Fortifying Smart Home Security: A Robust and Efficient User-Authentication Scheme to Counter Node Capture Attacks.

In smart home environments, the interaction between a remote user and devices commonly occurs through a gateway, necessitating the need for robust user authentication. Despite numerous state-of-the-art user-authentication schemes proposed over the years, these schemes still suffer from security vulnerabilities exploited by the attackers. One severe physical attack is the node capture attack, which allows adversaries to compromise the security of the entire scheme. This research paper advances the state of the art by conducting a security analysis of user-authentication approaches regarding their vulnerability to node capture attacks resulting in revelations of several security weaknesses. To this end, we propose a secure user-authentication scheme to counter node capture attacks in smart home environments. To validate the effectiveness of our proposed scheme, we employ the BAN logic and ProVerif tool for verification. Lastly, we conduct performance analysis to validate the lightweight nature of our user-authentication scheme, making it suitable for IoT-based smart home environments.

Enhancing Security and Privacy in Healthcare Systems Using a Lightweight RFID Protocol.

Exploiting Radio Frequency Identification (RFID) technology in healthcare systems has become a common practice, as it ensures better patient care and safety. However, these systems are prone to security vulnerabilities that can jeopardize patient privacy and the secure management of patient credentials. This paper aims to advance state-of-the-art approaches by developing more secure and private RFID-based healthcare systems. More specifically, we propose a lightweight RFID protocol that safeguards patients' privacy in the Internet of Healthcare Things (IoHT) domain by utilizing pseudonyms instead of real IDs, thereby ensuring secure communication between tags and readers. The proposed protocol has undergone rigorous testing and has been proven to be secure against various security attacks. This article provides a comprehensive overview of how RFID technology is used in healthcare systems and benchmarks the challenges faced by these systems. Then, it reviews the existing RFID authentication protocols proposed for IoT-based healthcare systems in terms of their strengths, challenges, and limitations. To overcome the limitations of existing approaches, we proposed a protocol that addresses the anonymity and traceability issues in existing schemes. Furthermore, we demonstrated that our proposed protocol had a lower computational cost than existing protocols and ensured better security. Finally, our proposed lightweight RFID protocol ensured strong security against known attacks and protected patient privacy using pseudonyms instead of real IDs.

A Plum On Thumb: A Rare Presentation Of Synovial Sarcoma.

Synovial sarcoma (SS) is a rare and aggressive mesenchymal tumour accounting for around 5-10% soft tissue neoplasms usually found in joints of upper and lower extremities. A 35years old healthy looking male patient from Afghanistan presented with swelling on palmar side of base of thumb from last one year. Seven months back excisional biopsy was taken report of which showed neurofibroma/dermatofibroma with. No evidence of malignancy seen. From last 5months mass reappeared and gradually increased in size with itching sensation and mild pain. On local examination there was 5×4×5 cm reddish mass on palmar surface of base of thumb with extension into mid thenar eminence with diffuse margins. X-ray showed soft tissue density mass with spikes of calcification. Ultrasound showed 4.2×4×4.5 cm heterogeneous solid lesion on anteromedial surface of root of right thumb without any remarkable intralesional calcification and remarkable intralesional vasculature. MRI reported lobulated well defined soft tissue mass eliciting low to intermediate signal on T1 and WIs and bright signal on T2and STIR Vividly enhancing mass. Case was operated mass was excised and biopsy sent. Post op status was unremarkable. Biopsy reported poorly differentiated biphasic synovial sarcoma. No recurrence seen till 3months.

Developmental Dysplasia Of The Hip In Older Children; Prospects Of Functional And Radiological Outcome Following A Single Stage Triple Procedure.

BACKGROUND: Developmental dysplasia of the hip (DDH) is a diverse entity, which range from mild acetabular dysplasia to frank irreducible hip dislocation. Data regarding the safety and efficacy of one stage triple procedure is limited. Our aim was to analyse the mid-term functional and radiological outcome of single stage triple procedure for children with DDH after walking age. METHODS: This is a prospective case series of 23 patients (26 hips) who were diagnosed as cases of DDH between July 2014 and June 2017. We included patients with age 20 months and above from both genders who underwent the single stage triple procedure of open reduction, femoral and pelvic osteotomy during the three years. Functional and radiological outcome were assessed according to McKay's and Severin's grading systems respectively.. RESULTS: Sixteen (69.6%) girls and 7 (30.4%) boys with a mean age of 4.4±1.9 years. The mean follow-up duration was 8.9±3.2 months. The mean preoperative acetabular index (AI) was 40.3º±2.7º which reduced to an average of 23.4º±3.8º at the end of follow-up. Eight (34.8%) of patients achieved grade I (excellent) of McKay's classification and 9 (39.1%) grade II (good). Postoperatively, 22 (95.7%) patients were below grade III and only one (4.3%) patient was in grade IVa. One case of avascular necrosis of femoral head was observed. CONCLUSIONS: The single stage triple procedure involving femoral and pelvic osteotomies have excellent functional and radiological outcomes, however, avascular necrosis of the femoral head, redislocation and osteoarthritis in long-term are the adverse events associated with the condition.

Measurement of cerebral blood flow using phase contrast magnetic resonance imaging and duplex ultrasonography.

Phase contrast magnetic resonance imaging (PC-MRI) and color-coded duplex ultrasonography (CDUS) are commonly used for measuring cerebral blood flow in the internal carotid (ICA) and vertebral arteries. However, agreement between the two methods has been controversial. Recent development of high spatial and temporal resolution blood vessel wall edge-detection and wall-tracking methods with CDUS increased the accuracy and reliability of blood vessel diameter, hence cerebral blood flow measurement. The aim of this study was to compare the improved CDUS method with 3 T PC-MRI for cerebral blood flow measurements. We found that cerebral blood flow velocity measured in the ICA was lower using PC-MRI than CDUS (left ICA: PC-MRI, 18.0 ± 4.2 vs. CDUS, 25.6 ± 8.6 cm/s; right ICA: PC-MRI, 18.5 ± 4.8 vs. CDUS, 26.6 ± 6.7 cm/s, both p < 0.01). However, ICA diameters measured using PC-MRI were larger (left ICA: PC-MRI, 4.7 ± 0.50 vs. CDUS, 4.1 ± 0.46 mm; right ICA: PC-MRI, 4.5 ± 0.49 vs. CDUS, 4.0 ± 0.45 mm, both p < 0.01). Cerebral blood flow velocity measured in the left vertebral artery with PC-MRI was also lower than CDUS, but no differences in vertebral artery diameter were observed between the methods. Dynamic changes and/or intrinsic physiological fluctuations may have caused these differences in vessel diameter and velocity measurements between the methods. However, estimation of volumetric cerebral blood flow was similar and correlated between the methods despite the presence of large individual differences. These findings support the use of CDUS for cerebral blood flow measurements in the ICA and vertebral artery.

Individual variability of cerebral autoregulation, posterior cerebral circulation and white matter hyperintensity.

KEY POINTS: Cerebral autoregulation (CA) is a key mechanism to protect brain perfusion in the face of changes in arterial blood pressure, but little is known about individual variability of CA and its relationship to the presence of brain white matter hyperintensity (WMH) in older adults, a type of white matter lesion related to cerebral small vessel disease (SVD). This study demonstrated the presence of large individual variability of CA in healthy older adults during vasoactive drug-induced changes in arterial pressure assessed at the internal carotid and vertebral arteries. We also observed, unexpectedly, that it was the 'over-' rather than the 'less-reactive' CA measured at the vertebral artery that was associated with WMH severity. These findings challenge the traditional concept of CA and suggest that the presence of cerebral SVD, manifested as WMH, is associated with posterior brain hypoperfusion during acute increase in arterial pressure. ABSTRACT: This study measured the individual variability of static cerebral autoregulation (CA) and determined its associations with brain white matter hyperintensity (WMH) in older adults. Twenty-seven healthy older adults (13 females, 66 ± 6 years) underwent assessment of CA during steady-state changes in mean arterial pressure (MAP) induced by intravenous infusion of sodium nitroprusside (SNP) and phenylephrine. Cerebral blood flow (CBF) was measured using colour-coded duplex ultrasonography at the internal carotid (ICA) and vertebral arteries (VA). CA was quantified by a linear regression slope (CA slope) between percentage changes in cerebrovascular resistance (CVR = MAP/CBF) and MAP relative to baseline values. Periventricular and deep WMH volumes were measured with T2-weighted magnetic resonance imaging. MAP was reduced by -11 ± 7% during SNP, and increased by 21 ± 8% during phenylephrine infusion. CA demonstrated large individual variability with the CA slopes ranging from 0.37 to 2.20 at the ICA and from 0.17 to 3.18 at the VA; no differences in CA were found between the ICA and VA. CA slopes measured at the VA had positive correlations with the total and periventricular WMH volume (r = 0.55 and 0.59, P < 0.01). Collectively, these findings demonstrated the presence of large individual variability of CA in older adults, and that, when measured in the posterior cerebral circulation, it is the higher rather than lower CA reactivity that is associated with WMH severity.

Outcome Analysis Of Two Different Injection Solutions For Epidural Injection In Radicular Lumbar Backache Syndromes.

BACKGROUND: Backache is a significant source of disability and suffering in our society. The treatment modalities need continued enhancement in order to achieve the desired goals of lowering morbidity and financial losses while improving the response of the patient. METHODS: This prospective comparative study was conducted at the department of Orthopaedics and Spine Surgery, Khyber Teaching Hospital Peshawar from July 2013 to June 2015. Two interventional groups were designated; Group 1 was comprised of 54 patients who were injected with epidural bupivacaine plus methylprednisolone while Group 2 included 55 patients who were injected with bupivacaine only. Outcome was assessed using the visual analogue scale and Oswestry disability index (ODI). RESULTS: Fifty-five female and 54 male patients with mean age 49.37 years±10.46 SD, Mean symptoms duration was 15.01 months±9.32 SD. Common presenting symptoms were backache (77.1%), lower limbs pain (66.1%), dermatomal paresthesias (54.1%) and neurogenic claudication in 57.8% patients. The mean visual analogue score (VAS) after injection was 3.18±1.29 while mean ODI after injection was 23.615. There was a statistically significant reduction in VAS scores (2-sided p=0.003, OR =4.03, 95% CI: 1.535-10.60) following the injection. CONCLUSIONS: An epidural spinal injection is a viable option for achieving relief of pain & improves functioning in individuals with radicular backache. However, further research is advised in order to clarify the role of ESI for long-term relief.

Outcome Of Two Column Acetabular Fractures Treated Operatively Through Single Posterior Approach.

BACKGROUND: Involvement of both columns in acetabular fractures is a common presentation; these fractures create a challenging situation for the surgeons in terms of understanding the dimensions of osseous injury and selection of surgical approach. The study was done with an objective to evaluate the efficacy of single posterior approach for acetabular fractures involving both columns directly reducing the posterior wall and column and indirectly reducing the anterior column. METHODS: An evaluation of 25 adult patients 18 male and 7 female presenting in the accident and emergency department of Khyber Teaching Hospital from December 2013 to June 2015 having acetabular fracture involving both the anterior and posterior column were included in this case series study. All patients were operated within 8 days of injury by a single operating team. Exposing and reducing the posterior acetabular column through kockerlengenbeck approach did open reduction and internal fixation with reconstruction plate and cortical screws. Additional lag screw was used to stabilize anterior column after indirect reduction with confirmation through C- arm and digital palpation through the greater sciatic notch. Patients were followed up for 6 months and Harris Hip score was evaluated after the end of the follow up period and the result was analysed. RESULTS: Majority of the patients 20 out of 25 had haris hip score more than 90 after 6 months of the operative management. CONCLUSIONS: It is suggested that acetabular that fractures involving both the acetabular columns in certain situations, may be managed by a single posterior approach as it is associated with good clinical outcome and involves lesser soft tissue complications.

Vascular coupling in resting-state fMRI: evidence from multiple modalities.

Resting-state functional magnetic resonance imaging (rs-fMRI) provides a potential to understand intrinsic brain functional connectivity. However, vascular effects in rs-fMRI are still not fully understood. Through multiple modalities, we showed marked vascular signal fluctuations and high-level coupling among arterial pressure, cerebral blood flow (CBF) velocity and brain tissue oxygenation at <0.08 Hz. These similar spectral power distributions were also observed in blood oxygen level-dependent (BOLD) signals obtained from six representative regions of interest (ROIs). After applying brain global, white-matter, cerebrospinal fluid (CSF) mean signal regressions and low-pass filtering (<0.08 Hz), the spectral power of BOLD signal was reduced by 55.6% to 64.9% in all ROIs (P=0.011 to 0.001). The coherence of BOLD signal fluctuations between an ROI pair within a same brain network was reduced by 9.9% to 20.0% (P=0.004 to <0.001), but a larger reduction of 22.5% to 37.3% (P=0.032 to <0.001) for one not in a same network. Global signal regression overall had the largest impact in reducing spectral power (by 52.2% to 61.7%) and coherence, relative to the other three preprocessing steps. Collectively, these findings raise a critical question of whether a large portion of rs-fMRI signals can be attributed to the vascular effects produced from upstream changes in cerebral hemodynamics.

Global brain hypoperfusion and oxygenation in amnestic mild cognitive impairment.

BACKGROUND: To determine if global brain hypoperfusion and oxygen hypometabolism occur in patients with amnestic mild cognitive impairment (aMCI). METHODS: Thirty-two aMCI and 21 normal subjects participated. Total cerebral blood flow (TCBF), cerebral metabolic rate of oxygen (CMRO2), and brain tissue volume were measured using color-coded duplex ultrasonography (CDUS), near-infrared spectroscopy (NIRS), and MRI. TCBF was normalized by total brain tissue volume (TBV) for group comparisons (nTCBF). Cerebrovascular resistance (CVR) was calculated as mean arterial pressure divided by TCBF. RESULTS: Reductions in nTCBF by 9%, CMRO2 by 11%, and an increase in CVR by 13% were observed in aMCI relative to normal subjects. No group differences in TBV were observed. nTCBF was correlated with CMRO2 in normal controls, but not in aMCI. CONCLUSIONS: Global brain hypoperfusion, oxygen hypometabolism, and neurovascular decoupling observed in aMCI suggest that changes in cerebral hemodynamics occur early at a prodromal stage of Alzheimer's disease, which can be assessed using low-cost and bedside-available CDUS and NIRS technology.

The effect of chronic kisspeptin administration on seminal fructose levels in male mice.

The discovery that kisspeptin was critical for normal fertility in all mammalian species including humans, ushered in a new chapter in our understanding of the control of GnRH secretion. Kisspeptin, the product of the KISS1 gene, plays an essential role in the regulation of spermatogenesis acting primarily at the hypothalamic level of the gonadotropic axis. Among the many identified substances in human semen, fructose is becoming increasingly significant. Fructose is synthesized and secreted by the seminal vesicles. Its synthesis is regulated by androgens and it is correlated directly with the levels of testosterone. Dose dependent degeneration of seminal vesicle has been described following intraperitoneal kisspeptin treatment; however, effects of kisspeptin administration on the levels of seminal fructose remain elusive till date. The present study, therefore, addresses the effects of 12-day administration of kisspeptin on seminal fructose levels in male mice. Kisspeptin-10 was administered intraperitoneally at different dosage concentrations (1 µg, 1 ng, and 10 ρg) to adult male mice, twice daily for 12 days. Seminal fructose levels were studied photometrically after 12 days of treatment. At the end of the treatment, seminal fructose levels decreased significantly after all tested doses. Chronic intermittent kisspeptin-10 administration negatively regulates seminal fructose levels in adult male mice.

Optimized antimicrobial peptide (Bacitracin) production by immobilized and free cells and of Bacillus Spp GU215 using Wood chips and silicon polymer beads.

The immobilization of bacillus spp. GU215 on silicon polymer beads, wood chips was performed and antibiotic peptide (bacitracin) production, optimization of parameters were investigated. The immobilized cells presented elevated levels of activity than free cells. The silicon polymer based cells showed widest zones of inhibitions (18mm) in 72 hours and 4% concentration of glucose, PH 8 and 30°C, whereas a marginal decrease in the activity (14mm) was noticed in case of wood chips based immobilization systems and least stable immobilization in 72 hours incubation time, 4% glucose concentration, PH 8 and 30°C. This study illustrates that the silicon polymer based beads facilitate a strong interactions with bacitracin producing cells and render them suitable for excessive and long time production of antibiotic.

Inhibitory effects of Olea ferruginea crude leaves extract against some bacterial and fungal pathogen.

This work aimed to evaluate the inhibitory effects of Olea ferruginea crude leaves extract that are commonly used as remedy to cure infections in the tribal (Khyber Agency) areas of Pakistan against some of bacterial and fungal pathogens. The crude n-hexane fraction was appreciably active against both gram positive and negative microorganisms (MIC ranged from 7.5 to 15 mg/ml) followed by butanol fraction (MIC 15 to 30 mg/ml). Conversely least biological activity was shown by chloroform (30mg/ml) and methanol (15 to 30mg/ml) crude fractions. The MBC observed for all crude fractions was same or 2 times higher when compared with MIC for all crude extract fractions. Likewise all the fractions showed activity against Aspergillus niger and maximum zones of inhibition were shown by the n-hexane fraction (14 ± (0.02), butanol (13 ± (0.02) followed by methanol (9 ± (0.05) and chloroform fractions (7 ± (0.02). These results clearly imitate the antibacterial and antifungal potential of Olea ferruginea and hence we recommend the whole plant for further futuristic studies.

Production of peptide antibiotics by Bacillus sp: GU 057 indigenously isolated from saline soil

A total of 112 soil samples were taken from differents areas of district D.I.Khan and Kohat (KPK) Pakistan and screened for production of antibiotics against the Micrococcus luteus and Staphylococcus aureus. Widest zone of inhibition (18mm) was produced by microorganism isolated from saline soil. The strain was later identified as Bacillus GU057 by standard biochemical assays. Maximum activity (18mm inhibition zone) was observed against Staphylococcus aureus after 48 hours of incubation at pH 8 and 4% concentration of glucose. The antibiotic was identified by autobiography as bacitracin. The Bacillus strain GU057 was confirmed as good peptide antibiotic producer and can effectively be indulged as biocontrol agent.

Production of peptide antibiotics by Bacillus sp. GU 057 indigenously isolated from saline soil.

A total of 112 soil samples were taken from differents areas of district D.I.Khan and Kohat (KPK) Pakistan and screened for production of antibiotics against the Micrococcus luteus and Staphylococcus aureus. Widest zone of inhibition (18mm) was produced by microorganism isolated from saline soil. The strain was later identified as Bacillus GU057 by standard biochemical assays. Maximum activity (18mm inhibition zone) was observed against Staphylococcus aureus after 48 hours of incubation at pH 8 and 4% concentration of glucose. The antibiotic was identified by autobiography as bacitracin. The Bacillus strain GU057 was confirmed as good peptide antibiotic producer and can effectively be indulged as biocontrol agent.

In vitro screening of Circium arvense for potential antibacterial and antifungal activities.

The antimicrobial activities of Circium arvense extracts were evaluated against two human gram positive (Staphylococcus aureus, Micrococcus luteus) and four gram negative pathogen (Escherichia coli, pseudomonas aeruginosa, Enterobacter, Klebsiella pneumoniae). The Methanol extracts of Circium arvense were used to obtain various fractions (X1) n-hexane, (X2) chloroform, (X3) ethyl acetate and (X4) n-butanol. The agar well diffusion assay and agar dilution susceptibility testing were carried out to determine the zone of inhibitions and the minimum inhibitory concentration respectively. Antifungal activity was employed by agar well diffusion method. The Ampicilline, Ofloxacine and Itraconazole were used as standard agents. Almost all fractions exhibited more or less antimicrobial activity. The X2 (Chloroform) fraction was reported as highly active fraction with good antimicrobial activity MIC 0.312 mg/ml against staphylococcus areous. The MBC values of fraction X2 (chloroform) was 2 times the MIC. Similarly all fractions exhibited good inhibitory activities against Aspergillus niger. The fraction X1(n-hexane) was found highly active 6(±0.11), followed by X2 (chloroform) fraction 5 (±0.17). Present study provides a base to explore the antimicrobial potential of Circium arvense. It is concluded that the Circium arvense having potential antibacterial and antifungal activities, irrespective of fact that the MIC values reported were high. Further investigations are recommended to exploit the hidden medicinal value of plant.

Review of prescriber approach towards rational drug practice in hospitalised patients.

BACKGROUND: The rational drug prescribing practice is an important health concern around the globe that not only interferes patient's life but also the socioeconomic issues. OBJECTIVE: The aim of current study was to evaluate the rational use of drug, prescribing behaviour of consultant physicians, role of medical team members in irrational therapy and form the basis for providing necessary information to the policy makers. METHODS: This cross-sectional study was conducted involving a set of 340 medication orders containing about 1,755 medications prescribed to patients in DHQ Teaching Hospital DI Khan, Pakistan from March to July 2009. The WHO operational package for monitoring and assessing country pharmaceutical situations indicators were used for data collection. RESULTS: Among drugs prescribed per average encounter, 75% were dispensed from hospital pharmacy. Generally about 22.3% encounters of overdosing, 16.16% drug duplication, 24.25% drug-drug interactions, 3.5% adverse drug effects and 3.8% cases of contraindications were recorded. The proportion of consultations with antibiotics and injectables prescribed was 80% and 57% respectively. Likewise not less than 70% patients were prescribed NSAIDS, 67% steroids, 55% vitamin supplements, and 34% oral re-hydration solutions. Minimum 5 drugs per prescription were recorded and 70% of prescriptions were reported with high cost of therapy. CONCLUSION: The drug practice among hospitalised patients was clearly irrational accompanied by high levels of medication error. An accurate prescribing decision, appropriate treatment, and rational use of drugs are major needs of the day to ensure safe medication practice.

Management outcome of closed femoral shaft fractures by open Surgical Implant Generation Network (SIGN) interlocking nails.

BACKGROUND: Many hospitals in our country lack surgical expertise and operating room facilities like image intensifier and fractures table to carry out closed interlocking nails (ILN) in femoral shaft fractures. But availability of Surgical Implant Generation Network (SIGN) interlocking nails & nailing instrumentation have made open ILN of these fractures possible at very basic level of our health care system. We have carried out open SIGN nailing in patients with closed fractures of shaft femur without the use of image intensifier. Result for fracture union was evaluated both clinically and radio-logically, and graded at 8 months (32 weeks) after treatment by Thoressen's criteria. METHODS: An experimental study of open SIGN nailing was carried out on 47 patients with fractures shaft of femur who had been admitted to our tertiary care hospital from January 2006 to December 2007. Inclusion criteria were adult patients older than 16 years with closed fractures of the shaft femur, and have presented within a week of the injury, and have not had any previous surgical treatment for the fracture. Malnourished patients and patients with open, pathological fractures and non union cases were excluded from the study. A standard protocol was followed on all patients, which is describing below. The data obtained was analysed using SPSS. RESULTS: The union rate was 97.83% in open nailing at 32 weeks after surgery and the Mean +/- SD time to union was 19.65 +/- 5.19 weeks (ranges from 16-32 weeks).We obtained excellent results in 39 patients (83.33%), good in 4 patients (8.50%), fair in 3 patients (6.38%) and poor in one (2.12%). CONCLUSIONS: The open SIGN nailing, without the use of image intensifier, for treatment of closed fractures of shaft femur achieves excellent result in term of fracture union. Results obtained are comparable to the results of closed interlocking nailing, requires less expertise and resources, and its use is recommended for long bones fracture care at the very level of our health care system.