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Abstract Accurately predicting the remaining useful life (RUL) of lithium-ion (Li-ion) batteries is vital for improving battery performance and safety in applications such as consumer electronics and electric vehicles. While the prediction of RUL for these batteries is a well-established field, the current research refines RUL prediction methodologies by leveraging deep learning techniques, advancing prediction accuracy. This study proposes AccuCell Prodigy, a deep learning model that integrates auto-encoders and long short-term memory (LSTM) layers to enhance RUL prediction accuracy and efficiency. The model’s name reflects its precision (“AccuCell”) and predictive strength (“Prodigy”). The proposed methodology involves preparing a dataset of battery operational features, split using an 80–20 ratio for training and testing. Leveraging 22 variations of current (critical parameter) across three Li-ion cells, AccuCell Prodigy significantly reduces prediction errors, achieving a mean square error of 0.1305%, mean absolute error of 2.484%, and root mean square error of 3.613%, with a high R-squared value of 0.9849. These results highlight its robustness and potential for advancing battery health management.

Abstract Background and purpose This comparative systematic review and meta-analysis investigated the incidence of ischemic stroke in intermediate-to-high-risk patients undergoing transcatheter aortic valve replacement versus surgical aortic valve replacement. Methods We conducted a systematic review and meta-analysis following the PRISMA guidelines, searching PubMed, Google Scholar, Embase, Web of Science, and Cochrane CENTRAL databases from their inception to December 2023. The evaluated outcomes were primarily incidence of stroke and transient ischemic attack (TIA), along with other secondary safety end-points at 30 days and 1 year post-procedure. Odds ratios (ORs) with 95% confidence intervals (CIs) were utilized for each study, employing a random-effects model for data synthesis irrespective of heterogeneity. Statistical heterogeneity was assessed using I2 statistics. All statistical analyses were conducted using Review Manager. Results We screened 8028 articles and included 8 studies consisting of 5 randomized controlled trials and 3 observational studies. The studies examining 30-day and 1-year stroke incidence found no significant difference between TAVR and SAVR patients (OR 0.83, 95% CI 0.59 to 1.17, p = 0.30, OR 0.92, 95% CI 0.64 to 1.33, p = 0.67, respectively). Both TAVR and SAVR also had a comparable risk of having a transient ischemic attack within 30 days (OR 0.93, 95% CI 0.24 to 3.63, p = 0.92, I2 52%) and 1 year (OR 1.15, 95% CI 0.72 to 1.82, p = 0.56, I2 0%) following the procedure. Regarding safety endpoints, TAVR had lower rates of all-cause mortality and acute kidney injury at 1 year post-procedure, but a higher incidence of major vascular complications at both 30 days and 1 year compared with SAVR. Conclusion The results suggest that TAVR and SAVR have comparable outcomes for both TIA and stroke incidence at 30 days and 1 year post-procedure, but display varying safety profiles in intermediate-to-high surgical risk patients.

Abstract Aim Dengue fever (DF), carried by Aedes mosquitoes, affects millions worldwide. Platelet-inducing human IL-11 analogues may be effective in treating DF-associated thrombocytopenia. Methodology A prospective study was done at Dr. Ziauddin Hospital, a tertiary care hospital in Karachi, Pakistan, from September 2023 to April 30, 2024. Results This study recruited 300 DF patients characterized by thrombocytopenia (platelet count

Abstract Background Cardiogenic shock (CS) is associated with high in‐hospital mortality. Objective assessment of its severity and prognosis is paramount for timely therapeutic interventions. This study aimed to evaluate the efficacy of the shock index (SI) and its variants as prognostic indicators for in‐hospital mortality. Methods A retrospective study involving 1282 CS patients were evaluated. Baseline patient characteristics, clinical trajectory, hospital outcomes, and shock indices were collected and analysed. Receiver operating characteristic (ROC) curves were employed to determine the predictive accuracy of shock indices in predicting in‐hospital mortality. Results Of those evaluated, 866 (67.6%) survived until discharge. Non‐survivors were older (66.0 ± 13.7 vs. 57.4 ± 16.2, P

Abstract Breast cancer (BC) is a malignant neoplasm which is classified into various types defined by underlying molecular factors such as estrogen receptor positive (ER+), progesterone receptor positive (PR+), human epidermal growth factor positive (HER2+) and triple negative (TNBC). Early detection of ER+ and TNBC is crucial in the choice of diagnosis and appropriate treatment strategy. Here we report the key genes associated to ER+ and TNBC using RNA-Seq analysis and machine learning models. Three ER+ and TNBC RNA seq datasets comprising 164 patients in-toto were selected for standard NGS hierarchical data processing and data analyses protocols. Enrichment pathway analysis and network analysis was done and finally top hub genes were identified. To come with a reliable classifier which could distinguish the distinct transcriptome patterns associated to ER+ and TNBC, ML models were built employing Naïve Bayes, SVM and kNN. 1730 common DEG’s exhibiting significant logFC values with 0.05 p-value threshold were identified. A list of top ten hub genes were screened on the basis of maximal clique centrality (MCC) which included CDC20, CDK1, BUB1, AURKA, CDCA8, RRM2, TTK, CENPF, CEP55 and NDC80.These genes were found to be involved in crucial cell cycle pathways. k-Nearest Neighbor (kNN) model was observed to be best classifier with accuracy 84%, specificity 66% and sensitivity 95% to differentiate between ER+ and TNBC RNA-Seq transcriptomes. Our screened list of 10 hub genes can thus help unearth novel molecular signatures implicated in ER+ and TNBC onset, prognosis and design of novel protocols for breast cancer diagnostics and therapeutics.

Abstract Drought is one of the foremost outcomes of global warming and global climate change. It is a serious threat to humans and other living beings. To reduce the adverse impact of drought, mitigation strategies as well as sound projections of extreme events are essential. This research aims to strengthen the robustness of anticipated twenty-first century drought by combining different Global Climate Models (GCMs). In this article, we develop a new drought index, named Maximum Relevant Prior Feature Ensemble index that is based on the newly proposed weighting scheme, called weighted ensemble (WE). In the application, this study considers 32 randomly scattered grid points within the Tibetan Plateau region and 18 GCMs of Coupled Model Intercomparison Project Phase 6 (CMIP6) of precipitation. In this study, the comparative inferences of the WE scheme are made with the traditional simple model averaging (SMA). To investigate the trend and long-term probability of various classes, this research employs Markov chain steady states probability, Mann–Kendall trend test, and Sen’s Slope estimator. The outcomes of this research are twofold. Firstly, the comparative inference shows that the proposed weighting scheme has greater efficiency than SMA to conflate GCMs. Secondly, the research indicates that the Tibetan Plateau is projected to experience “moderate drought (MD)” in the twenty-first century.

BackgroundLabor induction is a common obstetric intervention, increasingly performed worldwide, often using prostaglandins like misoprostol and dinoprostone.ObjectiveThis study aims to compare the effectiveness and safety of intravaginal misoprostol versus dinoprostone for inducing labor, examining their impact on various maternal and neonatal outcomes.MethodsA systematic review and meta-analysis were conducted using four databases—PubMed, Google Scholar, EBSCO, and the Cochrane Library—from January 2000 to April 2023. We included randomized controlled trials (RCTs) involving singleton pregnancies at term (37–42 weeks) with unfavorable cervices, where intravaginal misoprostol was compared to dinoprostone. Key outcomes evaluated for effectiveness included vaginal delivery within 24 h, overall vaginal delivery rate, and need for oxytocin augmentation. Safety outcomes assessed were tachysystole, uterine hyperstimulation, abnormal cardiotocography, NICU admissions, cesarean delivery, and APGAR scores. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model in Review Manager (RevMan) version 5.4.1.ResultsEight RCTs with a total of 1,801 participants (937 in the misoprostol group and 864 in the dinoprostone group) met the inclusion criteria. Misoprostol required a significantly less oxytocin augmentation than dinoprostone [RR = 0.83; 95% CI (0.71, 0.97), p = 0.02]. Other outcomes, including rates of cesarean delivery, uterine tachysystole, hyperstimulation, and NICU admissions, showed no significant differences between the two groups, indicating comparable safety and efficacy profiles.ConclusionThis meta-analysis demonstrates that intravaginal misoprostol is an effective and safe alternative to dinoprostone for labor induction at term. Misoprostol achieved comparable efficacy and safety outcomes while requiring less oxytocin augmentation, supporting its potential as a practical induction agent in clinical settings.

This article discusses the growing burden of smog in Pakistan, tracing its origins to vehicular emissions, industrial pollutants, and agricultural practices. It highlights current national initiatives and advocates for enhanced government interventions to mitigate smog's adverse effects on ocular health. It also emphasizes the need for collective action to safeguard ocular health amid rising smog pollution in Pakistan.

We critically explored the use of Normalisation Process Theory (NPT) in the evaluation of a co-designed intervention toolkit for Healthy Ageing through Innovation in Rural Europe (HAIRE). The toolkit was co-designed and implemented in rural communities in Belgium, France, the Netherlands and the United Kingdom. NPT was applied as a novel analytical framework to shed light on key practices and processes that supported implementation. Further, the paper discusses how social innovation research helps frame co-designing such interventions with local communities. During the study, 25 semi-structured interviews were conducted with project partners and volunteers who were involved in toolkit co-design and implementation. A need for co-designing toolkits that explore ageing holistically was identified. Holistic understandings of ageing can be developed by paying attention to person-centred and place-based (context-specific) aspects of ageing. Finally, we illustrate how NPT can guide future evaluation frameworks as it offers the flexibility required to understand context-specific implementation.

The Internet of Things (IoT) has revolutionized the way we connect and interact with the world around us, bringing unprecedented levels of automation, convenience, and efficiency. As this transformative technology continues to evolve, researchers and industry experts are exploring emerging trends and technologies that have the potential to shape the future of the IoT landscape. In this article, we provide a brief overview of the current state of IoT and delve into key areas of innovation, including edge computing, artificial intelligence (AI), 5G connectivity, blockchain, and sustainable energy harvesting. These advancements hold immense promise in addressing challenges, enhancing security, enabling real-time applications, and fostering sustainability within the IoT ecosystem. Understanding and harnessing these emerging trends is crucial for unlocking the full potential of the IoT and driving its continued growth and impact on various industries and everyday life. Keywords: Internet of Things, IoT, edge computing, artificial intelligence, machine learning, 5G connectivity, blockchain, energy harvesting, sustainability.

Background. COVID-19 is a virus that affects the respiratory system most commonly. However, cases of widespread effects of COVID-19 on the human body have been emerging. During our search, we found that COVID-19 associated encephalitis has been reported in literature as a severe complication of COVID-19 infection. Case report. We report a case of COVID-19 associated encephalitis. Our patient had extensive inpatient morbidity because of this illness. Conclusions. We believe that COVID-19 associated encephalitis is a condition with high mortality and very limited data about risk factors, diagnosis and treatment, and, as such, more studies are needed to enhance medical knowledge regarding this disease.

Abstract Aims Patients with chronic kidney disease (CKD) or heart failure (HF) are disproportionally affected by frailty, an independent predictor of morbidity. The prevalence of frailty and its impact on quality of life (QoL) in a unique population of patients with both CKD and HF (CKD‐HF) is unclear. The aim of this study was to investigate the association between frailty and QoL in patients with CKD‐HF. Methods and results Patients were identified from a tertiary care cardiorenal clinic. Eligible patients had CKD‐HF with a stable estimated glomerular filtration rate of

The synergy of neuroleadership and Islamic values is crucial in addressing leadership challenges posed by Generation Z, particularly in combating toxic leadership, negative culture, and turnover. Generation Z's unique behaviors require leaders who combine neuroleadership and Islamic values to inspire and create positive environments. However, a lack of studies in Indonesia, the largest Muslim-majority country, highlights a significant research gap. Using a mixed-method approach, this study investigates how Islamic values and neuroleadership influence leadership skill development. We conducted focus group discussions with 60 participants and surveyed 317 active members of the biggest Islamic organization in Indonesia, aged 17–23, to test the hypotheses. The results show that both neuroleadership and Islamic values affect leadership skills. Among the eight neuroleadership indicators, transfer and caring are the most influential in shaping leadership skills. Additionally, in accordance with Islamic values, fairness and tolerance are key factors for effective leadership. Generation Z seeks to be heard and understood. While they may lack problem-solving skills, they excel in fairness, tolerance, and relationships.

BACKGROUND: Achilles tendinopathy is a condition affecting the Achilles tendon, causing discomfort, swelling, and decreased function. It’s common in middle-aged athletes and runners, with overuse injuries increasing due to increased sports activity. Achilles tendinopathy causes significant pain and functional limitations in athletes. Hip muscle dysfunction may occur in athletes having Achilles tendinopathy. This study aims to determine hip muscle functional performance in athletes with Achilles tendinopathy, benefiting both athletes and the therapists by designing more effective rehabilitation protocols. OBJECTIVE: To determine functional hip muscle performance among athletes with Achilles tendinopathy. METHODOLOGY: A descriptive cross sectional study was conducted at 6 different sports clubs among athletes diagnosed with Achilles tendinopathy. Six months from June, 2023 to December 2023 was the total study’s duration. Through the technique of non-probability convenient sampling, 80 participants who fulfilled the inclusion criteria were selected for the data collection. Data was collected by using single leg squat test and the findings were analyzed by using its three point ordinal rating criteria. SPSS version 21 was used to analyze the data. Single leg squat test of injured and uninjured side and participant’s demographic characteristics were collected as a descriptive statistics. RESULTS: Out of the eighty participants, 8 showed good performance, 29 fair performances, and 43 poor performances on the injured side, while 23 showed good performance, 30 fair performances, and 27 poor performances on the uninjured side. P value was found to be 0.000 (

This study evaluates the performance of a geosynthetic reinforced soil integrated bridge system (GRS-IBS) in terms of total displacement by varying different design parameters simultaneously and also suggests optimum values of them. These parameters include, i. backfill internal friction angle (∅b) and reinforcement spacing (Sv), ii. Backfill internal friction angle (∅b) and geogrid axial stiffness (EA) at varying reinforcement spacing (Sv), iii. Backfill internal friction angle (∅b) and number of bearing bed layers, and the effect of retained backfill slope (mb). Simulations were conducted using PLAXIS 2D software. Analysis showed that the cumulative effect of these parameters had a significant effect on total displacement but after a certain point increase or decrease in their values showed no effect on the results while some parameters showed negligible effect on the deformation of the wall. Furthermore, due to the notable effect of ∅b, Sv and EA on the total displacement of the wall, the impact of these parameters was also investigated on the development of tensile force in the topmost layer of geogrid in GRS IBS. It was noted that the shape of the tensile force distribution graph was the same for all the cases and the order of the parameters in terms of their effect on tensile force was Sv > ∅b > EA. Also, a detailed analysis of tensile force development in all the layers of geogrids showed that if Sv ≤ 0.2 m, the spacing between reinforcement in the lower portion of GRS IBS can be increased as these layers showed approximately zero tensile load.

Objectives: This study evaluated relative vaccine effectiveness (rVE) of MF59-adjuvanted trivalent inactivated influenza vaccine (aTIV) vs high-dose trivalent inactivated influenza vaccine (HD-TIV) for prevention of test-confirmed influenza emergency department visits and/or inpatient admissions (“ED/IP”) and for IP admissions alone pooled across the 2017–2020 influenza seasons. Exploratory individual season analyses were also performed. Methods: This retrospective test-negative design study included United States (US) adults age ≥65 years vaccinated with aTIV or HD-TIV who presented to an ED or IP setting with acute respiratory or febrile illness during the 2017–2020 influenza seasons. Test-positive cases and test-negative controls were grouped by vaccine received. The rVE of aTIV vs HD-TIV was evaluated using a combination of inverse probability of treatment weighting and logistic regression to adjust for potential confounders. Results: Pooled analyses over the three seasons found no significant differences in the rVE of aTIV vs HD-TIV for prevention of test-confirmed influenza ED/IP (−2.5% [−19.6, 12.2]) visits and admissions or IP admissions alone (−1.6% [−22.5, 15.7]). The exploratory individual season analyses also showed no significant differences. Conclusions: Evidence from the 2017–2020 influenza seasons indicates aTIV and HD-TIV are comparable for prevention of test-confirmed influenza ED/IP visits in US adults age ≥65 years.

Background A multidisciplinary heart team (HT) approach to patients with complex coronary artery disease has a class IB recommendation, yet there are limited data on adherence to HT treatment recommendations and long‐term clinical follow‐up. The objective of this study was to assess adherence rates to HT recommendations and assess long‐term mortality rates among patients with complex CAD. Methods and Results Six hundred eighty‐four sequential HT cases for complex coronary artery disease from January 2015 to May 2017 were reviewed. After excluding cases with significant comorbid valve disease, baseline characteristics were compared based on HT treatment recommendations: optimal medical therapy, percutaneous coronary intervention, and coronary artery bypass grafting. Adherence rates were manually extracted, and 5‐year mortality rates were obtained from the Michigan Death Registry. Seventy‐two percent of 405 included patients were men (mean age 66±11 years), with high rates of medical comorbidities. Estimated surgical risk scores were lowest in the coronary artery bypass grafting group. Optimal medical therapy was recommended in 138 patients (34%), percutaneous coronary intervention in 95 (23%), and coronary artery bypass grafting in 172 (42%). Adherence to HT recommendations across groups was high (96%) and did not differ between treatment groups. Over 5 years of follow‐up, there were 119 deaths, resulting in a cumulative mortality rate of 29%. Conclusions In the largest HT cohort in the United States to date, high rates of adherence to HT recommendations were observed among high‐risk patients with coronary artery disease. High rates of adherence to HT recommendations were observed irrespective of treatment group recommendation, suggesting that HT recommendations were individualized and acceptable to both patients and physicians alike.

Human gastrointestinal infections caused by Campylobacter species is the second most important foodborne illness after salmonellosis worldwide. Poultry represent one of the main sources of Campylobacter organisms. In the present study, the short variable region of flagellin gene (SVR-flaA) typing was carried out to determine the variation among the circulating strains of Campylobacter jejuni and Campylobacter coli. The C. jejuni and C. coli isolated from poultry and poultry meat were screened for the presence of virulence determinants like cadF, flaA, cdtB, and wlaN gene. The screening for wlaN gene is crucial in view of the fact that most patients with Guillian Barre’s (GB) syndrome with a preceding history of diarrheal illness have been found to harbor wlaN gene−positive C jejuni strains. Out of the 200 samples comprising poultry meat and cloacal swabs, 21.5% of samples were found to harbor Campylobacter spp. of which 2.5% were Campylobacter jejuni, and 19% were confirmed as Campylobacter coli. The cadF, flaA, cdtB virulence genes were detected in all the Campylobacter spp. isolated in the present study. The presence of the wlaN gene in the Campylobacter jejuni isolated in the present study may pose a public health threat with long−term human health implications. The SVR-flaA typing of twelve Campylobacter isolates obtained in the present study revealed that Campylobacter coli flaA sequence OL471375 is a new strain with a novel allele type 1,675 and peptide sequence 5 which stands deposited in pubMLST database for Campylobacter. The other flaA-SVR gene sequences identified in this study were OL471369, OL471370, OL471371, OL471372, OL471373, and OL471374. Among twelve Campylobacter spp., three distinct DdeI-RFLP patterns were observed, each varying in size from 100 to 1,000 base pairs. Antimicrobial profiling of the Campylobacter spp. isolated in the present study revealed that 50% of the strains were multidrug resistant. All the Campylobacter spp. were resistant to ciprofloxacin (CIP), ampicillin (AMP), penicillin (PEN), and nalidixic acid (NAL) whereas 57.1% of strains were resistant to tetracycline (TET) and erythromycin (ERY) 28% to amoxicillin (AMX) and enrofloxacin (ENO), 85% to amikacin (AMK). The high degree of resistance to fluoroquinolones observed in the present study is crucial in view of fluoroquinolones being drugs of choice for the treatment of human Campylobacter infections.

Background: Hepatitis is a major health issue. The aim of this study was to assess the knowledge, attitude and practices (KAP) of medical students regarding hepatitis B and C. Methods:A descriptive cross-sectional study conducted from March, 2018 to May, 2018. 310 medical students from Allama Iqbal Medical College participated. KAP towards Hepatitis B and C was assessed by using a pre-validated questionnaire. Association of gender and year of study was established with KAP of respondents. Also, associations of knowledge with attitude and practices were also established using Chi-square test taking ≤0.05 as standard p-value. SPSS version 21.0 was used. Results:269 (86.77%) out of 310 distributed questionnaires were received. 116 (43.1%) respondents fell in age group 16-20, 150 (55.8%) in 21-25 years while 3 respondents (1.1%) were 25 year and above. 146 (54.3%) respondents were females and 123 (45.7) respondents were male. There were 54 (20.1%) respondents from first year, 59 (21.9%) respondents from second year, 53 (19.7%) respondents from third year, 55 (20.4%) respondents from fourth year and 48 (17.8%) respondents from final year. 132 (90.4%) female respondents and 98 (79.7%) male respondents had good knowledge regarding hepatitis B and C. No significant relationship was established between gender of respondents with their attitude and practices. As for relationship of knowledge of respondents with their attitude and practices, no significant association could be established.Conclusion: Overall, the medical students have adequate knowledge, sensible attitude but unsatisfactory practices in regards to Hepatitis B and C.

Pancreatitis is an inflammatory condition affecting the pancreas and is classified into 2 types, acute and chronic, which can manifest in various forms. This review article summarizes the role of predictive and prognostic values of inflammatory markers in the pathogenesis of acute pancreatitis, mainly focused on preclinical and clinical studies. It includes serum amyloid A (SAA), monocyte chemotactic protein-1 (MCP-1), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), C-reactive protein (CRP), IL-10, myeloperoxidase, pentraxin 3, and plasminogen activator inhibitor 1. SAA3 plays a crucial role in developing acute pancreatitis by triggering a receptor-interacting protein 3–dependent necroptosis pathway in acinar cells. Targeting SAA3 could be a potential strategy for treating acute pancreatitis. The recruitment of monocytes/macrophages and the activation of the systemic MCP-1 signaling pathway play a role in the progression of pancreatitis, and blocking MCP-1 may have a suppressive effect on the development of pancreatic fibrosis. The ESR can predict severe acute pancreatitis with slightly lower accuracy than CRP. When ESR and CRP levels are combined at 24 hours, they predict severe acute pancreatitis accurately. IL-6 plays a crucial role in activating the Janus kinase/signal transducers and activators of the transcription pathway, exacerbating pancreatitis and contributing to the initiation and progression of pancreatic cancer. Endogenous IL-10 plays a crucial role in controlling the regenerative phase and limiting the severity of fibrosis and glandular atrophy induced by repeated episodes of acute pancreatitis in mice. The predictive and diagnostic roles of these inflammatory factors in pancreatitis were introduced in detail in this review.

In the realm of material innovation, the remarkable versatility of thermoplastic-based highly filled composites emerges as a pivotal advantage for fabricating metal parts, seamlessly integrating design flexibility. This study delves into the fusion of design and manufacturing, spotlighting the convergence of material extrusion additive manufacturing (MEX) and metal injection moulding (MIM) processes through the adept utilization of three distinct in-house developed copper-feedstocks. Each feedstock had a different composition that influenced their processability; two feedstocks were for solvent and thermal debinding, and one was only for thermal debinding. The sintering was carried out under the same conditions for all produced specimens to assess the effect of binder composition on the properties of the sintered components. Structural integrity evaluations of sintered specimens encompassed 3-point bending, hardness tests, and metallography. It was possible to perform MEX with all produced filaments and MIM with the pellets of the same feedstocks and to obtain acceptable-quality specimens. Regardless of the shaping method, specimens shaped with binders containing a soluble binder survived the thermal and sintering steps. The specimens produced from the feedstock intended solely for thermal debinding experienced a nearly complete loss of shape during the debinding process. For the specimens that could be debound and sintered without defects, a relative density between ∼88 and 94 % was measured for MEX components and ∼93 and 95 % for MIM components after sintering. All sintered components showed the same diffraction peaks as pure copper powder, confirming that the reductive hydrogen atmosphere provided protection from contamination and reduced the oxides that could have appeared during thermal debinding in air. Moreover, adequate shrinkage of ∼10–18 % was observed in the sintered specimens. Vickers microhardness of the MEX and MIM sintered components were ∼32 HV and ∼36 HV, respectively. Compared to MEX, MIM-produced sintered components showed a higher maximum stress (i.e., σmax = 79 ± 3.2 MPa). These results demonstrate that the binder composition plays a crucial role in determining the success of metal MEX and MIM processes. Having the possibility to choose between MEX and MIM allows for greater design flexibility for copper parts.

Abstract Background Person-centered breastfeeding counseling is a key but often overlooked aspect of high-quality services. We explored women’s experiences of the Breastfeeding Heritage and Pride™ program, an evidence-based breastfeeding peer counseling program serving women with low incomes in the United States. Methods This study was conducted through an equitable community-clinical-academic partnership and guided by the World Health Organization (WHO) quality of care framework for maternal and newborn health, which highlights three domains of positive experiences of care: effective communication; respect and dignity; and emotional support. In-depth interviews were conducted with a purposive sample of women participating in the Breastfeeding Heritage and Pride™ program. Women were asked to describe their experiences with the program including examples of when good quality counseling was or was not provided. Each interview was conducted in English or Spanish, audio-recorded, and transcribed verbatim. Data were analyzed using reflexive thematic analysis. Once themes were generated, they were organized according to the three care experience domains in the WHO quality of care framework. Results Twenty-eight in-depth interviews were conducted with a racially/ethnically and socio-economically diverse sample of women. Three themes described effective communication practices of peer counselors: tailoring communication to meet women’s individual needs; offering comprehensive and honest information about infant feeding; and being timely, proactive, and responsive in all communications across the maternity care continuum. Two themes captured why women felt respected. First, peer counselors were respectful in their interactions with women; they were courteous, patient, and non-judgmental and respected women’s infant feeding decisions. Second, peer counselors showed genuine interest in the well-being of women and their families, beyond breastfeeding. The key theme related to emotional support explored ways in which peer counselors offered encouragement to women, namely by affirming women’s efforts to breastfeed and by providing reassurance that alleviated their worries about breastfeeding. These positive experiences of counseling were appreciated by women. Conclusions Women described having and valuing positive experiences in their interactions with peer counselors. Efforts to expand access to high-quality, person-centered breastfeeding counseling should, as part of quality assurance, include women’s feedback on their experiences of these services.

This paper presents a novel and insightful approach to beamforming a $2\times 2$ antenna array using the theory of characteristic modes. The array comprises four rectangular patch antenna elements designed on an FR-4 substrate resonating at 2.4 GHz. The characteristic mode analysis (CMA) presented a fascinating physical insight into the surface current directions and the radiation characteristics of the array structure. The excitation of a specific characteristic mode led to the design of a dual-beam antenna array. After feed excitation, characteristic mode analysis (CMA) was employed to understand multi-beam pattern reconfigurability in the multi-port structure. The information of distinct and orthogonal modal characteristic fields guides the beamforming of multibeam arrays. Modal characteristic fields of specific modes were identified using a modal weighting coefficient that may combine upon port phase change for beamforming at a certain scan angle. The potential of multi-dimensional coverage of a multibeam array is presented by selecting the different phase combinations of feeding ports. The paper discusses the strengths and limitations of beam scanning due to the combination of modes. This physical insight is beneficial for future pattern reconfigurable antenna array design procedures. Measurements on a realized prototype are in a good agreement with simulations, proving the proposed concept.

With ongoing advancements in natural language processing (NLP) and deep learning methods, the demand for computational and memory resources has considerably increased, which signifies the determination of efficient and compact models in resource-constrained environments. A comprehensive overview of the most recent advancements in pruning and quantization methods for deep neural networks is provided in this paper. Numerous cutting-edge techniques that harness the complementary advantages of pruning and quantization have been analyzed, highlighting their effectiveness in reducing model size, enhancing computational efficiency, and minimizing memory usage. These techniques include Quantization and Sparsity Aware Fine Tuning, Compression Learning by In-Parallel Pruning-Quantization, GroupReduce, Quantization-Pruned Attention, Structured Pruning, Normalized Linear Quantization (Prune and NLQ), Quantization and Pruning for Sentiment Analysis, an Automatic mixed-precision Quantization approach for BERT compression (AQ-BERT), Mixed Precision Quantization, Unstructured Pruning, and Quantization, and Magnitude Pruning. The datasets utilized, models employed, and outcomes achieved are taken into account within this research. The utilization of pruning and quantization techniques across diverse deep-learning tasks, NLP, and sentiment analysis are also discussed. Moreover, issues such as compatibility with hardware configurations, optimization complexities, accuracy degradation, and other constraints have been analysed. Several challenges and limitations of weight or unit pruning that are utilized for optimizing memory and quantization techniques to enhance precision are explored. The in-depth analysis of these state-of-the-art techniques and experiments provides a broad understanding. Furthermore, strategies to effectively reduce the computational and memory demands of neural networks without compromising their performance are also analysed.

The next generation (6G) wireless communication technology has super advantages in high transmission rates scenarios. Internet of Things (IoT) has been applied in recent years due to its wide connection. However, effective resource optimization methods must be analyzed to meet the high requirements of key performance indicators in 6G wireless IoT networks. This paper discusses a general investigation of the resource optimization strategies in the 6G IoT system. The study aims to find the main solutions to optimize 6G IoT network performance. First, an overall summary of current research is preferred resource optimization in latency, reliability, Energy Efficiency (EE), Spectrum Efficiency (SE), bandwidth utilization efficiency, rate, and power efficiency. Second, we propose the multi-indicator tradeoff strategies associated with the latest resource optimization approaches and investigate optimal strategies. Furthermore, we show the limitations of the current resource optimization methods and discuss the future works of resource optimization for IoT devices in 6G communication. Our survey aims to help researchers optimize 6G IoT network performance using advanced techniques.

A novel approach is presented for synthesizing radiation patterns of substrate-integrated waveguide leaky wave antennas in two stages. In the first stage, the antenna is considered an equivalent rectangular waveguide with slots, and a comprehensive equivalent circuit model is constructed. Varying slot configurations are accommodated by the developed equivalent circuit model. Each slot section is represented as an admittance with the incorporation of Elliott’s slot theory. Computations of the relative aperture fields are performed using circuit theory, and the far-field pattern is estimated through array theory. In the second stage, the circuit model is utilized for genetic algorithm-based optimization, enabling customization of the radiation pattern to meet specific requirements. The methodology has a computational advantage over full-wave simulations, resulting in a significantly faster and more efficient design process. Numerical verification through simulation of various examples and experimental validation through antenna fabrication are presented, affirming agreement between calculated and measured results. Remarkable effectiveness in antenna engineering can be attained for future wireless communication systems by using the proposed technique.

Background: Smoking has multisystem effects on human body due to hypoxia and systemic inflammation, which it produces. This contributory effect is observed in ocular tissues as well. The aim of the study was to evaluate retinal nerve fiber layer (RNFL) thickness in healthy individuals with a history of smoking, using optical coherence tomography (OCT). Methods: Patients healthy eyes n=300 were examined. Two groups were made; Group A with history of smoking (n=50) and Group B with no history of smoking (n=250). Subjects with a history of diabetes, hypertension, raised intra ocular pressure (IOP >21 mmHg), any neurological disease or family history of glaucoma were excluded from the study. Independent t-test was used to assess the thickness variation with smoking status. ANOVA was used to analyze the differences in both groups. p value

Background: Erythromycin, a commonly used antibiotic for various respiratory tract infections, is well documented for its hepatotoxic effect, which is probably due to the oxidative stress produced by this drug. Azadirachtica Indica, commonly known as Neem is a rich source of various bioactive compounds and has shown strong antioxidant effect in various researches. This study was designed to find out the effect of aqueous extract of Neem leaves on liver enzymes; Alanine transaminase (ALT) and Aspartate transaminase (AST) against liver damage caused by erythromycin. Methods: This study was conducted in Baqai Medical University, Karachi in 2017 spanning a period of 6 months. Eighty male albino wistar rats were taken randomly and were divided into 4 groups of 20 animals each; A(control), B (received erythromycin 100mg/kg body weight), C (received erythromycin 100mg/kg body weight plus aqueous Neem Extract at the dose of 500mg/kg body weight) and “D” (received only aqueous Neem Extract at 500mg/kg body weight). After 14 days of continuous treatment, rats were sacrificed and the blood samples were collected via cardiac puncture and then sent to the laboratory for the investigation of liver enzymes ALT and AST using standard reagent kits. Results: Serum ALT and AST enzymes were found to be decreased in group B and C. The results were Statistically significant. Conclusion: Azadirachtica Indica aqueous extract showed protective effect on erythromycin induced hepatic damage.

Background: The Covid-19 pandemic effected individuals worldwide. A significant number of specimens examined by pathologists are obtained from oropharyngeal region containing a highly viral titer along with increased preference of the virus to these tissues compared to other areas of the body requiring. The need of knowledge, attitudes such as appropriate Personal Protective Equipment (PPE) along with discarding of samples and adherence to protocols while dealing with these samples is necessary. Therefore, we aimed to assess the knowledge, attitude and practices of oral pathologists pertaining to modifications in laboratory protocols issued by various international organizations. Methods: A validated questionnaire with 22 close-ended questions was given to academic faculty, practicing pathologists and trainees of the pathology department working in a government institute (n=37). Statistics were applied and p

Background: Thyroid gland volume (TGV) is highly variable as it is greatly influenced by age, gender, anthropometric measurements and geographical location. It has become essential for every population to determine reference range of their normal thyroid gland volume (TGV) in healthy individuals. This in turn will help the population in grading of goiter and will guide in large scale iodine monitoring programs. Objective: To determine TGV in a subset of Karachi population and to determine its association with age and gender. Methods: A cross-sectional study employing 421 volunteers aged 21 years and above went through the ultrasound (US) examination of their thyroid gland (TG) after being confirmed euthyroid by their serum thyroid stimulating hormones (TSH) evaluation. Results: TGV in the study was found to be 6.26 ± 2.89 ml. Males had significantly higher TGV 6.78 ± 2.88 ml as compared to females 5.7 ± 2.79 ml (P=0.00). Volume of right lobe was significantly greater than that of left lobe (P=0.00) in both the genders. TGV increased significantly with age till 60 years (P

OBJECTIVES Few studies have captured the experiences of widening participation (WP) medical students, and none have compared their experiences to their non-WP peers. This study aims to identify which challenges WP students are more likely to face. METHODS A 22-item questionnaire was distributed to medical students across all UK medical schools. Students were asked yes or no questions on whether they faced challenges in finances, socializing, physical and mental health, academic attainment, and COVID19-related teaching changes. RESULTS One-hundred seventy-six medical students from all year groups across the UK responded, with 97 students from a WP background. WP students were significantly more likely to have their personal background impacting their mental health (OR = 2.65, P = 0.002), more than twice as likely to feel that their job impacted their studies (OR = 2.53, P ≤.05), more likely to feel limited by their financial situation (OR = 2.29, P ≤.05) and to receive support from student finance (OR = 2.08, P

Objective:Breast imaging for male patients is a controversial topic due to the high prevalence of gynecomastia compared to male breast cancer. Worldwide, men are undergoing more breast imaging despite the low incidence of male breast cancer. Gynecomastia is a benign condition, but the anxiety it causes and unnecessary medical costs are still high.Materials and Methods:In accordance with Royal College of Radiology guidelines, a retrospective study was performed in two cycles to determine if mammography or ultrasound should be included in the workup of male patients who were referred to a breast care unit for a lump that was deemed benign by doctors.Results:There was 100% concordance between clinical diagnosis and imaging findings.Conclusion:In this population imaging was not necessary in cases of probable gynecomastia and benign conditions found during a clinical assessment. Standardised patient assessment methods can improve care and ensure accurate evaluation.

Purpose: To examine the effects of radiation therapy on sexual health in cervical, breast, and prostate cancer patients. Methods: Four electronic databases (PubMed/PubMed Central, Google Scholar, Embase(Ovid), and SCOPUS) were searched, and articles published in English from January 1, 2011, through 2022 were extracted. Five reviewers independently selected primary studies that reported patient sexual health symptoms caused by cervical, breast, or prostate cancer following radiation therapy treatment. The primary outcome measures sexual health trends during or after radiation therapy through external beam radiotherapy or brachytherapy where applicable. Secondary outcomes measured predictive factors contributing to sexual health scores (age, race, and geographical location). Results: 32 studies with a total of 5033 individuals were included in the systematic review. Overall, 19 studies reported a reduction in sexual health trends, 8 reported mixed trends, and 4 reported no significant trends in sexual health. Of the 10 breast cancer studies, 6 reported decreased sexual well-being, 2 found no trends, and 2 stated mixed trends. Among 12 prostate cancer studies, 5 reported worsening sexual health, 2 found no trends, 1 reported positive sexual functioning, and 4 found mixed trends. Among 10 cervical cancer studies, 8 reported worse sexual health, while 2 reported mixed trends. Younger breast and cervical cancer patients who received radiation therapy experienced greater body image and sexual health concerns. Evidence was insufficient to evaluate trends in geographical location or race between sexual health and radiation therapy. Conclusion: In this study, prostate, breast, and cervical cancer patients who received radiation therapy treatment experienced more troublesome sexual health symptoms compared to non-irradiated cancer patients. Interventions to improve sexual health should be prioritized.

The order Hymenoptera holds great significance for humans, particularly in tropical and subtropical regions, due to its role as a pollinator of wild and cultivated flowering plants, parasites of destructive insects and honey producers. Despite this importance, limited attention has been given to the genetic diversity and molecular identification of Hymenopteran insects in most protected areas. This study provides insights into the first DNA barcode of Hymenopteran insects collected from Hazarganji Chiltan National Park (HCNP) and contributes to the global reference library of DNA barcodes. A total of 784 insect specimens were collected using Malaise traps, out of which 538 (68.62%) specimens were morphologically identified as Hymenopteran insects. The highest abundance of species of Hymenoptera (133/538, 24.72%) was observed during August and least in November (16/538, 2.97%). Genomic DNA extraction was performed individually from 90/538 (16.73%) morphologically identified specimens using the standard phenol-chloroform method, which were subjected separately to the PCR for their molecular confirmation via the amplification of cytochrome c oxidase subunit 1 (cox1) gene. The BLAST analyses of obtained sequences showed 91.64% to 100% identities with related sequences and clustered phylogenetically with their corresponding sequences that were reported from Australia, Bulgaria, Canada, Finland, Germany, India, Israel, and Pakistan. Additionally, total of 13 barcode index numbers (BINs) were assigned by Barcode of Life Data Systems (BOLD), out of which 12 were un-unique and one was unique (BOLD: AEU1239) which was assigned for Anthidium punctatum. This indicates the potential geographical variation of Hymenopteran population in HCNP. Further comprehensive studies are needed to molecularly confirm the existing insect species in HCNP and evaluate their impacts on the environment, both as beneficial (for example, pollination, honey producers and natural enemies) and detrimental (for example, venomous stings, crop damage, and pathogens transmission).

Background: Idiopathic carpal tunnel syndrome is a carpal tunnel median nerve neuropathy. CTS is the most typical type of peripheral neuropathy Objective: To determine the effects of carpal bones mobilization and tendon gliding exercise on patients with Carpal Tunnel Syndrome. Methodology: This was a quasi-experimental study. Data was collected from Faisal Hospital and Civil Hospital Faisalabad from April 2022 to August 2022. The total sample size was 32 and calculated from the open epi tool. Patients were recruited in this study by considering the inclusion and exclusion criteria. Patients were divided into two groups. The patients in group A were treated by carpal bone mobilization, and those in group B were treated by tendon gliding exercise. Throughout the course of four weeks, the intervention was carried out three times per week. The outcome measure tools of this study were the Numeric Pain Rating Scale and the Boston Carpal Tunnel Questionnaire. The data was analyzed using SPSS version 23. Results: There was a significant difference in reduction of pain intensity, symptom severity and improvement in functional ability between two groups i.e. Carpal Bone Mobilization and Tendon Gliding at end of four weeks (P

OBJECTIVES: To investigate the impact of fear of missing out, belongingness, and peer pressure on social media addiction and to find out the gender difference in social media addiction. METHODS: This cross-sectional survey was designed to collect data from 471 young adults through purposive sampling. The study was conducted from 28th January 2020 to 23rd May 2020 in southern Punjab (Multan, Bahawalpur, Vehari and Layyah) region of Pakistan. An online survey consisting of Fear of missing out scale, Belongingness scale, Peer pressure scale, and Addictive social media usage scale (ASMUS) was shared with participants along with the informed consent. RESULTS: Out of 471 young adults 273 (58%) were females and 198, (42%) were males. Mean age of participants was 19.91±2.23 years. Fear of missing out is positively correlated with belongingness (r =0.26; p

Abstract The annual growth rate of pharmaceutical industry in Pakistan is 10% and is continuously expanding to fulfill the increasing demand of the rapidly growing population. But inability of the pharmaceutical sector to comply with the environmental standards leads to the introduction of large quantities of various pollutants in the natural environment which presents serious ecological challenges. In this study, effluent wastewater samples from 14 manufacturing units of the pharmaceutical industries of the National Industrial Zone, Rawat, Pakistan, were collected and characterized for physicochemical parameters including color, odor, pH, electric conductivity, temperature, total dissolved solids, total suspended solids, salinity, dissolved oxygen (DO), chemical oxygen demand (COD), nitrates, sulfates and phosphates according to the standard methods. The detection and quantification of diclofenac (DCF)—one of the commonly prescribed drugs in Pakistan—were carried out in the pharmaceutical wastewater samples (PWWSs) using HPLC-PAD. Exceptionally high concentration of the diclofenac was detected in the industrial disposal of MB-12 (311,495 µg L−1 ). PWWSs were analyzed using chemometric techniques including principal factor analysis (PFA) and cluster analysis (CA). PFA explained almost 81.48% of the total variance by the newly extracted four components and complemented the strong Pearson’s correlation coefficient (r) of DCF concentrations to that of the levels of COD, r = 0.752, and DO, r = − 0.609, in PWWSs. Six clusters were generated during similar wastewater characteristics-based CA dendrogram, in which reverse osmosis-treated PWWSs were observed to cluster with the untreated PWWSs, suggesting the need to adopt an advance and better wastewater treatment methods by the pharmaceutical industries.

Chronic kidney disease (CKD) is common in patients with heart failure (HF) and is associated with high morbidity and mortality. There has been remarkable progress in the treatment of HF over recent years with the establishment of guideline-directed medical therapies including: (1) Beta-blockers, (2) renal angiotensin aldosterone system (RAAS) inhibition (i.e., angiotensin-converting enzyme inhibitor [ACEi], aldosterone receptor blocker [ARB] or angiotensin receptor-neprilysin inhibitor [ARNI]); (3) mineralocorticoid receptor antagonists (MRA), and (4) sodium-glucose cotransporter-2 inhibitors (SGLT2i). However, there are challenges to the implementation of these medications in patients with concomitant CKD due to increased vulnerability to common side-effects (including worsening renal function, hyperkalaemia, hypotension), and most of the pivotal trials which provide evidence of the efficacy of these medications excluded patients with severe CKD. Patients with CKD and HF often have regular healthcare encounters with multiple professionals and can receive conflicting guidance regarding their medication. Thus, despite being at higher risk of adverse cardiovascular events, patients who have both HF and CKD are more likely to be under-optimised on evidence-based therapies. This review is an updated summary of the evidence available for the management of HF (including reduced, mildly reduced and preserved left ventricular ejection fraction) in patients with various stages of CKD. The review covers the evidence for recommended medications, devices such as implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy (CRT), intravenous (IV) iron, and discusses how frailty affects the management of these patients. It also considers emerging evidence for the prevention of HF in the cohort of patients with CKD. It synthesises the available evidence regarding when to temporarily stop, continue or rechallenge medications in this cohort. Chronic HF in context of CKD remains a challenging scenario for clinicians to manage, which is usually complicated by frailty, multimorbidity and polypharmacy. Treatment should be tailored to a patients individual needs and management in specialised cardio-renal clinics with a multi-disciplinary team approach has been recommended. This review offers a concise summary on this expansive topic.

As the elderly population continues to grow worldwide, their physical and mental well-being begin to decline, leaving them susceptible to various health-related issues. [1]. According to WHO, from 2015 to 2050, the percentage of people aged 60 and over in the world will almost double, rising from 12% to 22% [2]. A recent study conducted on the geriatric population (≥60 years) in Karachi Pakistan (n=1200) concluded that the geriatric population is suffering from various disorders and health issues such as obesity (35.2%), depression (51.8%), cognitive impairment (63.1%), vision loss (31%) and chronic diseases (60%) [3]. The availability of nursing services, healthcare, and social support for older people is limited in both the public and private sectors, leading to significant concerns. As a society, we must question whether we are fulfilling our responsibility to care for those who once cared for us. With life expectancy on the rise, it is critical to consider how we will meet the evolving healthcare needs of our aging population. This highlights the urgent need for an effective and sustainable approach to elderly care that can address the challenges arising from demographic changes. Our healthcare system is not yet ready to abide by the healthcare needs of the elderly but introducing geriatric nursing as a general and a subspecialty level in healthcare setups can reduce this burden. Geriatric nursing is a prior existing yet emerging field where geriatric nurses are trained and well-equipped to understand the disease process and healthcare-related needs of older people. To achieve our vision of geriatric home health care, we need to focus on interdisciplinary collaboration, effective communication, and culturally congruent care. This requires strengthening the political system and balancing social, technological, legal, and environmental factors. Ongoing training and education can raise awareness among healthcare professionals, while communication at various levels - interpersonal, organizational, community, and national - is crucial for successful implementation. This can involve communicating through family, friends, peers, media, social networking, stakeholder, and nongovernmental organizations, as well as holding meetings with directors and governing bodies at the policymaker level [4]. It is crucial to increase public awareness regarding elderly care through various media platforms and to include and implement geriatric care education in both undergraduate and graduate curricula across all nursing and medical schools in Pakistan [5]. As the growing population is rapidly growing access to quality healthcare must increase too and geriatric nurses can become a bridge between the older population and their access to quality care. Elderly care requires specific skills and knowledge about the physiological, social, and cultural impacts of aging hence professionally trained geriatric nurses can improve the quality of care and quality of life of older adults [6]. Rehabilitation and awareness programs led by these nurses on individual, family, and community levels can bring an optimistic change in identifying and taking care of the acute to chronic health conditions of our aging population.

Objective: To determine the outcomes of coronavirus disease-2019 lockdown pertaining to clinical skills among undergraduate medical students. Method: The cross-sectional questionnaire-based study was conducted after approval from the Jinnah Sindh Medical University, Karachi, at 6 public and private medical education institutions in Karachi from July 3 to August 3, 2021, and comprised undergraduate students from the 3rd, 4th and final academic years. Data was collected using a pre-designed questionnaire. Data was analysed using SPSS 20. Results: Of the 383 subjects, 260(67.9%) were females and 123(32.1%) were males. The overall age range was 20-25 years. There were 145(37.9%) students from the 3rd year, 154(40.2%) from 4th and 84(21.9%) from the final year. Among them, 251(84.2%) accepted having decreased efficiency in clinical skills because they were not being able to train in person, 157(41%) claimed that certain topics related to clinical study were given in exams even though they were not taught, and 164(72.6%) faced difficulty in exams related to clinical skills. Conclusion: Coronavirus disease-2019 caused disruption in routine life, and medical education was not an exception. E-learning modality was found to be insufficient, and patient exposure elevates confidence, eliminates hesitation, and improves clinical skills. Key Words: COVID-19, Clinical skills, Undergraduate medical students.

Abstract The article examines the extent of foreign policy continuity or change and level of foreign policy achievement or underachievement during the Bolsonaro presidency. These are analysed through the lens of ‘strategic diplomacy’, a concept that considers state capacity for agile long-term oriented diplomatic action. It evaluates three areas of foreign policy, including regional integration, OECD membership, and climate negotiations. The main finding was that Bolsonaro’s foreign policies, even if achieved, were often strategic diplomacy failures and damaged Brazil’s international reputation. The article’s contribution lies in applying a new concept to provide a fresh perspective on Brazilian foreign policy.

AbstractBackground The emergence of genetically-modified human proteins and glucagon-like peptide-1 (GLP-1) receptor agonists have presented a promising strategy for effectively managing diabetes. Due to the scarcity of clinical trials focusing on the safety and efficacy of semaglutide as an adjunctive treatment for patients with type 2 diabetes who had inadequate glycemic control with metformin, we conducted a systematic review and meta-analysis. This was necessary to fill the gap and provide a comprehensive assessment of semaglutide compared to sitagliptin, a commonly prescribed DPP-4 inhibitor, in this patient population.Methods A comprehensive and systematic search was carried out on reputable databases including PubMed, the Cochrane Library, and Elsevier’s ScienceDirect to identify relevant studies that compared the efficacy of once-weekly Semaglutide with once-daily Sitagliptin in individuals diagnosed with type 2 diabetes mellitus. The analysis of the gathered data was performed utilizing the random-effects model, which considers both within-study and between-study variations.Results The meta-analysis incorporated three randomized controlled trials (RCTs), encompassing 2401 participants, with a balanced distribution across the treatment groups. The primary focus of the study revolved around evaluating changes in HbA1C, blood pressure, pulse rate, body weight, waist circumference, and BMI. The findings revealed that once-weekly Semaglutide showed substantially improved HbA1C (WMD: −0.98; 95% CI: −1.28, −0.69, p-value: < 0.0001; I2: 100%), systolic (WMD: −3.73; 95% CI: −5.42, −2.04, p-value:

Introduction Countries are grappling with a rapidly worsening upsurge in the opioid-related overdose deaths, misuse and abuse. There is a dearth of data in Pakistan regarding the practices and competencies of pharmacists in handling opioid-related issues.Study design A cross-sectional study, conducted across Punjab, Pakistan.Method The study deployed a validated survey to evaluate the competencies and practices of the community and hospital pharmacists.Results 504 community pharmacists and 279 hospital pharmacists participated in the survey with an overall response rate of 85.5%. Almost half of the respondents ‘never’ or ‘sometimes’ made clinical notes in a journal or dispensing software to monitor ongoing opioid use. Generally, pharmacists were reluctant to collaborate with physicians or notify police regarding the abuse/misuse of opioids. Hospital pharmacists achieved significantly higher mean competency scores than chain and independent community pharmacists (p

Introduction: Accurate placement of an endotracheal tube (ETT) is critical for patient safety during medical procedures. The research explores the potential of ultrasound technology to provide a reliable alternative for ETT confirmation, offering insights into its diagnostic performance and the implications for enhancing patient care in surgical settings. Aims & Objectives: To determine the diagnostic accuracy of ultrasound for the confirmation of endotracheal tube keeping Capnography as a Gold standard. Place and Duration of Study: It is a Cross Sectional study and the study was carried out in Operation Theater Shaikh Zayed Hospital Lahore, within 6 months after approval of synopsis i.e. from 5th May, 2020 till 4th November, 2021. Material & Methods:Total 219 patients who fulfilled the inclusion criteria were enrolled. After standardization of anesthetic measures all patients were intubated by direct laryngoscopy. ETT placement was assessed by capnometry and by ultrasonography. Endotracheal tube placement was labeled (as per operational definition) on both the techniques.The analysis of the data was conducted using SPSS version 21.0, a p-value of ?0.05 was considered significant. Results: The mean age, BMI, neck circumference and thyromental distance of the patients was 39±8.15 years, 27±3.42 Kg/m 2, 29.5±4.63cm and 6.9±0.50cm. There were 58% males and 42% females in the study. Ultrasonography exhibited sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy rates of 98.5%, 90.6%, 98.9%, 86.1%, and 97.7%, respectively, in its ability to detect the accurate placement of endotracheal tubes (ETT). Conclusion: The sensitivity, specificity, diagnostic accuracy and promptness of recognition for confirmation of tracheal placement of ETT is higher withultrasonography compared to the gold standardcapnography in patients undergoing elective surgery under general anesthesia.

Background: Blood pressure (BP) monitoring has a very crucial role in physical therapy for accurate evaluation and re-evaluation of the patient, otherwise it can lead to inaccurate clinical decision making and the patient may be falsely diagnosed. It is an important cardinal sign that cannot be neglected in making clinical decision, may put the individual to a greater risk of cardiovascular and other health problems. Objective: to explore the knowledge, attitude, and practice behavior regarding BP among physical therapists (PT) of twin cities. Methods: A cross sectional study was conducted in 6 months, from January 2019 to June 2019 in different hospitals of Islamabad and Rawalpindi. The data was collected from n=296 PT of twin cities after obtaining the written consent. The data of knowledge, attitude and practice behaviors towards BP was collected by semi structured questionnaire. The results were presented in table and graph while description was given as Mean ± SD and f (%). Results: The mean age of study participants was 28.4±3.71 years. The overall mean score of knowledge (4.27±3.05) showed that n=159(53.72%) participants in the study have poor knowledge about the information related to BP. While attitude score (19.74±.2.29) showed that majority of the sample n=179(60.47%) have positive attitude towards the importance of BP evaluation during assessment, management and educating the patient. While observing the behaviour, mean score (14.55±4.78) showed that physical therapist has acceptable behaviour towards the BP measurement. But frequency distribution showed that n=160(54.05%) physical therapist has poor behaviour towards BP measurement during their practice. Conclusion: The knowledge and practice behavior regarding the BP assessment and evaluation among the physical therapist is very poor, while their attitude is positive towards the importance of BP evaluation during assessment, management and educating the patients. Keywords: Blood pressure, inpatient clinic, outpatient clinic, physical therapy.

Background and Objectives: Even though Blood Transfusion Service is considered as life-saving intervention, it is associated with the occurrence of uneventful reactions from the transfusion of blood and blood units. Bhutan Blood Bank is fragmented with different levels of services provided which leads to varied levels of adverse blood transfusion reaction reported. Study on the hemovigilance system at tertiary care hospital is conducted so as to study the frequency and types of reactions over a period of three years from 1st January 2019 to 31st December 2021. Methods: All ATRs occurring within a period of 3 years were studied according to the Blood Bank standard operating procedure. Adverse transfusion events related to blood and blood units were analyzed and classified on the basis of their clinical features and laboratory tests. Descriptive statistics were used to represent the adverse transfusion reactions. Results: During this period, a total of 19,961 blood and blood components were issued and 120 adverse transfusion events were reported. Most reaction reported were febrile non-hemolytic transfusion reaction, FNHTR (59.2%) followed by allergic reaction (22.5%) occurring predominantly in females (93%). Packed red cells were the common component causing adverse events (83 %) with most observable in Group A (42.5%) blood units. Conclusion: Febrile and allergic reactions are the most common type of reaction reported. Although such reaction type is least harmful but fatal reaction can occur and preventive measures must be taken to avoid such reactions. This preliminary study indicates the importance of having continuous monitoring and quality assessment scheme in addressing the issues of adverse transfusion reaction. Furthermore, establishing a hospital transfusion committee is vital for delivery of safe and efficient blood transfusion services.