Muhammad Afsar Siddiqui

Recent outbreak of cutaneous anthrax in Bangladesh: clinico-demographic profile and treatment outcome of cases attended at Rajshahi Medical College Hospital

BackgroundHuman cutaneous anthrax results from skin exposure to B. anthracis, primarily due to occupational exposure. Bangladesh has experienced a number of outbreaks of cutaneous anthrax in recent years. The last episode occurred from April to August, 2011 and created mass havoc due to its dreadful clinical outcome and socio-cultural consequences. We report here the clinico-demographic profile and treatment outcome of 15 cutaneous anthrax cases attended at the Dermatology Outpatient Department of Rajshahi Medical College Hospital, Bangladesh between April and August, 2011 with an aim to create awareness for early case detection and management.FindingsAnthrax was suspected primarily based on cutaneous manifestations of typical non-tender ulcer with black eschar, with or without oedema, and a history of butchering, or dressing/washing of cattle/goat or their meat. Diagnosis was established by demonstration of large gram-positive rods, typically resembling B. anthracis under light microscope where possible and also by ascertaining therapeutic success. The mean age of cases was 21.4 years (ranging from 3 to 46 years), 7 (46.7%) being males and 8 (53.3%) females. The majority of cases were from lower middle socioeconomic status. Types of exposures included butchering (20%), contact with raw meat (46.7%), and live animals (33.3%). Malignant pustule was present in upper extremity, both extremities, face, and trunk at frequencies of 11 (73.3%), 2 (13.3%), 1 (6.7%) and 1 (6.7%) respectively. Eight (53.3%) patients presented with fever, 7 (46.7%) had localized oedema and 5 (33.3%) had regional lymphadenopathy. Anthrax was confirmed in 13 (86.7%) cases by demonstration of gram-positive rods. All cases were cured with 2 months oral ciprofloxacin combined with flucoxacillin for 2 weeks.ConclusionsWe present the findings from this series of cases to reinforce the criteria for clinical diagnosis and to urge prompt therapeutic measures to treat cutaneous anthrax successfully to eliminate the unnecessary panic of anthrax.

The psychosocial impact of diabetes in adolescents: A review

Type 1 Diabetes mellitus is known to have a major psychological impact on adolescents. Different types of therapies have been developed to support the patient as well as their families to deal with this impact. These include Behavioral Family Systems Therapy and Cognitive Behavioral Therapy. However, studies conducted recently, though few in numbers have shown a direct relationship between general psychological functioning and metabolic control. Self-management of diabetes and its complication therefore, is an integral part of these program. This review looks into the various studies carried out that decide the best approach towards addressing the psychological aspect of type 1 Diabetes Mellitus.

Perception of Stress, Anxiety , Depression and Coping Strategies among Medical Students at Oman Medical College

Objective: To explore the stress sources, prevalence of anxiety and depression and coping strategies among preclinical and clinical under graduate medical students. Methods: A cross sectional study was conducted on Oman Medical College Students of pre-clinical and clinical years. Data was collected using Medical Student Stressor Questionnaire (MSSQ), Hospital Anxiety and Depression scale (HAD) and COPE questionnaire. Statistical analysis was performed using SPSS (IBM SPSS Statistics 20.0). Results: A total of 288 participants were enrolled in which 123 were pre-clinical and 165 were clinical medical students. Nearly two thirds (78.1%) of students were aged between 20-24 years. Among all 87.5% (252) were females and 12.5% (36) were males. Collective score of academic stress factors in the pre-clinical group was not statistically different (p = 0.865) to the clinical group. There was no significant difference (P: 0.826; 95% CI: -3.511-2.804) in the mean score of preclinical and clinical group regarding Social Stress factors. Coping strategies to control stress score in the pre-clinical group was statistically significantly (p < 0.001) higher than the clinical group. Conclusion: The higher level of stress is associated with poor academic performance, large content of study material, exam and time constraints. Coping strategies in students were mainly better time management, emotional support, talking to family members/friends helps and good sleep relaxes them to control stress.

Recognition of Core Elements of Medical Professionalism among Medical Students and Faculty Members

OBJECTIVES Medical students and future physicians have chosen to pursue a profession that requires personal integrity, compassion and a constant awareness of the commitment made by them. Professionalism includes personal behaviors, knowledge, and competency. It includes the attitudes and values one holds and that run through the profession as a whole. Medical students learn professionalism during the course by either direct teaching or experiential learning. We conducted this study to estimate the self-reported level of practice of the core elements of professionalism by medical students and medical faculty and compared the two groups. METHODS One-hundred and nine students and 83 faculty members of Oman Medical College completed a professionalism questionnaire. The survey questions related to core elements of professionalism and were grouped under professional knowledge, professional skills, professional attitude, and qualities essential for professionalism. RESULTS The response rate was 65.6% (109 of 166) among students and 75.5% (83 of 110) from faculty members. Response to the questions on professional skills between the student and faculty group was significantly different (p < 0.001). Similarly, there was a significant difference in the responses related to professional attitude between the student and faculty group (p < 0.001). Students and faculty members have a significant difference in opinion regarding up to date knowledge of basic and clinical sciences and clinical competency (p = 0.024). Similarly, significant differences in opinion regarding up to date knowledge of basic and clinical sciences and clinical competency in clinical and basic sciences faculty members (p = 0.001). Students identified good communication skills (82.6%), and faculty staff identified up to date professional knowledge (62.7%) as the most important aspect of professionalism. CONCLUSIONS Both students and teaching faculty agreed that the top most professional elements are up to date knowledge, good communication skills, and teamwork. Hence, it is important that faculty members encourage their students to improve their professional skills and attitude.

Haemodialysis and Vascular Access in the End Stage Kidney Disease

The efficiency of haemodialysis treatment relies on a functional status of vascular access. A vascular access makes life-saving haemodialysis treatments possible. The efficiency of haemodialysis treatment relies on a functional status of vascular access. The purpose of this review was to discuss the role of haemodialysis and vascular access in end stage kidney disease. Vascular access and its related problems represent the main factors that determine a rise in the rate of incidence of the disease among haemodialysis patients and, consequently, a rise in the healthcare expenses. Vascular access can be divided into three categories: arteriovenous fistula, central venous catheter and arteriovenous graft. Central venous catheter has a number of disadvantages, including a considerable risk of infection and mortality. It also has negative implications for the use of a fistula for dialysis. In contrast, arteriovenous fistula is the most beneficial method, as it has a low risk of infection and mortality, and can ensure long-term functional access. Furthermore, there are three configurations of native arteriovenous fistula that can be used for haemodialysis providing flexibility of approach depending on risk factors of the individual patient.

Variable Phenotypic Expression Including Late Presentation of Hypertrophic Cardiomyopathy in LEOPARD Syndrome with P.Q510E Mutation in PTPN11 Gene

LEOPARD syndrome is a complex dysmorphogenetic disorder of variable penetrance and expressivity. Mutations in the PTPN11 gene are frequently reported in patients with Noonan syndrome (NS) and LEOPARD syndrome (LS). Q510E mutation in PTPN11 has always been associated with lethal or rapidly progressive hypertrophic cardiomyopathy both in NS and LS patients. Besides, deafness is also frequently present in these patients, but reproductive fitness is questioned. We herein describe a case of LEOPARD syndrome from Bangladesh with Q510E mutation in the PTPN11 gene. Our patient almost fulfilled the entire acronym of LEOPARD with very late presentation of hypertrophic cardiomyopathy at the age of 36 yrs. Interestingly patient has intact hearing and normal reproductive capacity, biologically fathered two children.