Building stronger foundations: exploring a collaborative faculty mentoring workshop for in-depth growth.

BACKGROUND: Mentorship training programs demand a paradigm shift from theory-driven to hands-on practical approach with prioritization of preparation of mentors and mentees for their roles through self-awareness and targeted professional development planning. There is a lack of evidence generated from the health professions education institutions of global south regarding effectiveness of workshops in fostering mentorship culture. METHODS: This mixed method study with convergent parallel design was conducted through a collaborative mentoring workshop; "Faculty Mentoring-Building stronger by digging deeper" by Aga khan University Medical College, Karachi and University of Lahore, Punjab, Pakistan. Objective of the research was to emphasize the importance of faculty mentoring program, roles and responsibilities of mentors and mentees and perception of the participants regarding the associated role of institutions. It aimed to educate faculty members to develop personal development plans for becoming effective mentors and mentees. The demographic data was collected before the workshop, during the workshop data was collected from SWOT analysis, followed by goal settings and the action plans made by participants at the end. Post workshop online feedback was acquired by a questionnaire to comprehend participants' educational attainment. Association between quantitative findings was done through ANOVA, while the qualitative data was subjected to thematic analysis. RESULTS: Total of 37 faculty members participated in the hands-on workshop. All faculty equally perceived the workshop as satisfactory and reported that hands-on practice led to positive experience of setting clear goals and action plans in developing oneself both as mentor and mentee. Themes identified were; Faculty Mentorship Program, Personal development Plan of Mentors and Mentees and Building Positive Mentor-Mentee Relationships. Voluntary structured program, choice of more than one faculty mentor and portfolio development based on personal SWOT was recommended by participants for the success of formal mentoring programs. CONCLUSION: Medical Faculty of Pakistani Universities at all career levels is interested in development of formal mentoring programs in their universities. Formal training for the same is also recommended by the participants. Institutions should cultivate a culture of mentorship that supports the professional growth and success of academics for cultivating the minds that are in turn shaping our future generations.

Assessing the predictive validity of Provincial Medical & Dental College Admission Test (MDCAT).

Objective: To assess the predictive validity of Punjab Provincial Medical & Dental College Admission Test (MDCAT). Methods: A retrospective correlational study was conducted at the Fatima Memorial Hospital College of Medicine & Dentistry in Lahore, Pakistan. Data were analysed from 415 medical students who had completed the MBBS program from 2018-2020. Bivariate and multivariable regression models were used to adjust for confounders such as age, gender, city of origin, and pre-medical performance. A novel performance-trajectory analysis was used to evaluate whether students with different preadmission MDCAT scores had different performance trajectories in medical school. Results: On simple bivariate analysis, there was a weak but significant (correlational coefficient 0.22-0.33, p<0.001) correlation between MDCAT scores and professional exam scores for all years of medical college. However, multivariable analysis of Matric/Fsc track showed no significant correlation (p > 0.05) between MDCAT and professional exam scores after the first two years. For O/A level students, there was no correlation between MDCAT and professional exam scores for any year of medical college (p>0.05). Trajectory analysis showed that students with exceptionally high MDCAT scores had a superior performance trajectory compared to those with the lowest quartile of MDCAT scores while students with average MDCAT scores had overlapping performance trajectories. Conclusion: For students from the Matric/FSc track only, there is a weak but significant correlation between MDCAT scores and professional exam scores for the first two years. No such correlation exists for O/A level students. Exceptionally high MDCAT scores are predictive of higher achievement in professional exam scores.

Resilience and academic performance: Exploring the link in dental students.

This study aims to assess the correl ation between t he resilience level of dental students (preclinical and clinical years) and its effects on their academic performance. It is a correlational research study that was carried out on second, third, and final-yea r denta l students at Lahore Medical & Dental College, Lahore. Academic resilience was judged by using the academic resilience scale (ARS-30). The correlation between resilience and academic performance was e s tablished by appl ying the bivar iate Pea rso n correlation. The mean age of the stude nt s was 2 1.49±1.39 years. Among 196 dental students from different years, 132 (67.35%) were females and 64(32.65%) were males. A strong p ositive co rrelati on was obser ved bet ween the academic performance and resilience of denta l students, i.e. r=0.774. From the results, it can be concluded that there is a positive correlation between academic resilience and academic performance among dental students.

Faculty perceptions regarding an individually tailored, flexible length, outcomes-based curriculum for undergraduate medical students.

PURPOSE: The perception of faculty members about an individually tailored, flexible-length, outcomes-based curriculum for undergraduate medical students was studied. Their opinion about the advantages, disadvantages, and challenges was also noted. This study was done to help educational institutions identify academic and social support and resources required to ensure that graduate competencies are not compromised by a flexible education pathway. METHODS: The study was done at the International Medical University, Malaysia, and the University of Lahore, Pakistan. Semi-structured interviews were conducted from 1st August 2021 to 17th March 2022. Demographic information was noted. Themes were identified, and a summary of the information under each theme was created. RESULTS: A total of 24 (14 from Malaysia and 10 from Pakistan) faculty participated. Most agreed that undergraduate medical students can progress (at a differential rate) if they attain the required competencies. Among the major advantages mentioned were that students may graduate faster, learn at a pace comfortable to them, and develop an individualized learning pathway. Several logistical challenges must be overcome. Providing assessments on demand will be difficult. Significant regulatory hurdles were anticipated. Artificial intelligence (AI) can play an important role in creating an individualized learning pathway and supporting time-independent progression. The course may be (slightly) cheaper than a traditional one. CONCLUSION: This study provides a foundation to further develop and strengthen flexible-length competency-based medical education modules. Further studies are required among educators at other medical schools and in other countries. Online learning and AI will play an important role.

Barriers and Facilitators for Female Healthcare Professionals to Be Leaders in Pakistan: A Qualitative Exploratory Study.

Purpose: Despite being in high numbers in medical colleges, only a small proportion of women join the workforce and even fewer reach leadership positions in Pakistan. Organizations like United Nations and Women Global Health are working towards closing the gender gap. The study aims to explore the enablers and barriers for women in healthcare leadership and to explore the strategies to promote women in leadership positions in Pakistan's specific societal culture. Methods: In this qualitative exploratory study, semi-structured interviews of 16 women holding leadership positions in the health-care profession, ie, medical and dental (basic or clinical sciences) were included. The data were collected until saturation was achieved. The data were analyzed in MS Excel. Deductive and Inductive thematic analysis was done. Results: Thirty-eight codes were generated that were combined in the form of categories. The major themes that emerged from the data were: elevating factors, the shackles holding them back, let us bring them up and implicit bias. Elevating factors were intrinsic motivation and exceptional qualifications, while the shackles were related to gender bias, male insecurities, and lack of political background. It was noteworthy that differences in gender roles were highly defined by culture and religion. Conclusion: There is a need to change the perception of South Asian society and redefine gender roles through media and individual attempts. Women must take charge of their choices and believe in themselves. The institutional policies to help promote gender equality would be mentorship programs for new faculty, gender-responsive training for everyone, equal opportunities for all, and maintaining gender diversity on all committees.

Effects of informal learner handover in clinical dental education.

BACKGROUND: It is currently under discussion whether Learner Handovers (LH) are beneficial, disadvantageous, or useful in Health Professions Education. Research has not been conducted to determine the extent of existing informal learner handover (ILH) through faculty discussions. In addition to providing stakeholders with added context, examining the nature of ILH may also provide insight into the bias associated with Learner Handover. METHODS: Transcripts from a series of semi-structured Focus Group Discussions (FGDs) and interviews (from January to March 2022) were iteratively reviewed to identify relevant patterns and correlations. The study involved the voluntary participation of 16 active clinical dental faculty members with a variety of designations. We did not discard any opinions. RESULTS: It was found that ILH had a mild impact on students' training. ILH effects can be categorized into four key areas: (1) faculty behavior with students, (2) faculty expectations from students, 3) teaching approach, and 4) faculty feedback practices. Furthermore, five additional factors were identified as having a greater influence on ILH practices. CONCLUSIONS: In clinical dental training, ILH has a minor effect on faculty-student interactions. Faculty perceptions and ILH are strongly influenced by other factors contributing to the student's 'academic reputation. As a result, student-faculty interactions are never free of prior influences, so stakeholders need to take them into consideration when creating a formal LH.

New challenges in the use of nanomedicine in cancer therapy.

Nanomedicines are applied as alternative treatments for anticancer agents. For the treatment of cancer, due to the small size in nanometers (nm), specific site targeting can be achieved with the use of nanomedicines, increasing their bioavailability and conferring fewer toxic side effects. Additionally, the use of minute amounts of drugs can lead to cost savings. In addition, nanotechnology is effectively applied in the preparation of such drugs as they are in nm sizes, considered one of the earliest cutoff values for the production of products utilized in nanotechnology. Early concepts described gold nanoshells as one of the successful therapies for cancer and associated diseases where the benefits of nanomedicine include effective active or passive targeting. Common medicines are degraded at a higher rate, whereas the degradation of macromolecules is time-consuming. All of the discussed properties are responsible for executing the physiological behaviors occurring at the following scale, depending on the geometry. Finally, large nanomaterials based on organic, lipid, inorganic, protein, and synthetic polymers have also been utilized to develop novel cancer cures.

Assessing the educational impact of cognitive level of MCQ and SEQ on learning approaches of dental students.

OBJECTIVES: MCQ's and SEQ's are the most widely used assessment tool in dental colleges across Pakistan. This study explores the impact of assessment tool: MCQ's and SEQ's on learning approach of dental students and also identifies correlation between these assessment tools and deep & surface learning approaches in integrated and discipline based curriculum. METHODS: A quantitative co-relational study was conducted in 2018 on 2nd and 4th year dental students. A pre-validated "Revised Study Process Questionnaire" was used. Spearman's rho correlation coefficient and Wilcoxon signed ranks test were applied to determine the relationship between learning approaches and assessment tools. Internal consistency was calculated by Cronbach's alpha. RESULTS: Ninety six students out of one hundred and fifty completed the questionnaire. Correlation test showed that surface approach correlates significantly with MCQ's (0.73) while no co-relation exists with SEQ's (-0.14) in our study. Deep approach has a strong and significant correlation with SEQ's (0.80) as compared to MCQ's (0.056). CONCLUSION: Assessment tool has an impact on learning approaches used by the students. It was concluded that students used to prefer deep learning approach while preparing for SEQ's as they were designed at higher cognitive level, whereas, they preferred surface approach while preparing for MCQ's as they were developed at low cognitive order.

Advantages, Limitations and Recommendations for online learning during COVID-19 pandemic era.

OBJECTIVE: During COVID-19 pandemic, the institutions in Pakistan have started online learning. This study explores the perception of teachers and students regarding its advantages, limitations and recommendations. METHODS: This qualitative case study was conducted from March to April 2020. Using maximum variation sampling, 12 faculty members and 12 students from University College of Medicine and University College of Dentistry, Lahore were invited to participate. Four focus group interviews, two each with the faculty and students of medicine and dentistry were carried out. Data were transcribed verbatim and thematically analyzed using Atlas Ti. RESULTS: The advantages included remote learning, comfort, accessibility, while the limitations involved inefficiency and difficulty in maintaining academic integrity. The recommendations were to train faculty on using online modalities and developing lesson plan with reduced cognitive load and increased interactivities. CONCLUSION: The current study supports the use of online learning in medical and dental institutes, considering its various advantages. Online learning modalities encourage student-centered learning and they are easily manageable during this lockdown situation.

Role of diagnostic factors associated with antioxidative status and expression of matrix metalloproteinases (MMPs) in patients with cancer therapy induced ocular disorders.

BACKGROUND: Cancer patients when treated with different chemotherapeutic drugs often develop mild to severe sight threatening diseases during or after chemotherapy. The mechanism involved in the pathogenesis of ocular toxicities is poorly understood. Oxidative stress, inflammation and MMPs (angiogenic factor) are involved in the progression of chemotherapy related ocular disorders. MATERIALS AND METHODS: The concentration of oxidative stress markers such as MDA, NO and levels of different antioxidant molecules such as SOD, CAT, GSH, GPx, GPr, VIT A, VIT E and VIT C present in the serum of chemotherapy treated patients (n = 50) and in normal persons (n = 20) were estimated by the direct spectrophotometric method while the concentration of TNF-α and MMP-9 activity were determined using human TNF-α and MMP-9 ELISA kits. RESULTS: The concentration of SOD and CAT (0.356 ±â€¯0.05 µg/dl and 1.26 ±â€¯0.01 µmol/mol of protein) was significantly lower as compared to that (1.09 ±â€¯0.03 µg/dl and 3.99 ±â€¯0.04 µmol/mol of protein) in controls. The levels of GPx (0.06 ±â€¯0.01 mmol/dl) in the cancer patients were much lower than those in the controls (0.78 ±â€¯0.06 mmol/dl). Lower level of GSH (0.96 ±â€¯0.003 µg/dl) in serum of the diseased group was observed as compared to healthy group (7.26 ±â€¯1.40 µg/dl). The level of Vit A, Vit C and Vit E was lower in systemic circulation of cancer patients (109.99 ±â€¯6.35 µg/ml, 1.26 ±â€¯0.36 µg/ml and 1.29 ±â€¯0.191 µg/ml) as compared to control subjects (166.35 ±â€¯14.26 µg/ml, 3.25 ±â€¯0.099 µg/ml and 6.354 ±â€¯2.26 µg/ml) respectively. The concentration of nitric oxide was significantly higher in the cancer patients (45.26 ±â€¯6.35 ng/ml) than that in the normal subjects (16.35 ±â€¯3.26 ng/ml). The higher concentration of MDA (8.65 ±â€¯3.26 nmol/ml) was observed in the patients than normal ones (1.254 ±â€¯0.065 nmol/ml). The quantity of TNF-α was significantly higher in chemotherapy treated patients (32.68 ±â€¯4.33 pg/ml) as compared to the control group (20.979 ±â€¯1.98 pg/ml). Significantly higher concentration of MMP-9 (40.26 ±â€¯3.26 ng/ml) was observed in the cancer patients than the controls (7.256 ±â€¯1.95 ng/ml). CONCLUSION: Lower levels of antioxidant enzymes and non-enzymatic small molecules and higher levels of oxidative stress and inflammatory clinical parameters such as NO, MDA, TNF-α and MMP-9 may be involved in the pathogenesis of systemic chemotherapy related ocular complications such as cataract, glaucoma, blepharitis, retinitis pigmentosa, macular degeneration, pterygium and retinal degeneration.

In silico and in vivo characterization of cabralealactone, solasodin and salvadorin in a rat model: potential anti-inflammatory agents.

BACKGROUND: The present study investigates the hepato- and DNA-protective effects of standardized extracts of Cleome brachycarpa (cabralealactone), Solanum incanum (solasodin), and Salvadora oleioides (salvadorin) in rats. MATERIALS AND METHODS: Hepatotoxicity was induced with intraperitoneal injection of carbon tetrachloride (CCl4) (1 mL/kg b.wt.) once a week for 12 weeks. The hepato- and DNA protective effects of the extracts in different combinations were compared with that of a standard drug Clavazin (200 mg/kg b.wt.). Tissue alanine aminotransferase, alpha-fetoprotein, tumor necrosis factor alpha (TNF-α), isoprostanes-2α, malondialdehyde, and 8-hydroxydeoxyguanosine, the significant hallmarks of oxidative stress, were studied. RESULTS: Histopathological findings of the liver sections from the rat group which received CCl4+cabralealactone, solasodin, and salvadorin demonstrated improved centrilobular hepatocyte regeneration with moderate areas of congestion and infiltration comparable with Clavazin. For in silico study, the identified compounds were subjected to molecular docking with cyclooxygenase-2 and TNF-α followed by a molecular dynamics study, which indicated their potential as anti-inflammatory agents. CONCLUSION: Cabralealactone, solasodin, and salvadorin confer some hepatoprotective and DNA-damage protective effects against CCl4-induced toxicity. They successfully restored the normal architecture of hepatocytes and have the potential to be used as inhibitor to main culprits, that is, cyclooxygenase-2 and TNF-α. They can combat oxidative stress and liver injuries both as mono and combinational therapies. However, combination therapy has more ameliorating effects.

Nanomedicines as emerging platform for simultaneous delivery of cancer therapeutics: new developments in overcoming drug resistance and optimizing anticancer efficacy.

Development and formulation of an efficient and safe therapeutic regimen for cancer theranostics are dynamically challenging. The use of mono-therapeutic cancer regimen is generally restricted to optimal clinical applications, on account of drug resistance and cancer heterogeneity. Combinatorial treatments can employ multi-therapeutics for synergistic anticancer efficacy whilst reducing the potency of individual moieties and diminishing the incidence of associated adverse effects. The combo-delivery of nanotherapeutics can optimize anti-tumor efficacy while reversing the incidence of drug resistance, aiming to homogenize pharmacological profile of drugs, enhance circulatory time, permit targeted drug accumulation, achieve multi-target dynamic approach, optimize target-specific drug binding and ensure sustained drug release at the target site. Numerous nanomedicines/nanotherapeutics have been developed by having dynamic physicochemical, pharmaceutical and pharmacological implications. These innovative delivery approaches have displayed specialized treatment effects, alone or in combination with conventional anticancer approaches (photodynamic therapy, radiotherapy and gene therapy), while reversing drug resistance and potential off-target effects. The current review presents a comprehensive overview of nanocarrier aided multi-drug therapies alongside recent advancements, future prospects, and the pivotal requirements for interdisciplinary research.

Implications of Isoprostanes and Matrix Metalloproteinase-7 Having Potential Role in the Development of Colorectal Cancer in Males.

BACKGROUND: Colorectal cancer (CRC) is the third most common type of cancer and leading cause of death worldwide. Major risk factors involved in the development of CRC are increased dietary sources, genetics, and increasing age. Purpose of the study was to find the role of different variables in the progression of CRC. METHODOLOGY: 50 blood samples from CRC patients and 20 samples from control were collected. Serum was separated from the blood by centrifugation. This serum was assessed for several antioxidants like superoxide dismutase (SOD), glutathione, glutathione peroxidase, glutathione reductase, catalase, vitamin A, C, and E, and pro-oxidants such as malondialdehyde, advanced oxidation protein products (AOPPs), and AGEs according to their respective protocols. Matrix metalloproteinase-7 (MMP-7) and isoprostanes were assessed by ELISA kits. RESULTS: Lower levels of GSH (4.86 ± 0.78 vs 9.65 ± 1.13 µg/dl), SOD (0.08 ± 0.012 vs 0.46 ± 0.017 µg/dl), CAT (2.45 ± 0.03 vs 4.22 ± 0.19 µmol/mol of protein), and GRx (5.16 ± 0.06 vs 7.23 ± 0.36 µmol/ml) in the diseased group were recorded as compared with control. Higher levels of GPx (6.64 ± 0.19 mmol/dl) were observed in the subjects in comparison with control group (1.58 ± 0.30 mmol/dl). Highly significant decreased levels of vitamin A (0.81 ± 0.07 vs 2.37 ± 0.15 mg/ml), vitamin E (15.42 ± 1.26 vs 25.96 ± 2.19 mg/ml), and vitamin C (47.67 ± 7.69 vs 80.37 ± 10.21 mg/ml) were observed in the patients in contrast to control group. The reversal of antioxidants in later stages of CRC may be due to compensatory mechanisms in cancerous cells. The levels of MDA (nmol/ml) were also assessed, which shows significantly increased level in CRC patients as compared with control groups (3.67 ± 0.19 vs 1.31 ± 0.27). The levels of protein oxidation products [AGEs (2.74 ± 0.16 vs 0.84 ± 0.05 IU) and AOPPs (1.32 ± 0.02 vs 0.82 ± 0.07 ng/ml)] were significantly increased in subjects as compared with control. The levels of MMP-7 (64.75 ± 3.03 vs 50.61 ± 4.09 ng/ml) and isoprostanes (0.71 ± 0.03 vs 0.16 ± 0.02 ng/ml) were also analyzed. This shows that the levels of isoprostanes increased due to high lipid peroxidation mediate higher levels of MMP-7, which promotes development of CRC. CONCLUSION: Following study suggested that elevated oxidative and inflammatory status along with lipid peroxidation and matrix metalloproteinases are the chief contributors in the progression of CRC.

Potential role of amino acids in pathogenesis of schizophrenia.

Schizophrenia is a syndrome of inconclusive etiopathogenesis with a prevalence of about 1% in general population. Underlying factors include genetic predisposition and defected neurodevelopment in early stages of life. The role of amino acids has been indicated in some reports. However, very few workers have detailed the effect of each amino acid in the pathophysiology of schizophrenia. Thus, in the present review, we aimed to provide an insight into the potential role of amino acids levels during schizophrenia. Any single amino acid defect cannot lead to the development of the disease. Higher concentration of glycine, serine, glutamate, homocysteine, and arginine are reported by many scientists in blood samples of patients of schizophrenia. Levels of rest of the amino acids show inconsistent results. Involvement of glutamate in pathophysiology of schizophrenia was hypothesized as early as the 1980s. It was demonstrated that dissociative anesthetics which are N-methyl-D-aspartate (NMDA) receptor antagonists can produce all negative, psychotic, cognitive, and physiological features of schizophrenia in healthy controls. This led to the development of hypothesis of NMDA receptor hypofunctioning in the pathophysiology of schizophrenia. Later on, it was also found that agents enhancing functioning of NMDA receptor at glycine modulatory site, improved symptoms in patients of schizophrenia receiving antipsychotic medications. Thus, the relationship of perturb amino acid levels with the biological basis and pathophysiology of schizophrenia is an important area to be further explored for effective management of schizophrenic patients.

Implications of prognostic variables in the assessment of autoimmunity in hepatitis C patients receiving interferon therapy.

Systematic administration of interferon-alpha (INF-alpha) is considered as the backbone of HCV therapy since 1991. Interferon (IFN) therapy can cause vasculitis, glomerulonephritis, cryoglobulinemia and certain other autoimmune diseases such as sialoadentitis, lichen planus and thyroiditis. Related to the factors of interferons, extensively studied gland is thyroid gland. A strong association was observed between thyroid disease and HCV patient when they were exposed to IFN therapy. Vitamin D, malondialdehyde (MDA), thyroid hormones and auto antibodies were biochemically assessed from the venous blood of seventy five HCV patients and fifty healthy controls. The results of all parameters were analyzed by independent sample t-test. The results of the study demonstrated a clear picture that the levels of vitamin D decreased as compared to control but increases in case of MDA. The levels of antibody titer represent that thyroglobulin-antibody (TGAb) thyroid peroxidase-antibody (TPOAb) as well as thyroid stimulating hormone receptor-antibody (TSHRAb) were raised in the patients suffering from HCV with thyroid dysfunction as compared to control. Similarly, the levels of thyroid hormones were also elevated in the HCV patients. Antibodies generated against thyroidal enzymes leads to impaired function of these enzymes thus causing decreased synthesis of thyroid hormones. As exogenous INF triggers the release of cytokines that mediate the recruitment of immune cells with increased production of inflammatory markers lead to production of lytic granules which have direct toxic action on thyroid cells and ultimately increased lipid peroxidation of thyrocytes. The results of the present study clearly demonstrated that the decreased levels of vitamin D in HCV patients receiving IFN therapy were responsible to induce autoimmunity against thyroid gland and adjutant therapy may be helpful to alleviate the possible thyroid disorders.

Assessment of biochemical and antioxidative status in patients suffering from dengue fever.

A multi-centred study was designed to collect dengue epidemiologic data from government and registered private hospitals/clinics and maintained archive of frozen specimens in bio-bank to be used for future dengue epidemic control program, and assess the epidemiology of dengue fever (DF) by evaluating biochemical and oxidative status of patients. ELISA IgM antibodies test was done to confirm DF. From August 2010 to December 2011, 101 confirmed blood samples of DF patients referred to pathology lab of Jinnah Hospital Lahore were subjected to the epidemiologic assessment by evaluating the biochemical and physiological indices and alterations of circulating antioxidants. Clinical features of DF patients and effect of fever on blood components and serum proteins of liver were recorded. The hospital stay in DF, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) showed significant difference. Significant increases in serum alanine amino transferase (ALT) (P=0.000), aspartate amino transferase (AST) (P=0.000), alkaline phosphatase (ALP) (P=0.000), malondialdehyde (MDA) along with significant decreases in total protein (TP) (P=0.000), reduced glutathione (GSH) (P=0.000), superoxide dismutase (SOD), catalase (CAT) (P=0.000), and sialic acid contents (P=0.016) were observed. A positive correlation existed between bound sialic acid levels, liver enzymes and circulating antioxidants (r=0.656, P=0.016). In the present study, alterations of circulating antioxidants in DF suggest that DF might be a metabolic response to an acute, self-limiting tropical viral infection, and a consequence of the viral inflammatory process.

Roles of Natural Compounds from Medicinal Plants in Cancer Treatment: Structure and Mode of Action at Molecular Level.

Every year, cancer takes the life of millions of people. Conventional treatments have produced unsatisfactory results for some types of cancer, and the side effects are extensive, leading to a shift in the focus of treatment towards alternative medicines. Indeed, medicinal plants have long been investigated by scientists for their anti-cancer properties. Some phytochemicals that are important active constituents of plants, including catechins, ursolic acid, silymarin, glycyrrhizin, ellagic acid, gallic acid and various types of flavonoids, have shown promise in future cancer management. The current review covers various aspects of cancer treatment based on medicinal plants at molecular level and sheds light on their structures and modes of action.

New possibilities in hepatocellular carcinoma treatment.

Hepatocellular carcinoma diagnosis and treatment has witnessed many major changes and challenges in the past two decades. Increasing incidence of HCC has introduced new monitoring systems and increased the efficacy of screening tests, as well as prognosis of the disease, including the staging system, serological testing and diagnostic imaging. Moreover, surgical resection, liver transplantation and herbal therapy have improved treatment. The most encouraging specific serological marker for HCC is alpha fetoprotein (AFP), which, along with ultrasonography, has improved earlier detection of HCC. Most recently, circulating tumor cell measurement has emerged as a promising tool for the prognosis of HCC. Herbal drugs and herbal composite formula drugs are promising towards the prevention of invasion and proliferation of tumor cells. Chemotherapeutic agents, such as sorafenib, bevacizumab and erlotinib, which target growth factor receptors in signaling pathways, are also used as HCC treatments. Furthermore, radiotherapy is employed in the treatment of unresectable tumors. The present report provides an analysis of the above parameters in the management of HCC.

Molecular characterization of FLT3 mutations in acute leukemia patients in Pakistan.

Fms-like tyrosine kinase 3 (FLT3) performs a vital role in the pathogenesis of hematopoietic malignancies. Therefore in recent times, the focus of several studies was on use of FLT3 as a prognostic marker. The present study investigated the molecular characterization and incidence of FLT3 mutations in acute leukemia patients in Pakistan. A total of 55 patients were studied, of which 25 were suffering from acute lymphoblastic leukemia (ALL) and 30 were suffering from acute myeloid leukemia (AML). The polymerase chain reaction demonstrated FLT3/ ITD mutations in 1 (4%) of 25 ALL patients, a male with the L2 subtype. In AML cases the rate was 4 (13.3%) of 30, three males and one female. The AML-M4 subtype was found in three and the AML M2 subtype in the other. In the AML cases, a statistically significant (p=0.009) relationship was found between WBC (109/L) and FLT3/ ITD positivity. However, no significant relationship was found with other clinical parameters (p>0.05). In acute myeloid leukemia (AML) FLT3/ITD+ mutation was more prevalent in elderly patients 31-40 age groups, 21-30 and 51-60 age groups respectively. In acute lymphoblastic leukemia (ALL) statistically no significant relationship was found between clinical features and FLT3/ITD positivity (p>0.05). However, in acute lymphoblastic leukemia (ALL) FLT3/ITD+ mutation was more commonly found in age groups of 21-30.