Role of Cytokines in the Pathogenesis of Non-Alcoholic Fatty Liver Disease

A number of factors are linked with non-alcoholic fatty liver diseases (NAFLD), a condition that ranges from clinically benign fatty liver to its more severe form, non alcoholic steatohepatitis (NASH). In this study, we evaluated the role of cytokines secreted from adipose tissue in the pathogenesis and progression of NAFLD. We also compared anthropometric profile, lipid profile and insulin resistance data in 105 NAFLD patients with 77 normal subjects. These subjects showed a normal serum albumin level, prothrombin time and renal function but elevated aminotransferases. Predisposing factors were diabetes mellitus (35%), overweight (56%) and hyperlipidemia (44%). Insulin resistance (IR), determined by homeostasis model assessment (HOMA) was confirmed in 70% patients with NAFLD and 42% patients fulfilled the minimum criteria for insulin resistance syndrome (IRS). NAFLD patients showed elevated levels of pro-inflammatory cytokines tumor necrosis factor (TNF)-α, and interleukin (IL)-6, while anti-inflammatory cytokines IL-4 level decreased and IL-10 level remain unchanged; however, TGF-β1 level elevated significantly compared to normal subjects. While insulin level and HOMA-IR both were significantly positively correlated with BMI, waist-to-hip ratio, total cholesterol, VLDL-cholesterol, triglyceride and TGF-β1; glucose, IL-6 and TNF-α levels were significantly positively correlated with HOMA-IR only. In conclusion, pro-inflammatory cytokines play an important link between metabolic and liver disorders in the fat accumulation, and thereby cause IR, inflammation and liver fibrosis.     

Diagnosis,Evaluation, and Treatment of Lead Poisoning in General Population

Among the heavy metals, lead still remains the major toxic pollutant of the environment. Human exposure to lead can occur through numerous pathways including air, food, dust, soil, and water. In the present study 14 lead poisoned patients with non-occupational lead exposure were evaluated. They were followed up and compared against the controls with no history of lead exposure. The patients had high blood lead levels and symptoms of weakness, dizziness, abdominal pain, generalized body ache, loss of appetite, and anxiety. Repeated course of chelation therapy helped to bring down their body burden of lead. Alternative sources for lead exposure can cause severe lead poisoning in general population. Screening and medical management of such individuals is very important to identify and eliminate sources of lead. The treatment and management requires a thorough medical evaluation and environmental intervention.     

Cytokine Gene Polymorphism in Idiopathic Nephrotic Syndrome Children

The pathogenesis of idiopathic nephrotic syndrome is not completely understood. We postulate that cytokine gene polymorphisms may influence susceptibility or clinical course in Idiopathic Nephrotic Syndrome. Polymorphisms of IL-4, IL-6, and TNF-α cytokines were investigated in 150 children with Idiopathic Nephrotic Syndrome and 569 healthy controls by using polymerase chain reaction and restriction fragment length polymorphism. On comparing patient with controls strong association were found for IL-6, TNF-α and IL-4 at allelic level (IL-6-G174C (G vs. C): P = <0.001; OR = 6.33, TNF-α-G308A (G vs. A): P = <0.001; OR = 1.99, IL-4-C590T (C vs. T): P = 0.048; OR = 1.38). Further when SR group was compared with SS group significant association was found at genotypic level in all the studied genetic polymorphisms. Studied cytokine gene polymorphisms may influence susceptibility to idiopathic nephrotic syndrome and might affect steroid response in INS patients.     

A Curious Case of Hyperbilirubinemia

A 60-year-old patient suffering from easy fatigability was noted to have high total but normal conjugated bilirubin level though serum colour was pale. On further investigation the patient was found to be suffering from multiple myeloma and gamma globulin was possibly interfering with total bilirubin estimation.     

Building Professionalism in Human Dissection Room as a Component of Hidden Curriculum Delivery: A Systematic Review of Good Practices

The core values in medical practice which are essential for the humane outlook of a physician are clubbed within the domain of medical professionalism. Professionalism along with other discipline-independent skills (human skills) is propagated implicitly in medical schools as components of a “hidden curriculum.” Evidence suggests a strong association between “hidden curriculum” delivery and development of professionalism in the human dissection room. In this review article, the authors have tried to highlight a few exclusive practices adopted by medical schools which enhance the implementation of the “hidden curriculum” within the practice of human dissection and successfully inculcate the key components of professionalism such as integrity, respect, and compassion among students. These distinctive concepts are aimed at humanizing the experience of anatomical dissection by revealing the identity of the donors along with their personal details either through display of video clips of donor interviews, interactions with the family members of the donor over a meal or recognition of the donor as a mentor and organizing memorial services in honor of donors after conclusion of the dissection in the presence of their family members. The resounding success of these good practices in building professionalism among medical students from the onset of the academic curriculum has signaled a new chapter in anatomical sciences education. It has become imperative to recognize the visionary efforts of a select few medical educators and begin incorporating these recent trends into the delivery of the “hidden curriculum” within the evolving gross anatomy education model.     

An Investigation of Novice Pre-University Students’ Views towards MOOCs: The Case of Malaysia

There has been a growing number of studies dedicated to understanding how Massive Open Online Courses (MOOCs) impact the e-learning community. Yet, little is still known about how novice pre-university students perceive the use of MOOCs in Malaysia. This study explored pre-university students’ perceptions of, challenges with, and intention towards MOOCs by using interview data. The results showed that students’ general perceptions of the MOOC were positive, reporting that they gained additional knowledge, marks towards their Diploma and benefiting from the opportunity to create an online learning community. However, they were challenged by their language competency and awareness of MOOCs. Outcomes from this study may offer some practical implications to educational decision-makers in Malaysia towards promoting the use of MOOCs among students.

Abbreviations: MOOC: Massive Open Online Courses; cMOOC: Connectivist Massive Open Online Courses; xMOOC: eXtended Massive Open Online Courses; ahMOOC: adaptive hybrid Massive Open Online Courses; LMS: Learning Management System; MQA: Malaysian Qualifications Agency; STEM: Science, Technology, Engineering, and Mathematics     

Sickle Cell Trait Presenting as Chronic Calcific Pancreatitis with Pseudocyst- A Case Report

Sickle cell disease is known to cause acute pancreatitis either due to gall stones obstructing the pancreatic duct or by vaso-occlusive mechanism. However chronic pancreatitis is a very rare complication in sickle cell anemia. We report a case of sickle cell trait presenting with chronic pancreatitis with pseudo cyst. USG abdomen and CT abdomen confirmed the diagnosis of chronic calcific pancreatitis with pseudocyst. Etiological work up for other causes did not reveal anything except sickle cell trait. This case represents a rare association between chronic calcific pancreatitis and sickle cell trait.     

Bibliometrics of global malaria vaccine research

Objectives: This study evaluates malaria vaccine research carried out in different parts of the world during 1972–2004 using different bibliometric indicators. Method: Data have been downloaded from PubMed for the period 1972–2004 using the keywords (malaria* or plasmodium or falciparum) and (vaccine*) in the title and abstract fields. The study examined the pattern of growth of the output, its geographical distribution, profile of different countries in different subfields and pattern of citations using GOOGLE Scholar. Results: Malaria vaccine research output is gradually increasing. The USA, followed by the UK and Australia contributed the highest number of papers. Publication activity has decreased in Switzerland and Sweden, but has increased in Brazil and China. The majority of the countries have focused on the development of asexual blood stage malaria. Citations per paper and incidence of high‐quality papers for the USA, the UK, Papua New Guinea and Denmark are more than the average. The majority of the prolific institutions are located in the USA, the UK, France and Australia. Conclusion: The last two decades have witnessed considerable growth in research output in this field, while a successful malaria vaccine still remains elusive. Interestingly, the countries like the USA, the UK and Australia that lead in the quantity, quality and citation of this output are often not those directly affected by malaria.