The Efficacy of Ivabradine Alone, Metoprolol Alone and Combination of Ivabradine and Metoprolol in Reducing Heart Rate Among Patients Undergoing Computed Tomography Coronary Angiography

Objectives: to determine the efficacy of Ivabradine alone, Metoprolol alone and Combination of Ivabradine and Metoprolol in reducing heart rate among patients undergoing Computed Tomography Coronary Angiography (CTCA). Methodology: it was a randomized controlled trial comprised of 200 patients. Patients undergoing CTCA having heart rates greater than 80 bpm were divided into three groups. Group A was given Ivabradine and a placebo, Group B received Metoprolol and placebo while Group C was administered with Ivabradine and Metoprolol an hour prior to the scan. The scan was carried under similar situations. Heart rate and variability was recorded before and during the scan. Results: The mean heart rate variability and mean reduction in heart rate of Group A was 3.13±1.01 and 19.02±2.05 respectively. The mean heart rate variability and mean reduction in heart rate of Group B was 4.27±1.08 and 12.11±2.45 respectively. While, the mean heart rate variability and mean reduction in heart rate of Group C was 1.88±0.42 and 25.03±2.74 respectively. Conclusion: Ivabradine is an effective and safe drug for reducing heart rate in patients having CTCA, especially among patients who are unable to tolerate calcium channel blockers and beta blockers owing to their side effects. Keywords: Ivabradine, Metoprolol, Computed tomography coronary angiography, heart rate reduction, heart rate variability

Hyperlipidemia Patterns in Newly Diagnosed Young Diabetic Patients

Objective: To analyze hyperlipidemia patterns among newly diagnosed young diabetic patients. Study Design: A descriptive cross-sectional study Place and Duration: Study was conducted in DHQ Teaching Hospital, DG Khan, Bahawal Victoria hospital, Bahawalpur, and Sheikh Zayd Hospital, Rahim Yar Khan from July 2017 to July 2018.Methodology: All the patients were young and newly diagnosed with Diabetes Mellitus. Data collection was done via non probability consecutive sampling included patients’ demographics, past medical history, co-morbidities, and lab findings were assessed. SPSS version 24 was used to analyze data. P value ≤ 0.05 was taken as significant.Results: Eighty patients were included in this study. Diabetic nephropathy, diabetic retinopathy, macrovascular complications, hyperglycemic hyperosmolar non-ketotic coma history, family history and hypertension were noted in n=12 (15%), n=6 (7.5%), n=9 (11.3%), n=1 (1.3%), n=34 (42.5%) and n=11 (13.8%) respectively. The mean hyperlipidemia, hypertriglyceridemia, of the patients was 4.54±0.52 mmol/L, 2.59±1.13 mmol/L, 1.39±0.80 mmol/L, 1.03±0.59 mmol/L respectively. Conclusion: the study has shown that the prevalence of increased levels of triglycerides is more than increased LDL cholesterol levels among these patients. As it has been established that hypertriglyceridemia is a known risk factor for causing cardiovascular disorders among diabetic patients, it should be addressed and managed accordingly at the onset of diabetes. Keywords: Hyperlipidemia, Diabetes Mellitus, low density lipoproteins, high density lipoproteins, insulin.

Educación online en medio de la crisis de COVID-19: problemas y desafíos en el nivel de educación superior en Pakistán

The objective of this study is to examine the main constraints experienced in the online mode of education during this pandemic at higher education level in Pakistan. The COVID-19 pandemic credibly transformed the method of learning and teaching from face to face to online.  In unexpected sudden septicity, universities in Pakistan have started online education without proper instructional provision and relevant experience. For this purpose, the data is collected from 750 students and teachers across all over the regions in Pakistan. The study has used partial least square structural equation modeling (PLS-SEM). The findings show that technological bottlenecks, institutional preparedness, and digital divide are significant challenges. The differences in perceptions of rural and urban areas are also very important referring to several policies implications, implementing information communication technology (ICT), friendly curriculums, enhancing online accessibility and infrastructure development. This study contributes to help universities for developing effective e-learning policies for students in the situation of COVID-19.   El objetivo de este estudio es examinar las principales limitaciones experimentadas en el modo de educación online durante la pandemia en el nivel de educación superior en Pakistán. La pandemia de COVID-19 transformó el método de aprendizaje y enseñanza presencial a online. En una septicidad repentina inesperada, las universidades de Pakistán han comenzado la educación online sin formación adecuada y sin experiencia previa. Para ello, se recopilan datos de 750 estudiantes y de profesores de todas las regiones de Pakistán. El estudio ha utilizado el modelo de ecuaciones estructurales de mínimos cuadrados parciales (PLS-SEM). Los hallazgos muestran que los cuellos de botella tecnológicos, la preparación institucional y la brecha digital son desafíos importantes. Las diferencias en las percepciones de las áreas rurales y urbanas también son muy importantes en lo que respecta a las implicaciones de varias políticas, la implementación de tecnologías de la información y la comunicación (TIC), planes de estudio amigables, la mejora de la accesibilidad online y el desarrollo de infraestructura. Este estudio ayuda a las universidades a desarrollar políticas efectivas de e-learning para estudiantes durante la pandemia de COVID-19

Antihyperuricemic activity of gum of Calophyllum inophyllum ultra high dilutions in potassium oxonate induced wister albino rats

356-359  Hyperuricemia is a biochemical abnormality and it affects the quality of life. Many medicinal substances are used in lowering the uric acid. The study designed to find hypouricemic effects ofultrahigh dilutions, the gum of Calophyllum inophyllum, Acid benzoicum in oxonate of potassium induced hyperuricemic wistar albinomodel.   The experiment consist of 11 groups of albino rats. All the groups were treated with oxonate of potassium except normal control. Healthy group of animals received only distilled water, hyperuricemic control group were given alcohol mixed in distilled water. A standard allopathic medical substance Allopurinol and Acid benzoicum ultra high dilutions were given in time dependent manner (single dose/day) in different experimental groups. Blood samples were collected by rat tail vein bleeding. The uric acid and creatinine levels of serum were analyzed by using standard measuring kits. The Student's t-test was used for statistical analysis of difference between the groups p ≤ 0.05 was reflected significant.   Oral intake of Acid benzoicum ultrahigh dilutions reduceduric acid levels of hyperuricemic wistar albino rats in time dependent mode. At 3rd day and 7th day administration of Acid benzoicum ultrahigh dilutions decreased the level of uric acid more ominously as compared to one day administration. However, allopurinol a standard allopathic drug normalized the uric acid level in all experimental groups.   The current work showed significant hypouricemic effects of Acid benzoicum ultrahigh dilutions in hyperuricemic wistar albino model. However, clear conclusion of hypouricemic activity of Acid benzoicum needed repetition of experimental work

Exploring The Drivers of Technology Acceptance: A study on Pakistani University Student

The purpose of this study is to validate the technology acceptance model (TAM) in an educational context to explore the drivers of technology on students of Pakistani university. Technologies have extended the teaching quality and open the new doors for the student to make their career highly professional. The data were collected from 508 students through online questionnaire in Pakistan. For analyzing the research model PLS-SEM partial least squares method to structural equation modeling was chosen to analyze the effect of Trialability, Attitude towards technology, Behavior intention, perceived ease of use, perceived enjoyment, facilitating condition, Perceived usefulness, Technology complexity and demographic factors. The gap which we have find is about underprivileged countries that are poor in technology and have not get advancement and success in there so many countries yet. Limitation for this study are we have collected the data from university students. The research is based on descriptive research. Researchers choose a no probabilistic convenience sampling technique to collect data as it is fast, inexpensive and easy. The finding of this study is that all the independent variable has positive and significant relationship with dependent variable. We recommend that future researcher can add more variable to the research and use most updated software version

Educación online en medio de la crisis de COVID-19: problemas y desafíos en el nivel de educación superior en Pakistán

The objective of this study is to examine the main constraints experienced in the online mode of education during this pandemic at higher education level in Pakistan. The COVID-19 pandemic credibly transformed the method of learning and teaching from face to face to online. In unexpected sudden septicity, universities in Pakistan have started online education without proper instructional provision and relevant experience. For this purpose, the data is collected from 750 students and teachers across all over the regions in Pakistan. The study has used partial least square structural equation modeling (PLS-SEM). The findings show that technological bottlenecks, institutional preparedness, and digital divide are significant challenges. The differences in perceptions of rural and urban areas are also very important referring to several policies implications, implementing information communication technology (ICT), friendly curriculums, enhancing online accessibility and infrastructure development. This study contributes to help universities for developing effective e-learning policies for students in the situation of COVID-19.El objetivo de este estudio es examinar las principales limitaciones experimentadas en el modo de educación online durante la pandemia en el nivel de educación superior en Pakistán. La pandemia de COVID-19 transformó el método de aprendizaje y enseñanza presencial a online. En una septicidad repentina inesperada, las universidades de Pakistán han comenzado la educación online sin formación adecuada y sin experiencia previa. Para ello, se recopilan datos de 750 estudiantes y de profesores de todas las regiones de Pakistán. El estudio ha utilizado el modelo de ecuaciones estructurales de mínimos cuadrados parciales (PLS-SEM). Los hallazgos muestran que los cuellos de botella tecnológicos, la preparación institucional y la brecha digital son desafíos importantes. Las diferencias en las percepciones de las áreas rurales y urbanas también son muy importantes en lo que respecta a las implicaciones de varias políticas, la implementación de tecnologías de la información y la comunicación (TIC), planes de estudio amigables, la mejora de la accesibilidad online y el desarrollo de infraestructura. Este estudio ayuda a las universidades a desarrollar políticas efectivas de e-learning para estudiantes durante la pandemia de COVID-19.Universidad Pablo de Olavid

Exploring The Drivers of Technology Acceptance: A study on Pakistani University Student

The purpose of this study is to validate the technology acceptance model (TAM) in an educational context to explore the drivers of technology on students of Pakistani university. Technologies have extended the teaching quality and open the new doors for the student to make their career highly professional. The data were collected from 508 students through online questionnaire in Pakistan. For analyzing the research model PLS-SEM partial least squares method to structural equation modeling was chosen to analyze the effect of Trialability, Attitude towards technology, Behavior intention, perceived ease of use, perceived enjoyment, facilitating condition, Perceived usefulness, Technology complexity and demographic factors. The gap which we have find is about underprivileged countries that are poor in technology and have not get advancement and success in there so many countries yet. Limitation for this study are we have collected the data from university students. The research is based on descriptive research. Researchers choose a no probabilistic convenience sampling technique to collect data as it is fast, inexpensive and easy. The finding of this study is that all the independent variable has positive and significant relationship with dependent variable. We recommend that future researcher can add more variable to the research and use most updated software version

A State-Observer-Based Protection Scheme for AC Microgrids with Recurrent Neural Network Assistance

The microgrids operate in tie-up (TU) mode with the main grid normally, and operate in isolation (IN) mode without the main grid during faults. In a dynamic operational regime, protecting the microgrids is highly challenging. This article proposes a new microgrid protection scheme based on a state observer (SO) aided by a recurrent neural network (RNN). Initially, the particle filter (PF) serves as a SO to estimate the measured current/voltage signals from the corresponding bus. Then, a natural log of the difference between the estimated and measured current signal is taken to estimate the per-phase particle filter deviation (PFD). If the PFD of any single phase exceeds the preset threshold limit, the proposed scheme successfully detects and classifies the faults. Finally, the RNN is implemented on the SO-estimated voltage and current signals to retrieve the non-fundamental harmonic features, which are then utilized to compute RNN-based state observation energy (SOE). The directional attributes of the RNN-based SOE are employed for the localization of faults in a microgrid. The scheme is tested using Matlab® Simulink 2022b on an International Electrotechnical Commission (IEC) microgrid test bed. The results indicate the efficacy of the proposed method in the TU and IN operation regimes on radial, loop, and meshed networks. Furthermore, the scheme can detect both high-impedance (HI) and low-impedance (LI) faults with 99.6% of accuracy

Clinical Outcomes of Full Endoscopic Thoracic Discectomy in Acute Disc Herniation: A Case Report from Khyber Pakhtunkhwa

Objectives:  Thoracic disc herniations are rare relative to lumber and cervical spine herniations and account for 0.25% to 0.75% of cases in the general population. This case report presents a rare case of a 65-year-old male diagnosed with thoracic disc herniation and managed through full endoscopic thoracic discectomy. Clinical Presentation:  A 65-year-old wheelchair-bound male presented to OPD with complaints of paresthesia and sensory symptoms along with motor weakness from the past 2 weeks. No Symptoms of bowel and bladder dysfunction were present. Diagnosis/Intervention:  Sagittal and axial MRI findings revealed disc herniation at the T11 – T12 level. Full endoscopic thoracic discectomy through a transforaminal approach was performed to decompress the spinal cord. Conclusion:  Acute thoracic disc herniations although rare, can present with variable clinical manifestations. Full endoscopic thoracic discectomy through a transforaminal approach is a safe and effective surgical procedure associated with improved patient outcomes, increased satisfaction scores, and decreased chances of complications. Keywords:  Acute thoracic disc herniation, endoscopic discectomy, full endoscopic thoracic discectomy

The Clinical Outcomes of Craniotomy in the Management of Cranial Arachnoid Cyst: An experience from Ali Institute of Neurosciences, Irfan General Hospital Peshawar: A Retrospective Case Series

Objective:  Intracranial arachnoid cyst is a non-neoplastic clinical entity that develops due to the splitting or duplication of the membrane surrounding the arachnoid matter. Nonspecific symptoms are usually treated conservatively. If the symptoms are severe, progressive, and disabling, surgical intervention is indicated. We aimed to evaluate the effectiveness and clinical outcomes of craniotomy in the management of arachnoid cysts. Material and Methods:  A retrospective case series study was conducted at Ali Institute of Neurosciences, Irfan General Hospital from the records of the past 8 years. Clinical records were analyzed. Thirty-six patients were included in our study as they were diagnosed as having symptomatic and progressive symptoms which required surgical intervention. In those patients, the standard procedure of Craniotomy was performed. Clinical and neuroimaging outcome scales were used. Results:  Mean age of the participant was 9 years at the time of surgery. Most of the arachnoid cysts were located in the temporal area 20 (43%), followed by post fossa 4(9%). The majority of the patients (63%) were characterized in COS 1 on the clinical outcome scale while there was no patient in COS 4 category. More than half of the patients (54%) had the cyst reduced to less than 50% of the original volume (NOS 2) while 25 percent of patients had the cyst size reduced but was still greater than 50% (NOS 3). Conclusion:  Craniotomy, an open surgical procedure is an effective intervention in improving clinical and radiological outcomes. However, it is also associated with significant recurrence rates along with other complications