Mapping the Causal Connections among Exchange Rate Fluctuations and Agriculture Production: New Evidence from Pakistan Utilizing Cointegration Analysis

This study is the foreign exchange rate and export sector and impact on macroeconomics variables. The objective is to research the experiential association between the rate of exchange and the export sectors of Pakistan. The time series data has been used which covered 1980- 2020. In this study, we used three major sectors that have been selected for this research like the Agricultural sector as the dependent variable. Rate of exchange, foreign direct investment, rate of inflation, and interest rate are being used as explanatory variables in this study. For the long run and short run estimation among variables; we used the Auto regressive distributed lag model (ARDL). Likewise, Augmented Dickey Fuller (ADF) uses the estimation of the integration of order. According to long run findings of this study illustrated that model one, exchange rate is positive and significant. Foreign direct investment is both positive and significant, as is the money supply (M2). Trade openness is a positive and significant impact on agriculture. &nbsp

Successful Surgical and Medical Management of Cesarean Scar Pregnancy in 2 Patients

Background: Cesarean scar pregnancy (CSP), once a rare entity, is on the rise due because of an increase in the cesarean section rate worldwide. Currently, there is no standard protocol available for managing CSP. To contribute to the existing literature, this article presents the current authors' experience with 2 cases of CSP that were treated successfully with two different modalities. Cases: Case 1: A 34-year-old, gravida 2, para 1, was diagnosed with a CSP on initial transvaginal ultrasound (TVUS) scan at 6 weeks of gestation. Aspiration of the gestational sac and a local injection of methotrexate was performed. After 2 weeks, the gestational sac increased in size with thinning of the CS scar (1?mm), and plateauing of the ß?human chorionic gonadotropin (ß-hCG) occurred. Laparoscopic excision of the CSP and myometrial repair resulted in resolution. Case 2: A 31-year-old, gravida 3, para 1, achieved pregnancy after a frozen?thawed embryo transfer cycle. A TVUS scan, performed at 6 weeks of gestation showed a CSP. The patient's ß-hCG level was 310 mIU/mL. Systemic methotrexate was administered intramuscularly. The patient's ß-hCG on days 4 and 7 was 260 and 252, respectively. A repeat TVUS on day 7 showed a resolving gestational sac. A second dose of methotrexate resulted in complete resolution of the CSP. Results: The treatments (aspiration, methotrexate, and laparoscopic excision for Case 1, and methotrexate for Case 2) enabled resolution of the CSPs of these 2 patients. Conclusions: Various treatment modalities have been described for managing CSP with varied levels of success. When local injection of methotrexate into the gestational sac of CSP is unsuccessful, laparoscopic removal is safe and effective. Moreover, in the presence of low levels of ?-hCG, treatment with systemic methotrexate is usually successful. (J GYNECOL SURG 30:168)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140096/1/gyn.2013.0131.pd

Management Dilemma of Concurrent Fundal Submucous Fibroid and Incomplete Uterine Septum in a Patient with Recurrent Pregnancy Loss

Background: We describe a patient presenting with recurrent pregnancy loss secondary to concurrent uterine factors. Case: The patient was a 31-year-old white female who presented with recurrent pregnancy loss on two occasions. The couple had a normal work-up for recurrent miscarriages except for a fundal type II submucosal fibroid on transvaginal 3D ultrasound (US) with saline infusion hysterosonogram (SIH). Laparoscopic myomectomy and repair of the myometrial defect was performed. At the conclusion of the procedure, a diagnostic hysteroscopy suggested a possible concurrent incomplete short uterine septum, which could not be corrected for fear of cutting the myomectomy sutures. The patient did not appear for follow up, which led her to have three more miscarriages and one chemical pregnancy. The presence of a short uterine septum was confirmed on SIH with 3D US. The patient underwent hysteroscopic division of the short uterine septum. Results: Postoperative SIH showed a normal uterine cavity, and currently the patient is trying to conceive. Conclusion: Coexistence of a type II submucous fibroid in the fundal region of the uterus and an incomplete uterine septum presents both a diagnostic and management challenge. Surgical management of such coexisting uterine pathology cannot be performed in a single session. (J GYNECOL SURG 29:165)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140093/1/gyn.2012.0029.pd

Frequency of Adverse Maternal and Neonatal Outcomes in Patients with Low Serum Fibrinogen Level and Placental Abruption

Objective: To assess frequency of adverse maternal and neonatal outcomes in patients with low serum fibrinogen level and placental abruption.Place and duration: It was held in Gynecology Department Nishtar Hospital Multan from 12 November 2017 to 25 July 2018.Study Design: Case control retrospective study.Methodology: A total of 100 patients were included in this clinical trial and they were diagnosed with placental abruption. They were categorized on the basis of serum fibrinogen level into three groups; high fibrinogen group (400-600 mg/dL), normal fibrinogen group (300-400 mg/dL) and low fibrinogen group (<200 mg/dL). . The pregnant women with uterine rupture, wound of birth canal, placental accrete, placental praevia, HELLP syndrome, severe preeclampsia, monochorionic multiple pregnancies, major fetal anomalies and sign of intrauterine infection were excluded and all other women with single or more pregnancies were eligible for this clinical study. Computer software SPSS version 23.2 was used for entering and analyzing data. Frequency and percentage was calculated for baseline variables. Frequency and percentage was calculated for laboratory parameters. Frequencies and percentage was calculated for maternal and neonatal outcome variables like mode of delivery, PIH, GDM A, postpartum hemorrhage (PPH), postpartum anemia (PPA), FFP and RCC transfusion, ISTH DIC score, delay discharge from hospital, fetal death, Apgar score at 5 min <7, birth weight, still birth, umbilical artery pH < 7.00, neonatal gestational age and IUFG. ANOVA test was used to find frequency and percentage. P value was < 0.05 was considered to be significant.Result: 100 patients were included in this study and they were divided on the basis of serum fibrinogen level into three groups i.e. n=40 high Fibrinogen group (400-600 mg/dL), n=35 normal Fibrinogen group (300-400mg/dL) and n=25 low Fibrinogen group (<200mg/dL). All the data recorded from all three groups regarding PIH, GDM, FFP, RCC transfusion, ISTH DIC score, delayed discharge from hospital was insignificant. The differences were statistically significant of postpartum hemorrhage PPH (p=0.001) and postpartum anemia PPA (p=0.002). The data recorded from three groups regarding, Apgar score at 5 min <7, Birth weight (g), Umbilical artery pH < 7.00 and intrauterine fetal growth was statistically insignificant. The statistical differences observed in three groups were as; fetal death (p=0.047), still birth (p=0.016), and gestational age (weeks) (p= 0.001) respectively.Conclusion: It has been concluded that low serum fibrinogen level has higher frequency of adverse maternal and neonatal outcomes including postpartum hemorrhage (PPH), postpartum anemia (PPA), fetal death, small gestation age of neonates and still birth than normal and high serum fibrinogen level. Keywords: Low serum fibrinogen, Placental Abruption, Maternal, Neonatal outcomes

Efficacy of Intra Vaginal Misoprostol as Various Doses versus Intra cervical Dinoprostone in Cervical Ripening and Induction of Labor

Objective: To compare the efficacy of intra vaginal misoprostol as various doses versus intra cervical dinoprostone in cervical ripening and induction of labor.Study Design: A Prospective Randomized Controlled Trial.Place and Duration of Study: Obstetrics and Gynecology Department of Nishtar Medical University and Hospital, Multan from May 2016 to July 2018.Methodology: We divided 168 patients into three groups; Group M1 and M2 were given 25µg and 50µg misoprostol, respectively; Group D was given 0.5mg dinoprostone. Complete history was followed by complete examination. Outcome variables, age, parity, gestational age, indications for the induction of labor and initial Bishop Score were compared. Data was put in SPSS 23 and analyzed by applying one way ANOVA and Chi-square tests, as appropriate considering p≤0.05 statistically significant.Results: Induction to vaginal delivery interval was 15.51±6.18min in Group-M1, 12.14±4.65min in Group-M2 and 13.43±6.96min in Group-D (p=0.008). The women who need oxytocin supplementation were 30.6%, 17.7% and 41.9% from Group M1, M2 and D, respectively (p=0.013). Bishop Score after 6 hours of delivery was 3.45±1.2, 4.41±1.5 and 4.21±1.3 in group M1, M2 and D, respectively, and the difference was highly statistically significant (p<0.001). All other variables were comparable among the groups (p>0.05).Conclusion: Higher dose of misoprostol i.e. 50µg misoprostol is higher in efficacy than 0.5mg dinoprostone which is in turn better than 25µg misoprostol. But 50µg misoprostol can cause hyper-stimulation and dinoprostone needs oxytocin augmentation. Misoprostol is a good and cheap agent for the induction of vaginal delivery. Keywords: misoprostol, dinoprostone, cervical ripening, induction of labor.

Price and Income Elasticities of Crude Oil Demand: Cross Country Analysis

Volatility in crude oil price is the main issue in this era. Great volatility in price of crude oil affects the demand of oil directly and indirectly in developing countries because these countries are oil importing countries especially Pakistan, India and China. Crude oil therefore contributes to and thereby influences the GDP of the country as a source of energy. It is very critical and essential for any country to explore and produce gas to improve energy shortage, for some deliberate importance of gas because natural gas is very clean, cheap and sustainable source to produce energy within a country. This study aimed to analyze the price and income elasticities of crude oil demand in developing countries time series data used from the period of 1971-2014. ADF test was used to check the stationary of variables and it is seem that all variable are not stationary at level. ARDL used for co integration and all variables of the models have long run relation with dependent and explanatory variables. Price and income elasticities of crude oil demand were measured in short and long run for developing countries and it was concluded that long run elasticities of price and income were less inelastic or some cases like China was elastic than short run elasticities of price and income of crude oil demand. It was suggested that oil importer countries should explore the alternatives of oil within a country to fulfill the domestic demand

Self-Medication Practice and Their Risk Factors Among BScN 4 Years Students

Self-medication is the use of medicines to treat self-diagnosed disorders or symptoms, or the periodical or continued use of prescribed drugs for acute or chronic disease or symptoms. It’s going to include the use of herbs, the retention and Re-use of Medication without prescribed by doctors. Self-medication is widely practiced in both developed and developing countries. . Practice of getting self-medication was relatively high, because of easy access of drugs from public pharmacy and they also have knowledge about medicines. The study's overall objective was to identify the level of knowledge, attitude, and self-medication practices among undergraduate BScN 4 year student. This would be a descriptive cross sectional quantitative study .Quantitative cross sectional design used data to make statistical inference about nursing students of knowledge, attitude and practice regarding self-medication. Total, 250 BScN students were involved in this study. The data was collected using a validated questionnaire. Overall 53.6% BScN students often practice self-medications,while 46.4% students were not practice self-medications. In a study conducted in a private college of Nursing Lahore, it was found that self-medication is significantly higher in among BScN 4 year’s student nurses. We found that our respondent’s education has also impact on practice and attitude of self-medication. The awareness regarding self-medication among student is good about 60% populations have knowledge regarding medication benefits. As per the findings, 75.8% BScN students visited to a qualified medical practitioner. While 24.2% students were not visited to a qualified medical practitioner. 71.2% BScN students respond that the indications of self-medication Headache/ fever. Inappropriate self-medication can cause harm to the students and also whom they recommend as healthcare providers in the future. Therefore, there is a need to educate nursing students and make them more aware about adverse effects of self-medication. Keywords: Self-care, medical practitioner, nursing Students, Drugs, Self-medication, Knowledge DOI: 10.7176/JNSR/13-18-02 Publication date:October 31st 202

Self-Medication Practice and Their Risk Factors among BScN 4 Years Students

Self-medication is the use of medicines to treat self-diagnosed disorders or symptoms, or the periodical or continued use of prescribed drugs for acute or chronic disease or symptoms. It’s going to include the use of herbs, the retention and Re-use of Medication without prescribed by doctors. Self-medication is widely practiced in both developed and developing countries. . Practice of getting self-medication was relatively high, because of easy access of drugs from public pharmacy and they also have knowledge about medicines. The study's overall objective was to identify the level of knowledge, attitude, and self-medication practices among undergraduate BScN 4 year student. This would be a descriptive cross sectional quantitative study .Quantitative cross sectional design used data to make statistical inference about nursing students of knowledge, attitude and practice regarding self-medication. Total, 250 BScN students were involved in this study. The data was collected using a validated questionnaire. Overall 53.6% BScN students often practice self-medications,while 46.4% students were not practice self-medications. In a study conducted in a private college of Nursing Lahore, it was found that self-medication is significantly higher in among BScN 4 year’s student nurses. We found that our respondent’s education has also impact on practice and attitude of self-medication. The awareness regarding self-medication among student is good about 60% populations have knowledge regarding medication benefits. As per the findings, 75.8% BScN students visited to a qualified medical practitioner. While 24.2% students were not visited to a qualified medical practitioner. 71.2% BScN students respond that the indications of self-medication Headache/ fever. Inappropriate self-medication can cause harm to the students and also whom they recommend as healthcare providers in the future. Therefore, there is a need to educate nursing students and make them more aware about adverse effects of self-medication. Keywords: Self-care, medical practitioner, nursing Students, Drugs, Self-medication, Knowledge DOI: 10.7176/JHMN/104-03 Publication date: November 30th 202

Malicious node detection using machine learning and distributed data storage using blockchain in WSNs

In the proposed work, blockchain is implemented on the Base Stations (BSs) and Cluster Heads (CHs) to register the nodes using their credentials and also to tackle various security issues. Moreover, a Machine Learning (ML) classifier, termed as Histogram Gradient Boost (HGB), is employed on the BSs to classify the nodes as malicious or legitimate. In case, the node is found to be malicious, its registration is revoked from the network. Whereas, if a node is found to be legitimate, then its data is stored in an Interplanetary File System (IPFS). IPFS stores the data in the form of chunks and generates hash for the data, which is then stored in blockchain. In addition, Verifiable Byzantine Fault Tolerance (VBFT) is used instead of Proof of Work (PoW) to perform consensus and validate transactions. Also, extensive simulations are performed using the Wireless Sensor Network (WSN) dataset, referred as WSN-DS. The proposed model is evaluated both on the original dataset and the balanced dataset. Furthermore, HGB is compared with other existing classifiers, Adaptive Boost (AdaBoost), Gradient Boost (GB), Linear Discriminant Analysis (LDA), Extreme Gradient Boost (XGB) and ridge, using different performance metrics like accuracy, precision, recall, micro-F1 score and macro-F1 score. The performance evaluation of HGB shows that it outperforms GB, AdaBoost, LDA, XGB and Ridge by 2-4%, 8-10%, 12-14%, 3-5% and 14-16%, respectively. Moreover, the results with balanced dataset are better than those with original dataset. Also, VBFT performs 20-30% better than PoW. Overall, the proposed model performs efficiently in terms of malicious node detection and secure data storage. © 2013 IEEE