Postgraduate medical education in U.K. and Pakistan.
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Biomedical subjects
Publications and source records attributed to N A Jafarey.
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This study consists of 56 carcinoma cases of the oral cavity and oropharynx, 56 controls matched for age, sex, and habits, and 100 other controls proportionate to the population of Karachi. Biopsy material of the carcinoma cases and oral smears of the two control groups were negative for HSVI and HPV with peroxidase-antiperoxidase staining. The Enzyme Immunosorbent assay (EIA) of sera revealed significantly high levels of anti HSV-I IgG and IgM antibodies in carcinoma cases (96.43% and 25.00%, respectively) when compared with matched controls (73.21% and 3.5%, respectively).
The Diploma in Family Medicine (DFM) Examination is a new certification offered by the College of Physicians and Surgeons of Pakistan, and its Department of Medical Education designed a scientific examination. First, the Expert Advisory Committee for Family Medicine was formed, relevant training objectives were determined, a training programme to achieve the objectives was designed and a valid syllabus was chosen. Then the examination was designed, where the candidates must pass the objective theory papers before taking the clinical examination. The clinical examination consisted of an Objective Structured Clinical Examination (OSCE) and traditional case presentations. The candidates had to pass each of the components, and attain an overall aggregate of 60%. In the first six examinations, 752 candidates sat for the theory examinations, 332 (44.14%) were eligible for the clinical examination, and 170 (23%) passed. If 60% marks obtained in case presentations is taken as the gold standard which is the current CPSP policy and compared to OSCE marks, then 75% marks in OSCE had a sensitivity of 67% and a specificity of 79%.
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Endoscopic biopsies of antral mucosa from 26 patients with Helicobacter pylori-associated gastritis were studied by electron microscopy (EM). Scanning electron microscopy (SEM) showed clustering of H. pylori in the intercellular areas, being entrapped by the microvilli which were decreased at the sites where the bacilli were seen. The observations of SEM were confirmed by transmission electron microscopy (TEM), which showed adherence of the bacilli to the cell surface, producing cup-shaped depressions in the epithelial cells, and occasionally intracellular infiltration by H. pylori. There were also depletion of mucus granules, degenerative changes, and disruption of intercellular junction complexes of the epithelial cells. Post-treatment biopsies showed complete disappearance of the bacilli, and ultrastructural changes associated with H. pylori infection were resolved.
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Separate and combined effects of methotrexate and total body irradiation were studied on normal lungs of mouse. Forty female albino mice weighing 25 to 30 gms were divided into five groups including that of controls. On gross inspection, 70% of lungs of combined therapy group showed signs of congestion, 10% edematous changes and 20% blackish mottling. Microscopic examination revealed marked histopathological changes in the lungs of combined therapy group and milder changes in the methotrexate (Group III) and total body irradiation (Group IV) groups. These findings confirm the enhanced effects of combination of radiations and methotrexate.
The prevalence of H. pylori infection in 200 dyspeptic patients undergoing upper G.I. endoscopy was investigated by histology and rapid urease test. H. pylori was associated with 86% cases of chronic gastritis, 84.6% cases of duodenal ulcers and 78.5% of gastric ulcers. None of the 15 histologically normal gastric biopsies showed H. pylori.
In a placebo controlled prospective clinical trial of bismuth salicylate in helicobacter pylori associated gastritis, 52 adult patients were randomly allocated to treatment with bismuth salicylate or placebo. Helicobacter pylori were totally cleared in 77% patients in bismuth group but none in placebo group (P less than 0.001). Resolution of gastritis (P less than 0.001) and improvement of symptoms (P less than 0.01) were significantly better in patients where H. pylori infection cleared as compared to patients where the infection persisted.
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The effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on the gastric and duodenal mucosa was studied in 53 patients. On endoscopic biopsies, 87% patients showed gastritis and 90% duodenitis. Chronic superficial gastritis was the most frequent lesion in the stomach (49%); and mild duodenitis in the duodenum (54%). The antrum was the most frequently involved site in the stomach. An interesting finding in cases of duodenitis was the presence of dilated intestinal glands plugged with mucus.