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IntroductionAfter trivalent oral poliovirus vaccine (tOPV) cessation, Pakistan has maintained immunity to type 2 poliovirus by administering inactivated polio vaccine (IPV) in routine immunization, alongside monovalent OPV type 2 (mOPV2) and IPV in supplementary immunization activities (SIAs). This study assesses the change in poliovirus type 2 immunity after tOPV withdrawal and due to SIAs with mOPV2 and IPV among children aged 6–11 months.MethodsThree cross-sectional sequential serological surveys were conducted in 12 polio high-risk areas of Pakistan. 25 clusters from each geographical stratum were selected utilizing probability proportional to size.ResultsSeroprevalence of type 2 poliovirus was 49%, with significant variation observed among surveyed areas; 80% in Killa Abdullah, Mardan & Swabi, and Rawalpindi. SIAs with IPV improved immunity from 38 to 57% in Karachi and 60 to 88% in Khyber. SIAs with IPV following mOPV2 improved immunity from 62 to 65% in Killa Abdullah, and combined mOPV2 and IPV SIAs in Pishin improved immunity from 28 to 89%. Results also reflected that immunity rates for serotypes 1 and 3 were consistently above 90% during all three phases and across all geographical areas.ConclusionThe study findings highlight the importance of implementing effective vaccination strategies to prevent the re-emergence of poliovirus. Moreover, the results provide crucial information for policymakers working toward achieving global polio eradication.

Background: Measles virus infection remains a significant cause of childhood mortality and morbidity despite continued global efforts and the availability of a safe and effective vaccine. Molecular analysis of indigenous measles viruses could provide critical information on outbreak linkages and transmission pathways that can aid the implementation of appropriate control programs in Pakistan. Methods: Blood samples and throat swabs were collected from subjects suspected with measles in Islamabad, Pakistan from 2013 to 2015. Serum samples were tested for the presence of measles immunoglobulin M (IgM) antibodies using enzyme-linked immunosorbent assay (ELISA) while throat swabs were used for the isolation (Vero/SLAM cell line) and subsequent characterization and phylogenetic analysis of measles strains. Results: Of 373 blood samples, 66% tested positive for measles IgM. Male subjects were more often infected (58%) than female (42%) with the highest frequency of positive cases (63%) in the 0–5-years age group. Among the positive cases, only 13% had received one or two doses of the measles vaccine, while 87% were unvaccinated. Of 80 throat swabs, 29 (36%) showed a measles virus-specific cytopathic effect (CPE) and were characterized as genotype B3 through partial sequencing of the nucleoprotein (N) gene. Phylogenetic analysis revealed the Pakistani B3 strains to be closely related to strains from neighboring countries (Iran and Afghanistan) as well as with B3 viruses from the USA, Germany, and the UK. Conclusions: The study results showed that despite the availability of an effective vaccine, the burden of measles infections is very high in Pakistan due to poor routine immunization coverage even in major cities, including the capital city of Islamabad. It is imperative that national health authorities take urgent strategic steps to improve routine immunization and implement adequate molecular identification methods to tackle future measles outbreaks. Keywords: Measles virus, Epidemiology, Outbreak

Study DesignA cross-sectional study.PurposeTo describe the characteristics of lumbar vertebrae of Pakistani patients reporting at a tertiary care hospital and compare with studies from other populations.Overview of LiteratureSeveral studies have been conducted to determine morphometry of lumbar vertebrae. Most of the studies involve Caucasian populations, still data on other populations still sparse. This is the first study describing lumbar morphometry of a Pakistani population.MethodsAn observational study was conducted based on a review of thin-cut (3 mm) computed topographic images of lumbar vertebrae. Two-hundred and twenty vertebrae from forty-nine patients were studied, and various dimensions were analyzed.ResultsGenerally, the size of the vertebrae, vertebral canals and recesses were found to be greater in male patients. The difference was statistically significant for transverse and anteroposterior diameters of the vertebral bodies and sagittal diameter of pedicles on the left side (p

Background Gallbladder carcinoma (GBC) is a rare but highly aggressive malignancy, often discovered incidentally during cholecystectomy for symptomatic cholelithiasis. Despite significant geographic variation, the association between gallstones and GBC is well-documented, with chronic inflammation from gallstones potentially contributing to carcinogenesis. Objective This study aims to determine the prevalence of incidental GBC in patients undergoing cholecystectomy for symptomatic cholelithiasis at a tertiary care hospital in Peshawar, Pakistan. Materials and methods This retrospective cohort study was conducted at the General Surgery Department, Hayatabad Medical Complex, Peshawar, from February 2, 2021, to July 1, 2024. A total of 230 patients, aged 18-55 years and diagnosed with symptomatic cholelithiasis, were included. Cholecystectomy was performed, and all excised gallbladders were histopathologically examined for carcinoma. Statistical analysis was conducted using IBM SPSS (version 26), with a significance threshold of p ≤ 0.05. Results Out of 230 patients, 7 (3.04%) were found to have incidental GBC upon histopathological examination. Among these, five had adenocarcinoma, and two had papillary carcinoma. The carcinoma was confined to the mucosa (T1a) in four cases, while three cases had deeper invasion (T1b). Patients with incidental carcinoma had a significantly longer symptom duration (mean: 14.2 ± 3.1 months) and were older on average (mean age: 49.2 ± 4.3 years) compared to non-carcinoma patients (p = 0.001 and p = 0.002, respectively). No malignancy was suspected intraoperatively in any case. Conclusion Incidental GBC was present in 3.04% of patients undergoing cholecystectomy for symptomatic cholelithiasis, with longer symptom duration and older age as significant risk factors. The findings underscore the importance of histopathological examination of cholecystectomy specimens in regions with high gallstone prevalence, as early detection of incidental carcinoma can facilitate timely oncological intervention., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board (IRB) Hayatabad Medical Complex Peshawar issued approval 1679. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alam et al.)

Background: Inguinal hernia repair, a globally prevalent surgical procedure, has witnessed the widespread adoption of the transabdominal preperitoneal (TAPP) approach, promising reduced postoperative pain, faster recovery, and lower recurrence rates. However, hernia recurrence remains a persistent challenge, necessitating a comprehensive exploration of influencing factors specific to TAPP repair., Objective: The objective of this study is to identify and analyze key factors contributing to inguinal hernia recurrence post-TAPP repair Materials and methods: This is a retrospective cohort study involving 152 patients undergoing TAPP repair at Hayatabad Medical Complex Peshawar, from November 2020 to October 2023. Demographic, preoperative, and postoperative data were meticulously collected. Statistical analysis employed IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States)., Results: An 8.5% recurrence rate was observed, with influencing factors including insufficient myopectineal orifice (MPO) dissection in three cases (23%), smaller mesh size in two cases (15.4%), infected mesh in two cases (15.4%), mesh dislodgement in one case (20%), and missed sac in one case (20%). Clinical examination and imaging studies diagnosed recurrences in 30.8% and 69.2% of cases, respectively., Conclusion: Despite the advantages of TAPP repair, hernia recurrence persists, emphasizing the need for ongoing refinement of surgical techniques. This study identifies critical influencing factors, notably insufficient MPO dissection, guiding efforts to enhance the efficacy of TAPP repair and improve patient outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Hadi et al.)

Background: Road traffic accidents are the greatest cause of death worldwide. Most intra-abdominal injuries caused by blunt abdominal trauma have been treated surgically for a very long period. Over the past few decades, conservative care has gained in popularity and effectiveness as a treatment choice for blunt abdominal trauma., Objective: To determine the efficacy of conservative management in patients suffering from splenic injury in blunt abdominal trauma., Methods: The study included 62 cases of blunt abdominal trauma treated non-operatively in the general surgery department of the Hayatabad Medical Complex Peshawar between June 2021 and December 2022., Results: Minimal hemoperitoneum was observed in 47 (75.8%) cases, moderate hemoperitoneum was noted in 11 (17.7%) cases, and 4 (6.4%) patients didn't have free fluid in the abdomen. There was no massive hemoperitoneum among the study patients. No major complications were observed during the study period. Only 7 (11.3%) cases develop minimal pleural effusion while 2 (3.2%) patients developed splenic abscess. Mortality was observed in only 1 (1.6%) case., Conclusions: Conservative management is a safe and efficient strategy and should be considered as a first line of treatment for all hemodynamically stable patients who suffered blunt splenic injury., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Osman et al.)

The Internet of Vehicles (IoV) enables vehicles to share data that help vehicles perceive the surrounding environment. However, vehicles can spread false information to other IoV nodes; this incorrect information misleads vehicles and causes confusion in traffic, therefore, a vehicular trust model is needed to check the trustworthiness of the message. To eliminate the spread of false information and detect malicious nodes, we propose a double-layer blockchain trust management (DLBTM) mechanism to objectively and accurately evaluate the trustworthiness of vehicle messages. The double-layer blockchain consists of the vehicle blockchain and the RSU blockchain. We also quantify the evaluation behavior of vehicles to show the trust value of the vehicle's historical behavior. Our DLBTM uses logistic regression to accurately compute the trust value of vehicles, and then predict the probability of vehicles providing satisfactory service to other nodes in the next stage. The simulation results show that our DLBTM can effectively identify malicious nodes, and over time, the system can recognize at least 90% of malicious nodes.

Background Inguinal hernia repair is one of the commonest general surgical procedures performed all over the world. The introduction of synthetic mesh and laparoscopic repair has revolutionized inguinal hernia surgery in the recent past. Laparoscopic transabdominal preperitoneal (TAPP) repair is now considered a well-established procedure with minimal complications and short hospital stay and less recurrence. The TAPP approach gives a good view of the inguinal anatomy and a better understanding of the sac contents. The learning curve associated with TAPP repair is much less as compared to total extraperitoneal (TEP) repair. The aim of this study was to assess the effectiveness of TAPP repair for inguinal hernia in terms of the duration of surgery, hospital stay, complications, and recurrence rate. Method From March 1, 2019, to February 28, 2021, a total of 60 patients with inguinal hernias between ages 25 and 70 years were included in the study. A preoperative anesthesia assessment was done, and informed written consent was taken from all patients. The TAPP procedure was performed with polypropylene mesh in all cases, and surgery was performed by a surgeon with more than five years of laparoscopic experience. Results The total number of patients included in the study was 60. All patients were male. The mean±standard deviation (SD) age of the patients was 54.6±11.4 years. Unilateral primary inguinal hernia was present in 46 (76.6%) cases, recurrent in eight (13.3%) cases, and primary bilateral in six (10%) cases. The mean±SD duration of surgery for unilateral inguinal hernia was 59.1±15.7 minutes, and for bilateral hernia, it was 83.5±12.6 minutes. The mean hospital stay was 3.6±1.5 days. Scrotal swelling was noted as a common complication in seven (11.6%) cases, surgical site infection (SSI) in three (5%), mesh infection in two (3.3%), urinary retention in two (3.3%), and chronic pain in one (1.6%). No recurrence was noted. Conclusion Transabdominal preperitoneal repair for inguinal hernia is a very effective procedure with a short learning curve and minimal complication rate. The hospital stay is less, and recurrence is very low., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ahmad et al.)

In today's competitive world, software organizations are moving towards global software development (GSD). This became even more significant in times such as COVID-19 pandemic, where team members residing in different geographical locations and from different cultures had to work from home to carry on their tasks and responsibilities as travelling was restricted. These teams are distributed in nature and work on the same set of goals and objectives. Some of the key challenges which software practitioners face in GSD environment are cultural differences, communication issues, use of different software models, temporal and spatial distance, and risk factors. Risks can be considered as a biggest challenge of other challenges, but not many researchers have addressed risks related to time, cost, and resources. In this research paper, a comprehensive analysis of software project risk factors in GSD environment has been performed. Based on the literature review, 54 risk factors were identified in the context of software development. These were further classified by practitioners into three dimensions, i.e., time, cost, and resource. A Pareto analysis has been performed to discover the most important risk factors, which could have bad impact on software projects. Furthermore, a modified firefly algorithm has been designed and implemented to evaluate and prioritize the pertinent risk factors obtained after the Pareto analysis. All important risks have been prioritized according to the fitness values of individual risks. The top three risks are "failure to provide resources," "cultural differences of participants," and "inadequately trained development team members.", Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Asim Iftikhar et al.)

The demand for global software development is growing. The nonavailability of software experts at one place or a country is the reason for the increase in the scope of global software development. Software developers who are located in different parts of the world with diversified skills necessary for a successful completion of a project play a critical role in the field of software development. Using the skills and expertise of software developers around the world, one could get any component developed or any IT-related issue resolved. The best software skills and tools are dispersed across the globe, but to integrate these skills and tools together and make them work for solving real world problems is a challenging task. The discipline of risk management gives the alternative strategies to manage risks that the software experts are facing in today's world of competitiveness. This research is an effort to predict risks related to time, cost, and resources those are faced by distributed teams in global software development environment. To examine the relative effect of these factors, in this research, neural network approaches like Levenberg-Marquardt, Bayesian Regularization, and Scaled Conjugate Gradient have been implemented to predict the responses of risks related to project time, cost, and resources involved in global software development. Comparative analysis of these three algorithms is also performed to determine the highest accuracy algorithms. The findings of this study proved that Bayesian Regularization performed very well in terms of the MSE (validation) criterion as compared with the Levenberg-Marquardt and Scaled Conjugate Gradient approaches., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2021 Asim Iftikhar et al.)

Objective: The study aimed to document the impact of interpersonal communication (IPC) activities on increasing volume of family planning clients, new users, long term contraceptive uptake, post-partum, and post abortion family planning uptake at the associated health facilities of the Sabz Sitara Network., Methodology: A comparative secondary analysis of retrospective programme service delivery data from two groups of providers was performed. The exposure variable is defined as receipt of IPC. The six outcome variables are volume of: family planning (FP) clients, FP clients less < 25 years, intra-uterine device (IUD) insertions, post-partum FP clients (PPFP), users, and post-abortion FP (PAFP) clients., Results: The increase in client volume in IPC supported providers is significant for all the FP outcomes when adjusted for provider qualification and location. The adjusted model shows a significant increase of 10 more FP clients, 2 more youth clients and IUD insertions each, 3 more new users, and 1 more client for post abortion services., Conclusions: The IPC intervention has a positive and significant impact on increasing client volume for all related FP outcomes at the associated provider facilities. Location and qualification of providers seem to moderate the impact. Considering qualification, and geo-social demographics of the area to tweak intervention intensity and design will help amplify the associated beneficial outcomes and minimize underperformance. To maximize return on investment, subsequent evaluations should help determine the ideal time frame required to achieve and sustain the positive results.

The study endeavored to analyze the risk perception, sense of place, and disaster preparedness in response to landslide disaster-prone mountain areas of Gilgit-Baltistan, Pakistan. To this end, we surveyed 315 rural residents of two vulnerable landslide districts (Hunza and Nagar) of Gilgit-Baltistan. To explore the relationships between the dimensions of risk perception, sense of place, and disaster preparedness, we used partial least squares (PLS) structural equation modeling (SEM) to test the hypotheses. The results derived from PLS-SEM have implied that there is a significant negative relationship between risk perception (apprehension and unidentified) with a sense of place (bond with society and place dependence). It was observed that the residents usually overestimate the risks of disasters due to their limited scientific knowledge regarding disaster occurrence, which reduces their dependencies on the place. We revealed that disaster preparedness enhances the place attachment and reduces the apprehension of landslides in the study area. This study devotes to government and relevant agencies to devise policies that can help relocate the vulnerable rural settlements, develop, and educate the masses on disaster mitigation and prevention strategies, and help prepare a suitable landslide management plan.

Background: Neurosarcoidosis is a serious extra pulmonary manifestation of sarcoidosis. Its presentation ranges from peripheral or cranial neuropathy to central nervous system dysfunction. It can mimic stroke or multiple sclerosis. Due to the variation in clinical presentation, diagnosis is difficult and often delayed., Objective: Determine the proportion of patients with neurosarcoidosis who have positive findings on chest CT, lung biopsy or lymph node biopsy., Methods: Retrospective study at the Sarcoidosis and Interstitial Lung Disease Center at Wayne State University-Detroit Medical Center in Detroit, MI. Medical records of 424 patients were reviewed and 69 patients with neurosarcoidosis identified., Results: We found that most patients diagnosed with neurosarcoidosis had normal PFT values except for reduction in DLCO. However, we also found that 71% of the patients had abnormal findings on chest CT consistent with sarcoidosis.  Additionally, 57% of the patients had non-caseating granuloma on hilar lymph node biopsy., Conclusion: Patients with neurosarcoidosis may not have any pulmonary symptoms. However, they are most likely to have abnormal chest CT, hilar lymphadenopathy and reduction in DLCO.  These data suggest that pulmonary evaluation is warranted in patients who are suspected to have neurosarcoidosis.

Big Data has gained much attention from the academia and the IT industry. In the digital and computing world, information is generated and collected at a rate that rapidly exceeds the boundary range. Currently, over 2 billion people worldwide are connected to the Internet, and over 5 billion individuals own mobile phones. By 2020, 50 billion devices are expected to be connected to the Internet. At this point, predicted data production will be 44 times greater than that in 2009. As information is transferred and shared at light speed on optic fiber and wireless networks, the volume of data and the speed of market growth increase. However, the fast growth rate of such large data generates numerous challenges, such as the rapid growth of data, transfer speed, diverse data, and security. Nonetheless, Big Data is still in its infancy stage, and the domain has not been reviewed in general. Hence, this study comprehensively surveys and classifies the various attributes of Big Data, including its nature, definitions, rapid growth rate, volume, management, analysis, and security. This study also proposes a data life cycle that uses the technologies and terminologies of Big Data. Future research directions in this field are determined based on opportunities and several open issues in Big Data domination. These research directions facilitate the exploration of the domain and the development of optimal techniques to address Big Data.

Hybrid waveguides consisting of a metal plane separated from a high-index medium by a low-index spacer have recently attracted a lot of interest. TM and TE modes are guided in two different layers in these structures and their properties can be controlled in different manners by changing the waveguide dimensions and material properties. We examine the effects of different parameters on the characteristics of the two modes in such structures. We show that by properly choosing the dimensions, it is possible to cut off the TE mode while the TM mode can still be guided in a well-confined manner. Using this property of the hybrid guide, we propose a TM-pass polarizer. The proposed device is very compact and compatible with the silicon-on-insulator platform. Finite-difference time-domain simulation indicates that such a polarizer can provide a high extinction of the TE mode for a reasonable insertion loss of the TM mode.

Background: Peptic ulcers were believed to be caused by stress, dietary factors, and gastric acid, but the link between H. pylori and peptic ulcers was identified in 1983. To see the frequency of Helicobacter pylori infection in patients with perforated duodenal ulcer and advise eradication therapy in these patients. This cross sectional study was conducted in Surgical Unit Hayatabad Medical Complex, Peshawar, during January 2007-June 2008., Methods: A total of 50 cases were included in the study. All cases presenting to our unit with acute perforated duodenal ulcer were recruited. After resuscitation and baseline investigations, all underwent emergency laparotomy via upper midline incision, after thorough peritoneal lavage, the perforation margins were freshened and closed over an omental patch. Serum from every patient was tested for H. pylori and accordingly managed., Results: Out of the 50 cases, 45 were males, and 5 were females. Age ranged from 20- 80 years old. All patients underwent emergency laparotomy. Postoperatively, all were started on PPI treatment and serum testing for H. pylori was done. Thirty-four (68%) turned out positive and 16 (32%) were found to be negative for H. pylori., Conclusion: There is still a high frequency of H. pylori infection in patients with perforated duodenal ulcer. But comparing these results with the various data available, there is a significant decline in H. pylori positive perforated duodenal ulcer patients.

Objective: To determine the range of complications occurring in infants of diabetic mothers (IDMs)., Design: An observational cross-sectional study., Place and Duration of Study: Federal Government Services Hospital, Islamabad and National Institute of Child Health, Karachi, from August 1999 to January 2000., Subjects and Methods: All IDMs born during the study period were immediately admitted to the neonatal intensive care unit after delivery. Maternal history was obtained and a detailed physical examination was performed to detect congenital abnormalities. Babies were screened for hypoglycemia, hypocalcemia, hyperbilirubinemia, birth asphyxia, respiratory distress syndrome (RDS) and birth trauma. Outcome of IDMs and relative frequencies of various complications were evaluated. Results were analyzed using statistical package for social sciences (SPSS) version 11., Results: A total number of 40 babies with IDM were included in the study. Out of diabetic mothers, only 19 (47.5%) were taking insulin albeit irregularly. No mother was taking oral hypoglycemic agents, 5 (12.5%) were following only dietary advice while 16 (40%) were not following any advise for control of diabetes. Twenty-two (55%) mothers were delivered by C-section and 18 (45%) had vaginal delivery. Seven (17.5%) mothers experienced birth injuries, all of them were delivered vaginally and majority of them were large babies. Fifteen percent IDMs suffered from birth asphyxia. Most (82.5%) were delivered vaginally. Congenital anomalies were found in 10 (25%) babies. Eighteen (45%) were macrosomic, 20 (50%) were appropriate for gestational age (AGA) and 02 (5%) were small for gestational age (SGA) or growth retarded. Hypoglycemia was noted in 35% and hypocalcemia in 15%. Hyperbilirubinemia was observed in 12 (30%) newborns. Mortality was 7.5%., Conclusion: The results of this study show a high frequency complications in IDMs. The diabetic mothers should have regular antenatal follow-up and maintain good glycemic control throughout pregnancy. Cesarean section may be allowed more liberally, especially with clinical evidence of macrosomic baby, to avoid birth injury and asphyxia. All deliveries of diabetic mother should be attended by pediatrician to minimize complications.