Retention of Knowledge in Preclinical Disciplines by Clinical Students in the IIUM Medical Programme

Introduction: A thorough knowledge in the various disciplines of the basic sciences is a major importance for the practice of clinical medicine. Many basic sciences teachers share a common concern that much of what they teach in preclinical phase is soon forgotten when students move to clinical years. Objective: To examine the retention of such knowledge by clinical students in the Medical Programme of International Islamic University Malaysia (IIUM). Methods: Sixty seven Year 3 and 64 Year 5 students undergoing the Paediatric posting rotation of the academic sessions 2011/2012 were included into this study. Open-ended, short-answer questions of the completion type in the disciplines of anatomy, physiology, biochemistry and general pathology constructed by experts were used. These questions were used to test the retention of the above stated knowledge. Self-administered questionnaire was also designed to obtain the perceptions of students on the learning of basic medical sciences. Results: A significant difference was seen between the mean total scores for the Year 3 and Year 5 students in the basic medical sciences knowledge tests (31.9% vs. 37.7%; p = 0.002). Year 5 students showed significantly higher retention of knowledge on anatomy and biochemistry (p<0.001 and p=0.021). Overall in approximately 50% of the questions students indicated that they knew the answers but could not recall. Seventy percent of students stated that they only attempted to retain facts that they perceived as important. Almost all the students (96.2%) agreed that they remembered information better due to vertical integration in the curriculum. Conclusions: This study did not see deterioration in the retention of knowledge in basic medical sciences as the clinical students progress through clinical years. Students stated that the integration of knowledge in basic medical sciences disciplines into the clinical sciences during the preclinical years helped them remember facts better

Microarray data analysis to identify differentially expressed genes and biological pathways associated with Tualang Honey supplementation in NASH animal model

Tualang Honey (TH) is a multifloral jungle honey that has been shown to have anti-inflammatory and antioxidant properties. Thus, it has been proposed as a potential supplement in the management of non-alcoholic steatohepatitis (NASH). This study aimed to identify potential key genes and biological process associated with the therapeutic effects of TH in NASH animal model. Twenty Sprague Dawley rats were used in this experiment. Five rats were given standard commercial pellets throughout the experiment and acted as controls. Fifteen rats were subjected to the 12% high-cholesterol diet (HCD) for sixteen weeks to induce NASH. They were then divided into 3 groups, with each group receiving 3 different dosages of TH supplementation for four weeks. RNA was extracted from serum using RNeasy extraction kit (Qiagen) and microarray analysis was performed. A total of 3062 differentially expressed genes (DEGs) were identified including 2788 upregulated genes and 274 downregulated genes in all treated groups. There were 15 genes significantly upregulated including aldehyde dehydrogenase family, cytochrome P450 and nuclear transcription factor. Whilst, 13 genes were significantly downregulated such as apelin, interferon regulatory factor 2 and stearoyl-Coenzyme A. Following pathway enrichment analysis, 34 biological processes were significantly modified (p < 0.05). Among the pathways implicated in the effects of TH were those involved in the inflammatory response, lipid biosynthetic process and cholesterol metabolic process. The present study demonstrated that the DEGs involved in the therapeutic effects of TH were enriched in several pathways and further validation is required to confirm their specific roles

The identification of microRNAS Pathogenic pathway in acute Myocardial Infarction of young adults

Acute myocardial infarction (AMI) is a severe form of coronary heart disease where Malaysians are getting AMI at younger age compared to well-developed countries. MicroRNAs (miRNAs) are implicated in AMI pathogenesis, but no study looked at their profiling or involvement in young population. The present study aims to profile the miRNAs expressions in healthy controls (aged 18 to 45 years), young AMI (YAMI) (aged ≤ 45 years), and mature AMI (MAMI) (aged ≥ 46 years) patients with matching criteria, and to determine the effect of the dysregulated miRNAs on the target mRNAs as well as the pathways involve in the pathogenesis of AMI. This study was conducted on twenty Malay males for each group in Kuantan, Pahang. Total RNA was extracted from plasma and the miRNA expression profiling was carried out on the BGISEQ500 SE50 sequencing platform with BGI sequencing libraries. The sequence data were analyzed using Gene Ontology (GO) to determine the role of the differentially expressed genes, followed by the Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis for identification of the biological pathways in YAMI against MAMI. The top six dysregulated miRNAs identified during sequencing were validated using quantitative reverse-transcription polymerase chain reaction (qRT-PCR) between the groups. ANOVA and unpaired T-test were used to analyze the differences of miRNAs and gene expression between the three groups. This study revealed that majority AMI patients were smokers, where YAMI patients had higher BMI, SBP, DBP and TG while MAMI patients had higher FBG than the rest of the group. A total of 1599 miRNAs were differentially expressed in AMI (YAMI and MAMI) patients compared to healthy controls, where 1288 were upregulated and 311 were downregulated (FDR ≤ 0.001). However, when YAMI patients were compared to MAMI patients, 1497 miRNAs were found to be dysregulated, of which 1090 miRNAs were upregulated, and 407 miRNAs were downregulated (FDR ≤ 0.001). The top ten upregulated miRNAs were miR-552, miR-4446-3p, miR-432-5p, miR-548j-5p, miR-219, miR-982, miR-181a-2-3p, miR-654-5p, miR-58 and miR-548k; while the top ten downregulated were miR-16-5p, miR-1064, miR-431-5p, miR-790 miR-1177, miR-201, miR-105, miR-518, miR-419 and miR-1103. This study also discovered ten novel miRNAs: miR-4446-3p, miR-982, miR-58, miR-548k, miR-1064, miR-790, miR-1177, miR-201, miR-419, and miR-1103. The validation of the top six dysregulated miRNAs between YAMI and MAMI patients revealed the upregulation of miR-423-5p by 2.08-fold (p = 0.040) and downregulation of miR-431-5p by 33.90-fold (p = 0.034), and miR-378a-5p by 34.61-fold (p = 0.040). For these 1497 differentially expressed miRNAs, 34,195 target genes were predicted by GO analysis. The functional analysis demonstrated 11,199 GO terms found to be involved in biological processes, 12,012 in cellular components, and 10,984 in molecular functions were significantly enriched (p < 0.05). The target genes that were mapped to the signal transduction pathway in KEGG revealed 346 classes were enriched. In conclusion, miRNAs are differentially expressed between young and mature AMI, ten of which are novel. Three biological pathways, ascorbate and aldarate metabolism, collecting duct acid secretion and glycosaminoglycans biosynthesis – heparin sulfate/heparin were identified but their involvements in the regulatory mechanisms on gene expression in Young AMI need further evaluation

Evaluation of histologic localization of tumour-associated macrophages in invasive breast carcinoma and its association with prognostic parameters

Introduction: There were 2.1 million new cases of breast cancer in 2018 worldwide. Recent cancer research has focused on the heterogeneous population of cells within the tumour microenvironment (TME). Non-cancerous cells surrounding the tumour and macrophages are the most abundant cells in TME. These macrophages, termed as tumour-associated macrophages (TAMs), are responsible for modulation of tumour growth and metastasis. This study aimed to evaluate the localization of TAMs infiltration within samples of breast carcinoma and its association with pathological prognostic parameters. Materials and Methods: In 128 paraffin-embedded cases diagnosed as invasive carcinoma, TAMs were immunostained with anti-CD163 antibody and the density of TAMs were counted within the tumour nests and tumour stroma. Results: TAMs were seen in both Tumour nests and tumour stroma. High CD163-positive stromal (p=0.0001) and nest (p=0.005) TAMs were significantly associated with higher tumour grades. High CD163-positive stromal TAMs were also significantly associated with negative estrogen receptor (ER) and progesterone receptor (PR) markers (p<0.0001 and p=0.001, respectively), and triple-negative subtype (p=0.002). Multivariate analysis showed that tumours with higher grades had higher TAMs infiltration in both tumour stroma (p=0.005; Odds Ratio (OR)= 13.917; 95% Confidence Interval (CI)=2.178-88.910) and nest (p=0.021; OR= 6.201; 95% CI=1.314-29.260). Conclusion: This research revealed that high TAMs infiltration in tumour stroma was associated with poor prognostic parameters. We also found that TAMs in tumour stroma and nests had different degrees of association with the clinicopathological parameters. Therefore, evaluation of TAMs will be a useful prognostic marker and may serve as potential cellular target for novel treatment modality in invasive breast cancers

The effect of flaxseed extraction on skin elasticity of the healing wound in rabbit

Medicinal herbs are widely used because of low side effects, recommendation of related industries for cultivation of medicinal plants, preventing the outflow of currency, and particularly the suggestion of world Health Organization to use medicinal herbs. On the other hand, due to lack of an effective medicine for wound healing studying the effects of medicinal herbs on wound healing is essential. Management of disturbed wounds, large skin defects and the areas where skin tension precludes wound closure is of high clinical importance. Healing in such wounds occurs through epithelization and contraction processes (second-intentions healing) that may result in certain undesirable complications including keloid formations, poor final cosmetic appearance and the formation of a fragile epithelia

The effects of Tualang honey on sperm profile and follicular-stimulating hormone in high cholesterol diet induced animal model

Introduction: Hypercholesterolaemia is a recognised factor associated with male infertility. However, currently, there is limited therapy available. Tualang honey (TH) is a type of Malaysian polyfloral wild honey produced by the rock bee (Apis dorsata) that has been proven to exert both anti-inflammatory and anti-oxidative effects. This study aimed to determine the effects of TH on the sperm profile and follicular-stimulating hormone (FSH) level of high cholesterol diet (HCD) administered rats. Materials and Methods: Thirty male Sprague Dawley rats were randomly divided into a control group (n=6) fed with the standard diet and HCD group (n=24). The rats in the control group were fed with standard rat pellets while rats in the HCD group were fed with 12% HCD for 16 weeks. At the end of 16 weeks, rats in HCD group were divided into four subgroups (H1, H2, H3, and H4) and continued with 12% HCD in addition to administration of distilled water, 1.2, 2.4, and 3.0 g of honey per kg body weight daily respectively for another 4 weeks. While the rats in the control group continued with commercial rat pellets without honey supplementation for the same duration. At the end of 4 weeks, all rats were sacrificed, and blood specimens were taken for FSH estimation, and the cauda epididymis was collected for sperm analysis. Results: The FSH level and the sperm parameters (sperm concentration, morphology, percentage of total sperm motility,progressive motility, and viability of rats in HCD subgroup H1 were significantly reduced compared to the control (p<0.001). In contrast, all TH supplemented subgroups demonstrated significant improvement in their sperm parameters (p<0.001). The higher the dosage of TH in the HCD subgroup, the greater the improvements in the sperm concentration, morphology, and viability. Although the levels of FSH were increased in all treated HCD groups compared to H1, there was no significant difference in the serum FSH levels between the groups. Conclusion: The Tualang honey supplementation improved the sperm profile in HCD induced animal models

The effects of Tualang honey on sperm profile in high cholesterol diet induction animal model

Background: Hypercholesterolaemia and obesity are recognized factors associated with male infertility. They have been shown to reduce the semen quality, change the sperm proteomes and also contribute to erectile dysfunction. However, currently there is limited therapy available. Tualang honey (TH) is a type of Malaysian polyfloral wild honey produced by the rock bee (Apis dorsata) proven to exert both anti-inflammatory and anti-oxidative effects. Objective: This study aimed to determine the effects of TH on the sperm profile of animal model with chronic exposure to high cholesterol diet. Methodology: Thirty male Sprague Dawley rats 2 weeks of age weighing 200 - 250 gm were divided into two groups, the high (12%) cholesterol diet (12% CD; n= 24) and standard diet (SD; n=6) and were fed for 16 weeks. At 16 weeks, the rats in the 12% CD group were subsequently divided into four groups. The first group was continued with only 12% CD while the other 3 groups in addition to the 12% CD, they were given TH supplement at different doses (1.2, 2.4 and 3.0 g/kg/day) for 4 weeks. Sperm profile analysis from the caudal epididymis was performed for all groups at the end of the 4 weeks. Results: At 16 weeks of 12% CD, the sperm concentration, the percentage of total sperm motility, progressive motility and viability reduced significantly compared to the SD group (p<0.001). On the contrary, all TH supplemented groups demonstrated significant improvement in the sperm concentration, percentage of sperm viability, total sperm motility and progressive motility (p<0.001). Conclusion: TH supplementation of animal model with chronic exposure to high cholesterol diet improved the sperm profile parameters. Based on our findings, there is a need to further explore the potential TH in improving male infertility associated with hypercholesterolaemia and obesity

Numeracy skills for undergraduate nursing students’ clinical skill assessment: an expository analysis

Introduction: Nursing and mathematics are synonymous, particularly in clinical settings. Numeracy skills have been identified as one of the competency elements for outcome-based education in nursing. Studies have shown that undergraduate nursing students continue to perform poorly on clinically-related numeracy tasks, making errors that betray fundamental misconceptions about the underlying mathematics. These conditions can be eliminated when an effort is made and the effects can be rewarding for nursing students, nursing academics and as well as improving patient care. Aim: This study aimed to address the importance of numeracy skills for undergraduate nursing students’ clinical skill assessment. Method: This study used an expository analysis approach to address the issues of the importance of numeracy skills competency in the clinical skill assessment of undergraduate nursing students. We have analysed the current undergraduate nursing curriculum and clinical skill assessment components. Moreover, we also review the available literature related to numeracy skills competency for nursing students and newly registered nurses. Finding: Numeracy skills are one of the important elements of competencies skills that have been introduced to the current Malaysian undergraduate nursing programme. However, the achievement part of it is still questionable. Evidence has shown that new graduate nurses often lack the numeracy skills needed to enable them to do their jobs safely and effectively in the clinical setting. Among the errors done by the new graduate nurses and nursing students are drug calculation errors and which accounted for 30-40% in the clinical. Conclusion: Numeracy skills competency assessment is vital for undergraduate nursing students who have to make complex calculations and analyse the patient’s situation in their clinical setting. Improving numeracy skills for undergraduate nursing students can reduce medical errors and ultimately improve efficiency in the nursing care towards their patients

Development and evaluating content validity of clinical skill analysis index tools

BACKGROUND: The current structured nursing clinical skill assessment checklist is steps driven and the soft skills component is fragmented and limited. AIM: This study aimed to evaluate the face and content validity of a tool that had been developed to assess the current structured clinical skill assessment for the Malaysian undergraduate nursing program. METHODS: The face and content validity of the instrument were examined based on the opinions of experts. The item content validity index and scale content validity index (S-CVI) were calculated by using the mean approach and inter-rater agreement. The content validity of the instrument was assessed by S-CVI/UA and S-CVI/Ave. The scale was revised based on comments from a panel of eight experts in the first review stage and thereafter, evaluated by another group of three experts in the second review stage. RESULTS: There were nine soft skills elements identified for the clinical skill analysis index (CSAI) tools in this study. Those were communication skill, social skill and responsibility, critical thinking skill, problem-solving skill, teamwork, leadership skill, professional and ethical decision-making skill, numeracy skill, and interpersonal skill. The findings at the face validity stage yielded ten domains with eight nursing core procedures areas being retained, based on 95% or more agreement from expert responses. The result of S-CVI/UA and S-CVI/Ave of the CSAI tools yielded scores of 0.91 and 1 respectively. CONCLUSION: Findings indicated that this instrument had an excellent face and content validity to assess the current structured clinical skill assessment for the Malaysian undergraduate nursing program