Continuing medical education (CME) generally aims to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession. CME covers the body of knowledge and skills generally recognized and accepted by the profession as within the basic medical sciences, the discipline of clinical medicine, and the provision of health care to the public. CME credit hours are generally earned through events approved by the recognized CME Committees. Physicians earn credit based upon the number of learning contact hours. Most licensing bodies require a set number of these credit hours for renewal of license (maintenance of certification). In the developing world, medical registration may not be subject to an updating (revalidation) process and may simply mean having obtained a medical qualification and paid renewal fees for the “Doctor's Syndicate”. We propose that, for the sake of patients' safety and other benefits, doctors should earn a minimum number of CME hours as a prerequisite of their maintenance of medical certification. In the development phase, voluntary scheme may be adopted. To encourage provision of such programs, the accreditation process, should initially be simple and may get progressively stricter at later stages. To avoid pharmaceutical bias the accrediting body could come up with a list of clinical topics that are of high relevance and importance to the practice, and recent translational research findings. This could be done in collaboration with scientific societies and postgraduate academic institutions. We think maintaining a list of “credible providers” is more relevant than imposing a complicated application process with each event. Using “paperless” online application and accreditation processes should save time and effort.

Enviroxime is an antiviral compound that inhibits the replication of polio and rubella virus. The antiviral activity of this compound was tested in two cell lines (L2OB and RD for poliovirus and HeLa and WISH for Rubellavirus). At a concentration of 32μg/ml or less, the compound is relatively non-toxic to cell lines but has significant antiviral effect. We found the minimal inhibitory concentration (MIC) of 0.06 μg/ml for polio, and 0.125 μg/ml for rubella virus. The therapeutic index (TI) defined as the ratio of the minimal dose of the drug that is toxic to the cells to the dose which inhibit the viral multiplication, is used to evaluate the drug activity. If this index is more than one, the margin of safety for the drug is large. In this study the TI of enviroxime against poliovirus was 54 while it was 14 against Rubella virus. Hence we speculate that this compound if used as an antiviral agent in humans, would have minimal or no side effect.

A cross-sectional retrospective drug utilization study was conducted in different wards of the Zawiya teaching hospital, Libya, over a 15-month period. One hundred prescriptions were examined, of which 51% were for females. The World Health Organization (WHO) indicators (utilization in defined daily doses (DDD); DDD/1000inh/ day) were used and the ATC/DDD method was implemented. The most frequently prescribed antibiotic (30 occurrences) was amoxicillin+clavulanic acid, while the least frequent (once) was neomycin or cloxacillin. The DDD/1000inh/day of amoxicillin+clavulanic acid was the highest (11.69) and that of ciprofloxacin was lowest (2.86). The ward with the highest number of prescribed antibiotics (35%) was surgery, while the ward with the lowest number (9%) was ENT. Average treatment period was found to be five days. In conclusion, our data showed an overuse of amoxicillin+clavulanic acid in contrast to other antibiotics. High pharmacological effectiveness against most local and systemic infections, low incidence of side effects, and the availability of many suitable dosage forms with different strengths was thought to be the reason that prescribers tended to prefer amoxicillin+clavulanic acid over other antibiotics. This study showed a need for microbiological investigation before treatment of infections. This also helps physicians to have a more precise idea about prescriptive patterns prevalent in the Libyan community.

Background: Patellofemoral pain syndrome (PFPS) is a commonly seen condition in athletes. Several potential contributing factors have been postulated. Although hip muscle strength has been suggested to play a major role, concentric hip muscle function in athletes with PFPS has not been formally investigated. Objectives: We aimed to compare the concentric hip muscle strength in athletes with PFPS with that of controls, and to derive a concentric knee extension-to-flexion (quadriceps: hamstring) ratio Subjects and Methods: University athletes with PFPS (n=25) and asymptomatic controls (n = 25) were studied. Concentric torque of the hip abductors, adductors, flexors and extensors along with concentric knee extensors and flexors torque were assessed. Participants rated their knee pain in the week before the study on a visual analog scale and a self-administered anterior knee pain scale (AKPS). Strength testing was performed at 60°/s. Results: Participants with PFPS exhibited much lower concentric hip abduction, adduction, flexion and extension peak torque compared to controls. The concentric hip abduction to adduction and extension to flexion ratios showed no difference. Quadriceps:hamstring ratio was higher for PFPS participants. Conclusion: We propose that concentric hip muscle strength is significantly affected in PFPS. Clinicians are urged to include concentric strengthening exercises for the hip along with quadriceps and hamstring muscles during the rehabilitation of athletes with PFPS.

Polymorphic ventricular tachycardia (PMVT) is characterized by QRS complexes of changing amplitude that appear to twist around the isoelectric line. Torsades de Pointes (Tdp) is a variant of PMVT in which there is prolongation of QTc interval (generally exceeding 500 milliseconds). A number of medications have been noted to prolong the QTc interval. We describe a clinical case in which the culprits are Azithromycin and Fluoxetine. Azithromycin has been regarded as a “safer” macrolide when it comes to proarrhythmia as compared to erythromycin or clarithromycin. However, in certain clinical circumstances like combination drug usage, unique clinical features like underlying pancreatitis in this particular patient, some of the medications that are deemed low risk can certainly be more proarrhythmic. It is therefore important to review the clinical and pharmaceutical profiles of every patient before choosing which medications to prescribe.