Estimation of inflammatory cytokines in maternal serum for assessing the outcome of threatened miscarriage.

Objectives: This study investigates the use of pro- and anti-inflammatory cytokines in predicting the outcome of pregnancy complicated by threatened miscarriage. Materials and Methods: Of the 140 eligible pregnant women recruited for the study, maternal serum levels of selected inflammatory cytokines (IL-2, IFNγ, IL-4, and IL-13) for 70 women with threatened miscarriage were analysed for this study. Serum concentrations were measured using the enzyme-linked immunosorbent assay (ELISA) kit. Inevitable miscarriage or ongoing pregnancy was used as the outcome, whereas serum levels of selected inflammatory cytokines, women's sociodemographic characteristics, gynaecologic history, and clinical history were used as the explanatory variables. The Student's t test was used to compare the cytokine profiles between women with inevitable miscarriages and women with normal ongoing pregnancy after 13 weeks of gestation. Poisson regression models were performed to investigate the factors associated with inevitable miscarriage. Results: The result revealed significantly higher pro-inflammatory cytokines, IL-2 (P < 0.001), and IFNγ (P < 0.001) in women with a pregnancy that resulted in an inevitable miscarriage than in those that resulted in an ongoing pregnancy. The incidence rate of inevitable miscarriage increased by 16% (IRR = 1.16, 95% CI: 0.58-2.32) for a unit increase in IL-2 and by 25% (IRR = 1.25, 95% CI: 1.09-1.43) when adjusted for sociodemographic characteristics, gynaecology, and clinical history. Conclusion: The IL-2 was the best biomarker for predicting the outcome of threatened pregnancy with a sensitivity of 80% and a specificity of 70% at 1.30 pg/mL cut-off point.

Diagnostic accuracy of transvaginal ultrasonography and hysterosalpingography in the detection of uterine cavity pathologies among infertile women.

Background: Uterine cavity pathology may affect the endometrium or myometrium, resulting in distortion of the uterine cavity, and is responsible for 2%-5% of infertility. The methods for its assessment usually involve imaging modalities like pelvic ultrasonography, often transvaginal-(TVS), and hysterosalpingography-(HSG), with hysteroscopy-(HSC) as the gold standard. However, HSC is not readily available in resource-poor-settings. Purpose: To determine and compare the diagnostic accuracy of TVS and HSG in detecting uterine cavity pathology using HSC as a gold standard. Materials and Methods: A cross-sectional analytical study of consenting infertile women for evaluation of the uterine cavity using transvaginal-ultrasonography, hysterosalpingogram, and hysteroscopy. The primary-outcome-measures were the sensitivity, specificity, and accuracy of TVS and HSG in detecting uterine cavity abnormalities using HSG as the gold standard. Results: Eighty-eight participants were analysed for this study. The lesions confirmed on HSC were intrauterine-adhesions (43.1%), endometrial polyps (14.8%), submucous fibroids (18.2%), intrauterine-septum (13.6%), and cavity distortion (14.8%). The overall sensitivity with TVS was 57.7%, with a specificity of 97.6%, a positive-predictive-value (PPV) of 88.2%, and a negative-predictive-value (NPV) of 88.2%, giving a percentage-accuracy of 88.2%. In comparison, HSG had a sensitivity of 72.1%, a specificity of 99.4%, a PPV of 97.4%, and an NPV of 92.0%, giving an overall accuracy of 92.9%. The detection rates of TVS and HSG in this category were: fibroids (97.7% vs 89.8%; p = .0004) and adhesions (73.9% vs 87.5%; p = .0002), respectively. Conclusion: HSG appears to be the superior modality for detection of obliterative uterine cavity pathologies, while TVS is better suited for myometrium and endometrial lesions.

Residents-as-teachers: A Needs Assessment of Residents' Teaching Skills in the Clinical Setting Using Direct Observation of Teaching.

BACKGROUND AND OBJECTIVES: Residents play a significant role in teaching undergraduate medical students though most residents have not received formal training in teaching and may be adopting ineffective teaching strategies. Many institutions have established a residents-as-teachers (RaT) programme to improve residents' teaching skills. However, many RaT programmes were established without a context-specific needs assessment. This study describes a need assessment survey of residents' teaching skills. The specific objectives of the study were to determine the residents' selfperceived and true learning needs for facilitating clinical teaching, the preferred important topics and methods of instruction for a RaT programme. METHODS: This cross-sectional, prospective, observational, quantitative study involved self-assessment of residents' teaching skills and assessments of those residents by medical students and an observer during actual clinical bedside teachings using the Maastricht Clinical Teaching Questionnaire. RESULTS: Thirty-nine (78%) out of 50 residents participated in the study, of which 20 agreed to direct observation of teaching. Sixty-two (85%) of the 73 medical students completed 82 evaluations of residents' teaching. The residents' self-perceived and true learning needs were in the domains of exploration, scaffolding, modelling, coaching and reflection. The leading preferred topics were communication skills, leadership, the teaching of procedural skills, and bedside teaching. The preferred methods of instruction were interactive sessions with teachers and working in small groups with a facilitator. CONCLUSIONS: Residents performed well in creating a safe learning environment but were poor in exploration, scaffolding, modelling, coaching and reflection domains of teaching. These findings will inform the design of a tailor-made RaT programme.

CONTEXTE ET OBJECTIFS: Les résidents jouent un rôle important dans l'enseignement des étudiants en médecine de premier cycle, bien que la plupart des résidents n'aient pas reçu de formation formelle en enseignement et puissent adopter des stratégies d'enseignement inefficaces. De nombreuses institutions ont mis en place un programme de résidents en tant qu'enseignants (RaT) pour améliorer les compétences pédagogiques des résidents. Cependant, de nombreux programmes RaT ont été établis sans évaluation préalable des besoins spécifiques au contexte. Cette étude décrit une enquête sur les besoins en compétences pédagogiques des résidents. Les objectifs spécifiques de l'étude étaient de déterminer les besoins d'apprentissage auto-perçus et réels des résidents pour faciliter l'enseignement clinique, les sujets importants préférés et les méthodes d'instruction pour un programme RaT. MÉTHODES: Cette étude quantitative prospective observationnelle transversale impliquait une auto-évaluation des compétences pédagogiques des résidents et des évaluations de ces résidents par des étudiants en médecine et un observateur lors d'enseignements cliniques en direct au lit du patient à l'aide du Questionnaire d'Enseignement Clinique de Maastricht. RÉSULTATS: Trente-neuf (78 %) des 50 résidents ont participé à l'étude, dont 20 ont accepté l'observation directe de l'enseignement. Soixantedeux (85 %) des 73 étudiants en médecine ont complété 82 évaluations de l'enseignement des résidents. Les besoins d'apprentissage auto-perçus et réels des résidents étaient dans les domaines de l'exploration, de l'échafaudage, de la modélisation, du coaching et de la réflexion. Les sujets préférés étaient les compétences en communication, le leadership, l'enseignement des compétences procédurales et l'enseignement au lit du patient. Les méthodes d'instruction préférées étaient les séances interactives avec les enseignants et le travail en petits groupes avec un facilitateur. CONCLUSIONS: Les résidents se sont bien comportés dans la création d'un environnement d'apprentissage sûr mais étaient faibles dans les domaines de l'exploration, de l'échafaudage, de la modélisation, du coaching et de la réflexion de l'enseignement. Ces résultats orienteront la conception d'un programme RaT sur mesure. MOTS-CLÉS: Résidents en tant qu'enseignants, évaluation des besoins, enseignement clinique au lit du patient, évaluation, compétencespédagogiques.

Thermographic Mapping of Arterial Perforators in the Leg.

Background: Preoperative localisation of perforators aids in easy intraoperative dissection. Infrared thermography is a simple, safe, and effective tool with a short learning curve that is useful in identifying perforators. It has been found to have a high concordance rate when compared with computed tomography angiography and is useful in identifying arterial perforators in the leg. Objectives: To create a thermographic map of arterial perforators in the leg and to determine the correlation between the number of perforators identified and the length of the leg. Materials and Methods: This was a cross-sectional study. The length of the leg was measured and the location of perforators corresponding to the distribution of the anterior tibial, posterior tibial, and peroneal arteries was identified using thermography. The mean number of perforators corresponding to the different surfaces of the leg was noted, this was then correlated with the length of the leg using the Pearson correlation coefficient. Results: Using thermography, perforators were identified along a line drawn from the medial malleolus to the medial tibia plateau and from the lateral malleolus to the head of the fibula and within 2 cm of these lines. More perforators were found in the middle third of the leg and there was no significant correlation between the number of perforators and the length of the leg. Conclusion: A useful surface marking to aid the identification of perforators in the leg using infrared thermography was found. There was no significant correlation between the length of the leg and the number of perforators.

Why Acute Undernutrition? A Qualitative Exploration of Food Preferences, Perceptions and Factors Underlying Diet in Adolescent Girls in Rural Communities in Nigeria.

BACKGROUND: Adolescent girls are nutritionally vulnerable due to their rapid growth and increased nutrient requirements. Nigeria has the sixth-largest population in the world. This study qualitatively explored the food preferences, perceptions of nutritive value and factors underlying food consumption of adolescent girls in rural communities in Nigeria. METHODS: The data were collected via the free listing of foods and focus group sessions conducted in the Hausa language with 48 unmarried adolescent girls. The discussions were audio-recorded, transcribed, translated into English, and analyzed using a deductive thematic framework. RESULTS: The mean age of the respondents was 13.0 ± 2.7, and almost half (48%) had a primary school education. A total of 19 and 23 foods were identified as preferred, and perceived as nourishing, respectively. The top 10 foods present on both free lists overlapped considerably in terms of cognitive salience. The focus group themes included nutrition knowledge, food preferences, autonomy, household food allocation, courtship practices, and agricultural landscapes and economic access. The participants had minimal knowledge of nutrients and food groups, and their preferred foods were limited in diversity. The key factors in food preferences were desirable health effects, sensory attributes, and the contribution of foods to a desirable body image for marriage. Household food choices depended on parents. Thus, a desire for independence was an incentive for early marriage, mostly at 13 to 17 years. Gender inequities in household food distribution (quantity) and animal protein intake were reported. The participants believed that boys need more food for strength to impregnate girls. As part of a courtship practice, the girls received gifts of animal source foods from potential suitors. The food options were limited by financial challenges and low agricultural diversity. CONCLUSION: To interrupt the cycle of inadequate food consumption and undernutrition in these adolescent girls, policy makers need to promote nutrition education and address the underlying determinants of inequitable access to nutritious foods.

Lead optimization of Allium sativum L. compounds for PTP1B inhibition in diabetes treatment: in silico molecular docking and dynamics simulation.

Protein tyrosine phosphatase 1B (PTP1B) has been identified as a promising drug target for the development of diabetes medications via an inhibition mechanism. Using a computational approach, this study investigates the binding mechanism of lead optimized natural compounds from Allium sativum against the human PTP1B. The molecular docking, induced-fit docking, and binding free energy calculations were analyzed using Schrödinger Suite 2021-2. MD simulation, and gene enrichment analysis was achieved via the Desmond module of Schrödinger to identify best compounds as inhibitors against PTP1B in diabetes management. The docking scores of the lead optimized compounds were good; 5280443_121 from apigenin had the best binding score of -9.345 kcal/mol, followed by 5280443_129 with a binding score of -9.200 kcal/mol, and 5280863_177 from kaempferol had a binding score of -8.528 kcal/mol, followed by 5280863_462 with a binding score of -8.338 kcal/mol. The top two lead optimized compounds, docked better than the standard PTP1B inhibitor (-7.155 kcal/mol), suggesting them as potent inhibitors than the standard PTP1B inhibitor. The outcomes of the induced-fit docking were consistent with the increased binding affinity used in the Glide computation of the five conformed poses between the derivatives (5280443_121, 5280443_129, 5280863_177, and 5280863_462) and the protein (PTP1B). Based on the binding fee energies (MM-GBSA), the lead optimized compounds from kaempferol exhibited more stability than those from apigenin. In the pharmacophore development, all the models exhibit good results across the different metrics. The best performing model with five of five matches on a 1.34 and 1.33 phase score was DDRRR_1, DDRRR_2, and DDDRR_1. The average BEDROC value (= 160.9) was 1, while the average EF 1% value across all models was 101. There were no substantial conformational modifications during the MD simulation process, indicating that the apigenin derivatives (5280443_121) was stable in the protein's active site in 100 ns. IGF1R, EGFR, INSR, PTPN1, SRC, JAK2, GRB2, BCAR1, and IRS1 are among the 11 potential targets found in the protein-protein interaction (PPI) of A. sativum against PTP1B that may be important in A. sativum's defense against PTP1B. Sixty-four (64) pathways were found by KEGG pathway enrichment analysis to be potentially involved in the anti-PTP1B of A. sativum. Consequently, data obtained indicates the effectiveness of the in silico studies in identifying potential lead compounds in A. sativum against PTP1B target.Communicated by Ramaswamy H. Sarma.