Scorpion sting management at tertiary and secondary Care Emergency Departments

Objectives: We sought to review the management of scorpion stings in tertiary and secondary care emergency departments in Oman and determine physician's knowledge of management protocols

Methods: We conducted a retrospective study of all scorpion stings cases seen in Sultan Qaboos University Hospital [SQUH] emergency department [ED] from March 2016 to July 2017. Additionally, we conducted a survey of ED physicians regarding their management of scorpion stings in three different EDs including SQUH

Results: The total number of scorpion stings seen at SQUH during the study period was 128. Localized pain was seen in 97.7% [n = 125], swelling in 14.8% [n = 19], and local redness in 7.0% [n = 9] of patients. Around 13.0% [n = 17] of patients were found to have systemic symptoms with tachycardia being the most common. Bedside clotting test was done for 11.7% [n = 15] of patients. The most commonly used treatment was local anesthesia [54.7%, n = 70]. No patient received scorpion antivenom. In the 89 surveyed physicians the main management method used was analgesia [88.8%, n = 71] followed by local anesthesia [81.1%, n = 65]. Most physicians [80.0%, n = 64] believed that local anesthesia was the most effective management. However, 32.5% [n = 26] ordered a whole blood bedside clotting test, 69.2% [n = 18] of which were junior doctors

Conclusions: Most scorpion sting cases managed in SQUH had local symptoms. Tachycardia was the most common systemic manifestation. Bedside clotting test was not commonly ordered and mainly requested by junior doctors. Local anesthesia infiltration is the recommended management for scorpion sting. Analgesia was the main management followed by local anesthesia

Knowledge and attitudes of students of college of medicine towards evidence-based medicine and barriers to its use in clinical practice in Erbil city, Iraq

Background and objective: Evidence-based medicine, by guiding medical care towards meaningful outcomes to patients, has a significant worldwide impact on medical care and education. It is important that medical students, whom are the future physicians, keep themselves updated with recent advancement in medical knowledge and health care. The aim of this cross-sectional study was to determine the attitude, knowledge and barriers among students towards evidence-based medicine and making them familiar with the concept and advantage of evidence based medicine

Methods: A cross-sectional study was conducted on 163 sixth year students of the College of Medicine at Hawler Medical University during the period from October 2012 to May 2013. The response rate was 86.5%. Knowledge towards evidence-based medicine, accessing and interpreting evidence and perceived barriers to practice evidence-based medicine among participants were the main outcome measures

Results: Of 141 of participants that filled the questionnaire, only 69.5% had heard about evidence-based medicine. Around 82% stated that they had knew evidence-based medicine and only 23.5% had knew steps of evidence-based medicine. Around 65% of respondents welcomed the promotion of evidence-based medicine and 74.4% agreed with that finding from the current study in which it would be helpful in daily management of patients. Furthermore, 31.6% of students reported that standard textbook as a frequent source used for medical knowledge. Around 91% of students did not know the strongest evidence in the hierarchy of evidence and only small proportion of students reported that they understand the common epidemiological concepts that are used in evidence-based medicine

Conclusion: Evidence-based medicine is relatively a new concept among students at the College of Medicine in Erbil. Although the students appeared interested in learning and implementing evidence-based medicine in clinical practice, they need more guidance and training to ensure the correct use of evidence-based medicine ideals

Modulation of Macrophage Activity by a Herbo-mineral Formulation in Murine Model.

Aim: The present paper investigates the effect on immune responses by a herbo-mineral formulation, Khamira Marwarid [KM], prescribed in the Indian subcontinent as a rejuvenator, especially to convalescing patients of typhoid fever, in murine model. Study Design: KM was administered orally for short, intermediate and long duration [5, 15 and 30 days respectively] at a dose of 2g/kg body weight. Results: Administration of KM enhanced the antigenic and mitogenic activity, induced by ovalbumin and Con A (mitogenic stimuli), of mice whole splenocytes. KM caused a marked increase of production of Th-1 cytokine (IFN-) and a non significant decrease of production of Th-2 cytokine (IL-4) by splenocytes when stimulated with Concanavalin A. Oral administration of KM, by itself did not induce the production of NO by macrophages, but enhanced the production of NO in response to LPS as compared to unstimulated control. However, dose duration related suppression of NO production was observed. KM also enhanced significantly the phagocytosis that was evaluated using the phagocytic rate (PR) and phagocytic index (PI). Conclusion: The results indicate the immunomodulatory potential of KM leading to a Th1 dominant immune state and activation of macrophages and may find use in immunotherapy of tumors.

Arachidonic acid affects biofilm formation and PGE2 level in Candida albicans and non-albicans species in presence of subinhibitory concentration of fluconazole and terbinafine

Candida albicans utilizes arachidonic acid (AA) released during the course of infection (Candidiasis) from phospholipids of infected host cell membranes and synthesizes extracellular prostaglandin(s) which play an important role in hyphae formation and host cell damage. C. albicans biofilms secrete significantly more prostaglandin(s) and evidence suggests that Candida biofilms have dramatically reduced susceptibility to majority of antifungal drugs. AA influences the saturation level of lipids and fluidity of yeast cell membranes. Therefore the aim of this study was to evaluate the effect of AA alone or in combination with antifungal agents on biofilm formation and production of prostaglandin (PGE2) in C. albicans, C. parapsilosis, C. glabrata, C. tropicalis, and C. albicans amphotericin B resistant strain (AmBR). Maximum biofilm formation was found to be in the case of C. albicans compared to C. non-albicans species. However, among the non-albicans species C. tropicalis exhibited highest biofilm formation. Treatment with AA in combination with subinhibitory concentrations of fluconazole and terbinafine separately exhibited significant (p < 0.05) reduction in biofilm formation against C. glabrata, C. parapsilosis, C. tropicalis and AmBR as compared to their individual effect. Further, these two antifungal agents in combination with AA caused an increase in production of prostaglandin from fungal cell itself which was significant (p < 0.05) in case of all the strains tested.

Detection of histidine rich protein & lactate dehydrogenase of Plasmodium falciparum in malaria patients by sandwich ELISA using in-house reagents.

Background & objectives: Despite major control efforts, malaria remains a major public health problem that still causes high mortality rate worldwide especially in Africa and Asia. Accurate and confirmatory diagnosis before treatment initiation is the only way to control the disease. The present study was undertaken to develop reagents using sandwich ELISA for simultaneous detection of PfHRP2 (Plasmodium falciparum histidine rich protein) and PfLDH (P. falciparum lactate dehydrogenase) antigens in the proven malaria cases. Methods: The antibodies were raised against two epitopes of PfHRP2 protein and three unique and unexplored epitopes of PfLDH protein. These antibodies were able to detect PfHRP2 and PfLDH antigens in culture supernatant and parasitized RBC lysate of P. falciparum, respectively up to 50 parasites/μl. The in-house reagents were tested in 200 P. falciparum positive patients residing in Baghpat district of Uttar Pradesh in northern India. Results: Microsphere (PLGA) with CpG ODN were used to generate high titre and high affinity antibodies against selected peptides of PfHRP-2 and pLDH antigen in mice and rabbit. The peptide specific peak titre varied from 12,800 - 102,400 with an affinity ranging 0.73 - 3.0 mM. The indigenously developed reagents are able to detect PfHRP2 and PfLDH antigens as low as 75 parasites/μl of blood with a very high sensitivity (96-100%) and specificity (100%). Interpretation & conclusions: The study highlight the identification of unique epitopes of PfHRP2 and PfLDH, and the generated antibodies against these antigens were used for quantitative estimation of these two antigens using sandwich ELISA. No corresreactivity with P. vivax infected patients was observed with the sera.

Transient cell function disruption by low dose acute exposure of ionizing radiation.

Incubation of BMG-1 cells with thallium chloride (201Tl) in the range of diagnostic dose did not show a smooth uptake curve and appeared to have an unsuspected deviation in initial phase. In the present study this unexpected phenomenon was explored, using commonly used radionuclides (viz., 201Tl and 131I). Comparison was made with technetium-99m pertechnetate (99mTcO4-) and technetium-99m labeled methoxyisobutylisonitrile (99mTc-MIBI) that are known to show conventional 2 phase graph representing inflow and outflow segments. Serial in vitro, ex-vivo and in vivo gamma scintigraphy as well as NMR spectroscopy experiments were conducted to corroborate the results. BMG-1 cells demonstrated a four-phase uptake pattern with 201Tl as compared to a conventional biphasic pattern with 99mTc-MIBI. Flow cytometry data however did not reveal any 201Tl induced cell injury. Further, mice tissue extracts injected with 201Tl also showed a transient depression in its uptake. Scintigraphy experiments in rabbits administered with diagnostic dose of 201Tl and 131I confirmed the in vitro and ex vivo findings. Further, proton NMR spectroscopy showed decrease in the level of choline at 3 h and 24 h in 201Tl treated animals as compared to control. Phosphoethanolamine peak firstly decreased at 3 h but reached normal level at 24 h time point. No significant change was observed in the level of betaine. This transient reduction in internalization of 201Tl and 131I may represent a hitherto unknown acute effect of low dose radiation, i.e., transient depression in Na+-K+ ATPase pump activity without any apparent evidence of cell damage, representing a transient cell membrane dysfunction. The phenomenon may present a mechanistical explanation of ‘thyroid stunning’ at cellular level and suggest that it may be more universal in nature than suspected till now.

Antibiotics in upper respiratory tract infections: appropriateness of the practice in Jordan

This study was conducted to assess how common is the use of antibiotics in the treatment of acute upper respiratory tract infections by primary health care providers in north of Jordan, and the appropriateness of that use. Furthermore, to assess antibiotic use in relation to patients and physician characteristics. A cross-sectional survey was conducted among patients with acute upper respiratory tract infections attending primary health centers in Irbid governorate in north of Jordan. All patients with upper respiratory infections above the levels of the bronchioles were eligible for inclusion in this study. Accordingly, 234 patients were included. Each patient was first seen and treated by the health center general practitioner and re-examined and evaluated independently by a family medicine consultant during the same visit. The mean age of patients was 17.1 years [SD=16.4] and more than half of them [56%] were children < 15 years old. General practitioners prescribed antibiotics to 61% of the patients, and these prescriptions were inappropriate in 86% of the cases. Patients' characteristics such as age, sex and education showed no role on the antibiotic prescribing decision of their physicians. Antibiotic use for upper respiratory tract infections in Jordan is common and largely inappropriate, and the characteristics of patients did not influence antibiotic prescribing by physicians. We recommend further investigations of this important issue, to find out the reasons of overusing antibiotics by physicians in these illnesses