Notes

H2o tension and dysfunction of mycorrhizas cause parallel shifts in phyllosphere microbiome composition.
Healthcare workers (HCWs) with MRSA nasal colonisation pose a serious threat of passing on the infection to patients. A cross sectional study was designed to investigate the effect of ablution on MRSA nasal colonisation and was conducted at the Department of Pathology, King Edward Medical University. A total of 220 nasal swab samples, 110 from ablution performing HCWs and 110 from non-ablution performing HCWs were processed for the identification of Staphylococcus aureus and sensitivity testing for Cefoxitin. In the ablution performing group, 11(10%) HCW were harbouring Staphylococcus aureus in their nose, while in non-ablution performing group 32 (29%) HCWs had colonisation of Staphylococcus aureus. Frequency of MRSA colonised HCWs was 9/11 (82%) in ablution performing group, while in the non-ablution group 16/32 (55%) had MRSA in their nose. Logistic regression analysis demonstrated that the duration of working experience and non-performance of ablution are the potential risk factors.In December 2016 physicians in Karachi, Pakistan,witnessed an increase in patients presenting with febrile illness and severe polyarthralgia. Subsequently, chikungunya virus (CHIKV)) was isolated from three patients. This virus was sequenced and compared with other isolates of CHIKV obtained in India and Pakistan during recent outbreaks. Phylogenetic analysis indicated that the Karachi isolates were most similar to the East Central South African CHIKV lineage and showed sequence homology to isolates obtained in other parts of Pakistan and India. More importantly, two of the CHIKV isolates had a nucleotide substitution in the E1 gene corresponding to an amino acid change at chain F portion of the E1 protein.
To identify nursing instructors' clinical education competencies.

The integrative review comprised research articles published between 2008 and 2018 on Medline, Scopus, Web of Science and Education Information Resource Centre databases searched through relevant key words. All the short listed papers were reviewed and quality assessment was done. Data was analysed using content analysis method. selleck compound Nursing instructors' clinical education competencies were extracted from the original texts in the form of initial codes which were categorised into subcategories and categories based on comparisons of their similarities and differences. Finally, themes were extracted as expression of content hidden in the data to generate new insights.

Of the 17 studies selected, 6(35.3%) were quantitative, 4(23.5%) qualitative, 3(17.6%) review studies and 4(23.5%) were mixed-methods studies. Three overarching themes identified were clinical teaching process competencies, students' supervision competencies in clinical settings and nursing instructors' professional ethics.

The review provides insightful information on nursing instructors' clinical education competencies. Nursing educational institutions need to be encouraged to incorporate these concepts into educational curricula to empower nursing instructors and to enhance the quality of clinical education.
The review provides insightful information on nursing instructors' clinical education competencies. Nursing educational institutions need to be encouraged to incorporate these concepts into educational curricula to empower nursing instructors and to enhance the quality of clinical education.Hepatocellular carcinoma is the sixth common cancer diagnosed and fourth leading cause of cancer-related deaths worldwide. Its incidence is on rise due to increasing prevalence of chronic hepatitis C virus infection. Pakistan is ranked second in countries burdened by hepatitis C virus in the world. Management of hepatocellular carcinoma is complex as it develops on the back of liver cirrhosis, and the risk of mortality is an accumulation of both tumour-related factors as well as liver decompensation. A multidisciplinary tumour board is an ideal approach to improve the outcomes of hepatocellular carcinoma since this ensures assimilation of input from a diverse group of care-providers, including hepatobiliary and transplant surgeons, gastroenterologists, interventional radiologists, oncologists and palliative care specialists. A multidisciplinary tumour board provides tailored approach to individual cases in a timely fashion to avoid treatment delays and communication gaps to improve the overall outcomes.
To compare the difference in "memory recall" among undergraduates (UGs) and postgraduates (PGs) medical students reading printed text (hard copy) vs. on-screen text (soft copy).

Final year UGs medical students (Group A) were divided into two batches, one batch was given hard copy of 1258 worded text and other group was given a soft copy of the same text. Likewise PGs (Group B) were divided into two batches, each batch was given hard copy and soft copy of the same text material with identical physical attributes. All batches were asked to read the text in 15 minutes. Text was then removed and a proforma containing statements pertaining to recall of the text material was administered to all.

The scores of students reading soft copy text were significantly higher compared to student reading text from hard copy (p<.008) in the proforma assessing memory recall.

The memory recall from reading on screen text is better than reading printed (paper) text, implying that with the advancement of technology and early exposure to computer screen, students are developing the habit of reading on screen text more conveniently.
The memory recall from reading on screen text is better than reading printed (paper) text, implying that with the advancement of technology and early exposure to computer screen, students are developing the habit of reading on screen text more conveniently.
To perform a clinical audit of the practices related to the management of third and fourth degree perineal tears.

The retrorspective study was conducted in 2019 at the Aga Khan University Hospital, Karachi, and comprised medical records from January 2008 to December 2018 of women having singleton term vaginal delivery and sustaining obstetric anal sphincter injuries. The change in practices regarding tear management was compared with a previous audit done at the same institution in 2008. Data was analysed using SPSS 20.

Of the 25,370 deliveries, 142(0.56%) sustained obstetric anal sphincter injuries. There was a significant increase compared to the previous audit in terms of documentation of the method of repair, use of delayed absorbable suture material for the repair of external anal sphincter and follow-up at 6 weeks to see the success of repair and plan the next delivery (p<0.05). The use of vacuum vaginal delivery increased to 27(19%) from 5(4%), but there was decrease in injuries complicated by instrumental vaginal deliveries (p<0.05).

Despite the increase in the number of deliveries, the frequency of obstetric anal sphincter injuries remained similar to the previous audit, indicating that regular clinical audits are integral to keeping clinical practice in accordance with the established standards.
Despite the increase in the number of deliveries, the frequency of obstetric anal sphincter injuries remained similar to the previous audit, indicating that regular clinical audits are integral to keeping clinical practice in accordance with the established standards.
To evaluate indications for insertion, complications and indications of central venous port catheters, and to identify indications for their removal.

The retrospective study was conducted at Okmeydani Training and Research Hospital, Istanbul, Turkey, and comprised data from January 2006 to June 2014 of patients who had central venous port catheters. The indications for removal of the catheters were also evaluated.

Of the 1198 patients whose records were reviewed, 605(50.5%) were women and 593(49.5%) were men. The overall mean age was 52.3±12.78 years. Of the total, 1142(95.33%) cases related to chemotherapy treatment. There were 127(10.6%) complications; the most common being catheter occlusion 46(36.2%). The catheters were removed in 182(15.2%) patients. Among them, 83(45.6%) catheters were removed because they were no more needed.

In the light of the findings, there is a need for standardised guidelines for evaluation before central venous port catheter insertion and follow-up after insertion to detect and to avoid possible complications.
In the light of the findings, there is a need for standardised guidelines for evaluation before central venous port catheter insertion and follow-up after insertion to detect and to avoid possible complications.
To determine the prevalence and determinants of prediabetes among adolescents.

The cross-sectional study was conducted at a public-sector medical university in Quetta, Pakistan, from December 2019 to February 2020, and comprised students aged 16-19 years. A self-administered questionnaire was used to gather socio-demographic data. Fasting blood sample was taken to measure the fasting plasma glucose level, lipid profile and glycated haemoglobin levels. Height, weight, neck circumference and waist circumference were also measured. Data was analysed using SPSS 21.

Of the 351 subjects, 158(45%) were males and 193(55%) were females. The overall mean age was 18.81±0.41 years. Of the total, 81(23.1%) participants were found to have prediabetes. Neck circumference was identified as the strongest predictor for prediabetes, followed by high level of triglycerides, high systolic blood pressure, low levels of high-density lipoproteins, high levels of low-density lipoproteins, high diastolic blood pressure, waist circumference and body mass index (p<0.05). There was no significant difference in the prevalence of prediabetes among male and female students (p>0.05).

There was no significant difference in the prevalence of prediabetes among male and female medical students. Neck circumference, Waist circumference, Body mass index, systolic blood pressure, Diastolic blood pressure, Triglyceride and High density Lipoprotein were strong predictors of prediabetes in adolescent population.
There was no significant difference in the prevalence of prediabetes among male and female medical students. Neck circumference, Waist circumference, Body mass index, systolic blood pressure, Diastolic blood pressure, Triglyceride and High density Lipoprotein were strong predictors of prediabetes in adolescent population.
To determine the reasons of neonatal referrals from secondary-care to tertiary-care setting, and to assess neonatal outcomes for the referred cases.

The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data from July 2015 to June 2019 Related to all neonates born after 32 weeks of gestation at the satellite secondary-care centres in Kharadar, Garden and Karimabad who had been referred to the main tertiary care hospital. The reason for referral, need of mechanical ventilation, referral place and neonatal outcome were noted. Data was analysed using SPSS 22.

Of the 348 cases, 211(60.6%) were boys. The overall mean gestational age was 36.42±2.61 weeks and the mean birth weight was 2.54±0.67 kg. The outcome was neonatal mortality in 42(12%) cases. Of the remaining 306(88%) cases, 284(92.81%) were discharged from the hospital and 22(7.18%) left against medical advice. Overall, mechanical ventilation was needed in 63(18.1%) patients. There was a significant association of mechanical ventilation with low Appearance, Pulse, Grimace, Activity, and Respiration score at 1 and 5 minutes (p<0.
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