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Background: Pandemic of COVID-19 has gathered up the surrounding respiratory diseases such as asthma. The need to combat asthma is an unanswerable question nowadays and about 20-30% of people are getting into the trap of asthma. Objectives: The mechanistic involvement of GPCR receptors in the protuberant signaling pathway such as Neuropeptide S receptor 1 (NPSR1 receptor) acts as a projected entry that needs to be inhibited for the prohibition of asthma. Methods: Exaggerative G-proteins of NPSR1 receptors are exposed as a target through GPCR modeling to point drug targeting. Three Drug-Drug Conjugates (DDCs) are designed through the combination of nine chemical compounds through methylene bridges and selection was done based on docking energy and ADMET profiling. Designation of three Monoclonal Antibody Conjugates (MACs) is expedited using single monoclonal antibodies, linked through EAAAK linkers and the best conjugate was valued based on docking energy, allergenicity, toxicity, and surface accessibility leading towards cloning and expression. Results: The best Drug-Drug Conjugate was Fluoroquinolone and 1-Indanone conjugate which possessed -7.7 Kcal/mol docking energy, lipophilicity 6.41, water solubility 1.19e-09 mg/ml, and pharmacokinetics -8.31 cm/s, indicating it to act as best drug candidate. The best Monoclonal Antibody Conjugate was Ustekinumab and Belimumab conjugate which retained -383.1 Kcal/mol docking energy, computed as non-allergen and nontoxic. Conclusion:: The use of MACs and DDCs may prove an effective treatment for lethal diseases like asthma and the future exertion will support the in vitro synthesis delivered in this study of conjugation against bronchial diseases.

Fabry disease is an X-linked lysosomal storage disorder caused by reduced activity or absence of the alpha-galactosidase A enzyme resulting in systemic accumulation of glycosphingolipids. End-stage renal disease (ESRD) is a late-stage manifestation of Fabry disease, typically presenting in the fifth decade of life, but is very rare in childhood. Here we present a case of an 11-year-old boy with classical Fabry disease presenting with ESRD requiring haemodialysis and transplant. Diagnosis was confirmed by renal biopsy, GLA mutation and low alpha-galactosidase A levels. He has an unusual genotype, hemizygous for the c.1000–11T>A intronic variant and positive for the pseudodeficiency allele D313Y. Due to the possibility of very early and accelerated disease progression, Fabry disease should be considered as a possible diagnosis in unexplained renal failure in males from a younger age.

A woman in her late teens with a history of Juvenile idiopathic arthritis (JIA) and ongoing sicca symptoms presented with syncope. Upon admission, she was found to be bradycardic with a second-degree atrioventricular (AV) block. After infectious, structural and metabolic aetiologies had been ruled out, she was worked up for rheumatologic causes.Our patient had elevated titres of anti-Sjogren syndrome (SS) antibodies anti-Ro antibodies and was diagnosed with AV block secondary to SS. She was treated with a permanent pacemaker. Patient was followed up in clinic where she denied further syncopal episodes and was started on secretagogues for sicca symptoms.

Linearized modes of oscillation in terahertz range and weakly dissipating electrostatic solitary pulses are studied in semiconductor plasmas in the framework of quantum hydrodynamics. Many-particle effect is expressed in the local density approximation with the help of exchange-correlation potential and the species space charge effect is included through Poisson’s equation. Using reductive perturbation technique, damped Korteweg de-Vries equations is derived with a linear damping term arising due to electron (hole)–phonon collisions. Time evolution of solitary acoustic pulses is presented analytically and numerically. Typical values corresponding to GaAs, GaSb, InP and GaN semiconductors are used for parametric analysis and pulse profile with collision-induced dissipation and quantum effects of statistical pressure, Bohm potential and exchange-correlation potential. The pulses are stable and can withstand perturbations for a considerable time before damping.

Dantzig-Wolfe decomposition (DWD) is a classical algorithm for solving large-scale linear programs whose constraint matrix involves a set of independent blocks coupled with a set of linking rows. The algorithm decomposes such a model into a master problem and a set of independent subproblems that can be solved in a distributed manner. In a typical implementation, the master problem is solved centrally. In certain settings, solving the master problem centrally is undesirable or infeasible, such as in the case of decentralized storage of data, or when independent agents who are responsible for the subproblems desire privacy of information. In this paper, we propose a fully distributed DWD algorithm which relies on solving the master problem using a consensus-based Alternating Direction Method of Multipliers (ADMM) method. We derive error bounds on the optimality gap and feasibility violation of the proposed approach. We provide preliminary computational results for our algorithm using a Message Passing Interface (MPI) implementation on cutting stock instances from the literature and synthetic instances where we obtain high quality solutions., Comment: Corrected typos; added references; added a new set of experiments and a new application

Background: Black Cumin/Nigella sativa (NS) which belongs to the botanical family of Ranunculaceae commonly grows in Eastern Europe, the Middle East, and Western Asia. Its prolonged use can produce physiological changes with or without affecting the architecture of different organs like the heart (cardiac remodeling). The data for the cardiovascular benefits of black cumin are not well-established scientifically. Objectives: To determine the direct cardiovascular effects of Nigella Sativa extract on heart rate, cardiac contractility (apical force), ECG, and coronary flow in the normal heart with and without cardiac remodeling. Methods: This experimental study was conducted on forty-two (42) rabbits. These rabbits were divided into seven groups, each comprising six animals (Group I-VI without cardiac remodeling and Group VII with cardiac remodeling). NS was given to these groups in different doses i.e., Group I (NS=10ug), Group II (NS=30ug), Group III (NS=100ug), Group IV (NS=300ug), Group V (NS=3000ug), Group VI (NS=10000ug) and VII (NS=300ug). Radnoti's working heart system was used to determine the effects of NS on heart rate, cardiac contractility (apical Force), ECG, and coronary flow in a normal heart with and without cardiac remodeling. The results were analyzed using SPSS version 28. Results: Results of this study revealed negative chronotropic and positive inotropic effects without ECG changes in the normal heart and with ECG changes in the remodeled heart. Conclusions: Prolonged use of Nigella sativa can lead to disturbed ECG by affecting the conducting tissue.

Objectives: To screen new-borns to diagnose any hearing impairment early. Method: The prospective, cross-sectional study was conducted at the Department of Otorhinolaryngology, Head and Neck Surgery Liaquat National Hospital, Karachi, from November 1, 2020, to April 30, 2021, and new-borns of either gender aged >12h born via spontaneous vaginal delivery, induced labour, and Caesarean section. A predesigned questionnaire was used to collect detailed case history, including gestational age, duration of labour, and other prenatal, natal, and postnatal risk factors. Otoacoustic emission test was performed, and infants referred twice were scheduled for complete diagnostic evaluation and brainstem evoked response audiometry. Data was analysed using SPSS 23. Results: Of the 267 neonates, 249(93.3%) passed the first screening. Of the remaining 18(6.7%) neonates, 8(44.4%) passed the second screening, while 10(55.5%) were asked to come for a follow-up after three weeks. Of them, 3(30%) returned for check-up, while 7(70%) did not show up. Conclusion: Neonatal risk factors associated with hearing loss need to be identified, and a comprehensive hearing screening programme is required for neonates. Key Words: Hearing, Otoacoustic emission, High risk, Neonatal screening.

This study investigates the impact of oil price variations, exchange rates, macroeconomic factors and domestic stock volatility in South Asian countries. This study employs a general autoregressive heteroskedastic (GARCH) model using quarterly data from 2001 to 2021. The results reveal that there is a significant relationship between the domestic stock of credit and macroeconomic factors. We find surprising results for the set of the countries; there is a negative impact of asset portfolio investment in the domestic stock for Afghanistan, Bangladesh, India and Pakistan and a positive effect for the remaining countries. There is a positive impact on the economic growth in the majority of countries with the exception of Afghanistan and Bangladesh. Inflation seems to increase while there is an increase in the credit in the economy except for Bangladesh, Bhutan and Nepal. Exchange rate has a negative impact on the domestic stock except for India and Nepal. Further, there is a positive effect on the interest rate spread in Bangladesh, India and Pakistan. Finally, oil prices have a significant impact on exchange rates within the countries’ investments.

COVID-19 has overwhelmed health services globally. Oral antiviral therapies are licensed worldwide, but indications and efficacy rates vary. We aimed to evaluate the safety and efficacy of oral favipiravir in patients hospitalised with COVID-19.We conducted a multicentre, open-label, randomised controlled trial of oral favipiravir in adult patients who were newly admitted to hospital with proven or suspected COVID-19 across five sites in the UK (n=2), Brazil (n=2) and Mexico (n=1). Using a permuted block design, eligible and consenting participants were randomly assigned (1:1) to receive oral favipiravir (1800 mg twice daily for 1 day; 800 mg twice daily for 9 days) plus standard care, or standard care alone. All caregivers and patients were aware of allocation and those analysing data were aware of the treatment groups. The prespecified primary outcome was the time from randomisation to recovery, censored at 28 days, which was assessed using an intention-to-treat approach. Post-hoc analyses were used to assess the efficacy of favipiravir in patients aged younger than 60 years, and in patients aged 60 years and older. The trial was registered with clinicaltrials.gov, NCT04373733.Between May 5, 2020 and May 26, 2021, we assessed 503 patients for eligibility, of whom 499 were randomly assigned to favipiravir and standard care (n=251) or standard care alone (n=248). There was no significant difference between those who received favipiravir and standard care, relative to those who received standard care alone in time to recovery in the overall study population (hazard ratio [HR] 1·06 [95% CI 0·89-1·27]; n=499; p=0·52). Post-hoc analyses showed a faster rate of recovery in patients younger than 60 years who received favipiravir and standard care versus those who had standard care alone (HR 1·35 [1·06-1·72]; n=247; p=0·01). 36 serious adverse events were observed in 27 (11%) of 251 patients administered favipiravir and standard care, and 33 events were observed in 27 (11%) of 248 patients receiving standard care alone, with infectious, respiratory, and cardiovascular events being the most numerous. There was no significant between-group difference in serious adverse events per patient (p=0·87).Favipiravir does not improve clinical outcomes in all patients admitted to hospital with COVID-19, however, patients younger than 60 years might have a beneficial clinical response. The indiscriminate use of favipiravir globally should be cautioned, and further high-quality studies of antiviral agents, and their potential treatment combinations, are warranted in COVID-19.LifeArc and CW+.

Background: Patient/client management is comprehensive multidirectional process. It includes patient client examination, evaluation, diagnosis, prognosis, intervention and then discharge plans from supervised treatment to follow ups. The process of examination includes comprehensive history taking, performing systemic review and special tests and measures. Aim: To investigate Pakistani physiotherapists’ current practice, skills and understanding of evidence-based practice in order to improve the utilization of the evidence base in physiotherapy in the country. Methods: This observational cross section study was done in Pakistan Institute of Medical Sciences and Islamabad Medical and Dental College, Islamabad between January 2021 and March 2021. Physiotherapists(n=369) were contacted through non-probability convenience sampling technique. Respondents were contacted at clinical facilities in the twin cities of Pakistan. The content of the questionnaire was validated using the literature and the method of Lynn MR et al. The results were extracted, conclusion was drawn, suggestions and recommendations were made. Results: The participants mean age was 27.58±7.41 years. The male/female ratio was almost same. Approximately half of the respondents 50.4% were agreed about the role of EBP in practice.57% respondents were agreed that EBP removes the art from clinical practice. 58.5% respondents were agreed about benefit of EBP and EBP improves clinical outcomes and 53.4%respondents were agreed about help of EBP in decision making. Attitude and knowledge need analysis was positive but there found compromise in utilization of this evidence-based practice, while this study showed more utilization. Conclusion: Five steps of evidence-based practice were found being infrequently practiced. Physiotherapists had good to fair understanding of evidence-based practice. Physiotherapists had fair to poor appraisal skills. Keywords: Clinician practice; Data base; Evidence-based practice; Physical therapist; Practice guideline; Patient management.

Nonconventional protein isolates were prepared from defatted oilseeds (sesame, flaxseed, and canola). Bioevaluation was performed via growth study parameters i.e., protein efficiency ratio (PER), net protein ratio (NPR), and relative net protein ratio (RNPR). The highest values for these parameters were recorded in sesame protein isolates (SPIs) followed by canola protein isolates (CPIs) and flaxseed protein isolates (FPIs). Nitrogen balance study parameters represented maximum true digestibility (TD) in SPI trailed by FPI and CPI. However, biological value (BV) was found higher in FPI. Similarly, the highest value for net protein utilization (NPU) was noticed in FPI tracked by SPI and CPI. Moreover, safety assessment of protein isolates was also performed including serum protein and kidney and liver function tests. All these parameters showed nonsignificant variations among the tested protein isolates. The outcomes of research explicated that these protein isolates can play a pivotal role to increase the protein level of individuals.

This study was carried out to examine the prevalence of AFM1 contamination across different areas of Chattogram, Bangladesh, and to assess the level of AFM1 in raw milk samples from various dairy farms. A cross-sectional study was conducted to assess the farming standards of three different Chattogram neighborhoods—Bakalia, Khulshi, and Pahartali—and to ascertain the amount of AFM1 in milk. In the study location, 30 commercial dairy farms were randomly chosen, and data on farming methods, milk production techniques, and knowledge of aflatoxin contamination were gathered. Using the enzyme-linked immunosorbent assay (ELISA) method, collected milk samples (n = 90) were examined for the presence of AFM1. The farms produced 71.67±14.71 liters of milk on average every day, which was primarily supplied to dairy processing plants. For feeding the cows, all farms used concentrates and forage. The mean concentration of AFM1 in milk samples collected from Bakalia was higher (190.00±120.87 ng/L) than that in milk samples collected from the Khulshi (108.44±66.19 ng/L) and Pahartali (189.25±160.78 ng/L). The overall prevalence of AFM1 was 43% (N=39) of the total examined samples. A total of 69% (N=27) and 5% (N=2) of AFM1 positive samples exceeded the European Union Regulation (50 ng/L) and BSTI/BFSA regulations (500 ng/L) respectively. There was a significant difference in the occurrence of AFM1 in Bakalia regarding Khulshi and Pahartali. This research will aid in measuring the AFM1 content in raw milk and helping to address public health issues.

We showed in past work that nanopatterned monolayer graphene (NPG) enables spectrally selective thermal emission in the mid-infrared (mid-IR) from 3 to 12 $\mu$m. In that case the spectral selection is realized by means of the localized surface plasmon (LSP) resonances inside graphene. Here we show that graphene decorated with metallic nanoparticles, such as Ag nanocubes or nanospheres, also realize spectrally selective thermal emission, but in this case by means of acoustic graphene plasmons (AGPs) localized between graphene and the Ag nanoparticle inside a dielectric material. Our finite-difference time domain (FDTD) calculations show that the spectrally selective thermal radiation emission can be tuned by means of a gate voltage into two different wavelength regimes, namely the atmospherically opaque regime between $\lambda=5$ $\mu$m and $\lambda=8$ $\mu$m or the atmospherically transparent regime between $\lambda=8$ $\mu$m and $\lambda=12$ $\mu$m. This allows for electric switching between radiative heat trapping mode for the fomer regime and radiative cooling mode for the latter regime. Our theoretical results can be used to develop graphene-based thermal management systems for smart fabrics., Comment: 20 pages, 7 figures

Attendance management is a critical task in various organizations, including educational institutions, offices, and businesses. Traditional methods of attendance tracking, such as manual roll call or using physical time clocks, are often time-consuming. Our research paper presents a comprehensive study on an automated face recognition attendance system, proposing a novel approach that leverages deep learning-based face recognition techniques. Our system shows promising results in terms of accuracy, efficiency, and security, and has the potential to revolutionize attendance management in various organizations. Further research and development in this area can lead to widespread adoption of face recognition attendance systems, benefiting organisations and user alike.

In some situations, the population of interest differs significantly in size, for example, in a medical study, the number of patients having a specific disease and the size of health units may vary. Similarly, in a survey related to the income of a household, the household may have a different number of siblings, and then in such situations, we use probability proportional to size sampling. In this article, we have proposed an improved class of estimators for the estimation of population mean on the basis of probability proportional to size (PPS) sampling, using two auxiliary variables. The mathematical expressions of the bias and mean square error (MSE) are derived up to the first order of approximation. Four real datasets and a simulation study are conducted to assess the efficiency of the improved class of estimators. It is found from the real datasets and a simulation study, that the proposed generalized class of estimators produced better results in terms of minimum MSE and higher PRE, as related to other considered estimators. An empirical study is given to support the theoretical results. The theoretical study also demonstrates that the proposed generalized class of estimators outperforms the existing estimators.

This present work uses the three main components for alloying, silver nitrate, aluminium nitride, and titanium diboride. Stir casting was used to make AA 6061 composites with varying weights of 0, 3, 6, 9, and 12%. Microhardness, tensile strength, and compressive strength of produced composites were evaluated. Several wear tests were performed on the composites to measure their resistance to abrasion and erosion. The mass loss was calculated because of wear testing. Conventional and unconventional methods like the Taguchi technique and analysis of variance were employed to study and analyze the abrasive and erosion wear test outcomes to obtain better wear resistance for different weight % of AA 6061 compounds and to investigate the most important input and output characteristics employing the said optimal strategies. Reinforcement percentages were raised to improve mechanical quality.

Objectives: The objective of the current study was to determine the frequency of anxiety and depression among patients diagnosed with acute coronary syndrome (ACS) at a tertiary care cardiac center in Pakistan. Methodology: This cross-sectional study was conducted at a tertiary care cardiac center in Pakistan from May to November 2019. We included patients of either gender, between 30 and 70 years of age, diagnosed with ACS, and presented within 72 hours of onset of symptoms. After the standard treatment of the condition, the Beck Depression Inventory Scale (BDI) and Beck Anxiety Inventory (BAI) were used to assess post-AMI depression and anxiety. The BDI ≥17 was categorized as depression and BAI ≥11 was taken as anxiety. Results: In the selected sample of 122 patients, the mean age was 58.7 ± 10.2 years and 88 (72.1%) patients were male. Diabetes mellitus was detected in 76 (62.3%) patients and 64 (52.5%) patients were smokers. The mean BDI score was 28.6 ± 6.5 and mean BAI score was 19.5 ± 5.1. Anxiety and depression were observed in 36 (29.5%) and 51 (41.8%) patients, respectively. Conclusion: Depression and anxiety are a common remnants of ACS, hence, in our day to day clinical practice, appropriate consideration should be given to the psychological wellbeing of patients in addition to the management of ACS.

Objectives: We investigated the correlation between baseline C-reactive protein (Hs-CRP) levels and severity of coronary artery disease (CAD), measured in terms of Syntax Score (SScore), among patients presenting with acute coronary syndromes (ACS). Methodology: This cross-sectional study was conducted at the Armed Forces Institute of Cardiology (AFIC), Rawalpindi, from April 2022 to October 2022. Baseline Hs-CRP levels were obtained for all the patients. Patients were divided into three groups as per the SScore as low (≤ 22), intermediate (≥ 23), and high (≥ 33) burden of CAD. Results: Out of the 200 patients studied, 82.5% (165) were males, and mean age was 60.16±10.66 years. Diabetics were 50% (100) of the sample, 48.5% (97) were hypertensive, and smokers were 17.5% (35). Median Hs-CRP was 4.0 mg/L [2.0-12.5 mg/L], and median left ventricular ejection fraction (LVEF) was 45% [40-55%]. Median SScore was 23.5 [14.5-30.0], with 44.5% (89) categorized as low, 36.5% (73) as intermediate, and 19% (38) as high burden of CAD. The correlation between Hs-CRP and SScore was 0.236 (p=0.001) and -0.229 (p=0.001) with LVEF. A significant increase in Hs-CRP was observed in relation to the burden of CAD (p

Examining how ESD affects students' pro-environmental attitudes and actions is the primary goal of this research. Two hundred children were chosen at random from a variety of schools for the study. Students' pro-environmental attitudes and actions were measured before and after the ESD intervention. The study found that ESD significantly increased the number of pupils who displayed pro- environmental attitudes and practices. The results reveal that students who received ESD were more likely to recycle, take public transportation, and reduce their energy consumption. The study also found that ESD greatly increased students' favorable environmental attitudes through increasing their knowledge and comprehension of environmental issues. The study concludes that ESD should be used in schools to encourage students to adopt more environmentally friendly lifestyles.

Background Clostridium perfringens, the causative agent of necrotic enteritis (NE) in chickens, has an enormous economic impact on global broiler production. The non-medically important antibiotic avilamycin was approved in Canada in 2014 to prevent and control NE in broiler chickens. Objectives To compare avilamycin susceptibility in C. perfringens isolates collected pre- and 7 years post-avilamycin approval in Canada and determine the avilamycin resistance mutation frequency rate in C. perfringens. Methods The MICs of avilamycin were determined for 89 strains of C. perfringens recovered from clinically relevant NE field cases pre-avilamycin approval between 2003 and 2013 (n = 50) and post-avilamycin approval between 2014 and 2021 (n = 39) across Canada. For determining the mutant prevention concentration (MPC) of avilamycin for C. perfringens strains, a strain with avilamycin MIC of 1 mg/L was randomly selected. Results MIC studies showed no difference in avilamycin susceptibility in pre-avilamycin and post-avilamycin isolates (MIC50/90: pre-avilamycin approval 2/2 mg/L and post-avilamycin approval 1/2 mg/L). The MPC was 8 × MIC (8 mg/L) for the selected strain. Conclusions These findings suggest that the susceptibility of C. perfringens strains to avilamycin was not impacted by its continued use in the 7 years following its approval in Canada. Avilamycin, a non-medically important antibiotic, poses no threat to human health regarding cross-resistance or co-selection of other medically important antibiotics. These factors make avilamycin an appropriate choice for continued use in broiler chickens to prevent and control NE without increased antimicrobial resistance concerns.

This study explores the resilience of women, their alienation (spiritual or physical detachment from others), and the use of female bonding as a tool of resilience in Toni Morrison's Paradise and Khaled Hosseini's A Thousand Splendid Suns. The theoretical framework includes the Alienation Theory by Charles Reitz (2000), the Resilience Theory by Luthans et al. (2006) and the concept of Female Friendship by Elizabeth Abel (1981). The wearisome experience of the women in both of these novels is such a situation that they form mutual connections to compensate for the loss of mother/father love, face harsh social circumstances, and fight against the challenges created by gender differences. Female friendship becomes a powerful tool that helps women in combatting patriarchal oppression and a weapon of struggle to be free from societal pressures which give them a sense that they are objects. Toni Morrison's Paradise, by portraying the failure of women's relationships, exposes the ubiquitous power of patriarchy and relevant challenges. Even then, there is a spiritual kind of optimism that the death of women is in fact a future prediction of women's freedom from patriarchy. Similarly, Khaled Hosseini ends A Thousand Splendid Suns on an optimistic note that a woman builds a home for abandoned and deserted women. Thus the women show resilience in hard times by making mutual bonds and then struggling for liberation. It signifies that both of these writers have affiliations with feministic ideals of women's liberation. This study lays the foundation for further research in resilience studies in combination with alienation and female friendship in these novelists.

The most significant natural hazard, flooding brings about incredible distress for a massive inhabitants and property failure. The existing research examines the determination of the Impact of flood women physical health in 2022 at District Rajanpur. Due to socio-biological restrictions and their association in domestic chores, women are more at risk to natural disasters than men are. Women have diverse health and hygiene difficulties than males do, and even within women, these issues vary depending on a person's age and physical situation. In extremely tragedy liable upward country like Pakistan, many folks practice a superior rate of natural tragedy with disturbing health effect. To learn the outline of women’s exposure for the period of flood in the context of their physical condition and cleanliness. To study the impact of flood on the health of different sort of women (age categories, pregnant women, lactating women, elderly women). To study how women, hold with such problems of flood, study is conducted on major data that was assembling via survey. The conclusion is then examined and thoroughly drained. With particular reference to health problems and diseases, sanitation, cleanliness, and other factors, the data revealed the objectionable and deplorable situations of the women of diverse age groups.

Background: The main objective of this study was to ascertain the proportion of individuals diagnosed with acute appendicitis who exhibited clinically and preoperatively normal levels of total leukocyte count. Methodology: During the months of June 2021 and March 2022, researchers from the Department of Surgery at Jinnah Postgraduate Medical Center in Karachi, Pakistan, conducted a prospective observational study. All the patients presented with an impression of acute appendicitis above the age of twelve were included. Complete history, clinical examination, emergency investigations including CBC, UCEs, Ultrasound, X-Rays, Alvarado score were recorded in a predefined pro forma. Patients with low ALVARADO score and normal TLC with signs and symptoms of acute appendicitis were compared with CRP levels which directed the decision of appendectomy rather than conservative management. Per operative findings of stages of acute appendicitis such as acute inflamed, suppurative, gangrenous and perforated appendix were also noted. Appendix was sent to the laboratory and histopathological reports of the specimen were assessed. Results: Patients diagnosed with acute appendicitis and subsequently operated on totaled 270 in the study, 156 (57.78%) were having and ALVARADO score of less than 7 mostly due to normal TLC, while 114 patients (42.22%) were having ≥ 7 ALVARADO score. Preoperatively and histopathological reports of 270 patients of appendicitis 25% patents were acutely inflamed/catarrhal stage , 15.5% gangrenous, 20.59% perforated, while higher number of patients i.e. 38.91 were suppurative appendicitis. Conclusion: Most patients presenting with symptoms of acute appendicitis have normal TLC, meaning low TLC. This needs to be confirmed by caring out by proper examinations and getting inflammatory markers or in cases confirmatory CT if diagnosis can not be made clinically or by lab investigations. Keywords: Appendicitis, ALVARADO score, C-reactive protein, total leukocyte count

This study extensively evaluated brand image and main purpose was to find out in what way Brand Engagement will moderate the influence of Brand Image on Brand Loyalty to determine customers’ purchase intention. Current research utilized the survey method for data collection. To study the relationships between variables, the selected industry was famous female apparel brands of Pakistan, in different cities such as Lahore, Islamabad, Sialkot and Multan. The current research used questionnaire as the research instrument to interact with the sampling population. Only females were targeted to get data. Non probability sampling techniques was utilized in the study that included convenience and snowball sampling. Sample size was 300. Current research showed that brand image possesses substantial positive effect on brand loyalty and all antecedents of brand image were positively affecting the brand image. Moreover, brand loyalty has also been established to have significant positive impact on purchase intention. Brand engagement showed insignificant negative result as a moderator between brand image and brand loyalty showing that customers are not emotionally committed to the brand of their choice instead they are just becoming loyal due to other reasons. The evaluation of Brand Image has been done by incorporating many unique antecedents and the relationship of these antecedents was checked with brand image to imply better appreciation of brand image. Furthermore moderating effect of brand engagement among brand image and brand loyalty was unknown in past researches. The contribution of this research is theoretical, practical as well as contextual since we have conducted this study on a matchless framework regarding the female apparel brands in Pakistan.

This study delves into the use of English Diction in modern Urdu poetry and its impact on the stylistic context. The research focuses on selected poets and their incorporation of English words and phrases into their Urdu poetry. The study aims to understand how this inclusion affects the literary style and meaning of the poetry. It also explores the sociolinguistic implications of this phenomenon on the Urdu language and the relationship between the poets and their audience. This article aims to explore the stylistic implications of this trend through a stylistic analysis of the selected Urdu poets: Asad Muhammad Khan, Iftikhar Jalib, Salim-ul-Rehman, Akhtar Usman, Azra Abbas, Afzal Ahmed Syed, Zahra Nagah, Parveen Shakir, Zee Shan Sahil, Naseer Ahmad Nasir, Ali Muhammad Farshi, Waheed Ahmad, Rawish Nadeem and Arshad Meraj. The influence of English on Urdu can be seen as a reflection of the increasing globalization and Westernization of Pakistani society. The poets included in this study represent different generations and come from different parts of Pakistan, but they all share a common experience of growing up in a society that is increasingly exposed to English. The stylistic implications of the use of English Diction in Urdu poetry are varied and complex. On one hand, it can be seen as a way of enriching the poetic language, bringing new nuances and connotations to the Urdu lexicon.

Polyoxometalates (POMs) featuring 7, 12, 18, or more, redox-accessible transition-metal ions are ubiquitous as selective catalysts, electrocatalysts, and sensitized photocatalysts, especially for oxidation reactions. The corresponding synthetic and catalytic chemistry of stable, discrete, and capping-ligand-free polythiometalates (PTMs), which could be especially attractive for reduction reactions, is much less well developed. Among the challenges is the propensity of PTMs to agglomerate and form larger clusters of indeterminate size, as well as the tendency for agglomeration to block access of candidate reactants to potential catalyst active-sites. Nevertheless, the pervasive presence of transition-metal sulfur clusters metalloenzymes or cofactors that catalyze reduction reactions, and the justifiable proliferation of studies of 2D metalchalcogenides, and especially their edge sites, as reduction catalysts, point to the promise of well-defined and controllable PTMs as catalysts for reduction reactions, including complex, bond-forming, many-electron reactions. Here we report the fabrication of agglomeration-immune, reactant-accessible, capping-ligand-free CoIIMoIV6S24n- clusters as periodic arrays in a water-stable, hierarchically porous Zr-metal-organic-framework (MOF; NU1K) by first preparing and installing a disk-like Anderson polyoxometalate, CoIIMoVI6O24m(-), in size-matched (

Targeting the interaction of leukocyte-associated immunoglobulin-like receptor-1 (LAIR-1) and its ligands has been shown to reinstate antitumor immunity. In addition, the introduction of the LAIR-1 decoy protein, LAIR-2, sensitizes previously resistant lung tumors to programmed death-1 (PD-1) blockade, indicating the potential of LAIR-1 as an alternative marker for anti-PD-1 resistance in lung cancer. Here, we assessed LAIR-1 as compared with programmed death-ligand 1 (PD-L1) expression in various tumors, with a focus on non–small cell lung cancer (NSCLC) and its histologic subtypes using multiplexed quantitative immunofluorescence (mQIF) in 287 (discovery cohort) and 144 (validation cohort) patients with NSCLC. In addition, using multispectral imaging technology on mQIF images, we evaluated the localization of LAIR-1 on various cell types. We observed that CD14+, CD68+, and CD163+ monocytes and CK+ tumor cells predominantly expressed LAIR-1 more than other cell types. Furthermore, LAIR-1 expression in the tumor compartment was significantly higher in patients with lung adenocarcinoma (LUAD) than those with lung squamous cell carcinoma subtype (**, P = 0.003). Our results indicated that high tumor LAIR-1 expression in patients with LUAD is negatively associated with OS (overall survival, HR = 2.4; *, P = 0.02) highlighting its prognostic value in LUAD but not in other subtypes. The Pearson correlation between LAIR-1 and PD-L1 is 0.31; however, mutual exclusive staining pattern (i.e., several cases were positive for LAIR-1 and negative for PD-L1) was observed. Altogether, our data suggest that the combination therapy of anti-PD-1/PD-L1 with anti-LAIR-1 or the anti-LAIR-1 monotherapy alone may be promising cancer immunotherapeutic strategies.Significance:The spatial, quantitative assessment of LAIR-1 in NSCLC shows positive association of OS with high LAIR-1+/CD68+ cell densities and negative association of OS with high LAIR-1 expression in LUAD tumor subtype.

Pakistan has also internal as well as external security threats. By means of internal threats are provincialism, sectarianism and etc. When Pakistan was created it was based on the two-nation theory but now there are more than two nations like Punjabis, Sindhi’s, Balochi and Pathans. Due to this reason, the people of Pakistan do not think as Pakistani but they divide them according to their provinces. And if the talk goes about sectarianism there are two groups of people who fight with each other on the name of their religion. Now the time goes about external security threats, there are many countries against Pakistan and trying their best to beat it down. For example, Pakistan has a main issue related to Kashmir. But it’s not only the direct relation with other country, it’s the threat to the security of neighbor country and its effect on the people like after 9/11 a war is start in Afghanistan and its hardly effect the Pakistani tribes and also the other country relation and their effect on Pakistan securityery main things are written here. All this need a network in which so many threats can cover-up regarding security.

Objective: To determine the sensitivity and specificity of the clinical diagnostic tests of subacromial impingement syndrome. Method: The systematic review comprised search on PubMed, PEDro, Cochrane Library and Google Scholar databases. For prospective cohort studies published in peer-reviewed English-language journals without any time limit, at least fully describing one clinical test. Only studies with free full text available were included. Data extracted included sensitivity and specificity for each clinical test, and variations were sorted out by the 3 reviewers by discussion. Results: Of the 4137 studies identified, 2951(71.3%) were on PubMed, 119(2.9%) PEDro, 5(0.1%) Cochrane Library and 1062(25.7%) Google Scholar. After screening out all the studies that did not match the detailed inclusion criterion, 3(0.07%) studies were selected for review; 1(33.3%) each done in Spain, Turkey and France. Overall, there were 181 aged 15-82 years; 85(47%) males and 96(53%) females. Supraspinatus palpation test had a sensitivity of 92%, while the modified Neer test had specificity of 95.56% in terms of ruling out subacromial impingement syndrome. Conclusion: Supraspinatus palpation and modified Neer tests were found to be the most effective in the diagnosis of subacromial impingement syndrome. Key Words: Clinical test, Diagnostic accuracy, Sensitivity, Specificity, Subacromial impingement syndrome.

Background: Antibiotic resistance is increasing against Salmonella Typhi (S. Typhi), causative agent of enteric fever, at a very high pace in Pakistan. The objective of this study was to evaluate the emergence of multi and extensively drug resistant Salmonella Typhi among suspected patients in a public health care facility in Lahore. Patients and methods: 5cc blood samples from the patients with high grade fever (>38°C), vomiting and bradycardia (heart rate 84 bpm) were collected from laboratory of Arif Memorial Teaching Hospital, Lahore over six months (August 2020-January 2021), After informed consent, questionnaire were filled and total 97 samples were taken from suspected patients and screened for Salmonella Typhi by using Typhidot IgG/IgM by ELISA kit (one step typhoid fever) for S. Typhi. Gram staining, culture and biochemical testing was performed for confirmation. Antibiotic susceptibility testing was used to evaluate the emergence of antibiotic resistance. Statistical analysis was performed by using SPSS 20.0, software. Chi square test was used, Results: Total 55 (56.7%) samples out of 97 (100%) were reported positive for Salmonella Typhi. Antimicrobial susceptibility testing results indicated that 6 samples were resistant to more than one antibiotic commonly called as multidrug resistant, 44 samples were extensively drug resistant and 5 samples were nonresistant/sensitive to selected antibiotics. Highest resistance was reported against Ampicillin (51 samples (92.7%) and Co-trimoxazole (50 samples (90%)). Resistance against Moxifloxacin and Tobramycin, Ciprofloxacin, Ceftriaxone Cefuroxime and Cefotoxime, Cefxime, Levofloxacin, Salbactum, Imepenum and Amikain was 47 (85.4%), 46 (83.6%), 45 (81.81%), 44 (80%), 37 (67.2%), 32 (58.18%), 14 (45%) and 9 (16.3%) respectively. Lowest resistance was reported against Meropenum 5 (9%) and Azithromycin 1 (1%). Conclusion: It is concluded that the monitoring of MDR and XDR must be performed by all clinical microbiology/pathology laboratories to implement effective measures to reduce the emergence of antimicrobial resistance.