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Abstract The study has investigated the implications of three estimation methods, namely L-moments, Maximum Likelihood, and Maximum Product of Spacing (MPS), for fitting the four-parameter Kappa Distribution (KAPD) in extreme value analysis using Monte Carlo simulations. The accuracy of the estimates has been evaluated using root mean square error (RMSE) and bias. The paper also includes an analysis of the effect of the estimation method on the estimated quantiles considering a real-life example of annual maximum peak flows and the Generalized Normal Distribution as the error distribution. Assessment metrics of the empirical analysis include standard error, L-scale, and 90% confidence limits of the estimated quantiles. The results reveal that MPS is a preferred method of estimation of parameters for KAPD, i.e. having the lowest RMSE values, especially in the presence of heavier tail and significant positive skewness for small to very large sample sizes. Secondly, the method of L-moments is recommended due to its low bias while analyzing the distribution of shape parameters having a slightly heavier tail, and slight or moderate positive skewness. The results associated with the quality of estimated quantiles using real-life data are consistent with the findings of simulation outcomes.

Background: Afghan refugees in Pakistan, particularly in Quetta, Balochistan, encounter formidable barriers in accessing maternal, newborn, and child health (MNCH) services. These challenges have been intensified by the COVID-19 pandemic and entrenched systemic health inequities. Methods: This qualitative study, conducted from February to April 2023, aimed to assess the obstacles within health systems and community environments that hinder MNCH service access among Afghan refugees. The study involved 20 key informants through in-depth interviews and focus group discussions, including Afghan refugee women, community elders, health workers, and representatives from non-governmental organizations and government agencies. The research focused on experiences during the initial four waves of the COVID-19 pandemic (2020-2021), utilizing a conceptual framework integrating Health Emergency Disaster Risk Management (Health-EDRM) with primary health care. Findings: The study identified significant systemic barriers to accessing MNCH services, such as insufficient funding, inadequate health infrastructure, and discriminatory practices within the healthcare workforce. Additionally, community-level obstacles were prominent, including cultural and language differences, geographical isolation, and economic constraints. The integration of Health-EDRM into local health systems was minimal, with many stakeholders either needing to be made aware of or unengaged with the framework. Conclusion: The findings highlight a critical need for comprehensive policy reforms, infrastructure enhancement, and community-centered approaches to address Afghan refugees’ health needs effectively. Strengthening the integration of health-EDRM into health systems is crucial for enhancing resilience and ensuring continuous care during health emergencies. The study calls for concerted efforts to implement culturally sensitive health interventions that include disaster risk management components to improve MNCH outcomes among Afghan refugees in crisis-affected settings. Addressing systemic and community-level barriers makes creating a more resilient and equitable health system for vulnerable populations possible.

In this article, the modified α equation is solved using the direct algebraic approach. As a result, numerous new and more generalized exact solutions for such equations have been found, taking into account the wide range of travelling structures. The rational, trigonometric, hyperbolic, and exponential functions with a couple of licentious parameters are thus included in these exact answers. Analytical solutions feature a variety of physical structures, which are visually studied to demonstrate their dynamic behavior in 2D and 3D. Considering the parameters, all feasible phase portraits are shown. Furthermore, we used numerical approaches to determine the nonlinear periodic structures of the mentioned model, and the data are graphically displayed. Additionally, we employed numerical approaches to determine the nonlinear conditions that contribute to the presented model, and the data are graphically displayed. After evaluating the influence of frequency following the application of an external periodic factor, sensitivity exploration is used to study quasi-periodic and chaotic behavior for several starting value problems. Furthermore, the function of physical characteristics is investigated using an external periodic force. Quasi-periodic and quasi-periodic-chaotic patterns are described with the inclusion of a perturbation term. The direct algebraic methodology would be used to derive the soliton solution of modified α equation, from which the Galilean transformation derives traveling wave solutions of the considered and a bifurcation behavior is reported. Analytical and numerical methods have been used to have the condition of the travelling wave phase transformation. The well-judged values of parameters are enhanced well with a graphically formal analysis of such specific solutions to illustrate their propagation. Then a planer dynamical system is introduced, and a bifurcation analysis is utilized to identify the bifurcation structures of the dynamical model’s nonlinear wave propagation solutions. Additionally, the periodic and quasi-periodic behavior of the discussed equation is analyzed using sensitivity analysis for a range of beginning values. To further comprehend the dynamical behaviors of the resultant solutions, a graphic analysis is conducted.

The fourth-order nonlinear Boussinesq water wave equation, which describes the propagation of long waves in the intertidal zone, is investigated in this study. The exact wave patterns of the equation were computed using the tanh method. As stability decreased, soliton wave structures were derived using similarity transformations. Numerical simulations supported these findings. The tanh method introduced a Galilean modification, leading to the discovery of several new exact solutions. Subsequently, the fourth-order nonlinear Boussinesq wave equation was transformed into a planar dynamical system using the travelling wave transformation. The quasi-periodic, cyclical, and nonlinear behaviors of the analyzed equation were particularly examined. Numerical simulations revealed that varying the physical parameters impacts the system’s nonlinear behavior. Graphs represent all possible examples of phase portraits in terms of these parameters. Furthermore, the study was proven to be highly beneficial for addressing issues such as shock waves and highly active travelling wave processes. Sensitivity analysis theory and the Lyapunov exponent were employed, offering a wide variety of linear periodic and first-frequency periodic characteristics. Sensitivity analysis and multistability analysis of the Boussinesq water wave equation were thoroughly investigated.

OBJECTIVE: To evaluate the relationship of microbes with different Wagner's Classification in diabetic foot infections and assess their susceptibility to the antibacterial agents. METHODOLOGY: A prospective observational study was conducted from February 2014 to January 2019. A total of 100 patients of Type II Diabetic patients with age 30-70 years without any gender bar according to Wagner's type 2, 3, 4, and 5 were included. A sample of pus/tissue was taken by culture swab stick or sterile jar bottle from the Ulcer or infected tissue and sent for culture and sensitivity as per CLSI guidelines. Bacterial isolation concerning different grades of Wagner's Classification and their relative susceptibility to antibiotics was assessed. RESULTS: Of 100 diabetic feet infections, the mean age of the patients was 43.1±10.0 years making male to female ratio 1.8׃1. 40% of patients come in Wagner's grade III, followed by 38%, 12% and 10% in Wagner's grade IV, V and II, respectively. We found that out of n=190 microbes cultured maximum number n=85(44.7%) related with Wagner’s grade IV from which 25(13.1%) species were gram +ve and 60(31.5%) were gram–ve species, followed by 65(34.2%) microbes related with grade III from which 20(10.5%) species were gram+ve and 45(23.6%) were gram–ve species, 23(12.1%) microbes related with grade II(gram+ve=08(4.2%), gram–ve=15(7.8%)) and 17(8.9) microbes related with grade V(gram +ve=07 (3.6%), gram–ve=10(5.2%)). CONCLUSION: Maximum number of microbes related to Wagner grade IV and Imipenem was the most susceptible drug among all organisms, and Ampicillin was the most resistant drug.

As a result of oversimplified anti-cubic non-linearity, we are interested in form optical solitons to the nonlinear Schrödinger equation (NLSE). The modified G′G2 creates new solitons that include periodic type solitons in chirped forms. These findings are extremely beneficial to the study of optics. The acquired outcomes are confirmed and explained using various graphs. Computational results show that the preceding analytical expansion scheme is efficient. We present some sufficient conditions for the presence of random quasi-periodic measures for various partial differential equations and sufficient conditions for the presence of quasi-periodic measurements and satisfaction of the NLSE equation. It is discovered that a saddle point bifurcation causes the transition from periodic to quasi-periodic actions in a sensitive area. Further investigation reveals favorable conditions for the multidimensional bifurcation of increasingly complex solutions. Our results provide insight into the complex interplay between periodic and quasi-periodic behaviors and further our understanding of the complex dynamics displayed by these PDE‘s. The outcomes that are being given broaden the field's current understanding and provide opportunities for more investigation into the intricate mathematical structures that underlie partial differential equation solutions.

As one of the most perilous industries, agriculture presents both fatal and non-fatal risks to farmers. Pakistan, a notable Asian nation, heavily depends on agriculture, which constitutes 23% of its GDP and employs 37.4% of its workforce. The study investigates the challenges within Pakistan’s agriculture sector and enriches the existing literature by gathering data on agricultural machine-related injuries in Pakistan during 2022–2023. The survey, conducted from November 2022 to April 2023, involved 55 respondents, predominantly from Sindh and Punjab. The findings indicate a total of 507 injuries, with approximately a quarter being fatal (121 incidents). Sindh emerges as a significant hotspot, with the majority of injuries documented there. With respect to the key sources of injuries, the fodder cutter is a primary source of injuries with 201 injuries documented, accounting for approximately 40% of all injuries. Threshers contributed to 197 injuries, approximately 39% of the total, and about 52 are tractor-related injuries, making up about 10% of machine injuries. Regarding the severity and demographics of injuries, about 38% of cases involve amputation, with a higher incidence among males (77%) and individuals aged 15–34 years (65%). It is important to acknowledge the study’s limitations, including a small participant pool and a brief data collection period. This research advocates for safety regulations, accident reduction measures, and increased safety awareness among farmers, aiming to foster a safer and more sustainable agricultural environment in Pakistan.

The study examines the propagation of solitary waves in optical fibers controlled by the Radhakrishnan–Kundu–Lakshmanan model (RKL) equation, which includes a cubic–quintic non-Kerr refractive index. The first step in this study involves utilizing the extended algebraic method to derive solitonic solutions for the given equation. These solutions are subsequently graphically represented for a variety of parameter values. The proposed strategy allows for the discovery of a range of solutions.The controlling model is incorporated into a planar dynamical system via the Galilean transformation, resulting in the transformation of the governing model. The effects of both the quintic nonlinearity and self-phase modulation on the perturbed and unperturbed systems are explored using the effective potential and related phase portrait. The governing model is thus transformed into a planar dynamical system. Furthermore, this study harnessed a variety of numerical techniques. These methods encompassed time series analysis, phase portraits examination, and meticulous sensitivity inspections. Additionally, we employed a Poincaré section to assess the equation’s responsiveness to external perturbations. The outcomes reveal a fascinating observation: the perturbed system’s behavior shifts from a quasi-periodic state to a chaotic one, contingent upon the amplitude and frequency of the external perturbation. Moreover, we conducted multistability analysis for specific sets of physical parameters, uncovering the equation’s tendency to exhibit multistability in such scenarios.

Background: The eradication of poliovirus and improving routine immunization (RI) coverage rates present significant challenges in Pakistan. There is a need for interventions that focus on strengthening community engagement to improve routine immunization coverage. Our primary objective is to assess the impact of an integrated strategy designed to enhance community engagement and maternal and child health immunization campaigns on immunization coverage in Pakistan’s high-risk union councils of polio-endemic districts. Method: We implemented an integrated approach for routine immunization and maternal and child health in the polio-endemic district of Pakistan. This approach involved setting up health camps and actively engaging and mobilizing the local community. An independent team conducted surveys at three key points: baseline, midline, and endline, to evaluate immunization coverage among children under the age of five. The primary outcome measures for the study were coverage of OPV, IPV, and changes in the proportion of unvaccinated and fully vaccinated children. To select clusters and eligible households in each cluster, we utilized a 30 × 15 cluster sampling technique. Multivariable associations between socio-demographic factors and changes in the proportion of fully vaccinated children at the UC level were assessed using hierarchical linear regression models. Results: A total of 256,946 children under the age of five (122,950 at baseline and 133,996 at endline) were enrolled in the study. By the endline, full immunization coverage had increased to 60% or more in all three study areas compared to the baseline. Additionally, there was a significant increase in the coverage of both OPV and IPV across all three provinces at the endline. The full immunization rates were assessed on three levels of the framework: the distal, intermediate (access and environment), and proximal level (camp attendance and effectiveness). At the distal level, on multivariate analysis, family size was found to be a significant predictor of change in immunity within the families (β = 0.68; p ≤ 0.0001). At the intermediate level, the likelihood of full immunization decreased with the decrease in knowledge about vaccination (β = −0.38; p = 0.002), knowledge about polio vaccine (β = −0.25; p = 0.011), and knowledge about IPV (β = −0.06; p = 0.546). Perceived obstacles to vaccination were fear of adverse events (β = −0.4; p ≤ 0.0001) and lack of education (β = 0.23; p = 0.031), which were found to be significant in bivariate and multivariate analyses. At the proximal level, community mobilization (β = 0.26; p = 0.008) and attendance at health camp (β = 0.21; p ≤ 0.0001) were found to enhance full immunization coverage. On the other hand, the most prominent reason for not attending health camp included no need to attend the health camp as the child was not ill (β = −0.13; p = 0.008). Conclusions: This study found that community mobilization and attendance at health camps significantly enhanced full immunization coverage. The findings highlight the importance of community engagement and targeted interventions in improving immunization coverage and addressing barriers to healthcare seeking.

The oral poliovirus vaccine (OPV) has been the mainstay of polio eradication, especially in low-income countries, and its use has eliminated wild poliovirus type 2. However, the inactivated poliovirus vaccine (IPV) is safer than OPV, as IPV protects against paralytic poliomyelitis without producing adverse reactions. The present study compared mucosal and humoral responses to poliovirus vaccines administered to previously OPV-immunized children to assess the immunity gap in children in areas of high poliovirus transmission. A cluster-randomized trial was implemented in three high-risk districts of Pakistan—Karachi, Kashmore, and Bajaur—from June 2013 to May 2014. This trial was community-oriented and included three arms, focusing on healthy children below five years of age. The study involved the randomization of 387 clusters, of which 360 were included in the final analysis. The control arm (A) received the routine polio program bivalent poliovirus vaccine (bOPV). The second arm (B) received additional interventions, including health camps providing routine vaccinations and preventive maternal and child health services. In addition to the interventions in arm B, the third arm (C) was also provided with IPV. Blood and stool samples were gathered from children to evaluate humoral and intestinal immunity. The highest levels of poliovirus type 1 serum antibodies were observed in Group C (IPV + OPV). The titers for poliovirus type 2 (P2) and poliovirus type 3 (P3) were noticeably higher in those who had received a routine OPV dose than in those who had not across all study groups and visits. Providing an IPV booster after at least two OPV doses could potentially fill immunity gaps in regions where OPV does not show high efficacy. However, IPV only marginally enhances humoral immunity and fails to offer intestinal immunity, which is critical to stop the infection and spread of live poliovirus in populations that have not been exposed before.

Abstract Breast cancer is among the lethal types of cancer with a high mortality rate, globally. Its high prevalence can be controlled through improved analysis and identification of disease‐specific biomarkers. Recently, long non‐coding RNAs (lncRNAs) have been reported as key contributors of carcinogenesis and regulate various cellular pathways through post‐transcriptional regulatory mechanisms. The specific aim of this study was to identify the novel interactions of aberrantly expressed genetic components in breast cancer by applying integrative analysis of publicly available expression profiles of both lncRNAs and mRNAs. Differential expression patterns were identified by comparing the breast cancer expression profiles of samples with controls. Significant co‐expression networks were identified through WGCNA analysis. WGCNA is a systems biology approach used to elucidate the pattern of correlation between genes across microarray samples. It is also used to identify the highly correlated modules. The results obtained from this study revealed significantly differentially expressed and co‐expressed lncRNAs and their cis‐ and trans‐regulating mRNA targets which include RP11‐108F13.2 targeting TAF5L, RPL23AP2 targeting CYP4F3, CYP4F8 and AL022324.2 targeting LRP5L, AL022324.3, and Z99916.3, respectively. Moreover, pathway analysis revealed the involvement of identified mRNAs and lncRNAs in major cell signalling pathways, and target mRNAs expression is also validated through cohort data. Thus, the identified lncRNAs and their target mRNAs represent novel biomarkers that could serve as potential therapeutics for breast cancer and their roles could also be further validated through wet labs to employ them as potential therapeutic targets in future.

OBJECTIVE: To analyze the demographic features and patterns of fodder cutter machine injuries in rural areas of Hyderabad, Sindh. METHODOLOGY: This descriptive study was conducted in the Department of Orthopedic Surgery and Traumatology at Liaquat University of Medical Health Sciences Jamshoro from February 2018 to January 2019. Total 56 patients with fodder cutter machine injuries of either sex and any age presented were included in the study. Data collected and analyzed on SPSS version 21. RESULTS: In this study 56 patients affected by fodder cutter machine injury were received, out of these 38 (68%) were male and 18 (32%) were females. All patients sustained injuries to the upper limbs. The mean age was 24.54±12 years. Amputations of the distal phalanges were the commonest injuries noted in 11(13.5%) patients followed by palm and dorsum of the hand injuries (11.1%, n=9) and amputations at carpometacarpal joints (11.1%, n=9. Majority (86%, n=48) patients were injured while operating the machine at home and (14%, n=8) patients sustained injuries while laboring outside of home. Majority (75%, n=42) patients were injured by electric motor driven, while 14 (25%) were injured by manual machine. Time of injury was mostly in the morning (48%, n=27) followed by afternoon (41%, n=23) and evening (10.7%, n=6). CONCLUSION: Amputations of the right-hand distal phalanges were the most commonly reported injuries due to electric fodder cutter machines used at home in the morning time. Male adolescents were more prone to these injuries than others.

The behaviors of optical solitons with spatio-temporal dispersion of the nonlinear Schrödinger’s equation with Kerr medium is discussed by using diverse integration technique. The tanh method is used to obtain the dark and bright, kink and anti-kink optical soliton, single and periodic solitons, and V-shape soliton. Furthermore, necessary as well as sufficient conditions for the formation of the solutions are also reported. Moreover, the planer dynamical system of the discussed equation is constructed using Galilean transformation and all possible phase portraits are presented and sensitive inspection is applied to check the sensitivity of the considered equation. Moreover, after adding perturbed term the chaotic and quasi-periodic behaviors have been observed for different values of parameters and multistability is reported at the end.

In this article, the dynamics of modified nonlinear waves for the generalized breaking soliton (gBS) equation have been explored by using analytical and numerical approaches. Firstly, the Tanh method is used to derive the solitonic solutions of the considered equation and their graphical illustrations for different values of parameters have been discussed. By using the proposed strategy, a variety of solutions can be found. Furthermore, the Galilean transformation is used to investigate the bifurcation behavior of the model. All possible phase portraits have been drawn and examined in detail. More specifically, it is shown that under defined parametric restrictions, the model has a straightforward specific value. At each fixed point, the existence of periodic points and bifurcation analysis is also confirmed. To clarify theoretical results, detailed numerical simulations are offered. Then by introducing perturbed term, the periodic and quasi-periodic behaviors of the discussed equation for various initial values are reported. Different periodic solutions can also be found in this parameter zone. Furthermore, it is reported that discussed equation is multi-stable for different values of parameters. Finally, sensitivity analysis for different initial value problems has been elaborated.

OBJECTIVE: To assess the factors for desiring the traditional bone setters in our community & their complications. METHODOLOGY: This retrospective study was conducted at Department of Orthopaedic Surgery & Traumatology, LUMHS Jamshoro from February 2018 to March 2020. Total 87 cases presented at Orthopaedic outpatient clinic after appearing Traditional Bone Setters. Age group from 06 to 81 years through musculoskeletal trauma existing with complications secondary to bonesetter’s treatment were included. Data was collected on predesigned proforma through record of department after approval from ERC. All the patients received traditional bone setter’s handling. The data was obtained & analyzed on SPSS version 21. RESULTS: Total 87 patients, 58(64.36%) were male & 29(33.33%) female M:F ratio 2:1. minimum age 6 years to maximum of 81 years. The mean age was 16.48±32 and 11 patients were under the age of 12 years. Regarding the level of education, 23(26.5%) were illiterate, 23(26.5%) had primary & 17(19.5%) secondary education, 24(27.5%) were graduate or with higher education. Common mode of injury was road traffic accidents reported in 69(79%), 17(19.5%) had history of falls and assaults in 3 (3.5%). Among them, 13(15%) farmers, 12(14%) businessmen, 11(12.6%) were students, 10(11.5%) Government employee, 9(10%) laborers, 8(9%) teachers, 7(8%) unemployed, 6(6.89%) housewives, 4(4.6%) doctors, 3(3.5%) female nurses, 2(2.3%) drivers, 2(2.3%) patients were male nurses. Regarding contact to bonesetter, patients went by themselves were 7(8%), 80(92%) patients were referred by different sources. CONCLUSION: It has been found that traditional bone setters in our community increase the rate of complications like mal-union, nonunion, and bone infections. Still people are being attracted to bone setters despite of all complications.

Objective: To assess the nourishment level of married women of reproductive age in a two rural setting. Method: The cross-sectional study was based on secondary data of the Impact Assessment Survey 2019, which was conducted by the People’s Primary Health Care Initiative from January to May, 2019, in Dadu and Jacobabad districts of the province of Sindh, Pakistan. Nutritional status of married women of reproductive age was analysed using mid-upper arm circumference; 0.05). Conclusion: Overall nutrition status of the married women of reproductive age in the two rural districts of Sindh was less than satisfactory. Key Words: Undernourishment, Underweight, Mid-upper arm circumference, Women of reproductive age, Pakistan. Continues...

Abstract The study provides results of regional frequency analysis (RFA) using annual maximum peak flows (AMPF) of 36 sites located on various streams and rivers of Khyber‐Pakhtunkhwa, Pakistan. Assumptions of randomness, independent and identical distribution regarding AMPF at each site have been validated using different statistical tests. The region of 36 sites is heterogeneous as confirmed by L‐moments based heterogeneity measure. Therefore, it is subdivided into four homogeneous regions considering the most influential site characteristic among available using wards clustering method and Euclidean distance. To identify good‐fit‐regional distribution(s), from a set of popular three‐parameter distributions, L‐moment ratio diagram and |Z‐Dist| statistic are used as goodness‐of‐fit criteria. To obtain the most suitable distribution having robust properties, a simulation‐based assessment analysis is performed for each homogeneous region considering root mean square error and 95% error bounds of regional quantiles as accuracy measures. Due to non‐linearity (in the functional relationship between the mean of AMPF at various sites and their corresponding site characteristics) and the existence of multicollinearity between the site characteristics, radial basis function (RBF) network has been used for the estimation of quantiles at ungauged sites. The results show that the adopted methodology is useful for the estimation of quantiles at gauged and ungauged sites within the defined homogeneous regions.

Pancreatic cancer (PaCa) is the seventh most fatal malignancy, with more than 90% mortality rate within the first year of diagnosis. Its treatment can be improved the identification of specific therapeutic targets and their relevant pathways. Therefore, the objective of this study is to identify cancer specific biomarkers, therapeutic targets, and their associated pathways involved in the PaCa progression. RNA-seq and microarray datasets were obtained from public repositories such as the European Bioinformatics Institute (EBI) and Gene Expression Omnibus (GEO) databases. Differential gene expression (DE) analysis of data was performed to identify significant differentially expressed genes (DEGs) in PaCa cells in comparison to the normal cells. Gene co-expression network analysis was performed to identify the modules co-expressed genes, which are strongly associated with PaCa and as well as the identification of hub genes in the modules. The key underlaying pathways were obtained from the enrichment analysis of hub genes and studied in the context of PaCa progression. The significant pathways, hub genes, and their expression profile were validated against The Cancer Genome Atlas (TCGA) data, and key biomarkers and therapeutic targets with hub genes were determined. Important hub genes identified included ITGA1, ITGA2, ITGB1, ITGB3, MET, LAMB1, VEGFA, PTK2, and TGFβ1. Enrichment analysis characterizes the involvement of hub genes in multiple pathways. Important ones that are determined are ECM–receptor interaction and focal adhesion pathways. The interaction of overexpressed surface proteins of these pathways with extracellular molecules initiates multiple signaling cascades including stress fiber and lamellipodia formation, PI3K-Akt, MAPK, JAK/STAT, and Wnt signaling pathways. Identified biomarkers may have a strong influence on the PaCa early stage development and progression. Further, analysis of these pathways and hub genes can help in the identification of putative therapeutic targets and development of effective therapies for PaCa.

Psoriasis is the most common and chronic skin disease that affects individuals from every age group. The rate of psoriasis is increasing over the time in both developed and developing countries. Studies have revealed the possibility of association of psoriasis with skin cancers, particularly non-melanoma skin cancers (NMSC), which, include basal cell carcinoma and cutaneous squamous cell carcinoma (cSCC). There is a need to analyze the disease at molecular level to propose potential biomarkers and therapeutic targets in comparison to cSCC. Therefore, the second analyzed disease of this study is cSCC. It is the second most common prevalent skin cancer all over the world with the potential to metastasize and recur. There is an urge to validate the proposed biomarkers and discover new potential biomarkers as well. In order to achieve the goals and objectives of the study, microarray and RNA-sequencing data analyses were performed followed by network analysis. Afterwards, quantitative systems biology was implemented to analyze the results at a holistic level. The aim was to predict the molecular patterns that can lead psoriasis to cancer. The current study proposed potential biomarkers and therapeutic targets for psoriasis and cSCC. IL-17 signaling pathway is also identified as significant pathway in both diseases. Moreover, the current study proposed that autoimmune pathology, neutrophil recruitment, and immunity to extracellular pathogens are sensitive towards MAPKs (MAPK13 and MAPK14) and genes for AP-1 (FOSL1 and FOS). Therefore, these genes should be further studied in gene knock down based studies as they may play significant role in leading psoriasis towards cancer.

Background: Afghan refugees in Pakistan, particularly in Quetta, Balochistan, encounter formidable barriers in accessing maternal, newborn, and child health (MNCH) services. These challenges have been intensified by the COVID-19 pandemic and entrenched systemic health inequities. Methods: This qualitative study, conducted from February to April 2023, aimed to assess the obstacles within health systems and community environments that hinder MNCH service access among Afghan refugees. The study involved 20 key informants through in-depth interviews and focus group discussions, including Afghan refugee women, community elders, health workers, and representatives from non-governmental organizations and government agencies. The research focused on experiences during the initial four waves of the COVID-19 pandemic (2020-2021), utilizing a conceptual framework integrating Health Emergency Disaster Risk Management (Health-EDRM) with primary health care. Findings: The study identified significant systemic barriers to accessing MNCH services, such as insufficient funding, inadequate health infrastructure, and discriminatory practices within the healthcare workforce. Additionally, community-level obstacles were prominent, including cultural and language differences, geographical isolation, and economic constraints. The integration of Health-EDRM into local health systems was minimal, with many stakeholders either needing to be made aware of or unengaged with the framework. Conclusion: The findings highlight a critical need for comprehensive policy reforms, infrastructure enhancement, and community-centered approaches to address Afghan refugees' health needs effectively. Strengthening the integration of health-EDRM into health systems is crucial for enhancing resilience and ensuring continuous care during health emergencies. The study calls for concerted efforts to implement culturally sensitive health interventions that include disaster risk management components to improve MNCH outcomes among Afghan refugees in crisis-affected settings. Addressing systemic and community-level barriers makes creating a more resilient and equitable health system for vulnerable populations possible. [ABSTRACT FROM AUTHOR]

As one of the most perilous industries, agriculture presents both fatal and non-fatal risks to farmers. Pakistan, a notable Asian nation, heavily depends on agriculture, which constitutes 23% of its GDP and employs 37.4% of its workforce. The study investigates the challenges within Pakistan's agriculture sector and enriches the existing literature by gathering data on agricultural machine-related injuries in Pakistan during 2022–2023. The survey, conducted from November 2022 to April 2023, involved 55 respondents, predominantly from Sindh and Punjab. The findings indicate a total of 507 injuries, with approximately a quarter being fatal (121 incidents). Sindh emerges as a significant hotspot, with the majority of injuries documented there. With respect to the key sources of injuries, the fodder cutter is a primary source of injuries with 201 injuries documented, accounting for approximately 40% of all injuries. Threshers contributed to 197 injuries, approximately 39% of the total, and about 52 are tractor-related injuries, making up about 10% of machine injuries. Regarding the severity and demographics of injuries, about 38% of cases involve amputation, with a higher incidence among males (77%) and individuals aged 15–34 years (65%). It is important to acknowledge the study's limitations, including a small participant pool and a brief data collection period. This research advocates for safety regulations, accident reduction measures, and increased safety awareness among farmers, aiming to foster a safer and more sustainable agricultural environment in Pakistan. [ABSTRACT FROM AUTHOR]