The positive impact of introducing modified directed self-learning using pre-small group discussion worksheets as an active learning strategy in undergraduate medical education.

BACKGROUND: Directed self-learning (DSL) is an active learning approach where the learners are provided with predefined learning objectives and some facilitation through the learning process in the form of guidance and supervision. It can help establish a strong foundation for autonomous and deep learning. OBJECTIVE: The aim of this study was to introduce a modified form of DSL to second-year undergraduate medical students using pre-small group discussion (pre-SGD) worksheets. The authors intended to evaluate its effectiveness through theme assessment and investigate students' perceptions using a feedback questionnaire. METHODS: This was an analytical cross-sectional study. Modified DSL (MDSL) was introduced to 96 second-year undergraduate medical students in two themes. Students were divided randomly into two groups. One group was exposed to traditional DSL (TDSL), and the other was introduced to MDSL using pre-SGD worksheets for the first theme. Groups were reversed for the second theme. The activity was followed by a theme assessment, which was scored for research purpose only. The scores of this assessment were compared, and perceptions of the students were gathered using a validated questionnaire. Data were analyzed using IBM's statistical package of social sciences (SPSS) version 22. RESULTS: The comparison of theme assessment scores revealed statistically significant difference (P = 0.002) in median scores between control TDSL and experimental MDSL groups. The percentage of students scoring ≥80% in theme assessment was significantly higher in the experimental group compared to the control group (P = 0.029). This strategy was well perceived by the students in terms of acceptability and effectiveness as depicted by a high degree of agreement on the Likert-scale. CONCLUSION: Modified DSL resulted in significant improvement in academic performance of undergraduate medical students. MDSL was also well perceived as an active learning strategy in terms of acceptability, effectiveness, and comparison with TDSL. [Figure: see text].

Effectiveness of analog of Humanin in ameliorating streptozotocin-induced diabetic nephropathy in Sprague Dawley rats.

Diabetes mellitus (DM) is associated with numerous complications, including nephropathy, which principally occur due to hyperglycemia-induced oxidative stress and inflammation. Humanin (HN), a novel peptide generated from mitochondria, has anti-oxidant and anti-inflammatory potential as observed in different disease models. However, role of HN in diabetic nephropathy (DN) has not yet been explored. This study aimed to evaluate biochemical and molecular aspects of the effects of HN analog, Humanin-glycine ([S14G]-humanin) on streptozotocin (STZ)-induced rat model of DN. Ninety Sprague Dawley (SD) rats were randomly segregated into three groups - A (control), B (disease control) and C (treatment). DM type-I was induced in group B and C via single intra-peritoneal dose of STZ (45 mg/Kg). Seven days following STZ injection, rats were deemed diabetic if their blood glucose level was > 250 mg/dL. Subsequently, diabetic rats in group C were injected with [S14G]-humanin intra-peritoneally (0.4 mg/Kg/day) for sixteen weeks. Biochemical analysis revealed that diabetic rats had markedly elevated levels of serum glucose, creatinine, BUN, TNF-α, and kidney tissue SOD. Whereas, significant decline was detected in serum insulin and albumin levels. All these parameters were significantly reversed in group C after administering [S14G]-humanin. Moreover, qRT-PCR analysis displayed up-regulation of pro-inflammatory (IL-18, IL-6, IL-1α, IL-1ß, TNF-α) and down-regulation of anti-inflammatory cytokines (IL-10, IL-1RN, IL-4) in diabetic rats (group B). [S14G]-humanin treatment significantly reversed the expression of IL-18 and IL-1α, however, change in relative expression of IL-6, IL-1ß, TNF-α and anti-inflammatory cytokines was insignificant (group C). Conclusively, the findings of this study depicted potential therapeutic role of [S14G]-humanin in pre-clinical rodent model of DN.

Effects of Recombinant Irisin on Body Mass Index, Serum Insulin, Luteinizing Hormone and Testosterone Levels in Obese Female BALB/c Mice.

OBJECTIVE: To determine the effects of recombinant irisin on body mass index (BMI), serum insulin, luteinizing hormone (LH) and testosterone levels, and to correlate the serum insulin levels with serum luteinizing hormone and testosterone levels and to correlate the body mass index with serum insulin levels in obese female BALB/c mice. STUDY DESIGN: Laboratory-based experimental study. PLACE AND DURATION OF STUDY: Department of Physiology, Shifa College of Medicine, Islamabad in collaboration with Research Laboratory of Shifa College of Medicine, National Institute of Health (NIH) and Reproductive Physiology Laboratory, Quaid-e-Azam University, Islamabad, from March 2015 to September 2016. METHODOLOGY: Ninety female BALB/c mice were divided into three equal groups. Group A which was the control group was fed with normal chow diet. Group B and Group C were fed with high fat-high sucrose (HF-HS) diet for five weeks to induce obesity. After four weeks group C was divided into two subgroups. Group C-low dose (LD) was injected with low dose irisin and group C-High dose (HD) was injected with high dose irisin for one week. After five weeks, the BMI, serum insulin, LH and testosterone levels were measured in all the groups. Data was analysed by SPSS version 21. P-value of <0.05 was considered significant. RESULTS: Group B showed statistically significant elevation in BMI, serum insulin, LH and testosterone levels as compared to Group A (p <0.001, <0.001, 0.007 and 0.014, respectively). Group C-HD showed statistically significant decrease in BMI, serum insulin, and LH as compared to Group B (p <0.001, 0.013 and 0.028, respectively). Serum testosterone level was also decreased in group C-HD as compared to Group B, however the difference was not significant. CONCLUSION: Obesity increases the serum insulin, LH and testosterone and irisin significantly lowers the elevated BMI, serum insulin and LH levels in female BALB/c mice. It also lowers the elevated testosterone levels, but not significantly.

Effect of Kisspeptin on Serum Prolactin and Gonadotropins Levels in Balb-c Mice with Induced Chronic Stress.

OBJECTIVE: To determine and compare effects of kisspeptin on serum prolactin, luteinizing hormone and follicle stimulating hormone levels in Balb-c mice with and without exposure to chronic restraint stress. STUDY DESIGN: An animal experimental study. PLACE AND DURATION OF STUDY: Shifa College of Medicine / Shifa International Hospital Islamabad, in collaboration with National Institute of Health, Islamabad and Centre for Research in Experimental and Applied Medicine Laboratory, Army Medical College, Rawalpindi, from April 2014 to June 2015. METHODOLOGY: Mice divided into three groups, each containing 30 mice. Control group (group A) received intraperitoneal injection of saline, group B was administered with intraperitoneal injection of saline and restrained stress, and group C was administered with both stress and kisspeptin 100 ng daily for four weeks. Restraint stress was applied to groups B and C for three hours per day by immobilising individual mice in wire-mesh restrainers. At the end of four weeks blood sampling was done. Serum luteinizing hormones (LH), serum follicular stimulating hormone (FSH) and serum prolactin (PRL) were analysed by ELISA. RESULTS: Serum prolactin level increased in group B (stressed) and group C (stressed + kisspeptin treated) as compared to control group; and decreased in group C as compared to group B. Serum LH and FSH in group B was decreased as compared to control, and it was increased in group C as compared to control and group B. CONCLUSION: Administration of kisspeptin increases level of gonadotropins and reduces stress-induced hyperprolactinemia, which may improve fertility despite stress in animal.

Exploring the trustworthiness and reliability of focus groups for obtaining useful feedback for evaluation of academic programs.

BACKGROUND: At Shifa College of Medicine, evaluation is an integral part of the curriculum. We used focus groups as a tool to obtain in-depth information regarding students' experience with the new integrated, system- based curriculum. The purpose of this study was to explore the usefulness of focus groups in identifying important issues for curriculum improvement and to explore the trustworthiness and representativeness of data obtained through this strategy. METHODS: In 2012, we used focus groups to seek feedback from students regarding their experience with the integrated curriculum. One course of each of the three preclinical years was selected for this purpose. Three parallel focus groups were conducted for each selected course. Each focus group was audio recorded, and the moderator and a volunteer student took additional notes during the session. The audio recordings were transcribed and data obtained from the three sources were analyzed, coded, and categorized independently by three investigators. Both manifest and latent themes were identified, using an inductive approach. Final agreement on themes was reached by comparison of the independently done thematic analysis by the three researchers. Reliability of data was established by comparing responses from the three parallel focus groups of each course. Trustworthiness of inferences was ensured by multiple coding, audit trail and member checking with focus group participants who reviewed the themes for validity. RESULTS: Most of the data on students' perceptions of their courses from each of the parallel groups were in agreement: Similar themes were seen within groups of the same class as well as across the three preclinical years. CONCLUSION: Focus groups can be a useful tool for collecting trustworthy and reliable information through a process that promotes interaction among student participants. They can support quantitative data from students and be used to support curriculum reform.

Competency-based integrated practical examinations: Bringing relevance to basic science laboratory examinations.

BACKGROUND: The practical examinations in subject-based curriculum have been criticized for lack of relevance and clinical application. We developed competency-based integrated practical examinations (IPEs) for first two years incorporating basic science principles with clinical relevance in our integrated curriculum. AIM: To bring relevance to basic science laboratory practical examinations by conducting competency-based IPEs. METHODS: IPEs were developed according to competency-based blueprinting for each integrated module. Clinical scenarios were used as triggers followed by tasks pertaining to laboratory tests, relevant physical diagnosis and ethics/professional aspects utilizing standardized patients. Checklists were developed for standardized marking. A feedback questionnaire and two focus group discussions were administered to a random group of students from both first and second year students. Faculty members' feedback was also recorded on a questionnaire. RESULTS: Almost all the students agreed that IPE was a useful experience. Eighty-nine percent agreed that it was a fair examination and elicited a lesser degree of psychological stress. Eighty-two percent agreed that IPE encouraged critical thinking and application of knowledge. However, students suggested better organization and longer duration of stations. Faculty members also liked the experience. CONCLUSION: In conclusion, IPEs were well-received and valued both by students and faculty members.

Experience with a theme-based integrated renal module for a second-year MBBS class.

Integrated learning is the need of the hour. We at Shifa College of Medicine switched to an integrated modular curriculum last year. In the present article, we describe our experience with the renal module in year 2 of a 5-yr undergraduate medical curriculum. A multidisciplinary renal modular team developed the relevant objectives, themes, and clinical cases. The learning strategies used were large-group interactive sessions, small-group learning, problem-based learning, practicals, and self-directed learning. Assessment was both formative and summative. Student and faculty feedback questionnaires were administered at the end of the module. Forty-four percent of the students agreed that the basic science and clinical concepts were well balanced and integrated. Fifty-seven percent of the students believed that important learning issues could be identified and that participation and critical thinking were encouraged during the small-group sessions. Eighty-five percent of the facilitators agreed that they were able to motivate students for critical thinking and better learning through integrating various disciplines. In conclusion, the integrated method of curricular delivery was well received by students and faculty members, and it can be used successfully in undergraduate medical education in developing countries.

Status of serum leptin levels in females with infertility.

OBJECTIVE: To assess serum leptin levels in infertile females referred to a tertiary care hospital in Pakistan. METHODS: A case control study was carried out at Shifa College of Medicine/Shifa International Hospital Islamabad, Pakistan from January 2005 to August 2005. Serum leptin levels of 44 infertile females were compared with 44 age matched fertile female controls. RESULTS: The results revealed that serum leptin levels were significantly raised in infertile women (69.7+/-40.2ng/ml) as compared to fertile controls (41.1+/-27.3ng/ml) with p=0.000. Mean body mass index BMI was also found to be significantly higher in infertile women (27.2+/-6.8kg/m2) as compared to fertile females (24.1+/-5.2kg/m2) with p-value of 0.019. Moreover, a strong positive correlation was found between BMI and leptin levels as leptin levels increased with increase in BMI. Mean leptin levels in overweight women were significantly higher (81.4+/-32.4ng/ml) as compared to normal weight women (30.6+/-20.6ng/ml) with p=0.000. CONCLUSION: The present study has indicated that overweight accompanied by hyperleptinemia is associated with infertility in females. However, further studies are required to determine the exact mechanism by which enhanced body mass and serum leptin levels lead to female infertility.