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Background and Aim: Informal prescribers (IPs) significantly contribute to the development of antimicrobial resistance and in disseminating pathogens from poultry to humans and other animals through the food chain, posing a serious global health threat. Therefore, this study aimed to assess whether the knowledge of IPs has an impact on their attitude and practice toward antimicrobial use, antibiotic residues, and antimicrobial resistance. Materials and Methods: In this cross-sectional study, we conducted a pre-tested and questionnaire-based survey to investigate the knowledge, attitude, and practice of IPs in selected parts of the Mymensingh division, Bangladesh. Then, we used the linear regression model test with R-squared (R2) to measure the association between the study variables. Results: Our investigation revealed that 70% of the IPs knew about antibiotics and 75% had good knowledge about antibiotic resistance, whereas only 50% were aware of withdrawal periods. Informal prescribers also displayed good attitudes toward the use and sale of antibiotics with withdrawal periods and completion of medication (50%). Analysis of their practice on the sale and prescription of antibiotics showed that 70% and 30% of IPs use antibiotics against bacterial infections and other conditions, respectively. Most of them do not consult a veterinarian before selling or prescribing antibiotics, although 80% claim to do so. This is because 75% of IPs gave other options regarding their consultations. However, 95% of IPs uses antibiotics only for therapeutic purposes. Furthermore, only 10% sell antibiotics based on a veterinarian’s recommendation. Approximately 45% of IPs use single antibiotics at a time, while the rest use multiple antibiotics, individually or combined. Approximately 15% use antibiotics monthly, while 85% use them whenever the need arises. The knowledge and attitude of IPs are significantly affected by their age (p ≤ 0.025). The district of domicile also impacted their knowledge. Surprisingly, IPs from Jamalpur had significantly better knowledge compared to those from Mymensingh and Sherpur (p ≤ 0.01). The attitude of IPs from Jamalpur and Netrokona also differed significantly (p ≤ 0.001) from that of Mymensingh and Sherpur. The knowledge of IPs influenced their attitude up to 80.5% (r2 = 0.628) and their practice up to 75.4% (r2 = 0.545). Conclusion: The knowledge of IPs greatly influenced their attitude and practice, while sociodemographics also influenced their knowledge and attitude toward antimicrobial use, antibiotic residues, and antimicrobial resistance.

Objective: To develop faculty consensus of orthodontic learning outcomes associated with knowledge and skills of “Treatment” required for undergraduate students. Study Design: Qualitative study Place and Duration of Study: Islamic International Dental College, Islamabad, 15th January, 2016 to 15th March, 2016. Materials and Methods: A Delphi method was used in two rounds to develop consensus by orthodontic faculty from various dental colleges of Pakistan. Learning outcomes related to skills were formulated in the form of a questionnaire and sent to study participants. A five point likert scale was used to obtain perception of dental faculty. Later, a qualitative approach was adopted by giving open ended questions associated with skills required in “Treatment” part of undergraduate orthodontic course. The quantitative data was analyzed by using SPSS version 20. The qualitative data was obtained and analyzed using NVivo version 11. Results: Twenty participants (N= 20) responded with their feedback to closed-ended first questionnaire and sixteen participants responded to the second open-ended questionnaire. Out of the 28 learning objectives, participants achieved consensus on 21 items particularly on knowledge and skills related to treatment planning for mixed dentition in first round. Whereas in second round, out of seven non consensus items, two learning objectives, three dimensional location of maxillary canine and skill in fabrication of functional appliances could not achieve consensus. Conclusion: The orthodontic faculty agreed that undergraduate students must have skills of history taking, oral examination, x-ray, and removable appliances for orthodontic discipline.

Abstract A 40 year-old female, with a history of cardiac surgery for congenital aortic valve stenosis and von Willebrand's disease (VWD) presented with increasing shortness of breath due to mixed aortic valve dysfunction. With a paucity of such cases in the literature, we describe the successful outcome of a patient with VWD who underwent elective redo-redo aortic root replacement with a mechanical valved conduit. She was given a three-month trial of warfarin pre-operatively to evaluate the extent of bleeding risk. Her post-operative course was uneventful and she was discharged home after six days.