A Rare Case of Septic Knee Arthritis Caused by Clostridium perfringens in a Patient With Colostomy.

Septic arthritis of the knee is commonly caused by aerobic organisms. Rarely, it can be caused by Clostridium perfringens, usually due to penetrating trauma. This is a rare case of C. perfringens septic arthritis in a patient with colostomy due to hematogenous spread. The patient was treated successfully with a synovectomy and a prolonged intravenous antibiotic course. The case report summarizes the existing literature on the topic and discusses the diagnosis, management, and prognosis of such cases as well.

Hypercalcemia due to Co-Occurring Metastatic Breast Cancer and Primary Hyperparathyroidism.

Hyperparathyroidism and malignancy are both causes of hypercalcemia. Breast cancer patients usually have hypercalcemia due to metastases or paraneoplastic syndrome resulting from ectopic PTHrP production. Occasionally, other causes such as primary hyperparathyroidism may co-exist and contribute to the hypercalcemia as well. We present the case of a 61 year old with a history of breast cancer with bony metastasis who presented with a corrected calcium level of 17.9 mg/dl. Bloodwork and imaging was suggestive of primary hyperparathyroidism. This case highlights the rare co-existence of dual etiologies of hypercalcemia and provides an overview of the presentation, diagnostic approach and management in such scenarios.

Unique Location and Origin of a Ganglion Cyst.

Ganglion cysts usually occur around the wrist. Occasionally, they can also occur around the shoulder in the spinoglenoid and suprascapular notches. Rarely they can be found on the long head of biceps as it traverses the glenohumeral joint. Such lesions are usually diagnosed on MRI and might need minor surgery. We present the case of a young athlete with a rare location of ganglion cyst, successfully diagnosed and managed non-invasively by using sonography. This represents a time and cost-conscious approach as compared to traditional methods.

Prevalence and Associated Factors of Smoking Among Final Year Medical Students: A Multicentric Survey From Pakistan.

Introduction Smoking is the leading cause of lung cancer around the world. In a developing country like Pakistan with low levels of literacy and general awareness about adverse effects of smoking, doctors play a pivotal role in educating the masses about its harmful consequences and providing support for smoking cessation. However, their efficacy is affected if they smoke themselves, and oftentimes the habits cultivated during educational recourse are carried into the professional careers. The aim of this study was to document the prevalence of smoking among final year medical students of Lahore, Pakistan, and the factors associated with it. Methodology Study approval was obtained from Combined Military Hospital (CMH) Lahore Medical College, Ethics Review Committee. A cross-sectional survey was carried out in four medical colleges and hospitals of Lahore, Pakistan. A questionnaire consisting of 14 questions related to basic demographics and smoking was used after being pilot tested on 20 students of CMH. The overall response rate was 74.89%. Data was collected from 337 respondents, of which 38 forms were discarded and 299 forms were analyzed by SPSS V21. Results Among the 299 respondents, there were 128 males (42.81%) and 171 females (57.19%) with 32 (10.70%) smokers. Male students reported smoking (n = 27, 21.09%) more than their female counterparts (n = 5, 0.02%). The mean age of participants was 23.01 years. Students having an active smoker at home had statistically significant positive correlations with current smoking status and the number of cigarettes smoked per day. Students with household smoking contacts were also more likely to smoke if they belonged to the male gender. Conclusion Prevalence of smoking in medical students is lower than in the general population but still considerable in the male students. There is a need to target this particular population with interactive counseling sessions, education campaigns, and anti-smoking rules to decrease smoking among them and through them in the society.

Knowledge Regarding Basic Facts of Stroke Among Final Year MBBS Students and House Officers: A Cross-Sectional Survey of 708 Respondents from Pakistan.

INTRODUCTION: Stroke is the leading cause of neurological disability in the world. In Pakistan, house officers (HOs) are usually the first contact for a stroke patient in the emergency department. Sometimes they need to make quick decisions regarding diagnosis and management without specialist supervision. Thousands of current final year MBBS (Bachelor of Medicine, Bachelor of Surgery) students will be performing the duties of HOs soon. This study documents the knowledge and confidence levels of final year students and HOs in Pakistan regarding basic facts related to initial diagnosis and management of stroke. MATERIALS AND METHODS: A questionnaire was developed using two standard textbooks of medicine and current stroke guidelines of the American Heart Association. The pre-tested self-administered questionnaire was distributed among 800 final year MBBS students and HOs in 14 medical colleges and hospitals in four different cities. The response rate was 88.5%. Data analysis was done using SPSS V.21. The CMH Lahore Medical College Ethics Review Committee approved this project. RESULTS: Respondents included medical students (n=496) and HOs (N= 212); most were female (n = 452, 63.9%). Of these, 31.4% had managed or assisted in the management of a patient with a stroke and had a higher confidence level in its diagnosis (p< 0.001) and management (p <0.001). Having a family member with stroke was associated with higher confidence in the diagnosis of stroke (p < 0.05) but not with confidence in its management (p = 0.41). Most correctly defined stroke (60.6%), identified the CT scan as the initial diagnostic modality (88.1%), knew the dosage of aspirin (64.9%), knew the time limit for thrombolysis (67.4%), and were familiar with the risk of deep vein thrombosis in immobilized stroke patients (85.4%). Less than half (44.5%) chose tissue plasminogen activator (t-PA) as the preferred initial intervention for acute ischemic stroke. CONCLUSION: This multicenter survey shows that the knowledge and confidence of medical students and HOs in Pakistan regarding initial diagnosis and management of stroke are inadequate in most domains. There is a need to improve the medical training for stroke in emergency departments for optimal outcomes. Public education campaigns about stroke should be conducted to increase the general awareness of the population about the prevention, signs, symptoms, and emergency steps to be taken when encountering a case of stroke.