Family medicine in undergraduate medical curriculum: a cost-effective approach to health care in Pakistan

Shifa College of Medicine introduced a two-week rotation in Family Medicine for their third-year medical students in 2008. The purpose of this study was to determine what impact it made on students and how many would consider becoming Family Physicians in future. A questionnaire-based prospective study conducted at Shifa College of Medicine, Islamabad during academic year 2008. A total of 46 students rotated in Family Medicine throughout the academic year-2008. Fifteen students were aware of Family Medicine as a specialty prior to starting their rotation, and only 3 expressed an interest to pursue Family Medicine as a future career. At the start of the rotation only 15 students were able to give correct definition of Family Medicine and on questioning whether it should be a part of the undergraduate curriculum, only 24 answered yes while the rest were unsure. After the rotation, a significant number of students [37%; p<0.01] considered having a career in Family Practice, and 80% [n=37] were able to give correct definition of Family Medicine as a humanistic approach of medicine with aim to prevent, treat and rehabilitate. About its utility in the undergraduate curriculum, 44 [96%] students believed it should be a regular feature in their curriculum, while 30 [65%] students agreed that their outlook towards patient care had changed. When asked what they learnt most during the rotation, students quoted empathy and development of communication skills. Family medicine rotation as part of undergraduate medical curriculum may help in fostering an interest among medical students in this newly emerging subspecialty which could have a profound effect on delivery of quality health care in this country

Vitamin B[12] deficiency- a major cause of megaloblastic anaemia in patients attending a tertiary care hospital

Folate and vitamin B[12] deficiencies have been known to cause megaloblastic anaemia. Since the deficiencies of these two vitamins are very common in Pakistani population, it would be imperative to investigate their role in causing megaloblastic anaemia. The objective of this study was to find out the contribution of folate and vitamin B[12] deficiencies in causing megalobalstic anaemia in our patient population. In this retrospective cohort study, clinical records of 220 patients [101 females and 119 males with an age range of 1-80 years] who presented themselves with macrocytic anaemia at the Aga Khan University Hospital were collected. Data pertaining to complete blood count and serum levels of folate and vitamin B[12] were analysed. The mean haemoglobin [Hb] level was 6.8 +/- 0.2 gm/dl. Sixty-nine percent of the patients had severe anaemia [Hb<8gm/ dl]. Mean +/- SEM values of haemoglobin, serum folate and serum B[12] were not significantly different between males and females [Hb 6.4 +/- 0.3 gm/dl vs 6.3 +/- 0.3 gm/dl; folate 6.9 +/- 0.8 eta g/ml vs 7.8 +/- 1 eta g/ml; B[12] 259 +/- 65 rho g/ml vs 225 +/- 45 rho g/ml, respectively]. Linear regression analysis showed that serum folate was inversely related with the mean corpuscular volume [MCV, p=0.04]. Spearman's correlation analysis indicated an inverse mild association between MCV and serum folate [correlation coefficient= -0.18]. Folate deficiency was 43.3%, while vitamin B[12] deficiency was 78.5% in these patients. Seventy-one percent of folate-deficient patients had vitamin B[12] deficiency was 78.5% in these patients. Seventy-one percent of folate-deficient patients had vitamin B[12] deficiency as well, while 26.1% of patients with B[12] deficiency had a co-occurrence of folate deficiency. Vitamin B[12] deficiency appears to be the major factor leading to megaloblastic anaemia in our study population. Inadequate dietary intake, over-cooking of our food and poor absorption might be contributing to high prevalence of vitamin B[12] deficiency in this population

Studies on the elemental composition and anti fungal activity of medicinal plant Lippia nodiflora L against skin fungi

Lippia nodiflora L, an indigenous herb has many medicinal uses. Present work was carried out to study the antifungal activity of crude extracts of L. nodiflora L. against the human pathogenic fungi. Crude extracts from the leaves and shoots of plant were prepared in different solvents including ethanol, methanol, ethyl acetate, chloroform and water and tested for antifungal activity against Aspergillus niger, A.. flavus, Paecilomyces varioti, Microsporum gypseum, and Trichophyton rubrum. Concentration of various elements e.g. Al, Ca, Cu, Fe, Mg, Mn, P, S and Zn were determined by using atomic absorption spectrophotometer and UV spectrophotometer. All crude extracts including ethanol, methanol, ethyl acetate, chloroform and aqueous extracts showed high activity against test organisms. Ethanol and aqueous extracts appeared to be the most effective antifungal agents as compared to methanol, chloroform and ethyl acetate. Moreover, the plant L. nodiflora L has high concentration of various essential elements. The medicinal plant Lippia nodiflora L contains considerable amount of elements which are important component of many formulation, used in skin care

Increased levels of erythrocyte glutathione in acute myocardial infarction: an antioxidant defence

Glutathione [GSH] has a central role in the defence against oxidative damage. This study was carried out to investigate any change in erythrocyte GSH levels in a population of patients with acute myocardial infarction [AMI] and compare them with levels in normal healthy subjects. Method: GSH levels were determined in erythrocytes of one hundred and seventy six patients with AMI [age: 30-70 years; 131 males and 45 females] admitted to the National Institute of Cardiovascular Diseases, Karachi. These levels were compared with eryrocyte GSH levels obtained from 95 normal healthy subjects [controls]. Mean ' SD erythrocyte GSH levels in AMI patients and controls were found to be 2.34 ' 0.62 micro mol/ml of packed cells and 2.08' 0.62 micro mol/ml of packed cells, respectively. The two values when compared with one way ANOVA were found to be significantly different [p=0.001]. Age had little effect on erythrocyte GSH levels in both AMI patients and normal healthy subjects. Increased production of reactive oxygen species is a feature of cardiovascular disease, such as AMI and cells can respond to mild oxidative stress by upregulating antioxidant defence in terms of increased production of GSH

Risk factors and behaviors for coronary artery disease [CAD] among ambulatory Pakistanis

To determine the frequency and distribution of various risk factors and behaviours for coronary artery disease [CAD] among ambulatory Pakistanis. It is a cross-sectional descriptive study carried out at the Aga Khan University Hospital, a teaching hospital in Karachi. All the subjects were adults [18-60 years] presenting at the general checkup clinic with no history or evidence of CAD by convenient sampling method. Demographic variables included risk factors and behaviors including diabetes, hypertension, dyslipidemia, family history of heart disease, obesity, smoking and sedentary lifestyle. Among 370 ambulatory Pakistanis, the proportions of major risk factors for CAD were: sedentary life style 72%, family history 42%, dyslipidemia 31%, obesity 24%, hypertension 19% and diabetes mellitus 15%. Diabetes, hypertension and dyslipidemia were poorly controlled in the study population. Proportions of the three major risk factors [smoking, hypertension and dyslipidemia] occurring singly, doubly and all three together in the study population were found to be 39%, 11% and 1%, respectively. Data were also analyzed for risk factors by comparing those with and without family history of CAD to eliminate any bias. The results were not statistically significant except for the sedentary life style [P=0.016]. There is a high prevalence of CAD risk factors in this study population. Modifiable risk factors like diabetes, hypertension and high cholesterol need better control. Preventive screening programs and healthy lifestyle behaviours need to be emphasized upon in the community

Induction of white cell proliferation due to haematopoietic growth factors is associated with an increase in multiple forms of dihydrofolate reductase in non-neutropenic cancer patients

OBJECTIVE: Granulocyte-colony stimulating factor [G-CSF] and granulocyte macrophage-colony stimulating factor [GM-CSF] are frequently used in cancer patients to overcome the granulocytopenic effects of chemotherapy, and also to mobilize the stem cells. The mobilized stem cells are collected from the peripheral blood and used for transplantation following high doses of chemotherapy. However, the molecular mechanism by which these colony stimulating factors [CSFs] bring about proliferation of myeloid precursor cells is not clearly known. Dihydrofolate reductase [DHFR], which has an established role in DNA synthesis, could be a link between administration of CSF and stem cell proliferation. The purpose of this study was to investigate whether CSFs induce white cell proliferation by producing multiple forms of DHFR. METHODS: Twelve patients with non-haematological malignancies were treated with either G-CSF or GM-CSF to mobilize stem cells. Nine healthy subjects were treated with placebo as controls. Blood samples were obtained before and after stimulation with CSFs or placebo. White blood cells were separated and concentrations of both active DHFR and immunoreactive nonfunctional form of DHFR were determined in their cytoplasm using methotrexate-binding assay and enzyme-linked immunosorbent assay, respectively. Total leucocytes count [TLC] was also monitored before and after stimulation with CSFs or placebo. There was a significant [P < 0.05] increase in concentration of immunoreactive nonfunctional form of DHFR and TLC following stimulation with CSFs. There was an increase in concentration of active DHFR as well, however, this did not reach statistical significance. In the placebo-treated subjects, no significant increase in active DHFR, immunoreactive nonfunctional form of enzyme or TLC was observed. However, it was noticed that the base-line values of active DHFR and immunoreactive nonfunctional form of enzyme in leucocytes of cancer patients were higher than the base-line values in leukocytes of normal healthy subjects. Our data suggest that colony stimulating factors induce white cell proliferation by increasing levels of multiple forms of DHFR

Role of methotrexate as an anti-inflammatory drug

Methotrexate has been known so far as an anticancer drug with a wide application in numerous neoplastic diseases, such as acute lymphocytic Ieukemia, osteogenic sarcoma, adenocarcinoma of head and neck, breast and ovary, and certain lymphomas. However, for the past few years it has been used in low doses in the management of rheumatoid arthritis and severe asthma indicating its anti-inflammatory role. On the basis of a number of clinical trials carried out on rheumatoid arthritis patients, the American Health and Public Policy Committee has put forward certain guidelines regarding the efficacy and safety of methotrexate therapy in this particular disease. The therapy also appears to have a definite steroid- sparing effect in the management of severe asthma. The success so far achieved with methotrexate as an anti-inflammatory agent in the treatment of rheumatoid arthritis and severe asthma is suggestive that the therapy would gain more ground not only in the management of these diseases but other inflammatory diseases as well

Relationship of caries incidence to the recovery of S.mutans and from lactobacilli from plaque and saliva

The purpose of this study is to evaluate the relationship of DMF-T to the recovery of S. mutans and Lactobacilli from plaque and saliva. The main objective was to find out whether S.mutans count or lactobacilli count of saliva be used as caries susceptability of a person. Twelve volunteers were included in the study. Plaque and Saliva samples were cultivated on suitable selective media. Results revealed that the number of S.mutans from persons with greater DMF-T score was greater in general. The saliva contained more bacteria than the plaque. Lactobacilli on the other hand were found inconsistent and there was no relationship of DMF-T to the recovery of Lactobacilli either from saliva or plaque

Comparison of wet weight total CFU, S mutans and PH changes of plaque collected from composite fillings and natural teeth

In this in-vivo study carried out in the Department of Operative Dentistry, Nishtar Medical College, Multan, plaque from two different types of the composite fillings and that from natural teeth was compared by cultivation of CFU and S. mutans and pH measurements. It was observed that CFU per milligram of plaque from different sources varied. S. mutans was cultivated from plaque of Heliosit and natural teeth. pH drop was seen in plaque collected on Hospital. Despite the presence of S. mutans in plaque of natural teeth a rise in pH was observed

Amount and total viable bacteria of plaque from 3 different composite resins

The present study was designed to evaluate the differences in amount of plaque and number of viable bacteria in plaque from three different [macro-filled, micro-filled and hybrid] composite resins. An intra-oral appliance was used. Appliances were worn by ten volunteers for a period of 7 days for each material. Results revealed that macro-filled resins collected more plaque. The rougher samples collected more plaque as compared to the smoother counterpart of the same material. The samples which had more amount of plaque gave smaller member of viable bacteria

new form of dihydrofolate reductase in cancer cells

By using ligand-binding radioassay for the enzyme dihydrofolate reductase [DHFR], a new form of this enzyme has been identified in L1210 leukemia cells. This form of DHFR displays very low affinity for the anticancer drug, methotrexate [MTX]. Further enzyme kinetic studies using a sensitive radioenzymatic assay for DHFR revealed that this form of DHFR had catalytic activity for the reduction of dihydrofolic acid to tetrahydrofolic acid. Studies using gel filtration chromatography with Sephadex G-75 at pH 5.0 and pH 7.2 on crude L1210 leukemia cell lysate and purified L1210 DHFR, both complexed with radiolabelled MTX, provided additional evidence that the MTX binding results were not due to some experimental artifacts. This low affinity form of enzyme was also found in two human colon tumor tissues. We suggest that, presence of a low affinity form of the enzyme in certain cancer cells may be one of the underlying causes of resistance to MTX therapy in these cells