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Aim: To determine the frequency of cardiomyopathy in children having Thalassemia major diagnosed on the basis of Echocardiography. Study Design: A cross-sectional study. Place and Duration: Paediatric department at Peoples medical college hospital (PMCH), Nawabshah from September 2019 to March 2020. Methodology: A total of 236 Thalessemic children visiting as outpatients or inpatients meeting inclusion criteria were enrolled. Informed consent was taken from the patients or their attendants. All demographic variables that included age, gender, address, educational status, family history, age of diagnosis of the disease, start of treatment and number of transfusions graded as none, occasional, were included. Echocardiography findings were performed and then recorded. Results: Mean age of the patients was 10.60±4.064 (5-18) years, 110(49.1%) study subjects were female and 126(50.8%) were male patients. While 75(31.78%) study subjects have family history of thalassemia. A total of 87(36.9%) study subjects have left ventricular dysfunction, 13(14.9%) have global dysfunction, 11(12.6%) have isolated systolic dysfunction and 63(72.4%) have isolated diastolic dysfunction. Conclusion: In -thalassemia, heart disease is the key determinant of prognosis and survival. In this study we found a significant number of thalassemia children having cardiac involvement and ventricular dysfunction.

Introduction: Glucose Homeostasis can potentially be affected by Vitamin D. Vitamin D deficiency has been identified as a global problem with an estimated one billion people worldwide suffering from vitamin D deficiency or insufficiency. Vitamin D deficiency (VDD) is a global health issue and is on the rise in Pakistani pediatric population. Type 1 diabetes (T1D) also negatively impacts bone health and is associated with a modest reduction in bone mineral density (BMD) and strength (7,8) Given the negative impact of vitamin D inadequacy and T1D on bone health, Adolescent with both conditions have multiple risk factors for increased skeletal fragility. In this study we evaluated glycemic changes after vitamin D3 supplement in patients with type I diabetes mellitus and vitamin D deficiency. Objective: To determine the mean glycemic changes after vitamin D3 supplement in children with type I diabetes mellitus and vitamin D deficiency presenting at a tertiary care hospital in Karachi. Methodology: A quasi experimental study design was conducted on 40 children who were presenting in OPD of NICH Karachi for six months. All patients were subjected to demographics and detailed history for Type 1 Diabetes and Vitamin D deficiency. Immunoturbidometry for HbA1C and ELISA for 25OHD was performed. Vitamin D3 supplement was advised as per operational definition. Insulin dose was recorded by parents for three months. 25OHD and HbA1C levels were measured following Vitamin D3 supplements. Statistical analysis was performed to analyze the significance. Results: We observed a significant difference in mean HbA1c level at pre-treatment and post treatment was 9.89±2.04 and 8.42±1.87 respectively with Vitamin D3 supplements, with p-value 0.001. Conclusion: Vitamin D3 supplement improves HbA1C in patients with type I diabetes and vitamin D deficiency.

Coronavirus disease 2019 (COVID-19) is an infectious disease that can present with a wide range of symptoms. Abdominal pain is less common than other symptoms but is more frequent among patients with severe disease. Various abdominal imaging findings are described in the literature for children and adults with COVID-19 infection. Mesenteric lymphadenopathy is reported in pediatric patients with COVID-19 gastrointestinal infection. It is very rarely reported in the adult population. We report a case of an adult male with multiple risk factors, who presented with severe abdominal pain and tenderness in the right inguinal fossa. He was evaluated for differential diagnosis of acute appendicitis, renal colic, diabetic ketoacidosis (DKA), and COVID-19. His investigations showed normal laboratory tests and a normal chest radiograph. His CT abdomen showed a normal appendix and multiple prominent mesenteric lymph nodes. His COVID-19 PCR was positive. He was discharged after pain relief with home isolation instructions and symptomatic management. Our case represents an atypical clinical presentation of COVID-19 infection in many ways. His laboratory investigations were not suggestive of COVID-19. Our patient’s abdominal imaging findings represent a rare association of COVID-19 with mesenteric lymphadenitis in adults. The clinical course of our patient was smooth after discharge and he did not develop any complications of COVID-19 despite multiple risk factors. Our case reminds the significance of keeping broad diagnostic differentials in the emergency department. Although mesenteric lymphadenitis is often a self-limiting condition affecting children and young adults, it is the most frequent alternative diagnosis of acute appendicitis and intussusception. Mesenteric lymphadenitis can be the sole atypical presentation of COVID-19 in adults. Atypical presentations are not uncommon due to the scarcity of data on this evolving disease.

This paper examines whether momentum drives the disposition effect and vice versa in the US stock market. The results from the analysis of the Fama-Macbethregressions show that the disposition effect drives momentum but not the other way around. Furthermore, we find that this relationship varies over time. Along with the disposition effect, size also has an impact on the momentum. Therefore, the relationship between momentum and disposition effect is examined based on size deciles, and results demonstrate that the relationship does not vary significantly with the size of stocks. However, both the cumulative returns and capital gain varies monotonically with the size of stocks.

Background Transthoracic echocardiography (TTE) plays a vital role in the assessment of the surgical management of patients with tetralogy of Fallot (TOF). Accurate assessment of the main pulmonary valve annulus, main pulmonary artery (MPA), and branch pulmonary arteries are crucial for decision-making regarding the surgical approach in the form of total correction. It is also important for performing a systemic-to-pulmonary artery shunt operation and affects the outcome. In some patients with poor echogenic windows, it is sometimes difficult to obtain accurate measurements. Cardiac computed tomographic angiography (CTA) can be a superior diagnostic modality. Therefore, the aim of this study was to evaluate the degree of agreement between TTE and CTA in assessing the main pulmonary valve annulus and the size of the MPA and its branches among patients with TOF patients. Methodology Patients above one year of age, with TOF, presented during the study period of six months - from January 1, 2019, to June 30, 2019, were included in the study. All the patients had TTE and cardiac CTA to assess the annulus and the size of the MPA and its branches (right pulmonary artery (RPA) and left pulmonary artery (LPA)). CTA measurement of all parameters was compared with TTE measurement of the same on three different views each by computing the Bland-Altman plot and Pearson correlation coefficients. Results A total of 73 TOF patients were included in this study. The correlation coefficients between CTA and TTE for the measurement of the annulus were 0.767 and 0.833 for the parasternal short-axis view and the subcostal view, respectively. The correlation coefficients between CTA and TTE for the measurement of MPA were 0.820 and 0.866 for the parasternal short-axis view and the suprasternal view, respectively. The correlation coefficients between CTA and TTE for the measurement of RPA were 0.883 and 0.897 for the parasternal short-axis view and the suprasternal view, respectively. Similarly, the correlation coefficients between CTA and TTE for the measurement of LPA were 0.848 and 0.877 for the parasternal short-axis view and the suprasternal view, respectively. Conclusion In conclusion, there is a strong correlation and agreement between cardiac CTA and TTE for the assessment of the annulus and the size of the pulmonary artery (PA) and its branches in patients with TOF.

Medical errors are one of the major causes of preventable deaths globally. The common causes of this error are miscommunication of information and delay in treatment because of a delay in transmission of clinical information to the doctors. This delay is mainly because of the manual nature of current practices and large patient to nurse ratio. The neonatology department faces major issues in this regard as ill and/or premature new-born infants require constant monitoring to ensure the levels of certain parameters (vital signs) remain within a particular range in order to avoid life threatening or organ damaging situations. To address this issue, an automated system to continuously measure three important vital signs (e.g, temperature, pulse rate, and pulse oxygen concentration) and to automatically indicate clinically significant situations is presented here. This system measures three vital signs using wearable sensors and communicates the data wirelessly with an accuracy of 0.1 degree Centigrade temperature, 0.1 percent oxygen saturation and 0.2 beats per minute pulse rate. An alarm is generated if parameters are out of the safe range. The autonomous and low cost system can successfully aide hospital staff, eliminate risks of human error in the emergency communication system.

The main purpose of this study is to determine the weak form efficiency of the emerging gold markets such as China, India and Russia with the special focus on testing random walks (RWS) and martingale difference sequence (MDS) hypotheses during different periods of time. This study uses biased free statistical techniques such as runs test, parametric variance ratio tests and recent modified non-parametric variance ratio tests based on ranks and signs by using daily spot gold prices from January 12, 1993 to October 28, 2016. Findings of the study suggest that Russian gold market is weak form efficient throughout the period whereas other two markets are found weak form efficient during second sub period only that is, January 2000 to December 2005.

This study provides new insights to predict the excess return of a security. As if factor premia are getting influenced by the sentiments that means sentiments are ultimately affecting the excess return of a security. To meet the objective, a composite index developed by Baker and Wurgler is used as sentiment proxy. Monthly data are used from July 1965 to September 2015 in U.S. context. Granger casualty, Vector Autoregression (VAR), and Fama–Macbeth regression are applied to get the results. Results show that investor sentiments significantly drive the Fama factors’ premia: size premium and profitability premium. Sentiments also contain some information to explain the investment premia but fail to explain the market risk premium and value premium. Furthermore, results suggest that sentiments increase the explanatory power of model measured by R square. In short, this study suggests that investor sentiments play a role in explaining the Fama–French five-factor premia.

The present study was conducted with an objective to extract all possible interrelated etiological factors of cystic ovary and to evaluate the best treatment protocol in dairy cattle under field condition of temperate region. A total of 54 cattle (47 cows and 7 heifers), suffering from ovarian cyst were retrospectively used to study prevalence and outcome of the disease over a period of 5 years. Highest prevalence was recorded in crossbred Jersey, in 2nd lactation and during summer. Major clinical signs showed by the animals with ovarian cysts (OC) were either repeat breeding or anestrus. In case of repeat breeding, irregular cycle (sometimes short and sometimes long in the same cow) in 23.33% (7/30), nymphomania in 13.33% (4/30), short cycle (10-15 days) in 23.33% (7/30) and long cycle (23-30 days) in 10% (3/30) cases were noticed. In remaining 30% cases (9/30) normal cycles were noticed. Right ovary affected more than left one and mean number of cysts recorded were 1.17 per animal. Follicular cysts could be treated with GnRH in 75% (9/12) cases, and, luteal cysts with cloprostenol in 83.33% (10/12) cases. However, in cases where cyst could not be differentiated by rectal palpation, administration of cloprostenol 9 days after HCG treatment was found 66.67% (8/12) effective in curing the disease. It is concluded that both follicular and luteal cysts can be treated successfully with GnRH/hCG and prostaglandin or its analogue, respectively.

This paper analyze whether momentum effect drives disposition effect and vice versa during the period of January 1963 to 2017 in the stock market of USA. To examine the relationship, Fama and Macbeth (1973) cross sectional regressions are performed in the study. The results show that disposition effect drives momentum but not the other way around. Furthermore, this relationship is also examined for three sub-samples, and we find that relationship between momentum and disposition effect varies over the time and one possible reason could be crisis as sample is divided on the basis of the dot-com bubble and global financial crisis. Another finding of the study is that along with the disposition effect, size also has an impact on the momentum effect. To further analyze the impact of size on momentum and disposition effect, we test the relationship between momentum and disposition effect on the basis of size deciles. The results demonstrate that relationship does not vary significantly over the size of stocks but it does have an impact on momentum and disposition effect as past cumulative returns, and capital gain varies monotonically with the increase in the size of stocks.

To evaluate the role of maternal factors, biomarkers, and uterine-artery Doppler in the prediction of hypertension during pregnancy.A prospective cohort study was performed between December 2012 and November 2014. All singleton pregnancies between 11 weeks and 13 weeks, 6 days of pregnancy were included. Patients had their body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), mean arterial pressure, uterine-artery Doppler pulsatility index, and pregnancy-associated plasma protein A (PAPP-A) and free β-human chorionic gonadotropin levels recorded. Any patients diagnosed with hypertension during follow-up were assigned to the case cohort; all other patients were assigned to the control group.Hypertension during pregnancy was observed in 198 (9.7%) of 2042 patients that attended follow-up. The mean BMI, mean arterial pressure, uterine-artery Doppler pulsatility index, and the PAPP-A level at study enrollment were all significantly correlated with the later development of hypertension (P0.001 for all variables). The combined sensitivity, specificity, positive predictive value, and negative predictive value of using the investigated parameters to predict hypertension was 76%, 80%, 31%, and 93%, respectively.Patient BMI, mean arterial pressure, PAPP-A, and pulsatility index were found to be effective predictors of hypertension during pregnancy. Combining these predictors may be beneficial in selecting individuals for close monitoring and early intervention during pregnancy.

Extreme programming (XP) is causing a lot of hype currently. Pair programming is one of its practices, where two programmers work collaboratively at one computer on the same design, algorithm, code, or test. The purpose of this technique is to produce higher quality code in less time. The collaborative working of two brains is better than one as long as both are actively trying to accomplish the same goal. It depends on many things, such as creativity, productivity and brainstorming which are the essential factors of the programming activity. The existence of these factors can vary in homogenous and heterogeneous pairs, so the functional brainstorming capability of different pairs during programming may vary in terms of quality, accuracy and speed. This paper presents the empirical analysis between the homogenous and heterogeneous pairs in terms of efficiency, accuracy, quality, quantity of bugs, brainstorming performance and creativity potential during programming activity

Next generation of information systems will rely on cooperative intelligent agents for playing a pivotal role on behalf of their customers in activities like searching, finding, and relevant information in complex and open environment. Today’s web-based environment is providing a maximum benefit for customers in shape of web-based questions and answers or by acquiring information from intelligent agents. We have also tried to look some of the fundamental issues context-based iterative principles and telepathy procedures that are essential for the successful approach as they work under the principle of brain scaling with each other. In this paper we are proposing an intelligent e-MCSR. It is context-based support for interaction with customers over Internet environment. We have implemented and tested the e-MCSR as an entity with an intelligent interaction. We have also developed a mutual conversation between the customer and e-MCSR within the e-Marketplace. This solution is presently supported by a customizable context-based transaction model and knowledge rules. We found it as a cost effective solution for e-Business.

Presently the use of commercial-off-the-shelf (CO TS) products for a system development is increasing. COTS usage is beneficial in reduction of software development cost and shortens time-to-market. However, the supply chain of COTS by the vendor in software development activities also raises risks for the integrator such as COTS vendor that does not sufficiently satisfy the integrator's requirements e.g., document on the product is not available, slippage in schedule, vaporware, modifications made by the vendor can alter the compatibility of one COTS with other, non assured long time support in the supplied COTS etc. As CO TS-based software development has a dependence on vendor thus the sound evaluation that helps to decide which vendor is suitable and reliable in supply chain in a specific context is necessary. This paper presents the evaluated COTS vendor marketplace and discusses the vendor related issues in the scenario and proposes the COTS vendor selection method

This work presents agent-oriented and service-oriented environment, which combines the concept of services and agents to build distributed system. Customers may find services that help complete their tasks. Services are wrapped by service interface agents. It is mainly described here how agents locate specific service interface agent by submitting requests to the service server with descriptions of required services in the network. We also discuss the intermediate source role of /spl pi/-calculus technology in the co-operation of P2P process systems to get services within intra-organizational and inter-organizational connectivity. Our translation replaces P2P communication shared with different local and global organizations; we prove that this preserves and reflects process meets essential requirements for inter-organizational processes system based on an Internet service daemon. This paper mainly describes the approaches, how agents locate specific product service interface agent by submitting requests to the different organizations product service server with descriptions of required product services in the inter-connected organizations.

Several existing research protocols have already studied long running transactions within a formal context and many of them seemed to use concepts which are not suitable. However, there still exists a great challenge to perform transactions in the loosely coupled environment. In this paper, we present formal model for compositional protocol with the asynchronous /spl pi/-calculus with compensation and exception handling. We study the practice of /spl pi//sub RBT/-calculus, by discussing few paradigmatic examples, its theory, by defining semantics and providing a correct encoding of /spl pi//sub RBT/-calculus into asynchronous /spl pi/-calculus. /spl pi//sub RBT/-calculus is a business process modeling protocol and a distinctive feature of the language is its support for compensation. Compensation is an action taken to recover from error or cope with a change of plan, especially when rollback of a process is not possible. We also propose a process-oriented transactional business coordination model with hierarchical structure. It allows dependencies across hierarchies and supports various transactional behaviors of different services. Based on this model, a novel failure recovery algorithm is presented. It can ensure semantic atomicity for long running Web services composition. Analysis shows it can effectively reduce compensation sphere and thus decrease costs.

The use of a Web source as a communication channel drives requirements for next generation advanced e-business, such as fast e-access and e-customer support capabilities. Recent mobile technology advances have increased demand for mobile customers to connect to existing organizations. In this paper we discuss the intermediate role of /spl pi/-calculus technology between different interconnected organizations, with /spl pi/-calculus technology playing an important role in sharing products required by many organizational platforms. It also provides an ideal implementation platform, furnishing tools that help streamline complex applications. Our framework facilitates a mobile agent application development system, providing key features for distributed organization interface communication systems. This work provides a formal approach of HO/spl pi/-calculus where mobile agents are specified. The specification part of our system (emphasizing mobility) was carried out by using HO/spl pi/-calculus and for the part of execution (the migration of agents). Regarding our mobile agent surfing product from interconnected organizations; we prove that this preserves and reflects process behavior, and meets essential requirements of mobile calculus processes. It also enables mobile access, automated trading, simplicity and adaptability for realization as a distributed transaction based paradigm for e-shopping based on an intelligent agent interface.

Seeing a great need of strong connectivity automation system in between different organizations for the promotion of the best services based upon reliable intermediate source, this paper presents the implementation co-operation of different services in the inter-organizational process locally and globally, that can play important role in sharing services required by many organizational platforms. We discuss how the Inter-organizational π-calculus technology can express organization communications within organizational distributed environment, through an encoding of the inter-organizational π-calculus technology, an enriched system that explicitly represents Names which are known universally but always refer to organizational information. Our presented translation replaces organization-to-organization communication shared with different organizations; we prove that this preserves and reflects process behavior, meets essential requirements for inter-organizational processes system based on an internet service daemon, and also investigate some limitations of the encoding.