Knowledge, attitude and perceptions about tetanus and rabies among family physicians; results of a survey at a teaching hospital in karachi, pakistan

To assess the knowledge, attitude and perception among family physicians about tetanus and rabies. Setting: This study was conducted at the International Family Physicians Conference held at the Aga Khan University. Method: It was a cross sectional study of convenient sampling. The participants were asked to fill a pre-tested questionnaire comprising of 26 questions. Both open and close ended questions were included. A total of 111 doctors fulfilling the inclusion criteria filled in the questionnaire.Result: Out of 111 doctors who participated in this study, vast majority were working in the urban area (86.5%). 59.5% had not seen a case of tetanus and 71% had not seen a case of rabies in the preceding 6 months. Only 37% would use both tetanus toxoid and tetanus immunoglobulin in case of a dirty wound; 30% would administer tetanus toxoid and anti-tetanus serum in such a case. About 65% knew the current recommendation on rabies vaccination whereas 58% knew the correct post-exposure prophylaxis in case of suspected rabies.Conclusion: The level of knowledge about tetanus and rabies was clearly found to be deficient. More than half of the doctors enrolled in the study did not show correct knowledge on tetanus and rabies vaccination. The reasons for these deficiencies in knowledge appear to be inadequate teaching about these important diseases in the medical school. In addition, lack of reading habit and non-availability of continuous medical education programmes at the government level also contributes

A Dynamical Study of Risk Factors in Intracerebral Hemorrhage using Multivariate Approach

The purpose of this study is to investigate the effects of clinical covariates to the outcome of Intracerebral Hemorrhage (ICH) patients in terms of best fitted and excellent discriminate model of binary response variable. Clinical data of 985 patients with ICH have collected using the International classification of diseases, Ninth revision codes. The diagnosis of ICH was confirmed by neuro-imaging in all patients. Univariate analysis revealed that out of 88 covariates 46 were found to be significant (p\u3c0.05). The multivariable analysis using multiple logistic regressions, exhibited a significant negative relationship between ICH and hypertension. The improvement among ICH patients having hypertension was 0.5 (p=0.001, ARR=0.5, 95% C.I. 0.3 – 0.8). The improvement among ICH patients using antihypertensive medicine was 1.3 (p = 0.016, ARR=1.3, 95% C.I. 1.1 – 1.5). Thus present study showed that ICH has strong relationship with use of antihypertensive medicine. The improvement of patients who were using antihypertensive medicine at the time of discharge was 3.0 times (p \u3c 0.0001, ARR=3.0, 95% C.I. 2.7 – 3.2) as compared to those who did not use antihypertensive medicine. The change in ARR from 1.3 to 3.0 times shows that the use of antihypertensive medicine and ICH outcome variable are positively associated. The change in ARR of hypertensive range of SBP also indicates that the blood pressure range and ICH outcome variable are negatively associated. The neurological symptomatology, slurred speech and double vision are important factors of proposed statistical models. Moreover, a clear decrease was found in mental status from normal to coma in applicable model. Surgery is an important part of recovery, and estimated that the improvement among the ICH patients, who were treated with surgery, was 1.4 times with significant p-value in best fitted models. The complication of pneumonia during treatment of ICH subjects has highly significant negative association with outcome variable. Present Model has 0.892 area under the curve with sensitivity (0.852), specificity (0.793) and p-value (0.204). This indicates that the model gives the impression to fit quite well for predictive performance of the ICH outcome variable and the model is excellent model

Spinal infections in adult Indian population: clinical study and management of various spectrums- An Institutional Experience

Background: Spinal infection (SI) by definition is an infectious disease affecting the vertebral body, the intervertebral disc, and/or adjacent paraspinal tissue.In this observational study, we describe patient distribution, etio-pathogenesis, clinical presentation of spinal infections in adults and their best possible management, that is  conservative/ surgical along with follow up in a tertiary care hospital attached to a medical college in India. Materials and Methods: This study was carried out from July 2017  to March 2020 in the Neurosurgery department of a tertiary care hospital attached to a medical college in India. We enrolled 90 patients for our study. Outcome and complications assessments were carried out for all patients over a period of two years. Results Out of 90 cases 57(63.3%) were male & 33(36.6%)were female, 58(64.4%) were in the age group of 30-40yrs, 74(82.2%) were from lower socio economic status(as per modified Kuppuswamy scale). Location wise, 21 (23.3%) were in the cervical region, 18 (20%) in dorsal, 34 (37.7%) in dorsolumbar and 17(18.8%) in the lumbo sacral region. 56 (62.2%) patients underwent surgery, out of which 24 (26.6%) patients were diagnosed as tuberculosis on biopsy, 11 patients grew staphylococcus aureus,03 were positive for fungi,  rest showed no growth/no organisms on microscopy. 34 patients were managed conservatively with CT guided biopsy and antibiotics /ATT. of the 90 patients, 16(17.77%) were lost to follow up, of the remaining 74, 17(18.88%) came in category (a) 23(25.5%) in category (b) and 34(37.77%) came in category (c). Conclusion: We conclude by saying that Tuberculosis remains the most common cause of spinal infection in India even now. Detailed workup helps to decide treatment strategy either Conservative and surgical

Mantle Cell Lymphoma in the Thyroid: A Rare Presentation

Background: While 2% of all extranodal Non-Hodgkin Lymphomas present in the thyroid, there exists insufficient data to describe the incidence of mantle cell lymphoma in the thyroid. A case series of 1400 patients revealed that \u3c 1% of thyroid lymphomas may be MCL; hence better understanding of the disease course is essential. Patient Findings: A 65-year-old female was referred for a multinodular goiter. Multiple fine needle aspirations from the dominant right nodule were consistent with Hashimoto\u27s thyroiditis and flow cytometry was negative. Due to progressing dysphagia, she underwent total thyroidectomy. Summary: Pathology revealed MCL with mantle zone growth pattern in the right thyroid. Flow cytometry showed monoclonal B cells comprising 9% of total cells. The Ki-67 index was 10%. She was diagnosed as having stage IIE MCL and offered conservative management by medical oncology, given that she had no B symptoms. Conclusion: Though chemotherapy is the treatment of choice in MCL, a subset of patients with low-grade disease may be observed. As in our patient, mantle zone growth pattern and a Ki-67 index \u3c 10% suggest a favorable prognosis. A diagnosis of primary MCL in the thyroid remains rare and staging modalities as well as treatment options continue to evolve