Bilateral Chylothorax Post Blunt Trauma: A Case Report

Introduction: Blunt trauma is a rare cause of chylothorax. In this study an uncommon case of traumatic chylothorax after blunt trauma is described along with treatment options.   Report on a Case: A 50-year-old male was admitted to the hospital with sudden onset of shortness of breath for one day. He had a history of road traffic accident 2 days ago, in which he received a strong jerk while trying to avoid impact with the dashboard of the vehicle. He has no past medical history. On examination, He was fully conscious and oriented. Air entry on both sides of the chest was reduced. The x-ray of the chest revealed bilateral blunting of costo-phrenic angels due to pleural effusion. Pleural fluid was sent for biochemical, microbiological and histopathological analysis. Fluid Triglyceride and cholesterol levels were elevated. Culture and sensitivity were negative while cytopathological analysis revealed increased WBCs. CT scan of the chest did not reveal any malignancy or mediastinal lymph nodes.  Bilateral Chest intubation was done to treat severe shortness of breath, that drained milky white fluid. The patient was observed without any particular treatment other than chest intubation. The patient responded well and was discharged uneventfully after five days.  Conclusion: Despite its rarity, chylothorax can occur after blunt trauma. Diagnosis should be confirmed by laboratory testing. Conservative management with or without chest intubation is a common treatment option.  Keywords: Blunt chest trauma, Chylothorax, Tri­glyceride.  &nbsp

Risk assessment across life cycle phases for small and medium software

Risk is labelled as an undesirable event that is encountered by every project irrespective of industry. Most software projects fail to meet the planned targets, i.e., scope, time, cost and quality. Software projects faced a wide range of risks and all risks cannot be dealt with the same priority. Risk can be prioritized by the probability of its occurrence and its impact. Therefore, risk assessment is required to highlight and prioritize serious risks. However, a very few researches targeted risk assessment faced by small and medium software projects. This research performs a risk assessment and highlighted serious risks faced by professionals working on small and medium software projects by documenting probability and impact. The chances of success of software projects can be increased by performing a proper risk assessment. The risks are identified by exploring and reviewing the existing literature. The identified risks are grouped by life cycle phases. This research utilizes a questionnaire-based approach to record the response of 163 software professionals working in Pakistan software industry. SPSS is used for data management and for performing statistical analysis. Probability and impact of each risk are measured to highlight the potential risks. The results concluded that the severity level of the majority of risks faced by small and medium software projects in Pakistan software industry is significant and high. The success of every project matters a lot for the progress of the organizations working on a small and medium level. Therefore, this research guide professionals and organizations to consider and prioritize the risk faced while working on small and medium software projects to increase the chances of the project's success

Playing Doom with Anticipator-A3C Based Agents Using Deep Reinforcement Learning and the ViZDoom Game-AI Research Platform

The built-in game agents act according to the pre-written scripts and make decisions, take actions like they have been stated. They acquire and take advantage of unfair information, instead of acting flexibly like human players, who make decisions only based on game screens. This chapter focuses on studying the application of Deep Learning and Reinforcement Learning in games agents and the improvement of the related algorithms. The goal is to develop a game agent that makes decisions in human’s way and gets rid of relying on unfair information. A game agent (CNN) is implemented by augmenting the A3C algorithm. This agent takes the original real-time game screen as the input of the network, and then output the matching policy. The agent interacts with ViZDoom and reads the real-time game screen to make decisions for controlling the character to act. This chapter improved the A3C algorithm by adding an anticipator network to the original model structure. The goal of doing this is to make the agent act more like human players. It will generate anticipation before making decisions, then combine the real-time game screen with anticipation images together as a whole input of the network defined by the A3C algorithm. It can use the combination of the data to make decisions and output the discrete actions. Because the method only changes the structure of data for the input of the network, so it is a model-free method and can be easily transplanted to other algorithms. The performance of A3C is compared with variants proposed in this chapter, analyzed the differences between them and gathered the experimental data from the latest articles as a comparison which studies the same problem. The result shows, that the A3C algorithm with Anticipation performs better than the A3C algorithm

SPATA: Strong Pseudonym based AuthenTicAtion in Intelligent Transport System

Intelligent Transport System (ITS) is generally deployed to improve road safety, comfort, security, and traffic efficiency. A robust mechanism of authentication and secure communication is required to protect privacy and conditional resolution of pseudonyms to revoke malicious vehicles. In a typical ITS framework, a station can be a vehicle, Road Side Unit (RSU), or a server that can participate in communication. During authentication, the real identity of an Intelligent Transport System-Station (ITSS), referred to as a vehiclečň should not be revealed in order to preserve its privacy. In this paper, we propose a Strong Pseudonym based AutenTicAtion (SPATA) framework for preserving the real identity of vehicles. The distributed architecture of SPATA allows vehicles to generate pseudonyms in a very private and secure way. In the absence of a distributed architecture, the privacy cannot be preserved by storing information regarding vehicles in a single location. Therefore, the concept of linkability of certificates based on single authority is eliminated. This is done by keeping the real identity to pseudonym mappings distributed. Furthermore, the size of the Certificate Revocation List (CRL) is kept small, as only the most recent revoked communication pseudonyms are kept in the CRL. The privacy of the vehicle is preserved during the revocation and resolution phase through the distributed mechanism. Empirical results show that SPATA is a lightweight framework with low computational overhead, average latency, overhead ratio, and stable delivery ratio, in both sparse and dense network scenarios

Emergence of fluoroquinolone resistance among drug resistant tuberculosis patients at a tertiary care facility in Karachi, Pakistan

Background: Pakistan is classified as one of the high multi-drug resistant tuberculosis (MDR-TB) burden countries. A poorly regulated private sector, over-prescription of antibiotics and self-medication has led to augmented rates of drug-resistance in the country. Pakistan\u27s first national anti-tuberculosis drug resistance survey identified high prevalence of fluoroquinolone resistance among MDR-TB patients. Further institutional evidence of fluoroquinolone drug-resistance can support re-evaluation of treatment regimens as well as invigorate efforts to control antibiotic resistance in the country.Findings: In this study, data for drug-susceptibility testing (DST) was retrospectively analyzed for a total of 133 patients receiving MDR-TB treatment at the Chest Department of Jinnah Postgraduate Medical Center, Karachi, Pakistan. Frequency analyses for resistance patterns was carried out and association of fluoroquinolone (ofloxacin) resistance with demographics and past TB treatment category were assessed. Within first-line drugs, resistance to isoniazid was detected in 97.7% of cases, followed by rifampicin (96.9%), pyrazinamide (86.4%), ethambutol (69.2%) and streptomycin (64.6%). Within second-line drugs, ofloxacin resistance was detected in 34.6% of cases. Resistance to ethionamide and amikacin was 2.3% and 1.6%, respectively. Combined resistance of oflaxacin and isoniazid was detected in 33.9% of cases. Age, gender and past TB treatment category were not significantly associated with resistance to ofloxacin.Conclusion: Fluoroquinolone resistance was observed in an alarmingly high proportion of MDR-TB cases. Our results suggest caution in their use for empirical management of MDR-TB cases and recommended treatment regimens for MDR-TB may require re-evaluation. Greater engagement of private providers and stringent pharmacy regulations are urgently required

Gut Microbiome: A New Organ System in Body

The gut microbiome is comprised of various types of bacteria, fungi, protozoa, and viruses naturally occurring in humans and animals as normal microflora. Gut microorganisms are typically host specific, and their number and type vary according to different host species and environment. Gut microbes contribute directly and/or indirectly to various physiological processes including immune modulation, regulation of various neurotransmitter, and hormones, as well as production of many antioxidants and metabolites. They also play a role as antibiotic, anti-inflammatory, anti-diabetic, and anti-carcinogenic agents. Moreover, the ability of gut microbes to attenuate various systemic diseases like coronary heart disease, irritable bowel syndrome, metabolic diseases like diabetes mellitus, and infectious diseases like diarrhea has recently been reported. Current research findings have enough evidence to suggest that gut microbiome is a new organ system mainly due to the microorganisms’ specific biochemical interaction with their hosts and their systemic integration into the host biology. Investigations into the potential ability of gut microbiome to influence metabolism inside their host via biochemical interaction with antibiotics and other drugs has recently been initiated. This chapter specifically focuses on the importance of gut microorganisms as a new organ system

Ferula asafoetida Linn. is effective for early functional recovery following mechanically induced insult to the sciatic nerve of a mouse model

Purpose: To evaluate the effect of Ferula asafoetida (oleo gum resin powder) on sensory and motor functions retrieval on an induced sciatic nerve injury in a mouse model.Methods: A mechanical crush was inserted in the sciatic nerve of all the experimental mice after acclimatization. The mice were allocated to four groups; one normal chow group (control, n = 7) and three Ferula asafoetida chow groups (each n = 7) of different doses (50, 100 and 200 mg/kg). Muscle grip strength, muscle mass, and sciatic functional index were measured to evaluate the motor function regain, while sensory function regain was assessed by hot plate test. Oxidative stress and glycemic levels were measured by biochemical assays.Results: The findings of this study indicate that Ferula asafoetida 200 mg/kg has a highly significant (p≤ 0.001) ameliorating effect in terms of improved grip strength (77.7 ± 5.4 % for 200 mg/kg vs. 46 ± 5.1 % for control), reversal of SFI towards normal ( -34 ± 8.1 for 200 mg/kg group vs. –61 ± 6.1 for control), decrease in paw withdrawal latency (7.10 ± 0.06 s for 200 mg/kg group vs. 15 ± 0.5 s for control) on day 12 post-injury, as well as restoration of skeletal muscle mass towards normal. Interestingly, F. asafoetida chow 50 mg/kg and 100 mg/kg groups also impacted significant (p < 0.01) improvement in the ameliorative effect. However, the differences among all treatment groups in ameliorating recovery were not significant (p > 0.05). Moreover, comparatively improved (p < 0.0001) total antioxidant capacity along with reduced total oxidant status (p = 0.01) in the Ferula asafoetida chow (200 mg/kg) group, indicate the antioxidative effect of this plant. Furthermore, the treated mice (200 mg/kg) also expressedan improved glycemic level (p = 0.0005).Conclusion: Ferula asafoetida supplementation helps to accelerate both sensory and motor function retrieval following sciatic nerve injury. This  improvement is thought to be correlated with the antioxidant capacity of the plant. However, further investigations are required to identify the therapeutic principles responsible for the observed actions. Keywords: Sciatic nerve injury, Ferula asafoetida, Function recovery, Oxidative stress, Biochemical analysi