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The theme of this study is to investigate the theoretical and numerical simulation of heat and mass transfer of magneto hydrodynamic power-law nanofluid flow over a stretching sheet with surface heat flux and Soret/Dufour effects. The mass flux and energy flux increase with temperature and concentration differences using the Soret/Dufour impact. The similarity transformations were used to transform a physical problem into a non-linear differential equation, and the non-linear equations were solved by the Keller box technique. The Soret/Dufour and magnetic field are incorporated into a nanofluid model. The similarity transformation was used to reduce thermal energy, mass, and momentum in algebraic systems. The impact of nanofluid factors, such as generalized Brownian motion parameter Nb, Dufour parameter Df, Soret parameter Sr, Le, and Pr, are generalized Lewis and Prandtl numbers; the thermophoresis parameter Nt and magnetic parameter on dimensionless stretching surface functions are shown numerically and graphically. The quantitative relationship between heat transfer and skin friction is shown by using Keller box and MATLAB. The skin friction coefficient Cf, Sherwood number Shx, and Nusselt number Nux values were also computed and displayed on the graph. The increment in slip temperature, fluid velocity, and fluid concentration is enhanced with a high Dufour parameter. The temperature variation and fluid concentration are decreased with applied-magnetic effects because the magnetic field acts like an insulating material in heat transfer systems. The enhancement in the Nusselt number and Sherwood number is increased with Soret and Dufour effects. [ABSTRACT FROM AUTHOR]

In the present investigation, zirconium dioxide (ZrO2) and zirconium diboride (ZrB2) have been used in the development of an aluminum-based composite. A microwave sintering technique was employed for the processing of the composite. The aluminum-based composite was developed with the constant 5 wt.% of ZrO2. The weight percent of ZrB2 increased from 2.5% to 7.5%. Uniform distribution of the reinforcement particles was observed for the composition Al–5 wt.% ZrO2–2.5 wt.% ZrB2 composite and Al–5 wt.% ZrO2–5 wt.% ZrB2 composite. The relative density of Al–5 wt.% ZrO2–5 wt.% ZrB2 composite was found to be 0.9874. The percent porosity of the Al–5 wt.% ZrO2–5 wt.% ZrB2 was 1.259%. Results showed that hardness, compressive strength, % tensile strength, and fatigue strength (at 1 × 107 cycles) were improved by about 74.28%, 18.18%, 58.77%, and 60.77%, respectively. XRD of the Al/ZrO2/ZrB2 composite showed the presence of Al, ZrO2, ZrB2, MgAl2O4, and Al2Cu phases. The number of grains per square inch for composition Al–5 wt.% ZrO2–5 wt.% ZrB2 composite was found to be 989.11. This result showed that a finer grain structure has been obtained after the solidification of Al–5 wt.% ZrO2–5 wt.% ZrB2 composite. The fracture surface of the Al–5 wt.% ZrO2–5 wt.% ZrB2 composite was composed of a dendrite structure with micro-porosities. Dimples were also not observed from the tensile fracture surface morphology of the composite. [ABSTRACT FROM AUTHOR]

Fruit infections have an impact on both the yield and the quality of the crop. As a result, an automated recognition system for fruit leaf diseases is important. In artificial intelligence (AI) applications, especially in agriculture, deep learning shows promising disease detection and classification results. The recent AI-based techniques have a few challenges for fruit disease recognition, such as low-resolution images, small datasets for learning models, and irrelevant feature extraction. This work proposed a new fruit leaf leaf leaf disease recognition framework using deep learning features and improved pathfinder optimization. Three fruit types have been employed in this work for the validation process, such as apple, grape, and Citrus. In the first step, a noisy dataset is prepared by employing the original images to learn the designed framework better. The EfficientNet-B0 deep model is fine-tuned on the next step and trained separately on the original and noisy data. After that, features are fused using a serial concatenation approach that is later optimized in the next step using an improved Path Finder Algorithm (PFA). This algorithm aims to select the best features based on the fitness score and ignore redundant information. The selected features are finally classified usingmachine learning classifiers such asMediumNeuralNetwork, WideNeuralNetwork, and Support Vector Machine. The experimental process was conducted on each fruit dataset separately and obtained an accuracy of 100%, 99.7%, 99.7%, and 93.4% for apple, grape, Citrus fruit, and citrus plant leaves, respectively. A detailed analysis is conducted and also compared with the recent techniques, and the proposed framework shows improved accuracy. [ABSTRACT FROM AUTHOR]

Human facial emotion detection is one of the challenging tasks in computer vision. Owing to high inter-class variance, it is hard for machine learning models to predict facial emotions accurately. Moreover, a person with several facial emotions increases the diversity and complexity of classification problems. In this paper, we have proposed a novel and intelligent approach for the classification of human facial emotions. The proposed approach comprises customized ResNet18 by employing transfer learning with the integration of triplet loss function (TLF), followed by SVM classification model. Using deep features from a customized ResNet18 trained with triplet loss, the proposed pipeline consists of a face detector used to locate and refine the face bounding box and a classifier to identify the facial expression class of discovered faces. RetinaFace is used to extract the identified face areas from the source image, and a ResNet18 model is trained on cropped face images with triplet loss to retrieve those features. An SVM classifier is used to categorize the facial expression based on the acquired deep characteristics. In this paper, we have proposed a method that can achieve better performance than state-of-the-art (SoTA) methods on JAFFE and MMI datasets. The technique is based on the triplet loss function to generate deep input image features. The proposed method performed well on the JAFFE and MMI datasets with an accuracy of 98.44% and 99.02%, respectively, on seven emotions; meanwhile, the performance of the method needs to be fine-tuned for the FER2013 and AFFECTNET datasets. [ABSTRACT FROM AUTHOR]

Background: Palliative radiotherapy in patients with metastatic spinal cord compression is a wellknown treatment modality but little is known whether it improves quality of life and performance status. Our study focusses on analyzing the impact of palliative radiotherapy on these two parameters in patients with metastatic spinal cord compression. Methods: We performed a prospective observational study from August 2020 to April 2021 to assess consecutive patients presenting to emergency department with suspected MSCC. We enrolled 24 patients in the study, and they were evaluated for their performance status and quality of life using ECOG and FACITPAL 14 scores respectively. Palliative radiotherapy was administered, and the patients were followed up four to six weeks later. Their ECOG and FACIT-PAL 14 scores before and after receiving palliative radiotherapy were analyzed. Results: The mean age of the patients was 48 (IQR 35-62), with 14 (58%) being male. 1 patient died soon after admission. Median dose fractionation was 2000 cGy. Median (IQR) of ECOG performance status score on admission and follow up was 2.5 (1.0-3.7) and 1.5 (1.0-3.7), p=0.719, respectively. Median (IQR) FACIT-PAL 14 score on admission and follow up were 35.5 (34.0-37.6) and 36.5 (30.2-44.7), p=0.277, respectively. Our results indicate that there was no statistically significant difference in the median ECOG performance status and FACIT PAL 14 scores before and after the administration of palliative radiotherapy. Conclusion: Our study indicates that palliative radiotherapy in patients with metastatic spinal cord compression had little benefit in objectively improving quality of life and performance status using the well-known and widely used scores. This lack of response could be due to delayed presentation of the patients. Earlier involvement of palliative care team could have improved both these parameters. Further research with larger population of patients over a longer period is needed to further assess these outcomes. [ABSTRACT FROM AUTHOR]

Objective: To estimate the effect of improving waste collection services on waste disposal behaviour and exposure to environmental risk factors in urban, low‐income communities in Pakistan. Methods: We enrolled six low‐income communities in Islamabad (Pakistan), four of which received an intervention consisting of a door‐to‐door low‐cost waste collection service with centralised waste processing and recycling sites. Intervention communities underwent community‐level and household‐level mobilisation. The effect of the intervention on waste disposal behaviour, exposure to waste and synanthropic fly counts was measured using two cross‐sectional surveys in 180 households per community. Results: Intervention communities had less favourable socio‐economic indicators and poorer access to waste disposal services at baseline than control communities. Use of any waste collection service increased from 5% to 49% in the intervention communities (difference 44%, 95% CI 41%, 48%), but the increase was largely confined to two communities where post‐intervention coverage exceeded 80% and 90%, respectively. An increase in the use of waste collection services was also found in the two control communities (from 21% to 67%, difference 47%, 95% CI 41%, 53%). Fly counts decreased by about 60% in the intervention communities (rate ratio 0.4, 95% CI 0.3, 0.4) but not in the control communities (rate ratio 1.52, 95% CI 1.1, 2.2). The decrease in fly counts was largely confined to the two high‐coverage intervention communities. Conclusion: Introduction of a low‐cost waste collection service has the potential for high uptake in low‐income communities and for decreasing the exposure to waste and synanthropic flies at household level. Intervention success was constrained by low uptake in half of the intervention communities. [ABSTRACT FROM AUTHOR]

Objective: To analyze the predictive value of drumhead perforation to overall visceral damage by the blast waves. Study Design: Retrospective observational study. Place and Duration of Study: It was a multi-centric study extending from Jul 2005 to Jun 2009. Blast victims in Wana (Pak Afghan border area, a hot center of war against terrorism in Pakistan), Lahore (provincial capital of Punjab, Pakistan) and Quetta (provincial capital of Baluchistan, Pakistan) were included in the study. Methodology: A total of 354 patients were included in the study. A preliminary examination by surgeon and ENT specialist was carried out to evaluate patient’s general condition and state of tympanic membranes. Sonographic examination, computerized tomography (CT) scan and other relevant investigations were subsequently carried out to further ascertain the patient’s condition and visceral damage. The data were then analyzed to correlate visceral damage as a result of blast injury to the laterality and size of tympanic membrane perforation. Results: The extent of visceral damage was less in cases with intact drumheads, more in cases with unilateral perforation and maximum in cases with bilateral subtotal perforation. Conclusion: The size and laterality of drumhead perforation as a result of blast injury is a rough predictor of visceral damage sustained as a result of blast injury. [ABSTRACT FROM AUTHOR]

Objective: To investigate the dependency on feeding gastrostomy tubes in patients with head and neck cancers treated with radiotherapy alone or concurrent chemo-radiotherapy. Study Design: Retrospective longitudinal study. Place and Duration of Study: Combined Military Hospital, Rawalpindi and Shaukat Khanum Hospital, Peshawar Pakistan, from Jan and Jul 2022. Methodology: A total of 115 patients with head and neck cancers having no baseline dysphagia and having gastrostomy tubes were included. All had received an equivalent of 60 greys in 30 fractions or more of radiotherapy. Their swallowing was evaluated weekly during radiotherapy and then every 4-6 weeks on post-treatment follow-up. The total time duration of patient dependency on feeding gastrostomy tube after treatment completion was noted for each head and neck cancer subsite. Results: Of a total of 115 patients, 49(43%) of the patients had nasopharyngeal cancers, 22(19%) had laryngeal, 29(24%) oral cavity, 7(6%) hypopharyngeal and 9(8%) had cervical esophageal cancers. Proportion retaining gastrostomy tube for more than six months of treatment was 8.7% (median duration of retention was five months) with hypopharyngeal, nasopharyngeal, oral cavity, and laryngeal cancer were 14%, 9%, 9% and 5%, respectively. Conclusion: The proportion of patients with head and neck cancers requiring more than six months of a gastrostomy tube is 5-14%. Baseline assessment of swallowing and nutrition and prophylactic feeding gastrostomy can avoid treatment interruptions. Longer duration of retention of a gastrostomy tube is associated with poor quality of life in head and neck cancer patients receiving radiation or concurrent chemo-radiation. [ABSTRACT FROM AUTHOR]

Neuroendocrine breast carcinoma (NEBC) is histologically a rare type of invasive breast cancer. It constitutes only 0.2-0.5% of all invasive breast cancers. In this case series, we are presenting five cases having primary neuroendocrine breast cancers that had been reported at a high-volume cancer centre in Pakistan. In this study, neuroendocrine breast cancer patients at Shaukat Khanum Memorial Cancer Hospital and Research Centre Peshawar were evaluated. We had retrospectively collected information on demographic characteristics of our patients, physical examination, radiological findings, surgical procedures with their outcomes, histopathological and immuno-histochemical characteristics, systemic adjuvant/neoadjuvant therapy and follow-up. [ABSTRACT FROM AUTHOR]

Objectives: To determine the short-term mortality rate of patients on mechanical ventilation in a tertiary care center in Sialkot, Pakistan. Study Design: Descriptive cross sectional study. Place and Duration of Study: This study was conducted jointly by the departments of Anesthesiology, Surgery and Gynecology & Obstetrics at Combined Military Hospital Sialkot Cantonment, from Jul 2013 to Jun 2015. Material and Methods: A total of 112 patients placed on mechanical ventilation were included in this study. The patients' age, gender, disease on admission, duration of ventilation, indication for ventilation, outcomes and complications were noted. SPSS 21 was used for data analysis. Results: Fifty-eight (51.78%) patients expired while 54 (48.21%) were weaned off successfully. In the former group of expired patients, the major factors contributing towards the mortality were multi-organ failure (37.9%), VAP/ventilator-associated pneumonia (32.7%), coagulopathy (29.3%) and sepsis (27.5%). However, in the survivor patients group5 patient (9.25%) developed VAP, 3 (5.55%) developed pneumothorax while 3 others (5.55%) developed a fever of unknown etiology. Conclusion: The short-term mortality rate of patients who receive mechanical ventilation in an intensive care unit (ICU) in Sialkot, Pakistan is significantly higher than that of developed countries. [ABSTRACT FROM AUTHOR]

Background: Adnexal tumors of the skin are a large and diverse group of benign and malignant neoplasms, which exhibit morphological differentiation toward one of the different types of adnexal epithelium present in normal skin and they pose a diagnostic challenge. The purpose of this study is to share our experience with these rare but aggressive tumors at a tertiary care cancer hospital in a developing country. A retrospective review of 11 patients diagnosed with rare adnexal tumors and their variants from January 2005 to December 2014, treated either surgically or non-surgically, was performed to describe the clinicopathological characteristics and outcome of the disease.Case Presentation: A total of 11 patients were diagnosed with adnexal carcinoma and its variants: a 34-year-old Sindhi man, a 59-year-old Punjabi woman, a 32-year-old woman from Khyber Pakhtunkhwa, a 43-year-old Punjabi woman, a 64-year-old Punjabi man, a 51-year-old man from Khyber Pakhtunkhwa, a 51-year-old Punjabi woman, a 74-year-old Punjabi woman, a 75-year-old Punjabi man, a 61-year-old man from Khyber Pakhtunkhwa, and a 53-year-old man from Khyber Pakhtunkhwa. The male to female ratio was 1.2:1. The histological variations were sebaceous differentiation (n = 4), microcystic adnexal carcinoma (n = 4), trichilemmal carcinoma (n = 1), pilomatrix carcinoma (n = 1), and hidradenocarcinoma (n = 1). The mean age at presentation was 54 years (range 32 to 75). The primary subsite of involvement was the scalp in nine patients followed by eyelids in two patients. Surgery was the primary treatment modality in almost all patients; postoperative radiotherapy (PORT) was offered to eight patients. The median dose of radiation was 45 Gy to the primary site. Indications for radiotherapy included close margins (n = 2), positive margins (n = 1), high grade histology (n = 4), and multifocal disease (n = 1). On follow-up, two patients presented with local, one regional and two patients developed distant metastasis.Conclusions: Adnexal carcinomas are rare tumors with diverse histological patterns and a tendency for locoregional and distant metastasis. Surgery should be the mainstay of treatment reserving radiotherapy for adjuvant, palliative, and re-treatment scenarios. [ABSTRACT FROM AUTHOR]

Granulomatosis with polyangiitis (GPA) previously known as Wegner's granulomatosis, is a small vessel vasculitis that preferentially involves capillaries, arterioles and venules, presenting as multisystemic disease classically with alveolar haemorrhage and renal insufficiency. We report a case of GPA diagnosed on history, clinical findings and supported by imaging and very high levels of C-ANCA. Renal biopsy confirmed the typical histopathological findings. We discuss herein the management of the case and review of literature. [ABSTRACT FROM AUTHOR]

Objective: This study was cross sectional survey conducted to find the prevalence of Restless legs syndrome (RLS) in end stage renal disease (ESRD) patients on haemodialysis (HD). Methods: Data were obtained from 250 patients on chronic maintenance HD. To assess the prevalence of RLS, Clinical diagnostic criteria for RLS was used which is established by the International RLS Study Group. Results: Total 250 patients were included in this study. 153 (61.2%) patients were male and 97 (38.8%) were females. Mean age of the patients was 45.27 years. Mean duration of HD was 26.10 months. Total162 (64.8%) patients were found to be suffering from RLS. Out of 153 males, 87(56%) were suffering from RLS and among 97 females, 75(77.3%) were suffering from RLS. In our study, gender was statistically significantly associated with RLS (p-value 0.001). In age groups 159(63.6%) patients were below 51 years; among them 102(64.1%) were suffering from RLS; whereas 91(36.4%) patients were equal or above 51 years of age and among this group 60(65.9%) patients were suffering from RLS. There was no statistically significant association between RLS and age groups (p-value 0.776). Conclusions: RLS is common in patients undergoing regular HD. It is more commonly seen in females. [ABSTRACT FROM AUTHOR]