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Objective ENT is underrepresented in the curriculum, and this has been compounded by coronavirus disease 2019. Recent restructures have removed ENT placements from the curriculum. This lack of exposure needs to be addressed, and increased use of online learning represents an opportunity to facilitate this. This study aimed to evaluate whether online learning can effectively deliver undergraduate ENT teaching. Methods An online ENT module was created; content was structured on the Sheffield Medical School curriculum. Pre- and post-module tests and 5-point Likert scales were used to assess student knowledge and confidence, respectively. Results A total of 115 participants were recruited. Test scores improved by 29 per cent (p < 0.001) and confidence by 66 per cent. Anatomy and ENT conditions demonstrated significant improvement in confidence, with a lower confidence score for examination. Conclusion This study showed improved knowledge and confidence, whilst highlighting greater efficacy in content over practical skills teaching. Online learning is a validated educational tool; however, it should not be used as a replacement but as an adjunct to supplement learning.

BackgroundNosocomial infections are a global health problem, affecting 1.4 million people in treatment centers, responsible for 80,000 estimated annual deaths. The current study aimed to assess the factor influencing nosocomial infections and to choose the best antibiotic for its treatment through culture analysis.MethodologyThe current study was conducted in a tertiary care hospital Rawalpindi. A total of 120 patients with at least one nosocomial episode were included. Blood, urine, and wound swab sample were collected for hematology, biochemistry, electrolyte, and microbial analysis. Multivariate regression analysis through SPSS (ver. 16.0) were done, p-value of ≤ 0.05 was considered statistically significant.ResultThe prevalence of culture-confirmed nosocomial infection was 25%, among which age groups (P = 0.00, 95% CI, − .382-.271) were significantly correlated. Hematological analysis shows that 73.3% have lymphopenia (P = 0.00, 95% CI .567-1.175), 73.3% have Neutrocytosis (P = 0.00, 95% CI .553-1.122) and anemia (26.7%) (P = 0.002, 95% CI .097-.404) were statistically significant. Raised level of ALT (60%), Bilirubin (26.7%) and ALP (13.3%) among liver functional tests (P = 0.68, 95% CI .686- .280) found insignificant however abnormal level of urea (33.3%) and creatinine (46.7%) (P = 0.00, 95% CI -1.227-.392) were significantly correlated with nosocomial infections. Electrolytes profile shows that Hypernatremia (26.7%) (P = 0.000, 95% CI-.491–.227) were strongly correlated. Culture analysis isolated six bacterial agents, comprising 83.3%:16.6% ratio of gram-negative and gram-positive isolates. Klebsiella pneumonia was frequently isolated gram-negative, while Methicillin-Resistant Staphylococcus aureus was the only gram-positive isolate collected. Urinary tract infection (UTI) (36.6%) was frequently found, followed by bloodstream infection (26.6%) (BSI). The majority of the gram-negative isolates were sensitive to Imipenem while resistant to Amoxicillin + Clavulanic acid, Trimethoprim/sulfamethoxazole, cefoxitin, Levofloxacin, Norfloxacin, and linezolid antibiotics. Methicillin-resistant staphylococcus aureus was found sensitive against Trimethoprim/sulfamethoxazole while resistant towards linezolid, Imipenem, and Cefotaxime.ConclusionThe current study revealed that nosocomial infection is still prevalent in our hospital environment and the leading cause of drug resistance and dysfunctions of various factors like WBCs, LFTs, RFTs, electrolytes, coagulation factors and anemia, which can lead to morbidity and mortality.

Introduction: Necrotising otitis externa (NOE) is a serious, progressive infection of the external ear canal. If untreated, it can invade into temporal bone, skull-base and surrounding tissue resulting in cranial nerve palsies, neurological infections and death. Patients present with unremitting, severe otalgia, otorrhoea and oedematous ear canals containing granulation. Surgery has a limited role; the mainstay of treatment involves a long course of intravenous antibiotics. Currently, there is no data on the complications of antibiotic treatment for NOE. This project aims to provide evidence on the nature/frequency of severe treatment-related complications requiring a change in antibiotic regime. Methods: A retrospective 5-year cohort analysis was performed on 64 patients who were treated for confirmed NOE with intravenous antibiotic therapy. Clinical notes, blood results and antibiotic prescriptions were documented and analysed. Results: Average duration of treatment was 11 weeks (range=38 weeks). There was an average of 2.1 antibiotic regimes per patient with 10 cases requiring inpatient admission due to treatment-related complications. 63% of treatment changes were directly related to adverse effects of intravenous antibiotics. Drug allergy/intolerance (n=18) and clinical deterioration i.e. Lack of symptomatic improvement and/or worsening inflammatory markers (n=18), were the most common reasons for antibiotic change. Neutropenia, deranged liver function tests and acute kidney injury were also recognised adverse effects of treatment. Conclusion: This study provides the first evidence on the notable frequency of antibiotic-related complications in NOE patients. Larger, multicentre studies are required in the future to validate our findings and will better inform both clinicians and patients of the risks of treatment.