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The introduction of Central Bank Digital Currencies (CBDCs) in Pakistan presents a transformative opportunity to enhance the nation's financial landscape by providing a more efficient, inclusive, and secure medium for financial transactions. CBDCs can facilitate cross-border payments, enhance financial inclusion and control for financial crime. However, the success of implementing digital currencies depends very much on society's acceptance of this idea. This study uses a quantitative descriptive design to explore public opinion, awareness and readiness to adopt the Central Bank Digital Currencies in Pakistan. A survey was conducted with respondents from diverse demographic backgrounds to assess their understanding of CBDCs, concern regarding privacy and financial security, and overall willingness to adopt digital currencies issued by the central bank. In this study, the factors that may influence or predict the success of Central Bank Digital Currency in Pakistan's economy are independent variables. The success of CBDC in usage and integration in Pakistan's economy is the dependent variable. Gender and profession are control variables. The analysis that was conducted highlights a generally positive outlook towards CBDC among the survey participants, tempered by notable concerns about trust and sustainability. However, the findings suggest that while there is cautious interest in CBDCs among common Pakistanis, substantial efforts are needed to address the knowledge gap and mitigate concerns about security and privacy. Digital education of the population is one of the key factors in successfully implementing digital currencies in any country, particularly Pakistan. In addition, trust issues remain a critical barrier, especially among those aware of CBDC's benefits. Thus, the results of this study will be useful for policymakers and financial institutions in the context of planning activities for implementing CBDC in Pakistan.

Abstract Background With a wide therapeutic index, efficacy, ease of use, and other neuroprotective and respiratory benefits, caffeine citrate(CC) is currently the drug of choice for preterm neonates (PTNs). Caffeine-induced excessive energy expenditure, diuresis, natriuresis, and other CC-associated potential side-effects (CC-APSEs) result in lower daily-weight gain (WG) in premature neonates. This study aimed to evaluate the risk factors for daily-WG in neonates exposed to different dose regimens of caffeine in ICU. Method This retrospective cohort study included neonates of ≤ 36weeks gestational age (GA) and received CC-therapy. The same participants were followed for data analysis in two postnatal phases: 15–28 and 29–42 days of life (DOL). Based on daily CC-dose, formed group-I (received; standard-doses = 5 mg/kg/day), group-II (received;>5-7 mg/kg/day), and group-III (received;>7 mg/kg/day). Prenatal and postnatal clinical characteristics, CC-regimen, daily-WG, CC-APSEs, and concomitant risk-factors, including daily-caloric intake, Parenteral-Nutrition duration, steroids, diuretics, and ibuprofen exposure, were analyzed separately for group-II and group-III using group-I as standard. Regression analysis was performed to evaluate the risk factors for daily-WG. Results Included 314 PTNs. During 15–28 DOL, the mean-daily-WG(MD-WG) was significantly higher in group-I than group-II [19.9 ± 0.70 g/kg/d vs. 17.7 ± 0.52 p = 0.036] and group-III [19.9 ± 0.70 g/kg/d vs. 16.8 ± 0.73 p 7-10 mg/kg/day (β=-1.36; 95%CI:-1.56,-1.02) were associated with a lower daily-WG. However, during 29-42DOL, this association was present only for > 7-10 mg/kg/day (β=-1.54; 95%CI:-1.66,-1.42). The GA ≤ 27weeks (β=-1.03 95%CI:-1.24, -0.88) was associated with lower daily-WG only during 15-28DOL. During both periods of therapy, higher cumulative-caffeine dose and presence of culture proven sepsis, tachypnea, hyponatremia, and feeding intolerance were significantly associated with lower daily-WG. Conversely, daily kcal intake was found to be linked with an increase in daily-WG in both periods. Conclusion In this study cohort exposure to higher caffeine daily and cumulative doses is associated with lower postnatal daily-WG in PTNs than standard-daily doses, which may be due to its catabolic effects and CC-APSEs.

Although the flourishing of the Internet of Things and artificial intelligence has accelerated the development of wearable smart bioelectronics, heavy reliance on external power remains a problem that needs to be solved. Thermoelectric materials have emerged as a promising solution, efficiently converting body heat into electrical energy to provide a stable and unrestricted power supply for wearables. Moreover, in the field of wearable thermoelectric biosensing, where flexibility is highly demanded, hydrogels with excellent electrical conductivity, flexibility and biocompatibility through structural and compositional optimization have become ideal materials for constructing biosensors and meet the diverse application needs of wearable bioelectronics. This article systematically reviews the latest research progress on thermoelectric gels for self-powered wearable biosensing, including the principles of thermoelectric operation, as well as the preparation, design, and application of thermoelectric hydrogels. The current state of thermoelectric gel-based wearable applications in the fields of temperature sensing, strain sensing, temperature-strain synergistic sensing, respiratory monitoring, and sweat analysis are displayed in the article. Finally, the paper summarizes the current challenges and prospects of thermoelectric gels in self-powered wearable bioelectronics, encouraging the rapid application and realization of thermoelectric gel-based smart wearables.

During January and February 2022, a huge spike in the cases of COVID-19 was recorded in the Khyber Pakhtunkhwa (KP) province of Pakistan prompting the civil administration to institute new restrictions. To investigate the underlying causes of this surge, the regional Public Health Reference Lab (PHRL) launched a screening effort throughout the Province’s remote and urban areas. Herein, we present our survey results during the peak months of the pandemic. The data indicated the prevalence of highly transmissible delta- and Omicron-like virus variants, which may explain the rise in positive cases. Phylogenetic analysis revealed the genetic association between the sequences from this study and those found in Pakistan as well as from geographically distant countries, suggesting a complex evolutionary history. For screening, we deployed an easy-to-use single primer-based polymerase chain reaction (PCR) assay to identify the circulation of SARS-CoV-2. The assay was validated using clinical swabs of COVID-19 patients and obtained consistent results with Sanger sequencing. Our survey identified a patient simultaneously infected with two variants of concern, indicating the presence of the Deltacron variant, although we cannot discount the possibility of sequencing errors. We recommend that SARS-CoV-2 be continuously monitored to detect single nucleotide polymorphisms (SNPs) that are causally linked to the emergence of new lineages. Our method provides a rapid and cost-effective detection assay for SARS-CoV-2 in a resource-constrained setting.

Abstract: As it stands, Spigelian hernias are rare and generally overlooked or misdiagnosed. We report a case in which a Spigelian hernia presented to us as a painless abdominal swelling in a 39 year old obese female with no known co-morbids The hernia appeared as swelling in the right lower quadrant, which was non tender at the time of admission and showed no signs of strangulation. Diagnosis of the hernia was made on CT-scan and an open technique was adapted to repair it. The post op period was insignificant in the patient. Key Words: Spiglelian Hernia, Hernia, Spigelian Fascia Defect.

Background and purposeWe proposed an artificial neural network model to predict radiobiological parameters for the head and neck squamous cell carcinoma patients treated with radiation therapy. The model uses the tumor specification, demographics, and radiation dose distribution to predict the tumor control probability and the normal tissue complications probability. These indices are crucial for the assessment and clinical management of cancer patients during treatment planning.MethodsTwo publicly available datasets of 31 and 215 head and neck squamous cell carcinoma patients treated with conformal radiation therapy were selected. The demographics, tumor specifications, and radiation therapy treatment parameters were extracted from the datasets used as inputs for the training of perceptron. Radiobiological indices are calculated by open-source software using dosevolume histograms from radiation therapy treatment plans. Those indices were used as output in the training of a single-layer neural network. The distribution of data used for training, validation, and testing purposes was 70, 15, and 15%, respectively.ResultsThe best performance of the neural network was noted at epoch number 32 with the mean squared error of 0.0465. The accuracy of the prediction of radiobiological indices by the artificial neural network in training, validation, and test phases were determined to be 0.89, 0.87, and 0.82, respectively. We also found that the percentage volume of parotid inside the planning target volume is the significant parameter for the prediction of normal tissue complications probability.ConclusionWe believe that the model has significant potential to predict radiobiological indices and help clinicians in treatment plan evaluation and treatment management of head and neck squamous cell carcinoma patients.

Background and objective: Chronic anal fissure is a common health problem related to high morbidity. The chemical option for treating chronic anal fissures is highly preferred. Methods: A clinical prospective comparative study was carried out in the General Surgery Outpatient Department in Rizgary Teaching Hospital, Erbil, KRG, during the period from January 2019 to December 2021,on a sample of 100 patients randomly recruited patients with chronic anal fissures divided into two groups with 50 participants each: the DTZ group, who received 2% diltiazem ointment, and the GTN group, who used 0.2% glyceryl trinitrate ointment twice daily for 6 consecutive weeks. The aim of the study is to compare the efficacy and effects of topical Diltiazem (DTZ) and topical glyceryl trinitrate (GTN) in the management of chronic anal fissures. Results: There was a highly significant association between fissure healing at the 4th week and patients treated with DTZ (P

Background: Wilms Tumor (WT) is a highly curable cancer if treatment is appropriate and timely. The outcomes and prognostic factors in a large low- and middle-income country (LMIC) tertiary center were assessed. Materials and methods: Retrospective review of data of all patients, 0–15 years diagnosed between 2010 and 2020 with WT. Kaplan Meier curves were used for survival analysis, and the chi-square test was used for multivariate analysis. Results: Of the 40 patients enrolled (median age: 38 months) in the cohort, 10 had metastatic disease. The most common site of metastasis was lungs (6/10). Nine (22.5%) abandoned treatment. Large tumor (>500 ml) volume was found in half the patients at diagnosis. The majority of patients were treated per the SIOP approach. Out of 34 who went for surgery, 31 received neoadjuvant chemotherapy with tumor shrinkage to less than 500 ml in 26/31 (80%). Maximum tumor shrinkage was observed in the SIOP low-risk group (p

Groundwater pollution is now a significant threat to the ecosystem. The untreated disposal of municipal and industrial wastes through drains into water bodies (rivers, lakes, and canals) is the primary source of contamination. The highly contaminated water harms individual health. In this study, total dissolved solids (TDS) and arsenic (As) mobilization were explored depthwise from a drilled borehole at main Raiwind Road, Thokar Niaz Baig, near River Ravi, Lahore. The concentrations of TDS and As in the aquifer indicate that the top shallow aquifer bearing high salts occurred due to local inputs of waste effluents discharged into the River Ravi. In contrast, at deep shallow aquifers, enrichment of As with elevated pH results from the geochemical oxidative dissolution process. The results showed that natural and anthropogenic activities influence groundwater throughout the depth. The TDS and As concentrations were found above the World Health Organisation (WHO) guideline values at some depth intervals, which are harmful to human health. HIGHLIGHTS Depthwise evaluation of total dissolved solids and arsenic from drilled borehole is performed.; Concentration of TDS and arsenic varied from shallow to deep groundwater.; Groundwater quality is changing due to natural and anthropogenic activities.;

Habenaria aitchisonii Reichb was analyzed in this research, including its chemical composition and its in vitro antioxidant, anti-inflammatory, acute oral toxicity, and antinociceptive activity. The chloroform and ethyl acetate fractions were found to be the most powerful based on in vitro antioxidant, anti-inflammatory, and analgesic assays. The acute oral toxicity of the crude methanolic extract was determined before in vivo studies. The acetic acid and formalin tests were used to measure the antinociceptive effect, and the potential mechanisms involved in antinociception were explored. The carrageenan-induced paw edema test was used to examine the immediate anti-inflammatory effect, and many phlogistic agents were used to determine the specific mechanism. Furthermore, for ex vivo activities, the mice were sacrificed, the forebrain was isolated, and the antioxidant levels of glutathione (GSH), superoxide dismutase (SOD), thiobarbituric acid reactive substances (TBARS) and catalase (CAT) were estimated using a UV spectrophotometer. No toxicity was seen at oral dosages up to 3,000 mg/kg. The antinociceptive impact was much higher than the standard drug. Both the inflammatory and neurogenic phases of the formalin experiment revealed an analgesic effect in the chloroform and ethyl acetate fractions. In carrageenan anti-inflammatory assays, the chloroform fraction (Ha.Chf) was the most potent fraction. We further studied the GC-MS of crude plant extract and found a total of 18 compounds. In the anti-inflammatory mechanism, it was observed that the Ha.Chf inhibits the COX-2 as well as 5-LOX pathways. The results exhibited that this species is a good source of phytocomponents like germacrone, which can be employed as a sustainable and natural therapeutic agent, supporting its traditional use in folk medicine for inflammatory conditions and pain.

The strong ethnopharmacological utilization of Isodon rugosus Wall. Ex. Benth is evident in the treatment of several types of pain and inflammation, including toothache, earache, abdominal pain, gastric pain, and generalized body pain and inflammation. Based on this background, the antinociceptive effects of the crude extract, various fractions, and essential oil have been reported previously. In this research work, we isolate and characterize pure bioactive compounds from I. rugosus and evaluate possible mechanisms using various in vivo and in vitro models. The pure compounds were analyzed for analgesic and anti-inflammatory activities through various assays. The column chromatography of the chloroform fraction of I. rugosus led to the identification of two pure compounds, i.e., 1 and 2. Compound 1 demonstrated notable inhibition (62% writhing inhibition, 72.77% COX-2 inhibition, and 76.97% 5-LOX inhibition) and anti-inflammatory potential (>50% paw edema inhibition at various intervals). The possible mechanism involved in antinociception was considered primarily, a concept that has already been elucidated through the application of naloxone (an antagonist of opioid receptors). The involvement of adrenergic receptors was investigated using a hot plate model (an adrenergic receptor antagonist). The strong ethnomedicinal analgesic background of I. rugosus, supported by previous reports and current observations, leads to the conclusion that I. rugosus is a potential source of antinociceptive and anti-inflammatory bioactive compounds. It may be concluded from the results that the isolated analgesic compounds of I. rugosus may be a possible alternative remedy for pain and inflammation management with admirable efficacy and safety profiles.

Background. Abnormal uterine bleeding is a broad term involving various irregularities of the menstrual cycle. Previously various terms were used to define abnormalities in menstrual bleeding. To create a universally accepted system of nomenclature, the Federation of Obstetrics and Gynecology proposed the new terminology PALM-COIEN. The current study is aimed to classify cases of abnormal uterine bleeding as per PALM-COEIN. Materials and Methods. It is a retrospective, observational study using the data from 110 patients, who underwent hysteroscopic evaluation and endometrial biopsy and were categorized based on PALM-COIEN. Patients were grouped under these categories after detailed history, examination, investigations, hysteroscopic findings, and histopathology. Results. Polyp was the commonest group (n=45, 40.9%) in our study, which was followed by leiomyoma (n=30, 27.27%), ovulatory disturbances (n=28, 25.45%), adenomyosis (n=5, 4.54%), malignancy (n=2, 1.81%) respectively. Conclusions. Hysteroscopic evaluation is a simple and useful tool to find out the structural pathologies of PALM-COIEN classification. Further histopathological confirmation of clinical diagnosis can enhance the diagnosis and treatment modalities.

Hepatitis C virus (HCV) infection is a significant global health concern, prompting the need for effective treatment strategies. This in-depth review critically assesses the landscape of HCV treatment, drawing parallels between traditional interferon/ribavirin therapy historically pivotal in HCV management and herbal approaches rooted in traditional and complementary medicine. Advancements in therapeutic development and enhanced clinical outcomes axis on a comprehensive understanding of the diverse HCV genome, its natural variations, pathogenesis, and the impact of dietary, social, environmental, and economic factors. A thorough analysis was conducted through reputable sources such as Science Direct, PubMed, Scopus, Web of Science, books, and dissertations. This review primarily focuses on the intricate nature of HCV genomes and explores the potential of botanical drugs in both preventing and treating HCV infections.

People living with HIV experience psychosocial needs that often are not addressed. We designed an innovative low-resource model of phone-based psychosocial counseling (P-PSC). We describe cohort characteristics, acceptability, feasibility and utilization of P-PSC at health facilities supported by Baylor Foundation Malawi. Staff were virtually oriented at 120 sites concurrently. From facility-based phones, people with new HIV diagnosis, high viral load, treatment interruption or mental health concerns were referred without identifiable personal information to 13 psychosocial counselors via a WhatsApp group. Routine program data were retrospectively analyzed using univariate approaches and regressions with interrupted time series analyses. Clients utilizing P-PSC were 63% female, 25% youth (10–24 y) and 9% children (