Five ways to get a grip on teaching advocacy in medical education: the health humanities as a novel approach

The advocate role is recognized as an intrinsic medical competency. Despite recent attention to pedagogical approaches, it is a role that remains poorly understood and difficult to teach. At the same time there is a growing body of evidence showing the necessity of incorporating humanities-based education into medical curricula. Here, we present five ways to use the humanities as a tool for teaching the advocate role including: decentre the physician as expert, develop engaged providers, engage learners in curricular decisions, value the humanities (and show it), and keep it practical.

Molecular characterization of toll-like receptor 2 of ruminants and comparative expression in nilgai (Boselaphus tragocamelus) vs. buffalo (Bubalus bubalis)

Toll-like receptors play role in the innate immune responses and orchestrate the adaptive immunity by induction of proinflammatory cytokines and up-regulation of costimulatory molecules. The present study has characterized TLR2 cDNA in nilgai, buffalo, sheep and goat that recognizes the peptidoglycan of Gram-positive bacteria. TLR2 coding sequences were amplified from monocytes cDNA and cloned in pGEMT-easy vector for nucleotide sequencing. Sequence analysis revealed 2355-bp-long TLR2 open reading frame encoding 784 amino acids in all the species studied. Nilgai TLR2 has 97.8% to 95.1% identity at nucleotide level and 96.2% to 92.7% identity at amino acid level with other ruminant species studied. Nonsynonymous substitutions exceeding synonymous substitutions indicated evolution of this receptor through positive selection among ruminants. Furthermore, basal TLR2 messenger RNA expression in different immune cells and tissues quantified by real-time polymerase chain reaction revealed highest level in in vitro derived dendritic cells followed by peripheral blood mononuclear cells. Skin and testes also expressed significant level in both nilgai and buffalo. Comparatively, nilgai immune cells and tissues expressed more TLR2 transcript than buffalo, thus elucidating stronger armamentarium of antibacterial immunity in nilgai as compared to buffalo.

Characterisation of peacock (Pavo cristatus) mitochondrial 12S rRNA sequence and its use in differentiation from closely related poultry species

1. Poaching of peacocks, the national bird of India, is illegal. People kill this beautiful pheasant bird for tail feathers and mix the meat with chicken or turkey. Differentiation of the meat of these species is essential in order to address the ambiguity about the origin of the sample. 2. The present study was carried out to investigate the use of polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) of mitochondrial 12S rRNA gene for identification of these species. 3. Peacock mitochondrial 12S rRNA partial gene was amplified using universal primers, cloned and characterised. It was found to be 446 nucleotides long. 4. Sequence analysis revealed 86.8 and 84.1% similarity with reported turkey and chicken sequences, respectively. Sequence and phylogenetic analysis showed that the peacock is much closer to the turkey than the chicken. 5. PCR-RFLP of 446 bp amplicon using commonly available restriction enzymes AluI and Sau3AI produced a differential pattern for identifying these poultry species unambiguously.

Arsenic trioxide for treatment of myelodysplastic syndrome: An experience from India

13156

Background: Myelodysplastic Syndrome (MDS) is a heterogeneous group of clonal diseases of the haematopoietic stem cells. The hallmark of the disease is ineffective haematopoiesis characterized by dysplasia with incomplete maturation and progressive increase in the percentage of myeloblast. No standard treatment is currently available for MDS. The early clinical experience has confirmed the activity of arsenic trioxide in MDS. The drug is able to induce differentiation and apoptosis and to inhibit cell proliferation or angiogenesis. It has the potential to be active in tumour models in MDS. The preliminary result of ongoing studies conducted in patients with MDS suggests that arsenic trioxide produces haematological improvement including durable transfusion independence in 30% of patients. The aim of our study was to see the response of MDS with arsenic trioxide and to see the toxicity profile of arsenic trioxide in Asian Indian population. Methods: During period from July 2005 to December 2005 we selected consecutive 10 patients of MDS in Refractory Anaemia, Refractory anaemia with ringed sideroblasts, Refractory anaemia with blast excess, Refractory anaemia with blast excess in transformations and chronic myelo monocytic leukemia phases. All patients had performance status more than 60%, some karyotypic abnormalities & in cytopenic phase. Median age of the patients 65 years (range 42 to 70 years). All patients were treated with arsenic trioxide 10mg (Alkem/India) daily for 2 hours infusion 28 days. In 15 days interval 3 courses were repeated. Response assessments were done by haematological, cytogenetic & quality of life assessment. All patients were evaluated after 3 courses of arsenic trioxide. Result: Sixty percent (6 patients) patients had shown major haematological response, forty percent minor & twenty percent has major cytogenetic response. Twenty percent of the patients has disease progression where as 20% has stable disease. The only mild adverse effects were seen in forms of nausea, vomiting, diarrhea, abdominal pain & dermatitis in 30% of patients. Only one patient (10%) had QT prolongation in ECG. Conclusion: We concluded that arsenic trioxide is very useful drug in myelodysplastic syndrome. It is also well tolerated in Asian Indian Population.

No significant financial relationships to disclose.