An acute gastroenteritis outbreak associated with a contaminated water supply system, Turkey, 2018

Disruption of routine monitorization and chlorination of the water supply system during a week-long holiday led to a multi-organism gastroenteritis outbreak in a district with limited laboratory support. More than a 10-fold increase in patients with gastroenteritis was reported. Enteropathogenic Escherichia coli, Enteroaggregative E. coli, and norovirus were detected in human specimen samples. The main water tank and pipes were rusted; 13 out of the 19 water samples tested positive for total Coliform (1-920 colony-forming units (CFU)/100 ml) and E. coli (1-720 CFU/100 ml). Chlorine levels were below 0.2 ppm in seven of the nine samples. Information of 1,815 cases was obtained from the hospital records with a crude attack rate of 2.9%. Cases widespread in the district increased throughout the holiday, epidemic curve revealed a point-source outbreak. The case-control study revealed that consumption of drinking tap water and using it to clean vegetables/fruits were significantly associated with the illness. While drinking only bottled water had a protective effect against the illness. The culture technique showed that the water supply samples were positive for pathogenic bacteria. Upon decision in a multi-stakeholder meeting, the water tank was cleaned, and the Municipality initiated the renovation of the water supply system.

Outcomes of surgery in patients aged ≥90 years in the general surgical setting

Introduction An increasing proportion of the population is living into their nineties and beyond. These high risk patients are now presenting more frequently to both elective and emergency surgical services. There is limited research looking at outcomes of general surgical procedures in nonagenarians and centenarians to guide surgeons assessing these cases. Methods A retrospective analysis was conducted of all patients aged ≥90 years undergoing elective and emergency general surgical procedures at a tertiary care facility between 2009 and 2015. Vascular, breast and endocrine procedures were excluded. Patient demographics and characteristics were collated. Primary outcomes were 30-day and 90-day mortality rates. The impact of ASA (American Society of Anesthesiologists) grade, operation severity and emergency presentation was assessed using multivariate analysis. Results Overall, 161 patients (58 elective, 103 emergency) were identified for inclusion in the study. The mean patient age was 92.8 years (range: 90-106 years). The 90-day mortality rates were 5.2% and 19.4% for elective and emergency procedures respectively (p=0.013). The median survival was 29 and 19 months respectively (p=0.001). Emergency and major gastrointestinal operations were associated with a significant increase in mortality. Patients undergoing emergency major colonic or upper gastrointestinal surgery had a 90-day mortality rate of 53.8%. Conclusions The risk for patients aged over 90 years having an elective procedure differs significantly in the short term from those having emergency surgery. In selected cases, elective surgery carries an acceptable mortality risk. Emergency surgery is associated with a significantly increased risk of death, particularly after major gastrointestinal resections.

Anatomical differentiation of direct and indirect inguinal hernias: Is it worthwhile in the modern era?

The study aimed to assess the clinical accuracy of differentiating direct and indirect inguinal hernias preoperatively by different grades of surgeons. A retrospective audit was conducted over a 9-year period and comprised all adult inguinal hernia patients operated by one consultant surgeon. The hernias were differentiated into direct and indirect hernias based on the direction of cough impulse and the deep ring occlusion test. The preoperative diagnosis was compared with intraoperative findings. During the study period, 503 patients were examined. Of these, 272 patients were diagnosed as having indirect hernias and 56 patients as having direct hernias. In 175 patients, no attempt was made to differentiate indirect and direct hernias. When compared with intraoperative findings, the diagnosis was correct in 77% of the indirect hernias and 55% of direct hernias. Of the patients in whom no differentiation was attempted, 115 patients had indirect hernias, 56 had direct hernias, and four had both. For indirect hernias, the diagnostic accuracy was 82, 63, and 30% for consultant, registrars, and senior house officers. For direct hernias, the diagnostic accuracy was 66, 50, and 44%, respectively. This study demonstrates relatively poor accuracy in diagnosing direct inguinal hernias regardless of seniority.

Road rage and road traffic accidents among commercial vehicle drivers in Lahore, Pakistan

Road rage and road traffic accidents increase the burden of morbidity and mortality in a population. A cross-sectional survey with convenience sampling was conducted among commercial vehicle drivers in Lahore, Pakistan (n = 901) to record their behaviours/experiences regarding road rage and road traffic accidents. Respondents were asked about incidents of shouting/cursing/rude gestures or threats to physically hurt the person/vehicle, by others or themselves, in the previous 24 hours or 3 months, and their involvement in road traffic accidents in the previous 12 months. Auto-rickshaw drivers were significantly more likely to report various road rage experiences/behaviours and involvement in accidents compared with bus and wagon drivers. A total of 112 respondents (12.4%) reported being involved in a road traffic accident in the previous 12 months but traffic police did not record the accident in 52.7% of cases. The results of this study underline the need to improve road safety in Pakistan.

Road rage behaviour and experiences of rickshaw drivers in Rawalpindi, Pakistan

A cross-sectional survey with convenience sampling was conducted among rickshaw drivers in Rawalpindi, Pakistan to study their road rage behaviour and experiences. Cumulatively 318 male drivers participated in this study. The most common forms of road rage reported were: having been shouted at; and having experienced rude gestures from other drivers (78.9% each). Least common forms of road rage reported were: threats of physical hurt or having actually been physically hurt ( < or = 3% each). Rickshaw drivers with shorter driving time (< or = 10 years) had significantly more road rage experiences than those who had been driving for more than 10 years (P < 0.01). There is a need for nationally representative surveys to study road age in commercial vehicle drivers so as to improve road safety in Pakistan.

A 5-year analysis of readmissions following elective laparoscopic cholecystectomy - cohort study

AIMS

This study aimed to determine readmission rates, causes for readmission and outcomes for patients undergoing elective Laparoscopic Cholecystectomy (LC) without intraoperative cholangiogram (IOC).

METHODS

Timing related to readmissions was grouped as <6 weeks, 6 weeks-1 year, 1-2 years and >2 years. Outcomes and variables related to readmission were evaluated.

RESULTS

101 readmissions (6.6) were noted amongst 1523 consecutive LC. The median follow up was 4 years (range 1.6-6.4 years). There was no difference in the median age (48 vs. 53 years, P = 0.2) and sex of the patients between the readmitted and no readmission groups. The incidence of readmissions (n = 101) within the first 6 weeks, 6 weeks-1 year, 1-2 years and >2 years were 2.8%, 1.5%, 1.4% and 0.7% respectively. The most common reasons for readmissions were non-specific abdominal pain (NSAP) (36%), obstructive jaundice (14%), peptic ulcer disease (10%), intra-abdominal collection (4%) and bile leak (3%), pancreatitis (3%), and other reasons (30%). Overall, 24 (22%) of readmissions were related to biliary problems, the majority of these occurred (15/24, 63%) within 6 weeks of LC. The incidence of retained stones within the first 6 weeks, 6 weeks-1 year, 1-2 years and >2 years were 0.4%, 0.3%, 0.1% and 0% respectively. Overall 14 (14%) patients were readmitted with retained stones and all were managed by ERCP & ductal clearance.

CONCLUSIONS

Readmission rate following elective LC is low with the majority occurring within the first 6 weeks and only a quarter of these related are directly to biliary pathology. In the absence of routine IOC, around 1% of patients present with retained stones within 2 years of LC. A small fraction of patients continue to suffer from NSAP and should be warned prior to the surgery.

Use of topical negative pressure in assisted abdominal closure does not lead to high incidence of enteric fistulae

AIM

Reports suggested an increase in enterocutaneous fistulae with topical negative pressure (TNP) use in the open abdomen. The purpose of this study was to establish if our experience raises similar concerns.

METHOD

This is a 5-year prospective analysis, from January 2004 to December 2008, of 42 patients who developed deep wound dehiscence or their abdomen was left open at laparotomy requiring 'TNP' to assist in their management. The decision to use TNP was taken if it was felt unwise or not feasible to close the abdomen.

RESULTS

There were 22 men; the median age was 68 (range 21-88) years. Twenty of 42 patients had peritonitis, 5/42 had oedematous bowel, 5/42 ischaemic gut, one had a large abdominal wall defect following debridement due to methicillin-resistant staphyloccus (MRSA) infection, 11/42 developed deep wound dehiscence. In 30/42, VAC abdominal dressing system and TNP were applied. In 12/42, VAC GranuFoam and TNP were used, of these five patients required a mesh to control the oedematous bowel. Four of 42 patients died. A total of 34 patients had anastomotic lines, 2/42 developed enteric fistulae, and both survived.

CONCLUSION

This study does not support the reports suggesting a higher fistulae rate with TNP. In our opinion, its use in the open abdomen is safe.

Attitudes about honour killing among men and women--perspective from Islamabad

BACKGROUND

The concept of honour has cultural, social and moral underpinnings that determine its expression and perseveration. Women are viewed as the bearers of family honour with chastity equated with abstinence from premarital or extramarital relationships and obeying norms determined and dictated by traditions and societies. The objective of this study was to determine the opinions of men and women pertaining to killing in the name of and saving one's honour.

METHODS

A cross-sectional survey with convenience sampling was conducted among the 18 years and older (range 18-71) men and women. Respondents were approached in markets, bus-stops, hospitals, and various other public places in Islamabad from April 12th to June 27th 2006. A structured, interviewer-administered, and pretested questionnaire was used with both open and close-ended questions on demographics and attitudes about honour killing based on a vignette that was slowly read out in Urdu, in a neutral and judgment-free tone of voice to potential respondents. Responses to close-ended questions based on the vignette provided, and pattern among men and women were compared using Pearson Chi-square test to determine associations between the dichotomous variables and gender, while responses to one open-ended question were summarised based on the observed similarities and bivariate associations with gender were determined.

RESULTS

We approached 630 conveniently selected individuals at various public places in the city of Islamabad. Six hundred and one agreed to participate and completed the questionnaire, i.e., the response rate was 95.4%. Three hundred and seven respondents were male (51.1%), and 294 (48.9%) were females. Three hundred forty-three 343 (57.1%) respondents believed that the man in the vignette did the right thing by killing his wife upon finding her in bed with another man. Divorcing one's wife rather than resorting to killings, after having found her with another man was approved by 220 (36.6%) respondents, while the rest answered as 'don't know'.

CONCLUSION

Majority of men as well as women considered it justifiable and acceptable to kill one's wife as a mean to save one's honour. The most significant finding was the fact that overwhelming number of men and women did not believe in either forgiveness or divorcing one's wife who has engaged in extramarital sexual relationship.

Comparative analysis of attitudes and perceptions about rape among male and female university students

BACKGROUND

Rape and other forms of violence against women have been reported to be common in Pakistan, and police is often reluctant to register a rape complaint. We assessed and compared the attitudes and perceptions of male and female university students towards rape of females by males.

METHODS

A cross-sectional survey with convenience sampling was conducted among the male and female students of Quide-e-Azam University, Islamabad. A structured, self-administered, anonymous and pre-tested questionnaire was used with close-ended questions. Students were asked about their attitudes and beliefs regarding characteristics of the female rape victims, male perpetrators and contexts in which this type of violence is more or less likely. Interviewers approached conveniently-selected participants and explained the objectives of the survey, while emphasising voluntary participation in this study. Data was analysed for frequencies and counts, while Chi-square test was used to for pairwise comparisons between male and female students with STATA 9.

RESULTS

Five hundred and four students, 247 male and 257 female, completed the questionnaire. Male students were more likely to believe that strong character of a woman would ostensibly shield her from the advances of a rapist; only young and pretty women get raped; woman's willingness is present in rape. About 25% of students also believed that a raped woman is not worthy of becoming another man's wife. One third of students believed that there could be no rape in marital context.

CONCLUSION

Rape myths were common in our educated study respondents with significant gender differences. Attitudes and beliefs blaming the female victim of rape were more common in males.

Internet access and utilization for health information among university students in Islamabad

BACKGROUND

Internet has changed the way we live and work. Advent of this technology has fundamentally transformed our lives the way invention of automobile changed how our lives and cities looked and worked before. Practically no information is available on the use of Internet for health by the people of Pakistan. The Objectives of the study were to assess the access and utilization pattern of Internet by university students in Islamabad, with emphasis on the healthcare information seeking.

METHODS

An anonymous, self-administered, and pre-tested questionnaire with questions on the access, and usage pattern of Internet, seeking health care information online, and belief about reliability of such information; was distributed to only those students who were enrolled in masters or higher degree programs.

RESULTS

A total of 600 students were approached and 598 (99.7%) completed the questionnaires. The mean age of students was 23.5 years (range 19-40). The majority of students (423) were enrolled in masters program. Four hundred and sixty-eight students (78.26%) students had access to the computer either at home or at their university hostel. While 304 (50.84%) students had Internet access at home or in their university hostel. Out of 304 students who reported having access to Internet in the past three months, one hundred and thirty-nine (43.4%) students replied affirmatively to the question of having used Internet for seeking health care information. And 109 (78.4%) thought that such information was reliable. Out of 139 students who had used Internet for seeking health information, 35 (25.2%) students replied affirmatively to the question of having discussed health information obtained from Internet with their doctor/physician whom they visited for any illness/treatment.

CONCLUSION

Majority of Islamabad university students in this study had access to computer and Internet. Young and healthy state of this educated age group perhaps accounts for limited use of Internet for seeking healthcare related information. However, high reliability of Internet obtained health information needs to be further studied in terms of websites utilized for seeking such information.

Job satisfaction among male physicians: perspective from Northern Iraq

OBJECTIVE

To determine the level of job satisfaction among male physicians in northern Iraq.

DESIGN

Cross-sectional study.

PLACE AND DURATION OF STUDY

Three public hospitals in the cities of Erbil and Kirkuk in northern Iraq, from May to June 2004.

SUBJECTS AND METHODS

Male physicians, currently working in public sector hospitals for at least one year, were given a structured, self-administered, anonymous and pre-tested questionnaire with both closed and open-ended questions. Data were collected on demographic and professional characteristics. Likert scales were used for job related characteristics. Data were analyzed for frequencies and mean scores for demographic and professional characteristics, while job related characteristics were analyzed with means and standard errors.

RESULTS

Out of 174 male physicians participating in this study, 132 (75.8%) responded as always or usually, satisfied with their career as a physician with a mean score of 4.3 (SE 0.1). Ninety-seven (55.7 %) physicians reported their work related stress as either severe or moderate, with a mean score of 2.6 (SE 0.1). But 153 (87.9 %) physicians reported as always or usually being in control of their professional work-related activities, with a mean of 4.5 (SE 0.08), while mean level of stress at home/personal life was 2.2 (SE 0.06).

CONCLUSION

Over seventy percent of male physicians in public-sector hospitals were satisfied with their jobs; however, links between working conditions and levels of job satisfaction were not clearly discernible.

Prescribing privileges for psychologists among university students in Islamabad

Psychologists as part of a team, make important contributions for the treatment of psychiatric disorders. New Mexico and Louisiana in United States have recently granted prescribing privileges to psychologists who have successfully completed additional training. This study determined the opinions of conveniently selected university students in Islamabad on clinical psychologists being granted similar prescribing privileges after additional training and certification by the Pakistan Medical and Dental Council (PMDC). Four hundred and five students completed the questionnaires; with 51 students enrolled in Psychology departments who were excluded from the reported analysis. One hundred and sixty-five respondents were male (46.6%), and 189 (53.4%) were female. Two hundred and seventy-six (78%) students were enrolled in masters, while the rest in higher degree programme. Cumulatively, 272 (76.8%) students believed that after additional training, clinical psychologists may be allowed to prescribe drugs for the treatment of psychiatric disorders by the PMDC. This viewpoint was reinforced by the act that 264 (74.6%) students replied affirmatively to the question that they would feel comfortable in referring a friend or taking a family member to a clinical psychologist who is trained in prescribing drugs. Results of our study demonstrated that university students in our study were overwhelmingly in favour of prescribing privileges for psychologists in Pakistan. Professional bodies like PMDC and Pakistan Psychological Association need to broach this subject for greater access to psychiatric services in the country.

Emergency preparedness and humanitarian action: the research deficit. Eastern Mediterranean Region perspective

The WHO Eastern Mediterranean Region, extending from Morocco in the west to Pakistan in the east, with a population exceeding 490 million, suffers a large proportion of both natural and man-made disasters. Humanitarian partners in the health sector have played a major role in averting the excessive mortality and morbidity in response to previous emergencies; nevertheless much remains to be done to provide the evidence through rigorous research methods to standardize other essential elements of the health response to humanitarian emergencies. Strengthening of academic institutions, prioritization of research, financial resources and linkages with institutions in the developed world can ameliorate the situation in the Region.

Occupational injuries in welders--results from a six month follow-up study

BACKGROUND

Injuries are an under recognized public health problem globally. We assessed the number and type of occupational injuries in welders, in a prospective manner.

METHODS

A cohort of 208 welders was re-interviewed twice at three-month intervals to determine the type and frequency of injuries in the welders primarily involved in the automobile sector, in the twin cities of Islamabad and Rawalpindi in Pakistan. Data was analyzed for frequencies and counts with STATA 8.

RESULTS

Cumulatively, 105 injuries were reported by 61 welders in the two follow-ups, who took 28 days off as a result of these injuries, in the past six months. Four welders reported multiple injuries involving the same injury episode. None of the welders reported any permanent disfigurement as a result of these injuries.

CONCLUSION

Occupational injuries are common in the welders working primarily in the automobile sector in the twin cities of Islamabad and Rawalpindi. Foreign bodies in the eyes are the most common type of injuries sustained by these welders.

Injury profile in young female adolescents-a case study from Islamabad

BACKGROUND

Injuries are an under recognized public health problem globally. We assessed the prevalence and correlates of injuries in adolescent school girls.

METHODS

A cross-sectional survey with convenience sampling was conducted among the two girl's middle schools in Islamabad, using structured, self-administered, anonymous and pre-tested questionnaire. All the class seven and eight students attending the school on the day of study were distributed questionnaires in the classrooms, who handed-over the completed questionnaires to their designated teacher. Data was analyzed for frequencies and counts with STATA 8.

RESULTS

One hundred eighty-two questionnaires were completed; average age of respondents was 12 years (range 11-14). Cumulatively, 78 (42.8%) students reported sustaining 93 medically attended unintentional injuries in the past year; among these 11 (14.1%) reported two injuries and 2 (2.6%) reported three injuries. For 43 (46.2%) injuries, respondents consulted a general practitioner (Doctor practicing near home), while for the rest of injuries, students were taken to the hospital for treatment.

CONCLUSION

Medically attended unintentional injuries in the preceding one year were common in the school girls, with home being the most frequent place of injuries. Falls with injuries on hands and arms was the most common site of injuries.

Progression of electroclinical changes in complex partial status epilepticus: filling in the blanks

Treiman has described five electroclinical stages through which the EEG progresses during generalized convulsive status epilepticus (GCSE). The EEG can show similar patterns in patients with complex partial status epilepticus (CPSE), but there is no agreement as to whether the different patterns seen in the human EEG result from a similar orderly progression through similar stages. We report the case of a patient in CPSE whose EEG passed progressively through two of the earlier stages described by Treiman. This case of EEG progression in a single patient suggests that CPSE can progress through stages analogous to those in GCSE.

Streptonigrin. 1. Structure-activity relationships among simple bicyclic analogues. Rate dependence of DNA degradation on quinone reduction potential

A series of simple aza and diaza bicyclic quinones related to the AB ring system of streptonigrin (1) have been synthesized and tested in vitro for their ability to degrade DNA under conditions similar to those used with the parent drug. The results obtained from a study of 22 quinones indicate that there is a quantitative linear relationship between their reduction potentials and the rate at which they degrade DNA under identical conditions in vitro. Almost all of the synthetic substances were superior to 1 in their DNA-degrading ability.