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Objective: Purpose of this study is to determine the frequency of keratoconus with consanguinity. Study Design: Comparative/cross-sectional study Place and Duration: This comparative/cross-sectional study was conducted at Shahida Islam Medical and Dental College Lodhran and Jinnah International Hospital, Abbottabad in the period from May, 2022 to October, 2022. Methods: Total 53 patients of keratoconus were presented in this study. Included patients were aged between 8-32 years. Participants completed a self-administered survey that inquired about demographic information, KC findings, clinical symptoms, and parental marital status. All data was analyzed using SPSS 20.0. Results: There were 31 (58.5%) females and 22 (41.5%) males in all cases. Mean age of the patients was 19.25±12.92 years. 35 (66.03%) cases had rural residency and 18 (33.97%) cases were had urban residency. 25 (47.2%) cases had poor socio-economic status. Of the patients surveyed, 29 (54.7%) had first-cousin weddings between their parents, 16 (30.2%) had second-cousin marriages, 5 (9.4%) had third-cousin marriages, and 3 (5.7%) had marriages beyond the immediate family. Significant associations between consanguinity and KC were found at the p

Objective: The purpose of this study is to evaluate the mean change in intraocular pressure following trabeculectomy with Mitomycin C in patients who present with congenital glaucoma. Study Design: Observational/ Cross-sectional Place and Duration: Data was collected from different hospitals of Pakistan, including Jinnah International Hospital, Abbottabad and Department of Ophthalmology, Sahara Medical College, Narowal from December 2021 to May 2022. Methods: The study included 62 patients, both male and female, with primary congenital glaucoma, ranging in age from birth to five years. After receiving signed permission from patients' legal guardians, we were able to record their demographic information. Trabeculectomy using 0.4mg/ml Mitomycin C was performed on all of the patients. Mitomycin C was placed for 2 minutes under the scleral flap. The intraocular pressure was measured before surgery and again 12 days later. Statistical analysis was performed using SPSS 22.0. Results: Included children had mean age 1.9±3.16 years. We found that, majority of the patients 39 (62.9%) were males and 23 (37.1%) cases were females. The mean intraocular pressure before and after surgery was significantly different, with a p-value of 0.002 (29.41±5.22 Vs 15.17±1.73). Conclusion: It has been determined that doing a trabeculectomy while administering mitomycin C results in a significant decrease in intraocular pressure. Following surgery, a substantial reduction in intraocular pressure was noted by the attending physician. Keywords: Intra-ocular Pressure, Primary Congenital Glaucoma, Mitomycin C, Trabeculectomy

Transportation sector is one of the major contributors to GHG emissions, and it is essential to investigate the role of electric vehicles in economic and environmental performance of developing countries. In this research work, the authors seek to investigate the usage pattern of three-wheeler vehicle by taking a Pakistan-based survey approach and analyzing the responses from various three-wheeler drivers across the country. The survey results indicate that the adoption of hybrid and electric three-wheelers in Pakistan would be welcomed by the users due to increased economic benefits, despite having a high initial capital cost. On an average basis, the regular three-wheeler is run for more than 5 days a week, 101-150 km daily across more than 10 h, and enables the owner to make around PKR 20,000-25,000 (~ US $119-US $149) after approximately PKR 15,000 (~ USD $89) is spent every month on fuel and maintenance. The adoption of hybrid or electric three-wheelers can easily improve the monthly earnings by 50%. In addition to this, the GHG emissions from the transportation sector will be considerably lowered around 3-6 tonnes of CO

Objective: The main purpose of this study is to evaluate the efficacy of intracameral and subconjunctival injections of dexamethasone in the prevention of postoperative inflammation in patients who are having cataract surgery. Study Design:Observational/comparative study Place and Duration: Conducted at Jinah International Hospital , Abbottabad, from February 2021 to August 2021. Methods: Total 90 patients of both sexes with ages 3-15 years were presented in this study. All the included patients underwent cataract surgery. After obtaining the permission from parents, we collected demographic data on all of the enrolled children, including their age, gender, and place of residence. 45 patients received intracameral in group A and sub-conjunctival dexamethasone provided to 45 patients of group B. Post-operatively slit lamp biomicroscopy was done to assess inflammation after 1st and 3rd day between both groups. SPSS 22.0 was used to analyze all data. Results: Among 90 patients, majority of the cases were males 57 (63.3%) and rest were females 33 (36.7%). The mean age of the patients in group A was 9.6±14.76 years and in group B mean age was 8.6± 8.52 years.25 (55.6%) patients in group A and 22 (48.9%) cases of group B had urban residency. Post-operative, we found higher frequency of inflammation in group B in 12 (26.7%) as compared to group A in 3 (6.7%) cases with p value

Objective: The purpose of this study is to conduct an analysis of the effectiveness of treating school-aged children by patching the eye that is considered to be dominant and performing refraction using active visual therapy (AVT). Place of study: Jinah international hospital abbottabad Duration of study: October 2021 to April 2022 Methods: There were 65 children with ages 6-16 years had anisometropic amblyopia included in this study. After informed written agreement, participants' demographics were recorded. Posterior and back anterior segments were checked. Recorded best visual therapy. Refractive error of amblyopic eyes was +7 to -5 diopters. Refraction was corrected. Improvement in visual acuity and refraction were assessed every two months. Post-treatment visual acuity of 6/24, 6/36, 6/60 was tested with a regression and correlation T-test. SPSS 21.0 analyzed all data. Results: Among 65 children, 40 (61.5%) were males and 25 (38.5%) were females. Mean age of the patients was 8.7±4.17 years. Hypermetropia was the most common refractive error found in 45 (69.2%) cases followed by myopia in 20 (30.8%) cases. Pre-treatment 24 (36.9%) patients had BCVA 6/24, 12 (18.5%) patients had 6/36, 17 (26.2%) patients had 6/60 and 12 (18.5%) had CF. Post-treatment 18 (27.7%) had BCVA 6/6, 10 (15.4%) had 6/9, 11 (16.9%) cases had 6/12, 12 (18.5%) children had 6/18, 5 (7.7%) had 6/24, 6 (9.2%) had BCVA 6/60 and 3 (4.6%) had CF. Conclusion: In this study, we came to the conclusion that the treatment for anisometropic amblyopia, which involves the patching of the patient's dominant eye and the refraction of the amblyopic eye using active visual therapy, is beneficial. Keywords: Best Corrected Visual Acuity (BCVA), Counting Fingers (CF), Visual Acuity (V.A), Refractive Errors, Active Visual Therapy (AVT)

Objective: In the present study an attempt was made to assess the effect of pterygium excision on the induced astigmatism, and the relationship between the size of pterygium and the amount of astigmatism. Study Design: Cross-sectional study Place and Duration: Conducted at Jinnah International Hospital during from March 2021 - September 2021. Methods: There were fifty five patients of both genders were presented in this study. Patients were aged between 20-65 years. After obtaining informed written permission, we collected demographic data on all of the participants, including their age, gender, place of residence, and job title.All the included patients in this study had pterygium. The paired t-test was used to compare data from before and after surgery. One-way analysis of variance was used to compare preoperative astigmatism to the grade of pterygium. SPSS 24.0 was used to analyze all data. Results: Among 55 patients, 30 (54.5%) were males and 25 (45.5%) were females. Mean age of the patients was 35.9±15.45 years. There were 32 (58.2%) patients had urban residency and 23 (41.8%) cases had rural residency. Majority of the patients were outdoor workers 38 (69.1%). Majority of the eyes had grade II pterygia 24 (43.6%), 17 (30.9%) patients had grade III and 12 (21.8%) had grade IV pterygia and 2 (3.6%) had double headed pterygia. Pre-operative mean astigmatism in eyes with grade II was 3.43± 1.34D, in eyes of grade IIImean astigmatism was 4.83 ±1.62D and in eyes of grade IV 8.78±2.39D decreases to 1.5±2.18D, 1.56±3.61D and 5.11±4.32D. We found visual acuity same in 26 (47.3%) and improvement in 29 (52.7%) eyes from 0.50± 1.41 D to 1.1±0.56 D. Refractive cylinder was improved to 2.91±2.61D with p vale

Objective: Aim was to compare the visual results of patients who received ECCE and phacoemulsification for the treatment of age-related cataracts. Study Design: Prospective study Place and Duration: Conducted at Jinnah International Hospital during from Jan, 2021 to Dec, 2021. Methods:There were 130 patients of both genders presented for cataract surgery. Patients were aged between 35-75 years.When patients signed an informed permission form, demographic information such as age and sex were recorded. Patients were equally divided in two groups. Group I received phacoemulsification (phaco) cataract surgery and group II received conventional extracapsular cataract extraction. Intraoperative and post-operative complication among cases was assessed. At last follow up best corrected visual acuity was assessed and compared among both groups. SPSS 24.0 was used to analyze complete data. Results:Among 130 cases, majority of the cases 85 (65.4%) were males and 45 (34.6%) were females. 15 (11.5%) patients were aged between 35-45 years, 45 (34.6%) patients were aged between 46-55 years, 38 (29.2%) were aged between 56-6 years and 32 (24.6%) had age > 65years. Post-operative we found significantly good vision among patients of phaco group in 54 (83.1%) cases as compare to group II in 31 (47.7%) cases. Frequency of intraoperative complications was higher in group II 9 (13.8%) as compared to group I 3 (4.6%) cases. Post-operative complications in group I was corneal decompensation, high astigmatism and posterior capsule opacity but in group II high astigmatism and corneal decompensation were the complications. Conclusion:We came to the conclusion that the visual outcome was considerably better in the Phaco operation compared to the ECCE technique (p = 0.003). As a result, we advocate for the provision of Phaco equipment in hospitals that have sufficient capabilities for the performance of intraocular surgery. Keywords:PhacoemulsificationSurgery, Extracapsular cataract extraction, Complications, Vision Acuity

Manufacturing sector has traditionally employed the concepts of lean manufacturing for production optimization and waste elimination. However, the looming danger of climate change demands responsible production and consumption; oftentimes the environmental aspects have been ignored for economic gains. The fourth industrial revolution brought about a paradigm shift in the manufacturing landscape, yet there is dearth of approaches that combine the concepts of lean manufacturing, environmentally conscious manufacturing and Industry 4.0 for improving the production and ecological performance of manufacturing sector. This study has fulfilled this research gap by developing a comprehensive implementation framework that combines lean manufacturing, green manufacturing and Industry 4.0 in a harmonious manner. Using a longitudinal case study approach, the developed framework has been applied to an auto-parts manufacturing firm to achieve reduced lead time, value added time, non-value-added time and greenhouse gases (GHG) emissions. The results revealed that the approaches of first-in-first out (FIFO), total productive maintenance (TPM), smart production control, cyberphysical systems, 6R and smart energy monitoring are extremely beneficial in achieving optimized and cleaner production, where the lead time, non-value added time and value added time has been reduced by 25.60%, 56.20% and 24.68% respectively, whereas the carbon dioxide, methane and nitrous oxide emissions were reduced by 55%. The theoretical contribution of this research work lies in the development of a novel integration framework that combines the concepts of lean manufacturing and green manufacturing with Industry 4.0 technologies, whereas practitioners can benefit from the synergistic combination to achieve automation-based fast and environmentally conscious manufacturing.

In the modern world, it is imperative to apply the concepts of Lean, Agile, Resilient and Green, collectively known as LARG Manufacturing to achieve business excellence. The objective of this study is to explore the possibility of collaboration between constituents of LARG Manufacturing with the facets of Industry-4.0. In this context, a thorough systematic literature review has been conducted to validate the research gap regarding integration of LARG Manufacturing with Industry 4.0. The study revealed that LARG constituent practices can be amalgamated with various facets of Industry-4.0 to provide operational, economic and environmental benefits. The increased process visibility, elimination of wastes, fast processes, high level of responsiveness to disruptions and eco-friendly manufacturing are the salient features of the LARG Manufacturing & Industry-4.0 synergy, fuelled by automation and BigData. In future, a comprehensive technology integrated implementation framework can be developed that employs LARG constituents with Industry-4.0 or Artificial Intelligence to achieve sustainability.

Topical anaesthesia is safe and inexpensive type of anaesthesia used during phacoemulsification as compared to local anaesthesia. The trend of conducting surgeries under topical anaesthesia is increasing globally. The objective of this study was to determine the perception of severity of pain during phacoemulsification using topical anaesthesia.This descriptive cross-sectional study was conducted at Jinnah International Hospital Abbottabad for a period of one year and included 196 patients of posterior subcapsular cataracts. Data was collected on a pretested structured questionnaire and analysed by SPSS version 20. Chi square test was used to find association between variables and p-value of equal or less than 0.05 was considered significant.The mean age of the patients was 60.43±14.63 years. Out of 196 patients, 110 (56.1%) were males and 86 (43.9%) were females. During surgery pain score was 0 (no pain) in 149 (76%), 1 (mild) in 14 (7.1%), 2 (moderate) in 15 (7.7%) and 3 (severe) in 18 (9.2%) patients. Pain score was found to be significantly associated with gender (p=0.003) and age group (p=0.008).Phacoemulsification can be safely performed under topical anaesthesia in patients with posterior subcapsular cataracts with minimum intraoperative pain perception by the patients.

The concepts of lean manufacturing operations and sustainability are congruent in nature, marked by the facet of improving organizational efficiency. However, only difference lies in the definition of waste. This definition is given a new dimension by sustainability by incorporating the extensive scope of reductions in the environmental consequences in the form of 6R (reduce, reuse, recycle, recover, redesign and remanufacture); which requires a consolidated integrated approach. Therefore, as to affirm the requirement, a systematic literature review has been carried out which scrutinized previous researches in view of their originality, methodology, objectives and limitations. Based on this literature study, 25 most related approaches (lean and sustainable integrated approaches) were selected and their originality was investigated. Investigation revealed that few research articles are integrating lean and sustainable approaches. This study identifies the gap of the integration of lean practices with 6Rs and a framework was developed which implemented on the case study that carries ability to attain 6R based sustainable lean production systems. Because of more social and environmentally friendly atmosphere achieved through 6R based implementation, the results achieved are 50% decrease in heating cost by redesigning furnaces (from oil furnaces to gas furnaces), 36.33% improvement in value added time, 40.14% in lead-time and 22% reduction in labour utilization. This improvement indicates that use of proposed integrated framework is highly beneficial for any kind of manufacturing sector.

Lean manufacturing has always ensured production optimization by eliminating wastes, and its implementation has helped in improving the operational performance of the organization since it eliminates the bottlenecks from the processes, thus making them efficient. In lean scenarios, the focus is on “waste” elimination, but in agile manufacturing, the focus is on the ability of comprehension of changing market dynamics and the resilience. One of the major factors in the combined implementation of lean and agile approaches is inadequate planning, monitoring and lack of awareness regarding changing market trends, and this can be countered by utilizing the effective tool of K-Chart. Through a systematic literature review, the authors establish the requirement of effective planning and monitoring in the implementation of integrated lean and agile approach, concluding that K-Chart is a handy tool to adopt for their effective implementation. The result provides a new vision of lean implementation through K-Chart, whereas it provides clarity to practitioners by presenting a K-chart based implementation framework for achieving favourable results. Being a literature review the research work can be validated through a case study approach in future through a comparative analysis between various implementation techniques and K-Chart.

Lean Manufacturing (LM) has traditionally helped industries in removing the non-value-added processes to achieve operational excellence. Similarly, the blue ocean strategy helps organizations in creating an uncontested market space where the competition is irrelevant. The authors posit that the integration of two approaches helps in achieving holistic manufacturing excellence, and there is a paucity of approaches that integrate the two paradigms. In order to fill this research gap, the authors have developed an integrated framework that combines the concepts of lean manufacturing and blue ocean manufacturing (BOM), via a structured survey. Using the lean tool of value stream mapping and four-action framework of BOM, the framework was duly implemented on the selected case study and reductions in lead-time and value-added time were recorded to be 26% and 39% respectively. In addition to that, more than 50% reduction in the environmentally detrimental GHG emissions was recorded through the implementation of the integrated framework. The novelty of the research work lies in the amalgamation of lean manufacturing and Blue Ocean manufacturing, concomitant to which economic and environmental sustainability can be achieved. The framework provides clarity to practitioners and academicians regarding the implementation of two approaches (LM and BOM) in a harmonious manner to attain reduction in non-value added activities and delivery times which attains market leadership through high-quality product manufacturing with lower production time and costs. This economic lever is capable of delivering economic sustainability and implicates improved environmental performance through reduced energy consumption. In future, research work can be carried out using the innovative concepts of Industry 4.0 with lean and sustainable manufacturing.

Computational treatment of natural languages is a very challenging task. For effective machine translation of multi-sentential discourse units from a source language into some target language, resolution of anaphoric expressions is of crucial importance. This paper presents the computational treatment of the rarely studied form of pronominal reference called reflexives. A knowledge-poor, rule-based algorithm has been developed to identify and resolve the reflexives in Urdu discourses. The proposed algorithm resolves the reflexives in Urdu discourses with more than 85% accuracy.

A 76-year-old man who had undergone a routine coronary artery bypass grafting operation developed severe haemodynamic instability in the early postoperative period in spite of multiple inotropic supports. Due to persistent instability of haemodynamics and worsening acidosis his chest was re-explored with detection of no obvious abnormality. An intra-aortic balloon pump (IABP) was inserted for additional support. The chest had to be left open overnight and closed formally next morning. A chest X-ray at that stage showed a large hiatus hernia with huge gastric dilatation compressing the heart. Decompressions of the stomach lead to dramatic improvement in his circulatory status with rapid weaning of inotropes and IABP and he could be extubated. This case illustrates the importance of recognising the presence of hiatus hernia in preoperative chest X-ray and prophylactic NG tube insertion at the time of cardiac surgery in these cases.

This paper analyzes a new laparoscopic surgical setup with two surgical robots. Requirements and constraints are outlined and the architecture selected for the surgical robots is presented and discussed. Analytical models of the inverse and forward kinematics are provided together with a detailed analysis of mobility and constraints. The velocity kinematics is addressed and singularity analysis outlined.