Comparison of Decaying Antibody Level After SARS-CoV-2 Infection in Case of Home Treated and Hospital Treated Patients at Different Interval

The aim of the study was to evaluate the quantities difference and persistence of antibody in home and hospital treated patients at different interval. A cross-sectional study was conducted in the Department of Biochemistry and Molecular Biology, BIRDEM General Hospital, from July, 2020 to June, 2021. This study protocol was approved by Institutional Review Board (IRB), BIRDEM. SARS-CoV-2 caused death of huge number of people. The disease most commonly represents with fever, cough, loss of smell sensation, fatigue etc. Who had mild symptoms did not admit at hospital. But when the disease progress to respiratory distress, involvement of lung field more than 50.0% and other complications then the patients need hospital admission. Hospital treated patients showed higher antibody status in comparison to home treated patients. Moreover it was reported that increased amount of antibody developed after 3rd and 4th months of SARS-CoV-2 infection. In this study, statistically significant difference of decaying antibody level between home and hospital treated patients was observed.

Analysis of Socio Demographic Risk Factors of Cervical Intraepithelial Neoplasia at Colposcopic Clinic in Mymensingh Medical College Hospital

Cervical intraepithelial neoplasia (CIN) is a pre-malignant lesion of the cervix of uterus. Several risk factors increased the risk of developing CIN. Purpose of this study was to evaluate the socio-demographic risk factors related to CIN at our setting. This Cross sectional observational study was performed at Colposcopic clinic of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from 9th November 2017 to 8th May 2018. Overall demographic features of 50 patients of precancerous cervical lesion show that, most of the patients belonged to the age group 30-39 years (46.0%), mean age was 32.7±10.3 years. Maximum numbers of respondents came from rural area (58.0%), followed by urban area (42.0%). Among them house wife- 46.0%, daily worker- 30.0% and illiterate 36.0%, primary level of education 32.6%. Among the patients the poor class 46.0% and 58.0% of the respondents were married at age ≤19 year. Among the respondents, (26.0%) were conceived their first child 1 month after their marriage and 54.0% of the women within 12 months of marriage. In this study multipara were (62.0%). Oral contraceptive pill was taken by (42.0%) of patients. The association of risk factors revealed that betel or tobacco chewing present in 28.0% cases; history of menstrual regulation (MR), dilatation, evacuation and curettage (DE&C), miscarriage were in 26.0% cases, family history of cancer were in 16.0% cases and multiple sexual exposure was in 10.0% cases. Women develop pre-malignant cervical lesions require early treatment. It is recommended that provision of proper health care support, early detection of CIN and proper management, can reduce the fatal outcome of the disease.

Exploring developmental assignments shaping experience-driven acquisition of leadership competencies in young clinicians

BACKGROUND

Experiential leadership development is well documented in the corporate sector, but those models cannot be applied as is, in the healthcare domain. The current study proposes a framework for the healthcare sector to enable experiential leadership development for young clinicians. The authors identify developmental assignments (DAs) and explore those characteristics [developmental assignment characteristics; DACs] therein that help develop leadership competencies in young clinicians.

METHODS

As part of a qualitative exploratory study in Pakistan, the authors conducted 16 semi-structured interviews with senior clinicians in leadership positions with post-graduate residents under their supervision from different medical specialties. The participants were selected through purposive sampling, ensuring a maximum variation sample. Focusing on participants' experiences and perspectives related to experience-driven leadership development, the authors used a multi-level theoretical framework for analysis.

RESULTS

The thematic analysis resulted in 19 subthemes with four overarching themes for both objectives. The authors categorized the developmental assignments (DAs) into clinical, academic, and administrative assignments. These assignments can be utilized for leadership development by ensuring that they have the requisite characteristics built into their context and structure. These developmental assignment characteristics (DACs) can range from learner-driven to supervisor-driven. The learner-driven characteristics include autonomy, high levels of responsibilities, unfamiliar assignments, working across boundaries, managing diversity, making a commitment, and creating change. The supervisor-driven characteristics include briefing, debriefing, accountability, and learner-assignment matching. The authors also developed a learner-assignment matching (LAM) framework to guide supervisors in customizing and adjusting the level of each DAC in a DA.

CONCLUSION

A modern healthcare educational system can utilize studies like this to enable supervisors to develop required leadership skills in young clinicians along with clinical skills.

Entrustment in physician-patient communication: a modified Delphi study using the EPA approach

BACKGROUND

Competency based curricula across the globe stress on the importance of effective physician patient communication. A variety of courses have been used to train physicians for this purpose. However, few of them link competencies with practice resulting in confusions in implementation and assessment. This issue can be resolved by treating certain specific patient communication related tasks as acts of entrustment or entrustable professional activities (EPAs). In this study, we aimed to define a competency-based framework for assessing patient physician communication using the language of EPAs.

METHODS

A modified Delphi study was conducted in three stages. The first stage was an extensive literature review to identify and elaborate communication related tasks which could be treated as EPAs. The second stage was content validation by medical education experts for clarity and representativeness. The third stage was three iterative rounds of modified Delphi with predefined consensus levels. The McNemar test was used to check response stability in the Delphi Rounds.

RESULTS

Expert consensus resulted in development of 4 specific EPAs focused on physician-patient communication with their competencies and respective assessment strategies all aiming for level 5 of unsupervised practice. These include Providing information to the patient or their family about diagnosis or prognosis; Breaking Bad news to the patient or their family; Counseling a patient regarding their disease or illness; Resolving conflicts with patients or their families.

CONCLUSIONS

The EPAs for Physician-patient communication are a step toward an integrative, all-inclusive competency-based assessment framework for patient-centered care. They are meant to improve the quality of physician patient interaction by standardizing communication as a decision of entrustment. The EPAs can be linked to competency frameworks around the world and provide a useful assessment framework for effective training in patient communication. They can be integrated into any post graduate curriculum and can also serve as a self-assessment tool for postgraduate training programs across the globe to improve their patient communication curricula.

ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF STAPHYLOCOCCUS AUREUS STRAINS IN ISLAMABAD, PAKISTAN

Objective: To investigate the prevalence of S. aureus in hospitalized patients of Islamabad. Study Design: Cross-sectional study. Study Duration: Pakistan Institute of Medical Science, Applied Microbiology and Biotechnology Lab, COMSATS Institute of Information Technology, Islamabad, from Sep 2017 to Sep 2018. Methodology: A total of 500 samples were collected. The isolates were divided into four study groups according to their source of origin i.e. group 1 (dermal group), group 2 (nasal group), group 3 (blood group) and group 4 (urine group). Gram staining, catalase test and DNA se media analysis were done for validation of S. aureus. Disc diffusion test (for antibiotic susceptibility), Oxacillin disc test (to differentiate between methicillin-resistant Staphylococcus aureus and methicillin-susceptible staphylococcus aureus) and minimal inhibitory concentration (for susceptibility to vancomycin), were performed. Results: Degree of the prevalence of staphylococcus aureus was 21%, 17%, 9% and 8% in group 1, 2, 3 & 4 respectively. The overall prevalence of staphylococcus aureus was 19.5% in all isolates. The disc diffusion test showed the descending resistance pattern of isolates i.e. 100, 94, 94, 76, 58, 55, 47, 43, 40 and 37% for penicillin, ciprofloxacin, Kanamycin, erythromycin, tetracycline, oxazolidinone, sulfamethoxazole, doxycycline, clindamycin, and cipoxin respectively. Minimal inhibitory concentration found only one sample resistant at 2ug/l concentration of Vancomycin. Moreover, Oxacillin disc test showed 52% methicillin-susceptibleStaphylococcus aureus while 48.2% methicillin-resistant staphylococcus aureus among all isolates. Conclusion: There is an increase in the frequency of methicillin-resistant staphylococcus aureus. Single vancomycin resistant staphylococcus aureus strain was also isolated.

Healthcare needs of the Muslim patient community in the undergraduate medical curriculum - Are we there?

Objective:

Muslim patients have a unique set of healthcare needs that are related to their faith. These are generally not formally addressed in the medical curricula. The study aimed to recommend additional content that would better tailor the undergraduate curriculum to cater to the needs of this large cohort – Muslim patients. This is with the expectation that patients would have their faith-related health queries resolved by healthcare providers.

Methods:

A quantitative descriptive survey design was adopted. A 46-item questionnaire formulated through a literature review was put forth to experts using the Delphi Technique. Experts were selected based on having an academic rank of associate professor and above or medical education credentials. Three iterative rounds were conducted for exploring consensus over a period of five months. Panel agreement of >70% was the criteria for inclusion.

Results:

Items were categorized under 7 subject themes: Medicine, Psychiatry, Surgery, Gynecology, Obstetrics, Medical Ethics, and Islamic Studies. Consensus was eventually reached for 41 out of 46 items. These topics included but were not limited to “The Muslim patient in Ramadan to: fast or not to fast?” and “Muslim women and decision-making on pregnancy termination”.

Conclusion:

The study suggested that the topics proposed herein were in fact legitimate faith-related healthcare needs of Muslim patients. Their inclusion would add value to the undergraduate medical curriculum and would train practitioners to improve patient outcomes more holistically.

Study of curriculum of Doctor of Physical therapy programme based on World Federation of Medical Education standards

Objective:

To evaluate the curriculum for Doctor of Physical Therapy (DPT) programme based on World Federation of Medical Education (WFME) standards.

Methods:

A questionnaire was constructed based on WFME ‘Should’ and ‘Must’ standards. It was validated by five experts in two rounds. It is comprised of Items/ questions with Yes/No options. The questionnaire was filled by the DPT Faculty and final year students at Riphah International University, Islamabad from March 01, to April 30, 2017.

Results:

The key weakness identified were students participation in program management, evaluation, mission statement, program designing, curriculum committee, students activities and organization, and other matters relevant to students, followed by the use of external examiners, reliability and validity of assessment tools, scrutiny of assessments by external examiners and feedback to the students on assessment. The integration of behavioral and social sciences, readiness of graduates for postgraduate studies, institutional autonomy and academic freedom for curriculum development and designing, and opportunity for the participation of other stakeholders were identified as strengths.

Conclusions:

As per WFME standards the curriculum for DPT program needs improvements in student’s assessments and their participation in program management, evaluation, mission statement and designing, along with facilitation in student’s activities, organizations. Strengths of the curriculum were integration of behavioral and social sciences, readiness for postgraduate studies, institutional autonomy and academic freedom for the development and designing of curriculum, and the participation of other stakeholders.

Educational impact of Mini-Clinical Evaluation Exercise: A game changer

Background and objective:

Workplace based assessment has a strong educational impact in terms of student’s clinical performance by steering their learning towards the desired learning outcomes. Educational impact is hardly measured in the sphere of medical education and this study is an attempt to measure educational impact of post graduate residents. The aim of this study was “To explore educational impact of Minicex (Mini-clinical evaluation exercise) on residents with respect to their learning”.

Methods:

A mixed convergent parallel method was selected, participants were identified through non-probability convenience sampling, total 10 participants were chosen for data collection, all of them experienced four minicex encounters which generated their scores (the quantitative data), after first two Minicex encounters each participant was interviewed using a structured interview technique, similarly, after 3^rd and 4^th Minicex encounters. Data was entered in the SPSS version -21 to calculate descriptive statistics. Inferential statistics were determined using ANOVA to calculate improvement in score over time and P-value to report statistical significance. Qualitative analysis was done using thematic analysis approach with the help of themes based on interview questions: priori theme. NVIVO was used for triangulation of themes accordingly.

Results:

The results indicate statistically significant improvement in scores and p values were considered significant at 0.05. Also, qualitative analysis provided reasons for improvement in scores and residents’ satisfaction such as feedback, motivation, self-directed learning, peer assisted learning.

Conclusion:

The study concluded that residents learning behavior and, their satisfaction from assessment method can be enhanced through work place based assessment particularly in context of minicex (mini-clinical evaluation exercise) so encouraging its use in similar situations. However, the scope for generalization of results remains limited owing to a small sample size.

Reflective Abilities of Undergraduate Dental Students in a Public Sector Medical College in Pakistan

This article was migrated. The article was not marked as recommended. Aims:Traditional teaching decreases students' motivation therefore researchers worked on reflection to mount Miller's pyramid from knowledge towards performance. Reflectors are self-directed and lifelong learners. Reflection heightens learning caliber and ameliorates educational outcomes. So this study was conducted to "Measure reflective abilities of undergraduate dental students in a public medical college." Materials & Methods:A descriptive, quantitative study was carried out at Bolan Medical College, Quetta from December, 2015-May, 2016. Reflection-in-Learning Scale was distributed to all (85) dental students. Participants filled RLS which was then collected; data was coded and entered in SPSS version-20. Analysis of Variance test compared Reflection-in-Learning Scale score among the academic years, Shapiro test checked its normality, and Tukey test examined post hoc multiple comparisons. Results:In total 85 participants 21 belonged to 1st year, 16 were from 2nd year, 20 and 28 from 3rd and 4th years respectively. Female participants made 72.9% and 76.5% participants were 20-22 years old. Overall RLS score was 81.52 ± 4.90. Third year scored 83.35 ± 4.87, 4th year scored 82.57 ± 4.10, 2nd year scored 81.31 ± 4.41, and 1st year scored 78.52 ± 5.34. Conclusion:This study provides insight of dental student's reflective level and serves as a vehicle to examine their reflective abilities. Senior batches were good reflectors.

The association of age with glycaemic and cholesterol control in patients with type 2 diabetes mellitus

OBJECTIVE

To find the risk of dyslipidaemia in diabetic patients of different age groups.

METHODS

This cross-sectional study was conducted at Holy Family Hospital, Rawalpindi, and Pakistan Ordnance Factories Hospital, Wah Cantonment, Pakistan, from February to July 2014, and comprised type 2 diabetic patients. Patients' body mass index was calculated and biochemical tests were performed for high-density lipoprotein, total cholesterol, low-density lipoprotein, triglyceride and glucose. Data was analysed using SPSS 20.

RESULTS

Of the 40 patients, 17(42.5%) were men and 23(57.5%) women. The blood glucose control of younger age group (30-40 years) was 234±90.37mg/dl compared to older age group (60-70 years) with a mean of 173.4±54.2 mg/dl. Serum triglyceride levels of the youngest age group (30-40 years) were the highest with a mean value of 216±137 mg/dl. There was a significant association between age and triglyceride levels (p=0.03) , while the serum high-density lipoprotein level of this group was lowest with a mean of 29.6±13.4 mg/dl.

CONCLUSIONS

There was a significant association between triglyceride levels in the youngest age group of patients with type 2 diabetes.

Physical activity levels in Bangladeshi adults: results from STEPS survey 2010

Objectives

Physical inactivity is an established risk factor for non-communicable diseases (NCD) and identified as the major public health concern worldwide. However, nationally representative and internationally comparable data on physical activity (PA) are lacking in Bangladesh. The objective of this paper was to determine nationally representative prevalence of PA levels among Bangladeshi adults.

Study design

Cross-sectional survey.

Methods

Data, on PA for this paper, were analysed from the NCD risk factors survey 2010 in Bangladesh. A standardized approach known as STEPS (STEPSwise approach to Surveillance for NCD risk factors) was followed for this survey. A total of 9275 adults (aged ≥ 25 years) were interviewed. Data on PA were processed and analysed according to Global Physical Activity Questionnaire (GPAQ) version 2 analysis framework.

Results

Of total 9275 respondents 4312 were men and 4963 women with a mean age of 42.4 (±13.5) years. Median MET-minutes of total PA in a typical week was double in rural areas (3360) than urban (1680) areas. The overall country wide prevalence of low PA was 34.5% (95% confidence interval, 33.5–35.5), urban 37.7% (36.3–39.1) and rural 31.6% (30.3–32.9). Women in general were more inactive (women, 53.6% [52.2–55.0], men 15.4% [14.9–17.1]). The main contributions to total PA were from work (urban 47.0%, rural 61.0%), and active commuting (38.0%, 30.0%) domains. Leisure-time PA represented only a small proportion (15.0%, 9.0%).

Conclusions

Insufficient physical activity is highly prevalent among the Bangladeshi adult population. Promoting overall PA at leisure-time and commuting considering country context can be feasible options with special attention to the women.

Introducing regular formative assessment to enhance learning among dental students at Islamic International Dental College

OBJECTIVE

To evaluate the effectiveness of Formative Assessment in enhancing learning among dental students, and to interpret the assessment from students' perspective in this regard.

METHODS

The experimental non-randomised controlled study was conducted from January to June 2013 at Islamic International Dental College, Islamabad, and comprised first year Bachelor of Dental Surgery students attending regular physiology lectures and tutorials. Summative assessments conducted at the end of each unit were included as pre-intervention tests. After one month's planning, central nervous system unit was delivered in a month's trial with four formative assessment and feedback sessions (one per week). Likert scale-based student feedback questionnaire was administered. Post-intervention summative assessment was done by Multiple Choice and Short Essay Questions. Data was analysed using SPSS 17.

RESULTS

Out of 68 students, 64(94.1%) agreed that a conducive environment was maintained and 62(90%) agreed that such sessions should be continued throughout the year; 59(87%) reflected that the feedback provided by the teacher was timely and positive and ensured equitable participation; 56(82%)agreed that it enhanced their interest in the subject; 56(68%) agreed that they were now more focussed; and43(63%)were of the opinion that they have progressed in the subject through these sessions. There was highly significant improvement in the monthly post-intervention test scores compared to pre-intervention test (p=0.000).

CONCLUSIONS

Formative assessment sessions enhanced motivation and learning in first year dental students. Organised regular sessions with students' feedback may contribute to the development of pedagogic practice.

Risk factors of acute coronary syndrome among Bangladeshi people

Two hundred consecutive patients of acute coronary syndrome aged 30-80 years (inclusive) admitted to the coronary care unit of National institute of Cardiovascular Diseases, Dhaka, were prospectively recruited as cases. Two hundred controls were prospectively selected either from individuals attending in the Shaheed Suhrawardy Medical College Hospital, admitted for elective surgery or in medicine ward for conditions that were unlikely to confound a comparative analysis. The Cases had significantly lower yearly incomes than controls, and significantly higher number of cases is occupied as sedentary worker. Smoking was an important risk factor. About 70% of cases and 45% of controls smoked previously cigarettes. Consumption of non smoke tobacco is another risk factor. The high risk of IHD in developing countries attributed to low consumption of fruit and vegetables, and in our study regular consumption of fruits (taking fruit at least 4 days a week) shows 20.5% cases and 33% of controls (OR 0.524, 95%CI 0.333-0.823) and p value was 0.005. Around 23.5% of the cases were diabetic compared with 4.5% of controls. We found 5% cases and 1.5% controls having known dyslipidemia. Although the body-mass index of cases was 24.68±3.06 Kg/M² and controls 20.54±4.37 Kg/M². The WHR was also significantly greater in cases 0.98±0.05M vs. controls 0.93±0.102M (p<0.001). About 31% of cases and 2% of controls had past history of myocardial infarction. The most predictive independent variables were previous smoking (p<0.001), WHR (p<0.001), history of hypertension (p<0.001), and income (p<0.001). Smoking and WHR were associated with the highest risks. The variables revealed to be significantly associated with acute coronary syndrome by bivariate analyses were all entered into the model directly. Eleven variables entered into the model. Of them Age, occupation, family income (yearly), fruit consumption, known hypertension, known DM, known dyslipidemia, previous MI, previous smoking, BMI and Waist and hip ratio were found to be the independent predictors of acute coronary syndrome. The study found that smoking tobacco, diabetes mellitus, hypertension, visceral obesity and less fruit intake are the important factors of acute coronary syndrome in Bangladesh.

Effects of dietary chromium chloride, nicotinic acid and copper sulphate on meat of broilers

1. Combinations of chromium and copper were added to the diet to assess their effects on broiler meat characteristics. 2. For this purpose 175 one-day-old broiler chicks were divided into 7 equal groups and were given treatment feeds containing copper sulphate, chromium chloride and nicotinic acid in different combinations. 3. The study was carried out for 5 weeks and samples were collected at the end of 15, 29 and 35 d of treatment and at 42 d after a withdrawal period of one week. 4. Cholesterol content had decreased significantly in breast meat at d 29 in all treatment groups. In thigh meat, it decreased significantly at d 29 in groups receiving two concentrations of chromium + two concentrations of copper. Cholesterol content remained lower even after withholding the treatment for one week. 5. Crude fat content decreased significantly in breast meat in all treatment groups. In thigh meat, at d 29, a significant reduction in crude fat was observed only in birds receiving low chromium and high copper. 6. Crude protein at d 29 increased significantly in breast meat of birds receiving low chromium and high copper, and low or high chromium, while it decreased significantly in treatment groups after withholding the treatment. In thigh meat, at d 29, it increased significantly in treatment groups but decreased significantly after withholding the treatment. 7. It was concluded that chromium and copper, along with nicotinic acid, have modulating effects on broiler meat under tropical conditions.

Acute hypervitaminosis A in a young lady

Acute vitamin A toxicity from a large dose has been reported to cause pseudotumour cerebri. Usually it is common in children. Herein we present the case of a young lady of 18 years old with the complaints of headache, vomiting, back pain and diplopia after ingestion of high dose (about 10 million international units) vitamin A capsule intentionally at a time due to some family problems. She gave no history of fever, convulsion, unconsciousness, pain in eyes, difficulties in walking and jaundice or any urinary problem during this illness. On query she gave no history of taking any other drugs including oral contraceptive and tetracycline & steroids. She also gave no history of sleep disorder. There was bilateral papilloedema, pupils were a bit dilated symmetrically but reacting to light, visual acuity 6/60 on left eye and 6/18 on right eye and bilateral 6th cranial nerve palsy more marked on left side. MRI of brain and orbits showed normal study. Patient improved after giving acetazolamide.

Continuum of medical education: objectivity in instructional method, learning and assessment

OBJECTIVE

To find the effect of objectivity practiced during instruction and assessment on learning.

METHOD

Fifty first year BDS students of Islamic International dental college, Islamabad were selected for a descriptive case series study extending from January to mid February 2007. Before starting the haematology module, specific learning objectives were defined. Interactive student centered instructional method was adopted in the form of interactive lectures and small group discussions. Assessment tool selected for measuring predefined objectives were to choose one best and the correct statement MCQS. Students were informed of the assessment pattern and practiced. Out of 65 test items 58 required a correct choice while 7 MCQS were objectively structured with "choose one best answer," mixed in the main test pool and marked with an asterisk.

RESULT

Evaluation survey showed dissatisfaction regarding the traditional lecture system. Although students were satisfied with the learning environment but majority disagreed with the reliability and validity of the current assessment method. After introducing the reforms in the instructional method and assessment pattern, the level of student satisfaction became high and their feedback was positive regarding the learning experience. The qualifying criteria for the 50 students was achieving 50% in both type of MCQS. In objectively structured choose one best type, 80% of the students scored more than 50% marks (i.e. 4 out of 7). In choose the correct statement, 96% of the students scored more than 50% marks (i.e., 29 out of 58). Final scoring for 65 test items showed that 96% of the students scored more than 50% marks.

CONCLUSION

Introducing objectivity in instruction, learning and assessment gives good outcome in medical education. Learners groomed in such an environment are critical thinkers as evidenced by test results of, objectively structured choose one best type.

Are we complying with NICE guidelines on the use of prostaglandin E2 for induction of labour? A survey of obstetric units in the UK

To determine whether obstetric units in the UK comply with the recommendations by the National Institute for Clinical Excellence (NICE) on the maximum doses of intravaginal prostaglandin for induction of labour, a cross-sectional telephone survey of all obstetric units in the UK listed on Dr Foster's website was undertaken. The maximum doses recommended by NICE were exceeded by 86.4% (76/88) and 61.1% (55/90) of units that use intravaginal prostaglandin tablet and intravaginal prostaglandin gel, respectively. Units that use prostaglandin tablets were four times more likely to exceed the recommended maximum dose (OR = 4.03, 95% CI, 1.9 - 8.4), six times more likely to use 50% or more of the recommended maximum dose for nulliparous women (OR = 5.9, 95% CI, 3.1 - 11.0), and six times more likely to use 50% or more of the recommended maximum dose for multiparous women (OR = 6.5, 95% CI, 3.0 - 13.9). A majority of obstetric units in the UK exceed the maximum doses of intravaginal prostaglandin recommended by NICE for induction of labour.

Kikuchi-Fujimoto disease

A 14 year-old Bangladeshi girl presented with high fever, painful swellings in the neck, anorexia, weight loss and night sweating. On examination she had multiple enlarged and tender cervical lymph nodes. Other systems were normal. Laboratory investigations for sepsis and autoimmune diseases were negative. Initial fine needle aspiration and cytology of affected lymph node was suggestive of tubercular lymphdenitis. But she did not respond to anti-tubercular treatment. Kikuchi-Fujimoto disease was diagnosed from the histopathological appearance of excised lymph node. She completely recovered with symptomatic treatment. Kikuchi-Fujimoto disease, also called Kikuchi's disease or histiocytic necrotizing lymphadenitis is a rare, benign but enigmatic disease of unknown aetiology. The disease is self-limited and has an excellent prognosis. Its recognition is crucial because it can be mistaken for systemic lupus erythematosus, malignant lymphoma, tubercular lymphadenitis or even, for metastatic adenocarcinoma. Clinicians' and pathologists' awareness of this disease may help prevent misdiagnosis and inappropriate treatment.

Of mice and mutations: phenotypic effects of the diabetic db/db and ob/ob mutations on the skull and teeth of mice

AIM

To compare the phenotypic appearance of the skull bones and teeth of wild type C57BL/6J mice with that of diabetic leptin-deficient (ob/ob) and diabetic leptin receptordeficient (db/db) mice used as models for diabetes.

STUDY DESIGN AND METHODS

Skulls were extracted from the carcasses of mice belonging to wild-type C57B/6J mice, db/db mice on a C57BLKS/J background, and ob/ob mice on a C57B/6J background. After removal of overlying tissue, the skulls and mandibles were then left to dehydrate and examined for phenotypic variations in structure and wear.

RESULTS

Bone surfaces of the skulls of wild type mice had a whiter and smoother surface compared with a yellowish colour with a grainy texture in the two mutant strains. The frontal, parietal and occipital bones were translucent in the two mutant strains. Breakages of the zygomatic arches and mandibles were more common in the ob/ob and db/db mice than in the wild type mice. Half of the teeth of the db/db mice and 90% teeth of the ob/ob mice showed considerable wear compared with marginal wear in the wild type mice.

CONCLUSIONS

These observations suggested that the teeth of the two diabetic mutant strains are exhibiting considerable signs of hypomineralization with increased fragility and decreased bone thickness.

Critical roles of PPAR beta/delta in keratinocyte response to inflammation

The immediate response to skin injury is the release of inflammatory signals. It is shown here, by use of cultures of primary keratinocytes from wild-type and PPAR beta/delta(-/-) mice, that such signals including TNF-alpha and IFN-gamma, induce keratinocyte differentiation. This cytokine-dependent cell differentiation pathway requires up-regulation of the PPAR beta/delta gene via the stress-associated kinase cascade, which targets an AP-1 site in the PPAR beta/delta promoter. In addition, the pro-inflammatory cytokines also initiate the production of endogenous PPAR beta/delta ligands, which are essential for PPAR beta/delta activation and action. Activated PPAR beta/delta regulates the expression of genes associated with apoptosis resulting in an increased resistance of cultured keratinocytes to cell death. This effect is also observed in vivo during wound healing after an injury, as shown in dorsal skin of PPAR beta/delta(+/+) and PPAR beta/delta(+/-) mice.

A new withanolide glycoside from physalis peruviana

A new withanolide glycoside, 17beta-hydroxy-14, 20-epoxy-1-oxo-[22R]-3beta-[O-beta-D-glucopyranosyl]-witha-5, 24-dienolide (1), has been isolated from the whole plant of Physalis peruviana. Its identity was determined using a combination of spectroscopic data including 2D NMR techniques and chemical transformations.

Nutritional and immunisation status, weaning practices and socio-economic conditions of under five children in three villages of Bangladesh

A total of 479 children aged 6-60 months (male/female, 240/239) were studies during 1991 to 1992. Weight for age, height for age (mean +/- SD) were 72 +/- 11%, 90 +/- 7 and 87 +/- 10% of NCHS median respectively. According to Gomez classification, 96% of children had varying degrees of protein energy malnutrition (PEM) (28.4% mild, 58.2% moderate and 9.2% severe). According to Waterlow classification 84% were stunted(36% mild, 33% moderate and 15% severe) and 67% were wasted (47% mild, 18% moderate and 2% severe). Of all children 368 (77%) received BCG and 439 (82%) received partial or full dose of DPT and Polio vaccines. Among children aged 13-60 months 75% received Measles vaccine. Weaning food was started at (mean +/- SD) 8 +/- 4 months. Low household income, parental illiteracy, small family size (< or = 6), early or late weaning and absence of BCG vaccination were significantly associated with severe PEM. Timely weaning, education and promotion of essential vaccination may reduce childhood malnutrition especially severe PEM.

Further inhibition studies on guanidinobenzoatase, a trypsin-like enzyme associated with tumour cells

Guanidinobenzoatase is a proteolytic enzyme capable of degrading fibronectin and is a tumour associated enzyme. Guanidinobenzoatase has been shown to be an arginine selective protease and is distinct from trypsin, plasminogen activator, plasmin, thrombin and a newly described tumour associated enzyme specific for guanidino phenylalanine residues. These conclusions have been derived from inhibition studies employing 4-methyl-p-guanidinobenzoate as substrate. Three active site titrants for trypsin have been shown to be good substrates for guanidinobenzoatase. A new active site titrant for trypsin, rhodamine bisguanidinobenzoate, can also be used to assay guanidinobenzoatase in a stoichiometric manner. This active site titrant can be employed to label guanidinobenzoate on the surface of leukaemia cells.