Objectives: We aimed this study to determine the relationship of various factors related to poor immunization in children in an earthquake affected community. Methods: We conducted this cross sectional study during 2007-2008 in Muzaffarabad district of Pakistani side of Kashmir. We selected 43 villages as clusters and in the second, 860 children between 12-24 months were selected from households through systematic sampling. Mothers of the eligible children were interviewed with a questionnaire. Logistic regression analysis was run to measure association of various factors with appropriate immunization status of the children. Results: We found that 74% of children had completed their required doses of routine immunization. There were greater odds of a child being unvaccinated if the family lived at a distance that was to be covered in more than 10 minutes by any transport (OR 1.12, 1.08-1.17), mother of the child was not educated (OR 2.4, 1.3-4.4), child belonged to a low Socioeconomic status (SES) (OR 3.5, 2.1-6.3), family had any challenge or situation that where they could not take the child to a health facility for vaccination (OR 2.3, 1.4-3.7) and for a female child  that belonged to minority ethnic group (OR 1.7, 1.0-2.5). Conclusion: Improvement in access of communities, especially of minority and poor in disaster stricken, to immunization services and female education and awareness about the need for immunization in children could play a role in improving immunization coverage in such settings.

Objective: To determine the resistance and sensitivity pattern of Methicillin-Resistant Staphylococcus aureus (MRSA) isolates to Linezolid along with its prevalence in a tertiary care hospital of Karachi, Pakistan Methods and Materials: A Cross sectional study was carried out. This study lasted for about 1 year. Prevalence and sensitivity of linezolid, Vancomycin and Oxacillin was tested against isolates of MRSA. Results: Out of total 369 specimens 165 were found to be MRSA making the prevalence in our study 44.7% .All of the isolates which were tested positive for MRSA were susceptible to linezolid and no resistance was noted when compared with previous studies performed in Europe and USA. Conclusion: Stringent implementation of infection control measures along with screening for resistance in patients on prolonged Linezolid therapy or who previously went under linezolid therapy should be performed, coupled with judicious usage of the aforementioned antibiotic should be undertaken, as sufficient data is not available at this point for the clinical spectrum of Linezolid resistant Staphylococcus aureus (LRSA) , antimicrobial resistance.

Objective: The aim of this study is to detect the overall evaluation of nursing students toward simulation makets throughout the practice education and to reveal their learning styles in relation to certain individual features. Materials and Methods: The data were collected via questionnaires including students’ evaluation toward simulation makets and “Kolb learning styles inventory.” Participants included 103 male and female nursing students in Turkey. For the analysis, percentage, means, standard deviation, t-test, and ANOVA were utilized. Results: 71% of the students stated that the laboratory was suitable for the skill education but 53.4% uttered the duration of the practice was not enough. Students were found to have different learning styles (28.2% assimilating, 27.2% convergent, 26.2% accommodating, and 18.4% divergent). Conclusion: The results demonstrated that the duration of the laboratory practice and the number of the makets should be increased during the education of students with different learning styles.

Introduction: Fracture fixation has become advanced with the advent of new and custom metal implants for each type of bone/fracture. After union though, the implant ceases to be important, and may be removed. Routine removal is advocated by some, and opposed by others. Nevertheless some patients require removal of the hardware because of various implant related problems. Our study was aimed at identifying the most common causes for implant removal. Objective: To investigate the common indications of orthopaedic implant removal surgeries. Methods: Adult patients admitted for implant removal in our department were included in the study. They were operated in the next OT list. They were then followed for an average 4 months for resolutions of symptoms or appearance of new problems. Results: 83 patients were studied. 71 of them were males. The mean age was 38 years.  The reasons for removal of implants were found to lie in five categories: pain/discomfort/prominent hardware; infected hardware; implant failure; elective (patient’s insistence); other reasons. Overall, the most frequently removed implants in our series were distal tibial/ankle plates (14.45% of implants removed), femoral intramedullary nails (13.25%), olecranon wires and plates (12.04%), and tibial intramedullary nails and patellar TBWs (9.53% each). Discussion and conclusion: The clinical indications of implant removal are not well established, and few definitive data exist to guide whether routine implant removal is appropriate. Symptomatic hardware frequently needs removal. We found that pain and implant prominence (mechanical symptoms) are the most common indications. Infection is the next most common, followed by hardware failure. Other indications are implant failure, bone resorption due to excessive stress shielding and patient’s will. Removal is however, not an easy surgery, and several factors like bone ingrowth and wear of the implant may make its removal difficult.  

Aim: To compare the students' perception of Team-Based Learning (TBL): the paper (hard copy) compared with the e-copy (electronic copy) in the Family Medicine Course of the Fifth Year Medical Students, Qassim University College of Medicine. Methods: A cross sectional study was conducted during the family medicine course in 2015 – 2016 to compare the hard copy and the e-copy TBL sessions. We used Google Drive to distribute, collect and analyze the questionnaire. The results of the e-copy TBL are shown and displayed directly with each session to the students, which was not the same as practiced with hard copy. We used also SPSS (version 17 for Windows) for more statistical analysis. Results: The total number of respondents of students in each was 96; a phase of TBL phase 1 (hard copy) and phase 2 (e-copy). Male were 64 (66.7%) and females 32 (33.3%). The first three knowledge questions showed no difference between the mean score between paper and e-copy TBL, but of the perception questions showed a significant difference between the paper and e-copy TBL. Conclusions: the results of the survey showed that the students prefer e-copy TBL as a course format, as it was an attraction for most of the students and making them even more successful in the key exam and e-copy TBL develop the skills needed to work productively in task-groups.

Objective: To estimate the risk profile of coronary heart disease among the staff members of Qaasim University and assess their knowledge in a screening campaign in Qassim Region, Saudi Arabia. Methodology: A cross-sectional study was conducted among male & female staff at Qassim University campus.  All   employees of Qassim University were invited to participate in the study. Data were collected through a self-administered questionnaire. The study sample size was 233 staff and employees. The data were entered and analyzed by using SPSS version 18. The data analysis focused on providing point estimates for the risk factors. Results: The study found that 30% of participants have one or more risk factors for CHD, namely Obesity 20.6%, Diabetes 10.3%, Hypertension 12.4%, Dyslipidemia 10.7% and smokers (11.6%). About 54% of the participants have a family history of at least one chronic disease as a risk factor for CHD. Conclusion: The most common risk factor of coronary heart disease among the staff members is obesity by 20.6 %. Risk factors for coronary heart disease are quite common among Qassim University staff. These finding need to Increase the health education and disease promotion program as an important intervention to reduce the occurrence and severity of coronary heart disease risk factors and to improve the quality of the life of the staff members of Qassim University.  

Objective: Globally the number of people living with acquired immunodeficiency virus (PLHIV) particularly in sub-Saharan Africa is growing. This has been resulted in increased number of tuberculosis (TB) new cases. To control burden of TB among PLHIV, a number of collaborative TB/HIV activities were recommended. However, data about collaborative TB/HIV services in study area is scarce. The objective of this study is to assess Intensified TB Case Finding (ICF), implementation of Isoniazid Preventive Therapy (IPT) and associated factors among PLHIV. Methodology: A facility based cross sectional study design was employed among 419 randomly selected PLHIV from public health facilities of Harari region. Systematic sampling method was used to obtain sample from each health facilities. Interviewer administered questionnaire was used to collect data. Data was entered into EpiData and analyzed by SPSS statistical software. Multivariate logistic regression analysis was conducted to determine presence of association between variables using odds ratio with 95% confidence interval and association was declared significant at P-value ≤ 0.05. Results: One hundred fifteen (75.2%) of the respondents reported that they offered screening for TB during their HIV chronic cares and 94 (29.8%) of them were found to be positive for active TB. Sex, educational status, residence area, Antiretroviral Therapy (ART) utilization status and missing dose of ART were found significant factors for TB infection. Nearly four-fifth (78.7 %) of the study participants were provided IPT. Conclusions: Screening of TB among PLHIV and implementation of IPT in the region is lower when compared to the findings of other studies conducted in different parts of the country and needs to be improved through implementation of national and international guidelines.  

Objectives: Histiocytic hyperplasia with hemophagcytosis (HP) is relatively uncommon condition that has often been mistaken in the past for neoplastic disorders. This study was undertaken to investigate the possible etiology of HP, its intensity in the bone marrow and also its effect on hematological parameters with the extent of disease activity. Methods: Blood samples were collected and bone marrow examination was performed in 250 patients with varied etiology showing HP. Complete bloodcounts, reticulocyte count, and RBC morphology were determined. HP was examined in the bone marrow smears by leishman staining. Severity of HP was determined by grading of its intensity in the bone marrow smears. Results:  Our data showed variable degree of HP (mild, moderate, severe) in the bone marrow smears of patients having different underlying disorders. Hemophagorytic syndrome (HPS) with clinical and biochemical derangements was found in 24 (9.6%) patients. HPS was mostly associated with infection. The etiological distribution in different group of disorders was ;nonmalignant-hematological-conditions (NMHC) (56.80%), infections (24.80%), storage disorders (4.40%), malignant hematological conditions (4.40%) autoimmune disorders (1.20%) and miscellaneous group (8.40%). Distribution of patients in different grades of intensity of HP was ;grade I (35.50%; mild), grade II (45.50%; moderate) and grade III (19.60%; severe). Conclusion: We conclude that severe degree of HP has profound effect on hematological parameters particularly hemoglobin and platelet counts. This phenomenon may presents as HPS with fatal outcome. We also conclude that there was no effect of age on either intensity of HP or on blood counts.  

Clostridium difficile- associated disease continues to be one of the leading health concerns worldwide. Clostridium difficile ( C. difficile ) is considered as a causative agent of nosocomial diarrhea that causes serious infection, which may result in death. The incidences of C. difficile infection (CDI) in developed countries have become increasingly high which may be attributed to the emergence of newer epidemic strains, extensive use of antibiotics and limited alternative therapies. The available treatment options against CDI are expensive and promote resistance. Therefore, there is urgent need for new approaches to meet these challenges. T his review discusses the current understanding of CDI, the existing clinical treatment strategies and future potential options as anti-difficile agents based on the available published works .

Type 2 diabetes mellitus (DM) is a public health concern worldwide and an important cause of morbidity and mortality. Type 2 DM is associated with microvascular and macrovascular complications. Diabetic nephropathy (DN), which is characterized by proteinuria, is one of the most serious long-term microvascular complications of DM. The proportion of DN is increasing worldwide. DN is the leading cause of chronic kidney diseases and end stage renal disease (ESRD), which constitutes the major workload of dialysis centers worldwide. Microalbuminuria is the earliest sign of DN, so the early detection of microalbuminuria and early control of diabetes retards the progression of DN.

     Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism characterized by episodes of muscle weakness and hypokalemia. TPP is typically present in young Asian men, female and non-Asian ethnic group can also be affected. TPP is a curable cause of hypokalemic periodic paralysis, can often be the first manifestation of thyrotoxicosis. Factors like high carbohydrate diet, strenuous exercise, emotional stress and steroid can precipitate an attack of TPP. The presence of both hypokalemia and elevated level of thyroxine (T 4 ) and triidothyronine (T 3 ) are important diagnostic features during the acute episode. Treatment of TPP involves 2 steps, immediate action to reverse the paralysis by correction of hypokalemia followed by measures to prevent future attacks by restoration of a euthyroid state. We report a first case of TPP, which was delayed to diagnose, from our hospital due to Graves’ disease in Asian man who present with second episode of paralytic attack before the diagnosis was made which is also unusual as attacks were not frequent.

Assessment is a central element of the learning process; it defines what students consider important and measures their personal achievements across all phases of professional development. It gives institutions a valuable feedback about the success of realizing program goals and institution objectives.1 E-assessments are special types of assessments that use technology for management or delivery. Although the field is relatively new, the number of e-assessments delivered online or supported by technology continues rapidly to grow in size, number, and diversity in both formative and summative domains.2,3 E-assessment can be particularly helpful in improving feedback given to students, enhancing self-regulation skills, promote higher achievement through formative assessment and improve retention rates, it is also noted for increasing student engagement, and motivation.1,2 In contrast to traditional methods of assessment that leave little trail behind; e-assessments have the potential to generate large amounts of data about the students and assessments alike, coupled with increased computation power, a rapidly improving data science and big data research methods, it serves as an ideal platform for assessment and learning analytics (LA).4,5 LA is a rapidly developing research field in the field of technology enhanced learning that aims at “measurement, collection, analysis and reporting of data about learners and their contexts, for the purposes of understanding and optimizing, learning and the environment in which it occurs.â€5 Using analytics in medical education can improve decision-making based on actual data that are derived from studying students’ online behavior, it can foster institutional growth, increase productivity, create innovative models and enable institutions to understand their strengths and challenges.4,6 The main applications for analytics so far have been the creation of early alert systems of underachieving, identification of at-risk students, student profiling, estimation of the impact of interventions and adaptive learning recommendations.7 Although the potential of assessment data is huge, it is still underexplored and largely under-developed, due to the fact that researchers treat assessment as an outcome they work to optimize, rather than an integral part of the analytics data cycle. Harnessing the power of e-assessment analytics can effectively close the LA data loop and add to the yield and usefulness of LA.8 With the advance of research in both disciplines; boundaries between learning and assessment would fade, since LA are used to assess learning and assessment analytics are used to understand learning, enabling better adaptive assessments and personalized learning strategies.3 Assessment analytics benefits would extend to all stakeholders involved in the educational process. At the institutional level, it will help assess programs by comparing cohorts of students, offer inter- and intra-school benchmarking, nationwide inter-institutional benchmarking or even at the international levels. It will also shed lights on efficiency of teaching methods, evaluate curricular developments and quality assurance. At the teacher level, it can inform curriculum design, teaching and learning practices, assess how far intended learning outcomes of a course were achieved, identify problematic teachers, deficient item authors and spot areas in need of improvement. At the student level, it will provide detailed reports about their learning progress, enable them to measure attainment of knowledge and skills over time (ipsative progress), compare it to where they started, benchmark performance against other learners or cohorts. Moreover, improvements in programs, curricula, teaching methods or assessment would always be positively reflected on students.3,9 Medical institutions should work to harness the power of data that e-assessments generate, to better understand how they perform and what it takes to be better.