Chronic suppurative otitis media is persistent and insidious disease that often lead to destructive changes and irreversible sequelae if not treated properly. The study aimed to find the pattern of antimicrobial drug susceptibility of the pathogenic microorganisms causing tubotympanic type of CSOM. The study was conducted in 65 patients with tubotympanic type of disease attending the (ENT) OPD clinic at Central Hospital-Tripoli, Libya. Drug susceptibility testing was carried out using a Kirby Bauer disc diffusion method. Pathogens were isolated from 96.9% patients with a total of 95, of the 95 isolates, (88.4%) were bacterial pathogen and (11.6%) were fungal. The most predominant isolates were Pseudomonas aeruginosa (31.6%), followed by Staphylococcus aureus (25.3%) and Proteus mirabilis (8.4%). The antimicrobial profile of the major isolates of Pseudomonas aeruginosa revealed maximum sensitivity to ciprofloxacin (93.3%), followed by polymyxin (90.0%), ceftazidime (83.3%) and amikacin (73.3%). Whereas the antimicrobial profile of the isolates Staphylococcus aureus was revealed maximum sensitivity to ciprofloxacin (95.8%), followed by amoxil/clavulanic acid (83.3%), cephalexin, gentamicin, chloramphenicol (79.2%) each, neomycin (75.0%) and erythromycin (70.8%). On the other hand Proteus mirabilis showed high level of sensitivity to ciprofloxacin, ceftazidime (100%) each, followed by amoxil/clavulanic acid, amikacin (87.5%) each, gentamicin, neomycin, trimethoprim sulphamethoxazole (75.0%) each. Our finding highlight the importance of a continuous and periodic evaluation of microbial pathogens causing tubothympanic CSOM and their susceptibility patterns to antimicrobial drugs, this will guide the clinician for choosing the appropriate treatment regimen and prevention of the emergence of resistant strain as well as can minimize complication that require surgery.

Objectives: Osteoporosis is an asymptomatic disease characterized by low bone mass and loss of the quality of bone, which increases the risk of a bone fracture. This is the most common reason for a broken bone among the geriatric population. Educational intervention is ideal for osteoporosis because many of its risk factors can be treated, such as poor dietary calcium intake and limited amounts of physical activity. This study aimed to determine the effect of the prevention program on knowledge regarding osteoporosis among geriatrics and to associate the level of knowledge with selected demographic variables. Materials and Methods: Pre-experimental design adopted. Totally 60 geriatric people aged >60 years visited the selected chronic outpatient clinic were selected by using a convenient sampling technique. The data collected through a structured questionnaire to measure knowledge regarding osteoporosis. The educational awareness program was conducted as a group for 30 minutes. The pre-test and post-test scores were analyzed, in terms of both descriptive and inferential statistics. Results: Out of 60 samples 15% & 55% had adequate knowledge, 61.7% & 40% people had average knowledge and 23.3% & 5% had inadequate knowledge in pre and post-test. The paired ‘t’ test value 6.5147 is highly significant (P<0.01) which proved the effectiveness of osteoporosis prevention programme (OPP). There was a significant association found between the level of knowledge and education and BMI at P<.05 level. Conclusion: Prevention is the most effective method of decreasing the morbidity and mortality of osteoporosis. Nurses have a major impact on educating geriatrics about the risks for osteoporosis.

Background: Urinary tract infections attack about 150 million people each year globally and nowadays there is a high emergence of antibiotic resistance strains among E. coli species that cause UTI. The objective of this study was to detect Aminoglycosides resistance among E. Coli strains isolated from patients with urinary tract infection. Method: A total of 70 urine specimens were collected from patient with symptoms of urinary tract infection in sterile urine containers, and then inoculated in CLED media, incubated at 37c for 24 hours. E. Coli species were identified according to their colonial morphology, indirect gram staining reaction, and biochemical tests. Identified species were tested for antimicrobial susceptibility against the following aminoglycosides: Amikacin, Kanamycin, Streptomycin, Gentamicin, and Tobramycin using Kirby-bauer disc diffusion method. Results: The study revealed that 55.7% of urinary tract infections were caused by E. Coli. The study also showed that 12.8% of isolated E. Coli species were resistant to Amikacin, 28.2% to Gentamicin, 43.6% to Streptomycin, 48.7% to Kanamycin, and 53.8% to Tobramycin. Conclusion: The study concluded that the overall resistance of isolated E. coli species to aminoglycosides was 37.4% the most powerful Aminoglycoside against E. Coli species was Amikacin.

The effect of Indocid® was determined using thirty (30) albino rats of mixed sex, aged 3 months weighing 110-200g. They were acclimatized to their environment for 2 weeks during which they were fed with standard pelleted feed and water. The study is divided into acute toxicity testing and main experimental phase. The acute toxicity testing for the determination of the median lethal dose was ascertained using 12 rats divided into groups K, L, M. The main experiment using 18 rats divided into groups A, B, C, D, E and F of three (3) rats in a group in different cages, cage A served as control. The rats were orally administered graded doses of Indocid dissolved in water once daily along with their feed for 30 days. Cages B-F received 3.0, 2.5, 2.0, 1.5 and 1.0 mg/kg respectively and were closely observed. At day 31, the rats were randomly selected, sacrificed, the stomach, and small intestine were excised, examined grossly and subsequently processed for light microscopy. Grossly the organs and tissue appeared to have several perforations especially evident in the small intestine. Further histological examination revealed erosion of the stomach and intestine. This result forms the basis for further research into the danger posed to indiscriminate users of Indocid®.

Schistosome is a treamatode, snail-born parasitic of circulatory system in domestic animals and man. Ruminants are usually infected with cercariae by active penetration of the unbroken skin. It is an economically important disease caused by several Schistosoma species and results in economic losses through mortality and morbidity. The geographical distribution of Schistosoma species infecting cattle are mainly determined by the distribution of their respective intermediate host snails. The disease affects rural communities particularly those who depend upon irrigation to support their agriculture and drink contaminated water. Effective transmission of schistosomiasis occurs when the schistosome parasites, the aquatic snail hosts and the human or animal definitive hosts meet in space and time in surface water. The pathological changes with the disease are attributed by the adult parasite, cercaria and the eggs of the parasite. Health education, chemotherapy, environmental and biological control as well as provision of clean water have an innumerable role in the control activity of the disease. The use of traditional medicines in the treatment of schistosomiasis are economically important and a growing concern. There are various types of plants like Phytoplacca dodecandora (Endod) is the most widely used anti molluscicidal properties with minimal side effects used by developing countries and continuous to be used in the modern world. Diagnosis is based primarily on the clinico pathological pictures, parasitological techniques, post mortem findings, Serological techniques and Molecular diagnostic techniques .The most effective way to control cattle Schistosomiasis in endemic areas is to prevent contact between the animals and the parasite. Awareness creation about the disease, destruction of the snail intermediate host population at their breeding sites, either by chemical or biological methods may be considered as a recommendation to prevent the occurrence of bovine schistosomiasis.

Introduction: Internship is the period when a medical graduates acquires skills which enables him/her to become an effective physician of first contact of the community. However, new graduates go through this period only preparing for the post graduate entrance exam without acquiring many skills and practical knowledge. We conducted a cross-sectional study to document the self-perceived competence of the interns in performing the basic medical skills. Materials and Methods: This was a cross-sectional study conducted on 70 medical interns graduating from a private medical college in North India. The interns who were willing to participate in the study were asked to state the level of their competence on a 3-point scale in a 95 point questionnaire .The questionnaire was divided as per clinical specialties and further sub-divided into competence in examination skills, core skills and knowledge, attitude and performance skills. Results: All the interns self-rated that they were competent in recording basic clinical variables, 60% percent students self-rated that they were fully competent in examination skills and core competencies of internal medicine but only 37.14% felt competent in knowledge and attitudinal skills. In surgery, more than 60% interns rated themselves to have good core competencies, 37.14% rated themselves to be competent in examination of surgical patients whereas only 28% interns rated themselves as competent in knowledge and attitudinal skills of surgery. Only one third interns self-rated that they had good examination skills pertaining to ENT and Ophthalmology. Similarly less than 20% interns self-rated that they were good at core competencies related to Ophthalmology and ENT departments. Conducting a normal vaginal delivery was considered a core competency of Ob-Gyn (Obstetrics and Gynaecology) department. Only 12 interns (27.8%) self-rated to be fully competent to do so, 51.4% interns self-rated that they had good examination skills and only 10% interns felt competent in knowledge and attitudinal skills of Ob-Gyn. Majority of the students rated themselves as having good examination skills and core competencies in pediatrics. Discussion: In the present study less than 60% interns rated themselves as competent in examination skills and core competencies in major clinical specialities except in Ob-gyn, while less than ten percent (9.3%) self evaluated their examination skills as poor. This implies that many of the graduates did not feel competent to carry out the role of a junior doctor with confidence. A variety of studies from other countries have found that many graduates feel inadequately prepared for the role of junior doctor [11-13] and criticisms that medical schools do not prepare graduates for early medical practice have been voiced many times. Conclusions: All the graduate medical doctors are not fully competent to perform the basic medical and surgical procedures. They are especially lacking in knowledge and attitudinal skills so medical educators need to stress on training the graduates in knowledge application and critical thinking.

Protein Loosing Enteropathy (PLE) is a disorder characterized by either increased loss of proteins from the digestive system or defect in the absorption of proteins. It is a rare complication seen in some cases of Fontan surgery, the reason for which remains an enigma. There are many causes elucidated like increased central venous pressure, decreased cardiac output, increased mesenteric resistance, lymphatic obstruction and so on. Though panoply of treatment options is available for the management of PLE post Fontan, there is still no consensus regarding the causes, consequences and treatment protocol. We present a case of 22 year old girl who underwent Fontan procedure for complex congenital heart disease at the age of 3. She developed diarrhea, hypoproteinemia, hypoalbuminemia, hypocalcemia 18 years after surgery and was diagnosed as protein loosing enteropathy post Fontan based on strong clinical findings after excluding other causes of hypoalbuminemia and was managed conservatively. PLE post Fontan has a grave prognosis and is essential to elucidate the exact pathophysiological abnormality thus paving way for better therapeutic management.