Chemerin levels in chronic kidney disease: A systematic review and meta-analysis

IntroductionChemerin as an inflammatory biomarker has gained attention in its biomarker capability. Several studies measured its levels in chronic kidney disease (CKD), as one of the common non-communicable causes of mortality and morbidity. Hence, this systematic review and meta-analysis aimed to investigate this association.MethodsPubMed, Scopus, Embase, and the Web of Science databases were systematically searched for studies investigating chemerin levels in any CKD stage (including end-stage renal disease patients undergoing hemodialysis (HD)) and comparing it with healthy controls. Random effect meta-analysis was performed to calculate the standardized mean difference (SMD) and 95% confidence interval (CI).ResultsA total of eight studies were included, comprised of 875 individuals, with a mean age of 56.92 ± 11.78 years. All studies had high quality based on the New Castle-Ottawa Scale (NOS). Meta-analysis revealed significantly higher levels of chemerin in CKD patients compared to healthy controls (SMD 2.15, 95% CI 0.83-3.48, p-value<0.01). Additionally, HD patients had statistically higher levels of chemerin than controls (SMD 2.10, 95% CI 0.58-3.62, p-value=0.01). In meta-regression, publication year accounted for 23.50% and 24.17% of heterogeneity for these analyses, respectively.ConclusionChemerin can be potentially used as a biomarker in CKD patients, which can suggest the inflammatory pathways for the disease. Further research is warranted for the assessment of its clinical applications and enlightening its role in the pathophysiology of CKD

A Case Based-Shared Teaching Approach in Undergraduate Medical Curriculum: A Way for Integration in Basic and Clinical Sciences

To present a multiple-instructor, active-learning strategy in the undergraduate medical curriculum. This educational research is a descriptive one. Shared teaching sessions, were designed for undergraduate medical students in six organ-system based courses. Sessions that involved in-class discussions of integrated clinical cases were designed implemented and moderated by at least 3 faculties (clinicians and basic scientists). The participants in this study include the basic sciences medical students of The Tehran University of Medical Sciences. Students’ reactions were assessed using an immediate post-session evaluation form on a 5-point Likert scale. Six two-hour sessions for 2 cohorts of students, 2013 and 2014 medical students during their two first years of study were implemented from April 2014 to March 2015. 17 faculty members participated in the program, 21 cases were designed, and participation average was 60 % at 6 sessions. Students were highly appreciative of this strategy. The majority of students in each course strongly agreed that this learning practice positively contributed to their learning (78%) and provided better understanding and application of the material learned in an integrated classroom course (74%). They believed that the sessions affected their view about medicine (73%), and should be continued in future courses (80%). The percentage demonstrates the average of all courses. The program helped the students learn how to apply basic sciences concepts to clinical medicine. Evaluation of the program indicated that students found the sessions beneficial to their learning

Long Term Follow-Up of Sulfur Mustard Related Bronchiolitis Obliterans Treatment

Bronchiolitis obliterans (BO) is the most remarkable pulmonary sequels of war-related sulfur mustard inhalation. There is little if any data about long-term efficacy of associated BO treatment. Five years spirometric records of three groups of patients with obstructive pulmonary diseases (asthma, COPD, BO) and documented sulfur mustard inhalation were evaluated. The BO patients were treated with inhaled Seretide 125-250/25 (2 puffs BID), azithromycin (250 mg, three times/week) and N-acetylcysteine (1200-1800/day). Asthma and COPD patients were treated according to existing guidelines. Seventy-three (38 asthma, 16 COPD and 19 BO) patients completed the 5 years follow-up. Basal and final FEV1 in BO patients (2.69±0.81 and 2.39±0.65 respectively) were not significantly different from COPD patients (2.46±0.56 and 1.96±0.76 respectively). There was also no significant difference between the yearly FEV1 decline in BO patients compared to COPD patients (60±84 cc vs. 99±79 cc respectively, P=0.163). The non-significant difference of FEV1 decline in BO compared to COPD patients suggests the effectiveness of azithromycin, inhaled steroid and N-acetyl cysteine in BO patients. Considering safety and possible effectiveness, this treatment is recommended until more data is available from controlled clinical studies

Preparing Medical Students to Become Effective Tutors: A Reaction, Learning and Behavior Evaluation Study

Background We investigated three specific research purposes: (1) To assess the performance of tutors in guiding problem-based learning groups after participating in the tutor training program (TTP); (2) to examine the differences between tutors’ performance in related factors, including the tutors’ gender and education level; (3) to determine the tutors’ reaction to and learning from TTP. Methods This mixed method, concurrent triangulation study was carried out at Tehran University of Medical Sciences, School of Medicine in 2015. The participants included 22 students of medicine as tutor and 240 newly admitted students as tutee. After training, each tutor was assigned to a group of 10 members (a total of 22 groups) (n = 240) at a PBL session. Based on the Kirkpatrick's model, the tutors’ reaction to and learning from the TTP were evaluated using a peer evaluation form. Furthermore, utilizing the field note record form, their performance was recorded by an expert external observer. Results There was no evidence of difference in tutors’ performance between men and women. The median was 13.37 (13.16 - 13.90) for men and 13.40 (12.37 - 13.48) for women, P = 0.89. We found no difference in tutors’ performance based on the level of education using the Kruskal- Wallis test (χ2 = 1.84, DF = 2, P = 0.39). Analysis of the field notes showed 4 main themes. Conclusions The performance of men is as good as women in tutoring. Furthermore, junior students perform the same as senior students. Four main themes of tutors’ performance in PBL session were “helping to learn how to apply basic science”, “deep learning enhancement”, “group dynamics creation” and “interest in the field of education”