comparative study of functional outcome of treatment of intra articular fractures of distal radius fixed with percutaneous Kirschner's wires vs T-plate

Background and Objective: Fractures of the distal radius are common with a variable prognosis in case of intra articular extension. The available options include Plaster, External fixation, Prefabricated Splintage using Ligamentotaxis, K-wire fixation, and open reduction internal fixation with T-plate without an as yet clear advantage of one over the others. If these fractures are allowed to collapse, radial shortening, angulation and articular incongruity may cause permanent deformity and loss of function. This limited small scale study was intended to compare the functional results of treatment of these fractures with a T plate and K-wires

Methods: This was a prospective experimental study conducted at department of Orthopedics of PGMI/Lahore General Hospital, Lahore. Total 30 patients were included and randomized into two groups of 15 patients each. Group-A patients were treated with Krischner's wires and Group-B patients were treated with a T-Plate with open reduction. Informed consent was taken. Post operative follow up was done for 12 weeks for the outcome parameters [Green and O'Brien score]

Results: Mean age of patients in Group-A and B was 36.13 +/- 9.81 and 44.73 +/- 7.86 years respectively. In Group-A there were 10 male and 5 female patients and in Group-B there were 8 male and seven female patients respectively. In Group-A nine patients presented with Fernandez type-II and six patients presented with Fernandez type-III fracture. While in Group-B 10 patients presented with Fernandez type-II and five patients presented with Fernandez type-III fracture. Among Group-A patient's final outcome was excellent in 86.67% patients while in Group-B only 53.33% patients had excellent outcome at three months follow up

Conclusion: Percutaneous Kirschner's wires appeared to be more effective as compared to T-Plate fixation in terms of functional outcome for treating intra-articular distal radius fractures

Leadership Attitudes and Beliefs of Pharmacy Students: A cross-sectional Study from a Malaysian University.

Background: Pharmacy profession requires pharmacists to have leadership qualities to respond the challenges in healthcare system to meet the patient’s medication-related needs. Therefore, to build leadership qualities among pharmacists, it is essential to discuss it during the early training of the future pharmacists. Aim: The study aims to evaluate leadership attitudes and beliefs of pharmacy students at School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM). Methods: The study was designed as a cross-sectional, descriptive survey. All undergraduate pharmacy students (n=478) were targeted for the study. The Leadership Attitudes and Beliefs Scale was usedResults: Three hundred and forty-five students responded to the survey (response rate = 72.1%). The mean scores for hierarchical and systemic thinking were 25.7±6.56 and 30.7±6.88 respectively. It indicates that most of the students believe in a high hierarchical-high systemic thinking. Significant associations observed in a comparison between ethnicity and leadership aspects: leader being responsible of controlling, keeping authority, and charge of the organization (p=0.002,p=0.024and p=0.047respectively). Gender was reported to have a significant association with factors of participation (p=0.035) and security of the organization (p=0.014).Conclusion: The study findings suggest that pharmacy undergraduates prefer a high hierarchical thinking and high systemic thinking approach to leadership. Therefore, specialized programs about leadership are suggested to be included as part of the students activities and training. In these programs, more emphasis on systemic thinking is needed rather than overly depending on hierarchical thinking. Moreover, students should be equipped with knowledge necessary to decide which style of leadership to adapt to promote the well-being of the organization.

Plastibell device circumcision versus bone cutter technique in terms of operative outcomes and parent's satisfaction

Objective: To compare the rate of complications of Plastibell and bone cutter circumcision technique and recognition of top worries and satisfaction rate in the mind of parents before and after the procedure of Plastibell device [PD] circumcision in infants less than 6 months of age

Methods: It was a descriptive prospective study conducted at department of surgery Sheikh Zayed Hospital, Rahim Yar Khan. Two hundred parents of infants of less than six months of age were recruited for this study. Infants were divided into two equal groups. Group I included Plastibell circumcision technique and Group II included Bone Cutter Circumcision technique. Data was analyzed using SPSS Version 17. Independent sample t-test and chi-square test was used to compare quantitative and qualitative variables respectively. P-value <0.05 was taken as significant difference

Results: Total number of two hundred infants were included in this study. Most common worries of parents about Plastibell Device circumcision were; fear of fever [42.0%]. Fear of pain and bleeding [66.0%]. Plastibell Device method was associated with less operation time and bleeding as compared to bone cutter method [P-value <0.0001 and <0.0001 respectively]. Incidence of complications other than bleeding and infection was 3.0% in bone cutter method and 1.0% in Plastibell device method. Pain score was significantly less in plastibell device group [p-value <0.0001]. Post-operatively, 98% parents showed complete procedural satisfaction in Plastibell group versus 87% parents in bone cutter one month after surgery [P-value 0.003]. About 4% parents in bone cutter method group showed cosmetic displeasure versus only 1% parents in plastibell device group

Conclusion: The study concluded that Plastibell Device circumcision is a safer technique for circumcision and is associated with highest level of parent's satisfaction

prospective observational study assessing the outcome of Sepsis in intensive care unit of a tertiary care hospital, Peshawar

Objective: The current study aims to explore the factors associated with outcome among patients with severe sepsis and septic shock admitted to the intensive care unit, Northwest General Hospital and Research Centre, Peshawar, Pakistan

Methods: A prospective observational study was carried out at intensive care unit of our hospital from February 2014 to October 2015. Data was collected using a structured format and statistical analysis was done using SPSS version 20®. Regression model was applied to identify the factors contributing to the outcome of severe sepsis and septic shock. P-value less than 0.05 was considered statistically significant

Results: Majority of the patients meeting the criteria of this study were male 147 [54.9%] with a mean age of 54.8. The most common source of sepsis was lung infections [42.2%] followed by urinary tract infections [18.7%], soft tissue infections [6.3%] abdominal infections [6%] and in 6.3% patients the source remained unknown. Further analysis has revealed that increase in number of days of hospitalization was observed to be slightly associated with the outcome of the treatment [1.086 [1.002 - 1.178], 0.046]. Moreover, the risk of mortality was the higher among the patients with septic shock 22.161[10.055 - 48.840], and having respiratory, kidney and central nervous system complications. Overall it is seen that septic shock alone was found responsible to cause death among 32.0% of the patients [Model 1: R2 0.32, p=0.000], and upon involvement of the organ complications the risk of mortality was observed to 42.0%

Conclusion: Chances of recovery were poor among the patients with septic shock. Moreover, those patients having respiratory and urinary tract infection are least likely to survive

Study investigating the impact of pharmacist involvement on the outcomes of diabetes medication therapy adherence program Malaysia

Involvement of pharmacists in improving medication adherence among diabetic patients is recognized globally. In Malaysian healthcare system, pharmacists are also operating health services i.e. Diabetes Medication Therapy Adherence Clinic [DMTAC]. This study aimed to assess the clinical outcomes of patients managed by pharmacists [DMTAC], in a Malaysian hospital setting. This was an open labelled randomised study. Type 2 diabetes patients with HbA1c >/=8% were recruited and arbitrarily divided into the intervention group [usual care plus DMTAC] and the non-intervention group [usual care only]. Those enrolled in the intervention group were scheduled for follow-up for eight consecutive visits. Improvements in lab results were compared longitudinally [pre and post analysis] between the groups. Data analysis was done using PASW 18[registered] version. A total of 76 patients were enrolled, with 39 patients in the intervention group and 37 patients in the non-intervention group. Mean HbA1c [-0.90% vs. -0.08%, p=0.011] and fasting blood glucose levels [-3.45mmol.l vs. +0.79mmol/l, p=0.002] reduced significantly between the intervention group vs. non-intervention group. Total cholesterol and low-density lipoprotein cholesterol [LDL-C] were also significantly reduced in the intervention group [TC -0.34mmol/l, p=0.018] [LDL -0.45mmol/l, p=0.001]. In conclusion, pharmacists managed DMTAC significantly improved glycaemic control and lipid profile of diabetic patients

Factors associated with utilization of antenatal care services in Balochistan province of Pakistan: an analysis of the Multiple Indicator Cluster Survey [MICS] 2010

Objective: The study was conducted to identify factors affecting the utilization of Antenatal Care [ANC] in Balochistan Province, Pakistan

Methods: Data on ANC utilization, together with social and economic determinants, were derived from a Multiple Indicator Cluster Survey [MICS] conducted in Balochistan in 2010. The analysis was conducted including 2339 women who gave birth in last two years preceding the survey. The researchers established a model to identify influential factors contributing to the utilization of ANC by logistic regression; model selection was by Akaike Information Criterion [AIC] and Bayesian Information Criterion [BIC]

Results: Household wealth, education, health condition, age at first marriage, number of children and spouse violence justification were found to be significantly associated with ANC coverage. Literate mothers are 2.45 times more likely to have ANC, and women whose newborns showed symptoms of illness at birth that needed hospitalization are 0.47 times less likely to access ANC. Women with an increase in the number of surviving children are 1.07 times less likely to have ANC, and those who think their spouse violence is socially justified are 1.36 times less likely to have ANC. The results draw attention towards evidence based planning of factors associated with utilization of ANC in the Balochistan province

Conclusion: The study reveals that women from high wealth index and having education had more chances to get ANC. Factors like younger age of the women at first marriage, increased number of children, symptoms of any illness to neonates at birth that need hospitalization and women who justify spouse violence had less chances to get ANC. Among components of ANC urine sampling and having tetanus toxoid [TT] in the last pregnancy increased the frequency of visits. ANC from a doctor decreased the number of visits. There is dire need to reduce disparities for wealth index, education and urban/rural living

Antimicrobial activity of Nigella sativa L. seed oil against multi-drug resistant Staphylococcus aureus isolated from diabetic wounds

Microbial resistance to existing antibiotics has led to an increase in the use of medicinal plants that show beneficial effects for various infectious diseases. The study evaluates the susceptibility of multidrug resistant Staphylococcus aureus to Nigella sativa oil. Staphylococcus aureus was isolated from 34 diabetic patient's wounds attending the Renaissance hospital, Nsukka, Southeast Nigeria. The isolates were characterized and identified using standard microbiological techniques. Isolates were cultured and a comparative In vitro antibiotic susceptibility test was carried out using the disk diffusion method. Of the 34 samples collected, 19[56%] showed multidrug resistance to the commonly used antibiotics. Nigella sativa oil was then studied for antibacterial activity against these multidrug resistant isolates of Staphylococcus aureus in varying concentration by well diffusion method. The oil showed pronounced dose dependent antibacterial activity against the isolates. Out of 19 isolates, 8[42%] were sensitive to undiluted oil sample; 4[21%] of these showed sensitivity at 200 mg/ml, 400 mg/ml and 800 mg/ml respectively. Eleven [58%] of the isolates were completely resistant to all the oil concentrations. The present study, reports the isolation of multi-drug resistant S. aureus from diabetic wounds and that more than half of isolates were susceptible to different concentrations N. sativa oil

Prevalence of potential drug-drug interactions among internal medicine ward in University of Gondar Teaching Hospital, Ethiopia

<p><b>OBJECTIVE</b>To determine the prevalence, clinical significance and the associated risk factors of potential drug-drug interactions (DDIs) at internal medicine ward of University of Gondar (UOG) hospital.</p><p><b>METHOD</b>A prospective cross-sectional study was conducted on patients treated in internal medicine ward of UOG hospital from April 29, 2013 to June 2, 2013. Data was collected from medical records and by interviewing the patients face to face. Descriptive analysis was conducted for back ground characteristics and logistic regression was used to determine the associated risk factors.</p><p><b>RESULT</b>In our study, we have identified a total number of 413 potential DDIs and 184 types of interacting combinations with 4.13 potential DDIs per patient. Among 413 potential DDIs most were of moderate interactions 61.2% (n=253) followed by 26% (n=107) of minor interactions and 12.8% (n=53) of major interactions. There was significant association of occurrence of potential DDIs only with taking three or more medications.</p><p><b>CONCLUSION</b>We have recorded a high rate of prevalence of potential DDI in the internal medicine ward of UOG hospital and a high number of clinically significant DDIs which the most prevalent DDI were of moderate severity. Careful selection of drugs and active pharmaceutical care is encouraged in order to avoid negative consequences of these interactions.</p>

Initial experience of high power diode laser for vaporization of prostate

Objectives: Prospective evaluation and experience of high power diode, 980nm diode laser for bladder outlet obstruction due to enlarged prostate

Methods: Total of 50 patients were included in the study. International prostate symptom score, quality of life, international index of erectile function-5, prostate specific antigen and prostate volume were compared with values at three months and six months postoperatively

Results: At the end of three months of postoperative period, the mean +/- SD international prostate symptom score decreased significantly from 20.83 +/- 3.77 to 9.23 +/- 2.79 [p=0.0001]. The mean maximal flow rate increased significantly from 8.23 +/- 2.12 to 18.56 +/- 5.09 ml per sec [p=0.0001]. Quality of life score changed considerably as compared to baseline. There was no deterioration in erectile function according to the international index of erectile function-5 short form

Conclusion: The high power diode laser provides significant improvements in International Prostate Symptom Score and the maximal flow rate with low morbidity

Selenium in human health and disease: a review

Selenium is an essential trace element for humans and animals, and selenium deficiency is associated with several disease conditions such as immune impairment. Free radicals are produced in the body as a result of many biochemical processes in the body. All aerobic organisms possess antioxidant defense system to combat oxidative stress. Selenium is an important constituent of antioxidant enzymes, especially, glutathione peroxidase and some other selenoproteins that participate in various physiological activities and protects the cell against the deleterious effects of free radicals by modulating the cell response. However, their exact role is still unknown. Moreover, many human diseases are related to the cell cycle regulation. Selenium intakes, greater than the recommended daily allowance [RDA], appear to protect against certain types of cancers by finding its role in regulation of cell proliferation and apoptosis. The role of selenium has been explored in normal thyroid functioning, enhancing immune function, carcinogenesis, cardiovascular diseases, in the prevention of pre-eclampsia, diabetes mellitus and male reproduction etc. This article reviews introductory aspects of selenium as an essential micronutrient, different sources of selenium, Pharmacokinetics and its role in various pathologies and aims to provide an update on selenium profile

Tuberculous lymphadenitis at Penang general hospital, Malaysia

To evaluate the incidence, treatment and clinical outcomes of tuberculous [TB] lymphadenitis at Penang General Hospital, Malaysia. Penang General Hospital is the referral center for all tuberculosis patients in the state of Penang. Patient records were reviewed to identify patients with confirmed diagnosis of TB lymphadenitis between January 2006 and December 2008. Data were analyzed using SPSS version 15. Of 1,548 tuberculosis cases, 109 [7.0%] patients had TB lymphadenitis. The mean age was 36.4 +/- 12.87 years and of the 109 patients with TB lymphadenitis, 35 [33.0%], 37 [34.0%] and 36 [33.0%] were observed for 2006, 2007 and 2008, respectively. Ethnically, 45 [41.3%] were Malay followed by 37 Chinese [33.9%]. Among risk factors for TB lymphadenitis, HIV and diabetes mellitus were seen in 17 [15.6%] and 11 [10.0%] patients, respectively. Cough and fever were the most frequently reported symptoms. In a majority of cases [n = 90, 82.5%] positive results were obtained for fine-needle aspiration [FNA]. Directly observed therapy was given to all patients. Sixty-two [56.9%] patients were successfully treated, and 5 [4.6%] patients died during the treatment. There was no increase in the incidence of TB lymphadenitis over the 3-year study period. The incidence was slightly higher in male than female gender and in Malay [ethnic group]. Diabetes mellitus and HIV were the most commonly reported risk factors. FNA is the most reliable diagnostic test