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Stroke is among leading life threatening neurological emergency and single most important reason for disability. Objective: To determine the frequency of carotid artery stenosis in patients with ischemic stroke by using color Doppler ultrasound of carotid arteries. Method: This Cross sectional study was carried out at Medical Unit-III, Abbasi Shaheed Hospital, and Karachi for Six months from 1st December 2017 to 31st May 2018. 170 diagnosed patients of ischemic stroke fulfilling the inclusion criteria were enrolled. Brief history and bio data were entered in the Pro forma. Ultrasound carotid Doppler was done for all the patients included in the study. Effect modifiers were controlled through stratification of age, gender, hypertension, diabetes mellitus, dyslipidemia, obesity, smoking status and history of CVA to see their effect on the outcome variable. Post stratification chi square test/fisher exact test was applied while odds were computed by binary logistic regression taking p-value of ≤0.05 as significant. Results: Among 170 patients with ischemic stroke visiting Medical Unit-III, Abbasi Shaheed Hospital, Karachi who were included in this study, the mean age of patients was 53.14 ±7.49 years and duration of disease was 2.72±0.89 years. 84 (49.4%) were male and 86 (50.6%) were female. Amongst patients with ischemic stroke, 90 (52.9%) had carotid artery stenosis and 80 (47.1%) did not have carotid artery stenosis. Conclusion: Our study showed that notable number of patients with ischemic stroke had carotid artery stenosis; furthermore, risk factors like hypertension, dyslipidemia and smoking were firmly associated with carotid artery stenosis

Agroforestry is a type of land management in which trees or shrubs are planted around or amid crops or pastureland. It integrates agriculture and forestry technology to create land-use systems. This approach aids farmers in raising production, managing nutrient cycling, and enhancing their socio-economic standing. However, well-managed systems have several advantages over monocultures, although this approach is not widely used in the country. Agroforestry is hampered by a lack of competent management, a lack of technological help, a rigorous regulation of tree harvesting, and an irregular, unorganized market. As a result of these factors, farmers are hesitant to plant trees on their land, leading to the notion of agroforestry not being widely used in the world. Through this chapter, the authors attempt to understand the reasons for the lack of knowledge about agroforestry and help in designing solutions using serious gaming to alter farmers' behavior and propose a method in the form of a serious game to promote agroforestry practices among the farmers.

Purpose:The purpose of study was to analyze impact of intellectual potential of human capital on telecom companies of Pakistan with the mediating role of strategic knowledge management. The impact of intellectual potential has been tested on performance of telecom companies of Pakistan. It also tested mediating role strategic knowledge management between intellectual potential and organizational performance. Methodology and Design: Data was collected through online questionnaire from 150 employees of telecom companies in Pakistan. Findings: Findings of study supported the model as results showed that there are significant relationships among the variables. Conclusion:The role of people has redefined due to Knowledge economy and many organizations have realized that employees are a valuable asset. Thus, the potentially competent managers have drastic impact on the strategic management of the organization by creating, developing and implementing policies, new ideas and practices that will improve the organizational performance.

Objectives: To highlight an economical laparoscopic technique for rapidrecovery & early return to work especially for the 3rd world inguinal hernia patients. StudyDesign: Descriptive study. Setting: Surgical unit of Nishtar Hospital Multan. Period: 02 yearsi.e. from January 2014 to January 2016. Methods: There were 90 patients in the study. A prolenemesh of 15 x 15 cm used for the repair of inguinal hernia laparoscopiclly without the use ofspacer balloon & tacker (To make it cost effective). Results: Out of 90 patients only 3 patientsdevelop scrotal seroma. All the patients discharged on the 1st postoperative day & allowed toreturn to their normal routine work from the 3rd postoperative day onward. Conclusion: (e-TEP)without spacer balloon & tacker is an economical approach toward the inguinal hernia repair.

Objectives: To describe the incidence of wound infection when gall bladderremoved through umbilical port using the bag formed by surgical glove with a group where bagis not used. Study Design: Descriptive study. Setting: Surgical units of Nishtar Hospital Multan.Period: Two years from November 2013 to November 2015. Material and Method: There were100 patients in study. All patients were divided in two groups, in one group a bag formedby surgical glove is used in other group gall bladder removed without bag. Results: In firstgroup where bag is used minor wound infection occurred in only one patient at the umbilicalport site. In second group where bag is not used for the extraction of gall bladder, the minorwound infection occurred in three patients. Conclusion: The use of endoglove is beneficial inminimizing the port site infection & it is also economical.

This study was conducted to compare outcomes of different doses of succinylcholine, in terms of intubation condition, onset of action, duration of action and abdominal fasciculation.Thus, randomized control trial was conducted in the department of anaesthesia and ICU, Nishter Hospital Multan from April 2016 to November 2016. A total number of 60 patients with ASA status I and II were enrolled. All patients were divided into three groups by lottery method. Data was entered and analysed by computer software SPSS version 23.2. Descriptive variables like age and onset of action were presented as mean and SD and continues statistics like gender, abdominal fasciculation and incubation condition were presented as frequency and percentages. Chi square test and one-way ANOVA was applied to see effect modification and significance of results. The p-value 0.05 was considered as significant.A Total number of 60 patients included in this study and all were female. The mean age of the patients was 28.15±4.5 years. The main outcome variables of this study were the fasciculation, satisfactory intubation, onset time (seconds) and duration of action (in minutes). In group (A) 1mg, abdominal fasciculation was found 80%, 85% and 75% in group A, B, C respectively. It was also observed that satisfactory intubation was found 90%, 80% and 30% in three groups respectively. The mean onset time was 50.95±4.6, 70.7±5.66 and 94.15±8.73 seconds in three groups respectively. Similarly, the mean duration of action was 16.1±3.76, 13.55±3.01 and 8±2.05 minutes respectively.Results of our clinical trial suggest that succinylcholine in low doses shorter duration of action and low rate of abdominal fasciculation which is desirable for rapid induction but onset of action is prolonged and intubation conditions were not satisfactory predominantly. So, we concluded that low doses of succnylcholine are not so much beneficial that I can replace full doses of succinylcholine when used for rapid induction and intubation.

After the corporate default of major corporations in the past years such as Enron Lehman Brothers etc the study has been a major area for research the default of us based giants has act as a distress and alarming situation for emerging economies with different areas of research regarding corporate defaults this paper focuses on examining the relationship of ownership structure with the performance of a firm through financial performance ratios and default of publically listed companies on Malaysian stock exchanges. Results suggested defaulted firms ownership concentration is unable to show significant relationship with the performance of these firms

Aim: To compare the analgesic efficacy of a single dose preoperative intramuscular Ketorolac versus diclofenac sodium forprevention of postoperative pain after third molar surgery. Design: This Experimental comparative study. Setting: Department of Anesthesia,Pakistan Atomic Energy Commission, Al-Zahra Hospital, Geo Care, and Maryam Maternity Hospital, DG Khan. Period: October 2011 to March2012. Material and Method: Patients undergoing elective third molar surgery were randomly assigned into one of the two groups. In eachgroup, 60 patients completed the study properly. Group-I received diclofenac sodium 75 mg IM 20 min preoperatively and group-II receivedKetorolac 30 mg IM 20 min preoperatively. Result: Patient in Ketorolac group reported significantly lesser pain intensity scores in the 3rd hourpain than the Diclofenac group (p-value lesser than 0.0001). Patient also reported significantly longer mean time to rescue analgesic 7.5 hversus 4.8h (p lesser than 0.001., student t test) that is approximately 2.5 h longer duration of preventive analgesic consumption (p=0.006,student t test). Conclusions: Preoperative intramuscular injection of Ketorolac 30 mg is more effective than Diclofenac 75 mg in the preventionof post operative 3rd molar pain.

Computer-assisted analysis of electroencephalogram (EEG) has a tremendous potential to assist clinicians during the diagnosis of epilepsy. These systems are trained to classify the EEG based on the ground truth provided by the neurologists. So, there should be a mechanism in these systems, using which a system’s incorrect markings can be mentioned and the system should improve its classification by learning from them. We have developed a simple mechanism for neurologists to improve classification rate while encountering any false classification. This system is based on taking discrete wavelet transform (DWT) of the signals epochs which are then reduced using principal component analysis, and then they are fed into a classifier. After discussing our approach, we have shown the classification performance of three types of classifiers: support vector machine (SVM), quadratic discriminant analysis, and artificial neural network. We found SVM to be the best working classifier. Our work exhibits the importance and viability of a self-improving and user adapting computer-assisted EEG analysis system for diagnosing epilepsy which processes each channel exclusive to each other, along with the performance comparison of different machine learning techniques in the suggested system.