BALLOON TRAWL; A SAFE AND EFFECTVE WAY OF REMOVING COMMON BILE DUCT (CBD) EMBEDDED STENTS

Biliary stenting has been used since the 1970s to relieve biliary obstruction for a variety of causes including benign and malignant biliary strictures. Migration of stents proximally into the biliary tree or distally into the intestinal tract is relatively uncommon. We report a case of a 64-year-old female with a peri-ampullary tumour, who had symptomatic obstructive jaundice following endoscopic retrograde cholangiopancreatography and plastic stent insertion. Follow-up imaging showed proximal migration of the plastic stent and blockage of the distal common bile duct (CBD) secondary to the periampullary tumour. The biliary stent was safely removed endoscopically using balloon trawl. This case highlights that, while biliary stenting for strictures is generally safe and effective, stent migration to proximal CBD can occur. Balloon trawl is safe and effective way of removing such stents. Key words: Biliary stricture, common bile duct, endoscopic retrograde cholangiopancreatography, periampullary tumour, stents

STAPHYLOCOCCUS CASSETTE CHROMOSOME MEC TYPING OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS STRAINS PREVAILING IN HAYATABAD MEDICAL COMPLEX, PESHAWAR

Introduction: Methicillin resistance Staphylococcus aureus is a very potential human pathogen, and its significant antibiotic resistance further complicates the management of this pathogen. Methicillin resistance in S. aureus is conferred by the presence of SCCmec elements but there are different types of SCCmec in MRSA which results in the need of typing of SCCmec elements. Material & Methods: This cross-sectional study was conducted to determine the current antibiotic resistance pattern and prevalence of different types of SCCmec elements in the circulating MRSA at Hayatabad Medical Complex, Peshawar. A total of 60 non repetitive MRSA isolates collected from pus aspirate and wound swab were enrolled in the study. All the MRSA isolates were tested by disc diffusion method against the ten antibiotics and further subjected to the SCCmec typing through two multiplex PCR reactions. Results: Out of the total tested MRSA isolates 80% were resistant to Ciprofloxacin, 63.4% to Erythromycin, 58.4% to Gentamicin, 55.0% to Cotrimoxazole, 51.6% to Tetracycline, 48.4% Fusidic acid, 46.6% to Clindamycin, 35.0% to Doxycycline, while Quinupristin/Dalfopristin and Linezolid kill 100% strains of the MRSA included in the study. SCCmec typing of MRSA isolates showed that prevalence of SCCmec type-III was 3.3% (3/60), types-IV was 58.3% (35/60), and type-V was 38.3% (23/60). Conclusion: The studied MRSA showed worrisome resistance, but Quinupristin/Dalfopristin and Linezolid kill all the strains of MRSA. The prevalence of SCCmec types IV and V is very high which indicates that the circulating MRSA clone are community associated, because they harbour SCCmec type IV and V

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

Approximating a Giving Up Smoking Dynamic on Adolescent Nicotine Dependence in Fractional Order.

In this work, we consider giving up smoking dynamic on adolescent nicotine dependence. First, we use the Caputo derivative to develop the model in fractional order. Then we apply two different numerical methods to compute accurate approximate solutions of this new model in fractional order and compare their results. In order to do this, we consider the generalized Euler method (GEM) and multi-step generalized differential transform method (MSGDTM). We also show the unique positive solution for this model and present numerical results graphically

Sociocultural determinants of psychological distress and coping among South Asian individuals with chronic illness

Abstract Sociocultural determinants affect the physical and mental well-being and coping of individuals with chronic illnesses. However, no studies have examined the relationship of sociocultural determinants with psychological distress and coping. The purpose of this study was to determine the levels of psychological distress and coping among individuals with chronic illness and identify sociocultural determinants affecting distress and coping. A cross-sectional design was used. Data were collected from a convenience sample of 384 individuals admitted to inpatient settings and attending outpatient clinics at two tertiary care hospitals. The validated Urdu-translated version of the Hospital Anxiety and Depression Scale, and the Brief COPE scales were used for data collection. The mean HADS-Depression score was (11.38 ± 2.53), and the HADS-Anxiety score was 13.42 ± 2.34), indicating high levels of depression and anxiety. The most commonly used coping strategies were problem-focused coping (15.95 ± 4.95), followed by emotion-focused coping (15.01 ± 2.33), and avoidance coping (13.89 ± 4.77). Higher levels of psychological distress in individuals with chronic illnesses underscore the importance of implementing community-based support approaches. Varied use of coping strategies was influenced by the type of chronic illness, living conditions, educational level, years of living with a chronic illness, family dynamics, and available support systems

Correction: Approximating a Giving Up Smoking Dynamic on Adolescent Nicotine Dependence in Fractional Order.

[This corrects the article DOI: 10.1371/journal.pone.0103617.]