IntroductionDiabetes Mellitus is the most common endocrine disorder and metformin is the most commonly prescribed oral hypoglycemic agent. Metformin is well known to cause viamin B12 deficiency due to effect on calcium-dependent membrane action in the terminal ileum leading to malabsorption of vitamin B12. The purpose of this study is to determine prevalence and associations of Vitamin B12 deficiency in patients of type 2 diabetes mellitus treated with metformin.MethodsThis case control study was carried out in department of medicine, Combined Military Hospital, Kharian from 1st Jan 2012 to 30 december 2012. We enrolled 114 outdoor patients of type 2 diabetes mellitus currently on metformin for atleast 12 months, by consecutive sampling, and 105 age and sex matched patients taken as control. Patients with vitamin B12 levels of less than 150 pg/ml were said to be B12 deficient. The results were analyzed on SPSS version 16.ResultsSerum B12 levels were low in 35 patients (31%) on metformin as compared to only 9 patients (8.6%) among controls,(p value 0.002). Mean B12 levels were significantly low in metformin group 311 pg/ml (±194.4), p value 0.03. Dose of metformin had inverse correlation with B12 levels and the difference was statistically significant with p-value < 0.001.ConclusionOur study demonstrated significantly high prevalence of vitamin B12 deficiency in patients treated with metformin with significant effect of dose and duration of metformin use on B12 levels. Physicians must recognize this important fact and screen diabetics on metformin therapy for underlying B12 deficiency.

Objective More than half of the world’s population live in areas with a potential risk of acquiring dengue fever (DF). Health education interventions are effective, barring a language communication gap. The objective of this study was to estimate the effect of health education in the knowledge, attitude, and practices (KAP) towards DF control and prevention in public and private schools. Materials and methods We assessed the DF control and prevention strategy KAP of students of eight public and private schools in Jeddah, Saudi Arabia before the dengue health education intervention sessions (pre-I) and three months following the education intervention sessions (post-I) using the same closed-ended validated questionnaire. Schools and students were selected by a multistage stratified random sample method. Statistical analysis was done using the paired and independent T-test in IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY). Results We found a significant mean difference in the overall knowledge (pre-I, 7.86 ± 2.61; post-I, 10.94 ± 2.35), attitude (pre-I, 5.16 ± 1.50; post-I 6.23 ± 1.30), and practice (pre-I, 2.96 ± 1.33; post-I, 3.94 ± 1.12) scores. Private schools scored better post-intervention scores in knowledge and practice compared to public schools in local and English language medium. Conclusions Health education programs are essential for DF prevention and management. Institutes whose populations consists of students with various language backgrounds should not be ignored. Bilingual educational sessions are important in such private institutes. Our results indicate additional emphasis is required on putting interventional knowledge into practice.

The study investigated the effects of Van Hiele's phase-based teaching strategy and gender on Pre-service mathematics teachers' geometry achievement in Niger State, Nigeria. Based on the theoretical framework of the study, three research objectives with corresponding null hypotheses were formulated to guide the study. The study employed a two-by-two (2x2) quasi experimental factorial design. One hundred and forty-nine (149) pre-service mathematics teachers from two colleges of education situated in Niger state, Nigeria were used as research sample. The sample colleges were selected using a purposive sampling technique. The experimental group was exposed to Van Hiele's phase-based teaching strategy while the control group was taught same topics with conventional teaching strategy. Geometry Achievement Test (GAT) covering topics in Geometry was used to collect data for both pre and post achievement test. A Cronbach alpha was computed to ascertain the internal consistency of the instrument (GAT) and reliability coefficient of 0.79 was obtained. The data was analyzed using Analysis of Covariance (ANCOVA) at 0.05 level of significance. The results of the study revealed that van Hiele's phase-based teaching strategy is more effective than conventional teaching strategy in improving pre-service mathematics teachers' achievement. It was therefore recommended that, since it has been established from the findings of this study that van Hiele phase-based teaching strategy is more effective than conventional teaching strategy in improving preservice mathematics teachers' geometry achievement, both prospective (pre-service teachers) and practicing teachers who seek to enhance their instructional practices and promote their learners' geometric understanding to embrace the van Hiele phase-based teaching strategy in their classrooms.

The study investigated the effects of van Hiele’s phase-based teaching strategy and gender on pre-service mathematics teacher attitude towards geometry in Niger state, Nigeria. The study employed pre-test and post-test quasi-experimental design using a two-by-two (2x2) factorial matrix with one experimental and control group. The experimental group was exposed to Van Hiele’s phase-based teaching strategy while the control group was taught the same topics with conventional teaching strategy. Three null hypotheses with corresponding research question were formulated to guide the study. Attitudes Towards Geometry questionnaire (ATGQ) was the instrument employed to collect data from 149 sampled pre-service mathematics teachers from the two colleges of education situated in Niger State, Nigeria. The sample colleges were selected using purposive sampling technique.  A reliability coefficient of 0.73 was obtained for Attitudes Towards Geometry questionnaire.  Two-way Analysis of Variance (ANOVA) was employed in analysing the data at 0.05 level of significance. The results of the study revealed that van Hiele’s phase-based teaching strategy is more effective in improving pre-service mathematics teachers’ attitude towards geometry. It was recommended among others, that since van Hiele phase-based teaching strategy was found to be effective in enhancing pre-service mathematics teacher attitude towards geometry, the strategy should be employed by lecturers in course of teaching students. The teacher education programme should be geared towards training of mathematics lecturers to learn van Hiele phase-based teaching strategy as it supports effective teaching and learning which thereby improving learners’ attitudes towards learning geometry.

Background: Streptococcal tonsillitis is a common pediatric ailment which is faced by physicians on a daily basis and is associated with disastrous complications if not treated adequately. The objective of this study was to compare the efficacy, safety and cost-effectiveness of intravenous co-amoxiclav with benzyl penicillin in the treatment of severe streptococcal tonsillitis in children. Material and Methods: This Randomized Controlled Trial was carried out at CMH Mardan, Khyber Pakhtunkhwa from January 2018 to November 2019. A total of 310 children with severe tonsillitis, aged between 5 to 15 years were selected from outpatient department of Combined Military Hospital Mardan. The cases were divided into two groups. Injection co-amoxiclav was given to patients in Group A (n=155) and injection benzyl penicillin was administered to patients in Group B (n=155). Both groups were compared in terms of effectiveness of treatment, safety and cost effectiveness. All the data was assessed with help of SPSS (Statistical Package for Social Sciences) version 21. Chi square and independent T test were used with P-value < 0.05 taken as statistically significant. Results: There were 310 children with severe tonsillitis, 155 in each group. Mean age in Group A was 9.35 ± 3.17 years and in Group B, 9.96 ± 2.96 years, respectively. In Group A, 2 cases developed hypersensitivity to injection co-amoxiclav after initial test dose as compared to 3 cases in Group B. Mean duration for complete resolution of symptoms (i.e. hospital stay) was 4.13 ± 0.375 days for Group A as compared to 4.09 ± 0.377 days for Group B (P=0.458). Mean cost of antibiotic drugs for each child in Group A was Rs. 965.88 ± 298 and in Group B was Rs. 152.36 ± 53. Benzyl penicillin was found to be significantly cost effective as compared to co-amoxiclav (P=0.000). Conclusions: Both the drugs have similar efficacy and safety profile in the treatment of severe streptococcal tonsillitis in children. However, benzyl penicillin is more cost effective than co-amoxiclav in our study population.