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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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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Introduction: Monitoring of blood glucose (BG) is an important aspect of the diagnosis and management of diabetes. Self monitoring of blood glucose (SMBG) of patients at home can provide patients and physicians with valuable information in the management of diabetes mellitus. Objective: The aim of this pilot study was to assess the awareness, attitude and practice of SMBG among primary care diabetic patients in Muscat region. Materials and Methods: The study was conducted in two phases. In the first phase 140 patients attending diabetes clinics at various health centers in Muscat region were interviewed to identify patients who practice SMBG. In the second phase a closed ended questionnaire containing 10 questions related to demographic characteristics and attitude was self administered to 50 patients recruited from the first phase to generate the data. Results: It was found that only one third of the patients use glucometer to monitor their BG at home. However, majority of the patients were aware of the significance and importance of glucose home monitoring and thus recommended the practice of SMBG to other diabetic patients. Participants acknowledged the role of pharmacist in educating and training the patient about the proper use of glucometers. Patients were convinced with the device performance and pricking finger was not a deterrent, but at the same time the frequency of BG monitoring was poor among the participants. Conclusion: Overall the participants had a positive attitude towards SMBG but there is a room for the improvement among the participants who showed poor frequency of BG monitoring. There is a need to aware and educate the Omani diabetic patients about the importance of SMBG to achieve the desired therapeutic goals.

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Background: Physiotherapy or Physical therapy (PT) grew as an allied health professional specialty originally under the field of Medicine, but later took its evolution as a paramedical service - both individually and as part of Rehabilitation. Objective of Study: To quantitatively explore the existing evidence base for physiotherapy/physical therapy in PubMed through review and analysis of current scientific literature. Materials and Methods: Descriptive exploratory study through a literature search was done to identify nine time-points in the timeline from 1970-2010, with five-year intervals to identify the scientific trend. The number of obtained citations were classified and analyzed under the names of search filters of PubMed namely - text availability, publication date, species, article type, language, gender, subject areas, journal categories, and age groups. The numbers for categories and subcategories of search filters were considered for comparison and analysis. Descriptive analysis using frequencies on Microsoft Excel 2010 worksheet was done. Results: There is an exponential increase in number of articles in general over the 40 years. There was more number of 'abstract available' articles. Human studies were more than animal studies. There was more number of clinical trials and randomized controlled trials among the article types. More articles were of English language, with nearly equal gender representation. There were more number of articles on complementary medicine, and MEDLINE journals had more articles, with more in adult and middle-age for study populations. Conclusion: This study provided information on current state of evidence for physiotherapy/physical therapy in a 40-year trend. This trend was similar to overall trend for all articles indexed in PubMed.

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Objectives : The latissimus dorsi muscle is a large, flat muscle that covers the inferior half of the posterior trunk. It is a very useful natural cover that can be utilized to cover even a wide defect. This study is an attempt to study the limitations of the flap and to describe the complications associated with the latissimus dorsi flap at the donor and recipient sites. This was a retrospective analysis of a prospective study conducted during August 2008 to July 2011 (3 years) with permission from the institutional ethical committee. This study included 23 patients (n = 23) with their or their attendants' informed consent. Materials and Methods : The patients were admitted through plastic surgery outpatient department or referred from orthopaedics department. Flap selection was done regarding size, site, shape of defect, status of surrounding tissue, presence of external fixator, mobility of different joints, and patient comfort. Limitations and complications of this flap were recorded and managed accordingly. The data collection and storage was done on pre-formed working Performa sheets. Results were analyzed using statistical analysis including determining average mean (χ) = ∑x ₁ + x ₂ +…….x _n /n and comparison with previous studies. Results: When used as free-flap or pedicle-flap, latissimus dorsi can cover extensive and distant defects without obvious donor site loss of function. The latissimus dorsi muscle and myocutaneous flap in pedicle-flap or free-flap form has provided a consistently reliable method of reconstruction of head and neck, upper limb, lower limb, chest, abdomen, breast, and myelomeningocele. Conclusions: Vulnerability of the vascular pedicle to kink and bulkiness of the flap precluding its use in small defects were few of the limitations seen in this study.

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Background: Glibenclamide is oral antidiabetic drug that belongs to a class of medications known as sulfonylureas. It is indicated for the treatment of Type II non-insulin-dependent diabetes. Aim: The purpose of this work was to improve the dissolution of glibenclamide by utilizing solid dispersion technology. Materials and Methods: Glibenclamide was dispersed in water-soluble polymers; polyethylene glycol (PEG) 6000, and polyvinylpyrrolidone (PVP) using fusion and solvent method, respectively. The solubility and dissolution kinetics of solid dispersions were studied. Results: The effect of various drug:polymer ratios on the equilibrium solubility of glibenclamide was evaluated. The solubility increased as the amount of polymers was increased. Glibenclamide-PVP solid dispersion showed a threefoldincrease in the solubility of glibenclamide as compared to glibenclamide-PEG solid dispersion. The dissolution of dispersed glibenclamide was diffusion-controlled. The hydrodynamic layer thickness is influenced by the stirring rate. The data indicated that increasing the stirring rate decreased the thickness of the hydrodynamic layer. Tablets with an improved dissolution profile as compared to commercial product Euglucon^® tablets were prepared. Conclusions: The solubility and dissolution profiles of glibenclamide were improved by solid dispersion technology. This may lead to enhancement of the bioavailability and efficiency of the drug.

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Context: The publication productivity of colleges of medicine and pharmacy in four Arab universities, namely King Saud University, Assiut University, University of Khartoum and University of Jordan located in Saudi Arabia, Egypt, Sudan and Jordan, respectively, was compared. Aims: To determine colleges' publication contribution relative to their universities and countries in the period 2005-2010. Materials and Methods: The Web of Science bibliographic database was used to determine article publications as well as US patent office and EPO websites were also used to determine the number of international patents. Settings and Design: Publication productivity was analyzed and rankings were constructed based on the number of publications and average number per population or staff members for countries, universities and colleges. The Web of Science bibliographic database for number of published articles and US patent office and EPO websites for number of international patents were used. A one-way analysis of variance was used to describe statistical significance when probability value (P) was less than 0.05. Results: Publication productivity was analyzed and rankings were constructed based on the number of publications and average number per population or staff members for countries, universities and colleges. Colleges of medicine and pharmacy have a contribution of about 25% of the overall university publications for almost all universities. Generally, colleges of medicine had higher percent share than colleges of pharmacy in university publications, with one exception in college of pharmacy in University of Jordan. Conclusion: In general, many universities and colleges of medicine and pharmacy have been established, which could explain the increase in scientific published work in the four Arab countries in the last two decades. However, upon performing a ranking many individual variations were observed depending on the methods used for evaluation.

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Bilateral choanal atresia (BCA) in newborns is thought to be a potentially life threatening anomaly. Unlike unilateral choanal atresia, its' early detection and management is considered to be an emergency. The aim of the present case presentation is an attempt to explain how a newborn, who is an obligatory nasal breather can survive this anomaly and adapt a new pattern of breathing. In this study, we present two rare cases of isolated BCA. According to our knowledge, only few similar cases were reported in the literature. The first one is a 60-year-old female that was discovered accidentally during clinical examination for a different complaint. The second case is a 24-year-old male presenting with bilateral nasal obstruction since childhood. The female declined the offer of surgical interference while the male underwent endoscopic drilling of the atretic plate, no stent was required post-operative. He was followed-up for more than a year with no evidence of restenosis. It can be concluded that isolated missed BCA in infants is compatible with life. Why these patients survive this anomaly, is a topic for discussion. We propose a trial of pacifier as a first line of management to allow the newborn with isolated BCA to adapt a new pattern of mouth breathing, thus avoiding early surgical interference with its risk of complications.

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Testicular torsion is an acute vascular event in which the spermatic cord becomes twisted on its axis, such that the blood flowings to and/or from the testicle becomes impeded. This results in ischemic injury and infarction. Testicular torsion in adulthood is relatively unusual and has a higher morbidity rate. Any delay in the diagnosis can lead to the loss of the spermatogenic function of the testis and an increased risk of orchidectomy. Closed reduction is the initial treatment of choice. Open surgical reduction is recommended for possible testicular torsion or rupture.

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Maxillary ameloblastoma is a benign odontogenic neoplasm. Excision should involve wide margins because of its high recurrence rate and, ideally, be followed by reconstruction. A 23-year-old female patient presented with recurrent ameloblastoma. The recurrent lesion was managed by a total maxillectomy preserving the inferior orbital rim. Reconstruction of midfacial defects after tumor resection or trauma has evolved from skin graft to pedicled flaps and more recently, to free tissue transfer. Each of these reconstructive modalities has its specific indications, advantages, and drawbacks. In our case simultaneous reconstruction was performed with a temporalis myofascial flap for obliteration of the maxillary sinus and nasal cavities. Temporalis muscle is one of the regional flaps that can be used to reconstruct midfacial defects. The muscle is available close to the surgical field and has a constant vascular supply. However, the flap has a limited arc of rotation and most of the muscle bulk is used in the pedicle. Therefore, various modifications of the surgical procedure were attempted in order to increase the arc of rotation of the flap. The temporalis muscle flap can provide a reliable, one-stage reconstructive alternative for more complicated surgical procedures for moderate-sized midfacial defects.

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Our lifestyle has changed much during the last few decades. In the changed scenario the biggest users of health care system are the elderly people. A 65 year old male patient reported to King Khalid University-dental clinics, complaining of inability to masticate, unaesthetic facial appearance and psychological stress. He had multiple missing teeth, severely broken teeth and recurrent aphthous ulcers. Digital photographs displayed on a large monitor helped us to explain to him the dental problems, solutions and their possible consequences. The rehabilitation process started by relief of presenting symptoms, extraction of teeth with hopeless prognosis, periodontal treatment, excavation of carious teeth, root canal treatment for the indicated teeth and restoration of all coronal portion of the remaining teeth. Fixed partial dentures were constructed in the maxillary arch first. The mandibular arch was restored by a combination of fixed partial dentures with extra-coronal attachments joined with removable partial denture following a mandibular transitional denture. Review after 3 and 6 months revealed a marked improvement in the patients' over all condition.

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Objective: Atrial arrhythmias can lead to discomfort and hemodynamic instability. The aim of this study was to determine the incidence and timing of development of atrial fibrillation (AF) after valvular replacement surgery for rheumatic heart disease and to know various risk factors for development of these arrhythmias. Materials and Methods: The study conducted over a period of 30 months with effect from August 2006 to February 2009. Patients of rheumatic valvular disease with normal preoperative sinus rhythm undergoing valve replacement under cardio pulmonary bypass were selected for the study. Results: A total of 28 out of 80 patients (35%) developed AF during the postoperative period in the hospital. Most of the episodes (46.42%) occurred between 24-48 h in intensive care unit (ICU). Age, preoperative history of intermittent AF, systemic hypertension, left atrial size (>50 mm), left ventricular ejection fraction <50%, and aortic cross clamp time >50 min were significantly related to the development of AF in the postoperative period (P < 0.05). Conclusion: Atrial arrhythmias are most frequent in the first 2-3 days after the cardiac surgery, but they can occur at any point in the recovery period. Age, preoperative history of intermittent AF, systemic hypertension, left atrial size (>50 mm), left ventricular ejection fraction <50%, and aortic cross clamp time >50 min are the factors that lead to AF in the postoperative period.

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Background: Fall-related injuries will disable the injured person to earn money or lead to death or will lead the family to the poor economic condition. Aims: To find the case fatality rate, type of fall-related injuries, and the body parts affected by injuries among the hospitalized patients with fall-related injuries from 1 ^st April 2005 to 31 ^st March 2010. Patients and Methods: A retrospective study on hospitalized fall-related injured patients in MOSC Medical college Hospital, Kolenchery, Ernakulam, Kerala, India from 1 ^st April 2005 to 31 ^st March 2010. Data collected from the registers maintained in the medical records department. Z test was used for the comparison of proportions. Results: Of 4530 patients admitted with fall-related injuries during the study period, 2723 (60.1%) were males and 1807 (39.9%) were females. The major types of fall-related injuries were fall on and from stairs and steps (1.3%), fall involving bed (1.4%), fall from tree (3.2%), fall from one level to another (14.1%), unspecified falls (77.75%). While going to injuries, affected on body region were head (42.2%), elbow and forearm (13.1%), knee and lower leg (7.9%), hip and thigh (7.6%). Most of the fall-related injuries were happened in the age group of 15-64 years. Fall-related injuries were happened more in males than in females in the age group of 15-64 years. Fall-related injuries were more happened in females than in males in the age group of >64 years. The case fatality rate due to falls was 2.25%. Of 102 deaths, 74 (72.55%) were males and 28 (27.45%) were females. Proportion of male deaths 74 (2.7%) was more than of females 28 (1.5%) (P = 0.0079). Of 102 deaths, 46 (44.4%) were occurred in the age group of >64 years. Conclusion: Take care and give care is the only policy to prevent the fall-related injuries. Whoever be the injured, wherever it is affected, the injuries always make loss on human work power and national economy. Therefore, the only solution for this is the prevention by ensuring the human physical environment as healthy. In addition to this, much emphasis needs to be given to the older ones while handling them.

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Background: Urodynamic study played a very crucial role in confirming urinary incontinence (UI), differentiating its type and assessing its severity. In addition, it is considered to be the gold standard tool for every patient with UI for directing the line of treatment and for follow up. Objective: To determine the role of urodynamic study in confirming the diagnosis of UI in Iraqi women. Differentiate the type of UI and assess the importance of risk factors in its development. Materials and Methods: This study was performed in the Urology Department, Gazi Al Hariri Hospital, Baghdad Teaching Medical City between January - May, 2011. Seventy five female subjects aged 18 to 78 years were studied (50 patients and 25 control subjects). Medical history, clinical examination and urodynamic tests were performed. Results: Twenty six patients suffer stress UI, 9 patients had urged UI, and 11 patients with mixed UI. Only 4 incontinent patients showed normal urodynamic study. The mean urinary bladder capacity of patients was smaller than those of control subjects, specifically those patients with stress and urge UI. Significantly less volumes of first desire and strong desire to void in most patients than those of control subjects. Urethral pressure profile and urethral closure pressure, values were significantly less in stress and mixed UI patients groups. However, urge and mixed UI patients show significantly higher maximum detrosal pressure. All UI patients have higher maximum urine flow rate and average urine flow rate values. The volume of post voiding residual urine was not different between UI patients groups and control subjects. Conclusion: Urodynamic study has an important role in confirming the diagnosis of UI and differentiating its type.

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