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Abstract Background Multiple educational modalities have been utilized including leaflet, face-to-face counseling and watching videos in waiting areas for engaging patients. Considering the two challenges of waiting time frustration and lack of health screening awareness, Family Physicians’ waiting area are an ideal place to bridge this gap. The objective of this study is to evaluate the effectiveness of video-based health education intervention in improving knowledge about health screening among patients and their families sitting in waiting area of Family Medicine clinics. Methods It was a pre and post quasi-experimental study that was conducted in family medicine clinics located at main campus and Outreach centers of a tertiary care hospital. A total of 300 participants were approached during the six month period. The intervention consisted of an educational video on health screening. The content of the video was taken from the recommended preventive care guidelines from CDC and USPSTF. The pre-and post-intervention knowledge of the participants was assessed through a semi-structured coded questionnaire by an interviewer who was trained in data collection. Data was analyzed using SPSS version 26. Pre and post intervention knowledge adequacy was determined using MacNemar’s Chi-square test. Results Total 300 participants voluntarily participated into the study. Median age of the participants was 28 (IQR = 23.25–36.75) years. Majority of participants were males (56%). Following the intervention, there was significant increase in the proportion of participants (51.3% versus 68%) who had understanding of health screening check-up (p

This case series offers the successful management of cytomegalovirus (CMV) viremia in patients who developed CMV infection post renal transplantation. The patients have been treated with three doses of CMV immunoglobulin and ganciclovir for 21 days. The CMV load in each affected person extensively reduced after treatment, indicating the effectiveness of this regimen in coping with CMV viremia in resource constrains setting

Background: Dysmenorrhea is a very common problem and a large number of females in our society are suffering from it. This study aims to determine the prevalence of dysmenorrhea and its associated lifestyle and other factors. Methodology: This was a cross-sectional study which was conducted among females aged between 15 to 45 years in urban population of district Ghaziabad through a house-to-house survey, using a pre-designed, semi-structured questionnaire. Results: The prevalence of dysmenorrhea was 67.8%. Out of the participants having dysmenorrhea, 36.5% females were experiencing mild pain, 44.3% were experiencing moderate pain and 19.1% were experiencing severe pain. The chances of dysmenorrhea were significantly more in participants of 15 to 25 years of age, participants who had attained early menarche, those having pre-menstrual symptoms and those who had passage of clots during menstruation, participants consuming refined flour, fried food, preservatives, soda and those who were skipping meals. Participants doing physical exercises showed less chance of menstrual pain. Conclusions: The prevalence is dysmenorrhea is quite high in our society. It may be related to factors which are modifiable, such as diet and exercise. An improvement of lifestyle is recommended.

The study explored students’ perception regarding how ethical considerations are integrated into accounting curricula at the tertiary level in Ghana, guided by both the International Education Standards (IES) and the CIPP model. It questions the effectiveness of accounting education in adequately preparing students to face ethical challenges, with a specific focus on tertiary institutions in Ghana. Using a positivist paradigm and a cross-sectional survey methodology, the study targeted final-year undergraduate accounting students in public tertiary institutions. Multiple sampling techniques, including proportionate, stratified, and simple sampling, were utilized to select 307 students for the study. The collected data underwent analysis using descriptive statistics (frequency, percentage, mean and standard deviation) and inferential statistics (multiple linear regression). The study found a significant 70% alignment between the curricula of the sampled universities and the requirements of IES 4. Moreover, it revealed a limited use of participative teaching approaches in ethics within accounting lessons. Additionally, the findings revealed that students have a low perception of the effectiveness of accounting curricula in addressing their professional ethical needs. This perception was influenced by factors such as age, religiosity and, to a lesser extent, gender.

Abstract Immunoglobulin E (IgE)‐mediated food allergies are the most common type of food allergy, often causing rapid symptoms after exposure to allergens posing a serious health risk and a high impact on patient's and caregiver's quality of life. Omalizumab, a humanized anti‐IgE monoclonal antibody, reduces allergic reactions by binding to circulating IgE. Omalizumab has been successfully used in allergic asthma, chronic rhinosinusitis with nasal polyps, and chronic urticaria, and was recently approved for treating IgE‐mediated food allergies by the US Food and Drug Administration (FDA). This GA2LEN ANACARE Consensus Statement presents our position on the use of omalizumab for treating IgE‐mediated food allergies, based on a systematic review and meta‐analysis, experience with use for other conditions, and expert consensus achieved via an eDelphi process. Following publication of the recent OUtMATCH study (stage 1) results and subsequent FDA approval, we propose that there is now sufficient evidence to recommend omalizumab as the only drug currently available that can mechanistically reduce IgE‐mediated food allergic reactions. We acknowledge that the evidence does not reach the highest level of evidence which would be needed for a guideline recommendation.

Background: Acute poisoning is a major medical emergency that translates into morbidity and mortality across all age groups, it is a potentially preventable cause of illness and death. This study was carried out to assess the epidemiological information of acute poisoning among the general population presented to the three campuses of a private tertiary care teaching hospital in Karachi, Pakistan. Method: The cross-sectional study was conducted at three campuses of a private tertiary care teaching hospital, Dr. Ziauddin Hospital in Karachi, comprising of records from January 1, 2018, to December 31, 2022, of patients reporting acute poisoning. These records were accessed after getting approval from the Ethical review committee. Consecutive sampling technique was applied while data was collected. All cases of acute poisoning reporting to the emergency department with complete records were included. While data of those with any other diagnosis or incomplete record were excluded. Descriptive analysis was performed for quantitative variables. For categorical data frequency and percentages were extracted. The chi-square test was used to associate categorical variables. P value less than 0.05 was taken as statistically significant. Results: The total number of cases was n=518 out of which n=235 (45.4%) were males while n=283 (54.6%) were females and the maximum number of cases n=111 (21.4%) were associated with Benzodiazepines followed by insecticide poisoning and ingestion of rodenticides. Conclusions: The most susceptible groups to acute poisoning were found to be women and children. A prevalent agent that caused toxicity was benzodiazepines; the biggest number of cases occurred in April, while the lowest number occurred in December. The year 2020 was linked to the highest number of cases.

Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disorder with risk of sudden cardiac death (SCD) in children and adolescents. Mavacamten, also referred to as MYK-461, a myosin inhibitor of cardiac myocytes is studied in symptomatic HCM. The safety and efficacy of this medication is not well studied in pooled meta-analysis. Online database search was performed from inception to September 2023. We selected randomized clinical trials that compared Mavacamten with placebo/guideline medical treatment for HCM. We studied safety outcomes (Serious adverse events (SAEs), treatment emergent adverse events (TEAs) and Atrial fibrillation). Functional status of patients was assessed as New York Heart Association (NYHA) Classification improvement of at least + 1 grade, Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) change from baseline). Relative risk ratios were used in randomized model using Review Manager Version 5.4 statistical software. A total of 4 RCTs comprising 503 patients were included in meta-analysis. On random effect model, we found that HCM patients that received Mavacamten had significant symptomatic improvement as depicted by improvement in NYHA class by at least + 1 grade (RR = 2.15; P

ABSTRACT Background: Antenatal care is an essential pillar of safe motherhood. The aim is to give optimal care to the mother so that she can endure the nine months of pregnancy without any complications. A proper exercise plan further helps in achieving appropriate care. The aim of the study is to determine the role of physical therapy in antenatal care as perceivedbytheclients. Methods: It was a was cross sectional study and females in their nine months of pregnancy aged between 18 to 40 years were inducted in the study. A total of 375 participants were selected through purposive sampling technique. Data entry was done on SPSS version 20 and frequencies and percentages were taken as descriptive statistics for categorical variables. ‘ Results: There were 375 patients among which 81.9% were housewives, 15.5% were working women while 2.7 % were students. 83.7% of the women were aware of physical therapy out of which 95.2% women agreed that physiotherapy has positive role in antenatal care yet only 42% actually attended physiotherapy sessions and 36% were currently following exercise programme. Conclusion: The perception and knowledge of women regarding physical therapy (exercise) during pregnancy is reasonable but a small numberof subjects exercise during pregnancy. Key Words: Pregnant Females, Antenatal Care, Physical Therapy.

One of the most significant public health issues today is AMR (AMR), which poses significant difficulties in controlling and treating infectious diseases. It is believed that the abuse and overuse of numerous antibacterial agents in the healthcare and agriculture industries led to the emergence of antimicrobial resistance. Even though irrational prescriptions have been blamed for the rise in resistance among microbes to various antimicrobial drugs, a variety of environmental factors have also been linked to the development of multidrug-resistant (MDR) organisms. Several studies have stressed the significance of using a one-health approach, or a holistic strategy, to combat antibiotic resistance that takes into account people, animals, and the environment. Models describing how resistance starts and spreads could be created with a better understanding of the environmental factors that encourage its development. Yet, preventing the establishment and spread of mobile resistance elements is challenging since it is unclear how and when the environment favors resistance growth. Hence the current review focuses on the agricultural factors predisposing humans to the risk of AMR and preventive strategies.

Background: Parental stress is the major factor that increases a risk of unwillingly placing children with disabilities. The aim of our study is to assess the frequency of depression amongst parents of children with intellectual disability. Methods: This was a cross sectional study conducted for 10 months in various hospitals and rehabilitation centers in Karachi, Pakistan. Participants were inducted using purposive sampling technique. Parents of intellectually challenged children up to 18 years of age were included and a self-administered questionnaire was utilized for data collection both in English and Urdu. PHQ 8 was used to assess the severity of depression amongst parents. For all purposes, p-value of

Background: Continuing professional education (CPE) or continuous education (CE) is the means by which people maintain their knowledge and skills related to their profession. Mandatory continuing education is a major factor in relicensure that is being licensed to practice for a specific period with the license either getting renewed at the end of that period or forfeited. This study is designed to assess the awareness regarding importance of continuing professional education as a requirement for re-licensing among General Dental Practitioners and Specialists and to identify the role of governing bodies for endorsing re-licensure procedure on the basis of CME Methods: Cross sectional study was conducted among 450 dentists practicing in Karachi (July 2013 to Dec 2013), divided in to two groups ;General Dental Practitioners (n=350)and Consultant Specialists(n=100). Simple Random sampling technique was applied thorough lottery from available list of Dentists and Consultants. Data was collected through a self administered questionnaire. SPSS version 20 was used for analysis and Chi –square test to assess associations of categorical variables. P value less than 0.05 was considered as significant. Results: Majority participants n= 250 (55.6%) were aware about re -certification and re-licensing and n= 292 (64.9%)knew the difference between the two. Only n=153 (34%) were of the view that re -certification and re-licensing should be made mandatory in Pakistan. Conclusion: The awareness of CME & re-certification is high among our professionals Key Words: Re-certification, Re-licensing, Continuous Medical Education.

In Pakistan, tobacco consumption is at an all-time high with the tobacco industry witnessing a boom. According to the Pakistan Tobacco Company, production and sale has taken a sharp leap from Rs.1,000 million rupees to Rs.1,750 million in 2008. The youth remain particularly vulnerable as massive antismoking ad campaigns have failed to drill in the health hazards. The aim of this study is to assess the attitude, perception and practices of youth regarding cigarette smoking. Comparative cross-sectional study was conducted in Ziauddin University and Bahria University. Sample was taken from all years of teaching. Data was collected through self-administered structured questionnaire that was developed in English. It comprised of questions pertaining to their year of study, smoking history, and perception and practices regarding smoking. A total of 450 students were surveyed, medicine (n=260) and engineering (n=190). One-fourth of the survey sample admitted to have tried to smoke at least once in their lifetime (p=0.001), and at least 20% medical students (n=53) and 35% of engineering students (n=66) surveyed had smoked a cigarette (p=0.001). While students studying medicine were better aware of the risks associated with smoking and tobacco consumption, however compared to engineering students their overall knowledge of the health risks was unsatisfactory. A significant number of medical students were unable to list and hence effectively counsel about long and short term health benefits. Peer pressure and media played a large role in students picking up the habit. KEY WORDS: Pakistan/Epidemiology, Smoking, Karachi, Mechanism Medical Students.

Background: For an adolescent the requirement of sleep does not decline though the opportunity to sleep is limited on account of lifestyle predilections, academic schedules, and compelling changes in the biological processes. Sleep affects physical growth, performance and emotional thinking in addition to influencing the cognitive functioning and attention span. Objective: The primary purpose of this study was to know the effects of late sleeping habits on academic performance in school girls aged 10-13 years and to identify the factors leading to late sleeping habits in school girls aged 10-13 years. Methods: A cross sectional survey was conducted on 355 girls studying in girls only schools. Multistage sampling technique was used. Sleep and academic performance questionnaire was administered after taking written informed consents from principals, students and their parents/guardians. Chi square test was applied for finding association between sleep habits and academic performance. P value less than 0.05 was taken as significant. Results: No significant association was found between late sleeping habit and academic performance since majority of the students i.e. 267 (75%) students slept before 11pm, the time which demarcates the late sleeping time with normal time. Significant association was found between habit of book reading before bed time and above average academic performance. Around 43% students drink milk before sleeping and majority watch television before sleeping. Likewise students who wake up fresh in the morning and do breakfast have above average academic performances. Conclusion: Study findings conclude that majority of the girl students in the age group of 10-13 years sleep at an appropriate time and satisfy the day’s requirement of 9 hours sleep. Therefore it does not affect their academic performance as majority of the students in the survey secured good grades. Key Words: Late Sleeping Habit, Academic Performance, Sleep Behavior, Bedroom Environment

Background: Osteporosis is increasingly observed as a major public health concern as it leads to poor quality of life, pain and often disability for those effected. Especially in the developing countries, its prevalence in alarming in the face of poor awareness and management. Objective: To assess the risk factors for osteoporosis in females coming to a tertiary care hospital of Karachi. Methods: This was hospital based case control study conducted in a private tertiary healthcare facility of Karachi. It was carried out in 2012. 57 cases and 60 controls were selected through WHO Sample size calculator. Matching among cases and controls was based on gender, socioeconomic status and age group. Data was collected through questionnaire based personal interviews. Data entry and analysis was done using Epi Info. Association between categorical variables was found using chi square. Odds ratio was calculated for finding association between different risk factors and osteoporosis. The study was cleared through the Ethical review board. Results: One hundred and seventeen cases and controls were taken in this study with the age range of 45+ years (mean age 56.8 ± 11.8). Statistically significant difference was found in under 50 age group where cases were only n=8 (14%) as compared to controls n=25(42%). Parsi ethnicity showed strong association with osteoporosis (OR 2.23). Strong association was observed between smoking and osteoporosis with an Odds Ratio of 4.0. Strong association was observed with Rheumatoid arthritis (OR 2.8, CI at 95% 1.2-6.3) and Calcium deficiency (OR 2.2, CI at 95% 1.1-4.7). Conclusion: The study revealed specific to Parsi ethnicity, family history, smoking, rheumatoid arthritis and Vitamin D deficiency were found to be potent risk factors. Therefore as reaffirmed from our study also, risk factors except from the non modifiable ones should be tackled well in advance through health education and interventions. Key Words: Osteoporosis, Rheumatoid Arthritis, Bone Density

The later part of twentieth century has seen alternative medicine finally becoming a recognized entity, defined as a variant to conventional mode of management of diseases. It was named ‘Alternative’ as it was regarded as a substitute to the orthodox medical management. Finally the term Complementary and Alternative Medicine (CAM) was coined when combo treatment involving both conventional and alternative methods were used for optimum results..

Background: To find an association between presence of Chronic disease with Oral Health. Methods: It was a cross sectional study conducted in the Dental OPD of LCMD Karachi in 2014. Three hundred participants were enrolled in this study through consecutive sample technique. Data was collected using the self administered questionnaire along with the assessment of oral health examination, which was carried out by the Researcher and data was analyzed on SPSS version 20. Results: It was observed that 59% (n=176) suffered from chronic diseases and when oral examination was conducted, it was revealed that 39% (n=117) had mobile teeth (P value= 0.001), 39.3% (n=118) had missing teeth P value=(0.001) , 60.8% (n=115) had bleeding gums, 60.2% (n=112) had halitosis, 60.2% (n=71) had dry mouth, 61.3% (n=84) had oral ulcers,60.6% (n=117) had complain of food deposition and 60% (n=90) had tooth spacing due to periodontal diseases. Conclusion: It was concluded from this study that majority of participants with chronic diseases had poor oral health which needs immediate attention by the medical practitioners during the treatment of chronic diseases and as well as dentists should counsel the patients for maintenance of oral health. It still remains a chicken egg dilemma regarding the temporal sequence of events as many oral pathogens share a common factor with NCDs. Key Words: Association Non communicable Diseases, Oral Health

Background: It is estimated that more than 6 million children die in the developing world at the hands of preventable conditions; primarily pneumonia and diarrhea. WHO in 1992 initiated the Integrated Management of Childhood Illness (IMCI) program as a strategy to provide an integrated approach for the management of major causes of childhood morbidity and mortality. Objective: To assess if IMNCI workshops that are held in hospitals that have post graduate training program in field of pediatrics are effective in enhancing knowledge; hence skills for improving health care delivery in limited resources. Methods: A KAP survey was conducted in 2013 among IMNCI trained doctors working in 5 tertiary care hospitals of Karachi. N=57 doctors were identified and administered a structured questionnaire based on recall questions and scenarios. Questionnaire was developed from a similar study conducted elsewhere. Data entry and analysis was done on SPSS version 20. Results: A total of n=57 doctors were included in the study, out of them resident medical officers (RMO) were n=10, postgraduate trainees (PG) n=38 and Medical Officers (MO) were n=9. Mean score of correct answers was 14 (3). No significant difference was observed when mean scores of PGs was compared with RMO and MO combined through application of Independent sample t test. Conclusion: The study revealed gaps in knowledge and practices of trained doctors regarding management according to IMNCI guidelines. Key Words: IMNCI, Vaccination, WHO, Training Programs.

Background: To assess the satisfaction levels of employees in a health care organization at Karachi, Pakistan. Methods: A cross sectional survey was conducted on 598 employees working at University and tertiary care hospital for a period of 5 months. Purposive sampling technique was used for collection of data. All employees working for at least one year at any level of management were included in the study. Part time employees, visiting staff, those absent at the time of data collection and those who refused to consent were excluded from the study. Self administered questionnaires were utilized for the purpose of data collection. Entire analysis was performed using SPSS version 20. P value less than 0.05 was taken as significant. For descriptive statistics frequency and percentages were calculated for categorical variables while mean and standard deviation for numerical variables. Analysis of Variance was applied to see association between different groups. The study was approved by the ethical review board. Results: Majority 69.4% (n=415) employees were found to be satisfied. Upper management was seen to have slightly lower scores of satisfaction compared to middle and lower management levels. Between clinical & non-clinical side there was also no significant difference observed in the satisfaction level. Satisfaction levels were seen directly proportional to age and length of service. When overall benefits were seen non clinical side 61% (n=84) were found to be more dissatisfied than clinical side 40% (n=53). Conclusion: Study findings conclude that majority employees were satisfied. However most were dissatisfied with the overall benefit package and vacation policy. Key Words: Employee satisfaction, Management, Tertiary care hospital

Background: Chronic Hepatitis C (CHC) is highly prevalent in Pakistan. Current standard treatment is Interferon alpha/ Peginterferon with oral ribavirin. Interferon therapy is associated with development & worsening of depressive symptoms in CHC patients and to determine the frequency of depressive and anxiety symptoms among patients on treatment with interferon/ Pegasus. Methods: This cross sectional study was conducted at OPD of Liaquat University Hospital Hyderabad during a period of 4 months (from July2013 to October2013). A sample of 120 patients aged 18-60 years, either currently receiving interferon/ Pegasus treatment or had received that treatment during last 12 months was taken. Known cases of anxiety, depression and those suffering from other debilitating co morbid conditions like carcinoma & non-consenting were excluded. Ethical approval was taken from LUH ethical review committee. A Proforma was used to gather the data. The data collected were analyzed using SPSS version 20.0. Mean (±SD) were computed for quantitative variables. Categorical variables (such as gender and outcome variables i.e. anxiety and depressive symptoms) were measured in frequencies and percentages. Stratification was done with regard to age group & gender to see the impact of these on the outcome followed by application of chi-square test with P-value

Background: Body dysmorphic disorder (BDD), once known as dysmorphophobia, is a mental disorder in which the person afflicted is engrossed with an imagined imperfection in their appearance that is actually normal or is very minor. Methods: The cross-sectional study was conducted in Karachi at Ziauddin University targeting female students between the ages of 17– 25, using an adapted questionnaire which was used to diagnose BDD and determine the role of media in influencing their self-image. Results: Out of the 180 students included in this study, at least 9.4% were highly concerned about one or more than one physical attributes, while 2.8% showed extreme concern. 6.1% met the DSM-V criteria for BDD. The most frequent foci of concern were: Being too fat or too thin (35%), skin (24.4%), hair (15%), teeth (14%) and nose (14%). 24.4% of the students got sad/angry/depressed because of their appearance .The study also showed that 42% of the subjects spent 1-2 hours watching television every day, and 13.9% watching 3-7 hours of television per day. 46.7% also regularly visit entertainment/beauty websites or read entertainment magazines. 22.8% were extremely satisfied with their appearance, as opposed to 4.4% which were extremely dissatisfied. Conclusion: Our results show that BDD is widespread amongst female college students. The body features of concern were recognized and the influence that media, either through the use of beauty magazines or television/movies on self-image was estimated. Key Words: Body Dysmorphic disorder (BDD), Females, Frequency, Risk factors

Background: Injuries due to motorcycle accidents are frequent happenings in developing countries as people utilize it commonly as a mode of transport. In Pakistan 56% of Maxillofacial injuries can be associated to Road traffic accidents (RTA) majority of which are due to involvement of motorbikes. Methods: This cross sectional survey was carried out in public tertiary care setting in the year 2016. Three Hundred and Seventy participants were inducted in the study using Purposive sampling technique. Only those with maxillofacial injuries were included and diagnosed through conventional and panoramic radiographs and computed tomographic scans. Those who consented were included whereas, participants with language barrier or unable to answer were excluded. Data was collected by questionnaire with analysis being performed on SPSS version 21. Descriptive analysis was performed for quantitative variables with association between categorical variables tested through chi square. Bond of error was taken at 5% with 95% confidence interval. Permission was sought from ethical review board. Results: Majority, [267(84.5%)] were young patients with [ 282(89.2%)] patients involved in Motorcycle accidents. Of total participants male gender was [275(87%)] the driver inflicted in most situations [184(58.2%)]. Most patients [285(90.2%)] were without any safety device. Majority [220(69.6%)] had Mandibular fractures whereas, 111(35.1%) had Maxillary fractures. Soft tissue injuries were seen in 212(67.1%) patients. Conclusion: Motorcycle related accidents are common cause for maxillofacial injuries in road traffic accidents. Most patients suffered soft tissue injuries. Most commonly fractured bones were mandible and maxilla. Key Words: Maxillofacial injuries, Motorcycle, Accidents

The current agriculture system of the world is facing a massive challenge to agricultural productivity. Agricultural productivity must be increased to maintain enough food. Due to the various plant diseases, the expected agricultural productivity is impossible to achieve. Using Deep Learning (DL) in the agriculture field, farmers can monitor continuously rather than manually checking plants’ health. ResNet, DenseNet, GoogleNet, Inception, and YOLO are deep learning-based computer vision models. The most significant advantage of Deep Learning is that we do not need to extract features from the image manually. You feed the raw pixels in the images directly as inputs to the network. The network learns to extract features while training the model. The basic objective of this work is to propose multiple convolutional neural network-based models and identify the best model suitable for classifying the individual plant image into healthy and disease (multiple diseases) classes. This will help farmers and agriculturists to have a 360° insight into the cultivation status of the plants. Furthermore, to assess the proposed models; different quality metrics have been computed (i.e., accuracy and loss on the training, validation, and test datasets) to perform the comparative analysis between our proposed and existing techniques. These proposed models achieved a validation accuracy of 97% using MobileNet V1, 96% using MobileNet V1, and 83% using Vanilla CNN. While on 33 challenging images, a test accuracy of 82% using MobileNet V1, 76% using MobileNet V1, and 53% using Vanilla CNN has been achieved.

Face recognition using an image-processing technique is a valuable and effective approach to verifying the identity of a human being. Authorizing users based on human face identification remains one of the biggest challenges. However, with the improvement of deep learning and the creation of deep convolutional neural networks, the performance of face recognition has significantly improved. However, the outcomes from different models and networks are quite different in terms of accuracy. This paper proposes a face recognition model based on a Convolutional neural network (CNN). The recognition rate of the AT&T and AR data set on the proposed model is 99.17% and 99.12%.

Abstract Detection of cyber‐threats in the smart grid Supervisory Control and Data Acquisition (SCADA) is still remains one of the complex and essential processes need to be highly concentrated in present times. Typically, the SCADA is more prone to the security issues due to their environmental problems and vulnerabilities. Therefore, the proposed work intends to design a new detection approach by integrating the optimization and classification models for smart grid SCADA security. In this framework, the min‐max normalization is performed at first for noise removal and attributes arrangement. Here, the correlation estimation mechanism is mainly deployed to reduce the dimensionality of features by choosing the relevant features used for attack prediction. Moreover, the optimal features are selected by using the optimal solution provided by the Holistic Harris Hawks Optimization (H3O). Finally, the Perceptron Stochastic Neural Network (PSNN) is utilized to categorize the normal and attacking data flow in the network with minimal processing time and complexity. By using the combination of proposed H3O‐PSNN technique, the detection accuracy is improved up to 99% for all datasets used in this study, and also other measures such as precision to 99.2%, recall to 99%, f1‐score to 99.2% increased, when compared to the standard techniques.

Abstract Background Pneumothorax associated with a steep head-down position in vaginal hysterectomy surgery is rare but can cause life-threatening complications. Case presentation We report a case of a female patient with no obvious lung pathology who suffered intraoperative pneumothorax associated with prolonged steep Trendelenburg position. To the best of our knowledge, this is the first well-documented case of this association. A 53-year-old female, diagnosed as a case of recurrent umbilical hernia with cystocele and rectocele was planned for vaginal hysterectomy with anterior perineorrhaphy and posterior colpoperineorrhaphy along with open mesh repair for umbilical hernia under general anaesthesia. Approximately 90 min after the steep Trendelenburg position, the peak inspiratory pressure increased, while the oxygen saturation decreased. The airway pressures remained continuously on the higher side whole throughout the surgery despite an interrupted propped-up position in between. The patient could not be extubated and shifted to the intensive care unit (ICU) where ultrasonography (USG) of the lung and chest x-ray showed signs of pneumothorax. Intercostal tube drainage (ICTD) was placed, and the patient improved dramatically. It was suspected that a steep head-down position for a prolonged period led to persistently raised airway pressures and the subsequent development of pneumothorax. Conclusions Pneumothorax can develop in rare circumstances even if airway pressures are under the safety range. So, careful monitoring and immediate treatment are necessary to prevent the condition from worsening and anaesthesiologists must be aware of such potential danger.

Background Workplace violence (WPV) is a global problem that affects healthcare workers’ physical and mental health and impairs work performance. Pakistan’s healthcare system is not immune to WPV, which the World Health Organization recognises as an occupational hazard. Objectives The primary objective of this systematic review is to determine the prevalence of physical, verbal, or other forms of WPV in healthcare workers in Pakistan. Secondary objectives include identifying the associated risk factors and perpetrators of WPV. Methods A systematic review of six electronic databases was conducted through August 2022. Studies were included if they met the following criteria: 1) healthcare workers (HCWs), including physicians, nurses, and paramedic staff working in the private or public sector of Pakistan; 2) exposure to physical, verbal, or any type of violence. Data were extracted and analysed for the prevalence of WPV, types of violence, associated risk factors, and perpetrators of violence. Results Twenty-four studies including 16,070 HCWs were included in this review. Verbal violence was the most common form of violence levied, with its highest prevalence (100%) reported in Islamabad and lowest verbal violence prevalence (25%) in Karachi. Verbal abuse was preponderant against female HCWs, while physical abuse was directed more towards males. The most common perpetrators were patient attendants, followed by the patients. Conclusion Our review determines a 25–100% prevalence of WPV against HCWs in Pakistani medical setups. This occupational hazard needs the attention of relevant authorities in the country to put protective enforcement policies in place. Large-scale surveys should be conducted to better gauge the current plight of HCWs in the nation.

Background: Antenatal care coverage increased tremendously in the last two decades in developing countries, with at least half of women having 4 or more visits to a clinic. But this rise in utilization did not translate into substantially lower maternal and neonatal mortality rates. Objective: To determine the time of initiating antenatal care and assess the effect of time of initiation of antenatal care (ANC) on the content of care received and factors associated with the time of initiating care. Methods: This was a retrospective cross-sectional study conducted from September 2020 to December 2020. The study population included all women who delivered at the hospital. The time of the first antenatal visit and content of care received by the woman was assessed. The primary outcome variable was the time of the first antenatal visit. Secondary measures included the content of care received by women. Results: Of the 1388 women included, only 160 (11.5%) had their first visit before 14 weeks of pregnancy. When stratified according to time of visit, blood pressure measurement (p=0.021), weight measurement (p= 0.011), urine testing (p=0.015) and iron and folic acid supplementation (p=0.013) were significantly greater for women who started care within three months. Women who were older (p˂0.001) and had delivered before (p=0.001) were more likely to access antenatal care earlier. Similarly, women with some education (p ˂0.001) and higher monthly income (p=0.003) started visits sooner than those who were uneducated and had lesser income. On the multivariable model, lower age, being nulliparous, no formal education and lower income were determinants of late booking. Conclusion: The prevalence of early initiation of antenatal care was very low. The content of care received by women who presented early was also significantly different from those who presented late. Older age, previous birth; education and monthly income were determinants of early antenatal care visits. Awareness programs for early initiation of antenatal care need to be implemented

Abstract Introduction Adverse childhood experiences (ACEs) are proposed to increase the risk of developing multiple sclerosis (MS) later in life. This systematic review aimed to explore the correlation between ACEs and MS development, age of onset, quality of life in MS patients and MS relapse rates. Methods We searched a total of six databases in June 2022 and retrieved the relevant studies. The population included adult (18+) individuals who either had been diagnosed or were at risk for developing MS and also had exposure to ACEs. Our primary outcomes include the risks of MS development, age of MS onset, and MS relapse rate in patients who were exposed to different types of ACEs. Results A total of 11 studies were included in our review. A study reported that among 300 women diagnosed with MS, 71 (24%) reported a history of childhood abuse; moreover, with further research, it was concluded that ACEs were associated with the development of MS. Abuse that occurred 2–3 times per week was associated with an 18.81‐fold increased risk of having MS when compared to the unexposed sample. The relapse rate of MS was found to be substantially greater in severe cases of ACEs compared to individuals who did not report any ACEs. Conclusions Results support a significant association between ACEs and the development of MS; individuals with a positive history of ACEs develop MS symptoms earlier. Moreover, the severity of ACEs is also linked with increased relapse rates of MS.

This article discusses the documentary evidence on the Efficient Market Hypothesis (EMH) This study examines the nexus between economic growth, FDI and employment. We employ panel data for BRICS and ASEAN nations for the period 1993 to 2019. We have used FGLS considering the cross-section dependence and slope heterogeneity. Moreover, we apply the Pairwise Dumitrescu-Hurlin panel non-causality tests to confirm the direction of causality. The study finds that overall impact of FDI and employment on economic growth is ambiguous. However, in HIE, FDI positively impact economic growth. We observed bidirectional causality between FDI and economic growth. Human capital and globalization have positive impact on economic growth. The relation between FDI and employment is ambiguous. However, it may increase employment in high income economies. To receive the intended benefit of FDI, authorities should focus on the local development of the region. The positive sign of openness suggests restrictive trade policies should not be encouraged. However, the sophisticated policy is required to maintain the high economic growth and low unemployment.

Electroencephalography (EEG) signals have a major impact on how well assistive rehabilitation devices work. These signals have become a common technique in recent studies to investigate human motion functions and behaviors. However, incorporating EEG signals to investigate motor planning or movement intention could benefit all patients who can plan motion but are unable to execute it. In this paper, the movement planning of the lower limb was investigated using EEG signal and bilateral movements were employed, including dorsiflexion and plantar flexion of the right and left ankle joint movements. The proposed system uses Continuous Wavelet Transform (CWT) to generate a time–frequency (TF) map of each EEG signal in the motor cortex and then uses the extracted images as input to a deep learning model for classification. Deep Learning (DL) models are created based on vision transformer architecture (ViT) which is the state-of-the-art of image classification and also the proposed models were compared with residual neural network (ResNet). The proposed technique reveals a significant classification performance for the multiclass problem ( $p < 0.0001$ ) where the classification accuracy was $97.33~\pm ~1.86$ % and the F score, recall and precision were $97.32~\pm ~1.88$ %, $97.30~\pm ~1.90$ % and $97.36~\pm ~1.81$ % respectively. These results show that DL is a promising technique that can be applied to investigate the user’s movements intention from EEG signals and highlight the potential of the proposed model for the development of future brain-machine interface (BMI) for neurorehabilitation purposes.

This era is all about energy, humans cannot survive without energy. Conventional energy resources are not enough to fulfill the needs of energy that’s why it is necessary to find alternate energy resources that will be efficient and environment friendly. Microbial Fuel Cell (MFC) is one of the reasonably low costs and is considered as environment friendly It degrades the harmful substance during production of electricity. This technology helps out for the producing of electricity by using the microbes. The generation of electricity is the new form of non-renewable energy by treating of the waste water from different types of effluent. The purpose of this technology is to produce the electricity that is environment friendly and sustainable. This review is also the part of research which is also to make a comparison of different MFC feeds which have unique chemical composition and are rich of various biological species and designing. This report also contains the discussion of MFC principle, necessary components, bacteria that are responsible for electricity production. This MFC contain the different batch type of reactor and in each reactor anode and cathode are dipped for time to check the response of flow of electron. Electrodes are used for drawing the comparison data of the MFC and giving new direction for the researchers. Salt bridge or membrane is connected between the reactor for the flow of proton to the cathode side and oxygen is supplied in the cathode compartment.

Firms, regardless of their nature, are focused on improving their quality. Different factors have been identified by the previous researchers that influence the employee performance (EP). Work-life balance (WLB) is encouraged as an inclusive policy, directed at all workers to achieve a more harmonious balance between their work responsibilities and their personal responsibilities and interests. This study offers new insight into the implications of regulatory changes on the organizational policies related to WLB for improving EP from a developing country like Bangladesh. The main purpose of the study is to investigate the interfacing relationship between WLB and EP in the private commercial banks in Bangladesh. This study reviewed previous literature to find different empirical and theoretical contributions in establishing WLB and EP. The study mainly used a quantitative research method to explore the current scenario of WLB, identify the factors that affect the WLB, and finally measure the level of impact of the WLB on the EP in the banking industry of Bangladesh. Total 325 bankers were selected conveniently from different branches of the top ten selected banks. SPSS and smart PLS were used to analyze data. Descriptive statistics and SEM analysis were employed in the study. This study argues that when there is an association among the factors of WLB, there is the likelihood that the EP of the organization will be improved. Hence the study concludes that the banking industry needs to improve WLB position, which will ultimately improve organizational performance through EP.

Abstract Background A healthy diet in the adolescence period is essential for physical, mental, and immunological development. We aimed to assess macronutrient consumption in the diet of adolescent school children using 24 h recalls in four seasons of the year. Method This was a longitudinal study conducted from February 2014 to June 2015. The study population included 155 school children aged 7–14 years from an urban school in Karachi. 24HR recall was conducted on 4 random days of the 4 main seasons. A food composition table was developed where the weight, calories, carbohydrate, fat, and protein content of the food items were listed. Macronutrients quantification was calculated by using proportional weight from the food composition table. Food groups were also assigned to each food item including vegetables, fruits, grains, protein foods, dairy products, and oils. Results A total of 155 adolescent children aged between 7 and 14 years were approached. Out of the 155 preadolescents and adolescents, 150 (96.7%) agreed to participate. The mean (SD) age of the children was 11.31 (1.6) years, and 59% of all the children were males. Overall mean (SD) daily intake for all seasons was 195.31 (86.87) grams of carbohydrates, 94.77 (71.87) grams of proteins, and 55.87 (30.79) grams of fats. Carbohydrates formed 48.16%, protein 21.92%, and fat 29.93% of the total caloric intake. The mean (SD) daily caloric intake was 1517 (644) grams. Overall, the highest source of calories was from carbohydrate 781 (347) Kilocalories (Kcal), followed by fat 502 (277) Kcal and protein 379 (287). The Carbohydrate intake in 24 h was highest in the autumn; 212.81 (85.37), and there was a significant difference in carbohydrate intake in all seasons (p value 0.003). Consumption of discretionary food group was high (31.3%), and consumption of fruits and vegetables was low (29%). Conclusion The study reports a suboptimal caloric intake of fewer than 2000 cal/day among the adolescents from school. The highest source of calories was from carbohydrates.The highest consumption of food was in autumn and the least in summer. Fruits and vegetable intake was low, and discretionary food intake was high.

Selection of medical students requires both cognitive and soft skills assessment. Shalamar Medical and Dental College (SMDC) has been using on-campus multiple mini interviews to assess the latter but due to Covid-19 pandemic it became imperative that an alternative be found. The aim of this communication is to share the process SMDC went through to plan, design, and ultimately conduct WhatsApp-based multiple mini interviews (wMMI) in a low risk method as an entry criteria for undergraduate medical students. The process involved designing scenarios appropriate for online interviews, training the faculty members regarding conducting MMI as well as the use of technology, and designing an online webpage for enrolling, scheduling and assessing candidates. We were able to successfully complete wMMI process for 522 candidates within one week in a low risk setting using WhatsApp as communication medium with strong IT and administrative support. Keywords: Medical student; Admission; Selection; Multiple mini interviews;

Flavonoids are a large subgroup of polyphenols known to be sourced from over 6000 natural products, including fruits, vegetables, bark, and herbs. Due to their antioxidant properties, flavonoids have been implicated as a therapy source for many diseases and conditions, including inflammation, vasculitis, venous insufficiency, and hemorrhoids. Currently, some flavonoids are being researched for their antioxidant ability concerning neuroprotection. These flavonoids can penetrate the blood–brain barrier and, depending on the specific flavonoid, retain adequate bioavailability in certain brain regions. Further data suggest that flavonoids could have a strong anti-inflammatory effect in the brain, which not only could be a robust therapeutic source for known neuroinflammatory diseases such as Alzheimer’s Disease or Parkinson’s Disease but also could be a therapeutic source for ischemic or hemorrhagic conditions such as a stroke. While flavonoid toxicity exists, they are relatively safe and non-invasive drugs from natural origins. As such, exploring the known mechanisms and therapies may highlight and establish flavonoid therapy as a viable source of therapy for stroke patients. As stated, many flavonoids are already being isolated, purified, and implemented in both in vitro and in vivo experiments. As these flavonoids proceed to clinical trials, it will be important to understand how they function as a therapy, primarily as antioxidants, and by other secondary mechanisms. This review aims to elucidate those mechanisms and explore the neuroprotective role of flavonoids.

Background: Healthcare for mothers and children is a significant indicator of a country's well-being. India is one of the nations that were experiencing a rather slow improvement in maternal and child health. Aims: The objective of this study is to analyse the changes in maternal healthcare in India from 2010-11 in health inputs like health infrastructure and government expenditure, health outcomes like antenatal care, postnatal care, institutional delivery, and health impact like Maternal Mortality Ratio (MMR). Methodology: The study is based on secondary data. It employs Average Increasing Rate (AIR) and Average Reduction Rate (ARR), as well as a panel data random effect model, on key health indicators for Indian states. Results: Empirical results say MMR has a statistically significant inverse relationship with female literacy, Per capita Net State Domestic Product (PNSDP), and institutional delivery. The study concludes that after the introduction of NRHM and its constituent elements like JSY and JSSK, government expenditure on health, infrastructure, the percentage of antenatal care, post-natal care, and institutional delivery increased in most of the Indian states, thus helping to increase the pace of the reduction of MMR. However, state performance varies greatly. Conclusions: Policy alone will not provide the desired results; it is also critical to focus on education, particularly female literacy, and economic empowerment. We can make a difference in the health sector if these come together.

Summary: Background: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p

Introduction: Osteochondroma of the coronoid process also known as Jacob’s disease, has rarely been reported in the literature and it posses a challenge as diagnosis may be overlooked in favour of other causes of limited mouth opening. Case Report: This is a case report of an adult male patient who presented with restricted mouth opening in whom radiological imaging, especially 3D computed tomography, played a role in establishing the diagnosis of Jacob’s disease. Conclusion: An osteochondroma of the coronoid process of the mandible (Jacob’s disease) is a rare cause of restricted mouth opening and its diagnosis can be overlooked in favour of TMJ ankylosis. The CT scan plays an important role in diagnosis and in planning for surgery.

The neurofeedback stimulus content has direct implications for the efficacy of the psychophysiological applications for neurofeedback modality. In particular, enhancements of neurofeedback stimulus content can facilitate improvements in the efficacy of neurofeedback applications in clinical practice. To further elaborate on this aspect, this study introduced systematic enhancements in neurofeedback stimulus content by developing enhanced neurofeedback stimulus content for stress mitigation. The enhancements included the automatic selection of colour of neurofeedback stimulus content environment and instruction messages, as well as, the adaptive selection of threshold of quantitative electroencephalogram (QEEG) features, such as frontal alpha power and frontal alpha asymmetry. The enhancements were based on the outcomes from previous research on the selection of neurofeedback stimulus content for stress mitigation. The improvement in the efficacy of neurofeedback stimulus content was measured statistically by comparing the QEEG and topographic maps. In this study, electroencephalogram data from 20 participants were acquired during multiple sessions of neurofeedback. Analysis of variance and a post hoc test were used to verify the improvement on the efficacy of the neurofeedback application for stress mitigation after the enhancements of the neurofeedback stimulus content; a t–test was used to verify the statistical significance of the stress mitigation by the neurofeedback. The results indicate that the enhancement of the developed neurofeedback stimulus content facilitated stress mitigation during the early sessions of neurofeedback. In conclusion, the efficacy of neurofeedback can be improved using the developed stimulus content with enhancements.

Madam, Since the beginning of 2021, massive vaccination programmes have been initiated, aiming to curb the COVID-19 pandemic, yet certain groups remain vulnerable, especially pregnant women (1). A recent study has emphasized the implications of COVID-19 in pregnant females; evaluating statistics from various countries, the authors reported maternal mortality to be 22 times higher in pregnant women with COVID-19 diagnosis than those without (2). Compared with those without COVID-19, infected females giving birth showed significantly higher rates of ICU admission, respiratory intubation, mechanical ventilation, and a greater risk of having a preterm birth of fewer than 37 weeks (2). In Pakistan, Covid-19 is speculated to cause multiple complications among unvaccinated pregnant women. When local data was collected and presented at a webinar “Pregnancy in Covid-19 and importance of vaccine” held by a public medical university in association with the American Society of Microbiology, it was highlighted that Covid-19 caused a death rate of 8% in pregnant women. Each year, approximately 14% of pregnant women are susceptible to have medical complications. (3) These adverse outcomes during pregnancy accentuate the need for vaccination of pregnant individuals. Recent studies have started assessing the outcome of Covid-19 vaccination on the pregnant women population and demonstrated positive results. Blakeway et al reported that women who received at least one dose of COVID-19 vaccine in pregnancy versus unvaccinated females had similar rates of all adverse pregnancy outcomes and concluded that vaccines do not affect perinatal outcomes (4). Guidelines recommending urgent vaccination for pregnant people have also been released, stressing that the benefits of the vaccine supercede any potential risks (1). However, several factors have hindered the process of vaccination of pregnant women such as the exclusion of pregnant women from clinical trials that have caused difficulty in establishing confidence of pregnant women in the vaccines In addition, the prevailing conspiracy theories in Pakistan about vaccination programmes, being a Western agenda to induce sterility in Muslim women has further hindered the success of vaccination programme for pregnant women. (5) Physicians must implement the past positive findings of vaccination among pregnant women when counseling patients who are pregnant, planning a pregnancy, breastfeeding, or planning to breastfeed, and facilitate them in opting for government authorized vaccines for clinical use. At the same time, pregnant women who wish to wait for more data to make an informed decision must be supported and updated by their doctor regularly. ---continue

Madam, preterm birth (PTB) is classified as having a gestational age of fewer than 37 weeks; annually, approximately 15 million infants are born preterm worldwide(1). Major risk factors of PTB include placenta previa, fetal distress, maternal thyroid disease, and maternal asthma(2). Both teenage (35 years) mothers carry an increased risk of giving birth prematurely(2). Previous studies have shown a positive correlation between PTB and numerous disorders, including hypertension, diabetes mellitus, and hyperlipidemia(3). Mounting evidence suggests PTB is a significant risk factor for ischemic heart disease (IHD) and stroke. However, due to prior discrepant findings, there is a possibility that these associations might be spurious. However, recent literature surfaced two cohorts by Crump et al. in 2019(4) and 2021(3). In 2019, compiled data from 2,141,709 participants over 43 years, and preterm babies were found to have a significantly higher risk of developing IHD in the future (aHR: 1.44 [1.19-1.73](4). Moreover, the incidence of IHD was more prevalent among preterm-born men than preterm-born women(4). The 2021 cohort evaluated the frequency of stroke with PTB. It concluded that PTB was associated with higher risks of both hemorrhagic stroke (aHR: 1.15 [0.97–1.35]) and ischemic stroke (aHR: 1.31 [1.07–1.60]), compared with full-term birth(3). These results are worrisome for Pakistan since it has a high tally of PTB cases, as highlighted by a 2017 study by Hanif et al., which showed a 21.64% prevalence of PTB among 1691 females(2). These preterm infants have an increased likelihood of acquiring IHD and Stroke coupled with the already established diseases including hypertension, diabetes, and hyperlipidemia later in life, which exacerbates the already high disease burden in Pakistan. Moreover, unaware of the medicines’ cost-effectiveness, medical practitioners commonly prescribe expensive popular generics for treating IHD(5), which inflicts a substantial financial burden on these patients. Hence, paediatricians should be advised to follow up with preterm babies regularly assess their progress, educate mothers about the risk factors of PTB and minimize the chances of them showing up down the line by emphasizing proper diet, regular exercise, and abstinence from smoking. Nationwide campaigns and awareness drives are a few ways the general population could be made aware of PTB and its threat to the health of these children in the future. Continue...

Dear Madam, Since its first appearance in India in December 2020, the B.1.617.2 (delta) variant has spread across 85 countries as of yet. Its rapid proliferation has enforced WHO to classify the strain as a “variant of concern”. Equipped with 10 spike protein mutations (T19R, (G142D*), 156del, 157del, R158G, L452R, T478K, D614G, P681R, D950N), especially the P681R mutation at the cleavage site S1-S2,1 the virus now has the ability to replicate and transmit at a rate much faster than the original SARS-CoV-2. This is evident from the fact that it is detectable in infected individuals just under 4 days after it’s contraction, with a viral load 1,260 times higher, as compared to 6 days with the earliest form.2 Researchers are uncertain regarding the efficacy of existing vaccines against the delta strain. A recent preliminary study analysed the efficacy of BNT162b2 (Pfizer) and ChAdOx1 nCoV-19 (AstraZeneca) against the mutated version. The study revealed markedly lower effectiveness after one dose, and moderate effectiveness after two doses among people infected with delta variant for both the vaccines.3 The recent finding is daunting for Pakistan as the nation has seen a rapid surge in delta variant cases. In Karachi alone, the positivity ratio has inflated up to an alarming level of 23.6% with the major hospitals operating at full capacity.4 Although the process of vaccination is ongoing, still 20202951(20 million) individuals remain partially vaccinated,5 while the rest of the population remains unvaccinated which poses a serious concern for Pakistan since such individuals, as stated earlier, are at a greater risk of contracting the delta variant.3 Considering that the virus will continue to mutate, it is imperative that preventive guidelines including the use of a mask, social distancing must be practiced and travel restrictions must be imposed in order to curtail the spread. Additionally, booster shots can be administered to increase the efficacy of these vaccines. Moreover, a study conducted on mice evaluated the response of recombinant chimpanzee adenovirus (AdC7) vaccine expressing S, receptor-binding domain (RBD) or tandem-repeat dimeric RBD (RBD-tr2) (AdC7-RBD-tr2) administered via intramuscular (systemic) and intranasal (mucosal) route. This vaccine exhibited a greater neutralising effect on the delta variant than the existing vaccines. The intranasal administration produced mucosal immunity with neutralizing activity in Broncho alveolar lavage fluid thus offering greater protection to the respiratory tract, a quintessential goal to terminate SARS-CoV-2 transmission.6

Objective: To assess the safety attitudes of labour room practices of FCPS residents. Study Design: Mixed method sequential study. Place and Duration of Study: Department of Obstetrics and Gynaecology unit I and unit II, Civil Hospital Karachi/Dow University of Health Sciences, from Oct 2017 to Feb 2018. Methodology: The first phase of the study was collection of quantitative data using a Safety attitude questionnaire followed by second phase of two focus group discussions. Quantitative data was computed and analysed in SPSS-19, while qualitative data was transcribed involved verbatim followed by coding of the data with thematic analysis. Results: A total of 79 residents were approached out of which 69 consented to participate in the study yielding a response rate of 87.3% (69/79). The total mean domain scores of SAQ were highest for stress recognition domain (63.7 ± 18.1), while the least domain scores were for job satisfaction (60.5 ± 15.9). Amongst, year one and year four residents the mean domain scores were highest for working condition domain (68.8 ± 20.2), (64.1 ± 10.9) respectively. It has been endorsed in FGD that there was good collaboration among doctors however supporting staff were not sufficient in number, in addition their behavior was unprofessional and irresponsible. There was compromised cleanliness and insufficient medical supplies to fulfill the needs of huge number of patients. Conclusion: The safety attitudes of FCPS residents, showed positivity towards Job satisfaction, safety climate and team work, however excess work load, stress and communication gaps are negatively affecting the safety...

Background and Objective: In 2002 Multiple Mini Interview (MMI) was introduced to assess the noncognitive and/or high cognitive traits. Shalamar Medical and Dental College (SMDC), Lahore encouraged the process of MMI resulting in implementing and piloting the process from 2015. Acceptability is considered as the important aspect to support the validity evidence and since MMI was conducting the very first time in Pakistan for undergraduate admission, it was important to address its acceptability. The objective of this study is to assess the stake holder’s acceptability for Multiple Mini Interviews (MMI) for the selection of medical students.Methods: This was a cross-sectional study and data was collected at SMDC Lahore, in years 2015 and 2016. The research sample included candidates who applied for the admission in SMDC and examiners, trained faculty of SMDC involved in process MMI for 2015 and 2016. Acceptability of MMI was determined using post-MMI survey through questionnaire with 5-point Likert scale. Data was analysed using Statistical Package for the Social Sciences (SPSS) 20.0. Demographics were determined. Means, standard deviations and frequencies for each statement of the questionnaire were calculated. Mann-Whitney U-test was applied on the similar statements of the questionnaire among the candidates and examiners for both years separately.Results: In post-MMI survey most of the statements showed more than 80% acceptability for MMI among stake holders for both 2015 and 2016. Comparison of similar statements among candidates and examiners revealed no significant difference except asked about the time duration (5 minutes) was enough to assess the attributes (P=0.003 & P=0.001) for both years 2015 and 2016 respectively.Conclusion: Study provided the evidence of stake holders’ (candidates and examiners) acceptability of MMI in medical schools’ admission. It reflected that they are contented with the process

Patients presenting with bacteremia and the presence of multiple infected emboli sites should be promptly investigated for heart valve endocarditis as the possible culprit. We present a case of Eustachian valve endocarditis secondary to multiple abdominal surgeries to highlight not only the importance of recognizing risks factors, other than intravenous drug use, in the pathogenesis of right sided endocarditis, but also to illustrate the significance of systematically interrogating all the heart valves, including the Eustachian valve during echocardiography.

The effective educational systems aimed at improving Cognitive Skills (CS) both in and out of institutions. Such system relies on timely prediction of CS during students' activities in intuitions. Meanwhile, literature is saturated with the number of approaches which have used study schedules, biological and environmental factors to predict CS. However, the loopholes in prior studies have become the main source of inspiration for the current attempt. In this study, we propose a Bayesian Neural Network which predicts CS by iterative manipulations of CS under the profound influence of Student's Basic Attributes. Initially, the study classifies the Basic Attributes into three factors (1.age group, 2. gender, and 3. parent's cohabitation status) which have multiple layers. Furthermore, the technique splits the range of CS into 20 periodic outcome variables (with a period of 0.5). Eventually, the network iteratively estimates each outcome of CS by feed-forward process through Basic Attributes layers. We have reviewed the performance of the proposed network by using a students' score dataset. The results have illustrated that the current technique obtained significant prediction accuracy in terms of accuracy measures.

يركّز هذا البحث على بيان موقف القرآن الكريم من تثبيت أنشطة النساء حول المساجد، كالمشاركة في صلاة الجماعة واستماع الخطبة والمساهمة في الأعمال الخيريّة والإصلاحية. لأن النساء في القارّة الهندية خاصّةً تمنع من المساجد استدلالاً من بعض الأحاديث فقط، والقرآن أحق في بيان الأصول لهذه القضية. استخدم الباحث المنهج الاستقرائي، وتم ذلك عن طريق جمع الآيات القرآنية التي تتحدّث عن حضور النساء في المساجد، والمنهج التحليلي تم عن طريق تحليل الآيات المتعلقة بالموضوع. وتوصل البحث إلى نتائج، ومن أهمّها: خروج النساء إلى المساجد وعقد الأنشطة حولها أمر ثابت بالقرآن الكريم. فمن يشتبه في مثل هذا الحكم الثابت فلا بدّ له من الرجوع إلى المصادر الأصليّة للإسلام: القرآن الكريم ثم الأحاديث النبوية. فقضية حضور النساء في المساجد جائز لما دلّ عليه القرآن الكريم والأحاديث النبوية تُبين كيفيّتها وضوابطها، كما تُبين الموانع منها.

Background The prevalences of obstructive and restrictive spirometric phenotypes, and their relation to early-life risk factors from childhood to young adulthood remain poorly understood. The aim was to explore these phenotypes and associations with well-known respiratory risk factors across ages and populations in European cohorts. Methods We studied 49 334 participants from 14 population-based cohorts in different age groups (≤10, >10–15, >15–20, >20–25 years, and overall, 5–25 years). The obstructive phenotype was defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) z-score less than the lower limit of normal (LLN), whereas the restrictive phenotype was defined as FEV1/FVC z-score ≥LLN, and FVC z-score

Electricity is the fundamental need of human society. Any nation's growth depends on energy. The worldwide electricity consumption increases and conventional electricity sources are causing pollution. Therefore, some non-conventional energy recourses are mandatory to be designed and developed for electricity generation, and they are useful and environment-friendly. In this study, a renewable, non-conventional energy source prototype has been developed, based on the mechanism of power generation from speed breaker with ratchet and pawl mechanism. This study aims to convert the kinetic energy of vehicles into electrical energy which can be used for street and highway lighting and conservation of electrical energy.

Cardiovascular disease (CVD), a broad-spectrum term comprising coronary artery disease, stroke, hypertension, and heart failure, presents as one of the most significant strains on global healthcare systems. Coronary artery disease, caused by atherosclerosis, has various modifiable risk factors such as dietary changes and exercise. Since these risk factors are found to be linked to oxidative stress and inflammations, the dietary supplementation with vitamins’ role in treating and preventing the diseases has been of much debate. With various vitamins having anti-inflammatory and antioxidative properties, studies have explored their correlation with cardiovascular health. Therefore, this narrative review explores and evaluates the benefits and risks of all vitamin supplementations in patients with CVD and provides future recommendations.