Search

INTRODUCTION Inflammatory bowel diseases (IBD) are thought to be caused by a dysregulated immune response in the digestive tract, amongst other factors (environmental, genetic predisposition, microbiota). Data on acute viral hepatitis (AVH) infection outcomes in patients with underlying IBD are scarce. We aimed to investigate the relationship between IBD and outcomes of patients with AVH. METHODS This is a retrospective longitudinal study of patients admitted with a primary diagnosis of AVH (A,B,C,D,E). We retrieved data from the Nationwide Inpatient Sample (NIS) databases from the years 2016 to 2019 using ICD-10 CM codes for AVH. Multivariate logistic regression analysis was performed in patients with IBD to estimate the effect of IBD on the primary outcomes of mortality, hospital utilization, and acute hepatitis complications, adjusted for patient and hospital confounders. A T-Test and Chi Square test were performed to compare baseline characteristics in patients admitted for AVH with and without a secondary diagnosis of IBD. We used STATA® Version 17.0 Software (STATACORP, TEXAS, USA) for analysis. The p-value was set at p < 0.05 for statistical significance. RESULTS A total of 47614 adult patients with a primary diagnosis of AVH were identified; four hundred twenty five (0.9%) had a secondary diagnosis of IBD. Most were middle-aged (mean age: 44 years), male (53%) white (78%), and were admitted in large sized (51%) and teaching hospitals (68%). There was no statistically significant change in the length of stay or total healthcare cost associated with the presence of IBD. Having IBD was associated with no change in the risk of fulminant hepatitis (OR = 0.55, p= 0.262, CI: 0.19 - 0.55), hypoglycemia (OR = 1.14, p= 0.904, CI: 0.13 - 9.56), thrombocytopenia (OR = 0.46, p= 0.209, CI: 0.14 - 1.53), and coagulopathy (OR = 1.22, p= 0.781, CI: 0.29 - 5.12). No case of mortality, hepatorenal syndrome or liver transplant was reported. DISCUSSION Despite the fact that IBD is associated with a dysregulated immune response in the digestive tract, our study showed that the presence of IBD in patients affected by acute viral hepatitis does not carry a significant impact on the outcomes of IBD (hospital utilization, morbidity, mortality). Broader studies are required to establish an association between IBD and AVH outcomes.

Background: Diabetes and an augmented risk of CHD also known as coronary heart disease have long been associated, although the danger's exact magnitude is unknown. Objective: The aim of this research is to assess and evaluate the effect of diabetes and previous CHD on mortality from all causes and CHD. Methods: In a retrospective longitudinalresearch, 91285 male physicians whose ages ranged from 40 to 84 were grouped into the following 4 groups: (1) a control group of 82 247 males who were at baseline independent of CHD anddiabetes, (2) 2317 men who had experienced diabetes without experiencing CHD, (3) 5906 men who had experienced CHD without experiencing diabetes, and (4) 815 men who had experienced both conditions. Both coronary heart disease (CHD)and overall mortality rates were evaluated in these groups. Results: During 5-year period (497952 people) 3627 fatalities from all causes were noted, including 1242 CHD deaths. Men with diabetes but no CHD had a maturity level hazard ratio of 2.3 (2.0-2.6) with a 95% confidence interval, men with CHD but no diabetes had a maturity level hazard ratio of 2.2 (2.0-2.4), and men with both CHD and diabetes had a maturity level hazard ratio of 4.7 (4.0-5.4) with a 95% confidence interval for death from any cause. Men with diabetes who did not have CHD had a 3.3 (2.6-4.1) chance of mortality from CHD, men with CHD who did not have diabetes had a 5.6 (4.9-6.3) risk of mortality from CHD, and men who had both diabetes and CHD had a 12.0. (9.9-14.6) the risk of death from CHD. After multivariate adjustments for body mass index (BMI), alcohol usage, physical activity, and smoking status as well as stratified by these covariates, these correlations remained constant. Conclusions: These prospective data show a strong correlation between diabetes and an elevated risk of death from CHD and all-cause. The increased risk diabetes poses for mortality from all causes is comparable to that posed by a record of CHD, although death from CHD is more strongly predicted by a history of CHD. But those who have both CHD anddiabetesare known to be at a higher risk. Keywords: diabetes, disease, heart, cardiovascular

Aim: It has lately been demonstrated that children with nephrotic syndrome induced by the minimal modifying disease can have excessive salt retention, triggered vasoactive hormone, and long-term edema. Methods: The current study looks at these problems in kids who do not have MCD and have nephrotic syndrome. Significant sodium retention (fractional sodium excretion, FENa, 0.3 7 0.3%) was detected in three kids having hypovolemic complaints. The suppression of lithium elimination in addition to maximum water excretion suggests ardent sodium reabsorption throughout the nephron. The levels of aldosterone, renin, and norepinephrine have all been high. Sixteen additional non-MCD kids had stable edema. FENa was 1.9 7 1.2%, whereas FELi, Vmax, and hormones were mostly normal and comparable to information from 37 nonproteinuric youngsters. Results: Thirteen kids having MCD had hypovolemic signs and significant sodium retention (FENa 0.4 7 0.4%), while 16 were normal (FENa 1.2 7 0.8%). In terms of tubular salt processing and hormones, the very same differential might be established for non-MCD youngsters. Furthermore, hypoproteinemia was distinct. Plasma colloid osmotic pressure was considerably less in children having non-MCD lesions (4.3 7 0.5 mmHg) than among those who had stable edema (14.1 7 4.7 mmHg; P, 0.06); really no variation observed in MCD (corresponding, 8.2 6 4.1 and 9.8 7 2.3 mmHg). Conclusion: In conclusion, whether they have non-MCD or MCD, kids having renal disease can appear to have pathophysiologic images of reduced effective circulation volume or constant edema. The pathophysiology of the hypovolemic picture appears to remain distinct, given that this is linked to severe hypoproteinemia exclusively in non-MCD kids. Keywords: Nephrotic Syndrome, Ardent Salt Retention, Vasoactive Hormone, Sustained Edema.

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

Astragalus Stocksii a local flowering plant found in Hana Valley, Quetta Pakistan, used as home medicinal plant form many years. It is an encouraging source of bioactive compounds and has been conventionally manipulated for the coverage of several diseases. The present study based on the evaluation of phenolics, antioxidants and anti-inflammatory activities of Astragalus Stocksii by using three different solvents, i.e. ;acetone, ethanol and methanol. The results showed that extraction yield depends upon the type of the solvents used for extraction. Among these, extraction in methanol has the highest phenolic contents (10.086±0.08mgCE/g DW),total antioxidant capacity (TAC, IC50=14.50±0.01 μg/mL,phospho-molibdenummethod,IC50=66.62± 0.03 μg/mL by DPPH method)and high anti-inflammatory activity (IC50=75.0 ±2.5 μg/mL, oxidative burst assay). These results indicate that methanol is the best solvent for extraction of phenolic and antioxidants in Astragalus Stocksii. The high results of anti-inflammatory for Astragalus Stocksii suggests its use inpharmaceutical and nutraceutical industries.

INTRODUCTION Crohn’s disease (CD) has been known to cause transmural inflammation of the gastrointestinal wall with manifestations including ulcers, abscesses, and fistula. Peptic ulcer disease (PUD) is most commonly caused by Non-Steroid Anti-Inflammatory Drugs (NSAIDs) use &/or Helicobacter pylori infection. Possible complications of PUD include perforation, bleeding, and cancer. There is no established relationship between the presence of CD and the outcomes of PUD. Therefore, we aimed to investigate the outcomes of PUD in patients with CD. METHODS This is a retrospective longitudinal study of patients admitted with a primary diagnosis of CD in the United states (US) from 2016 to 2019, using data from the nationwide inpatient sample (nis) database. A T-Test and Chi-Square were performed to compare baseline characteristics of patients with a primary diagnosis of pud, with and without a secondary diagnosis of CD (table 1). A multivariate logistic regression analysis was applied to estimate the primary outcomes of mortality, length of hospital stay (LOS) and total hospital charges (THC), and morbidity (ibd complications) adjusted for patient and hospital confounders. We used STATA® Version 17.0 Software (STATACORP, Texas, USA) for data analysis. The p-value was set at p < 0.05 for statistical significance. RESULTS A total of 582,710 adult patients with a primary diagnosis of PUD were identified; among them, 0.9% (n= 3415) had a secondary diagnosis of CD. Baseline characteristics are detailed IN TABLE 1. When compared to patients without cd, patients with CD were younger (mean age: 61 years), with more females (54.5% vs 48.8%, p=0.0000) and whites (79% vs 70.9%, p=0.000), and a lower prevalence of alcohol use (4.9% vs 10.9%, p=0.000). A statistically significant increase in LOS by 1.33 days (p = 0.000), and THC by 19,273 US Dollars (p = 0.010) was seen in patients with CD. Having CD was associated with no change in mortality (OR = 0.58, P = 0.206), or PUD complications, including anemia (OR = 1.07, P = 0.407), peptic ulcer bleeding (OR = 1.15, P = 0.490), perforation (OR = 1.76, P = 0.115), hypovolemic shock (OR = 1.00, P = 0.115), septic shock (OR = 1.15, P = 0.667), and blood transfusions (OR = 0.92, P = 0.411) (Figure 1). No case of gastric malignancy was identified in our study population. DISCUSSION The presence of CD does not carry a significant impact on PUD outcomes in terms of mortality and acute PUD complications. However, hospital utilization appears to be higher in patients with CD. In order to identify a possible relationship between CD and gastric malignancy, studies over longer periods would be necessary .

INTRODUCTION Several risk factors have been associated with inflammatory bowel diseases (IBD), including genetic, environmental, gut microbiota and immune dysregulation. Psychiatric disorders have been linked to IBD. However, the question of whether psychiatric conditions affect the severity of patients with IBD remains unanswered. We aimed to investigate the relationship between mood disorders and IBD outcomes. METHODS This is a retrospective longitudinal study of patients admitted with a primary diagnosis of IBD. Data was retrieved from the Nationwide Inpatient Sample (NIS) databases of the years 2016 to 2019 using ICD-10-CM codes for IBD. Multivariate logistic regression analysis was applied to estimate the effect of mood disorders on the outcomes of IBD (mortality, complications and hospital utilization), while adjusting for patient and hospital confounders. A T-Test and Chi Square test were performed to compare baseline characteristics in patients admitted for IBD with and without a secondary diagnosis of mood disorder (table 1). We used Stata® Version 17.0 Software (Statacorp, Texas, USA) for analysis. The p-value was set at p < 0.05. RESULTS A total of 374745 adults with a primary diagnosis of IBD were identified; less than one fifth (21%) had a documented mood disorder. A significantly higher proportion of females (66%, p-value=0.000) and Whites (81%, p-value=0.000) were noted in the mood disorder group. Having a mood disorder was associated with no statistically significant change in mortality (Odds ratio (OR) = 0.86, p = 0.461), anemia (OR = 0.99; p = 0.891), gastrointestinal bleed (OR = 0.99; p = 0.910), inflammatory polyps (OR = 0.79; p = 0.452), toxic megacolon (OR = 0.79; p = 0.664), colorectal cancer (OR = 0.70; p = 0.133), primary sclerosing cholangitis (OR = 1.34; p = 0.228), and pyoderma gangrenosum (OR = 1.01; p = 0.945) (figure 1). A statistically but non clinically significant reduction in the risk of intestinal abscess (OR= 0.81; p = 0.024), stenosis (OR= 0.68; p = 0.000), and fistula (OR= 0.84; p =0.012), was noted in patients with mood disorder. However, an increased hospital utilization was noted in patients with mood disorder (length of stay: 0.59 days, p-value = 0.000; total healthcare cost: 3372 US Dollars, p-value = 0.000). DISCUSSION IBD patients demonstrate a higher prevalence of mood disorders when compared to the general population, especially in females and Whites. Our study showed that the presence of mood disorder concurrently with IBD does not significantly affect the outcomes of IBD in terms of mortality, or morbidity. A multidisciplinary approach of patients with IBD including diagnosis and management of the underlying psychiatric disorders could help optimize the hospital utilization of patients with IBD.

As humanity prepares for deep space exploration, understanding the impact of spaceflight on bodily physiology is critical. While the effects of non-terrestrial gravity on the body are well established, little is known about its impact on human behaviour and cognition. Astronauts often describe dramatic alterations in sensorimotor functioning, including orientation, postural control, and balance. Changes in cognitive functioning as well as in socio-affective processing have also been observed. Strikingly, no comprehensive theoretical model exists to outline the impact of non-terrestrial gravity on behaviour. Here, we have reviewed the key literature across the last 10 years and explored the impact of non-terrestrial gravity across three key functional domains: sensorimotor functioning, cognition, and socio-affective processing. We have proposed and preliminary validated a neurocognitive model to account for the effects of non-terrestrial gravity in these domains. Understanding the impact of non-terrestrial gravity on human behaviour has never been timelier and it will help mitigate against risks in both commercial and non-commercial spaceflight.

Background: We developed a hypertension (HTN) care initiative in a metropolitan based Primary Ambulatory Care to advocate and increase adherence to blood-pressure (BP) standards. The strategy involved, Treat to Target (T2T), linked health promotion by addition of BP clinic slots and training Nursing staff to optimize BP monitoring and care. Uncontrolled HTN leads to increased risk CVD complications with a socioeconomic cost attached. Thus, we evaluated the pre- and post-T2T period outcomes for systolic BP control. Methods: Patients that presented to ambulatory clinic prior to and during the T2T initiative were selected in a case control paired chart review (24 months pre & post initiative). Enrollment criteria included BP readings greater than 130 mmHg systolic or 80 mmHg diastolic in the T2T period or change in current BP medication were selected and enrolled into the BP initiative. The nursing staff reviewed BP diary, addressed medication concerns, established a patient center module to promote salt reduction/medication adherence/exercise/weight loss. Final BP outcomes were assessed, pre and post T2T initiative for systolic & diastolic control, number of visits, and meeting the set BP standards. Results: A total of 2729 patients were included in paired review. The mean age was 61.3±9.6 years, 57% were females, and 70% were Latinx & 25% were Blacks. At baseline, mean systolic BP was 143.2mm Hg in the T2T group and 144.1 mmHg in the control group. At last follow-up in the period of the study, mean systolic BP fell by 7.6 mmHg (to 135.5mmHg) in the T2T group and by 9.5 (to 134.6mmHg) in the control group. The average number of visits decreased from control to the T2T period by 31% (5.1±3.0 vs. 3.5±1.5, p Conclusions: The HTN initiate by increasing BP clinic spots run by Nursing to educate, monitor and titrate BP control which resulted in sustained BP reduction with fewer visits and decreased uncontrolled BP events and was a sustainable initiative. Broad-scale implementation is both justified and warranted in a metropolitan ambulatory care setting, which will entail cost initially, and in turn develop continual relationship to reduce HTN related compliance.

Carotid body tumors, also known as chemodectomas/paraganglionomas; are rare neuroendocrine tumors that arise from parasympathetic ganglionic cells. They are usually benign with incidence of malignancy is Case presentation 43 y/o female with PMH of GERD, obesity, asthma and anxiety disorder who came to endocrine clinic for left middle thyroid lobe nodule(0.9×0.6×0.6cm) evaluation; incidentally noted to have a multilobulated heterogeneous hypo echoic and iso-echoic mildly vascularized solid nodular mass (3.46×1.83×1.93 cm) in the left carotid bifurcation area; splaying the common and the internal carotid arteries on US. Review of systems was positive for left sided neck pain, intermittent palpitations, headaches, anxiety, and sleep disturbances. Clinical exam was remarkable for thyromegaly and a palpable non-tender 3cm left neck mass with no cervical lymphadenopathy. Initial labs were notable for mild elevation of chromogranin A (108.4 ng/ml) with normal levels of TSH, free T3, free T4, plasma metanephrines and 24-hour urinary metanephrines. Considering patient's persistent symptoms; plasma catecholamines levels were done and were negative. MRI soft tissue neck confirmed 2.8 cm lobular mass suggestive of paraganglioma. Metastatic work up was negative. Patient was referred for genetic testing considering young age and to rule out hereditary disorders. Interim, patient presented to the ED with complain of sudden onset lumbar backache without sphincteric involvement; neurological exam was unrevealing but on MRI lumbar spine found to have a 5.7×4.8×4cm lobulated well-circumscribed homogeneous soft tissue mass suggestive of schwannoma. Cervical and thoracic spine imaging was unremarkable. MRI brain showed a 1.1cm enhancing mass in right Meckel cave suggestive of meningioma. PET-DOTATATE scan was performed that revealed left neck mass as intensely avid, Right petrous apex mass as moderately avid and lumbar mass as not avid at all, consistent with the diagnosis of paraganglionoma, meningioma and schwannoma respectively. No evidence of DOTATATE avid nodal/ distant metastatic disease was found. Initially a hereditary etiology was suspected but genetic testing including (VHL, NF1/2, SDHD, SDHB) came back negative. Case was discussed with multidisciplinary teams; Neurosurgery service recommends conservative management of both meningioma and schwannoma at the moment considering benign course. Regarding paraganglioma, as tumor is non-secretory on repeated work up; sympathetic blockade is not warranted and patient is scheduled for pre-op embolization and surgical resection by Head and Neck surgery. Conclusion Paraganglionomas are generally benign non-secretory tumors that usually occur with other neuroendocrine tumors both as hereditary syndromes and sporadic cases. But their association with non-neuroendocrine tumors is mere incidental or has a genetic causation; is still unclear and warrants further research. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Over the past few decades, a significant change in the nature of employment and family patterns has been observed globally. The objective of this paper is to determine how work requirements affect family by exploring the phenomenon of the work-family conflict (WFC) and how the family demands impinge the work life – the family-work conflict (FWC) by examining the key issues leading to this critical issue. The qualitative phenomenological case study method is used, the data were collected by conducting in-depth interviews from 50 female respondents working in 12 private and public organizations of Pakistan. The findings showed a strong negative relationship between long working hours and lack of spousal support with work-family conflict. The findings recommend that an effective way to reduce the work-family conflict is through developing a positive and comfortable working environment for employees. Furthermore, the findings stressed the need to frame guidelines for the administration of work family conflict at the organizational level as it is associated to the job contentment and performance of the employees.

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

A variety of diarylpyrazole derivatives III-VI were synthesized and structurally characterized using FTIR

Productivity can be enhanced by reducing wastages in a process while maintaining or increasing the amount of output. This is real work carried out in the automotive industry. In our work, we enhanced the productivity of the assembly line in an automotive plant by applying lean methodologies. There is an extensive range of tools available to remove all kinds of wastes, from which we selected the following two tools to remove waste that will enhance productivity, Value Stream Map (VSM) and Overall Equipment Effectiveness (OEE). The purpose of using VSM is that it easily highlights the bottlenecks in any existing process. For VSM we need to conduct a time and motion study to understand the structure of an organization. At the same time, OEE helps us measure the efficiency of our system being utilized. After applying these tools, we easily identified the parts which needed improvement in the process. It has reduced our cycle time of sub-assemblies by 50% and transportation time by 60%. This overall enhanced the productivity of the system by 20%. The index of OEE increased by 2%. Our work has improved the productivity of the assembly line in an automotive plant. In the future this work can be further improved by our successors for better productivity, fulfilling future customer needs.

In this research, structure of SARS-CoV-2 spike glycoprotein S1 and S2 along with TMPRSS2, TMPRSS4, TMPRSS11A, TMPRSS11D and TMPRSS11E serine protease (which activates S1 and S2) are used for docking with repurposed inhibitor drug molecules. We searched for a universally active drug molecule which binds with glycoproteins and serine protease with binding energy above a pre-set threshold value, thus single handedly inhibits the virus glycoprotein interaction with ACE-II receptor on human cell preventing the virus RNA transfer to human cell. Through data analysis performed on binding energies of the selected repurposed inhibitors, we found out five molecules to have high binding energies on both spike glycoproteins and serine protease, while showing less variance in their binding energies. Among these five, Edoxaban is an FDA approved commercially available drug molecule. Hence, high binding molecular inhibitors for spike glycoprotein and serine protease for treatment of SARS-CoV-2 were identified.

In this research we used the structure of SARS-CoV-2 related, recently mapped, atomic structure of nsp10/16 proteins for docking with some known drug molecular structures at pH 7 and 5. Chosen molecules were azo -N=N- and -COOH derivatives. It was revealed that the molecules showed good binding energy with nsp10/16 protein at both pH. These molecules can act as protein-nucleic acid interface (PNAI) inhibitor drug molecules. Such molecules can be used in combination with polymerase and protease inhibitors for treatment of SARS-CoV-2.

In this research we used the structure of SARS-CoV-2 main protease (Mpro) for docking with Anti-HIV protease inhibitor drug molecules within pH 4-8. By carrying out the variance analysis of binding energies at pH 4-8, it was revealed that the binding energy and mode of interaction of the potential ligands with SARS-CoV-2 Mpro, was dependent on variation of pH. We found out that two of the selected protease inhibitors have differential binding characteristics with changing pH hence their binding energies and mode of interaction depends upon intracellular pH. This differential binding behavior can lead to development of pH selective potent drug molecules for binding with viral protease at lowered intracellular pH of virus infected cell.

The objective of this study was to investigate the awareness of Physical Therapy among undergraduate students. A cross sectional survey was administrated from undergraduate students of different universities of Gujranwala. Opinion from Participants was taken regarding there awareness level about physical therapy. For this purpose, a well-structured questionnaire was used to investigate about awareness of physical therapy. SPSS software and Microsoft excel was used for Data analysis. We have found that most of the participants were males. The main barrier of not having knowledge about this field is lack of interest of students towards this as they consider it not a well-developed field. Most of the students have just basic knowledge about the term physical therapy. We concluded that awareness of physical therapy needs to be improved among undergraduate students of Gujranwala. Keywords: Awareness, Physical therapy, undergraduates.

Diabetes mellitus is a chronic progressive illness that causes considerable morbidity related to macro and micro vascular complications, resulting in an ever growing healthcare burden globally. Early Initiation of Insulin has significant impact on improving both long term health outcomes and quality of life among diabetics in comparison to oral medications alone. But both patients and physicians often resist early initiation of therapy, a phenomenon known as “Psychological Insulin Resistance” (PIR). Objective of study was to assess such barriers among diabetic patients in Pakistan. We selected 300 patients both type 1 and 2 through convenience sampling from diabetic clinics of 2 tertiary care hospitals. Data was collected through structured questionnaires and analyzed using SPSS version 17. A p-value 5 years) and advanced disease were more satisfied about their glycemic control with insulin and willing to recommend it to others but at the same time, feared about its lifelong commitment once started, with all these variables having statistical significance (p-value

Background and Objective: Initiation of Insulin therapy during earlier stages has proved to significantly improve health outcomes among diabetics in comparison to oral medications. Not only patients but physicians are also often resistant to early initiation of insulin therapy. The objective was to assess misconceptions and barriers to early initiation of insulin therapy among diabetic patients coming to a diabetic clinic. Methods: This cross sectional study was conducted on 300 patients selected by convenience sampling arriving in Diabetes Outdoor Clinics of Mayo and Services Hospitals, Lahore during August 2017 to May 2018. The data was entered and analyzed by using SPSS version 17. Results: Out of 300 patients included in study, 39% (n= 117) were males and 61% (n=183) were females. The mean age of the participants at presentation was 48.46±13.15 years with a range of 13 to 80 years. Study participants considered it embarrassing to inject insulin in public place (p-value 0.01). The fear associated with lifelong commitment to insulin therapy once it is started, was also found statistically significant (p-value 0.001)particularly in subjects who have long duration of DM (>5 years). Conclusion: Perceptions of diabetic patients about insulin therapy are still barriers to early initiation of therapy and tend to prevail in Pakistan and around the globe. How to cite this:Arshad I, Mohsin S, Iftikhar S, Kazmi T, Nagi LF. Barriers to the early initiation of Insulin therapy among diabetic patients coming to diabetic clinics of tertiary care hospitals. Pak J Med Sci. 2019;35(1):39-44. doi: https://doi.org/10.12669/pjms.35.1.237 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Software-defined networking (SDN) is the propitious step towards the future. Data Plane decoupling from control plane makes the networking environment more flexible and programmable. Cost effectiveness, flexibility, programmability makes SDN the favorite choice for todays industry. SDN architecture can also provide numerous benefits in wireless scenario. However, there are some open research issues related to security that need researcher’s and academia’s attention. Attack plane is introduced due to the fact that control logic is separated from tje data forwarding plane. This paper presents a simple authentication mechanism using hash table, cryptographic hash function and REST API for access points (APs) and applications to secure the communications. The unauthorized applications are not allowed to access network resources. Additionally, unauthorized access points are not allowed to communicate with other network elements. The wireless topology is emulated and tje proposed application is tested to validate the results. The application generates the report about total authorized and unauthorized access points in the topology. The application is allowed to run at all times in the network and alert the administrator about malicious device. This malicious device and application is not allowed to communicate with other network element or access network resources. Performance evaluation has been carried out by measruing the time required to run the application for varying number of Access Points (APs).

Human behaviour is a trade-off between exploitation of familiar resources and exploration of new ones. In a challenging environment—such as outer space—making the correct decision is vital. On Earth, gravity is always there, and is an important reference for behaviour. Thus, altered gravitational signals may affect behaviour control strategies. Here, we investigated whether changing the body’s orientation to the gravitational vector would modulate the balance between routine and novel behaviour. Participants completed a random number generation task while upright or supine. We found decreased randomness when participants were supine. In particular, the degree of equiprobability of pairs of consecutive responses was reduced in the supine orientation. Online gravitational signals may shape the balance between exploitation and exploration, in favour of more stereotyped and routine responses.