Teaching Family Medicine and General Practice / 가정의학회지

The teaching of family medicine and general practice should aim to develop an appreciation of the unique nature and role of the specialty. Teachers should relate patient cases to the principles of family medicine. These principles include (1) compassionate care; (2) a generalist/holistic approach focusing on the whole person, family, and community; (3) continuity of relationship, i.e., building a patient-physician bond of trust; (4) reflective mindfulness; and (5) lifelong learning. The curriculum, instructional strategy, and assessment should be carefully aligned. Core competencies include patient-centered communication, physical examination skills, clinical procedures, palliative care, humanities in medicine, holistic care, shared decision-making, family therapy, home and community visits, chronic disease care, problem-based documentation, team-based care, data-driven improvement, information mastery, ethics and professionalism, and work-life balance. Family medicine/general practice is defined as the medical specialty that manages common and long-term illnesses, focusing on overall health and well-being. Hence, clerkship schedules should maximize clinical exposure and opportunities for self-reflection. A learner-centered approach should begin with a self-identified inventory of learning needs based on the curriculum; next, these needs should be chosen as topics for student presentations. Teaching methods should include mini-workshops: a combination of didactic lectures and small-group exercises. Individual face-to-face formative feedback should occur at midcourse and culminate in a group reflection on the learning experience. Clinical supervision should gradually decrease as each resident demonstrates safe patient care. Procedure skills training should be closely supervised, formally documented, and constitute about one-fourth of learning sessions.

Citrus peel extract and powder attenuate hypercholesterolemia and hyperglycemia using rodent experimental modeling

Objective To investigate hypocholesterolemic and hypoglycemic potential of citrus peel extract and powder using rodent experimental modeling. Methods Considering the fact, rat feeding trial was carried out for a period of 56 d to access the prophylaxis of citrus peel flavonoids by employing normal (study I), hyperglycemic (study II) and hypercholesterolemic (study III) rats. Each study was further divided into three groups to ensure the provision of selected diets, i.e., control, functional and nutraceutical diets. Each study was further divided into three groups to ensure the provision of selected diets, i.e., control, functional and nutraceutical diets. Results Declining trend for total cholesterol was observed in all studies with maximum reduction (8.55%) in rat group fed on nutraceutical diet in study III. Likewise, levels of low density lipoproteins and triglycerides reduced 11.39% and 7.89% respectively in hypercholesterolemic rats. Moreover, nutraceutical diet alleviated the sera glucose level by 8.96% in study II. Conclusions Conclusively, inclusion of citrus peel bioflavonoids in dietary therapies is a promising strategy to modulate lipidemic and glycemic attributes without imparting any deleterious effect on hematological parameters.

Anti-hypercholesterolemic and anti-hyperglycaemic effects of conventional and supercritical extracts of black cumin (Nigella sativa)

Objective To explore the hypoglycaemic and hypocholesterolemic potential of conventional and supercritical extracts of black cumin. Methods Purposely, rat modelling was carried out for 2 months by designing three studies i.e. study I (normal rats), study II (hyperglycaemic rats) and study III (hypercholesterolemic rats). Each study was further divided into three groups based on diet i.e. control, functional diet (contained extract of black cumin prepared by using conventional solvent) and nutraceutical diet (contained extract of black cumin prepared by supercritical fluid extraction system). Results During whole trial, an abating trend was observed in the level of serum cholesterol with maximum reduction (12.8%) in nutraceutical group of study III. Low density lipoprotein and triglyceride level was also lowered maximum in study III as 17.1% and 11.6%, respectively. Whereas, highest decline in glucose level was in nutraceutical group of study II as 11.2%. Conclusions Inclusion of black cumin extracts in diet significantly lowers the occurrence of hyperglycaemia and hypercholesterolaemia. Furthermore, hypoglycaemic and hypocholesterolemic potential of nutraceutical diet is more prominent as compared to functional diet.

Preventive Gabapentin versus Pregabalin to Decrease Postoperative Pain after Lumbar Microdiscectomy: A Randomized Controlled Trial

STUDY DESIGN: Randomized controlled trial. PURPOSE: The purpose of this study was to compare pregabalin and gabapentin for mean postoperative visual analog score (VAS) for pain in patients undergoing single-level lumbar microdiscectomy for intervertebral disc prolapse at a tertiary care hospital. OVERVIEW OF LITERATURE: Pregabalin has a superior pharmacokinetic profile and analgesic effect at lower doses than gabapentin; however, analgesic efficacy must be established during the perioperative period after lumbar spine surgery. METHODS: This randomized controlled trial was carried out at our institute from February to October 2011 on 78 patients, with 39 participants in each study group. Patients undergoing lumbar microdiscectomy were randomized to group A (gabapentin) or group B (pregabalin) and started on trial medicines one week before surgery. The VAS for pain was recorded at 24 hours and one week postoperatively. RESULTS: Both groups had similar baseline variables, with mean ages of 42 and 39 years in groups A and B, respectively, and a majority of male patients in each group. The mean VAS values for pain at 24 hours for gabapentin vs. pregabalin were comparable (1.97±0.84 vs. 1.6±0.87, respectively; p=0.087) as were the results at one week after surgery (0.27±0.45 vs. 0.3±0.46, respectively; p=0.79). None of the patients required additional analgesia postoperatively. After adjusting for age and sex, the VAS value for group B patients was 0.028 points lower than for group A patients, but this difference was not statistically significant (p=0.817, R²=0.018). CONCLUSIONS: Pregabalin is equivalent to gabapentin for the relief of postoperative pain at a lower dose in patients undergoing lumbar microdiscectomy. Therefore, other factors, such as dose, frequency, cost, pharmacokinetics, and side effects of these medicines, should be taken into account whenever it is prescribed.

Homozygous mutations in NTRK1 gene underlie congenital insensitivity to pain with anhidrosis in Pakistani families

Congenital insensitivity to pain with anhidrosis is a rare autosomal recessive disorder presenting with loss of pain sensation, thermal sensation defects, and self-mutilating behavior. In the present study, we recruited two consanguineous pedigree showing pain insensitivity symptoms from Pakistan for clinical and molecular investigations. In family A, one female patient displayed classical CIPA symptoms along with microcephaly and severe intellectual disability. During course of the disease, her right foot was amputated and had remarkable dental degeneration and teeth shedding. In family B, one boy presented with classical symptoms of congenital insensitivity to pain with anhidrosis. Blood was collected from both families for molecular studies. Sequencing with the Ilumina Trusight One Sequencing Panel covering 4813 OMIM genes revealed a known homozygous mutation c.2084C>T; p.P695L of NTRK1 in family A and a novel truncated mutation c.2025C>G; p.Y681X in family B. Protein modeling analysis of both mutations (p.P695L and p.Y681X) predicted loss of the rigidity in tyrosine kinase domain of NTRK1 that led to conformational changes as well as deleterious effect on protein function. The known mutation was reported more than a decade ago in a family from Northern Israel and other non-sense mutation is newly identified. It is interested that most of NTRK1 mutations are associated with this domain. This is first ever report of NTRK1 variants in congenital insensitivity to pain with anhidrosis patients from Pakistan.

Synthesis, characterization and biological evaluation of tryptamine based benzamide derivatives

Benzamides and tryptamine are biologically significant compounds, therefore, various benzamide analogous of tryptamine have been efficiently synthesized using tryptamine and different benzoyl chlorides, in order to find new biologically active compounds. The resulting products were then characterized by melting point determination, calculation of R[f] values and LC-MS techniques. At last, structure activity relationship [SAR] of the synthesized compounds was evaluated against two microbial strains; Bacillus subtilis and Aspergillus niger. All the five prepared products have shown high yield, sharp characterization and significant resistance against the growth of tested microorganism, providing a new range of tryptamine based benzamide derivatives having significant antimicrobial activities

Surgical correction of grown up tetralogy of fallot

Objective: To get an audit of outcome of our patients operated for total correction for grown up Tetralogy of Fallot

Study Design: Observational / analytic study

Place and Duration of Study: This study was conducted at the Department of Cardiac Surgery, NICVD, Karachi from January 2015 to August 2016

Materials and Methods: We reviewed our surgical record and collected the data of patients with age 18 years and beyond, who underwent for total correction in Tetralogy of Fallot. We had included the patients whose prospective record of their surgical as well as socioeconomic outcome

Results: Total 35 patients were identified, out of 35 patients 19 were selected as final cohort of patients for our study they included 11[48%] females and 8 [42%] males with age range of 18 to 28 years. Procedures for TOF repair included trans-annular patch [n=7], trans-ventricular [n=5], trans-atrial [n=2]. While the remaining patients [n=3] had combined approaches [tran-atrial with trans-pulmoary or trans-ventricular with trans-pulmonary]. The 30-day mortality rate was 16% [right ventricular failure n=1; tamponade n=1; low cardiac output with pulmonary edema as a result of residual ventricular septal defect n=1]. 3 patients were re-explored due to mediastinal bleeding with one of them had developed cardiac tamponade. Follow-up of minimum 3 month to maximum of 15 months was feasible in 16 out of 19 survivors, improvement in functional class [NYHA] was observed in 11 patients

Conclusion: Complete repair of TOF in patients 18 years or older is possible but carries increased operative risk. Survivors have improvement in their functional class as well as social status however it is difficult to commit on economical productivity of patients

Synthesis, Spectral investigation [[1]H, [13]C] and Anti-microbial Screening of benzophenone imines

New series of benzophenone imines with general formula Ph[2]-C=NR; R = Benzyl, 4-Fluorobenzyl, Naphthyl, Phenyl, 4-Nitrophenyl were synthesized by condensation of dichlorodiphenylmethane and different aromatic primary amines [1:1] Those imines were characterized by different physiochemical and spectroscopic techniques like melting point, elemental analysis, FT-IR, multinuclear NMR [[1]H, [13]C]. After characterization, imines were subjected to antimicrobial activities. All compounds showed promising activity against different bacterial strains like Escherichia coli, Bacillussubtilis, Pasturellam ultocida and Staphylococcus aureus as well as fungal strains like Alternata alternaria, Ganoderma lucidium, Penicillium notatum and Trichoderma harzianum using Amoxicillin and Flucanazole as a standard drugs respectively

When drotaverine [No-Spa] injected in to the perivascular tissues of internal mammary artery [IMA] relives the peri-operative vascular spasm and increases the blood flow in IMA when used as a pedicle graft in CABG

To compare two groups of patients submitted to different modes of delivery of Drotaverine and its effect on internal mammary artery spasm during Coronary artery by pass grafting at The National Institute of Cardiovascular Diseases, Karachi. Experimental study. This study was carried out at the National Institute of Cardiovascular Diseases Karachi from 1[st] Jan 2013 to 31[st] December 2013. Data was analyzed from one hundred patients who underwent CABG at our institute. They were divided into two groups: Group 1 consisted of 50 patients in which Drotaverine [No-Spa] was sprayed topically over the IMA: Group 2 also consisted of 50 patients in which Drotaverine [No-Spa] was injected with blunt needle in the peri vascular tissue of IMA. After Drotaverine application, the mean blood flow were significantly low in Group I was 117.2 +/- 4.87ml/min as compared to Group II which was 136.2 +/- 7.11 ml/min [p<0.01]. Result of our study suggests; Drotaverine injected perivascularly better relieves spasm of internal mammary artery and increases the blood flow

Acoustical behavior of some amino acids in aqueous disodium citrate solutions over temperature range [298.15-313.15] K

Sound velocity, U, and density,Rho, of some amino acids viz. glycine, methionine, phenylalanine and tryptophan were determined in 0.1, 0.2 and 0.3 mol kg[-1]aqueous disodium citrate solutions as a function of concentration at 298-313.15K using DSA 5000M. The experimental data were further used to compute various acoustical parameters such as adiabatic compressibility, beta, apparent molar compressibility, phi[k], partial molar compressibility, phi°[k], transfer adiabatic compressibility, phi[ktr] constant, S[k], and the hydration number, n[h]- The transfer adiabatic compressibility shows the supremacy of hydrophilic-ionic interactions under hydrophobic-ionic interactions. The above-mentioned parameters are relevant for the efficiency of mediation in pharmacology and can be interpreted in terms of structure-making or structure-breaking ability of these amino acids in the solution

Type 2 diabetics: relationship of glucose and insulin levels in the asymptomatic offsprings of patients with type 2 diabetes

Objective: To measure and compare the glucose and Insulin levels of asymptomatic offspring of type 2 diabetic patients with asymptomatic offspring of non diabetics

Study design: Case control study

Place and duration: Department of Pathology PGMI, Lahore and Diagnostic Laboratory of UVAS, Lahore, from 1st October 2009 to 30th June 2010

Methodology: Non diabetic healthy offspring of diagnosed patients with type 2 diabetes mellitus attending the medical departments of LGH Lahore, both male and female below 30 years of age, documented by normal fasting blood glucose level and not having any symptom of diabetes were included

Results: In this study glucose and insulin were measured in 100 subjects. Glucose was measured by GOD PAP method and Insulin by ELISA technique. Mean +/- SD of glucose in control group was 80.75 +/- 14.21and in study group was 80.92 +/- 13.38having non significant difference having P value 0.081. Mean +/- SD of insulin in control group was 16.80 +/- 4.09 and in study group was 18.40 +/- 13.32 having non significant difference having P value 0.098

Conclusion: Insulin and glucose concentrations were within normal limits, and were not having any significant direct or inverse relationship [p=0.076]

Health education materials for Arab patients: content and design preferences

To investigate the content and design preferences of printed health education leaflets among Arab patients. A survey questionnaire to 17 subjects [women: n = 8, men: n = 9; age range 17-70 years] and three focus-group discussions [total 16 participants] were used to assess preferences by showing samples of Arabic health education materials. The questionnaire was administered by interviewers. For the focus-group discussions, the sessions were conducted by a trained interviewer, audio recorded and analyzed thematically. The subjects' educational level was from no formal schooling to university level. In survey component, all patients preferred photographs over clipart. Typeface ['font'] preferences were for Simplified Arabic in 8 subjects [47%] and Mudir MT in 7 [41%]; the 16-point font size was favored by 14 [82%] patients. In the three focus-group discussions, themes that participants expressed included use of standard Arabic with local dialects, short sentences, and culturally appropriate advice with practical and quantifiable examples. The participants preferred health education materials to be color trifold brochures illustrated with pictures and not clipart and written in Arabic using the Simplified Arabic font in 16-point size

Lingual tuberculosis

Tuberculosis is a common disease in developing countries like Pakistan. Although it can involve almost any region of the body, some presentations are still very rare. This is a case report of a 36 years old male with tuberculous lesion on the tongue presenting as a lump. Patient also had disseminated disease. There are very few cases reported of this rare presentation across the globe

Treatment options for Guillain-Barre syndrome [GBS] - a comparative assessment of treatment efficacy between intravenous immune globulin [IVIG] with plasmaphoresis

To compare the therapeutic efficacy of Intravenous immune globulin [IVIG] with Plasma exchange [plasmaphoresis] in patients of Acute Inflammatory Demyelinating Polyneuropathy i.e. Guillain-Barre syndrome [GBS]. Randomized Controlled Trial [RCT]. The study was of 12 months duration conducted at Department of Medicine, Neurology Unit of Military Hospital Rawalpindi from Jun 2008 to Jun 2009. 60 Patients of GBS were randomly assigned to two treatment groups. Group A received Intravenous immune globulin [IVIG] and Group B Plasma Exchange. Patient's functional status according to London scale grade was assessed at the time of admission and at 02 and 04 weeks after giving treatment. Improvement in mean London scale Grades in each group was calculated at different weeks from baseline and then both groups were compared to each other. In each group there was significant improvement [P-value< 0.001] from baseline-2weeks and baseline-4 weeks. But when compared to each other both the groups had comparable improvement [p-value> 0.05]. Both IVIG and Plasma Exchange have equal therapeutic efficacy in the treatment of patients of GBS