Background: Pre-eclampsia is a pregnancy-specific disorder recognized clinically by the onset of hypertension and proteinuria. It complicates about 2%-10% of pregnancies worldwide and contributes to maternal and foetal morbidity and mortality. However there is paucity of information on its prevalence in Calabar. Aims: To determine the prevalence of pre-eclampsia in the University of Calabar Teaching Hospital, Calabar, Nigeria over a period of 3 years for the purpose of further genetic studies. Settings and Design: A descriptive epidemiologic study that consisted of all documented cases of Pre-eclampsia in a tertiary referral center from 2009 to 2011. Materials and Methods: Data on pre-eclamptic patients were obtained from the Records Department of the hospital. Statistical Analysis: The results were anaylzed using SPSS version 17, percentages, mean and standard deviations were used to describe data. Results and Conclusions: A total of 8,524 deliveries and 104 cases of pre-eclampsia were documented giving an overall prevalence of 1.2%. The prevalence in 2009, 2010, and 2011 was 0.7%, 1.2%, and 1.5%, respectively. Fifty-nine case notes were available for analysis (56.7% retrieval). The mean age of the patients was 27 ± 4.9 and majority; 25 (42.4%) were in the age group 25-29 years. The mean parity was 1.1 ± 1.4 and 26 (44.1%) were nulliparous. 11 (18.6%) had family history of hypertension, 2 (3.4%) had personal history of hypertension, and 2 (3.4%) had a personal history of pre-eclampsia. The slight increase in the prevalence rate over the years underscores the need for close surveillance.

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Background: The role of research was supported by faculty, researchers and professional organizations as an essential standard for practice and professional accountability. It is important to equip students with a strong research foundation to facilitate judging applicability of findings to clinical settings, and conducting research and eventually improving the quality of health-care. Increasing attention is directed to students' attitudes and involvement in research, however, no previous studies were located on the attitudes of Saudi students towards research. Aim: To investigate the attitudes of nursing students toward research in Saudi Arabia. Materials and Methods: A descriptive design with convenient sample of 244 senior students at a three-campus college of nursing in three regions in Saudi Arabia using a 22-items self-administered 4-point likert type attitude questionnaire. Results: Majority of students reported positive attitudes toward research with highest scores for 'usefulness of research' and 'personal interest in research' and lowest scores for 'using research in clinical practice'. Research attitudes significantly correlated with students' seniority and having completed a research course. Conclusions and Recommendations: Assessing students' attitudes towards research enhances implementation of findings in patient care and proposes means for developing positive attitudes and raising students' awareness of future role as practicing nurses. Students had positive attitudes toward research and its usefulness in professional work and less positive attitudes toward using research in practice. Faculty should develop students' knowledge and attitudes while studying at the college. Nursing and health-related professions researchers should direct attention to promoting the ultimate implementation of evidence-based practice by students as well as nurses

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Background: Pseudomonas aeruginosa is an aerobic, motile, Gram-negative rod which is responsible for 10% of all hospital-acquired infections. Objectives: This study was conducted to determine the frequency, risk factors and antibiotic resistance pattern of P. aeruginosa isolated from various clinical samples. Materials and Methods: Present retrospective hospital record based cross-sectional study included a total of 6280 clinical samples collected from patients at a tertiary care hospital, South Odisha, India from January 2011 to December 2012. Samples were processed and identified by standard protocol. The P. aeruginosa was tested for antibiotic resistance by Kirby-Bauer disc diffusion method (according to Clinical and Laboratory Standards Institute guidelines). Results: From 6280 clinical samples, 3378 (53.8%) samples yielded significant growth and 327 samples were positive for (9.7%, 327/3378) P. aeruginosa (6.8% of nosocomial and 2.9% of community-acquired infections). Maximum 221 (67.6%) isolates were obtained from pus/swab, followed by urine 15% and blood (4.9%). Elderly, in-patients and invasive procedures were found to be significant risk factors in the setup investigated (P < 0.05). Out of 327 isolates, 277 (84.7%) isolates were multidrug-resistant, 99 (35.7%, 99/277) isolates were extensively drug-resistant. No pandrug-resistant isolate was obtained. Majority of isolates were sensitive to imipenem, meropenem and piperacillin/tazobactam, showed the least resistance rate of 6.4%, 8% and 11.3% respectively. Conclusion: This hospital based epidemiological data will help to implement better infection control strategies and improve the knowledge of antibiotic resistance patterns among clinicians. Thus, there is a need for periodical antimicrobial surveillance to monitor the resistance patterns in local hospitals.

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Background: Electronic health record (EHR) applications improved quality and diminished health services cost. Aims: Project aimed to determine utilization and barriers of EHR by physicians. Settings: Three governmental hospitals in Eastern Province in Saudi Arabia adopted EHR system with the same software and functionalities. Design: Study was cross-sectional. Materials and Methods: EHR functionalities tool of a previous study was used. Additionally, tool included physicians' data and barriers of utilizing functionalities. Response scale of using functionalities was 'used' or 'not used'. Questionnaires were distributed among physicians working in departments adopting EHR. Overall response rate was 57.5% (319/555). Results: There was under-utilization of almost all functionalities. The least one was 'data back-up and disaster recovery' (18.2%) and the highest was 'enter pharmacy orders' (96.2%). There was no use of communication tools with patients as e-mails, facsimile and short messages. Physicians had no access to charts while they are outside hospital. Patients had no access to records. There was under-utilization of Automatic International Classification of Diseases (ICD) (27.6%). Most common barriers were system hanging up (86.5%), loss of access to records transiently if computer crashes or power fails (85.6%), fastness in utilizing system (84.3%), and system takes additional time for data entry (83.4%). Lack of continuous training/support from IT staff in the hospital (79.3%), lack of customizability of the system according to users' needs (78.1%), complexity of technology (74%), disturbing patient-doctor communication (71.2%, P < 0.05), and lack in belief in EHR adoption (63.6%, P ≤ 0.05) were cited. Conclusions: Under-utilization of most of functionalities. Physicians should be encouraged to use it via overcoming the obstacles.

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Background: Iron-deficiency anemia is a public-health concern in developing countries. Weekly iron folic acid (IFA) consumption can significantly reduce the prevalence of nutritional anemia among adolescents. The government of India launched the Weekly IFA Supplementation (WIFS) programme in 2012 to the reduce prevalence and severity of nutritional anemia among adolescent population. Objectives: To study factors influencing WIFS programme at selected schools in rural Puducherry and to explore perceptions regarding WIFS programme qualitatively. Methodology: A school-based cross-sectional study was conducted during July-December 2013 in selected government schools of Bahour commune in rural Puducherry. After obtaining permission from school headmasters, a total of 240 school children (both boys and girls from 9 ^th to 10 ^th standards) were interviewed. Pretested pro forma in local language was used, and multistage sampling technique was followed for quantitative data collection. Qualitative information was collected through 6 focus group discussions. Data were analyzed using SPSS version 17.0 (SPSS Inc., Chicago, Illinois, USA) and Anthropac 4.98.1/X software. Results: About 47.2% children were consuming IFA tablets regularly, 52.8% were consuming occasionally or rarely. Stomach pain (41.7%), nausea and vomiting (24.5%), and disliking of tablets (22.3%) were predominant causes for IFA tablet refusal. Reduced fatigue (43.7%), increased appetite (41.1%), and improved concentration (37.7%) were cited as major benefits of IFA tablets. Gender, type of family, parents' education, and occupation were not associated with consumption of IFA tablets. Girls perceived that IFA tablets causes weight gain, and may have side effects such as bad taste, pain abdomen, and giddiness. Boys considered that these tablets were not necessary and have side effects such as stomach pain and nausea and often throw away tablets. Occasional unavailability of IFA tablets, poor awareness regarding importance of IFA tablets, and casual programme implementation were other important factors. Conclusion: Creating awareness regarding the importance of IFA supplementation and careful programme implementation including regular supply of IFA tablets should be considered to make WIFS programme successful.

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Background: Data on prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections among pregnant women in non-institutionalized health facilities in Nigeria are missing. Aim: This study aimed at determining the prevalence and associated risk factors of HIV, HBV, and HCV infections among pregnant women receiving antenatal care in a traditional birth home in Nigeria. Setting and Design: This was a cross-sectional study conducted in a traditional birth home. Materials and Methods: Blood and sera samples obtained from 360 pregnant women were tested for the presence of HIV, HBV, and HCV antibodies and hemoglobin concentration determined using standard technique. Questionnaires were used to obtain demographic information. Statistical Analysis: INSTAT ^® statistical software. Results: The prevalence of HIV infection was significantly higher among pregnant women with no formal education and among those with multiple marriages (P = 0.008 and P = <0.0001 respectively). Only HIV infection was associated with anemia (OR = 4.154, 95% CI = 1.699, 10.157, P = 0.002). Age, gravidity, parity, marital status, history of blood transfusion, and educational status did not significantly affect the prevalence of HBV and HCV infections. Conclusions: The prevalence of HIV, HBV, and HCV infections were 7.2%, 2.2%, and 0.8%, respectively. Anemia was significantly associated with HIV infection only. Intervention effort at reducing HIV, HBV, and HCV infections and associated sequelae among pregnant women receiving antenatal care in traditional birth homes is strongly advocated.

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Context: The study of medicine is extensive, time-consuming, and highly stressful, especially during preclinical study period. Aim: To assess perceived stress in medical students studying in a medical college in Saudi Arabian Eastern Province and observe any gender-related variations in stress. Study and Design: Cross-sectional comparative study. Materials and Methods: The present study was carried out in College of Medicine, University of Dammam using Arabic version of Perceived stress scale-10 questionnaire. Eighty students (40 males and 40 females) studying in 2 ^nd year were included in the study. Statistical Analysis: Data were analyzed by using Microsoft Excel and SPSS version 19. Descriptive analyses were conducted to determine the frequency distributions of the study variables. Independent sample t-test was used to compare stress scores among male and female students. Stress level was analyzed by quartiles of perceived stress. Results: The overall prevalence of stress found in this study was 71.7%. Mean perceived stress score of all the students was 17.31 ± 5.31. There was no significant difference in the mean stress scores of males and females students. The percentage of students with no, mild, moderate, and severe stress was found to be 28.3%, 21.7%, 31.7%, and 18.30%, respectively. Conclusions: The present study indicates of high prevalence of stress in these medical students in the preclinical years. Hence, there is a need to take measures by the authorities to reduce stress among students.

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Background: Alterations in nuclear structure are the indications of cancer diagnosis. This study has thus focused on variation in nuclear morphometry in breast lesions. Aim: The aim of the study is to compare morphometric characteristics of different types of breast lesions and evaluate its utility in differentiating benign against malignant. Study Design: Sixty fine needle aspiration cytology (FNAC) of ethanol fixed samples were obtained and stained with Papanicolou stain. All diagnoses reported were confirmed histopathologically. Nuclear morphometric parameters for free cells in smears were calculated using the ImageJ 1.47 morphometric computer software. Result: The nuclear morphometric parameters including mean nuclear area, perimeter, diameter, long axis, and short axis were found to be statistically significant (ANOVA, P < 0.0001) in differentiating benign and malignant breast aspirates. Conclusion: Nuclear morphometry has been found to be a valuable objective method in differentiating benign and malignant breast lesions, especially in the grey zones, when diagnostic dilemmas are encountered. This study results demonstrate that the size-related parameters (area, perimeter, diameter, long, and short axes) of the nucleus are the most appropriate nuclear morphometric parameters for differentiating between benign lesions and infiltrative ductal carcinoma of the breast.

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Background: Nurses are the key components of healthcare system and their knowledge is vital for improving the effectiveness of inhaler techniques. We aimed to study the baseline knowledge of nurses on obstructive airway diseases and inhaler techniques. Subjects and Methods: A descriptive study was performed among the practicing nurses (n = 24) in a Tertiary Care Teaching Hospital of Central Nepal. Information on demography, knowledge on obstructive airway diseases, and knowledge on inhaler techniques was assessed. Results: About 34% nurses mentioned the three common obstructive airway diseases. None of the nurses mentioned two tools used for measuring airway obstruction; however, 56.4% mentioned at least one correct tool. Majority (87.5%) of them thought that dry powder inhalers allow maximum deposition of drugs in the lung, but 70.8% were unaware of the steps of administration of drugs through inhaler/rotahaler. Conclusion: Practicing nurses had inadequate knowledge about obstructive airway diseases and inhaler techniques. There is urgent need of intervention to improve current knowledge and practice of nurses on obstructive airway disease and inhaler techniques.

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Intervertebral disc degenerative (IVDD) is a common orthopaedic condition characterized by a series of cellular, biochemical, structural and functional changes that imparts a large socioeconomic impact on healthcare system. Progressive loss of normal extracellular matrix constituents, namely proteoglycans and water content, is thought to be a key contributor to IVDD. The ability to sustain or augment normal matrix composition may slow down or reverse disc degeneration. Traditional concepts for treatment of lumbar disc degeneration have aimed at symptomatic relief by limiting motion in the lumbar spine, but novel treatment strategies involving direct injection of active substance, stem cells, growth factors and gene therapy have been attracting more attention in respect to prevent, slow or even reverse disc degeneration. Understanding the pathophysiological basis of disc degeneration will lay the foundation for the emergence of exciting new regenerative or reparative biological treatments for this debilitating condition either by inducing disc regeneration or replacing the degenerated disc.

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Context: Oral candidiasis is the most common oral opportunistic infection has seen in the immunocompromised patients. Apart from C. albicans the non-Candida albicans Candida species, which are less susceptible to the commonly used antifungal drugs are major etiological agent for candidiasis. Thus, the treatment strategy for candidiasis should be different in case of multiple species infection. Aims: The aim of this present study is to compare the antifungal susceptibility patterns of Candida species isolated from mono species and multiple species oral Candidal carriage. Materials and Methods: The species of Candida, isolated from mono and multiple species oral Candidal carriage of the healthy and immunocompromised patients were used for the experiment. Antifungal susceptibility test was performed by using disk diffusion susceptibility method on Methylene blue Glucose- Mueller-Hinton agar. Statistical Analysis Used: Paired student's t-test. Results: In this, present study, variability in antibiogram of Candida species isolated from mono species and the corresponding species isolated from multiple species combinations were reported. The susceptibility ranking for antifungal drugs for the strain isolated from mono species OPC (C. albicans > C.tropicalis > C. glabrata > C.krusei) and for the strains isolated from multiple species combination (C. albicans > C. glabrata > C.krusei > C.tropicalis) for mean of the five antifungal drugs combined were reported. Species of C. albicans and C. tropicalis were reported more resistant towards anti fungal agents when these present in mono-species condition, whereas; C. krusei and C. glabrata were more susceptible when these present in mono-species condition. Polyenes (amphotericin-B and nystatin) compounds were found to be most effective than azoles against Candida spp. isolated from multi-species lesions as none of the strain were shown resistant towards these drugs, conversely; a significant fraction of C. tropicalis and C. albicans isolated from mono-species lesion were shown resistant toward polyenes compound tested. Conclusions: The findings of this study shows statistically insignificant diverse antifungal susceptibility pattern of Candida species isolated from mono and multiple species Oropharyngeal Candidiasis combinations.

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Background: Human immunodeficiency virus (HIV)-infected patients are now recognized as one of the higher risk groups for increased rates of both methicillin-resistant Staphylococcus aureus (MRSA) colonization and infections over the past decade. Staphylococcus aureus are known to colonize the anterior nares of HIV-infected patients with greater frequency than that of the general population, leading authors to postulate that this higher colonization burden might translate into a higher incidence of infections. Settings and Design: The study was a prospective study, including HIV-infected patients. Exclusion criteria: Patients having diabetes or any other immunodeficient conditions besides HIV. Materials and Methods: One hundred and forty two non-duplicate patients with HIV infection, attending the anti-retroviral therapy (ART) center at a tertiary care hospital were studied for nasal carriage of MRSA and associated factors affecting nasal colonization. Nasal swabs were used for isolation of S. aureus. MRSA were detected by using cefoxitin (30 μg) disc as per the Clinical Laboratory Standards Institute (CLSI) guidelines. Careful examination for dermatoses was carried out. Statistical Analysis: Descriptive statistics and testing of hypothesis were used for the analysis using SPSS 16 software. Results and Conclusions: Seventy two (50.70%) of the 142 patients were colonized with S. aureus in the anterior nares. Significant number of S. aureus carriers were in the 31-40 year age group. Methicillin resistance was found in 26 (36.11%) isolates. Cotrimoxazole prophylaxis was found to be a risk factor for MRSA colonization (P < 0.0001). Decreased CD4 counts was found to be a significant risk factor for MRSA colonization (P < 0.0001).

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Background: Little is known about knowledge and attitudes of pharmacy students regarding human immunodeficiency virus (HIV) or how knowledge and attitudes compare internationally. Aims: The primary objective of this study was to compare pharmacy students' knowledge and attitudes of HIV between students in Doha, Qatar, and Saskatchewan, Canada. Materials and Methods: A cross-sectional survey was administered to pharmacy students enrolled at Qatar University and at the University of Saskatchewan. Results: Overall response rate was 36.1%, with 51% and 32% completing the survey in Qatar and Canada, respectively. While most students at both institutions were knowledgeable about HIV, students from Qatar had a significantly greater number of misconceptions. Attitudes and beliefs differed significantly between students in Canada and Qatar. Conclusions: Findings suggest that students are generally knowledgeable and have positive attitudes; however, several misconceptions and negative beliefs remain. Current educational strategies should further emphasize modes of HIV transmission and prevention.

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Background: Trachoma is a leading preventable infectious eye disease caused by repeated infection with eye strains of the bacteria Chlamydia trachomatis. Developing countries that have poor environmental sanitation, inadequate water supply, and poor socioeconomic status are highly exposed with the disease. Aims of the study: The aim of the research was to assess the risk factors of active trachoma among children 1-9 years old in Maksegnit town. Settings and Design: Cross-sectional community based study was conducted in April 2012; in Maksegnit town located at Gondar Zuria District, North Gondar, northwest Ethiopia. Materials and Methods: A total of 420 children (age 1-9-years-old) from 420 households were included in the study. All children were examined for trachoma by optometrists and ophthalmic officers using the World Health Organization (WHO) simplified clinical grading system. Interviews and observations were used to assess risk factors. Descriptive statistics was carried out for variables in the study and odds ratio (OR) with 95% confidence interval (CI) were used to assess the association between the potential risk factors and active trachoma. Result: The prevalence of active trachoma was found to be 100 (23.8 %). Unclean face (adjusted odds ratio (AOR) = 4.12; 95% CI = 1.92-8.81), flies on face (AOR = 2.310; 95% CI = 1.32-4.05), and using wood and animal dung as a source of energy for cooking (AOR = 2.190; 95% CI = 1.152-4.163) were independent predictors of active trachoma. Conclusion: Trachoma is still a major public health problem in the study area. Trachoma prevention programs that include smoke-free household energy, fly control, sanitation, and hygiene are recommended to lower the burden of trachoma in Maksegnit town.

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Introduction: Management of periodontitis-related oral malodor may include simple measures such as scaling and root planning (SRP) and oral hygiene instructions. Aim: A prospective cross-sectional study was conducted to evaluate the effect of non-surgical management of periodontitis on controlling halitosis (oral malodor) measured by Halimeter. Methodology: Clinical data were recorded from 60 participants who were attended the out-patient periodontics clinic at the College of Dentistry of King Khalid University, Abha city, Saudi Arabia. The participants were grouped as periodontitis (case), non-surgically treated periodontitis and healthy (control). Volatile sulfur compounds were measured in parts per billion (ppb) as a caliber for halitosis for each group using a Halimeter ^® . Data were statistically analyzed utilizing the Chi-square distribution test (P < 0.05). Results: In the average, case group showed strong halitosis 230.00 ± 54.29 ppb that was reduced to weak halitosis 124.25 ± 26.43 ppb following non-surgical (SRP) management of chronic periodontitis, with the deeper pockets, increased halitosis was measured as mean halitosis of periodontitis and treated cases 188.90 ± 14.22 ppb and 114.70 ± 20.75 ppb, 240.25 ± 58.08 ppb and 128.25 ± 39.31 ppb and 294.33 ± 19.64 ppb and 137.50 ± 23.36 ppb, respectively, in 5-6, 6.1-7 and 7.1-8 mm groups respectively. Conclusion: Based on study results, halitosis is directly related to periodontitis and periodontal pocket depth among the adults, which can be successfully controlled by SRP.

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Aim: Analytical HPTLC technique was developed for the simultaneous estimation of candesertan celexitil (CAN) and hydrochlorothiazide (HYD) in 2 totally different strengths of pharmaceutical dosage form. Materials and Methods: Chromatography was performed on 60F 254 TLC pre-coated aluminum plates with mobile phase of toluene: ethyl acetate: formic acid (85%) in the ratio of 6:4:1 v/v. The mean Rf values with standard deviation were found to be 0.39 ± 0.01 and 0.73 ± 0.01 for CAN and HYD, respectively. Results: The linear regression data has shown a good linear relationship over a concentration range of 200-1200 ng/spot for each drug with a correlation coefficient of 0.9999. Limit of quantification and the limit of detection establish the sensitivity of the developed technique. The stability study indicates that drugs were stable up to 72 hours. The technique was precise and relative standard deviations were found to be less than 0.05%. System suitability tests are used to verify that the resolution and repeatability of the system is adequate for the analysis. The technique was specific and selective since there is no additional peak beside with main peak. The Robustness study, recovery study and percentage of assay of the formulation were within the limit as per ICH guidelines. Conclusion: A simple, rapid, cost-effective, eco-friendly, specific, precise, sensitive and efficient analytical HPTLC technique was developed for the simultaneous estimation of candesertan celexitil (CAN) and hydrochlorothiazide (HYD) completely in 2 totally different strength of pharmaceutical marketed formulations.

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Background: Knowing etiology and antimicrobial susceptibility patterns of bacterial isolates from patients with community-acquired pneumonia (CAP) is important in reducing the morbidity and mortality. Objective : To determine the bacterial etiologies and antimicrobial susceptibility pattern of isolates from patients with CAP. Materials and Methods: Cross-sectional study was conducted from March to July 2012. Sputum and blood specimens were collected, and microbiological investigations were performed using standard procedures. Data were presented using descriptive statistics. Results : Bacterial isolates from both sputum and blood cultures of patients were similar. Most common bacterial isolates from gram-positive bacteria were Streptococcus pneumoniae (12.8%) and Staphylococcus aureus (10.5%) and from gram-negative bacteria were, Pseudomonas aeruginosa (6.8%), Klebsiella. pneumoniae (5.3%), and Escherichia coli 3.8%. Most S. pneumoniae isolates were resistant to oxacillin (55%). High resistance rates of S. aureus isolates were observed to tetracycline (100%), penicillin (81.3%), trimethoprim-sulfamethoxazole (81.3%), erythromycin (75%), and doxycycline (50%). Gram-negative bacteria isolates were resistant to tetracycline (66.7-100%), doxycycline (50-100%), trimethoprim-sulfamethoxazole (66.7-100%), and ampicillin (66.7-100%). Resistance to two or more drugs was also observed among 62.7% of bacterial isolates. Conclusion: High rate of antimicrobial resistance was observed to commonly prescribed antimicrobial agents for CAP as empiric therapy.

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Introduction: Iron-deficiency anemia (IDA) is quite common in female adolescents and adults worldwide. Despite the higher prevalence of IDA, there is a paucity of research in finding its prevalence and potential causes in young Saudi female population. Thus, the aim of this study was to determine the prevalence and possible causes of IDA in young female medical students and search for risk factors in the studied group. Materials and Methods: One hundred and twenty female students from Imam Abdulrahman Bin Faisal University were selected by randomized sampling whose blood samples were taken to measure their hemoglobin (Hb) and serum ferritin levels. According to the World Health Organization criteria, individuals with Hb <12 g/dL and ferritin <15 ng/mL were considered anemic. The sociodemographic, gynecological, and dietary data were collected from all the respondents with the help of a well-designed 15 items questionnaire. The association between IDA and the potential risk factors was found through Fishers' exact test or Chi-square test. Results: Among the studied group, 38.3% of total population were anemic. Mean Hb ± standard deviation (SD) was found to be 12.6 ± 1.3 and mean ferritin ± SD was 18.9 ± 5.2. No statistically significant correlation (P > 0.05) was found between IDA and the background, gynecological history, and dietary habits of the anemic participants. Conclusions: The higher prevalence rate of anemia among Saudi female medical students (38.3%) was similar to the earlier reports of the Gulf region. Considering the higher ratio of anemic students, iron supplements should be prescribed to the affected youngsters to improve their Hb level.

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In a prospective clinical study in North Kordofan (Western Sudan), the possible association between blood groups and anti-malarial antibody responses with clinical outcome of Plasmodium falciparum malaria among Sudanese patients was investigated. A total of 184 individuals were consecutively enrolled from an outpatient clinic. Sixty six (35.9%) patients were classified as complicated malaria (CM), 53 (28.8%) with uncomplicated malaria (UM) and 65 (35.3%) were malaria free controls (MFC). Phenotypes of ABO blood groups were typed using commercial anti-sera. The antibody responses to MSP2 malaria antigens were assessed by an enzyme-linked immunosorbent assay (ELISA). The frequency of O blood group was significantly lower in those with CM when compared with MFC and UM patients (P value < 0.001 and 0.002 respectively). The levels of IgG1, IgG2 and IgG3 antibodies were statistically significantly higher in UM and MFC compared with CM patients. Statistical analysis indicated that higher levels of total IgG, IgG1, IgG2, and IgG3 specific to the MSP2 (both antigen forms, 3D7 and FC27) were associated with a reduced risk of complicated CM in O blood type carriers than in non-O blood type carriers, P value <0.001. Taken together, the current study indicates that blood group O is associated with a reduction in the risk of developing complicated malaria in western Sudan. Our results also revealed that the natural acquisition of immunity against clinical malaria appeared to be more associated with IgG1 and IgG3 antibodies, signifying their roles in parasite-neutralizing immune mechanisms.

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Background: Imperforate anus with recto-vestibular fistula is the most common form of imperforate anus in females and is an intermediate type of this disease, which is treated surgically. The current study aimed to compare three techniques used for the treatment of imperforate anus with recto-vestibular fistula. Materials and Methods: Fifty-four cases of imperforate anus with recto-vestibular fistula were managed using three main approaches: posterior sagittal ano-rectoplasty, anterior sagittal ano-rectoplasty, and the anal transposition or trans-sphincteric ano-rectoplasty (TSARP). The functional results and cosmetic appearance for each case after treatment were evaluated in patients above 3 years of age (43 cases). Results: The functional outcomes were good in all treatment groups; however, the better cosmetic results were evident in the group treated using TSARP, a technique, which preserves the skin bridge between the new anus and the posterior fourchette, does not disturb the perineal body, and avoids division of the levator muscles. In this group, a continence rate of 100% but a higher constipation rate (41%) than in the other groups was recorded. Conclusion: TSARP is recommended for imperforate anus with recto-vestibular fistula.

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Introduction: Microbial contamination of operating theaters (OTs) is a major cause of nosocomial infections (NIs). Purpose: Thus, the purpose of this systematic review was to determine the degree of contamination present on OTs and to evaluate the methodological quality of this evidence. Materials and Methods: Published studies from December 2000 to December 2012 were identified in nine major databases. Methodological quality was evaluated using a quantitative critical appraisal tool. Data were extracted and analyzed using four major outcome measures. Results and Conclusion: A total of 45 studies were identified investigating the levels of microbial contamination on OTs; of which 26 were included in the review. The included studies reported that 51.3% of all sampled air/articles/surfaces of OTs were contaminated. However, the majority of microbial contamination and hence any risk of acquiring a NIs can be reduced substantially by implementing the infection control measures. Further research is also required on the role of OTs in NIs.

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Introduction: Non-fermenting gram negative bacilli (NFGNB) are taxonomically diverse group of pathogens that has emerged as a major cause of health care associated infections especially in immunocompromised hosts. Identification of NFGNB and monitoring their susceptibility pattern are important for proper management of infections caused by them. Prevalence and antibiogram of NFGNB has not yet been reported from this part of India. Aim of the present study was to characterize the prevalence of NFGNB along with their antimicrobial sensitivity pattern among the patients coming to our hospital a tertiary care center. Materials and Methods: A total of 2585 various clinical specimens were received in laboratory and were processed. Non fermenters were identified using a standard protocol. Antimicrobial susceptibility testing was performed by Kirby Bauer disc diffusion method. Results: Among 2585 clinical samples 241 yielded NFGNB accounting for an isolation rate of 9.32% and a total of 246 non fermenters were grown as five samples yielded two types of NFGNB. Pseudomonas species (49.59%) and Acinetobacter species (43.09%) were the most commonly isolated NFGNB. A high level of antibiotic resistance was recorded for most of the first and second line drugs. Imipenem and amikacin were the drugs with maximum activity. Overall imipenem resistance was found to be 30.54%. Conclusion: Identification of NFGNB and monitoring their susceptibility patterns will help in proper management of infections caused by them. Improved antibiotic stewardship and infection-control measures will be needed to prevent or slow the emergence and spread of multidrug-resistant NFGNB in the healthcare setting.

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Aim: This study was designed to test the Sudanese parents' knowledge, attitudes and practice (KAP) toward self medicating their children. Design and Methods: A cross-sectional study was carried out by using a pretested questionnaire. Non probability convenient sampling method was used to select the participants. The total sample size was 1000 parents from different health settings in Khartoum State, Sudan in the period from January to June 2011. Results: The obtained response rate was 94.9%. The majority of Sudanese parents in this study 84% used to recommend western medicines to their children. More than one-third of children had received parental self medication in the month preceding this study. The results revealed that parents in 95.7% cases, self medicated their children from minor illnesses. The most frequently used medicines are antibiotics 36.6% followed by paracetamol 31.5%, even though the most common symptom reported was fever 39.7%. In case of self-treatment failure; 64.0% of responded parents used to consult physicians in public settings, while 8.0% seek advice from the community pharmacists. The main reasons of parental self medication were the expensive consultation fees and the long waiting time in the clinics. Conclusion: The study revealed that parents' knowledge was inadequate, and their parental self medication practice showed to be inappropriate. The study outcomes urge instant move toward educating parents on risk of liberal use of medicines in children.

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Context: The increased use of generic medicines has been associated with remarkable cost saving and is one of several strategies aimed to reduce pharmaceutical expenditure. Aims: To identify consumers' perceptions on generic medicines. Settings and Design: A cross-sectional survey was conducted during April-June 2011 in Taif City in Saudi Arabia. Materials and Methods: Adult consumers (aged >18 years) were recruited. Data were collected by face-to-face interview using a pre-tested questionnaire. Statistical Analysis Used: Associations between different variables were tested by using Chi-square tests or Fisher exact tests when appropriate. All statistical tests were conducted at an a priori significance level of P < 0.05 using Statistical Product and Service Solutions (SPSS) version 16. Results: Overall; 450 participants were recruited (males were 78.4% and 77.8% their ages were <40 years). Higher education graduates were 245 (54.4%) and those who were practicing non-medical jobs were 326 (72.4%). Participants who preferred using brand medicines over generic ones were 282 (62.7%). Preference of using brand over generic medicines increased significantly with consumers' age (≤40 years, 210 (60.3%); 40-60 years, 63 (72.4%); >60 years, 6 (75.0%)); (P = 0.015). Interviewees who did not prefer using generic medicines because of their low prices compared to brand ones were 223 (51.8%). Participants who believed that generic medicines have low efficiency compared to brand ones were 176 (39.1%). Respondents who thought that generic medicines have more side effects than brand ones were 110 (24.4%). Conclusions: The results showed general unawareness on generic medicines and generic substitution. No single variable was found to be associated with consumers' knowledge on generic medicines.

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Growth hormone (GH) is a peptide hormone necessary for normal postnatal growth as well as human metabolism. It works via its widely expressed receptor (GHR), which is a dimer of transmembrane glycoproteins, belonging to cytokines type I receptor family. Signaling via GHR is initiated by conformational changes triggered upon GH association. GHR is recognized as an important therapeutic target for treatment of many pathologic conditions, including growth disorders and cancer by designing highly specific and efficient GHR agonists or antagonists. However, engineering of such molecules requires deep understanding of the structure and function of both GH and GHR protein molecules. This work reviews the current status of knowledge covering the molecular structure of both GH and GHR and their molecular interactions, in addition to different GH agonists or antagonists developed to regulate GH action.

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