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ABSTRACTThis editorial highlights the different barriers and enablers of antibiotic amnesty campaigns in community pharmacies. The main enablers of antibiotic amnesties included effective counselling and successful use of promotional resources, whilst the main barriers included lack of education in patients and staff. Enabling factors such as effective counselling and use of promotional resources should be continued with patients, whilst the main barriers can be tackled with provision of sufficient education, training, and knowledge for patients. Educating staff, by providing appropriate training to all staff members present in the pharmacy, can positively contribute to the success of antibiotic amnesty campaigns. The findings of this work can inform the development of interventions needed to improve antibiotic amnesties, resulting in more antibiotics being returned and contributing towards tackling the issue of antimicrobial resistance (AMR).

Background: Dental needle aspiration is a rare complication of oral procedures given the advances in medical technology. Aspirations in general may also be asymptomatic, apart from the possible remote history of upper airway irritation at the time of induction. Clinicians should take a detailed history and examination, along with appropriate diagnostic imaging before discharging these patients from the emergency department. Case presentation: A young patient presented with an acute complaint of pain and coughing post-dental procedure. On arrival at the emergency department, she was vitally and clinically stable, without signs of respiratory distress. There were no complaints reported apart from minor throat pain. Imaging done in the emergency department revealed the presence of a 32 mm needle in the distal airway. She underwent emergency flexible bronchoscopy, and the foreign body was removed under direct visualization. The patient remained stable throughout the procedure and had an uneventful stay until discharge. Conclusion: While needle aspiration is a relatively uncommon occurrence, its early detection is always critical before further damage to local structures can occur. Regardless of presentation and symptoms, basic imaging is mandatory before the disposition is decided. [SJEMed 2024; 5(1.000): 058-060]

Introduction: Autism spectrum disorder (ASD) is a heterogeneous disorder characterized by deficits in social-emotional reciprocity and associated behavioral symptoms. The goal of this study was to examine perinatal risk factors for ASD and their correlates in a tertiary care hospital in Dubai, United Arab Emirates (UAE). Methods: We conducted a case-control study of 87 children diagnosed with ASD using the DSM-5 criteria, who were born between 1999 and 2014, and diagnosed between 2014 and 2016, and 134 age- and gender-matched control subjects. Data were collected from hospital medical records. Associations between ASD and maternal, birth, and neonatal risk factors were examined using logistic regression analysis. Results: Maternal fever was associated with ASD (p = 0.018), with 0% in the control group and 5% in the cases. Multivariate logistic regression analysis revealed a trend for an association between high birthweight (>4,000 g) and ASD (95% CI: 0.76–59.93, p = 0.086). Conclusion: The data affirmed the established gender difference of approximately four males to one female and supported previous findings associating ASD with prematurity. Larger representative studies are further required to explore risk factors for ASD in the UAE.

We report the case of a patient who presented with septic shock and multiorgan failure. Methicillin-resistant Staphylococcus aureus and Talaromyces marneffei were cultured from his blood. He was treated with a course of vancomycin along with amphotericin. Further work-up revealed him to be HIV positive with an absolute CD4 count of 14 cells/μL. Despite aggressive medical support, he eventually succumbed to his illness with Klebsiella pneumonia sepsis. To the best of our knowledge, this is the first reported T. marneffei infection in the Middle East and the first observation of concomitant community-acquired methicillin-resistant S. aureus bacteraemia and talaromycosis from the Middle East region.

Abstract Background This study assessed retrospectively the clinical outcomes of single implant-supported crowns and implant-supported fixed dental prostheses (FDPs). Methods This case series compared biological and technical complications in single implant-supported crowns and implant-supported bridges in a time framed sample of all patients who received dental implants between 2009 and 2016 in Dubai Health Authority. Only 3-unit implant-supported prostheses (FDPs) with one intervening pontic and an implant each end were included for comparison to single crown supported implants. Cantilevered implants, implant-supported dentures and cases involving bone grafts or sinus lifts were excluded. The primary outcome measure was marginal bone loss, measured on digital radiographs taken after prosthesis placement at baseline and one year after implant loading, whilst peri-implantitis and technical complications were secondary outcomes. Mixed regression models adjusted for clustering of implants within patients was used for patient and implant factor associations. Results A total of 454 patients (152 males; 302 females) had 1673 implants. The mean age of males (53.7 years, SD 14.6) was significantly greater than females (49.3 years, SD 12.9, p

Background: The ability to walk independently from place to place with or without a walking aid is called ambulation. Uncontrollable and abnormal walking patterns are called walking abnormalities. Walking abilities along general health of patients are affected after cerebrovascular diseases. Objectives: The objective of the study is to determine the health related quality of life in stroke patients ambulating with walker. Methods: The present research is a cross-sectional study for total number of 78 patients enrolled in it. The study was conducted at Aziz Bhatti Shaheed (DHQ) teaching hospital and Dr. Ejaz Physiotherapy services, Gujrat, Pakistan. Total four months is time lapsed during the study and survey. Results: As a response to general health status, half of then people from sample said their health is good. Sixty percent patients responded that the physical and social functioning was less impaired. Bodily pain does interfere with activities of daily living. Most of the patients answered that emotional health status is more impaired. Conclusion: Moderate to severe activities have much interference on general health, physical and social functioning of the patients. These two categories required maximum, while mild activities need little assistance to accomplish the work. Accomplishment of less work due to emotional health problem compared with afore ailment is also a considerable factor. Bodily pain during past four week is found to be moderate with interference to normal activities as per response of patients. Keywords: Cerebrovascular Disease, Health Related Quality of Life, Transient Ischemic Attack, World Health Organization.

Background: Neural oscillations reflect rapidly changing brain excitability states. We have demonstrated previously with EEG-triggered transcranial magnetic stimulation (TMS) of human motor cortex that the positive vs. negative peak of the sensorimotor μ-oscillation reflect corticospinal low-vs. high-excitability states. In vitro experiments showed that induction of long-term depression (LTD) by low-frequency stimulation depends on the postsynaptic excitability state.Objective/Hypothesis: We tested the hypothesis that induction of LTD-like corticospinal plasticity in humans by 1 Hz repetitive TMS (rTMS) is enhanced when rTMS is synchronized with the low-excitability state, but decreased or even shifted towards long-term (LTP)-like plasticity when synchronized with the high-excitability state. Methods: We applied real-time EEG-triggered 1-Hz-rTMS (900 pulses) to the hand area of motor cortex in healthy subjects. In a randomized double-blind three-condition crossover design, pulses were synchronized to either the positive or negative peak of the sensorimotor μ-oscillation, or were applied at random phase (control). The amplitude of motor evoked potentials was recorded as an index of corticospinal excitability before and after 1-Hz-rTMS. Results: 1-Hz-rTMS at random phase resulted in a trend towards LTD-like corticospinal plasticity. RTMS in the positive peak condition (i.e., the low-excitability state) induced significant LTD-like plasticity. RTMS in the negative peak condition (i.e., the high-excitability state) showed a trend towards LTP-like plasticity, which was significantly different from the other two conditions. Conclusion: The level of corticospinal depolarization reflected by phase of the μ-oscillation determines the degree of corticospinal plasticity induced by low-frequency rTMS, a finding that may guide future personalized therapeutic stimulation.

We present the case of a patient who fell from a 3-m height. He was bought to the emergency department and immediate resuscitative measures were taken. His GCS on presentation was 15, and the airway was patent and maintainable. Breathing was equal bilaterally, the blood pressure and capillary refill were established to be normal, and a bedside E-FAST scan was negative. He was found to have a dislocated left knee, with sensorineural loss distal to the injury. After the dislocation was reduced, a whole-body CT scan was performed and revealed an incidental finding of thrombus in the inferior vena cava (IVC). A thrombus in the IVC by itself is an uncommon complication among trauma patients, but among the cases noted in literature, most patients with an IVC thrombus had a slightly delayed presentation and it was usually discovered a few days after admission. Management of the thrombus depends on the stability of the patient’s presentation. When feasible, operative or otherwise invasive procedures can be delayed, allowing for the medical management of the thrombus. IVC filters may also be used, but their use may be limited due to anatomical restrictions, as in our case.

A female, aged 55 years, was presented to the clinic concerned with her inability to function properly due to missing teeth and collapse of her vertical dimension. On examination, remaining tooth position of the upper arch was favorable for telescopic denture and remaining tooth position of the lower arch was favorable for removable prosthesis. The patient requested an aesthetic maxillary and mandibular denture with no visible metal clasps on smiling. Therefore, upper telescopic removable complete denture and lower chrome cobalt removable prostheses were suggested to the patient as conservative treatment to reestablish her occlusal vertical dimension and restore her aesthetics and function.

Background: We present our experience with optimization and diagnostic use of quantitative real-time polymerase chain reaction (PCR) targeting the lytA gene of Streptococcus pneumoniae for the detection of S. pneumoniae in whole blood of children

Hypertonic saline (HTS) is a solution containing higher molar concentrations of sodium and chloride. HTS has been in clinical use for many decades. Due to its osmotic and volume expanding properties, it is being increasingly used for management of a variety of conditions; most notably raised intracranial pressure (ICP) from multiple etiologies, resuscitation during shock and removal of thick respiratory secretions. Commonly used and easily available in the Western states, few hospitals in Pakistan use HTS owing to a lack of awareness, associated costs and poor availability. The objective of this review is to provide an update on recent knowledge gained on hypertonic saline solution use in clinical settings. in this review, we discuss the historical background, mechanism of action, clinical indications and adverse effects of HTS and discuss trials assessing their clinical utility.

An elderly, bed ridden patient with a history of stroke was admitted for management of aspiration pneumonia. Two days after insertion of a nasopharyngeal airway, sudden respiratory distress prompted further investigations which led to the eventual diagnosis and removal of the nasopharyngeal airway that had been aspirated. The device was removed under conscious sedation with fiber optic bronchoscopy. Keywords: Nasopharyngeal airway, Aspiration, Respiratory distress, X-ray

Learner centered education has been one of the major highlights that has revolutionized the teaching method in every department. While some effort has been made to better implement peer learning into the curriculum in some universities, it remains a vastly underused utility that can be employed both in and out of the classroom. Learning among, and teaching others who are at the same level of education does not only lead to enhanced memory and recall, it also develops critical real-world skills that can enhance the involved individual both professionally and academically. This article is a medical student’s perspective on encouraging peer assisted education in the healthcare environment, and a preliminary learning guide for the students who wish to implement this method of education.

ABSTRACT: Objective: One option to treat locoregional recurrence of thyroid carcinoma is with percutaneous ethanol injection (PEI). Although complications with this treatment are rare, we describe a patient who developed Horner syndrome after PEI. In addition, we reviewed the literature on complications after PEI for thyroid disease.Methods: A clinical case report was performed on a patient who underwent PEI and subsequently developed ptosis, miosis, and anhidrosis. Based on these classic findings, she was diagnosed with Horner syndrome. A Medline search was performed to identify all complications after PEI for thyroid disease.Results: A 31-year-old woman with stage 1 papillary thyroid carcinoma (PTC) metastatic to the cervical lymph nodes was treated by total thyroidectomy and central lymph node dissection followed by radioactive iodine. The disease recurred in a single lymph node in the right neck, and she opted for PEI treatment. Postprocedurally, the patient developed right-sided miosis, ptosis, and anhidrosis. Symptoms were consistent with Horner syndrome. She was treated with a steroid burst and taper. After 6 months, her symptoms improved but had not fully resolved.Conclusion: PTC can be treated in multiple ways. To avoid re-operation in patients with recurrent PTC that is limited to a few lymph nodes, PEI can be a useful treatment option. Ethanol injection into live tissue causes dehydrative effects and can damage nearby structures. However, the literature demonstrates that serious complications after PEI are rare. Nonetheless, these rare complications are important to acknowledge in order to better counsel patients prior to treatment.Abbreviations: PEI = percutaneous ethanol injection; PTC = papillary thyroid carcinoma

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Background: High prevalence of mental disorders is associated with psychoactive substances, significantly contributing to morbidity, disability, and premature mortality. Worldwide, individuals who use electronic-cigarettes (EC) and have a mental health diagnosis are more likely to experience stress, depression, and drug use. This study aims to measure the prevalence of both EC use and mental health disorders namely, anxiety and depression additionally to investigate the association between EC use and mental health status among the general population of Saudi Arabia.Methods: A cross-sectional analytical study was conducted across Saudi Arabia from November 2022 to May 2023. The survey was divided into three sections. The first section focuses on the demographics, while the second part asked about both conventional and EC smoking and their frequency. The third section assessed mental health status using a Patient Health Questionnaire with a 9-item depression scale (PHQ-9) and a 7-item Generalized Anxiety Disorder scale (GAD-7).Results: The study revealed 21.1% reporting EC use in the past thirty days. While 19.8% reported smoking tobacco one or more days within the last thirty days. Regarding mental health, 36.6% of individuals had minimal anxiety, while 42.4% experienced mild anxiety. Moreover, most of the participant were considered to have mild followed by minimal depression accounting for 36.7% and 31.9%, respectively. The results indicated a positive and significant correlation between perceived depression scores and nicotine dependence among EC users. Additionally, there was a strong relationship between gender and nicotine dependence, with men being more inclined than women.Conclusion: There is a correlation between nicotine use and mental health outcomes; people who use nicotine products are more likely to experience anxiety and depression. [ABSTRACT FROM AUTHOR]

A female, aged 55 years, was presented to the clinic concerned with her inability to function properly due to missing teeth and collapse of her vertical dimension. On examination, remaining tooth position of the upper arch was favorable for telescopic denture and remaining tooth position of the lower arch was favorable for removable prosthesis. The patient requested an aesthetic maxillary and mandibular denture with no visible metal clasps on smiling. Therefore, upper telescopic removable complete denture and lower chrome cobalt removable prostheses were suggested to the patient as conservative treatment to reestablish her occlusal vertical dimension and restore her aesthetics and function. [ABSTRACT FROM AUTHOR]