Volume 6 Issue-3 July-Sep, 17

This is the most frequently asked questions by doctors. We were taught in traditional system of education. Are we not competent doctors? Doctors of our time are performing well internationally and nationally than why to change it? Yes there is no second opinion about it. Let’s look at it in the perspective of the required competencies of the 21st century doctors, the standards of medical education and its control, the problems that the health care system is facing in developing country..

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Background:

Urea plasma species, the main human ureolytic pathogens, usually implicated in opportunistic infections. This study was aimed at comparing the sensitivity of the culture method and PCR in identifying Urea plasma species; and to evaluate the sensitivity of PCR in distinguishing Urea plasma urealyticum and Urea plasma parvum in clinical samples using a newly designed primer from our laboratory.

Methods:

Subjects included were both male and female patients attending STD reference centers (Lagos University Teaching Hospital and Jos University Teaching Hospital consisting of both male and female. A total of 119 patients (32 male, 87 female) who have been infertile for at least two years or those that present manifestations or reports of infertility, urethritis, spontaneous abortion, pelvic inflammatory diseases, preterm, low birth weight and neonatal pneumonia were included in this study. For the control, 117 asymptomatic male and female (w/o history or clinical symptoms of infertility) were recruited.

Results:

The PCR assay showed more sensitivity and specificity in the identification of Urea plasma species than culture. Of the 119 patients, 26 (21.85%) were positive for U. urealyticum, while 49 (41.18%) were positive for U. parvum and 19 (15.97%) for both organisms. Of the 117 control specimens, 15 (12.82%) were positive for U. urealyticum, while 20 (17.09%) for U. parvum and 3 (2.56%) for both organisms.

Conclusion:

PCR assay showed more sensitivity and specificity in the identification of Urea plasma species than culture Application of modern molecular techniques should be encouraged for the study of Urea plasma sp and other related fastidious organisms in Nigeria.

Key Words:

Urea plasma, culture, mycoplasma, molecular characterization, PCR

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Background:

Prostate cancer is the second most common cancer in men. Diagnosis of prostate cancer mainly depends upon histological examination. Prostate cancer expresses various immune markers, for example HER2/neu.
The objective of this study was to determine and score the immunohistochemical expression of HER2/neu in prostate adenocarcinoma biopsies. We have also compared the association of HER2/neu expression with biological behavior and risk factors of prostate adenocarcinoma.

Methods:

A cross sectional study was carried out using prostate biopsies, clinically suspected of prostate adenocarcinoma. The diagnosis of adenocarcinoma was confirmed and histological characterization was done by evaluating the morphological features. The tumors were graded according to the revised 2015 Gleason’s grouping. Immunohistochemical analysis for HER2/neu expression was performed in the most representative tumor block. Mean frequency and percentages were calculated for quantitative variables, whereas chi-square test and Fisher’s Exact Test were applied for qualitative variables. P-value of < 0.05 was considered as significant.

Results:

Only one case showed moderate HER2/neu expression. An insignificant statistical difference was observed between HER2/neu expression and prostate adenocarcinoma. The positive case had age more than 60 years with moderately increase in serum PSA levels and was aggressive in nature at the time of diagnosis.

Conclusion:

Our results indicated that HER2/neu expression is absent or very rare in prostate adenocarcinoma.

Key Words:

Prostate, adenocarcinoma, Gleason’s Group, Serum PSA, HER2/neu

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Background:

Kidney dimensions are influenced by different factors such as side, age, gender and geographical location. Thus, the purpose of our study was to determine reference range of kidney dimensions and effect of age, gender and side on renal dimensions in adults in a subset of Karachi population.

Methods:

The study was conducted from December, 2016 to May, 2017 in the department of Radiology, Ziauddin Hospital, Clifton Campus, Karachi. A total of 250 individuals (129 males and 121 females) aged 21 to 60 years without known renal disease were included in the study. Study participants were those who presented to Radiology Department with non-renal disease for abdominal contrast computerized scan. All individuals were categorized according to gender and age. Statistical analysis was done on Statistical Package for Social Sciences (SPSS) version 20. Independent sample T test, one way ANOVA and Pearson’s correlation analysis were applied. P- value of ≤ 0.05 was considered significant.

Results:

Mean right renal length, width and anteroposterior thickness were 10.81±0.71 cm, 4.77±0.23 cm and 4.36±0.21cm respectively. Mean left renal length, width and anteroposterior thickness were 11.12±0.73 cm, 4.84±0.23 cm and 4.44±0.19 cm respectively. Mean volume of right and left kidneys were 118.80±17.98 cm3 and 126.00±18.36 cm3 respectively. A significant difference (p=0.001) was found between right and left kidney dimensions. A weak positive correlation of mean renal volume of both kidneys was observed between males and females (right renal volume r=0.024, left renal volume r=0.035). While a significant moderate negative correlation was seen between mean renal volume and age (right r= -0.456, p < 0.001: left r= -0.462, p < 0.001).

Conclusion:

This study presents a reference range of renal dimensions in adults without known renal disease in a subset of Karachi population. It is concluded that renal dimensions and renal volume varies significantly with side of kidney, gender and age.

Key Words:

Kidney, Gender, Adult, Tomography

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Background:

Enterobacteriaceae are a large family of gram negative bacteria including many genera. The emergence and spread of resistance in Enterobacteriaceae is increasing due to the production of extended spectrum beta lactamase (ESBL) enzymes. Combinations of Beta-lactam/Beta-lactamase inhibitors such as Piperacillin/Tazobactam and Cefoperazone/Sulbactam have good activity against these isolates. The purpose of this study is to determine the antimicrobial susceptibility pattern of Piperacillin/Tazobactam and Cefoperazone/Sulbactam against isolates of Enterobacteriaceae from a tertiary care hospital laboratory of Pakistan. This study validates better options for empirical antimicrobial treatment for this group of difficult to treat pathogens.

Methods:

A total of 2111 clinical samples were received for culture and sensitivity from both in and outpatients. Samples were inoculated on Chocolate agar, Sheep blood agar and MacConkey’s agar and were incubated for 24 to 48 hours according to standard technique. All isolates belonging to the family Enterobacteriaceae identified by conventional biochemical tests were included in the study. Antimicrobial sensitivities of Enterobacteriaceae were tested and interpreted by Kirby-Bauer disc diffusion method according to Clinical Laboratory Standard Institution criteria.

Results:

Out of 2111 clinical samples, 214 isolates of Enterobacteriaceae were identified. Escherichia coli was recognized as the predominant pathogen (130/214; 60.75%). Frequency of extended spectrum beta lactamases producing Enterobacteriaceaewas100/214(47%) in 214 samples. Antimicrobial sensitivity was 80% (172/214) to Piperacillin/Tazobactam and 83% (178/214) to Cefoperazone/Sulbactam against the total 214 isolates of Enterobacteriaceae.

Conclusion:

Piperacillin/Tazobactam and Cefoperazone/Sulbactam are potential and better empirical treatment options for treating isolates of Enterobacteriaceae. This will help in reducing selection pressure on last resort antimicrobials and hence curtail antimicrobial resistance.

Key Words:

Antimicrobial susceptibility. Piperacillin/Tazobactam. Cefoperazone/Sulbactam. Enterobacteriaceae. Beta lactamases.

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Background:

Lower spinal back pain, a very common everyday problem, experienced by most people in their life, is usually nonspecific low back pain and varies with changes in posture and activity. It is also called mechanical low back pain.

Objective:

The objective of this study was to examine the effectiveness of therapeutic ultrasound with and without ketoprofen gel on pain and disability in patients with nonspecific low back pain.

Methods:

The study design was randomized clinical trial, conducted at MadinahTeaching Hospital and Sugraha trust hospital Faisalabad. This study included males and females between ages 20 to 35. A convenient sampling technique was applied, as patients who were visiting the physiotherapy department during months of Febraury-June 2016 were considered. Signed consent forms and the privacy of patients was taken into consideration. Two groups were made; Group A received ultrasound with Ketoprofen gel and strengthening and stretching exercises whereas Group B received ultrasound with Aqua sonic gel and strengthening and stretching exercises. Total treatment sessions were over a period of 10 consecutive days. The pain intensity was measured by visual analogue scale (VAS) and functional level was measured by Oswestry Disability Questionnaire(ODQ) before, in the middle and at the end of the treatment.

Results:

There was a significant difference before and after treatment in pain intensity between ketoprufen gel (3.07±0.77 and p=0.000) and aqua sonic gel (5.08±0.85 and p=0.06). There was a reduction in disability level after the treatment in both groups but greater improvement was achieved by Ketoprofen gel as compared to aqua sonic gel.

Conclusion:

Therapeutic ultrasound with ketoprofen gel along with stretching and strengthening exercises is more effective than the aqua sonic gel ultrasound in the management of non-specific lower lumbar back pain.

Key Words:

ketoprufen, therapeutic ultrasound, nonspecific low back pain

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Background:

TThe close association of physiology with clinical medicine is highlighted in the preclinical years, and also in hospital practice later. Integration of basic sciences with clinical training is remarkably challenging for the dental curriculum. Many medical and dental schools have modified their preclinical curricula to signify the relevance of basic science to practice. Since its inception, Ziauddin Dental College has introduced guide books. They are comprised of the learning objectives for each integrated module. The objective of this study is to determine the clinical relevance of Physiology objectives in Dental practice.

Methods:

The learning objectives of Physiology from three modules were given to 22 House officers from the field of Dentistry. The questionnaire included the learning objectives taken from the guide book and the participants were asked to determine the clinical relevance of objectives on Likert scale from 1 to 5.

Results:

Out of 38 Physiology objectives from three modules marked by House officers, 30 (79%) were determined as highly relevant and 8 (21%) as moderately relevant.

Conclusion:

The Physiology learning objectives of Respiratory, Cardiovascular and Hemopoietic & Immune system, taught at ZDC were found to have a high clinical relevance.

Key Words:

Physiology objectives, Dental Practice, Clinical relevance

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Background:

With the growing incidence of multi-drug resistant organisms, Infection Control programs in hospitals need to be more vigilant regarding staff practices and targeted training should be provided to ensure clinical staff is aware of their role in breaking the chain of infection. The objective of this study was to identify gaps in the knowledge, attitude and practices of clinical staff with regard to infection control protocols, in order to develop comprehensive training programs for the implementation of these protocols in routine duties.

Methods:

A descriptive, cross sectional study was conducted on 246 clinical staff in a tertiary-care teaching hospital, through a structured questionnaire developed to assess the knowledge, attitude and practices of clinical staff. Statistical analysis was performed through SPSS(Ver. 20.0)

Results:

A staff of 246 participated in the survey (151 nurses, 72 doctors and 23 paramedical staff). Respondents considered bed sores, respiratory and urinary tract infections as common hospital acquired infections, but only 14% included sepsis and infected venous access in this category. 219 (89%) staff acknowledged receiving Infection Control training and 167 (68%) staff always performed hand hygiene but 69 of 246 participants (28%) did not consider recapping to be a risk factor for infections and145 (59%) were unaware of vaccination schedules.

Conclusion:

Results show that clinical staff has basic knowledge of transmission routes and personal protective equipment, but concepts are not clear regarding vaccination schedules and post-exposure prophylaxis. Additionally, compliance with Infection Control guidelines should be monitored through audits for further enforcement.

Key Words:

infection control, surveys, education

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In this case report the patient belongs to rural Sindh, with poor prenatal care. She came with her third pregnancy to Ziauddin Hospital referred from interior of Sindh, with the history of previous two premature deliveries due to oligohydramnios.

Fraser syndrome is a rare congenital condition that includes multi-organ abnormalities and usually has a poor prognosis. The most obvious deformities noted are cryptophthalmos, syndactyly, laryngeal stenosis, and bilateral renal agenesis, displacement of umbilicus, undescended testes and clitoromegaly. The transmission of the syndrome is autosomal recessive and is caused by a mutation in the FRAS1, FREM2 or GRIP1 genes. The pathology, however, is unclear, but the mutations are known to alter programmed cell death, causing defects in the metabolism of retinoid.

The details of the case are the patient was of a 20-year-old female presented in her 3rd pregnancy at 34 weeks of gestational amenorrhea which was complicated with severe oligohydramnios. She delivered an underweight baby via cesarean section who had a poor cry and bradycardia at the time of birth. His structural defects included bilateral syndactly, laryngeal stenosis and undescended testes. The patient also had a history of two cesarean sections. Her first child was born with limb defects and anophthalmia and died immediately after birth. Her second child was terminated due to severely reduced amniotic fluid. Patients with a previous history should have genetic counseling beforehand and prenatal ultrasound based diagnosis.

Key Words:

Fraser Syndrome, Cryptophthalmos, Syndactyly

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Visual complications in patients with infective endocarditis include central retinal artery or vein occlusion, corneal ulcers, endophthalmitis, sub-retinal abscess, papillitis, optic neuritis and cortical blindness due to septic micro-embolization. Although there is no epidemiological data available on the visual complications of infective endocarditis, however, many case reports reveal that these are common and could be the first presentation of infective endocarditis.

We presented a case of a young gentleman, an intravenous drug abuser who presented with fever and bilateral, painless, vision loss. Fundoscopic examination revealed Roth spots. Echocardiography showed vegetation on anterior mitral leaflet. Blood cultures showed growth of Staphylococcus Aureus. His MRI brain showed small areas of diffusion restriction in bilateral parieto-occipital regions.The patient receivedbroad spectrum antibiotics for native valve endocarditis. His vision improved after 18 hours of hospital stay.

We emphasize the importance of recognizingthe visual complications in patients with infective endocarditis. Early diagnosis leads to early treatment and reversibility of this focal deficit.

Key Words:

Vision, Endocarditis, Early diagnosis

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Plants have been used to cure epileptic seizures, since ancient times. Approximately 70 percent people living in developing countries still rely on complementary and alternative medicines (CAM) regardless of the improvement in conventional medicine. People, particularly living in rural and tribal areas, have faith in Hakeem’s. According to them, alternative treatments do not have toxic effects and are more easily accessible, cost effective and have been used traditionally. Standard drugs therapies have several adverse effects; people become resistant and require a combination of treatments which may double the risk of adverse effects. Herbal agents could be a better alternative to conventional medicine; hence to prove the effectiveness and safety of medicinal plants, evidences-based researches are required from different parts of world. In order to prove the efficacy of herbal agents, different animal models of seizures are used to evaluate efficacy of plants and among all of them Maximum electroshock (MES) induced seizure model (a model of tonic-colonic seizure), is used as gate keeper to assess the anti-seizure efficacy of newly tested plants.

Key Words:

Ant seizure efficacy, epilepsy, herbal cure, alternative medicines.

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As professionals in the healthcare industry, there is a duty deeply ingrained within us to be better today than what we were yesterday. This means that each day we have the opportunity to rise up to bigger challenges, whether it is to pass an Endotracheal tube into an unconscious patient with severe neck edema, or to increase the vaccine coverage to more rural areas. Understandably it is the decisions made at a national level which have the potential to be more impactful…

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