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Objective: To determine the role of angiography for the assessment the type of patent ductus arteriosus in children under 18 years. Study Design: Observational Retrospective study. Setting: Children’s Hospital Lahore. Period: October 2021 to February 2022. Material & Methods: The sample size calculated was 245 but, at the end of the period of four months only 120 patients fulfilled the criteria and were included in this study convenient sampling technique was used to collect the data. Patients with patent ductus arteriosus were included in this study. Patients with other congenital heart diseases were excluded. Essential measurements included Types of Patent Ductus Arteriosus (PDA), (PDA) Size, Ampulla Size, Aortic and Pulmonary systolic and diastolic pressures. Results: In this study 120 patients with PDA were included. Out of 120, 38 (31.7%) patients were male and 82 (68.3%) patients were female. The age range of the patients was 8 months to 18 years (mean;5.44 ± 3.972 years). The weight range of the patients was 5.3 to 41 Kg (mean;16.05 ± 8.38Kg). The mean PDA size was 4.01 ± 1.80. The mean Ampulla size was 9.92 ± 3.13. The types of PDA detected by angiography were Type A 59(49%), Type B 15(12.5%), Type C 20(16.7%), Type D 20(16.7%), Type E 5(4%), Type F 1(0.8%). The mean Aortic systolic pressure was 105.5±18.99 and diastolic pressure was 57.2 ±14.4. The mean Pulmonary Artery systolic pressure was 47.4 ± 23.3 and diastolic pressure was 27.7 ±14.2. Conclusion: Angiography was found more accurate for the assessment of all the anatomical types of PDA especially TYPE B, C, D and F. More precise measurements of the ampulla and PDA sizes were obtained using angiography. We may conclude that Angiography is a much better and good modality than other modalities for the assessment of the types of PDA.

Objective: To compare the efficacy and safety of metformin versus Sitagliptin among treatment naïve patients of type-2 diabetes mellitus (T2DM). Study Design: Randomized Controlled Trial. Setting: Department of Medicine, Unit-III, Bahawal Victoria Hospital, Bahawalpur. Period: September 2021 to August 2022. Material & Methods: During the study period, a total of 320 treatment naïve T2DM patients (160 in each group) were randomly enrolled and followed up. Baseline demographics of all patients including gender, age, BMI (kg/m2), fasting plasma glucose (FPG) and baseline HbA1c were recorded. Patients of Group-A were given oral Sitagliptin 100mg once daily whereas patient in Group-B were prescribed oral metformin as 500-2000 mg per day aiming achievement of glycemic goals. Repeat HbA1c and FPG levels were tested at the end of 12th and 24th weeks therapy among both study groups. Side effects related to studied drugs were also observed and recorded. Results: Out of a total of 320 patients, 57 patients (27 in Group-A and 30 in Group-B) lost follow up so 263 patients were included in the final analysis. Majority of the patients, 134 (51.0%) were male. Mean age, BMI and duration of diabetes among study participants were 53.07+9.62 years, 29.44+4.74 kg/m2 and 1.96+2.3 years respectively. No statistically significant difference was noted at zero, 12 or 24 weeks in between both study groups (p>0.05) in terms of reduction in HbA1c or FPG levels during the study period (p>0.05). Conclusion: Both metformin and Sitagliptin effectively reduce HbA1c and FPG levels among treatment naïve T2DM patients with relatively good tolerability and safety. Both study drugs can be used as initial monotherapy among T2DM patients with relatively mild-to-moderate disease.

Objective: To find out the efficiency of leukocyte esterase reagent strip (LERS) testing for the diagnosis of spontaneous bacterial peritonitis (SBP). Study Design: Cross Sectional, Validation study. Setting: Department of Medicine, Unit-III, Bahawal Victoria Hospital, Bahawalpur. Period: January-December 2019. Material & Methods: A total of 235 patients of both gender, aged 18-60 years, having CLD with ascites, with any child pugh class and duration of CLD between 6-12 months were enrolled. Ascitic fluid was obtained at bedside and immediately dispatched for testing in a clean and dry test tube with reagent strip Multistix® 10 SG. Screening tests were calculated for accuracy of LERS test with respect to confirmed cytology testing. Results: Majority, 152 (64.7%) were male, 94 (40.0%) between 51-60 years age group and 146 (62.1%) had child pugh class C. Overall, mean age was noted to be 46.82+9.45 years. LERS testing turned out to be positive among 138 (5837%) cases. Confirmation of SBP through cytology was noted among 141 (60.0%). Sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of LERS for the diagnosis of SBP with respect to cytology confirmation was calculated to be 90.8%, 89.4%, 92.8%, 86.6% and 90.2% respectively. Conclusion: The LERS testing was found to have high SE, SP, PPV, NPV and diagnostic accuracy in diagnosing SBP among patients of CLD with ascites. LERS can be used at bedside while it very simple and easy to perform.

Graphical abstract A sizeable amount of scholarly work has been done on different aspects of financial, economic, and environmental factors. In the present study, the nonlinearity is determined between financial development and carbon dioxide emissions in the long-run and short-run periods. According to the finding, the continued financial development initially increases the carbon dioxide emissions in the short and long run. Simultaneously, the square term of financial development reduces carbon dioxide emissions and proves the inverted U-shaped hypothesis in the short and long periods. The consumption of fossil fuels produces carbon dioxide emissions, leading to environmental pollution. In contrast, renewable energy sources have fostered ecological sustainability by reducing CO2 emissions in the long and short term. At the same time, a positive response from labor productivity to carbon dioxide emissions causes environmental pollution, while capital formation is not acknowledged as a significant contributor to CO2 emissions. The Error Correction term has ascertained the reduction in error and convergence of the model from short to long term with a speed of 8% per annum. The study suggested that renewable energy and financial development should be indorsed for environmental preservation in developing European and Central Asian economies. Financial development in favor of low-cost renewables, advancing cleaner production methods, solar paneling, and electrification are a few possible remedies to achieve environmental sustainability in the short-run as well as long-run time frame.

This study aims to analyze the asymmetric relation between renewable energy consumption and CO2 emissions in China using the STIRPAT-Kaya-EKC framework. To delve into the asymmetric effect of renewable energy consumption on the environment, the non-linear ARDL model is used. The results of this study confirm the asymmetric impact of renewable energy on the environment in the long run as well as in the short run. However, the negative shocks to renewable energy have a greater detrimental influence on the environment than the benign effect due to the positive shock to renewable energy. Population growth affects the environment in the short run, whereas technology only affects environment quality in the long run. Moreover, the study supports the EKC theory in China. This research emphasizes that the administration can improve the economy’s lifespan by allocating substantial funds to establish legislation to maintain a clean environment by subsidizing renewable energy infrastructure and research and innovations for low-carbon projects.

The purpose of this article is to review the literature and outlining the role of abdominal and chest ultrasonography in the diagnosis and as a predictor of severity of dengue fever. Methods: Standard medical electronic databases were searched and relevant articles were used to present the conclusive outcomes. Results: Eighteen studies on 2601 patients undergoing chest and abdominal ultrasonography fulfilled the inclusion criteria. The incidence of plasma leakage triad such as pleural effusion, ascites and gallbladder wall thickening was 44.98 %, 39.44 % and 61.89 % respectively. Other ultrasonic findings included Hepatomegaly, splenomegaly and pericardial effusion. Conclusion: In patients with suspected dengue fever and dengue haemorrhagic fever, the abdominal and chest ultrasonography, although nonspecific, may be a relevant ancillary tool for the early diagnosis of microvasculature hyper-permeability in addition to a tool used for the prediction of disease severity identifying mild and severe cases of DF. Furthermore, ultrasonography may also be used for the differential diagnosis of other febrile conditions affecting both pediatric and adult population.

Intimal medial thickness (IMT) is associated with many cardiovascular diseases as atherosclerosis, coronary artery disease, stroke and hypertension etc. Intimal medial thickness of common carotid arteries (CCA) can be measured by high-resolution modality i.e, B-Mode Ultrasonography. Objective: The objective of this study was sonographic assessment of intima media thickness of common carotid artery in normotensive and hypertensive individuals. Methods: A total of 70 individuals both hypertensive (40) and normal (30) were included in the study and IMT of both right and left CCA was measured. Intima-media thickness of the anterior wall of the distal part of CCA both right and left was taken in hypertensive and normal (without hypertension and neurologic disease) in Pakistani population. Results: In this case control study 70 individuals were scanned, 40 (57.1%) individuals had prior history of hypertension and other 30 (42.9%) were without any prior history of hypertension or any neurologic disease. A significant correlation of intimal medial thickness with increasing age (r=0.6 and P value of .000) was found. The atherosclerotic changes effect the IMT, as the patients with plaques had increased IMT as compared to those without plaques. Sensitivity and specificity of ultrasound in hypertensive and normotensive patients was 50.0 and 66.7. Sensitivity and specificity of ultrasound in present and absent plaque patients was 87.5 and 87.1. Conclusions: IMT increases with advancing age. IMT also increases in patients with other signs of atherosclerosis such as plaque formation.

This study aims to analyze the impact of ICT, renewable energy consumption, and financial development on CO

The major objective of this research is to examine the connection among poverty, population growth and its impact on economic development of different developing countries. This research comprised of panel data for period of 2002-2015. The data has been taken World Bank Indicator (WDI) for twenty six developing countries. To find out the results we use panel data. For the analysis of data we have applied Hausman and Fixed Effect Model in this study. Findings of the study indicate that the consumption of government, export, gross capital formation and industrial value added have positive impact on growth of developing economies. The results show that the variation in these variables has positive effect on dependent variables. On the other hand, economic growth increases due to positive changes in this variable. It is seen in this study that population and poverty has negative impact on GDP per capita in selected developing countries.

Background: Physical activity is one of the leading health indicators, considered an essential factor in the population's health and quality of life promotion. Physical inactivity is the fourth leading risk factor for global mortality. Physical inactivity has been linked with chronic disease and obesity in most populations. This study aims to compare the prevalence of physical activity and overweight/obesity among students of the university. Methods: A cross-sectional survey was conducted from March to September 2019 on undergraduate students from different departments of Peshawar University. A sample of 377 (male n = 243, female n = 134) was taken through convenience sampling. Those individuals who were physically disabled and not willing to participate were excluded from the study. Those meeting the inclusion criteria were given the International Physical Activity Questionnaire (IPAQ short form). Demographic data included age, weight, and height was self-stated by the participants. The levels of physical activity in each of three domains (leisure, transport, and domestic) were calculated and presented as metabolic equivalent (M.E.T.) hour per week in the form of means, percentage, and frequency in different physical activity domains. Results: The overall sample showed that 13.70% of participants were inactive, 27.76% showed a low level of physical activity, 41.29% showed moderate physical activity level, and 17.24% showed a high level of physical activity. A total of 90.98% of participants were involved in leisure physical activities, 93.10% presented transport-related physical activity, and 74.80% were involved in domestic-related physical activity. Average time spent during sitting was found to be 53.32 hrs/week and 7.61 hrs/ day, with females being more involved in sitting activities as compared to males. A significant difference was found between B.M.I. and sitting domain (p-value 0.002) with a Pearson value of -0.12 showing a negative correlation. Conclusion: The B.M.I. and Physical Activity are found negatively associated with each other. Male students were more physically active than females as females spend their majority of time sitting. It is concluded that students are moderately active, while a minimal percent of students are highly active. There were a few numbers of respondents too who were physically inactive, which shows that there is still unawareness of physical activity on the university level.

This study determines the role of natural resources’ utilization, foreign direct investment (FDI), and fossil fuel consumption in economic growth by utilizing panel data of 25 developing Asian countries from the period 1996 to 2016. Pool Mean Group (PMG) regression is used for this purpose, and the results show that the rent received from forests has a sizeable share in the economic growth of developing Asian Countries. The study shows that an increase in FDI is stimulating economic growth in developing countries. However, although the utilization of natural resources has a positive impact on economic growth, the results show a statistically insignificant role of natural resources in improving economic growth. Finally, the results show that the rent obtained from forest resources, mineral resources, and oil extraction makes a significant contribution to economic growth. The findings highlight that FDI and the rent received from the pool of natural resources are significant contributors to economic growth, as they are both helping to develop industrialization in the nations concerned and improve the level of per capita income. However, the findings also suggest that there is a need to consider the limited availability of natural resources and to deal with this situation by (a) developing policies that can ensure the efficient use of such rent received from the natural resources by importing advanced technologies from developed nations and (b) using the rents from natural resources to promote the business environment and attract FDI in developing countries.

To investigate potential risk factors of leukaemia.This case-control study was conducted in 5 hospitals in the province of Punjab, Pakistan, from May to September 2014, and comprised adult leukaemia patients and healthy controls with similar gender and marital status, and children patients and healthy controls with matching age and gender. Interviews were carried out face-to-face with adults and with the parents of the minors to obtain information on family history, lifestyle risk factors, employment history, residential history, trauma history and occupational and non-occupational exposures by using a close-ended questionnaire. Data was analysed using SPSS 16.Of the 75 adults, 25(33.3%) were patients and 50(66.6%) were controls,while of the 120 children, 40(33.3%) were patients and 80(66.6%) were controls. Among adults those at risk of leukaemia had exposure to chemical factory (p0.05),positive family history of leukaemia (p0.006), positive trauma history (p0.004), those who dyed hair (p0.003), smokers (p0.054) were born 1st or 4th among their siblings (p0.037), lived near crops (p0.069), worked in oil-refining factory (p0.12), or spent more than 7 hours under direct sunlight (p0.002). Among children subjects those at a greater risk of leukaemia had a positive trauma history (p0.000) who were born 1stor 4th among their siblings (p0.028), and had a positive family history of leukaemia (p0.0484).Knowledge of particular risk factors can help plan and execute safety measures to reduce potentially harmful exposures and decrease risk of leukaemia.