Association of Ground Glass Opacities with Systemic Inflammation and Progression of Emphysema.

RATIONAL: Ground glass opacities (GGO) in the absence of interstitial lung disease are understudied. OBJECTIVE: To assess the association of GGO with white blood cells (WBCs) and progression of quantified chest CT emphysema. METHODS: We analyzed data of participants in the Subpopulations and Intermediate Outcome Measures In COPD Study (SPIROMICS). Chest radiologists and pulmonologists labeled regions of the lung as GGO and adaptive multiple feature method (AMFM) trained the computer to assign those labels to image voxels and quantify the volume of the lung with GGO (%GGOAMFM). We used multivariable linear regression, zero-inflated negative binomial, and proportional hazards regression models to assess the association of %GGOAMFM with WBC, changes in %emphysema, and clinical outcomes. MEASUREMENTS AND MAIN RESULTS: Among 2,714 participants, 1,680 had COPD and 1,034 had normal spirometry. Among COPD participants, based on the multivariable analysis, current smoking and chronic productive cough was associated with higher %GGOAMFM. Higher %GGOAMFM was cross-sectionally associated with higher WBCs and neutrophils levels. Higher %GGOAMFM per interquartile range at visit 1 (baseline) was associated with an increase in emphysema at one-year follow visit by 11.7% (Relative increase; 95%CI 7.5-16.1%;P<0.001). We found no association between %GGOAMFM and one-year FEV1 decline but %GGOAMFM was associated with exacerbations and all-cause mortality during a median follow-up time of 1,544 days (Interquartile Interval=1,118-2,059). Among normal spirometry participants, we found similar results except that %GGOAMFM was associated with progression to COPD at one-year follow-up. CONCLUSIONS: Our findings suggest that GGOAMFM is associated with increased systemic inflammation and emphysema progression.

Impact of salinity stress on cotton and opportunities for improvement through conventional and biotechnological approaches.

Excess salinity can affect the growth and development of all plants. Salinization jeopardizes agroecosystems, induces oxidative reactions in most cultivated plants and reduces biomass which affects crop yield. Some plants are affected more than others, depending upon their ability to endure the effects of salt stress. Cotton is moderately tolerant to salt stress among cultivated crops. The fundamental tenet of plant breeding is genetic heterogeneity in available germplasm for acquired characteristics. Variation for salinity tolerance enhancing parameters (morphological, physiological and biochemical) is a pre-requisite for the development of salt tolerant cotton germplasm followed by indirect selection or hybridization programs. There has been a limited success in the development of salt tolerant genotypes because this trait depends on several factors, and these factors as well as their interactions are not completely understood. However, advances in biochemical and molecular techniques have made it possible to explore the complexity of salt tolerance through transcriptomic profiling. The focus of this article is to discuss the issue of salt stress in crop plants, how it alters the physiology and morphology of the cotton crop, and breeding strategies for the development of salinity tolerance in cotton germplasm.

Empirical analysis of cost-effective and equitable solid waste management systems: Environmental and economic perspectives.

The solid waste management (SWM) system is in a transitional phase in developing economies, and local municipalities and waste management companies are stepping toward integrating a waste treatment approach in the scheme of waste handling. However, there is an urgent need to explore cost-effective techniques, models, and potential revenue streams to sustain the state-run waste sector self-sufficiently. The proposed SWM model aims to support the local waste sector in Islamabad, the capital city of Pakistan, with 100% service area coverage to attain environmental and economic sustainability by defining dedicated waste collection streams to ensure quality material recovery under a cost-effective approach and modality. The innovative approach is applied to allocate the tonnage to various streams as per the city's current land use plan. The estimated/cost of the cleanliness services will be USD13.1 million per annum with an estimated per ton cost of USD 23. The establishment of the proposed material recovery facility (MRF) will process about 500 t/d of waste to produce 45 t/d compost and recover 130 t/d of recyclables. The environmentally friendly model saves 2.4 million tons of CO2‒eq/month from composting and recycling. The average economic potential from MRF and debris-crushing plants, including environmental benefit value, is calculated as USD 3.97 million annually. Recovery of services fee (70%) for various collection streams based on city land use and socio-economic conditions will generate revenue of USD 7.33 million annually. The total revenue will be USD 11.31 million (86% of total annual expenditures) to track the sector's self-sufficiency. To successfully reach the Sustainable Development Goals (SDGs) and Nationally Determined Contributions (NDCs), engaging the private sector from environmentally advanced economies to collaborate in the waste sector to enhance local technical capabilities is recommended.

Bilateral inguinoscrotal swelling: An uncommon presentation of omental cystic lymphangioma.

Abdominal cystic lymphangioma is a rare benign tumour in children. It is often difficult to diagnosis pre-operatively due to a varied spectrum of symptoms. We report a case of a male infant who presented with gross bilateral inguinoscrotal swelling. Provisional diagnosis of congenital communicating hydrocele was made and investigation revealed a large abdominal cyst. Patient underwent explorative laparotomy and the cyst arising from greater omentum, extending into bilateral scrotum, was excised and bilateral herniotomy done. Mass was confirmed to be lymphangioma on biopsy. This case is unique as an abdominal lymphangioma presented solely as inguinoscrotal swelling, with no abdominal symptom. To our knowledge, this is the first case of omental cystic lymphangioma involving both inguinoscrotal regions. Our case suggests that abdominal cystic lymphangioma should be a part of the differential diagnosis in any child with gross inguinoscrotal swelling in whom initial impression is of communicating hydrocele.

Postoperative intussusception in children operated for primary intussusception - A very rare entity.

Postoperative intussusception (POI) after abdominal and non-abdominal operations is a rare but recognized condition discussed several times in literature. There are scarce reports regarding POI in children operated primarily for intussusception. We discuss three such cases that were seen in our institution in the last two years. The patients showed symptoms of atypical ileus that failed to resolve two to eight days following primary surgery. Ultrasound reported intussusception and surgical intervention was sought. All patients had ileoileal intussusception. Manual reduction was successful in two cases. One had intestinal necrosis and underwent resection and anastomosis. Recovery was satisfactory without recurrence. POI should be suspected in patients who show signs of intestinal obstruction in early postoperative period. A second POI should be kept in mind after surgical reduction of the first intussusception. Ultrasound should be performed to aid diagnosis followed by urgent surgical intervention.

Effectiveness of early pharmaceutical interventions in symptomatic COVID-19 patients: A randomized clinical trial.

Objective: We assessed the effectiveness of oral Hydroxychloroquine (HC), Azithromycin (AZ) and Oseltamivir (OS), alone or combined, among patients hospitalized with mildly symptomatic coronavirus infectious disease (COVID-19). Methods: Following the approval of the National Bioethics Committee and prospective registration (clinicaltrials.gov NCT04338698), a multicenter randomized clinical trial of adaptive design was conducted at 10 multispecialty hospitals in Pakistan. Patients were randomized into seven treatment groups. Starting April 15, 2020, consenting, eligible, otherwise healthy adult patients or those with co-morbidities under control, were recruited if they presented with mildly symptomatic COVID-19 (scored 3 on a 7-point ordinal scale anchored between 1 = not hospitalized, able to undertake normal activities, to 7 = death) confirmed by quantitative Real-Time Polymerase Chain Reaction (qRT-PCR). Two primary outcomes were assessed by day seven: Turning qRT-PCR negative; and clinical improvement of two points from the baseline. Outcome rates were compared using a chi-square test. Multiple imputations were applied to handle missing data. An interim data analysis was carried out on July 19, 2020, following which the study continued without treatment group changes. Data Safety and Monitoring Board advised to stop recruitment due to its futility on January 18, 2021. Results: Of 471 patients randomized, a total of 426 (90.4%) completed the follow-up for primary outcomes. Based on imputed data analyses at day seven: Total qRT-PCR negative cases were 137/471 (29%, 95% CI 25.0 - 33.4). By day seven, a total of 111/471 (23.5%, 95% CI 19.8 - 27.6) showed clinical improvement. No serious or non-serious adverse event was reported. Conclusions: Among patients with mild COVID-19, there was no statistically significant difference in the effectiveness of oral antimalarial, antiviral, or antibiotic treatments.Clinicaltrials.gov ID: NCT04338698.

Exploitation of various physio-morphological and biochemical traits for the identification of drought tolerant genotypes in cotton.

BACKGROUND: Drought is one of the limiting factors for quality and quantity of cotton lint in tropical and sub-tropical regions. Therefore, development of drought tolerant cotton genotypes have become indispensable. The identification of drought tolerant genotypes is pre-requisite to develop high yielding cultivars suitable for drought affected areas. METHODS: Forty upland cotton accessions were selected on the basis of their adaptability and yield. The collected germplasm accessions were evaluated at seedling stage on the basis of morphological, physiological and biochemical parameters. The experiment was conducted under controlled conditions in greenhouse where these genotypes were sown under different levels of drought stress by following factorial under completely randomized design. The data were collected at seedling stages for root and shoot lengths, relative leaf water content, excised leaf water losses, peroxidase content and hydrogen peroxide concentrations in leaf tissues. RESULTS: The biometrical analysis revealed that germplasm is significantly varied for recorded parameters, likewise interaction of genotypes and water stress was also significantly varied. The cotton germplasm was categorized in eight clusters based on response to water stress. The genotype Cyto-124 exhibited lowest H2O2 content under drought conditions, minimum excised leaf water loss under stress environment was exhibited by genotypes Ali Akber-802 and CEMB-33. Overall, on the basis of morphological and biochemical traits, SL-516 and Cyto-305 were found to be drought tolerant. Genotypes 1852 - 511, Stoneville 15-17 and Delta Pine-55 showed low values for root length, peroxidase activity and higher value for H2O2 contents. On the basis of these finding, these genotypes were declared as drought susceptible. CONCLUSION: The categorization of cotton germplasm indicating the differential response of various parameters under the control and drought stress conditions. The recorded parameters particularly relative leaf water contents and biochemical assays could be utilized to screen large number of germplasm of cotton for water deficit conditions. Besides, the drought tolerant genotypes identified in this research can be utilized in cotton breeding programs for the development of improved cultivars.

Radiomics for Improved Detection of Chronic Obstructive Pulmonary Disease in Low-Dose and Standard-Dose Chest CT Scans.

Background Approximately half of adults with chronic obstructive pulmonary disease (COPD) remain undiagnosed. Chest CT scans are frequently acquired in clinical practice and present an opportunity to detect COPD. Purpose To assess the performance of radiomics features in COPD diagnosis using standard-dose and low-dose CT models. Materials and Methods This secondary analysis included participants enrolled in the Genetic Epidemiology of COPD, or COPDGene, study at baseline (visit 1) and 10 years after baseline (visit 3). COPD was defined by a forced expiratory volume in the 1st second of expiration to forced vital capacity ratio less than 0.70 at spirometry. The performance of demographics, CT emphysema percentage, radiomics features, and a combined feature set derived from inspiratory CT alone was evaluated. CatBoost (Yandex), a gradient boosting algorithm, was used to perform two classification experiments to detect COPD; the two models were trained and tested on standard-dose CT data from visit 1 (model I) and low-dose CT data from visit 3 (model II). Classification performance of the models was evaluated using area under the receiver operating characteristic curve (AUC) and precision-recall curve analysis. Results A total of 8878 participants (mean age, 57 years ± 9 [SD]; 4180 female, 4698 male) were evaluated. Radiomics features in model I achieved an AUC of 0.90 (95% CI: 0.88, 0.91) in the standard-dose CT test cohort versus demographics (AUC, 0.73; 95% CI: 0.71, 0.76; P < .001), emphysema percentage (AUC, 0.82; 95% CI 0.80, 0.84; P < .001), and combined features (AUC, 0.90; 95% CI: 0.89, 0.92; P = .16). Model II, trained on low-dose CT scans, achieved an AUC of 0.87 (95% CI: 0.83, 0.91) on the 20% held-out test set for radiomics features compared with demographics (AUC, 0.70; 95% CI: 0.64, 0.75; P = .001), emphysema percentage (AUC, 0.74; 95% CI: 0.69, 0.79; P = .002), and combined features (AUC, 0.88; 95% CI: 0.85, 0.92; P = .32). Density and texture features were the majority of the top 10 features in the standard-dose model, whereas shape features of lungs and airways were significant contributors in the low-dose CT model. Conclusion A combination of features representing parenchymal texture and lung and airway shape on inspiratory CT scans can be used to accurately detect COPD. ClinicalTrials.gov registration no. NCT00608764 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Vliegenthart in this issue.

Adipocyte Na, K-ATPase Signaling Attenuates Experimental Uremic Cardiomyopathy.

Oxidative stress has been shown to cause an alteration of intracellular signaling in adipocytes that may lead to various comorbidities of obesity and cardiovascular complications. Evidence suggests that dysregulation of Na, K-ATPase signaling can contribute to systemic inflammation and redox signaling that leads to various metabolic disturbances. Hence the present study aims to explore the specific role of adipocyte Na, K-ATPase signaling in the amelioration of pathophysiological alterations of experimental uremic cardiomyopathy. Experimental uremic cardiomyopathy was induced by partial nephrectomy (PNx), and adipocyte-specific expression of NaKtide, a peptide that inhibits Na, K-ATPase signaling, was achieved using a lentivirus construct with NaKtide expression driven by an adiponectin promoter. Cardiomyopathy and anemia induced in partial nephrectomy mice were accompanied by an altered molecular phenotype of adipocytes, increased systemic inflammatory cytokines and oxidant stress within 4 weeks. These changes were significantly worsened by the addition of a Western diet (enriched in fat and fructose contents) but were prevented with specific expression of NaKtide in adipocytes. The skeletal muscle-specific expression of NaKtide did not ameliorate the disease phenotype. Adipocyte dysfunction and uremic cardiomyopathy developed in PNx mice, both were significantly ameliorated by the adipocyte-specific expression of NaKtide. These findings suggest that oxidative milieu in the adipocyte has a pivotal role in the development and progression of uremic cardiomyopathy in mice subjected to partial nephrectomy. If confirmed in humans, this may be a lead for future research to explore novel therapeutic targets in chronic renal failure.

Seroprevalence of SARS-CoV-2 antibodies in pediatric hospital surgical unit: a lower-middle-income country perspective.

BACKGROUND: The objective of our study was to measure and give insight into the seropositivity of anti-SARS-CoV-2 antibodies in the patients in our pediatric hospital surgical unit in Pakistan. METHODS: A prospective cohort study was conducted at a tertiary care pediatric hospital surgical unit in Pakistan between 1 January 2021 and 1 June 2021 on the enrolled neonates and children aged 1 day to 13 years. All patients from three different pediatric strata [neonates (<1 month), infants (1 to 12 months) and children (>1 year)] were enrolled in the study. RESULTS: Six-hundred patients were enrolled, and 426 patients were included in the study. Among 426 patients, 234 (54.9%) were male, and 192 (45.1%) were female. Overall only 118 (27.7%) patients developed symptoms. The other 308 (72.3%) were asymptomatic of which 28 (9.1%) had fever, 28 (9.1%) had cough, 38 (12.33%) had body aches, 292 (94.8%) had vomiting/diarrhea, and only 28 (9.1%) developed loss of smell and taste. Our results showed seropositivity of 27.7% (n = 118), while 72.3% (n = 308) had negative antibody titers. CONCLUSION: A much higher pediatric SARS-CoV-2 burden of 27.7% was found in our pediatric surgical unit than has previously been reported in the literature of 6.8% for children in pediatric hospitals or pediatric surgical units. Contrary to reporting early in the COVID-19 pandemic, this study determined that children experience a significant burden of COVID-19 infection. Thus, children appear very important in SARS-CoV-2 pandemic, from harboring the virus and further studies need to be done to find if they are transmitting the disease silently.

Mutual Coupling Reduction in Antenna Arrays Using Artificial Intelligence Approach and Inverse Neural Network Surrogates.

This paper presents a novel approach to reducing undesirable coupling in antenna arrays using custom-designed resonators and inverse surrogate modeling. To illustrate the concept, two standard patch antenna cells with 0.07λ edge-to-edge distance were designed and fabricated to operate at 2.45 GHz. A stepped-impedance resonator was applied between the antennas to suppress their mutual coupling. For the first time, the optimum values of the resonator geometry parameters were obtained using the proposed inverse artificial neural network (ANN) model, constructed from the sampled EM-simulation data of the system, and trained using the particle swarm optimization (PSO) algorithm. The inverse ANN surrogate directly yields the optimum resonator dimensions based on the target values of its S-parameters being the input parameters of the model. The involvement of surrogate modeling also contributes to the acceleration of the design process, as the array does not need to undergo direct EM-driven optimization. The obtained results indicate a remarkable cancellation of the surface currents between two antennas at their operating frequency, which translates into isolation as high as -46.2 dB at 2.45 GHz, corresponding to over 37 dB improvement as compared to the conventional setup.

A Super-Efficient GSM Triplexer for 5G-Enabled IoT in Sustainable Smart Grid Edge Computing and the Metaverse.

Global concerns regarding environmental preservation and energy sustainability have emerged due to the various impacts of constantly increasing energy demands and climate changes. With advancements in smart grid, edge computing, and Metaverse-based technologies, it has become apparent that conventional private power networks are insufficient to meet the demanding requirements of industrial applications. The unique capabilities of 5G, such as numerous connections, high reliability, low latency, and large bandwidth, make it an excellent choice for smart grid services. The 5G network industry will heavily rely on the Internet of Things (IoT) to progress, which will act as a catalyst for the development of the future smart grid. This comprehensive platform will not only include communication infrastructure for smart grid edge computing, but also Metaverse platforms. Therefore, optimizing the IoT is crucial to achieve a sustainable edge computing network. This paper presents the design, fabrication, and evaluation of a super-efficient GSM triplexer for 5G-enabled IoT in sustainable smart grid edge computing and the Metaverse. This component is intended to operate at 0.815/1.58/2.65 GHz for 5G applications. The physical layout of our triplexer is new, and it is presented for the first time in this work. The overall size of our triplexer is only 0.007 λg2, which is the smallest compared to the previous works. The proposed triplexer has very low insertion losses of 0.12 dB, 0.09 dB, and 0.42 dB at the first, second, and third channels, respectively. We achieved the minimum insertion losses compared to previous triplexers. Additionally, the common port return losses (RLs) were better than 26 dB at all channels.

Assessment of radiological indices and physiochemical characterization of sediments in Chashma Lake, Pakistan.

Twenty surface sediment samples were gathered from Chasma Lake, deciding the radionuclides 137Cs, 226Ra, 228Ra, 232Th, and 40K and their associated hazard indices. The deliberate radionuclide activities of present research have been contrasted with earlier research, and acquired outcomes in the present study are found below the results in the world. The radiation hazard indices following the presence of natural radionuclides in sediment samples were estimated, and the results assigned the values of all the determined radiological indices found inside the worldwide suggested limits. It was concluded from the current review that the sediment of Chashma Lake is safe for construction and agriculture and does not make radiation dangerous to the nearby local area of the lake.

Prevalence of visual dysfunction and ocular motility disorders in developmentally delayed patients.

Objective: To evaluate the prevalence of reduced visual acuity (VA), refractive errors (RE), reduced contrast sensitivity and strabismus in developmentally delayed (DD) patients. Methods: This descriptive cross sectional study was carried out in Ophthalmology Departments of Mayo Hospital, Lahore, The Children's Hospital, Lahore and The Children's Hospital, Multan from June 2019 to December 2019. We recruited 257 patients of either gender, between the ages of 06-16 years having intelligence quotient (IQ) ≤ 80 by Wechsler Intelligence Scale for Children (WISC) from the out-patient departments. Detailed systemic and ophthalmic history was taken and through anterior and posterior segment examination was carried out. VA was assessed with age matched VA charts. Cycloplegic refraction with 1% cyclopentolate was carried out. Contrast sensitivity was measured with hiding Heidi charts. Strabismus was assessed with Hirschberg and covers /uncover tests. Results: The mean age of the patients was 8.88 years with standard deviation (SD) of ± 2.70. The prevalence of reduced VA, RE, strabismus and reduced contrast sensitivity in these children were 43.58%, 52.92%, 52.14% and 32.7% respectively. Out of these 52.92% RE, 56 (21.79%) were myopic, 66 (25.68%) were hyperopic and 14 (05.45%) were astigmatic. The percentage of esotropia was 72 (28.02%) and exotropia was 62 (24.12%). Conclusion: The results of our study in DD children have shown that a significant number of children have reduced VA, RE, strabismus and reduced contrast sensitivity. Apart from general management of DD children by a pediatrician, the ophthalmic management of these problems must be carried out by a pediatric ophthalmologist to improve their quality of life.

Twelve tips to organise a mock OSCE.

The objective structured clinical examination (OSCE) is central to assessing clinical competence in undergraduate and postgraduate exams for medical and allied healthcare professions. A mock OSCE on the other hand is a simulation of the OSCE and a unique learning experience for the examinee. They benefit in a variety of ways; from enhancing their time management skills to receiving feedback that can improve their clinical skills. Unfortunately, opportunities to participate in simulated OSCEs remain limited. Reasons include difficulty in fulfilling organisational requirements and equipment-related costs. Mock OSCEs can be set up by undergraduate students or junior trainees for peers, without senior supervision or direct guidance. This article will discuss 12 tips regarding the arrangement of mock OSCEs to guide organisers, including accessing resources and establishing the content of the exam.

Relationship of BMI with the diet, physical activity and oral hygiene practices amongst the dental students.

BACKGROUND: Regardless of attaining adequate knowledge regarding oral hygiene, physical activity, and healthy eating habits, dental students still face oral health problems. This study was aimed to assess the association of oral hygiene habits, physical activity, and eating habits with the BMI in the dental students. METHOD: This multi centric cross-sectional study was conducted from January to May 2021 in Pakistan. Three hundred and eighty-six study participants enrolled as undergraduate dental students, both males and females, were included in the study. A questionnaire used to gather data, was modified from a study conducted by Jouhar et al. Chi-square testing was used in order to assess the relationship between two categorical variables. Linear regression was performed to assess the association with putative confounders. Statistical significance was considered for p value < 0.05. RESULTS: Regarding brushing teeth, 57% of the underweight individuals brushed once daily, 69.8% of the healthy, 79.2% of overweight, and 48% of obese participants brushed twice. Horizontal brushing technique was performed by 50% of the underweight participants, followed by scrub technique. A soft bristled brush was frequently used by underweight (42.9%) and healthy (66%) individuals, while a medium textured bristle brush was used by overweight (62.3%) and obese (54.2%) participants. Majority of the underweight (64.3%), overweight (48.1%), and 45.8% of obese individuals had meals thrice a day, while healthy (62.3%) individuals had meals twice a day. CONCLUSION: This study further intensified the contributing role of having an excessive dietary intake and sugar consumption in causing obesity and dental caries. Findings from the current study, identify a statistically significant relationship that exists between BMI levels with oral hygiene, eating habits and the physical activity.

Radiological risk assessment in sediment of Namal Lake, Mianwali, Pakistan.

This study is concentrated on the radiological risk assessment of sixteen surface sediment samples recovered from Namal Lake, District Mianwali, Punjab, Pakistan. The activity of 137Cs, 40 K, 226Ra, 228Ra, and 232Th was carried out with the help of a high purity germanium detector (HPGe) in the sediment, varied in the ranges of > 0.02-3.73 ± 1.31, 98.32 ± 21.45-341.02 ± 58.67, 18.34 ± 2.16-34.23 ± 4.34, 1.62 ± .30-2.34 ± .52, and 0.14 ± 0.10-2.34 ± 0.59 Bq kg-1 with average values 0.74 ± 0.29, 237.26 ± 37.97, 25.06 ± 4.74, 1.97 ± 0.39, and 1.73 ± 0.33 Bq kg-1, respectively. The measured concentrations in the current study have been compared with other earlier studies in the world. The data was also used for determining the other useful parameters like radium equivalent activity, absorbed dose rate, annual effective dose rate, and external and internal hazards index to assess the radiological risk assessment for the environment around the study area. The ERICA Tool software was also applied for radiological risk assessment for lake fish due to the radioactivity present in the lake sediments. It was concluded from the results of ERICA tool that the risk quotient in this study is less than one indicating that no toxic effects of radioactivity for Namal Lake fish.

Effect of Pilates based exercises on symptomatic knee osteoarthritis: A Randomized Controlled Trial.

OBJECTIVE: To determine the effects of Pilates exercises on pain, knee range of motion and functional disability in women with knee osteoarthritis. METHODS: The double-blind randomised controlled trial was conducted at the National Orthopaedic Hospital, Bahawalpur, Pakistan, from April to September 2018, and comprised female patients with knee osteoarthritis. The subjects were selected and randomised into control group A receiving isometrics and intervention group B receiving Pilates exercises. Both groups received one-hour sessions 3 times per week for 8 weeks. The groups were assessed at baseline and at the end of the 8th week using numeric pain rating scale and Western Ontario and McMaster Universities osteoarthritis index for pain and functionality level respectively. Data was analysed using SPSS 23. RESULTS: Of 44 patients, there were 22(50%) in each of the two groups. Mean age of group B was 57.60±6.34 years, and it was 55.65±7.28 in group B. Mean body mass index of group B was 25.812±4.16, and it was 26.93±4.4 in group A. The study was completed by 40(91%) patients; 20(50%) in each of the two groups. Both groups showed significant improvement for pain, range of motion and physical function post-intervention (p<0.05). Group B showed significantly more improvement in terms of pain and physical function compared to group A (p<0.05). CONCLUSIONS: Pilates exercises were found to be more effective in the treatment of patients with knee osteoarthritis. TRIAL REGISTRATION NUMBER: Chi CTR 2000030486.

Effect of median nerve neuromobilization on functional status in patients with carpal tunnel syndrome: A double blinded randomized control trial.

Objectives: To measure additional benefits of neuromobilisation along with conventional treatment in improving the functional status in patients having carpal tunnel syndrome. METHODS: The prospective, double-blind randomised controlled trial was conducted from August 2018 to June 2019 at the Physiotherapy outdoor clinic of Mayo Hospital, Lahore, Pakistan, and comprised patients of either gender aged 20-45 years with <3-month history of carpal tunnel syndrome. The patients were randomised into control group 1 and experimental group 2. Group 1 received conservative treatment including ultrasound therapy, wrist splinting, and tendon-gliding exercises, while Group 2 additionally received neuromobilisation. Functional limitation was measured using the Functional Status Scale and the Symptom Severity Scale of the Boston Carpal Tunnel Syndrome Questionnaire. Patients had 2 sessions per week for 6 weeks. Clinical data was noted at baseline, after 3 weeks of treatment and finally at the end of the 6-week intervention. Data was analysed using SPSS 21. RESULTS: Of the 66 patients, there were 33(50%) in Group 1; 3(9.1%) males, 30(90.9%) females, overall mean age 37.79 ±5.91 years. The remaining 33(50%) were in Group 2; 2(6.1%) males, 31(93.9%) females, overall mean age 35.58 ±7.15 years. Both the groups showed significant improvement (p <0.05), but the addition of neuromobilisation in Group 2 showed better results compared to Group 1(p<0.05). CONCLUSIONS: The addition of neuromobilisation to routine physical therapy was found to have significantly decreased the symptoms of carpal tunnel syndrome and improved the functional status of the patients. Registration No: ChiCTR2000029377(http://www.chictr.org.cn/showproj.aspx?proj=48704).

SELAMAT: A New Secure and Lightweight Multi-Factor Authentication Scheme for Cross-Platform Industrial IoT Systems.

The development of the industrial Internet of Things (IIoT) promotes the integration of the cross-platform systems in fog computing, which enable users to obtain access to multiple application located in different geographical locations. Fog users at the network's edge communicate with many fog servers in different fogs and newly joined servers that they had never contacted before. This communication complexity brings enormous security challenges and potential vulnerability to malicious threats. The attacker may replace the edge device with a fake one and authenticate it as a legitimate device. Therefore, to prevent unauthorized users from accessing fog servers, we propose a new secure and lightweight multi-factor authentication scheme for cross-platform IoT systems (SELAMAT). The proposed scheme extends the Kerberos workflow and utilizes the AES-ECC algorithm for efficient encryption keys management and secure communication between the edge nodes and fog node servers to establish secure mutual authentication. The scheme was tested for its security analysis using the formal security verification under the widely accepted AVISPA tool. We proved our scheme using Burrows Abdi Needham's logic (BAN logic) to prove secure mutual authentication. The results show that the SELAMAT scheme provides better security, functionality, communication, and computation cost than the existing schemes.