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Background: Oral cancer is currently one of the major public health problems globally. Awareness of the risk factors of oral cancers may result in patients seeking medical advice earlier, which in turn can lead to early detection and a better prognosis of such lesions. Literature also reports lack of awareness to be the most common barrier to care-seeking by oral cancer patients. Objective: To determine oral cancer awareness and its associated factors among among dental patients attending free consultation camp in a tertiary care hospital in Karachi. Methods: A cross-sectional study was conducted in a tertiary care dental hospital in district Malir, Karachi, from January 2019 to June 2019. After checking eligibility and taking verbal informed consent, the participants were interviewed using a questionnaire to assess their oral cancer awareness. Data were analyzed on SPSS version 20. Crude and adjusted odds ratio with 95% confidence interval were computed using binary logistic regression to determine the association of demographic characteristics with awareness. Results: The median age of study participants was 37 (IQR=45-29) years whereas 105 (65.2%) of them were female. The mean awareness score of the participants was 8.94±2.71. Moreover, only 34 (21.1%) participants had adequate awareness whereas 127 (78.9%) had inadequate awareness regarding oral cancer. In a multivariable model, education of the patients was found to be associated with adequate awareness regarding oral cancer. Conclusion: It was concluded that certain gaps exist in the awareness of dental patients regarding oral cancer, and apart from the education, none of their demographic characteristics significantly influenced it.

Objective: To determine the knowledge, attitude and practices regarding management of biomedical waste among the house officers and nursing staff in teaching hospitals of District South, Karachi. Methods: A cross sectional knowledge, attitude and practice survey was conducted from November 2018 to April 2019 among the house officer and the nursing staff working at different teaching hospitals of District South, Karachi. A total of 196 house officers and staff nurses were included in the study after checking their eligibility. The participants were interviewed by the principal investigator with the help of a structure questionnaire develop specifically for this study. Data were entered and analyzed on SPSS version 20. Inferential analysis was performed using Mann Whitney U test and Kruskal Wallis H test whereas the significance level was set at 0.05. Results: The study results revealed that among demographic variables categories of age and profession had significantly different mean knowledge rank (p

Background: Diabetes mellitus is one of the most common public health issues globally whose incidence is on the rise, particularly in middle-income and low-income countries. Primary care physicians are the first line of defense in treating and directing diabetics and their families. Despite this, available literature points out a lack of awareness among them regarding type 2 diabetes mellitus and its management. Objective: To determine the awareness and its associated factors regarding type 2 diabetes mellitus and its management among medical practitioners working in different health facilities of Karachi. Method: A cross-sectional study was conducted from June 2016 to November 2017 on medical practitioners working at different public and private health establishments of Districts Malir and Korangi, Karachi. Data from 208 conveniently sampled medical practitioners from the randomly selected union councils of these two districts were collected through the study questionnaire after taking their verbal informed consent. Data were analyzed on SPSS version 21. Crude and adjusted odds ratio with 95% confidence interval were computed using binary logistic regression to determine the association of study variables with adequate awareness. Results: A total of 328 medical practitioners were approached out of which only 208 returned the questionnaire yielding a response rate of 63.4%. The median age of study participants was 38 (IQR=47-30) years. 148 (71.2%) of them were males whereas 168 (80.8%) of them were privately employed. It was found that 146 (70.2%) participants had adequate awareness whereas 62 (29.8%) had inadequate awareness regarding type 2 diabetes mellitus and its management. Univariate and multivariable analysis showed that none of the demographic characteristics of the practitioners were significantly associated with awareness. Conclusion: Medical practitioners were found to be adequately aware of many aspects of diabetes mellitus type 2 and its management. Their awareness, however, was not associated with their demographic characteristics.

Objective: To assess learning styles and preferred teaching methodologies of medical students in relation to year of study. Methods: A cross-sectional study was carried out among 523 medical students of Baqai Medical College, Baqai Medical University, Karachi, from May 2019 to October 2019. All male and female students from first to final year, who attended the undergraduate MBBS program in the medical college, were included in the study. The study questionnaire was administered to all enrolled undergraduate medical students, from first to fifth year, on the campus out of which 523 forms were collected. The study instrument was a questionnaire containing students’ demographic details, David Kolb’s Learning Style Inventory 4.0 and their preferred teaching methodologies scored using a 5 point Likert scale. The association of various learning styles and preferred teaching methodologies with year of study was assessed by using Pearson chi-square test. Results: Out of 523 students who returned the form 518 had completed the questionnaire. A majority of the students had imagining or experiencing learning style. No change in learning style was observed between years of study. The top three teaching methodologies with highest mean scores were small group discussion (3.58±1.12), problem based learning (3.56±1.11) and demonstration on models (3.54±1.20). A significant association between some preferred teaching methodologies and year of study was found such as interactive lecture (p=0.011), problem based learning (p=0.026), small group discussion (p=0.024), and one way lecture (p=0.028) while a highly significant association was noted in case of student presentation (p=0.001). Conclusion: The present study showed that different years of study at medical schools did not significantly affect students’ learning styles, although the students did change their preferences to some teaching methodologies. Longitudinal studies are necessary to reveal whether there is an effect of learning styles over time in medical education.

Objectives: To assess the frequency of self-medication and its associated factors among outpatients. Methods: A cross-sectional study was conducted at the outpatient department of Fatima Hospital, Baqai Medical University, from May 2019 to September 2019. After checking eligibility, a total of 360 outpatients were included in the study using the convenience sampling technique. Being aged 18 years or above and belonging to either gender were the study's inclusion criteria, whereas refusal to give verbal informed consent was the exclusion criterion of the study. The data was collected by interviewing the study participants using a structured questionnaire. Statistical package for social sciences version 21 was used for data analysis, while inferential analysis was performed using univariate and multivariable binary logistic regression. Results: The study results showed that 118 (32.8%) of the participants were suffering from a chronic illness, 240 (66.7%) of them kept medicines at their houses, 235 (65.3%) of them self-medicated, whereas the mean duration of their self-medication was found to be 9.90 ± 8.51 years. Moreover, age, educational status, employment status, and keeping medicines at the house were significantly associated with self-medication of the participants were those who were aged 50 years or above (AOR,7.83; 95% CI,2.27-27.04; p=0.001), able to read and write (AOR, 4.36; 95% CI, 1.58-11.98; p=0.004) and kept medicines at the house (AOR, 46.35; 95% CI, 20.07-107.06; p

Objective: To assess the burden of trauma during the last three years (2016-18) caused by road traffic accidents presenting to the trauma centre of tertiary care public hospital in district central, Karachi. Methods: All the accident cases presenting in the trauma center of the hospital in last three years who were defined as accidents occurring on a public road and involving at least one moving vehicle were included in the study. Those with incomplete medical records were excluded. This was a crosssectional study where records of a total of 2857 individuals were retrospectively collected and their socio-demographic information, history of road traffic crashes, clinical history and examination was noted. Data was analyzed through SPSS while descriptive statistical analysis of continuous and categorical variables was performed. Results: The mean age of patients admitted to the trauma centre was 29.3 ± 16.7 years with no significant difference between both gender. Out of 2857 patients with road traffic accident injuries, around 80.9% were males. The most prevalent age group was 16-30 years of age, which was over 40.2%, followed by subjects of 31 - 45 years age group which was 21%. The study results further showed that over 51.3% of the road traffic accident patients were discharged normally, followed by 46.7% subjects who left against medical advice. Overall death rate was 2% (n=57). Conclusion: This study helps to identify the latest accident burden and pattern of injuries to develop plans aimed at prevention of road traffic accidents. Looking at the burden, the most affected was the younger subjects (16-30 years) highlighting the need for targeting this population for educational programs and policies about safe driving. Among the road traffic accidents cases the subjects who left against medical advice cases was gradually decreasing from 2016 to 2018 suggesting better healthcare facilities at the tertiary care hospital and corresponding increasing patient's confidence in them.

A cross-sectional survey was conducted from February 2016 to September 2016 to assess knowledge, attitude and practices regarding implants among women of childbearing age visiting Reproductive Health Services Center, Civil Hospital,Karachi. A total of 396 adult non-pregnant married females of child bearing age, from 18 to 49 years old, were interviewed using a structured questionnaire.Only153 (38.6%) of therespondentshad knowledge about implants whereas out of them 122 (79.7%) acquired it from family planning clinics. Almost two third of them (n=267, 67.4%) were in favor of using implants as a contraceptive method. Moreover, 244 (61.6%) of them were of the opinion that if given the choice, they will use implanon though out of total 316 (79.8%) respondents who ever used contraceptives, only 3 (0.9%) used implants.Despiteafavorable attitude, limited knowledge and poor practices of the respondents highlighted the study findings. Keywords: Knowledge, Attitude, Contraception, Progestins, Continuous...

Objective: To determine the awareness regarding weaning and its associated factors among mothers in Kashmore, rural Sindh. Methods: A cross-sectional study was conducted among infant’s mothers regarding awareness for weaning at Kashmore, a rural community in interior Sindh, from March 2108 to November 2018. The inclusion criteria were age of mothers 30 years or above and child’s age more than two years whereas mothers refusing to give verbal informed consent were excluded from the study. A total of 200 mothers were included in the study and were interviewed by using a questionnaire designed specifically for the study. Data were analyzed using statistical package for social sciences version 20 while Mann Whitney U test and Kruskal Wallis H test were used for inferential analysis. The study duration spanned over 9 months. Results: The mean age of the mothers was 27.1 ± 6.3 years and the average number of children for every household was 2.4 ± 1.3. When participants were asked about what weaning foods should be given to assess their awareness, 176 (88.0%) mothers said bread or roti, 153 (76.5%) said yogurt, 144 (72%) said boiled rice, 133 (66.5%) said vegetables, 130 (55.0%) said suji or kheer, 95 (47.5%) said egg yolk while only 71 (35.5%) said fruits. The study results further showed that among the socio-demographic characteristics compared the mean awareness scores of the mothers were significantly different across categories of mothers’ education (p

Objective: To assess tuberculosis related knowledge, attitude and practice among final year medical students of Karachi. Methods: A cross-sectional study was conducted in two medical colleges located in different districts of Karachi from January 2017 to June 2017. Being a final year medical student of the college was the inclusion criterion whereas refusal to give written informed consent was the exclusion criterion of the study. Data were collected on a structured questionnaire administered by the principal investigator to all the participants. Data collected were analyzed using SPSS statistical package version 20. Results: Around two-thirds students knew that tuberculosis cannot be treated only on radiographic findings while a majority of them knew about the treatment regimens but knowledge about the different TB medicines and their side effects was variable. About 90% of the students believed that directly observed treatment short course therapy is effective while a similar number believed Bacille Calmette Guerin vaccination prevents tuberculosis. A fair number of students (63.1%) practice wearing of face mask while a majority (89.3%) of them reported that contagious patients should be isolated. Over 95% of the students stated that they give tuberculosis patients counseling and health education. Conclusion: Majority of students had correct knowledge, attitude and practices regarding tuberculosis. Increased exposure and education to medical students in both academic and clinical settings is recommended.

A cross-sectional awareness survey was conducted among final year MBBS students of ISRA University, Hyderabad from May 2017 to November 2017. After checking eligibility and taking verbal informed consent, 100 participants were included in the study and interviewed using a self-administered questionnaire. Data was analyzed on Statistical Package for Social Sciences version 21. The study results showed that 29 (29%) of the study participants got information about family planning methods from health care providers, 27 (27%) through social circle, 24 (24%) through mediawhile 20 (20%) through conference, meetings and events. Furthermore, 42 (42%) of the participants correctly identified all permanent family planning methods, 65 (65%) correctly identified temporary family planning methods, 47 (47%) correctly identified short-term family planning methods whereas 54 (54%) correctly identified long term family planning methods. Efforts by both public and private sector to enhance awareness regarding family planning methods among medical students are recommended

Objective: To determine the frequency of skin diseases and its associated factors among patients visiting a dermatology clinic in Karachi. Methods: A cross sectional study was carried out from December 2018 to May 2019 at Baqai Institute of Health sciences, Baqai Medical University, Karachi. Available relevant data of all patients visiting a selected dermatology clinic in Karachi for a period of two years, from 1st January 2017 to 31st December 2018, were retrospectively gathered and recorded on the study questionnaire by the principal investigator. Statistical package for social sciences version 19.0 was used for analysis. Chi-square test was applied to check associations between the independent variables and the study outcome whereas the significance level was set at 0.05. The duration of the study was six months. Results: The study findings revealed that the highest frequency of skin diseases among the patients was of psoriasis (25.3%), followed by dermatitis (23.3%), scabies (14.1%), fungal infection (11.9%), acne (9.0%), folliculitis (4.4%), atopic dermatitis (4.1%), keloid (3.2%), warts (2.8%) and vitiligo (1.9%). Moreover, 51.2% of the patients came in the summer season. The study results also showed that season was found to be significantly associated with the diagnosis of the patients both among patients aged 25-49 years (p

A cross-sectional survey was carried out to determine the factors associated with self-reported glycemic control among outpatients with diabetes mellitus type 2 visiting a private tertiary care hospital of Karachi, from July to October, 2018. A total of 185 participants of either gender, aged 30 years, with obesity and a self-reported diagnosis of diabetes mellitus type 2 for at least 1 year were included in the study and interviewed using a structured questionnaire. Data were analyzed on statistical package for social sciences version 21 whereas chi-square test and binary logistic regression were used for inferential analysis. The study results showed that regular medicine intake, regular exercise and weight change during the previous year were significantly associated with self-reported glycemic control of the patients (p

Abstract Objective: To assess oral health-related knowledge, attitude and practices and their associated factors among 3rd year BDS students in public sector dental colleges of Karachi. Methods: A cross-sectional survey was carried out to assess oral health-related knowledge, attitude and practices among 3rd year BDS students from November 2018 to April 2019. 3rd year BDS students of either gender in public sector dental colleges of Karachi were included in the study whereas those refusing to give verbal informed consent were excluded from the study. After checking eligibility, a total of 372 3rd year BDS students from five public sector dental colleges of Karachi were included in the study by using a convenience sampling technique. Data were collected by the principal investigator using a pre-tested structured questionnaire. Data were entered on Statistical Package for Social Sciences version 19. After checking normality, the inferential analysis was carried out using the Mann Whitney U test whereas the significance level was set at 0.05. Results: The study results showed that the knowledge and attitude regarding oral health of dental students were overall satisfactory, however their practices were not found to be satisfactory. Moreover, it was found that the mean rank of knowledge score was significantly different across various categories of age 'p=0.001' whereas the mean rank of practice score was significantly different across various categories of gender 'p=0.005'. Conclusion: It was concluded that knowledge score was significantly different across categories of age while practice score was significantly different across categories of the gender of the students. Serious efforts are recommended to be taken by all stakeholders in order to motivate dental students so that they can translate their adequate knowledge and positive attitude regarding oral health into appropriate practices.

Abstract Objective: To assess depression and its associated factors among patients coming to the dental OPD of a public and a private dental college of Karachi. Methods: A cross-sectional study was carried out in public and a private dental college of Karachi from November 2018 to May 2019. The inclusion criterion of the study was being 18 years of age or above whereas those who refused to give written informed consent were excluded from the study. After checking eligibility and taking written informed consent, a total of 250 participants were included in the study using systematic random sampling. These dental outpatients were interviewed by the principal investigator with the help of a pretested structured questionnaire that contained questions about socio-demographic information, dental risk factors and questions from Patient Health Questionnaire-9. Data were analyzed on the statistical package for social sciences version 21. Inferential analysis was performed using chi-square test whereas the significance level was set at 0.05. Results: The study results revealed that 70 (28.0%) participants had minimal depression, 99 (39.6%) had mild depression, 45 (18.0%) had moderate depression, 28 (11.2%) had moderately severe depression whereas 8 (3.2%) had severe depression. Moreover, among demographic characteristics, only monthly income (p=0.037) and family history of depression (p

BackgroundAntibiotics are regularly prescribed by dental professionals in their practice, for the purpose of dental treatment as well as for the prevention of infection. The inappropriate use of antibiotics is a significant factor in the rise of antibiotic resistance. There is an immediate need for the advancement of prescribing guidelines and instructive polices to encourage the rational and appropriate utilization of medications especially antibiotics in dentistry.ObjectiveThe aim of this study was to identify the frequency of antibiotic prescription for treating dental infections in children among dentists in teaching institutions of Karachi, Pakistan and whether they are adhering to the prescribed international guidelines.MethodsA cross-sectional study was conducted in three private and two public colleges of Karachi. After taking written informed consent and checking the inclusion criteria, a total of 380 participants were interviewed using a pre-designed validated questionnaire which included demographic profile and clinical case scenarios. Data were entered and analyzed on SPSS version 20. Inferential analysis was performed using chi-square test. The significance level was set at 0.05.ResultsOf the 380 subjects, a majority (71.3%) treated 15 or less children per month (n = 271) while 28.7% of dentists (n = 109) treated more than 15 children per month. Overall adherence to American Academy of Pediatric Dentistry guidelines was low from 26.1% to 44.2%. The difference between adherence of dentists with low and high volume of pediatric patients was significantly different for case scenarios 1, 3, 4 and 5 (pConclusionsThis study shows that majority of dentists, particularly dentists with high volume of pediatric patients lacked adherence to professional guidelines for prescribing antibiotics for treating dental infection in children. There seem to be a lack of harmony between the recommended professional guidelines and the antibiotic prescribing pattern of dentists. Regular updates and continuing medical education for the health professionals regarding comprehensible and specific professional guidelines may lead to improved adherence of antibiotics prescription amongst dentists.

Background: Shoulder joint pain is the third most common musculoskeletal problem with the prevalence of 26% in general population. It is believed that the mechanical compression of acromial structures between the coraco-acromial bony structures and the head of the humerus progress towards the development of shoulder impingement syndrome (SIS). Objective: The aim of this study was to assess the short-term effect of scapular movements with mobilization in individuals with shoulder impingement syndrome. Methodology: It was a quasi-experimental study design, in which total of 74 subjects with primary complaint of unilateral shoulder pain due to sub acromial impingement syndrome, who were referred to the department of physical therapy were recruited. This study was carried out at the Department of Physical Therapy, Defence National Hospital Lahore and Pakistan Society for Rehabilitation of Disabled Lahore. This study was completed in 06 months from April 2015 to October 2015. A total of 50 Subjects who fulfilled the inclusive criteria were allocated into two treatment groups A and B. Group A was treated with scapular and shoulder mobilization and group B was only treated with shoulder joint mobilization. Each group received 3 treatment sessions for one week. Outcomes of the treatment interventions were recorded through visual analogue scale, shoulder pain and disability index and shoulder range of motion before and at the end of the treatment session. Results: There was significant improvement in pain (p value=0.00), disability (p value=0.00) and shoulder range of motion (p value=0.00) measured after treatment and at the end of 1 week of treatment across the treatment group. However, this improvement was greater in the group which was managed with both scapular and shoulder joint mobilization as compared to the group which was managed with shoulder joint mobilization only. Conclusions: It is concluded that scapulothoracic joint mobilization along with gleno-humeral joint mobilization is more beneficial in minimizing pain and improving ROM in individuals with SIS than glenohumeral joint mobilization alone. Keywords: Mobilization, Manual Therapy, Shoulder Pain

Objective: To assess dental anxiety and its associated factors among patients visiting OPD of differ- ent tertiary care dental hospitals of Karachi. Methods: A cross-sectional study was conducted from April 2018 to November 2018 in two public and two private dental colleges of Karachi namely Karachi Medical and Dental College, Dr. Ishrat-ul-Ibal Khan Institute of Oral Health Sciences, Hamdard Dental College and Baqai Dental College. Being aged ³ 18 years of either gender were the inclusion criteria whereas refusal for a written informed consent was the exclusion criterion.After checking eligibility and taking written informed consent, a total of 247 participants were interviewed by the principal investigator using a questionnaire which included Corah's Dental Anxiety Scale and Dental Concerns Assessment. Data were entered and analyzed on SPSS version 20. Inferential analysis was performed using chi-square test and Mann-Whitney U test after checking normality. The significance level was kept at 0.05. Results: The study findings revealed that 2.4% of the patients interviewed were severely anxious, 8.1% were highly anxious, 37.2% were moderately anxious while 54.3% were not at all anxious. Moreover, patients with younger age and monthly household income between 16000 and 75000 ru- pees had significantly higher mean dental anxiety scores. Conclusion: The study findings revealed that up to 45.7% patients were anxious up to some degree. There is a need for better understanding of factors potentially increasing anxiety in dental patients in order to avoid them as negative experiences in past are known to trigger dental anxiety in future.

This study focused on gas/Newtonian and gas/non-Newtonian two-phase horizontal fluid flow behavior by analyzing their flow regime identification and flow structural analysis on a horizontal flow loop apparatus. This involved the recognition of two-phase flow regimes for this flow loop and validation with existing flow maps in the literature. In addition, the study included flow pattern identification via wavelet analysis for gas/Newtonian and gas/non-Newtonian two-phase fluid flow in a horizontal flow loop apparatus. Furthermore, the study was extended to the detailed examination of slug frequency in the presence of air/Newtonian and air/non-Newtonian fluid flow, and the predicted slug frequency model was applied to the studied systems. The obtained results suggest that the flow regime maps and slug frequency analysis have a significant impact. The obtained pressure sensor results indicate that the experimental setup could not provide high-frequency and high-resolution data; nevertheless, wavelet decomposition and wavelet norm entropy were calculated. It offered recognizable flow characteristics for bubble, bubble-elongated bubble, and slug flow patterns. Therefore, this study can provide deep insight into intricate multiphase flow patterns, and the wavelet could potentially be applied for flow analysis in oil and gas pipelines.

Objective: To assess pressurised metered dose inhaler technique of the nursing staff in different government hospitals of Karachi. Methods: A cross-sectional study was carried out in four randomly chosen government hospitals of Karachi. After checking for study criteria and obtaining written informed consent, a total of 120 nurses were interviewed and then given a placebo inhaler to demonstrate their inhaler technique. The reference for assessment was the 12-step inhalation technique suggested by the American College of Chest Physicians. Results: The study results revealed that out of the 12 steps of the inhaler technique, only 3 steps were followed by a majority of the study participants i.e. taking the cap off (64.2%), putting the metered dose inhaler in mouth with lips sealed (59.2%) and breathing in slowly by pressing down the metered dose inhaler (62.5%). The mean inhaler technique score of the study participants was 3.18 ± 2.34 out of 12 and only 1 (0.8%) of them had correct inhaler technique. Furthermore, the mean inhaler technique score was significantly higher for higher education level (p=0.001) and greater experience (p

Background: Piriformis muscle syndrome is often over looked in the clinical practice as its presentation resembles with other pathology (back, buttock, and leg). Due to its inconsistent objective findings, it is often considered as a diagnosis of exclusion. Familiarity with the prevalence will, therefore, increase its awareness about diagnosis. Objective: The objective of this study was to determine the prevalence of piriformis syndrome in working and non-working women with low back pain Methodology: This comparative cross sectional study was done by using non-probability purposive sampling on 88 low back female patients. They were, then, divided into working and non-working women groups. FAIR test and piriformis stretch were used to diagnose the piriformis muscle syndrome. Results: On the basis of above mentioned diagnostic criteria, prevalence of piriformis syndrome was found in 76 (86.36%) women. Of which, 35 (80%) patients werein working group while 41 (93%) patients belong to non-working group.It is found that this syndrome is common in both working and non-working women. However, there is no significant difference found between two groups (p-value = 0.06) in term of prevalence. Conclusion: Due to high prevalence of piriformis muscle syndrome among female patients with low back pain, clinicians must consider its possibility during differential diagnosis of low back pain. There is also a need to develop an awareness program of disability and the piriformis muscle syndrome among women. Keywords: Piriformis Muscle Syndrome, Low Back Pain, FAIR Test, Physical Therapy

Shrinking water resources all over the world and increasing costs of water consumption have prompted water users and distribution companies to come up with water conserving strategies. We have proposed an energy-efficient smart water monitoring application in [1], using low power RFIDs. In the home environment, there exist many primary interferences within a room, such as cell-phones, Bluetooth devices, TV signals, cordless phones and WiFi devices. In order to reduce the interference from our proposed RFID network for these primary devices, we have proposed a cooperating underlay RFID cognitive network for our smart application on water. These underlay RFIDs should strictly adhere to the interference thresholds to work in parallel with the primary wireless devices [2]. This work is an extension of our previous ventures proposed in [2,3], and we enhanced the previous efforts by introducing a new system model and RFIDs. Our proposed scheme is mutually energy efficient and maximizes the signal-to-noise ratio (SNR) for the RFID link, while keeping the interference levels for the primary network below a certain threshold. A closed form expression for the probability density function (pdf) of the SNR at the destination reader/writer and outage probability are derived. Analytical results are verified through simulations. It is also shown that in comparison to non-cognitive selective cooperation, this scheme performs better in the low SNR region for cognitive networks. Moreover, the hidden Markov model’s (HMM) multi-level variant hierarchical hidden Markov model (HHMM) approach is used for pattern recognition and event detection for the data received for this system [4]. Using this model, a feedback and decision algorithm is also developed. This approach has been applied to simulated water pressure data from RFID motes, which were embedded in metallic water pipes.

Background: Geriatric is an important sub specialty of physical therapy and fall is a key health issue associated with old age. Objective: To find out the role of sensory and acute medical problems causing fall in elderly population of Pakistan. Materials and methods: A Cross sectional survey was conducted at Ghurki teaching trust hospital Lahore, for the period of three months from October to December 2010.Total number of people included was 100. Purposive sampling technique was used. Elders above 60 years having recent history of at least one fall were included regardless of gender. The data were entered and analyzed using SPSS 11.5. Results: Out of 100 there were 83 who had vision problems, 63 % had decreased feeling and numbness or tingling in their feet, 32 % were unsure of footing and trouble on even ground or inline. There were 26% people who had flu like symptoms and 30% people had health problems that limited the activities (heart or breathing problem). Conclusion: The study demonstrates that majority of elderly have sensory and significant medical conditions that can increase the risk of falling. Key words: Accidental fall, Aged, sensory problems, significant health problems

Background: Speech and language delay is uncommon developmental disorder. Speech delay if persists may lead to problem and adverse effects on literacy, education and psychological development. Objective: The purpose of present study id to find out the most common risk factors of speech delay in children of 2 to 6 years of age. Methodology: Cross sectional survey was used to determine common risk factors of speech delay using convenient sampling technique. In this study the questionnaire was filled by the examiner in the interview; collected data from the parents and children sample of 55 children (45 male, 10 females) was taken indirect interview to parents or caregivers in a formal sitting; history was taken on history form being used in outpatient department. After taking consent development using Portage Guide for Early Education (PGEE) portion for language was applied on child, questions were asked from parents and performed by the child. The collected data was analyzed by using SPSS 17. Results: Results showed that the common risk factors for speech delay are anomaly, socioeconomic status of parents and living status of parents. Keywords: Socioeconomic Status, Organicity, Speech Delay, Prediatrics

Purpose: The purpose of this study was to determine the factors associated with Pterygium, utilizing history and examination. Methods: In this prospective case series study, a total of 1227 patients with Pterygium presenting at the Department of Ophthalmology, Chandka Medical College Hospital Larkana, Pakistan, from January 1997 to January 2015 were included. A standard proforma containing proposed risk factors was filled in for every patient. Clinical examination was performed on slit-lamp biomicroscope to confirm presence of pterygium. Results: Out of the total 1227 patients, 656 (53.46%) were males, and 571 (46.54%) were females. Mean age ± standard deviation was 53.12 years ± 15.85 years, and the age range was 20–79 years. 1063 (86.63%) patients belonged to areas with hot and dry weather, 421 (34.31%) patients had a positive family history for Pterygium, 740 (60.31%) patients had history of previous exposure to toxic chemicals, and 364 (29.67%) patients had dry eye. Conclusion: This study points towards the simultaneous role of multiple risk factors including sun exposure, hot climate, toxic material exposure, familial transmission, and dry eye in association with pterygium.

Ultra-wideband (UWB) communication systems occupy huge bandwidths with very low power spectral densities. This feature makes the UWB channels highly rich in resolvable multipaths. To exploit the temporal diversity, the receiver is commonly implemented through a Rake. The aim to capture enough signal energy to maintain an acceptable output signal-to-noise ratio (SNR) dictates a very complicated Rake structure with a large number of fingers. Channel shortening or time domain equalizer (TEQ) can simplify the Rake receiver design by reducing the number of significant taps in the effective channel. In this paper, we first derive the bit error rate (BER) of a multiuser and multipath UWB system in the presence of a TEQ at the receiver front end. This BER is then written in a form suitable for traditional optimization. We then present a TEQ design which minimizes the BER of the system to perform efficient channel shortening. The performance of the proposed algorithm is compared with some generic TEQ designs and other Rake structures in UWB channels. It is shown that the proposed algorithm maintains a lower BER along with efficiently shortening the channel.

Objective: Laparoscopic nephrectomy has been adopted by many centers in the last few decades. However, there are a few inherent challenges while adopting laparoscopic nephrectomy in a new unit. These include a significant learning curve required to adopt this modality. This study aimed to share the initial experience of adopting laparoscopic nephrectomy at our center. Methods: In total, 101 patients were analyzed in the study. These patients underwent laparoscopic radical or simple nephrectomy (for renal mass and noncancer renal cases respectively) at Department of Urology, Pakistan Kidney and Liver Institute and Research Centre, Lahore from April 2018 till January 2021. Data were entered in the statistical analysis software file. Analysis was attained by utilizing SPSS version 20. Implementation of Mean along with standard deviation values was utilized in the case of the continuous variables. While frequency/percentages represented categorical factors. Results: The mean age of patients was 42.81±15.49 years and their overall BMI was 26.41±5.30 kg/m2 . Out of these, 57 (56.43%) were males and 44(43.56%) were female. Eighteen percent of patients had a previous surgical history on the ipsilateral side. Total operative time was 163.98±58.02 minutes while mean hospital stay reached 3.2±0.87 days. The tumor-free margin was attained in all cases of radical nephrectomy. Based on Clavien-Dindo classification, Grade-1 (n=3; 2.97%), Grade-2 (n=6; 5.94%), Grade-3A (n=1; 0.99%), and Grade-3B (n=1; 0.99%) complications were observed. Conclusion: In a newly developed urology center, laparoscopic nephrectomy can be a daunting task. Good teamwork among the surgical team members and careful selection of cases can result in satisfactory procedural outcomes. [ABSTRACT FROM AUTHOR]