FREQEUNCY OF ACUTE CARDIAC COMPLICATIONS IN CHILDREN WITH END STAGE RENAL DISEASE.

Background; Chronic kidney disease is a global health problem which is related with significant disease morbidity. Hemodialysis is a life saving modality but it is also associated with certain cardiovascular complications which do compromise quality of life of these patients. This study was conducted to document the frequency of cardiac complications in patients with end – stage renal disease. Objective: To Determine the Frequency of Acute cardiac Complications in children with end-stage renal disease undergoing Hemodialysis. Material and Methods; The patients going for dialysis were completely assessed clinically by the doctor before the start of procedure. Continuous monitoring of BP, Pulse and ECG was done during the whole procedure using cardiac monitor, readings were recorded every 30 minutes. Results; Mean age of our study cases was 11.31 ± 2.63 years. Of these 231 study cases, 154 (66.7%) were boys while 77 (33.3%) were girls. Mean duration of the disease was 16.78 ± 9. 42 months. Mean duration on hemodialysis was 11.91 ± 7.06 months. Of these 231 study cases, 127 (54.97%) were from rural areas and 104 (45.03%) were from urban areas. Arrhythmia was seen in (3.9%), intradialytic hypotension in 39 (16.9%) and intradialytic hypertension in 48 (20.8%) of our study cases. Conclusion; Intradialytic Hypertension and hypotension are the major complications of the hemodialysis in our study. Cardiovascular complications were significantly associated with disease duration and duration on hemodialysis. Early diagnosis and proper monitoring of these patients can help reduce disease morbidity and improve quality of life of these patients. Keywords; acute complications, hemodialysis, arrhythmia. DOI: 10.7176/JMPB/55-10 Publication date:May 31st 201

FREQUENCY OF PLASMODIUM VIVAX IN PATIENTS HAVING UNCOMPLICATED MALARIA.

Background; Malaria which is potentially life threatening disease that is spread by protozoan parasites. Malaria yet remains to be a important public health concern among most of the endemic regions of world. There are 5 most common human species of plasmodium referred as “Plasmodium falciparum, P. vivax, P. ovale, P. knowlesi, and P. malariae” which can spread the disease.  The major complications are caused by P. falciparum and P. vivax, with P. falciparum being the more virulent. This study was conducted to determine the frequency of plasmodium falciparum among patients with uncomplicated malaria in our population. Objective; To determine the frequency of Plasmodium vivax in patients with uncomplicated malaria. Study Design; Descriptive, Cross-sectional study. Setting; Department of Medicine, Nishtar Hospital, Multan. Results; Of these study cases, 93 (56.4 %) were male patients while 72 (43.6%) were female patients. Mean age of our study cases was noted to be 35.52 ± 10.39 years. Majority of our study cases i.e. 101 (61.2%) were from rural areas while 64 (38.8%) were from urban areas, 129 (78.2%) were poor and 65 (39.4%) had positive history of using anti – malarial drugs. Mean duration of disease was 4.37 ± 2.82 days and majority of our patients i.e. 107 (64.8%) had disease duration up to 5 days. Plasmodium vivax was diagnosed in 129 (78.2%) patients. Conclusion; High frequency of plasmodium vivax was noted in our study, among patients with uncomplicated malaria. Plasmodium vivax was significantly associated with female gender and previous use of anti–malarial drugs. Keywords; plasmodium falciparum, malaria, plasmodium vivax. DOI: 10.7176/JMPB/55-11 Publication date:May 31st 201

Impact of Brand Label on Purchase Intention of a Customer

Main target of this research is examining the relationship between the purchase intention of cosmetics and brand label. The image of the store mediates the relationship between purchase intention and brand label in the cosmetics sector of Pakistan. To check the direct or indirect effect of brand label on purchase intention, data was collected from 200 customers of different stores. Snow ball sampling technique is used for the collection of data from respondents, and PLS-SEM 3 was used to test the hypothesis. The findings indicate that brand label positively and significantly impact customer purchase intention of cosmetics and store image is also positively linked with brand label and mediating the relationship between purchase intention and brand label. Findings will help the retail service sector to understand the importance of store image and how to enhance the consumers purchase intentions. Over long term, customer retention is better and business profitability is greater

Cerebral fungal infection with mycotic aneurysm of basilar artery and subarachnoid haemorrhage

A 28-year-old Pakistani man was admitted with unresolved severe headaches for the past four weeks. Magnetic resonance (MR) imaging and MR angiography showed an enhancing mass in the sphenoid sinus, bilateral cerebellar infarcts and aneurysmal dilatation of the basilar artery. The differential diagnosis included fungal infection versus neoplastic lesion. The scrappings taken through the endoscope from the sphenoid sinus were initially negative for fungal infection. However, the second biopsy, done after putting him on antifungal, itraconazole 200 mg twice daily, revealed the presence of a fungal infection (aspergillosis). MR imaging revealed extension of the fungal infection from the sphenoid sinus into the clivus, and then intracranially. Imaging also revealed aneurysmal dilatation of the basilar artery and infarctions in the cerebellum and subarachnoid haemorrhage. Despite aggressive antifungal treatment, the Patient died after 29 days. This case report describes the probable mechanism of fungal mycotic aneurysmal vascular dilatation and growth. It also points to the need for a rapid diagnosis of potential cases and an aggressive treatment approach of confirmed cases of fungal infections of the central nervous system

Comparison of Bupivacaine and Dexmedetomidine versus Bupivacaine Alone in Transversus Abdominis Plane Block for Post-Operative Analgesia

Objective: To study the effects of adding dexmedetomidine to bupivacaine in transverses abdominis plane block in comparison with using bupivacaine alone. Materials and Methods: This was a prospective comparative study that was conducted in the Anaesthesia Department, CMH, Lahore over a period of six months from 1st June 2020 to 30th November 2020. Fifty patients of the American Society of Anesthesiologist Class I and II with an age range between 40 to 60 years were divided into two groups. Group B received 20ml of 0.25% bupivacaine with 2ml of normal saline on each side in the transversus abdominis plane block while group BD was given 20ml of 0.25% bupivacaine with dexmedetomidine 0.5mcg/kg on each side (in a volume of 2ml). Post-operative pain was assessed with a visual analogue scale. Rescue analgesia was given when a score of greater than 3 was observed using this scale. Time to first rescue analgesia was noted. Total opioid consumption in the first 24 hours was also recorded. Patients were observed for postoperative hypotension and bradycardia.Results: The mean-time for the first dose of analgesia for group B and BD was 302.92 ± 24.01 and 419.28 ± 31.97 minutes respectively with a p-value of 0.001. The mean of the total consumption of opioids in 24 hours post-operatively for group B and BD was 14.20±2.36 and 10.40±1.38 mg respectively with a p-value of 0.001. Hypotension was not seen in any patient in either group. Only one patient developed bradycardia and he belonged to group BD. P-value was 0.327.Conclusion: The addition of dexmedetomidine to bupivacaine for transversus abdominis plane block for postoperative analgesia significantly prolongs the duration of analgesia and reduces the postoperative opioid requirements

Analysis of Arm Movement in Badminton of ForehandLong and Short Service

The Badminton, in respect to shuttle velocity, is one of the fastest racket sports along with Long Tennis. The ability to respond quickly and effectively to a constant changing environment is a key factor to successful performance in addition service plays a vital role in winning a point. Thus, the study was proposed to analyse arm movements of six male university players of long and short services. The data was collected during competition situation. The biomechanical variables and segmental variables of upper extremities were- shuttle velocity, shuttle height at contact, shuttle attaining maximum height, shuttle angle, wrist angle, elbow angle and shoulder angle. The mean age, body height and body weight were reported as (20.83±1.72) years, (167.13±7.06) cm and (59.00±3.68) kg respectively. Canon Legria HF S10 Comcorders operating at 60 Hz was used to record the movement. The identified clips were analyzed with the help of Silicon Coach Pro7's motion analysis software. The result of study revealed that there were significant differences between forehand long and short serve in elbow angle, shuttle height at contact and shuttle attaining maximum height at 0.05 level of significance

Fracture Pattern Analysis of the Upper Cretaceous-Eocene Carbonates along with the Ghumawan Dome, Hazara Basin

Deformational history of the Hazara basin indicates a primitive collision of the two landmasses that undergoes an episodic deformation with NE-SW structural trend. Panjal Thrust (PT) and Main Boundary Thrust (MBT) demarcate the northern and southern extremities of the basin, respectively. The area bounded between these two thrusts is the core consideration of the present research. Different stratigraphic units juxtapose along the Hazara Kashmir Syntaxes (HKS), while the strike-slip component is indicated by imbrication due to thrusts. The study is amied to analyze the paleo-stresses along with developed fracture patterns. Field data were collected via Circle Inventory Method from various localities of the Ghumawan dome, Hazara basin. The zones of upper Cretaceous to Eocene carbonates were mainly targeted during the data collection. Win-Tensor was the key software that helps to analyze the paleo-stresses and fracture pattern of the study area. NW-trending fracture pattern was observed with a highly non-symmetric to dense fracture pattern. The local thrust system lead to severely de-shape the study area. N-S oriented σ1 indicated the compressional tectonic condition that prevailed during deformation of this area. Some segments also show extensional features i.e. normal faulting

Uma abordagem baseada em seleçao pelas conseqüencias para aprendizagem de redes neurais multi-camadas voltadas r concepçao de sistemas autômos inteligentes

Orientador : Maurício F. FigueiredoDissertaçao (mestrado) - Universidade Federal do ParanáResumo: Um modelo de rede neural artificial é proposto. A rede neural possui múltiplas camadas. Cada camada da rede neural é formada por uma grade quadrangular de neurônios (em um espaço toroidal). As conexões sinápticas de cada neurônio abrangem três tipos: excitatórias inter-camadas, laterais inibitórias intra-camada e laterais excitatórias intra-camada. A disposição espacial das conexões é do tipo Gaussiana e específica para cada tipo de sinapse. Cada neurônio estabelece um número restrito de conexões. O modelo de arquitetura contribui para eliminar restrições apresentadas por arquiteturas em que entradas e conexões são distribuídas a todos os neurônios de cada camada. O modelo do neurônio apresenta dinâmica interna, proporcionando uma memória da atividade recente e assumindo papel importante na aprendizagem. A aprendizagem ê baseada na seleção pelas conseqüências, conforme princípios de aprendizagem por reforço. Em particular, a de aprendizagem por reforço utilizada é do tipo clássico. Os experimentos definidos para investigação e confirmação das capacidades da rede neural consideram um ambiente simulado, condizente com o modelo de Seleção pelas Conseqüências. Os resultados obtidos em simulações mostram que o modelo é capaz de reproduzir diversos fenômenos comportamentais, que são: aquisição de comportamento respondente, extinção de comportamento respondente, aquisição de comportamento operante, extinção de comportamento operante, capacidade de generalização de estímulos, habilidade no controle da intensidade das respostas, capacidade de controle de múltiplas respostas e fusão de sensores. Experimentos também ilustram o importante papel das conexões laterais inibitórias e das conexões laterais excitatórias na modelagem da formação de grupos neurais em nível operante. Entende-se que a capacidade de aprendizagem alcançada pela rede neural proposta torna-a viável para a concepção de sistemas autônomos inteligentes com potencialidades superiores àqueles divulgados na literatura especializada.Abstract: A model of an artificial neural network is proposed. The neural network has multiple layers. Each network layer is formed by a quadrangular grid of neurons (on a toroidal space). The synaptic connections that every neuron has are defined between tree types: inter-layer excitatory, lateral intra-layer inhibitory and lateral intra-layer excitatory. The spatial disposition of connections is of a Gaussian type and specific for each type of synapse. Each neuron has a limited number of connections. The model contributes to eliminate restrictions presented by other architectures in witch connections are distributed to all of the neurons of each layer. The neuron model presents an internal dynamic, working as a memory of its recent activity and having important role in the learning process. The learning procedure is based on the selection by consequences according to reinforcement learning principles. Particularly the reinforcement learning approach used is of the classical type. The experiments defined for the investigation and confirmation of the capacities of the neural network consider a simulated environment that works according to the Selection by Consequences model. The simulation results show that the model is capable of reproducing several behavioral phenomena that are: acquisition of respondent behavior, extinction of respondent behavior, acquisition of operant behavior, extinction of operant behavior, stimulus generalization capacity, ability to control the response intensity, capacity to control multiple responses and sensor fusion. Besides that, the experiments also illustrate the important role of the lateral inhibitory and lateral excitatory connections for a correct shaping of operant level responses and neural groups. It is understood that the learning capacities that the proposed neural network exhibits make it viable for the conception of intelligent autonomous systems with potentialities superior to those already presented in the specialized literature