M. Shoaib

Summary The new direct-acting anticoagulants such as dabigatran and rivaroxaban are usually not monitored but may be associated with haemorrhage, particularly where renal impairment occurs. They have no effective “antidotes”. We studied 17 patients receiving dabigatran 150 mg twice daily for non-valvular atrial fibrillation and 15 patients receiving rivaroxaban 10 mg daily for the prevention of deep venous thrombosis after hip or knee replacement surgery. We assessed the effect of these drugs on commonly used laboratory tests and Calibrated Automated Thrombogram (CAT) using plasma samples. We also assessed effects in fresh whole blood citrated patient samples using thromboelastography on the TEG and the ROTEM. The efficacy of nonspecific haemostatic agents prothrombin complex concentrate (PCC), Factor VIII Inhibitor By-passing Activity (FEIBA) and recombinant activated factor VII (rVIIa) were tested by reversal of abnormal thrombin generation using the CAT. Concentrations added ex vivo were chosen to reflect doses normally given in vivo. Dabigatran significantly increased the dynamic parameters of the TEG and ROTEM and the lag time of the CAT. It significantly reduced the endogenous thrombin potential (ETP) and reduced the peak height of the CAT. Rivaroxaban did not affect the TEG and ROTEM parameters but did increase the lag time and reduce ETP and peak height of the CAT. For both drugs, these parameters were significantly and meaningfully corrected by PCC and FEIBA and to a lesser but still significant extent by rFVIIa. These results may be useful in devising a reversal strategy in patients but clinical experience will be needed to verify them.

Irritable bowel syndrome (IBS), a gastrointestinal disorder affecting 7-12% of the population, is characterized by abdominal pain, bloating, and alternating bowel patterns. Data on risk and protective influences have yielded conflicting evidence on the effects of alternative interventions, such as vitamin D. This review focuses on the effects of vitamin D on IBS. A systematic review and meta-analysis considered all articles published until 4 April 2022. The search for randomized controlled trials assessing vitamin D efficacy in IBS with outcomes, primary (Irritable Bowel Severity Scoring System (IBS-SSS)) and secondary (IBS quality of life (IBS-QoL) and serum level of calcifediol (25(OH)D)), was performed on six databases, Google Scholar, Web of Science, SCOPUS, EMBASE, PubMed (MEDLINE), and Cochrane Central Register of Controlled Trials. We included six trials with 616 patients. The pooled analysis found no difference between vitamin D and placebo in improving IBS-SSS (MD: -45.82 with 95% CI [-93.62, 1.98], p = 0.06). However, the pooled analysis favored vitamin D over placebo in improving the IBS-Qol (MD: 6.19 with 95% CI [0.35, 12.03], p = 0.04) and serum 25(OH)D (MD: 25.2 with 95% CI [18.41, 31.98], p = 0.00001). Therefore, further clinical trials are required to reach clinically applicable and generalizable findings.

The aerospace metal cutting industry's search for environmentally friendly practices that do not compromise machining performance is well known. One of the major objectives is the reduction in use of cutting fluids, which play a major role in containing the harsh effects of severe heat generated during machining. Machining performance and product quality can be improved by controlling heat during machining. The purpose of this study was to determine the effectiveness of various environmentally friendly metalworking fluid (MF) strategies for the sustainable turning of aerospace aluminum alloy (Al-5.6Zn-2.5Mg-1.6Cu-0.23Cr-T6) for automotive, marine, and aerospace industrial applications. The SEM images were analyzed for worn tool surfaces and machined surfaces. Under dry conditions, heat does not dissipate well, and will enter the workpiece due to the absence of coolant. This causes extreme damage beneath a turned workpiece. Thus, at 10 µm, a drop in microhardness of approximately 20% can be observed. A similar observation was made in a Ranque-Hilsch vortex tube (RHVT) and in compressed air; however, the drop in hardness was relatively low compared to dry conditions. This evaluation of microhardness indicated a heat-based attention in the turned workpiece, and thus, the heat-based effect was found to be lowest in RHVT and compressed air compared to dry conditions. Results showed that RHVT reduces temperature up to 10%, surface roughness 13%, and tool wear 20% compared to dry turning. Overall, RHVT was identified as more effective environmentally friendly cooling strategy than dry and compressed air for the turning of aluminum alloy 7075-T6.

Alcohol withdrawal syndrome (AWS) is a complication frequently encountered among patients who are chronic alcohol abusers. It is considered to have a significant impact on the United States healthcare system. It not only has a toll on the healthcare spending but also contributes to significant morbidity and mortality. Benzodiazepines are considered first line in the treatment of AWS. Since patients with alcohol use disorder have downregulated gamma aminobutyric acid (GABA) receptors, this often leads to benzodiazepine resistance. Phenobarbital is also used in the management of alcohol withdrawal syndrome. Here we present a systematic review and meta-analysis of the efficacy and safety of the drug. We conducted an electronic database search for relevant studies published between the inception of the project and November 20, 2022, in three databases, including Medline/PubMed, Embase, and Cochrane Library. Our study included all original studies with prime focus on the baseline characteristics of patients admitted to the intensive care unit (ICU) for alcohol withdrawal syndrome and management/monitoring protocol implemented for its treatment. The primary outcomes that were the focus of our study consisted of changes in the length of hospital stay, length of ICU stay, and changes in scoring systems (for alcohol withdrawal assessment and monitoring) following the implementation of phenobarbital. The secondary outcomes included complications such as intubation and mortality. Based on our analysis, the mean difference in hospital stay was statistically significant at -2.6 (95% CI, -4.48, -0.72, P=0.007) for phenobarbital compared to the benzodiazepine group. We were unable to comment on the heterogeneity in our meta-analysis due to the standard deviation not being reported in one study. There was no statistically significant difference regarding the length of stay in the intensive care unit compared to the control/comparative arm, with a mean difference of -1.17 (95% CI, -1.17, 0.09, P=0.07), with considerable heterogeneity (I2=77%, P=0.002). Our meta-analysis also investigated the risk of intubation between the phenobarbital and the control/comparative group. There was statistically significant difference in the incidence of intubation, relative risk (RR) 0.52 (95% CI, 0.25, 1.08, P=0.08), with considerable heterogeneity (I2=80%, P=0.0001). Our study concludes that phenobarbital is an effective tool in the management of AWS in an ICU setting. However, various studies have reported contradictory results, and vital information appears to be lacking. Moreover, there is a lack of uniformity in terms of phenobarbital dosing. Drug administration should be adapted according to the severity of the symptoms. Further studies need to be conducted discussing the safety profile and adverse effects of the drug when it comes to the management of alcohol withdrawal syndrome.

Schiff bases are a class of organic compounds with azomethine moiety, exhibiting a wide range of biological potentials. In this research, six chiral Schiff bases, three ‘S’ series (H1−H3) and three ‘R’ series (H4−H6), were synthesized. The reaction was neat, which means without a solvent, and occurred at room temperature with a high product yield. The synthesized compounds were evaluated for analgesic potential in vivo at doses of 12.5 and 25 mg/kg using acetic-acid-induced writhing assay, formalin test, tail immersion and hot plate models, followed by investigating the possible involvement of opioid receptors. The compounds H2 and H3 significantly (*** p < 0.001) reduced the writhing frequency, and H3 and H5 significantly (*** p < 0.001) reduced pain in both phases of the formalin test. The compounds H2 and H5 significantly (*** p < 0.001) increased latency at 90 min in tail immersion, while H2 significantly (*** p < 0.001) increased latency at 90 min in the hot plate test. The ‘S’ series Schiff bases, H1−H3, were found more potent than the ‘R’ series compounds, H4−H6. The possible involvement of opioid receptors was also surveyed utilizing naloxone in tail immersion and hot plate models, investigating the involvement of opioid receptors. The synthesized compounds could be used as alternative analgesic agents subjected to further evaluation in other animal models to confirm the observed biological potential.

This research manifesto has a comprehensive discussion of the global dynamics of an achievable discrete-time two predators and one prey Lotka–Volterra model in three dimensions, i.e., in the space R3. In some assertive parametric circumstances, the discrete-time model has eight equilibrium points among which one is a special or unique positive equilibrium point. We have also investigated the local and global behavior of equilibrium points of an achievable three-dimensional discrete-time two predators and one prey Lotka–Volterra model. The conversion of a continuous-type model into its discrete counterpart model has been completed by adopting a dynamically consistent nonstandard difference scheme with the end goal that the equilibrium points are conserved in twin cases. The difficulty lies in how to find all fixed points O,P,Q,R,S,T,U,V and the Jacobian matrix and its characteristic polynomial at the unique positive fixed point. For that purpose, we use Mathematica software to find the equilibrium points and all of the Jacobian matrices at those equilibrium points. Moreover, we discuss boundedness conditions for every solution and prove the existence of a unique positive equilibrium point. We discuss the local stability of the obtained system about all of its equilibrium points. The discrete Lotka–Volterra model in three dimensions is given by system (3), where parameters α,β,γ,δ,ζ,η,μ,ε,υ,ρ,σ,ω∈R+ and initial conditions x0,y0,z0 are positive real numbers. Additionally, the rate of convergence of a solution that converges to a unique positive equilibrium point is discussed. To represent theoretical perceptions, some numerical debates are introduced, including phase portraits.

Abstract Polygenic risk scores (PRS) quantify the genetic liability to disease and are calculated using an individual's genotype profile and disease‐specific genome‐wide association study (GWAS) summary statistics. Type 1 (T1D) and type 2 (T2D) diabetes both are determined in part by genetic loci. Correctly differentiating between types of diabetes is crucial for accurate diagnosis and treatment. PRS have the potential to address possible misclassification of T1D and T2D. Here we evaluated PRS models for T1D and T2D in European genetic ancestry participants from the UK Biobank (UKB) and then in the Michigan Genomics Initiative (MGI). Specifically, we investigated the utility of T1D and T2D PRS to discriminate between T1D, T2D, and controls in unrelated UKB individuals of European ancestry. We derived PRS models using external non‐UKB GWAS. The T1D PRS model with the best discrimination between T1D cases and controls (area under the receiver operator curve [AUC] = 0.805) also yielded the best discrimination of T1D from T2D cases in the UKB (AUC = 0.792) and separation in MGI (AUC = 0.686). In contrast, the best T2D model did not discriminate between T1D and T2D cases (AUC = 0.527). Our analysis suggests that a T1D PRS model based on independent single nucleotide polymorphisms may help differentiate between T1D, T2D, and controls in individuals of European genetic ancestry.

Background: Breast cancer is characterized by uncontrolled cell growth in the breast tissue and is a leading cause of death globally. Cytotoxic effects and reduced efficacy of currently used therapeutics insist to look for new chemo-preventive strategies against breast cancer. LKB1 gene has recently been categorized as a tumor suppressor gene where its inactivation can cause sporadic carcinomas in various tissues. Mutations in the highly conserved LKB1 catalytic domain lead to the loss of function and subsequently elevated expression of pluripotency factors in breast cancer. Objectives: The utilization of drug-likeness filters and molecular simulation has helped evaluate the pharmacological activity and binding abilities of selected drug candidates to the target proteins in many cancer studies. Methods: The current in silico study provides a pharmacoinformatic approach to decipher the potential of novel honokiol derivatives as therapeutic agents against breast cancer. AutoDock Vina was used for molecular docking of the molecules. A 100 nano second (ns) molecular dynamics simulation of the lowest energy posture of 3'-formylhonokiol- LKB1, resulting from docking studies, was carried out using the AMBER 18. Results: Among the three honokiol derivatives, ligand-protein binding energy of 3' formylhonokiol with LKB1 protein was found to be the highest via molecular docking. Moreover, the stability and compactness inferred for 3'- formylhonokiol with LKB1 are suggestive of 3' formylhonokiol being an effective activator of LKB1 via simulation studies. Conclusion: It was further established that 3'- formylhonokiol displays an excellent profile of distribution, metabolism, and absorption, indicating it is an anticipated future drug candidate.

This investigation aims to investigate the pine wilt disease model (PWDM) employing hybrid bio-inspired algorithm. The artificial neural networks-based genetic algorithm (ANNs-GA) as global search and sequential quadratic programming (SQP) serve as local search framework. The model consists of two populations, i.e. host ([Formula: see text] and vector ([Formula: see text]. There are four classes in host population representing susceptible host [Formula: see text], exposed host [Formula: see text], asymptomatic host [Formula: see text] and infectious host [Formula: see text] whereas in vector susceptible [Formula: see text] and infectious [Formula: see text] class are present. Activation function is introduced for the formulation of the fitness-based function as mean squared error by using nonlinear PWD equations for the accomplishment of ANNs-GASQP paradigm. The stability, robustness and effectiveness of proposed paradigm is comparatively evaluated through Adam numerical scheme with absolute error analysis. Computational complexity of GASQP is determined by convergence criteria of best global weight, fitness evaluation, time, generations, iterations, function counts and mean square error. Moreover, the statistical analysis is performed via Theil’s inequality coefficients (TICs), mean of absolute deviation (MAD) and root mean squared error (RMSE) for multiple trials of ANNs-GASQP. Results reveal that accuracy is obtained up to 3–11 decimal places which proves the reliability of proposed ANNs-GASQP solver.

Several approaches have been developed to estimate the ultimate capacity of piles, such as static and dynamic load tests, static analysis from soil borings, and directly utilizing in-situ test results. Recently, there has been increased interest in using in-situ cone penetration test (CPT) to estimate pile capacity. Several analytical pile-CPT methods have been developed, which involve several correlation assumptions that can affect their accuracy. In this paper, three tree-based machine learning (ML) models, namely decision tree (DT), random forest (RF), and gradient boosted tree (GBT), are developed for estimating the ultimate capacity of piles from CPT data. A database that contains 80 pile load tests and associated CPT data collected in Louisiana was used to develop these ML models. The measured ultimate pile capacity (Q m ) was determined using Davisson’s interpretation method from the load–settlement curve of each pile load test. Among the developed ML models, GBT demonstrated the most accurate ML model compared with the others. The estimation of ultimate pile capacity from the GBT model is compared with those obtained from the four best-performing direct pile-CPT methods (based on a previous study): the University of Florida (UF), probabilistic, European Regional Technical Committee 3 (ERTC3), and Laboratoire Central des Ponts et Chaussées (LCPC) methods. The GBT and pile-CPT methods were evaluated and ranked based on analysis of multiple statistical criteria. The results clearly showed that the GBT model outperforms the four direct pile-CPT methods for estimating the ultimate capacity of piles.

The current study explores the production of charged Higgs particles through photon-photon collisions within the Two Higgs Doublet Model context, including one-loop-level scattering amplitude of Electroweak and QED radiation. The cross-section has been scanned for plane ($m_{\phi^{0}}, \sqrt{s}$) investigating the process of $\gamma\gamma \rightarrow H^{+}H^{-}$. Three particular numerical scenarios low-$m_{H}$, non-alignment, and short-cascade are employed. Hence using $h^{0}$ for low-$m_{H^{0}}$ and $H^{0}$ for non-alignment and short-cascade scenario, the new experimental and theoretical constraints are applied.The decay channels for charged Higgs particles are examined in all the scenarios along with the analysis for cross-sections revealing that at low energy it is consistently higher for all scenarios. However as $\sqrt{s}$ increases, it reaches a peak value at 1$~$TeV for all benchmark scenarios. The branching ratio of the decay channels indicates that for non-alignment, the mode of decay $W^{\pm} h^{0}$ takes control %{} when $BR(H^{\pm} \rightarrow W^{\pm} H^{0})$ decreases at larger values of $m_{H^{0}}$.} and for short cascade the prominent decay mode remains $t\bar{b}$, while in the low-$m_{H}$ the dominant decay channel is of $W^{\pm} h^{0}$. In our research, we employ contemporary machine-learning methodologies to investigate the production of high-energy Higgs Bosons within a 3$ $TeV Gamma-Gamma collider. We have used multivariate approaches such as Boosted Decision Trees (BDT), LikelihoodD, and Multilayer Perceptron (MLP) to show the observability of heavy-charged Higgs Bosons versus the most significant Standard Model backgrounds. The purity of the signal efficiency and background rejection are measured for each cut value.

This research study presents an approach for analysis of pico hydro waterwheels by both experimental and numerical methods. The purpose of this research is to harness the energy efficiently from flowing water of irrigation channels and other shallow water sources in rural areas because the electrification of rural areas through connection to grid electricity is very costly. The novelty of this research work lies in testing of the waterwheel as a high-speed device, which is not usually explored. The review of existing literature reveals that pico waterwheels have been extensively studied but without changing the blade profile immersed in the water stream ot the inclination angle of the water stream. In this study, a pico scale waterwheel was tested with three different types of blade profiles, namely a C-shape blade, V-shape blade and straight blade, through computational fluid dynamics (CFD) simulations for different tip speed ratios (TSR), varying the immersed depth of the blade in the stream and changing the angle of the water conduit while keeping the number of blades and the diameter of the wheel constant. The numerical and experimental results were validated for the C-shape blade profile. A substantial improvement in performance is observed with a C-shape blade profile at a TSR of 0.88. The results show that by varying the angle of the water conduit, the maximum performance is achieved at inclination φ = 45°, with an overall improvement of 4.87% in the efficiency.

Left bundle branch area pacing (LBBAP) may offer greater physiological benefits than traditional biventricular pacing (BiVP). However, there are limited data comparing the efficacy of LBBAP vs BiVP in patients with systolic heart failure (HF).The purpose of this meta-analysis was to compare the feasibility and electromechanical and clinical outcomes of both LBBAP and BiVP.We conducted a systematic review of studies retrieved from various databases including PubMed, Embase, Google Scholar, Scopus, and Cochrane Central Register of Control Trials (CENTRAL) published up to May 22, 2023. The risk ratio (RR) and standardized mean difference (SMD) with corresponding 95% confidence intervals (CIs) were calculated for dichotomous and continuous outcomes, respectively.We included 12 studies with a total of 3004 patients (LBBAP = 1242, BiVP = 1762). Pooled results showed that LBBAP resulted in a significant increase in left ventricular ejection fraction (SMD 0.40, 95% CI 0.25, 0.54, P < .00001), echocardiographic response (RR 1.19, 95% CI 1.10 to 1.29, P < .0001), improvement in New York Heart Association functional class (SMD -0.44, 95% CI -0.65 to -0.23, P < .0001), QRS duration reduction (SMD -0.90, 95% CI -1.14 to -0.66, P < .00001), left ventricular end-diastolic diameter reduction (SMD -0.31, 95% CI -0.57 to -0.05, P = .02), fewer HF hospitalizations (RR 0.72, 95% CI 0.62, 0.85, P < .0001), and improved survival (RR 0.73, 95% CI 0.58, 0.92, P = .007). In addition, LBBAP was associated with shorter fluoroscopy time (SMD -0.94, 95% CI -1.42 to -0.47, P < .0001) and lower pacing threshold at implantation (SMD -1.03, 95% CI -1.32 to -0.74, P < .00001) and at 6 months (SMD -1.44, 95% CI -2.11 to -0.77, P < .0001) as compared with BiVP.Compared with BiVP, LBBAP was associated with better electromechanical and clinical outcomes, including left ventricular ejection fraction, QRS duration, echocardiographic response, New York Heart Association functional class, HF hospitalization, and all-cause mortality in patients with systolic HF.

Abstract We have observed MoO3(010) surface on an atomic level by NC-AFM(Noncontact atomic force microscopy) for the first time. White arrays with 0.40 and 0.37 nm dimensions along [100] and [001], respectively, were observed, which corresponded to the topmost oxygen atoms of MoO3(010).

The Resistive Plate Chambers (RPCs) are employed in the CMS experiment at the LHC as dedicated trigger system both in the barrel and in the endcap. This note presents results of the RPC detector uniformity and stability during the 2011 data taking period, and preliminary results obtained with 2012 data. The detector uniformity has been ensured with a dedicated High Voltage scan with LHC collisions, in order to determine the optimal operating working voltage of each individual RPC chamber installed in CMS. Emphasis is given on the procedures and results of the High Voltage calibration. Moreover, an increased detector stability has been obtained by automatically taking into account temperature and atmospheric pressure variations in the CMS cavern.

During 2013 and 2014 (Long Shutdown LS1) the CMS experiment is upgrading the forward region installing a fourth layer of RPC detectors in order to complete and improve the muon system performances in the view of the foreseen high luminosity run of LHC. The new two endcap disks consists of 144 double-gap RPC chambers assembled at three different production sites: CERN, Ghent (Belgium) and BARC (India). The chamber components as well as the final detectors are subjected to full series of tests established in parallel at all the production sites.

A comparative study for the wind power density of the two investigated coastal sites viz. Pasni and Gwadar is presented in this paper. Pasni and Gwadar are located along the coast belt of Balochistan in Arabian Sea. Investigations are performed on daily wind speed data recorded at 12:00 UTC, obtained from Pakistan Meteorological | department (PMD) for a period five years, i.e. from 2003 to 2007. The recorded wind speed data distribution is fitted to the Weibull distribution function described by two fitting parameters i.e. scale (c) and shape (k). The Weibull parameters are numerically calculated using the Method of Moment (MoM). Monthly mean wind speeds for the two stations are predicted and wind power densities are calculated for the two stations. Comparison of the wind power densities of the investigated sites reveals a higher wind energy yield for Pasni as compared to Gwadar. The highest wind power density is predicted for the month of May.

The Resistive Plate Chambers (RPCs) are employed in the CMS Experiment at the LHC as dedicated trigger system both in the barrel and in the endcap. This article presents results of the radiation background measurements performed with the 2011 and 2012 proton-proton collision data collected by CMS. Emphasis is given to the measurements of the background distribution inside the RPCs. The expected background rates during the future running of the LHC are estimated both from extrapolated measurements and from simulation.

Thrombocytopaenia is a commonly encountered finding in hospitalised patients. Many antibiotics, especially beta-lactams, are well known to cause thrombocytopaenia by an immune-mediated mechanism. We present a 55-year-old woman who was admitted to the hospital with a complicated urinary tract infection resulting in right-sided pyonephrosis and pararenal abscess. She was observed to develop thrombocytopaenia after initiation of cefepime therapy. Following an extensive work-up for her new-onset thrombocytopaenia, she was diagnosed as a case of a drug (cefepime)-induced thrombocytopaenia. Her platelet count recovered back to normal levels after cessation of cefepime therapy. Based on our PubMed search, there are only a few cases of cefepime-induced thrombocytopaenia published in the literature. This paper illustrates that physicians should include cefepime among the possible aetiologies of thrombocytopaenia. Additionally, this article outlines the currently available approaches to the diagnosis and management of drug-induced thrombocytopaenia.

Bacterial diseases are a huge concern for poultry farmers and cause huge economic losses to poultry industry every year. Various diseases can initiate respiratory signs in poultry, including mycoplasmosis. Mycoplasmosis is a major threat currently faced by poultry industry worldwide. In poultry main pathogenic species of Mycoplasma are Mycoplasma gallisepticum and Mycoplasma synoviae. Mycoplasma is a worldwide avian pathogen that causes immense losses in the poultry industry by decreasing eggs production, reducing growth and increased condemnation at slaughter houses. Mycoplasma is a wall-less bacterium that causes chronic respiratory disease in all types of chickens. Mycoplasmosis is an egg transmitted, hatchery disseminated and economically very important disease of chickens. Commonly used methods for diagnosis of Mycoplasma include isolation and identification of bacteria, several serological tests and molecular techniques. Closely located poultry farms, rearing of mixed avian species in close milieus, mixed commercial poultry farming and presence of wild birds in close proximity to poultry farms have made this disease very difficult to control. The review summarized the pathogenesis of Mycoplasma, associated risk factors, diagnostic tools and control measures. Best measures to control Mycoplasmosis include biosecurity, hygiene, good management, monitoring and removal of infected flocks, routine vaccination and farmer awareness. To reduce the risk of transmission of disease to other poultry populations, there should be continued monitoring of flocks for Mycoplasma.

Small cell carcinoma of the larynx is a rare form of neuroendocrine carcinoma. Clinical and radiological properties are similar to other laryngeal cancers, prompting histopathology examination. Symptoms include sore throat, dysphagia, odynophagia, and weight loss. Multiple management options have been demonstrated in the literature. However, combined radiation and chemotherapy have proven to improve survival. Unfortunately, the prognosis for this cancer is dismal, as survival from diagnosis rarely exceeds two years. In this article, we present a 64-year-old female patient who presented with a sore throat and was diagnosed with primary small cell cancer of the larynx. Despite the relapse after the initial four cycles of chemotherapy with carboplatin and etoposide, our patient responded well to nivolumab and ipilimumab and is still in remission on a six-month follow-up.

The muon spectrometer of the CMS (Compact Muon Solenoid) experiment at the Large Hadron Collider (LHC) is equipped with a redundant system made of Resistive Plate Chambers and Drift Tube in barrel and RPC and Cathode Strip Chamber in endcap region. In this paper, the operations and performance of the RPC system during the first three years of LHC activity will be reported. The stability of RPC performance, such as efficiency, cluster size and noise, will be reported. Finally, the radiation background levels on the RPC system have been measured as a function of the LHC luminosity. Extrapolations to the LHC and High Luminosity LHC conditions are also discussed.

The common techniques to study protein-protein proximity in vivo are not well-adapted to the capabilities and the expertise of a standard proteomics laboratory, typically based on the use of mass spectrometry. With the aim of closing this gap, we have developed PUB-MS (for Proximity Utilizing Biotinylation and Mass Spectrometry), an approach to monitor protein-protein proximity, based on biotinylation of a protein fused to a biotin-acceptor peptide (BAP) by a biotin-ligase, BirA, fused to its interaction partner. The biotinylation status of the BAP can be further detected by either Western analysis or mass spectrometry. The BAP sequence was redesigned for easy monitoring of the biotinylation status by LC-MS/MS. In several experimental models, we demonstrate that the biotinylation in vivo is specifically enhanced when the BAP- and BirA- fused proteins are in proximity to each other. The advantage of mass spectrometry is demonstrated by using BAPs with different sequences in a single experiment (allowing multiplex analysis) and by the use of stable isotopes. Finally, we show that our methodology can be also used to study a specific subfraction of a protein of interest that was in proximity with another protein at a predefined time before the analysis.

Fecal cortisol has been suggested an indicator of preceding physiological stress, while the secretory IgA acts as the first defense against pathogens, viruses and bacteria in animals.Fresh fecal samples of adult Taihangshan macaques (Macaca mulatta tcheliensis) were collected during mating and nonmating periods, respectively, to understand the influences of mating status on physiological condition of wild macaques, through variation in fecal cortisol and IgA levels.The results showed that.(1) mean concentration of fecal cortisol in mating period (AM: 1751.12 ± 199.16 ng/g; AF: 1366.38 ± 117.85 ng/g) were significant higher than that in non-mating period (AM: 705.97 ± 82.86 ng/g; AF: 699.51 ± 56.06 ng/g).( 2) there was significant difference in fecal IgA levels between mating and non-mating periods in AF, but not in AM. (3) there were obvious negative correlations between fecal cortisol and IgA levels both in AM (P = 0.04) and AF (P = 0.01) in mating period, but not in non-mating period (AM: P = 0.19; AF: P = 0.21).We concluded that mating-related stress influences not only stress hormone level but also immunological response of adult Taihangshan macaques, and that the stress-linked immunosuppression hypothesis was supported in mating period.

An audit was conducted in the exodontia department of Punjab Dental Hospital, Lahore, to assess the quality of records being kept by the undergraduate students in their third and final year, who form a major chunk of the workforce in the hospital, working in the mentioned department. The main objective behind this exercise was to improve the standards of record keeping and bring them in line with the standards practiced around the world, ultimately resulting in better patient care.This audit was undertaken while keeping in view all the necessary steps of a successful clinical audit. Initially, 150 records were randomly obtained from undergraduates of both third and fourth years and evaluated against a modified CRABEL score, which grades the records on a scale of 100. The results of this part of the audit were shared with the batches that were doing their clinical rotation in exodontia at the time of this audit, and a teaching session was conducted on better record-keeping standards. Following this, a repetition of the previous audit was undertaken to complete the audit cycle. Results: The most commonly omitted component in the records in the initial audit was the patient complaint closely, followed by proper medical history and supervisor signatures. In the following, 'reaudit' compliance was seen to be improved, and all the components of record-keeping less commonly being omitted except medical history and date.A more comprehensive patient record keeping is possible with proper intervention and inculcation of record-keeping awareness in the undergraduate course, especially in the clinical years.

Mandibular condylar fracturing are a common outcome of mandibular trauma. Condylar and subcondylar injuries benefit best from the retromandibular technique, which also offers the greatest exposure to the joint and ascending ramus. Objective: To determine the efficacy of the retromandibular approach in treating condylar fractures with open reduction and internal fixation (ORIF). Methods: A total of 25 subjects with age range 14 to 55 years having unilateral mandibular condylar fractures with disturbed occlusion utilizingretromandibular approach were included in the study. Relevant information was gathered and evaluated. Results: The average age of the sufferer was 31.18 ± 8.17 years and mean duration of fracture was 5.32 ± 0.73 days. There were 21(84%) male patients and 04 (16%) female sufferers. RTA was the most common mode of injury seen among patients (60%). The shattered segments' anatomic reduction and fixation were successful. The efficacy was 72% on basis of ease of operation and 96% on fracture stability. Conclusion: This technique is effective in term of ease of operation and fracture stability. Scar acceptability can be considered drawback of this procedure

Background: Odontogenic tumors represent the heterogeneous organization of lesions with numerous histopathological characteristics and medical manifestations. Ameloblastoma is real neoplasm of odontogenic epithelium, constitute one percentage of oral complete ectodermal tumors &amp;9percentage of an odontogenic tumors4. This tumor is benign, which suggests the insidious slowly increase, regionally aggressive having excessive recurrence rate5 Aim: To evaluate radiographical features and root resorption among patients of Ameloblastoma reporting to Dept. of OMFS Study Design: Descriptive Cross-Sectional Study Place and duration of study: Department of Oral and Maxillofacial surgery, Multan Dental College Multan. Duration of this study was 2 years from 1st Jan 2021 to 31th Dec 2022. Methodology: A descriptive audit including all patient records with a histo-pathologically confirmed report of ameloblastoma based on the routine Hematoxylin and Eosin stain. Consecutive non-probability sampling technique was used. Results: One hundred and forty people with an ameloblastoma were contained within ours study amongst whom 45(32.1%) were female and 95(67.9%) were men. 123(87.9%) lesions were found in the mandible. Swelling was mostly told symptoms in 137(97.8%) of all cases. 76(54.3%) showed root resorption. Radiographically, the multilocular appearance accounted for 97(69.3%) while uni-loculancy was present in 43(30.7%) of the lesions. Practical implication: This study help in diagnosis of amelolastoma. This also guides the clinician to differentiate different forms of aelolastoma and differentially diagnose from other radiolucent lesions. Conclusion: This study pointed that ameloblastoma was seen more in men when compared with females Most cases showed root resorption. Mostly ameloblastomas were of multi-locular form/pattern with posterior are of lower jaw as most frequent site involved. Keywords: Ameloblastoma, features, radiolucency &amp; Multi-locular

When employing x-ray images, fracture identification in orthopaedics is a difficult task. A large percentage of humerus fracture patients are seen in hospitals, particularly in their emergency departments. Similar to this, after a fracture, accurate callus production monitoring is crucial for bone healing. Thus, a fractured patient’s diagnosis and therapy must be accurate and administered promptly. This work investigates the use of deep learning on X-ray images of the humerus for fracture snd bone callus formation analysis to help physicians in the diagnosis of such fractures, especially in emergency settings.This study is named HD-NET, which stands for Humerus Deep Net. The framework includes image enhancement using a Gaussian filter and histogram equalization, two-stage object detection, image super-resolution, U-NET segmentation with feature recalibration. Finally, an LSTM with a sequence length of 2 is used to analyze callus formation at the fracture site. The LSTM takes the segmented area as input and outputs a prediction for the stage of healing and potential complications. The proposed framework was evaluated on a combination of the MURA dataset and a self-collected dataset.Results demonstrated that in terms of specificity, sensitivity, and accuracy, the suggested framework performed better than earlier studies. This research can be expanded to different bone types and is useful for orthopaedic practitioners.

Background: Kidney transplant is only the cure of end stage renal diseases. It is because it provides the maximum replacement of renal functions. New onset diabetes after transplantation is one of the serious and chronic problem of renal transplant. NODAT is reported to occur in 4%-25% of renal transplant recipients. New onset diabetes may be identified after the renal transplant at any time. Objective: The study aimed to determine the frequency of new onset of diabetes mellitus in the patients with live related renal transplant. Study design: It is a retrospective study conducted in the department of nephrology and transplantation, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat for the duration of six months from July 2022 to December 2022. Material and Methods: There were 50 patients in PTDM group and 70 were in the non PTDM group. The anthropometric and clinical characteristics were recorded. The SPSS software was used for the analysis. The Patients were divided into two groups according to the diagnosis. Results: The average age of patients in PTDM group is 43.2 years whereas in non-PTDM group the average age is 45 years. Statistical analysis revealed that results are statistically significant with 95% CI. Most of the cases appeared during 2 weeks of transplant however, 14 patients also reported about diabetes after 2 months of transplant. Conclusion: Common metabolic disease PTDM is usually diagnosed during first 6 weeks of renal transplantation. Old age, family history of diabetes, the presence of IGF during first week of transplantation are some of the risk factors that lead to PTDM prevalence. The PTDM was observed in the 40% patients in our study. Keywords: renal functions and post-transplant diabetes mellitus.

Background: It is commonly observed in the patients undergoing kidney transplant. The red cell mass increased in this condition but the plasma volume remain normal. It is characterized by the hematocrit levels equal to 51% or greater than 51%. Study design: It was a cross-sectional and descriptive study conducted at the department of nephrology and transplantation, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Gambat. This study was conducted for the duration of six months from January 2022 to June 2022. Material and Methods: There were total 90 patients selected for the study. There were 35 patients in the control group and 55 patients in the Post-transplant Erythrocytosis patients group. The 25 out of 35 were male and 7 were females. The 17 out of 55 were male and 38 were females. Haemoglobin and Hematocrit was assessed retrospectively. Those with Hct &gt; 51 was labelled as PTE. The study comprised of control group and PTE group having post erythrocytosis patients. The duration of dialysis of the patients was 12 and 13 months for control and PTE group respectively. Results: The red cell and plasma volume of the control group and PTE was analyzed and it showed that most of the patients had their RCV and PV in the normal range. However, there were 5 patients in control group and 15 patients in PTE group that had reported low level of RCV. The percentage of alive patients with functional graft was more in case of control (97%) as compared to PTE group (83%). Conclusion: The study was done to find the frequency of post-transplant Erythrocytosis among patients and control group. It was found that there were several risk factors that could possibly play role in causing the disease. The 21% of the patients were diagnosed with PTE. Keywords: Erthrocytosis, haematocrit, and haemoglobin.

Beef has become high quality livestock product and its demand is continuously increasing in developed nations. Use of innovative forage production techniques is need of hour to cater the increasing demand of livestock products. A study was designed in Republic of Korea to evaluate the influence of intercropping triticale with legumes under different manure levels for optimum forage yield and carrying capacity of Hanwoo beef cattle in a split plot design with 3 main and 4 sub-plots. Triticale was cultivated as monocrop, mixed cropped with hairy vetch and winter pea under 3 main plots. Four manure levels were also evaluated under 4 sub-plots: 0 kg N (nitrogen)/ha (control), 50, 100 &amp; 150 kg N/ha. The collected data were analyzed using general linear model procedure through Statistical Analysis Software. Findings showed that intercropping scheme with little manure application is an innovative approach for higher forage yield under limited land resources. The optimum yield of triticale-hairy vetch and triticale-winter pea could be met with application of manure at 50 kg N/ha level, whereas optimum crude protein yield and Hanwoo carrying capacity could be achieved even without manure application. Possible reason behind optimum forage yield might be efficient rhizobial symbiosis between two cereal and leguminous intercropped species. Additionally, manure application might play significant role in maintaining nutrient balance and soil physical properties. It was concluded based on findings that adequate forage yield can be achieved for beef cattle through intercropping cereal crops; triticale with legumes (hairy vetch and winter pea) under 50 kg N/ha cattle manure level.

Abstract A generic method for finding central configurations in the general four body coplanar problem with four different masses is derived. New families of non-symmetrical central configurations with non-equal masses are found and all known symmetrical four body non-collinear central configurations are shown to be derivable subsets using this generic model. In this model, three masses are distributed on the vertices of a triangle. Then the fourth mass is allowed to be at any other point in the plane forming either convex or concave central configurations. In this general setting, a necessary condition is derived for the existence of central configurations and for requiring the masses to be positive. Using both analytical and numerical techniques, regions of possible central configurations can be derived. The special cases of four body central configurations investigated include isosceles trapezoids, right trapezoids, right quadrilaterals, convex kites and concave kites. In most of these special cases, the number of parameters of the problem can be reduced from four to two and hence the regions of existence can be shown graphically. A number of cases both convex and concave with no symmetry restrictions or equality of masses were also investigated to demonstrate the generality of the method for finding central configurations in the general four body coplanar problem with four different masses.

Background: Cross-infection during clinical training can occur when an infectious pathogen is transmitted between a medical staff and a patient in the clinical setting. Dental professionals, including dental/oral hygienists, doctors and P. A’s, are always at high risk of getting HIV and / or hepatitis B. Cross-infection is well-defined as “spread/transfer of infection amongst staff and patients in clinic or hospital setting”. Methods: Questionnaire based Cross-sectional study was done on post-graduate residents of the Multan dental college Multan. 58 post-graduate residents took part in our research. Universal sampling was done for collection of data. Partakers signed an informed consent. Results: Fifty-eight postgraduate residents completed the form. Males were eighteen while ladies were forty.79% participants believe that dental setups/hospitals are more liable to contamination compared to other healthcare areas. All PGR’s believe that vaccination against the hepatitis B virus is obligatory for a dental professional and they maintain additional precautions generally whenever dealing AIDS &amp; hepatitis B, C patients. 93% residents wash their hands regularly after treating each &amp; every patient and indicated that use of PPE plays an important role in preventing cross-contamination. 96.5% of subjects were conscious whenever handling sharp instruments. Majority of these PGR’s use facemask &amp; gloves nevertheless Protective eyewear, aprons &amp; head-caps were not used by most of them. Conclusion: Participants showed satisfactory awareness about cross-contamination control. Knowledge gained must also be transferred to their daily practice. Dental institutes should also focus on establishing policies to control cross-contamination at the institutional level.

OBJECTIVE : Objective of the study is to determine the effectiveness of CISC in management of recurrent urethral strictures after visual internal urethrotomy. METHODOLOGY : This study performed in department of urology Saidu teaching hospital Swat from June 2016 to July 2019 on 215 patients who were diagnosed as having urethral stricture disease. Patients were counseled for CISC after removal of catheter 2 times a day for 8 weeks and at 8th week cystourethroscopy performed along with detail evaluation of symptoms of urethral stricture to know recurrence of stricture. RESULTS: 81.39% patients have no urethral stricture on cystourethroscopy and symptomatic evaluation at 8th week post visual internal urethrotomy while 18.60% patients have recurrent urethral stricture . Length of urethral stricture is the most important prognostic factor, stricture of less than 1 cm has success rate of 62.39% while stricture of more than one cm length has success rate of 20% as shown in table IV. CONCLUSION: In this study it has been confirmed that CISC is safe ,cost effective procedure and most of the patients can do it in home with out any complications.

Nanobodies (Nb) are monomeric heavy-chain fragments derived from heavy-chain only antibodies naturally found in Camelids and Sharks. Their considerably small size (~3-4 nm; 13 kDa) and favorable biophysical properties make them attractive targets for recombinant production. Furthermore, their unique ability to bind selectively to specific antigens, such as toxins, chemicals, bacteria, and viruses, makes them powerful tools in cell biology, structural biology, medical diagnostics, and future therapeutic agents in treating cancer and other serious illnesses. However, a critical challenge in nanobodies production is the unavailability of nanobodies for a majority of antigens. Although some computational methods have been proposed to screen potential nanobodies for given target antigens, their practical application is highly restricted due to their reliance on 3D structures. Moreover, predicting nanobodyantigen interactions (binding) is a time-consuming and labor-intensive task. This study aims to develop a machine-learning method to predict Nanobody-Antigen binding solely based on the sequence data. We curated a comprehensive dataset of Nanobody-Antigen binding and nonbinding data and devised an embedding method based on gapped k-mers to predict binding based only on sequences of nanobody and antigen. Our approach achieves up to 90% accuracy in binding prediction and is significantly more efficient compared to the widely-used computational docking technique.

Nanobodies (Nb) are monomeric heavy-chain fragments derived from heavy-chain only antibodies naturally found in Camelids and Sharks. Their considerably small size ( $$\sim $$ 3–4 nm; 13 kDa) and favorable biophysical properties make them attractive targets for recombinant production. Furthermore, their unique ability to bind selectively to specific antigens, such as toxins, chemicals, bacteria, and viruses, makes them powerful tools in cell biology, structural biology, medical diagnostics, and future therapeutic agents in treating cancer and other serious illnesses. However, a critical challenge in nanobodies production is the unavailability of nanobodies for a majority of antigens. Although some computational methods have been proposed to screen potential nanobodies for given target antigens, their practical application is highly restricted due to their reliance on 3D structures. Moreover, predicting nanobody-antigen interactions (binding) is a time-consuming and labor-intensive task. This study aims to develop a machine-learning method to predict Nanobody-Antigen binding solely based on the sequence data. We curated a comprehensive dataset of Nanobody-Antigen binding and non-binding data and devised an embedding method based on gapped k-mers to predict binding based only on sequences of nanobody and antigen. Our approach achieves up to $$90\%$$ accuracy in binding prediction and is significantly more efficient compared to the widely-used computational docking technique.

With the ever-growing energy storage demands for electrical grids, vanadium redox flow batteries (VRFB), a stellar candidate, need continuous cost, cyclability, and energy density improvement. The VRFB tend to lose vanadium from electrolyte solutions due to the precipitation of V 2 O 5 during charging, resulting in a significant loss of energy density. We monitored the solubility and electrochemical characteristics of vanadium electrolyte solutions with V 2 O 5 as the starting material in the presence of different additives, namely HCl and MSA (methanesulfonic acid), for over three months. On average, the ionic conductivity of solutions with additives was 50 mS higher than that of without additives. Additives also improved the electrochemical performance and lowered charge transfer resistance. UV/Vis and Raman spectroscopy were utilized, and a reaction mechanism responsible for improved conductivity and kinetics was proposed.

Abstract Flexible, scalable, and low‐cost energy storage solutions are required for the widespread use of renewable energy and the mitigation of climate change. State‐of‐the‐art lithium‐ion batteries provide high specific energy density; however, designing a safe and cost‐effective grid‐scale lithium‐ion battery is still a major challenge. Redox flow batteries are scalable due to their ability to decouple power and energy; however, the commercial applications of these batteries are limited because of expensive ion‐selective membranes. In this paper, we report a modified battery design approach in which Bi/BiOCl and V 4+ /V 5+ reaction‐based redox couples are utilized while employing a gel‐based architecture. We show, for the first time, that Bi/BiOCl conversion reaction based redox couple can reversibly work against traditional vanadium‐based redox pair in an aqueous electrolyte. Redox active materials in this cell design are in the gel form, and a traditional membrane or a separator is not required. This proof‐of‐concept battery delivers 0.9 V with a volumetric energy density of 22.14 Wh/L.

The armyworm is one of the major threats to global food crop security. It is a polyphagous pest that has recently spread to Gilgit Baltistan (GB) from another region of Pakistan. This pest has posed a significant threat to economically important cereal crops like wheat and maize, as well as to vegetable crops such as beans, forage crops like berseem and alfalfa, and fruit trees. While it has been reported in other regions of Pakistan, there has been no confirmed presence of the armyworm in GB, Pakistan. In April 2022, the armyworm invaded crops in districts Gilgit, Nagar, Hunza, Diamer, and Baltistan region. To monitor its movement, the integrated pest and disease management (IPDM) department of GB established mechanical traps in these districts. The armyworm outbreak persisted in these districts until the end of June 2022. The field survey revealed that the pest primarily targeted wheat, beans, maize, berseem, clovers, forage grasses, and vegetables. Suspected armyworm moths were captured and identified as Mythimna unipuncta through morphological analysis. Various pesticides were applied in the aforementioned districts to manage the armyworms. Additionally, the farming community of GB was provided with mechanical traps and spray machines. The invasion of armyworms might be attributed to climate change, which has been observed over the last 4-5 years in GB. This case study confirms the first instance of armyworm immigration into GB, and it will serve as a valuable resource for the monitoring and management of armyworms. Moreover, raising farmer awareness about climate change and its impact on armyworms is essential. To effectively manage insect pests under changing climatic conditions, it is crucial to collaborate with stakeholders and farmers to prepare and enhance armyworm risk assessment maps. Furthermore, a comprehensive study involving molecular identification of the Fall Armyworm (FAW) should be conducted to achieve scientific identification

Background: Incidental maxillary sinus pathologies refer to unexpected findings of abnormalities within the maxillary sinuses discovered during routine dental imaging examinations. Objective: To determine the frequency of incidental maxillary sinus pathologies in dental patients on cone-beam computed tomographic (CBCT). Study Design: Cross sectional study. Settings: Department of Dentistry Multan Medical and Dental College, Multan Pakistan. Duration: From August 2022 to January 2023. Methods: This study included 132 adult patients presenting with cone-beam computed tomographic (CBCT) images for dental assessment. Exclusion criteria comprised maxillofacial trauma, previous surgery, or congenital anomalies. Patient demographics and radiographic findings were recorded, with two radiologists independently assessing CBCT images for incidental maxillary sinus pathologies. Descriptive statistics and subgroup analyses were performed in SPSS. Results: The mean age was 46.3±10.2 years. In gender distribution, 60 patients (45.5%) were male, while 72 patients (54.5%) were females. The overall prevalence of incidental maxillary sinus pathologies was present in 75 cases, accounting for 56.81% of the total. Among the pathologic findings, mucous retention cysts were the most common, present in 35 patients (63.6%), followed by polyps in 15 patients (27.3%), sinusitis in 10 patients (18.2%), and anatomical variations in 20 patients (36.4%). Conclusion: The study identified an overall prevalence of incidental maxillary sinus pathologies in 56.81% of the dental patient population, emphasizing the importance of comprehensive evaluation during routine dental assessments.

Due to increase in demand our conventional resources are insufficient to fulfill the world energy demand. Renewable techniques are extremely economical due to converting useless waste into energy. To achieve that purpose anaerobic digestion was performed on banana peels with co digested with biogas slurry. Input feedstock to anaerobic plant was banana peels which already passed through four pretreatments such as, glycerol, sodium hydroxide, calcium hydroxide and acetic acid at variable conditions. Glycerol treatment give most efficient results due to more removal of lignin up to 87%. Anaerobic digestion is completely environmental friendly with no carbon dioxide emission and due to benefits it can adopted more in future on industrial and domestic scale. 6 liter capacity tank was installed at 4 liter with 10% TS level to giving space at top for biogas production. Trails was performed at two temperature 37°C and 55°C but more biogas produced at 55 °C with retention time period of eighteen days. In slurry tank manually stirring was provided and produced gas was calculated through water displacement method. This study help to decrease city waste by installing anaerobic plants. In that way we can achieve sustainability and waste can also be controlled.

Background: The global incidence of fatal head injuries is greater than the number of non-fatal cases. The presence or absence of a skull fracture, its type and site along with the type of intracranial hemorrhage has immense significance in the final outcome in cases of head injuries.&#x0D; Objective: To determine the frequency of intracranial hemorrhage and its different pattern in patients presented with skull fracture following blunt head injury in a tertiary care setting.&#x0D; Material and Methods: The study employed cross sectional study design and was conducted in Neurosurgery Unit of Lady Reading Hospital, Peshawar. The study duration was six months after approval of synopsis (29-06-2019 to 29-12-2019). A sample size of 196 patients was calculated using WHO calculator. Non probability consecutive sampling was used for patient’s selection. Ethical approval and consent forms were taken. Diagnosis of skull fracture and intracranial bleeding were made on the basis of CT brain and per op findings. Data was analyzed using SPSS version 17. Post stratification chi-square test was applied. P value ≤0.05 was considered significant.&#x0D; Results: Total 196 patients were included in study. There were 129(65.8%) male and 67(34.2%) female. Mean age of patients was 35.7 years±9.9SD. Intracranial hemorrhage was present in 32(16.3%). Type of intracranial hemorrhage was subdural in 10(5.1%), intrcerebral 3(1.5%), subarchnoid 3(1.5%), intraventricular 4(2%), contusion 2(1%), combination 2(1%), and extradural 8(4.1%). Intracranial hemorrhage is significantly associated with GCS, Occupation, cause of injury, location of injury and type of intracranial injury (p&lt;0.001).&#x0D; Recommendation: According to the findings, frequency of intracranial hemorrhage was relatively high. This study recommend all patients with skull fractures due blunt head trauma be subjected to thorough brain damage check-up. The type and location of skull fracture is an indirect indicator of the severity of force of impact which leads to damage to the underlying brain and results in fatality.&#x0D;

Aim: To reassess the high specificity of alkaline phosphatase as a serum tumor marker in patients with osteosarcoma Study type: Retrospective cohort study Study place and duration: Department of Orthopedics, DHQ Hospital Gujranwala from January 2013 to June 2021 Methods: The medical record of 140 osteosarcoma patients were reviewed retrospectively, who received treatment for osteosarcoma during January 2015 and June 2021. According to clinical factors at diagnosis, the difference in prevalence of increased ALP was assessed using Fisher`s extract test and χ2 test. In the groups with normal and high level of serum ALP at presentation, the disease-free survival (DFS) and overall survival (OS) were compared using The Kaplan–Meier estimate. At presentation the prognostic ability of increased ALP was examined using Cox regression analyses. For determination of therapeutic steps and survival related changes in levels of ALP during therapy and survival related response of ALP to therapy, Linear Mixed model (fixed model) was used. Results: Sensitivity, specificity , Positive predictive value, negative predictive value, PLR, NLR and DOR of ALP in Metastatic osteosarcoma at 15 months follow up was 55.4%, 80.3%, 62.1%, 74.2%, 3.14, 0.864 and 5.241 respectively. Similarly, Sensitivity, specificity , Positive predictive value, negative predictive value, PLR, NLR and DOR of ALP in Metastatic osteosarcoma at 3 years follow up was 56.4%, 92.5%, 83.1%, 70.1%, 6.321, 0.632 and 8.543 respectively. Conclusion: ALP has been found to be a very important tumor marker having high specificity in patients with osteosarcoma. MeSH words: Osteosarcoma, Tumor, Biomarker, Alkaline Phosphatase, Metastasis, Sensitivity, Specificity

Aqueous sodium-ion batteries are the promising candidates for large scale energy storage applications owing to their cost effectiveness and environmental safety. However, the development of a stable cathode material with high capacity is still a challenging task for the commercial viability of aqueous electrolyte-based sodium-ion batteries. This work demonstrates the development of hierarchically nanostructured high-capacity cathode material by encapsulating sodium decavanadate Na 6 V 10 O 28 (NaDV) in the scaffold of manganese-based metal-organic framework Mn-BTC (where BTC is 1,3,5-benzenetricarboxylic acid) by an in situ synthesis. The uniform distribution of NaDV in the pores of Mn-BTC enables the multielectron redox properties of NaDV whereas the diverse 3D diffusion channels, high surface area, and flexible architecture of MnBTC ensures high intercalation capacity by suppressing the agglomeration and providing faster ionic diffusion kinetics in the NaDV@Mn-BTC nano-hybrid cathode material. The Mn-BTC framework not only ensures the stabilization of NaDV but also enhances sodium storage capacity by the involvement of Mn in the redox process. The NaDV@Mn-BTC cathode material exhibits high reversible capacity of 137 mAh/g at 1C rate. High capacity of this cathode material suggests that development of these nano-hybrid materials is a feasible approach to design high energy cathode materials for aqueous batteries.

The cancer of breast is the 2nd leading source of cancer death in females. A modified radical mastectomy encompassed the combines removal of the axillary lymph nodes with all breast tissue removal from the affected breast. The most common complication of surgery is formation of seroma. Inadequate data is accessible on this topic. This analysis therefore provides valued information on this problem associated with infection of wound. Objective: To govern the initial complications after radical modified mastectomy in women with cancer of breast. Study Design: A descriptive case study. Place and Duration: In the Surgical department of Muhammad Teaching Hospital, Peshawar for the duration of one-year from November 2020 to October 2021. Methods: This descriptive case study was conducted at the surgical department of Muhammad Teaching Hospital, Peshawar for the duration of one-year from November 2020 to October 2021. The estimated sample size had an incidence of 18%, margin of error = 10% and CI = 95% of the sample size required is 62 patients. The sampling method used was non-probability purposive. Patients who met the selection criteria underwent a modified radical mastectomy with the prior conversant written consent. The patients were discharged home on the second day of surgery and were monitored weekly for the first 6 weeks at the clinic for primary complications such as seroma formation and wound infection. All related demographic data such as clinical information and age such breast cancer staging with possible complications were recorded at the culmination of 6-weeks. Data were entered into SPSS software version 21 and analyzed. Results: The study included 62 females with a modified radical mastectomy for breast cancer who fully met the criteria of inclusion. 46.10± 13.02 years was the patients mean age with 20-75 years age range. The mean postoperative day of infection in wound was 4.60± 1.9 days and the mean postoperative day for seroma was 9.21± 3.98 days. Stage II breast cancer was diagnosed in 44 patients (70.9%) and stage I breast cancer in 18 patients (29.1%). Wound infection was observed in 5 patients (8.1%), while 16 patients (25.8%) experienced complications related to seroma formation. Conclusion: This study showed that complications such as infection in the wound are significantly lower, but the incidence of seroma is consistent with nationwide studies that justify novel interferences to reduce the rate of these complications. Keywords: Modified radical mastectomy, Seroma, Wound infection.

Primary adrenal lymphoma (PAL) often occurs bilaterally and is a rare malignancy of old age. Workup for primary adrenal insufficiency often unmasks this underlying grave pathology. In this article, we present a case of a 73-yearold patient who presented with features of primary adrenal insufficiency and renal colic. Diagnostic abdominal imaging revealed bilateral suprarenal masses as the cause of adrenal gland destruction and the patient's symptoms. FDG PET-CT scan and histopathology confirmed the diagnosis of mature bilateral B-cell primary adrenal lymphomas. Though the patient showed an excellent initial response to the first four chemotherapy cycles, a relapse resulted in metastatic disease. This article highlights the PAL's disease course, imaging features, and management dilemma due to Chemotherapy's side effects and a higher recurrence rate. Keywords: Primary adrenal lymphoma, Primary adrenal insufficiency, R-CHOP, Role of imaging.

N-linked is the most common type of glycosylation which plays a significant role in identifying various diseases such as type I diabetes and cancer and helps in drug development. Most of the proteins cannot perform their biological and psychological functionalities without undergoing such modification. Therefore, it is essential to identify such sites by computational techniques because of experimental limitations. This study aims to analyze and synthesize the progress to discover N-linked places using machine learning methods. It also explores the performance of currently available tools to predict such sites. Almost seventy research articles published in recognized journals of the N-linked glycosylation field have shortlisted after the rigorous filtering process. The findings of the studies have been reported based on multiple aspects: publication channel, feature set construction method, training algorithm, and performance evaluation. Moreover, a literature survey has developed a taxonomy of N-linked sequence identification. Our study focuses on the performance evaluation criteria, and the importance of N-linked glycosylation motivates us to discover resources that use computational methods instead of the experimental method due to its limitations.

The present study was conducted to evaluate the soil’s suitability for the alfalfa crop in Nomal Valley, Gilgit Baltistan (GB), using a variety of physicochemical parameters and free-living soil nematodes as indicators. Ten soil samples from different sites (A1-A10) of the valley were collected in zip-lock plastic bags to test for free-living soil nematodes and physicochemical characteristics. Each sample’s free-living nematodes were extracted using the modified Baermann funnel method and counted using a compound microscope (at 40 and 100X). About 100 nematodes were identified from each sample to the family level. Based on feeding behavior, nematodes were divided into groups. Nematode population densities ranged from 102 to 507. The most prevalent feeding group members were bacterivores, while predators were the least common. Cephalobidae was the most frequently occurring family, which indicates soil’s fertility. Various physiochemical parameters, including soil temperature, pH, electrical conductivity (EC), moisture, bulk density, and texture, were also measured. The ranges for the selected soil parameters were as follows: pH 7.20-7.80, EC 68-252 mS/m, bulk density 0.91-1.37g/cm2, and soil temperature 22-30 ℃. All sites had slit loam soil texture except A-5, which had sandy loam.

Due to the easy access of internet and smart devices, people are becoming habitual to give their feedback on what they hear or watch, online. These reviews are very valuable for all sorts of users. Due to the widespread online activities, the count of these reviews has raised tremendously. This fact makes it humanly impossible to analyse them manually. So it needs time that reviews to be analysed and use patterns to be found and explored through the automated channel. This led to a new field of research known as Sentiment Analysis. This paper is targeting to design a model to perform sentiment analysis of Roman Urdu text using the reviews of Pakistan Super League’s official song. To perform this analysis five different techniques-- Naïve Bayes Kernal, Random Forest, Logistic Regression, K-Nearest Neighbour and Artificial Neural Network, are applied. Naïve Bayes Kernal and Logistic Regression correctly predicted 97.00% reviews.

A new muon reconstruction algorithm is introduced at the CMS experiment. This algorithm reconstructs muons using only the central tracker and the Resistive Plate Chamber (RPC). The aim of this work is to study how a muon reconstructed only with tracker and RPC information would perform compared to the standard muon reconstruction of the CMS detector. The efficiencies to reconstruct and identify a RPC muon with a transverse momentum greater than 20 GeV/c are measured. The probabilities to misidentify hadrons as muons at low transverse momentum are also reported. These probabilities are compared to the standard muon identification used at CMS.

Lower fertilizer use efficiency coupled with conventional irrigation methods has been the issue of agricultural production system in Pakistan contributing to lower crop yields.In this backdrop, an experiment was conducted to investigate the impact of drip-fertigation using different rates of N, P and K fertilizers i.e., F100 (100% of recommended), F75 (75% of recommended), F50 (50% of recommended) and F25 (25% of recommended) on hybrid maize in autumn and spring growing season.Results suggested that number of final harvested plants ha -1 decreased by 4.9% in autumn and 5.85% in spring season as fertilizer rates decreased from F100 to F25 while decrease in ears ha -1 was 5.9% and 6.05%, respectively.Plant and ear height remained stable with decrease in fertilizer rate from F100 to F50.On average with F25, crop reached maturity 2 days earlier in both autumn and spring seasons, respectively, against F100.Ear length and number of grains row -1 showed an increasing trend with increasing fertigation rate.Number of rows ear -1 showed significant response only in one growing instance out of four.In both seasons, crop produced or sustained highest fresh ear weight and grain yield (kg ha -1 ) at F75 indicating that a further increment of 25% nutrients (F100) would be an excessive rate.Protein and oil % were also higher at F75 treatment in both seasons.Partial factor productivity (PFP) showed a negative relation with increasing fertigation rate however higher PFP values at lower fertilizer rates were economically ineffective.In conclusion, application of 75% of the recommended N, P and K fertilizers through drip fertigation optimized the grain yield and quality of maize in Punjab.

Lower fertilizer use efficiency coupled with conventional irrigation methods has been the issue of agricultural production system in Pakistan contributing to lower crop yields.In this backdrop, an experiment was conducted to investigate the impact of drip-fertigation using different rates of N, P and K fertilizers i.e., F100 (100% of recommended), F75 (75% of recommended), F50 (50% of recommended) and F25 (25% of recommended) on hybrid maize in autumn and spring growing season.Results suggested that number of final harvested plants ha -1 decreased by 4.9% in autumn and 5.85% in spring season as fertilizer rates decreased from F100 to F25 while decrease in ears ha -1 was 5.9% and 6.05%, respectively.Plant and ear height remained stable with decrease in fertilizer rate from F100 to F50.On average with F25, crop reached maturity 2 days earlier in both autumn and spring seasons, respectively, against F100.Ear length and number of grains row -1 showed an increasing trend with increasing fertigation rate.Number of rows ear -1 showed significant response only in one growing instance out of four.In both seasons, crop produced or sustained highest fresh ear weight and grain yield (kg ha -1 ) at F75 indicating that a further increment of 25% nutrients (F100) would be an excessive rate.Protein and oil % were also higher at F75 treatment in both seasons.Partial factor productivity (PFP) showed a negative relation with increasing fertigation rate however higher PFP values at lower fertilizer rates were economically ineffective.In conclusion, application of 75% of the recommended N, P and K fertilizers through drip fertigation optimized the grain yield and quality of maize in Punjab.

Abstract Background Intrauterine copper devices are a popular type of contraceptives, being in use for a long time. Migration of IUCD into the bladder is one of the many side effects of this contraceptive measure. Though a rare phenomenon, IUCD acting as a foreign body can cause stone formation in the bladder. Case presentation We present a 42-year-old female patient who presented with increased urinary frequency, dysuria, and suprapubic pain. Examination showed mild tenderness in the suprapubic region. On X-ray pelvis, she was found to have a giant stone covering IUCD in the bladder. She ultimately underwent cystolithotomy, and her IUCD with stone was removed. Consequently, she was discharged on the 4th postoperative day with a satisfactory condition. Conclusion Vesical calculus can form following migration of IUCD in the bladder. This article highlights the importance of careful insertion and follow-up investigation of IUCD. Radiological modalities like X-rays pelvis provide excellent visualization of the IUCD and can be used to confirm the accurate location of the contraceptive device.

Abstract In current study, analysis is presented for peristaltic motion of applied magnetic field and entropy generation within couple stress (Cu/H2O) nanofluid through an endoscope. An endoscope contains two coaxial cylindrical tubes in which the internal tube is nonflexible while the external tube has sinusoidal wave passing through the boundary. Influences of mixed convection along with applied magnetic field are encountered as well. Formulated governing model is fabricated introducing long wavelength and creeping Stokesian flow approximation which are then analyzed numerically by utilizing Adams Bashforth method. For a physical insight, results are demonstrated to examine the behaviors of flow profiles and entropy generation number for emerging flow parameters with the help of graphs, bar-charts and tables.

Ficus benjamina is an ornamental plant that planted alongside the road of Pakistan to increase the beauty of country. Several insect pests are attacking on this beautiful plant, responsible in reduction of aesthetic value of country. Among insect pests, Trilocha varians is serious and destructive pest whose larvae feed on leaves resulting 100% defoliation. The study was conducted to check the life table of this emerging pest on F. benjamina under controlled conditions. The study showed that total life period of T. varians from egg to adult was 33-35 days. The highest apparent mortality was recorded in early larval instars and rapidly reduced in later instars (3rd instars) which even reached to zero from 4th larval instars to pupal stage. Age-specific survivorship (lx) of the cohort was gradually reduce in later instars. Maximum mortality at early stage may exert significant negative effect on the insect population. The management practices could be more fruitful against early instars as compared to later instars larvae.

The Resistive Plate Chambers (RPC) are used in the CMS experiment at the trigger level and also in the standard offline muon reconstruction. In order to guarantee the quality of the data collected and to monitor online the detector performance, a set of tools has been developed in CMS which is heavily used in the RPC system. The Web-based monitoring (WBM) is a set of java servlets that allows users to check the performance of the hardware during data taking, providing distributions and history plots of all the parameters. The functionalities of the RPC WBM monitoring tools are presented along with studies of the detector performance as a function of growing luminosity and environmental conditions that are tracked over time.

February 1 th 2013 marked the end of the first period of running of the Large Hadron Collider (LHC) and the start of a two-year break from operation (LS1) aimed at consolidating both the accelerator as well as the detectors. By the end of LS1, the LHC is expected to provide collisions at 13 Tev. While, by 2020, the ultimate instantaneous luminosity is expected to be 1034/cm2/s. To prepare for this scenario, the Resistive Plate Chamber system at the CMS experiment is planning several detector maintainance and consolidation interventions. These include High Voltage and Low Voltage system reparations, gas leak identification and reparation, signal channel connectivity and functionality. Commissioning and upgrade plans for the existing CMS RPC system are presented here.

The RPC muon detector of the CMS experiment at the LHC (CERN, Geneva, Switzerland) is equipped with a Gas Gain Monitoring (GGM) system. A report on the stability of the system during the 2011-2012 data taking run is given, as well as the observation of an effect which suggests a novel method for the monitoring of gas mixture composition.

Due to great competition in software industry the source code and binaries have to be protected.Source code available in plain form could be easily stolen and launched on any computer using IDE.We have given an architecture that will be used in both (single user environment and teaming environment) in order to provide source code protection.Source code protection would be achieved through authentication, authorization, encryption/decryption and hashing.

The ostrowski inequality expresses bounds on the deviation of a function from its integral mean. The aim of this paper is to establish a new inequality using weight function which generalizes the inequalities of Dragomir, Wang and Cerone .The current article obtains bounds for the deviation of a function from a combination of integral means over the end intervals covering the entire interval. A variety of earlier results are recaptured as particular instances of the current development. Applications for cumulative distribution function are also discussed.

The aim of this paper is to obtain some generalized weighted Ostrowski inequalities for differentiable mappings. Some well known inequalities can be derived as special cases of the inequalities obtained here. In addition, perturbed mid-point inequality and perturbed trapezoid inequality are also obtained. The inequalities obtained here have direct applications in Numerical Integration, Probability Theory, Information Theory and Integral Operator Theory. Some of these applications are discussed.

In this paper we discuss the central configurations of the Trapezoidal four-body Problem. We consider four point masses on the vertices of an isosceles trapezoid with two equal masses $m_1=m_4$ at positions $(\mp 0.5, r_B)$ and $m_2=m_3$ at positions $(\mp α/2, r_A)$. We derive, both analytically and numerically, regions of central configurations in the phase space where it is possible to choose positive masses. It is also shown that in the compliment of these regions no central configurations are possible.

The Resistive Plate Chamber (RPC) muon subsystem contributes significantly to the formation of the trigger decision and reconstruction of the muon trajectory parameters. Simulation of the RPC response is a crucial part of the entire CMS Monte Carlo software and directly influences the final physical results. An algorithm based on the parametrization of RPC efficiency, noise, cluster size and timing for every strip has been developed. Experimental data obtained from cosmic and proton-proton collisions at √s = 7 TeV have been used for determination of the parameters. A dedicated validation procedure has been developed. A good agreement between the simulated and experimental data has been achieved.

Abstract Growing reliance and new technologies have significantly optimized the drilling operations; un-drillable wells become drillable now. We strive to increase drilling efficiency, whether managed pressure drilling (MPD) or conventional drilling operations. Designing an MPD operation inherits multiple challenges and requires the evaluation of numerous parameters. These include bottom hole pressure management, tripping, cementing, logging &amp; completion operations. However, this paper only describes how the tripping processes can be optimized using effective mud cap design in very narrow window HP/HT MPD wells. Constant bottom hole MPD (CBH-MPD) is one of the extensively used variants of MPD around the globe. In CBH-MPD, Surface backpressure is the differentiating factor added to keep the bottom hole pressure (BHP) constant in static and dynamic conditions. A close-loop is necessary to attain this control on the annulus pressure with specialized equipment, including effective sealing around the drill string and choking the return flow. The sealing is only effective against the smooth surfaces; hence, one of the most significant challenges in MPD operations arises: having a constant BHP in case of pull out to the surface. If the downhole isolation valve (DIV) is deployed, the well can be shut on it. However, if a DIV is not available, the well can be balanced by designing an effective mud cap keeping the available trip margins. Planning and executing a mud cap for MPD is challenging and can be overlooked in the planning phase. Designing a mud cap is complicated as many factors need to be incorporated. This paper describes, in detail, how these challenges were identified, planned for, and overcome. Multiple parameters were analyzed in sequences for subjected wells to optimize the mud cap weight and spotting depths. These parameters include the available tripping window, bottom hole temperature, circulation pressures, mud additives, mud rheology, surge, and swab pressures. Residing time of the mud cap in the hole is also a key factor considered in the design as it may also disturb the CBH pressure. Other design considerations included rig compatibility and volume handling capacity, equipment limitations downhole and surface, availability of chemicals, and effective rollover plan. The effective mud cap design for these narrow HP/HT wells mentioned in these case studies was an arduous and challenging task. This paper also discusses the aforementioned mud cap design considerations and their effects on selecting an appropriate mud cap. Practical examples are shared from challenging case studies, elaborating the detailed design and execution aspects.

Introduction: Spinal cord injury (SCI) is the damage of the spinal cord from the foramen magnum to the cauda equina which happens because of coercion, incision or contusion. Objectives: The study's main objective is to find out how often people who have a severe spinal cord injury have neuropathic pain and how it affects their rehabilitation, balance, and quality of life. Material and methods: This descriptive study was conducted in Sheikh Zayed medical college, Rahim Yar Khan during 2020 to 2021. Most of the patients had started a SCI programme early on, including neurosurgeon and orthopaedic consults and therapy. The data were collected during the initial visit of the patients. Results: The data was collected from 162 patients. At-level pain was reported by 34% of those with neuropathic pain, whereas below-level pain was reported by 66% of those with neuropathic pain. In certain cases, neuropathic pain was characterised as both at and below a certain degree. Conclusion: It is concluded that Patients with traumatic SCI often experience a condition known as europathic pain. Patients' rehabilitation outcomes, balancing function, and general well-being may be impacted, as well as their general well-being. Keywords: SCI, Pain, Patients, Health

Background: Hydrocephalus is a clinical condition characterized by increased amount of cerebrospinal fluid in the brain. It results in dilatation of ventricles, increase intracranial pressure, brain atrophy, neurological impairment and even death. The management of hydrocephalous needs diversion, either intracranial or extracranial. The traditional treatment for all kind of hydrocephalous has been the implantation of ventricular shunt system. Endoscopic third ventriculostomy has been accepted as the procedure of choice for the treatment of obstructed hydrocephalous in adults and children. Methods: In this study, a total of 94 patients diagnosed with posterior fossa tumor and obstructive hydrocephalus were selected in a consecutive manner from the outpatient department and subjected to ETV. Glasgow coma scale (GCS) at baseline &amp; follow up were recorded to determine good or bad clinical outcome. Objective: To determine the outcome of Endoscopic Third Ventriculostomy in the treatment of Obstructive hydrocephalus secondary to Posterior fossa tumour in dhq hospital Mardan out of 94 patients. Results: The mean age of the patients was 10.82 + 4.49 years. Of the whole sample, we had 64.9% of males and 35.1% females. The mean GCS on baseline of our group of patients was 9.4 + 1.2 which was improved to 12.7 + 1.3 after Endoscopic third ventriculostomy. (p value 0.000). Good clinical outcome was observed in 71.3% of patients while bad clinical outcome in 28.7% of patients the mean age of the patients was 10.82 + 4.49 years. Of the whole sample, we had 64.9% of males and 35.1% females. The mean GCS on baseline of our group of patients was 9.4 + 1.2 which was improved to 12.7 + After Endoscopic third ventriculostomy. (p value 0.000). Good clinical outcome was observed in 71.3% of patients while bad clinical outcome in 28.7% of patients. Conclusions: Endoscopic third ventriculostomy is a preferred treatment for patients who had obstructive hydrocephalus due to posterior fossa t

I nvestment refers to the net addition to capital stock which is used for future production.It is a crucial ingredient of the national income identity.Investment augments physical, financial as well as human capital, each of them has its role in the production of an economy.Health and training facilities are most likely to increase the productivity and efficiency of the labor force.Investment in machinery, inventories, buildings, land, and computers, will make considerable accumulation to the productivity.Financial investment generates profits in various shapes including earning of interest on dividend, bonds and protections, value, and reinvestment of benefit to upgrade both profitability and benefit.According to Afzal (2004a) reserves and investment are primary large-scale variables which are observed surely striking for attaining speedy financial development, for the major economic purpose of any development plan in an emerging nation.For the country, it is hard to locate, which had the option to develop a high rate for a significant stretch without encountering high paces of capital arrangement or potentially high paces of investment funds.Afzal (2010) reported that developing and developed countries reveal encouraging investment savings association and in both time series and cross-sectional research.Accordingly, the fundamental job of speculation for actual output yield development is of top mystery since speculation both in microeconomic and mac-Abstract | This paper made an attempt of econometric analysis of the investment situation in Pakistan for the period 1990-2017.The variables including domestic credit, national savings, lagged investment (IV), imports, and the real exchange rate were found to be the major factors affecting investment in Pakistan.Among all, the savings coefficient is positive and insignificant because of savings in Pakistan had no healthy pattern.Exchange rate has adversely affected the investment because of unidirectional causality.Specification and analytical tests supported reliability of the investment does not affect investment model from key econometric issues.The stability test shows that investment fluctuated during the 1990-2017 periods.OLS and GMM results are comparable.OLS estimation results are reliable since these variables do not suffer from Endogeneity problem.

To compare the mean postoperative pain score in patients with ropivacaine infiltration in the access tract with placebo in patients undergoing mini percutaneous nephrolithotomy. Methods: Total 82 adult patients of either gender undergoing mini percutaneous nephrolithotomy, between 9 and 63 years of age were included in the study. The patients were randomly allocated into two groups by lottery method. Patients in group A were given 20ml of 0.25% ropivacaine in the access tract while patients in group B were given 20ml of normal saline as placebo at the beginning of surgery at the nephrostomy site. Post operatively all patients were carefully followed at 2, 4 and finally at 6 hours. All patients were examined to determine the pain scores at the mini PCNL puncture site using visual analogue scale. Results: The mean age of patients in group A was 40.60 ± 11.62 years and in group B was 40.26 ± 13.15 years. Out of 82 patients 43 (51.43%) patents were male and 39 (48.57%) were female with male to female ratio of 1.1:1. Mean postoperative pain score in patients with preoperative ropivacaine infiltration (group A) of nephrostomy tract was 3.2 ± 1.2 and in placebo (group B) was 5.60 ± 1.64 with p-value of 0.0001. Conclusion: This study concluded that mean postoperative pain score of ropivacaine infiltration in the PCNL tract is less than placebo in patients undergoing mini percutaneous nephrolithotomy.

Aim: To assess the ferrous level in Hypoxic Ischemic Encephalopathy. Methodology: Eighty four neonates from tertiary care hospital had been included. Neonates were classified as hypoxic on the basis of Sarnat and Sarnat scoring. 34 healthy neonates served as control. Among 50 patients two groups were made each containing 25 neonates. Group 1 comprising of 25 neonates of hypoxic ischemic encephalopathy of mild degree. Group 2 comprising of 25 neonates suffering from moderate to severe encephalopathy. Results: Serum ferrous was significantly elevated in neonates suffering from Hypoxic Ischemic Encephalopathy. Conclusion: The significant elevation of serum ferrous in hypoxic neonates reiterates the key role of serum ferrous in neonates with hypoxic ischemic encephalopathy. Keywords: Ferrous, oxidative stress.

BackgroundMechanical circulatory support (MCS) devices are increasingly used in cardiogenic shock (CS) with an aim to improve survival outcomes. The aim of our meta-analysis is to compare mortality and morbidity outcomes with use of Impella versus extracorporeal membrane oxygenation (ECMO) in adult patients with CS.MethodsWe searched Medline, EMBASE, Cochrane, and Clinicaltrials.gov databases (Inception to December 2021) for observational studies comparing Impella to ECMO in patients with CS. Risk ratio (RR) for categorical variables and standardized mean difference (SMD) for continuous variables with 95% confidence interval (CI) were calculated using a random-effects model.Results11 retrospective studies and one prospective study (Impella n=6547, ECMO n=1178) were identified. Impella use was associated with lower in-hospital mortality (RR 0.87, 0.80-0.96, p=0.004), lower stroke incidence (RR 0.30, 0.21-0.42, p<0.00001), and shorter length of ICU stay (SMD -0.35, -0.65 - -0.04, p=0.03). There was no significant difference in MCS duration, renal replacement therapy, mechanical ventilation, and baseline LVEF between Impella and ECMO groups.ConclusionsDisclosuresS. Ahmad Nothing to disclose. B. A. Khan Nothing to disclose. S. Muhammad Nothing to disclose. A. Yousaf Nothing to disclose. B. Abdelazeem Nothing to disclose. M. Ahmad Nothing to disclose. X. Tieliwaerdi Nothing to disclose. A. H. Qavi Nothing to disclose. BackgroundMechanical circulatory support (MCS) devices are increasingly used in cardiogenic shock (CS) with an aim to improve survival outcomes. The aim of our meta-analysis is to compare mortality and morbidity outcomes with use of Impella versus extracorporeal membrane oxygenation (ECMO) in adult patients with CS. Mechanical circulatory support (MCS) devices are increasingly used in cardiogenic shock (CS) with an aim to improve survival outcomes. The aim of our meta-analysis is to compare mortality and morbidity outcomes with use of Impella versus extracorporeal membrane oxygenation (ECMO) in adult patients with CS. MethodsWe searched Medline, EMBASE, Cochrane, and Clinicaltrials.gov databases (Inception to December 2021) for observational studies comparing Impella to ECMO in patients with CS. Risk ratio (RR) for categorical variables and standardized mean difference (SMD) for continuous variables with 95% confidence interval (CI) were calculated using a random-effects model. We searched Medline, EMBASE, Cochrane, and Clinicaltrials.gov databases (Inception to December 2021) for observational studies comparing Impella to ECMO in patients with CS. Risk ratio (RR) for categorical variables and standardized mean difference (SMD) for continuous variables with 95% confidence interval (CI) were calculated using a random-effects model. Results11 retrospective studies and one prospective study (Impella n=6547, ECMO n=1178) were identified. Impella use was associated with lower in-hospital mortality (RR 0.87, 0.80-0.96, p=0.004), lower stroke incidence (RR 0.30, 0.21-0.42, p<0.00001), and shorter length of ICU stay (SMD -0.35, -0.65 - -0.04, p=0.03). There was no significant difference in MCS duration, renal replacement therapy, mechanical ventilation, and baseline LVEF between Impella and ECMO groups. 11 retrospective studies and one prospective study (Impella n=6547, ECMO n=1178) were identified. Impella use was associated with lower in-hospital mortality (RR 0.87, 0.80-0.96, p=0.004), lower stroke incidence (RR 0.30, 0.21-0.42, p<0.00001), and shorter length of ICU stay (SMD -0.35, -0.65 - -0.04, p=0.03). There was no significant difference in MCS duration, renal replacement therapy, mechanical ventilation, and baseline LVEF between Impella and ECMO groups. Conclusions DisclosuresS. Ahmad Nothing to disclose. B. A. Khan Nothing to disclose. S. Muhammad Nothing to disclose. A. Yousaf Nothing to disclose. B. Abdelazeem Nothing to disclose. M. Ahmad Nothing to disclose. X. Tieliwaerdi Nothing to disclose. A. H. Qavi Nothing to disclose. S. Ahmad Nothing to disclose. B. A. Khan Nothing to disclose. S. Muhammad Nothing to disclose. A. Yousaf Nothing to disclose. B. Abdelazeem Nothing to disclose. M. Ahmad Nothing to disclose. X. Tieliwaerdi Nothing to disclose. A. H. Qavi Nothing to disclose.

Background: Odontogenic tumors derived from tooth forming apparatus, either epithelial or ecto-mesenchymal or both. Ameloblastoma is a true neoplasm of odontogenic epithelium, represent 1% of all oral ectodermal tumors and 9% of odontogenic tumors.It is a benign tumor that shows an insidious slow growth, locally invasive with high recurrence rate. Aim: To determine radiographical and clinical features of ameloblastoma in patients reporting to Oral and Maxillofacial Surgery. Study design: Descriptive Cross-Sectional Study Place and duration of study: Department of Oral and Maxillofacial surgery, Multan Medical and Dental College Multan during 6 months. Methodology: A descriptive audit including all patient records with a histopathologically confirmed report of ameloblastoma based on the routine Hematoxylin and Eosin staining during the period of 6 months. Consecutive non-probability sampling technique was used. Results: A total of 140 patient records were included in this study among whom 95 (67.9%) were male and 45(45%) were female. 123 (87.9%) lesions were found in the mandible, while 17(12.1%) in the maxilla. Swelling was the most commonly reported symptom in 137(97.9%) of the cases. Pain and tooth mobility were among other symptoms. Radiographically, the multilocular appearance accounted for 97(69.3%) while uni-loculancy was present in 43(30.7%) of the lesions. Conclusion: This study concluded that males are more affected with ameloblastoma than females. The 2nd and 3rd decades of life were the most common age group affected. Painless swelling was the most common clinical feature reported in ameloblastoma attributing to late diagnosis. Keywords: Ameloblastoma, features, multilocular, Radiograph.

Background: Laparoscopy has become the highest quality level way to deal with cholecystectomy since its inception 30 years preceding, and is perhaps the most normally performed general surgeries. Pain being a significant issue after laparoscopic cholecystectomy bringing about extended admissions or readmissions. With significant varieties in pain relieving conventions an integrated approach is important to diminish pain. The aim of this study is to assess the effectiveness of Bupivacaine as local anesthetic agent at port sites after laparoscopic cholecystectomy. Methods: Study population of 84 patients was divided into control group (receiving no local anesthetic) and study group (receiving Bupivacaine as local anesthetic). Visual analogue scale was used to quantify and compare pain perceived by each group; at fixed intervals of 6, 12 and 24 hours after shifting of the patients back to the ward. Results: Each group comprised 42 patients. At 6 hours post operative pain score in study group, 4.5±0.32 was significantly lower than in control group, 7.6±0.41 (p&lt;0.05). Though pain assessments at 12 and 24 hours didn’t reveal any significant differences among the two groups; postoperative requirement of Tramadol was significantly (p&lt;0.05) lower in study group (92±0.064mg) in comparison to control group (158±0.21mg). Conclusion: Use of long-acting local anesthetic injections at port sites after laparoscopic cholecystectomy significantly lowers pain during first 6 hours post operatively and also lowers narcotic analgesics requirements during post operative period.

Biofuels are getting attention as an alternative to fossil fuel for a lot of reasons, and one of them is their capability to neutralize carbon. Biofuels actively reduce the toxic levels of greenhouse gases from the environment, and the combustion of biofuels result in the net-zero emission of carbon. The carbon used by plants during growth is recycled, so it does not harm the environment as fossil fuel does by releasing GHG. Biofuel also controls the carbon emissions from biomass facilities which would have been released back into the atmosphere through natural decay or disposal through open burning. Biofuels from degraded land and non-food crops are promising and will help in climate change mitigation. Proper planning in land use and identifying the most appropriate policies for promoting will help in combating the global issue. The technology utilizing carbon isolation in various sources, for ethanol, biodiesel, and other biofuels production, is a sustainable solution to climate change rather than biofuels from food crops.

Cloud computing is the on-demand availability of computer system resources. Most technology industries are moving to the cloud. Cloud structures can be costly for users. Virtualization is used in cloud computing that helps the cloud at a low cost. Migrating virtual machines (VMs) helps to manage computation. Migration of virtual machines is a core feature of virtualization. The technique of migrating a running virtual machine from one physical host to another with minimal downtime is called "live virtual machine migration." This paper discusses the migration technique, i.e., migration before and after copying, and also issues related to live migration. This paper presents a better approach to the VM migration method and future challenges by differentiating from the previous live VM migration method.

Objective: To determine the association of eruption timing of the mandibular and maxillary first permanent molars with BMI of children in school children of Hyderabad. Subject and Methods: A total of 704 (364 boys 340 girls) school children from various government schools of Hyderabad city were enrolled in the study. All the children were in age range on 5 to 8 years. A dental examination was conducted to determine the presence of permanent mandibular and maxillary first molars. Children's height and weight were recorded in meters and kilograms, and their BMI was calculated. The SPSS version 22.0 was used to analyze the data Results: Out of 704, there were 364 (51.70%) boys and 340 (48.29%) girls. Mandibular 1st molar was the 1st tooth to erupt with mean age of 5.83±1.2 in boys and in girls it was 5.52±1.2. Most of the children were reported with normal weight as per BMI. Conclusion: An earlier median eruption timing was recorded for the mandibular permanent first molar compared to the maxillary permanent first molar. All the teeth examined in girls erupted earlier than in boys. Keywords: Eruption Timing, Body Mass Index, Mandibular First Molar, Maxillary First Molar, Children

Earth’s population is increasing each year and it has drastic effects on the environment as well as on the global food production. Climate change unfortunately, affects not only humans’ lives but also affects the ways through which we produce our food and system of agriculture. Many studies revealed that yield of green vegetables is expected to decrease by 35% due to increased emission of greenhouse gases. Many factors like warmer temperature, increased CO2 concentration, pathogens, and decreasing pollinators affect the global food production. Fish catch has been decreased in recent decades due to acidification of the water and warmer temperature while the production of livestock has also been decreased significantly because of climatic changes. Our ability to ensure food security and adequate nutrition in a rapidly changing biophysical environment will be the determining factor in the global disease burden in the next century. There is a direct relation between the climate and the global food production. This chapter is intended to provide information regarding the drastic effects of climate change that could be faced in future.

&lt;p&gt;&lt;strong&gt;Background and Objective:&lt;/strong&gt; Odontogenic tumors are heterogenous lesions with diverse clinical manifestations and histopathological features. Ameloblastoma is a slow growing, sizeable benign tumor with an increased recurrence potential. Radiographically, ameloblastoma mimics other odontogenic tumors occurring in the same region but can be differentiated based on certain features. The objective of the study was to evaluate the radiographic features and presence of root resorption in ameloblastoma as a diagnostic feature in the local population.&lt;/p&gt;&#x0D; &lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This retrospective hospital-based study was conducted at the Oral and Maxillofacial Surgery Department of Multan Medical and Dental College Multan, Pakistan from 1st Oct 2019 to 31st March 2020. Radiographs of 35 histopathologically confirmed cases of ameloblastoma were included in the study. These radiographs were assessed for site, locularity, and root resorption. Data were processed and analyzed by using SPSS version 23.0&lt;/p&gt;&#x0D; &lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean age of the patients was 35.35&amp;plusmn;18.2 years with male predominance (66% vs. 34%). A total of 55% cases presented below 35 years age group showing increased prevalence in young adults. Multilocular appearance was seen in 24 (68.5%) cases while uni-locular pattern was seen in 12 (31.5%) cases. Root resorption was detected in 19 (54.3%) cases. Statistically, root resorption was not significantly associated with the gender or age of the patients (p &amp;gt; 0.05).&lt;/p&gt;&#x0D; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Multi-locular appearance and root resorption are the key radiographical features of ameloblastoma presenting in our population.&lt;/p&gt;

Objective: To evaluate the denture hygiene practices among elderly complete denture wearers. Subject and Methods: A total of 210 denture wearers in age range of 40 to 80 years were recruited in the study. All the study subjects were interviewed regarding their complete denture in terms of wearing duration, cleaning frequency, cleaning methods, continuous wearing and instruction regarding its hygiene. Results: Mean age of patients was 54.03+11.06 years, minimum 38 years and maximum 80 years. Males were found in majority 56.7% and females were 43.3%. Most of the cases i.e 38.1% wearing the denture form 1-3 years, followed by 29.0% wearing denture from less than 6 months. Around 53.3% were cleaning their denture once a day. Denture cleaning frequency and cleaning methods were statistically insignificant according to age and gender Conclusion: Brushing with dentifrice and without dentifrice was the method of choice for cleaning. Awareness programs should be carried out regarding proper cleaning methods and its cleaning frequency and others. Keywords: Denture Hygiene, Complete Denture Wearers, Habits.

Objective: To assess post operative neurosensory deficit following craniomaxillofacial reconstruction using bicoronal flap. Subject and Methods: In altogether, 44 individuals between the ages of 18 and 60 were included in the research. All patients reported with primary complain of craniomaxillofacial trauma. Bicoronal flap was utilized in all patients. All patients were clinically examined for neurosensory deficits (supraorbital , supratrochlear region , zygomaticotempral and auriculotempral nerve). At least three intervals of one month, three months, and six months have been used to follow up on every case. Results: In 1st month evaluation, 14 patients were seen with neurosensory deficit with supraorbital nerve and 2 patients with supratrochlear nerve, while none of the patients were seen with disturbances in auriculotemporal and zygomaticotemporal nerve. At 6 month interval only 3 patients were remained with paresthesia of supraorbital nerve Conclusion: Using a bicoronal flap during craniomaxillofacial surgery is recommended, it provides excellent access and has reduced complications Keywords: Bicoronal Flap, Craniomaxillofacial Reconstruction, Neurosensory Deficit

Background: One of the common causes requiring hospital admission on surgical floor is anal fissure. The quality of life is immensely affected due to painful defecation and bleeding per rectum. Due to poor response to chemical management, acute anal fissure is now treated with surgical methods. Lateral internal sphincterotomy has now become definitive surgical procedure in the treatment of anal fissures. Aim: To compare the efficacy of chemical and surgical lateral internal sphincterotomy in patients of acute anal fissure. Methods: This study was conducted in surgical unit 1 from January 2020 to December 2020. A sample size of 100 were segregated in two groups of 50 each. Group-a was treated withlocal application of glyceryl trinitrate 0.2 percent ointment and group-b was treated with surgical lateral internal sphincterotomy. Results: Patients were ranged between 15-60 years of age. Mean age of the patients was 36.64±10.05 and 33.42±11.47 in group-a and b respectively. In group-a, 13 patients (26%) and in group-b 15 patients (30%) were male and 37 patients (74%) in group-a and 35 patients (70%) were female. Efficacy was observed in 16 patients (32%) of group-a and 50 patients (100%) of group-b. The p value of &lt;0.001 was found to be statistically significant. Conclusion: In conclusion, surgical sphincterotomy was significantly more effective in providing postoperative pain relief (p&lt;0.001). However, chemical sphincterotomy is a non-invasive, cost-effective, easier to apply, well tolerated and effective therapy for anal fissure and is a first line treatment especially in patients who are unwilling or unfit for surgery. Key words: chemical sphincterotomy, lateral internal sphincterotomy, acute anal fissure