interview-based survey to assess the knowledge of peripheral arterial disease among medical students

Objectives: Physicians have poor knowledge of peripheral arterial disease [PAD]. Inadequate exposure to PAD in medical school curricula may by a contributing factor. The objective of this study was to explore the awareness and knowledge of PAD among medical students

Methods: We conducted a descriptive cross-sectional study using an interview-based survey of the medical students in the college of medicine of King Saud University Riyadh, KSA

Results: Of 350 students, 244 students agreed that they had some knowledge about PAD. More students in their clinical years [3-5] had heard about PAD compared to students in their basic science years [1-2; 76.5% versus 65.4%, respectively]; however, the overall scores were low for both groups for recognition of PAD symptoms [mean scores, 2.83 out of 7 for students in years 3-5 versus 1.81 for students in years 1-2; p < 0.001]. The scores of the knowledge of risk factors were 4.86 and 2.77 out of 7 for students in years 3-5 and 1-2, respectively [p < 0.001]; the scores of preventive measures were 4.28 and 3.13 out of 6 for students in years 3-5 and 1-2 years, respectively [p < 0.001]; and the scores of treatments and complications were 4.41 and 3.57 out of 6 for students in years 3-5 and 1-2 years, respectively [p < 0.001]

Conclusion: This study has identified an alarmingly low level of PAD knowledge among medical students. Interventions are needed to address this gap in medical schools' curricula to improve care for patients with PAD in future doctors

Towards an electronic national injury surveillance system in Saudi Arabia

Given the need for a uniform, comprehensive, electronic nationwide surveillance system for injuries in Saudi Arabia, a system was designed with the objectives of establishing an epidemiologic profile of injuries in the country; evaluating injury indicators on an ongoing basis; identifying high-risk groups requiring specific interventions; monitoring and evaluating interventions for effectiveness; and producing reports to assist in planning and resource allocation. A special form for this purpose was designed, modified from validated forms used elsewhere for injury surveillance. This initiative of the Ministry of Health is also expected to help validate data collected by other sectors, such as the Ministry of Interior. This paper reviews the milestones of building the system and aims to prompt a debate within the scientific community, especially within the Eastern Mediterranean Region, about the best way to design injury surveillance systems for the Region in order to fine-tune the proposed system before its full-scale implementation

Incidence of Post-septoplasty Bleeding in patients without Nasal Packing

Objective: To evaluate the incidence of post-septoplasty hemorrhage and hematoma formation in patients without anterior nasal packs

Design: A Retrospective Study

Setting: ENT Department, Salmaniya Medical Complex, Kingdom of Bahrain

Method: Fifty-one patients with a symptomatic deviation of nasal septum who had septoplasty with/without inferior turbinoplasty were included in the study from August 2008 to April 2015. Patients who underwent septoplasty combined with endoscopic sinus surgery were excluded. Septoplasty was performed without postoperative anterior nasal packing, and the patients were assessed for postoperative bleeding and hematoma formation. All patients were followed-up for 4 weeks

Result: Two [3.9%] patients had postoperative bleeding on the day of operation. Forty-nine [96.1%] patients had no nasal bleeding during the hospital stay and no patient had hemorrhage after discharge. No patients had septal hematoma during the follow-up period

Conclusion: Incidence of bleeding following septoplasty without anterior nasal packing is very low and nasal packing should not be routinely used for this procedure

Prevalence of blood borne viruses in the dialysis unit, mubarak Al-Kabeer Hospital, Kuwait

Transmission of hepatitis B virus [HBV] hepatitis C virus [HCV] and human immune deficiency virus [HIV] does take place in dialysis units worldwide at different rates. The aim of this study was to identify the prevalence rates of HBV, HCV and HIV in the dialysis unit, Mubarak Al-Kabeer Hospital [MAKH], Kuwait. Design: Retrospective study Dialysis Unit and Virology Unit, MAKH, Kuwait Subjects: In 2012, a total of 1369 samples from adult patients on dialysis at MAKH were screened. HBV, HCV and HIV were screened for HBV surface antigen [HBsAg] [ARCHITECT HBsAg Qualitative II 2011, Abbott], HCV antibodies [Anti-HCV] [ARCHITECT Reagent Kit 2011, Abbott] and HIV antigen and antibody [HIV Ag/Ab] [ARCHITECT HIV Ag/Ab Combo Reagent Kit 2011, Abbott], respectively Prevalence rates of HBV, HCV and HIV in the dialysis unit, MAKH, Kuwait HBV, HCV and HIV prevalence among dialyzed patients in the MAKH dialysis unit was 1.2%, 6.3% and 0.1% respectively. This study, to our knowledge, is the only study providing recent data on blood borne viruses [BBVs] among patients in a dialysis unit in Kuwait. A multicenter study is recommended to determine the national prevalence of BBVs in all the dialysis unit of Kuwait

Knowledge and perceptions of prescribers regarding adherence to standard treatment guidelines for malaria: a comparative cross-sectional study from Pakistan

Despite the availability of standard treatment guidelines for malaria in Pakistan adherence to protocols by prescribers is poor. This descriptive, cross-sectional study aimed to explore the perceptions and knowledge of prescribers in Islamabad and Rawalpindi cities towards adherence to standard treatment guidelines for malaria. A questionnaire was distributed to a random sample of 360 prescribers; 64.7% were satisfied with the available antimalarial drugs and 41.3% agreed that antimalarial drugs should only be prescribed after diagnostic testing. Only half the prescribers had the guidelines available in their health facility. Almost all the prescribers [97.7%] agreed that there was a need for more educational programmes about the guidelines. Most prescribers were unaware of the correct standard treatment regimen for Plasmodium falciparum and P. vivax malaria. There were no differences in knowledge between males and females, but prescribers having more experience, practising as general practitioners and working in private health-care facilities possessed significantly better knowledge than their counterparts

Silibinin improves the cytotoxicity of methotrexate in chemo resistant human rhabdomyosarcoma cell lines

To investigate whether silibinin [SDH] could overcome chemoresistance of methotrexate [MTX]-resistant human rhabdomyosarcoma [hRD]. This study was conducted at the Department of Pharmacology and Toxicology, College of Pharmacy, University of Baghdad, Baghdad, Iraq from October 2012 to March 2013. In this in vitro study, resistance to MTX was induced in hRD cell line, the cells were treated with different concentrations of MTX or SDH alone, and in combination. Cell viability was determined by tetrazolium assay. The SDH in a concentration-dependent pattern, enhanced the sensitivity of MTX-resistant cells to the maximum cytotoxic concentration of MTX, and decreased the IC[50] [concentration resulting in 50% inhibition of cell growth] of MTX by 17.8 fold. The decrease in IC[50] of MTX was negatively correlated with increasing SDH concentrations with R[2] = 0.78 and p=0.04. The SDH improves the sensitivity of MTX-resistant hRD cell lines to the cytotoxic activity of MTX in concentration-dependent pattern

The Successful Treatment of Chronic Cholecystitis with SpyGlass Cholangioscopy-Assisted Gallbladder Drainage and Irrigation through Self-Expandable Metal Stents

A 34-year-old female with a history of advanced pulmonary sarcoidosis and right-sided heart failure presented with chronic, postprandial right upper quadrant pain, and weight loss. Endoscopic biliary drainage was deemed to be the most appropriate therapeutic option for her chronic cholecystitis. Endoscopic retrograde cholangiopancreatography utilizing the SpyGlass cholangioscopy system allowed us to access the cystic duct through which the gallbladder was ultimately decompressed, via biliary stent placement and gallstone irrigation. This is the first report of SpyScope assisted placement of fully covered self-expandable metal biliary stents into the cystic duct enabling definitive treatment of symptomatic chronic cholecystitis and cholelithiasis without cholecystectomy.

Management of diarrhoea cases by community pharmacies in 3 cities of Pakistan

Community pharmacies are valued for their potential role in the management of common ailments. This cross-sectional study aimed to document the management of diarrhoea by community pharmacies in 3 cities in Pakistan. Visits were performed to 371 randomly selected pharmacies to request advice for a simulated paediatric case of diarrhoea. The pharmacy's management was scored on a checklist including history taking and provision of advice and information. Customers were served by a salesperson in 97.3% of visits and by a pharmacist in only 2.2%. Medication was dispensed in 77.1% of visits. Of the medications dispensed, 58.7% were antiamoebics, 14.0% antibiotics and 18.9% antidiarrhoeals; only 8.4% were oral rehydration salts. None of the regimens matched with a standard prescription. The dosage regimen was explained to the customer in only 52.6% of cases. Drug safety, unqualified personnel, lack of history taking, inappropriate treatment and lack of counselling are concerns to be addressed

Characterization of a Mutant Bacillus thuringiensis d-endotoxin with enhanced stability and toxicity / Caracterización de una delta endotoxina mutante de Bacillus thuringiensis con estabilidad y toxicidad aumentadas

The centrally located a-helix 5 of Bacillus thuringiensis d-endotoxins is critical for insect toxicity through ion-channel formation. We analyzed the role of the highly conserved residue Histidine 168 (H168) using molecular biology, electrophysiology and biophysical techniques. Toxin H168R was ~3-fold more toxic than the wild type (wt) protein whereas H168Q was 3 times less toxic against Manduca sexta. Spectroscopic analysis revealed that the H168Q and H168R mutations did not produce gross structural alterations, and that H168R (Tm= 59 °C) was more stable than H168Q (Tm= 57.5 °C) or than the wt (Tm= 56 °C) toxins. These three toxins had similar binding affinities for larval midgut vesicles (Kcom) suggesting that the differences in toxicity did not result from changes in initial receptor binding. Dissociation binding assays and voltage clamping analysis suggest that the reduced toxicity of the H168Q toxin may result from reduced insertion and/or ion channel formation. In contrast, the H168R toxin had a greater inhibition of the short circuit current than the wt toxin and an increased rate of irreversible binding (kobs), consistent with its lower LC50 value. Molecular modeling analysis suggested that both the H168Q and H168R toxins could form additional hydrogen bonds that could account for their greater thermal stability. In addition to this, it is likely that H168R has an extra positive charge exposed to the surface which could increase its rate of insertion into susceptible membranes.

La a-Hélice 5 del domino I de las d-endotoxinas de Bacillus thuringiensis, es crítica para la toxicidad de las toxinas contra insectos al participar en la formación de canales iónicos. La participación en la función tóxica del residuo Histidina 168 (H168) –el cual es altamente conservado– fue estudiada mediante técnicas de biología molecular, electrofisiología y biofísica. La toxina mutante H168R fue ~ 3 veces más tóxica que la toxina silvestre (ts) en Manduca sexta, mientras que H168Q fue 3 veces menos tóxica. Los análisis espectroscópicos indicaron que las mutaciones no producen alteraciones estructurales significativas y que la toxina H168R (Tm= 59 °C) es más estable que las toxinas H168Q (Tm= 57.5 °C) y wt (Tm= 56 °C). Las tres toxinas exhibieron uniones de afinidad similares (Kcom) en vesículas de intestino de larvas de insecto, indicando que las diferencias en la toxicidad no se deben a cambios en la unión inicial al receptor. Los ensayos de unión/disociación y fijación de voltaje mostraron que la reducción de la toxicidad de la toxina H168Q se puede atribuir a una disminución en la inserción y/o en la formación de canales iónicos. De otro lado, H168R mostró una inhibición a la corriente de corto circuito mayor que la ts y un aumento en unión irreversible (kobs), lo cual es consistente con un menor valor de CL50. La modelación molecular sugiere que H168Q y H168R forman puentes de hidrógeno adicionales, lo que les confiere mayor estabilidad térmica. Adicionalmente, es probable que H168R tenga una carga positiva extra expuesta en la superficie, lo cual aumentaría su tasa de inserción en membranas susceptibles.

Thoracic ectopic kidney in a 86 year old male with multiple co-morbidities

Thoracic ectopic kidney is a rare congenital anomaly that is often missed. We report a case of diaphragmatic hernia associated with a left thoracic ectopic kidney and bowel herniation into the left hemithorax. Radiological studies including chest radiology and computed tomography confirmed the diagnosis

Anti-inflammatory activity of telmisartan in rat models of experimentally-induced chronic inflammation: comparative study with dexamethasone

Recently, significant progress has been made through the application of peroxisome proliferator activated receptor- [PPAR-] agonists as anti-inflammatory drugs that are efficacious, relatively free of side effects, and can be used effectively for a long time. The present study was designed to evaluate the dose-response relationship of the anti-inflammatory activity of telmisartan in rat models of chronic inflammation. The study protocol includes four stages: First stage: 48 rats were allocated into eight groups, each containing six rats, for the study of the anti-inflammatory activity of different doses of telmisartan in rat model of formaldehyde-induced chronic inflammation. Second stage: six rats were used to study the anti-inflammatory activity of telmisartan [1.5 mg/kg] in combination with dexamethasone [0.5 mg/kg] in the same model. Third stage: 48 rats were allocated into eight groups, each containing six rats, for the study of the anti-inflammatory activity of telmisartan in rat model of cotton pellet-induced granuloma. Fourth stage: six rats were used to study the anti-inflammatory activity of telmisartan [1.5 mg/kg] when used as adjuvant with dexamethasone [0.5 mg/kg] in the same model. Telmisartan in a dose-dependent pattern [0.1, 0.2. 0.4, 0.6, 1.5, 3 mg/kg] significantly suppressed inflammation in rat models of formaldehyde-induced chronic inflammation and cotton pellet-induced granuloma. When combined with dexamethasone, telmisartan [1.5 mg/kg body weight] significantly suppressed inflammation in both models, which is significantly higher than all of the effects produced by other approaches of treatment when telmisartan used alone. In conclusion, telmisartan decreased formaldehyde-induced chronic inflammation and cotton-pellet induced granuloma in rats in a dose-dependent pattern. Therefore, it may be considered as a potential treatment for chronic inflammatory conditions in human

Laparoscopic removal of a foreign body from the intestine

We report a case of laparoscopic removal of foreign body from the small bowel in a healthy 54-year-old lady affirming the simplicity and safety of this technique. This technique has also been reported by others in the literature

Multisectoral development for improved health outcomes: evaluation of community-based initiatives in the Islamic Republic of Iran

Community-based initiatives [CBI] are based on integrated multisectoral socioeconomic development with community participation and intersectoral support to improve the health and quality of life of the people. During 2005-06 the World Health Organization supported an evaluation of CBI in the Islamic Republic of Iran by collecting information from intervention villages on social capital and other indicators, with validation of the findings. The data showed some positive changes in the intervention areas compared with control villages. The evaluation suggests that the CBI approach is a useful tool for improving health and social indicators and providing mechanisms for community-based participation and intersectoral collaboration for health and development at the local level

Anti-inflammatory activity of silymarin in patients with knee osteoarthritis. A comparative study with piromcam and meloxicam

To evaluate the anti-inflammatory effect of Silymarin in patients with knee osteoarthritis OA in comparison with piroxicam and meloxicam. A double-blind clinical trial was performed at the Department of Rheumatology, Baghdad Teaching Hospital, Baghdad, Iraq during the period from October 2004 to September 2005, in which 220 patients 79 males and 141 females with painful knee osteoarthritis were randomized into 5 groups, treated with either silymarin 300mg/day, piroxicam 20mg/day, meloxicam 15mg, or a combination of silymarin with piroxicam or meloxicam. Serum levels of interleukin-1 alpha, interleukin-8, and the complement proteins C3 and C4 were assessed at zero time, and after 8 weeks. Silymarin reduces significantly serum levels of IL-1 alpha and IL-8, C3 and C4 after 8 weeks compared to the pre-treatment levels. Piroxicam showed no significant reduction in IL-1 alpha levels, while IL-8 decreased significantly, compared to pre-treatment value. Meloxicam elevates serum levels of IL-1 alpha significantly, while IL-8 did not significantly change compared to the pre-treatment value. Piroxicam or meloxicam produced slight, non-significant increase in serum levels of complement proteins after the 8-week treatment period. Adjunct use of silymarin with piroxicam results in significant reduction in both cytokines IL-1 alpha and IL-8, and serum levels of C3 and C4. However, its adjunct use with, meloxicam did not reveal any significant changes in this respect. Silymarin reduces the elevated levels of interleukins and complement proteins, when used alone, or in combination with NSAIDs for the treatment of knee OA

Evaluation of community psychiatric-home visit treatment versus outpatient treatment of chronic schizophrenic patients in Bahrain

Schizophrenia has a high rate of relapse. Treatment compliance is challenging in the long-term management of schizophrenia. The outcomes of previous studies on Community Psychiatry Service - Home Visit Treatment [CPS-HVT] are inconclusive. To evaluate the effectiveness of CPS-HVT in [a] reducing the number of admissions and [b] duration of admissions of chronic schizophrenic patients. A retrospective analysis by auditing files of all cases of adult schizophrenic patients in Bahrain who underwent CPS-HVT treatment. A total of 10 years follow-up [5 years of outpatient treatment before the referral to the community service and 5 years follow-up in the community service after the referral] was carried out. The number of admissions and the duration of admissions were compared. Of the total number of 232 patients 51 [22%] fulfilled the inclusion criteria. The sum total of 77 admissions during 5 years before the referral to the CPS-HVT was 2577 days [50.5 d/patient]. After the referral to the CPS-HVT the sum total of 48 admissions was 1383 days [27.1 d/patient], and no patient had more than 3 admissions. The number of non-hospitalized patients doubled during the 5 years follow-up in the CPS-HVT [n=13; 4 males vs. n=27; 10 males]. The proportion of males was 47.1% [n=24]. CPS-HVT is effective and superior to standard outpatient treatment of chronic schizophrenic patients in reducing the number and duration of admissions, in Bahrain. Future studies should evaluate a wide range of other outcomes, including the cost effectiveness of CPS-HVT. Considering the massive impact of community-based care on patients, caregivers, clinicians and the community at large, such studies are urgently needed

e-Learning: the next big thing in medical education

The rapid advances in Information and Communication Technology [ICT] and the wide use of the World Wide Web has important implications for education. This continuous advancement in technology [e.g. Broadband internet connections, Ubiquitous Computing, Open Source Softwares] in conjunction with the recent recommendations in medical education suggesting a move toward problem-based learning [PBL] and use of information and communication technologies. All these factors led to the evolution of the e-learning environment in medical education. An initiative is underway in Faculty of Medicine and Health Sciences [FMHS], Omdurman Islamic University [OIU], Sudan which aims to introduce a modern web-based learning environment that serves undergraduate medical students, supports the newly adopted philosophy of Problem-based Learning, and provides these new generations of doctors [Net generations] with the knowledge and skills they need to be successful practitioners. This digest endeavors to give a bird's-eye view of e-learning, its benefits and limitations and explores, with examples, some of the current uses of e-learning technologies in the education of medical students