangladesh Institute of Health Sciences (BIHS) hospital, a tertiary care center in Dhaka, Bangladesh. Sociodemographic information, anthropometric knowledge about diabetes were collected by semistructured, interviewer-administered questionnaires by the face-to-face interview technique. Respondents who achieved a 50% or higher score from a 16-item diabetic knowledge assessment questionnaire were considered to have good knowledge and their counterparts were considered as possessing poor knowledge about diabetes. Descriptive statistics was used to estimate the prevalence of knowledge. A univariate and multivariate logistic regression was carried out to identify significant factors associated with diabetic knowledge. Results: The participants’ mean age (±SD) was 52 ± 11years; among them, 57.3% were women, 17.1% were illiterate, and 31.5% belonged to a lower-income family. About one-third of them (29.2%) had good knowledge, and male participants were more educated and had higher diabetes knowledge compared with their counterparts. In particular, gender, education, occupation, monthly family income, and duration of diabetes showed a significant correlation with overall knowledge. On multivariate regression, age, education, duration of diabetes, and family members correlated independently with knowledge. Conclusions: On the basis of the current study, it is suggested that about two-third of the patients attending a tertiary care hospital had poor knowledge about diabetes. These results highlight the need for a coordinated educational program with a prioritized focus on older, newly diagnosed, and less educated groups, which reinforces the necessity for patient education.

Objective: To compare intravenous lignocaine vs. intravenous nalbuphine in terms of mean change in heart rate and mean arterial pressures (MAP) during awake tracheal extubation. Study Design: Randomized control trial. Place and Duration of Study: Main Operation Theatre, Combined Military Hospital Rawalpindi, from May 2016 to Dec 2016. Methodology: After approval of the study by the institution’s research ethics committee, the patients meeting inclusion criteria were assigned randomly to one of the two groups by lottery method. On return of spontaneous ventilation, patients in group L received intravenous lignocaine 1.5 mg/kg while group N patients received intravenous Nalbuphine 0.2mg/kg. Data recorded immediately (T1) and 5min after (T2) extubation. Results: After stratification of data in terms of age, gender, duration of surgery and ASA classification, evaluation of hemodynamic parameters (HR and MAP) between the two groups was done. The mean change in HR in group L was 6.66 ± 1.53 bpm and in group N was 4.43 ± 1.35. The mean change in MAP in group L was 4.90 ± 1.49 mm of Hg and in group N was 3.23 ± 1.33. p-value in both parameters was found to be less than 0.05 and thus declared significant. Conclusion: We concluded that intravenous nalbuphine, in the dose of 0.2mg/kg, is a better attenuator of hemodynamic response to extubation as compared to intravenous lignocaine and provides better stability of Heart rate and Mean arterial Pressure.

Abstract Immunoglobulin G4‐related disease (Ig4RD) is an inflammatory condition with unique clinical, serological, and pathological features. In this study, we report a challenging diagnostic clinical case of Ig4RD diagnosed based on histopathology. This unique imitating nature reinforces that it is crucial to consider the diagnosis of IgG4‐RD in those presenting with pachymeningitis.

Abstract Background In 2017, 80% of 425 million adults with diabetes worldwide were living in low and middle-income countries. Diabetes affected 6.9 million adults in Bangladesh and accounted for 3% of the country’s total mortality. Proper management of diabetes is the key to positive health outcomes. This study investigated how mobile phone-based health intervention could increase patient adherence and thereby improve the disease outcomes for diabetes type 2 in Bangladesh. Methods A mobile phone-based health project (including mobile phone reminders and 24/7 call center) was implemented in Dhaka District, Bangladesh from January to December 2014. A randomized control trial was carried out, recruiting randomly in intervention and control groups among the patients receiving treatment for type 2 diabetes at the Bangladesh Institute of Health Sciences Hospital, Dhaka, Bangladesh. A total of 320 patients from both groups at baseline and 273 at endline were interviewed. Results A significant improvement in patient adherence to diet, physical exercise, the cessation of use of tobacco and betel nut, and blood glycaemic control was found in the intervention group, whereas no such significant improvement was found in the control group. Cost and other co-morbidities were found to be the main reasons for non-adherence. Conclusion A mobile-health intervention should be considered as an additional option for non-communicable disease programs.

Abstract Background Cardiovascular disease (CVD) has emerged as a major public health concern in Bangladesh. Diet is an established risk factor for CVD but a tool to assess dietary intake in Bangladesh is lacking. This study aimed to validate a food frequency questionnaire (FFQ) using the 24-h dietary recall method and corresponding nutritional biological markers among rural and urban populations of Bangladesh. Method Participants of both genders aged 18–60 years were included in the analysis (total n = 146, rural n = 94 and urban n = 52). Two FFQs of 166 items were administered three-months apart, during which time three 24-h dietary recalls were also completed. Participants were asked to recall their frequency of consumption over the preceding 3 months. Urine and blood samples were collected for comparison between FFQ-estimates of nutrients and their corresponding biomarkers. Methods were compared using unadjusted, energy-adjusted, de-attenuated correlation coefficients, 95% limits of agreement (LOA) and quartile classification. Results Fair to moderate agreement for ranking energy, macro and micronutrients into quartiles was observed (weighted k value ranged from 0.22 to 0.58; p

Objective: To find out whether pre-emptive thoracic epidural analgesia is superior to conventional postoperative epidural analgesia for post-thoracotomy pain. Study Design: Randomized controlled trial. Place and Duration of Study: Department of anesthesia and critical care, Combined Military Hospital Rawalpindi, from Apr 2017 to Aug 2017. Methodology: After ethical committee approval and informed consent from patients, 40 patients undergoing thoracotomy were included in study. Preoperatively thoracic epidural catheter was inserted at T7-9 intervertebral space level. Group P was given 0.1ml/kg of 0.125% bupivacaine before induction of anesthesia; whereas group C was administered 5 ml 0.125% bupivacaine after closure of wound in supine position. Visual analog scale (VAS) was used to assess pain severity at 1 and 24 hours postoperatively, both at rest and after cough (R1, R24, C1 and C24 respectively). Data were analyzed with SPSS 16. Results: There was no statistical difference in demographic profile of both groups in terms of age, gender, site of insertion of epidural catheter, American Society of Anaesthesiologists (ASA) status or type of surgery. Pain was significantly less in group P at 1hour postoperatively (p=0.009). However, there was no difference in pain severity at rest at 24 hours and with cough at 01 hour or 24 hours postoperatively. Conclusion: Preemptive thoracic epidural analgesia provides better pain control in immediate postoperative period at rest. However, its efficacy is similar to conventional epidural analgesia in immediate post op period with cough and at 24 hours with cough and at rest.