Emergency Presentation of Abdominal Pain with Unusual Etiology

Abdominal pain has vast differentials and routine etiologies are diagnosed easily. Difficulty arises with uncommon presentation. This is a case of 28 years old lady presenting to emergency department of Holy Family Hospital, Rawalpindi with worsening abdominal pain, vomiting and loose stools over 2 weeks. Routine examination and workup did not help to find any cause. Ultrasound abdomen suspected matted gut loops with enlarged lymph nodes. CECT abdomen confirmed a non-differentiating tissue collection in right iliac fossa. Later diagnosis of complicated gossybioma (retained gauze surrounded by fibrotic tissue with entero-enteric fistula and fecolith in appendix) was confirmed by laparoscopy that was surgically removed. Conclusion: Gossybioma is infrequent but avoidable complication that needs to be considered by surgeon meticulously especially by swab counting, avoiding staff change over during procedure and consideration in follow up visit

Emergency Presentation of Abdominal Pain with Unusual Etiology

Abdominal pain has vast differentials and routine etiologies are diagnosed easily. Difficulty arises with uncommon presentation. This is a case of 28 years old lady presenting to emergency department of Holy Family Hospital, Rawalpindi with worsening abdominal pain, vomiting and loose stools over 2 weeks. Routine examination and workup did not help to find any cause. Ultrasound abdomen suspected matted gut loops with enlarged lymph nodes. CECT abdomen confirmed a non-differentiating tissue collection in right iliac fossa. Later diagnosis of complicated gossybioma (retained gauze surrounded by fibrotic tissue with entero-enteric fistula and fecolith in appendix) was confirmed by laparoscopy that was surgically removed. Conclusion: Gossybioma is infrequent but avoidable complication that needs to be considered by surgeon meticulously especially by swab counting, avoiding staff change over during procedure and consideration in follow up visit

Serological and Molecular Characterization of Blood Group A2 in Pakistan

Objective: To determine the frequency of Blood Group A2 genotype among Group A Pakistani whole blood donors. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Transfusion (AFIT), Rawalpindi Pakistan, from Jan 2019 to Jan 2020. Methodology: One thousand (1000) healthy and unrelated blood donors were selected. The blood samples were typed for ABO, and those of Blood Groups-A and AB were further subtyped with the help of anti-A1 lectin to categorize them as A1,non-A1, A1B and non-A1B Groups. Next, DNA of non-A1 samples was extracted, and a Polymerase Chain Reaction using sequence-specific primers (PCR-SSP) for type A2 was performed, followed by polyacrylamide gel electrophoresis (PAGE). Results: Among one thousand blood donors, 247(24.7%) were typed as Blood Group-A, 94(9.4%) as AB-Group, 339(33.9%) BGroup and 320(32%) O Group with variable strength of reaction with ABO antisera. A and AB Blood Groups were further subgrouped as A1 202(20.2%), A1B 77(7.7%), non-A1 45(4.5%) and non-A1B 17(1.7%). Anti-A1 antibodies were detected in 6(13.3%) of non-A1 samples. PCR of non-A1 samples showed 32(12.9%) to be genotypically A2, and the remaining 13(5.2%) were not A2 and were not further resolved. Conclusion: Blood Group A2 is not a rare Subgroup in our population. PCR-SSP is a more specific technique than anti-A1 lectin for establishing the Blood Group status of an individual

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Deep Emotions Recognition from Facial Expressions using Deep Learning

Deep emotion recognition has a wide range of applications, including human-robot communication, business, movies, services hotels, and even politics. Despite the use of various supervised and unsupervised methods in many different fields, there is still a lack of accurate analysis. Therefore, we have taken on this challenge as our research problem. We have proposed a mechanism for efficient and fine-grained classification of human deep emotions that can be applied to many other problems in daily life. This study aims to explore the best-suited algorithm along with optimal parameters to provide a solution for an efficient emotion detection machine learning system. In this study, we aimed to recognize emotions from facial expressions using deep learning techniques and the JAFFE dataset. The performance of three different models, a CNN (Convolutional Neural Network), an ANN (Artificial Neural Network), and an SVM (Support Vector Machine) were evaluated using precision, recall, F1-score, and accuracy as the evaluation metrics. The results of the experiments show that all three models performed well in recognizing emotions from facial expressions. The CNN model achieved a precision of 0.653, recall of 0.561, F1-score of 0.567, and accuracy of 0.62. The ANN model achieved a precision of 0.623, recall of 0.542, F1-score of 0.542, and accuracy of 0.59. The SVM model achieved a precision of 0.643, recall of 0.559, F1-score of 0.545, and accuracy of 0.6. Overall, the results of the study indicate that deep learning techniques can be effectively used for recognizing emotions from facial expressions using the JAFFE dataset

Effects of pre-heating method on the optical, wetting, photo-catalytic and UV sensing properties of Al:ZnO thin films

Aluminum doped zinc oxide thin films/ nanostructures have great importance in many technological applications such as transparent conducting oxides, photo-catalytic, electrochemical and opto-electronic devices. The pre-heating (drying) stage during sol–gel spin coating method is crucial for achieving better transparency level and smooth unstressed surface. In this research, effects of drying at fixed temperature (220 °C) and gradually rising temperature (rising rate 11 °C/min) under two different environments (i.e. temperature drying on i. hot plate ii. Oven) were explored. The SEM results showed that surface produced by fixed temperature drying on hot plate as well as in oven were cracked and rope stressed type, respectively. The texture obtained by gradually rising temperature was stressed granular on hot plate whereas uniformly distributed plane nano-granular in oven (on petri-dish). The XRD pattern revealed the polycrystalline nature and good crystal quality for sample with gradually rising temperature in oven. In case of gradually rising temperature in oven the maximum transmittance and band gap obtained were > 90% and 3.36 eV respectively. The refractive index and extinction coefficient were used to determine level of transparency in visible region by achieving values of 1.7 and 0.1 respectively. The super hydrophilic character achieved by contact angle 10° and better stain self-cleaning with degradation efficiency around 71% by photo-catalytic effect after UV irradiation. UV sensitivity was performed by using ardino microcontroller and max photo-response (voltage variation) was found 1.5 V. Moreover, response and recovery was around 14 s and 15 s respectively

Service Quality Assessment of Hospitals in Asian Context: An Empirical Evidence From Pakistan

Hospitals vary from one another in terms of their specialty, services offered, and resource availability. Their services are widely measured with scales that gauge patients’ perspective. Therefore, there is a need for research to develop a scale that measures hospital service quality in Asian hospitals, regardless of their nature or ownership. To address this research need, this study adapted the SERVQUAL instrument to develop a service quality measurement scale. Data were collected from inpatients and outpatients at 9 different hospitals, and the scale was developed using structural equation modeling. The developed scale was then validated by identifying service quality gaps and ranking the areas that require managerial effort. The findings indicated that all 5 dimensions of SERVQUAL are valid in Asian countries such as Pakistan, with 13 items retained. Reliability, tangibility, responsiveness, empathy, and assurance were ranked first, second, third, fourth, and fifth, respectively, in terms of the size of the quality gap. The gaps were statistically significant, with values ≤.05; therefore, hospital administrators must focus on each of these areas. By focusing on the identified areas of improvement, health care authorities, managers, practitioners, and decision makers can bring substantial change within hospitals