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The study's objectives were to inspect how media marketing influenced the development of customer satisfaction and trust through the mediating effect of consumer engagement. In Pakistan, a quantitative study was conducted to solve this problem. The core data for the research was gathered by a questionnaire from a sample group of around 310 persons, covering government employees, private sector workers, company executives, and students. The proposed framework under this study extracts the empirical stats using SPSS like demographics, reliability, descriptive statistics and correlation. Confirmatory Factor Analysis assessed the accuracy and effectiveness of the model and SEM-Structured Equation Model technique applied to the suggested model using SmartPLS 4. The findings revealed a significant positive association among factors of social media marketing, rewards, brand image, electronic word of mouth, customer engagement, customer trust and satisfaction. At the end of this study, limits and future implications are discussed, as well as practical and theoretical ramifications.

The study's objectives were to investigate the nexus of service quality and innovation in developing customer loyalty, with customer commitment and satisfaction as mediating. To address this issue, a quantitative investigation was carried out by a researcher in Pakistan. The primary study material was assembled through a survey questionnaire, with a sample population of approximately 369 individuals, which included Pakistani citizens who made online purchases. SEM (Hypotheses testing) showed a strong positive correlation between the variables service quality, service innovation, market orientation, customer commitment, customer satisfaction and customer loyalty. Limitations and future implications, as well as practical and theoretical implications, are discussed at the end of this paper.

Millions of people worldwide have been affected by the Coronavirus disease (SARS-CoV-2 or COVID-19) pandemic. Intensive care unit admissions are frequent and some patients with hypoxic respiratory failure need invasive mechanical ventilation. We retrospectively reviewed the medical records of 22 critically ill patients with SARS-CoV-2 pneumonia who required endotracheal intubation from March 2020 till August 2020 at our institute, a tertiary care government designated center for treating moderate and severely ill COVID patients. Patient’s demographics, clinical features, use of personal protective equipment (PPE) for intubation, intubation process, adverse events and anesthesiologist infection rate was determined. Patients intubated were elderly and comorbidities were common. We successfully intubated all patient using level-3 PPE. Hypoxia, hypotension, arrhythmias and unanticipated difficult airway were common events in peri-intubation period.

This research was aimed to determine the impact of milk source on mozzarella cheese's chemical, rheological, and organoleptic characteristics. A total of 10 lots of cow and buffalo milk mozzarella cheese each were prepared. Prominent milk source influence on the chemical characteristics and calorific values of mozzarella cheese was determined. A decrease in moisture content and an increase in fat, protein, ash, and calorific values were noted in mozzarella cheese against their respective milk. Moisture content in cow milk mozzarella cheese (CMM) was considerably higher than buffalo milk mozzarella cheese (BMM). Average fat, ash content and calorific values appeared considerably high in BMM cheese compared to CMM cheese but protein content was recorded inverse and statistically non-significant (P>0.05). The average meltability was slightly higher in CMM cheese and the stretchiness of CMM cheese appeared significantly high from that of BMM cheese. BMM cheese was remarkably high in yield in contrast to that of CMM cheese. Appearance, flavor, and body/texture scores were slightly higher in CMM cheese as compared to BMM cheese. Regardless, the average benefit computed for BMM cheese was high in comparison to CMM cheese, the differences among them were statistically non-significant. The present study concludes that buffalo milk is better to produce mozzarella cheese with higher calorific values, better yield, and with more economic values, while cow milk is better to produce mozzarella cheese with the more proteinous, enhanced stretchiness, and better organoleptic quality.

Objective: To determine impact of community based Medical Education on learning of undergraduate medical students. Study Design: Non-comparative, Prospective study. Setting: Irfania Ophthalmic Medical Camp, Lahore. Period: July 2019. Material & Methods: 70 students participated in a 4 hour interactive session, where they took a focused history, performed relevant clinical examination, and counseled patients regarding their disease. At the end, feedback was collected using a pre-tested questionnaire. Data obtained was analyzed using SPSS version 23, with mean ± SD determined for continuous variables and frequency with percentage for categorical variables. Results: Majority of the participants were female fourth year medical students. 97.1% found the camp system more efficient for learning, while 94.3% thought it should be included in future ophthalmic curricula. 81.5% of the participants were of the opinion that the camp had had a positive impact on their communication skills regarding taking focused history and counseling patients. Conclusion: In a country like Pakistan with a high burden of ophthalmic diseases and a developing medical curriculum, medical camps are essential for training and skill learning for undergraduate medical students, and should be included in the medical curriculum.

Aim: The research paper aims to analyze the frequency of Cyanotic and Acyanotic Congenital Heart Defects (CHDs) in children up to 2 years of age in Faisalabad, Pakistan and the secondary aim is to see the gold standard modality for the diagnosis of CHDs. Method: A cross-sectional study was performed via consecutive sampling based on 120 questionnaires conducted at the Faisalabad Institute of Cardiology. The data was collected with the permission of the relevant department and with the consent of the patient. Results: Data from 120 patients were collected with a 60% male to 40% female ratio. Out of 120 referred children (neonates; 29.9%, less than 1 year; 50.2%, greater than 1 year; 19.9%), 93% were diagnosed as having congenital heart defects. The relative frequencies of cyanotic and acyanotic congenital heart defects were 17% and 83%. The majority of patients with congenital heart disease detected have acyanotic congenital heart defects. Conclusion: Tetralogy of Fallot is the commonest cyanotic defect while Ventricular Septal Defect is the commonest acyanotic defect. To prevent complications, early detection of heart failure is very important for proper management. The 2D-echo with the Doppler test creates a gold standard for diagnosis.

Paraduodenal fossa hernias (PDFHs) represent 53% of all congenital internal hernias and 0.2-0.9% of all small bowel obstructions. Most of these hernias are diagnosed incidentally on laparotomy, and carry up to 50% lifetime risk of development of small bowel obstruction. We present our experience in diagnosing and treating a case of a massive left paraduodenal fossa hernia in a 17 year male, containing over 30% of the small bowel (jejunum and ileum), presenting with a history of recurrent incomplete small bowel obstruction. Plain abdominal radiography showed distended loops of jejunum and few air fluid levels. After laparotomy and identification of hernia, small gut was reduced and examined, which was found to be structurally and functionally intact with normal vascularity. The defect was closed with continuous absorbable suture (Vicryl 2-0) sparing the inferior mesenteric vessels. Patient’s post-operative recovery remained uneventful and he was discharged on 4th post-operative day.

The multisystem effects of SARS-CoV-2 encompass the thyroid gland as well. Emerging evidence suggests that SARS-CoV-2 can act as a trigger for subacute thyroiditis (SAT). We conducted a systematic literature search using PubMed/Medline and Google Scholar to identify cases of subacute thyroiditis associated with COVID-19 and evaluated patient-level demographics, major clinical features, laboratory findings and outcomes. In the 21 cases that we reviewed, the mean age of patients was 40.0 ± 11.3 years with a greater female preponderance (71.4%). Mean number days between the start of COVID-19 illness and the appearance of SAT symptoms were 25.2 ± 10.1. Five patients were confirmed to have ongoing COVID-19, whereas the infection had resolved in 16 patients before onset of SAT symptoms. Fever and neck pain were the most common presenting complaints (81%). Ninety-four percent of patients reported some type of hyperthyroid symptoms, while the labs in all 21 patients (100%) confirmed this with low TSH and high T3 or T4. Inflammatory markers were elevated in all cases that reported ESR and CRP. All 21 cases (100%) had ultrasound findings suggestive of SAT. Steroids and anti-inflammatory drugs were the mainstay of treatment, and all patients reported resolution of symptoms; however, 5 patients (23.8%) were reported to have a hypothyroid illness on follow-up. Large-scale studies are needed for a better understanding of the underlying pathogenic mechanisms, but current evidence suggests that clinicians need to recognize the possibility of SAT both in ongoing and resolved COVID-19 infection to optimize patient care.

Objective: To determine the pattern of antimicrobial sensitivity of common microorganisms isolated from diabetic foot infections presenting at a tertiary care center in North West, Pakistan. Methods: 201 patients were included in the study, which was conducted over a period of 08 months from January 2019 to August 2019, at the Diabetes & Footcare Clinic (DFC), Mayo Hospital Lahore. Deep-seated tissue samples (0.5 x 0.5 cm) were taken from ulcer bed and immediately sent for culture & sensitivity (C&S) testing. Antimicrobial susceptibility was determined in accordance with Clinical & Laboratory Standards Institute (CLSI) guidelines. Statistical analysis was performed using SPSS version 26.0. Data was presented as Mean ± SD for continuous variables & frequency with percentage for categorical variables. Results: Mean age of participants was 53.05 ± 10.70, from which 66.7 % (134) were male. Grade 3 DFUs (51.7%) and grade 2 DFIs were most prevalent (62.7%). Out of 201 tissue specimens, 389 bacterial isolates were collected. Monomicrobial specimens accounted for 28.4%, with the rest (71.6%) being polymicrobial. Gram negative organisms were 238 (61.11%) while the rest (38.89%) were gram positive organisms. There was a high incidence of methicillin resistant S. aureus (MRSA) at 64.58%. Highest susceptibility of S. aureus was reported with vancomycin and fusidic acid at 100% and 79.35%. Continuous...

Background: Urinary track infection (UTI) is a common infection in Pakistan. Poor knowledge about personal hygiene and lack of awareness are major reasons of this infection. All over the world and in Pakistan E. coli and K. pneumonia are main causative agents of UTI.Objectives:To analyze Antibiotic susceptibility pattern of bacterial strains isolated from urinary tract infections.Methods: In present study total 227 samples from Genomic Research Lab and Diagnostic Center Rawalpindi, Pakistan were tested for presence of different microbial infectious agents and their antibiotic resistance and susceptibility pattern. Biochemical test such as Gram staining, Lactose fermentation test, Motility test, Catalase test and Colony formation on MacConkey agar, Indole test, and Citrate utilization test were applied. The antibiotic susceptibility and resistance pattern was evaluated by using fourteen different antibiotics on MullarHigton agar. Top ten antibiotics were selected at a cut off value of 100 samples for E. coli and 20 samples for Klebsiella.Results: Against E. coli and K. species the most susceptible antibiotic was Imipenam with 97.5% and Amikacin with 94.9% susceptibility respectively. Moreover, against E. coli and K. species the most resistance antibiotic was Ciprofloxacin 81.7% and Tobramycin with 76.1% resistance respectively. The comparison of present study with pervious studies had shown an increase in resistance against various antibiotics.Conclusion: It is concluded from the present study that antibiotic resistance is on raise in Pakistan and the effect of each antibiotic was different with respect to type of infectious agent so it is recommended that the doctor should determine the dominant type of infectious agent and its susceptibility response before prescription of any antibiotic.  Â

Objectives: To determine the impact of exposure to second hand smoking on fetal birth weight and length. Study Design: Comparative Cross Sectional study. Setting: Physiology Department of Shaikh Zayed Postgraduate Medical Institute. Period: December 2015 to May 2016. Material & Methods: Non-probability convenience sampling was used to collect data from 120 women and their neonates, who were further divided in four equal groups based on level of exposure to second hand smoking. A self-administered questionnaire was used to collect data regarding level of exposure of mothers, while weight and length of neonates were measured objectively. Results: Mean birth weight (kg) in group-1 was 3.31 ± 0.50, in group-2 was 3.00 ± 0.28, in group-3 was 2.92 ± 0.48 and in group-4 was 2.66 ± 0.41. The p-value calculated by one way ANOVA was 0.001 which shows that birth weight was significantly different in all the groups. Mean birth weight of neonates showed inverse relation with SHS exposure of the mothers. Mean length (cm) of neonates in group-1 was 49.30 ± 1.70, in group-2 was 48.77 ± 1.47, in group-3 was 49.40 ± 2.12 and in group-4 was 48.53 ± 1.65. It was seen that there was no significant difference in length of neonates belonging to different groups. Incidence of low birth weight among all the groups was 11.6%. Conclusion: Second hand smoking of mothers affects birth weight of neonates which in turn influence the intellectual abilities and developmental milestones of neonates. Awareness should be made in society in this regard to prevent the burden of the disease in silent victims of smoking.

Objectives: To determine frequency and impact of burnout among surgeons and residents of different specialties at a tertiary care hospital in Punjab, Pakistan, over a period of 6 months. Study Design: Observational Cross-sectional study. Setting: Departments of General Surgery and Ophthalmology, Mayo Hospital Lahore and the Department of Gynecology, Lady Willingdon Hospital Lahore. Period: September to November 2019. Material & Methods: Out of 150 invited participants, 124 responded to the questionnaire. Grades of burnout were determined according to the American Public Welfare Association (APWA) inventory. Data analysis was performed using SPSS 26.0, with qualitative statistics determined as frequency and percentages, and quantitative correlations among variables determined by application of chi-square test with p-value ≤ 0.05 as significant. Results: Out of 124 participants, 48.3% were female while the rest were male, mostly in the age group of 26-30 years (75%). Majority (50.8%) belonging to General Surgery; 32.3% were from Gynecology and Obstetrics and 16.9% were from Ophthalmology. Most of the participants (81.4%) were residents, with majority (51.6%) working 60-80 hours per week. There was high rate of burnout, with 46.3% of females and 32.8% of males reporting early burnout, and 36.6% of females along with 25% of males reporting advanced burnout. General surgeons and gynecologists were more prone to advanced burnout, while eye surgeons and residents had an increased propensity towards developing burnout. Conclusion: There is a high rate of burnout among surgical residents and consultants, attributable to increased working hours, less pay, and decreased job satisfaction. Measures should be taken to curb this trend, both for patient safety as well as for personal and mental health improvement of surgeons.

Jawad syndrome is a multiple congenital anomaly and intellectual disability syndrome with mutation in RBBP8 reported only in two families. Here, we report on two new families from Pakistan and identified a previously reported variant in RBBP8, NM_002894.3:c.1808-1809delTA. We could show that this mutation impairs splicing resulting in two different abnormal transcripts. Finally, we could verify a shared haplotype among all four families and estimate the founder event to have occurred some 24 generations ago.

The Natural killer (NK) cells' ability to destroy cancerous cells is predominantly focused on the activation of the co-stimulatory and natural killer group two with receptor of member-D also called NKGD2/NKG2D. These identifies ligands that are MHC-Class1 structural homologs like that of the UL16 protein-binding type 2. The ULBP2 has been shown to mediate-natural resistance against the tumors mechanism in the condition of in-vitro, in-vivo, making it a possible target for producing the immune-therapeutic drugs for the diagnosis of the cancers and certain other viral diseases. In this present research, we created a stable and high-quality 3-D structure of the ULBP-2 protein through SWISS-Model also visualized by using UCSF-Chimera Tool. Moreover, the ULBP2 protein was prognosticated to be acts as antigenic, 11-discontinuous-B-Cell epitopes, 05 ULBP2 proteins antibody-based epitopes, and possible predicted the top hits of six linear B-cell epitopes. The ULBP2 protein carried seven cytotoxic-T lymphocytes (CTLs), two helper-T lymphocytes (HTLs), the LGKKLNVTTAWAQN is a promiscuous epitope MHC bounded to the T cells and with LRDIQLENY highest antigen scores in MHC molecule. Finally, the promising epitopes that could be successful in producing B-cell and T-cell mediated immunity against the required immune reaction to tumorigenesis were expected.

Purpose: Orbital trauma is associated with orbital blowout fractures, with associated globe injuries and loss of vision. Orbital reconstruction can be done with various implant materials. The aim of this study is to identify the safety and postoperative outcomes of using X-ray films as orbital implants during orbital reconstruction surgery. Study Design: An interventional case series. Place and Duration of Study: Ophthalmology departments of Lahore General Hospital and Mayo Hospital, Lahore from June 2001 to May 2017. Methods: Retrospective data of all the patients who came for orbital reconstruction surgeries from June 2001 to May 2017 was retrieved. All patients had undergone CT scan prior to surgery. Orbital reconstruction was done by a single surgeon, by bridging bony defect with sterilized X-ray film. All patients received post-operative antibiotics for 1 week. Results: Twenty three male patients were included in the series, with a mean age of 28 ± 2.47 years. Assault and sports injuries with a ball were the commonest form of trauma. Diplopia was the major presenting complaint in 91% of the patients. All patients underwent surgical reconstruction of the orbital floor of orbit with sterilized X-ray film using a lateral canthotomy approach. Only mild postoperative diplopia was recorded in 7 of the cases, with uneventful recovery in the majority. Conclusion: Sterilized X-ray film is a safe, cost effective, and durable material for reconstruction after orbital blowout fracture, especially in developing countries. Key Words: Orbital fracture, X-ray film, Diplopia.

Objective: The objective of this study was to determine knowledge and awareness among medical students and interns regarding COVID-19. Materials and Methods: An observational cross-sectional survey with 217 participants was carried out among medical students and interns of King Edward Medical University, and Mayo Hospital Lahore from March to May 2020. Results: Among participants, 62.2% were female, with 134 (61.8%) medical students and 83 (38.2%) medical interns. Social media was the most common source (39.9%) of information regarding COVID-19. Medical students and interns alike had good knowledge regarding the pandemic status of COVID-19 (91.7%); the relationship of COVID-19 with other coronaviruses; presence of asymptomatic carriers (84.3%); crude mortality rate (77.4%); and preventive measures (98.6%). However, knowledge about virus structure, genus, transmission, epidemiological characteristics, diagnosis, prevention and treatment was found to be inadequate among both interns and students. Conclusion: There is poor over all knowledge among medical students and interns regarding COVID-19, especially during a pandemic. Steps must be taken to improve knowledge by introducing changes in curriculum related to emerging diseases, and by active participation of medical students in learning and dissemination of information on COVID-19. &nbsp

Background Punjab is the most populous province of Pakistan, with only 12 countries in the world succeeding it in terms of population. Aims This review article has the objective of providing novel statistics regarding available cancer therapeutics in Punjab across four different sectors-including government, semi-private, trust and private sectors. Methods and results Keywords such as "cancer treatment," "facilities," "Pakistan," were used to search Pubmed Database. 36 results were generated: after sifting based on a personal reference list as well as for relevance, 16 articles were finally reviewed. Novel statistics regarding current state of access to cancer facilities were drawn from personal references as well as from studies conducted in other LMICs. There is a gross deficit of oncological services in Punjab, with the ratio of medical oncologists to population being 0.027 per 100, 000, and every oncologist checking 1300-1500 patients annually. Only 21.4% of the population has access to radiotherapy facilities. Major problems include lack of healthcare professional awareness; poor infrastructure including drug access, radiotherapy, and cancer pain management facilities; lack of planning; and lack of educational and research programs. Conclusions Improving education & training, developing infrastructure based on public-private-partnership models, building cancer registries and organizing national cancer screening programs, as well as encouraging basic health education and research in oncology, are measures that can ensure Punjab's healthcare delivery system becomes capable of handling increasing incident burden of cancer.

Alzheimer’s disease (AD) is the most common cause of dementia in elderly patients, affecting individuals older than 60 years. It is a complex degenerative brain disease characterized by progressive cognitive impairment. AD constitutes a major global health concern. A central role for inflammation has been implicated in the pathogenesis of AD. Despite the understanding of multiple molecular pathways in the pathophysiology of AD, novel treatment agents with a possible role in modifying the disease activity are still lacking. Our article provides a comprehensive review of various observational studies and randomized trials encompassing the use of anti-inflammatory agents in the management of AD patients and utilizes the conclusions derived therefrom to give recommendations in this regard.

Introduction: Hepatitis B virus (HBV) and hepatitis C virus (HCV) are among the principal causes of severe liver disease, including hepatocellular carcinoma and cirrhosis-related end-stage liver disease. The World Health Organization (WHO) estimates that there are 350 million people with chronic HBV infection and 170 million people with chronic HCV infection worldwide. Aims and objectives: The basic aim of the study is to find the risk factors of hepatitis B and C among local population of Pakistan. Methodology of the study: This study was conducted at Allama Iqbal Memorial Teaching hospital, Sialkot during March to July 2018. A total 120 study participants aged ≥18 years with clinically diagnosed CLD were included in the study by convenient sampling technique. Results: A total of 100 patients with signs and symptoms of CLD were recruited. Of these, 85 subjects completed the study. The mean age ± SD for all the study population wasyears (range = 18–80). Majority, 75.8% were below the age of 50 years, 67 (55.8%) were married, 32 (26.7%) single, 11 (9.2%) divorced, and 10 (8.3%) widow. In relation to residence area, 91 (75.8%) of the participants were urban dwellers. Conclusion: It is concluded that prevalence of HBV and HCV infections among CLD patients in this study is high. Dental extraction at health facilities has 2.95-time association of acquisition of HCV infection than those who do not have history of dental extraction.&nbsp

Introduction: Acute coronary syndrome is a term used for any condition brought on by sudden, reduced blood flow to the heart. Acute coronary syndrome depends on the specific characteristics of each element of the triad of clinical presentation (including a history of coronary artery disease). Objectives: The main objective of the study is to analyze the in-hospital complications after Percutaneous Coronary Intervention (PCI) of culprit vessel for Acute Coronary Syndrome (ACS). Materials and methods: This descriptive case series study was conducted at Punjab Institute of Cardiology, Lahore during September to December 2018. It was non-probability purposive sampling. All the baseline procedural and biochemical characteristics recorded. Frequency of males and females undergoing PCI of Culprit Vessel during this duration was calculated then these patients were evaluated for Post PCI Complications. Results: Males were more in number as compared to females. i.e 75 males (55.55%) and 60 females (44.44%). Out of these 110 patients (55 males and 55 females) were selected for this study. These patients were fulfilling the Inclusion and exclusion criteria. Baseline characteristics of the patients who underwent PCI are shown below in table 1. Mean age of the male patients was 49.8 ± 9.60 while that of female patients was 52.1± 8.91. Conclusion: It is the total obstruction of the artery usually at the site of access requiring surgical repair. Conclusion is defined as total obstruction of blood vessel usually due to the thrombus formation dissection or other mechanisms usually at the site of access of plaque pulse or Doppler signal and associated with sign and symptoms of an ischemic limb requiring surgical intervention. Key Words: Percutaneous Intervention, Culprit Vessel, Gender disparity, Vascular Complications.

Cancer affects more than 175,000 Pakistanis every year, imposing cost strains and increased financial, psychological and social burden on an already struggling populace. With a dearth of trained oncologists, the burden of advanced cancer in Pakistan is irrationally high, contributing to avoidably high mortality and morbidity rates. The involvement of primary care physicians in cancer screening, treatment decision making, and advanced care can be an effective strategy in the mitigation of this problem, without imposing any additional burden on the health resources. This integrated healthcare delivery approach needs to be encouraged and modeled to handle the growing cancer burden and to improve cancer survivorship in the country.

This research deals with the industrial financial forecasting in order to calculate the yearly expenditure of the organization. Forecasting helps in estimation of the future trends and provides a valuable information to make the industrial decisions. With growing economies, the financial world spends billions in terms of expenses. These expenditures are also defined as budgets or operational resources for a functional workplace. These expenses carry a fluctuating property as opposed to a linear or constant growth and this information if extracted can reshape the future in terms of effective spending of finances and will give an insight for the future budgeting reforms. It is a challenge to grasp over the changing trends with an effective accuracy and for this purpose machine learning approaches can be utilized. In this study Long Short-Term Memory (LSTM), which is a variant of Recurrent Neural Network (RNN) from the family of Artificial Neural Networks (ANN), is used for forecasting purposes along with a statistical tool IBM SPSS for comparative analysis. In this study, the experiments are performed on the data set of Pakistan GDP by type of expenditure at current prices - national currency (1970-2016) produced by Economic Statistics Branch of the United Nations Statistics Division (UNSD). Results of this study demonstrate that the proposed model predicted the expenses with better accuracy than that of the classical statistical tools.