We prospectively evaluated the performance of Cepheid's GeneXpert Xpert Flu assay in a target population of 281 adults presenting to the emergency department with an acute respiratory illness who met Centers for Disease Control and Prevention (CDC) criteria for recommended antiviral treatment. Compared with the Prodesse ProFlu؉ assay, Xpert Flu had an overall sensitivity of 95.3% and specificity of 99.2%. The majority of patients seeking care for influenza and other respiratory viruses present to episodic outpatient care settings, such as emergency departments (EDs) or other urgent or primary care settings, where rapid diagnosis and treatment are critical (1). Due to nonspecific symptoms, a provider's clinical diagnosis of influenza has low sensitivity, leading providers to rely on diagnostic testing for an accurate influenza diagnosis (2). Most commercially available real-time PCR (rt-PCR) tests are typically run in batches and require separate nucleic acid extraction, which significantly delays the results. The current antigen detection tests are rapid but have poor-to-moderate sensitivities, ranging from 10% to 70% (3). Rapid random-access PCR-based influenza tests, such as the GeneXpert Xpert Flu assay (Cepheid, Sunnyvale, CA, USA), may have clinical utility in filling this diagnostic gap, since it has a reported time to result of approximately 80 min and has a significantly higher sensitivity than rapid antigen detection tests (4).Prior to integration into routine clinical use, the clinical performance of Xpert Flu in the target population requires evaluation. Although clinicians in the outpatient episodic care setting may test an array of patients, accurate and rapid influenza testing with Xpert Flu would be most important in patients for whom the test result would impact clinical management, namely, those who meet the Centers for Disease Control and Prevention (CDC) criteria for antiviral therapy and are at risk for potential influenza-related complications. Several of these conditions, such as advanced age and pneumonia, have been associated with the decreased sensitivity of rapid antigen-based testing, highlighting the importance of evaluating Xpert Flu in this population (5). In order to fully translate rapid PCR-based testing into clinical practice, we prospectively evaluated the sensitivity and specificity of Xpert Flu in adult ED patients with an acute undifferentiated respiratory illness who met CDC criteria for recommended antiviral treatment.Adult ED patients with an undifferentiated acute respiratory illness who met CDC criteria for recommended influenza antiviral treatment at an urban university-affiliated tertiary-care ED were prospectively enrolled between December 2012 and March 2013. After written consent was obtained, as approved by the Johns Hopkins University institutional review board (IRB), a nasopharyngeal swab was collected from each patient and placed in 3 ml of viral transport medium (MicroTest M4RT; Remel, Lenexa, KS, USA). All the samples were aliquoted, stored at Ϫ70°C until com...

Background: Breast cancer is a major health burden mainly in the developed countries but its rates are also increasing in the developing countries. With such increasing rates of breast cancer it is imperative that the general population is aware of its risk factors, early screening methods and the preventive measures that can be undertaken before its development. Objective: To assess the awareness of breast-self-examination (BSE) & screening among the mothers belonging to different socioeconomic groups in Karachi, Pakistan. To assess the awareness of breast lump & its relation with breast cancer in mothers. Methods: This is a cross sectional research study constituting on a sample size of 284 people. The data was collected using a self administered questionnaire which was designed after detailed literature review. The date was collected from all 5 districts of Karachi, Pakistan. The duration of data collection was from April 2013 to November 2013. The data was analyzed using spss 19 with a 95% confidence interval and a 5% margin of error. A p-value of .05 or less was considered significant. Results: The results showed that most of the women (81%) have sufficient general knowledge about breast cancer and its outcomes but the awareness regarding the risk factors was limited. Only 38% were aware that old age is a risk factor, 34.9% knew that null parity is a risk factor while 57.7% believed that trauma to the breast, for example child hitting the breast, cause breast disease. The women were only partially aware of the screening methods available, only 53.2% of women knew how to self-examine their breast and 69% of them were not aware of the fact that mammography is the basic screening procedure. Results are similar for knowledge about signs and symptoms and only 46.8% were aware that bloody discharge and inward retraction of nipple may be due to breast cancer. Despite the limited current awareness about the breast diseases most women (82.4%) showed interest in learning more information about breast diseases and how might they be prevented. Conclusions: The study concluded that though the mothers were aware of breast cancer they still require sufficient knowledge regarding its risks, methods of screening and means to prevent it. In accordance with this need more initiatives should be undertaken to spread more awareness regarding this through media or other useful sources. But increasing awareness alone cannot deliver the desired results and there is a parallel need to increase the facilities and to make them accessible for all. Steps should also be undertaken to educate the women about their misconceptions regarding breast cancer and to make them free from unnecessary barriers as many women do not seek clinical advice due to these barriers.

Introduction: Background: The Medical Education has two most essential basis, sound theoretical knowledge and proficient clinical skills. Both of these factors depend on an efficient method of teaching in a proper clinical set-up. So that the medical students get most of the benefit out of it by learning and developing their clinical skills. Objective: The main objectives of this study are to determine the presence of difference in the learning environment in government and private hospitals of Karachi and to determine whether there is any biasness present in these systems on the basis of gender of students.Methods: Four renowned university hospitals were selected: two private and two government-based. 150 samples were collected from each university by a self-administered questionnaire. The analysis has been performed using SPSS 20 and the results are presented using chi square.Results: The study established that there is a striking difference between the learning environment in these clinical set-ups based on the theoretical knowledge of the students, the proper schedule of classes, hands on experience gained in the ward, new knowledge gained at the end of a wards rotation, doctors’ interaction with the students and the students’ motivation. This was represented by the 2 = 10.173 and p .00001. MG = 5.73 with a SD = 1.815 while MP = 6.76 with a SD = 1.883 (M = mean, G = Government hospital environment, P = Private hospital environment). According to the study there is no difference in treatment of the students on the basis of gender represented by the 2= 3.168 and a p is between .05 and .1.Conclusions: The private hospitals provide a sound theoretical knowledge to the students they lack the provision of optimum opportunities for the students to develop their clinical skills in comparison with government hospitals. It is however recommendable that both the systems lack any biasedness among the students on the basis of gender.