A total of 7097 patients were included in the study that was the confirmed cases of Hepatitis Cfrom four districts of Punjab, Pakistan, during the period of three years from Jul 1, 2018, to Jun 30, 2021. Included study settings were Sheikh Zayed Hospital, Rahim Yar Khan (n = 1349); Rural Health Care center, KachaKhu, District Khanewal (n= 1014); Basic Health Care Unit, Faisalabad (n = 846); and Outdoor Patient Department, Liver Clinic, Mayo Hospital Lahore (n = 3888).Three thousand one hundred ten patients were from the 2018-2019 year, 2385 patients were from 2019-2020, and 1602 patients were from 2020-2021. This study used a cross-sectional design. Different institutional review panels were approached to take the approval for the study. The article contains the entire plan for statistical analysis. This study was not funded by any organization as Pakistani does not provide this facility. This study interviewed all the patients who suffered from hepatitis C and was treated surgically. Inclusion and exclusion criteria have been presented in Table 1
The study was conducted by designing a questionnaire comprising of queries based upon transmission source of hepatitis C virus either by dental procedures or surgical procedures in Punjab, Pakistan. The English language was used to design the questionnaire and then translate it into the Urdu language for the convenience of some illiterate people. Data was collected after taking interviews from patients regarding the surgical history, and after taking interviews, patients were evaluated by their blood tests, e.g., ELISA and PCR. The following variables were studied; age, gender, study settings, surgical history (dental and general surgical), private and government sector analysis, patient's knowledge about sterilization, and inquiry about surgical instruments sterilization before going to operation theater for surgery. Before enrolling the patients for research, their consent has been taken. In the pandemic situation from the end of 2019 to 2021, we had continued to collect data with the SOPs (hand sanitization, mask-wearing, and social distancing). The situation has not affected our study.
2.1.Development of Ann Model
The ANN model was back-propagated and standard feed-forward and equipped with hidden layers, an output node, and input nodes. The feed-forward network layer contains the new tool, which is a multilayer perceptron network (MLP). The output layer is composed of neurons, while the input layer is made up of source nodes. The external work network is mainly linked through these two layers. There is an additional neuron layer, known as hidden neurons, as it is difficult to assess this layer directly. Through hidden neurons can extract the primary input data features. The backpropagation algorithms are used for backward and forward trained MLPs. The backpropagation algorithms are efficiently executed and have satisfactory computational efficiency for linear complexity. The optimal learning proficiency can be attained by activating the neurons through anti-symmetric and non-symmetric functions[12,13]. In this research, selected factors (age, gender, study settings, year of study, sector analysis, patient's knowledge about sterilization, and inquiry about surgical instruments sterilization before going to operation theater for surgery) were served as the input layers neurons. One factor (dental procedures and general surgical procedures) was performed as the output layer neuron. ANN model developed on the study years and identical factors with the same standards. The selected factors (age, gender, study settings, surgical history (dental and general surgical), private and government sector analysis, patient's knowledge about sterilization, and inquiries about surgical instruments sterilization before going to Operation Theater for surgery) were served as the input layers neurons. One factor (years of study, e.g., 2018-2019, 2019-2020, and 2020- 2021) was served as the output layer neuron.
2.2.Simulatting Discrete Pareto Distribution
Different phenomena like Pareto, Zipf, and power-law are used where small events are widespread, but the larger ones rarely occur. For instance, the occurrence of small earthquakes is quite common than the larger ones. Small cities are common than megacities. Some words are used frequently, like "and" and "the," while some words infrequently occur. According to the Economists, in the 19th century, 20 percent of the Italians possessed the country's 80% wealth, which is observed through Wilfried Fritz Pareto. That is why it is also recognized as the 80/20 rule. According to the power law's example for transmission distribution, the hypothesis was consistent with the empirical data that the frequency of cases drives from the condensed power-law distribution in the form of P(n) ~ n−μ, 1 ⩽ n ⩽ n max'. The histogram for the Pareto distribution was produced by utilizing the SPSS version 23, as shown in Fig. 3.
Descriptive statistics were applied to determine the mean and standard deviation of age and gender distribution of patients of every study year. The following Table 1 and 2 were calculated the frequency and percentage in the target population who participated in the study. The Chi-square test was also applied with SPSS 23.0 software, and P values < 0.05 were considered statistically significant.