Search results for: joint diseases
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3593

Search results for: joint diseases

3233 Computer-Aided Diagnosis of Polycystic Kidney Disease Using ANN

Authors: G. Anjan Babu, G. Sumana, M. Rajasekhar

Abstract:

Many inherited diseases and non-hereditary disorders are common in the development of renal cystic diseases. Polycystic kidney disease (PKD) is a disorder developed within the kidneys in which grouping of cysts filled with water like fluid. PKD is responsible for 5-10% of end-stage renal failure treated by dialysis or transplantation. New experimental models, application of molecular biology techniques have provided new insights into the pathogenesis of PKD. Researchers are showing keen interest for developing an automated system by applying computer aided techniques for the diagnosis of diseases. In this paper a multi-layered feed forward neural network with one hidden layer is constructed, trained and tested by applying back propagation learning rule for the diagnosis of PKD based on physical symptoms and test results of urinanalysis collected from the individual patients. The data collected from 50 patients are used to train and test the network. Among these samples, 75% of the data used for training and remaining 25% of the data are used for testing purpose. Furthermore, this trained network is used to implement for new samples. The output results in normality and abnormality of the patient.

Keywords: dialysis, hereditary, transplantation, polycystic, pathogenesis

Procedia PDF Downloads 356
3232 An Image Processing Scheme for Skin Fungal Disease Identification

Authors: A. A. M. A. S. S. Perera, L. A. Ranasinghe, T. K. H. Nimeshika, D. M. Dhanushka Dissanayake, Namalie Walgampaya

Abstract:

Nowadays, skin fungal diseases are mostly found in people of tropical countries like Sri Lanka. A skin fungal disease is a particular kind of illness caused by fungus. These diseases have various dangerous effects on the skin and keep on spreading over time. It becomes important to identify these diseases at their initial stage to control it from spreading. This paper presents an automated skin fungal disease identification system implemented to speed up the diagnosis process by identifying skin fungal infections in digital images. An image of the diseased skin lesion is acquired and a comprehensive computer vision and image processing scheme is used to process the image for the disease identification. This includes colour analysis using RGB and HSV colour models, texture classification using Grey Level Run Length Matrix, Grey Level Co-Occurrence Matrix and Local Binary Pattern, Object detection, Shape Identification and many more. This paper presents the approach and its outcome for identification of four most common skin fungal infections, namely, Tinea Corporis, Sporotrichosis, Malassezia and Onychomycosis. The main intention of this research is to provide an automated skin fungal disease identification system that increase the diagnostic quality, shorten the time-to-diagnosis and improve the efficiency of detection and successful treatment for skin fungal diseases.

Keywords: Circularity Index, Grey Level Run Length Matrix, Grey Level Co-Occurrence Matrix, Local Binary Pattern, Object detection, Ring Detection, Shape Identification

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3231 Target and Biomarker Identification Platform to Design New Drugs against Aging and Age-Related Diseases

Authors: Peter Fedichev

Abstract:

We studied fundamental aspects of aging to develop a mathematical model of gene regulatory network. We show that aging manifests itself as an inherent instability of gene network leading to exponential accumulation of regulatory errors with age. To validate our approach we studied age-dependent omic data such as transcriptomes, metabolomes etc. of different model organisms and humans. We build a computational platform based on our model to identify the targets and biomarkers of aging to design new drugs against aging and age-related diseases. As biomarkers of aging, we choose the rate of aging and the biological age since they completely determine the state of the organism. Since rate of aging rapidly changes in response to an external stress, this kind of biomarker can be useful as a tool for quantitative efficacy assessment of drugs, their combinations, dose optimization, chronic toxicity estimate, personalized therapies selection, clinical endpoints achievement (within clinical research), and death risk assessments. According to our model, we propose a method for targets identification for further interventions against aging and age-related diseases. Being a biotech company, we offer a complete pipeline to develop an anti-aging drug-candidate.

Keywords: aging, longevity, biomarkers, senescence

Procedia PDF Downloads 255
3230 The Osteocutaneous Distal Tibia Turn-over Fillet Flap: A Novel Spare-parts Orthoplastic Surgery Option for Functional Below-knee Amputation

Authors: Harry Burton, Alexios Dimitrios Iliadis, Neil Jones, Aaron Saini, Nicola Bystrzonowski, Alexandros Vris, Georgios Pafitanis

Abstract:

This article portrays the authors’ experience with a complex lower limb bone and soft tissue defect, following chronic osteomyelitis and pathological fracture, which was managed by the multidisciplinary orthoplastic team. The decision for functional amputation versus limb salvage was deemed necessary, enhanced by the principles of “spares parts” in reconstructive microsurgery. This case describes a successful use of the osteocutaneous distal tibia turn-over fillet flap that allowed ‘lowering the level of the amputation’ from a through knee to the conventional level of a below-knee amputation to preserve the knee joint function. This case demonstrates the value of ‘spare-parts’ surgery principles and how these concepts refine complex orthoplastic approaches when limb salvage is not possible to enhance function. The osteocutaneous distal tibia turn-over fillet flap is a robust technique for modified BKA reconstructions that provides sufficient bone length to achieve a tough, sensate stump and functional knee joint.

Keywords: osteocutaneous flap, fillet flap, spare-parts surgery, Below knee amputation

Procedia PDF Downloads 140
3229 Effect of Ageing of Laser-Treated Surfaces on Corrosion Resistance of Fusion-bonded Al Joints

Authors: Rio Hirakawa, Christian Gundlach, Sven Hartwig

Abstract:

Aluminium has been used in a wide range of industrial applications due to its numerous advantages, including excellent specific strength, thermal conductivity, corrosion resistance, workability and recyclability. The automotive industry is increasingly adopting multi-materials, including aluminium in structures and components to improve the mechanical usability and performance of individual components. A common method for assembling dissimilar materials is mechanical joining, but mechanical joining requires multiple manufacturing steps, affects the mechanical properties of the base material and increases the weight due to additional metal parts. Fusion bonding is being used in more and more industries as a way of avoiding the above drawbacks. Infusion bonding, and surface pre-treatment of the base material is essential to ensure the long-life durability of the joint. Laser surface treatment of aluminium has been shown to improve the durability of the joint by forming a passive oxide film and roughening the substrate surface. Infusion bonding, the polymer bonds directly to the metal instead of the adhesive, but the sensitivity to interfacial contamination is higher due to the chemical activity and molecular size of the polymer. Laser-treated surfaces are expected to absorb impurities from the storage atmosphere over time, but the effect of such changes in the treated surface over time on the durability of fusion-bonded joints has not yet been fully investigated. In this paper, the effect of the ageing of laser-treated surfaces of aluminum alloys on the corrosion resistance of fusion-bonded joints is therefore investigated. AlMg3 of 1.5 mm thickness was cut using a water-jet cutting machine, cleaned and degreased with isopropanol and surface pre-treated with a pulsed fiber laser at a wavelength of 1060 nm, maximum power of 70 W and repetition rate of 55 kHz. The aluminum surfaces were then stored in air for various periods of time and their corrosion resistance was assessed by cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). For the aluminum joints, induction heating was employed as the fusion bonding method and single-lap shear specimens were prepared. The corrosion resistance of the joints was assessed by measuring the lap shear strength before and after neutral salt spray. Cross-sectional observations by scanning electron microscopy (SEM) were also carried out to investigate changes in the microstructure of the bonded interface. Finally, the corrosion resistance of the surface and the joint were compared and the differences in the mechanisms of corrosion resistance enhancement between the two were discussed.

Keywords: laser surface treatment, pre-treatment, bonding, corrosion, durability, interface, automotive, aluminium alloys, joint, fusion bonding

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3228 Comparative Evaluation of Seropositivity and Patterns Distribution Rates of the Anti-Nuclear Antibodies in the Diagnosis of Four Different Autoimmune Collagen Tissue Diseases

Authors: Recep Kesli, Onur Turkyilmaz, Cengiz Demir

Abstract:

Objective: Autoimmune collagen diseases occur with the immune reactions against the body’s own cell or tissues which cause inflammation and damage the tissues and organs. In this study, it was aimed to compare seropositivity rates and patterns of the anti-nuclear antibodies (ANA) in the diagnosis of four different autoimmune collagen tissue diseases (Rheumatoid Arthritis-RA, Systemic Lupus Erythematous-SLE, Scleroderma-SSc and Sjogren Syndrome-SS) with each other. Methods: One hundred eighty-eight patients applied to different clinics in Afyon Kocatepe University ANS Practice and Research Hospital between 11.07.2014 and 14.07.2015 that thought the different collagen disease such as RA, SLE, SSc and SS have participated in the study retrospectively. All the data obtained from the patients participated in the study were evaluated according to the included criteria. The historical archives belonging to the patients have been screened, assessed in terms of ANA positivity. The obtained data was analysed by using the descriptive statistics; chi-squared, Fischer's exact test. The evaluations were performed by SPSS 20.0 version and p < 0.05 level was considered as significant. Results: Distribution rates of the totally one hundred eighty-eight patients according to the diagnosis were found as follows: 82 (43.6%) were RA, 38 (20.2%) were SLE, 22 (11.7%) were SSc, and 46 (24.5%) were SS. Distribution of ANA positivity rates according to the collagen tissue diseases were found as follows; for RA were 54 (65,9 %), for SLE were 36 (94,7 %), for SSc were 18 (81,8 %), and for SS were 43 (93,5 %). Rheumatoid arthritis should be evaluated and classified as a different class among all the other investigated three autoimmune illnesses. ANA positivity rates were found as differently higher (91.5 %) in the SLE, SSc, and SS, from the RA (65.9 %). Differences at ANA positivity rates for RA and the other three diseases were found as statistically significant (p=0.015). Conclusions: Systemic autoimmune illnesses show broad spectrum. ANA positivity was found as an important predictor marker in the diagnosis of the rheumatologic illnesses. ANA positivity should be evaluated as more valuable and sensitive a predictor diagnostic marker in the laboratory findings of the SLE, SSc, and SS according to RA.

Keywords: antinuclear antibody (ANA), rheumatoid arthritis, scleroderma, Sjogren syndrome, systemic lupus Erythemotosus

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3227 Lamb Waves Propagation in Elastic-Viscoelastic Three-Layer Adhesive Joints

Authors: Pezhman Taghipour Birgani, Mehdi Shekarzadeh

Abstract:

In this paper, the propagation of lamb waves in three-layer joints is investigated using global matrix method. Theoretical boundary value problem in three-layer adhesive joints with perfect bond and traction free boundary conditions on their outer surfaces is solved to find a combination of frequencies and modes with the lowest attenuation. The characteristic equation is derived by applying continuity and boundary conditions in three-layer joints using global matrix method. Attenuation and phase velocity dispersion curves are obtained with numerical solution of this equation by a computer code for a three-layer joint, including an aluminum repair patch bonded to the aircraft aluminum skin by a layer of viscoelastic epoxy adhesive. To validate the numerical solution results of the characteristic equation, wave structure curves are plotted for a special mode in two different frequencies in the adhesive joint. The purpose of present paper is to find a combination of frequencies and modes with minimum attenuation in high and low frequencies. These frequencies and modes are recognizable by transducers in inspections with Lamb waves because of low attenuation level.

Keywords: three-layer adhesive joints, viscoelastic, lamb waves, global matrix method

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3226 Insight into the Binding Theme of CA-074Me to Cathepsin B: Molecular Dynamics Simulations and Scaffold Hopping to Identify Potential Analogues as Anti-Neurodegenerative Diseases

Authors: Tivani Phosa Mashamba-Thompson, Mahmoud E. S. Soliman

Abstract:

To date, the cause of neurodegeneration is not well understood and diseases that stem from neurodegeneration currently have no known cures. Cathepsin B (CB) enzyme is known to be involved in the production of peptide neurotransmitters and toxic peptides in neurodegenerative diseases (NDs). CA-074Me is a membrane-permeable irreversible selective cathepsin B (CB) inhibitor as confirmed by in vivo studies. Due to the lack of the crystal structure, the binding mode of CA-074Me with the human CB at molecular level has not been previously reported. The main aim of this study is to gain an insight into the binding mode of CB CA-074Me to human CB using various computational tools. Herein, molecular dynamics simulations, binding free energy calculations and per-residue energy decomposition analysis were employed to accomplish the aim of the study. Another objective was to identify novel CB inhibitors based on the structure of CA-074Me using fragment based drug design using scaffold hoping drug design approach. Results showed that two of the designed ligands (hit 1 and hit 2) were found to have better binding affinities than the prototype inhibitor, CA-074Me, by ~2-3 kcal/mol. Per-residue energy decomposition showed that amino acid residues Cys29, Gly196, His197 and Val174 contributed the most towards the binding. The Van der Waals binding forces were found to be the major component of the binding interactions. The findings of this study should assist medicinal chemist towards the design of potential irreversible CB inhibitors.

Keywords: cathepsin B, scaffold hopping, docking, molecular dynamics, binding-free energy, neurodegerative diseases

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3225 Development and Validation of a HPLC Method for 6-Gingerol and 6-Shogaol in Joint Pain Relief Gel Containing Ginger (Zingiber officinale)

Authors: Tanwarat Kajsongkram, Saowalux Rotamporn, Sirinat Limbunruang, Sirinan Thubthimthed.

Abstract:

High-Performance Liquid Chromatography (HPLC) method was developed and validated for simultaneous estimation of 6-Gingerol(6G) and 6-Shogaol(6S) in joint pain relief gel containing ginger extract. The chromatographic separation was achieved by using C18 column, 150 x 4.6mm i.d., 5μ Luna, mobile phase containing acetonitrile and water (gradient elution). The flow rate was 1.0 ml/min and the absorbance was monitored at 282 nm. The proposed method was validated in terms of the analytical parameters such as specificity, accuracy, precision, linearity, range, limit of detection (LOD), limit of quantification (LOQ), and determined based on the International Conference on Harmonization (ICH) guidelines. The linearity ranges of 6G and 6S were obtained over 20-60 and 6-18 µg/ml respectively. Good linearity was observed over the above-mentioned range with linear regression equation Y= 11016x- 23778 for 6G and Y = 19276x-19604 for 6S (x is concentration of analytes in μg/ml and Y is peak area). The value of correlation coefficient was found to be 0.9994 for both markers. The limit of detection (LOD) and limit of quantification (LOQ) for 6G were 0.8567 and 2.8555 µg/ml and for 6S were 0.3672 and 1.2238 µg/ml respectively. The recovery range for 6G and 6S were found to be 91.57 to 102.36 % and 84.73 to 92.85 % for all three spiked levels. The RSD values from repeated extractions for 6G and 6S were 3.43 and 3.09% respectively. The validation of developed method on precision, accuracy, specificity, linearity, and range were also performed with well-accepted results.

Keywords: ginger, 6-gingerol, HPLC, 6-shogaol

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3224 Wavelet-Based Classification of Myocardial Ischemia, Arrhythmia, Congestive Heart Failure and Sleep Apnea

Authors: Santanu Chattopadhyay, Gautam Sarkar, Arabinda Das

Abstract:

This paper presents wavelet based classification of various heart diseases. Electrocardiogram signals of different heart patients have been studied. Statistical natures of electrocardiogram signals for different heart diseases have been compared with the statistical nature of electrocardiograms for normal persons. Under this study four different heart diseases have been considered as follows: Myocardial Ischemia (MI), Congestive Heart Failure (CHF), Arrhythmia and Sleep Apnea. Statistical nature of electrocardiograms for each case has been considered in terms of kurtosis values of two types of wavelet coefficients: approximate and detail. Nine wavelet decomposition levels have been considered in each case. Kurtosis corresponding to both approximate and detail coefficients has been considered for decomposition level one to decomposition level nine. Based on significant difference, few decomposition levels have been chosen and then used for classification.

Keywords: arrhythmia, congestive heart failure, discrete wavelet transform, electrocardiogram, myocardial ischemia, sleep apnea

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3223 Producing Outdoor Design Conditions based on the Dependency between Meteorological Elements: Copula Approach

Authors: Zhichao Jiao, Craig Farnham, Jihui Yuan, Kazuo Emura

Abstract:

It is common to use the outdoor design weather data to select the air-conditioning capacity in the building design stage. The outdoor design weather data are usually comprised of multiple meteorological elements for a 24-hour period separately, but the dependency between the elements is not well considered, which may cause an overestimation of selecting air-conditioning capacity. Considering the dependency between the air temperature and global solar radiation, we used the copula approach to model the joint distributions of those two weather elements and suggest a new method of selecting more credible outdoor design conditions based on the specific simultaneous occurrence probability of air temperature and global solar radiation. In this paper, the 10-year period hourly weather data from 2001 to 2010 in Osaka, Japan, was used to analyze the dependency structure and joint distribution, the result shows that the Joe-Frank copula fit for almost all hourly data. According to calculating the simultaneous occurrence probability and the common exceeding probability of air temperature and global solar radiation, the results have shown that the maximum difference in design air temperature and global solar radiation of the day is about 2 degrees Celsius and 30W/m2, respectively.

Keywords: energy conservation, design weather database, HVAC, copula approach

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3222 Stability Assessment of Chamshir Dam Based on DEM, South West Zagros

Authors: Rezvan Khavari

Abstract:

The Zagros fold-thrust belt in SW Iran is a part of the Alpine-Himalayan system which consists of a variety of structures with different sizes or geometries. The study area is Chamshir Dam, which is located on the Zohreh River, 20 km southeast of Gachsaran City (southwest Iran). The satellite images are valuable means available to geologists for locating geological or geomorphological features expressing regional fault or fracture systems, therefore, the satellite images were used for structural analysis of the Chamshir dam area. As well, using the DEM and geological maps, 3D Models of the area have been constructed. Then, based on these models, all the acquired fracture traces data were integrated in Geographic Information System (GIS) environment by using Arc GIS software. Based on field investigation and DEM model, main structures in the area consist of Cham Shir syncline and two fault sets, the main thrust faults with NW-SE direction and small normal faults in NE-SW direction. There are three joint sets in the study area, both of them (J1 and J3) are the main large fractures around the Chamshir dam. These fractures indeed consist with the normal faults in NE-SW direction. The third joint set in NW-SE is normal to the others. In general, according to topography, geomorphology and structural geology evidences, Chamshir dam has a potential for sliding in some parts of Gachsaran formation.

Keywords: DEM, chamshir dam, zohreh river, satellite images

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3221 Inhibitory Effect of Coumaroyl Lupendioic Acid on Inflammation Mediator Generation in Complete Freund’s Adjuvant-Induced Arthritis

Authors: Rayhana Begum, Manju Sharma

Abstract:

Careya arborea Roxb. belongs to the Lecythidaceae family, is traditionally used in tumors, anthelmintic, bronchitis, epileptic fits, astringents, inflammation, an antidote to snake-venom, skin disease, diarrhea, dysentery with bloody stools, dyspepsia, ulcer, toothache, and ear pain. The present study was focused on investigating the anti-arthritic effect of coumaroyl lupendioic acid, a new lupane-type triterpene from Careya arborea stem bark in the chronic inflammatory model and further assessing its possible mechanism on the modulation of inflammatory biomarkers. Arthritis was induced by injecting 0.1 ml of Complete Freund’s Adjuvant (5 mg/ml of heat killed Mycobacterium tuberculosis) into the subplantar region of the left hind paw. Treatment with coumaroyl lupendioic acid (10 and 20 mg/kg, p.o.) and reference drugs (indomethacin and dexamethasone at the dose of 5 mg/kg, p.o.) were started on the day of induction and continued up to 28 days. The progression of arthritis was evaluated by measuring paw volume, tibio tarsal joint diameters, and arthritic index. The effect of coumaroyl lupendioic acid (CLA) on the production PGE₂, NO, MPO, NF-κB, TNF-α, IL-1β, and IL-6 on serum level as well as inflamed paw tissue were also assessed. In addition, ankle joints and spleen were collected and prepared for histological examination. CLA in inflamed rats resulted in significant amelioration of paw edema, tibio-tarsal joint swelling and arthritic score as compared to CFA control group. The results indicated that CLA treated groups markedly decreased the levels of inflammatory mediators (PGE₂, NO, MPO and NF-κB levels) and down-regulated the production of pro-inflammatory cytokines (TNF-α, IL-1β, and IL-6) in paw tissue homogenates as well as in serum. However, the more pronounced effect was observed in the inflamed paw tissue homogenates. CLA also revealed a protective effect to the tibio-tarsal joint cartilage and spleen. These results suggest that coumaroyl lupendioic acid inhibits inflammation may be through the suppression of the cascade of proinflammatory mediators via the down-regulation of NF-ҡB.

Keywords: complete Freund’s adjuvant , Coumaroyl lupendioic acid, pro-inflammatory cytokines, prostaglandin E2

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3220 Economic Evaluation of Cardiac Rehabilitation Programs for Patients with Cardiovascular Diseases

Authors: Aziz Rezapour, Abdosaleh Jafari, Marziye Hadian, Elaheh Mazaheri

Abstract:

Introduction: Cardiac rehabilitation is an accurate educational and sporting program designed to help heart patients to increase their physical activities and reduce the risk factors that make their health worse and help to a healthier lifestyle so that they can return to their families and society with a better spirit. The aim of this study was to examine the cost-effectiveness and cost-utility of cardiac rehabilitation programs for patients with cardiovascular diseases. Methods: In the present review study, published articles related to cost-effectiveness and cost-utility of cardiac rehabilitation programs for patients with cardiovascular diseases within the time interval between 2004 and 2019 were searched using electronic databases. The methodological quality of the structure of articles was examined by Drummond’s standard checklist. Results: The results of reviewing studies showed that most of the studies related to the economic evaluation of cardiac rehabilitation programs in patients with cardiovascular disease were flawed in Drummond’s criteria, and only one study adhered to Drummond’s criteria. The results of the present study indicated use of cardiac rehabilitation programs in patients with cardiovascular disease was cost-effective. Conclusion: The results of this review study showed that although the results of the studies were different in terms of a number of aspects, such as the study perspective, the time horizons, and the costs of rehabilitation programs, they achieved a similar conclusion, they concluded that the use of cardiac rehabilitation programs in patients with cardiovascular diseases, leading to higher quality-adjusted life years (QALYs) and lower costs.

Keywords: economic evaluation, systematic review, cardiac rehabilitation, Drummond’s checklist

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3219 Evaluation of Mechanical Properties of Welds Fabricated at a Close Proximity on Offshore Structures

Authors: T. Nakkeran, C. Dhamodharan, Win Myint Soe , Ramasamy Deverajan, M. Ganesh Babu

Abstract:

This manuscript presents the results of an experimental investigation performed to study the material and mechanical properties of two weld joints fabricated within close proximity. The experiment was designed using welded S355 D Z35 with distances between two parallel adjacent weld toes at 8 mm. These distances were less than the distance that has normally been recommended in standards, codes, and specifications. The main idea of the analysis is to determine any significant effects when welding the joints with the close proximity of 8mm using the SAW welding process of the one joint with high heat put and one joint welded with the FCAW welding process and evaluating the destructing and nondestructive testing between the welded joints. Further, we have evaluated the joints with Mechanical Testing for evaluating by performing Tensile test, bend testing, Macrostructure, Microstructure, Hardness test, and Impact testing. After evaluating the final outcome of the result, no significant changes were observed for welding the close proximity of weld of 8mm distance between the joints as compared to the specification minimum distance between the weldments of any design should be 50mm.

Keywords: S355 carbon steel, weld proximity, SAW process, FCAW process, heat input, bend test, tensile test, hardness test, impact test, macro and microscopic examinations

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3218 Scope of Lasers in Periodontics

Authors: Atmaja Patel

Abstract:

Since the development of lasers in 1951, the first medical application was reported by Goldman in 1962. In 1960, T.H. Maiman produced the first Ruby laser and was used in cardiovascular surgery by McGuff in 1963. After a long time of investigations and new developments in laser technology first clinical applications were performed by Choy and Ginsburg in 1983. Introduction of the first true dental laser was in 1989. This paper is to highlight the various treatments and prevention of periodontal diseases. Lasers have become more predictable and effective form of treatment for periodontal diseases. The advantages of lasers include reduced use of anaesthesia, coagulation that yields a dry surgical field and hence better visibility, reduced need of sutures, minimal swelling and scarring, less pain and medication, faster healing and increased patient acceptance.

Keywords: lasers, periodontal surgery, diode laser, healing

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3217 Machine Learning for Disease Prediction Using Symptoms and X-Ray Images

Authors: Ravija Gunawardana, Banuka Athuraliya

Abstract:

Machine learning has emerged as a powerful tool for disease diagnosis and prediction. The use of machine learning algorithms has the potential to improve the accuracy of disease prediction, thereby enabling medical professionals to provide more effective and personalized treatments. This study focuses on developing a machine-learning model for disease prediction using symptoms and X-ray images. The importance of this study lies in its potential to assist medical professionals in accurately diagnosing diseases, thereby improving patient outcomes. Respiratory diseases are a significant cause of morbidity and mortality worldwide, and chest X-rays are commonly used in the diagnosis of these diseases. However, accurately interpreting X-ray images requires significant expertise and can be time-consuming, making it difficult to diagnose respiratory diseases in a timely manner. By incorporating machine learning algorithms, we can significantly enhance disease prediction accuracy, ultimately leading to better patient care. The study utilized the Mask R-CNN algorithm, which is a state-of-the-art method for object detection and segmentation in images, to process chest X-ray images. The model was trained and tested on a large dataset of patient information, which included both symptom data and X-ray images. The performance of the model was evaluated using a range of metrics, including accuracy, precision, recall, and F1-score. The results showed that the model achieved an accuracy rate of over 90%, indicating that it was able to accurately detect and segment regions of interest in the X-ray images. In addition to X-ray images, the study also incorporated symptoms as input data for disease prediction. The study used three different classifiers, namely Random Forest, K-Nearest Neighbor and Support Vector Machine, to predict diseases based on symptoms. These classifiers were trained and tested using the same dataset of patient information as the X-ray model. The results showed promising accuracy rates for predicting diseases using symptoms, with the ensemble learning techniques significantly improving the accuracy of disease prediction. The study's findings indicate that the use of machine learning algorithms can significantly enhance disease prediction accuracy, ultimately leading to better patient care. The model developed in this study has the potential to assist medical professionals in diagnosing respiratory diseases more accurately and efficiently. However, it is important to note that the accuracy of the model can be affected by several factors, including the quality of the X-ray images, the size of the dataset used for training, and the complexity of the disease being diagnosed. In conclusion, the study demonstrated the potential of machine learning algorithms for disease prediction using symptoms and X-ray images. The use of these algorithms can improve the accuracy of disease diagnosis, ultimately leading to better patient care. Further research is needed to validate the model's accuracy and effectiveness in a clinical setting and to expand its application to other diseases.

Keywords: K-nearest neighbor, mask R-CNN, random forest, support vector machine

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3216 Determination of Bromides, Chlorides and Fluorides in Case of Their Joint Presence in Ion-Conducting Electrolyte

Authors: V. Golubeva, O. Vakhnina, I. Konopkina, N. Gerasimova, N. Taturina, K. Zhogova

Abstract:

To improve chemical current sources, the ion-conducting electrolytes based on Li halides (LiCl-KCl, LiCl-LiBr-KBr, LiCl-LiBr-LiF) are developed. It is necessary to have chemical analytical methods for determination of halides to control the electrolytes technology. The methods of classical analytical chemistry are of interest, as they are characterized by high accuracy. Using these methods is a difficult task because halides have similar chemical properties. The objective of this work is to develop a titrimetric method for determining the content of bromides, chlorides, and fluorides in their joint presence in an ion-conducting electrolyte. In accordance with the developed method of analysis to determine fluorides, electrolyte sample is dissolved in diluted HCl acid; fluorides are titrated by La(NO₃)₃ solution with potentiometric indication of equivalence point, fluoride ion-selective electrode is used as sensor. Chlorides and bromides do not form a hardly soluble compound with La and do not interfere in result of analysis. To determine the bromides, the sample is dissolved in a diluted H₂SO₄ acid. The bromides are oxidized with a solution of KIO₃ to Br₂, which is removed from the reaction zone by boiling. Excess of KIO₃ is titrated by iodometric method. The content of bromides is calculated from the amount of KIO₃ spent on Br₂ oxidation. Chlorides and fluorides are not oxidized by KIO₃ and do not interfere in result of analysis. To determine the chlorides, the sample is dissolved in diluted HNO₃ acid and the total content of chlorides and bromides is determined by method of visual mercurometric titration with diphenylcarbazone indicator. Fluorides do not form a hardly soluble compound with mercury and do not interfere with determination. The content of chlorides is calculated taking into account the content of bromides in the sample of electrolyte. The validation of the developed analytical method was evaluated by analyzing internal reference material with known chlorides, bromides and fluorides content. The analytical method allows to determine chlorides, bromides and fluorides in case of their joint presence in ion-conducting electrolyte within the range and with relative total error (δ): for bromides from 60.0 to 65.0 %, δ = ± 2.1 %; for chlorides from 8.0 to 15.0 %, δ = ± 3.6 %; for fluorides from 5.0 to 8.0%, ± 1.5% . The analytical method allows to analyze electrolytes and mixtures that contain chlorides, bromides, fluorides of alkali metals and their mixtures (K, Na, Li).

Keywords: bromides, chlorides, fluorides, ion-conducting electrolyte

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3215 Structural Characteristics of HPDSP Concrete on Beam Column Joints

Authors: Hari Krishan Sharma, Sanjay Kumar Sharma, Sushil Kumar Swar

Abstract:

Inadequate transverse reinforcement is considered as the main reason for the beam column joint shear failure observed during recent earthquakes. DSP matrix consists of cement and high content of micro-silica with low water to cement ratio while the aggregates are graded quartz sand. The use of reinforcing fibres leads not only to the increase of tensile/bending strength and specific fracture energy, but also to reduction of brittleness and, consequently, to production of non-explosive ruptures. Besides, fibre-reinforced materials are more homogeneous and less sensitive to small defects and flaws. Recent works on the freeze-thaw durability (also in the presence of de-icing salts) of fibre-reinforced DSP confirm the excellent behaviour in the expected long term service life.DSP materials, including fibre-reinforced DSP and CRC (Compact Reinforced Composites) are obtained by using high quantities of super plasticizers and high volumes of micro-silica. Steel fibres with high tensile yield strength of smaller diameter and short length in different fibre volume percentage and aspect ratio tilized to improve the performance by reducing the brittleness of matrix material. In the case of High Performance Densified Small Particle Concrete (HPDSPC), concrete is dense at the micro-structure level, tensile strain would be much higher than that of the conventional SFRC, SIFCON & SIMCON. Beam-column sub-assemblages used as moment resisting constructed using HPDSPC in the joint region with varying quantities of steel fibres, fibre aspect ratio and fibre orientation in the critical section. These HPDSPC in the joint region sub-assemblages tested under cyclic/earthquake loading. Besides loading measurements, frame displacements, diagonal joint strain and rebar strain adjacent to the joint will also be measured to investigate stress-strain behaviour, load deformation characteristics, joint shear strength, failure mechanism, ductility associated parameters, stiffness and energy dissipated parameters of the beam column sub-assemblages also evaluated. Finally a design procedure for the optimum design of HPDSPC corresponding to moment, shear forces and axial forces for the reinforced concrete beam-column joint sub-assemblage proposed. The fact that the implementation of material brittleness measure in the design of RC structures can improve structural reliability by providing uniform safety margins over a wide range of structural sizes and material compositions well recognized in the structural design and research. This lead to the development of high performance concrete for the optimized combination of various structural ratios in concrete for the optimized combination of various structural properties. The structural applications of HPDSPC, because of extremely high strength, will reduce dead load significantly as compared to normal weight concrete thereby offering substantial cost saving and by providing improved seismic response, longer spans, and thinner sections, less reinforcing steel and lower foundation cost. These cost effective parameters will make this material more versatile for use in various structural applications like beam-column joints in industries, airports, parking areas, docks, harbours, and also containers for hazardous material, safety boxes and mould & tools for polymer composites and metals.

Keywords: high performance densified small particle concrete (HPDSPC), steel fibre reinforced concrete (SFRC), slurry infiltrated concrete (SIFCON), Slurry infiltrated mat concrete (SIMCON)

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3214 The Comparison of Joint Simulation and Estimation Methods for the Geometallurgical Modeling

Authors: Farzaneh Khorram

Abstract:

This paper endeavors to construct a block model to assess grinding energy consumption (CCE) and pinpoint blocks with the highest potential for energy usage during the grinding process within a specified region. Leveraging geostatistical techniques, particularly joint estimation, or simulation, based on geometallurgical data from various mineral processing stages, our objective is to forecast CCE across the study area. The dataset encompasses variables obtained from 2754 drill samples and a block model comprising 4680 blocks. The initial analysis encompassed exploratory data examination, variography, multivariate analysis, and the delineation of geological and structural units. Subsequent analysis involved the assessment of contacts between these units and the estimation of CCE via cokriging, considering its correlation with SPI. The selection of blocks exhibiting maximum CCE holds paramount importance for cost estimation, production planning, and risk mitigation. The study conducted exploratory data analysis on lithology, rock type, and failure variables, revealing seamless boundaries between geometallurgical units. Simulation methods, such as Plurigaussian and Turning band, demonstrated more realistic outcomes compared to cokriging, owing to the inherent characteristics of geometallurgical data and the limitations of kriging methods.

Keywords: geometallurgy, multivariate analysis, plurigaussian, turning band method, cokriging

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3213 Correlation between Dynamic Knee Valgus with Isometric Hip Abductors Strength during Single-Leg Landing

Authors: Ahmed Fawzy, Khaled Ayad, Gh. M. Koura, W. Reda

Abstract:

The knee joint complex is one of the most commonly injured areas of the body in athletes. Excessive frontal plane knee excursion is considered a risk factor for multiple knee pathologies such as anterior cruciate ligament and patellofemoral joint injuries, however, little is known about the biomechanical factors that contribute to this loading pattern. Objectives: The purpose of this study was to investigate if there is a relationship between hip abductors isometric strength and the value of FPPA during single leg landing tasks in normal male subjects. Methods: One hundred (male) subjects free from lower extremity injuries for at least six months ago participated in this study. Their mean age was (23.25 ± 2.88) years, mean weight was (74.76 ± 13.54) (Kg), mean height was (174.23 ± 6.56) (Cm). The knee frontal plane projection angle was measured by digital video camera using single leg landing task. Hip abductors isometric strength were assessed by portable hand-held dynamometer. Muscle strength had been normalized to the body weight to obtain more accurate measurements. Results: The results demonstrated that there was no significant relationship between hip abductors isometric strength and the value of FPPA during single leg landing tasks in normal male subjects. Conclusion: It can be concluded that there is no relationship between hip abductors isometric strength and the value of FPPA during functional activities in normal male subjects.

Keywords: 2-dimensional motion analysis, hip strength, kinematics, knee injuries

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3212 Montelukast Doesn’t Decrease the Risk of Cardiovascular Disease in Asthma Patients in Taiwan

Authors: Sheng Yu Chen, Shi-Heng Wang

Abstract:

Aim: Based on human, animal experiments, and genetic studies, cysteinyl leukotrienes, LTC4, LTD4, and LTE4, are inflammatory substances that are metabolized by 5-lipooxygenase from arachidonic acid, and these substances trigger asthma. In addition, the synthetic pathway of cysteinyl leukotriene is relevant to the increase in cardiovascular diseases such as myocardial ischemia and stroke. Given the situation, we aim to investigate whether cysteinyl leukotrienes receptor antagonist (LTRA), montelukast which cures those who have asthma has potential protective effects on cardiovascular diseases. Method: We conducted a cohort study, and enrolled participants which are newly diagnosed with asthma (ICD-9 CM code 493. X) between 2002 to 2011. The data source is from Taiwan National Health Insurance Research Database Patients with a previous history of myocardial infarction or ischemic stroke were excluded. Among the remaining participants, every montelukast user was matched with two randomly non-users by sex, and age. The incident cardiovascular diseases, including myocardial infarction and ischemic stroke, were regarded as outcomes. We followed the participants until outcomes come first or the end of the following period. To explore the protective effect of montelukast on the risk of cardiovascular disease, we use multivariable Cox regression to estimate the hazard ratio with adjustment for potential confounding factors. Result: There are 55876 newly diagnosed asthma patients who had at least one claim of inpatient admission or at least three claims of outpatient records. We enrolled 5350 montelukast users and 10700 non-users in this cohort study. The following mean (±SD) time of the Montelukast group is 5 (±2.19 )years, and the non-users group is 6.2 5.47 (± 2.641) years. By using multivariable Cox regression, our analysis indicated that the risk of incident cardiovascular diseases between montelukast users (n=43, 0.8%) and non-users (n=111, 1.04%) is approximately equal. [adjusted hazard ratio 0.992; P-value:0.9643] Conclusion: In this population-based study, we found that the use of montelukast is not associated with a decrease in incident MI or IS.

Keywords: asthma, inflammation, montelukast, insurance research database, cardiovascular diseases

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3211 Nutritional Wellness at the Workplace

Authors: Siveshnee Devar

Abstract:

Background: The rate of absenteeism and prevalence of NCDs in South Africa is extremely high. This is consistent with other educational institutions and workplaces around the globe. In most cases the absence of health and the presence of one or more non communicable diseases coupled with the lack of physical exercise is a major factor in absenteeism. Absenteeism at the workplace comes at a huge cost to the employer and the country as a whole. Aim: Findings from this study was to develop a suitable nutritional wellness program for the workplace. Methodology: A needs analysis in the form of 24-hour recall, food frequency, health and socio demographic questionnaires was undertaken to determine the need for a wellness program for the institution. Anthropometric indices such as BMI, waist circumference and blood pressure were also undertaken to determine the state of health of the staff. Results: This study has found that obesity, central obesity, hypertension as well as deficiencies in nutrients and minerals were prevalent in this group. Fruit and vegetable consumption was also below the WHO recommendation. This study showed a link between diet, physical activity and diseases of lifestyle. There were positive correlations between age and systolic blood pressure, waist circumference and systolic blood pressure, waist circumference and diastolic blood pressure and waist-to-height ratio and BMI. Conclusion: The results indicated the need for immediate intervention in the form of a wellness program. Nutrition education is important for both the workplace and out. Education and knowledge are important factors for lifestyle changes. The proposed intervention is aimed at improving presenteeism and decreasing the incidence of non- communicable diseases. Presenteeism and good health are important factors for quality education at all educational institutions.

Keywords: absenteeism, non-communicable diseases, nutrition, wellness

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3210 Assessment of Academic Knowledge Transfer Channels in Field of Environment

Authors: Jagul Huma Lashari, Arabella Bhutto

Abstract:

Last few years have shown increased an interest of researchers in knowledge and technology transfer. However, facts show fewer types of knowledge transfer practices in the developing countries. This article focuses on assessment transfer channels of academic research produced by highly qualified academicians working in universities in Sindh offering degrees in field of an Environment in Sindh Pakistan. The academic field has been chosen because in field of the environment there is alarming need of research into practice for sustainable development. Using case study approach; in this research qualitative interviews have been conducted from PhD faculty members working in the universities offering degrees in field of environment. Obtained data is analyzed using descriptive statistics and chi-square test with the help of statistical packages for social sciences (SPSS). Research explored 31 channels of academic knowledge transfer from detailed review of literature and exploratory interviews with participants. Identified knowledge transfer channels have been grouped together in 6 groups of knowledge transfer channels; As knowledge transfer through publications, networking, mobility of researchers, joint research, intellectual property and co-operations. Results revealed that academic knowledge have been transferred through publications, networking, and co-operation. However, less number of academic knowledge has been transferred through groups of knowledge transfer channels such as Intellectual Property and joint research.

Keywords: environment, research knowledge, transfer channels, universities

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3209 Image Processing-Based Maize Disease Detection Using Mobile Application

Authors: Nathenal Thomas

Abstract:

In the food chain and in many other agricultural products, corn, also known as maize, which goes by the scientific name Zea mays subsp, is a widely produced agricultural product. Corn has the highest adaptability. It comes in many different types, is employed in many different industrial processes, and is more adaptable to different agro-climatic situations. In Ethiopia, maize is among the most widely grown crop. Small-scale corn farming may be a household's only source of food in developing nations like Ethiopia. The aforementioned data demonstrates that the country's requirement for this crop is excessively high, and conversely, the crop's productivity is very low for a variety of reasons. The most damaging disease that greatly contributes to this imbalance between the crop's supply and demand is the corn disease. The failure to diagnose diseases in maize plant until they are too late is one of the most important factors influencing crop output in Ethiopia. This study will aid in the early detection of such diseases and support farmers during the cultivation process, directly affecting the amount of maize produced. The diseases in maize plants, such as northern leaf blight and cercospora leaf spot, have distinct symptoms that are visible. This study aims to detect the most frequent and degrading maize diseases using the most efficiently used subset of machine learning technology, deep learning so, called Image Processing. Deep learning uses networks that can be trained from unlabeled data without supervision (unsupervised). It is a feature that simulates the exercises the human brain goes through when digesting data. Its applications include speech recognition, language translation, object classification, and decision-making. Convolutional Neural Network (CNN) for Image Processing, also known as convent, is a deep learning class that is widely used for image classification, image detection, face recognition, and other problems. it will also use this algorithm as the state-of-the-art for my research to detect maize diseases by photographing maize leaves using a mobile phone.

Keywords: CNN, zea mays subsp, leaf blight, cercospora leaf spot

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3208 Computational Approach to the Interaction of Neurotoxins and Kv1.3 Channel

Authors: Janneth González, George Barreto, Ludis Morales, Angélica Sabogal

Abstract:

Sea anemone neurotoxins are peptides that interact with Na+ and K+ channels, resulting in specific alterations on their functions. Some of these neurotoxins (1ROO, 1BGK, 2K9E, 1BEI) are important for the treatment of nearly eighty autoimmune disorders due to their specificity for Kv1.3 channel. The aim of this study was to identify the common residues among these neurotoxins by computational methods, and establish whether there is a pattern useful for the future generation of a treatment for autoimmune diseases. Our results showed eight new key common residues between the studied neurotoxins interacting with a histidine ring and the selectivity filter of the receptor, thus showing a possible pattern of interaction. This knowledge may serve as an input for the design of more promising drugs for autoimmune treatments.

Keywords: neurotoxins, potassium channel, Kv1.3, computational methods, autoimmune diseases

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3207 Surface-Enhanced Raman Spectroscopy on Gold Nanoparticles in the Kidney Disease

Authors: Leonardo C. Pacheco-Londoño, Nataly J Galan-Freyle, Lisandro Pacheco-Lugo, Antonio Acosta-Hoyos, Elkin Navarro, Gustavo Aroca-Martinez, Karin Rondón-Payares, Alberto C. Espinosa-Garavito, Samuel P. Hernández-Rivera

Abstract:

At the Life Science Research Center at Simon Bolivar University, a primary focus is the diagnosis of various diseases, and the use of gold nanoparticles (Au-NPs) in diverse biomedical applications is continually expanding. In the present study, Au-NPs were employed as substrates for Surface-Enhanced Raman Spectroscopy (SERS) aimed at diagnosing kidney diseases arising from Lupus Nephritis (LN), preeclampsia (PC), and Hypertension (H). Discrimination models were developed for distinguishing patients with and without kidney diseases based on the SERS signals from urine samples by partial least squares-discriminant analysis (PLS-DA). A comparative study of the Raman signals across the three conditions was conducted, leading to the identification of potential metabolite signals. Model performance was assessed through cross-validation and external validation, determining parameters like sensitivity and specificity. Additionally, a secondary analysis was performed using machine learning (ML) models, wherein different ML algorithms were evaluated for their efficiency. Models’ validation was carried out using cross-validation and external validation, and other parameters were determined, such as sensitivity and specificity; the models showed average values of 0.9 for both parameters. Additionally, it is not possible to highlight this collaborative effort involved two university research centers and two healthcare institutions, ensuring ethical treatment and informed consent of patient samples.

Keywords: SERS, Raman, PLS-DA, kidney diseases

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3206 Households’ Willingness to Pay for Environmental and General Health Safety during the Advent of Ebola Virus Diseases in Nigeria

Authors: Shittu Bisi Agnes

Abstract:

Studies on households’ willingness to pay for environmental and general health safety in the advent of Ebola virus Diseases in Nigeria was carried out. This is aimed at revealing the means by which the virus was eventually eradicated in Nigeria as widely claimed in the media. This study therefore attempted to determine the environmental and general health condition in the State Of Osun, how socio-economic characteristics of the people affected willingness to pay. And also provide platform for the reduction of environmental and general health problems. Data were collected with the aid of well-structured questionnaire and administer 150 randomly selected people of study area, and oral interview was also utilized. Data collected were analyzed using both descriptive tools and inferential statistics vis-a-viz regression analysis. Findings showed 92.5% of respondents was aware of ebola virus diseases outbreak in Nigeria, 8.5% was unaware of any disease outbreak. And 65.7% of respondents was strongly willing to pay for environmental and general health safety 27.1% was fairly willing, 5.7% was indifferent and 1.7% was unwilling to pay. 5% rated the level of environmental and general health condition in the area has been good, 53.6% rated theirs has been fair, 33.6% as been poor. The average willingness to pay per household per month were #500.00, #250.00, #150.00 and #100.00 respectively for the four categories. It was recommended that policy instruments to increase peoples' income will accelerate eradication of environmental and general health problems, environmental health education in form of talk shop, workshop, lectures and seminars could be organized at the political ward levels, churches, mosque, and at schools. Environmental and general health safety related information could be disseminated through mass media, market women, and functional unions.

Keywords: ebola virus diseases (EVD), socio-economic, safety, pay, Osun

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3205 Emerging Issues of Non-Communicable Diseases among Older Persons in India

Authors: Dhananjay W. Bansod, Santosh Phad

Abstract:

Non-Communicable Diseases (NCD) are major contributing factors to the disease burden in the world as well as in India. With a growing proportion of older persons in India gives rise to several challenges. With the advancement of age, elderly is exposed to various kinds of health problems more specifically NCDs. Therefore, an effort has been made to examine the prevalence of NCDs among older persons and its treatment-seeking behaviour, also it is tried to explore the association between the NCDs and its effect on the overall wellbeing of older persons. Data used from “Building Knowledge Base of Population Ageing Survey” conducted in 2011 in seven states of India. Six chronic diseases used (non-communicable diseases) namely Arthritis, Hypertension, Cataract, Diabetes, Asthma and Heart diseases to understand the issues related to NCDs. Also seen the effect of NCDs on the wellbeing of the elderly, the subjective well-being consists of nine questions from which SUBI score generated for mental health status, which ranges from 9 to 27. This Index indicates that lower the score better is the mental health status. Further, this index modified and generated three categories of Better (9-15), Average (16-20) and Worse (21-27). The reliability analysis is carried out with the coefficient (Cronbach’s alpha) of the scale was 0.8884. The result shows that Orthopedic / musculoskeletal ailments involving arthritis, rheumatism and osteoarthritis are the most common type of ailment followed by hypertension. Two-thirds of the elderly reported suffering from at least one chronic ailment. Most chronic illness conditions received some form of treatment and mainly depend on public health facilities. Financial insecurity is the primary obstruction in seeking treatment for most of the chronic ailments which typically require a longer duration of medication and repeated medical consultations, both having significant economic implications. According to SUBI index, only 15 per cent of the elderly are in Better mental health status, and one-third of the elderly are with the worse score. Elderly with the ailments like Cataract, Asthma and Arthritis have worse mental health. It depicts that the burden of disease is more among the elderly and it is directly affecting the overall wellbeing of older persons.

Keywords: NCD, well-being, older person, India

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3204 A Cross Culture Analysis of Medicinal Plants and Phytotherapies: Highly Effective for Gastropathic Disorders among Three Ethnic Communities of South West Pakistan

Authors: Sheikh Z. Ul Abidin, Raees Khan, Rainer W. Bussmann, Mushtaq Ahmad, Shayan Jamshed, Humera Jabeen, Ajmal Khan

Abstract:

Gastropathic disorders are increasing rapidly and millions patients are reported every years across the world. Herbal medicines and traditional phytotherapies are very effective for many diseases including gastropathic ailments. Many communities and study region have their own unique remedies for such diseases. The current study was aimed to investigate and document high valued medicinal plants and folk remedies for different gastropathic disorders among the three ethnic groups of three regions in South West Pakistan. A total of 104 semi-structured interviews involving experts of traditional knowledge in 21 localities of the three regions (D.I. Khan, Zhob and Mianwali) were conducted. The interviews were especially focused on the documentation of folk herbal remedies. The collected data was analyzed using different quantitative methods. The highly effective plants from all localities were identified with the help of local interviewers and collected for proper taxonomic identification. A total of 56 medicinal plants and 33 effective recipes for 12 gastropathic diseases were documented from all the three ethnic groups in 21 localities. Fabaceae and Asteraceae were most prominently used for different gastropathic diseases. Diarrhea, vomiting and dysentery were the most commonly diseases treated with herbal remedies. It was observed that the three communities shared knowledge about the use of medicinal plants, 35 species were commonly reported from all three areas. However, each community had also their own unique uses of medicinal plants, e.g. 23 plants species were only used in Zhob, 20 plant species were only reported in D.I. Khan and 16 species in Mianwali. The present study reveals that different communities and ethnic groups share some traditional knowledge and also have their own unique knowledge of plants utilization. Gastropathic disorder is increasing very rapidly and the traditional cross-cultural knowledge of medicinal plants use can be very effective for its cure.

Keywords: cross cultural, ethnic groups, gastropathy, phytotherapies, South West Pakistan

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