Prevalence Of Peptic Ulcer In Patients Of Liver Cirrhosis Presenting With Upper Gi Bleed

BACKGROUND:  Although major cause of upper GI bleed in patients of liver cirrhosis is variceal bleed. However a significant proportion also presents with non-variceal bleeding (NVB). AIM: The aim of study is to determine the frequency of peptic ulcers in patients of liver cirrhosis presenting with upper GI bleed. METHODS: This descriptive cross sectional study was conducted in Gastroenterology section of medicine department at Benazir Bhutto Hospital from April 2017 to December 2018 . 672 patients of liver cirrhosis presenting with upper GI bleed were enrolled in study through non probability consecutive sampling. Upper GI endoscopy of all patients was performed by consultant Gastroenterologist and findings were documented on standardized Performa. RESULTS: 672 patients were included in study with mean age of 54.68 ±11.15. Among these 370 (55.1%) were males and 302 (44.9%) were females. 92 patients (13.1%) had peptic ulcer as cause of upper GI bleed. 112 patients (16.6%) had both peptic ulcer and variceal bleed as cause of Upper GI Bleed and endoscopic findings of remaining 468 patients (69.6 %) showed varices (oesophageal + gastric) as prime source of bleeding. CONCLUSIONS: In this study, peptic ulcer accounted for 13.1 % of all cases of UGI bleeding. Keywords: Peptic Ulcer, Variceal bleeding, Upper GI bleed, Cirrhosis

Perceptions of Teachers Regarding Corporal Punishment and Its Effects on Students’ Achievement at Primary School Level

The main objective of the present study was to analyze the perceptions of teachers regarding corporal punishment and its effects on students‟ academic achievement at primary school level. For this purpose, teachers of all primary school of Multan division were taken as a population. Out of the whole population, 111 primary teachers were selected randomly by using the simple random sampling technique. For need assessment, a questionnaire was developed as a research tool. The tool was validated by pilot study and reliability analysis was done on SPSS by using the Cronbach alpha.The questionnaire comprised 17 restricted response items and two open ended questions. The items were analyzed based onfive-pointLikert-type scale. The open-ended questions were constructed to find out the positive and the negative effects of corporal punishment onstudents‟ achievement and behavior. The data gathered from teachers was entered on excel and then shifted to SPSS. For analysis of the data, statistical techniques like arithmetic mean, percentage, and t- test were used. Overall, it was found from the study that majority of the teachers was in favor that corporal punishment is useful for maintaining discipline. On the other hand, the use of corporal punishment was decreasing the attendance rate and increasing the dropout ratio of students from school.Corporal punishment was also negatively influencing the children‟ academic performance. Corporal punishment was developing aggressiveness in behavior of the students. It was also found from the study that “Maar nahi Pyar” is acceptable for primary school students. Overall, negative effects of corporal punishment on students were found

An attention-augmented convolutional neural network with focal loss for mixed-type wafer defect classification

Silicon wafer defect classification is crucial for improving fabrication and chip production. Although deep learning methods have been successful in single-defect wafer classification, the increasing complexity of the fabrication process has introduced the challenge of multiple defects on wafers, which requires more robust feature learning and classification techniques. Attention mechanisms have been used to enhance feature learning for multiple wafer defects. However, they have limited use in a few mixed-type defect categories, and their performance declines as the number of mixed patterns increases. This work proposes an attention-augmented convolutional neural networks (A2CNN) model for enhanced discriminative feature learning of complex defects. The A2CNN model emphasizes the features in the channel and spatial dimensions. Additionally, the model adopts the focal loss function to reduce misclassification and a global average pooling layer to enhance the network's generalization by reducing overfitting. The A2CNN model is evaluated on the MixedWM38 wafer defect dataset using 10-fold cross-validation. It achieves impressive results, with accuracy, precision, recall, and F1-score reported as 98.66%, 99.0%, 98.55%, and 98.82% respectively. Compared to existing works, the A2CNN model performs better by effectively learning valuable information for complex mixed-type wafer defects

N-(4-Chloro­phen­yl)-3,4,5-trimethoxy­benzamide

In the title compound, C16H16ClNO4, the dihedral angle between the two aromatic rings is 67.33 (8)°. The crystal packing shows strong inter­molecular N—H⋯O hydrogen bonds that link the mol­ecules to form chains along [01]

Cushing syndrome in children: Pathophysiology, clinical features, diagnostic and therapeutic strategies

A rare condition called Cushing disease causes increased morbidity or mortality. Therapeutic methods such as anti-cortisol medications, bilateral adrenalectomy, or radiation procedures may therefore be required to prevent long-term dangers of hypercortisolism, such as hirsutism, moon face, facial plethora, and obesity. Endogenous hypercortisolism increases the risk of cardiovascular metabolic symptoms, osteoporosis, respiratory diseases, psychological difficulties, and infections while also having a high rate of morbidity or mortality. Significant fetal and mental complications during pregnancy are linked to Cushing syndrome. Early detection and treatment are essential. Except in the late trimester, surgery is the preferred method of treatment for Cushing syndrome during pregnancy, with medication therapy as a backup. Cushing syndrome is an endocrine illness that presents differently from other endocrine disorders, making it difficult for doctors to control

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

The inhibition of the β-TrCP-Nrf2 protein-protein interaction as a potential cancer therapeutic target

The E3 ligase protein β-transducin repeats-containing proteins (β-TrCP) is an essential component of the ubiquitin proteasomal system (UPS), responsible for the maintenance of cellular protein levels within the body. Key target substrates for degradation include IκB, PDCD4 and FOXO3 alongside the transcription factor nuclear factor erythroid-2-related factor 2 (Nrf2), responsible for cellular protection against oxidative damage. The tumour suppressive nature of the substrate targets and overexpression of β-TrCP seen within various cancers justifies its inhibition as a potential therapeutic for cancer. A small molecule substituted pyrazolone, GS143, alongside the natural product erioflorin have been identified as inhibitors of proteinprotein interactions (PPI) between β-TrCP and its targets as well as peptides based on sequences of the native ligands with KD values reported in the nanomolar range. This work centres on the design and synthesis of potential novel inhibitors of β-TrCP. Utilising in silico docking techniques through the modelling software AutoDock Vina and ICM-Pro, hit molecules have been selected for synthesis from various compound libraries. A selection of fragments, small molecules and peptides based on the binding sequences of native ligands were synthesised using a range of synthetic organic methods and purification procedures to produce a diverse library of compounds. The most promising compounds based on docking scores were screened in biophysical assays against the target protein. Molecular dynamics research was used to identify key residues involved in binding between prominent ligands and β-TrCP. Overall, this work has increased progress towards the discovery of a novel inhibitor of the E3 ligase β-TrCP

Emotional Instability, Employees Work Outcomes among Academia: Compulsory Citizenship Behavior and Leadership Style as Moderators

Nowadays Employees Work Outcomes is the primary concern of academia of higher education. Hence, to understand this perspective the current study has examined the impact of emotional instability on employees work outcomes (Workaholism, Organizational Citizenship Behavior and Burnout). This study also examined the moderating role of compulsory citizenship behavior and transactional and transformational leadership styles. Sample of the study was faculty members of public and private universities. Finding of the study showed that there was negative and significant relationship between emotional instability, workaholism and organizational citizenship behavior whereas, there was positive and significant relationship between emotional instability and burnout. Further results demonstrated that transactional and transformational leadership play moderating role in relation to emotional instability and workaholism. Nevertheless, this study will provide insight to develop policies to lowers the level of burnout, and will also help administrators to implement such leadership style that decrease emotional instability and raise performance