JAMS Third Issue Feb,2012

8/2/2019 JAMS Third Issue Feb,2012

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JAMS, team and board 2

Elixir of youth 5

Wallenberg syndrome 7

stem cells and heart valve replacement 9

Cell phones may be carcinogenic 11

Medical news 13

Nano medicine and its Uses 17

Medical technology 21

How food affects your moods 23

Clinical trials 26

Screening for nutritional risk among elderly population 27

Your way to USA 30

Nobel prize in Medicine 34

Case report 37

Case discussion 40

1Journal of Alexandria Medical Students


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Welcome to JAMS the first medical journal designed to be fromstudents to students. JAMS is a platform for medical students to

share & present medical articles about all what is new in medicine,articles written in simple & attractive way

Vision:

Journal of Alexandria Medical students is the first medical journal inAlexandria, even in Egypt designed to be from students to students. Our

vision is to make JAMS one of the important medical student journal in

Egypt and worldwide aiming to raise the Alexandria medical students'scientific level.

Mission:

Our mission is to provide a platform for medical students to share &present their medical articles... We had a "board of supervisors" from

our dear professors who support us and guide us to make good scientific

workWe publish our JAMS as online version in private site which islinked to Alexandria faculty of medicine site and as board version under

the Academic building in the faculty and as hard-copy version that will

be in the hand of every medical student and doctor.

Objectivs:

1. To provide a medium for Alexandria medical students to publish theirwork and share ideas with their peers.2.To provide a suitable forum for students to make the transitionbetween assignment-writing and producing publishable academic

work.

3.To inform students about medical topics and issues not typicallyaddressed in core curricula.

4.To facilitate discussion of current issues relevant to medical students.5.To foster the next generation of Alexandria medical researchers and

physician-scientists.



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Mohammed Abd Elfattah

mohammed DarweshFifth Year Medicine (Undergraduate)Faculty of medicine, Alexandria University

Mohammed Mostafa Abd

El-HameedFifth Year Medicine (Undergraduate)

Faculty of medicine, Alexandria University

Mohammed Sabry RostomFifth Year Medicine (Undergraduate)


Yehia Attito MohamedFifth Year Medicine (Undergraduate)


Mohammed Abd-Rabboh

Attia BadaweyFifth Year Medicine (Undergraduate)Faculty of medicine, Alexandria University

Mohamed Abd El-Moneim

GhonaimFifth Year Medicine (Undergraduate)


Amr El-DaqaqFifth Year Medicine (Undergraduate)


Mai Al KosiryFifth Year Medicine (Undergraduate)


Jams team at the opening ceremony



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Prof. Ashraf Saad Galal

Dean and Professor of Ophthalmology

Prof. Mahmoud El-Zalabany

Ex.dean and professor of pediatrics

Prof. Abd El-Aziz Belal

Ex .Dean and Professor of ENTProf. Yasser Mazloum

Professor of RadiologyProf. Samir Naeem

Professor of Endocrinology

Prof. Samir Helmy Asaad

Professor of Diabetes & Metabolism

Prof. Osamah Ebadaa

Professor of gastroenterology

Prof. Salah abd El-Meneem

Professor of Oncology

Prof. Fathy Elsewy

Professor of diabetes and metabolism

Prof. Mahmoud IBRAHIM

Professor of chest and sleep disorders

Prof. Mahmoud Hassanein

Professor of Cardiology

Prof. Osamah Ebadah

Professor of gastroenterology

Prof. Maha Hegazy

Professors of Physiology

Prof. Gehan Gewevel

Professor of community medicine

Assist. Prof. Hisham El-

Shishtawy

Professors of psychiatry

Assist. Prof. Nihal El

Habachi

Professors of Physiology

Assist. Prof. Ayman El-

ShayebProfessor of Tropical medicine

Board of supervisors



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By:Ahmed MustafaSixth year medicine (undergraduate)

According to

Greek mythology

the goddess Hebe

was the Goddess of

youth, she was

typically depicted

in Greek and

Roman works of art

as being young and

attractive, wearing

a sleeveless dress

and bearing a

pitcher or pitchers

that were alleged

to contain an elixir that could restore of

maintain a persons youthfulness.

Man was always fascinated by the idea of

eternal youth; In Euripides' play Heracleidae,

Hebe helped Iolaus to achieve that dream.

Herodotus mentioned a fountain containing

a very special kind of water located in the

land of the Ethiopians, he called it the

fountain of youth!! . The eastern versions of

the Alexander romance, which describes

Alexander the Great and his servant crossing

the Land of Darkness to find the restorative

spring, also revolved around the same idea.

If youth means a long healthy life then now

we really have a hope to make that true!!

Its the same way of science that tells you

you can really change cupper to gold if

someday you can perfectly understand and

used the nuclear science science may not beas exciting as the myth but at least it can give

you a solid profound truth to use!!!

Well the story of our drug, or Elixir if you

like!! , started by a paradox; Dr. Serge

Renaud, a scientist from Bordeaux University

in France in 1992, noticed that the although

the French people consume more saturated

fats than most of other nations they have

relatively low incidence of coronary heart

disease and to the surprise the incidence was

lower in the red wine consumers .

There were many

theories but a 1997

study reporting on

the potential

anticancer activity

of trans-resveratrol

spurred interest in

resveratrol as a

nutritional supplement. Resveratrol is a

substance found in large quantities in thetraditional Japanese and Chinese medicinal

herb Polygonum cuspidatum. It also occurs

naturally in grape skin extracts, red wine,

purple grape juice, peanuts, mulberries,

blueberries, and bilberries.

That attention driven by that study to

resveratrol led to further studies that showed

that resveratrol has cardioprotective,immunologic, antiplatelet, anti-

inflammatory, anticancer actions and

antiaging actions!!. Much interest has

evolved around resveratrol's potential for

improving brain and cardiovascular health.

Some of the observations of a protective

effect on brain health came from the

association between red-wine consumption

and lower incidence of dementia andAlzheimer's disease; clearance of brain

amyloid peptides by resveratrol in vitro has



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been claimed as a mechanism for improved

cognitive function in humans. In severalstudies resveratrol was found to activate

sirtuins, a family of seven enzymes

associated with the aging process.

In 2003 Howitz and Sinclair, the co-

discoverers of sirtuins, reported in the

journal Nature that resveratrol significantly

extends the lifespan of the yeast

Saccharomyces cerevisiae. Later studies

revealed that resveratrol also prolongs the

lifespan of the worm Caenorhabditis elegans

and the fruit fly Drosophila melanogaster.

We know, thanks to Sinclair, that calorie

restriction can activate sirtuins in mice .In

2006 a team led by Baur and Paerson

published a study on nature that showed that

resveratrol mimic that effect on mice and can

prevent adverse metabolic effect of high

calorie diet.

This all seems to be very promising but

definitive human clinical trials supporting its

protective benefits (short or long term)

against Alzheimer's disease, cardiovascular

disease, and cancer are lacking. Most of

these studies were in vitro studies or on

animals.

We still have to wait

for confirmation by

clinical trials for EBM

to approve usingresveratrol as Elixir

of youth. Ad lib use

of it as a supplement

is not advised.

Consuming food

containing resveratrol

may seem appealing

but keep in mind that you have to consume

enormous amount of grapes or mulberry toget a dose equivalent to that used in the

experiments.

Fortunately red wine is not an option in our

religion and society and even though you

also need massive amount of wine that

alcohol would destroy your liver on your

quest for health!!!

The bottom line for this is that we all believe

in science and its ability to conquer all the

obstacles so lets keep our fingers crossed

that resveratrol would soon be available

after finishing its trials and in the mean while

eat balanced healthy diet and dont follow

every hype.

References:

Baur JA, Pearson KJ, Price NL, et al.Resveratrol improves health and survival of

mice on a high-calorie diet. Nature 2006;

DOI:10.1038/nature05354

Dsire Lie. Resveratrol -- Apocryphal Claimor Promise?. Medscape clinical cases;

October 2009

Sue Hughes. Substance found that canprolong healthy life in mice. Heartwire;November 3, 2006



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By: Nora Hassan Abd Abd ElkawySixth year medicine (undergraduate)

Definition:

Wallenberg syndrome is a condition that

affects the nervous system. It is often caused

by a brain stem stroke. Symptoms may

include swallowing difficulty, hoarseness,

dizziness, nausea, vomiting, quick involuntary

eye movements (nystagmus), balance andcoordination problems and Horner

syndrome.

Wallenberg syndrome caused by

multiple sclerosis mimicking stroke

Wallenberg syndrome (WS), also known as

lateral medullary syndrome, is a well-

characterised brainstem syndrome that was

first described in 1895 by Dr Wallenberg. Thecomplete spectrum of WS symptoms and

signs includes vertigo, nausea and vomiting,

dysphagia, hiccoughs, nystagmus, ataxia,

ipsilateral facial spinothalamic sensory loss

(due to inclusion of the spinal trigeminal

tract) with contralateral body spinothalamic

hemianaesthesia, and ipsilateral Horners

sign. Incomplete forms of WS occur

frequently, presenting with various

combinations of these clinical signs.

Aetiology

The most common aetiology of WS is stroke due

to occlusion of the vertebral or posterior inferior

cerebellar arteries. However, non-vascular

disorders can also be the underlying cause for

WS, as has been reported in the literature. In

Western countries multiple sclerosis (MS) is a

common inflammatory demyelinating disorder of

the central nervous system. In most patients,

with the help of MRI and other investigations, MS

can be distinguished from ischaemic stroke

without difficulty. Occasionally, however, when it

presents more acutely, MS may be misdiagnosed

as stroke.

Case report:

A 52-year-old Caucasian woman was

admitted to our Neurology Unit. She first felt

tired and unwell on the day of presentationand went to bed with a mild throbbing

headache, which progressively worsened

over the next 30 minutes. After an hour she

developed vomiting and loss of balance on

walking. On admission, she was alert and

oriented. The general physical examination

was unremarkable. Neurological examination

revealed incomplete WS, including torsional

nystagmus in all directions, partial left

Horners sign, pain and temperature sensorydeficit of the left side of her face and the

right side of her body, and positive

Rombergs sign with falling to the left. There

were no bulbar symptoms. Motor

examination of all four limbs was normal. Her

past medical history included very occasional

migraines (three in her lifetime),

hypothyroidism and type 2 diabetes, the

latter being well controlled with oral

metformin (500 mg twice daily). She denied

any antecedent vascular events and reported

no family history of neurological disorders.

http://www.nlm.nih.gov/medlineplus/ency/article/000708.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000708.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000708.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000708.htm


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Fig. 2. (A) Axial and (B) sagittal T2-weighted MRI of the whole spine on two

weeks after admission showing evolution in the lateral medullary lesion,

typical of multiple sclerosis

An emergency cerebral MRI scan performed

after symptom onset revealed a recent left

medulla oblongata lesion, which hadrestricted diffusion on diffusionweighted

imaging (DWI; Fig. 1). Routine biochemical

investigations were normal. The patient was

diagnosed as having acute left lateral

medullary infarction with incomplete WS

and was commenced on aspirin (150 mg per

day) and atorvastatin (80 mg twice daily).

However, as the cerebral MRI had also

demonstrated some atypical lesions in the

subcortical white matter, the diagnosis of MSwas not excluded. After discharge from

hospital, the patient had persisting loss of

walking balance, nausea and anorexia. She

later recalled an episode of some electrical

sensations passing into both arms 6 months

previously, consistent with Lhermittes

phenomenon, which resolved within several

days. An MRI of the whole spinal cord was

subsequently performed, and revealed

an upper cervical cord lesion typical of

demyelinating disease. The images also

revealed evolution in the lateral

medullary lesion that furtherstrengthened the diagnosis of MS (Fig.

2). She was readmitted to hospital 1

month later, for further diagnosis and

treatment. The neurological

examination revealed bilateral

horizontal nystagmus, a wide-based

gait with falling to the left, and a

positive Rombergs sign. The other

neurological signs had since resolved.

Routine biochemistry tests and additionalautoantibody studies were normal. A

diagnosis of definite MS was made based on

McDonald criteria (two relapses and lesions

at two different anatomical sites). The

patient recovered slowly, and treatment with

interferonb-1a was initiated.

On a follow-up assessment, a repeat cerebral

MRI performed 3 months later showed a new

lesion in the right frontal white matter, a new

corpus callosum lesion and radiologicalevolution of the medullary lesion diagnostic

of MS. However, the patient has not

experienced any further clinical relapses

during the follow-up period of almost two

years. A recent cerebral MRI scan did not

demonstrate any new lesions, and the

dorsolateral medullary lesion had

significantly reduced in size.

References

1. NINDS Wallenberg's Syndrome Information Page.National Institute of Neurological Disorders and Stroke

(NINDS). February 15, 2007

2. Love BB, Biller J. Textbook of Clinical Neurology,3rd ed. In: Neurovascular System. Philadelphia,

PA:Saunders; 2007

3. Pryse-Phillips W, Murray TJ. Textbook of PrimaryCare Medicine, 3rd ed. In: . Clinical ischemic stroke

syndromes. Philadelphia, PA:Mosby, Inc; 2001

4. Wei Qiu, Jing-Shan Wu, William M. Carroll, FrankL. Mastaglia, Allan. Kermode,* Wallenberg syndrome

caused by multiple sclerosis mimicking stroke. CaseReports / Journal of Clinical Neuroscience 16 ; 2009:

17001702

Fig. 1. Cerebral axial (A) T2-weighted and (B) diffusion-weighted MRI

erformed at initial admission showin a left dorsal lateral medullar lesion



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By: Norhan Mostafa HamzaThird year medicine (undergraduate)

Blood is pumped in heart through the cham-

bers, aided by four heart valves (the mitral

valve, tricuspid valve, pulmonary valve and the

aortic valve). The valves open and close to let

the blood flow in only one direction.

So when a valve is said to be defec-

tive?

A defective heart valve is one that fails tofully open or close as it should normally do,

this defective valve may be:

A stenotic heart valve can't open com-pletely, so blood is pumped through a

smaller-than-normal opening.

A valve also may not be able to closecompletely. This leads to regurgitation

(blood leaking back through the valve

when it should be closed).

What can cause a defective heart

valve? A person can be born with an abnormal

heart valve, a type of congenital heart de-

fect

Also it can be damaged by:1. Infections such as infective endocarditis.2. Rheumatic fever.3. Changes in valve structure in the elderly.

How can we treat a defective heart

valve?

People with congenital heart valve defects

may need treatment with drugs while Some

valve defects may be repaired with surgery,

researches have been carried to use a new

technology in treating defective heart valves

& prevent the complications of surgeries ,thisnew technology is using stem cells.

What are stem cells?

Stem cellsare cells found in all multi cellu-

lar organisms. They are characterized by the

ability to renew themselves through mitot-

ic cell division and differentiate into a diverse

range of specialized cell types.

What is the aim of recent carried

researches?

A British research team led by the world's

leading heart surgeon has grown part of a

human heart from stem cells for the first

time. If animal trials scheduled for later this

year prove successful, replacement tissue

could be used in transplants for the hundreds

of thousands of people suffering from heart

disease within three years.



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Growing replacement tissue from stem cells is

one of the principal goals of biology. If a dam-

aged part of the body can be replaced by tissue

that is genetically matched to the patient, thereis no chance of rejection.

What is the progress of these re-

searches so far?

So far, scientists have grown tendons, cartilag-

es and bladders, but none of these has the

complexity of organs.

How the British research teamheaded by Professor MagdiYacoub

is trying to crack the problem?

Prof.Yacoub assembled a team of physicists,

biologists, engineers, pharmacologists, cellular

scientists and clinicians. Their task to character-

ize how every bit of the heart works has taken

10 years.

Prof.Yacoub said his team's latest work had

brought the goal of growing a whole, beating

human heart closer. "It is an ambitious project

but not impossible. The progress of nowadays

all over the world makes us believe that this

new this technology will be applied sooner than

we imagine.

What is Professor Magdi Yacoubs opinion about

the project?

If that trial works well, Prof.Yacoub is opti-

mistic that the replacement heart tissue,

which can be grown into the shape of a hu-

man heart valve using specially-designed col-

lagen scaffolds, could be used in patients

within three to five years.

Growing a suitably-sized piece of tissue

from a patient's own stem cells would take

around a month but he said that most people

would not need such individualized treat-

ment. A store of ready-grown tissue made

from a wide variety of stem cells could pro-

vide good matches for the majority of the

population.

Finally, we hope that this new technology

works out so that everybody can breathe air

and pump blood.

References:

http://www.guardian.co.uk/science/2007/apr/02/stemcells.genetics

http://www.heart-valve-surgery.com/heart-surgery-blog/2007/09/04/stem-cells-and-heart-valve-replacements/

http://stemcells.nih.gov/info/basics/basics1.asp Google images



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By:Jehan Magdy MoharramSixth year medicine (undergraduate)

The World Health Organization (WHO)

announced that radiation from cell phones

can possibly cause cancer. According to the

WHO's International Agency for Research on

Cancer (IARC), radiofrequency electro-

magnetic fields have been classified as

possibly carcinogenic to humans (group 2B)

on the basis of an increased risk for glioma

that some studies have associated with the

use of wireless phones.

Human exposures to RF-EMF (frequency

range 30 kHz300 GHz) can occur from use

of personal devices (eg, mobile telephones,

cordless phones, Bluetooth, and amateur

radios), from occupational sources (eg, high-

frequency dielectric and induction heaters,

and high-powered pulsed radars)

For workers, most exposure to RF-EMFcomes from near-field sources, whereas the

general population receives the highest

exposure from transmitters close to the

body, such as handheld devices like mobile

telephones.

The most important factors that determine

the induced fields are the distance of the

source from the body and the output power

level. Additionally, the efficiency of coupling

and resulting field distribution inside the

body strongly depend on the frequency,

polarisation, and direction of wave incidence

on the body, and anatomical features of the

exposed person, including height, body-mass

index, posture, and dielectric properties of

the tissues. Induced fields within the body

are highly non-uniform, varying over several

orders of magnitude, with local hotspots.

Holding a mobile phone to the ear to make

a voice call can result in high specific RF

energy absorption-rate (SAR) values in the

brain, depending on the design and positionof the phone and its antenna in relation to

the head, how the phone is held, the

anatomy of the head, and the quality of the

link between the base station and phone.

When used by children, the average RF

energy deposition is two times higher in the

brain and up to ten times higher in the bone

marrow of the skull, compared with mobile

phone use by adults

Use of hands-free kits lowers exposure to the

brain to below 10% of the exposure from use

at the ear, but it might increase exposure to

other parts of the body.

Epidemiological evidence for an association

between RF-EMF and cancer comes from

cohort, case-control, and time-trend studies.

The populations in these studies were

exposed to RF-EMF in occupational settings,

from sources in the general environment,and from use of wireless (mobile and

cordless) telephones, which is the most

extensively studied exposure source. One

cohort study and five case-control

studies were judged by the Working Group to

offer potentially useful information regarding

associations between use of wireless phones

and glioma.

References:

The lancet oncology,Published Online: 22 June

2011



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Guidelines of article submission:

Pages:one page for board, not more than three pages for online version, up tofive pages for in-depth window.

Size: A4 document. Language: English Title:interesting, clear, related to the topic. Content: clear, concise, interesting, only in medical field, updated and

undergraduate level.

Editing:1. Microsoft Word 97-2003 (*.doc) or 2007-2010 (*.docx) format.2. At least one picture related to the topic.3. Two columns.4. 12-point sized font.5. "Calibri" font.6. Leave a blank line after each new paragraph.7. Margins of 2.5cm on all sides.8. Orientation "Portrait".9. Revised well No Misspelled words.

References: should be listed inthe order in which they first appear in thearticle refer to the website

The publishable articles will be reviewed by the "board ofsupervisors"

Of course, you can share with us with medical comics, crosswords,

medical "do you know?" medical notes and case discussion.

Address: Alexandria Faculty of Medicine - Azarita - Alexandria Egypt.

Website:www.jams-online.com

Email:[email protected]

Facebook group:Journal of Alexandria Medical Students

http://c/Users/M.A.A.B/Desktop/2nd%20issue/www.jams-online.comhttp://c/Users/M.A.A.B/Desktop/2nd%20issue/www.jams-online.comhttp://c/Users/M.A.A.B/Desktop/2nd%20issue/www.jams-online.commailto:[email protected]:[email protected]:[email protected]://www.facebook.com/pages/Journal-of-Alexandria-Medical-Students/231574336860054http://www.facebook.com/pages/Journal-of-Alexandria-Medical-Students/231574336860054http://www.facebook.com/pages/Journal-of-Alexandria-Medical-Students/231574336860054http://www.facebook.com/pages/Journal-of-Alexandria-Medical-Students/231574336860054mailto:[email protected]://c/Users/M.A.A.B/Desktop/2nd%20issue/www.jams-online.com


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By: Mohamed GhonaimSixth year medicine (undergraduate)

Stem Cell Therapy May ReverseDiabetes :

An immune regulator from healthy cord

blood stem cells (CB-SCs) can "educate" the Tcells of a person with type 1 diabetes (T1D),

enabling the pancreas to produce insulin,

according to a report published

online January 10, 2012, in BMC Medicine.

Researchers base their "stem cell educator

therapy" on observations that multipotent

stem cells from human cord blood can alter

regulatory T cells (Tregs) and islet B cell

specific T-cell clones. The new approach

alters autoimmunity both in non-obese

diabetic mice and in islet B cells from patients

with diabetes. In a small, open-label trial, a

single treatment reduced the median daily

dose of required insulin and some B-cell

function; the researchers circulated

lymphocytes from patients' blood in a closed-

loop "stem cell educator," co-culturing the

cells for 2 to 3 hours with adherent CB-SCs

from healthy donors. The investigators

infused the "educated"lymphocytes into the

patients and measured

both levels of C-

peptide and glycated

hemoglobin and

indicators of immune

function at 4, 12, 24,

and 40 weeks. The

treated individualsdisplayed better C-

peptide and glycated

hemoglobin A1c values,

lower daily

requirement for insulin, and decreased

autoimmunity.

Patients with T1D had improved fasting C-

peptide levels & fall of Hb A1c levels .Stemcell education significantly increased the

percentage of Tregs in peripheral blood. The

CB-SCs produce an autoimmune regulator

which may eliminate autoreactive T cells.This

innovative approach may provide CB-SC-

mediated immune modulation therapy for

multiple autoimmune diseases while

mitigating the safety and ethical concerns

associated with other approaches.

Breast Cancer Vaccine ShowsPromising Results :

(CBS) A vaccine to prevent breast cancer

has shown favorable results in animals, they

found that a single vaccination with the

antigen a-lactalbumin prevents breast cancer

tumors from forming in mice, while inhibitingthe growth of existing tumors.



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In the current study, genetically cancer-

prone mice were

vaccinated half with a

vaccine containing the

antigen and vaccine thatdid not contain the

antigen. None of the

mice vaccinated with

the antigen developed

breast cancer, while the

other entire mice did.

The key is to find a

target within the tumor

that isn't typically found in a healthy person.

In the case of breast cancer, researchers

team targeted a-lactalbumin, a protein found

in the majority of breast cancers, but not in

healthy women, except during lactation.

Therefore, the vaccine can rev up a woman's

immune system to target a-lactalbumin,

stopping tumor formation without damaging

healthy breast tissue. While the researchers

are optimistic, they warn it's a big leap from

results in animals to similar results in humans

and there is no guarantee the treatment will

make it to human trials.

Red Meat Consumption LinkedWith Risk for Kidney Cancer :

People who eat lots of red meat may have a

higher risk of some types

of kidney cancer,

suggests a large U.S.

study performed onclose to 500,000 U.S.

adults age 50 and older,

who were surveyed on

their dietary habits,

including meat

consumption, and then

followed for an average

of nine years. When the

researchers found that the association

between red meat and cancer was stronger

for papillary cancers, but there was no effect

for clear-cell kidney cancers. People who ate

the most well-done grilled and barbecued

meat -- and therefore had the highest

exposure to carcinogenic chemicals from the

cooking process -- also had an extra risk of

kidney cancer compared to those who didn't

eat meat cooked that way. support the

dietary recommendations for cancer

prevention currently put forth by the

American Cancer Society -- limit intake of red

and processed meats and prepare meat by

cooking methods such as baking and

broiling."

New Class of Drug May VanquishCLL:

Navitoclax, a novel BH3 mimetic that

blocks the function of BCL-2, has shown

significant antileukemic activity in patients

with chronic lymphocytic leukemia (CLL) in a

phase 1 trial published in the Journal of

Clinical Oncology. "Navitoclax works in CLL



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because it stops the function of BCL-2, and

CLL cells are very dependent on BCL-2 to stay

alive. BCL-2 also helps CLL and other cancer

cells resist standard chemotherapy, so

inhibiting BCL-2 can lead to the CLL cellsdying or being set up to die if another stress

such as additional chemotherapy is added.

Adverse events were diarrhea, nausea,

vomiting, fatigue, and neutropenia, which

occurred in 10% or more of the patients.

Tamiflu-Resistant Influenza VirusSpreading in Australia

A variation of the pandemic 2009 A(H1N1)

influenza virus that is resistant to oseltamivir

(Tamiflu, Roche) appears to be spreading in

Australia, In the Australian study, 29 (16%) of

182 patients infected with the pandemic

influenza virus between May 2011 and

August 2011 harbored a version of the virus

that was oseltamivir-resistant. the

oseltamivir-resistant virus is detected in less

than 1% of patients with the pandemic 2009

A(H1N1) virus who have not been treated

previously with the antiviral. In addition,

transmission has been documented only in

closed settings suggesting the spread of a

single variant. Although the virus was

resistant to oseltamivir, it was still

susceptible to the antiviral medication

zanamivir.The authors write that as the

Northern Hemisphere heads into winter,

public health authorities there should rapidly

analyze pandemic virus strains from the

outset to determine whether an oseltamivir-

resistant version is spreading.

Researchers Report PositiveResults in Malaria Vaccine Study :

In the war against a disease killed almost

800,000 people in one year (2009) . A vaccine

candidate being studied in phase 3 clinical

trials in 7 African countries involving 15,460

children has prevented half of the potential

malaria cases among 1 group of the study

population; the vaccine candidate, RTS,

S/AS01, is a hybrid combining the hepatitis B

antigen with part of the protein called

sporozoite, the infective form of the malaria

parasite. In earlier studies, RTS,S/AS01

showed consistent protection

against Plasmodium falciparum, the most

serious form of malaria, and showed a 45.1%

(CI, 23.8% - 60.5%) improvement in the

intention-to-treat population in the current

results. However, the results also showed

that the level of protection from the vaccine

was lower after the first year than

immediately after vaccination. The authors

write that studies have shown different

results for protection levels and that this calls

for further investigation.



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Future researcher project

What is the future research

project?

It is the first project to be conducted by

JAMS and it is concerned with teaching

undergraduates the basic skills of Research

works organized in 11 sessions (for example:

How to write a research proposal?,

Evidence based medicine, clinical trials,

evidence-based medicine,..etc.), by

agreeing with members of the teaching staff

in Alexandria faculty of medicine who areinterested in holding such workshops.

Every session will be composed of:

Lecture. Training. Group discussion.

First, they can participate with

postgraduates in their research work as coresearchers.

Future research project is collaboration

between JAMS and AMSRA (Alexandria

medical student research association) whichaims at:

1. Increasing the participation of

undergraduate students in research

projects.

2. Improvement of research skills amongst

undergraduate students.

3. Preparing undergraduate students for

their postgraduate studies through their

early exposure to research activity.

4. Increasing communication between the

students and their teaching staff and

postgraduate researchers.

Finally, there will be good researchers that

will publish their research papers in JAMS

and other medical journals and share themwith their peer.



18/42

BY: Amr El-Daqaq

Sixth year medicine (undergraduate)

Nanomedicine is the medi-cal application of nanotechnol-

ogy. Nanomedicine ranges from

the medical applications of na-

nomaterials, to nanoelectronic

biosensors, and even possible

future applications of molecularnanotechnology. Current prob-

lems for nanomedicine involve

understanding the issues relat-

ed to toxicity and environmen-

tal impact of nanoscale materi-

als.

Medical use of nanomaterials

Two forms of nanomedicine that have al-

ready been tested in mice and are awaiting

human trials are using gold nanoshells to

help diagnose and treat cancer, and using

liposomes as vaccine adjuvants and as vehi-

cles for drug transport.

1-Drug delivery:

Nanomedical approaches to drug deliverycenter on developing nanoscale particles or

molecules to improve drug bioavailability.

Bioavailability refers to the presence of

drug

molecules where they are needed in the

body and where they will do the most good.

Drug delivery focuses on maximizing bioa-

vailability both at specific places in the body

and over a period of time. This can

potentially be achieved by molecular target-

ing by nanoengineered devices. It is all about

targeting the molecules and delivering drugs

with cell precision. More than $65 billion are

wasted each year due to poor bioavailability.

The strength of drug delivery systems is their

ability to alter the pharmacokinetics and bio-

distribution of the drug. Nanoparticles have

unusual properties that can be used to im-

prove drug delivery. Where larger particles

would have been cleared from the body, cells

take up these nanoparticles because of theirsize. Complex drug delivery mechanisms are

being developed, including the ability to get

drugs through cell membranes and into cell

cytoplasm. Efficiency is important because

many diseases depend upon processes within

the cell and can only be impeded by drugs

that make their way into the cell. Potential

nanodrugs will work by very specific and

well-understood mechanisms; one of the ma-jor impacts of nanotechnology and



19/42

nanoscience will be in leading development

of completely new drugs with more useful

behavior and less side effects.

2-In vivo imaging:

Nanoimaging is another area where tools

and devices are being developed. Using na-

noparticle contrast agents, images such as

ultrasound and MRI have a favorable distri-

bution and improved contrast. What nano-

scientists will be able to achieve in the future

is beyond current imagination. This might be

accomplished by self-assembled biocompati-

ble nanodevices that will detect, evaluate,

treat and report to the clinical doctor auto-

matically.

3-Nano & Cancer:

The small size of nanoparticles endows

them with properties that can be very useful

in oncology, particularly in imaging. Quantum

dots (nanoparticles with quantum

confinement properties, such as size-tunable

light emission), when used in conjunction

with MRI (magnetic resonance imaging), can

produce exceptional images of tumor sites.

These nanoparticles are much brighter than

organic dyes and only need one light source

for excitation. This means that the use of flu-

orescent quantum dots could produce a

higher contrast image and at a lower cost

than todays organic dyes used as contrast

media. The downside, however, is that quan-

tum dots are usually made of quite toxic el-

ements.

Another nanoproperty, high surface area to

volume ratio, allows many functional groups

to be attached to a nanoparticle, which can

seek out and bind to certain tumor cells. Ad-

ditionally, the small size of nanoparticles (10

to 100 nanometers), allows them to

preferentially accumulate at tumor

sites (because tumors lack an effec-

tive lymphatic drainage system). A

very exciting research question is

how to make these imaging nano-

particles do more things for cancer.

For instance, is it possible to manu-

facture multifunctional nanoparti-

cles that would detect, image, and

then proceed to treat a tumor? This

question is under vigorous investiga-

tion; the answer to which could

shape the future of cancer treat-

ment. A promising new cancer

treatment that may one day replace

radiation and chemotherapy is edging closer

to human trials. Kanzius RF therapy attaches

microscopic nanoparticles to cancer cells and

then "cooks" tumors inside the body with



20/42

radio waves that heat only the nanoparticles

and the adjacent (cancerous) cells.

Researchers at Rice University under Prof.

Jennifer West, have demonstrated the use of

120 nm diameter nanoshells coated with

gold to kill cancer tumors in mice. The

nanoshells can be targeted to bond to can-

cerous cells by conjugating antibodies or

peptides to the nanoshell surface. By irradiat-

ing the area of the tumor with an infrared

laser, which passes through flesh without

heating it, the gold is heated sufficiently to

cause death to the cancer cells.

4- Nano & Surgery:

At Rice University, a flesh welder is used to

fuse two pieces of chicken meat into a single

piece. The two pieces of chicken are placed

together touching. A greenish liquid contain-

ing gold-coated nanoshells is dribbled along

the seam. An infrared laser is traced along

the seam, causing the two sides to weld to-

gether. This could solve the difficulties and

blood leaks caused when the surgeon tries to

restitch the arteries that have been cut dur-

ing a kidney or heart transplant. The flesh

welder could weld the artery perfectly.

5- Nanonephrology:

Nanonephrology is a branch of nanomedi-cine and nanotechnology that deals with 1)

the study of kidney protein structures at the

atomic level; 2) nano-imaging approaches to

study cellular processes in kidney cells; and

3) nano medical treatments that utilize na-

noparticles and to treat various kidney dis-

eases. The creation and use of materials

and devices at the molecular and atomic

levels that can be used for the diagnosis and

therapy of renal diseases is also a part of

Nanonephrology that will play a role in the

management of patients with kidney diseasein the future. Advances in Nanonephrology

will be based on discoveries in the above ar-

eas that can provide nano-scale information

on the cellular molecular machinery involved

in normal kidney processes and in pathologi-

cal states. By understanding the physical and

chemical properties of proteins and other

macromolecules at the atomic level in vari-

ous cells in the kidney, novel therapeutic ap-proaches can be designed to combat major

renal diseases. The nano-scale artificial kid-

ney is a goal that many physicians dream of.

Nano-scale engineering advances will permit

programmable and controllable nano-scale

robots to execute curative and reconstructive

procedures in the human kidney at the cellu-

lar and molecular levels. Designing

nanostructures compatible with the kidney

cells and that can safely operate in vivo is al-

so a future goal. The ability to direct events

in a controlled fashion at the cellular nano-

level has the potential of significantly improv-

ing the lives of patients with kidney diseases.



21/42

6-Cell repair machines:

Using drugs and surgery, doctors can only

encourage tissues to repair themselves. With

molecular machines, there will be more di-

rect repairs. Cell repair will utilize the same

tasks that living systems already prove possi-

ble. Access to cells is possible because biolo-

gists can insert needles into cells without kill-

ing them. Thus, molecular machines are ca-

pable of entering the cell.

Also, all specific biochemical interactionsshow that molecular systems can recognize

other molecules by touch, build or rebuild

every molecule in a cell, and can disassemble

damaged molecules. Finally, cells that repli-

cate prove that molecular systems can as-

semble every system found in a cell. There-

fore, since nature has demonstrated the

basic operations needed to perform molecu-

lar-level cell repair, in the future, na-

nomachine based systems will be built that

are able to enter cells, sense differences from

healthy ones and make modifications to the

structure.

The healthcare possibilities of these cell re-

pair machines are impressive. Comparable to

the size of viruses or bacteria, their

compact parts would allow them to be more

complex. The early machines will be special-

ized. As they open and close cell membranes

or travel through tissue and enter cells and

viruses, machines will only be able to correct

a single molecular disorder like DNA damage

or enzyme deficiency. Later, cell repair ma-

chines will be programmed with more abili-

ties with the help of advanced AI systems.

Nanocomputers will be needed to guide

these machines. These computers will direct

machines to examine, take apart, and rebuild

damaged molecular structures. Repair ma-

chines will be able to repair whole cells by

working structure by structure. Then by

working cell by cell and tissue by tissue,

whole organs can be repaired. Finally, by

working organ by organ, health is restored to

the body. Cells damaged to the point of inac-

tivity can be repaired because of the ability

of molecular machines to build cells from

scratch. Therefore, cell repair machines will

free medicine from reliance on self-repair

alone.



22/42

By: Mohammed Abd-RabbohSixth year medicine (undergraduate)

About 15 years ago, MIT professors Robert

Langerand Michael Cima had the idea to devel-

op a programmable, wirelessly controlled

microchip that would deliver drugs after implan-

tation in a patients body. This week, the MIT

researchers and scientists from Chips Company

reported that they have successfully used such a

chip to administer daily doses of an osteoporo-

sis drug normally given by injection.

The results, published in the Feb. 16 online

edition of Science Translational Medicine,

represent the first successful test of such a

device and could help usher in a new era of

telemedicine delivering health care over a

distance, Langer says.

You could literally have a pharmacy on a

chip, says Langer, the David H. Koch Institute

Professor at MIT. You can do remote control

delivery, you can do pulsatile drug delivery,

and you can deliver multiple drugs.

In the new study, scientists used the pro-

grammable implants to deliver an osteoporosis

drug called teriparatide to seven women aged

65 to 70. The study found that the device deliv-

ered dosages comparable to injections, and

there were no adverse side effects.

These programmable chips could dramatically

change treatment not only for osteoporosis, but

also for many other diseases, including cancer

and multiple sclerosis. Patients with chronic

diseases, regular pain-management needs or

other conditions that require frequent or daily

injections could benefit from this technology,

says Robert Farra, president and chief operating

officer at MicroCHIPS and lead author of the

paper.

Compliance is very important in a lot of drug

regimens, and it can be very difficult to getpatients to accept a drug regimen where they

have to give themselves injections, says Cima,

the David H. Koch Professor of Engineering at

MIT. This avoids the compliance issue com-

pletely, and points to a future where you have

fully automated drug regimens.

Achievingprecision

The MIT research team started working on the

implantable chip in the mid-1990s. John Santini,

then a University of Michigan undergraduate

visiting MIT, took it on as a summer project

under the direction of Cima and Langer. Santini,

who later returned to MIT as a graduate student

to continue the project, is also an author of the

new paper.



23/42

In 1999, the MIT team published its initial

findings in Nature, the company was founded

and licensed the microchip technology from

MIT. The company refined the chips, includingadding a hermetic seal and a release system

that works reliably in living tissue. Teripar-

atide is a polypeptide and therefore much less

chemically stable than small-molecule drugs,

so sealing it hermetically to preserve it was an

important achievement, Langer says.

The human clinical trial began in Denmark in

January 2011. Chips were implanted during a

30-minute procedure at a doctors office using

local anesthetic, and remained in the patients

for four months. The implants proved safe, and

patients reported they often forgot they even

had the implant, Cima says.

Chips used in the study stored 20 doses of

teriparatide, individually sealed in tiny reser-

voirs about the size of a pinprick. The reservoirs

are capped with a thin layer of platinum and

titanium that melts when a small electrical

current is applied, releasing the drug inside. The

company is now working on developing im-

plants that can carry hundreds of drug doses per

chip.

Because the chips are programmable, dosages

can be scheduled in advance or triggered re-

motely by radio communication over a special

frequency called Medical Implant Communica-

tion Service (MICS). Current versions work over

a distance of a few inches, but researchers plan

to extend that range.

Consistent results

In the Science Translational Medicine study,

the researchers measured bone formation in

osteoporosis patients with the implants, and

found that it was similar to that seen in patients

receiving daily injections of teriparatide. Anoth-

er notable result is that the dosages given by

implant had less variation than those given byinjection.

Henry Brem, professor of neurosurgery, oph-

thalmology, oncology and biological engineering

at Johns Hopkins University School of Medicine,

called the results stunning.

Its very rare to find a paper that is really a

breakthrough in technology, says Brem, who

was not part of the research team.It fulfills the promise of polymer drug delivery and the

incredible sophistication of microchip capabili-

ties.

Once a version of the implant that can carry a

larger number of doses is ready, the company

plans to seek approval for further clinical trials,

Farra says. The company has also developed a

sensor that can monitor glucose levels. Eventu-ally such sensors could be combined with chips

that contain drug reservoirs, creating a chip that

can adapt drug treatments in response to the

patients condition.

References:

Published in Science Translational MedicineRapid Publica-

tion on February 16 2012

Sci. Transl. Med. DOI: 10.1126/scitranslmed.3003276



24/42

BY: Mohammed Sabry RostomSixth year medicine (undergraduate

Can your diet really help put you in a good

mood? And can what you choose to eat or

drink encourage bad moods or mild depres-

sion?

While certain diets or foods may not

ease depression (or put you instantly in a

better mood), they may help as part of anoverall treatment plan. There's more and

more research indicating that, in some ways,

diet may influence mood. We don't have the

whole story yet, but there are some interest-

ing clues.

Basically the science of food's effect on

mood is based on this: Dietary changes can

bring about changes in our brain structure

(chemically and physiologically), which can

lead to altered behavior.

How Can You Use Food to Boost Mood?

So how should you change your diet if you

want to try to improve your mood? You'll

find eight suggestions below. Try to incorpo-

rate as many as possible, because regardless

of their effects on mood, most of these

changes offer other health benefits as well.

1. Don't Banish Carbs -- Just Choose 'Smart'

Ones

The connection between carbohydrates

and mood is all about tryptophan, a nones-

sential amino acid. As more tryptophan en-

ters the brain, more serotonin is synthesized

in the brain, and mood tends to improve.

Serotonin, known as a mood regulator, is

made naturally in the brain from tryptophan

with some help from the B vitamins. Foods

thought to increase serotonin levels in the

brain include fish and vitamin D.

Here's the catch, though: While tryptophan

is found in almost all protein-rich foods, oth-

er amino acids are better at passing from the

bloodstream into the brain. So you can actu-

ally boost your tryptophan levels by eating

more carbohydrates; they seem to help elim-

inate the competition for tryptophan, so

more of it can enter the brain. But it's im-

portant to make smart carbohydrate choiceslike whole grains, fruits, vegetables, and leg-

umes, which also contribute important nutri-

ents and fiber.

So what happens when you follow a very

low carbohydrate diet? According to re-

searchers from Arizona State University, a

very low carbohydrate (ketogenic) diet was

found to enhance fatigue and reduce the de-

sire to exercise in overweight adults after just

two weeks.

2. Get More Omega-3 Fatty Acids

In recent years, researchers have noted

that omega-3 polyunsaturated fatty acids

(found in fatty fish, flaxseed, and walnuts)

may help protect against depression.



25/42

This makes sense physiologically, since

omega-3s appear to affect neurotransmitter

pathways in the brain. Past studies have sug-

gested there may be abnormal metabolism

of omega-3s in depression, although some

more recent studies have suggested there

may not be a strong association between

omega-3s and depression. Still, there are

other health benefits to eating fish a few

times a week, so it's worth a try. Shoot for

two to three servings of fish per week.

3. Eat a Balanced Breakfast

Eating breakfast regularly leads to im-

proved mood, according to some researchers-- along with better memory, more energy

throughout the day, and feelings of calm-

ness. It stands to reason that skipping break-

fast would do the opposite, leading to fatigue

and anxiety. And what makes up a good

breakfast? Lots of fiber and nutrients, some

lean protein, good fats, and whole-grain car-

bohydrates.

4. Keep Exercising and Lose Weight (Slowly)

After looking at data from 4,641 women

ages 40-65, researchers from the Center for

Health Studies in Seattle found a strong link

between depression and obesity, lower phys-

ical activity levels, and a higher calorie intake.

Even without obesity as a factor, depression

was associated with lower amounts of mod-

erate or vigorous physical activity. In many of

these women, I would suspect that depres-

sion feeds the obesity and vice versa.

Some researchers advise that, in overweight

women, slow weight loss can improve mood.

Fad dieting isn't the answer, because cutting

too far back on calories and carbohydrates

can lead to irritability. And if you're following

a low-fat diet, be sure to include plenty of

foods rich in omega-3s (like fish, ground flax-

seed, higher omega-3 eggs, walnuts, and

canola oil.)

5. Move to a Mediterranean Diet

The Mediterranean diet is a balanced,

healthy eating pattern that includes plenty of

fruits, nuts, vegetables, cereals, legumes, andfish -- all of which are important sources of

nutrients linked to preventing depression.

A recent Spanish study, using data from

4,211 men and 5,459 women, showed that

rates of depression tended to increase in

men (especially smokers) as folate intake de-

creased. The same occurred for women (es-

pecially among those who smoked or werephysically active) but with another B-vitamin:

B12. This isn't the first study to discover an

association between these two vitamins and

depression.

Researchers wonder whether poor nutrient

intake may lead to depression, or whether

depression leads people to eat a poor diet.

Folate is found in Mediterranean diet staples

like legumes, nuts, many fruits, and particu-

larly dark green vegetables. B-12 can be

found in all lean and low-fat animal products,

such as fish and low-fat dairy products.

6. Get Enough Vitamin D

Vitamin D increases levels of serotonin in

the brain but researchers are unsure of the

individual differences that determine how

much vitamin D is ideal (based on where you

live, time of year, skin type, level of sun ex-posure). Researchers from the University of

Toronto noticed that people who were suf-

fering from depression, particularly those

with seasonal affective disorder, tended to

improve as their vitamin D levels in the body

increased over the normal course of a year.

Try to get about 600 international units (IU)

of vitamin D a day from food if possible.



26/42

7. Select Selenium-Rich Foods

Selenium supplementation of 200 mi-

crograms a day for seven weeks improved

mild and moderate depression in 16 elderly

participants, according to a small study from

Texas Tech University. Previous studies have

also reported an association between low

selenium intakes and poorer moods.

More studies are needed, but it can't hurt

to make sure you're eating foods that help

you meet the Dietary Reference Intake for

selenium (55 micrograms a day). It's possible

to ingest toxic doses of selenium, but this isunlikely if you're getting it from foods rather

than supplements.

Foods rich in selenium are foods we should

be eating anyway such as:

Seafood (oysters, clams, sardines, crab,saltwater fish and freshwater fish)

Nuts and seeds (particularly Brazil nuts) Lean meat (lean pork and beef, skinless

chicken and turkey)

Whole grains (whole-grain pasta, brownrice, oatmeal, etc.)

Beans/legumes Low-fat dairy products8. Don't Overdo Caffeine

In people with sensitivity, caffeine may ex-

acerbate depression. (And if caffeine keeps

you awake at night, this could certainly affect

your mood the next day.) Those at risk could

try limiting or eliminating caffeine for a

month or so to see if it improves mood.

References:

Maes, M. Psychiatry Research, March22, 1999; vol 85: pp 275-291.

Appleton, K.M. Journal of AffectiveDisorders, Dec. 2007; vol 104: pp

217-223.

Medical Journal of Australia, Nov. 6,2000; 173 Suppl: S104-5. White A.M.

Journal of the American Dietetic As-

sociation, October 2007; vol 107: pp

1792-1796.

Sanchez-Villegas, PublicHealth Nutrition, 2006; vol 9: pp

1104-9. Simon, G.E. General Hospital

Psychiatry, Jan-Feb 2008; vol 30: pp

32-9.

Weiss, C.J. Journal of the AmericanDietetic Association, August 2005; vol

105: p 26.



27/42

Dr. Nihal El Habachi

ASS. Prof. of Physiology and Director of Alex. CRC

Protocol

The study plan on which aclinical research study is based.

It is carefully designed to answerspecific research questions.

What types of people mayparticipate, the schedule

of tests, procedures,

medications, dosages, the

length of the study, etc.

Research Studies Versus Clinical

Care

It is important to distinguishbetween:

Research AND Clinical Care. Research Subjects VS.

Patients.

The purpose of clinical care is totreat the individual patient while

that of research studies is to

gainknowledge that can be

generalized to groups of people. Research studies differ from

clinical care in three ways:

Follow a protocol. Collect data to be analyzed to

find answers to a Research

question.

May not always benefit theindividual.

Regulation of clinical

research

FOOD AND DRUG

ADMINISTRATION (FDA) The U.S. federal oversight

agency responsible for

protecting the public health by

assuring the safety, efficacy and

security of human and

veterinary drugs, biological

products, medical devices, food

supply, cosmetics, and products

that emit radiation.

Good Clinical Practice (GCP)

International ethical and scientificquality standards for designing,

conducting, recording, and

reporting trials that involve the

participation of human subjects

Purpose:Provides public assurance that the

rights, safety, and well-being of

study subjects are protected,

consistent with the principals that

have their origin in the

Declaration of Helsinki, and that

the clinical data are credible.

To be continued Keep in

Touch



28/42

Older adults are a potentially vulnerable group for malnutri-

tion, especially the newly hospitalized elderly patients or those

institutionalized. Thus, the prevention of nutritional problems

is crucial.

Aim of the work: To assess the risk of malnutrition using the

Mini-Nutritional Assessment (MNA) among three groups of el-

derly people; institutionalized, hospitalized and freely living

outpatient groups.

Methods: A total of 300 persons (100 in each group) aged 65

years and over participated in the study. MNA questionnaire,anthropometrics (Body Mass index, mid arm circumference and

Calf circumference) were used to collect data.

The sensitivity and specificity of the MNA test were assessed

using the Body Mass Index as the gold standard.

Results:According to MNA score (maximum 30 points), MNA

30) was reg-

istered in 47% of insti-

tutionalized elderly versus

44% and 40% of elderly in

hospital and community

dwelling respectively , this

differences could be at-

tributed to the limited mobil-

ity of elderly in institutions

and hospitals as compared to

the independent persons of

the community.

On the other hand, only 5%

of institutionalized elderly

and 8% of hospitalized had a

BMI index of less than 20.



29/42

According to MNA, higher per-

centages of malnutrition were

found among these two groups

(10% and 28% respectively). It

was previously stated by

McWhirter and Pennington in

1994 that BMI alone is not a sen-

sitive indicator of protein-energy

malnutrition as it does not distin-

guish between depletion of fat or

muscle. It was also proved in the

present study that the MNA test

had a high sensitivity in this

population for detection of mal-

nutrition as compared to the BMI measure.

Moreover, the MNA had detected a high

percentage of at risk patients among the

hospitalized group (43%) and relatively lower

percentages among the outpatient (18%) and

institutionalized (10%) groups.

Recent research has shown that whilst the

prevalence of malnutrition in the free-living

elderly population is low (3-6 %), the risk ofmalnutrition increases in the institutionalized

elderly, and on admission to hospital.

The MNA has been used to screen elderly

people for malnutrition in different settings

and countries. Review of many studies con-

ducted to assess the malnutrition problem in

elderly using the MNA test had shown wide

range of prevalence of malnutrition in differ-

ent settings. In elderly institutions, from 12previous studies a mean prevalence of 37%

(range 5-71%) for malnutrition was detected

using the MNA and 44% (range 26-67%) at

risk of under-nutrition were detected.

The large variability results mainly from the

differences in level of dependence and health

status among the elderly living in retirement

homes, nursing homes, or long-term care fa-

cilities and communities differences.In the present study, the lower figure of

malnutrition (10%) and/or the percentage of

persons at risk (10%) in the institutionalizedgroup, as compared to the previous studies,

could be related to the admission policy in

these institutions in Alexandria where they

only accept apparently healthy residents ex-

cluding those diseased or who are in need of

medical care.

In elderly from 8 previous studies using

MNA assessment , the mean prevalence of

malnutrition was 1% in community-dwellingelderly persons, 4% (range 0-13%) in outpa-

tients, and a prevalence of 33% (ranges 8-

63%) for elderly who were at risk for malnu-

trition .

Comparatively, the prevalence of malnutri-

tion among the outpatient group in the pre-

sent study is considered within the minimal

figures reported previously; however, 18%

were at risk for malnutrition. Similarly, a min-

imal level of 1% as malnourished was classi-fied by MNA in a European community dwell-

ing sample of elderly persons.

Malnutrition is highly prevalent in hospital-

ized patients. Despite this, it is not routinely

assessed in most hospitals worldwide. One of

the reasons that might explain this fact is

that there is no gold-standard nutritional as-

sessment tool, and much has been written

advocating this or that technique. Several

studies have recently reinforced the relation-

ship between poor nutritional status and



30/42

higher incidences of

complications, mortali-

ty, length of hospital

stay and costs. There-

fore, it is of the utmost

importance to be able

to diagnose malnutri-

tion early.

In hospital settings, A

high prevalence of un-

der nutrition has been

reported in elderly pa-

tients. In elderly from

10 studies a prevalenceof 20% (range 7-32%)

of malnutrition was

detected (using the

MNA tool) and 49% (range 25-60%) were at

risk of under nutrition and a low MNA score

was common. In the present study, the prev-

alence of malnutrition in the hospitalized

group (28%) as well as the prevalence of

those at risk (43%) was more or less at the

same level as the previously mentioned stud-ies.

Medication goes hand in hand with chronic

disease: chronically ill patients will probably

have medication. Chronic diseases can affect

energy intake and contribute to poor nutri-

tional status.

The attendants of the outpatient clinic the

university hospital are poor patients whocannot afford the animal proteins in contrast

to the institutionalized elderly persons who

stated during their interview that they had

three meals and animal protein was served

daily. Thus, the habit to eat all foods served

at meals could be related to the better die-

tary criteria shown in this group as compared

to the outpatient group.

Increased age and female fender were sig-nificantly associated with poor nutritional

states.

Conclusion

Hospitalized subjects were characterized by

the worst nutritional status in comparison to

the other two groups in MNA test .where

43% were at risk of malnutrition and 28%were malnourished with a mean MNA score

of 16.962.97. All underweight subjects (BMI


31/42

By: Mohammed Abd-RabbohSixth year medicine (undergraduate)

Overview:

U.S. residency programs

offer an excellent

opportunity for aspiring

doctors from around the

world to further their

education and gain

excellent experience.There are roughly 8,000

residency programs in the

United States. While this

process might seem quite

daunting, a basic

understanding of the different testing,

evaluation and matching processes will help

you advise students on how best to navigate

the path to a successful residency. Whatfollows is a step-by-step explanation of the

basic process.

We will illustrate the way to US in fivesteps as following :

Step 1 Complete the ECFMG Application:

The first step in the process is for students

to apply to the Educational Commission for

Foreign Medical Graduates (ECFMG,

www.ecfmg.org ) for a USMLE/ECFMG

Identification Number. Because of the variety

of educational standards, curricula, and

evaluation methods across the world, the

Accreditation Council for Graduate Medical

Education (ACGME) requires a standardized

testing procedure for all international

applicants. Be sure to familiarize yourself

with the information available on the ECFMG

website. The website provides the eligibility

requirements for starting the certification

process and walks you through the process of

applying for the required exams online

through an Interactive Web Application. Theexams are offered a number of times

throughout the year and are described in

more detail below.

Step 2Take USMLE:

What is USMLE?USMLE is abbreviation of United States

Medical Licensing Examination, and it is athree-step examination for medical licensure

in the United States and is sponsored by the

Federation of State Medical Boards (FSMB)

and the National Board of Medical Examiners

(NBME).

Students must have completed at least

three years of medical school to apply for any

of the required USMLE exams, which include

the Step 1 Medical Sciences exam and the

Step 2 Clinical Knowledge (CK) and Clinical



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Skills (CS) Exams. These same tests are also

administered to graduates of U.S. and

Canadian medical schools. The Step 1 exam is

aimed at testing genera! Scientific

knowledge: whereas Step 2 assesses a

student's ability to put this knowledge into

practice with a patient. Students should also

refer to the ECFMG Information Booklet tosee whether these exams can be substituted

with any of the medical science exams they

have taken previously. All three tests must be

passed within a seven-year period; if all three

are passed, results do not expire. The Step 1

and Step 2 CK Exams are administered

worldwide at Thomson Prometric test

centers. The Clinical Skills exam must be

taken in the United States. Students must

obtain a scheduling permit from ECFMG to

register and schedule the test date with

Prometric.

The USMLEs three Steps:-

Step 1 An eight-hour, computer-based,

multiple-choice exam that assesses whether

you understand and can apply importantconcepts of the sciences basic to the practice

of medicine, with special emphasis on

principles and mechanisms underlying

health, disease, and modes of therapy.

Step 1 ensures mastery of not only the

sciences that provide a foundation for the

safe and competent practice of medicine inthe present, but also the scientific principles

required for the maintenance of competence

through lifelong learning. It includes test

items in the following content areas:

Anatomy. Behavioral sciences. Biochemistry.

Microbiology. Pathology. Pharmacology. Physiology. Interdisciplinary topics, such as

nutrition, genetics, and aging.

It costs about $930 when taken in Egypt.Step 2 assesses whether you can apply

medical knowledge, skills, and understanding

of clinical science essential for the provision

of patient care under supervision and

includes emphasis on health promotion and

disease prevention. Step 2 ensures that due

attention is devoted to principles of clinical

sciences and basic patient-centered skills

that provide the foundation for the safe and

competent practice of medicine. I t consists

of Step2 clinical knowledge (CK) and step 2

clinical skills (CS).

Step 2 (CK) A nine-hour, computer-based,

multiple choice exam that covers clinical

science including diagnosis and management

principles It includes test items in the

following content areas:

Internal medicine. Obstetrics and gynecology. Pediatrics.



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Preventive medicine. Psychiatry. Surgery. Other areas relevant to provision of

care under supervision.

It costs about $945 when taken in Egypt.Step 2 (CS): It assesses whether you can

demonstrate the fundamental clinical skills

essential for safe and effective patient care

under supervision.

The day-long exam must be taken at

regional clinical skills evaluation center in theUnited States, it consists of twelve fifteen-

minute examinations of standardized

patients, with ten minutes to compose a

written record of the encounter (patient

note), there will be also encounter via

telephone.

There are three subcomponents of Step 2

(CS): Integrated Clinical Encounter (ICE),

Communication and Interpersonal Skills (CIS),and Spoken English Proficiency (SEP).

It costs about $1375.Step 3 assesses whether you can apply

medical knowledge and understanding of

biomedical and clinical science essential for

the unsupervised practice of medicine, with

emphasis on patient management in

ambulatory settings. Step 3 provides a final

assessment of physicians assuming

independent responsibility for delivering

general medical care.

It costs about $745. You dont have to take step 3 for applying

for residency program.

Step 2Apply to residency program:

After passing the required exams and

achieving ECFMC certification, students can

apply to the residency programs of their

choice through the Electronic Residency

Application Service (ERAS). Applications are

submitted during September.ERAS is a service developed by the

Association of American Medical Colleges

(AAMC) to transmit residency applications,

letters of recommendation, dean's letters,

transcripts and other supporting documents

to residency program directors, and after

reviewing the applications the national

residency match program (NRMP, the main

residency match results) will be available in

December.

Then admissions officers invite select

applicants for interviews, which typically take

place during November, December and

January. Here, admissions officers further

evaluate applicants based on the general

competencies required of residents: patient

care, medical knowledge, practice-based

learning and improvement, interpersonal and

Journal of Alexandria Medical Students 32Journal of Alexandria Medical Students


34/42

communication skills, professionalism, and

systems-based practice.

Because these programs are highly

selective, it is wise for students to spend time

researching all the potential residencies thatwould be a good fit given their academic

background and professional goals. The

Graduate Medical Education Directory

(Green Book) and the Accreditation Council

for Graduate Medical Education (ACGME) are

good resources for this research.

Step 4 Match with a Program:In February or March, following the

interview process, both applicants and

programs rank each other through the

National Resident Matching Program

(NRMP), a service which provides an

impartial venue for matching the preferences

of applicants and programs. In March of

2008, 15,242 graduates of American medical

schools and 4,650 graduates of non-U.S.

medical schools were matched to a first year

If residency position. The positions that are

not filled in the initial match process are then

listed on the NRMP website. These positions

can be filled in as quickly as an hour.

Note: All dates are subject to change.Step 5Obtain a Visa:

Following acceptance, medical schools send

accepted students an information packet,contract, and temporary license. The J1 visa

is the typical visa for residents although some

applicants are able to acquire an H-1B visa if

they have taken Step 3 of the USMLE tests or

apply for a waiver program to work for two

years in an underserved area after their

residency. Once the final certifications have

passed between the student, the interlocutor

agencies and the medical program, students

should contact their U.S. Embassy or

Consulate to set up a visa interview and

inquire about all of the documents required

for theirvisa.

Tips for you:How to prepare for a successful residencyinterview?

Call the program secretary to check for

current doctors from your own country or

region in order to connect with someone

currently involved with the program.

Study the program's website. Familiarize

yourself with the faculty - their professional

backgrounds, areas of expertise, andinvolvement in educational and training

programs.

Clearly communicate personal goals during

the interview.

Present previous experiences in an

articulate and organized fashion.

Send a thank you note after the interview

to express continued interest in the program.

How to find a residency program that will bebest fit?

Do not limit yourself to one specialty area.

Conduct through research on alternative

fields that may be of interest.

Remember that certain specialties tend to

be more competitive than others. Programs

such as internal medicine, pediatrics and

family medicine take only three years and are

less competitive, while specialties such as

surgery, ophthalmology, cardiology and

psychiatry are more competitive and require

additional time.

Talk to as many current residents as

possible. Find out if you click with them.

Lastly, I want to say that the purpose ofthis window is not to emigrate from

Egypt but to come back and improve thehealth care system and provide better

health to the Egyptian people.

https://www.acgme.org/acWebsite/dataBook/2010-2011_ACGME_Data_Resource_Book.pdfhttps://www.acgme.org/acWebsite/dataBook/2010-2011_ACGME_Data_Resource_Book.pdfhttps://www.acgme.org/acWebsite/dataBook/2010-2011_ACGME_Data_Resource_Book.pdfhttps://www.acgme.org/acWebsite/dataBook/2010-2011_ACGME_Data_Resource_Book.pdfhttps://www.acgme.org/acWebsite/dataBook/2010-2011_ACGME_Data_Resource_Book.pdfhttps://www.acgme.org/acWebsite/dataBook/2010-2011_ACGME_Data_Resource_Book.pdfhttp://www.unitedstatesvisas.gov/http://www.unitedstatesvisas.gov/http://www.unitedstatesvisas.gov/http://www.unitedstatesvisas.gov/https://www.acgme.org/acWebsite/dataBook/2010-2011_ACGME_Data_Resource_Book.pdfhttps://www.acgme.org/acWebsite/dataBook/2010-2011_ACGME_Data_Resource_Book.pdf


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By: Mohammed Abd El-Fattah

Sixth Year Medicine (Undergraduate)

In 2011, Nobel Laureates have

revolutionized our understanding of the

immune system by discovering key principles

for its activation.

Scientists have long been searching for thegatekeepers of the immune response by

which man and other animals defend

themselves against attack by bacteria and

other microorganisms. Bruce Beutler and

Jules Hoffmann discovered receptor proteins

that can recognize such microorganisms and

activate innate immunity, the first step in the

bodys immune response. Ralph Steinman

discovered the dendritic cells of the immune

system and their unique capacity to activateand regulate adaptive immunity, the later

stage of the immune response during which

microorganisms are cleared from the body.

The discoveries of the three Nobel Laureates

have revealed how the innate and adaptive

phases of the immune response are activated

and thereby provided novel insights into

disease mechanisms. Their work has opened

up new avenues for the development ofprevention and therapy against infections,

cancer, and inflammatory diseases.

Two lines of defense in the

immune systemWe live in a dangerous world. Pathogenic

microorganisms (bacteria, virus, fungi, and

parasites) threaten us continuously but weare equipped with powerful defense

mechanisms. The first line of defense, innate

immunity, can destroy invading micro-

organisms and trigger inflammation that

contributes to blocking their assault. If

microorganisms break through this defense

line, adaptive immunity is called into action.

With its T and B cells, it produces antibodies

and killer cells that destroy infected cells.

After successfully combating the infectiousassault, our adaptive immune system

maintains an immunologic memory that

allows a more rapid and powerful

mobilization of defense forces next time the

same microorganism attacks. These two

defense lines of the immune system provide

good protection against infections but they

also pose a risk. If the activation threshold is

too low, or if endogenous molecules can

activate the system, inflammatory diseasemay follow.

The 2011 Nobel Prize in Physiology or Medicine



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The components of the immune system

have been identified step by step during the

20th century. Thanks to a series of

discoveries awarded the Nobel Prize; we

know, for instance, how antibodies areconstructed and how T cells recognize

foreign substances. However, until the work

of Beutler, Hoffmann and Steinman, the

mechanisms triggering the activation of

innate immunity and mediating the

communication between innate and adaptive

immunity remained enigmatic.

Discovering the sensors of innate

immunity

Jules Hoffmann made his pioneering

discovery in 1996, when he and his co-

workers investigated how fruit flies combat

infections. They had access to flies with

mutations in several different genes including

Toll, a gene previously found to be involved

in embryonal development by Christiane

Nsslein-Volhard (Nobel Prize 1995). When

Hoffmann infected his fruit flies with bacteria

or fungi, he discovered that Toll mutants died

because they could not mount an effective

defense. He was also able to conclude that

the product of the Toll gene was involved in

sensing pathogenic microorganisms and Toll

activation was needed for successful defense

against them.

Bruce Beutler was searching for a receptor

that could bind the bacterial product,

lipopolysaccharide (LPS), which can causeseptic shock, a life threatening condition that

involves overstimulation of the immune

system. In 1998, Beutler and his colleagues

discovered that mice resistant to LPS had a

mutation in a gene that was quite similar to

the Toll gene of the fruit fly. This Toll-like

receptor (TLR) turned out to be the elusive

LPS receptor. When it binds LPS, signals are

activated that cause inflammation and, when

LPS doses are excessive, septic shock. Thesefindings showed that mammals and fruit flies

use similar molecules to activate innate

immunity when encountering pathogenic

microorganisms. The sensors of innate

immunity had finally been discovered.

The discoveries of Hoffmann and Beutler

triggered an explosion of research in innateimmunity. Around a dozen different TLRs

have now been identified in humans and

mice. Each one of them recognizes certain

types of molecules common in micro-

organisms. Individuals with certain mutations

in these receptors carry an increased risk of

infections while other genetic variants of TLR

are associated with an increased risk for

chronic inflammatory diseases.

A new cell type that controls

adaptive immunityRalph Steinman discovered, in 1973, a new

cell type that he called the dendritic cell. He

speculated that it could be important in the

immune system and went on to test whether

dendritic cells could activate T cells, a cell

type that has a key role in adaptive immunity

and develops an immunologic memory

against many different substances. In cellculture experiments, he showed that the

presence of dendritic cells resulted in vivid

responses of T cells to such substances.

These findings were initiall

JAMS Third Issue Feb,2012

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