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The crude distillation unit (CDU) is one of the most energy-intensive processes of a petroleum refinery. The composition of crude is subject to change on regular basis. The uncertainty in crude oil composition causes wastage of a substantial amount of energy in the CDU operation. In this study, a novel approach based on a multi-output artificial neural networks (ANN) model was devised to cope with variations (uncertainty) in crude composition. The proposed method is an extended version of another method of cut-point optimization based on hybridization of Taguchi and genetic algorithm. A data comprised of several hundred variations of crude compositions and their optimized cut point temperatures, derived from the hybrid approach, was used to train the ANN model. The proposed method was validated on a simulated CDU flowsheet for a Pakistani crude, i.e., Zamzama. The proposed method is faster and computationally less expensive than the hybrid method. In addition, it can efficiently predict optimum cut point temperatures for any variant of the crude composition.

In this case report, we present a case of a woman in her late 30s who presented with bilateral motor weakness, headache, hyperglycaemia and hypertension. Investigations revealed very high 24-hour urine cortisol of 90 524, ectopic adrenocorticotropic hormone secreting pheochromocytoma, normal metanephrine levels and empty sella, which has never been reported. CT chest and abdomen revealed enlarged left adrenal gland with large necrotic mass 4.7×4.0 cm most likely neoplastic lesion. The patient was cured after surgical removal of the left adrenal mass. Histological examination revealed 3.5×2.5×2 cm mass consistent with pheochromocytoma. After surgery and a short stay in the intensive care unit, the patient started improving and both antihypertensive treatment and insulin injections were withdrawn.

Case Presentation: A 48-year-old-female presented to the emergency department with dislodgement of her percutaneous endoscopic gastrostomy (PEG) tube, necessitating bedside replacement. Replacement was done without difficulty and gastrografin radiography was obtained to confirm positioning. Radiography revealed contrast filling the colon at the splenic flexure and proximal descending colon suggestive of colocutaneous fistula formation. Discussion: The patient required hospitalization with surgical consultation, initiation of parenteral nutrition, and conservative management of the fistula with surgical replacement of the PEG tube. Although rare, it is paramount for the emergency physician to be aware of this complication when undertaking bedside replacement of PEG tubes.

Heat-shock protein 70 (HSP70) chaperones play indispensable roles in protein folding, homeostasis, and protecting plants against abiotic stress. While well-characterized in model species, a comprehensive genome-wide analysis of the HSP70 family in carrot ( Daucus carota L .) has been lacking. The study aimed to identify the DCHSP70 gene family members in the Daucus carota genome and elucidate their evolutionary relationships, structural characteristics, and potential functional roles under stress conditions. We performed a systematic genome-wide analysis using bioinformatic approaches to identify family members. Phylogenetic relationships were analyzed using neighbor-joining methods, while chromosomal distribution and synteny were visualized to track evolutionary analysis. Promoter regions were screened for cis-regulatory elements, and protein-protein interaction (PPI) networks were constructed. Additionally, 3D structural modeling was performed using SWISS-MODEL and I-TASSER servers. A total of 52 DCHSP70 genes were identified and classified into six distinct phylogenetic subgroups based on their homology with Arabidopsis thaliana and Solanum lycopersicum . Chromosomal mapping revealed an uneven distribution across the nine chromosomes. Synteny analysis indicated that segmental duplication was the primary driving force behind the family evolution, with all the paralogous pairs undergoing strong purifying selection (Ka/Ks < 1). Analysis of cis-regulatory elements in the promoter regions identified a predominance of light, hormone, and stress-responsive motifs (e.g., ABRE, LTR, MBS), suggesting a complex regulatory network for environmental adaptation. The PPI network analysis revealed highly significant connectivity ( p  < 1.0e-16), with functional enrichment in protein refolding and cellular stress response. Structural modelling confirmed that most DCHSP70 proteins are conserved as monomers, with reliable 3D structures predicted even for divergent members like DCHSP70-15 and DCHSP70-46 using threading-based approaches. This study provides the first systematic characterization of the DCHSP70 family in carrot. The finding highlights the evolutionary conservation of these genes and their crucial role in the plant’s stress response mechanism, providing valuable targets for future breeding programs aimed at improving stress tolerance in Daucus carota .

Introduction: Capnocytophaga ochracea is found in the human oral microbiome and is a rare cause of antibiotic-resistant, opportunistic septicemia in immunocompromised hosts. The zoonotic transmission of C ochracea from canines to humans has not yet been reported in the literature. Cohabitation with people is associated with oral colonization in dogs and may be a reservoir for Capnocytophaga infections, which have a decreased susceptibility to first-line antibiotics commonly used to treat animal exposures. Case Report: This is the case of a 70-year-old male with a remote history of lymphoma status post splenectomy, in remission, who presented with stigmata of Capnocytophaga septicemia after a dog bite, which included purpura fulminans on physical examination. Initial broad-spectrum coverage with cefepime failed to slow the progression into multiorgan failure. A Capnocytophaga strain with extended resistance was suspected. Antibiotics were transitioned to meropenem, and the patient eventually made a good recovery. Blood cultures isolated C ochracea. Conclusion: Capnocytophaga infections should be suspected in patients with severe sepsis and purpura fulminans after a canine exposure. Canine pets may be a reservoir for Capnocytophaga species with increased antibiotic resistances, such as C ochracea, which trace their origins to the human oral microbiome. A thorough medical history is essential to identify risk factors such as asplenia and active immune compromise that are associated with infections from antibiotic-resistant strains and worse outcomes. For Capnocytophaga infections that fail initial therapies, cephalosporins should be avoided because of high resistance rates, and the use of carbapenems may be favored over combination beta-lactam/beta-lactamase inhibitors in select clinical scenarios.

Pakistan is fifth among high burden countries for tuberculosis. A steady increase is seen in extrapulmonary tuberculosis (EPTB), which now accounts for 20% of all notified TB cases. There is very limited information on the epidemiology of EPTB. This study was performed with the aim to describe the demographic characteristics, clinical manifestations and treatment outcomes of EPTB patients in Pakistan. We performed descriptive analysis on routinely collected data for cohorts of TB patients registered nationwide in 2016 at health facilities selected using stratified convenient sampling. Altogether 54092 TB including 15790 (29.2%) EPTB cases were registered in 2016 at 50 study sites. The median age was 24 years for EPTB and 30 years for PTB patients. The crude prevalence of EPTB in females was 30.5% (95%CI; 29.9-31.0) compared to 27.9% (95%CI; 27.3-28.4) in males. The likelihood of having EPTB (OR), was 1.1 times greater for females, 2.0 times for children, and 3.3 times for residents of provinces in the North-West. The most common forms of EPTB were pleural (29.6%), lymphatic (22.7%) and abdominal TB (21.0%). Pleural TB was the most common clinical manifestation in adults (34.2%) and abdominal TB in children (38.4%). An increase in the prevalence of pleural and osteoarticular and decline in lymphatic and abdominal TB was observed with advancing age. Diversity in demography and clinical manifestations were noted between provinces. The treatment success rate for all type EPTB was significantly high compared to bacteriology confirmed PTB with the exception of EPTB affecting CNS with a high mortality rate. The study provides an insight into demography, clinical manifestations and treatment outcomes of EPTB. Further studies are needed to explain significant diversities observed between provinces, specific risk factors and challenges concerning EPTB management.

A 59-year-old female presented to the emergency department with an acute onset of unilateral facial droop and aphasia. Collateral information obtained from her family revealed a diagnosis of prolonged subacute bacterial sinusitis with initiation of multiple antimicrobial regimens. The patient underwent a non-contrast computed tomography of the brain, which demonstrated a 1.2-cm lobulated extra-axial collection overlying the left frontotemporal region with an associated midline shift consistent with subdural empyema. The patient was initiated on intravenous antibiotics and underwent emergent burr hole placement with successful evacuation of the subdural empyema. Additionally, the patient's hospital course consisted of a bilateral maxillary antrostomy, bilateral total sphenoethmoidectomy, and bilateral frontal sinusotomy, septoplasty, as and excision of her right concha bullosa. Subdural empyema is a pyogenic infection of the subdural space located between the dura mater and the arachnoid matter, with high rates of morbidity and mortality. Treatment is based on rapid identification and treatment of the underlying causative factor as well as surgical evacuation to obtain source control.

A 60-year-old male patient presented to the emergency department of our hospital with right-sided chest wall pain and a palpable subcutaneous cord-like structure along the right anterior chest wall. Examination revealed tenderness over the cord-like structure, and the skin overlying the structure was freely mobile and did not have any sign of infection or inflammation. Bedside ultrasonography revealed an uncompressible tubular structure with the absence of a color Doppler flow signal. The patient's presentation was suggestive of Mondor's disease. The patient was discharged with instructions to utilize anti-inflammatory drugs, perform warm compresses, and seek primary care follow-up to ensure resolution. Mondor's disease is a rare disorder characterized by a superficial thrombophlebitis of the subcutaneous veins of the chest wall. For its diagnosis, a thorough examination of the patient's medical history and physical condition is suggested; further, the performance of point-of-care ultrasonography has also been suggested. Once recognized, further emergency department workup is typically unnecessary in cases of primary Mondor's disease. Despite being a mostly self-limited condition, greater awareness of this rare disease entity is required to ensure and coordinate close outpatient follow-up as well as monitor resolution due to its association with secondary causes such as vascular and breast carcinoma, vasculitis, and hypercoagulable disorders.

A 47-year-old male presented to the emergency department with 12 hours of nausea, vomiting, abdominal pain, and a widespread skin eruption with mottled, irregular, purpuric lesions with subsequent rapid decompensation. Laboratory analysis revealed thrombocytopenia, bandemia, elevated metamyelocytes, abnormal coagulation panel, decreased fibrinogen, elevated fibrin split products, renal dysfunction, bacterial rods, dohle bodies, and toxic granulation. Acute promyelocytic leukemia (APML) was confirmed via bone marrow biopsy, flow cytometry, and fluorescence in situ hybridization analysis. Disseminated intravascular coagulation (DIC) may be the initial presentation of APML. When treated promptly, APML can achieve high remission rates; however, conditions such as DIC continue to increase mortality requiring early recognition to improve survival rates.