The role of radiation treatment in the management of inflammatory musculoskeletal conditions: a revisit

Inflammatory musculoskeletal conditions are a common group of diseases among the elderly, worldwide. They are characterized by articular degenerative changes accompanied with often debilitating pain. Treatments often involve life-long analgesic therapy or joint replacement in extreme cases. The aim of this current review is to look at the role of radiation treatment with the hope of further study into the effectiveness of radiation treatment in reducing pain, eliminate or reduce the need for life-long analgesic therapy and thereby avoiding the analgesics’ side effects. Extensive literature search was done on PubMed and other available data base and the findings are presented and discussed. Literature showed that many countries in Europe, especially Germany use radiation routinely for the treatment of many degenerative disorders including osteoarthritis with good results and few side effects. A pilot study is therefore recommended with a view to establish the effectiveness or otherwise of this treatment method in patients.

Technical varieties of Ross procedure: a case series

Replacement of aortic valve with the pulmonary autograft is carried out through the Ross procedure due to its potential for growth, durability in pediatric population, and absence of anticoagulation. This case series reports the postoperative outcome of two technical variations of Ross procedure in eight patients who underwent surgery from January 2007 to December 2016. The dominant valvular hemodynamic indication was aortic regurgitation. The techniques employed for Ross procedure included free standing root replacement in six patients and modified root replacement with autograft stabilisation using Dacron interposition graft in two patients. Right ventricular outflow tract [RVOT] conduit reconstruction was achieved by utilisation of Contegra bio prosthesis in four patients; and use of manually constructed valved conduit comprising of PTFE [polytetrafluoroethelene] membrane and bovine pericardial tube in remaining four patients. There was no mortality and no re-intervention. The technical varieties of Ross procedure offer freedom from need of anti-coagulation, mortality, and RVOT conduit failure in younger adults

Current status of gonococcal antimicrobial susceptibility with special reference to azithromycin and ceftriaxone: report from a tertiary care hospital in bangladesh

Objectives: Successful treatment of gonorrhea has always been jeopardized by the emergence of resistance to antibiotics recommended as first-line therapies. The present investigation was carried out to demonstrate the current status of antimicrobial susceptibility of N. gonorrhoeae with a special reference to azithromycin and ceftriaxone

Methods: Microscopical detection in Gram-stained smear and isolation by culture in Thayer-Martin medium were done for 60 clinically suspected gonorrhea patients using urethral discharge or prostatic secretion for male and endocervical secretion for female. Isolates of N. gonorrhoeae were subjected to antimicrobial susceptibility testing by modified Kirby Bauer disk diffusion method against eight antimicrobial drugs including azithromycin and ceftriaxone

Results: Culture yielded a total of 25[42%] isolates of N. gonorrhoeae from 60 clinically suspected patients of both sexes; 21 from male [17 from urethral discharge and 04 from prostatic secretion] and 04 from female [endocervical secretion]. Isolates of N. gonorrhoeae showed moderate to high resistance [60 to 88%] to penicillin, tetracycline, cotrimoxazole, erythromycin, ciprofloxacin and cefixime. While resistance to azithromycin and ceftriaxone was 60% and 48% respectively, which was also moderate

Conclusion: Our findings indicate moderate to the high resistance of N. gonorrhoeae to conventional antibiotics. It also showed moderate resistance to azithromycin and ceftriaxone, current dual therapy recommended by the WHO for the treatment of genital gonorrhea, which is alarming

PBL triggers in relation to students' generated learning issues and predetermined faculty objectives: Study in a Malaysian public university

Objectives: Foundational elements of problem based learning [PBL] are triggers, tutors and students. Ineffective triggers are important issues for students' inability to generate appropriate learning issues. The objective of this study was to evaluate PBL triggers and to determine similarities of students' generated learning issues with predetermined faculty objectives

Methods: It was a retrospective study conducted in 2014 analyzing all 24 PBL-triggers used at Centre for Foundation Studies, International Islamic University Malaysia, in four semesters during two consecutive years 2011 and 2012. Triggers were used as textual and illustration format equally in each semester. Total 16 PBL-triggers with highest and lowest achieving similarities of learning issues with predetermined faculty objectives were selected equally from each semester and format. The trigger quality and learning issues related to predetermine faculty objectives were analyzed and presented as mean and percent distribution

Results: Mean similarities score of students' generated learning issues were 3.4 over 5 predetermined faculty objectives which was 68%, varied from 58% to 79%. More than 70% similarities were generated from five textual and four illustrated triggers, while <70% similarities observed from four illustrated and three textual triggers

Conclusion: Whatever the trigger formats in PBL, it is the designing considering influential variables that influence higher outcomes. Triggers should have planned clues that lead students to generate issues correlate with faculty objectives. Educational institution should emphasize on training needs of faculty at regular interval to develop and re-in force teachers' skills in trigger design, thereby to promote a sustainable educational and organizational development

Identifying the Core Content of a Dermatology Module for Malaysian Medical Undergraduate Curriculum Using a Modified Delphi Method

Background: Dermatology is a minor module in internal medicine undergraduate curriculum. Limited time is allocated for its teaching. Most graduates are inadequately prepared to diagnose and manage skin diseases. We aimed to identify the core content of a more effective dermatology module. Methods: A modified Delphi method was used to reach a consensus. A questionnaire was developed by a selected panel and sent to 20 dermatologists, family physicians and general practitioners (GPs), respectively. They were asked to rate diseases according to importance. The participants then answered the questionnaire again with results of the first round made available to them. The final module content was identified based on the panel’s collective opinions. Results: Eleven topics had mode and median values of 1 with an agreement level of more than 70%. They were as follows: (1) skin structure and function; (2) infections and infestations; (3) the skin in systemic diseases; (4) dermatology emergencies; (5) drug eruptions; (6) psoriasis; (7) eczema; (8) sexually transmitted infections; (9) leprosy; (10) acne; and (11) clinical skills and diagnostic procedures. A total of 56 diseases were identified as important. Conclusion: Results of this study reflect the importance of understanding the influence of regional factors on common and important skin diseases. These topics may be used to develop a more effective dermatology module for the Malaysian undergraduate medical curriculum.

Prevalence of prediabetes in secondary school students in Port Harcourt, Nigeria

This study aimed to assess the prevalence of prediabetes using impaired fasting glucose (IFG) in secondary school students aged 10 to 19 years in Port Harcourt; Nigeria; and to determine associated risk factors. Fasting blood glucose (FBG); blood pressure (BP); and body mass index (BMI) was measured. All students who had a FBG of 5.6 - 6.9mmol/l were asked to undergo an oral glucose tolerance test (OGTT). A total of 880 students were studied. The prevalence of IFG using the International Society for Paediatric and Adolescent Diabetes (ISPAD) criteria was 17% and prevalence was comparatively higher in subjects who were obese; had systolic prehypertension or diastolic hypertension; as well as a family history of diabetes. There was; however; no statistical association between the BMI percentile categories; BP category; sex and age category; or family history of diabetes and occurrence of IFG. The prevalence of IFG was 4% using the World Health Organization (WHO) criteria. Only one child had diabetes. Sixty-six (42%) students who had IFG had an OGTT; of which 10(15%) had IGT. We conclude that prediabetes is common in this population; and screening should be considered; at least in those with obesity or a family history in diabetes

Topical Anaesthesia for Pain Relief during High Dose Rate Brachytherapy for Carcinoma of the Cervix

Purpose: To determine the clinical efficacy of a local anaesthetic spray of 10 xylocaine in reducing pain and discomfort in patients undergoing high dose rate (HDR) brachytherapy. Patients and Method: Ninety two consenting patients diagnosed with cervical cancer and planned for HDR as part of their treatment were enrolled for the study. Each patient had three sessions of brachytherapy following the standard procedures. In the first session all the patients had brachytherapy in the usual manner with conscious Sedation with parenteral diazepam and pentazocine. For the second and third sessions; they had treatment sessions using conscious sedation and 10 xylocaine spray and a control session using conscious sedation and a placebo spray with 0.9 normal saline (NS) respectively. Visual Analogue Scale (VAS) was used in assessing pain during each of the procedure. Results: Only 80 patients completed the study. Their age ranged from 28-70 years with a median age of 54 years. The pre-treatment VAS median scores in the treatment and the control sessions were similar at 0.275 and 0.200. However; the post-procedure median VAS scores were increased to 6.3 in the control group and 3.2 in the xylocaine-treated group (P 0.0001). The haemodynamic status including the blood pressure (BP) and pulse rates (PR) were similar pre and post procedure in both groups. Conclusion: Topical xylocaine spray is efficacious in reducing pain and discomfort in HDR Brachytherapy without any appreciable adverse effect

Undergraduate medical education research in Malaysia: time for a change

Objective: Special Study Module [SSM] is a mandatory research module implemented in Universiti Kebangsaan Malaysia [UKM]. The objective of this paper is to provide a brief overview on the student research activities and to find out the outcome measures in terms of publication Methods: It was a retrospective study done on SSM research projects at UKM. The SSM research is conducted from beginning of year-4 until 1st seven weeks of year-5. In year-4, students are assigned to a facultysupervisor in small groups and spend every Thursday afternoon to plan and carry the research. Whole first seven weeks of year-5, students are placed with their supervisor continuously to collect data, do analysis, write report and present in the scientific conference. Outcomes of 5-years SSM research-projects starting from 2008/2009 to 2012/2013 academic session were analyzed. Results: Total 257 projects were completed and presented in annual scientific meetings from which 57 [22.2%] articles were published in peer reviewed journals. Conclusion: Mandatory undergraduate student research project brings an opportunity to develop students' capacity building from conception to final report writing and thereby narrowing the gap between education and practice. Medical schools should implement research module to bring changes in research and publication culture of undergraduate medical education

Stress among first and third year medical Studentsat University Kebangsaan Malaysia

To identify the stress-prevalence and coping-strategies among University Kebangsaan Malaysia [UKM] medical students. This was an observational study conducted among 234 UKM first and third year medical students. Standardized questionnaire on stress and coping strategies was used. Stress data was related to subjective experiences on some positive and negative adjectives such as tense, relaxed etc. Positive adjectives were measured by sign "++" and "+" scoring "1" while stress-negative adjectives were measured by sign "?" and "-" scoring "0". Forty-eight coping items under task, emotion and avoidance strategies were measured using 5-point Likert-scale. Overall stress-prevalence was 49%. Female and Malay respondents were more stressed. Significant differences of stress-level was observed between Malays and non Malays in first year [p=0.04] and in third year [p=0.01]. Most common strategies used to cope stress was task-oriented while emotion oriented was least. Stress-prevalence and stress-level in UKM medical students was high. Most of the respondents coped stress using task-oriented strategies. Stressor and its effective management must be ensured. Educational institutions should act as a creative designer of learning environment to get relieve from educational stressor

Spontaneous echo contrast masking thrombus in giant left atrium of mitral stenosis-a dilemma in clinical diagnosis

Spontaneous echo contrast [SEC] and thrombus in enlarged left atrium [LA] are common in mitral valvular disease [MVD] and SEC is considered to be a prethrombotic condition. Reliable exclusion of LA thrombus is important before any definitive curative attempts like percutaneous transluminal mitral commissurotomy [PTMC], closed mitral commissurotomy [CMC] or innovative therapies like pulmonary vein isolation and percutaneous closure of the LA appendage. Echocardiography, particularly the transesophageal echocardiography [TEE] is considered to be the gold standard for the diagnosis and to exclude LA thrombus. However, LA thrombus may remain rarely undetected even by TEE potentially making the interventions a risky job. We present a case of mitral stenosis [MS] with giant LA where profuse, dense SEC masked the underlying thrombus in the LA cavity

Simultaneous quantitation of Ofloxacin, Fexofenadine HCl and Diclofenac Potassium in affixed dose combinative formulation by HPLC-UV method

A high-pressure liquid chromatography [HPLC-UV] based simple and specific method for simultaneous quantitative determination of Ofloxacin, Fexofenadine HCl and Diclofenac Potassium has been developed and validated according to ICH guidelines. Chromatographic separation of the three drugs was carried out on 4.6 x 250mm x 5micro Licrospher RP Select B Column, using mobile phase constituted of methanol and phosphate buffer pH 3.5 [650: 350], pH adjusted to 3.5 +/- 0.05 with dilute ortho-phosphoric acid and delivered at a flow rate of 1ml/min. The eluents were detected at UV wavelength of 220nm and the retention times for Ofloxacin, Fexofenadine HCl and Diclofenac Potassium were 2.5 minutes, 4 minutes and 11.5 minutes, respectively. This method is suitable and specific for the three drugs and was found to be linear [R2>0.996], accurate, specific, reproducible and robust over a concentration range of 0.05 to 0.15mg/ml for Ofloxacin, 0.015 to 0.045mg/ml for Fexofenadine HCl and 0.0125 to 0.0375mg/ml for Diclofenac Potassium. The proposed method is simple and convenient, hence easily utilized for the characterization and quantitation of the three drugs in a single formulation for combination therapy of rheumatoid arthritis, sepsis, infection with fever and flu

Miniature radiography

Objective: This study was designed to find out the utility of MMR in hospital-based setup. Study Design: An observational, analytical study

Place and duration: The study was conducted at Radiology Department POF Hospital Wah Cantt for a period of two years. The study was started on 01[st] August 2009 and ended on 31[st] July 2011

Results: Out of 1401 patients attended 988 were advised MMR for pre employment med checkup and 413 reported for annual checkup [Table I]. 91% [1291] were male and 110 were female [Table II]. Majority [64%] of the subjects belonged to age group 20 to 30 years. [Table III].16 patient had pulmonary tuberculosis. [Table IV]

Conclusions: MMR is suggestive rather than diagnostic .It merely separates persons for whom further investigations are required. According to international standard our facility is much underutilized

Evaluation of Serum and Salivary IgG in Head and Neck Squamous Cell Carcinoma.

Aims: To evaluate salivary and serum IgG levels in patients with head and neck squamous cell carcinoma (HNSCC) and healthy control subjects and to assess the effect of treatment on IgG levels. Study Design: A cross sectional study. Place and Duration of Study: Department of Oral Pathology and Department of Radiotherapy, University College Hospital, Ibadan, Nigeria between January 2010 and December 2010. Methodology: Seventy eight subjects comprising 30 patients with untreated HNSCC, 18 patients with HNSCC receiving treatment and 30 healthy, age and gender-matched individuals were included. Serum and salivary samples from the participants were analysed for total IgG using ELISA technique. Results: The mean serum IgG in untreated and treated HNSCC patients was significantly lower compared with healthy controls (P=.001), while mean salivary IgG was significantly elevated (P=.001) in untreated HNSCC patients compared with treated and healthy controls. There was no significant correlation between serum and salivary IgG levels. Conclusion: In patients with head and neck squamous cell carcinoma, serum IgG was reduced while salivary IgG was elevated compared with healthy controls. Our finding suggests differential roles of immunoglobulin G in serum and saliva of patients with head and neck squamous cell carcinoma. Hence, salivary IgG may be a useful biomarker in patients with head and neck squamous cell carcinoma, while serum IgG levels may be useful in monitoring treatment in these individuals.

Radiology request form; a neglected medical document

An incompletely filled Radiology Request Form [RRF] is a common problem faced by both radiologists and radiographers. The study was carried out to objectively evaluate the adequacy of completion of radiology request forms in a tertiary care centre. Indoor and outdoor patient departments of POF Hospital Wah Cantonment. Descriptive, retrospective study. Radiology Department POF Hospital, Wah Cantonment. 01 Jul 2009 to 01 September 2009. A total of 1500 request forms received by the radiology department from 01Jul 2009 to 01Sep 2009 were reviewed. These included requests for a variety of examinations from different departments within POF Hospital, Wah Cantonment. A database of the collected forms was created, noting which of the various fields were adequately completed. Only 270 out of the 1500 forms were completed in full and 1230 were not completely filled. The only parameter fulfilled in all the forms was the presence of referring doctor's signature. The commonest blank fields were as follows: patient location: 62%, clinical notes: 67.26%, doctor's name: 47.33% and date of referral: 14.2%. The inadequate transmission of clinical information observed in this study is typical example of the various problems that radiologists have to face

High prevalence of hepatitis b and c in tb patients - will it be the next threat to tuberculosis control?

Background: Worldwide, tuberculosis and viral hepatitis are common diseases and both remain underdiagnosed and under-treated. Co-infection with tuberculosis and hepatitis is likely to make diagnosis, management and control of either disease difficult and challenging

Objective: To determine prevalence of HCV and HBV infection among PTB patients at Rahim Yar Khan, Pakistan

Patients and Methods: One hundred sputum smear positive pulmonary tuberculosis patients were screened for HCV and HBsAg. In this cross-sectional study, from 1st April to 31st December, 2010 results were analyzed by age, gender, marital, educational and socioeconomic status by using SPSS version 15

Results: Sociodemographic data showed that 66% patients were young between 15-49 years. Only 8 patients had history of blood transfusion, 4 had traveled abroad and none was drug abuser. Most of them were poor. Out of 100 patients [56 male and 44 female] 22% patients were positive for HCV and 3% for HBsAg. Prevalence of HCV infection was significantly higher in married [p value 0.03] and in those with history of blood transfusion [p value 0.004]. No significant statistical difference of prevalence of HCV between male and female, urban and rural, educated and uneducated and in those who traveled abroad or not was found

Conclusion: Prevalence of HCV infection among the pulmonary tuberculosis patients at Rahim Yar Khan [22%] is alarmingly high as compared with general adult Pakistani population [approx. 4.7%]

Role of serum eosinophil cationic protein as a biological marker to assess the severity of bronchial asthma

The study was carried out to evaluate the role of serum eosinophil cationic protein [ECP] as a biological marker for the diagnosis and to assess the severity of bronchial asthma. This observational cross-sectional study was conducted among 70 bronchial asthma patients and 45 disease controls [tuberculosis-15, chronic obstructive pulmonary disease-15, interstitial lung disease-15] enrolled from patients attending the outpatient department of the National Institute of Disease of the Chest and Hospital [NIDCH], Dhaka, Bangladesh during July 2010 to June 2011. Global Initiative of Asthma Management and Prevention [GINA] criteria were followed for selection of both atopic and non-atopic patients with intermittent or persistent [mild, moderate and severe] asthma. Serum level of eosinophil cationic protein [ECP], IgE, forced expiratory volume in 1 second [FEV[1]% predicted] and circulatory eosinophil [CE] count were estimated. Mean serum ECP level [28.8 +/- 42.9 vs. 6.82 +/- 3.5 ng/mL; P < 0.001], IgE level [383.59 +/- 225.3 vs. 135 +/- 131.8 IU/mL; P < 0.001] and percent circulatory eosinophil count [9.95 +/- 3.7 vs. 5.95 +/- 1.4; P < 0.024] were all found significantly raised among asthma patients than disease controls but%FEV[1] was equivocal. All grades of persistent asthma patients had significantly [P < 0.025 and P < 0.002] higher mean ECP level than intermittent cases but serum IgE level and CE count did not differ significantly. FEV[1]% predicted correlated well among moderate and severe persistent asthma but was equivocal for intermittent and mild persistent cases. This study has reinforced that serum eosinophil cationic protein is a dependable biological marker with more discriminatory power over other indicators for bronchial asthma and to assess its severity

Evaluation of diagnostic indices of lectin antigen and anti-lectin antibodies in amebic liver abscess

Diagnostic indices of Gal/Gal NAc lectin antigen and anti-lectin antibodies for amebic liver abscess were evaluated to see their usefulness. Forty [40] clinically suspected cases of liver abscess patients admitted in the Rajshahi Medical College Hospital [RMCH], Bangladesh during January to December 2007 were included. Liver abscess pus from all cases were tested for small subunit of ribosomal RNA [rRNA] gene of Entamoeba histolytica by Real Time PCR and only PCR-positive cases were further analyzed for detection of Gal/Gal NAc lectin antigen and anti-lectin antibodies in their liver abscess aspirates, plasma, saliva and urine using Enzyme-linked immunosorbent assay [ELISA] methods. Except liver abscess pus, all other samples were also tested for 20 patients suffering from diseases other than liver abscess, who served as controls for the study. Out of 40 patients, 39 were PCR-positive and considered as confirmed cases of amebic liver abscess. The rate of detection of lectin antigen and anti-lectin antibody in liver abscess pus was 12.82% and 56.41% respectively. Diagnostic sensitivities of lectin antigen in plasma, saliva and urine were 15.38% [95%CI 6-31%], 07.69% [95%CI 2-22%] and 00% respectively, while sensitivities of anti-lectin antibodies in all those samples were 100% [95%CI 88-100%], 87.17% [95%CI 72-95%] and 56.41% [95%CI 40-78%] respectively. Diagnostic specificities of lectin antigen was 100% in all specimens but for anti-lectin antibodies, specificities were 100% [95%CI 88- 100%] in plasma, 50% [95%CI 28-78%] in saliva and 70% [95%CI 46-87%] in urine. Overwhelming majority of cases [94.87%] received Metronidazole therapy for variable period before sample collection, which is correlated with low rate of antigen detection. Detection of lectin antigen for amebic liver abscess has very limited or no role where Metronidazole is used indiscriminately but detection of anti-lectin antibodies especially in plasma [100% sensitivity] and saliva [87.17% sensitivity] are excellent to satisfactory. Estimation of plasma IgG can be recommended as serodiagnostic tool for symptomatic amebic liver abscess

Gonococcal antigen detection by immunochromatographic assay: a reliable and point-of-care diagnostic test for gonorrhoea

The study was carried out to assess the reliability of Immunochromatographic test for gonococcal antigen in urethral swabs from suspected male patients to validate it as rapid and point-of-care test for gonorrhoea. A total of 80 clinically suspected cases of gonorrhoea in males of different age groups attending at the Skin and VD out patient department of Rajshahi Medical College Hospital [RMCH], Bangladesh during January to December, 2007 were enrolled. Urethral and/or prostatic secretions were collected aseptically for bacterial culture in Chocolate agar media, Gram-stained smear microscopy for gram-negative diplococci and rapid test by Immunochromatographic assay. Out of 80 samples, culture yielded growth of Neisseria gonorrhoeae in 47 [58.75%] cases, and microscopy revealed gram-negative diplococci in 45 [56.25%] cases. Immunochromatographic test was performed by following manufacturer's instructions in randomly selected 50 cases including 38 urethral swabs and 12 prostatic secretions with 35 cases found positive against 36 of those culture-positive cases. Considering culture as gold standard of diagnosis, sensitivity, specificity, positive and negative predictive values of Immunochromatographic test were calculated as 97.22% [95% CI 83-99%], 100% [95% CI 73-100%], 100%, and 93.33% respectively. This limited study reinforces that detection of gonococcal antigen by Immunochromatographic assay is a rapid, easy to perform and reliable diagnostic tool for early detection of acute male gonorrhoea with high sensitivity and specificity. It may be a useful test for screening clinically suspected case of gonococcal infections in male, particularly suitable as point-of-care test

Prevalence of dry socket related to gender and site

The aim of this study was to assess the prevalence of dry socket in association with gender, site and age. This study includes hundred consecutive patients with dry socket coming to the OPD at Oral Surgery Department, Khyber College of Dentistry, Peshawar. A comprehensive proforma was formu-lated and filled for comparison of gender, age and site in relation to dry socket. The results of this comparative study were analyzed through chi-square test. Females were 2.37 times more prone to dry socket as compared to males. Whereas, dry socket was found 2.94 times more common in mandibular extractions as compared to maxillary. It was less common in young age group [18%] as compared to older patients [67%]