Objective: In this prospective study, we determined phenotypic resistance to erythromycin among gram positive bacteria. Methods: Bacterial isolates were identified by conventional methods and by the MicroScan: D-test zone was performed according to the Clinical and Laboratory Standards institutes (CLSI) recommendations to determine inducible resistance to clindamycin on gram positive bacteria isolated from different clinical specimens .Bacterial isolates included : group A streptococci (GAS), group B streptococci (GBS), viridans streptococci, S.pneumoniae, Staphylococcus aureus (S.aureus) ( both methicillin susceptible (MSSA) and methicillin resistant (MRSA) . Results: A total of 1072 gram positive bacterial isolates were tested .The majority was from swabs collected from outpatient clinics. Erythromycin resistance was 8/23 (35%) for S. pneumoniae, 12/91(13%) for GAS and 17/300(5.7%) for GBS. All GAS and viridans streptococci possessed the efflux phenotype only, 8(8.8% and 1(20%), respectively. For GBS, cMLSB was 11(3.7%), 3 (1%) iMLSB and 2(0.33%) were of efflux phenotype. All S.pneumoniae strains possessed cMLSB phenotype. Seventy five isolates (16.3%) of MSSA were resistant to erythromycin compared to 160(83%) of MRSA. The majority of MSSA, 31/460 (6.7%) had an efflux phenotype while 26/460(5.6%) were of cMLSB and 19/460(4%) iMLSB phenotypes. Constitutive MLSB was the most predominant resistant phenotype, 152/193(78.8%) among MRSA. Conclusion: D-test zone should be considered for routine testing to detect inducible clindamycin resistance among significant gram positive bacteria. Keywords: Inducible resistance, constitutive resistance, efflux, erythromycin, clindamycin.

Activating mutations in Epidermal Growth Factor Receptor (EGFR) are common in lung adenocarcinoma of never smokers but are rare in other types of cancer. Here we have analysed mutations in exons 19 to 21 of EGFR and in exons 19 and 20 of the EGFR homolog HER2 in 54 cases of Esophageal Squamous Cell Carcinomas (ESCC) from patients recruited in Kashmir, India, a region of high incidence for this cancer. We report the detection of 3 mutations (6%) in the ATP-binding regulatory loops of the tyrosine kinase domain of EGFR (deletion 746-750, P753L, G719D). No mutation was found in HER2. This is the first report of activating EGFR mutations in ESCC, of the same type as those detected in lung adenocarcinoma of never-smokers. This suggests that a small proportion of ESCC patients in this high incidence area may benefit from treatment with EGFR tyrosine kinase inhibitors. Key words : EGFR, Mutations, Esophageal Cancer, Kashmir

Background - Hippophae rhamnoides, a high altitude habitat plant, has been extremely used in traditional medicinal practices for treating a variety of ailments. Recently, an extract (RH-3) prepared from berries of Hippophae rhamnoides has been reported to exhibit significant radioprotection against whole body lethal irradiation. Objective - Present study was undertaken to elucidate the DNA binding ability of an extract (RH-3) prepared from berries of Hippophae rhamnoides and its role in modulating radiation induced frank and clustered DNA damage. Method - Agarose gel electrophoresis was employed as method to understand DNA binding potential and DNA protective ability of RH-3. Results - RH-3 in a dose dependent fashion interacted with plasmid DNA (pUC18) reducing the mobility of supercoiled form and increasing the amount of the complex in the well indicating its ability to interact with plasmid DNA. RH-3 at higher concentrations (> 0.4 mg/ml) almost completely prevented the migration of supercoiled form without interfering with mobility of open circular form indicating its ability to selectively interact with supercoiled form. Studies done with supercoiled or open circular form also revealed the binding specificity of RH-3 for supercoiled form of plasmid. Both inhibited radiation induced strand breaks and DNA interaction by RH-3 were found to be dependent upon pH and the order of efficacy was found to be acidic pH> neutral pH > alkaline pH. RH-3 in a dose dependent manner inhibited radiation induced frank single, double strand breaks as well as endonuclease IV detectable abasic sites (clusters) and maximum reduction was observed at a conce Conclusion - Results obtained in this study suggest that the ability of RH-3 to interact with DNA could be playing a significant role in preventing radiation induced DNA damage. Key words: Clustered DNA damage, Hippophae rhamnoides, Radioprotection, pUC18, single strand breaks (ssb); double strand breaks (dsb).

Background: As focus has shifted from the healthcare providers to the healthcare consumers; patient satisfaction is being increasingly used worldwide for the assessment of quality of services provided by healthcare institutions. To understand patient satisfaction, “patient’s perception” of care must first be understood. Of all the healthcare workers nurses spend maximum time with the patients. Therefore, the nurse is in a unique position to influence and promote effective consumer relationships. Though patient satisfaction surveys with nursing care are routinely conducted in the developed world to monitor and improve the quality of care, the same is not true for the developing world especially in the Indian subcontinent. Objective: To conduct a study of patient’s perception of nursing care in a large teaching hospital. Methods: A prospective study spread over a period of one year was carried out. Sample size consisted of seven percent of patients each admitted as emergency and routine. All the randomly selected patients were administered questionnaires, thus obtaining a sample size of 2600. Of these 2500 questionnaires were usable for data analysis (valid response rate of 81.6%). Results: The results of the study revealed a relatively higher percentage of patients with poor perception regarding ‘explanation and information’, and ‘caring attitude’ aspects of nursing care (31.6% and 11.5% respectively). However more than 95% patients had good perception of ‘responsiveness’, ‘availability’ and ‘ward organization’ capability of the nurse. Conclusion: Patient satisfaction surveys should become a regular outcome monitoring feature in all the hospitals. Also In-service training programs for nurses, with special emphasis on communication are need of the hour and should become a regular exercise.

Objective: To determine the pattern of childhood dermatoses in Eastern province of Saudi Arabia (SA), in the setting of a university-affiliated hospital, and to compare this with other similar surveys conducted in SA. Methods: This is a retrospective study of pediatric patients attending the outpatient dermatology clinic and dermatology emergency room at King Fahad Hospital of the University, Al-Khobar, SA, over a period of 24 months from January 2004 to January 2006. All new pediatric patients less than 13 years of age were included. The patient's age, sex, nationality and diagnosis were extracted from the medical records and analyzed. Then our data were compared with previous hospital based surveys conducted in SA. Results: During the study period, a total of 11365 new patients were seen, including 383 pediatric patients. Pediatric consultations represent 3.4% of all dermatology consultation. The three leading causes for consultation were dermatitis and eczema (30.3%), followed by viral infections (12.5%), and pigmentary disorders (8.9%). Among dermatitis, atopic dermatitis was the most predominant condition (50%). Among viral infections, viral wart was the most frequent (70.8%). Comparing our data with a previous hospital survey conducted in the same region showed similar pattern with minor differences. Comparing our findings with other reports from Najran (Southern SA) and Al-Jouf (Northern SA) showed that dermatitis was the most frequent group of diseases in the three regions. It was followed by viral infections in Al-Khobar and Najran, and pyodermas in Al-Jouf. The third most frequent groups were pigmentary disorders in Al-Khobar and Najran, and viral infections in Al-Jouf. Conclusion: The majority of childhood dermatoses in various regions of SA may be grouped into relatively few diagnostic categories including eczema, infections, and pigmentary disorders.

This study compared the effectiveness of two surgical units in a tertiary care teaching hospital in performing laparoscopic cholecystectomy procedures from a hospital administration perspective. One surgical unit that was first to undertake laparoscopic procedures in the hospital had more experience than the other. The effectiveness was measured in terms of Average Postoperative Hospital Stay that directly affects Bed Turnover Rate and Average Duration of Surgery that directly affects OT Utilization. Rate of conversion to open cholecystectomy was also calculated for each unit separately. The same was compared with the globally acceptable standard. The study design was retrospective, collecting data from the medical records department. The sample size was calculated at level of significance of 5% and power of 90%. There is significance difference in the two surgical units only in terms of the duration of surgery. Conversion rates to open cases are well within the global standard and there is no significant difference between the two units in terms of post operative stay. Continuous medical education in terms of national/international workshops and in-house training for surgeons of Unit B are enough to further sharpen their skills in laparoscopy.

Background: Congenital heart diseases (CHD) constitute a common cause of birth defects with a multifactorial inheritance background. Objectives: to check for the dysmorphic features, consanguinity and cytogenetic pattern that may be associated with congenital heart disease in Egyptian cases from Mansoura, Egypt. Methods: This work is a pilot prospective controlled study including randomly selected 69 cases affected with congenital heart disease recruited from the Pediatric Cardiology Department, Mansoura University, Egypt. These cases were compared to 500 normal children of matched age and sex taken from the same locality serving as a control group. Complete history taking, clinical examination for dysmorphic features as well as cardiac examination were carried out for all subjects. Furthermore, cases were evaluated by Echocardiography and cytogenetic studies. Results: Egyptian children affected with CHD were significantly associated with positive family history of CHD, perinatal history of maternal diseases or drug intake during pregnancy and positive parental consanguinity (odds ratio = 10.5, 7.6 and 3.1 respectively). Significant associated dysmorphic features included ear anomalies, eye anomalies, cleft lip, polydactyly and cleft palate (odds ratio = 217.6, 176.6, 68.7 and 37.07 respectively). Seven cases (10.1%) had chromosomal aberrations and were associated with dysmorphic features. Conclusion: Risk of CHD increased with positive family history and consanguinity. Cytogenetic studies added to dysmorphic features seem to have an important clue for early diagnosis of CHD. Key words: Heart disease, risk factors, dysmorphism, Egypt.

Health and safety in clinical laboratories is becoming an increasingly important subject as a result of emergence of highly infectious diseases such as Hepatitis and HIV. A cross sectional study was carried out to study the safety measures being adopted in clinical laboratories of India. Heads of laboratories of teaching hospitals of India were subjected to a standardized, pretested questionnaire. Response rate was 44.8%. only 60% of laboratories had person in-charge of safety in laboratory. Seventy three percent of laboratories had safety education program regarding hazards. In 91% of laboratories staff is using protective clothing while working in laboratories. Hazardous material regulations are followed in 78% of laboratories. Regular health check ups are carried among laboratory staff in 43.4% of laboratories. Safety manual is available in 56.5% of laboratories. 73.9% of laboratories are equipped with fire extinguishers. Fume cupboards are provided in 34.7% of laboratories and they are regularly checked in 87.5% of these laboratories. In 78.26% of laboratories suitable measures are taken to minimize formation of aerosols. In 95.6% of laboratories waste is disposed off as per bio-medical waste management handling rules. Laboratory of one private medical college was accredited with NABL and safety parameters were better in that laboratory. Installing safety engineered devices apparently contributes to significant decrease in injuries in laboratories; laboratory safety has to be a part of overall quality assurance programme in hospitals. Accreditation has to be made necessary for all laboratories.

Objective: To assess the role of TOT sling procedure in current surgical management of female Stress Urinary Incontinence (SUI) in terms of post-operative results, cost effectivenss, pt acceptance and complications. Method: From June 2006 to September 2008, 30 patients of SUI were treated surgically by TOTsling procedure. Pre-operatively the patients were evaluated by thorough history taking, clinical examination and different diagnostic test depending upon the individual clinical scenario. Patients were explained in their own language the nature of procedure and the principle behind it. Any complication(s) (intra/postoperative) were noted. After discharging the patients they were followed up by atleast 3 visits (follow-up visits) at 1, 3 & 6 month interval. Any complications of the procedure and patient acceptance were evaluated at each follow-up. Results: The mean age of the total patients (n=30) was 39.5 yrs and 28 (93.33%) were multiparous. Involuntary loss of urine on straining was the most common complaint present in 25 (83.33%) patients and 22 (73.33) patients were having duration of symptoms less than 3 yrs. 9 (30%) patients were having mild cystocele pre-operatively which resolved after surgery. All the 30 (100%) patients were continent post-operatively while 7 (23.33%) were having lower urinary tract symptoms (LUTS). No major intra/post-operative complication was seen but, urgency, dysuria, fever and haematuria was seen post-operatively which resolved after few days. The operative time was 24 + 3.8 months and catheter was removed on 2.7 + 1.7 days post-operatively. Hospital stay was 6 + 2.4 days (3 – 11) and app. Cost of the treatment was Rs3253 + 360 (2700,3900). Conclusion: TOT Sling procedure is currently the Gold Standard for management of female SUI. It is very important to diagnose SUI and rule out other causes of incontinence because only the former one (Genuine SUI) is improved by TOT sling and other types may be even worsened by this procedure. Key Words: Assessment, TOT Sling, Efficacy, Post-op results, Cost effectiveness, Patient acceptance, Complications.

Background: Diarrhoeal disease forms one of the two major killer diseases in children under five years of age in the developing world. Data on the prevalence and related factors of diarrhea in Kashmir valley is quite scanty. Thus this study was carried out to find the burden of diarrhoeal disease and the effect of a temperate climate (as compared to a tropical one in rest of India) on the pattern of diarrhoeal disease in Kashmir valley. Methods: Cross sectional study was carried out using pretested interview schedule. Results: Overall period (last 15 days) and point (24 hrs) prevalence rates of diarrhoeal diseases among children under age of 5 years were calculated which came to the order of (25.2%) and (9.3%) respectively. Prevalence of diarrhoea decreased significantly with increased age and in summer months. Conclusion: The burden of diarrhoeal disease in Kashmir is quite high, like most places in the developing world. The age pattern, and seasonal pattern of diarrhoeal disease also resembles that found in studies across India and the developing world. Keywords: Diarrhoea, seasonal variation, age distribution.

Objective: To evaluate the accuracy of Ultrasound in the diagnosis of Infantile Hypertrophic Pyloric stenosis, especially with simultaneous use of grey-scale & colour doppler examination of pylorus. Methods: Fifty two infants with suspected Infantile Hypertrophic Pyloric stenosis (IHPS) were evaluated with grey-scale and colour Doppler examination. The sonographic findings were categorized as positive IHPS, negative IHPS and equivocal cases. Positive songraphic findings in 21 infants (40%) were confirmed at surgery. Negative sonographic findings in 27 infants (52%) were followed by ward chart reviews. Results: Sensitivity, Specificity and Accuracy of grey-scale & colour doppler examination for the diagnosis of IHPS were 100%. Conclusion: Sonography is the method of choice for the diagnosis of IHPS. Simultaneous greyscale and colour Doppler examination of pylorus for suspected IHPS is more accurate than simple grey-scale sonography. Key words: Grey-scale Sonography, Colour Doppler examination, Infantile Hypertrophic Pyloric stenosis, experienced radiologists.

Myxomas are the most common type of cardiac tumours in all age groups accounting for onethird to one-half of cases at postmortum and for about three quarter of tumours treated surgically. Most atrial myxomas, whether left or right, arise from the atrial septum. About 10% have other sites of origin, particularly posterior wall, anterior wall and the appendages (in order of frequency). Myxomas are frequently located in left atrium and produce symptoms when they fragment and cause systemic emboli or when they interfere with cardiac valvular function and cause pulmonary congestion. Careful surgical management of these lesions should be curative with minimal early and late morbidity and mortality. Recurrence of atrial myxomas can occur most likely in about 3% of patients. However, extensive resection of the myxoma attached to atrial septum or atrial wall can reduce the likelihood of recurrence to a greater extent. Long term clinical and echocardiographic follow-up is mandatory.

We report a case of a 45 year old non HIV infected female,who presented with multiple painful,livid reddish brown plaques, papules and nodules on both lower limbs and left index finger. The cutaneous nodular lesions on biopsy showed characteristic features of Kaposi’s sarcoma. This case is reported due to paucity of Kapsi’s sarcoma in non HIV Persons. It is typically a disease of older men from European and Mediterranean region. Here we present a case report of classic Kaposi’s Sarcoma in a young Indian female.

Brucellosis is a multisystem disease with a broad spectrum of clinical manifestations. Hematologic complications in the form of mild pancytopenia are occasionally reported in the course of acute brucellosis. Rarely, thrombocytopenia is severe and can be associated with purpura and mucosal bleeding. Epistaxis as the initial manifestation of brucellosis is a rarely reported phenomenon. A case of young adult is being reported who presented with epistaxis due to brucellosis-induced thrombocytopenia. Key words: brucellosis; epistaxis; immune; thrombocytopenia

Acanthamoeba is a free-living protozoan widely distributed in soil, water, and air. It can cause corneal infection (keratitis) in man, and may lead to blindness of the affected eye in 15% of untreated cases.The main risk factors are eye trauma and contact lens wearing. Early presentation of Acanthamoeba keratitis patients usually includes ocular pain, photophobia, and a unilateral red eye. The story of a female Sudanese housewife who suffered a blind left eye due to Acanthamoeba is described in this report. Key words: Acanthamoeba, blindness, keratitis

Medical education, the art and science behind medical learning and teaching, has progressed remarkably. Teaching and learning have become more scientific and rigorous, curricula are based on sound pedagogical principles, and Problem Based and other forms of active and self directed learning have become the mainstream. Teachers have progressed from the role of problem-identifier to that of the solution-provider. During the last three decades medical schools have been faced with a variety of challenges from society, patients, doctors and students. They have responded in several ways including the development of new curricula, the introduction of new learning situations, the introduction of the new methods of assessment and a realization of the importance of staff development. Many effective and interesting innovations have been forthcoming. The effective and efficient delivery of healthcare requires not only knowledge and technical skills but also analytical and communication skills, interdisciplinary care, counseling, evidence- and system-based care. This warrants our assessment systems to be comprehensive, sound and robust enough to assess the requisite attributes along with testing for essential knowledge and skills. Assessment is entering every phase of professional development. Assessment and evaluation are crucial steps in educational process. Before making a choice of assessment method, some important questions must be asked: what should be assessed?, why assess? For an assessment instrument one must also ask: is it valid? Is it reliable?, is it feasible? What is assessed and which methods are used will play a significant part in what is learnt. A wide range of assessment methods currently available include essay questions, patient management problems, modified essay questions (MEQs) checklists, OSCE, student projects, Constructed Response Questions (CRQs), MCQs, Critical reading papers, rating scales, extended matching items, tutor reports, portfolios, short case assessment and long case assessment, log book, trainer’s report, audit, simulated patient surgeries, video assessment, simulators, self assessment, peer assessment and standardized patients. Assessment has a powerful positive steering effect on learning and the curriculum. It conveys what we value as important and acts as the most cogent motivator of student learning. Assessment is purpose driven. In planning and designing assessments, it is essential to recognize the stakes involved in it. The higher the stake, the greater the implications of the outcome of the assessment. The more sophisticated the assessment strategies, the more appropriate they become for feedback and learning. Measuring progress in acquiring core knowledge and competencies may be a problem if the exams are designed to measure multiple integrated abilities, such as factual knowledge, problem solving, analysis and synthesis of information. Students may advance in one ability and not in another. Therefore, progress tests that are designed to measure growth from the onset of learning until graduation should measure discrete abilities. 4 Mastery testing (criterion-reflected tests) requires that 100% of the items are measured correctly to determine whether students have attained a mastery level of achievements. In non-mastery testing attainment of 65% of a tested material is considered sufficient. Global rating scales are measurement tool for quantifying behaviors. Raters use the scale either by directly observing students or by recalling student performance. Raters judge a global domain of ability for example: clinical skills, problem solving, etc Self assessment (self regulation) is a vital aspect of the lifelong performance of physicians. Self monitoring requires that individuals are able not only to work independently but also to assess their own performance and progress. Every form of assessment can be used as a self assessment exercise as long as students are provided with ‘gold standard’ criteria for comparing their own performance against an external reliable measure. Self assessment approaches include: written exams (MCQs, True/False, Essay, MEQs, modified CRQs), performance exams (checklists, global rating, student logbook, portfolio, video, etc). Oral examination/Viva has poor content validity, higher inter-rater variability and inconsistency in marking. The instrument is prone to biases and is inherently unreliable. Long Essay Questions can be used for assessment of complex learning situations that can not be assessed by other means (writing skills, ability to present arguments succinctly). The Short Answer Question (SAQ) is an open ended, semi-structured question format. A structured predetermined marking scheme improves objectivity. The questions can incorporate clinical scenarios. A similar format is also known as Modified Essay Question (MEQ) or Constructed Response Question (CRQ). Equal or higher test reliabilities can be achieved with fewer SEQs as compared to true/false items. If a large amount of knowledge is required to be tested, MCQs should be used. SAQs have a better content coverage as compared to long essay question. Extended Matching Item is based on a single theme and has a long option list to avoid cueing. It can be used for the assessment of clinical scenarios with less cueing. It is a practical alternative to MCQ while maintaining objectivity and consistency. It can be used in both basic and clinical sciences. Key Feature Test is a clinical scenario-based paper and pencil test. A description of the problem is followed by a limited number of questions that focus on critical, challenging actions or decisions. It has higher content validity with proper blueprinting. Long Case involves use of a non-standardised real patient. Long case may provide a unique opportunity to test the physician’s tasks and interaction with a real patient. It has poor content validity, is less reliable and lacks consistency. Reproducibility of the score is 0.39; meaning 39% of the variability of the score is due to actual performance of students (signal) and the remaining 61% of the variability is due to errors in measurement (noise) (Noricine,2002). In high stake summative assessment long case should be avoided. Short Case involves use of three to four non-standardised real patients with one to two examiners. It provides opportunity for assessment with real patients and allows greater sampling than single long cse. Objective Structured Clinical examination (OSCE) consists of multiple stations where each candidate is asked to perform a defined task such as taking a focused history or performing a focused clinical examination of a particular system. A standardized marking scheme specific for each case is used. It is an effective alternative to unstructured short cases. 5 Mini-Clinical Evaluation Exercise (Mini-CEX) is a rating scale developed by American Board of Internal Medicine to assess six core competencies of residents: medical interviewing skills, physical examination skills, humanistic qualities/professionalism, clinical judgment, counseling skills, organization and efficiency. Direct Observation of Procedural Skills (DOPS) is a structured rating scale for assessing and providing feedback on practical procedures. The competencies that are commonly assessed include general knowledge about the procedure, informed consent, preprocedure preparation, analgesia, technical ability, aseptic technique, post-proicdure management, and counseling and communication. Clinical Work Sampling is an in-trainee evaluation method that addresses the issue of system and rater biases by collecting data on observed behaviour at the same time of actual performance and by using multiple observers and occasions. Checklists are used to capture an observed behaviour or action oof a student. Generally rating is by a five to seven point 360-Degree Evaluation/Multisource Assessment consists of measurement tools completed by multiple individuals in a person’s sphere of influence. Assessment by peers, other members of the clinical team, and patients can provide insight into trainees’ work habits, capacity for team work, and interpersonal sensitivity In the Logbook students keep a record of the patients seen or procedures performed either in a book or in a computer. It documents the range of patient care and learning experience of students. Logbook is very useful in focusing students on important objectives that must be fulfilled within a specified period of time (Blake, 2001). Portfolio refers to a collection of one’s professional and personal goals, achievements, and methods of achieving these goals. Portfolios demonstrate a trainees’ development and technical capacity. Skill based assessments are designed to measure the knowledge, skills, and judgment required for competency in a given domain. Test of clinical competence, which allows decisions to be made about medical qualification and fitness to practice, must be designed with respect to key issues including blueprinting, validity, reliability, and standard setting, as well as clarity about their formative or summative function. MCQs, essays, and oral examinations could be used to test factual recall and applied knowledge, but more sophisticated methods are needed to assess clinical performance, including directly observed long and short cases, objective structure clinical examinations, and the use of standardized patients. The Objective Structure Clinical examination (OSCE) has been widely adopted as a tool to assess students, or doctor’s competences in a range of subjects. It measures outcomes and allows very specific feedback. Other approaches to skill-based assessment include: traditional (Oral exam/viva, long case); alternative formats (tackle the problems associated with traditional orals and long cases by having examiners observe the candidates complete interaction with the patient, training examiners to a structured assessment process, increasing the number of patient problems. Traditional unstructured orals and long cases have largely been discontinued in North America. While selecting an assessment instrument it is necessary to know precisely what it is that is to be measured. This should reflect course outcomes as different learning outcomes 6 require the use of different instruments. It is essential to use an instrument that is valid, reliable and feasible (calculating the cost of the assessment, both in terms of resources and time). Full variety of instruments will ensure that the results obtained are a true reflection of the students’ performance. Multiple sampling strategies as the accepted methods used in assessment in clinical competency include OSCE, Short Answer Questions, mini-CEX (Mini Clinical Evaluation Exerciser), Directly Observed Procedural Skills (DOPS), Clinical work sampling (CWS), and 360-degree evaluation. The assessment is an integral component of overall educational activities. Assessment should be designed prospectively along with learning outcomes. It should be purpose driven. Assessment methods must provide valid and usable data. Methods must yield reliable and generalisable data. Multiple assessment methods are necessary to capture all or most aspects of clinical competency and any single method is not sufficient to do the job. For knowledge, concepts, application of knowledge (‘Knows’ and ‘Knows How’ of Miller’s conceptual pyramid for clinical competence) context-based MCQ, extended matching item and short answer questions are appropriate. For ‘Shows How” multi-station OSCE is feasible. For performance-based assessment (‘does’) mini-CEX, DOPS is appropriate. Alternatively clinical work sampling and portfolio or log book may be used. Standard setting involves judgment, reaching consensus, and expressing that consensus as a single score on a test. Norm Referenced Scores are suitable for admission exercise that requires selection of a predetermined number of candidates. Criterion Referenced Standard (based on predefined test goals and standards in performance during an examination where a certain level of knowledge or skill has been determined as required for passing) is feasible for competency-based examination. Various approaches available include test-centred approach (Agnoff’s method and its variations), examinee-centred approach (borderline group method), and several other innovations. Blueprinting refers to a process emphasizing that test content should be carefully planned against learning objectives. The purpose of assessment should direct the choice of instruments. Needs assessment is the starting point of good assessment that identifies the current status of the students before the commencement of the actual educational activities. Needs assessment is used to determine the existing knowledge base, future needs, and priority areas that should be addressed. Student assessment is a comprehensive decision making process with many important implications beyond the measure of students’ success. Student assessment is also related to program evaluation. It provides important data to determine the program effectiveness, improves the teaching program, and helps in developing educational concepts. Good quality assessment not only satisfies the needs of accreditation but also contributes to student’s learning. Assessment methods should match the competencies being learnt and the teaching formats being used. Competence is a habit of lifelong learning, is contextual (e.g. practice setting, the local prevalence of disease, etc) and developmental (habits of mind and behaviour and practical wisdom are gained through deliberate practice. Further Reading 7 ACGME Outcome Project. Accreditaton Council for Graduate Medical Education & American Board of Medical Specialist. Toolbox for assessment methods, version 1.1. www.acgme.org/outcomes/assess/toolbox.pdf Case S M & swanson D B. Constructing Written Test for the Basic & Clinical Sciences, 3rd. ed. (National Board of Medical Examiners) Philadelphia, PA, USA). 2002. www.nbme.org/about/itemwriting.asp . Day S C, Norcini J J, Diserens D, et al. The validity of the essay test of clinical judgement. Acad Med. 1990;65(9):S39-40. Epstein RM, and Hundert EM. Defining and assessing clinical competence, JAMA 2002;387:226-35. Friedman Ben_David M. Standard setting in student assessment, AMEE education Guide No: 18 (Association for Medical education in Europe, Dundee, UK), 2000. Miller GE. The assessment of clinical skills/competencies/performance. Acad Med. 1990;65(9):S63-67. Norcini JJ, Swanson DB, Grosso LJ, Webster GD. Reliability, validity and efficiency of multiple choice questions and patient management problem item formats in assessment of clinical competence. Med Edu. 1985;19(3):238-47. Norman G. Postgraduate assessment – reliability and validity. Trans J. Coll. Med. S. Afri. 2003;47:71-75. Page G & Bordage G. & Allen T. Developing key feature problem and examination to assess clinical decision making skills. Acad Med. 1995;70(3): 194-201. Swanson DB. A measurement framework for performance based test. In: Hart IR, Harden RM (eds.), Further Development in assessing Clinical Competence. Montreal Can-Heal. 1987. Wass, Cees Van der Vleuten, John Shatzer, Roger Jones. Assessment of clinical competence. The Lancet 2001;357:945-49. Vleuten va der CPM. Validity of final examination in undergraduate medical traning. BMJ 2000;321:1217-19. Falchikov N, Boud D. Student Self-assement in higher education: a meta-analysis. Review of Education Research 1989; S9:345-430. Van der Vleuten CPM, Swanson DB. Assessment of clinical skills with standardized patients: state-of-the-art teaching and learning in medicine. 1990;22:58-76.

Breast cancer is the second most common cancer in the world and the most common cancer in females accounting to 23% of all cases. Between January 1998 and December 2004-2004, 6,882 cases were reported from all GCC states accounting to 11.8% from all cancers and 22.7% from cancers in females. An ASR/100,000 woman was 46.4 from Bahrain, 44.3 from Kuwait, 35.5 from Qatar, 19.2 from UAE, 14.2 from Oman and 12.9 from KSA. Breast cancer is the most frequent cancer in Arab women constituting 14-42% of all women cancers. Breast cancer in Arab countries presents almost 10 yrs younger than in USA and Europe. Median age at presentation is 48-52 and 50% of all cases are below the age of 50 where as only 25% of cases in industrialized nations are below the age of 50 yrs. What we need to fight this deadly disease is opening of screening centers with trained physicians equipped with ultrasound, x-ray unit, a pathology lab and most of all a system where a patient is seen urgently on referral to a secondary level care. Health education campaigns should be organized, female medical students should be encouraged to be general surgeons in a community where social customs still have value.

The frequency of the prostate disorders has been on the increase and disorders such as prostatitis, Benign Prostatic Hyperplasia and Prostatic Cancer have been on the rise. This study involved 60 cases which were further subdivided into various age groups. Study was based on the microscopic examination of prostatic tissue with individual tissues of different age groups. The microscopic examination of prostatic tissue of different age groups showed that the prostate tissue in contrast to other organs shows hyperplasia instead of atrophy and that as the age increases there is more proliferation of fibro- musculo glandular tissue producing increase in the size of prostate which manifests itself in the form of Benign Hyperplasia of Prostate. In certain Unfortunate conditions there is profound increase in the glandular element progressing to latent carcinoma of prostate and then to full fledged Carcinoma. A need for urgent readressal to the patient’s complaints as well as the importance of biopsy and histopathological examination of the tissue is important in the management of the problem. The histopathological examination can aid the physician/Surgeon to give the exact details about the possibility of cure, Effective therapy, and staging and most importantly the prognosis of the patients’ condition. In conclusion, there is change in the normal cellular architecture with the increasing age in the prostatic tissue.