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Thyroid eye disease (TED), also known as thyroid-associated ophthalmopathy, is an autoimmune disorder caused due to a complex interplay between autoantigens including the thyroid-stimulating hormone receptor and the insulin-like growth factor-I receptor. TED is characterized by progressive proptosis or diplopia. This systematic review aimed to compare the efficacy of the newer monoclonal antibody – teprotumumab and intravenous methylprednisolone (IVMP) in TED patients. We performed a systematic review of previously published studies from 2013 to June 2023. A total of 329 articles were screened; among them, 111 non-duplicate publications were identified. After the screening of titles and abstracts, 156 publications were excluded; then, another 47 published papers were excluded after the full-text screening. The remaining 15 eligible studies were included in this systematic review. The majority of studies used either teprotumumab alone or in combination with others. Among 15 studies, eight studies used teprotumumab in TED patients, whereas remaining 7 studies used a standard treatment regimen. This systematic review provides an overview of the existing treatment options using monoclonal antibody – teprotumumab and IVMP in TED patients. The overall assessment provides a finding that antibody – teprotumumab is is a good choice compared to conventional IVMP for providing better outcomes in patients with TED.

Abstract Background Linezolid-resistant Enterococcus faecium (LRE) is a global priority pathogen. Thirteen LRE were reported from clinical specimens between November 2021 and April 2023 at two laboratories in Karachi, Pakistan. We aimed to investigate the strain types and genes associated with linezolid resistance among these isolates. Whole genome sequencing (WGS) was performed and analyzed by multilocus sequence typing (MLST). The presence of linezolid resistance genes was identified using ResFinder v4.1.11 and the LRE-finder tool. Results Twelve isolates belonged to clonal complex 17 (CC17); ST80 (n = 10), ST612 (n = 1) and ST1380 (n = 1). Six isolates showed the presence of optrA gene and G2576T mutations in the 23S rRNA gene, while six showed poxtA and cfr(D) genes. One isolate showed the combination of optrA, cfr(D) and poxtA genes. Conclusion Our findings show the circulation of CC17 sequence types with a known outbreak potential and we identified molecular mechanisms of resistance that were not previously reported from Pakistan.

The current digital innovation, health crisis, together with catastrophic economic and financial events have disturbed both digital and conventional asset markets that caused drastic change in investment avenues. Therefore, the purpose of this study is to investigate the connectedness between Non-Fungible Token (NFTs), Decentralized Finance (DeFi) assets, and housing market by applying Quantile connectedness of Ando et al. [27]with extreme tail of distribution technique. The period of this study is extended from 5th March 2018 to 8th January 2024 which covered recent catastrophic events such as Bitcoin Price Crash-2018, COVID-19, Global plummet in Oil Demand-2020, and Russia-Ukraine War. The findings reveal that NFTs and DeFi assets possess weak connectedness with housing market in normal market state, however, connectedness become robust in extreme bearish and bullish market states. Moreover, NFTs and DeFi assets are net transmitters and housing market acts as net receiver of shock in all market states. Investors, portfolio managers, and policymakers should carefully analyze both digital financial assets and housing market especially during extreme events to build well diversified profit-gaining portfolios and to formulate policies.

Carbazole is a heterocyclic aromatic organic compound that has vast applications in pharmaceuticals, and in biological and material sciences. Carbazole derivatives show various biological activities such as antibiotic, anti-inflammatory, anti-tumor and anti-oxidant activities etc. Synthesis of N-arylated carbazoles has become a major area of interest for scientists due to their applications in organic light-emitting diodes, dye-sensitized solar cells, and other organic electronics. The N-arylated carbazoles have unique properties such as high thermal stability, wide band gap, and excellent electrical and optical properties. The methods used for the N-arylation of carbazoles include transition metal-catalyzed reactions and metal-free reactions. The most common and classical methods for the N-arylation of carbazoles are copper-catalyzed Ullmann coupling reactions, while palladium, nickel, and iron catalysts are also used. This review focuses on all the synthetic methods used for the N-arylation of carbazoles and their applications.

Plant extract-mediated fabrication of metal nanocomposites is used in cell proliferation inhibition and topical wound treatment, demonstrating significant effectiveness. Salvia hispanica L. (chia) seed extract (CE) is used as the reaction medium for the green fabrication of ecofriendly ZnO(CE) nanoparticles (NPs) and Ag/Ag2O(CE) and ZnO/Ag/Ag2O(CE) nanocomposites. The resultant nanoparticles and nanocomposite materials were characterized using UV–visible, Fourier-transform infrared (FTIR) spectroscopy, scanning electron microscopy (SEM), X-ray diffraction (XRD), and energy-dispersive X-ray (EDX) techniques. In the context of antioxidant studies, ZnO/Ag/Ag2O(CE) exhibited 57% reducing power and 86% 2,2, diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging. All three materials showed strong antibacterial activity against Staphylococcus aureus (S. aureus), Escherichia coli (E.coli), and Bacillus subtilis (B. subtilis) bacterial strains. Additionally, ZnO(CE), Ag/Ag2O(CE), and ZnO/Ag/Ag2O(CE) also revealed 64.47%, 42.56%, and 75.27% in vitro Michigan Cancer Foundation-7 (MCF7) cancer cell line inhibition, respectively, at a concentration of 100 μg/mL. Selectively, the most effective composite material, ZnO/Ag/Ag2O(CE), was used to evaluate in vivo wound healing potential in rat models. The study revealed 96% wound closure in 10 days, which was quite rapid healing compared to wound healing using clinically available ointment. Therefore, in conclusion, the ZnO/Ag/Ag2O(CE) nanocomposite material could be considered for further testing and formulation as a good anticancer and wound healing agent.

Nano-networks are envisioned to allow several nanoscale devices to transmit and receive information. One form of such networks is electromagnetic nano-networks working within the THz band. However, high overall path loss and molecular noise experienced in the THz band, as well as limited energy storage capabilities, restrict the communication range of nano-nodes and impact network efficiency. Therefore, optimizing the nano-network resources is necessary. In this paper, we present an optimization framework employing mixed-integer linear programming (MILP) to determine the most energy-efficient routing, bandwidth, and sub-band allocation for each nano-node in an electromagnetic nano-network operating within the THz band. Our model was tested for two different scenarios related to the priority of energy saving. We also compare our proposed optimal bandwidth, routing, and sub-band allocation against less complex designs where sub-bands with fixed bandwidth are employed in nano-nodes. Furthermore, we investigate the impact of nano-node’s processing and sensing units on the overall network energy consumption and the associated optimal bandwidth allocation and routing strategy. Given the considered parameters and the model’s assumptions, the results show that using the optimal multi-hops paths with higher bandwidth allocation for the considered sub-bands can be more energy efficient than sending the traffic using a single hop and lower bandwidths, especially when the transmission power dominates in the nano-network. On the other hand, when the processing and sensing unit’s energy consumption is dominant, then single hop schemes with lower bandwidth allocation result in the minimum network energy consumption. Finally, we discuss the limitations of the proposed energy-efficient strategies and point toward possible future research directions to which the model can be adapted.

Recent advances in Generative Adversarial Networks (GANs) have produced synthetic images with high visual fidelity, making them nearly indistinguishable from human-created images. These synthetic images referred to as deepfakes, have become a major source of misinformation due to social media. Technology is advancing rapidly, so reliable methods for distinguishing real from fake images are needed. The current detection mechanisms require image forensics tools such as error level analysis (ELA), and clone detection to detect manipulated images. These approaches are limited because they require forensics expertise to use, are manual in application nature, and are unscalable, creating a need for a framework for a scalable tool that experts and non-experts can use to combat the spread of manipulated images and preserve digital visual information authenticity. We approach this problem with a multi-model ensemble framework using the transfer learning method to effectively detect fake images. The proposed approach named Multi-Model GAN Guard (MMGANGuard)integrates four models into an ensemble framework to identify GAN-generated image characteristics to improve deepfake detection. The Gram-Net architecture, ResNet50V2, and DenseNet201 models are used with co-occurrence matrices using transfer learning for MMGANGuard. Through comprehensive experiments, the proposed model demonstrates promising results in detecting the deepfake with high accuracy on the StyleGAN dataset. For automated detection of deepfake-generated images, the proposed model exceeded 97% accuracy, 98.5% TPR, 98.4% TPR, and 95.6% TPR in these evaluations, eliminating the need for manual assessment which is promising for future research in this domain.

Tiny machine learning (TinyML) is a promising approach to enable intelligent applications relying on Human Activity Recognition (HAR) on resource-limited and low-power Internet of Things (IoT) edge devices. However, designing efficient TinyML models for these devices remains challenging due to computational resource constraints and the need for customisation to unique use cases. To address this, we propose a novel approach that utilises transfer learning (TL) techniques on edge micro-controller units (MCUs) to accelerate TinyML development. Our strategy involves pre-training generalised ML models on large-scale and varied datasets and fine-tuning them on-device for specific applications using TL. We demonstrate the effectiveness of our approach for HAR by experimenting with a convolutional neural network, long short-term memory TL (CNN-LSTM-TL) model architecture and visualisation techniques like t-distributed stochastic neighbour embedding (t-SNE) for dimensionality reduction. To further validate our model’s proficiency and adaptability, we conducted extensive testing using two distinct datasets: MotionSense and UCI. This dual-dataset approach allowed us to assess the robustness of our model across different data domains, showcasing its versatility and effectiveness in various HAR scenarios. Our results show significant model accuracy and reduced training time while maintaining high inference rates and low MCU memory footprint. We also provide insights into best practices for implementing TL on edge MCUs and evaluate classification performance metrics such as accuracy, precision, recall, F1 score, and categorical cross-entropy loss. Our work lays a solid foundation for faster and more efficient TinyML deployments through TL framework across different application domains and types of edge IoT devices.

Introduction: In response to the observed increase in junior doctors voluntarily extending their working hours, a quality improvement project (QIP) was initiated to explore the qualitative aspects of overtime and gain real-time insights into their experiences and work patterns. Junior doctors face amplified stressors due to professional demands, role uncertainties, relatively modest compensation considering their extensive training, inadequate leadership or support, and the pressures of meeting assessment and training requirements 1 .Consequently, they are susceptible to burnout and have an elevated risk of developing depression and anxiety2. Tens of thousands of junior doctors are working past the end of their shifts because hospitals are so understaffed, as per NHS3. Materials and methods: Cycle 1 of the QIP was conducted from 3–10 November 2023, revealing that 70% of junior doctors reported extensions beyond 45 minutes. Concurrently, staffing shortages were identified, with 37% of junior doctors experiencing inadequate staffing levels on five or more occasions during the study week. Subsequently, interventions were implemented, including improvements in staffing levels, introduction of morning handovers, and adherence to consultant ward round schedules. A tailored data collection form was utilised to capture details of overtime occurrences, causes, and workload assessments. Data for Cycle 2 was collected from 26 January – 2 February 2024. Analysis involved utilising bar graphs for comparison and descriptive statistics to understand trends and factors influencing extended working hours. Confidentiality and voluntary participation were ensured, with ethical approval obtained prior to the study. Results and discussion: Results from Cycle 2 of the audit indicated significant improvements following the implementation of interventions. There was a marked decrease in the proportion of junior doctors exceeding their scheduled hours, with only 40% reporting extensions beyond 45 minutes compared to 70% in Cycle 1. Additionally, the percentage of junior doctors experiencing inadequate staffing levels on five or more occasions during the study week decreased from 37% to 9%. Consultant adherence to allocated round times also improved, with only 41% of the time not adhered to in Cycle 2 compared to 71% in Cycle 1. Notably, attendance at scheduled development times increased, with 72% of participants attending in Cycle 2 compared to 40% in Cycle 1. Conclusion: However, limitations of the study include the need for further exploration into individual factors contributing to overtime. Moving forward, continued monitoring and evaluation will be necessary to sustain these improvements and identify any additional areas for enhancement. Overall, this QIP has provided valuable insights into optimising junior doctors' working conditions and highlights the importance of proactive interventions in promoting a healthier and more sustainable work environment within healthcare settings.

Background/Objectives: As a primary source of mortality and disability, bacterial infections continue to develop a severe threat to humanity. Nuclear medicine imaging (NMI) is known for its promising potential to diagnose deep-seated bacterial infections. This work aims to develop a new technetium-99m (99mTc) labeled tigecycline radiopharmaceutical as an infection imaging agent. Methods: Reduced 99mTc was used to make a coordinate complex with tigecycline at pH 7.7–7.9 at room temperature. Instantaneous thin-layer chromatography impregnated with silica gel (ITLC-SG) and ray detector equipped high-performance liquid chromatography (ray-HPLC) was performed to access the radiolabeling yield and radiochemical purity (RCP). Results: More than 91% labeling efficiency was achieved after 25 min of mild shaking of the reaction mixture. The radiolabeled complex was found intact up to 4 h in saline. Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) infection-induced rats were used to record the biodistribution of the radiopharmaceutical and its target specificity; 2 h’ post-injection biodistribution revealed a 2.39 ± 0.29 target/non-target (T/NT) ratio in the E. coli infection-induced animal model, while a 2.9 ± 0.31 T/NT value was recorded in the S. aureus bacterial infection-induced animal model. [99mTc]Tc-tigecycline scintigraphy was performed in healthy rabbits using a single photon emission computed tomography (SPECT) camera. Scintigrams showed normal kidney perfusion and excretion into the bladder. Conclusion: In conclusion, the newly developed [99mTc]Tc-tigecycline radiopharmaceutical could be considered to diagnose broad-spectrum bacterial infections.

Abstract Background Enterococcal bacteremia has become prevalent in the recent decade, especially in hospitalized patients. Moreover, the rise in resistance patterns against antibiotic drugs regarding enterococci infection, such as cephalosporins, ampicillin and vancomycin, is prevailing. The major driving force behind this is the incongruous use of antibiotics with a minor contribution from environmental stressors which calls for vigilant and prudent administration of evidence-based antibiotics. Methods A retrospective study was conducted from January 1 2017 until December 31 2021, at the tertiary care center, Dr Ziauddin Hospital in Karachi, Pakistan. Results Our research revealed ampicillin resistance in 87 (63.5%), with an estimated 25 (18.8%) mortality. Male gender 19 (76%) and vancomycin resistance 13 (52%) were associated with increased mortality. Furthermore, appropriate antibiotic therapy reduced the risk of death compared with inappropriate and excessive use of antibiotics 10 (40%) vs. 15 (60%) vs. 20 (80%) respectively. Targeted therapy with amoxicillin/clavulanic acid was associated with lower mortality 1 (4%) and higher discharge rates 34 (32.1%). On Kaplan-Meier survival, targeted therapy with amoxicillin/clavulanic acid was associated with shorter hospital stays and prolonged survival. UTI was found as the most common source of enterococcal bacteremia 57 (41.6%), followed by respiratory 21 (15.3%) and intra-abdominal 13 (9.5%). In 26 (19%) patients, no identifiable source of infection was found. Conclusion Vancomycin resistance and male gender were found independent risk factors for mortality. The use of inappropriate antibiotics significantly increases mortality in these patients. The appropriate antibiotic therapy reduces the risk of death. Furthermore, overuse of antibiotics didn’t reduce mortality; instead increased the financial burden and chances of developing multi-drug resistant strains of other organisms by increasing hospital stays of patients.

Feline mammary carcinoma (FMC) is a prevalent aggressive malignancy in cats, characterized by a poor prognosis and limited treatment options beyond mastectomy. This review explores the significance of various protein biomarkers, including HER2, BCL-2, RON, Ki 67, and COX-2, in diagnosing and treating FMC in cats. Early diagnosis and treatment due to the aggressive nature of FMC is important, which often leads to limited therapeutic options and poor responses in later stages. Biomarkers play a crucial role in improving diagnostic accuracy, guiding therapeutic decisions, and monitoring disease progression in cats with FMC. The review highlights the potential of biomarkers to revolutionize diagnostic approaches in veterinary clinics, offering a more targeted and effective strategy for managing feline mammary carcinomas.

The Asian region of earth has a rich agriculture system that provides extensive opportunities to boost pharmaceutical and nutritional research to address the use of food crops for health benefits and potential clinical applications. The traditionally cropped green leaf vegetable indigenously known as Bathu and botanically known as Chenopodium album (C. album) is traditionally used as a sedative, blood purifier, hepatoprotectant, diuretic, and antiscorbutic laxative. In this study, we investigated the anti-infection potential, anti-diabetic potential, and mineral composition of indigenously cultivated C. album plant extracts. Methanol and n-hexane solvents were used to extract phytochemicals at different extraction conditions. The maximum yield of 12.72 ± 0.36 g/100 g extract was obtained in methanol with 200 rpm shaking, 200 mL solvent, and an 8 h extraction period. Under the same conditions, n-hexane gave 2.09 ± 0.29 g/100 g extract. Good alpha-amylase inhibition efficiency was shown by the n-hexane extracts, while the methanol extracts showed good urease inhibition potential. The H6 extract had the lowest IC50 (8.16 ± 0.2 ug/mL) as compared to the standard acarbose (9.27 ± 0.6 ug/mL). Similarly, the M6 extract revealed a significant urease inhibitory potential, i.e., IC50 of 18.77 ± 0.6 ug/mL, which was close to the standard thiourea (IC50: 19.09 ± 0.7 ug/mL). Regarding the antibacterial study, the M6 extract showed 16.55 ± 0.57 mm ZOI against E. coli and 15.54 ± 0.55 mm in the case of S. aureus, as compared to the standard ciprofloxacin, which showed 26.08 ± 0.73 mm, and penicillin, which showed 21.12 ± 0.81 mm ZOI. Mineral profiling was investigated by ICP-OES, which showed significant amounts of Mg and Fe in all extracts. Our findings tend to show that systematic harvesting and utilization of this vegetable crop could be recommended as an alternative nutritional therapy in the management of internal infections and diabetes.

Objective: To determine IV Ondansetron efficacy in preventing post-spinal shivering during LSCS. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anaesthesiology, Combined Military Hospital, Rawalpindi Pakistan, from Sep 2018 to Mar 2019. Methodology: A total of 60 women undergoing LSCS under spinal anaesthesia were included. Group-A was given 8 mg/4 ml Ondansetron, while Group-B was given 4 ml Normal Saline 0.9% IV immediately before induction of spinal anaesthesia. Body temperature, level of sensory block, and shivering scores during the peri-operative period were recorded. After surgery, patients were shifted to Post Anaesthesia Care Unit (PACU). Shivering was graded using Crossley and Mahajan 5-item scale. Injection Tramadol 1mg/kg intravenously was used as a rescue anti-shivering drug. Results: The majority of the patients 33(55.0%) were between 18-25 years of age. Efficacy of Intravenous Ondansetron in preventing post-operative shivering during spinal anaesthesia in patients undergoing caesarean section was seen in 26 86(67%) patients (Group-A) as compared to 17(56.67%) patients in the Control Group (Group-B) (p-value=0.010). Conclusion: The study concluded that there was less post-operative shivering with intravenous Ondansetron during spinal anaesthesia in patients undergoing caesarean section as compared to the Control Group.

Objective: To determine the dose of Protamine required for reversal of Heparin effect in Coronary Artery Bypass Grafting (CABG). Study Design: Quasi-experimental study. Place and Duration of Study: Adult Cardiac Surgery Unit, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from May to Dec 2022. Methodology: Total 382 patients were included in this study through consecutive sampling and were divided into two groups (n=191 participants in each group). After induction of anesthesia, baseline Activated Clotting Time (ACT) was measured. About 300units/kg of unfractionated Heparin was given non-randomly before establishing Cardiopulmonary Bypass (CPB). After termination of CPB, Protamine was administered in doses of 1 mg/kg and 1.5 mg/kg to Group-A and Group-B respectively. Protamine was diluted in 20ml of saline, and administered at a rate of 100ml/hr. Once Protamine was administered, blood sample was taken after 5min for ACT measurement. If this ACT was within 10% of baseline, it was taken as sign for reversal of Heparin effect. Student t-test and Chi-square test were applied to compare the groups and level of significance taken was p

Objective: To compare the effectiveness of combining Magnesium Sulphate with Amiodarone vs Magnesium Sulphate to prevent cardiac arrhythmias in Coronary Artery Bypass Grafting (CABG) patients. Study Design: Quasi-Experimental Study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan, from Jul 2022 to Mar 2023. Methodology: Two hundred and sixty-two (n=262) Coronary Artery Bypass Graft patients, eligible for the study, were enrolled through consecutive sampling and divided into group A - experiment group (3 mg/kg amiodarone+30 mg/kg magnesium sulphate was given, n1=131) and group B- control group (30 mg/kg magnesium sulphate was given, n2=131) by non-random allocation lottery method at the removal of the aortic cross-clamp. The statistical package for social science, SPSS version 26:00 was used to analyse the data. Mean±SD was calculated for continuous variables whereas for categorical variables, percentages and frequencies were calculated. Chi-square test was utilized to find the association and student t-test was applied to find the mean difference between the study groups. Results: Study participants consisted of 194(74.1%) males and 68(26.0%) females. The patients' mean age was 57.29±9.88 years and 58.30±10.69 years respectively, in group-A and group-B. The frequency of pre and post-operative cardiac dysrhythmias was considerably different in both groups. In group-A, 22(16.7%) patients developed dysrhythmias, while in control group,dysrhythmias occurred in 49 (37.4%) patients (p-value

The phenomenon of climate change has become a global challenge that affects human activities in many ways. Exploring the sustainability and innovativeness of digital education is an important reference for the further implementation of science and education strategies and positive effects on climate change mitigation. This study designed two questionnaires for basic and tertiary education to address variability in education and collected 523 samples for basic education and 412 samples for tertiary education respectively. Using digital teaching practices and digital teaching quality as mediators, structural equation modelling (SEM) was used to examine the impact of digital education on sustainability and innovation in education. Research shows that digital teaching and learning in basic and higher education can significantly contribute to the two-way development of educational sustainability and innovation, through digital teaching and learning practices. Digital teaching practice and digital teaching quality in higher education play a complete mediating role, while basic education only plays a partial mediating role. Higher education emphasizes digital teaching and learning practice processes and teaching quality, and most students hope that online teaching and learning can be further integrated with offline education to form a new model of education. This study will help government departments understand the pedagogical reality of digital education at a deeper level and provide ideas for the subsequent sustainable development and educational innovation of digital teaching. It can also provide new ideas for climate change mitigation and sustainable development.

Cholesterol granuloma is a chronic foreign-body inflammatory response that is often seen in the middle ear, mastoid antrum, and petrous apex. However, it can also occur in other anatomical locations, including the orbit. A 34-year-old male presented with painless nonaxial proptosis of the left eye, and imaging revealed a well-defined intraorbital extraconal lesion consistent with an orbital cholesterol granuloma. The pathogenesis of this rare cystic condition is unknown, but trauma and inadequate airflow through pneumatized temporal bone air cells have been proposed as potential triggers. Treatment involves total excision of the granuloma with careful removal of residual tissue adherent to the bone and the periosteum to minimize the risk of recurrence. Cholesterol granulomas usually have a good prognosis.

The rapid growth of Internet of Things (IoT) devices has generated vast amounts of data, leading to the emergence of federated learning as a novel distributed machine learning paradigm. Federated learning enables model training at the edge, leveraging the processing capacity of edge devices while preserving privacy and mitigating data transfer bottlenecks. However, the conventional centralized federated learning architecture suffers from a single point of failure and susceptibility to malicious attacks. In this study, we delve into an alternative approach called decentralized federated learning (DFL) conducted over a wireless mesh network as the communication backbone. We perform a comprehensive network performance analysis using stochastic geometry theory and physical interference models, offering fresh insights into the convergence analysis of DFL. Additionally, we conduct system simulations to assess the proposed decentralized architecture under various network parameters and different aggregator methods such as FedAvg, Krum and Median methods. Our model is trained on the widely recognized EMNIST dataset for benchmarking handwritten digit classification. To minimize the model’s size at the edge and reduce communication overhead, we employ a cutting-edge compression technique based on genetic algorithms. Our simulation results reveal that the compressed decentralized architecture achieves performance comparable to the baseline centralized architecture and traditional DFL in terms of accuracy and average loss for our classification task. Moreover, it significantly reduces the size of shared models over the wireless channel by compressing participants’ local model sizes to nearly half of their original size compared to the baselines, effectively reducing complexity and communication overhead.

Federated Learning (FL) presents a mechanism to allow decentralized training for machine learning (ML) models inherently enabling privacy preservation. The classical FL is implemented as a client-server system, which is known as Centralised Federated Learning (CFL). There are challenges inherent in CFL since all participants need to interact with a central server resulting in a potential communication bottleneck and a single point of failure. In addition, it is difficult to have a central server in some scenarios due to the implementation cost and complexity. This study aims to use Decentralized Federated learning (DFL) without a central server through one-hop neighbours. Such collaboration depends on the dynamics of communication networks, e.g., the topology of the network, the MAC protocol, and both large-scale and small-scale fading on links. In this paper, we employ stochastic geometry to model these dynamics explicitly, allowing us to quantify the performance of the DFL. The core objective is to achieve better classification without sacrificing privacy while accommodating for networking dynamics. In this paper, we are interested in how such topologies impact the performance of ML when deployed in practice. The proposed system is trained on a well-known MINST dataset for benchmarking, which contains labelled data samples of 60K images each with a size $28\times 28$ pixels, and 1000 random samples of this MNIST dataset are assigned for each participant’ device. The participants’ devices implement a CNN model as a classifier model. To evaluate the performance of the model, a number of participants are randomly selected from the network. Due to randomness in the communication process, these participants interact with the random number of nodes in the neighbourhood to exchange model parameters which are subsequently used to update the participants’ individual models. These participants connected successfully with a varying number of neighbours to exchange parameters and update their global models. The results show that the classification prediction system was able to achieve higher than 95% accuracy using the three different model optimizers in the training settings (i.e., SGD, ADAM, and RMSprop optimizers). Consequently, the DFL over mesh networking shows more flexibility in IoT systems, which reduces the communication cost and increases the convergence speed which can outperform CFL.

Abstract L-Histidine immobilized montmorillonite is prepared and used as an adsorbent for removal of As(III) from aqueous solutions. The L-Histidine immobilized montmorillonite is characterized by FTIR, XRD, TGA and PZC techniques that confirmed the successful insertion of Histidine into interlayer of montmorillonite structure. The various parameters such as pH, reaction time, temperature, concentration of As(III) and adsorbent dosage are optimized to obtain maximum As(III) adsorption. It is observed that usually the removal of As(III) is increased with increasing the amount of adsorbent, contact time, temperature and till pH 6. The results showed that all these adsorption parameters greatly influenced the adsorption process. The various adsorption isotherm models including Langmuir, Freundlich, Temkin and Dubinin-Radishkevich (DR) as well as kinetics models are applied to the adsorption data. The Langmuir isotherm and pseudo-second order kinetics model are well-fitted to the adsorption data. Further, the probability distribution function (PDF) is applied that verified the adsorption data well while the Akaike’s Information Criterion (AICcorrected) and Absolute Average Relative Deviation (AARD) statistical models supported the best fit adsorption isotherms. The PDF model have provided a good statistical identification of adsorption parameters, adsorption rates and maxima whereas AICcorrected and AARD models revealed the well-fitting of Langmuir adsorption isotherm model in correlating the equilibrium data. Thermodynamic parameters (ΔH, ΔS, ΔG) proved the endothermic and spontaneous nature of adsorption process along with entropical changes occurring at solid-solution interface. The results showed that L-Histidine immobilized montmorillonite is an excellent material for As(III) adsorption with maximum adsorption capacity of 87.7 mg g−1.

Phlomis stewartii is a wild, perennial woody plant used for diverse therapeutic targets. The present work evaluated the influence of independent variables such as extraction time, solvent concentration, and speed in the range of (100 mL, 150 mL, and 200 mL), (2 h, 5 h, and 8 h), and (100 rpm, 150 rpm, and 200 rpm), respectively, on extraction yields, phytochemical components, total phenolic contents (TPC), and total flavonoid contents (TFC) of P. stewartii extract. In the present work, response surface methodology (RSM) was applied to optimize the extraction yield. High-performance liquid chromatography (HPLC) was performed to detect the bioactive constituents of the extracts. The potent extracts were analyzed to study α-amylase and α-glucosidase inhibitory activities. Under the optimized conditions of solvent concentration (200 mL), extraction time (8 h), and speed (150 rpm), the whole plant methanol extract (WPME) showed a maximum extraction yield of 13.5%, while the leaves methanol extract (LME) showed a maximum TPC of 19.5 ± 44 mg of gallic acid equivalent (GAE) per gram of extract and a maximum TFC of 4.78 ± 0.34 mg of quercetin equivalent (QE) per gram of extract. HPLC analysis showed the presence of p-coumaric, gallic acid, quercetin, salicylic acid, sinapic acid, and vanillic acid. LME showed the highest α-amylase inhibitory activity (IC50 = 46.86 ± 0.21 µg/mL) and α-glucosidase inhibitory activity (IC50 value of 45.81 ± 0.17 µg/mL). Therefore, in conclusion, LME could be considered to fix the α-amylase and α-glucosidase-mediated disorders in the human body to develop herbal phytomedicine.

Orbital and adnexal solitary fibrous tumors (SFT) are rare entities. The clinico-radiological and histologic features overlap with those of other spindle cell variants, and hence the use of immunohistochemical stains helps in making an accurate diagnosis. Furthermore, a thorough surgical resection is imperative to prevent tumor recurrences. We report a rare case of SFT arising primarily from the eyelid with multiple recurrences.

SMEs are well-known as the economic backbone of any country. Similarly, in Pakistan, they play a vital role in socio-economic development and income generation. However, some of Pakistan's Food Processing SMEs are reportedly less involved in the country's exports due to their inability to meet the quality of produce required for global markets. Pakistan's food industry is transforming from a traditional food processing system to higher-value-added products due to the demand from lifestyle - and health-conscious customers. This study aims to identify the critical success factors of quality management and analyze their impact on operational performance amongst food-processing SMEs in Pakistan. Previous studies demonstrated that critical Success Factors provide an effective way of focusing strategic direction, and enable management to focus on critical areas. Toward that end a questionnaire was developed and employed for data collection from respondents selected using a snowball sampling technique. A total of 302 food processing SMEs responded the survey. SPSS- Version 23 and Smart-PLS 3 were used for data analysis. It is believed that this study will help food manufacturers in Pakistan to improve their operational performance and product quality by practicing certain critical factors.

In the present report, we have described the case of a significantly delayed presentation of a pseudoaneurysm (PSA) and subsequent mass effect causing an acute deep vein thrombosis (DVT). The patient had presented with a mass in the right groin and edema of the right lower extremity prompting further imaging studies. The imaging studies demonstrated a superficial femoral artery PSA and an acute femoral vein DVT. Our patient had no history of recent trauma or femoral access procedures performed in the last ≥5 years. Surgical repair of the PSA was performed, and the DVT was managed with anticoagulation therapy.

Abstract Reconfigurable intelligent surfaces (RISs) are envisioned to transform the propagation space into a smart radio environment (SRE) to realize the diverse applications of sixth‐generation (6G) wireless communication. By smartly tuning the massive number of elements via controller, an RIS can passively phase‐shift the electromagnetic (EM) waves to enhance the system performance. The absence of radio‐frequency (RF) chains makes RIS an energy‐efficient and cost‐effective solution for future wireless networks. In this paper, the state‐of‐the‐art research on different aspects of RIS‐assisted communication is explored. Specifically, the fundamentals of RIS are first introduced, including the RIS's structure, operating principle, and deployment strategies. The emerging applications of RISs are then comprehensively discussed for 6G wireless networks. In addition, the crucial challenges for RIS‐assisted networks are elaborated, namely, RIS channel state information (CSI) acquisition and passive beamforming optimization. Furthermore, the recent research contributions leveraging the artificial intelligence (AI) based techniques for channel estimation, phase‐shift optimization, and resource allocation in RIS‐assisted networks are presented. Finally, to provide effective guidance for future research, important research directions for realizing RIS‐assisted network are highlighted.

Abstract Background Globally, occupational stress is a common finding among dentists. The present study aimed to assess prevalence of perceived stress among practicing dentists of Karachi, Pakistan, and assess the perceived stress levels according to the professional standing among dental surgeons. Methods A cross-sectional survey was conducted using a convenience sampling technique in which 200 dentists from Karachi were recruited. A self-constructed questionnaire was used to collect data, including demographic and professional backgrounds. Stress level assessment was performed using the perceived stress scale (PSS). Results The response rate was 78.5%. In general, a moderate stress level (mean PSS = 18.35 ± 5.417) appeared in the sample size of 157 dentists, and the prevalence of perceived stress was 86%. The level of perceived stress was significantly lower in groups including 40 years old and above (mean diff; p = − 0.197), Rupees 1 lac (100,000) and more of monthly income (mean diff; p = 0.029), 11 and more years of experience (mean diff; p = 0.001) and Assistant Professor/Associate Professor/Professor (mean diff; p = 0.035). Conclusion All groups representing the senior status of dentists have appeared with lower stress than groups representing the junior status of dentists. Exploratory studies are required to discover an effective coping strategy to deal with occupational stress among the junior dentists of Karachi.

Objective: To evaluate the antioxidant potential and pancreatic lipase inhibitory action of optimized hydroethanolic extracts of Solanum nigrum. Methods: Optimized extraction for maximum recovery of metabolites was performed using a combination of freeze-drying and ultrasonication followed by determination of antioxidant and antiobesity properties. The ultra-high performance liquid chromatography equipped with mass spectrometry was used to analyze metabolite profiling of Solanum nigrum. Computational studies were performed using molecular docking and electrostatic potential analysis for individual compounds. The hypolipidemic potential of the most potent extract was assessed in the obese mice fed on fat rich diet. Results: The 80% hydroethanolic extract exhibited the highest extract yield, total phenolic contents, total flavonoid contents along with the strongest 2,2-diphenyl-1-picrylhydrazyl scavenging activity, total antioxidant power, and pancreatic lipase inhibitory properties. The 80% hydroethanolic extract not only regulated the lipid profile of obese mice but also restricted the weight gain in the liver, kidney, and heart. The 80% hydroethanolic extract also reduced alanine transaminase and aspartate transaminase concentrations in serum. The effects of plant extract at 300 mg/kg body weight were quite comparable with the standard drug orlistat. Conclusions: Solanum nigrum is proved as an excellent and potent source of secondary metabolites that might be responsible for obesity mitigation.

Machine Learning (ML) on the edge is key to enabling a new breed of IoT and autonomous system applications. The departure from the traditional cloud-centric architecture means that new deployments can be more power-efficient, provide better privacy and reduce latency for inference. At the core of this paradigm is TinyML, a framework allowing the execution of ML models on low-power embedded devices. TinyML allows importing pre-trained ML models on the edge for providing ML-as-a-Service (MLaaS) to IoT devices. This article presents a TinyMLaaS (TMLaaS) architecture for future IoT deployments. The TMLaaS architecture inherently presents several design trade-offs in terms of energy consumption, security, privacy, and latency. We also present how TMLaaS architecture can be implemented, deployed, and maintained for large-scale IoT deployment. The feasibility of implementation for the TMLaaS architecture has been demonstrated with the help of a case study.

Objective: To determine the effect of NAC in prevention of post-operative atrial fibrillation in patients undergoing CABG. Study Design: Quasi experimental study. Place and Duration of Study: Adult Cardiac Intensive Care Unit, Armed Forces Institute of Cardiology & National Institute of Heart Diseases (AFIC&NIHD) Rawalpindi during 6 months. Methodology: 146 patients of both gender undergoing elective CABG were included in the study, having age between 30-70 years. However, any patient with history of arrhythmia including AF, thyroid dysfunction, ejection fraction less than 25%, any valvular lesion, dilated left atrium, dilated left ventricle, dilated right atrium, dilated right ventricle or having right atrial tear during surgery were excluded from the study. By using non-probability consecutive sampling, patients were divided into two groups by using envelope method. One group was given standard treatment (control group) while other group was named as NAC group (experimental group). Data analysis was performed using SPSS version-23. Descriptive statistics were reported as Mean±SD. Categorical variables were reported as frequency and percentage. Chi square test and T-test was used to determine association between different variables. Results: A total of 146 patients with mean age 55.27±7.3 yrs. 127(87%) were male and 19(13%) were females. 28(19.2%) patients had atrial fibrillation while 11(7.5%) patients had ventricular premature contractions (VPC). There was no statistically significant difference between ages (p=0.784), gender (p=0.461), AF (p=0.207) and VPC (p=0.347). Out of 73 (50%) patients from each group; the mean age of NAC group was 55.41±7.3 yrs and of control group was 55.08±7.1 yrs (p=0.784). Gender wise distribution of NAC group had 8(11%) females and 65(89%) males while in control group 11(15%) females and 62(85%) were males. AF was found to be 11(15%) and 17(23.3%) in NAC and control group respectively. In NAC group, VPC was 4 (5.5%) and in control group it was 66 (90.4%). Conclusion: This study shows that NAC decreases the frequency of post-operative atrial fibrillation and ventricular premature contractions, but the decrease is statistically insignificant in Pakistani population. However, keeping in view other beneficial effects of NAC, we would recommend more studies on this subject in Pakistani population.

Objective: To determine the frequency of post-operative pulmonary complications after (coronary artery bypass grafting)CABG surgery and to compare the respiratory complications of post COVID and comparison group Study Design: Analytical Cross- sectional study Study Place and Duration: Study was conducted in Adult Intensive Care Unit, Armed Forces Institute of Cardiology,Rawalpindi Pakistan, from Sep 2021 to Mar 2022. Methodology: 40 patients were selected, and divided into two groups using Non-Probability consecutive sampling. Group-A had history of COVID-19 infection and Group-B was a comparison group and had no history of COVID-19 infection. Patients presenting for elective On-Pump (coronary artery bypass grafting) CABG surgery and known history of COVID-19 were included in our study. Patients of age ranging 30 to 70 years irrespective of gender were included in the study. Any patient who had cardiopulmonary bypass time of more than 120 min, respiratory illness like asthma or Chronic Obstructive Pulmonary Disease (COPD), history of smoking, or requiring post-operative re-ventilation due to cardiac or neurological complication, were excluded from the study. After patients were received from Operation theatre, they were monitored for the respiratory complications and both groups were compared. Results: A total of 40 patients were included in this study having mean age 57.9±7.62 years. Most of the patient population was male 31(77.5%) and only 09(22.5%) were female patients. Study population was equally divided into two groups i.e.20(50%) in comparison group and 20(50%) in post COVID-19 group. There was no significant difference in age (p=0.714), ventilation time (p=0.068), gender (p=1.000), and re-ventilation (p=0.451) of both groups. While Intensive Care Unit stay(p=

Ertapenem is a member of carbapenem antibiotics used for the treatment of moderate-to-severe intra-abdominal, urinary tract, acute pelvic, and post-surgical gynecologic infections. The antibacterial activity of ertapenem is mediated through binding to penicillin-binding proteins which results in inhibiting the cross-linking of the peptidoglycan layer of the bacterial cell wall. Therefore, ertapenem can be labeled with technetium-99m (99mTc), a gamma emitter radionuclide, for the diagnosis of deep-seated bacterial infections, such as urinary tract, intra-abdominal, osteomyelitis, and post-surgical gynecologic infections. The labeling procedure was carried out by varying the reaction conditions, such as the amount of the ligand and reducing agent, pH, reaction time and temperature, and radioactivity. At optimized reaction conditions more than 93% 99mTc–ertapenem radioconjugate was obtained. 99mTc–ertapenem was found 90% intact in saline medium up to 6 h, while 88% intact in human blood serum up to 3 h. Biodistribution study showed target-to-non-target ratios of 2.91 ± 0.19, 2.39 ± 0.31, and 1.23 ± 0.22 in S. aureus, E. coli, and turpentine oil-infected rat models, respectively. The SPECT scintigraphy showed high uptake of 99mTc–ertapenem in bacterial-infected abscesses, and low counts were recorded in normal and turpentine oil-inflamed tissues. In conclusion, 99mTc–ertapenem can be a potent infection-imaging agent, which can diagnosis deep-seated bacterial infections at early stage but need further pre-clinical evaluation in variety of infection models.

DC motors are widely used in industries to provide mechanical power in speed and torque. The position and speed control of DC motors is receiving interest from the scientific community in robotics, especially in robotic arms, a flexible joint manipulator. The current research work is based on the position control of DC motors using experimental investigations in LabVIEW. The linear control strategy is applied to track the position and speed of the DC motor with comparative analysis in the LabVIEW platform and simulation analysis in MATLAB. The tracking error in the hardware setup based on LabVIEW programming is slightly greater than the simulation analysis in MATLAB due to the inertial load of the motor during steady-state conditions. The controller output shows the input voltage applied to the DC motor varies between 0 and 8 V to ensure minimal steady error while tracking the position and speed of the DC motor.

Abstract Background There is limited data on Pakistani dental students perceived competence in managing orofacial pain (OFP). This study aims to evaluate dental students self-perceived competence regarding the management of orofacial pain. Methods This cross-sectional study was conducted in Karachi at randomly selected two public and four private dental schools. This survey was conducted online from November 2020 to December 2020 in six dental schools. A questionnaire link was sent to the 475 students. A chi-square test and independent-sample t-test were conducted to assess the frequency distribution and compare mean scores of knowledge, diagnosis, and management parameters. Results Of the 475 students, 280 students filled the online survey leaving a response rate of 59%. A significant number of fourth-year students, 65 (51%, p = 0.005), feels knowledgeable regarding neuropathic pain compared to third-year students. The majority of the fourth-year students, 100 (78%, p = 0.010), feel comfortable managing intraoral pain. Almost all the students reported thinking that they need more knowledge related to five types of OFP. The fourth-year students had high mean scores related to knowledge, comfort in diagnosing and managing OFP categories. Conclusion This study found that dental students perceived competence regarding orofacial pain management varies in relation to specific categories, being lowest for psychogenic pain.

Purpose: Fibrin glue was used for anastomosis of lacrimal sac and nasal mucosal flaps and was compared with the conventional suture technique in external dacryocystorhinostomy. Methods: A prospective interventional randomized control study in which 50 consecutive patients of primary acquired nasolacrimal duct obstruction (PANDO) were equally allocated into two groups. The case group underwent glued technique of external dacryocystorhinostomy (Ext DCR) in which fibrin glue was used for the apposition of the anterior lacrimal sac and nasal mucosal flaps. In the control group, conventional technique of Ext DCR was used to suture the flaps. Functional success was assessed by improvement in epiphora and fluorescein dye disappearance test (FDDT), whereas anatomical success was assessed by lacrimal irrigation and endoscopic view of the osteotomy site. Results: The anatomical success in both the groups was 92%, whereas the functional success was 92% in the case group and 88% in the control group. The difference in the success rates between the two groups was statistically non-significant. Conclusion: Glued technique of Ext DCR is a simple and easy alternative to suturing of the flaps. Though the final outcome was comparable in both the groups, glue can be especially useful in uncooperative cases, in cases of excessive bleeding, or in situations where the flaps are very thin or have become friable.

Primitive neuroectodermal tumor (PNET) of the orbit is a very rare entity. We report a case of a 10-year-old boy having progressive protrusion of the eyeball, restricted ocular motility, ptosis, and ocular pain for 2 months. On examination, a fixed, nontender, firm, hyperemic, nonpulsatile globular mass was palpated in the superomedial quadrant of the orbit. Computed tomography scans of the orbit depicted a well-defined, soft tissue density lesion within the orbit without evidence of any bone defect or erosion. Surgical resection of the encapsulated lesion through anterior orbitotomy followed by histopathology and immunohistochemistry examination confirmed the diagnoses of PNET. The patient has been on regular follow-up for 2 years and has shown no sign of recurrence.

Customer experience is a source of retailers’ long-term competitive advantage. This study has examined the relationship between online customer experience and brand love through the mechanism of relationship quality in the context of online shopping in Pakistan. The moderating effect of value co-creation on the relationship of online customer experience with relationship quality and brand love has also been examined. Data were collected from a purposive sampling of 189 online customers in an online survey. Results showed that online customer experience significantly impacts customer relationship quality, which leads to brand love. The relationship between online customer experience and relationship quality is found more robust at high levels of value co-creation. However, we observed a significant negative moderating effect of value co-creation on the direct relationship between online customer experience and brand love. It suggests that including customers in the value co-creation process and affording them a pleasurable online shopping experience may be an excellent way to enhance customer relationship quality and brand love. Theoretical and practical implications of these findings are discussed.

With the increasing growth of online shopping, businesses are intertwining to establish new shopping antecedents. Customer experience has steadily become the most important source of retailers’ long-term competitive advantage via difference. To preserve long-term and sustained consumer loyalty, retailers must continually improve the customer experiences. This study presents a framework for online retailing in a digital environment called the Online Customer Experience-Engagement Context model in the presence of value co-creation (VCC). Data was gathered from 189 people who purchased products online. For additional analysis, testing the hypothesis, and model construction, SPSS 26 and Smart-PLS were used. The data was then evaluated further using descriptive statistics, path analysis, measurement, and structural model. The findings show that the online customer experience (measured as shopping environment, shopping procedure, staff service experience, and product experience) substantially influenced customer engagement, which improved customer loyalty. The VCC strengthened the link between online customer experience and customer engagement. It suggests that including consumers in co-creating a delightful online customer experience from time to time may be a valuable strategy for online retailers to increase customer engagement and loyalty. To create an overarching outcome, information integration theory (IIT), multi-attribute utility theory (MAUT), and the attitude-behavior-context theory (ABC) theories are converged to explain the proposed model in the study.

Abstract Extensive pesticides use is negatively disturbing the environment and humans. Pesticide bioremediation with eco-friendly techniques bears prime importance. This study evaluates the bioremediation of chlorpyrifos in soil using indigenous Bacillus cereus Ct3, isolated from cotton growing soils. Strains were identified through ribotyping (16s rRNA) by Macrogen (Macrogen Inc. Geumchen-gu, South Korea). Bacillus cereus Ct3 was resistant up to 125 mg L−1 of chlorpyrifos and successfully degraded 88% of chlorpyfifos in 8 days at pH 8. Bacillus cereus Ct3 tolerated about 30–40 °C of temperature, this is a good sign for in situ bioremediation. Green compost, farmyard manure and rice husk were tested, where ANOVA (P

Objective: To identify frequency of nosocomial urinary tract infections along with their antibiotic susceptibility in spinal cord injury patients. Study Design: Cross-sectional study. Place and Duration of Study: Acute Spinal Ward, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan, from Apr to Oct 2016. Methodology: Total 120 male and female patients of ages (18-70 years) with acute (>6 months) or chronic (>6 months) spinal cord injury admitted for rehabilitation and developing urinary tract infection 48 hours after admissionwere included. Patients whose culture results have polymicrobic bacteriuria samples, immune deficiency disorder and immunosuppressive therapy were excluded. Urine samples of all admitted patients suspected having urinary tract infections were collected and send to Armed Forces Institute of Pathology for culture sensitivity test showing isolated causative microorganisms and their antibiotics susceptibility. Results: About 34.58 ± 12.59 years was mean age, 120 patients were included. In these were 97 (80.80%) male and 23 (19.20%) females with male to female ratio of 4.2:1. Frequency of nosocomial urinary tract infections was found in 83 (69.17%) and no nosocomial urinary tract infections in 37 (30.83%) patients. This study shows the frequency of antibiotic susceptibility in spinal cord injury patients as follows; Amikacin in 111 (92.50%), Gentamicin in 108 (90%), Imipenemin 113 (94.17%), Tazocin in 115 (95.83%), Ceftriaxone in 105 (87.50%), Nitrofurantoin in 89 (74.17%) and Ciprofloxacin in 96 (80.0%) patients. Conclusion: This study shows that frequency of nosocomial urinary tract infections in spinal cord injury patients is high and tazocin and imipenem are the most sensitive antibiotics.

The intraocular pressure (IOP) is the principal indicator for diagnosis of glaucoma which is one of the leading causes of blindness. The IOP can vary throughout the day, and traditional methods of measuring it in a clinical setting only provide a fraction of the patient’s IOP pattern. This article presents a cost-effective way for continuous monitoring of IOP by utilizing a soft contact lens with strategically placed holes. The deformation of these holes due to the change in IOP can be used to detect the pressure variations throughout the day. Extensive COMSOL Multiphysics simulations are conducted to optimize the design and to test the viability of this method. The optimized lens design can achieve a large deformation ratio sensitivity of 0.39 per mmHg with an applied pressure range of 10 mmHg to 40 mmHg.

AIM: The aim of this study is to study the prevalence, incidence, and the epidemiological characteristics of the patients of acquired dacryocystitis at a tertiary eye care center of Northern India. MATERIALS AND METHODS: It was a prospective, cross-sectional study carried out over a period of 2 years (July 2016–July 2018). The prevalence, incidence, and the epidemiological characteristics of acquired dacryocystitis were studied and analyzed. Chi-square test was used to test the qualitative distribution. RESULTS: A total of 212 cases were included in the study. The prevalence rate of dacryocystitis was 19.5 cases per 10,000 patients, and the incidence rate was 15 cases per 10,000 patients. Chronic dacryocystitis (183; 86.30%) was more commonly encountered clinical type than acute dacryocystitis. Majority of cases (204; 96.23%) were due to the primary acquired nasolacrimal duct (NLD) obstruction, whereas eight cases (3.78%) were due to the secondary acquired NLD obstruction. Females were more commonly affected (156; 73.58%). The mean age was 44.44 ± 18.95 (range: 12–86) years. Majority of the patients 108 (50.94%) belonged to 3rd–6th decades of life. The disease was more prevalent in people belonging to lower-middle socioeconomic class (92; 43.40%) living in rural areas (130; 61.32%) and the majority of them were housewives (125; 59%). CONCLUSIONS: The incidence and prevalence of acquired dacryocystitis were 15 and 19.5 cases per 10,000 patients. It was much more common in females of lower socioeconomic status and is seen commonly in the 3rd to 6th decades of life.

This paper presents a novel design for a high resolution microelectromechanical systems (MEMS) technology based resonant gyroscope using the mode-localization effect in weekly coupled resonators (WCRs) as a mechanism for sensing the input angular rate. The design consists of a single proof mass with two three degree-of-freedom (3-DoF) WCRs systems attached on either side. The MEMS gyroscope is designed according to the microfabrication constraints of the foundry process, silicon-on-insulator multi-user MEMS process (SOIMUMPs). The shift in the resonance frequency values, amplitude ratios of the WCRs, and amplitude ratios difference of two sets due to electrostatic stiffness perturbation, corresponding to the input angular rotation, are discussed as an output metric for the measurement of angular rate. The results show that the amplitude ratio difference as an output metric allows achieving a linear output response and large dynamic range in comparison to the shift in the amplitude ratio and resonance frequency in 3-DoF WCRs in a single set. The dynamic range and resolution of the MEMS gyroscope in terms of maximum allowed resonators amplitude and the noise floor is discussed. The proposed MEMS gyroscope design has a sensitivity of 62830 ppm/°/ $s$ based on a difference in the amplitude ratios of resonators in two 3-DoF WCRs systems and a dynamic range of ±100 °/s. The resolution of the MEMS gyroscope is $31.09\times 10^{-6\circ }$ /s which is significantly higher than existing MEMS gyroscopes and is comparable to traditional bulky ring laser gyroscopes. This high resolution makes the proposed MEMS gyroscope design suitable for use in applications such as earth rotation rate measurement for gyrocompassing and high precision robotics.

This article investigates the nexus between bank-specific risks and the financial stability of the banks for a panel data set of 15 scheduled banks in Pakistan over a 12-year period from 2009 to 2020. Using the fixed-effect model, the study result shows that bank-specific risks, i.e., credit risk and liquidity risk are detrimental to bank stability, whereas funding risk has no significant impact on bank stability. Besides these, bank size has also a negative impact on bank stability, whereas the return on assets (ROA) revealed a positive influence. To ensure stability, bank management should establish policies that confirm secure loan granting and timely reimbursement from customers to minimize the credit risk. Besides this, management should keenly observe the liquidity position and should also effectively mobilize the customer deposits to attain financial stability.

A novel method for encryption, decryption, and control of data using the theory of “rings and fields” is proposed. A system comprising a ring or loop with a maximum of six vector tuples or sub-loops, which are changed into knots on a ring, is suggested, whereby these vector tuples at 0.4 ≤ nf ≤ 0.9 hold Dirac bosons. The Dirac bosons are precessed at characteristic frequencies and are integrated with a braid; the remaining fractional quantum bits (f-qubits) are occupied with Dirac fermions with the same braid, i.e., 0.1 ≤ nf ≤ 0.3. The fractional Fourier transform is used for modeling and simulating the eigenfunctions for stretching, twisting, and twigging. The fractional charges are quantized and invariant at knots, where subquanta—Dirac bosons—are held on the honeycomb lattice of graphene. The degeneracy of f-qubits is permanently established. The characteristic magnetic excitations due to different precessing frequencies of Dirac bosons are exploited for encryption and decryption. The spinning and precessing Dirac fermions are used for pyramidal switching. Addresses for f-qubits are evaluated by normalizing the Hamiltonian operator, which becomes Hermitian. The topological transitions for a quantized non-interacting electron as above are exploited. A method for encryption, decryption, and control of quantum information with seventy-two (72) “quantum chiral states” is suggested with graphene. The chiral matrix of nfxg2/ℏc, where 0.1 ≤ nf ≤ 0.9 and 0.02 ≤ g2/ℏc ≤ 0.08, is the most suitable option for f-qubits as compared to qubits especially when conformal mapping for quantum computation is accomplished.

The goal of Internet of Medical Things (IoMT) and digital healthcare systems is to provide people with the ease of receiving quality healthcare at the comfort of their homes. Hence, the aim of IoMT is the ubiquitous deployment of home-based healthcare systems. Making such systems intelligent and efficient for timely prediction of critical diseases can save millions of lives while simultaneously reducing the burden on the traditional healthcare systems e.g., hospitals. The advancement in IoT has enabled both patients and doctors to access real time data. This advancement has reduced the cost and energy consumption of digital healthcare systems by using efficient sensors and communication technologies. This paper provides a comprehensive review of various studies conducted for the development and improvement of IoMT. It analyses different sensors used for measurement of various parameters ranging from physiological to emotional signals. It also provides a detailed investigation of different communication technologies being used, their advantages, and limitations. Moreover, digital healthcare systems are now deploying machine learning technology for the prediction of health status of patients. These techniques and algorithms are also discussed. Data security and prediction accuracy are the main concerns in the development of this area. In conclusion, this paper reviews the various digital system designs in the context of healthcare, their methodology, limitations, and the present challenges faced by the e-health sector.

Periodontal disease is a common complication, and conventional periodontal surgery can lead to severe bleeding. Different membranes have been used for periodontal treatment with limitations, such as improper biodegradation, poor mechanical property, and no effective hemostatic property. Guided tissue regeneration (GTR) membranes favoring periodontal regeneration were prepared to overcome these shortcomings. The mucilage of the chia seed was extracted and utilized to prepare the guided tissue regeneration (GTR) membrane. Lignin having antibacterial properties was used to synthesize lignin-mediated ZnO nanoparticles (∼Lignin@ZnO) followed by characterization with analytical techniques like Fourier-transform infrared spectroscopy (FTIR), UV–visible spectroscopy, and scanning electron microscope (SEM). To fabricate the GTR membrane, extracted mucilage, Lignin@ZnO, and polyvinyl alcohol (PVA) were mixed in different ratios to obtain a thin film. The fabricated GTR membrane was evaluated using a dynamic fatigue analyzer for mechanical properties. Appropriate degradation rates were approved by degradability analysis in water for different intervals of time. The fabricated GTR membrane showed excellent antibacterial properties against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) bacterial species.

Objective: To assess the frequency and factors associated with dental caries in pregnant women attending antenatal clinic of a public sector hospital of Karachi, Pakistan. Methods: A descriptive cross-sectional study was conducted at the Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi from July 2019-March 2020. Pregnant women of age 18-45 years visiting antenatal clinic were included. The dental examination was carried out to assess the dental caries in accordance with the WHO diagnosis criteria. Frequency of dental caries along with factors like age, socioeconomic status, educational status, occupation, BMI, residence, family structure, gestational hypertension, and gestational diabetes were noted. . Results: Of 375 pregnant women, mean age was 30.32 ±4.37 years. Most of the women were from low socio-economic class 237 (63.2%), uneducated 231 (61.6%) and belonged from rural areas 196 (52.3%). Frequency of dental caries was found to be 108 (28.8%). In multivariate logistic regression model, uneducated females (aOR=9.53, 95% CI=3.93-23.10), rural area residents (aOR=19.73, 95% CI= 7.50-51.88), presence of gestational diabetes (aOR=8.86, 95% CI=3.78-20.73) and presence of gestational hypertension (aOR=4.33, 95% CI=2.01-8.92) remained statistically significant (p