systematic approach to multiple choice questions [MCQs]

This paper aims to enable examinees to optimize their performance in multiple choice questions [MCQ] by adopting a simple but systematic approach in solving such questions. Although this approach is based on our experience with candidates for the Membership Examination of the Royal College of General Practitioners [MRCGP] and examples used in this paper are typical of MRCGP questions, the approach is relevant to other similar examinations. Moreover, the presented approach may also help in developing significant cognitive skills relative to clinical practice

Uncertain post-term pregnancy: induction or surveillance?

This study aimed to evaluate the safety of unlimited fetal surveillance in women with uncertain post-term pregnancy compared with routine induction of labor at 42 weeks apparent gestation. This study included 120 women with singleton uncomplicated pregnancies at 42 weeks apparent gestation. Women were allocated randomly into two groups: Group I fetal surveillance for unlimited duration suing standard cardiotocography, amniotic fluid maximum pool depth and fetal kick count and group II routine induction at 42 weeks. The main outcome measures were antepartum fetal death, intrapartum management, mode of delivery and neonatal outcome. The results showed that women in surveillance group had shorter duration of labor [mean +/- SE, 6.5 +/- 0.4 hours vs 9.1 +/- 0.4 hours] and lower incidence of oxytocin use [42% vs 80% OR 0.2, 99% CI = 0.07-0.6]. There was also significantly less cesarean section rate in the fetal surveillance group [10% vs. 28%, OR 0.3, 99% CI = 0.2 - 0.6]. Meanwhile, there was no difference in the perinatal outcome. The results suggested that in women with uncertain post-term pregnancy, fetal surveillance yield easier labor [shorter duration and less use of oxytocin] and more chance for vaginal delivery than routine induction at 42 weeks without clear impact on the perinatal outcome

Transvaginal versus transabdominal ultrasonography in the evaluation of induced ovulation and its complications

The aim of this work was to evaluate the efficiency of TVS as compared to TAS in the monitoring of induced ovulation. The study included 35 patients undergoing hormonal therapy using hCG to induce ovulation. Each patient was examined at least four times during the menstrual cycle using both modalities. There was better correlation between the results of TVS and the estimated serum estradiol level in the study of five cases. In two cases TVS failed to show one or both ovaries, while TAS could do that. In conclusion, except in few cases, TVS is superior to TAS in the detection of the number, size and sharpness of the follicles during monitoring of induced ovulation specially in obese patients and in those with history of pelvic surgery and/or failed previous induction of ovulation. It avoids a full urinary bladder, an irritating request for both the patient and the radiologist, reduces the patient's discomfort at the time of the examination

Evaluation of complex and defined antigens of mycobacterium tuberculosis in an IgG-Specific ELISA for the diagnosis of tuberculosis

In recent years, several defined antigens of Mycobacterium tuberculosis have become available either by purifying the natural antigens using biochemical procedures, or by producing large quantities of recombinant antigens, using recombinant DNA technology. In this study, we evaluated these defined antigens of M. tuberculosis, along with the complex antigens, for humoral immune responses in an IgG-specific enzyme-linked immunosorbent assay [ELISA]. We hoped to develop a tuberculosis-specific ELISA of diagnostic potential. Our results show that IgG antibodies to the complex antigens [i.e. culture filtrate, cell wall and sonicate] and to some of the defined antigens [i.e. 38-kD antigen and lipoarabinomannan] of M. tuberculosis were significantly elevated in the sera of tuberculous patients, as compared to healthy contacts of tuberculous patients and patients suffering from nonmycobacterial infections. Among the IgG subclasses, IgG2 antibody reactive with culture filtrate, cell wall, and lipoarabinomannan antigens was elevated in the sera of most tuberculous patients. Since the complex antigens are difficult to standardize, and bacth-to-batch variations may occur with respect to the amount of active components in different batches, the use of defined antigens of M. tuberculosis in ELISA may be a better alternative in the early and specific diagnosis of tuberculosis

Evaluation of chlorpheniramine maleate sustained release formulations

Calcium alginate beads of chlorpheniramine maleate [CPM] were prepared and the drug release was studied at different pHs. The bioavailability of CPM from CPM-calcium alginate beads was assessed in rabbits and compared with that from dry adsorbed emulsion previously prepared. DSC and IR studies showed that the drug formed a complex with alginate molecules. Generally, the drug release was faster in alkaline pH [7.4] than in acidic pH [1.2]. The study revealed that CPM-beads were better than CPM-dry adsorbed emulsion as a sustained release formulation. The extent of bioavailability of CPM-beads showed, on equal dose basis, an equivalent therapeutic effect to one dose of regular release CPM

Evaluation of ball-mill ground mixtures of hydrophilic carriers and phenytoin

Phenytoin [P] powder was ground with several hydrophilic carriers; namely, avicel, lactose, gelatin, partially hydrolyzed gelatin and urea, using a ball-mill to enhance drug dissolution. The effect of mechanical treatment on the physicochemical properties of P was investigated by scanning calorimetry microscopy [SEM], different scanning calorimetry [DSC], infrared spectroscopy [IR] and X-ray diffractometry [X-ray]. Simple and ground mixtures of P with each carrier [in 1:1 and 1:4 ratios] were prepared. Dissolution of P and the different mixtures in 1% sodium lauryl sulfate [SLS] was found to be non-discriminative. When water was used as the dissolution medium, instead of 1% SLS, the ground mixtures exhibited higher dissolution rates. The effect of the carriers in this respect could be arranged as follows: Lactose > urea > avicel > gelatin. Grinding of P with lactose to less extent with other carriers resulted in the loss of DSC-peak symmetry of P. The defined IR absorption b and s in the fingerprint region of P were also obliterated to variable extents by the various carriers, especially with lactose. The results suggested the possibility of P-carrier interactions with higher tendency in case of lactose, through H-bond and van der Waals forces

In vitro and clinical evaluation of Chlorphen in polymeric films

In vitro-release profile of chlorphenesin from Eudragit films was investigated. As the hydrophilic polymer fractions, e.g. Eudragit RL 100, RLPM or L100 increased, the release rate of the drug from the matrix increased and the release pattern followed Higuchi model. Increasing drug concentration in the film also resulted in a considerable increase in the release rate of the drug. The release rate constant was found to be film thickness-independent, while the linear relationship between t0.5 and the square of film thickness confirmed the diffusion controlled profile. Incorporation of water- soluble and insoluble plasticizers affected the drug release rate to different extent, depending on the type and concentration of plasticizers. Increasing drug release rate from films due to plasticizers could be arranged as follows: Glycerol > glyceryl triacetate > PEG 400 > propylene glycol > dimethyl phthalate > diethyl phthalate. The effect of different enhancers on increasing drug release followed the order dimethyl sulfoxide > sodium lauryl sulfate > polyvinylpyrrolidine > Tween 80. Clinical evaluation of the selected formula was carried out on 20 patients and compared with an official cream. A complete cure of 70% of patients treated with films was an acceptable and promising result compared with 90% cure obtained with the cream

Diagnostic accuracy in acute appendicitis: comparison between clinical impression and ultrasound findings

A cross-sectional study to determine the diagnostic accuracy of clinical impression and graded compression abdominal ultrasonography in acute appendicitis used individually or complementary to each other was conducted in a busy surgical unit. Eighty nine cases subjected to categorized clinical impression and ultrasonography preoperatively achieved fairly high sensitivity [84.3% and 81.81% respectively] but low specificity [23.68% and 38.23%] with an overall negative predictive value of 31%, implying it to be a poor indicator to avoid negative appendicectomies

Assessment of individuals having insulin dependent [type 1] diabetes mellitus for more than 5 years

Forty-four diabetic individuals [age ranged between 10-20 years] having type I Insulin-Dependent Diabetes Mellitus for more than 5 years [duration of diabetes ranged between 5-10 years] were assessed. Twenty-eight [63.6%] individuals developed the illness before 8 years of age [age at diagnosis 3-8 years], while 16 [36.4%] individuals developed the illness after 9 years of age [age of diagnosis 9-14 years] Family history of diabetes mellitus type I was present in 8 [18%] diabetic individuals. Growth failure was present in 30 [68.1%] diabetic individuals. Retinopathy, back ground retinopathy, was present in 15 [34%] diabetic individuals. Persistent proteinuria was positive in 20 [45.5% diabetic individuals. Polyneuropathy was present in 23 [52.2%] diabetic individuals. A highly statistical significant correlation was found between the presence of retinopathy, proteinuria, polyneuropathy and the presence of family history of diabetes mellitus type I; no statistical significant correlation was found between the presence of retinopathy, proteinuria, polyneuropathy and age at diagnosis of diabetes. Therefore, it is suggested that poor glycaemic control genetic factor are the main risk factors that contribute to the development of diabetic complications in this group of diabetic individuals

Experience with 115 patients with congenital adrenal hyperplasma and evaluation of growth patterns in 24 patients with the salt-losing type

In this study the data on 115 cases of congenital adrenal hyperplasia [CAH] who were followed in the Pediatric Endocrine Clinic at Nemazee Hospital, Shiraz will be reported Among these cases 51 were male and 64 female. The most common type of CAH in these patients was the salt-losing type of 21-hydroxylase deficiency [85.2%]. 11-hydroxylase deficiency was present 13.04% of patients. There was only one case with 20,22-desmolase deficiency and one also with 3-beta-hydroxysteroid dehydrogenase deficiency. Presenting complaints were ambiguous genitalia, vomiting, failure to thrive, precocious puberty and hypertension. The analysis of data on 24patients with the salt-losing type of 21-hydroxylase deficiency who were followed for at least 2 years showed that these patients suffered from abnormal growth patterns. Growth failure was maximal during the first year of life

Evaluation of the results of radial shortening in the treatment of Keinbock's disease

Peste in 1843 before the advent of roentgenogram first described collapse of the carpal lunate. He believed the lesion to be a fracture with a traumatic etiology. Keinbock's in 1910 also thought the lesion to be the result of trauma. In 1928, Hulten noted that a short ulna was present in 78% of this patients with keinbock's diseases whereas only 23% of normal patients had a short ulna. No universally acceptable treatment is available for this disease. Treatment choice must be based on a number of variables including the experience of the swgeon, the desires and activity level of the patients, the anatomic variant of the ulna and most importantly on the stage of the disease. Twelve cases of keinbock's disease were treated in Kasr El Eini Hospital in the period from 1991-1995 by radial shortening. The indication, technique, results and complications of the procedure arepresenteed. The average follow up period was 2 years. The results were good in 83.3% [10 cases]

Plasma retinol in cholestatic infants and children: evaluation of therapy

Plasma retinol level was estimated in 20 patients with infantile cholestasis, 10 of them were supplemented with oral vitamin a 50, 000 iu/week. Ten children of matched age and sex were included as control. 70% of untreated cases had plasma retional level < 20 micro g dl[-1], in contrast to only 40% of treated ones. None of the control group had plasma retional level < 20 micro g dl[-1]. The least plasma retional level was observed at 7-9 months and it increased progressively with continuing oral therapy. Cases with neonatal hepatitis showed a significantly lower plasma retinol than those with extrahepatic biliary atresia [EHBA], paucity of intrahepatic bile ducts [PIHBD] and controls. It is realized that vitamin A deficiency is an established problem in infantile cholestasis. Supplementation with vit A is mandatory. Oral dose of 50,000 IU/week, attempated in this study is nearly satisfactory to prevent hypovitaminosis A in this group of children, however, parenteeral administration may be required in severe cholestasis and with non compliance with oral therapy

Evaluation of intranasal microscopic sinus surgery in 112 patients

One hundred twelve patients underwent intranasal microscopic sinus surgery [11 unilateral and 101 bilateral] for chronic sinusitis, orbital abscess decompression and fronto-ethmoidal mucocele. The operating microscopy was used to perform ethmoidectomy, middle meatal antrostomy, frontal sinusotomy, and to open the sphenoid sinus. The "angled 30", telescope was used, when direct visualization of the frontal sinus recess or maillarly sinus ostium was not achieved by the operating icroscxope or when direct inspection of the interior of the frontal, maxillary, and or sphenoid sinus was indicated. Visualization of the maxillary sinus ostium and the frontal recess, by the operating microscope were achieved in 81% and 64.3% of cases respectively. The presenting symptoms in order of frequency were facial pain [100%], postnasal discharge [89.2%], nasal obstruction [75.8%] and smell affection [24.1%]. After intranasal microscopic sinus surgery, headache improved in 85.7%, postnasal discharge improved in 62%, nasal obstruction improved in 98.8% and smell affection improved in 92.6%. 36 patients had monir complications, which included, synechia between the middle turbinate and lateral nasal wall [17.8%], postoperative hemorrhage [6.25%] and orbital ecchymosis [3.6%]. The incidence of synechia was higher in the group of patients [45 cases], in which partial resection of the middle tubrinale was not performed inspite of placing a spacer between the middle turbinate and the lateral nasal wall. For this reason it is wise to remove the anterior part and inferior free margin of the middle turbinate. As regard postoperative hemorrhage, the incidence was higher in the group of patients [27 cases] which did not perform bipolar cauterization of the inferior turbinate after partial resection. For this reason it wise to use bipolar cautery, when the inferior turbinate and or the turbinate are partially rsected. Or bital ecchymosis, can be avoided by placing the middle metal antrosomy just above the lateral attachment of the inferior turbinate and the maxillary sinus at the junction of the vertical and horizontal limbs of the infundibulum. Combination of the microscope and telescope was valuable in the treatment of paransala sinus diseases, minimizing the disadvantages of each technique and permitting a more safe and successful procedure with minimal complications