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Abstract Background The impact of wildfire smoke is a growing public health issue, especially for those living with preexisting respiratory conditions. Understanding perceptions and behaviors relevant to the use of individual protective strategies, and how these affect the adoption of these strategies, is critical for the development of future communication and support interventions. This study focused on the use of masks by people living in the Australian community with asthma or chronic obstructive pulmonary disease (COPD). Methods Semi-structured phone interviews were undertaken with people living in the community aged 18 years and over. Participants lived in a bushfire-prone area and reported having been diagnosed with asthma or COPD. Results Twenty interviews were undertaken between July and September 2021. We found that, during wildfire episodes, there was an overwhelming reliance on closing windows and staying inside as a means of mitigating exposure to smoke. There was limited use of masks for this purpose. Even among those who had worn a mask, there was little consideration given to the type of mask or respirator used. Reliance on sensory experiences with smoke was a common prompt to adopting an avoidance behavior. Participants lacked confidence in the information available from air-quality apps and websites, however they were receptive to the idea of using masks in the future. Conclusions Whilst COVID-19 has changed the nature of community mask use over the last couple of years, there is no guarantee that this event will influence an individual’s mask behavior during other events like bushfires. Instead, we must create social support processes for early and appropriate mask use, including the use of air quality monitoring.

Introduction: Concizumab is a once-daily prophylactic treatment in development for haemophilia A or B with or without inhibitors, and it is potentially the first treatment for haemophilia patients to be delivered subcutaneously using a prefilled, multi-dose pen-injector with a 4 mm, 32 G needle. Aims: To assess handling of the concizumab pen-injector and to assess the patient and caregiver preference of the concizumab pen-injector compared with current injection systems used to administer treatment for haemophilia. Methods: Adult and adolescent patients with haemophilia A or B with or without inhibitors and caregivers currently administering factor replacement or factor VIII (FVIII) mimetic therapy were included. After being trained, participants independently prepared and performed all injection steps and administered an injection into an injection pad. Time to train, time to prepare and inject, and the number of complete injections were measured. Participants evaluated handling and preference via the Haemophilia Device Handling and Preference Assessment Questionnaire (HDHPA). Results: 80 participants were included (44 adults, 21 adolescents, and 15 caregivers; 51% factor, 49% FVIII mimetic therapy). The average time to train was 7min49s, the average time to prepare and inject was 1min21s, and 96% complete injections were achieved. 98% (95% confidence interval [CI] 91–100%) of participants found the concizumab pen-injector ‘easy'or ‘very easy'to use. 96% (95% CI 89–99%) reported that the concizumab pen-injector was ‘easier'or ‘much easier'to use compared to their existing device. 88% (95% CI 78–94%) reported a preference for the concizumab pen-injector, 4% (n = 3) reported a preference for their existing device, and 9% (n = 7) reported ‘no preference’. Discussion/Conclusion(s): Patients and caregivers found the concizumab pen-injector easy to learn how to use and easy to use. Most participants reported a preference for the pen-injector compared with their current injection system.

Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.Setting Prospective, international, multicentre, observational cohort study.Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration number NCT04323644

BackgroundThe HIV cascade of care is a framework for monitoring HIV care, identifying gaps and informing appropriate interventions. This study aimed to describe the cascade of care in Oman in 2019 and highlight disparities at the sub-population level.MethodsWe used the UNAIDS Spectrum modelling software to estimate the number of people living with HIV. A national HIV surveillance database was used to identify Omani people (≥13 years old) diagnosed with HIV from 1984 through December 2019. We calculated the cascade indicators as of 31 December 2019 stratified by sex, age, HIV risk factor, residence, and region of HIV care. We also performed multivariate logistic regression to determine the predictors of attrition at linkage, retention, on ART, and viral suppression.ResultsAs of December 2019, the estimated number of people living with HIV in Oman was 2440. Out of the estimated number of people living with HIV, 69% were diagnosed, 66% were linked to care, 61% were retained in care, 60% were on ART, and 55% were virally suppressed. Of the 1673 diagnosed individuals, 96% were linked to care, 88% were retained in care, 87% were on ART, and 81% were virally suppressed. People who received HIV care outside Muscat had the largest attrition (11% loss) in the transition from linkage (97%) to retention (86%). Similarly, people aged 13-24 years had the largest attrition (13% loss) from "on ART" (88%) to viral suppression (75%). Logistic regression showed that both not reporting a specific HIV risk factor and receipt of HIV care outside Muscat independently predicted attrition at each cascade stage from linkage to care through viral suppression.ConclusionsOur findings identified substantial disparities across various subpopulations along the cascade of care in Oman. This analysis will be invaluable in informing future interventions targeting patient subgroups who are at the highest risk of attrition.

Objectives Informing research participants of the results of studies in which they took part is viewed as an ethical imperative. However, there is little guidance in the literature about how to do this. The Fluoxetine Or Control Under Supervision trial randomised 3127 patients with a recent acute stroke to 6 months of fluoxetine or placebo and was published in the Lancet on 5 December 2018. The trial team decided to inform the participants of the results at exactly the same time as the Lancet publication, and also whether they had been allocated fluoxetine or placebo. In this report, we describe how we informed participants of the results.Design In the 6-month and 12-month follow-up questionnaires, we invited participants to provide an email address if they wished to be informed of the results of the trial. We re-opened our trial telephone helpline between 5 December 2018 and 31 March 2019.Setting UK stroke services.Participants 3127 participants were randomised. 2847 returned 6-month follow-up forms and 2703 returned 12-month follow-up forms; the remaining participants had died (380), withdrawn consent or did not respond.Results Of those returning follow-up questionnaires, a total of 1845 email addresses were provided and a further 50 people requested results to be sent by post. Results were sent to all email and postal addresses provided; 309 emails were returned unrecognised. Seventeen people replied, of whom three called the helpline and the rest responded by email.Conclusion It is feasible to disseminate results of large trials to research participants, though only around 60% of those randomised wanted to receive the results. The system we developed was efficient and required very little resource, and could be replicated by trialists in the future.Trial registration number ISRCTN83290762; Post-results.

Introduction: Problem-based learning (PBL) is a kind of teaching- learning method in which students’ role is prime and they learn about a subject by active participation in problem solving. Methods: A total of 96 students studying in second year MBBS program were enrolled into present study. A questionnaire was given to students and they were asked to choose the option they felt about PBL methods. The questionnaire comprised of ten likert items out of which three were negative and seven were positive items. Results: Mean score for each statement in the questionnaire and the overall mean score were calculated. Overall mean score was 3.47. Conclusions: It was concluded that students of second year MBBS at BPKIHS, had a positive attitude towards PBL method of teaching-learning activity. J-GMC-N | Volume 11 | Issue 01 | January-June 2018, Page: 42-45

Background. Clinical education for physiotherapists forms a vital part of undergraduate programmes and equips students with competencies to practise autonomously as qualified health practitioners. However, disparities are evident in approaches to clinical education.Objective. To explore the perceptions of physiotherapy students, community-service physiotherapists and physiotherapy clinical supervisors regarding the clinical education framework at a tertiary institution in South Africa in order to understand preparedness of students for practice.Methods. A case study approach with two focus group discussions with students and interviews with community physiotherapists and clinical supervisors was employed. Data were analysed and categorised into key themes and sub-themes.Results. Five themes emerged from triangulation of data from the three groups: preparedness for professional practice, institutional barriers, curriculum disputes, personal factors and recommendations for physiotherapy clinical education. Students felt inadequately prepared owing to a perceived lack of exposure to certain aspects of physiotherapy, while community therapists believed that reflection on the undergraduate programme after qualifying contributed to their adequate preparation. Clinical supervisors supposed that students would benefit from actively engaging with teaching and learning opportunities, and clinical personnel collaboration was seen as key to facilitate a continuum in clinical education from classroom to healthcare setting.Conclusion. Participants reported that the existing curriculum structure may need to be revisited to address various issues, while holistic collaboration between students, supervisors and clinical personnel is imperative to create a cohesive learning environment.

Objective: To observe difference in the management of blunt trauma to the chest on the basis of conventional xray and computerised tomography of the chest. Methods: This prospective study was conducted between December 2011 to October 2012 in COMS in Bharatpur,a tertiary referral centre in central Nepal . Clinically stable thoracic injury patients were first evaluated with chest x-ray and the management on this basis was recorded. The findings of the CT chest were assessed and the type of management on the basis of CT was also recorded. Outcome was assessed in terms of mortality, morbidity, hospital and ICU stay with respect to the management on the basis of chest x-ray and CT scan. Results: Of the 129 patients, 74.4% were male and 25.6% were female with the patients ranging in age from 7 to 87 years (mean = 40.41 years). The most common mechanism of trauma to the chest was as a result of a motor vehicle accident (69.8%), followed by fall injury (20.2%). X-ray chest diagnosed rib fracture in 62%, haemothorax in 37%, pneumothorax in 27%, lung contusion in 10% and haemopneumothorax in 21% patients. Similarly CT chest diagnosed rib fracture in 86%, haemothorax in 54%, pneumothorax in 36%, lung contusion in 30% and haemopneumothorax in 30% patients. Mean hospital stay was 9.5 days in the group of patients having management on the basis of x-ray chest relative to mean stay of 10.2 days in the CT- chest group. In the management on the basis of xray group, there was a mean ICU stay of 2.8days compared to mean stays of 3.2 days in CT chest group. Conclusion: Though CT scan of the chest is more informative and differs the management of the blunt chest trauma, one should not forget to advise the cost effective, easily available and initial guiding agent, xray chest for early management of the chest injury patient. DOI: http://dx.doi.org/10.3126/jcmsn.v10i1.12764 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(1); 22-31

Objectives: Thoracic injury is a challenge to the thoracic surgeon practicing in developing countries. This prospective study was conducted to see the mode of injury, injury types and overall outcome of thoracic injury in our settings. Materials and methods: This prospective study was conducted in 100 thoracic injury patients between December 2011 to June 2012. The demographic features, type of the trauma, radiological assessment, associated organ injuries, management of the injury, surgical interventions, morbidity, mortality, length of hospital stay were analysed. Results: In this study the ages ranged from 7 to 84 years. There were 73 (73%) males and 27 (27%) females. The majority of patients (83%) were injured during the evening and night time. The majority of patients 92(92%) sustained blunt chest injuries. The mechanism of injury was not significantly associated with length of hospital stay (P > 0.05) and mortality (P > 0.05).Road traffic accident was the most common cause of injuries affecting 68(68%) of patients followed by fall injury of 19(19%). Rib fractures, haemothorax, pneumothorax and lung contusion were the most common type of injuries accounting for 83.0%, 57%,34% and 33% respectively. Associated extra-thoracic injuries were noted in 64.0% of patients. 45(45%) of the cases of haemothorax, pneumotharax and haemopneumothorax were treated by tube thoracotomy. Four patients (04%) had undergone thoracotomy. There were 09(09%) patients of flail chest and treated conservatively. Fourty six patients (46%) were admitted in the ICU. Eleven (11%) patients were treated with ventilator support. Seventeen (17%) patients had complication. The overall length of hospital stay ranged from 0 to 25 days. Conclusion: Road traffic accidents and fall from height are the major public health problems. Preventive measures at reducing road traffic accidents and timely management with closed tube thoracotomy are the main factors to be considered in the thoracic injury. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, 30-39 DOI: http://dx.doi.org/10.3126/jcmsn.v9i1.9671

INTRODUCTION A widely used in vitro culture, the neurosphere assay (NSA) has provided a means to retrospectively identify neural progenitor cells as well as to determine both their selfrenewal capacity. Objective of study was to isolate and compare growth of the embryonic neuronal stem cell and adult neuronal stem cells in presence of Epidermal Growth Factor (EGF) and Fibroblastic Growth Factor (FGF2). MATERIALS AND METHODS Embryonic neuronal stem cell were collected from cortical plate of dorsal telencephalon of fifteen C57BL/6 transgenic mice using stereoscopic microscope on 11th gestational day (GD). Adult mammalian neuronal stem cells taken from subventricular zone (SVZ) of the lateral ventricles and subgranular layer of the dentate gyrus of the hippocampus were cultured. The growth for the neurosphere was then observed in interval of 24 and 72 hours. RESULT The adult stem cell culture showed few intact cells with high amount of debris and 9% heterogeneous sphere after 24 hours while only 20 % was observed at the end of 72 hours. Higher proliferation rate was observed in embryonic neurospheres than the adult stem cell culture. CONCLUSION Presence of EGF and basic FGF2 is essential for culture of neurospheres.DOI: http://dx.doi.org/10.3126/jcmsn.v10i2.12946 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2); 1-3

Objective To determine the effectiveness of the duplex ultrasonography scanning in the management acute peripheral arterial injury. Materials and methods Its a prospective evaluation comparing duplex scanning with operative exploration finding in 78 patients.Duplex scan was used alone for 98 patients having clinical finding of acute vascular insufficiency. Results Duplex scanning had 100% sensitivity and 95.23% specificity compared with operative exploration in the 78 cases. Duplex scanning detected 78 injuries, 77 of which were confirmed by correlation with operative exploration and 20 patients did not have vascular injury. One false-positive result was due to spasm of the superficial femoral artery. Conclusions Duplex scanning is a noninvasive, safe, effective , rapid and lesion localising method of initial evaluation for acute peripheral vascular injury having clinical features of vascular insufficiency. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-3, 36-42 DOI: http://dx.doi.org/10.3126/jcmsn.v8i3.8684

Aims Arteriovenous fistula is considered as reliable form of vascular access for hemodialysis in Chronic Kidney Disease (CKD) patients. We aim to evaluate prospectively, the outcome and primary failure rate of Arteriovenous fistula in 30 Chronic kidney Disease patients with Glomerular Filtration Rate (GFR) Materials and methods This prospective study was conducted at the department of cardiothoracic and vascular surgery (CTVS), College of Medical Sciences, Bharatpur from May 2011 to May 2012. Thirty patients ranging from age 25 to 76 years with stage IV and V CKD, i.e. GFR below 30ml/min, were included in this study. Detailed physical examination including arterial pulses i.e. axillary, brachial, radial and ulnar and blood pressure in both upper limbs was recorded. Allens test was performed on every patient and left upper limb was used for AV fistula formation. Brachiocephalic fistula was made in 19 (63.33%), while radiocephalic fistula was made in 11 (36.67%) patients. Patients were evaluated post operatively, on outdoor basis, weekly for 6weeks. All patients were evaluated for the presence or absence of complications i.e. infection, hematoma, thrombosis, aneurysms and steal syndrome. Results The complication was primary failure in two patients. One male patient got secondary infection and one female patient got post operative hematoma leading to 6.66% primary failure of fistula. No other complications were noted. Conclusion Arteriovenous fistula is the gold standard for vascular access for hemodialysis in patients with deteriorating renal function and end-stage renal disease. It is designed to improve the effectiveness of dialysis with fewer risks and complications than other vascular accesses. This study gives the higher success rate of 93.33% and concludes that age should not be a limiting factor when determining candidacy for arteriovenous fistula creation and is the safe procedure. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-4, 1-6 DOI: http://dx.doi.org/10.3126/jcmsn.v8i4.8693

Retrorectal tumor is uncommon identity presenting with nonspecific sign and symptoms making difficulty in diagnosis. Benign tumors are more common than malignant. The lesion may be malignant or progress to malignancy from benign state. Retrorectal masses in young women may continue to grow and result in dystocia. Cystic lesions are also at risk of becoming infected, which renders subsequent excision more difficult and increase the risk of recurrence. Cross-sectional imaging is required to determine the extent of resection and the appropriate surgical approach. Surgical removal leads to favorable outcomes for patients with benign purely cystic retrorectal tumors. We report two such benign rectal lesions. ] Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-4, 46-50 DOI: http://dx.doi.org/10.3126/jcmsn.v8i4.8701

Introduction: Since 2 decades laparoscopichernia repair has gained key role in uncomplicated inguinal hernia surgery with advantages showed by several trials and guidelines. However, its role in complicated inguinal hernia such as incarcerated, obstructed and inguino-scrotal is debatable. Cases of large inguino-scrotal raises objection to laparoscopic procedure because of anticipated problems and complications in dissecting extended hernia sac even though posterior approach is advocated as repair of choice for complicated cases. Here, we reviewed our series of patients undergoing TEP in a limited time frame. Method: Between March 2013 and June 2014, 50 consecutive patients underwent TEP repair for inguinoscrotal hernia. Patient demographics, hernia characteristics, operating time, surgical technique, conversion rate, intraoperative, postoperative complications and recurrence was recorded and analyzed using MS Excel. Results: 50 patients were recorded, 26 had unilateral and 24 had bilateral hernias. Mean age was 52 (22-72) years. The mean operation time was 70 (50-140) min. Bilateral repairs took 45% (18 min) longer than for unilateral repairs (52 + 12 min). Two (12.5%) patients required combined open surgery to transect the incarcerated omentum. There was no mortality. Morbidity was limited to asymptomatic seroma formation in 2 (12.5%) patients; 1 patient of combined open-TEP approach had wound infection, both treated conservatively. Mean follow up was 6.3 months; we recorded 2 recurrences (12.5%). The mean length of hospital stay was 1.8 days. Conclusion: We conclude that TEP can be safely employed for complicated inguinal hernias repair. Surgical experience in mandatory with tailored technique to reduce morbidity and achieve good clinical outcome with acceptable recurrence rates.

Total 5 pediatric hepatectomy were performed at IOM TUTH during last 2 years. Three children were cases of hepatoblastoma and two were cases of symptomatic focal noduler hyperplasia (FNH). Two left hepatectomy for left hepatoblastoma, one right hepatectomy for right hepatoblastoma were performed and 2 non-anatomical resection of mass with 2 cm margin for focal nodular hyperplasia were performed. Median hospital stay was 7 days. Post operative period at hospital was uneventful. Three cases of hepatoblastoma received neoadjuvant and adjuvant chemotherapy. Among 3 cases of hepatoblastoma, there was one mortality due to severe sepsis when he was on adjuvant chemotherapy. Other 4 cases are living without recurrence.

Introduction: Standard recommendations for patients recovering from an episode of biliary pancreatitis include cholecystectomy with intra operative cholangiogram or ERCP during the same hospital admission as it is believed that the instigating factor is the passage of stones through the common bile duct. As ERCP is not widely available and expensive, cholecystectomy with IOC is routinely performed to rule out choledocholithiasis. However detection of common bile duct stones is challenging. Whether these patients undergoing cholecystectomy require direct common bile duct evaluation is controversial. Objective of the study was to see the presence of common bile duct stones in patients with resolving acute mild biliary pancreatitis. Methods: Patients admitted in the surgical ward in Patan Hospital and Bir Hospital with the diagnosis of mild acute biliary pancreatitis who underwent cholecystectomy with intra-operative cholangiography from August 2010 to July 2012 were studied. The outcome of cholangiogram was analyzed together with findings of common bile duct exploration. Results: A total of 52 patients with acute mild biliary pancreatitis were operated during this period. The common bile duct stone was found in 1.9%. Out of four patients with abnormal cholangiogram, only one patient (25%) had stone on exploration, rest of the three cases (75%) had negative exploration. Conclusion: The presence of common bile duct stone in case of mild acute biliary pancreatitis undergoing cholecystectomy is very low (1.96%), and thus policy of selective IOC should be applied for cases with mild biliary pancreatitis. Journal of Society of Surgeons of Nepal Vol.17(1) 2014: 11-15

Injuries following wild animal encounters continue to be a major public health problem. Majority of such injuries are minor, however, many injuries remain undocumented. Many victim die, primarily in third-world countries, before receiving adequate medical care. Penetrating injuries to the chest following the attack by the wild animals, though rare, present a challenging problem. Though a great number of papers have been published regarding the injuries following encounter with animals, least are the lethal injuries occuring in the thoracic region and the survival out of these grave injury is very minimum. We herein present the least possible surviving case with lethal penetrating injury of the chest and left lung following the goring by the rhinoceros. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-1, 52-55 DOI: http://dx.doi.org/10.3126/jcmsn.v8i1.6827

Background and Objectives: the purpose of this study was to clinically evaluate and compare the efficacy of "Brush Buddies" musical tooth brush and Colgate Smile tooth brush in the reduction of established plaque and gingivitis. Materials and Methods: for this study, 120 healthy kids (73 boys and 47 Girls) were selected. The subjects were randomly assigned into two groups by a second examiner; one group used Colgate Smile brush and the other group used "Brush Buddies" musical tooth brush. Plaque index (Quigley and Hein), Modified Gingival Index (Lobene and Associates) and Gingival Bleeding Index (Ainamo and Bay) were assessed at baseline, 30th day, 60th day, and 90th day. Results: all the baseline indices appeared to be well balanced. At the end of the study, reduction in plaque index, modified gingival index and gingival bleeding index were statistically highly significant during each interval for both the toothbrushes. For "Brush Buddies" musical tooth brush, the reduction in all clinical parameters were statistically significant for 30 days and 60 days interval, while nonsignificant at 90 days interval. Interpretation and Conclusion: both the tooth brushes used in this study were clinically effective in removing plaque, improving gingival health. Musical tooth brush is more effective initially but as the time period increases both tooth brushes give almost similar results.

Introduction: The IMPROVE Control Training program was designed by Indian Academy of Diabetes (IAD), and a non-intervention study was conducted to evaluate the effectiveness of this standardized healthcare professionals (HCPs) training program on achieving treatment goals in patients with diabetes mellitus and its impact on standard of care. Materials and Methods: This multi-center, parallel group, open-label, non-randomized, non-intervention study included patients with type 2 diabetes who had an HbA1c >9 at time of diagnosis or an HbA1c >7% even after 6 months of initiation of therapy with anti-diabetic agents (Oral anti diabetic agents (OADs) and/or insulin). The data recorded at baseline included demographic characteristics, medical history, and the treatment regimens. Results: The study included 20,493 patients with diabetes, of which 13,295 (64.9%) were men. The mean [standard deviation (SD)] duration of diabetes was 6.4 (4.2) years and 6608 (32.2%) reported complications of diabetes. Poor glycemic control [HbA1c = 9.4 (1.3), FPG (mg/dl) = 181.2 (45.7); mean (SD)] was observed. The postprandial glucose was also high [post-breakfast, lunch, and dinner values in mg/dl were 263.6 (68.5), 278.1 (69.6), and 250.2 (63.7), respectively] in these patients. Failure of OADs was the most common reason cited for initiation of insulin. Premixed insulin was rated the regimen of choice for initiating therapy by the physicians (62.2% vs. 34.5% who preferred basal insulin). Conclusion: The baseline results confirm the poor glycemic control and the delayed initiation and/or inadequacy of treatment in subjects with type 2 diabetes. These results also highlight the need for early and optimal insulin-based therapy.

Objective: To compare the efficacy and safety of sustained release (SR) formulation of pregabalin with immediate release (IR) formulation in patient with diabetic peripheral neuropathic pain. Materials and Methods: In this open label, randomized, comparative, multicentric study, the primary efficacy measure was reduction in visual analogue scale (VAS) of short form McGill pain questionnaire (SF-MPQ) score from baseline to last visit. The secondary evaluation measures included reduction in SF-MPQ descriptive score and present pain intensity score and change in clinical global impression - improvement of illness (CGI-I) and clinical global impression - severity of illness (CGI-S) from baseline to last visit. Total duration of the study was 12 weeks. Safety evaluation was done by recording treatment emergent adverse events and laboratory investigations at baseline and end of treatment. Results: Of 265 randomized patients, 133 received pregabalin SR tablets and 132 pregabalin IR. Patients randomized to both treatments responded to respective treatments. The least square means of VAS score in both the groups were reduced significantly (P

Background: In 2009, a novel task-shifting programme was started in rural Uganda to create access to quality acute and emergency care. Collaborative partners on the project are the Global Emergency Care Collaborative and Karoli Lwanga “Nyakibale” Hospital, Rukungiri, Uganda. One element of this training programme for non-physician emergency-care practitioners (ECPs) is the use point-of-care ultrasound for common emergency applications. As in much of sub-Saharan Africa, radiological diagnostic testing is insufficient in the district hospital's emergency department in which the ECP programme is conducted. X-ray and comprehensive ultrasound is potentially accessible during daytime hours only; however, it is sometimes limited by insufficient availability of materials and trained staff. Methods: The use of point-of-care ultrasound has been taught to ECPs through didactic and bedside teaching. As part of the basic curriculum, lectures are given on the use of emergency ultrasound; basic ultrasound physics and safety; extended focused assessment with sonography for trauma (E-FAST); ultrasound-guided nerve blocks; echocardiography; hepatobiliary ultrasound; lung, skin, and soft tissue ultrasound; and obstetric ultrasound. As the programme and skills of the ECPs have advanced, additional ultrasound applications have been added to the curriculum including aorta, renal, Deep vein thrombosis, inferior vena cava, and appendiceal ultrasound. In addition to the lecture component, bedside teaching is a major component. Visiting board-eligible or certified emergency physicians with advanced ultrasound training intermittently proctor exams at scheduled intervals with each emergency care practitioner throughout the course of their training. Findings: Through the course of this training programme, non-physician practitioners have integrated the use of bedside ultrasound into their clinical practice of emergency care. Interpretation: In a rural resource-limited setting where other diagnostic imaging is insufficient, bedside ultrasound can be taught to non-physician emergency practitioners to diagnose a myriad of emergency disorders. Funding: None.

Introduction: Femoral shaft fractures are among the most common major pediatric injuries treated by orthopaedic surgeons. Treatment ranges from strictly nonsurgical methods to surgical stabilization. Operative treatment of femoral shaft fractures in children with intramedullary nails (Ender’s and titanium elastic nails) is increasing because it has advantage of early mobilization, rapid healing and better control of alignment. Objectives: We evaluated the results of Ender’s nails fixation in femoral shaft fractures in children. Method: We studied 40 children with 40 femoral shaft fractures in age group 5-15 years. There were twenty four fractures in middle third, 7 in distal third and 9 in proximal third. Twenty fractures were transverse, 8 were oblique and 6 were spiral. Communition was seen in 6 cases. They were treated by closed reduction and Ender’s nail fixation. Retrograde fixation was done in 38 cases, in 2 cases antegrade fixation was done. Result: The mean follow up was 7.5 months. The average time to partial weight bearing was 3.8 weeks (2 to 6wks). The average time to full weight bearing was 8 weeks (6 to 12 wks). Union was achieved in all patients within a mean of 11 weeks (8 to 16 wks). Two patients had varus angulation of 8° and 6° each, whereas one had valgus angulation of 8°and one had anterior angulations of 10°. Lengthening of 1.2 cm was observed in one patient. In one case skin irritation due to nail was observed and that subsided without intervention. According to the Flynn criteria 34 had excellent and 6 had satisfactory results. No poor results were seen. Conclusion: Ender’s nail fixation can be preferred method of treatment for femoral shaft fractures in age group 5 -15 years as the results are excellent and satisfactory. It is technically simple and can be done in a closed manner. It spares the vascularity and growth plate.

This research contributes to helping educational establishments across the world develop self-efficacy techniques to improve communication skills within an accounting course design and other disciplines. This paper asks the research question: Does self-efficacy enhance accounting students' communication ability? Previous research has identified the business community requiring accountants to display high levels of communication ability. However, despite many deliberate pedagogical interventions over the years, communication skills are lacking in graduating accounting students. This paper describes a new approach of deliberate self-efficacy interventions in one UK university's undergraduate accounting curriculum to improve accounting students' communication ability. In addition, a self-efficacy framework of Stone and Bailey [(2007). Team conflict self-efficacy and outcome expectancy of business students. "Journal of Education for Business," 82(5), 258-266. https://doi.org/10.3200/JOEB.82.5.258-266.] is developed to model communication self-efficacy, outcome expectancy and behavioral intentions of the students. The data consists of the results of 131 first-year accounting students, and this paper contributes by helping to pinpoint two self-efficacy techniques to improving students' communication skills: 'personal mastery' and 'mentor support'.

Context: PID is a fairly common problem among woman and usually reflects long and often neglected story of reproductive morbidity. Aims: To study the social dimensions of health seeking behavior of PID patients reporting to Shree Sayaji General Hospital (SSGH), from the beginning of their morbidity till they reached the clinic; vocabulary used in describing the morbidity and social support available during their morbidity. Study Settings: SSGH Vadodara, a tertiary care referral hospital in the city. Study Design: In depth interview with multiple contacts Methods and Material: 120 patients of PID who came to SSGH were enrolled in the study. In depth interview technique was used for data collection and up to 3 sessions were conducted with them after taking their consent. Results: The treatment seeking pathway showed an average of three health care contacts before a patient reached SSGH. On an average, rural patients took more than 5 years while urban patients took 2 ½ years to reach SSGH with multiple contacts with other care givers prior to reaching SSGH. The most common presenting complaints were white discharge, pain in lower abdomen and backache. In 18% of patient’s decision for seeking treatment in SSGH was taken by the husband and in 39% of cases it was taken by patient and in 38% of cases it was taken jointly. Conclusions: The common pattern for health seeking behavior emerged as multiple contacts and substantial delay before a patient reached tertiary care unit hospital and rural patients took longer time to reach as compared with urban patients.

This research article identifies the contributions of PhD faculty members of Higher Education Institutions (HEIs) in Sindh Pakistan offering degrees in the environment discipline through published articles in journals, conference proceedings, research project reports and focused areas of research. The content analyses of curriculum vitae data of PhD faculty members is carried out in this article. As an outcome a methodology is developed which compares the conducted research with existing environmental issues existing in Sindh Pakistan. In total, 696 research contributions of PhD faculty members of HEIs offering degrees in field of Environmental Engineering & Environmental Sciences were explored. The PhD faculty members have disseminated their research by publishing 192 articles in international and 148 in national journals, presenting 71 papers in national and 117 papers in international conferences, 146 research project reports and 22 scholarly books. This research has identified different focused research areas chosen by PhD faculty members related to environmental issues in Sindh such as Waste Management, Water Quality, Environmental Resource Management, Water Management, Plant Biodiversity, Renewable Energy, and Air Pollution. While environmental issues in Sindh such as; Marine Pollution, Noise Pollution, Desertification, Deforestation, Agrochemicals, Sea Intrusion, Risks of Oil Spills at Ports, Climate Change, Global Warming, Ozone Depletion, and Acid Rain remained less focused by those PhD faculty members. This research concluded that larger numbers of research papers are published related to different environmental issues in Sindh but yet these problems remained unsolved. The finding suggests that academic research is making less impact on solution of local problems.