Amina Nadeem

Awareness and Acceptance of Evolution and Evolutionary Medicine Among Medical Students in Pakistan

Evolutionary medicine is a perspective on medical sciences derived through application of theory of evolution to aid in therapeutics. This study sought to determine the level of knowledge and acceptance of evolutionary theory in medical students along with their attitude toward teaching evolutionary medicine as a part of their undergraduate course. Factors that are likely to cause difficulty in teaching evolutionary medicine were also identified. A cross-sectional study was carried out at Army Medical College, National University of Sciences and Technology, Pakistan in which 299 medical students were selected by nonprobability convenient sampling technique to participate in the study. Participants’ views were obtained by a structured questionnaire comprised of three sections: appreciation of evolutionary medicine, acceptance of evolutionary theory, knowledge of evolutionary theory. Medical students had a low acceptance [mean measure of acceptance of theory of evolution (MATE) = 58.32] and a low knowledge (mean score of 5.20 out of a total ten marks). Students believed that religious beliefs, lack of resources, and an existent extensive medical curriculum would cause difficulty in imparting such an education despite its potential to improve medical research and clinical practice. Only 37.2% agreed that the subject should be taught in medical schools as an individual subject.

Gene-gene, gene-environment, gene-nutrient interactions and single nucleotide polymorphisms of inflammatory cytokines.

Inflammation plays a significant role in the etiology of type 2 diabetes mellitus (T2DM). The rise in the pro-inflammatory cytokines is the essential step in glucotoxicity and lipotoxicity induced mitochondrial injury, oxidative stress and beta cell apoptosis in T2DM. Among the recognized markers are interleukin (IL)-6, IL-1, IL-10, IL-18, tissue necrosis factor-alpha (TNF-α), C-reactive protein, resistin, adiponectin, tissue plasminogen activator, fibrinogen and heptoglobins. Diabetes mellitus has firm genetic and very strong environmental influence; exhibiting a polygenic mode of inheritance. Many single nucleotide polymorphisms (SNPs) in various genes including those of pro and anti-inflammatory cytokines have been reported as a risk for T2DM. Not all the SNPs have been confirmed by unifying results in different studies and wide variations have been reported in various ethnic groups. The inter-ethnic variations can be explained by the fact that gene expression may be regulated by gene-gene, gene-environment and gene-nutrient interactions. This review highlights the impact of these interactions on determining the role of single nucleotide polymorphism of IL-6, TNF-α, resistin and adiponectin in pathogenesis of T2DM.

Association of Interferon-Alpha and Ribavirin-Induced Thyroid Dysfunction with Severity of Disease and Response to Treatment in Pakistani Asian Patients of Chronic Hepatitis C

Objective. To determine the association of thyroid dysfunction with the severity of the disease and response to treatment in patients of chronic hepatitis C. Design. Cohort study. Patients. One hundred and sixty seven noncirrhotic chronic hepatitis C patients were grouped into treatment group (n = 107) and control group (n = 60). Measurements. Baseline S. ALT and S. AST by IFCC and S. TSH, S. free T4, and S.T3 level were measured by chemiluminescence method. The severity of the disease was measured by Knodell histopathological index (HPI) on liver biopsy. Study group patients underwent 24-weeks IFN and ribavirin therapy and thyroid functions were determined at weeks 0, 12, and 24. Response to therapy was determined by PCR-HCV test. Results. 20 treated patients (18.69%) developed thyroid dysfunction with relative risk (RR) of 11.25 and attributable risk (AR) of 91%. Females were at higher risk. Hypothyroidism was common than hyperthyroidism. There was no significant association between thyroid dysfunction and severity of the disease (P = 0.81) and response to therapy (P = 0.79). Conclusion. Interferon-alpha and ribavirin therapy induces thyroid dysfunction in chronic hepatitis C patients. There is no association between severity of disease and response to therapy with interferon-induced thyroid dysfunction.

Variations in association of Interleukin 6 -G174C single nucleotide polymorphism with type 2 diabetes mellitus—a review

Inflammation plays a role in the etiology of type 2 diabetes mellitus (DM). Interleukin-6 is one of the inflammatory markers which play role in the pathogenesis of diabetes mellitus DM. Single nucleotide polymorphism (SNP); -G174C in interleukin −6 (IL-6) gene promoter area has been reported to be associated with type 2 DM (T2DM). The frequency of polymorphism is found to be variable in various ethnic groups and also within an ethnic group. Many studies reported a positive association between T2DM and IL-6 SNP although quite a number of other studies failed to find such association. IL-6 polymorphism has been found to be associated with higher serum IL-6 levels, insulin resistance and BMI, although these findings are also challenged by many studies. There is no single explanation for such highly variable results in different studies. Presence of yet unidentified gene polymorphism in linkage disequilibrium with IL-6 SNP could be responsible. The different results can also be attributed to the study groups differing as age, gender distribution, age of onset of disease, life style, degree of obesity and glucose tolerance. This review highlights the varying results reported in association of IL 6 –G174C SNP with risk of T2DM, serum IL-6 levels, BMI and insulin resistance.

Correlation of serum alanine aminotransferase and aspartate aminotransferase levels to liver histology in chronic hepatitis C.

OBJECTIVE To assess the correlation of serum alanine aminotransferase and aspartate aminotransferase levels to severity of disease on liver biopsy in patients of chronic hepatitis C. STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY Department of Gastroenterology at Military Hospital, Rawalpindi, from January 2006 to February 2007. METHODOLOGY One hundred and seven diagnosed non-cirrhotic chronic hepatitis C adult patients were included. Serum alanine aminotransferase and aspartate aminotransferase levels were determined. Knodell histopathological Index was determined on liver biopsy. The correlation and regression value between serum alanine aminotransferase levels and liver histology and serum aspartate aminotransferase and liver histology in chronic hepatitis C patients was determined using Pearson correlation analysis. RESULTS Patients of chronic hepatitis C had raised serum alanine aminotransferase and levels with the mean baseline level of 93 International units per litre (IU/L) with a range of 13-383 IU/L. Serum aspartate aminotransferase levels were also elevated with mean baseline level of 59.65 IU/L ranging from 18-370 IU/L. On liver biopsy based on Knodell histopathological Index, 47.7% of patients had mild, 39.9% had moderate and 13.1% had severe disease. There was significant association between serum alanine aminotransferase levels severity of the disease on liver biopsy (p < 0.03) with weak positive correlation between the two (r = 0.217). There was also significant association between serum aspartate aminotransferase levels and severity of the disease on liver biopsy (p < 0.001) with weak positive correlation between the two (r = 0.32). CONCLUSION The serum alanine aminotransferase and serum aspartate aminotransferase levels do not indicate the severity of the disease on liver biopsy in chronic hepatitis C patients.

Multiple perineal sinuses in non-hodgkin's lymphoma.

A 60 years old male presented with a 10 years history of chronic discharging perineal sinuses with inguinal lymphadenopathy. Biopsy of the inguinal lymph node revealed follicular B-cell non-Hodgkins lymphoma while the biopsy of the sinuses was non-specific. It was diagnosed as a case of primary nodal NHL with secondary cutaneous manifestations of multiple perineal sinuses (paraneoplastic dermatosis). After two courses of chemotherapy, the discharge from the sinuses disappeared and the lesions healed by scarring.