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PURPOSEThis study aims to assess the status of radiation oncology peer review procedures across the Middle East, North Africa, and Türkiye (MENAT) region.METHODSA cross-sectional electronic survey was conducted among radiotherapy centers in the MENAT region in March 2024. It assessed peer review practices, departmental demographics, perceived importance of peer review, and potential barriers.RESULTSData from 177 radiation oncology centers revealed varying peer review implementation across the MENAT region. Egypt had the highest participation (16.4%) among all responders. Most centers (31%) treated 500-1,000 cases annually. The majority (77.4%) implemented peer review, with varying levels between countries and across different centers. Advanced radiotherapy techniques significantly correlated with implementation of peer review (P < .05). Peer review meetings were mostly scheduled on a weekly basis (46%) and organized by radiation oncologists (84.7%). Target volume contouring (89%) and radiotherapy prescription (82%) were frequently peer-reviewed. Respondents with peer review at their institutions significantly valued peer review for education, adherence to guidelines, improving planning protocols, and reducing variation in practice institutions without peer review (P < .05). The most frequently reported barriers to peer review were having a high number of patients (56%) and shortage of time (54%).CONCLUSIONPeer review is essential for improving the quality of practice in radiation oncology. Despite some discrepancies, numerous obstacles, and challenges in implementation, it is instrumental in the improvement of patient care in most centers throughout the region. Raising awareness among radiation oncologists about the importance of peer review is paramount to lead to better outcomes.

Research on automated mental health assessment tools has been growing in recent years, often aiming to address the subjectivity and bias that existed in the current clinical practice of the psychiatric evaluation process. Despite the substantial health and economic ramifications, the potential unfairness of those automated tools was understudied and required more attention. In this work, we systematically evaluated the fairness level in a multimodal remote mental health dataset and an assessment system, where we compared the fairness level in race, gender, education level, and age. Demographic parity ratio (DPR) and equalized odds ratio (EOR) of classifiers using different modalities were compared, along with the F1 scores in different demographic groups. Post-training classifier threshold optimization was employed to mitigate the unfairness. No statistically significant unfairness was found in the composition of the dataset. Varying degrees of unfairness were identified among modalities, with no single modality consistently demonstrating better fairness across all demographic variables. Post-training mitigation effectively improved both DPR and EOR metrics at the expense of a decrease in F1 scores. Addressing and mitigating unfairness in these automated tools are essential steps in fostering trust among clinicians, gaining deeper insights into their use cases, and facilitating their appropriate utilization.

Researchers are investigating eco-friendly binders like coconut shell ash (CSA), metakaolin (MK), and calcined clay (CC) as supplementary cementitious materials (SCM) in high-strength concrete (HSC). Abundantly available as industrial or agricultural waste, these materials, when combined with Portland cement (PC), offer synergistic benefits. This not only improves concrete performance but also addresses waste disposal issues, presenting a sustainable and environmentally friendly solution for long-term use in HSC production. However, this study performed on fresh and mechanical characteristics of HSC blended with CSA, MK, and CCA alone and together as SCM after 28 days of curing. A total of 504 samples of standard concrete were cast and the cubical samples were tested to achieve the targeted compressive strength about 80 MPa after 28 days. The experimental results indicated that the rise in tensile, flexural and compressive strengths of 9.62%, 8.27%, and 10.71% at 9% of CSA, MK, and CC as SCM after 28 days of curing. As SCM content increases, the density, porosity and water absorption of concrete decrease. Moreover, the workability of fresh concrete is getting reduced when the concentration of SCMs increases in HSC. In addition, the concrete's sustainability assessment revealed that employing 18% MK, CC, and CSA as SCM reduced carbon emissions by approximately 11.78%. It is suggested that using 9% CC, MK and CSA together in HSC yields the best results for practical applications in civil engineering.

Constraining the collision timing of India and Asia requires reliable information from the coeval geological record along the ~2400 km long collisional margin. This study provides insights into the India–Asia collision at the westernmost margin of the Indian Plate using combined U-Pb geochronological data and sandstone petrography. The study area is situated in the vicinity of Fort Munro, Pakistan, along the western margin of the Indian Plate, and consists of the Paleocene Dunghan Formation and Eocene Ghazij Formation. The U-Pb ages of detrital zircons from the Dunghan Formation are mainly clustered between ~453 and 1100 Ma with a second minor cluster between ~1600 and 2600 Ma. These ages suggest that the major source contributing to the Dunghan Formation was likely derived from basement rocks and the cover sequence exposed mainly in Tethyan Himalaya (TH), Lesser Himalaya (LH), and Higher Himalayan (HH). Petrographic results suggest that the quartz-rich samples from the Dunghan Formation are mineralogically mature and have likely experienced log-distance transportation, which is possible in the case of an already established and well-developed river system delivering the sediments from the Craton Interior provenance. Samples of the overlying Ghazij Formation show a major detrital zircon age clustered at ~272–600 Ma in the lower part of the formation, comparable to the TH. In the middle part, the major cluster is at ~400–1100 Ma, and a minor cluster at ~1600–2600 Ma similar to the age patterns of TH, LH, and HH. However, in the uppermost part of the Ghazij Formation, ages of

Objective: To investigate the relationship between the severity of hand injury with anxiety and depression. Study design: Cross-sectional study Place and Duration of Study: Departments of Psychiatry and Plastic Surgery, Combined Military Hospital, Multan Pakistan, from Jul 2021 to May 2022. Methodology: We consecutively included 104 patients. The patients were given a specifically designed proforma to assess the parameters. Hand injury severity was assessed using the Hands injury severity scoring system. In contrast, the presence of anxiety and depression was assessed using the Hospital Anxiety and Depression Scale. Results: The mean age of the patients was 33.19±4.14 years; 97(93.3%) were males, and 95(91.3%) were married. 44 patients (42.3%) belonged to the wood trade, 25 farmers (24%), building trade 23(22.1%), and 10(9.6%) belonged to the metal trade. 68(65.4%) sustained a combination type of injury, 15(14.4%) had injury and 14(13.5%) had crush injuries. Of 53(51.0%), axe was the cause, 21(20.2%) was due to saw, and 16(15.4%) were due to metal when the severity of hand injury was compared for correlation with anxiety levels (p=0.188) and level of depression (p=0.413). Conclusion: Results of this study highlight that the presence of anxiety is more than depression after hand injury but not significantly correlated.

BackgroundHuman brucellosis is a neglected disease transmitted to humans from animals such as cattle, goats, dogs, and swine. The causative agents are bacteria of the genus Brucella, intracellular pathogens usually confined to the reproductive organs of their animal hosts causing sterility and abortions. The objective of the study was to determine the seroprevalence of brucellosis among women with spontaneous abortions (SAW) and compare this seroprevalence with that of healthy pregnant women (HPW).MethodsThe case–control study was designed to determine the seroprevalence and molecular detection of brucellosis in women who suffered from spontaneous abortion and healthy pregnant women of the Haripur District of Pakistan. A total of 770 blood samples (n = 385 for each group) were collected from 9 public and 11 private hospitals in Haripur District from December 2021–March 2023. Data on demographic features, epidemiological variables, and risk factors were collected from each participant by structured questionnaires. Initial screening for brucellosis was performed by Rose Bengal Plate Test followed by qRT-PCR for molecular detection of the genus-specific BCSP-31 gene of Brucella.ResultsThe study showed that anti-Brucella antibodies were more found in SAW 23.63% (91/385) than in HPW 1.29% (5/385). Brucella specific DNA was amplified in 89.01% (81/91) seropositive samples of SAW. Demographic features and risk factors such as age, urbanicity, socioeconomic status, education, occupation, and animal contact were found significantly associated with brucellosis (p ≤ 0.05). Consumption of unpasteurized raw milk (OR = 18.28, 95%CI: 8.16–40.94) was found highly concomitant with seroprevalence.ConclusionThis study reports the first evidence of involvement of brucellosis in spontaneous abortions in women of Pakistan. The study can be used to develop strategies for risk management during pregnancy, to raise awareness for brucellosis, and develop control programs.

Objective: To compare the surgical outcomes in terms of recovery and complications of laparoscopic versus open appendectomy in patients presenting to tertiary care hospitals in Rawalpindi. Study Design: Prospective comparative study. Place and Duration of Study: The study was conducted at the Department of Surgery at Combined Military Hospital (CMH) Rawalpindi, Pakistan from 1st July 2022 to 31st December 2022. Methods: Seventy patients with clinically and radiologically confirmed acute appendicitis were segregated by lottery method into two equal groups of 35 each. Patients undergoing open appendectomy (OA) were placed in Group A, those planned for laparoscopic appendectomy (LA) were placed in Group B. Pre and postoperative outcomes, including Alvarado score, operating time, postoperative pain, and hospital stay documented and compared between the groups. Results: A mean age of 28.40 ± 6.73 years in the open appendectomy group and 29.06 ± 9.84 years in the laparoscopic appendectomy group was noted (P=0.745). The mean Alvarado score was 7.29 ± 0.95 in Group A and 6.86 ± 1.16 in Group B (P=0.098). A statistically significant difference was noted in the mean operation time of 67.29 ± 9.67 minutes for open appendectomy versus 38.77 ± 8.67 minutes for laparoscopic appendectomy (P < 0.05). The mean hospital stay was shorter for laparoscopic appendectomy, with 1.51 ± 0.61 days compared to 2.00 ± 0.54 days for open appendectomy (P

Cloud computing is vital in various applications, such as healthcare, transportation, governance, and mobile computing. When using a public cloud server, it is mandatory to be secured from all known threats because a minor attacker's disturbance severely threatens the whole system. A public cloud server is posed with numerous threats; an adversary can easily enter the server to access sensitive information, especially for the healthcare industry, which offers services to patients, researchers, labs, and hospitals in a flexible way with minimal operational costs. It is challenging to make it a reliable system and ensure the privacy and security of a cloud-enabled healthcare system. In this regard, numerous security mechanisms have been proposed in past decades. These protocols either suffer from replay attacks, are completed in three to four round trips or have maximum computation, which means the security doesn't balance with performance. Thus, this work uses a fuzzy extractor method to propose a robust security method for a cloud-enabled healthcare system based on Elliptic Curve Cryptography (ECC). The proposed scheme's security analysis has been examined formally with BAN logic, ROM and ProVerif and informally using pragmatic illustration and different attacks' discussions. The proposed security mechanism is analyzed in terms of communication and computation costs. Upon comparing the proposed protocol with prior work, it has been demonstrated that our scheme is 33.91% better in communication costs and 35.39% superior to its competitors in computation costs.

Objective: To compare the results of basilic vein elevation with basilic vein transposition in terms of wound complications and patency rates. Study Design: Quasi-experimental study. Place and duration of study: Vascular Surgery Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2021 to Jan 2022. Methods: Ninety-four patients participated in the study, with 47 in each Group. Patients in the basilic vein elevation (BVE) Group underwent single-stage elevation, whereas 34 underwent two-stage elevation. The patients were closely followed for a year after the first successful dialysis from the fistula at three months, six months and 12-months period. The primary patency rates were comparable in both Groups. Results: The mean age of participants was 52.46± 13.54 years, ranging from 23-76 years. There were 7(7.4%) patients in whom fistula failed to mature, out of which 4(8.5%) were from the Basilic Vein Transposition (BVT) Group, and 3(6.4%) were from the BE-Group. There were fistula salvage attempts in all cases, and 4(4.3%) fistulas were salvaged 2(4.3%) in each group.3(3.2%) fistulas were declared as primary failure. There were 17(37.8%) complications in the BVT-Group and 27(58.7%) in the BE-Group (p-value= 0.046). Conclusion: Various techniques have been related to brachiobasilic fistula creation with variable results in terms of postoperative complications and primary patency rates. Basilic vein transposition has a lower complication rate than basilic vein elevation.

BackgroundAutomatic speech recognition (ASR) technology is increasingly being used for transcription in clinical contexts. Although there are numerous transcription services using ASR, few studies have compared the word error rate (WER) between different transcription services among different diagnostic groups in a mental health setting. There has also been little research into the types of words ASR transcriptions mistakenly generate or omit. ObjectiveThis study compared the WER of 3 ASR transcription services (Amazon Transcribe [Amazon.com, Inc], Zoom-Otter AI [Zoom Video Communications, Inc], and Whisper [OpenAI Inc]) in interviews across 2 different clinical categories (controls and participants experiencing a variety of mental health conditions). These ASR transcription services were also compared with a commercial human transcription service, Rev (Rev.Com, Inc). Words that were either included or excluded by the error in the transcripts were systematically analyzed by their Linguistic Inquiry and Word Count categories. MethodsParticipants completed a 1-time research psychiatric interview, which was recorded on a secure server. Transcriptions created by the research team were used as the gold standard from which WER was calculated. The interviewees were categorized into either the control group (n=18) or the mental health condition group (n=47) using the Mini-International Neuropsychiatric Interview. The total sample included 65 participants. Brunner-Munzel tests were used for comparing independent sets, such as the diagnostic groupings, and Wilcoxon signed rank tests were used for correlated samples when comparing the total sample between different transcription services. ResultsThere were significant differences between each ASR transcription service’s WER (P.05). A comparison between the human transcription service output from Rev and the best-performing ASR (Amazon Transcribe) demonstrated a significant difference (P

In recent years, there has been a growing interest in researching and developing new antimicrobial agents from various sources to combat microbial resistance. Therefore, a greater attention has been paid to antimicrobial activity screening and evaluating methods. Microbial resistance is a major issue now days and is still a challenging situation for the whole globe. Scientists and researchers everywhere in the world are trying to cope this situation. Microbial resistance against drugs makes the microbes more active and more protective. To breakdown this protective zone WHO is still monitoring the drugs and modifying their formulas according to the needs. As well as new drugs from different sources have been discovered. Plants were the major source of drugs in past and also in present century. In present study three plants extracts (i.e., Carissa opaca, Ferula asafoetida and Cannabis sativa) were used against five bacterial strains named Escherichia coli, Staphylococcus aureus, Salmonella enterica, Pseudomonas aeruginosa, Streptococcus pyogenes. All the drugs were applied in the form of aqueous extract via well diffusion method and zone of inhibition were measured and photographed after 24 hours. The antibacterial effect of floral drugs in this study showed less or more activity. In conclusion, these antibacterial drugs shown killing of bacteria, on different concentrations zones of inhibition measured were of different size. All these selected plants shown a direct relation with concentration of extract, higher the concentration of extract gives larger zone of inhibition, hence these plants extracts are beneficial with respect to their accessibility as well as economically favorable and can proved a better approach in future.

Twitter has become the foremost standard of social media in today’s world. Over 335 million users are online monthly, and near about 80% are accessing it through their mobiles. Further, Twitter is now supporting 35+ which enhance its usage too much. It facilitates people having different languages. Near about 21% of the total users are from US and 79% of total users are outside of US. A tweet is restricted to a hundred and forty characters; hence it contains such information which is more concise and much valuable. Due to its usage, it is estimated that five hundred million tweets are sent per day by different categories of people including teacher, students, celebrities, officers, musician, etc. So, there is a huge amount of data that is increasing on a daily basis that need to be categorized. The important key feature is to find the keywords in the huge data that is helpful for identifying a twitter for classification. For this purpose, Term Frequency-Inverse Document Frequency (TF-IDF) and Loglikelihood methods are chosen for keywords extracted from the music field and perform a comparative analysis on both results. In the end, relevance is performed from 5 users so that finally we can take a decision to make assumption on the basis of experiments that which method is best. This analysis is much valuable because it gives a more accurate estimation which method’s results are more reliable.

Abstract With time, numerous online communication platforms have emerged that allow people to express themselves, increasing the dissemination of toxic languages, such as racism, sexual harassment, and other negative behaviors that are not accepted in polite society. As a result, toxic language identification in online communication has emerged as a critical application of natural language processing. Numerous academic and industrial researchers have recently researched toxic language identification using machine learning algorithms. However, Nontoxic comments, including particular identification descriptors, such as Muslim, Jewish, White, and Black, were assigned unrealistically high toxicity ratings in several machine learning models. This research analyzes and compares modern deep learning algorithms for multilabel toxic comments classification. We explore two scenarios: the first is a multilabel classification of Religious toxic comments, and the second is a multilabel classification of race or toxic ethnicity comments with various word embeddings (GloVe, Word2vec, and FastText) without word embeddings using an ordinary embedding layer. Experiments show that the CNN model produced the best results for classifying multilabel toxic comments in both scenarios. We compared the outcomes of these modern deep learning model performances in terms of multilabel evaluation metrics.

This research presents findings from a study focused on the Lower Triassic (Induan) Lower Mahil KS-1 Formation, situated on a homoclinal carbonate platform in Northern Oman. The sequence stratigraphy of this formation is characterized by a considerable thickness variation, slumps, and breccia deposits related to active normal faults coupled with intra-basin growth faults. The main objective was to establish a reliable stratigraphic framework for the Lower Mahil KS-1 Formation by integrating high-resolution carbon isotope data along with high-resolution spectral and total gamma-ray data. To achieve this, whole-rock samples were analyzed for δ13C and δ18O isotopes. Spectral and total gamma-ray records were obtained for the formation. Isotope sampling is conducted every 0.5 m in the Saiq Plateau and Wadi Sahtan sections. Furthermore, spectral gamma-ray measurements were taken at intervals of 10 cm from the logged sections. Within the third-order sequence, the spectral gamma-ray data revealed a distinct sea-level trend, leading to the division of KS1 into two different parts. Five fourth-order depositional sequences were identified by analyzing stable carbon isotopes, uranium, and total gamma-ray profiles. Four of these sequences displayed complete patterns, reflecting transgression and regression phases, while the fifth sequence was incomplete and solely comprised a transgressive phase. An essential outcome of the study is the correlation of the δ13C curve of the Lower Mahil KS-1 Formation with other similar formations around the Tethys region. This correlation indicates that the Lower Mahil KS-1 Formation captures the near-primary signal of carbon isotope variations in coeval seawater. As a result, it holds promise as a reference section for future investigations and studies in this field. Compared to the prior investigation, this study utilizes data with higher precision, capturing spectral gamma-ray measurements at 10 cm intervals and isotope measurements at 50 cm intervals. Furthermore, the study’s focus is confined explicitly to KS1.

Respected Madam, Patients with hypertension require a multi-drug regimen to manage hypertension. But, multi-drug management may lead to patients’ lower cohesion to drugs and multiple adverse effects. (1) On the contrary a single pill containing four drugs (calcium channel blockers, beta-blockers, angiotensin II receptor blockers, and thiazide diuretics) of low dosages may deliver the same outcomes with lesser inauspicious effects. Current hypertension guidelines of the American Heart Association categorically recommend using a combination of four drugs in to manage and control hypertension, preferably in single-pill preparations. (2) Most patients remain on a single-drug therapy with insubordinate control, despite the recommendations that most require single-pill combination therapy of four drugs for blood pressure management (3) A recent randomized control trial demonstrated that a combination of four blood pressure-reducing agents in a single-pill at lower doses provided a simple, safe and potent treatment that improved the patient’s cohesion to the drug. The quadruple combination consists of four drugs: calcium channel blockers, beta-blockers, angiotensin II receptor blockers, and thiazide diuretics. Quadruple therapy is proven to have many benefits, namely higher efficacy, fewer adverse effects, and fast acting. It is found to be cost-effective as compared to monotherapy of multi-drugs. It is also known that patients taking high doses of multiple drugs to control blood pressure would be at higher risk of facing adverse effects such as bradycardia, hypokalemia, metabolic alkalosis, and constipation being the most common ones. In contrast, quadruple therapy consists of low dosages and it’s a combination of drugs to be taken together which helps the patient to surpass the adverse effects and effectively lower the blood pressure. It is also noted that quadruple therapy has proved effective in primary hypertension as a trial on a quadruple single-pill combination showed that the single-pill combination effectively reduced blood pressure in patients with stage 1 hypertension (4). In light of the above evidence, healthcare professionals should know the benefits of using a single-pill quadruple therapy for managing hypertension instead of traditional monotherapy. Moreover, additional studies should be performed on the effectiveness of using quadruple therapy.

Objective: To conduct a thorough audit of laparoscopy as a diagnostic and therapeutic modality in patients with chronic pain abdomen. Study Design: Cross-sectional study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Multan, from Jul 2015 to Dec 2021. Methodology: One hundred fifty-three patients with chronic abdominal pain were included in this study. The cause of pain in all patients was unknown despite undergoing thorough history, examination and appropriate investigations. Laparoscopy was performed in all patients, and findings were recorded accordingly. Results: A total of 153 patients were included in this study 67(43.8%) patients were male, and 86 (56.2%) were female. The mean age was 33.268±12.171 years (ranging from 15 to 60 years). The average duration of pain was 10.23±2.204 weeks. The diagnosis was confirmed laparoscopically in 143 patients (93.33%). Ten patients remain undiagnosed (6.66%). The most common cause was chronic appendicitis in 68(44.4%), followed by ovarian disorders 35(22.9%). There was a significant improvement in mean pain scores between the pre-and post-operatively periods [6.765±1.116 Vs. 2.961±1.572 (p-value< 0.001)]. Conclusion: Diagnostic laparoscopy has a higher diagnostic and therapeutic accuracy in patients with chronic abdominal pain. It significantly improves post-operative pain.

Abstract This paper describes a study where an argon cold plasma jet, generated by a dielectric‐barrier discharge (DBD), is combined with nanosecond laser ablation (248 nm, 25 ns, 10 Hz) to deposit silver particle aerosols onto the substrate at atmospheric pressure. The deposition of the particle is examined using various microscopy techniques and absorption spectroscopy for the plasma jet produced by operating DBD in the normal and reversed mode. Plasma facilitated the deposition process by delivering the particle to the substrate and significantly influenced its morphology depending on the jet interaction, length, and substrate position. In both cases, the particles are clustered; however, there is less deposit for the plasma ignited in the reverse mode. The theoretical analysis of the deposition process is performed using ANSYS software and evaluated in terms of plasma‐induced flow velocity. This study infers that the hybrid plasma‐laser deposition scheme considered is attractive for material processing and deposition, especially overextended substrate distances, and for altering the properties of the deposited particles for practical utilization in surface‐enhanced Raman spectroscopy, solar cells, and catalysis.

Objective: To assess the outcome in patients with diabetic foot osteomyelitis being treated with antibiotics alone with those being treated with antibiotics coupled with conservative surgery. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi from Feb to Aug 2016. Methodology: Sixty patients with diabetic foot osteomyelitis, fulfilling inclusion criteria, were included in this study. They were divided into two groups of 30 each. The "Antibiotic-Group” received only antibiotics while, the "Surgical-Group" underwent surgery in addition to antibiotics. Results: There were 37 males (61.66%) and 23 females (38.33%). The average age of patients was 59.72±9.79 years. 20 patients (66.67%) had full recovery in the Surgical-Group, and in the Antibiotics-Group, 18 patients (60%) had healed wounds (pvalue=0.599) Conclusion: The outcome of antibiotics only and conservative surgery plus antibiotics is similar.

In the last decade, there has been an increase in research on ecologically benign, cost-effective, and socially useful cement alternative materials for concrete. Alternatives involve industrial and agriculture waste, the potential advantages of which may be recognized by recycling, repurposing, and recreating techniques. Important energy reserves and a decrease in Portland cement (PC) consumption may be attained by using these wastes as supplementary and substitute ingredients, contributing to a reduction in carbon dioxide (CO2) production. Consequently, the incorporation of marble dust powder (MDP) and calcined clay (CC) as supplementary cementitious material (SCM) in high strength concrete may lower the environmental effect and reduce the amount of PC in mixes. This study is conducted on concrete containing 0%, 5%, 10%, 15%, and 20% of MDP and CC as cementitious materials alone and in combination. The main objectives of this investigations are to examine the effect of MDP and CC as cementitious materials on the flowability and mechanical characteristics of high strength concrete. In order to examine the ecological effect of CC and MDP, the eco-strength efficiency and embodied carbon were considered. In this context, there are so many trial mixes were performed on cubical specimens for achieving targeted compressive strength about 60 MPa after 28 days. After getting it, a total of 273 concrete specimens (cubes, cylinders, and prisms) were used to test the compressive, splitting tensile, and flexural strength of high strength concrete correspondingly. Moreover, when the amount of MDP and CC as SCM in the mixture grows, the workability of green concrete decreases. In addition, the compressive strength, flexural strength, and splitting tensile strength are increased by 6.38 MPa, 67.66 MPa, and 4.88 MPa, respectively, at 10% SCM (5% MDP and 5% CC) over a period of 28 days. In addition, using ANOVA, response prediction models were generated and confirmed at a 95% level of significance. The R2 values of the models varied from 96 to 99%. Furthermore, increasing the amount of CC and MDP as SCM in concrete also reduces the amount of carbon embedded in the material. It is recommended that the utilization of 10% SCM (5% MDP and 5% CC) in high strength concrete is providing optimum outcomes for construction industry in the field of Civil Engineering.