Nihar Dash

Comparing the efficacy of team based learning strategies in a problem based learning curriculum

We introduced two variants of team based learning (TBL) strategies in pathology course to seek their efficacy in a problem based learning (PBL) curriculum. The TBL strategy was adopted in two different sessions. One during regular resource session (RS‐TBL) and other during a weekly review session (RVS‐TBL) of the PBL curriculum. The study involved 104 second year students during their 8 weeks of cardiovascular‐respiratory units and 3 weeks of hematology units. RS‐TBL was adopted for cardiovascular‐respiratory unit and RVS‐TBL for hematology unit. The first 8 weeks of the course were implemented as RS‐TBL and the last 3 weeks as RVS‐TBL. The results showed that the group performance was markedly improved than individual performance in both RS‐TBL and RVS‐TBL (p < 0.001). Comparison between the RS‐TBL and RVS‐TBL revealed that individual student and group performance was better in the RVS‐BL (p < 0.001). The result of the student attitudinal survey indicated an 88% agreement that TBL enhanced their understanding of pathology concepts and critical analysis. Most of the participants (85%) found RVS‐TBL to be more useful. Post‐TBL, end of semester examination results proved beneficial for the students in risk. The study demonstrated that RVS‐TBL may be preferably adopted to enhance the philosophy of TBL in a PBL curriculum.

Distribution and Resistance Trends of Community Associated Urinary Tract Pathogens in Sharjah, UAE

Objective To describe the spectrum of etiologic agents causing community associated UTI and their antimicrobial resistance trends in a large teaching hospital in Sharjah, United Arab Emirates. Methods A retrospective review of the microbiology laboratory records of four hundred ninety two cases of community associated UTI between April 2006 and March 2007 was carried out. Etiologic agents and their antimicrobial susceptibility pattern were analyzed. Results A wide spectrum of uropathogens was isolated of which the leading etiologic agents of community associated UTI were Escherichia coli (207 strains) and Klebsiella species (90 strains). Sixty-six per cent of Gram-negative bacilli were resistant to amoxicillin, 58.5% were resistant to trimethoprim-sulfamethoxazole and more than 50% were resistant to cephalexin. However, resistance rate to antimicrobials like ciprofloxacin and ceftriaxone remain relatively low 9.7% and 7.6% respectively. Conclusions Escherichia coli remains the leading cause of community associated UTI. In-vitro antimicrobial resistance pattern of the isolates revealed that trimethoprim-sulfamethoxazole, cephalexin and amoxycillin the commonly used first-line antimicrobials were becoming less and less effective in their treatment. This information can help in changing preferences of suitable antimicrobial agent in treatment of community associated UTI.

Incidence of community‐acquired methicillin‐resistant Staphylococcus aureus carrying Pantone‐Valentine leucocidin gene at a referral hospital in United Arab Emirates

Community‐acquired methicillin‐resistant Staphylococcus aureus (CA‐MRSA) is an emerging pathogen in hospitalized patients worldwide. The present study was undertaken to identify CA‐MRSA in hospitalized patients in a 350‐bed tertiary care hospital in Sharjah, UAE over a 2‐year period from January 2011 to December 2012. CA‐MRSA was defined based on identification within first 48 h of admission in the hospital. Staphylococcal cassette chromosome (SCC) mec typing of the CA‐MRSA isolates was carried out by multiplex polymerase chain reaction (PCR). Detection of PVL and mecA genes was done by PCR using the GenoType® MRSA test system (Hain Lifescience). Patients clinical data and antimicrobial susceptibility pattern of the CA‐MRSA isolates were also evaluated. Fifty seven of the 187 MRSA isolates were identified as CA‐MRSA. All the CA‐MRSA strains in our study belonged to SCCmecIV type and were positive for both PVL and mecA genes. The patients with CA‐MRSA infections were young (median age, 32 years) and the majority of infections involved the skin and soft tissue (36%). Antimicrobial susceptibility pattern of the CA‐MRSA isolates showed a better susceptibility profile to the non‐beta‐lactam antimicrobials with the exception of ciprofloxacin having 28% resistance. This study evidently strengthens the recent observation of an increase in CA‐MRSA emergence among hospitalized patients in the UAE.

Misidentification of Brucella melitensis as Bergeyella zoohelcum by MicroScan WalkAway®: a case report.

Objective: To describe the misidentification of Brucella melitensis as Bergeyella zoohelcum by MicroScan WalkAway®, a commonly used bacterial identification system. Clinical Presentation and Intervention: A 35-year-old man was admitted to the Intensive Care Unit with sepsis syndrome. Three sets of aerobic blood culture samples were positive after 48 h of incubation. The isolated organism was identified as B. zoohelcum using the MicroScan WalkAway (Siemens Healthcare Diagnostics Inc., West Sacramento, Calif., USA). However, due to the rareness of the pathogen, the isolate was reidentified as B. melitensis with Vitek® 2 system and later 16S ribosomal sequence analysis confirmed the isolate as B. melitensis having 100% match. Conclusion: This case showed that Brucella can be misidentified using MicroScan WalkAway. Countries where brucellosis is endemic need to be careful while using such automated identification systems in order not to miss the diagnosis of Brucella.

Community-acquired urinary tract infections due to extended-spectrum β -lactamase-producing organisms in United Arab Emirates

BACKGROUND The epidemiology of extended-spectrum β-lactamase (ESBL)-producing bacteria is fast evolving with increasing global trend towards community-acquired infections. Limited information available about ESBLs therapy outcomes and control strategies, especially in the Middle Eastern countries. METHODS We studied 399 ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates from urinary tract infections (UTIs) occurred between 2014 and 2016 in University Hospital Sharjah. We included 124 ESBL-negative E. coli and K. pneumoniae isolates from UTIs as controls. Pearson Chi squares test and independent t-test were used to compare difference between ESBL positives and negatives. Multivariate logistic regression analysis was also performed. RESULTS Approximately 75% of the E. coli and K. pneumoniae isolates causing UTIs were community-acquired. We found that recurrent UTIs, old age, and catheterization among other risk factors for community-acquired ESBL-positive UTIs. Majority of these ESBL-positive isolates were resistant to antibiotics such as ciprofloxacin (74%) and trimethoprim-sulphamethoxazole (73%) that are commonly used for treatment of community-acquired urinary tract infections. CONCLUSIONS ESBL-producing E. coli and K. pneumoniae have become major etiological pathogens of community-acquired UTIs in the United Arab Emirates. Healthcare providers should implement better infection control strategies and careful use of antimicrobials especially in out-patient and community settings.

Sepsis- The Dilemma Continues

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection [1]. Sepsis syndrome represents the body’s host response to infection. Classically, sepsis has been defined and classified as systemic inflammatory response syndrome (SIRS), sepsis and septic shock based on diagnostic criteria derived from the systemic response to inflammation (Figure 1). However, recently the term ‘severe sepsis’ has been dropped from the definitions to better identify, manage, report and improve outcomes [1]. The prevalence of sepsis is on the rise. Factors could be many; such as an ageing population, immunosuppression, evolving multidrug resistant pathogens, more people in the ICUs, as well as an increase in the number of low-birth-weight new-borns who are particularly at a high risk [2].

Undergraduate Medical Students’ Perception about Learning in Small Group at University of Sharjah

Learning in small groups is a key instructional strategy in medicine and more so in the problem based curriculum (PBL). It is perceived that working in small groups enhances acquisition, processing and retention of the ever increasing medical knowledge. Learning in small group will help the students to be better learner and improve their personal, social and cognitive skills. The objective of this study is to describe undergraduate medical students’ perception toward small group learning in a PBL curriculum. A cross-sectional descriptive study was conducted among the undergraduate medical students in the phase 2 of their MBBS program at University of Sharjah. A total of 277 undergraduate medical students participated in the study. The mean age of the study population was 20 years and 61% were female students. The most rewarding experiences as perceived by medical students were exposure to different views (71%), making friends (57%) improving their grades (52%) and underwent personal development (46%). The main disadvantages of small group learning were waste of time (55%), side talks (16%), and other distractions (14%). Majority of students had a positive perception towards small group learning and agreed that it enhances their collaborative learning and team work skills. Small group learning was perceived as a key instructional method in the PBL curriculum [3] and it enhances their grades, learning outcomes, personal development and critical thinking abilities [4].