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Human body has a set of unspecialized cells called as stem cells that have the ability to generate cells of specialized function. Volume of fractionated plasma extracted from autologous blood is termed as Platelet-rich plasma (PRP) that is rich in several growth factors. Both have shown effective results in the field of regenerative medicine. Physiologically, platelets are the first cells to concentrate at the site of tissue damage, therefore application of PRP in diverse surgical procedures enhances bone and soft tissue healing; this same phenomenon is currently being used in otology, head and neck flap surgery and yielding miraculous outcomes. The perspective role of stem cells in regenerative medicine is wrapped in its loosely arranged DNA with working genes; a similar concept is being worked upon in different ENT procedures with groundbreaking results. Continued...

Introduction: Two patients with jaundice reported to the National Institute of Health (NIH), Islamabad from Shakrial, Rawalpindi in April 2017. An outbreak investigation team was formulated to assess the disease magnitude, risk factors and control measures. Methodology: A case-control study was conducted in 360 houses in May 2017. The case definition was: onset of acute jaundice with any symptom including fever, right upper-quadrant pain, loss of appetite, dark urine, nausea and vomiting among Shakrial residents from March 10 - May 19, 2017. Four age and gender matched controls were selected for each case. Blood samples were sent to the NIH for laboratory confirmation. Frequencies, attack rates (AR), odd ratios, and logistic regression were computed at 95% confidence interval and p < 0.05. Results: A total of 25 cases (23 new) were identified with mean age 8 years and male to female ratio 1.5:1. Overall AR was 1.39% and the most severely affected age-group was 5-10 years (AR of 3.92%). Multivariate analysis revealed that raw vegetable consumption, lack of awareness and poor handwashing practices had significant association with disease spread. All blood samples were positive for hepatitis A, and no resident was previously vaccinated. Lack of awareness of disease spread among the community was the most probable reason for the outbreak. There were no new cases during follow up until May 30, 2017. Conclusions: Healthcare departments should implement public policies towards the management of hepatitis A in Pakistan. Health awareness sessions and vaccination for children ≤ 16 years age is recommended.

Objective To assess the pattern of injuries in autopsy examination of road traffic accident cases at Peshawar. Materials and Methods A community-based descriptive cross-sectional study included a total of 94 candidates presented for autopsy at the forensic medicine department, Khyber medical college from 01st July 2020 to 30th June 2021. Results The age of the subjects ranged from 2-80 years with a mean age of 36.9 ± 20.7 years. 96.8 % of subjects were having multiple injuries whereas, 3.2% were having a single injury. Overall, 94 cases had a total number of 303 injuries, out of which 90.76% were small-sized, 7.92% were medium-sized and 1.32% were large-sized including all kinds of injuries. The most common presenting injury was laceration (87.2%), preceded by abrasion (59.6%), then contusion (51.1%), fracture (23.4%), and hematoma (2.1%). The most common region involved in RTA was head & neck with 86.17%. Maximal deaths occurred within 3-6 hours following an RTA. The most common cause of death was an injury to the brain and its associated vessels. There is no significant correlation noted between the patterns of injury and the cause of death of subjects (p

Pakistan is home to several indigenous communities. However, life in cities is much more challenging than in under-developed areas. Due to social mobility, economic uplift, and better educational and health opportunities; communities migrate from their local towns to cities. Hence, each province reflects a diverse population and cultural groups speaking their mother tongues, practicing different religions, and following their cultural norms independently. Therefore, this study aims to explore the case of young migrant Kashmiri speakers who are residing in different urban parts of Karachi. As the focus is to identify the language use and identity patterns of young Kashmiri speakers in the presence of dominant languages and cultures. Consequently, the qualitative case study has been undertaken using purposive sampling to know about the scenario of young Kashmiris. For this purpose, data were collected from 05 participants using semi-structured interviews and the responses were analyzed using thematic analysis. The findings of the study show that the young Kashmiris use the Urdu language in different domains like home, market, education, and friends because of upward social mobility and lingua franca. As a result, it is being used in their ancestral hometowns as well. While the Kashmiri language has been restricted and it is only used for fun and interaction with only relatives. Similarly, the linguistic identity is predefined by being proud of the Kashmiri language, its association and affiliation with the Kashmiri land, and geography. Overall, although the language patterns showed a shift, the linguistic identity is preserved by a high ethnolinguistic vitality among the young generation in cities.

This study aims to explore some new causes, motivational factors behind manipulation of earnings management and its controlling measures through qualitative research methods in Pakistani context. Traditionally, many studies have been carried out in this field by using quantitative version. To break the saturation and to explore and identify more versions related to earnings management, qualitative approach has been followed in this study. Data were collected through semi-structured interviews from auditors, credit analysts, investors and academicians of accounting and analyzed using NVivo 10, software. Many quantitative studies have been conducted regarding the causes of earnings management; however, this novel study provides in-depth motivation behind earnings management, responsible entities for such manipulations and remedial actions in practical life by conducting interviews with most relevant bodies dealing with accounting statements. This study, in addition to traditional factors, has singled out the role of government and auditors, the attitude of managers and owners as the new entities responsible for earnings management. Reporting quality can be improved by having proper check and balance from government level, from the Security and Exchange Commission of Pakistan (SECP) and from auditors. Government and SECP can check whether the rules and regulations set for the companies are being implemented properly, and auditors can check whether companies are presenting their true picture to the outsiders. Additionally, the involvement of managers on the board should be reduced. Small sample size, time consuming semi-structured interviews, limited number of interviewees’ groups, non-availability of the experienced respondents and financial constraints in a qualitative study are a few leading limitations. The limitations may include the extent of the researchers’ bias, lack of comfort level for some respondents with the audio recording, but the authors have tried to maintain these limitations at the minimum possible level. Empirical studies can be conducted to scientifically investigate the extent of the relationship between these new entities and earnings management with more recommendations for stakeholders in the corporate sector in Pakistan and the economies with similar characteristics.

BACKGROUND: Iron deficiency anemia is most common nutritional deficiency in pregnant women due to increased iron turnover and additional requirement by fetus. Glycemic index is popularly measured by assessing glycated proteins. HbA1c is affected by several factors including pregnancy.OBJECTIVE: The aim of this study is to assess the relationship between iron deficiency anemia in pregnant women and glycated protein (HbA1c).PATIENTS AND METHODS: It is a prospective study conducted at a tertiary care hospital between the duration of April 2019 to June 2019. Total of 40 normal females were taken as control group, while 42 pregnant non – diabetic iron deficient patients.RESULTS: Both groups included females of reproductive age. All parameters including hemoglobin, serum iron, serum total iron – binding capacity (TIBC), serum transferrin saturation and serum ferritin showed statistically significant between two groups (p

Aberrant innominate artery lying high in the neck is a rare entity that can be encountered intraoperatively during midline neck surgeries such as thyroidectomy and tracheostomy. Surgeons should be mindful of this entity as injury to the artery can lead to life-threatening haemorrhage. We report a case of a 40 year old female in whom an aberrant innominate artery was identified high in the neck, while performing a total thyroidectomy. Keywords: Aberrant innominate artery, Thyroidectomy, Tracheostomy, Aorta.

Introduction: Points of entry (PoE) in Pakistan serve as key conduits for international travel, transport, and trade. Central Health Establishment (CHE) is a key stakeholder in the implementation of the International Health Regulations 2005 (IHR) core capacities at PoE and National Action Plan 2020 against COVID-19. A comprehensive screening plan for COVID-19 was carried out effectively despite limitations. Methods: A descriptive study on CDC guidelines for health screening at PoE was conducted from February 2020 to March 2021. Guidelines are based on 11 attributes to be implemented; these include legal and regulatory bodies to detain the travelers as suspect, isolate, and coordinate at PoEs, funds for screening, well-equipped quarantine facilities, referral health care facilities, protocols for primary and secondary screening, capacity building, supply of personal protective equipment and screening tools, and provision of basic facilities at isolation areas. Data were collected using both qualitative and quantitative methods from health officers and quarantine assistants of PoEs. The analysis of CHE’s information system was performed to assess the management of traveler surveillance. Results: Eleven attributes were addressed for health screening according to CDC guidelines and well implemented at PoE by CHE under the flagship of the MNHR&C. Primary health screening of 4,088,119 inbound travelers was conducted. Secondary health screening led to the referral of performed at airports for inbound travelers, with a positivity rate of 0.32. Conclusion: Preparedness and response for COVID-19 at PoE are in line with the National Action Plan of the Government of Pakistan and IHR (2005).

Objective: To assess hypertension in elderly people aged 60 and above residing in university campus Peshawar. Methodology: This cross-sectional study included a total of 103 elderly people aged 60 and above, selected from university campus Peshawar by simple random sampling from January to April 2019. Blood pressure was measured manually. Subjects with systolic blood pressure more than 140 and diastolic blood pressure more than 90 mm of Hg and signs & symptoms of hypertension were considered as hypertensive. Semi-structured questionnaires were used to collect the data. Data was entered and analyzed on SPSS version 20 and Microsoft Excel 2013. Results: The prevalence rate of hypertension in the study population was 68.0% (70/103), which contain 41.8% (43/103) of stage I and 26.2% (27/103) of stage II hypertension. The hypertension was more prevalent in males than females. The combined mean systolic blood pressure of the total population was 146.12 mmHg (SD 21.70 mmHg, 95% CI 141.92-150.31), while mean diastolic blood pressure was 89.61 mmHg (SD 14.15 mmHg, 95% CI 86.88-92.34). Conclusion: Although prevalence of hypertension in geriatric population is very high but major bulk is undiagnosed.

Objective: The incidence of stroke is greater in patients with end-stage renal disease (ESRD) as compared to the general population. It is thought that there may be a few extra risk factors in ESRD patients suffering from stroke as compared to ESRD patients without stroke. This study aims to better understand the risk factors for stroke that are unique to patients with ESRD. Methods: In order to find out the different causative factors influencing the production of ischemic stroke (IS) in patients with ESRD, we carried out this retrospective study at the DHQ hospital in Faisalabad. In this study total of sixty patients were recruited and further divided into two groups. The first group consisted of 30 patients with ESRD with a history of ischemic stroke, while 30 patients with stroke-free dialysis were selected as the age and gender control group. Patients with and without ischemic stroke were compared in terms of demographic characteristics, stroke risk factors, and lab results. Results: Patients with acute ischemic stroke had an average age of 56.70 ± 8.87 years with 52% male whereas the non-ischemic stroke group had an average age of 58.9 ± 9.20 years. Small vascular obstruction was found to be the most common subtype of IS (42%), followed by atherosclerosis of large vessels (28%). Compared with patients who did not have a stroke, patients who had a stroke had significantly higher rates of hypertension (HTN), higher systolic (SBP) and diastolic blood pressure (DBP) at admission. The group with a stroke had significantly lower total cholesterol and LDL cholesterol. Lower levels of low-density lipoprotein (LDL) and higher systolic blood pressure were found to be the independent risk factor for an ischemic stroke in a multivariate analysis (OR=1.025, 95% CI p=0.045 and OR=1.458, 95% CI, P=0.03 respectively). Conclusion: According to the findings of our study, ESRD patients with hypertension and diabetes have a higher chance of ischemic stroke and the lower LDL levels and higher systolic blood pressure were the independent predictors of ischemic stroke. Keywords: Hemodialysis, Ischemic stroke, risk factors, Hypertension, end stage renal disease

Introduction Thyroid nodules are common globally in almost one fifth of the adult population. The gold standard treatment for thyroid nodule is thyroid lobectomy or total thyroidectomy depending upon the diagnosis. Thyroidectomy has a few known complications but, as per the ATA consensus statement, it is a safe surgery to be done as a day care procedure. Objective To access the feasibility and safety of thyroid lobectomy as a day care surgery and its effect on decreasing overall financial burdens. Methods This retrospective chart review was done from 2006 to 2022. A total of 736 patients underwent thyroid lobectomy among which only 56 were done as day care surgery. Data analysis was done using the IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY, USA). Results A total of 40% of the population was male. The mean age of the study population was 42 years. Bethesda II was the most encountered diagnosis, with a rate of 69%. The majority of patients were discharged after 6 hours of postoperative observation. The only complication encountered was seroma, which was seen in two patients. Conclusion Thyroid lobectomy appears to be a safe procedure with a drastic difference in overall cost as a day care procedure. We recommend switching the practice of inpatient thyroid lobectomy to a day care procedure in carefully selected candidates. The major hurdle in day care lobectomy can be approval from insurance.

Christensen insightfully proposed disruptive innovation. The theory is growing stronger but is still haunted by vagueness and post hoc definition issues, which signifies the nature of disruptive innovation may remain unveiled. In order to eliminate the controversies and confusion, this study sorts out commonalities and key driving forces for market encroachment of disruptive innovation, and utilizes the interpretative structural model to reorganize the original theoretical framework based on the principle of “Occam’s razor”. The results show that (1) the value network is the theoretical outset of disruptive innovation and manifests as two different value dimensions at the product or technical level, which endows disruptive innovation with “duality”; (2) the duality makes disruptive innovation have asymmetric advantages and disadvantages compared to existing products or technologies in terms of price and performance; The asymmetry changes enterprises’ competition basis and consumers’ evaluation matrices, which essentially explains the key to market encroachment of disruptive innovation; (3) the duality is the essence that distinguishes disruptive innovation from other types of innovation.

For the past decade, the main problem that has attracted researchers’ attention in aerial robotics is the position estimation or Simultaneous Localization and Mapping (SLAM) of Unmanned Aerial Vehicles (UAVs) where the GPS signal is poor or denied. This article reviews the strengths and weaknesses of existing methods in the field of aerial robotics. There are many different techniques and algorithms that are used to overcome the localization and mapping problem of these UAVs. These techniques and algorithms use different sensors, such as Red Green Blue-Depth (RGB_D), Light Detecting and Ranging (LIDAR), and Ultra-wideband (UWB). The most common technique is used, i.e., probability-based SLAM, which uses two algorithms: Linear Kalman Filter (LKF) and Extended Kalman Filter (EKF). LKF consists of five phases and this algorithm is just used for linear system problems. However, the EKF algorithm is used for non-linear systems. Aerial robots are used to perform many tasks, such as rescue, transportation, search, control, monitoring, and different military operations because of their vast top view. These properties are increasing their demand as compared to human service. In this paper, different techniques for the localization of aerial vehicles are discussed in terms of advantages and disadvantages, practicality and efficiency. This paper enables future researchers to find the suitable SLAM solution based on their problems; either the researcher is dealing with a linear problem or a non-linear problem.

Purpose To deal with the issue of irresponsible consumer behavior, this study aims to find out the significant determinants that direct sustainability in consumers' responsible behavior. Design/methodology/approach The study is quantitatively designed (survey approach) and targeted 520 respondents by deploying multistage sampling technique. The collected data is statistically analyzed in SEM-path analysis technique through Smart PLS 3. Findings The outcomes of study indicated that awareness of wasteful consumption (ß = 0.27, p = 0.00) and wastophobia (ß = 0.73, p = 0.00) strongly influence consumers’ mind to bring sustainability in responsible behavior. Practical implications This study suggests that the empirically tested wastophobia model can pave foundations in the theoretical literature to manage waste other than electricity waste, including time, food, water, agriculture, garbage, hazardous environmental pollution and natural reservoirs waste. Originality/value The study originates that promoting various conscious and unconscious aspects of wasteful consumption by focusing on fearful consequences of electricity waste supports to bring sustainability in consumers’ responsible behavior.

PDF file 76K, Demographic characteristics of Patients

Supplementary Figure Legends - PDF file 90K, supplementary figures legends

Purpose: BIIB021 is the first oral, synthetic, non-geldanamycin–based HSP90 inhibitor that showed activity in preclinical models at low nanomolar concentrations. We performed a phase 1 trial of BIIB021 administered to subjects with advanced solid tumors.Experimental Design: Sixty patients received BIIB021 capsules orally on days 1, 4, 8, 11, 15, and 18 of each course in schedule 1, and on days 1, 4, 8, 11, 15, 18, 22, and 25 of each course in schedule 2. The treatment schedules were repeated every 28 days. In addition to determining the MTD, we evaluated pharmacokinetics of BIIB021 and pharmacodynamic effects of BIIB021 [Hsp70, HER2 extracellular domain (HER2-ECD)].Results: The MTD was 700 mg twice weekly when BIIB021 was dosed for 3 weeks out of each 4-week course. The MTD for continuous dosing regimen was established at 600 mg twice weekly. Gastrointestinal (nausea, vomiting), hot flashes, and neurologic (dizziness) events characterize the safety profile of BIIB021 dosed twice weekly, with events mostly mild or moderate. Plasma exposure to BIIB021 was dose-dependent. Cmax occurred at approximately 90 minutes and t1/2 was approximately 1 hour across dosing cohorts of 25 to 800 mg BIIB021 twice weekly. The biologic activity of BIIB021 was demonstrated in serum, PBMCs, and tumor tissue. Hsp70 levels were increased (>150% from baseline) and serum HER2-ECD was significantly decreased (>15% inhibition from baseline).Conclusions: BIIB021 twice weekly, given with or without the 1 of 4-week rest period was tolerated in subjects with advanced solid tumors at doses that are pharmacodynamically active. Clin Cancer Res; 20(2); 445–55. ©2013 AACR.

CCR Translation for This Article from A Phase 1, Dose-Escalation, Pharmacokinetic and Pharmacodynamic Study of BIIB021 Administered Orally in Patients with Advanced Solid Tumors

PDF file 62K, Clinical Activity Observed with BIIB021 in CLL

PDF files 200K, Supplemental Figure 1: BIIB021 Activity in Solid Tumor; Supplemental Figure 2: Changes in FDG-PET Imaging; Supplemental Figure 3: Clinical Activity Observed with BIIB021 in CLL

Papillary thyroid carcinoma is the most prevalent endocrine malignancy of the head and neck region. It makes up to 80% of all thyroid cancers, and has a 10-year survival rate of up to 95%. Differentiated thyroid carcinomas have good prognosis after a complete surgical extirpation as long as it is not associated with invasion of the surrounding structures. The advanced papillary thyroid carcinoma can invade the neighbouring structures of the thyroid gland, such as strap muscles, recurrent laryngeal nerve, trachea, oesophagus, larynx, pharynx, and carotids. Whenever papillary thyroid carcinoma is associated with invasion of aerodigestive tract it is difficult to excise the tumour. We report a patient with stage IV invasive papillary thyroid carcinomas as per Shin Staging system. The surgery was deferred from several hospitals considering the advanced stage of the disease with tracheal extension making it a problematic airway for both the anaesthesiologist and the operating surgeon. ---Continue

Objective: Our research aims to compare the diagnostic efficacy of transvaginal and transabdominal ultrasonography for detecting adnexal masses. Study Design: A Comparative study Place and Duration: Conducted at Central Park Medical College, Lahore, during from the period August 2021 to January 2022. Methods: This study included 84 women. Once written consent has been obtained, we involve consideration such as aging, gender, menstrual abnormalities (Oligomenorrhea / Menstrual periods), infertility, recurrent multiple miscarriages, series of acts, acne vulgaris, and obesity. The ultrasound data included the location, size, borders, hypoechoic and dilatation of ovary lesions. Group M had 42 patients and underwent for transvaginal ultrasound, whereas group N had transabdominal ultrasound with MRI. Using histological results (positive/negative), frequency of adnexal mass among all cases were compared. SPSS 20.0 analyzed all data. Results: In group M mean parity was 3.5±2.13 and in group N parity was 2.9±4.13. Most common complaint among all cases was infertility and irregular cycle. We found that frequency of adnexal mass in group M was lower than that of group N. It was determined that the specificity, positive predictive value, and negative predictive value of transvaginal sonography were all lower than those of transabdominal sonography. Conclusion: In this study, we came to the conclusion that abdominal ultrasonography combined with MRI was superior in terms of its usefulness and efficacy in identifying adnexal masses with genuine levels of both specificity and sensitivity. Keywords: Accuracy, Transvaginal ultrasonography,Transabdominal ultrasonography, Adnexal Masses, Complications

Objective: Using histology as the gold standard, this study aims to determine whether or not magnetic resonance spectroscopy can reliably diagnose malignant breast lesions. Study Design: Cross-sectional Place and Duration: Conducted at department of Radiology Central Park Medical College, Lahore. Duration was 6 months from October 2021 to March 2022. Methods: This research included 75 females. Malignancy-suspicious palpable lesions were included. Patients completed a consent form admitting the hazards before any data was gathered. The kinematics and morphology of dynamically enhanced magnetic resonance (MRS) images were studied. MRS's choline peak (Cho) was utilized to detect cancer. Single-voxel technique was employed to evaluate MRS' diagnostic accuracy in cancer. MRS and biopsies were compared. Data was analyzed using SPSS 24.0. Results: Malignant lesions were found in 65 (86.7%) of the patients by MRS, and in 58 (77.3%) of the cases according to the histological findings. Malignant lesions by MRS most frequently showed a ductal enhancement or a peripheral enhancement morphology. The results of MRS showed a 78% specificity, 85% accuracy, 90% sensitivity, 75% NPV, and 91% PPV. Conclusion: MRS must be employed because of its better specificity, sensitivity, and accuracy in characterizing breast lumps. MRS is a specific, sensitive, and effective diagnostic technique for breast cancer. Keywords: Accuracy, Magnetic resonance spectroscopy (MRS), Malignant breast lesion, Histopathology

Coronavirus disease 2019 (COVID-19) has emerged as an unforeseen challenge for head and neck cancer care providers. A similar challenge is also faced by other oncological fields, but the severity of this challenge is highest in otolaryngology because of the need for additional precautionary measures and curbs on the possibility of aerosol forming interventions related to the upper aerodigestive tract. In this narrative review, provision of ethical and consistent care on moral and professional grounds to head and neck cancer patients during the pandemic are discussed for professionals who provide head and neck oncology care.

The environmental Kuznets curve (EKC) explains the dynamics associated with income and environmental quality. This study utilizes bibliometric analysis and data visualization techniques and empirically determines the tendencies and patterns in the EKC literature. Furthermore, the study explains intellectual structure, construct development, evolution, collaborations, and research clusters within the EKC research domain during the last two decades, from 2000 to 2020. The study empirically analyzes 2,218 articles and 55,051 references from 328 journals, 4,146 authors, 99 countries, and 50 subject categories. The study used co-citation analysis to examined the noticeable research articles, journals and authors’ contribution. Moreover, the co-occurrence analysis examined the prominent countries, institutions and keywords in the concerned literature. Most studies in EKC domain focus on developing regions facing the dual challenge of growth and environmental sustainability. The current initiative categorizes the EKC knowledge domain into major research areas with the help of different clusters namely causality analysis, non-renewable energy, energy consumption, the EKC, and industrial pollution. The study further discusses emerging trends that provide future research fronts and intellectual development within the EKC framework.

Objective: To depict and characterize CT patterns of omental pathology and to determine the validity of omental caking in diagnosis of ovarian cancer. Methodology: A cross-sectional study was conducted in a tertiary care center between January 2020 to February 2021. In this study, 64 consecutive female patients with omental pathology, scheduled for biopsy, surgery and follow up were included. All CT scans were reviewed and findings were discussed with the consultant radiologists. The results were compared and confirmed on histopathology by either open surgical biopsy or per-cutaneous needle biopsy. Result: A total of 64 patients were enrolled in the study. Omental caking on computed tomography was identified in 44 (68.8%) patients. Presence of Omental caking was significantly associated with ovarian cancer (p

Climate change holds stern environmental implications. The devastating consequences includes, severe floods, droughts, acid rain, heat waves, ozone depletion high temperature are disrupting the economic stability of Pakistan. To minimize stern environmental deterioration, government has spent a huge investment on “clean green Pakistan” Project but the results are still unsatisfactory and acquires researchers’ dire intention to study Pakistani consumers preference for environment friendly products. Thus, the objective of the study is to investigate the critical factors influencing consumer preferences to buy green products. A quantitatively designed survey approach was considered to examining the theoretically grounded hypotheses of the study. The five point Likert scale questionnaire, consisted upon 30-item was deployed by focusing on convenience sampling method. The data were gathered from 203 targeted respondents in Abbottabad, Pakistan. To statistically examining the collected data we deployed correlation and one to one simple regression method in SPSS. The findings of the study witne­­ssed that consumer’s holds information about green product, quality, price and also intention for environment protection from degradation. Results indicated a weakly significant positive relationship among consumer preference and green price. Consumers are well exposed to green products but resisting to purchase due to higher prices in Pakistan. Thus, study recommends that, concerned authorities including; Government and multinational corporations should try to take proper initiatives by providing subsidy in prices. So customers can conveniently buy/use green products to bring sustainability in environmental degradation.

Objective: To compare the efficacy of steroid antibiotic wick with Ichthammol Glycerol wick in the management of Acute Otitis Externa in terms of tenderness and clearance of discharge/debris. Study Design: Quasi-experimental study. Place and Duration of Study: ENT Out Patient department of Combined Military Hospital Peshawar and Hayatabad Medical Complex Peshawar, from May to Nov 2018. Methodology: A total of 250 patients were included and divided into two groups of 125 each. After necessary suction clearance topical Ciprofloxacin/Dexamethasone (Cipotec-D) wick was placed in auditory canal of group A patients and topical Glycerol/Ichthammol wick was placed in group B. Follow up visits were done on 3rd and 7th day of starting the treatment. Results: Group A patients responded better in terms of tenderness (88%) however both groups had similar response in terms of discharge reduction (7.2% vs 6.4%). In terms of efficacy neither of the treatment proved more efficacious compared to the other (p-value 0.058). Conclusion: While steroid antibiotic wick is significantly more efficient in terms reducing tenderness, in terms of overall efficacy and discharge reduction Ichthammol/glycerol is equally effective.

The present study is a controversy on the three fundamental growth determinants. It contributes to the literature by divulging the effects of foreign direct investment and financial development on energy consumption in Central and Eastern European countries from 1990 to 2016. In doing so, second-generation multi-econometric methodological methods are adopted to conclude this study. The Pooled Means Group (PMG) estimation approach confirms that foreign direct investment is adversely associated with energy consumption. A one-point rise in FDI in the CEE region reduces energy consumption by 0.0172 points in the long run. Congruently, the globalization index also mitigates energy consumption. Conversely, financial development and economic growth stimulate energy consumption in the CEE region. Energy consumption boosts by 0.0626 points when a one-point escalation in financial development occurs. The U-shaped link between energy consumption and economic growth is revealed. The country-wise results show that energy consumption rises due to financial development and FDI in nine countries and one country. However, reduction in energy consumption occurs due to an upsurge of financial development in seven and FDI in six countries. Moreover, the causality results suggest that energy consumption causes financial development, and FDI. The policy suggestions are included to mitigate unsustainable energy consumption and renovate the energy policy in this region.

PurposeThe purpose of this study is to examine whether companies with high audit quality (AQ) are expected to use trade credit (TC) as a financing source. Traditionally, vendors are most likely to extend TC to creditworthy customers.Design/methodology/approachThe author uses the data from 134,099 firm-year observations of nine Asian emerging markets from 2001 to 2017. Further, to check the impact of AQ on trade credit, the authors employ ordinary least square (OLS) with fixed effects, cluster effect regression and random effect.FindingsThe findings indicate that vendors extend more TC to the companies audited by the BIG4 auditors as, these independent practitioners have greater competencies, expert intellectual capital, global networking connections, and high investment in information technology. The authors, therefore, conjecture that the company's use of TC increases with their improved AQ, especially audited by BIG4. The results are found consistent with this prediction and robust to the alternative measures of trade credit. Similarly, this positive association is more pronounced with the BIG4 partner's unqualified audit opinion.Research limitations/implicationsThis study uses the sample of Asian Emerging countries but the researchers cannot generalize the results to developed countries or other regions.Practical implicationsThis paper's findings have significant implications for the management, board of directors, shareholders and suppliers. Further, results are in favor of appointing BIG4 auditors to gain the trust of suppliers.Originality/valueDespite the wide-ranging literature that discusses the importance of quality audits in enhancing the firms' financial disclosures that leads to better access to finance through investors and lenders. But the TC as a financing source is ignored in relation to AQ. The study’s results extend the literature associating companies' AQ with financial decisions.

Objectives: To compare medical student’s knowledge about breast feeding practices at the induction and exit from medical college. Study design: Comparative study Place and duration of study: Department of Pediatrics, University College of Medicine & Dentistry, The University of Lahore. Study was conducted from January 2019 to December 2019. Material and method: Total 200 students were enrolled, 100 from first year and 100 from final year class. Ethical approval was taken from ethical review committee data was collected on hand filled questionnaire. Results: There were 39.5% males and 60.5% female students. The ANOVA test of the variance was applied to compare the knowledge of first year and final year students. Final year students have a good knowledge regarding timing of initiation and pattern of breastfeeding whereas knowledge regarding advice of pre-lacteal, continuation of breastfeeding up to 6 months and frequency of complementary feeding for initial days was lacking in both first year and final year MBBS students. Conclusion: This study concludes that our curriculum has incorporated adequate knowledge regarding benefits of breast feeding, but the students lack practical knowledge and skills of counseling the parents about avoiding pre-lacteal feeds and promoting complementary feeding, that is also essential for child growth and development. Keywords: Medical college, Curriculum, Exclusive Breast feeding (EBF), complementary feeding.

The rapid development of social technology has replaced physical interaction in the trading market. The implication of this technology is to provide access to the right information at the right time. The drawback of these technologies is that the eaves dropper can remove the user from the network and can create proxy participants. In this paper, we discuss how a social network overcome and prevent these data trading issues. To maintain the security of data trading, we applied ABE technique based on DBDH to secure data trading network. Our proposed τ-access policy scheme provides the best solution for the betterment of data trading network in terms of security. In τ-access policy scheme, the users can encrypt and decrypt Private Transactions Information (PTI) using our proposed τ-access policy. The security propertiesof τ-access policy are data confidentiality, data integrity, authenticity, non-repudiation, and unforgeability. The efficiency of our scheme is 77.73%, which is more suitable for data trading markets and trading strategies.