Functional and radiological assessment of complex tibial plateau fractures managed with Ilizarov fixator: a study of 60 cases

Background: Tibial plateau fractures represent 1% of fractures in adults. The soft tissue envelope is in jeopardy in these fractures and can be complicated by wound dehiscence and osteomyelitis. In an Ilizarov fixator, the juxta-articular wires are placed percutaneously with minimal disruption of periosteal and endosteal blood supplies, olive wires can compress the fracture lines. The aim was to analyse the results of application of Ilizarov fixator in patients with Schatzker V and VI of tibial plateau.Methods: The study was conducted with 60 patients who sustained Schatzker V and VI type of tibial plateau fractures, of either sex, of an age of more than 18 years as a prospective observational study. 50 patients were treated with closed reduction and ligamentotaxis and 10 with mini open reduction prior to ring fixator application. They were followed up for a mean period of 15.4 months. The results were assessed in according to the criteria of Honkonen and Jarvinen (1992).Results: All the fractures united at a mean of 13.2 weeks. 48 patients felt their knee to be fully stable and 4 patients had severe pain. All patients were able to fully extend their knee, 36 patients had a flexion of >130 degrees and in 24 ranged between 110-129 degrees. There were 40 excellent results, 12 good, 4 fair and 4 poor. 14 patients had pin tract infections which were treated by antibiotics, 4 patients required changing the pin.Conclusions: Application of Ilizarov fixator is a useful method for early, definitive management of complex tibial plateau fractures with excellent results

SMEs Intention towards Use and Adoption of Digital Financial Services

The purpose of this study is to analyses the SMEs owners and managers intention towards use and adoption of digital financial services in South Punjab, Pakistsan. SMEs are considered key contributors to economic activity, as a key-source of employment, growth, and invention. SMEs perform significant role in the system of national financial regulation all over the world, Jobs creation, and contributing to modernization in the financial regulation are significant exertions to achieve ecological sustainability and more growth in access to finance. Access to finance in emerging countries is one of core issue in development of SME sector as well as obstacle in economic growth. Microfinance institutions are considered a good manifesto to enhance access to inclusive finance as well as stress-free access to finance and financial literacy for SMEs to support economic growth but in Pakistan, to obtain these finances not easy for SMEs sectors. SMEs are unfortunately still struggling due to lack of inclusive finance and financial literacy. Recently financial institution introduced digital financial services at micro level that provide access to financial services to each and every citizen in the country without any restriction. To accomplish the purpose of the research, the data was acquired from the SMEs owners and mangers with a sample of 232 chosen randomly of South Punjab, Pakistan. In this research study, merged two best theories; the theory of planned behavior and technology acceptance model was used to describe their behavior. Multiple statistical tests run to check the normality by using Shapiro-Wilk test, reliability and multicollinearity of the data to test the assumptions of regression and correlation. Finally, the results of this intended study revealed that there is a moderate significant but positive relationship between the SMEs owners and managers intention towards use and adoption of digital financial services. The Government of Pakistan should create finance related awareness program, training, technical institution and make a rules and regulation. Further this study suggests to researchers that focus on internal and as well as external factors of SMEs in Pakistan

Detection and Operation of Unintentional Islands in the Presence of Distributed Generation Units

The complexities and challenges for reliable operation of power system have increased due to various types of Distributed Generators (DG) in the Distribution Network (DN) to supply the increasing load demand. It necessitates a comprehensive approach in planning the system towards effective and reliable operation of the system. During the operation of the system, detection of unintentional islanding is critical as non-detection of islanding event could lead to cascaded failure of the system due to active or reactive power imbalance leading to frequency, angle or voltage instability. If undetected, the instability in the islanded part can cascade into the stable part of the system resulting in complete failure of the system. A robust Modified Islanding Detection Technique (MIDT) has been proposed for identifying the islanding event early and accurately in the distribution networks with DGs installed for multiple objectives and is compared with existing passive Islanding Detection Techniques (IDT). A rank-based load shedding scheme is proposed for stable and reliable operation of the identified island, which sheds only the most vulnerable loads in the island for regaining the frequency and voltage stabilities. The proposed MIDT and rank based load shedding schemes were tested on 11kV IEEE 118 Bus Test system

Effect of Leadership Styles on Organizational Citizenship Behavior and Employee Turnover Intention

The study is aimed at finding the effect of leadership styles on organizational citizenship behavior and employees’ turnover intentions. A descriptive survey research strategy was adopted over a sample of 240 respondents selected conveniently from eight universities of Pakistan. Multifactor Leadership  Scale developed by the Williams and Anderson (1991) was used for data collection. Turnover Intention Scale developed by Roodt (2004) was used to determine employee turnover intention. Descriptive statistics along with ANOVA were used to analyze the data. The research indicated that transformational and transactional style of leadership have a positive relationship with organizational citizenship behavior whereas, laissez faire style has a negative relation with organizational citizenship behavior and positively related with employee turnover intention. Transformational and transactional style of leadership had an insignificant relation with employee turnover intention. &nbsp

Outcome after total knee arthroplasty with or without patellar resurfacing

Background: Patellar resurfacing in total knee arthroplasty has had its defenders and detractors. There seems to be a great difference in patellar resurfacing between countries and patellar resurfacing is still controversial. Some surgeons resurface the patella routinely, others not at all, and a third group prefers selective resurfacing. Therefore, in this prospective and randomised study, we compared the outcome after total knee arthroplasty with or without patellar resurfacing.Methods: In this study 50 cases (100 knees) were selected and each case was followed up for 2 years. In each case, one knee was operated by TKA with patellar resurfacing and the other by TKA with patellar non-resurfacing. Patients were followed-up for a period of 2 years and clinical and functional outcome of both knees was measured and compared by the help of knee society score (KSS) and VAS score.Results: There was statistically significant difference between the patellar resurfacing and non-resurfacing group with regard to knee society score, pain score and visual analogue score (VAS), with the patellar resurfacing having better scores. There was no significant difference in the functional scores between the 2 groups. Range of motion was complication rate was comparable in both the groups. However, there was no case of reoperation nor was there any complication related to the patellar implant. Conclusions: Patellar resurfacing in TKA leads to less post-operative persisting knee pain, and also leads to better outcome in terms of walking without pain, using stairs without pain and rest pain as compared to TKA without patellar resurfacing

Comparative study of management of intertrochanteric fracture by dynamic hip screw and proximal femoral nailing

Background: The purpose of the present study is to verify the theoretical advantages of the intramedullary device over the dynamic hip screw devices and also whether it actually alters the eventual functional outcome of the patient.          Methods: The study is comparative prospective study in which 40 patients were taken and treated either with dynamic hip screw or proximal femoral nailing. The clinical data will be collected and compared with pre-injury activity and present functional level with modified Harris hip score.Results: We found that there is no significant difference between Harris hip score in stable fracture (p value=0.222) fixed either with DHS or PFN. But there is statistically significant difference of score in unstable fracture (p value 0.040) treated by DHS and PFN. Functionally, utilizing the Harris hip scoring system, at the final follow-up, our study affirms PFN to be superior to DHS in unstable intertrochanteric fractures while in stable fractures, functional results are same.                                                                                         Conclusions: PFN is also found better in unstable fractures, because a greater number of patients having excellent Harris hip score. In stable fracture, functional result is same in both groups

Toward Software-Defined Networking-Based IoT Frameworks: A Systematic Literature Review, Taxonomy, Open Challenges and Prospects

Internet of Things (IoT) is characterized as one of the leading actors for the next evolutionary stage in the computing world. IoT-based applications have already produced a plethora of novel services and are improving the living standard by enabling innovative and smart solutions. However, along with its rapid adoption, IoT technology also creates complex challenges regarding the management of IoT networks due to its resource limitations (computational power, energy, and security). Hence, it is urgently needed to refine the IoT-based application’s architectures to robustly manage the overall IoT infrastructure. Software-defined networking (SDN) has emerged as a paradigm that offers software-based controllers to manage hardware infrastructure and traffic flow on a network effectively. SDN architecture has the potential to provide efficient and reliable IoT network management. This research provides a comprehensive survey investigating the published studies on SDN-based frameworks to address IoT management issues in the dimensions of fault tolerance, energy management, scalability, load balancing, and security service provisioning within the IoT networks. We conducted a Systematic Literature Review (SLR) on the research studies (published from 2010 to 2022) focusing on SDN-based IoT management frameworks. We provide an extensive discussion on various aspects of SDN-based IoT solutions and architectures. We elaborate a taxonomy of the existing SDN-based IoT frameworks and solutions by classifying them into categories such as network function virtualization, middleware, OpenFlow adaptation, and blockchain-based management. We present the research gaps by identifying and analyzing the key architectural requirements and management issues in IoT infrastructures. Finally, we highlight various challenges and a range of promising opportunities for future research to provide a roadmap for addressing the weaknesses and identifying the benefits from the potentials offered by SDN-based IoT solutions

Bomb blast injuries: an exploration of patient characteristics and outcome using Pakistan National Emergency Departments Surveillance (Pak-NEDS) data.

BACKGROUND: Bomb blast injuries result in premature deaths and burdening of healthcare systems. The objective of this study was to explore the characteristics and outcome of patients presenting to the emergency departments in Pakistan with bomb blast injuries. METHODS: Active surveillance was conducted in seven major emergency departments of Pakistan from November 2010-March 2011. All the sites are tertiary care urban centers. All the patients who presented to the hospital\u27s emergency department (ED) following a bomb blast injury as per self-report or the ambulance personnel were included in the study. Frequency of demographics, injury pattern, and outcomes were calculated. RESULTS: A total of 103 patients with bomb blast injuries presented to the selected emergency departments. The median age of patients was 30 years. Around three-fourth of the patients were males (n = 74, 74.7%). Most of the bomb blast patients were seen in Peshawar (n = 41, 39.8%) and Karachi city (n = 31, 30.1%) and the most common mode of arrival was non-ambulance transport (n = 71, 76.3%). Upper limb injuries (n = 12, 40%) were common in the under 18 age group and lower limb injuries (n = 31, 39.2%) in the 18 years and above group. There were a total of 8 (7.7%) deaths reported out of these 103 patients. CONCLUSION: Bomb blast injuries in Pakistan generally affect young males. Non-ambulance transport is the most common way to access emergency departments (ED). Overall ED mortality is high and capturing data during a disaster in an emergency department is challenging