Tuberculosis of male breast: A rare benign entity.

Granulomatous mastitis is a rare benign condition often seen in young lactating females of reproductive age group. Prepubescent males or elderly women may also be the victim of this infectious disease. Primary infection of the breast may occur through skin abrasions, open wounds or through the lactiferous ducts while secondary spread occurs from an infective focus elsewhere in the body via lymphatic or hematogenous routes. We present a case of breast tuberculosis diagnosed in a 62-year-old man at our institution. The patient presented with a palpable painful mass in the left breast with chronic sinus formation and pus discharge for a month with loss of appetite and weight loss. The etiology was unknown. The imaging features were suggestive of tuberculosis. Histopathology was concordant with imaging and showed chronic granulomatous inflammation with necrosis. The patient received oral anti-tuberculosis therapy for six months with no side effects or any further complications. Breast tuberculosis is a rare entity especially in male breast mimicking carcinoma. The mainstay of treatment is antitubercular therapy if imaging and histopathology confirms the diagnosis. Clinical awareness is necessary during diagnostic workup for establishing the correct diagnosis and treatment

Leadership Practice among Nurses in Tertiary Care Hospital Lahore

Introduction: The planned role of leadership can be used to examine on how to engage leadership models and use leadership behavior to progress organizational performance. The intangible assets such as leadership styles, culture, skill and competence, and motivation are key sources of strength in firms that can combine people and processes and organizational performance. A need was also observed for nursing leaders to reflect and self-evaluate their leadership considering perceptions from the team on their adopted actions and practices, as the leadership practices are powerful indicators of the performance of the work of the nursing team. Methodology: Leadership Practices - Self assessment and Leadership Practices – Observer: The data collection tool was used for this study is self-assessment scale. It was designed in 1987 to be utilized by a leader to self-evaluate themselves in how frequently they engage in leadership practices. The thirty descriptive statements are given and a Likert scale was used. The head nurses was required indicating their opinions by circle from, rarely or Very Seldom = 1, Once in a While = 2 Sometimes = 3 Fairly Often = 4 Very Frequently or Almost Always = 5. The five practices are identified as challenge the process, inspire a shared vision, enable others to act, model the way, and encourage the heart same repeatedly question asked from nurses to assess the perception (Posner & Kouzes, 1988). Results: The study revealed that the managers moderately performed the leadership practices. A significantly positive relationship was found between the manager and subordinate's assessment of challenging the process and inspiring a shared vision (p=.045). Discussion: the results of this study support the existence of a relationship between the self-assessment and the subordinate's assessment. This study also indicates that the managers in this study moderately exhibited the leadership practices as identified in Kouzes and Posner's (1987) research. DOI: 10.7176/JHMN/100-03 Publication date:May 31st 202

Mining Extracellular Vesicles for Clinically Relevant Noninvasive Diagnostic Biomarkers in Cancer

Extracellular vesicles (EVs) are nanosized vesicles secreted by virtually all cell types into the extracellular milieu. EVs transport bioactive molecules between cells and play multifaceted roles in cell-to-cell communications and in the pathogenesis of various human diseases including cancer. EVs are currently a focus of intensive interest, mainly because they hold a wealth of biological information in the form of differentially expressed nucleic acids and proteins, including DNA and cancer-related mutated genes, microRNAs, and a variety of transcriptional factors. Both the mutational content and any differentially expressed RNA are highly stable in patient blood or urine because they are encapsulated in EVs. This protects them against nuclease activity, pH change, temperature fluctuations, and multiple free-thaw cycles. Therefore, EVs isolated from patient fluids may serve as an ideal source of liquid biopsy for mining cancer signatures through mutation screening and genetic profiling. However, the methods for obtaining pure and intact EVs from patient samples, as well as the optimized characterization of tumor-derived EVs are still not rigorously defined for routine clinical use. High-throughput genomic or proteomic platforms may aid in the identification of novel diagnostic and prognostic biomarkers that collectively could lead to cancer monitoring and improved patient outcome

Relationship between Parental Bonding and Aggression among Medical College Students in Multan

This study aimed to explore the Relationship between Parental Bonding and Aggression among Medical college students. The study was based on correlational research design. The sample of 110 medical students was taken from Nishter Medical College, Multan, through simple random sampling technique. Survey method was used for data collection. The instruments used for data collection included Buss and Perry aggression scale (1992) (BPAQ),The Parental Bonding Instrument (PBI by Gordon Parker, Hilary Tupling, L.B. Brown , 1979 ).The collected data was analyzed through Statistical Package for Social Sciences (SPSS 20).The results revealed a negative correlation between parental bonding and aggression among medical students. Significant gender differences were found in term of parental bonding and aggression. This study can be helpful for parents to identify their bonding with the child and develop new strategies for addressing significant problem. Area of this study was restricted to Multan Nishter College. Future researches can include a large number of participants and also cover large research area for generalizability

Effect of tea and coffee consumption on the blood pressure, pulse wave velocity and aortic pressures in young healthy individuals: Effect of tea and coffee on CVS

Caffeine present in tea and coffee, the most commonly used beverages, has been implicated to have long term effects on cardiovascular system. The aim of this study was to document the acute and chronic effects of tea and coffee consumption on blood pressure, pulse wave velocity and aortic pressures in young, healthy individuals. This observational study was conducted on 86 healthy MBBS student volunteers of both genders between the age group of 18-27 years. Cardiovascular parameters (heart rate, peripheral blood pressure, central blood pressure, pulse wave velocity, augmentation pressure) were measured using PeriScope™. Participants were divided into 3 groups based on their history of consuming tea/coffee/both/none. Data collected was analyzed using SPSS 17.0. ANOVA or Welsh test of equality of means was used for knowing the differences for scale variables. Paired sample t test was used to know the acute effect of coffee consumption among group 1 participants in a before-after design. In regular tea consumers, the bilateral brachial SBP, DBP and MAP were significantly higher than individuals who did not consume tea regularly; similar results in these parameters were also observed in regular coffee drinkers. However the lower limb arterial parameters were not markedly differently in tea/coffee group compared to non-drinkers. In both tea and coffee group, AoSP and AoDP were significantly higher than non-drinkers. Additionally, coffee drinking has acute stimulatory effects on CVS as evident by increase in peripheral and central vascular parameters

Community-based management and outcome of omphalitis in newborns in Karachi, Pakistan

Objectives: To describe the clinical profile and outcome in newborns with omphalitis managed with home or clinic-based therapy.Methods: The descriptive study was conducted from September 2004 to August 2007 in three low-income communities in Karachi, Pakistan. Newborns with omphalitis detected by community health workers through active surveillance were referred to local clinics. Those with physician-confirmed omphalitis were treated for 7 days with topical gentian violet or oral cephalexin (as monotherapy) or topical gentian violet and oral cephalexin (combination therapy) at physician discretion, or injectable therapy (procaine penicillin and gentamicin) if clinical signs of sepsis were also present and family refused hospital referral. Follow-up was at 48-72 hours and 7 days. SPSS 16 was used for statistical analysis.Results: Among 1083 newborns with omphalitis, 578 (53.4%) had peri-umbilical cellulitis without purulent discharge; 365 (33.7%) had purulent discharge (with or without cellulitis); and 140 (13%) had omphalitis with sepsis Review of outcome data at one week showed that among 943 newborns without signs of sepsis, 938 (99.5%) had improved; 2 (0.2%) died, and 2 (0.2%) were lost to follow-up. There were 5 (3.6%) therapy failures, among 140 newborns with omphalitis and sepsis managed with parenteral antibiotics at 48 hours, but 139 (99.2%) had improved by one week, while 1 (0.8%) died.Conclusion: In resource-constrained environments, omphalitis can be managed in the community with minimal need for hospital referral. Further research to define optimal therapeutic regimens is needed

Central blood pressure parameters in young adults with and without parental history of hypertension: Central BP in young with parental history of HTN

Hypertension is increasingly being found in children and adolescence. The purpose of this study was to find out differences in the central arterial (aortic) blood pressure parameters in young adults with hypertensive and normotensive parents. 109 healthy volunteers between the ages of 17 and 25 years were enrolled for the study after taking consent. Brachial artery pressures and aortic parameters were recorded using PeriScope™ which determines aortic parameters and functional vascular age non-invasively based on oscillometric method. The results of this study showed no statistically significant difference between offspring of hypertensive parents and offspring of normotensive parents

SonoGames: Sounds of the right kind introducing gamification into radiology training

Background: Radiology as compared to other fields of medicine has lagged, in incorporating modern training modalities such as gamification and simulation into its teaching curriculum.Objective: This study aims to evaluate effectiveness of simulation-based teaching in collaboration with gamification. Bandura\u27s conception of self-efficacy was used to provide qualitative assessment of participants\u27 learning process through training event. Modified competitive game-based teaching methodology was utilized in an experimental study conducted for radiology residents. Workshop was divided into two sessions, first being three interactive didactic lectures followed by three competitive rounds. All participants were required to fill pre and post-self-efficacy questionnaire along with an activity evaluation form.Results: Significant self-efficacy scores were calculated for simulation-based stations of knowledge assessment and hands-on stations. Whereas significant association was also found between gender and knowledge assessment in communication skill (0.054), Professionalism (0.004), and general knowledge (0.018). Similarly, noteworthy correlation was found between gender and all hands-on skills. In conclusion, study reported an overall increase in knowledge of post-test scores compared to pre-test scores due to use of gamification in combination with simulation-based teaching which shows a positive role in clinical training. However, further consideration is needed to improve process of integrating simulation in clinical training of participants

Clinical Pharmacokinetics of Clavulanic Acid, a Novel β- Lactamase Isolated from Streptomyces clavuligerus and Its Variability

The clavulanic acid derived by fermentation of Streptomyces clavuligerus and possessed the capability to inactivate a broad range of β-lactamase enzymes. A complex physicochemical process involves the binding of clavulanic acid to β-lactamases in which clavulanic acid itself deplete irreversibly along with β-lactamase enzyme rendering amoxicillin spared which otherwise would hydrolyze by an enzyme. It is therefore termed as ‘suicide ‘inhibitor for β-lactamases. We discussed here pharmacokinetic parameters and identified factors responsible for the variability of absorption of clavulanic acid. The results based on individual plasma concentration-time curve of amoxicillin and clavulanic acid in an open, randomized, two-way crossover study involving 10 healthy male subjects administered with two amoxiclav formulations