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Background: Hepatitis C infection is highly prevalent in Pakistan. Six genotypes have been identified up till now. The most prevalent is genotype 3 in Pakistan. However, literature has shown variations among different regions in the prevalence of different genotypes. Objective: The Purpose of this study was to determine what is the prevalence of most common genotype of hepatitis C in the Peshawar district of KPK, Pakistan. Material & Methods: This cross-sectional study was conducted from July 2017 to July 2020 at Peshawar Institute of Medical Sciences, Peshawar in collaboration with Department of Biochemistry, Khyber Medical College, Peshawar, Khyber Pakhtunkhwa, Pakistan. Those patients whose blood sample turned out positive for Anti-HCV antibodies then underwent to PCR for HCV RNA. By using ROTOR Gene TM technique Genotype was found out. Data was analyzed by using SPSS version 18. Results: A total of 776 patients meeting the inclusion criteria, aged between 12 to 65 years, were included in this study, out of which 413 (53.22%) and 363 (46.78%) were males and females respectively. Regarding HCV genotyping; 388 (50.0%) were type 3a, 28 (3.60%) 3b, 117 (15.07%) type 2a, 22 (2.83%) types 2b, 18(2.31%) type 1a and14 (1.80%) 1b. 17 (2.19%) patients mixed types 2a and 3b, 16 (2.10%) were combined3a and 3b and 156(20.1%) were un-type able. Conclusion: The most common genotype in population residing in Peshawar district is genotype 3a and the second most common genotype is genotype 2a. Key Words: HCV genotype, HCV-RNA, PIMC, PCR, ELSA, ROTOR Gene

Introduction: In this systematic review, graft failure of two types of grafts (hamstring or patella tendon grafts) that are used for surgical reconstruction of the anterior cruciate ligament are reported and compared. Methods: This is a systematic review which is conducted in PubMed depending on preferred reporting item for systematic reviews and meta-analysis (PRISMA) criteria. We included a total of 19 studies which reported graft failure rates of at least one of the anterior cruciate ligament reconstruction methods mentioned above. To be able to compare studies with different follow-up periods, a yearly graft failure rate for each reconstruction group was calculated and then investigated for significant differences by using the Kruskal–Wallis test. Results: Overall, a total of 1366 patients treated with an anterior cruciate ligament reconstruction were included in the calculations. Comparison of graft types showed that hamstring tendon autografts had a yearly graft failure rate of 1.7 % in patients treated with Double-bundle hamstring autograft, 1.68 % among patients treated with single-bundle hamstring autograft and 1.6 % in patients with patellar tendon autograft. Conclusion: The results of this systematic revie showed that there is no significant difference in the graft failure rates per year among hamstring tendon autograft and bone–patellar tendon–bone autograft. Based on the results of this review, all graft options found to deliver comparable results in terms of graft failure rates and thus all graft type could be considered as reliable option for ACLR with superiority to hamstring tendon autograft.

Background: Post traumatic arthritis is one of the most common reasons for joint disability worldwide. The aim of this study was to review and discuss the functional outcomes as well as complications and survivorship related with total knee arthroplasty in the treatment of post traumatic arthritis. Methods: This is a systematic review which was conducted according to the PRISMA guidelines. In this study, we searched several data bases including PubMed, Cochrane Library and SCOPUS for English language clinical research studies whether prospective and retrospective studies in order to examines the use of total knee arthroplasty for the management of post traumatic arthritis. We assessed all relevant articles RESULTS: In this review, we included total of sixteen studies; ten studies were retrospective and six were prospective studies. The pooled results showed an increase in the range of motion and pain reduction after the surgery while the most common complications including infection, stiffness, intraoperative rupture of tendons, wound complications as well as osteolysis. Moreover, comparing the results with patients with osteoarthritis, patients with post traumatic arthritis needed more revisions especially for polyethylene wear. Conclusion: However, the high rate of complications reported with total knee arthroplasty, it is considered an effective treatment for post traumatic arthritis as it found to improve the range of motion and general functional outcomes.

Objectives: we aimed to compare the diagnosis accuracy between US and MRI in the diagnosis of full-thickness and partial-thickness rotator cuff tears and biceps tendon tears with arthroscopy used as the reference standard. Methodology: Comprehensive electronic search with time and language restrictions was conducted. Several known databases were included Ex: “PubMed, The Cochrane Library, Web of Science” from 2020 to 2020. We combined the search terms and limited the study to the English language. Depending on PRISMA checklist we would remove duplicates, articles would be screened based on title, abstract, and full text. Results: The electronic search strategy conducted in this review ended in 875 hits which after removing of duplicated reduced to 360 studies. These 360 studies were considered eligible for further evaluation, from which 348 studies were excluded for different reasons as 245 studies based on title and abstract, 86 studies do not relevant to the subject of this study or sitting of this review, 17 consider replies of authors, 2 books, and 28 were reviews. At end, 12 articles were included in the qualitative synthesis of the present review. Conclusion: we found that MRI had slightly better superiority than its accuracy, sensitivity and specificity especially, in Full and intact rotator cuff injuries. However, according to previous studies the use of US is still good because of its good sensitivity and specificity and cost- effective approach.

This study aims to identify the associations among performance criteria in the delivery of Green Building (GB) projects and their underlying conditions. The performance criteria included are social sustainability, economic sustainability, environmental sustainability, quality, schedule, and cost. A mixed methods approach is used, combining both qualitative and quantitative analysis. The findings from an online questionnaire survey (n = 104) are quantitatively and qualitatively analysed. Delphi method is used while conducting the survey. Semi-structured interviews (n = 30) are conducted to support, complement and help triangulate questionnaire survey findings and are also subjected to qualitative analysis. For GB projects, cost and schedule performance have a positive association among each other while cost performance has a positive effect on economic sustainability. Social, economic, and environmental sustainability have a mutually positive effect on each other. Beside the mutually positive associations among most criteria, in some cases negative and even no associations are also identified. Different conditions that affect the associations among performance criteria are identified including project planning, quality of project development process, life-cycle perspective, project management, Project Delivery Method (PDM), client's vision and motivation, regional constraints, regional climate, compliance requirements, and innovation. These underlying conditions affect performance across multiple criteria. The existing literature is used to verify the significance of these conditions for successful GB project development. This study has both theoretical and practical implications. In practice, project teams and decision-makers will be able to understand which conditions might result in a good performance in some criteria but underperformance in some other criteria. By controlling these conditions, across the project life-cycle, the desired performance on different criteria may be achieved. In theoretical terms, the identified associations and underlying conditions can lead to more holistic decision-making and multi-objective optimization models specifically designed for GB projects. The study is unique in its aim as well as the methodology used and the depth and breadth of the collected data. The study limitations include potential cognitive bias from the survey participants as well as a sole qualitative discussion of the effects of the key identified conditions on performance criteria associations.

Understanding the development process of Green Buildings (GBs) is critical in realizing their uptake. An in-depth review of 77 relevant studies is conducted to identify the various paradigms of GB development research, their contributions and limitations, their overlaps, and the ways of improving these paradigms. A code developed using Boolean operators and keywords is employed to search online databases (including Scopus and Web of Science) for relevant studies available until February 2019. Six paradigms of GB development research have been identified, including: Project Delivery Attributes (PDAs), Critical Success Factors (CSFs), barriers, drivers, risks, and benefits. A framework is developed to explain the role of various paradigms. Collectively, 323 factors encompassing the green building development research are identified. The literature analysis shows that 69 identified factors overlap across the six paradigms which highlights the common content across these paradigms. Overall, GB development research can be described as highly context-specific and relying on survey-based approaches. The PDA, barrier, and benefit paradigms are relatively more empirical in their methodological approaches, while the other paradigms typically employ non-empirical approaches. PDA and CSF as well as the Driver and Benefit paradigm tend to be closely related in terms of their conceptual approach and factors common across them. The review contributes to theory by providing a comprehensive database of the factors considered in the GB development literature. Furthermore, based on methodological and content-related limitations of the published research, the study provides recommendations for future research to increase the breadth and depth of research in this area.

Green buildings (GBs) are gaining popularity the world over. This study investigates the criteria that determine the success of GB projects. This study employs the interpretive qualitative approach. Semistructured interviews (n = 40) across five countries were conducted with experts active in different roles in GBs. Overall, 17 success criteria and 39 subcriteria are identified. Some key success criteria are about meeting the needs of building occupants (n = 25), meeting project aspirations (n = 16), realizing sustainable building operations (n = 15), and achieving GB certifications (n = 14). The identified criteria are inquired to determine whether they are about doing the “right things,” about doing “things right,” or about generating value. The interrelationships among success criteria and the priorities placed on some success criteria in GB projects according to the respondents are also discussed. Theoretically, the inquiry of criteria adds depth to the understanding of building project success in general, and GB success in particular. Practically, the comprehensive list of success criteria can be used as a guide on GB projects for performance evaluation and for controlling project performance.

Building materials with a low environmental impact are critical to the sustainability of the built environment. The environmental impact of materials can be determined by a Life Cycle Impact Assessment (LCIA), which constitutes multiple parameters such as the water used in a material’s life cycle. To use the LCIA approach for building material selection, its parameters need to be assigned different weights, which is the primary objective of this study. Building Information Modelling (BIM) can play an influential role when using LCIA during the building design process. With this consideration, we study the attention given to environmental sustainability in buildings and the responsiveness of BIM in this case. A multi-regional survey of 120 experts from academia and industry was conducted. The results show the relative importance of LCIA parameters and the focus of the building sector on environmental sustainability. The current and the future responsiveness of BIM towards environmental sustainability is also indicated. To promote the integration of LCIA in building design and performance assessment, the future role of BIM applications is explored. The results will contribute to research and practice in the sustainable built environment by helping select environment-friendly building materials.

Background: Psoriasis is a chronic inflammatory, immune mediated, provocative and challenging skin condition. It is a non-contagious but debilitating disease and a leading cause of socioeconomic burden on the health system. Objective: To evaluate the role of antioxidant levels, lipid peroxidation status and lipid profile in the etiology and degree of severity of psoriatic illness among psoriasis patients presenting in Dermatology department. Study Design: This study was carried out as a retrospective case control study. Place and duration of Study: It was carried out by the Department of Biochemistry, Basic Medical Sciences Institute (BMSI) in collaboration with Departmnt of Biochemistry, Khyber Medical College, Peshawar and Department of Skin and Venereal disease, Jinnah Post Graduate Medical Centre (JPMC) Karachi. Material and Methods: One hundred and twenty cases (n=130) of already diagnosed psoriasis patients were randommely and fifty healthy matched controls (n=50) of the same age and gender were included from the general population for comparison. Lipid profile including serum total cholesterol, TG, HDL-c and LDL-c levels were measured by enzyme colorimetric analysis on Micro Lab 300 (Merck & Germany). Antioxidant status SOD and lipid peroxidation status MDA were measured by ELISA technique. Statistical analysis was performed using SPSS software Version 16. In this analysis, a “p” value of less than 0.05 was considered to be significant. Results: The study showed significantly elevated levels of MDA, serum TG, total cholesterol and LDL-c levels in psoriatic patients in comparison with controls, whereas SOD levels and HDL-c levels were found to be significantly lower in psoriatic patients as compared to normal healthy matched controls. Conclusion: The findings of this study support the hypothesis that an imbalance in oxidant-antioxidant system may play a role in the etiology of psoriasis and the degree of severity of its presentation. The study also concluded that dyslipidemia was an observed risk factor for the development of cardiovascular diseases in psoriatic patients..

Green Building (GB) projects can positively affect society, the economy, and the environment. They are being adopted by different sectors of the building industry, including the office and residential sectors. As each building sector has a unique development environment, GBs in each sector are developed with particular drivers. Understanding the different drivers of GB development, the differences across sectors of building industry, and the reasons for those differences should give greater insight into how GB development might be promoted.

Tools for economic sustainability analyses are crucial for residential sector which is associated with high energy use. Along with the development of such tools, their effective implementation in building projects depend on their uptake by holistic design and modelling approaches, with BIM standing out as an exemplary case. Accordingly, the purpose of this study is to develop a fully representative economic sustainability assessment framework for residential buildings, with implications for BIM. A serious lag in research within the area of residential building economic sustainability assessment and use of BIM is realized from a systematic review of published studies. Through literature, a taxonomy of economic sustainability indicators, parameters and sub-parameters is developed, which helped design an economic sustainability assessment framework. An international survey and structured interviews are conducted to find the importance weights for the economic sustainability dimension as well as different framework constituents. The functionality of framework is validated through a case study, providing a conclusive value of 48.25% for economic performance of subject building, which is representative of the effectiveness of assessment for decision-makings. An extension within BIM environment is suggested to help foresee a futuristic integration of BIM with economic sustainability assessment.

Purpose While the general trends in green building (GB) research are known, there is not yet a detailed review of studies on project delivery attributes (PDAs) influencing GB project outcomes. The purpose of this paper is to review the literature to understand the contributions of existing research in this area and to identify the challenges, gaps, and lessons for the future research relating GB project delivery. Design/methodology/approach For the systematic review, specially developed coding based on Boolean operators is used to search for relevant studies in major databases, i.e. Web of Science and Scopus. The studies from the initial search (443) are subjected to two rounds of scrutiny for shortlisting only relevant publications. Using a qualitative review of the shortlisted studies (20), the research objectives and findings of the studies are synthesized and critically analyzed. The contributions and challenges facing research in this area are identified. Future research directions are proposed. Findings Studies in the area have established association between PDAs and various GB project success criteria. In the literature, some PDAs such as project delivery method have been given greater attention than others. Challenges facing PDA research in GB include: the limited number of GB project cases and the complexity of GB project delivery process involving an overwhelmingly large number of variables, thereby limiting scientific rigor and creating some gaps in knowledge. The interaction among PDAs and their cumulative effect on various project performance outcomes/metrics have not been studied, limiting the validity of the existing studies. Scope exists to apply a combination of non-linear, dynamic, probabilistic, explicit, and implicit modeling as well as inductive and deductive approaches to research in this area. Research limitations/implications Existing research findings have limited application in practice. Non-linear, dynamic, probabilistic, deductive, and inductive research techniques and approaches can substantially advance knowledge and lead to plausible findings that can be applied in practice. Originality/value Considering the critical role of PDAs in the successful delivery of GBs, the review provides clear directions for future research.

Building sustainability is a multi-dimensional concept that is increasingly becoming a focus of the mainstream construction industry. The choice of right materials, techniques, and systems for a building project was always important to ensure built environment sustainability but these days it has also become a difficult and confusing task owing to the availability of a wide array of processes, systems, techniques and materials (PSTM). To achieve sustainable design a responsive design process able to assess and optimize the use of a variety of available PSTM options is required. The purpose of the study reported in this paper is to develop a conceptual framework of a futuristic BIM-based Design Iteration (BIM-DIT) tool for selecting PSTM combinations during design. Such development can support decision-making process during the design stage of residential buildings by assisting the design team in the generation of design alternatives. The model development includes discussion of various components necessary for development and successful working of the hypothetical tool. The conceptual model development exercise shows that the hypothetical BIM-DIT tool can significantly benefit from the pre-existing design approaches in the built environment. The discussion shows that the PSTM combination selection approach used for BIM-DIT tool will help decision makers with precise knowledge of available options for achieving truly sustainable building projects. Although model development is largely inspired by pre-existing approaches, the use of these approaches for finding appropriate PSTM combinations through the involvement of all three sustainability dimensions is relatively new. Further development in this area can play a significant role in building design related decision-making.

Social sustainability is an important component of sustainable housing. A holistic view of social sustainability in residential buildings is lacking when it comes to modern tools and systems of building sustainability assessment, which creates gaps in analytical support necessary for sustainable decision-making. In order to pursue this issue, an assessment framework is proposed that uses a hierarchy of readily assessable sustainability indicators, parameters and sub-indicators. The proposed framework, though qualitative in nature, takes quantitative findings as inputs. It uses a weighted aggregation approach to provide a holistic social sustainability performance value of residential buildings and for determining the weights of indicators, parameters and sub-indicators, the study makes use of survey and structured interviews. Based on findings, the importance of social sustainability in residential and commercial buildings in different regions of world is also explored. A case study comprising of low-rise residential buildings provides an insight into the workability of proposed framework. Furthermore as a minor contribution of this research, the current and futuristic responsiveness of BIM towards social sustainability is explored and its role in use of the proposed framework is investigated.

Increase in urban population is resulting in increased population densities through high-rise residential buildings. High-rise residential buildings have some unique aspects. The purpose of the study reported in this paper is to assess the role high-rise related aspects can play in sustainable development. The research adopted a two-step approach. First, on the basis of a detailed review of the literature published on high-rise buildings, the aspects unique to high-rise buildings are identified and shortlisted through brainstorming sessions. The aspects are then allocated to some basic properties of sustainable systems obtained from published work. Second, through another explorative brainstorming on high-rise residential building aspects, a cause-effect relation among various building aspects and related issues is developed using a system dynamics modelling. This study used about 54 building aspects majorly found in high-rises. The findings show that the aspects affect sustainability in both the positive and negative ways. Linking the various building aspects together has also resulted in a cause-effect diagram visually explaining how constructing high-rise for a residential purpose can pose a fairly complex problem in terms of sustainable development. The findings show that most of the high-rise related aspects positively affect the effectiveness property of both the building and natural systems while also creating a detrimental effect on the psychological needs of humans. The qualitative assessment undertaken within this study for understanding the role of high-rise residential buildings in sustainability can lead to further research exploration in the subject area and can increase the understanding of high-rise complexity, consequently leading to well informed sustainable approaches.

A questionnaire to conduct a survey relating performance criteria investigation for Green Building projects. The questionnaire investigates the following aspects.1. Interrelationships among performance criteria in Green Building projects.2. Underlying factors which affect the interrelationships among performance criteria

Stereotypical construction of buildings, however convenient, poses its own set of challenges. It affects the sustainable development critically and can give rise to social, economic and environmental problems. In other words, same design of a building if repeated irrationally from one place to another even within an identical climatic region gives rise to some grave problems which can compromise multiple dimensions of sustainability. Mosque architecture has some elements that have gradually become its identity. In this research different elements of repetition i.e. stereotype features in mosque architecture are explored. While using a case study approach this research is used to assess mosque projects in an urban region of Lahore, Pakistan. While considering the case studies the positive and negative effects of stereotype elements on three dimensions of sustainability are investigated.

A questionnaire to conduct a survey relating performance criteria investigation for Green Building projects. The components of questionnaire include the following aspects for Green Office Building projects.1. Relative priorities of performance criteria 2. Factors influencing priorities of performance criteria3. Interrelationships among performance criteria

A questionnaire to conduct a survey relating performance criteria investigation for Green Building projects. The components of questionnaire include the following aspects for Green Office Building projects.1. Relative priorities of performance criteria 2. Factors influencing priorities of performance criteria3. Interrelationships among performance criteria

Building sustainability is subject to rational use of green-building systems and techniques. A suitable combination of these systems and techniques is at the heart of design parameters. To achieve user comfort and health as well as environmental protection and long-term economic benefits, designers must optimize combinations of particular systems and techniques. It is imperative to have efficient design strategies for achieving optimum solutions and effectively leading the complex process of selecting system and technique combinations to be integrated in overall design. With goal to optimize design effort, this research aims to propose different methodologies to help incorporate various green-building systems and techniques in design process. Systems and techniques prioritized by relative weights may ease the design process. Hence, with a focus on semi-arid climatic conditions, interviews are conducted from researchers and building practitioners who help express design priorities. Use of these pri...

Background Arthrodesis of small joints for hammer and claw toe deformities is a common forefoot operative procedure. Our objective was to review patients who underwent small toe arthrodesis with Smart Toe © intramedullary monobloc implant. Our aim was to assess patient's surgical outcome and to ascertain implant suitability. Methods This procedure was undertaken in 90 patients from February 2011 to December 2012. We present our review of 82 (91.1%) patients who attended the final six 6-month follow up. Mean age was 56.5 years. There were 7 (8.5%) males and 75 (8.5%) males and 75 (91.5%) females. Clinical and radiological evaluation was undertaken. A questionnaire was used to assess general symptoms, clinical outlook, deformity and patient's perceptions and acceptance. Foot and Ankle Outcome Score and Foot and Ankle Disability Index were used to judge outcome. Results There were 71 (86.6%) proximal and 11 (13.4%) distal interphalangeal joints with 69 (84.1%) second, 7 (8.5%) third, 6 (84.1%) second, 7 (8.5%) third, 6 (7.3%) fourth toes. There was persistent swelling in 7 (8.5%) and tenderness in 1 (1.2%). Appearance of toes was symmetrical in 71 (86.6%) and 11 (13.4%) were asymmetrical but asymptomatic. The mean range of movement of the adjacent joint was 53.9°. Control of toes was good in 72 (87.8%) patients. Mean percentage of improvement was 76.1% with 100% in 17 (20.7%) and over 80% in 47 (57.3%). Seventy (85.3%) would recommend and undergo repeat surgery. There were 2 (2.4%) cases of metal cut out. There was one (1.2%) implant failure. Union was achieved in 79 (96.3%) patients. Conclusion We feel that Smart Toe © small toe arthrodesis is a safe and reliable technique with good patient outcome and acceptance.

Digital templating of x-rays for total hip arthroplasty is used routinely for pre-operative planning. This is to assure that appropriately sized implants are selected to replicate patient's hip biomechanics. Multiple studies have shown that templating does not always correspond to the final implants used. The aim of this study was to assess the suitability of the x-rays taken pre-operatively for templating for total hip arthroplasty. We undertook a review of a series of pre-operative templating pelvis x-rays in 100 consecutive patients undergoing total hip arthroplasty. These x-rays were compared against set criteria to determine their suitability for use for templating. We determined that six x-rays met the criteria whereas ninety four x-rays did not meet the criteria for suitable x-rays. Twenty patients had repeat x-rays. The reasons for unsuitability were inadequate opposite femur (66%), absence or incomplete template (54%), inadequate femur length (47%), external rotation (39%), absence of opposite hip (4%). The twenty repeated x-rays were also reviewed for the same parameters and two (10%) satisfied the established criteria. It is imperative that x-rays for templating for total hip arthroplasty are done to a strict standard to obtain an x-ray that is appropriate for templating and there is minimal exposure of the patient to irradiation.