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This research investigates the ecological impacts of heavy metals in downstream river sediments with a focus on carbon emission efficiency in agriculture under the environmental regulation context. In this study, thirty sediment samples have been taken from the downstream region of the Shichuanhe River located in Xi'an, Shaanxi province, China, to analyze the availability of heavy metals. The results show that there are high ecological impacts in relation to the heavy metals and that impacts the carbon emission efficiency in agriculture directly. The analysis has also found the importance of significant environmental regulations in the management of such risks. This research has offered a unique angle on the relationship between heavy metal pollution and agricultural carbon release and has given important information on the improvement of environmental control measures. The implications highlight the need for the implementation of measures to enhance the policies that will help to prevent the ecological threats that are connected with heavy metals in the agricultural areas and, thus, improve the management of the environment.

Abstract Background Tracheostomy is considered the oldest and the most effective operative procedure for patients admitted to intensive care units and in emergencies. The study’s objective was to evaluate healthcare providers’ knowledge regarding tracheostomy care. Results All healthcare professionals directly involved in the provision of care to patients with tracheostomy were included and asked to fill out the questionnaire. The response rate was 87.63%. Out of 50, the mean comfort score was 37.69. 70.6% of participants reported having a comfort score equal to or more than 70%. Out of 10, the mean score was 5.29. Only 20.9% of participants were able to score equal to or more than 70%. The results demonstrate that healthcare professionals’ knowledge of tracheostomy care was below par. Only those who were experienced in this field were able to score above average. Conclusion The assessment of knowledge in tracheostomy care highlights the significance of ongoing education and training in the healthcare field. As medical practices evolve, it is imperative for healthcare providers to stay updated with the latest guidelines and techniques to provide the highest standard of care.

Abstract This study explores and explains how duality enables disruptive innovation to encroach on the market and redefine its boundaries under constraints of consumer preferences, purchasing power, technological performance, and complementary technologies. The findings indicate (1) disruptive innovation introduces a new value dimension into the market and enhances the heterogeneity of consumers’ demand, which creates prerequisites for its market encroachment while avoiding competing directly with incumbent enterprises; (2) when considering purchasing power constraints, the disadvantage of disruptive innovation in the preexisting value dimension becomes a price advantage of encroaching on the low-end market; (3) under the constraint of complementary technologies, disruptive innovation can open up new markets that incumbent enterprises have not yet touched by virtue of its advantages in the new value dimension; (4) disruptive innovation does not rely on technological performance to encroach on the market, indicating technological performance is not a necessity for identifying disruptive innovations.

Abstract Background Ibrutinib, a first-in-class inhibitor of Bruton’s tyrosine kinase, is approved for the treatment of various B-cell malignancies and chronic graft-versus-host disease. Based on encouraging preclinical data, safety and efficacy of ibrutinib combined with companion drugs for advanced renal cell carcinoma (RCC), gastric/gastroesophageal junctional adenocarcinoma (GC), and colorectal adenocarcinoma (CRC) were evaluated. Methods Ibrutinib 560 mg or 840 mg once daily was administered with standard doses of everolimus for RCC, docetaxel for GC, and cetuximab for CRC. Endpoints included determination of the recommended phase 2 dose (RP2D) of ibrutinib in phase 1b and efficacy (overall response rate [ORR] for GC and CRC; progression-free survival [PFS] for CRC) in phase 2. Results A total of 39 (RCC), 46 (GC), and 50 (RCC) patients were enrolled and received the RP2D. Safety profiles were consistent with the individual agents used in the study. Confirmed ORRs were 3% (RCC), 21% (GC), and 19% (CRC). Median (90% CI) PFS was 5.6 (3.9–7.5) months in RCC, 4.0 (2.7–4.2) months in GC, and 5.4 (4.1–5.8) months in CRC. Conclusions Clinically meaningful increases in efficacy were not observed compared to historical controls; however, the data may warrant further evaluation of ibrutinib combinations in other solid tumours. Trial registration ClinicalTrials.gov, NCT02599324.

Rabies is a neglected viral zoonotic disease with an almost 100% fatality rate. A pilot project was initiated by the National Institute of Health (NIH), Islamabad, in collaboration with Health Security Partners (HSP) to establish a real-time dog bite surveillance in humans in public sector secondary care hospitals of Islamabad. The main objective of this study was to analyze different characteristics of dog bite cases, identify gaps in surveillance, and recommend suggestions to improve and strengthen real-time dog bite surveillance systems. An observational cross-sectional study was conducted in two major public sector hospitals in Islamabad from December 2019 to July 2020. Data on demographic information, site of the dog bite, category of the dog bite, and treatment was collected via a WVS mobile-based application. Descriptive analysis was carried out for different variables at a p-value of

Metal Organic framework (MOF) has been a class of great interest during the past few years owing to its decidedly applicative, easily synthesized and improved characteristics. Ca-BTC MOF is synthesized by Hydrothermal technique and reported for the first time. Its structural morphology was analyzed using XRD, SEM, and EDS, showing the tetragonal crystal structure having grain size of 24.92 nm and purity of sample respectively. FTIR, Raman Spectroscopy ensures the metal organic framework between Calcium and the tri-carboxylic group. Photoluminescence measures the energy gap of 3.792 eV, showing approximately the semiconducting behavior of synthesized material. Zeta potential having value of −13.5 mV confirms the instability having good microbial activity and conductivity i.e 0.290 mS/cm which reveals important insights into its electrical properties.

Introduction Thyroid nodules are common globally in almost one fifth of the adult population. The gold standard treatment for thyroid nodule is thyroid lobectomy or total thyroidectomy depending upon the diagnosis. Thyroidectomy has a few known complications but, as per the ATA consensus statement, it is a safe surgery to be done as a day care procedure.

Abstract Background Persons in Pakistan have suffered from various infectious diseases over the years, each impacted by various factors including climate change, seasonality, geopolitics, and resource availability. The COVID-19 pandemic is another complicating factor, with changes in the reported incidence of endemic infectious diseases and related syndromes under surveillance. Methods We assessed the monthly incidence of eight important infectious diseases/syndromes: acute upper respiratory infection (AURI), viral hepatitis, malaria, pneumonia, diarrhea, typhoid fever, measles, and neonatal tetanus (NNT), before and after the onset of the COVID-19 pandemic. Administrative health data of monthly reported cases of these diseases/syndromes from all five provinces/regions of Pakistan for a 3-year interval (March 2018–February 2021) were analyzed using an interrupted time series approach. Reported monthly incidence for each infectious disease agent or syndrome and COVID-19 were subjected to time series visualization. Spearman’s rank correlation coefficient between each infectious disease/syndrome and COVID-19 was calculated and median case numbers of each disease before and after the onset of the COVID-19 pandemic were compared using a Wilcoxon signed-rank test. Subsequently, a generalized linear negative binomial regression model was developed to determine the association between reported cases of each disease and COVID-19. Results In late February 2020, concurrent with the start of COVID-19, in all provinces, there were decreases in the reported incidence of the following diseases: AURI, pneumonia, hepatitis, diarrhea, typhoid, and measles. In contrast, the incidence of COVID was negatively associated with the reported incidence of NNT only in Punjab and Sindh, but not in Khyber Pakhtunkhwa (KPK), Balochistan, or Azad Jammu & Kashmir (AJK) & Gilgit Baltistan (GB). Similarly, COVID-19 was associated with a lowered incidence of malaria in Punjab, Sindh, and AJK & GB, but not in KPK and Balochistan. Conclusions COVID-19 was associated with a decreased reported incidence of most infectious diseases/syndromes studied in most provinces of Pakistan. However, exceptions included NNT in KPK, Balochistan and AJK & GB, and malaria in KPK and Balochistan. This general trend was attributed to a combination of resource diversion, misdiagnosis, misclassification, misinformation, and seasonal patterns of each disease.

Aluminum 5454 alloys are considered a subject in this research, widely used in the industry, to develop die tools, molds, engine blocks, aircraft structural components, and many other commercial products. In this research, the WEDM process parameters effects on the Aluminum 5454 alloy tapered workpiece have been investigated. Tapered workpieces with angles of 30°, 45° and 60° are prepared, in which slots are generated using the WEDM process. The taper angle, peak discharge current and pulse-off time are selected as the controllable parameters in this research. Whereas other parameters are kept constant. Impact of the parameters over; kerf width, surface finish, MRR and wire have been investigated. ANOVA is applied to statistically analyze the influence of the factors over the four variables. Regression models for the four variables are determined and the Genetic Algorithm is applied to determine the feasible WEDM process parameters for the desirable magnitudes of the four variables. The regression models and optimized parameter values for different taper angles workpieces of Aluminum 5454 alloy can be used in the industry to increase the productivity and enhanced results.

Papillary thyroid carcinoma is the most prevalent endocrine malignancy of the head and neck region. It makes up to 80% of all thyroid cancers, and has a 10-year survival rate of up to 95%. Differentiated thyroid carcinomas have good prognosis after a complete surgical extirpation as long as it is not associated with invasion of the surrounding structures. The advanced papillary thyroid carcinoma can invade the neighbouring structures of the thyroid gland, such as strap muscles, recurrent laryngeal nerve, trachea, oesophagus, larynx, pharynx, and carotids. Whenever papillary thyroid carcinoma is associated with invasion of aerodigestive tract it is difficult to excise the tumour. We report a patient with stage IV invasive papillary thyroid carcinomas as per Shin Staging system. The surgery was deferred from several hospitals considering the advanced stage of the disease with tracheal extension making it a problematic airway for both the anaesthesiologist and the operating surgeon. ---Continue

Aberrant innominate artery lying high in the neck is a rare entity that can be encountered intraoperatively during midline neck surgeries such as thyroidectomy and tracheostomy. Surgeons should be mindful of this entity as injury to the artery can lead to life-threatening haemorrhage. We report a case of a 40 year old female in whom an aberrant innominate artery was identified high in the neck, while performing a total thyroidectomy. Keywords: Aberrant innominate artery, Thyroidectomy, Tracheostomy, Aorta.

Human body has a set of unspecialized cells called as stem cells that have the ability to generate cells of specialized function. Volume of fractionated plasma extracted from autologous blood is termed as Platelet-rich plasma (PRP) that is rich in several growth factors. Both have shown effective results in the field of regenerative medicine. Physiologically, platelets are the first cells to concentrate at the site of tissue damage, therefore application of PRP in diverse surgical procedures enhances bone and soft tissue healing; this same phenomenon is currently being used in otology, head and neck flap surgery and yielding miraculous outcomes. The perspective role of stem cells in regenerative medicine is wrapped in its loosely arranged DNA with working genes; a similar concept is being worked upon in different ENT procedures with groundbreaking results. Continued...

Coronavirus disease 2019 (COVID-19) has emerged as an unforeseen challenge for head and neck cancer care providers. A similar challenge is also faced by other oncological fields, but the severity of this challenge is highest in otolaryngology because of the need for additional precautionary measures and curbs on the possibility of aerosol forming interventions related to the upper aerodigestive tract. In this narrative review, provision of ethical and consistent care on moral and professional grounds to head and neck cancer patients during the pandemic are discussed for professionals who provide head and neck oncology care.

Introduction Management of the thyroid gland during laryngectomy has been controversial. The primary tumor may invade the thyroid gland by direct invasion or lymphovascular spread. Hypothyroidism and hypoparathyroidism are potential risks when lobectomy or total thyroidectomy are performed simultaneously. Objective To report the frequency of thyroid gland involvement by primary laryngeal squamous cell carcinoma in patients undergoing laryngectomy and to identify possible risk factors for thyroid gland involvement so that judicious excision of thyroid gland can be attained. Methods We performed a retrospective review of 9 years. Data was collected from medical records of patients dated from December 2009 to October 2018. All patients with laryngeal cancer who underwent laryngectomy with lobectomy or total thyroidectomy were included in the present study. Results We reviewed 151 laryngectomy records. A total of 130 surgeries included the thyroid gland with the excised specimen and were available for analysis. There were 124 males and 6 females. The mean age was 59.4 years old. The glottis was the most common subsite involved, in 70 patients, followed by 38 transglottic, 16 supraglottic and 03 subglottic tumors. On histology, 12 out of 130 excised thyroid glands were involved by squamous cell carcinoma. Only subglottic involvement (p = 0.01) was significantly associated with thyroid gland invasion (TGI). Type of laryngectomy, subsite of the primary tumor, thyroid cartilage involvement, neck nodal metastases, and perineural and lymphatic invasion by the primary tumor were not associated with TGI. Conclusion Only subglottic involvement is associated with TGI; therefore, preoperative and intraoperative assessment is necessary prior to considering excision of the thyroid gland.

Throughout the world, Internet of Things (IoT) have been used in different application areas to assist human beings in numerous activities such as smart buildings and cities via remote sensing-enabled techniques. However, simultaneous transmission of packet(s) by multiple devices Ci, which are interested to start a communication session with a common receiver device, is one of the challenging issues associated with these networks. In the literature, various mechanisms have been presented to resolve the aforementioned issue without changing the technological infrastructures; however, neighbourhood information of sensor nodes is not considered yet. In IoT-enabled remote sensing, neighbourhood information of various devices plays a vital role in developing a reliable communication mechanism specifically for scenarios where multiple devices Ci are interested to start communication with a common destination module. In this paper, a neighbourhood-enabled TDMA scheme is presented for the IoT to ensure the concurrent communication of multiple devices Ci with a common destination device Sj preferably with a minimum possible packet collision ratio (if avoidance is not possible). The proposed scheme bounds each and every member device Ci to assign a dedicated time slot to its neighbouring devices in the operational IoT network. Furthermore, neighbouring devices Ci are forced to communicate within the assigned time slot. Simulation results have verified that the proposed scheme is ideal solution compared to the existing schemes for the IoT and other resource-limited networks particularly in scenarios where the deployment process is random.

Introduction: The best initial investigation for thyroid nodule is fine needle aspiration (FNA). Bethesda System is an international standardized system of reporting thyroid nodules and recommends subsequent management. Every institution should assess the risk of malignancy in each category to avoid unnecessary thyroid surgeries, with this aim we conducted a review at our center to calculate risk of malignancy in each category. Materials and Methods: Retrospective 9-year (2009–2018) review of thyroid FNAs done at a tertiary care Centre. The FNA was stratified according to The Bethesda System. Histopathology reports of the operated cases were used to evaluate the cytology for diagnostic accuracy. Results: There were 495 patients who underwent thyroidectomy. The mean age of the cohort was 42.51 +/- 13.2 years and 387 (78.2%) were females. The frequency of Bethesda categories I, II, III, IV, V, and VI were 9.1%, 55.6%, 16.4%, 6.5%, 9.3%, and 3.2% respectively. Malignancy rate in operated thyroid nodules were 37.8%, 8.4%, 33.3%, 50.0%, 89.1%, and 100% for Bethesda categories I to VI, respectively. The sensitivity, specificity, negative predictive value and positive predictive value and their 95% CIs were calculated as 81.30 (73.28 – 87.76%), 77.06 (72.12 – 81.51%), 91.64 (88.3 – 94.1%) and 57.14 (51.79 – 62.33%). The overall diagnostic accuracy was 78.22 (74.12 – 81.95%). Conclusions: All the Bethesda categories showed greater malignancy risks than other reported studies. Knowledge of local rates of malignancy is important to accurately predict the risk of malignancy even when reported with internationally accepted nomenclature like the Bethesda System.

Introduction: Climate factors play an important role in the transmission of viruses, such as influenza viruses, MERS-CoV, and SARS-CoV-1. This study aimed to determine the relationship between changes in temperature, humidity, rainfall, and SARS-CoV-2 contagion. Five ecologically and climatically distinct regions were considered—Karachi, Lahore, Islamabad, Peshawar, and Gilgit-Baltistan. Method: Data on daily COVID-19 cases and deaths were retrieved from government officials, while meteorological information was collected from Pakistan Meteorological Department.. Statistical analysis was performed using SPSS version 20 and the Spearman rank correlation test was used to analyze the correlation between the meteorological factors and COVID-19 cases and deaths. Result: Positive correlation of COVID-19 incidence was observed with all the temperature ranges (maximum, minimum and average) and negative correlation was seen with humidity, DTR and rainfall. COVID-19 deaths were positively associated with temperature and were negatively associated only with humidity. Linear regression showed that for every unit increase in humidity, there was a −3.345 daily significant decrease in COVID-19 cases, while in Karachi for every unit increase in humidity, there remained a 10.104 daily significant increase in cases. In Gilgit-Baltistan, for every unit increase in average temperature and rainfall respectively, significant increases of 0.534 and 1.286 in daily cases were found. Conclusion: This study signifies the effect of climate factors on COVID-19 incidence and mortality rate, but climate factors are not the only variable and several other interlinked factors enhance the spread of COVID-19. Hence, effective mitigation policies, enhancing testing capacities, and developing public attitudes toward adopting precautionary measures are important to overcome this overwhelming pandemic.

In this research, generic and specific risks related to the critical activities of the engineering projects are identified. The surveys and interviews from various project managers and engineers of the leading consultant firms conducting engineering projects in Pakistan are the core identifiers. Specific risks associated with the common engineering projects are qualitatively analyzed to prioritize the risks according to their impact on the schedule and cost of the project. Critical activities related to the specific risks are identified. Estimated manhours without and with quantitative risk assessment have been determined to study the impact of including risk analysis on the schedule and cost of the engineering projects. The relationship between the critical activities and the total man-hours have also been developed to identify the most critical activity or activities influencing the man-hours and ultimately the cost of the project. The likelihood of occurrence of risks are also related to the man-hour completion, to analyze the effect of certainty of the man-hour’s determination, which is an important aspect of estimating schedule, EMV and finally cost. Using the analysis, it has been inferred that the 95% confidence level is not suitable all the time for the estimation of risk impact on the schedule and cost. It increases the man-hour estimation resulting in less competitive proposal to win the project.

Cryptography deals with designing practical mathematical algorithms having the two primitive elements of confusion and diffusion. The security of encrypted data is highly dependent on these two primitive elements and a key. S-box is the nonlinear component present in a symmetric encryption algorithm that provides confusion. A cryptographically strong bijective S-box structure in cryptosystem ensures near-optimal resistance against cryptanalytic attacks. It provides uncertainty and nonlinearity that ensures high confidentiality and security against cryptanalysis attacks. The nonlinearity of an S-box is highly dependent on the dispersal of input data using an S-box. Cryptographic performance criteria of chaos-based S-boxes are worse than algebraic S-box design methods, especially differential probability. This article reports a novel approach to design an 8 × 8 S-box using chaos and randomization using dispersion property to S-box cryptographic properties, especially differential probability. The randomization using dispersion property is introduced within the design loop to achieve low differential uniformity possibly. Two steps are involved in generating the proposed S-box. In the first step, a piecewise linear chaotic map (PWLCM) is utilized to generate initial S-box positions. Generally, the dispersion property is a post-processing technique that measures maximum nonlinearity in a given random sequence. However, in the second step, the concept is carefully reverse engineered, and the dispersion property is used within the design loop for systematic dispersal of input substituting sequence. The proposed controlled randomization changes the probability distribution statistics of S-box’s differentials. The proposed methodology systematically substitutes the S-box positions that cause output differences to recur for a given input difference. The proposed S-box is analyzed using well-established and well-known statistical cryptographic criteria of nonlinearity, strict avalanche criteria (SAC), bit independence criteria (BIC), differential probability, and linear probability. Further, the S-box’s boomerang connectivity table (BCT) is generated to analyze its strength against boomerang attack. Boomerang is a relatively new attacking framework for cryptosystem. The proposed S-box is compared with the state-of-the-art latest related publications. Results show that the proposed S-box achieves an upper bound of cryptographic properties, especially differential probability. This work hypothesizes that highly dispersive hamming distances at output difference, generated a systematic S-box. The mixing property of chaos generated trajectories utilized for decimal mapping. To test the randomness of generated chaotic trajectories, a cryptographically secure pseudo-random sequence was generated using a chaotic map that was tested using the National Institute of Standards and Technology (NIST) NIST-800-22 test suit.

Introduction: Paraganglioma are infrequent neuroendocrine tumors that are most commonly found in the carotid body, ganglia of the vagus, jugular and tympanic nerve. Very rarely they can involve other cranial nerves outside the cranial cavity, we present one such case of hypoglossal nerve paraganglioma in neck. Case Report: A 48 years old male presented with 1-month history of right sided stroke and aphasia. Ultrasonography of neck revealed a highly vascular mass on the right side of the neck. CT angiogram confirmed a highly vascular mass arising above the carotid bifurcation. With the working diagnosis of Glomus tumor, he underwent right sided neck exploration, however, intra-operatively tumor was found to be arising from the hypoglossal nerve instead. Surgery was abandoned on basis of the available literature, with only 6 reported cases in the past 54 years. Patient had no immediate post op complications and was sent for cyber knife treatment. After completion of 5 cycles of cyber knife there was a total of 45% reduction in the size of the paraganglioma with the resolution of the patient’s symptoms after a follow up of 6 months. Conclusion: Hypoglossal nerve paraganglioma is an uncommon tumor of the neck and can be misdiagnosed with the other tumors in this region especially chemodectoma and glomus tumor. The diagnostic criteria and appropriate treatment modalities have not been established due to the rare presentation hence hypoglossal paraganliomas should be kept in mind when Highly vascular neck mass is encountered.

People with vision impairment use Braille language for reading, writing, and communication. The basic structure of the Braille language consists of six dots arranged in three rows and two column cells, which are identified by visually impaired people using finger touch. However, it is difficult to memorize the pattern of dots that form the Braille characters. This research presents a novel approach for automatic Braille characters recognition. The designed approach works in two main stages. In first stage, image alignment & enhancement are performed using several image preprocessing techniques. In second stage, character recognition is performed with a proposed lightweight convolution neural network (CNN). As CNN shows promise for accurate recognition of optical characters. Therefore, we adopted several recently proposed state-of-the-art CNN networks for Braille characters’ recognition. To make the networks light and improve their recognition performance, we proposed a strategy by replacing few modules in the original CNNs with an inverted residual block (IRB) module with less computational cost. The novelty of this work lies in CNN model design and output performance. We executed the effectiveness of the designed setup through experiments on two different publicly available benchmark Braille datasets obtained from visually impaired people. On the English Braille and Chinese double-sided Braille image (DSBI) datasets, the proposed model shows a prediction accuracy of 95.2% and 98.3%, respectively. The reported test time of model is about 0.01s for English and 0.03s DSBI Braille images. In comparison to state-of-the-art, designed method is robust, effective, and capable to identify the Braille characters efficiently. In future, the functional performance of the proposed Braille recognition scheme will be tested through accessible user interfaces.

With the penetration of renewable energy sources based distributed generation (RES-DG) in the distribution network (DN), the operating time of protection relays becomes a major concern to avoid the mis-coordination and nuisance tripping of RES-DG. It is due to the bidirectional flow of current, variance in the fault current level, i.e. high fault current in case of Squirrel cage induction generator (SCIG) based RES-DG, and low fault current for an inverter-based RES-DGs. This paper proposes a novel User-defined dual setting direction overcurrent relay with hybrid time current-voltage (UDDOR-TCV) characteristics to intensify the proposed scheme’s flexibility without any communication assistance for radial DN. The proposed model is formulated in a constrained non-linear optimization fashion and solved with the MINLP solver of general algebraic modelling system(GAMS) software to determine the optimal relay settings. The propounded protection scheme is simulated on IEEE-33 bus radial distribution system and a local 40-bus system hosting the multiple SCIG and PV based RES-DGs at optimal locations. Detailed numerical studies are carried out to show the performance of the proposed scheme. 66.848% and 68.26% reduction in relay operation time with zero mis-coordination is achieved with SCIG-WTG case and PV-units case for the IEEE-33 bus system and a similar reduction in operation time is 68.937% and 66.563% for Local-40 bus system. Moreover, the relays numbers are reduced by 32.692% and 39.7% for IEEE-33 and Local-40 bus systems, respectively, due to the forward/reverse characteristics capability of the proposed UDDOR-TCV. The performance of the proposed scheme is also evaluated on IEEE-8 bus meshed DN. The results are compared with the existing protection schemes in recent literature.

Chronic diseases are increasing in prevalence and mortality worldwide. Early diagnosis has therefore become an important research area to enhance patient survival rates. Several research studies have reported classification approaches for specific disease prediction. In this paper, we propose a novel augmented artificial intelligence approach using an artificial neural network (ANN) with particle swarm optimization (PSO) to predict five prevalent chronic diseases including breast cancer, diabetes, heart attack, hepatitis, and kidney disease. Seven classification algorithms are compared to evaluate the proposed model's prediction performance. The ANN prediction model constructed with a PSO based feature extraction approach outperforms other state-of-the-art classification approaches when evaluated with accuracy. Our proposed approach gave the highest accuracy of 99.67%, with the PSO. However, the classification model's performance is found to depend on the attributes of data used for classification. Our results are compared with various chronic disease datasets and shown to outperform other benchmark approaches. In addition, our optimized ANN processing is shown to require less time compared to random forest (RF), deep learning and support vector machine (SVM) based methods. Our study could play a role for early diagnosis of chronic diseases in hospitals, including through development of online diagnosis systems.

Objective: To see the rate of publication of postgraduate residents' dissertation. Method: The single-centre retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, and comprised research publications from the residents of the departments of Surgery and Medicine who graduated between 2005 and 2020. The surgical subspecialties included Otolaryngology, Ophthalmology, Dentistry, General Surgery, Orthopaedics, Paediatric Surgery, Urology, Plastic Surgery and Cardiovascular Surgery. Data comprised demographics, current institution, current designation, information on dissertation/paper publication, topic of study, year of completion of dissertation, input from the research department, delay in exam due to incomplete dissertation and whether the paper got published in national or international journal. Data was analysed using SPSS 21. Results: Of the 103 subjects, 70(68%) were males and 33(32%) were females, while 73(70.8%) belonged to surgical specialties and 30(29.2%) were from non-surgical specialties. Of the 22(22.9%) who were able to convert, 12(54.5%) publications were carried by national peer-reviewed journals, while 10(45.4%) were carried by international journals; 9(40.9%) unpaid peer review journals and 13(59.1%) paid journals. Delay in exam due to incomplete dissertation was faced by only 16(16.6%) candidates. Conclusion: The rate of publication for resident dissertation was found to be low. Continuous...

Objective: To radiologically examine the impact of bad air quality on the x-ray findings of patients visiting a tertiary care hospital in Lahore. Material and Methods: This cross-sectional study was conducted in the outpatient department of CPTH, Lahore, from 1st of Oct. to 1st of Dec. 2021. A total of 40 patients from age groups between 21 – 60 years and from both genders, who presented with respiratory symptoms, were included in the study for their x-ray findings. As this was a radiological study, there was only one clinical parameter taken into consideration and that was x-ray chest. The patients enrolled in the study were divided into 4 groups, based on the severity of symptoms and findings on x-rays. Only non-smokers were included in the study. Results: Out of 40 patients, 18 showed no changes on x-ray chest, 12 showed minor appearance of unilateral peri bronchiolar shadows, 6 showed a more prominent appearance of peribronchiolar shadows bilaterally whereas 4 showed bilateral signs of lung fibrosis. Conclusion: Exposure to smog filled air can be linked to accelerated development of lung damage, even among people who have never smoked.

'Introduction;: Since the start of pandemic new variants have been evolving and moving from one country to another either by air travel or ground crossings. 'Objective': To find out factors associated with noncompliance of recommended guidelines by international passengers so that we can improve the arrangements at airports where required, improve future preparedness, and give recommendations to concerned authorities for improvement in enforcing guidelines. 'Methodology': A cross-sectional study was carried out at Islamabad International Airport during the months of June and July 2021. The study population included international arriving passengers aged 12 years and above. Questions were asked about following guidelines before boarding, on board, and after disembarkation. Twenty questions were asked to assess compliance level. A median cut off value was set for assessment of noncompliance. 'Results:' The male to female ratio was 1:1. The age range was 12 – 75 years. The odds of noncompliance to guidelines was higher in females compared to males. The results revealed a significant association between region of arrival of respondents and noncompliance. Passengers arriving from Afghanistan, France , UK and USA were more likely to be noncompliant to guidelines (p-value = 0.00). There was a significant association between occupation of participants and noncompliance. Housewives and retired were more likely to be noncompliant (p-value = 0.00). A significant association was observed between vaccinated people and noncompliance. 'Conclusion:' Travelers arriving from some specific countries were noncompliant to guidelines. Vaccinated were most noncompliant which indicates still we need to work on awareness and need legislations, fines or travel restrictions to noncompliant travellers.

Humanity has faced several foes over the centuries, a formidable one amongst them is the current pandemic of COVID-19. The symptoms of COVID-19 are more or less related to the nose and throat. Therefore, patients more often present to Ear Nose Throat (ENT) clinics with symptoms including cough, sore throat, fever and shortness of breath. In the management of head and neck pathologies, as the airway is a direct source of infection, the impact of COVID-19 holds special significance. This review has attempted to explain the various aspects of the disease itself, its diagnosis, the use of personal protective equipment (PPE) to provide an overview of the evolving recommendations in head and neck patients, the future outlook and the limitations faced in developing countries specifically for ENT patients.

SDCE (Software Development Cost Estimation) has always been an interesting and budding field in Software Engineering. This study supports the SDCE by exploring its techniques and models and collecting them in one place. This contribution in the literature will assist future researchers to get maximum knowledge about SDCE techniques and models from one paper and to save their time. In this paper, we review numerous software development effort and cost estimation models and techniques, which are divided into different categories. These categories are parametric models, expertise-based techniques, learning-oriented techniques, dynamicsbased models, regression-based techniques, fuzzy logic-based methods, size-based estimation models, and composite techniques. Some other techniques which directly do not lie in any specific category are also briefly explained. We have concluded that no single technique is best for all situations; rather they are applicable in different nature of projects. All techniques have their own pros and cons and they are challenged by the rapidly changing software industry. Since no single technique gives a hundred percent accuracy, that is why one technique and model should not be preferred over all others. We recommend a hybrid approach for SDCE because in this way the limitations of one model and technique are complemented by the merits of the other model/technique. We also recommend a model calibration to obtain accurate results because if a model was developed in a different environment, we cannot expect reliable estimates from it in a completely new environment.

Ewing Sarcoma of the head and neck region is an extremely rare entity. Treatment usually involves surgery, chemotherapy and radiotherapy in varying sequences. We present the third case to date of Ewing sarcoma of the larynx in a paediatric population. A 5-year-old boy presented to emergency room with acute respiratory distress. Computerized tomography scan showed a mass in the supraglottis; he was intubated using videolaryngoscope and tracheostomy was avoided, mass was removed by cold dissection. Final histopathologic examination revealed Ewing sarcoma. Further workup showed no systemic metastasis. Patient was advised adjuvant therapy which the family refused. Currently he is doing fine on 2 years of follow-up.

In the era of web 2.0, online forums, blogs and Twitter are becoming primary sources for sharing views, opinions and comments about different topics. Classifying these views, opinions and comments is known as sentiment analysis which is an active research area. Sentiment analysis has vast applications in different fields of life, such as marketing, e-commerce and business. Under the umbrella of sentiment analysis, sentiment quantification that deals with estimating relative frequency of class of interest is being investigated by researchers nowadays. In sentiment quantification, exploring effect of new features and comparison of diverse types of classifiers to assess their effectiveness needs further investigation. In this paper, we explore diverse feature sets and classifiers for sentiment quantification. In addition, empirical performance analysis of conventional machine learning techniques, ensemble-based methods and state-of-the-art deep learning algorithms on basis of features set, is performed. The computed results show that the diverse features sets affect the performance of classifiers in sentiment quantification. The results also confirm that the deep learning techniques perform better than the conventional machine learning algorithms.

Introduction: Fear is the normal response to any perceived threat especially when it comes to contracting a new disease resulting in stress and anxiety. This study was conducted during the peak epidemic phase of COVID-19 in Pakistan to assess fear level among Pakistani population regarding COVID-19. Method: A cross-sectional study was conducted during June-July 2020 in Pakistan. A pre-designed questionnaire based on “Fear of COVID-19 Scale” was distributed through email and social media platforms. Descriptive analysis was conducted and frequencies were calculated. Each response scored as 1 (strongly disagree) to 5 (strongly agree). The fear level was categorized as high (>20 score), Moderate (14-20 score) and low (

Land Use/Land Cover (LU/LC) change is among the dominant driving factors that directly influence water balance by transforming hydrological responses. Consequently, a thorough comprehension of its impacts is imperative for sustainable water resource planning and development, notably in developing worlds such as Pakistan, where agriculture is a major livelihood. This research intends to assess the continuing changes in LU/LC and evaluate their probable repercussions on the hydrological regime of the Potohar Plateau. The maximum likelihood classification (MLC) algorithm for land use classification of the high-resolution satellite imageries, the Cellular-Automata Markov Chain Model (CA-MCM) for the projection of LU/LC maps, and the Soil and Water Assessment Tool (SWAT) in tandem with SWAT-CUP for hydrological modeling were employed in this research. The high-resolution climatic dataset (10 × 10 km) was used in SWAT. The LU/LC analysis revealed a continual propagation of agricultural and built-up lands at the detriment of forest and barren land during the last three decades, which is anticipated to continue in the future, too. Hydrological model calibrations and validations were performed on multi-basins, and the performance was evaluated using different statistical coefficients, e.g., the coefficient of determination (R2), Nash–Sutcliffe Efficiency (NSE), Kling–Gupta Efficiency (KGE), and Percent Bias (PBIAS). The results yielded that the model performed very well and demonstrated the model’s robustness in reproducing the flow regime. The water balance study revealed that the anticipated LU/LC changes are projected to decrease the mean annual surface runoff, water yield, and streamflow due to an increase in percolation, lateral flow, sub-surface flow, and evapotranspiration. More significant variations of the water balance components were observed at the sub-basin level, owing to the heterogeneous spatial distribution of LU/LC, than at the basin level. The outcome of this study will provide pragmatic details to legislative bodies to develop land and water management ameliorative strategies to harness hydrological changes sustainably.

Background Over 3 million people lost their lives across the globe due to the COVID-19 related pandemic. The unprecedented restrictions on mobility have imposed in the form of isolation, quarantines, and lockdowns to curb the profound effects of the pandemic and retain physical health. This study examined the relationship between various pain levels, demographic variables and patient satisfaction with COVID-19 during isolation. Methods The primary data in this study were collected from isolated patients during their isolation and treatment in a public hospital. We obtained information from patients with COVID-19 (N = 100) about their demographic characteristics, varying levels of pain, and satisfaction with the services provided during the isolation period. We computed the descriptive statistics to explain the profile of participants, ANOVA was used to find out the difference between various groups on patient satisfaction, and structural equation modeling was performed to examine the link between pain levels, demographic factors, and patient satisfaction. This analysis was performed with STATA and SmartPLS-3. Results The findings of this study ascertained that respondent’s education (Beta, β = 2.961, p = 0.003), assets such as possession of a house (β = 4.563, p = 0.000), perception of income adequacy during the lockdown (=2.299, p = 0.022), and negligence in prevention (β = 1.975, p = 0.049) significantly affects patient satisfaction during the isolation period. Moreover, satisfaction with life, physicians and medicine, income adequacy, and fear of the participants was significantly linked to the pain level (Model F-stat = 86.323, p = 0.0001). Patients who were satisfied with their treatment had significantly lower odds of having pain (OR 0.023, 95% CI [0.001–0.0452]). Patients who had enough income to meet their basic necessities were found to have significantly lower odds of having pain (OR 0.155, 95% CI [0.032–0.740]. Discussion and Conclusion We conclude that a higher level of education, low income, and living in a rented house contributes significantly to the feeling of more satisfaction with the provided services. This implies that people with more affluent backgrounds are less likely to be satisfied with the provided services as low-income and living in rented house groups are more satisfied during isolation than others. The pain level is also affected by subjective factors such as fear and satisfaction which need to be considered while doing patient management. This study can be helpful in improving the delivery of public services of isolation centers by considering various characteristics and demographic factors of patients.

Pancreatic ductal adenocarcinoma (PDAC) accounts for about 3% of all cancers in the United States and about 7% of all cancer deaths. Despite the lower prevalence relative to other solid tumors, it is one of the leading causes of cancer-related death in the US. PDAC is highly resistant to chemotherapy as well as radiation therapy. Current standard-of-care chemotherapeutic regimens provide transient disease control but eventually tumors develop chemoresistance. Tumors that are deficient in DNA damage repair mechanisms such as BRCA mutants respond better to platinum-based chemotherapies. However, these tumor cells can utilize the poly adenosine diphosphate (ADP)-ribose polymerase (PARP) as a salvage DNA repair pathway to prolong survival. Hence, in the presence of BRCA mutations, the inhibition of the PARP pathway can lead to tumor cell death. This provides the rationale for using PARP inhibitors in patients with BRCA mutated PDAC. The phase III POLO trial showed a near doubling of progression-free survival (PFS) compared with placebo in advanced PDAC when a PARP inhibitor, olaparib, was used as maintenance therapy. As a result, the US Food and Drug Administration (FDA) approved olaparib as a maintenance treatment for germline BRCA mutated advanced PDAC that has not progressed on platinum-based chemotherapy. The success of olaparib in treating advanced PDAC opened the new field for utilizing PARP inhibitors in patients with DNA damage repair (DDR) gene defects. Currently, many clinical trials with various PARP inhibitors are ongoing either as monotherapy or in combination with other agents. In addition to germline/somatic BRCA mutations, some trials are enrolling patients with defects in other DDR genes such as ATM , PALB2 , and CHEK2 . With many ongoing PARP inhibitor trials, it is hopeful that the management of PDAC will continuously evolve and eventually lead to improved patient outcomes.

Objective: An outbreak investigation team was deputed to assess the magnitude of disease, to evaluate risk factors and recommend control measures. Study Design: Case control study. Place and Duration of Study: Boy’s Training Center Karachi, from 4th Apr to 28th Apr 2017. Material and Methods: On 30th March 2017, 30 suspected cases of acute viral hepatitis were reported. Active case search carried out and hospitals record reviewed. Age and gender matched controls (1:1) taken. Case definition was “Sudden onset of jaundice PLUS presence of Hepatitis E IgM on ELISA in a resident of Boys vocational training center from 9th March to 12th May 2017”. Total 79 blood samples collected for hepatitis screening and 5 water samples collected for microbiological/physiochemical testing. Descriptive analysis was carried out,frequencies/ attack rates were determined and odds ratios were calculated at 95% confidence interval and p

Optimization of the drilling parameters of the composite material is the key objective of this research, enhancing the surface roughness and minimizing the tool wear. In contrary to the other research, optimizing the machining parameters for a specific composite material for the mass productions, machining parameters are optimized for GFRP (Glass Fiber Reinforced Polymer), CFRP (Carbon Fiber Reinforced Polymer) and KFRP (Kevlar Fiber Reinforced Polymer) for the job shop production. In this research, the machining parameters are optimized for the enhanced surface roughness and minimum tool wear by varying the three types of composite material and three levels of the cutting speed. Nine experiments were performed, which were repeated twice in random manner to eliminate the biasness of the results. In these experiments, PVD (Physical Vapor Deposition) coated carbide inserts are used with the same geometry. Seventeen holes were machined in a single experiment, which surface roughness is measured by cutting the composite plate from middle of the hole and using the Countermatic surface roughness meter at different locations. Average surface roughness is determining for each set of varying parameters and plotted to observe the set of parameters for the minimum surface roughness. It has been observed that the minimum surface roughness are observed at; 1500rpm in GFRP, 2000rpm in CFRP and at 2500rpm in KFRP. Finally, the wear patterns are also observed on the drill inserts using SEM (Scanning Electron Microscope) and it has been found that no prominent wear has been observed in the drill inserts, whereas, prominent depletion of coating are found at the higher cutting speed.

Text data plays an imperative role in the biomedical domain. As patient's data comprises of a huge amount of text documents in a non-standardized format. In order to obtain the relevant data, the text documents pose a lot of challenging issues for data processing. Topic modeling is one of the popular techniques for information retrieval based on themes from the biomedical documents. In topic modeling discovering the precise topics from the biomedical documents is a challenging task. Furthermore, in biomedical text documents, the redundancy puts a negative impact on the quality of text mining as well. Therefore, the rapid growth of unstructured documents entails machine learning techniques for topic modeling capable of discovering precise topics. In this paper, we proposed a topic modeling technique for text mining through hybrid inverse document frequency and machine learning fuzzy k-means clustering algorithm. The proposed technique ameliorates the redundancy issue and discovers precise topics from the biomedical text documents. The proposed technique generates local and global term frequencies through the bag-of-words (BOW) model. The global term weighting is calculated through the proposed hybrid inverse documents frequency and Local term weighting is computed with term frequency. The robust principal component analysis is used to remove the negative impact of higher dimensionality on the global term weights. Afterward, the classification and clustering for text mining are performed with a probability of topics in the documents. The classification is performed through discriminant analysis classifier whereas the clustering is done through the k-means clustering. The performance of clustering is evaluated with Calinsiki-Har-abasz (CH) index internal validation method. The proposed toping modeling technique is evaluated on six standard datasets namely Ohsumed, MuchMore Springer Corpus, GENIA corpus, Bioxtext, tweets and WSJ redundant corpus for experimentation. The proposed topic modeling technique exhibits high performance on classification and clustering in text mining compared to baseline topic models like FLSA, LDA, and LSA. Moreover, the execution time of the proposed topic modeling technique remains stable for different numbers of topics.

Abstract Objectives: To evaluate the diagnostic accuracy of contrast enhanced CT scan to detect cervical nodal metastasis in oral cavity squamous cell carcinoma keeping final histopathology as gold standard. Methods: Cross sectional study conducted from 1st January 2015 - 31st October 2016. All patients undergoing surgery who had their CT scans done at our centre were included in the study. Diagnostic accuracy of CT scans was calculated using final histopathology as gold standard. All CT scan were reviewed by consultant radiologist. Results: Total 100 patients were reviewed, 70% were female, 55% had buccal and 32% had tongue cancer. 11 cases of T1, 20 cases of T2 , 4 cases of T3 and 21 cases of T4 stages were staged similarly by CT scan and histopathology, the kappa value of38.8%, p value

The ongoing COVID-19 pandemic is caused by SARs-CoV-2. The virus is transmitted from person to person through droplet infections i.e. when infected person is in close contact with another person. In January 2020, first report of detection of SARS-CoV-2 in faeces, has made it clear that human wastewater might contain this virus. This may illustrate the probability of environmentally facilitated transmission, mainly the sewage, however, environmental conditions that could facilitate faecal oral transmission is not yet clear. We used existing Pakistan polio environment surveillance network to investigate presence of SARs-CoV-2 using three commercially available kits and E-Gene detection published assay for surety and confirmatory of positivity. A Two-phase separation method is used for sample clarification and concentration. An additional high-speed centrifugation (14000Xg for 30 min) step was introduced, prior RNA extraction, to increase viral RNA yield resulting a decrease in Cq value. A total of 78 wastewater samples collected from 38 districts across Pakistan, 74 wastewater samples from existing polio environment surveillance sites, 3 from drains of COVID-19 infected areas and 1 from COVID 19 quarantine center drainage, were tested for presence of SARs-CoV-2. 21 wastewater samples (27%) from 13 districts turned to be positive on RT-qPCR. SARs-COV-2 RNA positive samples from areas with COVID 19 patients and quarantine center strengthen the findings and use of wastewater surveillance in future. Furthermore, sequence data of partial ORF 1a generated from COVID 19 patient quarantine center drainage sample also reinforce our findings that SARs-CoV-2 can be detected in wastewater. This study finding indicates that SARs-CoV-2 detection through wastewater surveillance has an epidemiologic potential that can be used as supplementary system to monitor viral tracking and circulation in cities with lower COVID-19 testing capacity or heavily populated areas where door-to-door tracing may not be possible. However, attention is needed on virus concentration and detection assay to increase the sensitivity. Development of highly sensitive assay will be an indicator for virus monitoring and to provide early warning signs.

Background: Treatment with gemcitabine/nab-paclitaxel confers a survival benefit over gemcitabine monotherapy in patients with advanced pancreatic cancer (APC). However, such treatment can be associated with significant toxicities especially in older patients and carries practical disadvantages related to a weekly schedule along with financial cost. We retrospectively analyzed patients >65 years of age with APC who received a modified biweekly regimen of gemcitabine/nab-paclitaxel to evaluate efficacy and toxicity. Methods: Patients aged >65 years with chemo-naïve APC with Eastern Cooperative Oncology Group performance status ⩽2 were studied. Patients were treated with a modified regimen of gemcitabine 1000 mg/m 2 and nab-paclitaxel 125 mg/m 2 every 2 weeks on days 1 and 15 of a 28-day cycle. Patients were evaluated for progression-free survival (PFS) and overall survival (OS) with analyses performed using the Kaplan–Meier method. Adverse events were recorded on the day of chemotherapy. Cancer antigen 19.9 was measured in every cycle and restaging scans were performed every two cycles. Results: A total of 73 patients (median age: 73 years; range: 66–93) were treated with biweekly gemcitabine/nab-paclitaxel as first-line treatment. The median OS and PFS were 9.1 months and 4.8 months, respectively. Around 66% of patients received growth-factor support based on American Society of Clinical Oncology guidelines and no patient developed neutropenic fever. The incidences of grade ⩾3 toxicity for neutropenia, anemia, thrombocytopenia, and neurotoxicity were 2%, 7%, 3%, and 5%, respectively. Dose reductions of gemcitabine/nab-paclitaxel were required in 10% and 4% patients, respectively. Conclusion: In patients older than >65 years of age with APC, a modified regimen of biweekly gemcitabine/nab-paclitaxel was found to be effective when compared with the historical control from the MPACT study. This regimen allowed for fewer dose reductions, reduced healthcare costs from additional appointments, travel-related cost, as well as a favorable side-effect profile while maintaining efficacy. Though retrospective in nature, this study underlines the need for further investigation, particularly in elderly patients with poor performance status, such as those with pancreatic cancer, and in order to combine with a third agent, such as a targeted treatment or immunotherapy.

Abstract The history of glomangiopericytoma began in 1924 when it was initially diagnosed by Stout and Murray. It is a rare tumour of the respiratory mucosa, with a prevalence of less than 0.5% among all sinonasal tumours. Literature shows female predominance among patients who develop glomangiopericytoma. So far, no accurate aetiology has been discovered, but there are certain risk factors, including trauma, use of corticosteroids and high blood pressure, which are believed to cause glomangiopericytoma. Patients usually present with a history of epistaxis or nasal blockage, though symptoms can get worse if the tumour is not resected timely and can lead to visual disturbance, chronic sinusitis and headache. It has reddish polypoidal appearance on examination. The best modality for the treatment of glomangiopericytoma is endoscopic surgical resection via trans-nasal approach. We present the case of a 70-year-old man, Continuous...

Abstract This study was conducted to assess the frequency of pre-operative malnourishment in patients being treated for oral cavity squamous cell carcinoma. A retrospective chart review was carried out at the Aga Khan University Hospital, Karachi, on 62 patients. Patients were screened pre-operatively through a standard nutritional assessment tool at the time of admission to assess for malnutrition. Mean age of presentation was 48.34 ± 13.11 years, mean height was 165 ± 8.62cm, weight 66.09 ± 14.98 kg and BMI of 24.09 ± 4.84. Males were 82.3% and 17.7% were females. At the time of admission, a significant number or patients, 12 (19.4%) were prone to malnourishment, while 3 (4.8%) patients were malnourished: Assessment was done by using a standardised nutritional assessment tool. Keywords: Malnutrition, Squamous cell Carcinoma, Radiotherapy Continuous...

Combination therapy with ibrutinib and cetuximab is being studied in a phase 1b/2 trial in patients with advanced gastrointestinal and genitourinary malignancies. Rash is a common cutaneous adverse effect for both medications. Ibrutinib is a Bruton’s tyrosine kinase (BTK) inhibitor approved for the treatment of several hematologic malignancies. The rash can be asymptomatic, nonpalpable, mild skin eruption, or palpable purpuric rash. A rarer panniculitis form has also been reported. Cetuximab, an epidermal growth factor (EGFR) inhibitor, approved for treatment in head and neck and advanced gastrointestinal malignancies is also known to cause acneiform rash in majority of patients. The rash is due to inhibition of EGFR in the basal keratinocytes and hair follicles. In the case of ibrutinib, the off-target effects on EGFR, c-kit, and platelet-derived growth factor receptor (PDGFR) are thought to be responsible for the cutaneous eruption of various forms of rash. The combination therapy with the BTK inhibitor and a direct EGFR inhibitor may potentiate the rash inducing effects of the drugs. Here, we describe a case of vasculitis in a patient with metastatic colon cancer who received both ibrutinib and cetuximab on a phase Ib/II clinical trial.

Objective: To determine the commonest stage of hypopharyngeal and upper esophageal carcinoma at presentation, common complications after surgery, perioperative mortality, and one-year survival rate after surgery. Study Design: A descriptive prospective study. Place and Duration of Study: Combined Military Hospitals, Rawalpindi, Lahore, and Malir, from Oct 2008 to Oct 2016. Material and Methods: Through consecutive sampling, 25 individuals were sampled after staging disease through TNM classifications provided by the 1983 American Joint Committee on Cancer Classification for hypopharyngeal cancers. Total laryngopharyngoesophagectomy and gastric pull-up reconstructive surgery was performed by two teams. The total operation time in hours and the approximate blood loss in ml during the procedure was documented. The patients were monitored post-operatively for pulmonary (respiratory failure requiring ventilatory support, atelectasis, pneumonia, pulmonary embolism, pleural effusion/hemothorax, etc.), cardiac (arrhythmias, myocardial infarction, and congestive cardiac failure), and surgical complications (wound infections, anastomotic leak, and fistula formation). The patients were also followed-up for survival at 1st, 6th, and 12th month. Results: There were 18 males and 7 females (mean age: 53 ± 14 years). Majority presented with T4N2M0-stage disease. The operation lasted for a mean time of 7.7 ± 1.3 hours (range: 6.3-11 hours) and a mean 1218 ± 338 ml (range: 590-2020 ml) blood was lost during the operation. The patients remained in the hospital for a mean 26 ± 16 days (range: 1-56 days). The commonest complication following operation was pleural effusion/hemothorax present in 72% of the patients. The perioperative mortality was 12% and one-year survival rate was 36%. Conclusion: Majority of our sampled patients presented with T4N2M0-stage disease. The mean operation time in our sample was longer with an increased incidence of anastomotic leaks when compared to the international data. The other complications and perioperative mortality were comparatively similar while one-year survival rate was lower.

This paper studies the relationship between GDP fluctuations and long-run economic growth by using macro-panel approach (with small N and large T) in a panel of five selected South Asian countries (SSAC) including Bangladesh, India, Nepal, Pakistan and Sri Lanka, over a period of 1980-2010. For this purpose, modern non-stationary panel techniques such as the cross section dependence test, unit root test under cross sectional dependence, panel cointegration and Group Mean Fully Modified OLS (GM-FMOLS) estimation are applied. The study finds a significant long-run cointegrating relationship between GDP fluctuations and long-run growth in the SSAC and GM-FMOLS estimates and shows that this link is negative. It indicates that GDP fluctuations have a significant negative impact on long-run growth in the SSAC and these fluctuations of GDP may be detrimental for long-run growth in developing countries. Therefore, the governments of such countries shouldn’t rely on growth-oriented policies only but should equally focus on managing these fluctuations in GDP to achieve sustained and stable growth rate.

With the emerging growth of digital data in information systems, technology faces the challenge of knowledge prevention, ownership rights protection, security, and privacy measurement of valuable and sensitive data. On-demand availability of various data as services in a shared and automated environment has become a reality with the advent of cloud computing. The digital fingerprinting technique has been adopted as an effective solution to protect the copyright and privacy of digital properties from illegal distribution and identification of malicious traitors over the cloud. Furthermore, it is used to trace the unauthorized distribution and the user of multimedia content distributed through the cloud. In this paper, we propose a novel fingerprinting technique for the cloud environment to protect numeric attributes in relational databases for digital privacy management. The proposed solution with the novel fingerprinting scheme is robust and efficient. It can address challenges such as embedding secure data over the cloud, essential to secure relational databases. The proposed technique provides a decoding accuracy of 100%, 90%, and 40% for 10% to 30%, 40%, and 50% of deleted records.

OBJECTIVE: HCV infection is more common among adults with type 2 diabetes and possibly it can affect the glycemic control in patients with diabetes. This study was conducted to find whether eradication of CHC infection with direct acting antiviral (DAA) agents is associated with good glycemic control in patients with type 2 diabetes or otherwise. MATERIAL AND METHODS: Among 545 patients with diabetes who were treated with DAA (Interferon & Ribavirin free regimen) for chronic HCV infection, were included in the study. Changes in average (HbA1c) levels and use of ant diabetic medication 6 months before and after DAA treatment were compared between patients who achieved sustained virologic response (SVR) and those who did not achieve SVR. RESULTS: In patients with high base line HbA1c, the drop in HbA1c in reference to DAA treatment was greater in those who achieved SVR (1.99%) in comparison to those who did not (1.70%) (Adjusted mean difference 0.29, p=0.02). The doses of anti diabetic agents decreased more in subjects who achieved SVR in comparison to those who met treatment failure. This was evident for those who were using Insulin for control of their diabetes, which dropped significantly from 46.4% to 41.3% in patients achieving SVR compared with a slight increase from 48.7% to 50.2% in those who were in treatment failure group. CONCLUSION: It is hereby concluded that improved glycemic control is associated with eradication of HCV with DAA based regimens evidenced by decrease in mean HbA1c and decreased insulin as well as oral anti diabetic agents use in SVR achievers.

Background. Gastric cancer is the fourth most common cancer worldwide and the second most common cause of cancer-related death. The majority of newly diagnosed gastric cancer cases present either as locally advanced tumor growth or with distant metastases. Case Report. Here, we describe a case of isolated brain metastases in a male patient with gastric cancer. Initially, our patient presented with dysphagia and was diagnosed with gastric cancer after a thorough evaluation. One year after chemotherapy and surgical resection of his gastric cancer, he presented with headaches, nausea, dizziness, and photophobia. Further evaluation of these symptoms led to the discovery of three metastatic brain lesions without evidence of extracranial metastases. Conclusions. Our review of the literature has found that such cases are rare. Additionally, our review of the literature demonstrates the poor outcomes associated with metastatic brain lesions from gastric cancer and highlights the importance of surgical resection in increasing overall survival time.