Retracted: Diagnostic Dilemma of a Diaphragmatic Hernia

Diaphragmatic hernia post esophagectomy is a rare complication but a reality in its existence. It is typically difficult to diagnose but highly depends on keeping high index of suspicion. In our case report, the young male who underwent esophagectomy for esophageal carcinoma, remained disease free and stable in his 9 months follow up, suddenly presented in the emergency department with the symptoms of shortness of breath, chest pain, vomiting and tachycardia. The case was typically complicated by the initial treatment given for acute ischemia and cardiogenic shock. Radiological findings proved to be helpful and turning point in the diagnosis and overall management

Effects of co-infection on the clinical outcomes of Clostridium difficile infection

Background: Clostridium difficile (C. difficile) is a spore-forming, Gram-positive rod that is known to be associated with antibiotic use. It is one of the leading causes of nosocomial diarrhea in the industrialized world and therefore warrants further study of its nature. It isn\u27t clear if co-infection by other organisms can affect the outcome of C. difficile infection (CDI). Methods: A single center retrospective study was done and it used inclusion criteria of 18 years of age and being tested positive for CDI on FilmArray® multiplex gastro-intestinal (GI) panel. Exclusion criteria were a GI panel performed on an outpatient basis, recurrent CDI, and the presence of end-stage renal disease, cirrhosis, or a non-GI infection. The stool sample for all patients were collected within 48 h of presentation to the hospital. There were 235 of 2576 GI panels selected for a retrospective chart review based on the above criteria. Among these 235 patients, 38 had a co-infection (CDI+ another GI infection = group A or cases) and the rest had only CDI (group B or controls). Group A was compared with group B for CDI severity, its response to treatment, recurrence, and length of the hospital stay, using 0.05 as the alpha criterion. Results: Most patients with CDI were female and above the age of 60 years. Co infection did not increase the severity of CDI based both on the American College of Gastroenterology criteria (p 0.16) as well as Infectious Disease Society of America criteria (p 0.77). Co infection group also didn\u27t have significantly different CDI related treatment failure rate (p 0.23), or CDI recurrence rate (p 0.49). Co-infection was also not associated with lengthier hospital stay (p 0.41). Conclusion: Our study suggests that co-infection doesn\u27t affect the severity of CDI or can cause treatment failures. Additionally, there was no significant increase in hospital stay, or increase in CDI recurrence associated with co-infection. Therefore, if CDI is the leading clinical diagnosis and a patient is tested positive for co-infection in addition to CDI on FilmArray® multiplex GI panel, this co-infection shouldn\u27t change the management for CDI. Limitations of this study (including retrospective nature of the study, small sample size, single site study, not including all microbiome and non-inclusion of race) should also be taken into account, while considering the applicability of the results of this study

Knowledge and beliefs of adolescents regarding sexually transmitted infections and HIV/AIDS in a rural district in Pakistan

Objective: To assess the knowledge and beliefs of adolescents (15-19 years girls and boys) regarding sexually transmitted infections (STIs) and HIV/AIDS. Methods: A community based cross-sectional survey was conducted in October 2002 in a rural district (Mirpurkhas) of Sindh province, Pakistan. Results: A total of 428 adolescent girls and boys were interviewed. Only 44% correctly named at least one STI, while 55% knew at least two modes of transmission for HIV/AIDS. Adolescents with education greater than or equal to secondary level, those who were able to read the newspaper, possessed electricity in their homes and were allowed to meet their friends once in six months had significantly more HIV/AIDS knowledge. Conclusion: We conclude that rural adolescents of Sindh need more knowledge regarding STIs including HIV/AIDS. There is a need to formulate strategies to raise the levels of awareness and knowledge among adolescents regarding these conditions. Our findings indirectly support the use of mass media and peer education strategies to provide factual information to adolescent

Premenstrual syndrome: Existence, knowledge, and attitude among female university students in Karachi

Objective: The aim of this study was to investigate the existence, knowledge, and the attitude of female students towards premenstrual syndrome (PMS).Methods: This cross-sectional study was conducted in three universities in Karachi, Pakistan. A total of 448 female students participated in the study. The clinical criterion of American College of Obstetricians and Gynecologists (ACOG) for PMS was used to assess the prevalence of PMS in the participants. The questionnaire was set in four parts, one each to assess the knowledge, the attitude, and practices regarding PMS and one to assess the gap between self-perceived PMS and actual PMS. Data were analyzed descriptively using the Statistical Package for the Social Sciences (SPSS), version 20 (IBM SPSS Statistics, Armonk, NY).Results: The majority (96.4%) of female students were aware of PMS, while only 19% females knew about premenstrual dysphoric disorder. The self-reported prevalence of PMS was 79.5% and the prevalence using the ACOG criteria was 23.9%. Common symptoms were irritability, angry outbursts, depression, breast tenderness, and gastrointestinal problems. More than half (60.4%) of the participants reported PMS disturbed their normal routine, while 81.5% reported stress exacerbated their symptoms. The majority (77.5%) of women believed PMS was a significant issue to be discussed but 49.4% did not take treatment for their PMS.Conclusion: There is a significant impact of PMS in the lives of Pakistani women, and it is a common problem all over the globe. Despite the growing awareness, there remains a considerable deficiency of knowledge about the necessity to consult a doctor or seek treatment for their symptoms

Antibiotic Sensitivity Pattern of Carbapenem-Resistant Pseudomonas Aeruginosa

Objective: To determine the sensitivity of Carbapenem-resistant Pseudomonas aeruginosa (CARP) with the panel of antibiotics according to Clinical and Laboratory Standards Institute (CLSI) 2020 guidelines. Study Design: Cross-sectional study. Duration and Place of Study: Armed Forces Institute of Pathology, Rawalpindi from Pakistan, Apr to Sep 2020. Methodology: All samples received at the Microbiology Department during the study period were included. Various samples such as blood, pus, sputum, Endobronchial washing (EBW), non-directed bronchial lavage (NBL), tissue and urine were processed in the laboratory. Samples were inoculated on appropriate culture media, and bacteria were identified according to their colony morphology, Gram staining characteristics and biochemical tests. Antibiotic susceptibility testing was performed using the Kirby Bauer Disk Diffusion technique according to Clinical and Laboratory Standards Institute (CLSI) 2020 guidelines. However, for susceptibility to Colistin, the agar dilution method was performed. Results: In our study, fifty-five Carbapenem-resistant Pseudomonas aeruginosa were isolated. Out of these fifty-five isolates,thirteen (23.6%) were sensitive to Tazocin, seven (12.7%) were sensitive to Ceftazidime, fourteen (25.4%) were sensitive to Gentamicin, 7(12.7%) were sensitive to Cefepime, (12.7%) to Aztreonam, 10(18.2%) were sensitive to Amikacin, 7(12.7%) to Ciprofloxacin, 6(11%) to Levofloxacin and forty-two (76.4%) were sensitive to Colistin. Conclusion: The susceptibility of Carbapenem-resistant Pseudomonas aeruginosa to all the antibiotics tested in this study was low. Isolates displayed the highest susceptibility to Colistin. Keywords: Antibiotic susceptibility profile, Carbapenems, Carbapenem-resistant Pseudomonas aeruginosa (CRPA), Disk diffusion technique

Assessment of Human Health Risk of Zinc and Lead by Consuming Food Crops Supplied with Excessive Fertilizers

For the study of heavy metals impact on human beings, areas in Sargodha city that were supplied with various types of fertilizers were chosen. The three industrial areas; (Bhalwal, Sillanwali, and Sahiwal) of this city were explored for research reasons. The researchers wanted to know how much heavy metal was in the soil, food crops, and human. Excess fertilizer use contributes to global pollution. Farmyard manure, urea, and potassium chloride were used on Site 1; urea phosphate, manure, and ammonium sulphate were used on Site 2; and super phosphate, ammonium phosphate, and nitrate phosphate were used on Site 3. Samples of commonly used food crops, their respective soils and blood of residents who ingested the food crops of the studied area were collected. The zinc and lead levels in soil (8.30-16.80 and 1.80-12.71 mg/kg) and food crops (0.26-2.02 and 2.26-4.70 mg/kg) were far lower than WHO permitted limits. Blood mean concentration of both Zn (2.30-4.30 mg/L) and Ni (0.24-0.70 mg/L) were found maximum in residents of Site 3. The values of pollution load index, bioconcentration factor, enrichment factor for both zinc and lead were (0.18-0.37 and0.220-0.948), (0.027-0.138 and 0.316-1.705), (0.020-0.144 and 0.515-2.780), respectively. Daily intake of metal (0.004-0.008 and 0.001-0.002 mg/kg/day) and health risk index (0.0001-0.016 and 0.005-0.115) values were observed to be lower in individuals for Zn and Pb, respectively. In present work values of all pollution indices wereSo, there would be no human health hazard

Morphological Identification and Resistance Profile of Antibiotic and Heavy Metals-Resistant Bacteria in Hospital Sewage of Peshawar

Background: Increased resistance of microorganisms to commonly prescribed antibiotics has emerged as a significant hurdle in contemporary medical practice. The World Health Organization (WHO) has declared antibiotic resistance as a " major threat to public health.". In the present study, bacterial isolates were selected based on high antibiotic and heavy metal tolerance from a water sample taken from hospital sewage.Methods: Antibiotic-resistant bacteria were isolated through the disk diffusion method. Gram staining was done for morphological identification. For molecular identification, the 16s rDNA PCR amplification was done with universal primers. Results: The strain BC1 was found resistant to ampicillin (10μg/ml), and cefixime (5μg/ml). While, susceptible to kanamycin (30μg/ml), azithromycin (15μg/ml) and intermediate in response to amoxicillin (30μg/ml). The strain BC2 was resistant to ampicillin (10μg/ml), cefixime (5μg/ml) and kanamycin (30μg/ml). While, Susceptible to amoxicillin (30μg/ml), and intermediate in response to azithromycin (15μg/ml). The strains were also found resistant to heavy metals.Conclusion: The recent investigation on bacterial strains from hospital effluent found interesting candidates for understanding the AMR bacteria and developing novel active biomolecules to combat the antibiotics problem. The isolated strains could be a source of novel resistant genes however; a comprehensive molecular analysis is needed for advanced studies

Effects of Fertilizers on Copper and Nickel Accumulation and Human Health Risk Assessment of Vegetables and Food Crops

Despite the fact that fertilizers have been used for millennia for sustainable crop production, this high and considerable dependence on fertilizers heightens environmental concerns with the indirect human exposure due to accumulation of toxins in food chain via soil contamination. The purpose of this study is to evaluate the application of fertilizers to the soil and their effect on the accumulation of copper and nickel in spinach (Spinacia oleracea), garlic (Allium sativum), wheat (Triticum aestivum), maize (Zea mays), and barley (Hordeum vulgare); as well as potential health concerns associated with consuming vegetables cultivated on this contaminated land. Samples of available soil, food crops, and human blood were collected from three different Tehsils: Bhalwal, Sahiwal, and Silanwali and were regarded as site 1, site 2 and site 3 respectively. Urea, farmyard manure, and potassium chloride were delivered to Site 1; urea phosphate, manure, and ammonium sulphate were delivered to Site 2; and superphosphate, ammonium phosphate, and nitrate phosphate were delivered to Site 3. Data was subjected to statistical analysis for computing out ANOVA and correlation. Analysis revealed that minimum copper concentration was found in the soil of T. aestivum grown at Site-1 while the inhabitants of Site 3 had the highest concentration of Cu in their blood. The highest level of HIR was found in the human beings that ate the S. oleracea grown at Site 3. It is strongly advised that fertilizers be used sparingly, as their excessive use can cause human health risks

Cartoonization, Caricature and Emotion Generation from A Single Intensity Frontal Facial Image

Interest in research activities in facial processing especially cartoonization, caricature and emotion generation have gradually increased over the recent years. The contribution of this paper is threefold. First, it provides an algorithms along with its results in which exaggerated cartoon like effects are added into a single facial frontal image according to the given cartoon template. The cartoon formed in this process will have similar features as of original image. Secondly, the study provides facial transformation algorithms and techniques to generate various artifacts and emotions including  sad, shy, happy, blank, serious, surprise and innocent. Thirdly, the study discusses different transformation algorithms to generate various caricatures from the single frontal facial image. The output images generated using these open source algorithms and techniques are also provided in this paper to assess their subjective quality