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Introduction: Patella fracture account for 1 Percent of all skeletal fracture, Patella fractures are problematic because the loss of the extensor mechanism of the knee, loss of articular congruity and stiffness of the knee joint. The surgical goals are anatomic reconstruction of the articular surface and stable fixation to allow early motion. Modified tension band wiring MTBW (MTBW) is the procedure of choice for patellar fracture these days because of the dramatic decrease in post-operative complications with this procedure.The complications noted in the early post-operative period are infection,loss of reduction, prominence of hardware, and knee stiffness. Objective: To determine the frequency of early post-operative complications following modified tension band wiring MTBW for closed patellar fractures. Methods: This study was conducted in the department of orthopedic surgery, Lady Reading Hospital, Peshawar from June 2010-september 2011. Through a descriptive cross sectional study, a total of hundred patients of closed patellar fractures were selected in a consecutive manner from the OPD and ER department. All patients were subjected to modified tension band wiring MTBW under G/A by an expert orthopedic surgeon and data was also collected at 1st week, 1st month, 3 months and 6 months regarding early post-operative complications like loss of reduction, infection, prominence of hardware and stiffness. Results: Total patients were hundred. There were 60 (60 Percent) males and 40 (40 Percent) were females. Mean age of the patients was 43.82 years + 14.3SD years (range 20-85 years). 74 (74 Percent) were presented with history of road traffic accident. Overall complication rate by the end of 6 months was a total of 25 Percent with of 21 Percent patients with infection, 11 Percent had developed stiffness, 6 Percent with hardware prominence and only 4 Percent with loss of reduction. Conclusion: The frequency of early post-operative complication following modified tension band wiring MTBW for closed patellar fractures was higher than previously reported and further research work should be carried out to identify the factors responsible for it. Keywords: Developed Stiffness, Closed Fracture Patella, Modified Tension Band Wiring MTBW, Early Post-Operative Complications, Hardware Prominence

Introduction: Anterior Knee Pain (AKP) is one of the most common causes of persistent problems after knee replacement. Total Knee Arthroplasty (TKA) is a surgical procedure in which artificial joint or prosthesis replace the damage knee. A significant proportion of the patients experience AKP after surgery. Objective: To find out the frequency of Anterior Knee Pain after Total Knee Arthroplasty. Study Setting: Department of Orthopedics, KTH Khyber Teaching Hospital, Peshawar. Study Design: A Cross sectional study. Study Duration: June -2020 to February -2021. Subjects and Methods: After recording complete history, physical examination and routine baseline investigations were done. Patients were put on OT list and surgeries were performed in all patients by expert orthopedic surgeon designated for performing total knee arthroplasty. Post-operatively, patients were kept under observations for 5 days in ward and were discharged if indicated. Patients were followed at regular intervals and finally at the end of 3rd month to measure the intensity of pain on VAS. Results: Out of 205 patients, 69.3% were males and 30.7% were females. Means ± SD calculated for age was 48.62±7.98 years, for BMI was 24.63±3.07 and for Pain on VAS was 1.31±1.39. Most patients (51.7%) were recorded in 51-60 years age group. Rheumatoid Arthritis (RA) in 18% while Osteoarthritis (OA) was found in 82% patients. 21.5% patients were diabetic while 31.7% patients were hypertensive. AKP at 3rd month was found in 8.8% patients. Conclusion: It is evident that anterior knee pain (AKP) after the total knee arthroplasty (TKA), or total knee replacement (TKR) is prevalent and clinically relevant. There is an absolute need for further investigations to find out ways to decrease or eliminate the AKP after TKA in order to improve the quality of life after this surgery. Keywords: Anterior Knee Pain, Total Knee Replacement, Total Knee Arthroplasty.

Objective: Given the threat related with surgical intervention of intracranial meningiomas in the older population because of maturing physiology and numerous co morbidities, an endeavor was made to distinguish mediators impacting results and to characterize a category of individuals who ought not be surgically treated because of deprived prognosis. Study Setting: The study was conducted in neurosurgery unit mardan medical complex / bacha khan medical college Name of Hospital, Pakistan. Methods: The investigation of 58 individuals over the age of 70 years was conducted to determine short- and long-term results. Additionally, we derived scores for our patients using the previously reported CRGS, SKALE, and GSS grading systems. Result: As per the SKALE reviewing framework, neurological grimness was exclusively associated with a crucial site (P=0.02). Six people (10.3 percent) capitulated to their wounds. The Karnofsky score (KPS 60 versus KPS 70; P=0.0162), the American Society scale status (ASA 1 or 2 versus ASA 3; P=0.0022), and the evaluation of meningioma’s were totally connected with mortality (P=0.012). The WHO grade (P=0.00048) and Simpson evaluation of resection (P=0.0437) were related with tumor repetition in six cases. Except for patients who died because of medical procedure or reoccurrence (15.5%), majority of subjects improved (50%) or remain unaltered (25.9%) in contrast with their karnofsky score before surgery. Conclusion: Neurological impairment following surgery was only observed in patients with a significant tumor placement (skull base, eloquent area, large vessels indulgence by the tumor). Because of the greatly increased threat of fatality, surgery should be carefully considered in individuals with a low functional state (KPS 60) or a bad bodily state (ASA 3 status). During routine visits, the majority of patients’ neurological health enhanced or remains constant in comparison to their condition before operation.

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Detab is a company in Jönköping that develops systems for feeding parts for robots and packaging processes. To control the flow of parts on their vibratory feeders, Detab uses different carpets with angled straws. The two mainly used carpets have been discontinued and must now be replaced. A newly emerged option is a contender in replacing one of the carpets. The new white carpet is completely additively manufactured. To compare the old carpet and the new carpet, data is needed to show how different settings affect the flow of the parts. Through design of experiments and response surface methods, tests can be performed in a systematic and mathematical way compare the performance of different settings. Some basic parameters were defined to begin the investigation of which design of experiments method would be used to best compare the carpets. The parameters defined where the parts that would be used in the tests, the factors that were to be adjusted during the tests, the maximum and minimum values of the selected factors and how the results would be measured. Different methods were tested, and finally optimal design was chosen and executed using the program Design-Expert. The completed tests resulted in response surfaces that were constructed using Design-Expert. These response surfaces were analyzed and several similarities and differences between the different carpets were observed. Primarily, it was found that the green carpet had more settings that resulted in a flow above 0 parts/minute. Using Design-Expert, the response surfaces could be analyzed to find the optimal settings and their expected response. These points and more were then compared with tests performed afterwards to see if the expected values matched reality. It turned out that there were some uncertainties in how well the surfaces could predict the response in comparison with reality. Based on the experiments carried out, recommendations were made on how the company should proceed to be able to assess whether the new carpet is worth using in future construction of their machines.

The current study was aimed to investigate the changes in tobacco usage and their correlations among students from a private university in Dhaka, Bangladesh, during the lockdown periods due to the COVID19 pandemic. It is designed as a cross-sectional study in which 572 students participated, among which 207 were smokers, in a self-administered online survey on Google Classrooms through Google forms. The socioeconomic characteristics of the participants, COVID-19, and tobacco use-related information were collected using a close-ended questionnaire. Participating students were asked if their tobacco consumption had changed during the COVID-19 lockdowns compared to before the pandemic. Among the smokers, 31.9% stated an increase in tobacco use in the extended lockdown periods imposed by the authorities to contain coronavirus infection and the rest had no change in such behavior. Tobacco intake in the form of cigarette smoking was substantially increased among the participants who thought the lockdown period was more stressful than preCOVID times (aOR = 5.767, 95% CI: 2.5-13.26, p < 0.001), participants whose caffeine intake increased (aOR = 3.524, 95% CI: 1.70-7.29, p < 0.002), participants who attended any social events during lockdowns (aOR = 2.720, 95% CI: 1.26-5.86, p p

This study investigates the changing political trends in erstwhile Federally Administered Tribal Areas of Pakistan. Analysis of the last three elections (2008, 2013, 2018) shows a substantial change in the region. The tribal structure, local traditions, power arrangement and electoral practices have changed significantly over a decade. The extension of the Political Parties Order to the region and its merger with Khyber Pakhtunkhwa stimulated political activities in the area that increased the political awareness of tribal people. The results of the 2013 and 2018 elections highlight the changes. Electoral activities, women participation and voter turnout increased with every election. Tribal youth joined existing political forums to demand their democratic rights. A significant percentage of the young, educated Pashtuns joined the Pashtun Tahafuz Movement in its demand for improved governance.

The research article primarily deals with non-Newtonian squeezing nanofluid flow between parallel plates by taking into account different phenomena in the modeled problem. The thermal radiation and magneto hydrodynamics impact in fluid flow model is mainly focused in this analysis. The proposed nanofluid model also encompasses thermophoresis and the Brownian movement effects. The basic equations of nanofluids model such as velocity, heat and concentration equations are transformed into ordinary differential equations with the help of appropriate similarity transformations. As a tool, the semi numerical scheme is used for solving the proposed problem with the greatest possible accuracy for the purpose of illustration and analysis. The basic physical parameters involved in velocity, heat and concentration profiles in the nanofluids flow are discussed in detail. The variation of skin friction, Nusselt number and Sherwood number along with their impacts on the velocity, heat and concentration are determined. It is also focused to show the influence of different physical parameters graphically as well as in tabulated form. Excellent agreement between the results of semi analytical method and already published work is obtained, indicating the validity of the semi analytical approach. The study presented herein fills the gap in the literature, and will have a broad impact in industrial and biomedical fields.

Background: Thoracolumbar fracture is nearly 90% of all the spine injuries which treated by spine surgeons. The choice of the stabilization type is still the subject of controversy. In long segment fixation, the problem is that more motion segment loss is concerned. The number of motion segments involved in fusion of spine fracture is minimized by posterior short segment fixation with index level screw. Objective: The purpose of the study is to assess the ability of short segment fixation with index level screw at fracture level to correct deformity, maintain correction and prevent failure. Method: 15 patients who were operated between March 2018 and January 2021 were taken for the retrospective analysis. All patients were surgically treated with short segment fixation using a posterior surgical approach with transpedicular instrumentation. Pedicle screws were placed at one level above and below the fracture site. Additionally, pedicle screws were also inserted at the index level of the fracture. All the patients were followed up at 3 months, 6 months and 12 months postoperatively. Results: The Mean pre-operative kyphosis was 14° (range 6° to 24°). Average post-operative kyphosis was 0° (range 6° to −18°). Average follow-up kyphosis of all cases was 10° (range 0.85° to 35.00°). Excluding failures, average follow-up kyphosis was 8° (range 0.85° to 25.00°). The height of the vertebral body was maintained upto 95% in 6 patients, 80% in 6 patients, and 70% in 3 patients. At initial one-month follow-up, average Oswestry disability score was severe at 52.63% (range 16% to 84%). At most recent follow-up, average Oswestry disability score was minimal at 5.5% (range 0% to 16%). One patient was lost to long-term follow- up. Mean difference from one-month follow-up to most recent follow-up (excluding failures) was 47.27% (P < 0.0001). Conclusion: The short same-segment fixation reduces the implantation failure rate and reoperation rate in our study. Long-term correction of kyp

Background: Legg-Calve-Perthes (LCP) disease, or idiopathic avascular necrosis of the femoral head occurs during early childhood and is caused by impaired circulation in the femoral head. Varus derotation osteotomy (VDO) was described over half a century ago, and is now a popular method for the operative treatment of Perthes disease. Objective: To find out the clinical and radiological outcome of varus derotation osteotomy for containment of femoral head in advanced Perthes disease. Materials and Methods: This observational study was conducted in the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from March 2015 to September 2017. Total 20 cases of advanced Perthes disease were enrolled. Pre- and post-operative period were evaluated by interview and clinical examination by using a semi-structured questionnaire. Demographic and clinical information were recorded. All patients had a pre- and post-operative x-rays. We used visual analog scales (VAS) for scoring pain; Wiberg’s central edge angle, epiphyseal extraction index, neck shaft angle and Larson (Iowa) hip score were used to assess the outcome of VDO. Comparison of continuous variables between the two groups was made with Student’s t-tests. Comparison of proportions between Herring groups B and C were made with chi-square tests. p

Purpose The study is an endeavour to find out the preservation status of rare documents in Srinagar. The rare documents, here, mean the manuscripts and rare books, journals, reports, magazines, archival documents, etc. These resources are available in private libraries of individuals and religious institutions in Srinagar. This study aims to find these private libraries of individuals/families and religious institutions, which are unknown to the scholarly world and observe the preservation status of rare documents. The main focus is to document their present preservation status to give an opportunity to the stakeholders, particularly the government organizations, to take appropriate action before they are lost forever. Design/methodology/approach Before conducting the survey, the investigator interviewed 114 persons including literary persons, faith leaders, librarians, faculty members from various prominent institutions in Srinagar to get leads regarding the persons/families and religious institutions in possession of rare documents. The investigator gathered data through two different schedules and later analyzed the same in this study after carrying out a pilot study to make necessary changes to the schedules compiled for the study. The investigator visited personally each family/individual and religious institution to gather the data for months together. Findings An arduous job was carried out in which around 111 individuals/families and religious institutions were found to be having such rare resources. However, the data gathered reveals a dismal picture of private libraries and religious institutions, in possession of rare documents, as almost all caretakers/ families are devoid of any knowledge regarding the maintenance of these important sources of knowledge. Further, the traditional methods of preservation are still in vogue in some private libraries. These traditional methods have opened new areas of research while at the same time can prove detrimental to the collection if they are useless. Originality/value The study is the first of its kind in the summer capital of Jammu and Kashmir i.e. Srinagar. The study gives an idea of preservation status of manuscripts and rare documents including books, magazines, journals, archival documents, etc. so that the same are taken care of for posterity. The study is an eye-opener for the policymakers, conservators, archivists and others interested in historical documents. The study will help in furthering the research process as it needs to be ascertained whether the traditional methods of preservation are fruitful. In short, the study is quite helpful in understanding the nature of collection in Srinagar so that appropriate steps are taken by all particularly the Government in J&K. The paper will surely help in the policy formulation in the future.

Tuberculosis (TB) is a communicable systemic infectious disease with high morbidity and mortality associated with it. Resistance to medications used to treat tuberculosis has been on the rise in recent years. (multidrug-resistant tuberculosis) (MDR-TB) is a significant challenge to (TB) control around the world. An observational research was conducted in a tertiary care teaching hospital to determine the interim pharmacological and microbial results of Rifampicin resistance TB patients. Data from Santhiram Medical College and General Hospital, Nandyal, Kurnool Dist. Andhra Pradesh were obtained from Aug 2020 to Feb 2021, after receiving ethical approval from the Institutional Ethics Committee. The effects of the regimen are determined in terms of cure, finished treatment, treatment failure, number of patients moved to MDR-TB, number of patients who died in long-term MDR-TB regimen patients. Microsoft Excel 2007 was used to analyse the data. There were 82 male and 23 female out of 105 patients included in the study. Of these 75 patients were from rural areas and 40 from urban areas Using the Chi-square test and X2=12.1026, p=0.0005, which was important, the correlation between geographical spread and treatment result was determined. Out of 115 patients, 99 (86.09 percent) were cured of their disease, 06 (5.22 percent) died, 10 (8.69 percent) developed MDR-TB, and 2 (1.74 percent) were deemed medication errors. Males between the ages of 51 and 70 are more vulnerable to TB than females, according to our results. Compared to females of the same age, male patients over 40 years of age are more vulnerable to MDRTB. this was not part of the research objectives, emphasis should not be placed on this as either conclusion or recommendation.

Background: Unplanned intensive care unit (ICU) admission occurs via activation of medical emergency team (MET) and conventional ICU referral (CIR), i.e., ICU consultation. We aimed to compare the dosage, association with unplanned ICU admissions and hospital mortality between MET and CIR systems. Methods: We performed a retrospective, single centre observational study on unplanned ICU admissions from hospital wards between July 2017 and June 2018. We evaluated the dosage (expressed per 1000 admissions) and association of CIR and MET system with unplanned ICU admission using Chi-square test. The relationship (unadjusted and adjusted to Australia and New Zealand risk of death (ANZROD) and lead time) between unplanned ICU admission pathway (MET vs CIR) and hospital mortality was tested by binary logistic regression analysis [Odds ratio (OR) with 95% confidence interval (CI)]. Results: Out of 38,628 patients hospitalised, 679 had unplanned ICU admission (2%) with an ICU admission rate of 18 per 1000 ward admissions. There were 2153 MET and 453 CIR activations, producing a dosage of 56 and 12 per 1000 admissions, respectively. Higher unplanned ICU admission was significantly associated with CIR compared to MET activation (324/453 (71.5%) vs 355/2153 (16.5%) p < 0.001). On binary logistic regression, MET system was significantly associated with higher hospital mortality on unadjusted analysis (OR 1.65 (95% CI: 1.09–2.48) p = 0.02) but not after adjustment with ANZROD and lead time (OR 1.15 (95% CI: 0.71–1.86), p = 0.58). Conclusions: Compared to CIR, MET system had higher dosage but lower frequency of unplanned ICU admissions and lacked independent association with hospital mortality.

Store deler av Norges hydrogenforbruk kommer fra grått hydrogen, som har store direkte utslipp. Derfor ønskes det å se på muligheter for alternative kilder for hydrogen i Norge. Et alternativ er grønt hydrogen, som er produsert ved å spalte vann ved bruk av elektrolyse. Norge har høy andel fornybare energikilder i strømnettet, som er optimalt for produksjon av grønt hydrogen ved å konvertere elektrisitet fra strømnettet til grønt hydrogen. Det finnes videre en del vindparker i Norge, blant dem en vindpark på Bessakerfjellet som har en installert effekt på 57,5MW. Anlegget konverterer per i dag vindkraft til elektrisitet, og selger elektrisiteten, ved hjelp av blant annet spottpriser. Spottprisene varierer basert på forbruk og belastning av strømnettet. Gjennom oppgaven blir det sett på samspillsøkonomien mellom å benytte seg av vindkraft i kombinasjon med hydrogenproduksjonsanlegg, hydrogenlagringstank og batteri i et mikronett, med formål om å optimalisere det økonomiske resultatet. Oppgaven benytter spottpriser for år 2019 som et utgangspunkt for teknoøkonomiske analyser, ved gjennomgang av datasettet for spottpriser 2019, finner man spottpris varierer fra 57 kr per MWh til 1069 kr per MWh. Ved å kombinere vindparken på Bessakerfjellet i et mikronett, kan optimaliseringen av strømforbruket oppnås ved hjelp av styringssystem som tar beslutning om hva og hvor strømmen skal gå for å optimalisere det økonomiske resultatet. Gjennom scenarioanalyser gjort i oppgaven, fremkommer det at ulike konfigurasjoner gir ulikt økonomisk bidrag til totaløkonomien, og ulike hovedelementer har ulikt økonomisk bidrag. Av scenarioanalyser gjort i oppgaven vil det være lønnsomt å produsere grønt hydrogen i kombinasjon med vindkraft hvis salgsprisen på hydrogen er over 4,5USD per kg. Bidrag fra batteri er negativt økonomisk og vil derfor fra anbefales å ikke benytte i stor skala hvis formålet er økonomisk optimalisering. Large parts of Norway's hydrogen consumption come from gray hydrogen, which has large direct emissions. Therefore, it is desired to look at opportunities for alternative sources of hydrogen in Norway. An alternative is green hydrogen, which is produced by splitting water using electrolysis. Norway has a high proportion of renewable energy sources in the electricity grid, which is optimal to produce green hydrogen by converting electricity from the electricity grid to green hydrogen. There are also several wind farms in Norway, among them a wind farm on Bessakerfjellet, which has an installed capacity of 57.5 MW. As of today, the plant converts wind power into electricity, and sells the electricity, using spot prices. Spot prices vary based on consumption and load on the power grid. The thesis looks at the interplay economy between using wind power in combination with a hydrogen production plant, hydrogen storage tank and battery in a microgrid, with the aim of optimizing the economic result. The thesis uses spot prices for the year 2019 as a starting point for techno-economic analyzes, when reviewing the data set for spot prices 2019, one finds spot prices vary from NOK 57 per MWh to NOK 1069 per MWh. By combining the wind farm on Bessakerfjellet in a microgrid, the optimization of power consumption can be achieved with the help of a control system that decides what and where the power should go to optimize the financial result. Through scenario analyzes done in the thesis, it emerges that different configurations make different financial contributions to the total economy, and different main elements have different financial contributions. From scenario analyzes done in the thesis, it will be profitable to produce green hydrogen in combination with wind power if the selling price of hydrogen is minimum 4.5USD per kg. Contributions from batteries are negative financially and will therefore be recommended not to use on a large scale if the purpose is economic optimization. M-IØ