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BACKGROUND: A striking number of low birth weight (LBW) Indian babies are born annually. Previous studies have confirmed the positive association between milk intake and birth weight. However, the relations between protein and vitamin B12 from milk and birth weight have not been systematically explored. AIMS: We examined the relations between birth weight and maternal intake of milk, protein from milk and vitamin B12 from milk. METHODS: This prospective, observational cohort study was conducted in an urban South Indian hospital. The dietary intakes of milk and milk products were assessed using validated food frequency questionnaire and at delivery birth outcomes were measured. The relations between milk products, milk protein, and vitamin B12 from milk with birth weight and gestational weight gain were assessed in 2036 births with first trimester dietary and delivery data. RESULTS: Median consumption of milk products in the first trimester was 310 g·day-1 and average birth weight was 2876 g. Birth weight was positively associated with intake of milk products and of % protein from milk products (%milk protein) in the first trimester [ß = 86.8, 95% confidence interval (CI): 29.1, 144.6; ß = 63.1, 95% CI: 10.8, 115.5; P < 0.001 for both]. Intake of milk products and of %milk protein in the third trimester was positively associated with gestational weight gain (GWG) between the second and third trimester (One-way ANOVA, P < 0.001 and = 0.001, respectively). Neither birth weight nor GWG were associated with %vitamin B12 from milk products. CONCLUSIONS: These findings indicate that intake of milk products in the first trimester and especially, protein from milk products is positively associated with birth weight in this South Asian Indian population.

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BACKGROUND: Learning of basic clinical skills is introduced in Years 1 and 2 of the MBBS Program; the Aga Khan University, Pakistan, through a structured Clinical Skills Teaching program. Acquisition of competence in performing these skills is assessed through use of the Objective Structured Clinical Examination (OSCE). Self-assessment is defined broadly as the involvement of learners in judging whether or not learner-identified standards have been met. OBJECTIVE: Compared Year 2 students' self-assessment of clinical skills with examiners' assessment of performance in an OSCE using a standard rating scale. METHODS: A self-assessment questionnaire was completed by all Year 2 students immediately after the OSCE. Students assessed their performance at three stations, using a performance rating scale. Examiners observed and evaluated the students during history-taking and physical examination using the same rating scale. RESULTS: There were significant positive correlations between examiners' assessments of performance and students' self-assessed ratings in taking consent, obtaining demographic information, history of presenting problems and summarization. Significant differences were observed in pre-procedural skills, comment on prostate, liver palpation percussion and spleen percussion. CONCLUSIONS: Findings highlight the strengths and weaknesses in clinical competence at the end of Year 2 and provide a direction to improve the gaps in the Clinical Skills Teaching program.

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BACKGROUND: In the last decades there has been a sharp rise in the elderly population throughout the world. The unique needs of the elderly require a multidisciplinary and comprehensive medical approach. None of the 50 medical schools in Pakistan teach geriatrics in their undergraduate or postgraduate training. This paper discusses the development and implementation of the first geriatric curriculum in a medical school of Pakistan and its effect on knowledge and attitudes of third-year medical students. METHODS: The curriculum was designed through collaboration and approval of various academic departments at the Aga Khan University in Karachi Pakistan. After a review of existing geriatric curricula at other institutions, a problem-based, inter-disciplinary spiral curriculum was designed. Strategy of student and course evaluation was planned and incorporated in the curricular program. No extra resources or funds were used. A component of the new curriculum was assessed by evaluating pre- and post- course knowledge, and seeking feedback from participating third-year students. RESULTS: A significant improvement in mean scores for summed overall knowledge in geriatrics (pre-test mean 4.7 vs. post-test mean 6.4, p value of <0.001; out of a maximum possible of 9 was noted. Breakdown of knowledge mean scores into component areas of knowledge showed a significant increase in understanding in aging demographics (pretest 0.7 vs. post-test 1.7, p value of <0.001), geriatric history taking (pretest 0.64 vs. post-test 0.88, p 0.001) and geriatric assessments (pre- test 1.4 vs. post- test 1.7, p value 0.01). A strong majority (87%) of the students felt that the overall course objectives were achieved. All students were satisfied with the quality of teaching, 90% rating it good or higher. CONCLUSION: An important advance in medical education was achieved via integration of a low cost, spiral geriatrics curriculum in a medical university of Pakistan. We found that introduction of the geriatric curriculum improved the knowledge of third-year medical students. This was our school's initial step towards building professional capacity in response to a rising elderly population.

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Plasma melatonin levels were measured at three-hourly intervals over 24 hours in 11 women with untreated anorexia nervosa, and in nine healthy women of normal weight. The circadian rhythm was unaltered but the nocturnal secretion of melatonin was significantly greater in anorectics. It is possible that this was related to nocturnal hypoglycaemia.

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Acrocyanosis, an uncommon disorder of the peripheral circulation, may occur in patients with anorexia nervosa. It is not known why this should be, nor whether acrocyanosis correlates with any other features of the disorder. The findings in an unselected series of 155 anorectics are reported. Acrocyanosis occurred in 32 and was more prevalent among the more severely ill. It was associated also with pallor of the face and trunk, slower pulse rates and higher fasting plasma glucose levels. Acrocyanosis could represent a more extreme form of a heat conserving mechanism not uncommon in anorectics. The possible relationship between peripheral vascular changes and plasma glucose levels requires further study.

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The view that the prevalence of anorexia nervosa is influenced by social attitudes and customs is a popular one. Unfortunately the scarcity of medical accounts prior to the later decades of the last century make it difficult if not impossible to estimate the prevalence of anorexia nervosa at various periods in history. The authors present the history of one of Goethe's literary heroines and suggest that similar studies could throw some light on the epidemiology of anorexia nervosa in the past.

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Twenty consecutive cases of anorexia nervosa admitted to a general medical ward were found to consist of ten who reduced weight by means of dieting and ten who in addition employed self-induced vomiting. Clinical and biochemical differences between "dieters' and "vomiters' were less pronounced than those reported elsewhere. However, the "vomiters' had higher scores on the anxiety, somatic and depression subscales of the Crown-Crisp Experiential Index and lower serum carotene concentrations. The implications of these findings are discussed.

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Recent work suggests that depriving endogenous depressives of sleep for 1 night may be followed by an alleviation of their illness. In order to facilitate further study of the mechanisms underlying this effect, hourly self-rated measurements of mood were obtained throughout the sleepless night and the time of onset of any response noted. Of the patients who improved, some did so during the day following sleep deprivation; in others the response did not occur until after the next night's sleep. The two groups of responders differed in terms of self-reported emotional arousal during the course of the sleepless night. The implications of these findings are discussed in relation to further studies of sleep deprivation therapy.

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A significant proportion of attenders at venereal diseases clinics can be regarded as potential psychiatric patients. However, there have been few reports on the value of readily available psychiatric advice at such clinics. The findings during a three-month period when a psychiatrist attended a venereal disease clinic are described. Twenty-two patients were referred for psychiatric assessment. Of the 20 who kept their appointment, 18 were diagnosed as mentally ill or as having a personality disorder. Of these two were already under psychiatric care, but 11 had never previously sought psychiatric assistance. The major sources of common venereological and psychiatric concern appeared to be among the promiscuous and the hypochondriacal patients. The former consisted of persons with personality disorders who were thought unlikely to respond to psychiatric treatment; but some of the latter improved after treatment with pimozide. Some patients defaulted and not all who persevered were helped. Nevertheless the results of a questionnnaire showed that the staff considered there was an important place for a psychiatrist within their clinic.

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Ten patients with psychotic depression were assessed on a battery of clinical, EEG, psychological, and biochemical measures during treatment with imipramine (150 mg/day). Significant changes occurred in the scores on self-rated and observer-rated depression scales and on an observer-rated side effect scale. Significant changes also occurred in the EEG evoked response, but the effects on spontaneous activity were minimal. The psychological measures revealed an improvement in performance as treatment progressed. The clinical significance of the changes observed was assessed with reference to their correlations with the clinical rating scores and with the plasma concentrations of imipramine and desmethylimipramine, and the changes observed following the administration of imipramine to non-depressed normal subjects. Changes in evoked EEG activity seemed on balance to be direct central effects of imipramine, whereas changes in psychological performance appeared to be secondary to clinical change.

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