Symptomatic central nervous system tuberculoma, a case report in the United States and literature review

Intracranial tuberculoma is one of the rare central nervous system manifestations of Mycobacterium tuberculosis (MTB), seen in only 1% of tuberculosis patients. It can manifest as single or multiple lesions, most commonly located in the frontal and parietal lobes. Clinical features are similar to any space-occupying lesion in the brain and can present in the absence of MTB symptoms in other parts of the body. In this article, a 69-year-old immunocompetent man, with history of treated latent tuberculosis infection (LTBI) was reported. He presented with multiple joint arthralgias, weight loss, odd behavior, forgetfulness, intermittent fevers and syncope. Brain imaging revealed numerous enhancing intra-parenchymal lesions in cerebral and cerebellar hemispheres. Patient was successfully treated with anti-tuberculosis medications and corticosteroids, with clinical improvement on future follow ups. High clinical suspicion for tuberculoma as a differential diagnosis of any brain lesion, even in immunocompetent patients in low MTB prevalence countries, can result in early diagnosis and successful clinical outcomes

Blastomycosis presenting as an isolated progressive painless verrucous skin lesion

A painless progressive verrucous skin plaque in an endemic area should raise suspicion for blastomycosis resulting in prompt biopsy with fungal stains and culture. Skin is a common extrapulmonary site. Itraconazole is treatment of choice

Microbial and parasitic contamination on circulating Pakistani Currency

Background: Fomites are nonliving objects that are capable of imbibing, harboring and spreading infectious microorganisms. Currency notes and coins, as exchangeable fomite, are constantly subjected to contamination. The objective of this study was to determine microbial and parasitic contamination of Pakistani currency thus highlighting the potential of money for spreading pathogens in the Pakistani community.Methods: In the present study, a total of 81 Pakistani currency notes and coins in circulation were randomly collected from different shopkeepers, vendors, canteen owners and restaurant cashiers in Lahore and analyzed for parasitological, fungal, aerobic and anaerobic microbial analyses by using various microbiological techniques.Results: The study revealed 92.5% of Pakistani currency to be contaminated with pathological microorganisms. Potential pathogens such as Staphylococcus spp. (48.05%), Streptococuss spp. (3.89%), Micrococcus spp. (5.19%), Bacillus subtilis (11.68%), Corynebacterium spp. (7.79%), Cronobacter sakazakii (2.59%), Burkholderia cepacia (1.29%), Klebsiella pneumoniae (2.59%), Serretia rubideae (1.29%), Bacteriodes spp. (34.46%) and Yeast and Mold (3.89) % respectively were isolated. The parasitological analysis of the currency evinces 13.58% of the samples with parasitic ova and cysts. Predominant ova and cysts of Entamoeba histolytica & Giardia lamblia were identified.Conclusion: This study indicates that currency notes and coins are excellent fomites that can harbor the microorganisms very well. The current analyses points out towards the unhygienic practices of the people spending money in the form of currency notes and coins. Launching effective and frequent awareness campaigns in the society can help to stop the spread of microorganisms to a greater extent

Mycobacterium smegmatis bacteremia in an immunocompetent host

Non-tuberculous mycobacteria can cause catheter associated blood stream infections. The causative agents are generally rapid growers that belong to the Mycobacterium fortuitum and Mycobacterium mucogenicum groups. A 65 year hospitalized patient with temporary central venous catheter who developed Mycobacterium smegmatis bacteremia. Bacteremia cleared after removal of the catheter. Patient was treated initially with 4 weeks of intravenous amikacin, intravenous meropenem, oral doxycycline and oral ethambutol and then deescalated to oral doxycycline and oral ciprofloxacin for 8 weeks. He improved clinically and remained stable. A literature search identified total of 22 articles that reported 47 unique cases of Mycobacterium smegmatis infection. To our knowledge, this is the first case of Mycobacterium smegmatis central venous catheter associated bacteremia in an immunocompetent host

Impact of Liquidity on Profitability and Performance: A Case of Textile Sector of Pakistan

Liquidity and firm performance has been a contentious concern among the finance scholars.Former researches interprets that asset liquidity increases debt level while in some countries firms having more liquidity were less leveraged and were dependant on internal finance.This study reconnoiters the effect of liquidity ratios on profitability and performance of textile sector of Pakistan from 2005 to 2014.Fixed effect panel regression model is applied to scrutinize the impact of liquidity ratios in presence of control variables like firm size and sales growth.Results interpret that current ratio has positive impact on profitability and performance while acid ratio has insignificant effect on the performance but has significant positive effect on profitability during the study period

Perforation of sigmoid neovagina in a patient with Mayer-Rokitansky-Küster-Hauser syndrom

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital aplasia of the uterus and upper part of the vagina in females. Treatment includes surgical creation of a functional neovagina. Perforation of the neovagina is extremely rare with only handful of cases reported in transgender patients post gender reassignment surgery. We report a first case of sigmoid neovaginal perforation in MRKS patient. The patient presented with progressively worsen abdominal pain and multiple intra-abdominal abscesses due to perforation of sigmoid neovagina. She was treated with surgical drainage and antibiotics and recovered clinically. Although exceedingly rare, we should keep history of sigmoid neovaginoplasty and possible perforation in patients with MRKS presenting with abdominal abscesses

Impact of transformational leadership on work performance, burnout and social loafing: a mediation model

The aim of this research was to study the effect of transformational leadership on employees’ work outcomes which include their work performances and working burnout, and their working behavior such as social loafing at workplace. Also, it studies the impact of intrinsic motivation as a mediator between transformational leadership and other stated variables. A cross-sectional survey was conducted to collect data from 308 employees working in the telecommunication sector. To test the hypotheses, Model 4 of Process Hayes was used to test direct and mediating effects among transformational leadership and employees’ work outcomes and working behavior. The results showed that transformational leadership has a significant positive relationship with mediator intrinsic motivation. The results also concluded that work performance has positive significant relationship with transformational leadership. However, there is indirect and insignificant relationship of transformational leadership with working burnout and social loafing. Therefore, it can be stated that organizational leaders must have transformational attributes by getting informed of their employees well because transformational leader can inspire employees to achieve anticipated or significant outcomes. It gives employees self-confidence over specific jobs, as well as the power to make decisions once they have been trained

Is your patient FIT & SAFE? A quality improvement project on the discharge of asthmatic patients from the Emergency Department: a UK based study project

Objective: The aim of the quality improvement project was to ensure that 80% of patients discharged from the Emergency Department received the Royal College of Emergency Medicine (RCEM) standards of asthma care.Methodology: We used the model for improvement’s plan, do, study, act (PDSA) methodology to accomplish this aim. 5 adult patients (>16 years) who presented with an asthma exacerbation and were discharged were selected per week. Patient notes were reviewed to see if they complied with the RCEM standards. Six PDSA cycles were carried out using a mixture of outcome, process and balancing measures. Various change ideas were introduced, tested an iterated including: a discharge mnemonic for asthma patients (FIT & SAFE) was derived and introduced, tailored teaching sessions for doctors and nurses, regular updates to staff using email and social media, and an electronic, asthma clerking pro-forma. Data was entered into run charts.Results: Baseline data was collected for 62 patients prior to the introduction of the change ideas. The results 12 weeks post PDSA cycles were as follows: psychosocial factors (25.8% vs 81.3%), inhaler technique (14.5% vs 53.3%), inhaler type (17.7% vs 84.2%), correct dose of prednisolone for 5 days (59.6% vs 81.5%), written advice (4.8%  vs 21.1%), and to see GP/clinic follow-up in 2 working days (37% vs 60.8%).Conclusion: There was a significant increase across most domains of the discharge process as recommended by the RCEM, after 12 weeks of implementation of various change ideas in the department

Is your patient FIT & SAFE? A quality improvement project on the discharge of asthmatic patients from the Emergency Department: a UK based study project

Objective: The aim of the quality improvement project was to ensure that 80% of patients discharged from the Emergency Department received the Royal College of Emergency Medicine (RCEM) standards of asthma care.Methodology: We used the model for improvement’s plan, do, study, act (PDSA) methodology to accomplish this aim. 5 adult patients (>16 years) who presented with an asthma exacerbation and were discharged were selected per week. Patient notes were reviewed to see if they complied with the RCEM standards. Six PDSA cycles were carried out using a mixture of outcome, process and balancing measures. Various change ideas were introduced, tested an iterated including: a discharge mnemonic for asthma patients (FIT & SAFE) was derived and introduced, tailored teaching sessions for doctors and nurses, regular updates to staff using email and social media, and an electronic, asthma clerking pro-forma. Data was entered into run charts.Results: Baseline data was collected for 62 patients prior to the introduction of the change ideas. The results 12 weeks post PDSA cycles were as follows: psychosocial factors (25.8% vs 81.3%), inhaler technique (14.5% vs 53.3%), inhaler type (17.7% vs 84.2%), correct dose of prednisolone for 5 days (59.6% vs 81.5%), written advice (4.8%  vs 21.1%), and to see GP/clinic follow-up in 2 working days (37% vs 60.8%).Conclusion: There was a significant increase across most domains of the discharge process as recommended by the RCEM, after 12 weeks of implementation of various change ideas in the department

An Empirical Analysis of the Relationship between Human Capital and Organizational Performance in Hospitality Sector in Pakistan

Human capital is professed as a critical factor and a special resource that can elevate the firm’s performance, generally, in most of the organizations, and specifically, in labor-intensive organizations. It is considered a special resource in the hotel industry where employees have direct interaction with customers. Although a lot of research has been done, however, the question of how much and what type of human capital is required by the organization to fight in the recent rivalry is still unanswered. This study is an effort to answer the aforesaid question about human capital in the hospitality sector in Pakistan (involving five stars, four-star, and three-star hotels separately). A theoretical framework and a research conceptual model is developed on the bases of in-depth literature. A cross-sectional field survey was conducted through an adopted and valid research instrument. Questionnaires were administered to 300 respondents selected by stratified random sampling, 275 were received and 250 were perfect for further use in SPSS version 22. Statistical analysis shows the results which clearly identify the strong and significant relationship between human capital and organizational performance. Moreover, microanalysis of components of human capital depicts that innovation and creation have the most significant impact among all of the three components, on organizational performance in all types of hotels in Pakistan. Theoretically, the current study added knowledge to the literature about the constructs of human capital, organizational performance, and organization success. Practically, in the hotel industry, it contributes to strategic decision making such as employees’ training, human capital investment, regulatory decisions, developing mechanisms in order to develop human capital as a unique and valuable resource that leads to the competitive advantage of the organizations. The current study is limited to five stars, four-star and three-star hotels in Lahore, Pakistan. It an important and initial step towards establishing a measurable and empirical value of human capital for organizations in the hospitality sector. However, It opens new vistas for researchers to further investigate the phenomenon