Effect of zinc in tablet and suspension formulations in the treatment of acute diarrhoea among young children in an emergency setting of earthquake affected region of Pakistan

A longitudinal cohort study was conducted at Camp Hospital Batagram in August 2006 to ascertain the effect of Zinc utilization in tablet and suspension formulations on the frequency and recovery rates of diarrhoea among young children in the emergency settings of earthquake affected region of Pakistan. Two hundred patients were recruited and followed up, the patients were allocated either of the 2 groups i.e. A (zinc in tablets form) and B (zinc in suspension form). Both groups also received WHO recommended treatment for diarrhoea. Most of the cases recovered from the illness within 3 days after presentation. Significant p-values were established among Zinc use and reduction in frequency of stools on Day 2 and 3, with better outcome in group B. The study supports the notion that zinc reduces the frequency and improves recovery rates of diarrhoea in any form and has better compliance and outcomes with the use in suspension form

UNVEILING THE NEXUS BETWEEN LEADERSHIP DYNAMICS AND INNOVATION CAPABILITIES IN DRIVING GREEN CREATIVITY: THE CRUCIAL MODERATING ROLE OF GREEN MOTIVATION AMONG SMES IN PAKISTAN

Objective: This study aims to explore the under-investigated area of green creativity within Pakistani SMEs by examining the influence of leadership dynamics (transformational and transactional leadership) and innovation practices.   Theoretical Framework: The research builds upon the concepts of green creativity, transformational leadership, transactional leadership, innovation practices, and green motivation.   Method: A survey methodology was employed with a sample of 191 managers and owners of SMEs in Pakistan. Data analysis was conducted using SmartPLS software.   Results and Discussion: The findings reveal positive relationships between transformational leadership, transactional leadership, innovation practices, and green creativity. However, green motivation was identified as a negative moderator in the relationship between innovation practices and green creativity. The study emphasizes the significance of leadership styles (transformational and transactional) and fostering a culture of innovation for driving green creativity within SMEs. Green motivation, while positive in itself, seems to hinder the impact of innovation practices on green creativity, requiring further investigation.   Research Implications: This research contributes to the understanding of green creativity in SMEs by highlighting the facilitating role of leadership dynamics and innovation practices. It underscores the need for future research to delve deeper into the moderating effect of green motivation.   Originality/Value: This study offers a valuable contribution to the existing environmental sustainability literature. It delves into green creativity within Pakistani SMEs, a previously unexplored area.  By examining leadership styles, innovation practices, and the surprising moderating role of green motivation, the research offers valuable insights for both businesses and policymakers to cultivate environmentally friendly practices within SMEs

Hip replacement for femur neck fracture in the elderly, effects of delayed surgical intervention on morbidity and mortality, a retrospective comparative study

Hip fracture is one of the most common injuries in the elderly population. Delay in operating on patients with hip fracture is associated with greater mortality and morbidity. A retrospective review of medical charts of patients who underwent primary total hip replacement (THR) for neck of femur fractures at our tertiary care level 1 trauma was carried out. Data was collected from the patients\u27 charts and analysed for 30-day mortality and morbidity. A total of 96 patients were included in the study. Out of the 36 patients in the delayed THR group, mortality within 30 days was observed in 4 (11.1%) patients while none was noted in the early THR group. The difference was statistically significant with a P-value of 0.008. With regards to post-operative complications, significantly higher percentage of patients were noted to have developed electrolyte imbalances (P = 0.003), postoperative psychosis (P = 0.02), and acute kidney injury (AKI) (P = 0.02) in the delayed THR group compared to the early THR group. Delay in surgery for neck of femur fracture is associated with increased 30-day mortality and postoperative complications

Effect and feasibility of district level scale up of maternal, newborn and child health interventions in Pakistan: A quasi-experimental study

Introduction: Pakistan has a high burden of maternal, newborn and child morbidity and mortality. Several factors including weak scale-up of evidence-based interventions within the existing health system; lack of community awareness regarding health conditions; and poverty contribute to poor outcomes. Deaths and morbidity are largely preventable if a combination of community and facility-based interventions are rolled out at scale.Methods and analysis: Umeed-e-Nau (UeN) (New Hope) project aims is to improve maternal, newborn and child health (MNCH) in eight high-burden districts of Pakistan by scaling up of evidence-based interventions. The project will assess interventions focused on, first, improving the quality of MNCH care at primary level and secondary level. Second, interventions targeting demand generation such as community mobilisation, creating awareness of healthy practices and expanding coverage of outreach services will be evaluated. Third, we will also evaluate interventions targeting the improvement in quality of routine health information and promotion of use of the data for decision-making. Hypothesis of the project is that roll out of evidence-based interventions at scale will lead to at least 20% reduction in perinatal mortality and 30% decrease in diarrhoea and pneumonia case fatality in the target districts whereas two intervention groups will serve as internal controls. Monitoring and evaluation of the programme will be undertaken through conducting periodical population level surveys and quality of care assessments. Descriptive and multivariate analytical methods will be used for assessing the association between different factors, and difference in difference estimates will be used to assess the impact of the intervention on outcomes.Ethics and dissemination: The ethics approval was obtained from the Aga Khan University Ethics Review Committee. The findings of the project will be shared with relevant stakeholders and disseminated through open access peer-reviewed journal articles

Novel Internet of Things based approach toward diabetes prediction using deep learning models

The integration of the Internet of Things with machine learning in different disciplines has benefited from recent technological advancements. In medical IoT, the fusion of these two disciplines can be extremely beneficial as it allows the creation of a receptive and interconnected environment and offers a variety of services to medical professionals and patients. Doctors can make early decisions to save a patient's life when disease forecasts are made early. IoT sensor captures the data from the patients, and machine learning techniques are used to analyze the data and predict the presence of the fatal disease i.e., diabetes. The goal of this research is to make a smart patient's health monitoring system based on machine learning that helps to detect the presence of a chronic disease in patient early and accurately. For the implementation, the diabetic dataset has been used. In order to detect the presence of the fatal disease, six different machine learning techniques are used i.e., Support Vector Machine (SVM), Logistic Regression, Artificial Neural Network (ANN), Convolutional Neural Network (CNN), Recurrent Neural Network (RNN), and Long Short-Term Memory (LSTM). The performance of the proposed model is evaluated by using four evaluation metrics i.e., accuracy, precision, recall, and F1-Score. The RNN outperformed remaining algorithms in terms of accuracy (81%), precision (75%), and F1-Score (65%). However, the recall (56%) for ANN was higher as compared to SVM and logistic regression, CNN, RNN, and LSTM. With the help of this proposed patient's health monitoring system, doctors will be able to diagnose the presence of the disease earlier

Political Federations are One of the Main Causes of Increasing Level of Anxiety among the University Students

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Enhancing Grid-Connected Microgrid Power Dispatch Efficiency through Bio-Inspired Optimization Algorithms

This work tackles the scheduling challenge of microgrids for smart homes, aiming to optimize energy management with both renewable and non-renewable sources. A power control center orchestrates the microgrid, coordinating distributed energy resources (DERs) for peak demand fulfillment and excess energy utilization. We propose a proportional-integral control system for efficient demand response, achieving reduced post-scheduling costs and a peak-to-average ratio. Comparative analysis reveals Ant Colony Optimization outperforms Binary Particle Swarm Optimization in cost and peak-to-average ratio reduction. Simulations explore two scenarios: Case 1 integrates with the main grid for reliability, while Case 2 utilizes solely renewable energy sources. Although Case 2 exhibits superior performance, Case 1’s dependence on the main grid offers greater real-world feasibility. Therefore, Case 1 with optimized DER scheduling emerges as the recommended solution for enhancing microgrid efficiency and ensuring reliable power supply in smart homes

Immunity and field efficacy of type 2-containing polio vaccines after cessation of trivalent oral polio vaccine: A population-based serological study in Pakistan

Background: In Pakistan and other countries using oral polio vaccine (OPV), immunity to type 2 poliovirus is now maintained by a single dose of inactivated polio vaccine (IPV) in routine immunization, supplemented in outbreak settings by monovalent OPV type 2 (mOPV2) and IPV. While well-studied in clinical trials, population protection against poliovirus type 2 achieved in routine and outbreak settings is generally unknown.Methods: We conducted two phases of a population-based serological survey of 7940 children aged 6-11 months old, between November 2016 and October 2017 from 13 polio high-risk locations in Pakistan.Results: Type 2 seroprevalence was 50% among children born after trivalent OPV (tOPV) withdrawal (April 2016), with heterogeneity across survey areas. Supplementary immunization activities (SIAs) with mOPV2 followed by IPV improved population immunity, varying from 89% in Pishin to 64% in Killa Abdullah, with little observed marginal benefit of subsequent campaigns. In the other high-risk districts surveyed, a single SIA with IPV was conducted and appeared to improve immunity to 57% in Karachi to 84% in Khyber.Conclusions: Our study documents declining population immunity following trivalent OPV withdrawal in Pakistan, and wide heterogeneity in the population impact of supplementary immunization campaigns. Differences between areas, attributable to vaccination campaign coverage, were far more important for type 2 humoral immunity than the number of vaccination campaigns or vaccines used. This emphasizes the importance of immunization campaign coverage for type 2 outbreak response in the final stages of polio eradication. Given the declining type 2 immunity in new birth cohorts it is also recommended that 2 or more doses of IPV should be introduced in the routine immunization program of Pakistan

Community engagement and integrated health and polio immunisation campaigns in conflict-affected areas of Pakistan: a cluster randomised controlled trial.

BACKGROUND: Pakistan faces huge challenges in eradicating polio due to widespread poliovirus transmission and security challenges. Innovative interventions are urgently needed to strengthen community buy-in, to increase the coverage of oral polio vaccine (OPV) and other routine immunisations, and to enhance immunity through the introduction of inactivated polio vaccine (IPV) in combination with OPV. We aimed to evaluate the acceptability and effect on immunisation coverage of an integrated strategy for community engagement and maternal and child health immunisation campaigns in insecure and conflict-affected polio-endemic districts of Pakistan. METHODS: We did a community-based three-arm cluster randomised trial in healthy children aged 1 month to 5 years that resided within the study sites in three districts of Pakistan at high risk of polio. Clusters were randomly assigned by a computer algorithm using restricted randomisation in blocks of 20 by an external statistician (1:1:1) to receive routine polio programme activities (control, arm A), additional interventions with community outreach and mobilisation using an enhanced communication package and provision of short-term preventive maternal and child health services and routine immunisation (health camps), including OPV (arm B), or all interventions of arm B with additional provision of IPV delivered at the maternal and child health camps (arm C). An independent team conducted surveys at baseline, endline, and after each round of supplementary immunisation activity for acceptability and effect. The primary outcome measures for the study were coverage of OPV, IPV, and routine extended programme on immunisation vaccines and changes in the proportion of unvaccinated and fully vaccinated children. This trial is registered with ClinicalTrials.gov, number NCT01908114. FINDINGS: Between June 4, 2013, and May 31, 2014, 387 clusters were randomised (131 to arm A, 127 to arm B, and 129 to arm C). At baseline, 28 760 children younger than 5 years were recorded in arm A, 30 098 in arm B, and 29 126 in arm C. 359 clusters remained in the trial until the end (116 in arm A, 120 in arm B, and 123 in arm C; with 23 334 children younger than 5 years in arm A, 26 110 in arm B, and 25 745 in arm C). The estimated OPV coverage was 75% in arm A compared with 82% in arm B (difference vs arm A 6·6%; 95% CI 4·8-8·3) and 84% in arm C (8·5%, 6·8-10·1; overall p<0·0001). The mean proportion of routine vaccine doses received by children younger than 24 months of age was 43% in arm A, 52% in arm B (9%, 7-11) and 54% in arm C (11%, 9-13; overall p<0·0001). No serious adverse events requiring hospitalisation were reported after immunisation. INTERPRETATION: Despite the challenges associated with the polio end-game in high-risk, conflict-affected areas of Pakistan, a strategy of community mobilisation and targeted community-based health and immunisation camps during polio immunisation campaigns was successful in increasing vaccine coverage, including polio vaccine coverage. FUNDING: Bill & Melinda Gates Foundation

Risk factors for acute respiratory infections in children between 0 and 23 months of age in a peri-urban district in Pakistan: A matched case–control study

Background: Acute respiratory infection (ARI) accounts for nearly 15% of all childhood mortality in South Asia, with children from rural areas at higher risk due to inaccessibility to healthcare facilities. We therefore aimed to identify risk factors associated with ARI in children under 2 years of age in rural Pakistan. Methods: A retrospective 1:2 matched case-control study was conducted between October and December 2018 in Taluka Kotri, Jamshoro District of Pakistan. Cases were identified as children between 0 and 23 months of age with a history of fever, cough, sore throat, fast breathing, difficulty breathing, or chest indrawing in the 2 weeks prior to the survey. Controls were participants without symptoms of ARI, matched based on age in months. Data analysis was conducted using STATA version 15. Univariate and multivariable conditional logistic regression analyses were used to identify factors associated with ARI, and p \u3c 0.05 was considered statistically significant. Results: We identified 1,071 cases of ARI who were matched with 2,142 controls. Multivariable analysis revealed that female gender [odds ratio (OR) 0.78, 95% confidence interval (CI): 0.67-0.91], exclusive breastfeeding (OR 0.81, 95% CI: 0.69-0.97), and comorbidity with diarrhea (OR: 1.64, 95% CI: 1.40-1.91) were significantly associated with ARI. Conclusion: Pakistan continues to progress toward reducing childhood mortality, particularly ARI-related deaths, for which it bears a great burden. This study identifies risk factors such as the male gender, breastfeeding, and comorbidities with diarrhea, which could open grounds for further programmatic implications in targeting a multifaceted approach to reducing incidences of ARI in rural areas of the country