Effects of co-infection on the clinical outcomes of Clostridium difficile infection

Background: Clostridium difficile (C. difficile) is a spore-forming, Gram-positive rod that is known to be associated with antibiotic use. It is one of the leading causes of nosocomial diarrhea in the industrialized world and therefore warrants further study of its nature. It isn\u27t clear if co-infection by other organisms can affect the outcome of C. difficile infection (CDI). Methods: A single center retrospective study was done and it used inclusion criteria of 18 years of age and being tested positive for CDI on FilmArray® multiplex gastro-intestinal (GI) panel. Exclusion criteria were a GI panel performed on an outpatient basis, recurrent CDI, and the presence of end-stage renal disease, cirrhosis, or a non-GI infection. The stool sample for all patients were collected within 48 h of presentation to the hospital. There were 235 of 2576 GI panels selected for a retrospective chart review based on the above criteria. Among these 235 patients, 38 had a co-infection (CDI+ another GI infection = group A or cases) and the rest had only CDI (group B or controls). Group A was compared with group B for CDI severity, its response to treatment, recurrence, and length of the hospital stay, using 0.05 as the alpha criterion. Results: Most patients with CDI were female and above the age of 60 years. Co infection did not increase the severity of CDI based both on the American College of Gastroenterology criteria (p 0.16) as well as Infectious Disease Society of America criteria (p 0.77). Co infection group also didn\u27t have significantly different CDI related treatment failure rate (p 0.23), or CDI recurrence rate (p 0.49). Co-infection was also not associated with lengthier hospital stay (p 0.41). Conclusion: Our study suggests that co-infection doesn\u27t affect the severity of CDI or can cause treatment failures. Additionally, there was no significant increase in hospital stay, or increase in CDI recurrence associated with co-infection. Therefore, if CDI is the leading clinical diagnosis and a patient is tested positive for co-infection in addition to CDI on FilmArray® multiplex GI panel, this co-infection shouldn\u27t change the management for CDI. Limitations of this study (including retrospective nature of the study, small sample size, single site study, not including all microbiome and non-inclusion of race) should also be taken into account, while considering the applicability of the results of this study

Western Concept of Nationalism and Islamic Concept of Nationalism: An Ideological and Philosophical Critique and Analysis

Western nationalism is a modern concept that gave birth to nation-states but because of its dynamic vitality, it is often considered to be a very old concept. Currently all the states are the result of the concept of Western nationalism. Owing to its significance and occasionally all-encompassing nature, it is erroneously believed to have a constant influence on political behavior.  One could argue that the American and French revolutions were the first truly potent examples of nationalism. In this concept of Nationalism well defined common territory, race, culture, language, sovereign government, and above all commonalities of interests have got a pivotal role. The Western concept of Nationalism confuses the intellect of the students of history with Islamic background because the Islamic concept of Nationalism has different connotations. This research is Qualitative based on content, discourse and thematic analysis having empirical nature.  The main argument of the study is that, the two concepts are entirely different having different backgrounds and different philosophies. Key Words:    Nation, Nationalism, Nation-State, Western, Islami

PREVALENCE AND ANTHELMINTIC EFFICACY OF ABAMECTIN AGAINST GASTROINTESTINAL PARASITES IN HORSES

The prevalence and anthelmintic efficacy of Abamectin against gastrointestinal parasites under field conditions in Faisalabad (Punjab, Pakistan) was studied in 100 horses. The overall prevalence of gastrointestinal parasites was 75%, including Strongylus spp. (50%), Oxyuris equi (12%), Parascaris equorum (8%) and mixed infection (5%). Among these naturally infected animals, 15 were selected. These horses were assigned to three groups on the basis of prevalent species of gastrointestinal parasites. Each group had five animals, comprising four treatment horses and a control horse. Abamectin was evaluated against these gastrointestinal parasites with a single shot at the dose rate of 0.2 mg/kg body weight administered through subcutaneous route which resulted in 98% reduction in faecal egg count after day 14 post-treatment. Non-treated horses remained positive for gastrointestinal parasites. No adverse reactions were observed during the experimental period. It was concluded that Abamectin is highly effective against gastrointestinal parasites in horses

Usability Assessment of an EHR’s Clinical Notes Interface from Attendings and Residents Vision: An Exploratory Study

Background: Usability gaps between current and future improved Electronic Health Record (EHR) system designs exist due to insufficient incorporation of User-Centered Design (UCD) principles during System Development Life Cycle (SDLC).Objectives: To evaluate the usability aspects of a commonly used EHR system specific to clinical notes usage from attendings’ and residents’ standpoints by analyzing objective measures of users’ performance and their subjective perceptions employing mixed methods approach.Methods: Usability of a commercial, inpatient EHR clinical notes documentation interface was analyzed from standpoints of two provider groups employing two standardized patient cases. Both objective and subjective data were collected from attending (n=6) and resident physicians (n=8) through usability testing employing a mixed method approach.Results: The study results suggested that (i) EHR usability and desirability is influenced by user characteristics, (ii) workloads associated with H&P and progress notes writing are perceived differently between two groups, (iii) repeated task performance improves user efficiency and (iv) user performance is correlated to their subjective system assessments.Conclusion: Understanding usability of clinical documentation interface from perspectives of two different user groups, provides interface designers with an opportunity to develop an EHR system centered on UCD principles

COMPARATIVE EFFICACY OF HYPERTONIC SALINE AND NORMAL SALINE SOLUTIONS IN EXPERIMENTALLY INDUCED ENDOTOXIC SHOCK IN DOGS

This study was contemplated to determine the comparative beneficial effects of hypertonic saline solution and sterile saline solution in induced endotoxic shock in dogs. For this purpose, 12 healthy Mongrel dogs were randomly divided into two equal groups (A and B). All the animals were induced endotoxaemia by slow intravenous administration of Escherichia coli endotoxins 0111:B4. Group A was treated with normal saline solution @ 90 ml/kg BW, while group B was given hypertonic saline solution @ 4 ml/kg BW, followed by normal saline solution @ 10 ml/kg BW. Different parameters were observed for evaluation of these fluids including clinical and haematological parameters, serum electrolytes, mean arterial pressure, and blood gases at different time intervals up to 24 hours post treatments. After infusion of respective fluids, all parameters returned to baseline values in both the groups but group B showed better results than group A except bicarbonates, which better recovered in group A. Thus, it was concluded that a small-volume of hypertonic saline solution could be effectively used in reversing the endotoxaemia. Moreover, it provides a rapid and inexpensive resuscitation from endotoxic shock

Antidiabetic activity of aqueous extract of Sigesbeckia orientalis (St. Paul’s Wort) in alloxan-induced diabetes model

The current study evaluated antidiabetic and antihyperlipidemic activities of aqueous extract of Sigesbeckia orientalis L. (St. Paul’s Wort) (AESO) in an alloxan-induced diabetic rat model. Following OECD guidelines safe doses of AESO were assessed in rats for the main study. Serum/bood glucose, α-amylase, and lipids levels and histopathological evaluations were conducted to assess antidiabetic and associated antihyperlipidemic efficacies of AESO. AESO was found to be safe up to the dose of 2000 mg/kg. Significant (p < 0.05) reduction in glucose and lipids (total cholesterol, triglycerides, low‑density lipoproteins) levels was observed in AESO treatment groups. Serum α-amylase, high‑density lipoproteins, and total body weight was increased significantly (p < 0.05) in diabetic rats treated with AESO. Histopathological data showed improvement in hepatocyte and pancreatic β-cells islets architecture. HPLC analysis identified quercetin, gallic acid, vanillic acid, p-coumaric acid, m-coumaric acid and cinnamic acid in AESO which are suggested to be responsible for observed antihyperglycemic and antihyperlipidemic attributes. Further studies to standardise the extract and evaluation of safety profile in long-term toxicity studies are recommended for safe and effective antidiabetic nutraceuticals development

Self-Medication Practice Among the General Community Of An Urban Squatter Settlement Near PNS Shifa Karachi

Objective: To assess the frequencyof self-medication amongst the residents of urban squatter settlement near PNS Shifa Karachiand to assess the factors leading to this practice. Materials and Methods: This cross-sectional descriptive study was conducted in the city of Karachi. The subjects were the community in general. A total of 60 subjects were enrolled and were either interviewed face-to-face or were asked to fill out the questionnaire relating to their self-medication practice. Results: Out of 60 subjects, 38 (63.3%) preferred the practice of self-medication. Minor ailment was the main reason for self-medication, 27 (45%) subjects responded headache as the most common reason and paracetamol was the most frequently used drug for self medication. It was used by 44(73.3%) of the subjects Conclusion: The practice of self medication is high in the community and there is a need to develop awareness of self-medication practice in the public along with restrictions for the pharmacies providing drugs without prescription

Self-medication amongst university students of Karachi: prevalence, knowledge and attitudes

OBJECTIVE: To determine the prevalence, attitude and knowledge of self-medication amongst university students of Karachi, Pakistan. METHODS: This cross-sectional, study was conducted from Jan-Feb 2007. A convenience sample was taken from 2 medical and 2 non-medical universities of the city of Karachi, Pakistan. Data was analyzed using SPSS v 14 and associations were tested using the Chi square test. RESULTS: Of the 572 participants (mean age=21 +/- 1.8 years, Male: Female ratio=1:1.5), 295 were medical and 277 were non-medical students. The prevalence of self-medication was 76%. Forty three percent students stated that they alter the regimen of prescribed medicines while 61.9% stated that they stop taking a prescribed medicine without consulting a doctor. The most common reason for self-medication was previous experience (50.1%) and the most common symptoms were headache (72.4%), flu (65.5%), and fever (55.2%). Commonly used medicines were analgesics (88.3%), antipyretics (65.1%) and antibiotics (35.2%). Eighty seven percent of students thought self-medication could be harmful and 82.5% students thought that it was necessary to consult a doctor before taking a new medicine. There was no significant difference between the self medication practices of medical and non medical students (p=0.8) CONCLUSION: Prevalence of self-medication is high in the educated youth, despite majority being aware of its harmful effects. There is a need to educate the youth to ensure safe practices. Strict policies need to be implemented on the advertising and selling of medications to prevent this problem from escalating

Perceptions about the cause of schizophrenia and the subsequent help seeking behavior in a Pakistani population – results of a cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>There is a cultural variability around the perception of what causes the syndrome of schizophrenia. Generally patients with schizophrenia are considered dangerous. They are isolated and treatment is delayed. Studies have shown favorable prognosis with good family and social support, early diagnosis and management. Duration of untreated psychosis is a bad prognostic indicator. We aimed to determine the perceptions regarding the etiology of schizophrenia and the subsequent help seeking behavior.</p> <p>Methods</p> <p>This cross-sectional study was carried out on a sample of 404 people at the out patient departments of Aga Khan University Hospital Karachi. Data was collected via a self-administered questionnaire. Questions were related to a vignette of a young man displaying schizophrenic behavior. Data was analyzed on SPSS v 14.</p> <p>Results</p> <p>The mean age of the participants was 31.4 years (range = 18–72) and 77% of them were males. The majorities were graduates (61.9%) and employed (50%). Only 30% of the participants attributed 'mental illness' as the main cause of psychotic symptoms while a large number thought of 'God's will' (32.3%), 'superstitious ideas' (33.1%), 'loneliness' (24.8%) and 'unemployment' (19.3%) as the main cause. Mental illness as the single most important cause was reported by only 22%. As far as management is concerned, only 40% reported psychiatric consultation to be the single most important management step. Other responses included spiritual healing (19.5%) and Sociachanges (10.6) while 14.8% of respondents said that they would do nothing. Gender, age, family system and education level were significantly associated with the beliefs about the cause of schizophrenia (p < 0.05). While these variables plus 'religious inclination' and 'beliefs about cause' were significantly associated with the help seeking behavior of the participants.</p> <p>Conclusion</p> <p>Despite majority of the study population being well educated, only a few recognized schizophrenia as a mental illness and many held superstitious beliefs. A vast majority of Pakistanis have non-biomedical beliefs about the cause of schizophrenia. Their help seeking behavior in this regard is inappropriate and detrimental to the health of schizophrenic patients. Areas for future research have been identified.</p

Association Of Vitamin D Status And Diabetes Mellitus

To evaluate the association of 25-hydroxyvitamin D3 (25OHD)inadequacyand hyperglycaemia in a Pakistani adult population.Study Design:Case control studyPlace &amp; Period of Study:Department of Pathology, PNS SHIFA Hospital, Karachi; Aug 2011 to Nov 2011.Method and Material:Plasma Glucose levels were measured in 86 patients divided on the basis of their 25-hydroxyvitamin D3(25OHD)levels in three groups, normal (&gt;31 ng/ml), insufficient (20-31ng/ml) and deficient (&lt;20ng/ml). Vitamin D insufficiency (VDI)and Vitamin D Deficiency (VDD) are collectively called Vitamin D inadequacy. 25OHD was measured by electrochemiluminescenceusing Roche Elecsys® Systems while glucose was estimated by routine methods on Roche Hitachi® Autoanalyser.Results:.Vitamin D levels were inversely correlated with plasma glucose levels(r=-0.38;p&lt;0.01) with an Odd Ratio of 3.59(95%confidence interval 1.29 to 8.70).Fasting plasma glucose was significantly higher in VDD patientsas compared to patients withnormal vitamin D status (p&lt;0.05).Conclusion:Higher glucose levels were found more frequent in patients with Vitamin D deficiency