Majority of the physicians including residents who teach had received no formal training in teaching. Consequently, they utilize skills obtained from their own experiences when they teach. Numerous reasons and benefits for providing residents with formal teaching training have been suggested. Accrediting and certifying bodies have recognized the importance of residents as teachers, conferring priority to residents teaching ability. Residents should receive formal instruction that is tailored to both their specialty and need. As teaching can be learned and refined over time, it needs to be reinforced with review sessions designed according to needs, experience and years of training. Effective resident educators will ultimately mature to competent physicians. Such physicians who can educate both their patients, their families, and improve patients' care. In this article, we reflect on the current status in conventional settings, new and emerging practices in fostering an educational role for residents and explore the various modules of such practices and the potential for introducing these practices into newer regions.

Background: The presence of extrahepatic disease, bilobar disease or greater than four hepatic lesions were once considered contraindications to hepatectomy for colorectal metastases but are being reconsidered. We reviewed our experience with resection of extrahepatic disease (EHD) at the time of hepatectomy for metastatic colorectal cancer to determine the impact on perioperative and long-term outcome. Methods: The medical records of 441 patients who underwent hepatectomy for colorectal cancer metastases from 1989 to 2010 were reviewed. Demographics, clinicopathologic characteristics, and outcomes were compared between those with and without extrahepatic disease. Overall survival curves were constructed using the Kaplan Meier method and compared with the log rank test. Multivariate analysis using logistic and Cox proportional hazards regression were used to determine predictors of perioperative mortality and longterm survival, respectively. Results: Fifty-nine (13%) patients presented with EHD at the time of hepatectomy. There were no significant differences between patients with and without EHD with regard to age, gender, disease free interval, or the number and distribution of hepatic metastases. Patients with EHD were as likely to undergo complete (i.e. R0) resection as those with isolated liver metastases (59% vs. 74%. p>0.05). Perioperative mortality in the 441 patients was 2.3%. Only increasing number of liver segments resected and perioperative complications were predictive of perioperative mortality by multivariate analysis. Median overall survival was 20.5 months in patients with EHD compared to 35.2 months in patients without EHD (p<0.001). Increasing age, the presence of EHD, bilobar disease, and length of stay in the ICU were significant predictors of decreased overall survival by multivariate analysis. Conclusion: Despite similar populations, extrahepatic disease remains a poor prognostic indicator for survival after hepatectomy for colorectal metastasis. Though a low perioperative mortality coupled with median survival of 20.5 months emphasizes the potential of a curative approach to patients with traditionally incurable disease, resection of EHD should be carefully weighed. The presence of resectable extrahepatic disease should not be a contraindication to hepatectomy for colorectal metastases but should be approached cautiously due to its poor prognostic factors.

Background: Low back pain is the most common cause of work related disability in persons aged less than 45 years. Workers who sit in front of the computer for more than 40 hours per week end up with low back pain. Bad positioning of the body parts in a single day doesn’t make poor postures, whereas adaptation of the incorrect posture for a longer duration results in weak muscles and postural problems. Abnormal posture results in pain, disability and muscle weakness. Most of the management of low back pain focuses on the rehabilitation of the pain and very few studies focus on work station corrections. Aim: This study aims to find out the effect of work station modification with Myofascial release therapy on pain and lumbar flexion range of motion in mechanical low back pain in desk job workers. Methods: Forty subjects were included using simple random sampling method, subjects were chosen following an inclusion and exclusion criteria. Group A, underwent myofascial release therapy, whereas group B underwent myofascial release therapy technique with work station modification. The outcome measures were pain and range of motion of lumbar spine, which measured using visual analogue scale and modified schober’s method. Student ‘t’ test was used to find out the difference between the groups. Results: This study showed that there was a significant difference between the group A & group B. Conclusion: The study concludes that the work station modification along with myofascial release therapy was very effective in improving range of motion, and reducing pain.

Background: Vitamin D deficiency is a common medical problem, especially in the gulf region of the Middle East. The prevalence in several studies has exceeded 50% and being more frequent among females. Objective: We assessed the prevalence of vitamin D deficiency in patients attending a general hospital in both men and women in different age groups. Methods: Vitamin D level data for patients who attended Dubai hospital in the period between 2008 and 2012 were examined retrospectively. The serum 25(OH) D levels were crosschecked in patients' charts and the hlaboratory electronic database. Patients with incomplete medical records, those already on treatment with vitamin D, and patients with contradicting results in the medical files and the electronic database has been excluded. Data were analysed using descriptive analysis relating vitamin D levels to age, gender, and ethnicity. Results: The total number included was 2836 patients. 81% of them had 25 (OH) D levels of <30 ng/ml. About 76.4% (n=2166) of the studied group were females. There was no difference in prevalence between males and females. Arab ethnicity was associated with more marked vitamin D deficiency and less sufficiency. Conclusion: We conclude that vitamin D deficiency is a considerably major health problem in the emirate of Dubai. Higher awareness among healthcare providers and the community is needed for screening and treatment necessity.

Background: Hand infection in diabetics is a well-known problem which results in high morbidity and occasional mortality. Patients and methods: 182 cases of hand infection were collected from the Qassim University over the past two years. 114 diabetic female patients, of any type (1, 2), were included in this study. Clinical examination and culture were done. Different media were used for the isolation of aerobic, anaerobic and yeast. Results: E. coli was the most prevalent organism in diabetic patients. The isolates that were observed in decreasing order of frequency, in diabetic patients, were E. coli, S. aureus, Streptococcus beta hemolytic, Pseudomonas aeruginosa, Proteus sp., Streptococcus viridans, Enterobacter, anaerobes and yeast (Candida). In the control cases we found S.aureus in high percentage followed by Coagulase negative Staphylococcus, Enterococcus and E.coli, Streptococcus beta hemolytic, P. aeruginosa, anaerobes and in low percentage K. pneumonia and Enterobacter. Conclusions: This study demonstrates bacterial composition of diabetic's hand flora predominated by Gram negative organisms. The presence of anaerobes, and fungi is noted.

Introduction: Obesity is a major public health problem. We evaluated the accuracy of various anthropometric variables among waist circumference (WC), waist: hip ratio (W:H), waist: height ratio (W:Ht), skin fold thickness (STs) that are used to predict body fat in obese middle age Indians. Methodology: A cross sectional study was undertaken on 51 individuals aged (30-55 years), with body mass index (BMI) of 23 or above (22 males and 29 females). Waist, hip circumference were measured by tape at specific levels. Biceps, triceps, subscapular, suprailiac and abdominal STs were measured by Harpenden calipers. Total body fat (TBF) was calculated using underwater weighing machine and intraabdominal fat (IAF) and subcutaneous body fat (SC) were estimated using ultrasonography. The status of metabolic syndrome was also determined in each subject. Result: WC showed significant association (p<0.01) with SC in both males and females. W:H ratio showed significant correlation with ultrasound measures of IAF and metabolic syndrome (p<0.01) in men. W: Ht ratio also showed significant correlation (p<0.01) with SC in both males and females and TBF in females. Conclusions: The ultrasonography measurements of IAF estimate visceral obesity and metabolic syndrome better than other anthropometric measurements and the effectiveness of other anthropometry indices requires reference to gender, TBF, IAF and SC.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a serious and life-threatening drug reaction characterized by fever, skin rash, peripheral eosinophilia, presence of atypical lymphocytes in peripheral blood smear, generalized lymphadenopathy and involvement of other body organs. The only agreed-upon therapy for DRESS in literature is withholding the culprit drug. There are no controlled trials on the use of steroids in this condition. Reports on the use of N-acetylcysteine in DRESS are very few. We report here a case of 36 year old female with severe DRESS that deteriorated rapidly upon tapering steroid therapy and dramatically improved on combination of pulse steroid therapy and N-acetylcysteine. This paper suggests that higher doses and gradual tapering of corticosteroid is a wise approach in treating patients with DRESS. It further emphasizes the possible beneficial role of N-acetylcysteine in this condition.

The association of chromosomal disorders with various neoplasms is well established. We report a case of 36 years old man who was referred for preoperative evaluation of functional status of “presumed” right adrenal mass. The patient was found to have clinical features of hypogonadism and further investigations confirmed the diagnosis of Klinefelter’s Syndrome. The patient proceeded to surgery and pathological examination of the removed mass revealed a mature retroperitoneal teratoma abutting the adrenal gland. This case demonstrates that patients with KS are at increased risk of extragonadal germ cell tumors unusual sites from the mediastinum and brain. Retroperitoneal teratoma in the adrenal gland region can be easily confused with adrenal related mass.

Atrial fibrillation (AF) is the commonest cardiac arrhythmia and it is associated with a substantial burden to the healthcare system. Among many of the risk factors of AF, excessive alcohol intake stands out as one of the modifiable risk factors. While alcohol consumption is a leisure that many indulge in, the repercussions on both health and the health economy are not to be under estimated. Alcohol intake contributes to AF incidence although there are differing opinions as to the quantity of alcohol ingestion, which causes AF development. This review article highlights evidence from a range of studies that delineate the effects of alcohol consumption on AF occurrence.