Wastewater treatment plants (WWTPs) are recognized hotspots for the proliferation and dissemination of antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs). As effluent discharge may introduce ARB into natural water ecosystems, assessing resistance patterns in these environments is critical to public and environmental health. This study aims to experimentally assess antibiotic resistance patterns in bacterial isolates from different stages of WWTP processes (influent, activated sludge, effluent), evaluating variations in resistance prevalence and identifying critical control points. Bacterial samples were collected across influent, biological treatment (activated sludge), and effluent from three municipal WWTPs. Standard microbiological culturing techniques were used to isolate representative bacteria (e.g., Escherichia coli, Pseudomonas spp., Enterococcus spp.). Isolates were subjected to antibiotic susceptibility testing against a panel of antibiotics (e.g., ampicillin, ciprofloxacin, tetracycline, vancomycin) using disk diffusion and minimal inhibitory concentration (MIC) assays, following CLSI guidelines. Resistance profiles were analyzed by stage and WWTP. Statistical analyses included chi-square tests and ANOVA to compare resistance rates across treatment stages. A total of 450 isolates were tested. Resistance prevalence significantly declined from influent to effluent for most antibiotics. For example, figure 1 shows a bar chart of percent resistance by sample stage: ampicillin resistance dropped from 75 % (influent) to 30 % (effluent); ciprofloxacin from 60 % to 25 %. figure 2 presents a line graph showing cumulative multi-drug resistance (MDR) rates decreasing across treatment stages. However, some isolates from effluent remained resistant to multiple antibiotics, including tetracycline and vancomycin. Findings highlight that conventional WWTP processes reduce—but do not eliminate—ARB. Results support the need for targeted disinfection or advanced tertiary treatments to minimize environmental release of resistance. Data provide a baseline for policymakers and engineers to strengthen wastewater treatment standards and safeguard public health.

Background: Charcot joint, known as neuropathic arthropathy, is a disorder often associated with neurodegenerative disorders that lead to decreased pain sensation and proprioception, resulting in joint degeneration. Multiple sclerosis (MS), primarily affecting the central nervous system, which may lead indirectly to the development of neuropathic arthropathy. Aim: was to provide an analysis of the imaging features of Charcot joint in patients with MS, through identifying patterns of joints involvement and bone pathology. Methods: A retrospective study conducted in al-Nasiriyah teaching hospital from 2022-2025 and included thirty MS patients with clinical suspicion of neuropathic arthropathy. Computed tomography (CT), and magnetic resonance imaging (MRI) scans were reviewed to assess the extent of joint pathology and characterize distinct imaging finding. Results: A total of 30 patients where included, their age range of 34–55 years, radiological findings included osteophyte formation in 15 (50%), bone resorption in 9 (30%), and joint subluxation in 6 (20%) of patients, severe joint degeneration in 21 (70%) patients. CT shows joint space narrowing in 18 (60%) patients, verifying the essential need for joints assessment. Conclusion: The study highlights the important role of comprehensive imaging techniques in diagnosing neuropathic arthropathy in MS patients, as both MRI and CT as particularly valuable tools for early detection then planning of the treatment.

Acute left-sided colonic diverticulitis can be categorized into complicated and uncomplicated. The surgical treatment for complicated diverticulitis can be divided into the sigmoid resection with stoma formation (Hartmann’s procedure) or sigmoid resection with anastomosis, accompanied by a protective ileostomy. In instances where patients with complicated left-sided diverticulitis are hemodynamically unstable, damage control surgery is indicated. Laparoscopic lavage serves as a bridging procedure for complicated diverticulitis with purulent discharge or classified as Hinchy 3, aiming to stabilize the patient for subsequent definitive surgery. This review will examine the surgical treatment of complicated left-sided diverticulitis, focusing on sigmoid resection with stoma (Hartmann’s procedure) and colonic resection with anastomosis. Additionally, the role of laparoscopic lavage in the treatment of complicated diverticulitis with purulent discharge will be explored.

Background: Although contrast-enhanced T1-weighted MR imaging is the standard of reference for diagnosing tumour in the cerebellopontine angle (CPA), high-resolution T2-weighted imaging may show more details of the seventh and eighth cranial nerve branches, resulting in more accurate tumour volume measurements. The Aim of Study: Was to evaluate the value of diagnostic accuracy of an unenhanced MR imaging protocol using unenhanced axial 3D constructive interference in steady state (CISS) in detection of small internal auditory canal lesions (IAC). Patients and Methods: cross-sectional study carried out over a period from April 2018 to February 2019 in the MRI department of Al-Imamain Al-Kadhemain medical city, included 38 patients (76 internal auditory canals), whom presentation with clinical features of (sensorineural hearing loss, tinnitus or vertigo) with suspicion of IAC lesions, sent by specialist after clinical examination. All patients were examined with axial T1WI, axial T2WI, coronal FLAIR, axial 3D-CISS sequence for evaluate its accuracy in detecting abnormalities of the CPA, IAC and inner ear. Each sequence assessed carefully for detection of any lesion within IAC, inner ear and CPA cistern, the statistical analysis is assessed for the sensitivity, specificity and accuracy. Results: 38 patients (76 IACs /CPA cisterns) met the inclusion criteria, included 18 (47.4 %) patients with radiological evidence of IACs /CPA cistern lesions, 20 (52.6%) patients without lesions, considered as the control group which confirmed by IAC/CPA cistern routine sequences in addition to confirmation by 3D-CISS sequence. Thus 76 IACs are examined 18 with lesions, 58 IACs without significant pathology. The sensitivity, specificity and accuracy of 3D CISS sequence and axial T2WI are estimated separately and both together. 9 lesions (50 %) found intracanalicular 4 fundal (22.2%) and 5 (27 %) within CPA cistern. The number of lesions in diseased group showing true positive results by 3D-CISS sequence were 17 (94.4 %) of detected lesions while one lesion (5.6%) showing false negative result by CISS sequence because it was arachnoid cyst not clearly identified. While the number of lesions in control group showing false positive results were 2 (10.0 %) due to volume averaging artifact, the true negative lesions were 18 (90.0 %), (P-value 0.0001). The number of lesions in diseased group showing true positive results by T2WI sequence were 15 (83.3%) of detected lesions while 3 lesions showing false negative result by T2WI sequence representing (16.7%). Whereas the number of lesions in control group showing false positive results were 4 (20.0%) due to artifact, the true negative lesions were 16 representing (80.0%) (P-value 0.0001). The Sensitivity of axial 3D-CISS sequence was (94.4%), specificity (90%) and accuracy (92.1%). The Sensitivity of axial T2WI sequence was (83.3%), specificity (80%) and accuracy (81.6%). Conclusion: 3D CISS sequence is supply high topographic resolution, with high contrast to noise ratio that highly beneficial for defining the exact location of the lesion and follow the vascular structures and nerves with clarity. It shows high sensitivity and specificity in detection of lesions of IACs and CPA cistern. Elderly patients and patients with allergy to gadolinium contrast agent can get benefit from using a 3D CISS sequence as screening and diagnostic tools and for follow up.

This case highlights a rare, but important complication of varicella infection in children- septic vasculitis presenting with purpura and neurological signs and symptoms mimicking meningitis. Clinicians should be aware that in post-varicella period, bacterial superinfection can lead to systemic features including vasculitis and encephalopathy, even in the absence of classical Central Nervous System (CNS) infection markers. Early recognition and prompt initiation of antibiotics are crucial for a favorable outcome. In our patient, the purpuric rash and altered sensorium raised suspicion of meningococcemia, but normal cerebrospinal fluid (CSF) and Magnetic Resonance Imaging (MRI) findings, along with neutrophilic leukocytosis, elevated C-Reactive Protein (CRP) and a positive clinical response to antibiotics, supported a diagnosis of sepsis-associated vasculitis, likely secondary bacterial infection following varicella infection. Timely recognition and intervention by administering intravenous antibiotics led to complete resolution of the clinical condition in a short span.

Antimicrobial resistance (AMR) remains a critical challenge in elder care, where frequent infections, polypharmacy, and immunosenescence contribute to poor outcomes. Traditional diagnostic methods, including culture-based and polymerase chain reaction assays, often fail to provide timely, comprehensive microbial identification, leading to prolonged empirical antibiotic use and worsening resistance trends. Precision metagenomics, a clinically refined application of next-generation sequencing, represents a transformative advancement in infection diagnostics and antimicrobial stewardship. By enabling culture-independent, high-resolution pathogen detection directly from clinical samples, precision metagenomics provides real-time identification of bacterial, viral, fungal, and parasitic pathogens, along with their antimicrobial resistance profiles. This approach facilitates early intervention, improves therapeutic precision, and minimizes unnecessary antibiotic exposure, particularly in long-term care facilities where multidrug-resistant organism outbreaks are prevalent. Additionally, the integration of non-invasive sample collection methods, such as diaper-derived urine and hydrogel-based wound dressings, enhances diagnostic accessibility for frail and cognitively impaired patients. As sequencing costs decline and bioinformatics pipelines become more efficient, the routine implementation of precision metagenomics in elder care settings will transition infection management from a reactive to a proactive paradigm. The synergy between precision metagenomics, artificial intelligence-driven clinical decision support systems, and real-time biosensors presents a novel framework for infection surveillance, offering a sustainable solution to combat AMR while optimizing patient outcomes. This paper explores the clinical applications, challenges, and future directions of precision metagenomics in elder care, emphasizing its role in redefining infection control and antibiotic stewardship.

The present study evaluates the cystatin C, glomerular filteration rate (GFR) and vanillylmandelic acid (VMA) in comorbid diabetic and hypertensive patients attending Federal University Teaching Hospital, Owerri, Nigeria. A total number of 200 persons were recruited for the research; 50 controls, 50 hypertensive, 50diabetic, and 50 hypertensive-diabetic persons. The respondents were Federal Teaching Hospital, Owerri. Verbal consent was sort and questionnaires were used to extract information regarding biodata and patients’ history of diabetes and hypertension. Blood pressure was determined. A standard venepuncture method was used to obtain seven milliliters (7ml) of blood from all the subjects under asceptic conditions. 3milliliters was dispensed into a plain container capped, labeled appropriately and allowed to clot at room temperature. The serum were separated from the red cell by spinning at 4,000 r.p.m for 5minutes. The supernatant serum obtained were stored frozen at -20 0C until the day of analysis. The remaining 2ml of blood was dispensed into a fluoride oxalate container for the estimation of fasting blood glucose. 5ml of urine was collected into sterile universal bottle, then aliquot into cryovials and stored at -20oC till the day of assay. All reagents were commercially purchased and the manufacturer’s standard operating procedures was strictly adhered to. The fasting blood sugar levels was higher in diabetic-hypertensive group (199.50  25.36 mg/dl) and diabetic groups (209.85  19.95 mg/dl) compared to hypertensive (84.10  9.03 mg/dl) and control group (84.20  9.40 mg/dl). The mean value of the diastolic pressure of the diabetic-hypertensive group (102.90  6.87 mmHg) decreased which was statistically significant (P<0.05) when compared with the diabetic group (75.10  4.58 mmHg). The mean value of the systolic pressure of the diabetic-hypertensive group (160.00  7.36 mmHg) was decreased which was statistically significant (P<0.05) when compared with the diabetic group (115.30  6.14 mmHg). Serum creatinine increased in diabetic-hypertensive group when compared with other groups. The cystatin C levels was higher in hypertensive group (0.90  0.14 mg/l) and lower in diabetic-hypertensive group (0.84  0.17 mg/l) but the mean difference between the groups was not significant (P >0.05). The mean value of VMA was higher in diabetic-hypertensive group (12.48  2.25 mg/24hr) compared to diabetic (11.26  1.74 mg/24hr) and control (9.96 1.43 mg/24hr) group. There was decrease in the mean value of GFR of diabetic-hypertensive group (71.80  8.30 ml/min/1.73m2) which was not statistically significant (P>0.05) when compared with other groups. While there was an increase in GFR value of hypertensive group when compared with other groups. There was a positive correlation between creatinine and cystatin C (r = 0.337) and their association was significant (p<0.05). There was a negative correlation between creatinine and VMA (r = -0.164) and their association was significant (p<0.05). There was a negative correlation between creatinine and GFR (r = -0.558) and their association was significant (p<0.05). There was a negative correlation between cystatin C and VMA (r = -0.078) and their association was not significant (p>0.05). There was a positive correlation between cystatin C and GFR (r = 0.019) and their association was not significant (p>0.05). In conclusion, good control of blood glucose and blood pressure level reduces the likelihood of the development of renal impairment which is usually associated with both diabetes and hypertension. Co-morbidity of diabetes and hypertension poses a higher risk of developing renal disease. Both serum creatinine, cystatic C and GFR are important biomarkers for renal impairment hence should be monitored on a regular basis for diabetic and hypertensive patients and much more frequently for hypertensive-diabetic patients.