Influence of Tax Awareness, Simplicity, and Knowledge on Voluntary Tax Compliance in Pakistan: The Mediating and Moderating Role of Tax Fairness and Social Norms

Tax revenue is one of the principal sources to accelerate government funds. Voluntary tax compliance can play the main role in accomplishing the target.  This study explores the role of Tax Awareness (TAW), Tax Simplicity (TSIMP), and Tax Knowledge (TK) in the determination of voluntary tax compliance behavior. This study father analyzes the mediating role of Perception of Tax Fairness (PTF) among TAW, TSIMP, TK, and voluntary tax compliance. This study also analyzes whether “Social Norms (SN)” moderated the relationship between Tax awareness (TAW) and Voluntary Tax Compliance (VTC). The study uses 2000 observations which are collected with two steps stratified sampling technique of five main metropolitan cities (Lahore, Karachi, Islamabad/Rawalpindi, Peshawar) and their National Assembly (NA) constituencies within each chosen city. The survey “Multi-Stakeholder Perception Survey for the Advocacy to strengthen Demand for Economic Reforms” was conducted on direct taxpayer behavior. This study utilized confirmatory factor analysis (CFA) to address the reliability and validity concern while Structural Equation Modeling (SEM) technique is applied for empirical investigation of the hypothesized relationship among modeled variables. The findings of the paper reveal that TK, TSIMP, TAW, SN, and PTF contribute positively to the determination of Voluntary Tax Compliance (VTC). Moreover, PTF significantly mediates among TAW, TSIMP, TK, and voluntary tax compliance. Moreover, SN strengthens the relationship between TAW and voluntary tax compliance. The study concludes with suggestions that the sustainability and self-reliance of Pakistan's economy are stringent on voluntary tax compliance of taxpayers. So, the efforts to review tax policies that can develop a simple and fair tax system with horizontal and vertical equity, improve tax awareness and tax knowledge, and educate taxpayers about social norms can help to meet many challenges of Pakistan today

Awareness About Diabetes And Its Complications Among Patients With Diabetes Mellitus

Abstract Objective: Awareness of diabetes and its potential complications is crucial for effective management and prevention of long-term health risks. This study aimed to assess the level of awareness and understanding of diabetes and its complications among patients diagnosed with type 2 diabetes mellitus. Methods: A cross-sectional study included 200 patients with type 2 diabetes mellitus as per the American Diabetes Association (ADA) criteria. Type 1 diabetes and gestational diabetes patients were excluded from the study. The duration of the study was 8 months. The patient’s awareness regarding diabetes and its complications was assessed as per the prefixed questionnaire.  Analysis of the data was carried out with SPSS version 28. The Chi-square test was used to investigate the association of awareness of diabetes mellitus with various independent variables variable as age and duration of diabetes. The level of statistical significance was p <0.05. Results: Among the participants, 80 (40%) were male and 120 (60%) were female. A significant portion of patients 73 (36.5%) were never informed about diabetes or its complications. 69 (34%) of patients were never educated about the symptoms of hypoglycemia. 142 (71%) of the patients had a glucometer and 88 (44%) participants had poor follow-up and never checked HbA1C. Moreover, Patients with longer diabetes duration were more likely to visit ophthalmologists at regular intervals (P value 0.023). 111 (56%) never checked their urine for proteinuria and 172 (86%) were aware that diabetes can affect their kidneys. Foot care and awareness of diabetic foot complications were lacking among patients. 48 (24%) examined their feet daily, 66 (33%) never examined their feet, and 73 (36%) were never told about foot care by their doctors. The statistically significant impact of age on patients' knowledge regarding blood sugar levels (P=0.009) and foot care (P=0.013) Conclusion: There is a significant lack of awareness among individuals with diabetes, highlighting the urgent need for educational initiatives. Both the public and private healthcare sectors should take the responsibility of providing awareness programs

COVID-19 and Pregnancy Outcome: An Experience in ‘COVID-19 Management Designated’ Tertiary Care Hospital, Rawalpindi, Pakistan

Background: The current COVID-19 pandemic has affected almost 17.3 million victims worldwide with mortality of almost 674K. Pregnancy is one of the most susceptible conditions for COVID-19 infection, but limited data is currently available about the clinical characteristics of pregnant women with the disease. Objective; to describe the clinical characteristics, co-morbidities, management, feto-maternal, and neonatal outcome in COVID-19 positive pregnant women. Methodology: A descriptive case series study was conducted in Obs/Gynae dept of Benazir Bhutto Tertiary Care Hospital, Rawalpindi, including all asymptomatic/symptomatic COVID-19 positive pregnant women and clinical suspects (COVID-19 PCR negative women) delivered in our hospital from 01st April 2020 to 31st July 2020. Their medical records were reviewed for clinical characteristics, management, feto-maternal and neonatal outcomes. Continuous variables were expressed in Mean & Range and Categorical variables as number & Percentage. Results: During the study period a total of 17 cases were reviewed. The mean maternal age was 28.94 yrs. Primigravida (07), Multipara (10). Mean gestational age was 37 wks (range; 30-41wks). Presenting symptomatology was varied. Asymptomatic; (29%), COVID-19 specific symptoms; fever & flu (12%), fever&cough (6%), shortness of breath(SOB) alone (6%), fever & SOB(6%) and pregnancy-related manifestations were labour pains (17%), eclampsia(6%), hydrocephalous fetus (6%) and hepatic encephalopathy(6%). The commonest co-morbidity was Hypertensive disorders of pregnancy (24%). Five women (29%) required ICU care. Lower segment caesarean sections(LSCS) (59%), vaginal delivery (41%). Eleven babies delivered with good Apgar score and birth weight. Two were early neonatal deaths (ENND) and 04 were received intra-uterine fetal deaths (IUDs). Fetal demise was associated with strong obstetric risk factors. Out of 13 live-born babies, RT-PCR Covid-19 testing was done in 10 (77%) cases and was negative. One mother was expired due to complications of hepatic encephalopathy, sepsis, and burst abdomen. Conclusion; The clinical course of COVID-19 disease in pregnancy seems to be no different from non-pregnant women. Clinical manifestations are diverse and infection contracted in the third trimester of pregnancy is associated with good feto-maternal and neonatal outcomes

Comparison Of ALT In Type 2 Diabetics with And Without Fatty Liver Disease

Objective: To determine the association of alanine aminotransferase in type 2 diabetic patients with and without fatty liver disease. Materials and Methods: A cross-sectional study was done for six months at Sheikh Khalifa Bin Zaid Al-Nahyan Hospital Rawalakot. In our study, we included all the patients who presented to the outpatient department (OPD) having type 2 diabetes mellitus. Their age, gender, height, weight, and duration of diabetes mellitus were noted. Their liver function test (LFTS), fasting blood sugar and HBA1c, and fasting lipid profile were also done at the time of their OPD visit and results were noted. They were given an appointment for an ultrasound abdomen from the radiology department for detection of fatty liver disease and the results were noted on the next OPD visit. Results: Total study population was 90 patients and out of which 35 (38.8%) were male and 55 (61.1%) were female. 58 years was the mean age of our study population. Fatty liver was present in 50% of patients. ALT was raised from a baseline value of 36 in 61% of patients while fasting blood sugar was raised in 83% of patients. The mean fasting blood sugar was 208 mg/dl. ALT was not significantly different in patients with and without fatty liver disease. However, it was found that patients with uncontrolled blood glucose levels have significantly raised ALT which was also statistically proven as the P value was less than 0.05. Also, patients with high blood glucose have a higher incidence of fatty liver disease as compared with normal blood glucose level patients but the difference was not statistically significant as shown by a P value more than 0.05. Conclusion: Fatty liver disease is more common in Type 2 diabetic patients with uncontrolled blood sugar. There is a high rate of raised ALT in diabetic patients whose blood sugar control is not optimum

Patient's Feedback Platform for Quality of Services via “Free Text Analysis” in Healthcare Industry

Data analysis of social media posting continues to offer a huge variety of information about the health situation faced by an individual. Social networking or social media websites provide us a wealth of information generated by users in a variety of domains, that generated information are unstructured and unlabeled and are not captured in an exceedingly systematic manner, as info generated is not humanly possible to process due to its size. One traditional way of collecting patients experience is by conducting surveys and questionnaires, as these methods ask fixed questions and are expensive to administer. In this paper, a patient feedback platform (PFP) using free text sentiment analysis is developed to computationally identify and categorize the polarity expressed in a piece of text. Six machine learning latest algorithms have been used as key evaluation for evaluating accuracy of the developed (PFP) model. Results achieved have shown 88 % accuracy on the basis of which it is recommended that developed (PFP) patient feedback platform could be used to improve E-health care services indeed

A novel pH-responsive hydrogel system based on Prunus armeniaca gum and acrylic acid: Preparation and evaluation as a potential candidate for controlled drug delivery

pH-responsive hydrogels have become effective and attractive materials for the controlled release of drugs at pre-determined destinations. In the present study, a novel hydrogel system based on Prunus armeniaca gum (PAG) and acrylic acid (AA) was prepared by a free radical mechanism using N, N-methylene bisacrylamide (MBA) as cross-linker and potassium persulfate (KPS) as initiator. A series of hydrogels varying PAG, AA, and MBA concentration was developed to determine the impact of these components. Formulated hydrogels were characterized for pH-responsive swelling, drug release, gel content, and porosity. Structural analysis was performed by FTIR, XRD, and SEM analysis. TGA study was applied to assess thermal stability. Oral acute toxicity and in vivo drug release were performed in rabbits. Hydrogels exhibited pH-dependent swelling and drug release. Swelling, drug loading and release, and porosity increased by increasing PAG and AA concentration while decreased by increasing MBA. The gel content of formulations was increased by increasing all three components. FTIR studies confirmed the development of copolymeric networks and the loading of drug. XRD studies revealed that hydrogels were amorphous, and the crystalline drug was changed into an amorphous form during loading. TGA results indicated that hydrogels were stable up to 600 °C. Acute oral toxicity results confirm that hydrogels were nontoxic up to a dose of 2 g/kg body weight in rabbits. The pharmacokinetic evaluation revealed that hydrogels prolonged the availability of the drug and the peak plasma concentration of the drug was obtained in 6 h as compared to the oral solution of the drug. Tramadol hydrochloride (THC) was used as a model drug. Hence, pH-responsive swelling and release, nontoxic nature and improved pharmacokinetics support that PAG-based hydrogels may be considered as potential controlled-release polymeric carriers

Synthesis of green metaloxide nanoparticles using aloe-barbadensis leaf extract (Acid Red 28) for dye removal applications

The present study focuses on the synthesis of stable metal oxide nanoparticles (MO-NPs) using Aloe Vera Barbadensis leaf extracts via a green route approach. The MO-NPs were synthesized by the interaction of Aloe-Barbadensis leaf extract with metaloxide salt and its azodye (Congo red). These NPs were then characterized using SEM (surface morphology), XRD (Crystallography structure, peaks of MO-NPs), UV-Vis (Absorption spectrum) and FTIR (presence of functional group). The SEM images revealed the surface morphology of nano sized powder while the XRD results showed that the particle size ranged between 5-30 nm. The UV-Vis absorption spectrum revealed that the MO-NPs are iron and copper oxide respectively. FTIR data, on the other hand, indicated the hydroxyl (OH) functional group stretching due to the presence of alcohols and phenolic chemicals in the extract. Moreover, the effect of physical properties such as solution concentration, their PH and MO-NPs adsorbent dosage on percentage of dye degradation was also determined. As per results, the NPs removed about 70-80% of Congo red dye solution at optimum condition of reaction factors. The dynamics of pseudo-second order was followed in the adsorption process by MO-NPs

Ficus benghalensis as Potential Inhibitor of 5α-Reductase for Hair Growth Promotion: In Vitro, In Silico, and In Vivo Evaluation

The screening of hair follicles, dermal papilla cells, and keratinocytes through in vitro, in vivo, and histology has previously been reported to combat alopecia. Ficus benghalensis has been used conventionally to cure skin and hair disorders, although its effect on 5α-reductase II is still unknown. Currently, we aim to analyze the phytotherapeutic impact of F. benghalensis leaf extracts (FBLEs) for promoting hair growth in rabbits along with in vitro inhibition of the steroid isozyme 5α-reductase II. The inhibition of 5α-reductase II by FBLEs was assessed by RP-HPLC, using the NADPH cofactor as the reaction initiator and Minoxin (5%) as a positive control. In silico studies were performed using AutoDock Vina to visualize the interaction between 5α-reductase II and the reported phytoconstituents present in FBLEs. Hair growth in female albino rabbits was investigated by applying an oral dose of the FBLE formulation and control drug to the skin once a day. The skin tissues were examined by histology to see hair follicles. Further, FAAS, FTIR, and antioxidants were performed to check the trace elements and secondary metabolites in the FBLEs. The results of RP-HPLC and the binding energies showed that FBLEs reduced the catalytic activity of 5α-reductase II and improved cell proliferation in rabbits. The statistical analysis (p 70%) suggested that hydroalcoholic FBLE has more potential in increasing hair growth by elongating hair follicle’s anagen phase. FAAS, FTIR, and antioxidant experiments revealed sufficient concentrations of Zn, Cu, K, and Fe, together with the presence of polyphenols and scavenging activity in FBLE. Overall, we found that FBLEs are potent in stimulating hair follicle maturation by reducing the 5α-reductase II action, so they may serve as a principal choice in de novo drug designing to treat hair loss

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