Pattern of online communication in teaching a blended oral surgery course.

AIM: To explore the factors that might affect the patterns of interaction amongst dental students that can be found in asynchronous online discussion fora. SUBJECTS AND METHODS: It is a qualitative study that involved the participation of 71 dental students (42 male and 29 female) who belong to one academic year. Students were participated in asynchronous online discussion fora as a part of a blended oral surgery course that involved both face-to-face lecture and an online learning environment using the Blackboard learning management system. Qualitative analysis of students' pattern of discussion was performed using Transcript Analysis Tool. RESULTS: The total number of postings was 410. Sixty-seven of 71 students participated in the discussion by writing posts, whereas all of the students had accessed all of the postings. A positive correlation between imposing vertical questions and the number of non-referential and referential statements was observed. Regarding horizontal questions, a positive correlation was observed with the number of referential statements, whilst there was a negative correlation with the number of non-referential statements. CONCLUSION: Asynchronous online discussion fora that are integrated as a part of a whole pedagogical practice may provide an opportunity for promoting learning, especially when consideration is given to the structure of problems, timely feedback by tutors and supportive strategies within the discussion threads.

CD14(+) HLA-DR low/(-) monocytes as indicator of disease aggressiveness in B-cell non-Hodgkin lymphoma.

INTRODUCTION: This study aimed to assess the correlation between the percentage of CD14(+) HLA-DR(low/-) immunosuppressive monocytes, plasma arginase 1 level, and disease aggressiveness in patients with B-cell non-Hodgkin lymphoma. METHODS: Forty-two patients with B-cell non-Hodgkin lymphoma and 20 healthy volunteers were enrolled in this study. Peripheral blood CD14+ HLA-DR(low/-) monocytes were detected by Flow cytometry, and their correlation with disease relapse and refractoriness was analyzed. RESULTS: The percent of CD14(+) HLA-DR(low/-) monocytes was significantly higher in the lymphoma patients than in the healthy controls (control, 9.3 ± 4%; lymphoma, 35.8 ± 20.2%; P < 0.0001), higher in stage III& IV than stage II (stage II, 26.48 ± 17%, n = 26; stage III & IV, 50.8 ± 15.4%, n = 16; P < 0.0001), more in diffuse large cell lymphoma than other pathology types and in relapsed/refractory patients than in patients who achieved remission during follow-up (relapsed/refractory, n = 18, 45.7 ± 16.7%; remission, n = 16, 21.4 ± 16.2%; P < 0.0001). The arginase I level correlated with increased percent of CD14(+) HLA-DR(low/-) monocytes (P < 0.0001). CONCLUSION: Increased CD14(+) monocytes with loss of HLA expression were seen in patients with higher stage disease, more aggressive pathology, and in relapse or refractoriness to treatment. Identifying therapeutic strategies to overcome the suppressive properties of these monocytes could be of value.

Colorectal cancer in younger patients - a single centre analysis.

Debate surrounds the nature of colorectal cancers in younger patients and whether they are more likely to present with aggressive disease. Pearson's correlation coefficient was used to examine whether a relationship exists between age and variables such as family history, mucinous tumours, metastases and final pathology. 41 patients under the age of 45 were diagnosed and operated for colorectal cancer between September 1998 and December 2010 in our centre. Nineteen patients were under the mean age of 35 years. There was no correlation between younger patients and metastatic disease (r= -0.129, p=0.440) or family history (r= -0.258, p=0.123). There was no correlation between age and Dukes staging (r= -0.052, p=0.756), tumour stage (r= -0.110, p=0.516), nodal status (r= -0.053, p=0.751), mucinous tumours (r=0.104, p=0.569) and cell differentiation (r= 0.046, p=0.787). Overall mortality was 26% and of those who survived 10% have metastatic disease. Median survival was 26 months after surgery. Younger patients under 45 appear to be a homogenous group in relation to colorectal tumour characteristics. Further longitudinal studies to examine the differences between this group and older people are needed.

The accuracy of intraoperative frozen section analysis of the sentinel lymph nodes during breast cancer surgery.

BACKGROUND: The sentinel node biopsy (SNB) is a reliable and minimally invasive procedure, representing a new standard of care for patients with clinically node-negative breast cancer. Several studies have confirmed the reliability and the accuracy of this new procedure. Accurate intraoperative evaluation of sentinel lymph nodes (SLNs) can determine the need for immediate axillary node clearance thus reducing arm morbidity in SLN-negative patients and avoiding a second surgical procedure in patients with positive SLNs. The aim of this study is to determine the accuracy and the limitations of intraoperative frozen section (IFS) analysis of SLNs during breast cancer surgery. PATIENTS AND METHODS: 96 female patients with clinically node-negative T1-T2 breast cancer who underwent the SNB procedure and IFS analysis by single section standard staining in two hospitals were reviewed. The SNB procedure was performed using the patent blue dye method alone or the combination of the dye and radioactive isotope techniques. The results of IFS and the final histology were compared. RESULTS: The mean number of SLNs removed was 2. Overall, 22% (21/96) of patients were found to be SNB-positive on final histology. Based on patients, there was a 96.8% concordance between the results of the IFS and the final histology; the sensitivity was 86% (18/21), and the specificity was 100%. There were 3 cases of false negative all of which contained micrometastases only. When micrometastases were excluded, the sensitivity was 100%. Based on SLNs (n = 196), the sensitivity was 91%, and the specificity was 100%. CONCLUSION: Intraoperative frozen section of sentinel lymph nodes in patients with early breast cancer is highly accurate for macrometastases but not for micrometastases.

Specific cellular immune response and cytokine patterns in patients coinfected with hepatitis C virus and Schistosoma mansoni.

Patients coinfected with hepatitis C virus (HCV) and Schistosoma mansoni show high incidence of viral persistence and accelerated fibrosis. To determine whether immunological mechanisms are responsible for this alteration in the natural history of HCV, the HCV-specific peripheral CD4(+) T cell responses and cytokines were analyzed in patients with chronic hepatitis C monoinfection, S. mansoni monoinfection, or HCV and S. mansoni coinfection. An HCV-specific CD4(+) proliferative response to at least 1 HCV antigen was detected in 73.3% of patients infected with HCV, compared with 8.6% of patients coinfected with HCV and S. mansoni. Stimulation with HCV antigens produced a type 1 cytokine profile in patients infected with HCV alone, compared with a type 2 predominance in patients coinfected with HCV and S. mansoni. In contrast, there was no difference in response to schistosomal antigens in patients infected with S. mansoni alone, compared with those coinfected with HCV and S. mansoni. These findings suggest that the inability to generate an HCV-specific CD4(+)/Th1 T cell response plays a role in the persistence and severity of HCV infection in patients with S. mansoni coinfection.

Acute hepatitis C without and with schistosomiasis: correlation with hepatitis C-specific CD4(+) T-cell and cytokine response.

BACKGROUND & AIMS: Immune responses during the first few months of acute hepatitis C virus (HCV) infection seem crucial for viral control, but the relationship of these responses to natural history is poorly characterized. METHODS: This prospective study investigated the HCV-specific CD4(+) and cytokine responses in patients with acute HCV hepatitis with or without Schistosoma mansoni coinfection, a parasitic infection with T helper (Th) 2 immune bias. HCV-specific CD4(+) proliferative responses and cytokine production in peripheral blood mononuclear cells were correlated with liver biopsy results at 6 months and at the end of follow-up. RESULTS: Whereas 5 of 15 patients with HCV alone recovered from acute HCV, all (17 of 17) patients with S. mansoni coinfection progressed to histologically proven chronic hepatitis. Coinfected patients had either absent or transient weak HCV-specific CD4(+) responses with Th0/Th2 cytokine production. The magnitude of the HCV-specific CD4(+) response at week 12 was inversely correlated with the fibrosis progression rate in chronically infected patients. CONCLUSIONS: Patients with acute hepatitis C and schistosomiasis coinfection cannot clear viremia and show rapid progression once chronic infection is established. This rapid progression is associated with a strong Th2 response in peripheral immune responses, suggesting that early development of vigorous Th1 responses not only facilitates clearance but delays disease progression.

Clinicopathological study of pilomatricoma.

OBJECTIVE: To study the clinical and histopathologic spectrum of pilomatricoma, the benign tumor of hair matrix. METHODS: Retrospective review of 27 cases of pilomatricoma (Calcifying epithelioma of Malherbe) reported at Bahrain Defence Force Hospital from 1993-1999. RESULTS: Most of the cases were confused clinically with sebaceous cysts. Seventy eight per cent of the cases occurred below the age of 30 years. Female to male ratio was 5:4. Head, neck and upper limb were the most common sites for pilomatricoma. The size of the tumors ranged from between 4-35 mm in diameter. Tumors were encapsulated and solid composed of shadow and basophilic cells, and stroma containing varying amounts of calcification, ossification and inflammatory cells. CONCLUSION: Pilomatricomas have a wide variety of clinical characteristics and are often misdiagnosed with other skin conditions. They should be considered along with other benign and malignant conditions in the clinical differential diagnosis of solitary firm skin nodules especially those, which occur in the head, neck and upper limb.

Reciprocal heterologous protection between Trichinella spiralis and Toxoplasma gondii concurrently present in experimental murine models.

Mixed parasitic infections have been long seen as a double impact on the host. In this study a different view of polyparasitism is demonstrated. The influence of the immunological environments created by two biologically different parasites on the pathogenesis of each other was evaluated. Swiss albino mice were sequentially infected with the intracellular protozoan Toxoplasma gondii (acute and latent), which elicits a T-helper 1 (Th1)-polarized immune response and the helminth parasite Trichinella spiralis, whose infection is predominated by a Th2 response. The results show a significant heterologous protection from one parasite towards the other. There was a highly significant lower Trichinella muscle larvae burden in mixed infection group compared to single Trichinella infection, in spite of delayed intestinal adult worm expulsion in the mixed infection group. A highly significant lower burden of T. gondii brain cysts in mixed infection compared to single latent Toxoplasma infection was also demonstrated. Concerning the anti-Toxoplasma antibody response, there was a significant lower levels in the latent Toxo-Trich. group compared to the group of latent toxoplasmosis only. These significant lower antibody titers were reproducible by two different assays; dye test and direct agglutination test.

Blood-reduced glutathione, pyruvic acid, citric acid, ceruloplasmin oxidase activity and certain mineral changes in diabetes mellitus before and after treatment.

In maturity onset diabetes the blood levels of total blood keto acids in terms of pyruvic, serum citric, calcium are significantly higher than in normal adults, while there is a decrease in reduced-blood glutathione, serum zinc, potassium and sodium levels. There were no significant differences between diabetes and normal adults in the serum levels of copper, ceruloplasmin oxidase activity, iron and magnesium.

Blood-reduced glutathione, serum ceruloplasmin and mineral changes in juvenile diabetes.

In cases of juvenile diabetes, there were lower than normal levels of reduced glutathione, ceruloplasmin oxidase activity, zinc, copper and sodium, while the other elements show no significant changes. The lower level of serum zinc, copper and sodium may be due to the osmotic diuresis and consequent polyurea of diabetes.