Background: The vermiform appendix is a wormlike diverticulum, arising from the posteromedial wall of the caecum, about 2cm from the ileocecal orifice. A cadaveric study was conducted to ascertain the average length, the most recurrent position and the location of the vermiform appendix with respect to the tenia coli. Materials and Methods: The study had a sample size of 41 cadavers gotten from the anatomical laboratory of five Universities within the south-south geopolitical zones in Nigeria. The length of the vermiform appendix was measured using a broom stick placed at its base to get the whole length of the vermiform appendix, stretched from base to its tip then measured with a digital venire calliper to deduce the length. This procedure is carried out two or more times and the average is taken. Results and Discussions: The average length of the vermiform appendix irrespective of sex was 8.7±0.89cm, while the average length for males and females were 8.80±0.9cm had 8.36±0.73cm respectively. The location of the vermiform appendix to the taeniae coli was found constant at the confluence of the three muscular bands of the taeniae coli which forms the musculature of the vermiform appendix. The most common position of the tip of the vermiform appendix was the retrocaecal position-22(53.7%), while the other positions are pelvic-11(26.8%), postileal-4(9.8%), subcaecal-3(7.3%) and preileal-1(2.4%). None was observed for the paracaecal position. Conclusion: The morphometry and the morphology of the vermiform appendix in Nigerian cadavers have been observed to follow a trend with respect to its length and position which is in tangent with most findings over the world

Background: The SCR is an operational indicator for the DOTS strategy of Revised National Tuberculosis Control Programme (RNTCP) in india. The present study was undertaken to determine the relationship between sputum smear grading and smear conversion rate among the category I smear positive pulmonary tuberculosis patients undergoing DOTS. Methods: A prospective cohort study was carried out among category I pulmonary smear positive patients registered at the DOTS centres of District TB centre Karuvelipady, Government hospital Ernakulam ,Government hospital Paravur. The patients with pre-treatment sputum grading 3+ were placed in High positive cohort (HP cohort) and those with pre-treatment sputum grading as 2+,1+ and scanty were placed in Low positive cohort (LP cohort) were followed periodically at two months (end of Intensive phase ),at three months (after one month extension of Intensive phase),at two months of Continuation Phase and then at the end of the treatment to record the sputum AFB result and treatment outcome as per the RNTCP guidelines. Accordingly, a total of 397 category I patients with 213 in HP cohort and 184 LP cohort were enrolled in the study during November 2016 to January 2017. Data were analyzed using Medcalc Online calculator. Results: After two months (end of the intensive phase), SCR was 53.52% (114 of 213) among the High Positive and 69.56% (128 of 184) in the Low Positive cohort (p-0.001).After three months (one month’s extension of intensive phase),cumulative SCR was 74.17% (158 of 213) in the High positive and 84.25% (155 of 184) in the Low Positive cohort(p-0.01).Cure rate was 68.07% (145 of 213) in the High Positive and 77.71% (143 of 184) in the Low Positive cohort. Default rate was 23% (49 of 213) in the High Positive and 12.5% (23 of 184) in the Low Positive cohort. Failure rate was 3.28% (7 of 213) in the High positive and 4.89% in the Low positive Cohort (9 of 184).Twelve patients (5.63%) died in HP Cohort, nine patients in LP Cohort (p-0.23). Treatment outcome was further compared among the patients according to their sputum status achieved at two and three months of the treatment after ignoring their initial sputum status. The cure rates for the patients who converted at two months was 92.56% (224 of 242) and for those who did not convert at two months, was 55.65% (64 of 115) (p- 0.00001). Similarly, the cure rate for the patients who converted at three months was 78.04% (64 of 82) and for those who did not convert at three months was 0% (74) (p-0.00).

This before-and-after study (without controls) with educational intervention was conducted at a municipal medical college to evaluate the effect of experiential learning in medical students by using narratives that focus on the affective domain. Medical students aged 18+ years, of either gender, were explained about the study. The participants took a pre-test, which was designed to seek the response of participants to ten bioethics-related narratives. Subsequently, the students were exposed to bioethics training wherein the narratives were discussed and a post-test, identical to the pre-test, was administered. A total of 120 students (53.33% females; 46.67% males) participated in the study. The gender differences in the pre- and post-test responses were not statistically significant. The difference was not statistically significant in pre- and post-test responses to questions in two narratives – surrogacy by childless couple and medical termination of pregnancy in case of congenital anomaly. The significant improvement in the post-test scores of participating students implied that they have inculcated the values learnt in their training. Narratives can simulate real-life situations and discussion on these narratives can help students in internalizing theoretical ethical concepts, improve moral reasoning and facilitate in handling certain ethical dilemmas that can improve doctor-patient relationship

This complete-enumeration, before-and-after type of study (without controls), was conducted to determine the effectiveness of communication skills training for first-year MBBS students in improving their knowledge and awareness regarding communication skills. The participants (60 first-year MBBS students, aged 18 years and above, of either gender) were briefed about the study and written informed consent was obtained. The students took a pre-test containing 10 multiple choice questions (one mark each, total 10 marks) pertaining to communication in various situations. Subsequently, these students were trained in communication skills using lecture, case scenarios and role play and a post-test was administered. The questions in the post-test were identical to that in the pre-test. The difference in the overall pre- and post-test scores was significant (Z=2.811; p=0.00494) but the gender differences in the scores were not significant. This study identified vital areas to be focused upon while imparting communication skills training to medical students. The participants favourably rated the training on communication skills. Teaching communication skills to first-year MBBS students will improve their attitude towards and communication with peers and staff members and also help overcome socio-cultural barriers between students

Antibiotics can enhance human lives by treating or preventing diseases. The prodigious, indiscriminate and improper use of antibiotics has played a substantial role in the outspread/emergence of antibiotic resistance bacteria. In the current scenario, a major public-health threat is the resistance to antibiotics. In addressing the problem on antibiotic resistance, the use of probiotics in lieu of antibiotics for treating certain diseases of host organisms has been investigated. Probiotics play a preventive role rather than a therapeutic role and is, thus, considered the opponents to antibiotics. Probiotics are live microorganisms which when administered in adequate amounts confer a health benefit on the host. Most probiotics are common members of the human intestinal tract, and they are ingested in large amounts in functional foods. This review emphasizes on how antibiotics and probiotics face each other pertaining to antimicrobial resistance

This study was conducted to determine the effect of n-butanol root extract of Leptadenia hastata and Packed cell volume (PCV) changes in albino rats. Thirty (30) albino rats comprising of both sexes were divided into six (6) groups (A - F) with each group containing five (5) rats. Group A and B were infected with Trypanosoma brucei brucei and treated with the extract at 100mg/kg and 200mg/kg respectively. Group C was infected but untreated control, while Group D was uninfected and untreated. Group E was infected with Trypanosoma brucei brucei and treated with diminazene aceturate at 3.5mg/kg. The proximate content and phytochemical properties of the extract were determined. After inoculation blood samples were collected daily to determine the parasitaemia and PCV according to standard laboratory technique. The proximate content analysis revealed the presence of dry matter, crude fiber, crude protein, moisture and ash, while alkaloids, carbohydrates, cardiac glycosides, saponin and terpenoids were the phytochemical constituents. Infected groups showed a prepatent period of 2 days with parasitaemia value increasing significantly (P>0.05) in groups (A and B) treated with extract in respective of the dose with the PCV fairly constant. The result of this study shows that the extract has no anti-trypanosomal activity but has haematinic potential

For many years medical community has attempted to standardize its approach to the assessment of patients. The vital signs are a valuable parameter with which to assess and monitor a patient's response to supportive treatment and antidote therapy. Vital signs play an important role in the practice of medical toxicology beyond evaluating and monitoring a patient's overall status as they are frequently valuable physiological clues to toxicology and disease gravity. In 1970’s two paediatric physicians Howard C Mortenson and Joseph Greensher, coined a term “Toxidromes” which is a combination word of toxic syndromes. They have quoted “Some common combination of manifestation which we have termed toxidromes can give a clue to the drug involved” in an article “The unknown Poison”. Aim: This paper aims to provide an understanding on the various vital signs and symptoms which is observed during poison treatment. Methodology: An extensive review of literature was carried out to elicit information on various vital signs and toxic syndromes. Results: The study revealed that the health care professionals on understanding various toxidromes can help them to identify the type of poison, its antidote and the can provide a better treatment. Conclusion: The healthcare professionals has to undergo training on toxidromes. Which can improve the treatment and outcome in any poisoning case

Objective: To determine students perspectives about effectiveness of teaching learning strategies used by nurse educators. Study Design: A cross- sectional study. Place and Duration: Isra College of Nursing Islamabad from June 2017 to September 2018. Methodology: A Structured questionnaire, including demographic information and questions regarding use of teaching learning strategies, was used. To assess the students perspectives about the effectiveness of these strategies five-point likert scale was used which include from marking point 1 for not effective to 5 for very effective. Data was analyzed using SPSS version 22. Results: Mean age and standard deviation of the participants was 28.5 ± 4.7 years respectively. In total, 36 students participated out of which 11 (30.5%) were male, whereas 25 (69.5%) were female. The most effective teaching learning strategy student perceived was case scenario and 77.8% found it very effective followed by group teaching which was found very effective by 47.2% of students, However the least effective strategy was cooperative teaching because only 11% of the students established it as effective. Conclusion: This study concluded that student perceived case based teaching as most effective teaching learning strategy than other educational methods, however students also forechoose the use of multiple teaching learning strategies for overall group learning

Depression is largely experienced in our societies. It is costly and highly prevalent medical condition having a lifetime prevalence of around 16% in US adults. Around 13.5 million adults got major depressive disorder in the last year and 34 million will get it at some point. Women experience it more likely about 1.5 to 3 times greater than men. Anyone can experience it at any age but most people experiences first episode in their early thirties. This review represents different factors that are associated with depression

Objective: The point of this examination was to assess the criticalness of the fetal kidney length (FKL) for the estimation of gestational age. Method: A cross sectional study was carried out on 399 pregnant women with singleton pregnancies having no complications at Baloch Hospital Lalian. Pregnant women with single fetuses underwent standard ultrasound fetal biometry. The fetal kidney length measurements were performed from 20th weeks to 38th weeks of gestation. These measurements were used to date the pregnencies. Results: A positive linear relationship was found between gestational age (measured by femur length) and length of left kidney. G.A in weeks (measured by femur length) = 25.430+1.912 (Left Kidney in cm) with R2=0.939 and p value=0.000<0.05. Another statistically significant positive linear relationship was found between gestational age (measured by femur length) and length of right kidney.G.A in weeks (measured by femur length) =13.496+5.727(Right Kidney in cm) with R2=0.939 and p value=0.000<0.05. Conclusion: FKL is easy to identify and measure. It is most accurate single parameter for estimating GA than other biometric indices especially in cases when the other parameters like BPD, FL, AC and HC are not reliable for assessing GA in the 2nd and 3rd trimester of pregnancy

Objective: Introduction: Saudi initiative for asthma provides an updated framework for the diagnosis and management of asthma based on the best global scientific information. However, the prevalence of childhood asthma in Saudi has dramatically increased from 5% to 25% in the last decade. Objectives: To obtain information from health care providers (HCPs) regarding their knowledge, attitudes and use of the national guidelines for diagnosis and management of the childhood asthma. Methods: The study consisted of mixed surveys [semi-structured interviews (phase 1) and online survey (phase 2)] of the HCPs (paediatric doctors, pharmacists and nurses) whom work at hospital and primary care centres in Najran region, Saudi Arabia. The surveys assessed the knowledge and adherence of the HCPs to the national care pathway. Results: The paediatric doctor’s interviews afforded that the main barriers to adherence to guidelines are the lack of awareness and resources. In the online surveys, of the 535 HCPs, 172 surveys were completed. Of these, 48% of the respondents reported being aware to children asthma guidelines. 42% of the respondents did not follow any paediatric asthma guidelines. More than half of respondents (51.7%) follow guidelines for the paediatric asthma diagnosis. The most common barrier for adherence to asthma guidelines were lack of awareness (40%), followed by patient non-compliance with clinical management plan, lack of resources, difficult to understand the guidelines and the lack of time (32%), (16%), (7%) and (4%), respectively. Vast majority of respondents (75%) didn’t attend any training courses regarding awareness with asthma diagnosis and management. The study also revealed that dust mites and air pollution are the most popular asthma triggers (38%). 43% of respondents strongly agreed that a Saudi gene may be responsible for asthma. Most of the participants are not familiar with the number of children were admitted to Hospitals in the last twelve months. Conclusions: The results support that HCPs need education regarding diagnosis and clinical management plans of asthma by attending courses and workshops. Establishment of an asthma care centre may improve awareness and identify in depth the effective pathways for rapid asthma diagnosis

This before-and-after type of educational interventional study using convenience sampling was conducted among rural adolescent males to find the prevalence of usage of various forms of tobacco and to determine the outcome of educational intervention on tobacco use among the participants. Using a pre-tested questionnaire, the participants were separately interviewed for about 20-30 minutes. The mean age of participants (n=180) was 17.80 ± 1.19 years. 34.4% had a positive family history of tobacco use. Tobacco consumption by family members significantly increased tobacco use among the adolescents (p=0.005). The major factors that influenced tobacco intake were social customs, peer pressure, perception of tobacco use as a “status symbol”. The number of smoked tobacco users in pre-intervention phase was significantly higher (p=0.0145), as compared to that in the post-intervention phase. In the pre-intervention phase, bidi, followed by cigarette were the commonly used smoked tobacco products while in the post-intervention phase, the commonly used tobacco products were cigarette, followed by bidi. Educational intervention resulted in reduction in frequency of tobacco use from 17.2% to 11.1%. Systematic long-term focussed programmes would be necessary for sustaining the beneficial effects of the educational intervention

Background: Urticaria or hives is a common skin condition usually resolves within a few hours and always by 24 hours. It is mediated by aberrant release of histamine and other inflammatory mediators from mast cells and basophils1. The therapeutic approach should be based on elimination or avoidance of the cause or trigger/stimulus, symptomatic drug treatment by reducing mast cell mediator release and inducing tolerance. Oral Bepotastine besilate is non-sedative, selective H1-R antagonist. Aim: To study the efficacy and tolerance of oral Bepotastine besilate in respect of wheal, pruritus, sedation and effectiveness in chronic urticaria patients. Methodology: All adult Patients attended out-patient department of our dermatology department, who had a history of wheals, erythema more than 6 weeks with pruritis were included. Pregnant and lactating women were excluded. After clinical diagnosis Oral bepotastine 10 mg twice daily was started and response ( pruritus, wheals, drug effectiveness and sleepiness ) was assessed by urticaria activity score (UAS), Medication effective score (MAS), Sedation scale in a predesigned performa on day 0,14 and 28. Results: The majority of patients showed significant improvement in pruritus and wheal scores as compared to baseline, starting from end of the second week visit. Among 45 patients; 38 had no sedation and 7 had mild drowsiness. Nine patients achieved complete relief. Conclusion: Bepotastine 10 mg twice daily is well tolerated, effective and non-sedative antihistamine drug for the treatment of chronic urticaria

A new simple, precise, accurate, sensitiveand rapid chromatographic method based on RP-HPLC was developed and validated for the estimation of Barnidipine HCl in bulk and in-house tablet dosage form. Methanol: Water (80:20 v/v)) was used as mobile phase. A gradient programing has been done, on a reverse phase C8 column (250×4.6mm×5μ) with flow rate 1 mL/min, monitored at 260 nm. The mean retention times of Barnidipine HCl were found to be 2.8 min respectively. Linearity of Barnidipine HCl was found to be 3-18 μg/mL, R2= 0.999 respectively. The developed methods have shown the best findings in terms of linearity, accuracy, precision, LOD and LOQ for API and in house tablets. The depicted method can routinely be used for the determination of Barnidipine HCl in bulk and for in-house tablets formulation

Aim: This is a retrospective study which was carried out for a period of six months in orthopedic inpatient department at Aster prime hospital, Hyderabad. Objective: The objectives of the study are to decrease the irrational use of drugs to the patients, decrease unnecessary drugs, usage of proper dosage and administration of the drugs and prevent adverse drug reactions in order to improve the quality of life of patients. Methodology: A total of 104 prescriptions of the patient treated with analgesics and antibiotics for post-operative pain management were collected and analyzed in the inpatient orthopedic department. The prescriptions were analyzed and categorized into varieties based on antibiotics and analgesics prescribed, demographic parameters, comorbid conditions, type of orthopedic diseases diagnosed, polypharmacy etc. Conclusion: The study presented the prescription trends of antibiotics and analgesics in orthopaedic department. This kind of study will help as a guideline to use drugs for policymaking decision in the health care system. Prescribing medicines by generic names would help in less expensive treatment. Polypharmacy and combination of drugs has to be discouraged to minimize adverse drug reactions and drug interactions

Introduction: Anaesthesia as a profession comprises of a wide range of involvement from supportive specialty to surgery to one involved in wholesome and complete care of patients, not only in operation theatres but also in intensive care units and pain clinics. The aim of this study is to assess the knowledge of our patients about anaesthesia care, so that in developing countries awareness programme can be arranged to educate the public. Material and Methods: The present cross sectional survey was conducted among 500 patients visiting department for pre anaesthesia check up. Patients were asked to answer 13 items questionnaire and answers were recorded on answer sheet by senior anaesthesiologist at the time of pre anaesthesia check up in outpatient clinic. The data was statistically analyzed using the SPSS statistical software version 16 and was expressed as number and percentage as required. Results: Among 500 patients, 251 (50.2%) participants knew anaesthesiology as a separate medical discipline, 320 (64%) thought of anaesthesiologist as a doctor. Regarding the responsibility for intensive care management of a complicated surgical patient, 16 among 500 patients considered anaesthesiologist to be responsible for that. 190 among 500 patients considered the role of anaesthesiologist in pain management and among 500 patients, 220 thought that surgeon, 18 thought that anaesthesiologist and 262 thought that nurse managed pain post-operatively. Conclusion: Patients had insufficient knowledge about role of anaesthesiologists as well as their role in improving the outcome of surgery. Henceforth, there is a need to establish closer links with the community to create awareness about the role of the anaesthesiologist

Type AB thymoma is a thymic epithelial neoplasm composed of component spindle cell (type A) and lymphocyte-rich (type B) component. An exceptional atypical type A thymoma variant with uncertain prognosis was added to the WHO classification of thymomas in 2015. We report a case of a 62 years old man presented with clinical myasthenia. The radiological examination revealed a well-circumscribed anterior mediastinal mass. The patient underwent complete thymectomy. Pathological and immunohistochemical analysis revealed an AB thymoma with atypical component of type A. At the first year post surgery follow-up appointment, the patient was alive with no evidence of recurrence or complication. The presence of atypical component of type A thymoma may increase the risk of progression or metastasis, so extended follow-up for patients is required

Osteoporosis has become an increasingly recognized complication among patients with chronic liver disease (CLD). The aim of the present study was to assess the prevalence and risk factors of osteoporosis in patients with CLD (primary biliary cholangitis and chronic viral hepatitis B or C patients) in comparison with a group of age- and sex-matched controls. Sixty-four patients with CLD (mean age 51.66 ± 11.54 years), 48 females and 16 males were included. Age- and sex-matched individuals from the general population served as controls. Osteoporosis was evaluated by dual energy X-ray absorptiometry (bone mineral density below -2.5 T score) at the lumbar spine (LS) and total hip (TH). Vertebral fractures were established by densitometric morphometry (vertebral fracture assessment). Bone turnover was assessed by intact parathyroid hormone, osteocalcin and C-telopeptides of type I collagen in the serum. Prevalence of osteoporosis in either the LS or the TH was 45.3%, twice as high as in the controls (19.6%) (RR 2.31, 95% CI 1.42–3.75, P\0.001). Age, menopausal status, cirrhosis and advanced histological stage are not determinant factors for developing osteoporosis in patients with CLD. However, female sex, cholestasis, lower weight and height but not body mass index seem to play predominant role. Three (5.3%) patients had dorsal and LS fractures. It was concluded that osteoporosis is effectively a complication of CLD. Cholestasis in addition to female sex and lower weight and height are risk factors of osteoporosis in CLD