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Aim: To determine various surgical presentation of abdominal tuberculosis Study design: cross sectional study Place and duration: This study was conducted at Peoples University of Medical & Health Sciences for Women (PUMHS-W) Nawabshah Pakistan from October 2017 to march 2020. Methodology: The data in this study were from cases of abdominal TB that were admitted as an acute or subacute abdominal emergency. The data of the patients were analyzed using SPSS version 22. Descriptive analysis was used to examine the data. The data was presented using numbers and percentages. Results: Females made up 62.66 % of the 150 cases. A total of 55.33 % of the cases were between the ages of 30 and 50 years. No history of TB was shown in 60.66% of the cases and a history of pulmonary TB was found in 26.66 % of the cases. In 96.66% of patients, abdominal pain was present, followed by vomiting in 52 % and fever in 22 %. 60.66 percent of the cases were classified as having subacute intestinal obstruction, whereas 39.33 % had acute abdominal symptoms. The most common symptom was abdominal pain, and the most common clinical presentation was subacute intestinal obstruction. Early identification is crucial for avoiding intestinal TB's systemic and local effects. Conclusion: Intestinal obstruction was the most common clinical presentation of abdominal tuberculosis followed by intestinal obstruction. Acute abdominal TB is one of the most common causes of acute abdomen in endemic areas, as intestinal TB is a common extrapulmonary manifestation of TB. The key to avoiding systemic and local consequences of intestinal TB is early detection. Keywords: Abdominal, Clinical presentation, Intestinal, Symptoms, Tuberculosis

Education is considered as an authentic tool for rapid nation building, empowerment, prosperity and economic development. The quality of education remained main issue for Policy makers and curriculum designer. Policy makers have dedicated huge amount of time and energy to provide quality education. Mainly focus of quality betterment relies was associated with infrastructural development like, buildings, furniture, laboratories, libraries and play grounds. In this relation, curriculum designing, hiring of new trained teacher, external environment, nutrition, poverty alleviation also remained priority for betterment of education. But the major element of education is related with student psychology. One major factor is being over shadowed; the motivation of the students, even with the best administrators, highly qualified faculty, curriculum and materials in place, if students are not motivated, to learn and excel, the achievement of goal will become difficult. Therefore, current study major purpose was to investigate the impact of teacher’s behavior on the motivation of students at high school. The study based on inductive approach. The quantitative technique was employed for data collection. The data were analyzed through statistical package for social science 24 version for windows. The findings of study revealed that impact of teacher’s behavior on the motivation of students is positively associated. The teacher motivation has great impact on student attitude, learning, understanding and mental development. Therefore, policy makers, curriculum designers should focus on motivation of students. Article visualizations

This study investigated the social anxiety and social competence as determinants of bullying student’s behavior of among college students in Pakistan. To define the level of social anxiety and bullying behavior of students which self, peers, regard fatalities as having poorer social skills through 20 behavior’s/competences. A convenience sample of 230 pupils aged between 12 to 14 years (130 girls and 100 boys) provided self-report and peer-report data. They were taken from four colleges of Hyderabad city Sindh Pakistan, like as I mentioned zubaida government degree Girls College Hyderabad, Hayat Girls College Hyderabad, Government Boys degree College Qasimabad, Government degree College kohsar Hyderabad. Furthermore the researcher has used quantitative method survey questionnaire distribute to the respondents for data collection. Analysis through SPSS version 26 Post hoc multiple comparisons of social anxiety and social competence of bullying behavior of students experiences with social anxiety in college students. Study situations using Mann–Whitney U tests demographic information of respondent’s, analysis reliability analysis. In results researcher has found some of the main cause behind this study social anxiety and bullying behavior of students playing negative role in the society. This research will be fruitful for the scholars and policy makers. Article visualizations

The simultaneous estimation of Cronbachs alpha coefficients from q populations under the compound symmetry assumption is considered. In a multi-sample scenario, it is suspected that all the Cronbac...

Introduction: Gallstones patients are mostly asymptomatic, but yet, it addsconsiderable burden to health care system as only in United States more than 600000laparoscopic cholecystectomies are performed annually. The introduction of day care withlaparoscopic (LC) surgery in the late 1980s increased the rate of cholecystectomy for about20%. This new intervention introduced changes in indications of cholecystectomy and putfurther impact on health care system. After the introduction of LC, many studies have highlightedand discussed the importance of adequate surgical skills in order to improve the timing andoutcome of surgery. The aim of this study was to see the conversion from laparoscopic to opensurgery in symptomatic patients. Study Design: Descriptive Cross Sectional Study. Period:January 2013 to 2015. Setting: Surgical unit I of Peoples Medical College Hospital Nawabshah.Methods: Study population consists of two hundred cases having non probability consecutivepatients of cholelithiasis who were eligible on inclusion criteria. Results: The conversion ratewas 10 %, seven (3.5%) patients had biliary injury, six (3%) had adhesions, four (2%) patienthad vascular injury, two (1%) patients had gut injury, one (0.5%) patient had dilated commonbile duct. Conclusion: Proper pre-operative assessment and proper anatomical recognition ofCalot’s triangle reduce the rates in conversion from laparoscopic to open surgery.

Introduction: The cleansing of intestinal contents, were considered the mostimportant factor in the prevention of complications by most of the surgeons. While morbidityand mortality have been a matter of main concern in colorectal surgery during the past severaldecades. Despite these drawbacks mechanical bowel preparation is till practiced by most ofthe colorectal surgeons worldwide in elective colorectal surgery. So the aims of this study wereto find out the frequencies of wound infections, hospital stay, anastomotic leak and wounddehiscence’s in patients of two cohorts underwent elective colorectal surgery. Study Design:Prospective randomized control trial (RCT) study after having informed consent of participationas per described policy. Setting: Surgical Unit – I of People’s University of Medical and HealthSciences Nawabshah. Period: January 2012 to March 2016. Methods: 112 patients of bothgenders from 20-65 years in age, who underwent for Elective open colorectal surgery. In MBP,Sulphate and electrolyte free 136gm of polyethylence glycol (PEG) / two sachets with three litersof water were begun over 12 to 16 hours, the day before surgery in cohorts A only. Results:Regarding outcomes, wound infections were 12.5% and 16% in group A & B respectively. Therewas no remarkable difference in post-operative length of hospital stay with mean stay of 8+2and 9+2 in group A & B respectively. While disruption of anastomosis were 5.3% and 9% ingroup A & B respectively, while the frequency of incisional hernia was same in both groups.Conclusion: There is no benefit of enduring MBP in Elective Colorectal Surgery and can safelybe performed without it.

In this article, we have developed asymptotic theory for the simultaneous estimation of the k means of arbitrary populations under the common mean hypothesis and further assuming that corresponding population variances are unknown and unequal. The unrestricted estimator, the Graybill-Deal-type restricted estimator, the preliminary test, and the Stein-type shrinkage estimators are suggested. A large sample test statistic is also proposed as a pretest for testing the common mean hypothesis. Under the sequence of local alternatives and squared error loss, we have compared the asymptotic properties of the estimators by means of asymptotic distributional quadratic bias and risk. Comprehensive Monte-Carlo simulation experiments were conducted to study the relative risk performance of the estimators with reference to the unrestricted estimator in finite samples. Two real-data examples are also furnished to illustrate the application of the suggested estimation strategies.

In this article, a large sample pooling procedure is considered for the reliability function of a Weibull distribution. Asymptotic properties of shrinkage estimation procedures based on the preliminary test are developed. It is shown that the proposed estimator has substantially smaller asymptoticmean squared error (AMSE) than the usual maximumlikelihood (ML) estimator inmost of the parameter space. Analytic AMSE expressions of the proposed estimators are obtained and the dominance picture of the estimators is presented by comparing them. It is shown that the suggested estimators yield a wider dominance range over theML estimator than the usual pretest estimator and give a meaningful size of the pretest. To appraise the small sample performance of the estimators, detailed Monte-Carlo simulation studies are also carried out.

Objectives: To evaluate the management strategies of patients with ileocaecaltuberculosis. Study Design: Cross sectional multi-institutional study. Period: One year. Setting:Liaquat University Hospital Hyderabad / Jamshoro and Peoples University Hospital Nawabshah.Patients and Methods: All the patients of ≥11 years of age, either gender diagnosed asileocaecal tuberculosis were recruited, enrolled and evaluate for management strategies. Thedata was analyzed in SPSS 16 and the frequency and percentage was calculated. Results:During one year study period total 85 patients were identified and diagnosed as ileocaecaltuberculosis. The mean age ±SD for whole population was 39.72±7.73 while it was 37.87±8.83and 40.88±8.52 in male and female population whereas the mean ± SD for duration ofsymptoms of whole study population was 5.52±1.61 months respectively. Sixty nine (81%)patients managed surgical while 16 (19%) managed conservatively. The non specific symptomsi.e. fever, pain and tender abdomen, loss of weight and appetite was observed while 70%subjects had Hb% was 40 mm/1st hour whereascommon radiological impression observed were narrowing of terminal ileum, pulled up caecumand obtuse ileocaecal angle. Conclusion: Ileocaecal tuberculosis management includesconservatives and surgical, the surgical options are ileocaecal resection, right hemicolectomiesand stricturoplasty

Under the homogeneity assumption of k reliability functions from a two-parameter Weibull distribution, we have developed the asymptotic theory for the simultaneous estimation of reliability functions. Improved estimation strategies based on the Graybill Deal, preliminary test and the James-Stein type shrinkage principles are discussed. Using the sequence of local alternatives and squared error loss function, we have derived the asymptotic distributional quadratic bias and risk of the said estimators. A comparison in terms of risk has also been carried out among the listed estimators relative to the benchmark maximum likelihood estimator. To be more specific, we have pointed out the regions where our suggested estimators perform better than other estimators. A comprehensive Monte-Carlo simulation study is presented to validate the behavior of various estimation methods in terms of simulated relative efficiency along with a real-data application.

… Background: Acute appendicitis continues to be the most common surgical problem till date and its diagnosis in this era of advance innovation still remains to be on lock horns, resulting in the high rates of negative appendectomy. In this perplexed dilemma the designed scoring systems have been forwarded to aid the clinical accuracy in patients for suspicious appendicitis.The appendicitis Inflammatory Response (AIR) score has outperformed the more widespread Alvarado scoring (ALS) in many documented studies. So, the aim of this study was to evaluate and compare the AIR score with ALS system for diagnostic accuracy in patients with suspicious appendicitis. Study Design: Prospective comparative study to evaluate the AIR and ALS at score of (5 – 8) in 150 patients with suspected appendicitis. Setting: Tertiary care hospital. Period: March 2016 to January 2018. Methods: The score were measured and compared for diagnostic accuracy through statistical analysis. Results: This prospective study has drawn an inference that AIR scoring system for suspicious appendicitis has slightly higher percentage (91.07%) of sensitivity compared to ALS system (86.36%). This study enunciates the positive, negative predictive values for profound accuracy of diagnosis with 91.07%, 73.68% and 86.67% by AIRs and 86.36%, 62.50% and 80% by ALS systems (ALs) respectively. Among 150 patients, 30 (20%) were with negative appendectomies. Conclusion: The data of present study appreciate that:AIRs system having variable of CRP and WBC has high diagnostic accuracy in comparison to ALS system of patients with suspected appendicitis.AIRs can safely protect the health care resource by avoiding un-necessary hospitalization, Investigations and interventions.

Objectives: To determine the frequency and clinical pattern of mass in rightiliac fossa. Study Design: Cross sectional multicenter study. Period: One year (from 03 March2014 to 02 March 2015). Setting: Patients with right iliac fossa mass of >11 years of and ofeither gender admitted in department of surgery at Liaquat university hospital Hyderabad /Jamshoro and Peoples University Hospital Nawabshah. Patients and methods: The data wasanalyzed in SPSS 16 and the frequency and percentage was calculated. Results: During oneyear study period, out of 227 patients, 112 subjects were observed to have right iliac fossa massdue to different etiologies, of which 82(73.2%) were males and 30 (26.8%) were females. Themean age ±SD for overall population was 39.32±8.66 while it was 37.88±6.75 and 38.93±7.72in male and female population respectively. The male population was predominant while thepatterns observed were appendicular mass in 19(17%), appendicular abscess in 26(23.21%),ileocaecal tuberculosis in 38(34%), carcinoma caecum in 14(12.5%), psoas abscess in 5(4.46%)and others in 10(9%) respectively. Conclusion: The highest incidence of mass in the right iliacfossa was seen in second, third and four decades with male population predominance. Thecommon disorders identified were ileocaecal tuberculosis, appendicular mass and abscessand carcinoma caecum respectively

This article addresses the problem of parameter estimation of the logistic regression model under subspace information via linear shrinkage, pretest, and shrinkage pretest estimators along with the traditional unrestricted maximum likelihood estimator and restricted estimator. We developed an asymptotic theory for the linear shrinkage and pretest estimators and compared their relative performance using the notion of asymptotic distributional bias and asymptotic quadratic risk. The analytical results demonstrated that the proposed estimation strategies outperformed the classical estimation strategies in a meaningful parameter space. Detailed Monte-Carlo simulation studies were conducted for different combinations and the performance of each estimation method was evaluated in terms of simulated relative efficiency. The results of the simulation study were in strong agreement with the asymptotic analytical findings. Two real-data examples are also given to appraise the performance of the estimators.

Objective: This prospective study was designed to see the outcomes in two different types of surgical repairs (suture or mesh) of primary ventral hernia. Methods: A total of 70 adult patients under went for elective primary ventral hernia suture or mesh repair at surgical unit-I of Peoples Medical College Hospital Nawabshah and Surgical Unit-I from March-2010 to Feb-2016 were included in this study on the basis of inclusion – exclusion criteria. Patient’s demographic characteristics, operative details, post-operative out-comes (complications and recurrence) were studied. Results: A total number of 70 consecutive patients having primary ventral hernia under went for an elective open repair either with suture (32/45.7%) or synthetic mesh (38/54.3%) were evaluated in this study. Among these patients 52 (74.2%) and 18 (25.8%) were female and male respectively, with mean age of 51.5 ± 12. A total of 3(7.89%) patients had recurrence with Mesh Repair and 06(18.75%) with suture repair at 3 years follow-up, p-value = 0.176. Conclusion: The mesh repair in ventral hernia has low wound complications and less recurrence of the hernia when compared with suture technique.

Objective: The objective of this study was to find out frequency of anastomotic leak at a hospital and deplore the morbidities, duration of hospital stay.Methods: A total of 102 patients of both genders from 18 – 60 years in age underwent for bowel resection and anastomosis through laparotomy incision at surgical unit one of People’s University of Medical & Health Sciences, Nawabshah, from January 2013 to December 2016 were enrolled in this cross-sectional study. Every patient received appropriate antibiotics for duration according to need post-operatively. Follow-up was every fortnightly for four months to evaluate the primary outcome as prevalence of leak and secondary outcome as morbidities, length of hospital stay incisional hernia and mortality.Results: The results showed that, out of 102 patients underwent open primary hand sewn gastro intestinal anastomosis, 16 (15.68%) were found with anastomotic leak. Among these 16 patients having anatomic leak, 11 (11%) were male & 5 (5%) were female. While, mortality occurred in 05 (5%%) patients.Conclusions: Anastomotic leak following gastrointestinal anastomosis is less complication in this study. Further studies are requested with large data and more follow-ups to ensure the findings of this study at national level.

Objective: Over bearing, appendectomies have continuously been pushing the surgical wisdom to connote on non-operative option of treatment so this study was designed with an objective to assess the outcomes of antibiotics as primary therapy for un“complicated acute appendicitis. Methods: A total of 96 patients of both genders from 16 to 60 years of age having uncomplicated acute appendicitis enrolled in this study were treated with antibiotics and were discharged on third day with having oral treatment on ciprofloxacin (500mg) twice a day and metronidazole (400mg) thrice a day for 07 days. Routine follow up was taken on days 15, 30, 90 180 and 360 and outcomes were recorded. Results: Among 96 patients, 10 (10.41%) worsened in symptoms (pain on visual analogue scale) were confirmed with WBC & Ultrasound reports and under went for appendectomies during initial hospital stay. While within 9 months, during follow up 11 (11.45%) patients were readmitted in hospital and operated after confirmation on re-examination and re- investigations. Total of 21 (22%) patients were subjected to appendectomy. Conclusion: Under proper observation, antibiotic treatment can be safe and effective in un-complicated acute appendicitis with reduced recurrence.

Excessive exchange rate volatility has a deleterious effect on international financial flows, external trade, investment and output. Among others, these economic costs prompt the central bank in emerging countries to contain excessive exchange rate volatility through intervention in the foreign exchange market. This article investigates the effectiveness of State Bank of Pakistan's (SBP) daily foreign exchange intervention starting from 3 July 2000 to 31 December 2005 (1593 trading day observations). The method of Generalized Autoregressive Conditional Heteroscedasticity, with exogenous variables (GARCH-X), used in this article, shows that SBP's intervention operation is very effective as it not only affects the exchange rate levels but also reduces the exchange rate volatility. It is also found that the short-term interest rate and the size of the foreign exchange reserves held by SBP also affect the exchange rate level and its volatility. Increase in short-term interest rate and higher foreign exchange ...