Knowledge and personal hygiene practice among food handlers in public university campus of Bangladesh

Background: Millions of people are suffering from food borne illness and it has become a growing public health concern in the world. To reduce the burden of food borne illness, food handlers must have accurate knowledge of food safety. The objective of the study was to assess the knowledge and level of personal hygiene practice among food handlers of Jahangirnagar University.Methods: It was a descriptive cross sectional study, done among the food handlers in Jahangirngar University Campus, Dhaka, Bangladesh from May 2016 to September 2016. Data were collected from 119 food handlers by using face to face interview using a pre-tested questionnaire. Statistical Package for Social Sciences (SPSS 22.0) software was used for data analysis.Results: Study found that 65.55% of the food handlers did not have adequate knowledge regarding personal hygiene. The study also found that 71.4% of the food handlers had poor hygiene practice. The study revealed that age, education and sleeping place and knowledge regarding personal hygiene were significantly associated with the respondent’s personal hygiene practice.Conclusions: The study shows that knowledge and its practice among the food handlers is very poor. Implementation of training and awareness program on personal hygiene are required to improve their knowledge and personal hygiene practice.

Unani concept of jaundice and its management

Jaundice is a disease, which is characterized by yellow staining of the skin and sclera by abnormally high blood levels of the bile pigment bilirubin. The yellowing extends to other tissues and body fluids. Bilirubin, a tetrapyrrole pigment, is a brokendown product of heme [ferroprotoporphyrin IX]. About 70 to 80% of the 250 to 300 mg of bilirubin produced each day is derived from the breakdown of hemoglobin in senescent red blood cells. The remainder comes from prematurely destroyed erythroid cells in bone marrow and from the turnover of hemoproteins such as myoglobin and crytochromes found in tissues throughout the body

The philosophy of Unani system of medicine is based on the humoral theory. The theory was central theme to the teachings of Hippocrates and Galen and it became the dominant theory in Europe for many centuries. As per the Unani system of medicine, the cause of jaundice is the accumulation of yellow or black humours in the cutaneous tissue and its nearby tissues. Based upon the nature of discoloration jaundice is classified into two types: Yellow Jaundice and Black Jaundice

In the allopathic system there lack of effective drugs for jaundice. Some hepatoprotective drugs are available but many side effects are associated with them due to their chemical composition. In Unani system of medicine, this disease can be cured with completely natural and noninvasive methods

Present study was conducted in MIJ Tibbia Unani Medical College, Mumbai in the year 2007. Nine patients suffering from sciatica due to lumbar spine osteoarthritis were selected. Their clinical examinations were conducted to diagnose the sciatica. The X-ray of the lumbar spine was also taken to confirm the diagnosis of osteoarthritis of lumbar spines. Massage with Roghan-e-Surkh on the lower back and affected lower limb for 8-10 minutes daily for 14 days caused a significant reduction in the symptoms and signs of sciatica after the completion of study

Theft of Unani formulations for the treatment of various diseases is not new but it is a matter of concern since last couple of decades. However, information regarding Unani Medicine exists in Arabic, Urdu, Persian and other regional languages. The examiners of different national/ international patent offices are unable to understand this information as prior art, before granting patents due to language barrier

Some of the examples of case studies of misappropriation of Pistacia lentiscus Linn is discussed in which the indication of Pistacia lentiscus Linn i.e. anti-inflammatory [mentioned in Unani classical texts] has been claimed for wrong patent

Complex fistula-in-ano: surgical management and outcome

Objective: To assess the outcome of the surgical management of patients with complex fistula-in-ano

Study design: Case series

Place and Duration of study: Department of General surgery Jinnah Postgraduate Medical Center Ward 2 Karachi, from January 2009 to December 2012

Methodology: An analysis of patients with complex fistula-in-ano treated with different operative techniques Resultswas done. The techniques included two stage seton fistulotomy, three stage seton fistulotomy, fistulectomy with sphincter repair, drainage of supralevator abscess and colostomy. Patients were followed-up through colorectal OPD with special emphasis on postoperative bleeding, healing, recurrence and fecal incontinence

Results: Out of total 123 patients with different types of anal fistulae there were 58 [47.1%] complex and 65 [52.8%] low anal fistulae. There were 105 [85.3%] males and 18 [14.6%] females. Out of 58 complex fistulae, 28 [48.2%] patients had inter-sphincteric, 12 [20.6%] transsphincteric, 10 [17.2%] suprasphincteric, 06 [10.3%] extrasphincteric and 02 [3.4%] horseshoe fistulae. Forty-one [70.6%] patients were treated with two-stage seton fistulotomy technique, 5 [8.6%] with three stage seton fistulotomy, 11 [18.9%] with fistulectomy with sphincter repair, and in 01 [1.7%] patient colostomy was made. Overall complication rate in two stage seton fistulotmy was 9.7% and 18.1% in fistulectomy with sphincter repair

Conclusion: Complex fistulae may be successfully treated by various techniques, but the two-stage seton fistulotomy technique was an effective method for this type of fistula

An experimental study of phage mediated bactericidal selection & emergence of the El Tor Vibrio cholerae.

Background & objectives: Factor causing the elimination of the classical biotype of Vibrio cholerae O1, and its replacement by the El Tor biotype causing the 7th cholera pandemic are unclear. Possible ability of the El Tor strains to adapt better than the classical strains to undefined environmental forces have been largely implicated for the change. Here we describe an environmental bacteriophage designated JSF9 which might have contributed to the range of factors. Methods: Competition assays were conducted in the infant mice model and in microcosms between representative El Tor and classical biotype strains in the absence or in the presence of JSF9 phage. Results: The JSF9 phage was found to kill classical strains and favour enrichment of El Tor strains, when mixtures containing strains of the two biotypes and JSF9 phage were subjected to alternate passage in infant mice and in samples of environmental water. Spontaneous derivatives of the classical biotype strains, as well as transposon mutants which developed resistance to JSF9 phage were found to be defective in colonization in the infant mouse model. Interpretation & conclusions: These results suggest that in addition to other factors, the inherent ability of El Tor biotype strains to evade predation by JSF9 or similar phages which kill classical biotype strains, might have enhanced the emergence of El Tor strains as the predominant pandemic biotype.

Alfagin: a herbal product beneficial in Hypercholesterolemia

To determine the effects of herbal drugs in Hypercholesterolemia, Experimental Study, This study was conducted in the Department of Pharmacology, University of Karachi from Jan. 2007 to Dec, 2008. In the present study experiments regarding lipid profile were performed on rabbits of either sex, the calculated dose was administered for 30 days and 60 days [High dose and low dose group], Alfagin possess wide therapeutic range and is comparatively safe, animals of neither group showed no gross toxicity, No death occurred in control and test animals, Alfagin has been shown having, lowering capability of cholesterol. It has been concluded that Alfagin is beneficial in hypercholesterolemia

Retained surgical sponge following abdominal surgery

Objective: To share the experience of gossypiboma cases, their presenting features, preoperative risk factors and post-operative outcome in terms of complications and recovery

Study Design: Retrospective study

Place and Duration of Study: Several government and private hospitals of Karachi, over an operative experience exceeding 35 years for the principal author and 15 years for the coauthors

Patient and Method:This study includes collective personal operative experience with patients having gossypibomas. It is compiled by two general surgeons and one gynecologist. Data of 14 cases with primary diagnosis of gossypiboma were reviewed and analyzed. Literature was searched for relevant information

Result: There were 11 female and 3 male patients. Mean age of the patients was 42 years [range 25 to 59 years]. Cesarean section was the commonest surgery performed in 5 patients followed by hysterectomies in 3 patients. Plain radiograph and CT scan abdomen were found to be helpful in diagnosis. Mean interval between initial and final surgeries was eight months [range one week to two years]. All patients recovered completely after surgical removal of gossypiboma

Conclusion: Retained sponge was more common in obstetrical procedures performed in emergency. Presence of abdominal mass or intestinal obstruction was the commonest presentation [93%]. Micro-air-bubbles in plain abdominal x-ray in a post laparotomy patient appeared to be a diagnostic feature of gossypiboma. CT scan was better than other radiological investigations in identifying the retained sponge

Teaching experience and reflection

The standard of education can be improved if educators actively assess themselves or have someone else evaluate their teaching skills. Reflection on multiple aspects of teaching can be used as a powerful tool for worldwide educationists. Teaching, particularly in nursing discipline, strives to move beyond the simple divulgence of facts and knowledge. It widens student's horizons, stimulates their intellects, and teaches them to become self directed. This manuscript is a qualitative review of observations in a class of nursing with context to teaching skills and its impact on students' interest in learning during the class. The authors have used their reflections to discuss the ways to improve teaching methodology and related them with various teaching learning theories

Frequency of anti-tuberculous therapy-induced hepatotoxicity in patients and their outcome

Tuberculosis [TB] is a very common droplet infection especially in the northern areas. If untreated, the disease may be fatal within 5 years in more than half of cases. To study the frequency of anti-tuberculous therapy [ATT] induced hepato-toxicity was the subject of the present hospital based descriptive study. The study was conducted in Medical Unit, Ayub Teaching Hospital and patients with diagnosed Tuberculosis in whom ATT was initiated were included in the study. The subsequent development of elevated liver enzyme levels and hepatitis, amongst some members of the study group; was diagnosed, with the help of clinical findings and Liver Function Tests [LFT's] and were dealt with according to severity. Out of the 500 patients studied 277 [55.4%] were male and 223 [44.6%] were female, 203 [40.5%] were in age group 21-35 years, 136 [27.1%] in age group 36-50 years, 141 [28.1%] in age group 51-65 years while 20 [4%] were above 65 years of age. Out of them 40 [8%] developed hepatotoxicity, 21 [4.2%] patients amongst the study group developed overt hepatitis, 20 [4%] of them made an uneventful recovery while 1 [0.2%] died of Fulminant Hepatic Failure [FHF]. ATT-induced hepato-toxicity, was frequently encountered in patients put on ATT

Antishigellosis and Cytotoxic Potency of Crude Extracts and Isolated Constituents from Duranta repens

The crude ethanol extracts (stem and fruits), their fractions and two triterpenes, beta-Amyrin and 12-Oleanene 3beta, 21beta-diol, isolated as a mixture from the chloroform soluble fraction of an ethanolic extract of Duranta repens stem, were evaluated for antibacterial, antifungal activities by the disc diffusion method and cytotoxicity by brine shrimp lethality bioassay. The structures of the two compounds were confirmed by IR, 1H-NMR, 13C-NMR and LC-MS spectral data. The chloroform soluble fraction of stem and ethanol extract of fruits possess potent antishigellosis activity and also exhibited moderate activity against some pathogenic bacteria and fungi but the isolated compound 1 (mixture of beta-Amyrin and 12-Oleanene 3beta, 21beta-diol) showed mild to moderate inhibitory activity to microbial growth. The minimum inhibitory concentrations (MICs) of the extracts (stem and fruits), their fractions and compound 1 were found to be in the range of 32~128 microg/ml. The chloroform soluble fractions of stem and ethanol extract of fruit showed significant cytotoxicity with LC50 value of 0.94 microg/ml and 0.49 microg/ml, respectively against brine shrimp larvae.

Post-cholecystectomy biliary injuries: diagnosis and management

To evaluate the management strategies following Bile Duct Injuries. Retrospective and prospective analysis from July 2002 to Oct. 2005. Surgical Ward-2, Jinnah Postgraduate Medical Centre, Karachi. All patients who were admitted with Iatrogenic Biliary injuries. The patients were clarked and their clinical features noted. After appropriate preparations they were treated on the basis of Bismuth Classification. A total of 21 patients presented with Iatrogenic Biliary injuries over a period of three years. There were 15 females and six males with a median age of 40 years. Fourteen patients had laparoscopic cholecystectomy while seven had open cholecystectomy. Six cases belonged to our unit while 15 were referred from other institutes. Sixteen patients presented with biliary leak, out of which two resolved, two had ultrasound guided aspiration and two ERCP stenting done, while 10 underwent peritoneal lavage with drain placement. One patient from lavage group required ERCP stenting while one patient that underwent stenting initially developed stricture and had to undergo Roux-en-Y hepaticojejunostomy. Five patients had biliary stricture at presentation, three were Bismuth Type I, one was Type III and one Type IV. These patients were treated with Roux-en-Y hepaticojejunostomy. Two had to undergo re-exploration, one needed lavage and the other revision hepaticojejunostomy. Three patients expired in the early postoperative period. Strategies need to be developed for dealing with bile duct injuries, with a view to reduce morbidity and mortality as early recognition and timely management improves the outcome of these patients

audit of the management of acute pancreatitis in a general surgical ward

To assess the results of the management of Acute Pancreatitis. Retrospective descriptive study from Jan. 2003 to Dec. 2005. Setting: Surgical Ward-2, Jinnah Postgraduate Medical Centre, Karachi. 62 patients with the diagnosis of Acute Pancreatitis. The demographic variables, cause and outcome of the cases were observed and recorded. Out of the total 62 patients, 37 had cholelithiasis; other causes were alcoholism, abdominal trauma, worms, instrumentation [ERCP] and drugs. All patients were classified according to APACHE-II scoring system into acute oedematous pancreatitis, severe acute pancreatitis and acute necrotizing pancreatitis. Forty eight patients developed complications including ARDS, anuria, hypotension, paralytic ileus and pseudocyst formation. Four cases died due to multiorgan failure. Current recommended principles in the management of Acute Pancreatitis are based on identification of patients having severe disease and the group at risk for the development of complications. APACHE-II is a helpful scoring system and CT scan is an effective diagnostic tool in difficult cases

Complement mediated bactericidal activity and humoral immune response in type 2 diabetes mellitus

Since diabetic patients suffer from protracted infections, the aim of this study was to determine the functions of serum complement and its relationship with immunoglobulin profiles in patients with type 2 diabetes mellitus [DM]. A total of 55 DM patients and 54 healthy volunteers were included in this study. Serum IgG was measured by nephelometry, complement components C3 and C4, and IgA were measured by immunoturbidometric methods. The bactericidal activities of complement from fresh serum and complement-inactivated serum were assessed against Escherichia coli DH5alpha cells using the standard plate count method. In the DM patients, IgG [p<0.001], IgA [p<0.02] and complement component C4 [p<0.001] were found to be significantly elevated whereas the levels of C3 were slightly lowered [p<0.4]. The complement mediated bactericidal activity in diabetic patients was significantly lower than the controls [p<0.01]. In contrast, while the serum complements were inactivated by heat treatment, the DM patients had significantly higher [p<0.01] bactericidal activity associated with heat-stable immune effector molecules, possibly elevated levels of serum IgG and IgA. The results of this study indicate that serum complement mediated bactericidal activity was impaired in type 2 diabetic patients, which might be a cause for delayed wound healing and repeated infections

variant of Bouveret's syndrome

Bouveret`s syndrome is gastric outlet obstruction caused by impaction of a large gall stone in the duodenal bulb, through a cholecystoduodenal fistula. In this case, which is a variant of Bouveret's syndrome, a 58 years old lady presented with right upper quadrant abdominal pain and vomiting. Investigations, including MRCP, revealed a large stone impacted in the duodenal bulb and another one at the duodenojejunal junction causing dilatation of the stomach and the duodenum. She underwent laparotomy with cholecystectomy, closure of cholecystoduodenal fistula and an enterotomy to remove the stone impacted at the duedenojejunal junction

Evaluation of safety profile of entoban syrup [a herbal product]

Entoban is a well balanced composition of medicinal herbs which includes Holarrhena antidysenterica, Berberis aristata, Aegle marmelos, Quercus infectoria, Butea Frondosa and Myrtus Communis. It is used in amoebic dysentery. The study was carried out on 27 healthy white rabbits of either sex weighing from 1800 to 2000 grams. All animals were equally divided into three groups one served as control, the other two received normal and high doses of entoban syrup. Before administration of the drug animals were acclimatized to housing conditions for 15 days. Entoban was administered in normal dose 1.14 mg / kg and 2.29 mg / kg high dose for a period of 60 days. The control group received normal saline equivalent to the volume of respective doses according to their body weight. Blood samples of about 7cc were collected from the animals through cardiac puncture various biochemical tests were done to consider cardiac, renal and hepatic parameters were done. Cardiac, renal and hepatic parameters were found to be in normal range with high dose. It de-termines that entoban is a safe drug. Therefore cardiac, renal, and hepatic toxicity has been ruled out. Entoban can be safely administered for amoebic dysentery because it does not affect the heart, liver and kidneys

experience of total mesorectal excision in surgery for rectal cancer

To evaluate the results following total mesorectal excision in rectal cancers. Place and Duration of Study: Surgical Ward 2, Jinnah Postgraduate Medical Centre [JPMC], Karachi. From January 2003 to December 2005. Fifty consecutive patients with histological diagnosis of rectal cancer were included in this study. In all cases tumor staging was carried out with ultrasound [US] and CT scan. Carcino-embryonic antigen [CEA] level was also done. They underwent surgery in the form of abdomino-perineal resection [APR], low anterior resection, ultra low anterior resection and Hartmans procedure. Total mesorectal excision [TME] was done in 42 patients and their postoperative morbidity and mortality were recorded. Out of 50 patients 6 were irresectable. These patients had evidence of disseminated disease on US and CT scan. Forty two were resectable. Age range was 14-60 years. Thirty patients were between 20-40 years. Male to female ratio was 4:1. Thirty three patients had tumor at anorectal junction, four patients had tumor at 7 cm from anal verge, in five the tumor was not palpable as it was in the mid rectum. APR was carried out in thirty-three patients, low anterior resection in the four, ultra low anterior resection in four, with covering ileostomy in all cases of low and ultra low anterior resection. One patient had Hartmans procedure. In 42 patients curative surgery was done. With limited follow up over a period of two years one patient who had APR developed local recurrence. Total mesorectal excision in rectal cancer surgery is known to give less postoperative morbidity and good local disease control. Appropriate training in total mesorectal excision should be given to surgeons under training in order to achieve standard surgical outcome

Transurethral incision of prostate as treatment of benign prostatic hypertrophy

To evaluate efficacy of transurethral incision of prostate [TUIP] as a treatment modality for BPH. During the period between May 1999 and April 2004 all patients with LUTS and prostates of less than 30 grams underwent transurethral incision of prostate. The operative course, early and long term complications were recorded till six months of follow up. A total of 85 patients were operated during the study period with the mean age of 56 years and average operating time of 22.5 minutes. Most patients [n=84] were discharged within 2 to 5 postoperative days. Early postoperative complications included hemorrhage requiring blood transfusion in two patients, clot retention in two patients and failure to void after catheter removal in two patients, which needed transurethral resection of prostate in the same admission. Seventy-eight patients reported improvement in symptoms while two patients reported no relief in symptoms. None of the patients reported worsening of symptoms or incontinence. Out of 58 sexually active men, 42 reported retrograde ejaculation and 8 patients suffered decreased ejaculate. Two patients reported erectile dysfunction. TUIP in prostates of less than 30 grams causing lower urinary tract symptoms is an effective and reliable procedure for young, sexually active men

Surgically treated rectal prolapse: Experience at a teaching hospital

To analyze our results regarding the surgical treatment of complete rectal prolapse performed at the Aga Khan University Hospital, from January 1988 to December 2003. Files were retrieved from our medical records and data was reviewed for all adult patients admitted and operated upon for complete rectal prolapse during our study period. Long-term follow-ups were obtained through these files and also by contacting patients through telephone and letters. Data was recorded in a standardized two-page proforma and analysis was carried out between different variables using SPSS 10.0. A total number of twenty surgeries [n=20] were performed. All patients had the presenting complaint of something coming out of anus, 70% [n=14] patients complained of some bleeding per rectum, 30% [n= 6] had anal pain and 20% [n=4] had faecal incontinence. Chronic constipation was found in 50% [n=10] patients, obstructive uropathy in 30% [n=6], weight loss, chronic cough and mental illness, each in 10% [n=2] of patients. Primary procedure was carried out in 70% patients. Mean operative time was 178 minutes; mean length of stay was 7 days with a mean follow-up of 25 months. Early complications were noted in 5% [n=1] patients, and late complications in 30% [n=6]. Based on this data, comparative analysis was carried out between different variables. Surgery is the only treatment for rectal prolapse in adults. Several procedures are done suggesting that there is no standard treatment for this ailment. The number of male patients was higher, chronic constipation was the most common risk factor, abdominal rectopexy was the favored procedure, perineal procedures were associated with shorter operative time, hospital stay, and were done more often in females and elderly. Revision surgery was associated with longer operative time and hospital stay

Dual inotropic activity of doxorubicin on heart [perfused] in the presence of propranolol

Doxorubicin an anthracycline antibiotic and antitumour agent is one of the highly effective antineoplastic drug for the treatment of several different human cancers. The clinical use of this drug is limited by its cardiotoxicity including dose related arrhythmias and often irreversible add from discussion cardiomyopathy. The inotropic and chronotropic activity of different doses of doxorubicin was first evaluated and after determining the fixed effective dose of doxorubicin, the beta receptor activity of doxorubicin was evaluated. The effect of propranolol on heart in presence of doxorubicin was evaluated. Thirty male rabbits weighing 1000 - 1500 grams were used. Drugs used were Doxorubicin and Propranolol. The actions of drugs were studied on the isolated heart of these animals. Krebs ringer buffered physiological solution was prepared and used. To perform the experiment complete set of Lagendroff's apparatus was used. Recording was done on graph paper. Other accessories used were isometric transducer, thermostat oxygen, one ml graduated insulin syringe [to inject the test samples]. Pate of contraction of heart and amplitude of contraction was measured [in centimeters] from baseline. Results were calculated statistically on S.P.S.S. We have evaluated the physiological interactions of Doxourbicin with Adrenaline [agonist] in the first part of the study and in this study the interaction with antagonist [Propranolol] has been studied to evaluate the effects leading to up or down regulation of b receptors