Surveillance of Chikungunya virus activity in some North-eastern states of India

Objective: To detect the prevalence pattern of Chikungunya virus in three states of Northeast India. Methods: A total of 1 510 samples were collected from different private and government hospitals of Assam, Arunachal Pradesh and Meghalaya. Serum was tested for the presence of IgM antibodies against Chikungunya virus followed by RT-PCR for amplification of Chikungunya E1 gene region using specific primers. Results: Overall, 11.83% (172/1 454) clinical samples were positive by MAC-ELISA and/or RT-PCR assay. Asymptomatic infection was seen in 17.86%. Males were more affected than females and age group 16-30 years was mostly affected. Fever (100.00%) was the primary symptom followed by headache (72.03%) and arthralgia (41.53%). Only 118 Chikungunya positive cases could be traced, of which 25.42% complained about sequelae of infection. In entomological investigation, Aedes aegypti was more predominant (92.10%) than Aedes albopictus (7.90%). No mosquito pools could be incriminated for Chikungunya virus. Conclusions: In this study, Chikungunya was observed to be prevalent in Assam, Arunachal Pradesh and Meghalaya. Though Chikungunya is a self-limiting infection, increasing morbidity by CHIKV infection is affecting social and economic status of individual. Thus, a community empowerment to effectively control mosquito population by employing different mosquito control measures along with personal protection is mandatory to tackle future outbreak of the disease.

Pharmacological studies of Adhatoda vasica and Calotropis procera as resource of bio-active compounds for various diseases

Adhatoda vasica and Calotropis procera species were investigated as a resource for new diverse pharmacological agents including B complex, individual total phenolic compounds and antioxidants for curing and treatments of many infectious diseases in human through advanced analytical methods. These plants are abundant in Khyber Pukhtoon Khawa, Pakistan as well as in all over the world and famous for their unique medicinal importance. These herbaceous species are so far used for animals curing while current exploration of these species showed that these species are a precious resource of various compounds which can be employed in the formation of different drugs. The results showed that the leaf and flower extracts of Adhatoda vasica and leaf extract of Calotropis procera contained higher contents of bioactive compounds. The chemical analysis of the samples resulted in higher values of total phenolic compounds [71.32mg GAE/g], total antioxidants [651% DPPH inhibition], the enzyme catalase [4716Mug/g], ash content [16.72%] and pH values in the Calotropis procera, whereas the total carotenoids [1987mg/100g], the enzymes, superoxide dismutase [4566Mug/g] and peroxidase [1322Mug/g] were higher in leaves of Adhatoda vasica. The flower extract of the Adhatoda vasica was rich in the flavonoids [0.87mg/100g] and organic matter [89.99%] as compared to Calotropis procera. The obtained data for each parameter was interpreted by applying Complete Randomized Design [CRD] along with factorial arrangements. The mean comparison was performed using LSD test at 5% probability level. The presence of these phytochemicals may lead to the conclusion that these herbal plants have the potential for formation of new drugs and can be used as herbal medicine for treatment of different cancer and viral diseases. These compounds are also useful in the treatment of the tumor

Molecular characterization and spoligotyping analysis of multi drug resistant mycobacterium tuberculosis from a high TB endemic area of Pakistan

Background: Multidrug resistant tuberculosis caused by Mycobacterium tuberculosis is an infection that is resistant to rifampicin and isoniazid. Management of Multidrug resistant tuberculosis is a serious challenge worldwide

Objectives: To investigate hotspot mutations in rpoB, katG and inhA genes and its possible co-relation with predominant genotypes in Khyber Pakhtunkhwa, Pakistan

Study design, settings and duration: This cross sectional study was conducted after approval from research and ethics committee of Provincial TB Control Program, Khyber Pakhtunkhwa in March 2015

Materials and Methods: A total of 166 clinical isolates were analysed which were collected from programmatic management of drug-resistant tuberculosis units. All samples were characterized by phonotypical drug susceptibility test, genotypic drug resistant test [line probe assay] and spoligotyping analysis using ''TB-SPRINT' micro bead assay

Results: Out of the total 166 samples, 97 strains were resistant to rifampicin [RIF] and 106 strains were resistant to isoniazid [INH]. Most common mutation in rpoB was S531L in 75 [77%] isolates followed by D516V in 10 [10%] and H526Y in 6 [6%] samples respectively. A rare mutation in rpoB gene at codon 522 and deletion of codon 518 was also reported. In 106 INH resistant strains, 97[91%] were associated with mutation in katG gene while resistance in 9 [8.4%] strain was due to mutation in the inhA promoter region. Spoligotyping analysis revealed 55 distinct types of different patterns. Spoligotyping patterns of 146 samples matched with 15 different linage of M.tuberculosis in which 101 [60%] were identified as the predominant CAS1-Delhi linage. The pattern of 20 strains [12%] did not matched to any other pattern in the SITVIT database and were named orphan KP

Conclusion: Molecular characterization of M.tuberculosis is very helpful in the early identification of MDR-TB. As CAS1-Delhi is the predominant type in this region, its association with drug resistance, treatment failure and patient demographic profiles should be investigated

[ effects of mycorhiza [glomus mosseae and glomus intraradiceae] and phosphorus on growth and phytochemical traits of Dracocephalum moldavica L. under drought stress]

Background: Drought stress reduces growth and changes metabolites of medicinal plants. Mycorrhizal fungus in interaction with phosphorus can modify drought stress

Objective: Study the effects of drought stress, mycorhiza and phosphorus fertilizer on growth indexes, quantity and quality of essential oil of medicinal plant Dracocephalum moldavica L.

Methods: This study was done on the base of factorial experiment in randomized complete block design with five replications. The factors were consist of three level of drought stress 95% Fc, 65% Fc and 35% Fc, three level of mycorrhizal inoculation [non-inoculated, Glomus mosseae and Glomus intraradiceae] and two level of phosphorus fertilizer [0, 100 kg/ha]

Results: Interaction effects were significant between drought stress, mycorhiza and phosphorus factors in all measured attributes at the 1% level. The highest fresh weight of plant and leaf were related to no drought stress condition [95% of field capacity], application of mycorhiza and phosphorus fertilizer treatments. The highest number of flowers, fresh weight of root, and essential oil percent were recorded in mild drought stress [65% of field capacity], mycorrhiza inoculation and application of phosphorus fertilizer. The lowest amount of all of above mentioned traits obtained in severe water stress, without Mycorhiza and phosphorus fertilizer treatments. The highest content of 6-methyl- 2-phenylindole and Z-citral in essential oil were obtained with no drought stress treatment. The mild water stress with application of G. intraradices increased the geranyl formate, geranyl acetate and caryophyllene oxide in essential oil

Conclusion: Application of two mychorhiza strains in severe water stress can increase physiological yield and essential oil percent of Deracocephalum moldavica in about 45- 100%. The essential oil was increased even in no water stress with application of mychorhiza strains

Fractured styloid process masquerading as neck pain: Cone-beam computed tomography investigation and review of the literature

Historically, Eagle syndrome is a term that has been used to describe radiating pain in the orofacial region, foreign body sensation, and/or dysphagia due to a unilateral or bilateral elongated styloid process impinging upon the tonsillar region. Because elongated styloid processes–with or without associated Eagle syndrome–can present with various symptoms and radiographic findings, it can be challenging for healthcare practitioners to formulate an accurate diagnosis. Abnormal styloid anatomy can lead to a multitude of symptoms, including chronic orofacial/neck pain, thus masquerading as more commonly diagnosed conditions. In this report, we describe a patient who presented to our department with styloid process elongation and fracture. A careful history, physical examination, and a conebeam computed tomography (CBCT) investigation led to the diagnosis. The patient was then referred for appropriate care. This case report demonstrates the utilization of CBCT in differentiating a fracture site from a pseudo-joint that might mimic a fracture.

Comparative role of pregabalin and carbamazepine regarding efficacy in painful diabetic neuropathy

Neuropathic pain is the most severe and resistant type of pain which has impact on quality of life ana behaviour; it most commonly occurs at night causing disturbed; sleep. Diabetes mellitus is a common cause of painful neuropathy. In this study, we are comparing the effectiveness of old treatment Carbamazepine with Pregabalin in painful diabetic neuropathy. The study was an open-label trial conducted in Diabetic Clinic of Medical Unit-Ill, Jinnah Postgraduate Medical Center, Karachi. The duration of the study was 90 days, from December 2010 to March 2011. The study has been approved from ethical committee of JPMC, Karachi with the reference NO.F.2-81/2010-GENL/195/JPMC. 60 established patients of painful diabetic peripheral neuropathy from Diabetic Clinic of Medical Unit-Ill OPD were included in the 90-day study, irrespective of gender, with duration of diabetes more than 10 years. All subjects are placed into two groups. In group A, comprising of 30 patients [n=30], Pregabalin was administered and in group B, also comprising of 30 patients [n=30], Carbamazepine. The intensity of pain was compared on visual analog scale of McGill pain questionnaire. In group A [Pregabalin], the mean pain score fell from 6.17+/-0.14 to 3.50+/-0.15 from day 0 to day 90 [p-value=0.001] and the percentage of change also in visual analog scale of McGill pain questionnaire was -43.31%. In group B [Carbamazepine], the changes in pain score from initially 6.07+/-0.14 falling to 4.23+/-0.13 from day 0 to day 90 [p-value=0.001] and the percentage of change was -30.31%. Pregabalin was observed to be more potent. Both drugs were well tolerated by all participants that also completed the entire duration of the trial

Expression and immunohistochemical localisation of the G[beta gamma]-activated and calcineurin-inhibited adenylyl cyclase isoforms in rat articular chondrocytes

Objective: to determine the expression and localisation of the G[beta gamma]-activated adenylyl cyclase [AC] isoforms 2, 4, and 7 and calcineurin-inhibited AC isoform 9 in rat articular chondrocytes

Study Design: experimental study

Place and Duration of Study: Jumma Research Laboratory and Histology Laboratory, The Aga Khan University, Karachi, from 2009 to 2011

Methodology: fresh slices of articular cartilage were taken from various synovial joints of rats of different age groups. The expression of AC isoforms was determined by RT-PCR and immunohistochemistry was performed to localise these isoforms in articular chondrocytes. Tissue sections were processed for immunostaining with respective antibodies. The color was developed by diaminobenzidine

Results: all the studied AC isoforms were found to be differentially expressed in different zones of the rat articular cartilage. Generally, expression of all AC isoforms studied increased with age. The expression of the AC isoforms through PCR was almost consistent with the localisation of these isoforms by immunohistochemistry

Conclusion: these data add to the information about signalling cascades possibly involved in articular chondrocytes. Variable expression of AC isoforms 2, 4, 7, and 9 suggest a role for the signalling cascades regulated by the AC isoforms in articular chondrocytes

public purchase of aphrodisiac products without prescriptions in the Alahsa region of KSA

Objectives: To investigate requests for common prescription-only aphrodisiacs across community pharmacies in the Alahsa region of KSA

Methods: A cross-sectional study was conducted among conveniently selected pharmacies in the eastern region of Alahsa, KSA. Self-administered questionnaires were directly distributed to 73 consenting community pharmacies. Completed questionnaires were coded, reviewed for accuracy and entered into a database in Statistical Package for the Social Sciences [Version 19.0; IBM Corporation, Somers, NY]. The data were analysed using descriptive analysis

Results: The survey response rate was 72.60%. With respect to the availability of aphrodisiacs and sexual supplements, most of the pharmacists disclosed that they had stocks of Viagra and Cialis. The most common men's health complication reported by pharmacists was erectile dysfunction [n ¼ 12, 22.6%], followed by premature ejaculation [n ¼ 4, 7.5%] and low sexual desire [n ¼ 1, 1.9%]. Less than half of pharmacists [n ¼ 9, 16.9%] cited Viagra and Cialis as preferred drugs for treating premature ejaculation. Approximately 32 [60.3%] proposed delayed sprays as the first line of action, while 13 [24.5%] considered antidepressants as their first-choice drug

Conclusion: The non-prescription dispensing of prescription-only medicines, including sexual enhancement products, is common in KSA. The majority of pharmacists continue to violate pharmaceutical laws

Factors associated with poor asthma control in the outpatient clinic setting

The goal of the study was to assess asthma control using asthma control test [ACT] and to explore the factors that effects asthma control among participants with bronchial asthma in the outpatient clinic setting. This cross-sectional descriptive study was conducted in the outpatient primary care clinic at King Abdulaziz Medical City in Riyadh. Adult patients who were diagnosed with bronchial asthma by their primary treating physician were recruited over a 6-month period. Patients completed the ACT and questionnaires, which identified factors that affect asthma control. Four hundred asthmatic patients [n = 400] were enrolled, and 70% of these patients were women. Fifty-four percent of patients inappropriately used the inhaler device. The estimated prevalence of uncontrolled asthma at the time of the study was 39.8%. Inappropriate device use by the patient was more frequently associated with uncontrolled asthma [P - value = 0.001]. Active smoking [P - value = 0.007], passive smoking [P - value = 0.019], unsealed mattress [P - value = 0.030], and workplace triggers [P - value = 0.036] were also associated with uncontrolled asthma. However, the extent of asthma control did not appear to be related to the existence of regular follow-ups, bedroom carpets, outpatient clinic visits, age, body mass index [BMI], or duration of asthma. The present study identified a high prevalence of uncontrolled asthma in the primary outpatient clinic setting and common risk factors that may contribute to poor asthma control

Fall-related injuries in a low-income setting: results from a pilot injury surveillance system in Rawalpindi, Pakistan

This study assessed the characteristics and emergency care outcomes of fall-related injuries in Pakistan. This study included all fall-related injury cases presenting to emergency departments [EDs] of the three teaching hospitals in Rawalpindi city from July 2007 to June 2008. Out of 62,530 injury cases, 43.4% [N = 27,109] were due to falls. Children [0-15 years] accounted for about two out of five of all fall-related injuries. Compared with women aged 16-45 years, more men of the same age group presented with fall-related injuries [50% vs. 42%]; however, compared with men aged 45 years or more, about twice as many women of the same age group presented with fall-related injuries [16% vs. 9%, P < 0.001]. For each reported death due to falls [n = 57], 43 more were admitted [n = 2443, 9%], and another 423 were discharged from the EDs [n = 24,142, 91%]. Factors associated with death or inpatient admission were: aged 0-15 years [adjusted odds ratio [aOR] = 1.35], aged 45 years or more [aOR = 1.94], male gender [aOR = 1.15], falls occurring at home [aOR = 3.38], in markets [aOR = 1.43], on work sites [aOR = 4.80], and during playing activities [aOR = 1.68]. This ED-based surveillance study indicated that fall prevention interventions in Pakistan should target children, older adult women, homes, and work sites

Increasing antimicrobial resistance among uropathogens: is fosfomycin the answer?

Urinary tract infection [UTI] is one of the most common infectious diseases in clinical practice. The choice of antibiotics for the treatment of UTI is limited by the rising rates of antibiotic resistance. There is an urgent need to discover new effective treatment solutions. Fosfomycin may be an interesting alternative to the currently used treatments of UTIs. The study was conducted over 6 months period [January to June 2013] in Department of Microbiology, JNMCH, AMU, Aligarh. A total of 1840 urine samples were submitted. Culture and sensitivity was done as per standard microbiological procedures. Methicillin-resistant Staphylococcus aureus [MRSA], high-level aminoglycoside resistance [HLAR], extended spectrum beta-lactamases [ESBL], AmpC and metallo-beta-lactamases [MBL] production was detected. Culture was positive in 504 [27.4%] cases. Gram-negative etiology was identified in 390 [73%] cases. ESBL production was detected in 154 [37.1%] while 82 [21.6%] were Amp C. No, MBL was detected. Among Gram-positive bacteria, 68 [51.5%] were MRSA, while 4 [13.3%] were vancomycin resistant enterococci [VRE]. HLAR was seen in 53.3% of enterococci. Fosfomycin was effective in 100% of MRSA, VRE, ESBL, HLAR, and overall, susceptibility to fosfomycin in AmpC producers was extremely high [99%]. Norfloxacin and cotrimoxazole were not proved effective as only three isolates were sensitive to norfloxacin, while all Gram-negative isolates were resistant to cotrimoxazole. Pseudomonas species showed 65% and 75% susceptibility to colistin and polymixin B, respectively. Fosfomycin has emerged as a promising option, especially in cases involving multi-drug-resistant pathogens in which previous antibiotics have failed to cure the infection

Prevalence of ocular pseudoexfoliation syndrome and associated complications in Riyadh, Saudi Arabia

To assess the prevalence of pseudoexfoliation syndrome [PEX], and associated ophthalmic complications among Saudi patients. The prevalence of PEX and associated ocular co-morbidities were determined among the Saudi patients visiting the Primary Care Clinic of Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia, between January 2009 and January 2010. A total of 1967 patients were examined biomicoscopically by ophthalmologists to determine the presence of PEX and associated ocular complications. Sixty-nine of the 1967 examined patients [3.5%] showed the presence of PEX with no significant gender difference. There was an age dependent increase in the prevalence of PEX after the age of 50 years. Pseudoexfoliation syndrome was associated with higher intraocular pressure, cataract, and poor vision. There was no significant difference in the prevalence of PEX in male and female Saudi patients. Pseudoexfoliation syndrome is an age-related disorder, and its prevalence increases with age. Further larger population based studies are warranted to assess the prevalence of PEX and associated risk factors

Risk factors for deliberate self-harm in patients presenting to the emergency departments of Karachi

To determine the risk factors for Deliberate Self-Harm [DSH] in patients presenting to the Emergency Departments [EDs] of three tertiary care hospitals of Karachi, Pakistan. Multicentre matched case control study. EDs of the Aga Khan University Hospital, Karachi, Civil Hospital, Karachi and Jinnah Postgraduate Medical Centre, Karachi, from March 2011 to February 2012. A total of 201 cases and 201 matched controls were taken from three hospitals situated in Karachi. All patients of 16 years and above presenting to the EDs of the hospitals with DSH attempt were invited to participate in the study. Controls were ED patients with complaints other than DSH. A control was matched with case for hospital, gender and age. Two questionnaires were used to collect information on the risk factors of DSH. Conditional Logistic Regression [CLR] was used to assess the association of various risk factors with DSH. Risk factors of DSH in Karachi included current history of mental disorder [OR = 4.53, 95% CI = 1.59 - 12.92], not sharing problems with someone [OR = 4.67, 95% CI = 2.4 - 9.0], living in rented houses [OR = 2.58, 95% CI = 1.37 - 4.84], Pathan ethnicity [OR = 5.05, 95% CI = 1.01-25.38] followed by others [OR = 3.88, 95% CI = 0.77 - 19.69] and Urdu speaking [OR = 2.71, 95% CI = 0.59 - 12.45]. Absence of physical illness in the past month had an inverse association with DSH [OR = 0.17, 95% CI = 0.07 - 0.37]. Mental illnesses, low socio-economic status and loneliness were the risk factors of DSH patients presenting to the three EDs of Karachi. Physical illness in the last month was protective against DSH in these patients. Psychiatric evaluation of DSH patients in the ED is important for early diagnosis and management of mental disorders

comparative study of job satisfaction among regular and staff on contract in the primary health care system in Delhi, India

Job satisfaction is a pleasant emotional state associated with the appreciation of one's work and contributes immensely to performance in an organization. The purpose of this study was to assess the comparative job satisfaction among regular and staff on contract in Government Primary Urban Health Centers in Delhi, India. The study was conducted in 2013, on a sample of 333 health care providers who were selected using a multistage random sampling technique. The sample included medical officers [MOs], auxiliary nurses and midwives [ANMs], pharmacists and laboratory technicians [LTs]/ laboratory assistants [LAs] among regular and staff on contract. Analysis was done using SPSS version 18, and appropriate statistical tests were applied. The job satisfaction for all the regular staff that is, MOs, ANMs, pharmacists, LAs, and LTs were relatively higher [3.3 +/- 0.44] than the contract staff [2.7 +/- 0.45] with 't'value 10.54 [P < 0.01]. The mean score for regular and contract MOs was 3.2 +/- 0.46 and 2.7 +/- 0.56, respectively, and the same trends were found between regular and ANMs on the contract which was 3.4 +/- 0.30 and 2.7 +/- 0.38, regular and pharmacists on the contract was 3.3 +/- 0.50 and 2.8 +/- 0.41, respectively. The differences between groups were significant with a P < 0.01. Overall job satisfaction level was relatively low in both regular and contract staff. The factors contributing to satisfaction level were privileges, interpersonal relations, working-environment, patient relationship, the organization's facilities, career development, and the scarcity of human resources [HRs]. Therefore, specific recommendations are suggested to policy makers to take cognizance of the scarcity of HRs and the on-going experimentation with different models under primary health care system

Clinical profile of cutaneous drug reactions

Objective: To find out the clinical profile of cutaneous drug reactions in a tertiary level hospital

Methods: In this cross-sectional study, carried out for a period from January 2011 to December 2011, data were collected from the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University [BSMMU], Dhaka, Bangladesh. Patients suffering from adverse drug reactions were the study population and within the period of data collection, twenty patients were selected

Results: Out of total twenty patients, 9 [45%] had fixed drug eruptions, 4 [20%] urticaria, 3 [15%] Stevens-Johnson syndrome, 2 [10%] morbilliform rashes and 2 [10%] had erythema multiforme. The most common clinical presentation was hyperpigmented macule/patch in 5 [25%] cases, followed by urticarial plaque 4 [20%], erosive lesion 3 [15%] and loss of skin in sheets <10% body surface area 3 [15%] and morbilliform rashes and target lesions in 2[10%] each. 6 [30%] patients developed mucosal involvement only and majority of them 8 [40%] had oral involvement. The most common type of offending drug causing the drug reactions were sulfur containing drugs in 8 [40%] cases, followed by NSAIDs in 6 [30%], quinolones 3 [15%], metronidazole and anticonvulsants in a few

Conclusion: The common types of cutaneous drug eruptions are fixed drug eruptions, urticaria, Stevens-Johnson syndrome, morbilliform rashes and erythema multiforme

Does knowledge about blood borne pathogens influence the reuse of medical injection syringes among women in Pakistan?

Injections with re-used syringes have been identified as a major risk factor for hepatitis B virus [HBV] and hepatitis C virus [HCV] infections in Pakistan. We analyzed data from the 2006-2007 Pakistan Demographic Health Survey [PDHS] to describe the distribution of injections administered with newly opened syringes and assessed the association of knowledge about blood borne pathogens with syringe reuse in Pakistan. In the PDHS, women aged 12-49 years were enrolled through a multistage stratified cluster-sampling strategy across Pakistan. Approximately 10,000 women were interviewed to collect information regarding receiving injections, the use of syringes taken out of new unopened packages for their last injections, and knowledge regarding the transmission of Human Immunodeficiency Virus [HIV], HBV and HCV through the re-use of syringes and transfusion of unscreened blood. Of the 5126/10,023 women who provided information concerning their last injection, 4342 [86%] received this injection with a new syringe taken out of an unopened package. The proportion of injections received with a new syringe increased with the education level, wealth, HIV knowledge and knowledge about HCV/HBV transmission through the re-use of syringes. In the multivariable model, respondents in the 4[th] [adjusted odds ratio [AOR]: 2.1, 95%CI: 1.4-3.0] and 5th [AOR: 2.4, 95%CI: 1.6-3.5] wealth quintiles, with some education [AOR: 1.4, 95%CI: 1.1-1.9], those in the 4[th] quartile of the HIV knowledge score [AOR: 1.5, 95%CI: 1.1-2.0], and those with the knowledge that a new syringe protects against HCV/HBV and HIV [AOR: 2.3, 95%CI: 1.5-3.5] were more likely to receive injections with a newly opened syringe. The patients' knowledge regarding the transmission of blood borne pathogens is an important factor in receiving injections with a new syringe

IgG Avidity Antibodies against Toxoplasma gondii in High Risk Females of Reproductive Age Group in India

Toxoplasma gondii is an obligate intracellular protozoan that is distributed worldwide. Recently, several tests for avidity of Toxoplasma IgG antibodies have been introduced to help discriminate between recently acquired and distant infections. The study was conducted in Jawaharlal Nehru Medical College and Hospital, India from February 2011 to September 2012. Serum specimens were subjected to Toxoplasma IgM ELISA and IgG avidity ELISA test. Out of 48 patients with abortions, 17 (35.4%) were positive for IgM ELISA, and 8 (16.6%) had low IgG avidity antibodies. Out of 48 patients with other obstetric problems, 23 (47.9%) were positive for IgM ELISA, and 17 (35.4%) had low IgG avidity antibodies. Combining both groups on avidity test, only 25 of 40 (62.5%) IgM-positive women had low-avidity IgG antibodies suggesting a recent T. gondii infection in these women. More importantly, 15 (37.5%) of the IgM-positive women had high-avidity antibodies suggesting that the infection was acquired before gestation The relation of IgM seropositivity with the following risk factors was not found to be statistically significant; contact with cats (0.13), non-vegetarian food habits (0.05), and low socio-economic status (0.49). While, for IgG avidity ELISA, only contact with cats (0.01) was significantly associated with seropositivity. All other risk factors have P-values of >0.05 (not significant). IgG avidity test when used in combination with IgM test was a valuable assay for diagnosis of ongoing or recently acquired T. gondii infection in India.

Appraisal of antimicrobial prescribing practices of governmental and non-governmental dentists for hospitals in the western region of Saudi Arabia

To scrutinize the knowledge, attitude, and antimicrobial practices in Saudi Arabian Dentistry. In this cross-sectional survey of dentists, a self-administered questionnaire comprising of 61 questions was dispersed to the participants randomly, which included their professional profile, awareness of the current scope of antimicrobial resistance, prescribing practice, frequency of antimicrobial prescription, and sources of continuing education of antimicrobials. The study took place in the Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia between February and April 2013. Knowledge and awareness concerning specific antimicrobials, with specific oral cavity lesion was 78% for the students and interns, 80% for residents, and 95.3% for specialists. Approximately 89% of the students, interns and residents, and 98.4% of the specialists endorsed indiscriminate use of antibiotics. In addition, 93.4% of students, 90% of interns and residents, and 90.6% of specialists agreed that lack of health education is one of the contributors to overuse of antimicrobials. Moreover, 91.9% of the interns, 80% of residents, and 75.5% of specialists preferred amoxicillin + clavulanate as their first choice; however, a wide variation in the dosage frequency, and duration was observed. Participants are well aware of the significance of antimicrobial resistance, and considered that judicious use of antimicrobials is highly imperative to restrain this fiery predicament. Divergence was demonstrated between specialists and residents in prescribing practices. Institutional antimicrobial guideline was not interesting to all the respondents. This highlights the need for incessant instructive intervention in order to accomplish the prime objective of retreating antimicrobial resistance

comparative analysis of the Baska Mask vs. proseal laryngeal mask for general anesthesia with IPPV

To compare the sealing pressure of the Baska Mask [BM] with Proseal laryngeal mask [PLM] in patients undergoing general anesthesia for a variety of elective non-head and neck surgical procedures.. Prospective, randomized, ethical issues committee approved interventional study. Setting: Operating rooms of Khoula Hospital, Muscat [Oman]. 52 consecutive adult patients of either sex requiring general anesthesia were included in the study. Patients with BMI >30, having known tendency to nausea/vomiting or pharyngeal pathology were excluded from the study. Following uniform induction with propofol 2-2.5 mg/kg, fentanyl 1.0-1.5 ug/kg, and relaxation with cisatracurium 0.1 mg/kg, either BM [n=30] or PLM [n= 22] was placed. Primary outcome measure was airway seal pressure while secondary outcome measures included device insertion time, number of attempts, leak fraction, duration of use, and laryngopharyngeal morbidity [sore throat, dysphagia, and dysphonia] at 1 hour and 4 hours postoperatively. Data collection was done by a staff member not involved with the study. The mean insertion time was significantly shorter in the BM group as compared to the PLM group [16.43 +/- 4.54 vs. 21.45 +/- 6.13] [P=0.001]. Mean sealing pressure was significantly higher in the BM group [29.98 +/- 8.51 vs. 24.50 + 6.19] [p= 0.013]. The leak fraction showed no difference between the devices and it ranged from 5.5-20% and 5-20% in the BM and PLM group respectively. All other studied parameters showed insignificant differences between the two devices. BM takes significantly shorter placement time and provides a better seal as compared to PLM

Multiple myeloma presenting as dysphagia

Plasmacytoma is a discrete solitary mass of neoplastic monoclonal plasma cells in either bone marrow or soft tissue sites. Extramedullary plasmacytoma or multiple myeloma of the larynx is extremely a rare condition. We report a 77-year-old male patient diagnosed with multiple myeloma and presented with dysphagia. The rarity of the disease incidence and difficulty of the diagnosis of this disease is discussed. We present this case to increase the awareness of the Otolaryngologists of this rare disease to expedite its diagnosis and management