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It is a rare event that a patient suspected to have a subglottic stenosis actually has a foreign body bronchus. We report a suspected case of subglottic stenosis secondary to partial hanging and prolonged intubation. However, surprisingly the rigid bronchoscopy revealed a betel nut at the level of carina.

Anaerobic digestion (AD) of sewage sludge is one of the most efficient, effective, and environmentally sustainable remediation techniques; however, the presence of complex floc structures, hard cell walls, and large amounts of molecular organic matter in the sludge hinder AD hydrolysis. Consequently, sewage sludge pretreatment is a prerequisite to accelerate hydrolysis and improve AD efficiency. This review focuses on pretreatment techniques for improving sewage sludge AD, which include mechanical, chemical, thermal, and biological processes. The various pretreatment process effects are discussed in terms of advantages and disadvantages, including their effectiveness, and recent achievements are reviewed for improved biogas production.

Previous data suggest zero-value, neutral outcomes (draw) are subjectively assigned negative rather than positive valence. The combined observations of faster rather than slower reaction times, subsequent actions defined by shift rather than stay behaviour, reduced flexibility, and, larger rather than smaller deviations from optimal performance following draws all align with the consequences of explicitly negative outcomes such as losses. We further tested the relationships between neutral, positive and negative outcomes by manipulating value salience and observing their behavioural profiles. Despite speeded reaction times and a non-significant bias towards shift behaviour similar to losses when draws were assigned the value of 0 (Experiment 1), the degree of shift behaviour approached an approximation of optimal performance when the draw value was explicitly positive (+1). This was in contrast to when the draw value was explicitly negative (-1), which led to a significant increase in the degree of shift behaviour (Experiment 2). Similar modifications were absent when the same value manipulations were applied to win or lose trials (Experiment 3). Rather than viewing draws as neutral and valence-free outcomes, the processing cascade generated by draws produces a complex behavioural profile containing elements found in response to both explicitly positive and explicitly negative results.

Introduction: Bacteremia and septicemia is life threatening condition resulting in major cause of mortality and morbidity.The aim of study was to determine the etiology of bacteremia and septicemia with antibiotic sensitivity profile of those organisms. Methods: A prospective study was carried out among the suspected cases from both inpatient and outpatient of TUTH from October 2009 .March 2010. Blood samples were collected and processed according to standard methodology. Results: Out of 2259 samples only 237 (10.49 %) showed bacterial growth. The most common isolates among Salmonella group was Salmonella enterica serotype typhi 71(29.95%) followed by Salmonella enterica serotype Paratyphi A 45(18.98%). Among non Salmonella group Pseudomonas aeruginosa 34(14.34%), Klebsiella pneumoniae 22(9.28%), Acinetobacter spp 15 (6.32%), Citrobacter spp 5(2.10%), Escherichia coli 3(1.26%) while Staphylococcus aureus 34 (14.3%) was most common followed by Enterococcus spp 3(1.26%), Streptococcus spp 2(0.84%), Coagulase Negative Staphylococcus 2(0.84%) and Listeria spp 1(0.42%) among Gram Positive organisms. Antibiogram revealed Cefotaxime, Ceftazidime, Azithromycin and Chloramphenicol for Salmonella group while for non Salmonella Imipenem, Meropenem and Amikacin as most effective antibiotics while Clindamycin, Cipro!oxacin and O!oxacin for gram positive. Conclusion: Gram negative bacteria was the predominant organism causing bacteremia and septicemia. Among them salmonella typhi and salmonella paratyphi were the leading aetiology. DOI: http://dx.doi.org/10.3126/joim.v34i3.8915 Journal of Institute of Medicine, December, 2012; 34:32-38