Brucellosis is a zoonotic disease caused by Gram-negative coccobacilli (Brucella) which is commonly spread by ingestion of animal milk or its products or inhalation of infectious aerosols. Modernization of milk and meat processing has reduced the incidence of brucellosis significantly in most developed nations. Literature search was carried out in the search engines using medical subject headings terms. Articles published in English between 1990 and 2016 were included in the review. Articles that describe the pediatric brucellosis particularly in the Middle East region were evaluated while preparing this short review. The disease is currently endemic in several African countries. As a result of mass migrations from endemic regions, the disease is reemerging in several nonendemic countries, and the global prevalence of the disease is likely to see an upward trend in the coming years. The disease has a wide spectrum of clinical symptoms and signs and could result in complications with significant morbidity. Pediatric brucellosis has major influence of the health of young children and is often underdiagnosed. This review details the overall prevalence of the disease in the community, the microbiological and clinical profile, diagnostic methods, and appropriate treatment strategies. The review findings highlight the need to implement strategies for early identification and treatment reemerging zoonotic infection to curb its complications and associated morbidity and mortality.

Purpose: The purpose of the study was to evaluate efficacy, safety, and stability of visual and refractive outcomes of combined photorefractive keratectomy (PRK) with accelerated corneal collagen cross-linking (CXL) in subclinical keratoconus. Materials and Methods: This retrospective study included 140 eyes (75 patients) with subclinical keratoconus which underwent simultaneous topography-guided PRK with acceleratedCXL (2.7 J/cm²). Outcome measures were pre- and postoperative uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, and keratometry. Results: Refractive and keratometric parameters demonstrated statistically significant improvement from baseline to postoperative 12 months. UDVA of ≥20/20 was achieved in 90.7% (127/140) eyes and ≥20/40 in 96.4% (135/140) eyes at last follow-up. Regarding refractive outcomes, 94.3% (132/140) eyes were within ± 1.00 D of attempted refractive correction and 82.9% (116/140) eyes had astigmatism of ≤0.25D postoperatively as compared to 22.9% (32/140) eyes at preoperative levels. Regarding safety, 90.7% (127/140) eyes maintained their preoperative CDVA and 7.2% (10/140) eyes lost ≥2 lines of CDVA. Complications included corneal haze in 7.14% (10/140) and corneal ectasia in 0.7% (1/140) eyes. Conclusion: During the 12-month follow-up, combined topography-guided PRK and accelerated CXL provided good visual and refractive outcomes offering spectacle independence in subclinical keratoconus eyes; however, development of one case of ectasia (0.7%) indicates compromised safety and seems to suggest that utilizing 2.7 J/cm² energy for CXL procedure may not be adequate.

Context: Despite the progress made in the field of surgical techniques and neonatal care, conditions such as prematurity, very low birth weight, and associated anomalies compounded with delayed diagnosis may negatively influence the successful outcome of esophageal atresia (EA). Aims: The aim is to study the early outcome analysis of patients with EA and tracheoesophageal fistula (TEF) at a high-volume tertiary care institute. Settings and Design: A retrospective study performed from January 2016 to December 2016. Subjects and Methods: The study included all patients of EA and TEF admitted in the Neonatal Intensive Care Unit of our department. Results: There were 430 new cases of EA/TEF. Type C was the most common (90.23%), followed by Type A (8.37%), Type E (0.69%), and one case each of Type D, esophageal web, and esophageal stenosis. Two hundred and twenty-four (52.10%) remained undiagnosed on the 1^st day of life. The average birth weight was 2200 g; 64.65% of patients were low birth weight. Associated major anomalies were present in 18.84% patients with gastrointestinal tract anomalies in 13.49% cases (anorectal malformation – 11.86%, duodenal atresia [DA] – 2.79%, and triple atresia – 0.93%) and VACTERL association in 11.63%. Surgical procedures were performed in 413 (96.05%) patients. Survival was seen in 29.77% cases, mortality in 68.84% and 1.39% patients left against the medical advice. The survival was better in Type C (29.89%) than Type A (27.78%) and also those without associated anomalies. VACTERL association had a very high (80%)-mortality rate. Septicemia (63.85%), severe pneumonia (53.71%), and congestive heart failure (24.32%) were main causes of mortality. Conclusions: Although there has been a marked improvement in the antenatal diagnosis of EA, most cases in our study remain undiagnosed in first 24 h of birth. Associated major anomalies were documented in approximately 1/5^th patients. Survival was present in less than 1/3^rd patients; survival outcomes were better in EA without associated anomalies. Early diagnosis with the help of red rubber catheter shortly after birth, measures to prevent pneumonia, strict infection control measures for prevention of septicemia, deployment of sufficient resources, and investigations for other associated anomalies are recommended to improve the outcomes of EA.

Background: Surgical site infection (SSI) includes all postoperative infections occurring at surgical sites. It is one of the most common causes of the morbidity and mortality in postoperative patients. Surgical antimicrobial prophylaxis (SAP) is a brief course of an anti-microbial agent for the prevention of SSI. Judicious use of antibiotics can decrease the morbidity associated with SSI, but inappropriate antibiotic use leads to antibiotic resistance. Aims and Objectives: Inappropriate use of antibiotics is still rampant, and the present study was planned to assess the prophylactic antibiotic usage in the surgery department. Materials and Methods: A prospective study was conducted on 200 patients in the Department of General Surgery, MMIMSR, Mullana, Haryana, with prior approval from the Institutional Ethical Committee. Results: Out of 200 patients, 193 received intravenous preoperative antimicrobial dose on the day of surgery. Most commonly prescribed group was the third-generation cephalosporin (61%). Fixed-dose combinations were also frequently used, among them piperacillin-tazobactam (20.5%) was the most common combination used. Average duration of postoperative prophylactic antimicrobial administration was 8.23 days. Conclusion: This study showed antibiotics were used as prophylactic in almost every patient. Still, many patients do suffer from SSI as average duration of antibiotic usage is around 8 days. To combat inappropriate antibiotic usage, there is need to make the SAP guidelines and to adhere to these guidelines.

Context: The commercially available oral solid dosage forms are used to prepare suitable liquid dosage forms extemporaneously by the pharmacists for pediatric, geriatric, and other patients with inability of swallowing tablets or capsules. These extemporaneous preparations are not subjected to tests for quality and stability like commercial products. The stability of extemporaneous preparations should be determined in hospital settings, but the practice is to rely on published information. Unavailability of stability data limits the availability of many medicines for special patients. The extemporaneously prepared omeprazole suspension is regularly used in hospital settings. Aim: This research was taken up to perform the stability study of extemporaneous omeprazole oral suspension frequently used in a referral hospital to determine the shelf life. Materials and Methods: Stability studies were performed by keeping the freshly constituted preparations in small containers at 2°C–8°C and 25°C ± 5°C; samples were withdrawn at 0, 7, 14, 21, and 28 days and assayed by spectrophotometric method at 301 nm. The percent degradation or stability was calculated for each preparation, and data were extrapolated to find out the shelf life. Results: It was found that the shelf life (t_90%) of omeprazole oral suspension, prepared extemporaneously, is 32 days at room temperature (25°C ± 5°C) and 54 days in refrigerator (2°C–8°C). Conclusion: Study outcomes shall help the hospital pharmacist to improve pharmaceutical services by dispensing the extemporaneous preparations with the knowledge of their stability and storage condition.

Context: The aim of this study is to evaluate the various determinants of the preanalytic phase of surgical pathology (SP) in Uyo. Materials and Methods: This is a cross-sectional descriptive study (prospective) of all SP specimens that were sent to the histopathology laboratory of University of Uyo Teaching Hospital, Uyo. A special pro forma/questionnaire was designed taking into account the various determinants of the preanalytic phase of SP. Results: The request form had the patients' name and sex in all cases reviewed. In all but 3%, the age was stated while the hospital number and site of biopsy or tissue were stated in 89% and 95%, respectively. Only 49% of cases had an adequate history. In majority of cases, the examination findings (63%) and previous investigations (83%) were not stated. The provisional diagnosis was indicated in 92% of cases while the requesting/managing clinicians' name was indicated in 94% of cases. Seventy percent of the request forms were written on behalf of the consultant by the resident doctors. The fixative was adequate in 92% of cases and all specimens came in formalin (though it was of different concentrations). Majority (92%) of the specimens came in plastic containers, which was adequate (large enough) for the size of the specimen. The provisional diagnosis was same with the histological diagnosis in 66% of cases. Conclusion: An adequately filled request form well labeled adequate specimen container containing the right amount of fixative will positively affect the preanalytic stage of SP.

Background: Smoking is the largest single preventable cause of death and disability worldwide. Cultural barriers, lack of smoking cessation training, and patients' complaints are among the reasons why health professionals avoid asking about or advising against smoking. Aim: The aim of the audit was to assess the prevalence and effects of smoking to lead a successful smoking cessation campaign. Materials and Methods: The project was divided into two phases. The first phase was the audit and the second phase was the smoking cessation campaign. Results: A 6-week audit at the Medical Protocol Department at King Abdulaziz Medical City, Riyadh, Saudi Arabia, showed that (1) there is a trend of increasing use of hookah among females; (2) A large percentage of smokers have dyslipidemia, hypertension, and diabetes; (3) There is a strong association between smoking (both cigarettes and hookah) and obesity. During the smoking cessation campaign week, 54 patients were enrolled onto the smoking cessation program. Four weeks following the patient's chosen quit date, 12 patients (22%) had successfully quit completely. A total of 21 patients reported that they have significantly cut down, 11 patients had not quit yet and the remaining 10 patients were not contactable. Conclusions: Smoking cessation campaigns and programs are successful at helping people quit smoking. They are by far one of the most cost-effective life-preserving clinical services and should be integrated into routine clinical care. Treating physicians need to specifically ask about smoking status and promptly refer patients to smoking cessation clinics.

Background: The incidence of stone disease in the pediatric age group dramatically increased in developing countries like Sudan. Despite, the challenges in the management of ureteral stone in the aforementioned age group, ureteroscopy (URS), lithotripsy using Holmium Laser (HO) has been reported as standard effective and safe. The aim of this study is to assess the outcome of URS lithotripsy using HO in preschool patients younger than 5 years of age. Materials and Methods: The results of treatment in 42 patients, who had undergone intervention for ureter stones at Gezira Hospital for Renal Disease and Surgery-Sudan, were prospectively evaluated. Miniscopes with an HO were used for lithotripsy. Results: The mean patient's age was 2.5 ± 1.2 years (1–4 years). The success rate was 69.9% after an average follow-up of 16 months (range 10–24). The majority 81% (n = 34) of study cases were presented with ureteric stones, which comprised 52.4% (n = 22) unilateral and 28.6% (n = 12) bilateral. The cases of unilateral and bilateral stricture include 6 and 2 cases, respectively. After the procedure, the ureteric stenting (double J) was used in 81% of the cases. The perioperative complication rate was 31.0%, and the most common complication was a failure of cannulation followed by the false passage. The mortality rate was zero. Conclusion: URS is considered safe and effective method for pediatric ureteric stones. The size of ureteroscope has an important role in the outcome and complications.

Background: The primary aim of this study was to evaluate the functional and high-level difficulties using disease-specific Arabic version of the self-reported questionnaire, knee injury, and osteoarthritis outcome score-physical function short form (KOOS-PS) in primary knee osteoarthritis (OA) patients. Methods: A cross-sectional studied involving the use of KOOS-PS which was administered on 149 primary OA knee patients at the time of the first consultation before the start of the medication and physiotherapy to prevent biased outcomes and were assigned to four groups based on age ranging from 43 to 79 years. Average time to administer this Arabic translated questionnaire was 10 min. Results: The mean and standard deviation from KOOS-PS-activities of daily living (KOOS-PS-ADL) domain were 61.1 ± 19.45, KOOS-PS-Sport/rec was 57.42 ± 20.3 indicating higher level difficulties noticed. There was no significant difference existed between Group-I and II, but the significant difference existed in the other age groups of KOOS-PS-ADL domain. There was insignificant difference existed between Group-I and II, significant difference existed in rest of the age groups of KOOS-PS-Sports/rec. Conclusion: Functional and higher level difficulties noticed in OA knee patients more in sports/recreational domain than activities of the daily living domain using the KOOS-physical function short form in Saudi populace.

Context: Evidence-based practice (EBP) is an integral part of stroke rehabilitation, to achieve optimal results by practicing best evidence available in the literature. Aims: A survey was conducted to find the knowledge of EBP and preferred treatment used by the physiotherapists in Saudi Arabia for stroke rehabilitation. Settings and Design: Eminent research scholars and experienced physiotherapists involved in stroke rehabilitation developed an EBP questionnaire containing 35 questions. The survey was intended to explore the current practice of stroke rehabilitation among physiotherapists. Subjects and Methods: Physiotherapists (n = 186) practicing stroke rehabilitation received online questionnaire through e-mail; only 156 complete questionnaires returned (86.2% of response rate). Statistical Analysis Used: Nonparametric tests were used to analyze data obtained from the questionnaire. Results: Physiotherapists preferred Bobath approach (77.7%) for stroke rehabilitation over newer techniques. The survey further shows that the majority of participants (59.6%) were unaware of process and implementation of EBP. Conclusions: Experienced and novice therapists showed a vast degree of variation in treatment approaches. Majority of the therapists preferred Bobath approach over newer techniques.

Context: Human papillomavirus (HPV) vaccination of young girls is yet to be a routine practice in Nigeria and parents' acceptance may influence immunization of their children. Aims: The aim of this study is to determine beliefs and concerns of parents about HPV vaccination of girls. Subjects and Methods : A cross-sectional survey of parents of girls between 10 and 15 years in 12 selected secondary schools of Ilorin using a self-administered questionnaire designed by researchers was conducted. Statistical Analysis Used: Data analysis involved univariate and bivariate analyses with SPSS version 20. The level of significance for all tests was set at 5%. Results: The respondents were 470 mothers between 31 and 50 years, 58.1% had at least secondary school education, 70.2% were employed, and 22.8% belonged to the upper social class. Of the study participants, 35.1% were aware of HPV vaccine and 33.8% knew that the vaccine was available in Nigeria. While 55.8% of mothers believed that all girls should be vaccinated, 19.5% responded that only sexually active girls should have it. Among all respondents, full protection, need for repeated doses, and age of the girls were significantly related to willingness to vaccinate statistically (P < 0.05). These concerns were not significant among mothers that were aware of HPV vaccines. Conclusions: There is low awareness of HPV vaccine among mothers in Ilorin despite the high prevalence of cervical cancer in our environment. Parental perception of HPV vaccines in terms of concerns and beliefs was significantly related to willingness of mothers to vaccinate their daughters.

Intrauterine contraceptive device (IUCD) is a common means of contraception in females which has a risk of getting missing due to its migration by means of perforating the uterus. Mrs. MB is a 36-year-old Para 4 + 0 4 alive woman who presented in our clinic with a history of vague tenderness in the left lower abdomen of 4-week duration. She was examined and her IUCD tag was missing, investigations result was further suggestive of a displaced IUCD. She subsequently had a mini-laparotomy following which the IUCD was retrieved from the anterior abdominal wall. Her postoperative recovery was satisfactory. Health workers need to be trained and re-trained on the contraceptive methods, especially IUCD. The areas of emphasis should be on criteria for proper selection of client, insertion techniques to reduce primary perforation of the uterus, and protocols on proper follow-up to reduce complication of secondary perforation of the uterus.