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This study intends to explore the ideology of the West in The Reluctant Fundamentalist by Mohsin Hamid who successfully portrayed the impact of 9/11 to view the ideology of the West for the East (Muslims). Edward Said’s Orientalism is an idea that represents views of the West about the East that fails to understand the cultural differences and perceives the East as biased, and subvert being opposed to reality. This idea of the West is rooted in the history of colonization and racism. The study follows qualitative research in the literary work of The Reluctant Fundamentalist by Mohsin Hamid through the dialogues of Changez. The novel depicted Changez as a reluctant fundamentalist and he was encountered of being Muslim due to the violent acts of some extreme radicals, and gave rise to the racist ideology of Islamophobia of the West.

We constructed a catechol detection biosensor that is enzyme-free and extremely selective using a glassy carbon electrode (GCE) modified with a copper-polypyrrole (Cu-PPy) composite.

The sensors are effectively used in the determination of Hq and Cat in a real water sample.

Purpose: Osteoporosis is a common health problem all over the world. Loss of bone mass with aging leads to osteoporosis. Different factors affect the bone mass loss and consequencltly osteoporosis prevalence. However, these factors are under-studied in the Pakistan.This study aims to identify the risk factors of osteoporosis among patients in Holy Family Hospital Rawalipindi. Methodology: This descriptive cross-sectional study was carried out in among 120 diagnosed patients of osteoporosis for six months from April 2021 to September 2021 in a tertiary care hospital of Rawalpindi. Patients were recruited in the study via a set of inclusion and exclusion criteria and non-probability convenient sampling technique. A self-strcutured questionnaire was used to collect data. Before data collection information consent was acquired from all participants. Data analysis was performed on SPSS version 25. Descriptive statistics were applied. Findings: Osteoporosis was more prevalent among the patients who had, age group with more than 45years (79.16%), female gender (72.50%), low education level (64.16%), lower socioeconomic status (68.33%), family history of osteoporosis (61.67%), sedentary lifestyle (57.50%), history of corticosteroids therapy (53.33%), no milk use (69.20%), no fresh vegetables and fruits use (80.00%), no inatke of calcium supplements (78.33%), no sunshine exposure (77.50%), and overweight (48.33%). In short, age group with age above 45years, female gender, low education level, lower socioeconomic status, family history of osteoporosis, sedentary lifestyle, overweight, history of use of corticosteroids, no milk use, no intake of fresh vegetables and fruits, no intake of calcium supplements, and no sunshine exposure, all raise the incidence of osteoporosis. Recommendations: People should take milk, fresh fruits and vegetables, calcium supplements, and sun bath. Furthermore, people should spend active life with proper weight.

This article investigates how working capital influences firm profitability. Pakistan's cement industry. Further, the research analyses the Average Collection Period, Average Payment Period, Inventory Turnover in Days, and Cash Conversion Cycle's impact on profitability.This analysis utilizes annual reports from PSE cement businesses (PSX).It included firm info. Quantitative research uses two approaches. Models first. Pearson correlates variables. Second, regression analysis is to determine profitability, liquidity, and other variables' causes. Working capital management (WCM) increases profitability by positively affecting the cash conversion cycle, inventory turnover, and sales. Managers are asked to give WCM more thought. Management must know how much money to use for fixed assets and working capital. Poor working capital management results.

Hypertension (HTN) is a very prevalent health issue around the world. Many factors influence HTN and some of those include diabetes, obesity, gender, age, and diet. Impact of diet on hypertension, is understudied in our region, therefore, this study was set to manifest the effect of diet on HTN prevalence. This cross-sectional study was performed among local Islamabad of population, Pakistan in 3 months from November 2019 to January 2020. 138 people were recruited in study via a developed criterion. Data was collected by self-designed proforma. Data analysis was done by applying IBM SPSS version 25. Descriptive statistics were used for quantitative variables. As data was non-parametric, so we applied non-parametric statistical tests like Mann Whitney test, Kruskal–Wallis test and Spearman correlation analysis were applied to assess, the difference in means of both systolic and diastolic BP between female and male, difference in means of both systolic and diastolic BP among three consumption frequency levels, and association, direction, and strength of between HTN and foods consumption. Present study indicates overall high prevalence of HTN (39.86%) among study population. Means of age, systolic and diastolic BP for study population were 43.42 (with SD of ±8.30) years, 138.01mmHg (with SD of ±19.37), and 89.38mmHg (with SD of ±7.10) respectively. Difference in means of both systolic and diastolic between females and males was not significant (p=0.093 and p=0.078 respectively) although these were higher among males and gender was not associated with HTN significantly (p=0.069). Strength and direction for association between fast food and HTN was strong and positive, for association between snack food and HTN was strong and positive while for association between fresh fruits and raw vegetables was strong and negative with correlation coefficients (+0.690 for diastolic, +0.710 for systolic), (+0.651 for diastolic, +0.661 for systolic), (-0.712 for diastolic, -0.712 for systolic) respectively. In short, present study concludes that HTN was more prevalent among males, fast food, snack foods eaters and fresh fruits and raw vegetables non-eater in contrast to females, fresh fruits and raw vegetables eaters and non-eaters of fast foods and snack foods. Higher consumption of fast foods and snack lead to higher prevalence of HTN and vice versa whereas higher consumption of fresh fruits and raw vegetables bring decline in the incidence of HTN incidence and vice versa. So, we are dependent on awareness among people about the influence of food on HTN and gender specific measures for each gender to reduce HTN incidence.

Purpose The rs641738 C>T in membrane-bound O-acyltransferase domain-containing protein 7 (MBOAT7) is implicated, along with the rs738409 C>G polymorphism in patatin-like phospholipase domain-containing protein 3 (PNPLA3), in nonalcoholic fatty liver disease (NAFLD). The association of these polymorphisms and NAFLD are investigated in Hispanic children with obesity. Methods Obese children with and without NAFLD were enrolled at a pediatric tertiary care health system and genotyped for MBOAT7 rs641738 C>T and PNPLA3 rs738409 C>G. NAFLD was characterized by the ultrasonographic presence of hepatic steatosis along with persistently elevated liver enzymes. Genetic variants and demographic and biochemical data were analyzed for the effects on NAFLD. Results Among 126 enrolled subjects, 84 in the case group had NAFLD and 42 in the control group did not. The two groups had similar demographic distribution. NAFLD was associated with abnormal liver enzymes and elevated triglycerides and cholesterol (pG had an additive effect in NAFLD; however, MBOAT7 rs641738 C>T had no effects alone or synergistically with PNPLA3 polymorphism. NAFLD risk increased 3.7-fold in subjects carrying PNPLA3 GG genotype and decreased in MBOAT7 TT genotype. Conclusion In Hispanic children with obesity, PNPLA3 rs738409 C>G polymorphism increased the risk for NAFLD. The role of MBOAT7 rs641738 variant in NAFLD is less evident.

Obstructive sleep apnea (OSA) is a common sleep related disorder, and it is affected by number of factors including age, gender, obesity, educational status and menopause. However, in the presence of conflicting findings regarding impact of menopause on OSA, our study was aimed to check the prevalence of OSA in women and impact on it of menopause. This descriptive cross-sectional study was conducted in around 3months from August 2020 to October 2020 in a rural area of Punjab, Pakistan. 205 participants were recruited according to set criteria of our study. Women with age from above 30 years to 60 years, who had regular menstrual cycles or had cessation of menses since at least one last year were enrolled in the study whereas women who had irregular menstrual cycles and were not willing to participate were excluded from the study. Data was collected by two questionnaires including self-structured proforma and STOP Questionnaire. Data analysis was done with the help of SPSS version 25. Different tests including Chi-square test and Independent Sample t-test were applied to evaluate the study variables. In general, current study indicates high prevalence (28.3%) of high risk of OSA among women, however, STOP score was higher among postmenopausal women (1.641 with SD±0.908) as compared to premenopausal women (1.073 SD±0.693)) which means that postmenopausal women had higher risk of development of OSA in comparison with premenopausal women. The association between OSA risk and menopause was statistically significant (p=0.001). The difference of score between premenopausal women and postmenopausal women was significant statistically (p=0.0001). In short, prevalence of OSA high risk is higher among postmenopausal women in comparison with premenopausal women and menopause affects OSA but the mechanism is still not clear.

Recently, an innovative method for wastewater treatment and nutrient removal was developed by combining the sequence batch reactor and membrane bioreactor to overcome pollution caused by shipboard sewage. This system is a modified form of the activated sludge process and involves repeated cycles of mixing and aeration. In the present study, the bacterial diversity and dominant microbial community in this wastewater treatment system were studied using the MACROGEN next generation sequencing technique. A high diversity of bacteria was observed in anaerobic and aerobic bioreactors, with approximately 486 species. Microbial diversity and the presence of beneficial species are crucial for an effective biological shipboard wastewater treatment system. The Arcobacter genus was dominant in the anaerobic tank, which mainly contained Arcobacter lanthieri (8.24%), followed by Acinetobacter jahnsonii (5.81%). However, the dominant bacterial species in the aerobic bioreactor were Terrimonas lutea (7.24%) and Rubrivivax gelatinosus (4.95%).

Heavy metals have adverse effects on microalgae metabolism and growth. Photosynthesis and lipid profile are quite sensitive to heavy metal toxicity. The impact of hexavalent chromium—Cr(VI) on photosynthesis and lipid accumulation in Mucidosphaerium pulchellum and Micractinium pusillum exposed to different concentrations (0–500 μg L−1) was investigated for 11 days. A significant (p &lt, 0.05) increase in lipid content was observed with increasing Cr(VI) concentration. However, growth was suppressed at higher concentrations exceeding 100 μg L−1. Addition of Cr(VI) in the cell culture medium showed a negative effect on quantum yield (Fv/Fm), and a photosynthetic inhibition of &gt, 65% was noted in both species at 500 μg L−1. However, the lipid gravimetric analysis presented inner cell lipid content up to 36% and 30% of dry weight biomass for M. pulchellum and M. pusillum, respectively. The fatty acids profiles of both microalgae species showed higher levels of hexadecenoic acid as well as ω3, ω6, and ω7 fatty acids. The effect of Cr(VI) on photosynthesis and lipid accumulation in both microalgae species was concentration and exposure time dependent. This shows that an appropriate concentration of Cr(VI) in culture medium could be beneficial for higher lipid accumulation in freshwater eukaryotic microalgae species.

The present study aimed to investigate the effects of organic carbon sources, cultivation methods, and environmental factors on growth and lipid content of Pavlova lutheri for biodiesel production. In the 250-mL flask bioreactors, P. lutheri was cultivated in the modified artificial seawater (ASW) medium containing glucose, glycerol, sodium acetate, or sucrose as an organic carbon substrate. The effects of different growth conditions (phototrophic, mixotrophic, and heterotrophic) and environmental factors such as photoperiod, light intensity, and salinity were evaluated. Growth of P. lutheri was inhibited under heterotrophy but was enhanced in mixotrophy as compared to phototrophy. Biomass and lipid content of P. lutheri were significantly (p

Background: The COVID-19 pandemic has drastically affected the socio-economic lives of people around the globe. Along with preventive measures like wearing mask, social distancing, practicing hand hygiene and staying home, the two main immunomodulatory strategies are vaccination and healthy diet intake. Our study was aimed to determine the inter-relationship between COVID-19 severity and vaccination status and between COVID-19 severity and diet. Methods: This comparative cross-sectional study was performed among 183 COVID-19 patients from July 2021 to December 2021 in a COVID-19 dedicated hospital of Rawalpindi, Pakistan. The convenient sampling was used to select the participants. Self-designed proforma with high reliability (Cronbach alpha value= 0.790) was used for the collection of data. Descriptive and inferential statistics were applied for the evaluation of study variables. Chi-square test was utilized to check the correlation between vaccination and COVID-19 and between diet and COVID-19.Results: Out of 183 participants 95 (51.91%) were vaccinated while 88 (48.09%) were un-vaccinated. Depending upon the guideline for COVID-19 infection severity provided by Government of Pakistan, 95 (51.92%) patients had asymptomatic infection, 72 (39.34%) patients had non-severe infection, 11 (6.00%) patients had severe infection, and 5 (2.74%) patients had critical infection. The association between vaccination and COVID-19 infection was statistically significant (p value 0.004). The correlation between COVID-19 infection severity and various diet types was also significant with plant-based diet (p=0.0001), animal-based diet (p=0.002), fast food (p=0.01), and micronutrients (p=0.0003).Conclusions: In short, our study suggests that COVID-19 infection was less severe among vaccinated patients in comparison to non-vaccinated patients. Furthermore, it also showed that high intake of plant-based diet and micronutrients was protective against COVID-19 infection whereas high intake of animal-based diet and fast food was associated with more severe COVID-19 infection.

Happiness is a collection of various kinds of emotions including positive and negative because of satisfaction in life. Happiness affects almost every aspect of life, however, among students, its most important impact is on their academic performance. Academic performance is positively affected by happiness and subsequently their performance as a physician. Therefore, our current study is set to assess the impact of happiness on academic performance among final-year medical students of Rawalpindi Medical University Pakistan. This may provide us a new way to bring improvement in academic performance of medical students. This descriptive cross-sectional study was carried out among final-year medical students of Rawalpindi Medical University in January 2020. Collection of data was accomplished with the help of two questionnaires including Oxford Happiness Questionnaire for happiness assessment and self-structured questionnaire which was developed to obtain required data about demographic details and marks in last professional examination. Students who had diagnosed any physical and mental illness were excluded. From total of 223 students who were enrolled at the beginning of study, only 186 returned correctly filled questionnaires so final sample size became 186. Data analysis was completed through SPSS v.25.0. Different statistical tests including Independent sample t-test, Chi-square test, Pearson’s correlation, and linear regression were used to assess the study variables. Statistically significant and strong positive association was noted between happiness and academic performance of students (p = 0.000). To evaluate the direction and strength of association between happiness and academic performance, Pearson’s correlation coefficient was calculated, and it was 0.809 with p-value 0.000). Difference in happiness score between male students and female students (p=0.015) and between boarder students and non-boarder students (p=0.000) was statistically significant. Likewise, the difference in academic performance that was assessed through marks in last professional examination was also statistically significant between male student and female students (p=0.001) and between boarder students and non-boarder students (p=0.000) was also statistically significant. With p-value of 0.000 for F test, simple linear regression model was valid. Value of unstandardized regression Coefficient (B) was 61.40. R² was 0.655 (65.5%). Our study overall shows higher happiness score and better academic performance among female and non-boarder students relative to male and boarder students. This current study also indicates statistically significant and strong positive association between happiness and academic performance, which means that increase in happiness increases the academic performance of students and vice versa. So, with the implementation of appropriate measures for the increase in happiness we can bring enhancement in academic performance of medical students.

Acute otitis media (AOM) is the commonest disease of childhood. High incidence of AOM might be due to immature Eustachian Tube and immaturity of immune system. Exclusive breast feeding is protective against acute otitis media, however, improper breastfeeding position can increase AOM occurrence in infants. This study aims to assess the association of improper breastfeeding position with occurrence of Acute otitis media in infants and to assess association of Maternal educational levels with feeding positions. 220 breastfed infants satisfying inclusion criteria with diagnosed AOM were enrolled. Study was conducted over a period of 6 months from August 2019 to January 2020. Demographic details and Detailed history regarding feeding positions and maternal educational levels were obtained through a Self-structured proforma from parents. Data analysis was done through descriptive statistics and chi square test and p value less than 0.5 was set significant. Out of 220 infants, 123(55.90%) were male and 97(44.10%) were females. AOM was more common in male infants than female infants, however it was not statistically significant(p=0.169). The mean age for enrolled infants(1-12months) was 6.90(±3.413). Statistically significant association between increase incidence of AOM and breastfeeding position was found(p=0.032). We also found a statistically significant association between maternal educational levels and breastfeeding position (p= 0.000). In this study, we have noted that Breastfeeding in supine position is associated significantly with increase in incidence of AOM. Feeding positions are statistically associated with Maternal Educational levels.

Background: Diabetes is one of the major health problems in the world. Along with multiple complications, one of those devastating complications, is diabetic foot and it can even lead to limb amputation. The objective of this study to recognize the risk factors for foot amputation among diabetic patients.Methods: This cross-sectional study was conducted at Sir Ganga Ram Hospital of Lahore. 268 diabetic patients were recruited through a set of inclusion and exclusion criteria. After taking informed consent from all patients, data was collected via a self-designed proforma. SPSS version 25 was used to analyze data. Chi-square was applied to identify any association.Results: From the total of 268 patients 72 (26.80%) were advised amputation, whereas, 196 (73.20%) patients were managed conservatively. The correlation between diabetic foot amputation and various factors which included gender (p=0.0001), educational status (p=0.0003), socioeconomic status (p=0.004), diet modification (p=0.002), blood sugar monitoring (p=0.001), life style (p=0.0003), therapy type (p=0.04), compliance with treatment (p=0.001), smoking (p=0.02), hypertension (p=0.004), ischemic heart disease (p=0.03), stroke (p=0.01), peripheral neuropathy (p=0.003), and peripheral arterial disease (p=0.001) was statistically significant, while, the correlation was not significant between diabetic foot amputation and duration of diabetes (p=0.07).Conclusions: In summary, the incidence of foot amputation among diabetic patients is quite high. The factors that lead to foot amputation are male gender, lower educational status, lower socioeconomic status, no diet modification, no blood sugar monitoring, sedentary life style, inappropriate therapy, poor compliance, history of smoking, hypertension, ischemic heart disease, stroke, peripheral neuropathy, and peripheral arterial disease.

Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the obesity epidemic and affects approximately 10% of children in the US. The presence of hepatic fibrosis may be the most important factor in determining the prognosis of NAFLD. Noninvasive methods to identify the presence of fibrosis in children with NAFLD are greatly needed. Hepatocyte apoptosis activates hepatic stellate cells and plays a central role in fibrosis progression in NAFLD. The aim of the present study was to evaluate the use of plasma cytokeratin-18 (CK18) fragment levels, a marker of hepatocyte apoptosis, as a noninvasive biomarker in detecting liver fibrosis in pediatric NAFLD.Consecutive children with biopsy-proven NAFLD were included and blood samples and anthropometric measurements were collected at the time of the biopsy. NAFLD activity score was calculated (0-8) and fibrosis stage was scored (0-4). We measured plasma CK18 levels using the M30-Apoptosense enzyme-linked immunosorbent assay kit.A total of 201 subjects were enrolled in the study. The mean age was 10.7 ± 2.5 years, and 37 % were boys. Sixty-eight percent of the patients had any fibrosis, with 56% having F1, 6% having F2, and 6 % having F3. CK18 levels were found to be significantly higher in subjects with any fibrosis compared with those without fibrosis (304.6 ± 124.8 vs 210.4 ± 70.9, P 0.001). CK18 level revealed good accuracy for prediction of any fibrosis (F1-F3) with AUROC of 0.75. Multivariate logistic regression was performed to assess whether CK18 in combination with another clinical factor could improve accuracy of prediction of fibrosis. Together, CK18 with waist circumference percentile generated an area under the receiver operating characteristics curve of 0.842 for prediction of any fibrosis.CK18 is a promising noninvasive biomarker for fibrosis in NAFLD in children. A fibrosis prediction model that includes CK18 and waist circumference percentile should be validated in other populations.

Translation of children fantasy novels and problems faced by translators in translating these novels into different languages is one of the core issues in the field of translation studies. This issue has got attention of many researchers and an extensive study has been carried out on various novels. The Harry Potter series of novels written by British author J.K. Rowling is one of the famous children fantasy novels that gained popularity worldwide and was translated into 73 languages. The use of various cultural terms and made up words in the novel has posed a great challenge for the translators. The purpose of the present study is to identify these cultural related terms and made up words in the novel “Harry Potter and the Chamber of Secrets” and to investigate the strategies used by the translator in translating them into Urdu language. A descriptive analysis of the translation of culture related items and made up words was made using the strategies proposed by Davies (2003). The findings of this research showed that translator mostly emphasized and predominantly used localization and transformation strategies for food items, magical objects and imaginative words.

Background: Body weight homeostasis and the progression of obesity to comorbidities such as nonalcoholic steatohepatitis (NASH), type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) involve the gut-brain axis, a complex and highly coordinated system of peripheral appetite hormones and centrally mediated neuronal regulation. Data on the role of a gut-adipose axis in children with obesity-related comorbidities are sparse. We determined novel signals in the gut-adipose axis such as pro-uroguanylin (PUG) produced in the gut and spexin, predominantly produced in white adipose tissue along with traditional appetite/satiety hormones in insulin-resistant children with (NASH) and simple obesity. Method: A total of 29 children (age: 8-17 years) in three groups, normal weight (NW; n=11; BMI95th%) and biopsy-proven NASH (n=9; NAS-score>2) were studied. Spexin, PUG, leptin, total (T)- and high molecular weight (HMW)-adiponectin and insulin were measured. Results: Spexin, PUG and both T and HMW adiponectins were lower in children with NASH compared to both children with simple obesity and their NW counterparts, while leptin and insulin were higher (p Conclusions: Lower concentrations of novel signals such as PUG and spexin in the current study suggest that perturbations in the gut-brain axis occur at an early age in the clinical course of obesity and NASH. The potential role of these novel gut-adipose axis signals, by themselves or in unison with other factors, in diagnosing and/or monitoring the development and/or progression of obesity-related comorbidities such as NASH, T2DM and CVD as well as the potential development of more directed therapies appears to be promising and warrants further studies. Disclosure M.D. Di Guglielmo: None. S. Mansoor: None. V. Uppal: None. K.N. Furuya: None. S. Kumar: None. P. Balagopal: None.

slamic finance industry has been expanded in the last decade and has branched out itself from banking to other financial sectors like Islamic Assets Management and Islamic Insurance Companies. Islamic finance industry growth over the past decade is impressive comparative to conventional sector particularly at the time of financial crisis. The focus of this research study is to assess the performance of Islamic and Conventional mutual funds in Pakistan for the period of 7 years ranging from 2007 to 2013. The research also studied the impact of NAV on mutual funds and how the volatility influences the Islamic and Conventional mutual funds. This research is based on the sample of equity funds using all Asset Management Companies in Pakistan on the basis of availability of each fund‘s NAV. The findings suggest that mutual funds performance led to mixed trend. The results indicates that portfolio returns of Islamic funds are more clustered around mean that shows the level of consistency in the performance of the Islamic funds, whereas portfolio returns of the Conventional funds are more volatile and inconsistent comparatively. Concerning overall performance, Islamic funds performed better than Conventional funds.

Background Nonalcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease in children and can progress to liver cirrhosis during childhood. Patients with more advanced fibrosis on biopsy tend to have more liver complications. Noninvasive hepatic fibrosis scores have been developed for adult patients with NAFLD; however, these scores have not been validated in children. The aim of our study was to evaluate some of these scores in assessing the presence of fibrosis in children with biopsy-proven NAFLD. Methods Our study consisted of 92 biopsy-proven NAFLD children from five major US centers. Fibrosis was determined by an experienced pathologist (F0‐4). Clinically significant fibrosis was defined as fibrosis stage C2, and advanced fibrosis was defined as F3‐4. The following fibrosis scores were calculated for each child: AST/ALT ratio, AST/platelet ratio index (APRI), NAFLD fibrosis score (NFS), and FIB-4 index. ROC was performed to assess the performance of different scores for prediction of presence of any, significant, or advanced fibrosis. A p value \0.05 was considered statistically significant. Results Mean age was 13.3 ± 3 years, and 33 % were females. Eleven (12 %) subjects had no fibrosis, 35 (38 %) had fibrosis score of 1, 26 (28 %) had fibrosis score of 2, and 20 (22 %) had a score of 3. APRI had a fair diagnostic accuracy for the presence of any fibrosis (AUC of 0.80) and poor diagnostic accuracy for significant or advanced fibrosis. AST/ALT, NFS, and FIB-4 index all either had poor diagnostic accuracy or failed to diagnose the presence of any, significant, or advanced fibrosis. Conclusion Noninvasive hepatic fibrosis scores developed in adults had poor performance in diagnosing significant fibrosis in children with NAFLD. Our results highlight the urgent need to develop a reliable pediatric fibrosis score.

International Maritime Organization recognizes vessel-induced pollution as a global issue. The designation of the Baltic Sea as the special uncontaminated area was the beginning of the regulations for preventing marine pollution. In this regard, a process is needed which meets the provisions of MEPC. 227(64) for the specificity and constrained conditions of vessels, removes both nitrogen and phosphorus, requires convenient operation and low construction cost and is little affected by the load variation of inflow. This study used an SBR(sequencing batch reactor) and MBR(membrane bioreactor) combined process to iterate the stirring and aeration process and maintained the ratio of raw wastewater parameters (C:N:P) to be 10:3:1 in order to assess the quality and future availability of ultimate outflow in each time period of the stirring and aeration process. The removal efficiencies of COD and T-N exceeded 90% and 93% respectively. However, a detailed mechanism will be identified by a further study on nitrogen removal issues like DO aeration condition, stirring duration, ORP and NO3. As the removal efficiency of T-P exceeded 95%, the SBR and MBR process formed anaerobic and aerobic conditions without a separate coagulation process for removing phosphorus, thereby enabling easy phosphorus release and uptake. The optimal stirring and aeration condition seems to be 70&ndash, 50 min. A further study will be efficiently conducted by focusing on the water quality criteria of the Maritime Environment Protect Committee. 227 (64) for E. coli and chlorine and a detailed mechanism.

Childhood obesity has reached epidemic proportions, and by 2012, more than one third of American children were overweight or obese. As a result, increasingly, children are developing complications of obesity including liver disease. In fact, non-alcoholic fatty liver disease is the most common form of chronic liver disease seen in children today. Recently, there has been a burgeoning literature examining the pathogenesis, genetic markers, and role of the microbiome in this disease. On the clinical front, new modalities of diagnosing hepatic steatosis and hepatic fibrosis are being developed to provide non-invasive methods of surveillance in children. Lastly, the mainstay of treatment of pediatric non-alcoholic fatty liver disease (NAFLD) has been largely through lifestyle interventions, namely, dieting and exercise. Currently, there are a number of clinical trials examining novel lifestyle and drug therapies for NAFLD that are registered with the US National Institutes of Health ClinicalTrials.gov website.

Nonalcoholic fatty liver disease (NAFLD) and its spectrum ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) and fibrosis have been increasing in the pediatric population. The presence and severity of fibrosis in patients with NAFLD are important prognostic factors for the risk of disease progression to cirrhosis. The gold standard for staging liver fibrosis is a liver biopsy. However, given the risks of this procedure, especially in the pediatric population, the development of noninvasive markers to diagnose and monitor progression of NAFLD is desirable. This paper will review recently developed noninvasive methods for diagnosing liver fibrosis in children with NAFLD. These include simple fibrosis scores, advanced biochemical markers, and radiologic imaging studies. Simple fibrosis scores use readily available laboratory tests; available one include AST/ALT ratio, AST to platelet ratio index (APRI), fibrosis (FIB)-4 index, NAFLD fibrosis score (NFS), pediatric NAFLD fibrosis index (PNFI), and pediatric NALFD fibrosis score (PNFS). Advanced biochemical markers include biomarkers of hepatocyte cell death such as cytokeratin 18 fragment levels, and markers of extracellular matrix turnover such as the Enhanced Liver Fibrosis (ELF) test and hyaluronic acid. Radiologic imaging studies estimate liver stiffness as a surrogate for liver fibrosis; these include transient elastography (TE), magnetic resonance elastography (MRE), and acoustic radiation force impulse imaging (ARFI).

Background Noninvasive hepatic fibrosis scores that predict the presence of advanced fibrosis have been developed and validated in adult patients with NAFLD. The aims of our study were to assess the utility of commonly used adult fibrosis scores in pediatric NAFLD and to develop a pediatric specific fibrosis score that can predict advanced fibrosis. Methods Consecutive children with biopsy-proven NAFLD were included. Fibrosis was determined by an experienced pathologist (F0-4). Advanced fibrosis was defined as fibrosis stage ≥ 3. The following adult fibrosis scores were calculated for each child: AST/ALT ratio, AST/platelet ratio index (APRI), NAFLD fibrosis score (NFS), and FIB-4 Index. Multivariable logistic regression analysis was performed to build a new pediatric model for predicting advanced fibrosis. Results Our cohort consisted of 242 children with a mean age of 12.4 ± 3.1 years and 63% were female. 36 (15%) subjects had advanced fibrosis. APRI and FIB-4 were higher in patients with advanced fibrosis compared to those with fibrosis stage 0-2; however, AST/ALT ratio and NFS were not different between the two groups. We used our data to develop a new model to predict advanced fibrosis which included: ALT, alkaline phosphatase, platelet counts and GGT. The multivariable logistic regression model (z) was defined as follows: z = 1.1+(0.34*sqrt(ALT))+(0.002*alkaline phosphatase) - (1.1*log(platelets) - (0.02*GGT). This value was then converted into a probability distribution (p) with a value between 0 to 100 by the following formula: p = 100 × exp(z)/[1+exp(z)]. The AUCROC for this model was 0.74 (95% CI: 0.66, 0.82). This was found to be significantly better than APRI, NAFLD Fibrosis Score and FIB-4 Index. Conclusion Noninvasive hepatic fibrosis scores developed in adults had poor performance in diagnosing advanced fibrosis in children with NAFLD. We developed a new pediatric NAFLD fibrosis score with improved performance characteristics.

To: determine the outcome of patients having undergone Video Assisted Thoracoscopic Surgery (VATS) for spontaneous pneumothrox in terms of hospital stay, complications and recurrence.The netrospective study included the review of 39 cases who had presented with spontaneous pneumothorax at the Aga Khan University Hospital, Karachi, Pakistan, between January 2001 to November 2008 and had undergone video assisted thoracoscopic surgery (VATS).The duration of hospital stay (had a range of 3 to 9 days), and the length of chest tube in place (a range of 2 to 8 days), 2 (5.1%) patients developed recurrence after VATS while 3 (7.6%) patients developed bleeding post operatively requiring transfusion and 2 (5.1%) patients developed atelectasis requiring bronchoscopy.Compared with figures for thoracotomy data from other studies, it was seen that the length of hospital stay and chest tube placement with VATS was less than that for thoracotomy, and the overall cost as well as post-operative pain was also low. The rate of recurrence was however comparable to that after thoracotomy.

Background: Noninvasive hepatic fibrosis scores that predict the presence of advanced fibrosis have been developed and validated in adult patients with NAFLD. The aims of our study were to assess the utility of commonly used adult fibrosis scores in pediatric NAFLD and to develop a pediatric specific fibrosis score that can predict advanced fibrosis. Methods: Consecutive children with biopsy-proven NAFLD were included. Fibrosis was determined by an experienced pathologist (F0–4). Advanced fibrosis was defined as fibrosis stage $3. The following adult fibrosis scores were calculated for each child: AST/ALT ratio, AST/platelet ratio index (APRI), NAFLD fibrosis score (NFS), and FIB-4 Index. Multivariable logistic regression analysis was performed to build a new pediatric model for predicting advanced fibrosis. Results: Our cohort consisted of 242 children with a mean age of 12.463.1 years and 63% were female. 36 (15%) subjects had advanced fibrosis. APRI and FIB-4 were higher in patients with advanced fibrosis compared to those with fibrosis stage 0–2; however, AST/ALT ratio and NFS were not different between the two groups. We used our data to develop a new model to predict advanced fibrosis which included: ALT, alkaline phosphatase, platelet counts and GGT. The multivariable logistic regression model (z) was defined as follows: z=1.1+(0.34*sqrt(ALT))+(0.002*alkaline phosphatase) – (1.1*log(platelets) – (0.02*GGT). This value was then converted into a probability distribution (p) with a value between 0 to 100 by the following formula: p=1006exp(z)/[1+exp(z)]. The AUCROC for this model was 0.74 (95% CI: 0.66, 0.82). This was found to be significantly better than APRI, NAFLD Fibrosis Score and FIB-4 Index. Conclusion: Noninvasive hepatic fibrosis scores developed in adults had poor performance in diagnosing advanced fibrosis in children with NAFLD. We developed a new pediatric NAFLD fibrosis score with improved performance characteristics.