Trends in undergraduate teaching of parasitology in medical schools of Pakistan

OBJECTIVE: Parasitic diseases are a major public health problem in the tropical and sub tropical countries including the subcontinent region. We aimed to assess methods of Parasitology education in medical schools of Karachi Pakistan. METHODS: Ten medical schools in Karachi, Pakistan were sent a structured questionnaire collecting information on different aspects of Parasitology education. The collected data was analyzed using SPSS version 14.0. RESULTS: The response rate of this study was 90%. Majority of the schools in Karachi, Pakistan (78%) taught Parasitology concurrently with Microbiology, Pathology, Pharmacology and Forensic medicine in third and fourth year of undergraduate training. More than 20 hours were spent on teaching through didactic lectures (56%), interactive lectures (22%), problem based learning (PBL) (22%), clinical cases (11%) and small group discussions (89%). A Clinical Microbiologist or Parasitologist taught Parasitology by using transparencies, handouts and/or computer aids. Variation in education methods existed mainly in the private medical schools. CONCLUSION: Medical curricula were meeting the European standards for teaching of Parasitology. However, there is a need for revision and modification in the curricula owing to the high burden of parasitic diseases in the subcontinent region

Immediate Pain Relief in Patients of Trigeminal Neuralgia After Microvascular Decompression (MVD)

Objectives:  The study was conducted to observe the pattern of pain relief and analyze the influence of demographic factors and co-morbidities in patients undergoing microvascular decompression for trigeminal neuralgia. Materials and Methods:  This prospective observational study conducted from July 2020 to July 2023 included 50 diagnosed cases of trigeminal neuralgia scheduled for MVD. Data homogenization, including detailed demographics at our institution, preoperative data including American Society of Anaesthesiologists (ASA) status, and Charlson comorbidity index, rigorously documented surgical parameters, The study design was structured follow-ups at 1, 6, and 12 months. Results:  Early postoperative outcome revealed 60% complete pain relief, 30% partial relief, and 10% no relief. Age was a significant correlate of outcomes, reinforcing the need for age-sensitive interventions. Nuances of the surgery, especially revision MVD, were associated with increased recurrence rates, emphasizing the need for precision. This study identifies preoperative variables that may affect long-term relief, well known factors in the literature (including multiple sclerosis) correlate with lower rates of relief and diagnostic tissue confirmation, which underscores the need for individualized metrics and longer-term follow-up in studies. Conclusions:  The data presented offers important information for furthering the knowledge of the clinical outcomes when undergoing MVD, highlighting the need for accurate objective measures in surgical assessments. The correlations identified provide routes to improving protocols and inform the precision of pain relief in patients with trigeminal neuralgia

Effectiveness of Fosfomycin against Extended Spectrum Beta-Lactamase Producing Escherichia coli in Urinary Cultures

Background: Urinary tract infections (UTI) considered, as the most frequently diagnosed infections constitute Escherichia coli (E. coli) as the most common etiological agents isolated from urinary cultures. Fosfomycin is becoming the best treatment option for UTI because of its rapid absorption, good concentration in urine. The present study aimed to determine and compare the susceptibility of Fosfomycin, presented as a favorable choice against E. coli producing extended spectrum beta-lactamase (ESBL) in urinary cultures of patients. Methods: This cross sectional study with non-probability consecutive sampling was held at Ziauddin University Hospital Microbiology Laboratory. A total of 222 urinary isolates of in and out patients yielding growth of ESBL positive E. coli were identified using standard microbiological technique. Susceptibility testing of antimicrobials was accomplished according to Clinical Laboratory Standard Institute (CLSI) guidelines. Detection of ESBL was done by double disk diffusion technique. Independent sample t-test was used to compare mean ages and Chi-squared test for the ESBL positivity in various age groups. A p-value of less than 0.05 was considered as statistically significant. Results: The mean age of the patients was 56.68±21.18 years. There were 59(26.58%) male and 163(73.42%) female. The sensitivity of ESBL producing E. coli to Fosfomycin was 94.59 % (210/222) which was much higher as compared to other antimicrobials, Meropenem (89%), Amikacin (83%) and Nitrofurantoin (78%). There was no statistically significant variance among the age groups with respect to fosfomycin susceptibility (p=0.601). Conclusion: Fosfomycin have high antimicrobial activity against ESBL positive E. coli in urinary samples. It could be a good treatment choice for urinary tract infections. Keywords: Urinary Tract Infections; Fosfomycin; Escherichia coli; Beta-Lactamases

Increasing Utilization of Standardized Tools for Measurement-Based Care in the Management of Generalized Anxiety Disorder

Introduction Generalized anxiety disorder (GAD) is a common mental health condition encountered in primary care settings. GAD screening, diagnosis, and management are challenging, among other issues that capture the attention of primary care physicians (PCPs). Measurement-based care (MBC) involves the systematic assessment of patients’ symptoms and treatment progress using standardized tools. Generalized Anxiety Disorder 7-Item (GAD-7) is a well-known screening and symptom-monitoring tool for GAD. It quantifies subjective symptoms objectively by measuring the patient’s anxiety level. We aimed to increase utilization of GAD-7 in outpatient clinics to improve diagnosis and management of GAD through educational interventions and by educating PCPs to access the GAD-7 tool in the EPIC electronic medical record (EMR) with ease. Methods This study employed a quasi-experimental interrupted time series design over 12 months. The intervention involved displaying posters educating family physicians on accessing GAD-7 screening tools in EMR and using smart phrases to document GAD-7 results in two outpatient family medicine clinics. SlicerDicer measured total anxiety encounters and GAD-7 utilization 3 months before and 9 months after intervention. Statistical process control was used, and control charts were created using the statistical software JMP Pro-16. A Poisson regression model was used to detect statistically significant differences using statistical software SAS 9.4. Results GAD-7 utilization increased from 4.5 in the preintervention period to 20.5 in the postintervention period. There was a significant increase in GAD-7 utilization over time after implementing our QI intervention. The control chart phase analysis showed a shift in the process with an increase in the average rate of GAD-7 utilization from 11.5 per 100 encounters per week in the preintervention phase to an average of 35.8 per 100 encounters per week postintervention phase. The effect was sustained over a year postintervention. The Poisson regression model also showed a 21% increase (p < 0.0001) in the incidence rate ratio in the post-intervention period as compared with the preintervention. Conclusion Utilization of GAD-7 as an application of MBC improved with the implementation of a bundled intervention using quality improvement tools. Other programs may replicate this in their similar quality improvement endeavors

Phytochemical Analysis, Antioxidant Activity, Fatty Acids Composition, and Functional Group Analysis of Heliotropium bacciferum

Heliotropium bacciferum is paramount in medicinal perspective and belongs to Boraginaceae family. The crude and numerous fractions of leaves, stem, and roots of the plant were investigated for phytochemical analysis and DPPH radical scavenging activity. Phytochemical analysis of crude and fractions of the plant revealed the presence of alkaloids, saponins, tannins, steroids, terpenoids, flavonoids, glycosides, and phenols. The antioxidant (free radical scavenging) activity of various extracts of the Heliotropium bacciferum was resolute against 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical with the avail of UV spectrophotometer at 517 nm. The stock solution (1000 mg/mL) and then several dilutions (50, 100, 150, 200, and 250 mg/mL) of the crude and fractions were prepared. Ascorbic acid was used as a standard. The plant leaves (52.59 ± 0.84 to 90.74 ± 1.00), stem (50.19 ± 0.92 to 89.42 ± 1.10), and roots extracts (49.19 ± 0.52 to 90.01 ± 1.02) divulged magnificent antioxidant activities. For the ascertainment of the fatty acid constituents a gas chromatograph hyphenated to mass spectrometer was used. The essential fatty acids for growth maintenance such as linoleic acid (65.70%), eicosadienoic acid (15.12%), oleic acid (8.72%), and palmitic acid (8.14%) were found in high percentage. The infrared spectra of all extracts of the plant were recorded by IR Prestige-21 FTIR model

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

U.S. War in Afghanistan: From Intervention to Counterinsurgency

US military intervention in Afghanistan was decisive and forceful, however, the Taliban&rsquo;s insurgency inevitably transformed U.S. military doctrine and strategy from conventional military intervention into Counterinsurgency&rsquo;s kinetic and non-kinetic operations. U.S. strategic and operational methodology despite exhausting all possibilities; troops&rsquo; surge, air dominance/surveillance, non kinetic peace building operations, failed to dislodge the threat of Taliban violence. An effort is made to identify the underlying factors contributory to the failure of the U.S. strategy, tactics and other challenges faced despite having unparalleled military superiority. This paper further probes the U.S. military strategic repositioning, social structure with the warlords and critically examines how the conflict drifted from intervention into Counterinsurgency irregular warfare

Role of prednisolone in management of post-dural puncture headache after spinal anesthesia in obstetric patients

Background and Aims: Post-dural puncture headache (PDPH) is a common cause of morbidity in patients subjected to dural puncture for spinal anesthesia. PDPH is mostly a benign condition but can lead to delayed hospital discharge and considerable morbidity for the parturient. We aimed to study whether there is a positive role of prednisolone in post dural puncture headache management (after spinal anesthesia) in patients undergoing lower segment cesarean section (LSCS). Methodology: A randomized controlled trial was conducted at department of gynecology and obstetrics, in Combined Military Hospital (CMH), Nowshera, from April 2018-September 2018. A sample size of 60 patients was determined through WHO calculator. Patients were selected through non probability consecutive sampling after ethical committee approval and consent forms were taken. Patients were randomly categorized into two groups. Group A was given tablet prednisolone while Group B was given a placebo tablet. Patients were followed for pain measurement using visual analogue scale (VAS). Data were analyzed using SPSS version 24. T-test and Chi-square test were applied. A p ≤ 0.05 was considered significant.Results: A total of 60 women undergone c sections were included in study. Mean age of women was 28.5 years ± 4.3. Mean pain scores were significantly reduced in prednisolone group as compared to placebo at 24, 48, 72 and 96 h (p = 0.00). Majority of patients in placebo group had severe headache as compare to oral prednisolone group after 96 h (p = 0.00).Conclusion: Post-Dural Puncture Headache is a major complications following LSCS in spinal anesthesia. Oral prednisolone usage is very effective in lowering severity of headache and duration of PDPH. Oral prednisolone also limits adverse events associated with PDPH after LSCS performed in spinal anesthesia.Citation: Afridi N, Fareed A, Fatima A, Role of prednisolone in management of postdural puncture headache after spinal anesthesia in obstetric patients . Anaesth. pain &amp; intensive care 2019;23(2):168-171</jats:p