In recent years, the use of alternative medicine has become more acknowledged in the United States. Many different practices are encompassed by the terms alternative, unorthodox, or complementary medicine, and their use by the population is just now being defined. The number of established family practice patients also using alternative medicine is not yet known. To help answer this question, a survey of family practice patients concerning their use of alternative medicine was performed in 4 family practices in a large community in the western United States. Volunteers from the survey respondents attended a focus group to discuss more fully their use of alternative medicine. Questionnaires were completed by 113 family practice patients. Fifty percent (57/113) of patients had or were using some form of alternative medicine, but only 53% (30/57) had told their family physician about this use. No significant difference in the percentage who used alternative medicine or who told their physician about it was attributable to gender, educational level, age, race, or clinic attended. The main reason given for using alternative medicine, alone or in combination with care from a family physician, was a belief that it would work. Many of those who worked in combination with a family physician spoke of acceptance and control, but those who did not work with their physician mentioned traditional medicine's limitations and narrow-mindedness. Family physicians need to be aware that many of their patients may be using alternative health care. Open and nonjudgmental questioning of patients may help increase physician knowledge of this use and lead to improved patient care as physicians and patients work together toward health.

It has been more than 50 years since antinuclear antibodies were first discovered and found to be associated with connective tissue diseases. Since then different methods have been described and used for their detection or confirmation. For many decades immunofluorescent antinuclear antibody test has been the "gold standard" in the diagnosis of these disorders. However to increase the sensitivity and specificity of antinuclear antibody detection further approaches were explored. Today a battery of newer techniques are available some of which are now considered better and are competing with the older methods. This article provides an overview on advancement in antinuclear antibody detection methods, their future prospects, advantages, disadvantages and guidelines for use of these tests.

Progressive and inexorable β-cell dysfunction is the hallmark of type 2 diabetes mellitus (T2DM) and β-cell regeneration using stem cell therapy may prove to be an effective modality. A total of 10 patients (8 men) with T2DM for >5 years, failure of triple oral antidiabetic drugs, currently on insulin (≥0.7 U/kg/day) at least for 1 year, and glutamic acid decarboxylase antibody negative were included. Patients on stable doses of medications for past 3 months were recruited. Primary end points were reduction in insulin requirement by ≥50% and improvement in glucagon-stimulated C-peptide levels at the end of 6 months of autologous bone marrow–derived stem cell transplantation (SCT), while secondary end points were a change in weight and HbA1c and lipid levels as compared to baseline. Seven patients were responders and showed a reduction in insulin requirement by 75% as compared to baseline. Mean duration to achieve the primary objective was 48 days. Three patients were able to discontinue insulin completely, although it was short-lived in one. Mean HbA1c reduction was 1% and 3 of the 7 responders had HbA1c value <7%. A significant weight loss of 5.5 kg was noted in the responders, whereas, nonresponders gained 2.2 kg of weight. However, weight loss did not correlate with reduction in insulin requirement ( r = 0.68, P = 0.06). There was a significant improvement in both fasting and glucagon-stimulated C-peptide level in the group ( P = 0.03) and responders ( P = 0.03). HOMA-B increased significantly in the whole group ( P = 0.02) and responders ( P = 0.04) whereas, HOMA-IR did not change significantly ( P = 0.74). Reduction in insulin doses correlated with stimulated C-peptide response at the baseline ( r = 0.83, P = 0.047) and mononuclear cell count of infused stem cells ( r = 0.57, P = 0.04). No serious adverse effects were noted. Our observations indicate that SCT is a safe and effective modality of treatment to improve β-cell function in patients with T2DM. However, further large-scale studies are needed to substantiate these observations.