Significance of fibulin-3 expression in bladder cancer: a tissue microarray-based immunohistochemical study.

BACKGROUND: Predicting the behavior of bladder cancer by easy noninvasive methods and with less cost is needed. Fibulin-3 (EFEMP1), a glycoprotein of the extracellular matrix that is encoded by the gene EFEMP1, has been nominated as one of the potential mediators of muscle invasion in bladder cancer. METHODS: In this tissue microarray-based immunohistochemical study, fibulin-3 level of expression was evaluated using a semiquantitative scoring system and was correlated with patient's age and sex and tumor grade and stage. RESULTS: A total of 160 urothelial carcinoma cases were analyzed. The age of the patients ranged from 25 to 91 years (mean, 60.15; SD, 11.60). Fibulin-3 was significantly associated with muscle invasion and overall tumor stage (p = 0.033 and 0.02, respectively). Fibulin-3 expression was nonsignificantly associated with tumor grade (p = 0.092) CONCLUSIONS: We found that the expression of fibulin-3 is significantly associated with muscle invasion in urinary bladder urothelial carcinoma. However, the prognostic role of fibulin-3 needs further investigations.

The significance of StAR-related lipid transfer protein-3 expression in breast cancer.

StAR-related lipid transfer domain containing proteins (STARD3) are a group of proteins that contain a steroidogenic acute regulatory protein-related lipid transfer domain. Breast cancer (BC) has been linked to the STARD3 gene. In this study, we sought to confirm the relationship of STARD3 protein expression with clinicopathological characteristics and BC molecular subtypes. Using tissue microarray, we examined the STARD3 protein expression in 200 BC tissues and 20 normal breast tissues. Higher protein expression of STARD3 was found in tumor tissues than normal tissues. One hundred and fifty-two (69.1%) of the 200 cases tested positive for STARD3 (high H-score), while seventy (30.9%) had a low STARD3 H-score. When STARD3 is present, its expression ranges from mild to strong. STARD3 H-score was strongly linked to human epidermal growth factor receptor 2 (HER2)-positive (p < 0.001) and estrogen receptor (ER)-positive (p < 0.009) patients, but not to triple-negative BC patients. STARD3 high H-score was associated with histological grade and tumor size. No significant associations were found with stage of the disease, pathological stage or node status. Our research revealed that STARD3 levels were higher in tissues from malignant BC, and it was associated with HER2 and ER, suggesting that it might be utilized as a marker for BC.

Effect of low-threshold versus high-threshold genitalia stimuli on the cystometry parameters in male rats.

The cross talk between external genitalia and urinary bladder could be used as part of management to certain pathological conditions affecting urinary bladder. Since urinary bladder function is also affected by pathologies of other organs (e.g., colon and esophagus), the effect of genitalia stimuli on parameters of bladder function in normal or under different pathological conditions needs to be characterized. Cystometry recordings in male rats were used to examine the effect of low-threshold (LT) and high-threshold (HT) stimulation of the scrotum and penis on urinary bladder function. These effects were studied in intact, colon irritation (CI), and esophagus irritation (EI) groups. Although HT penile stimulation had a significant inhibitory effect on micturition reflex in all groups, CI hypersensitized the penile-bladder inhibitory reflex. In addition, LT penile stimulation had a significant inhibitory effect on micturition, which was significant in CI group only. On the other hand, HT penile stimulation in CI group significantly increased the timing parameters of cystometry. Whereas LT and HT penile stimuli in EI group had a significantly increasing effect on all pressure parameters of cystometry. The scrotal stimuli had minimal effect on bladder function in all groups except for HT scrotal stimulation in the CI group, where it had a significant inhibitory effect on micturition reflex and significantly increased the maximum pressure and pressure amplitude of micturition cycles. These results show that CI and EI exacerbate the effects of genitalia stimuli, especially penile stimuli, on urinary bladder function.

Contraceptive use by Palestine refugee mothers of young children attending UNRWA clinics: a cross-sectional follow-up study.

BACKGROUND: UNRWA introduced family planning services in 1994 as an integral part of its expanded maternal and child health-care programme. The main objective of UNRWA's family planning programme is to promote the health of mothers, children, and their families. The aim of this follow-up study was to assess contraceptive practices in the target population 5 years after the 2010 follow-up study and to identify future programme needs. METHODS: This cross-sectional survey was a done by trained nurses from June 1 to Dec 31, 2015. Participants were Palestinian refugee mothers who attended Well Baby Clinics at all UNRWA health centres with their youngest child (aged 2 months to 5 years). A sample size of 10 478 participants was calculated on the basis of contraceptive use in 2010, using Epi Info sample size calculation. Women were interviewed, and retrospective data from health records were used as supplementary data. We did a multiple logistic regression to test if maternal age and parity predicted contraceptive use. We used the χ2 test to analyse the relation between previous contraceptive use and birth interval, birth weight, and gestational age. All participants provided verbal informed consent. The study was approved by the ethical committee in the UNRWA Health Department. FINDINGS: Data were obtained from 9860 mothers (mean age 29·8 years [range 29·4-30·1]). 5849 (59%) women were using modern contraceptives at the time of the survey, 1745 (18%) were using traditional methods, and 2265 (23%) were not using any contraceptive method. The most common modern contraceptive was an intrauterine device (2186 [37%] women), and UNRWA was the main provider for 4827 (83%) women using modern contraceptives. The most common reasons for not using contraceptives were a wish to have a child (873 [22%] women), pregnancy (747 [19%]), and a husband's opposition (775 [20%]). Using women with less than three pregnancies as the reference category, use of contraceptives was most likely in women with three to six pregnancies (adjusted odds ratio 1·58, 95% 1·43-1·73; p<0·0001) and in women with more than six pregnancies (1·6, 1·28-1·99; p<0·0001). Women with at least one male child were more likely to use contraceptives than women with no male child (1·39, 1·24-1·56; p<0·0001). Maternal age over 35 years was not a significant predictor for modern contraceptive use. We found a statistically significant correlation between previous contraceptive use and birthweight [c2=23·88; p<0·0001)] but not with gestational age. INTERPRETATION: It is encouraging that mothers seeking modern contraceptives rely on UNRWA to provide family planning services. We found that mothers with higher parity are more likely to use modern contraceptives that comply with UNRWA recommendations. As expected, modern contraceptives lead to better birth spacing. However, mothers above 35 years of age are not more likely to use modern contraceptives, and these mothers might be at higher risk for negative maternal and infant health outcomes. UNRWA family planning services could focus more on counselling this group of mothers. FUNDING: None.

Urinary bladder cancer in Jordanian adults: A histopathological and epidemiological study from a tertiary care center in Amman.

The aim of this retrospective study was to analyze urinary bladder cancer cases that were diagnosed in Jordan University Hospital, Amman according to age, gender, grade and muscle invasion.There were 212(85.1%) male and 37(14.9%) female patients. Of them, 115(46.2%) patients were aged <65 years (range: 25-64 years), 128(51.4%) were aged 65-84 years, and 6(2.4%) were aged > 85 years. Analysis of transitional cell carcinoma cases revealed that 143(59.3%) of the cases were of low grade, while 98(40.7%) were of high grade. Of these cases, 199(82.6%) were superficial, whereas 42(17.4%) were muscle invasive at initial diagnosis. Of the high-grade tumour cases, 57 (58.2%) and 5(5.1%) were found in the age groups 65-84 and >84 years, respectively. Both the grade and the muscle-invasion status were not significantly associated with patient gender. Our study showed significant demographic changes in urinary bladder cancer in comparison to a previous study from northern Jordan.

Clinical and histopathological features of breast cancer in Jordan: Experience from a tertiary care hospital.

OBJECTIVE: To analyse breast cancer cases with respect to age, menopausal status, hormone receptors and human epidermal growth factor receptor 2 expression, in addition to nodal and distant metastases. METHODS: This retrospective study was conducted at Jordan University Hospital, Amman, Jordan, and comprised cases of breast carcinoma among females between 2006 and 2015. Clinicopathological data was collected from patient files and laboratory reports. Data was analysed using SPSS v 17. RESULTS: Of the 752 cases, 559(74.3%) were invasive ductal carcinomas of non-specific type, followed by 36(4.8%) cases of invasive lobular carcinoma. Upon investigating the clinicopathological data on the breast cancer cases, 466(61.97%) cases had sufficient information for further analysis. Of them, 414(61.97%) patients were aged above 40 years and 190(40.77%) were post-menopausal. Moreover, 221(47.42%) cases showed lymph node metastases, but only 32(6.87%) had distant metastases. The expression of oestrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 was found to be positive in 343(73.6%), 299(66.7%) and 97 (24.6%) cases, respectively. Besides, 42(9.01%) cases were triple negative, which were diagnosed only in females below 40 years age. CONCLUSIONS: These results were in concordance with international reports, except for the association of triple negative breast cancer with age where it was mainly diagnosed among females younger than 40 years age.

Treatment outcomes in a cohort of Palestine refugees with diabetes mellitus followed through use of E-Health over 3 years in Jordan.

OBJECTIVE: The aim of this study was to use E-Health to report on 12-month, 24-month and 36-month outcomes and late-stage complications of a cohort of Palestine refugees with diabetes mellitus (DM) registered in the second quarter of 2010 in a primary healthcare clinic in Amman, Jordan. METHOD: Retrospective cohort study with treatment outcomes censored at 12-month time points using E-Health in UNRWA's Nuzha Primary Health Care Clinic. RESULTS: Of 119 newly registered DM patients, 61% were female, 90% were aged ≥40 years, 92% had type 2 DM with 73% of those having hypertension and one-third of patients were newly diagnosed. In the first 3 years of follow-up, the proportion of clinic attendees decreased from 72% to 64% and then to 61%; the proportion lost to-follow-up increased from 9% to 19% and then to 29%. At the three time points of follow-up, 71-78% had blood glucose ≤180 mg/dl; 63-74% had cholesterol <200 mg/dl; and about 90% had blood pressure <140/90 mmHg. Obesity remained constant at 50%. The proportion of patients with late-stage complications increased from 1% at baseline to 7% at 1 year, 14% at 2 years and 15% at 3 years. CONCLUSION: Nuzha PHC Clinic was able to monitor a cohort of DM patients for 3 years using E-Health and the principles of cohort analysis. This further endorses the use of cohort analysis for managing patients with DM and other non-communicable diseases.

What happens to Palestine refugees with diabetes mellitus in a primary healthcare centre in Jordan who fail to attend a quarterly clinic appointment?

OBJECTIVE: In a primary healthcare clinic in Jordan to determine: (i) treatment outcomes stratified by baseline characteristics of all patients with diabetes mellitus (DM) ever registered as of June 2012 and (ii) in those who failed to attend the clinic in the quarter (April-June 2012), the number who repeatedly did not attend in subsequent quarters up to 1 year later, again stratified by baseline characteristics. METHOD: A retrospective cohort study with treatment outcome data collected and analysed using e-health and the cohort analysis approach in UNRWA Nuzha Primary Health Care Clinic for Palestine refugees, Amman, Jordan. RESULTS: As of June 2012, there were 2974 patients with DM ever registered, of whom 2246 (76%) attended the clinic, 279 (9%) did not attend, 81 (3%) died, 67 (2%) were transferred out and 301 (10%) were lost to follow-up. A higher proportion of males and patients with undetermined or poor disease control failed to attend the clinic compared with those who attended the clinic. Of the 279 patients who did not attend the clinic in quarter 2, 2012, 144 (52%) were never seen for four consecutive quarters and were therefore defined as lost to follow-up. There were a few differences between patients who were lost to follow-up and those who re-attended at another visit that included some variation in age and fewer disease-related complications amongst those who were lost to follow-up. CONCLUSION: This study endorses the value of e-health and cohort analysis for monitoring and managing patients with DM. Just over half of patients who fail to attend a scheduled quarterly appointment are declared lost to follow-up 1 year later, and systems need to be set up to identify and contact such patients so that those who are late for their appointments can be brought back to care and those who might have died or silently transferred out can be correctly recorded.

An anti-inflammatory bundle may help avoid opioids for low-risk outpatient procedures.

BACKGROUND: Currently, over half of drug overdose deaths are due to opioids. Opioid alternatives may be prescribed to help curb the opioid epidemic. However, little is known about their efficacy for acute postoperative pain. METHODS: We studied patients who underwent low-risk outpatient surgery. Perioperatively, all patients were started on an anti-inflammatory bundle consisting of multimodal pain remedies. Opioids were available to the patients postoperatively. Pain scores and opioid use were recorded. RESULTS: Over 18 months, 120 patients underwent low-risk outpatient surgery and all used the anti-inflammatory bundle. All patients had a significant decrease in postoperative pain scores (p = 0.001). There was no significant difference in postoperative pain scores between those who followed the anti-inflammatory bundle alone and those who also used opioids (mean 2.2 vs 3.1/10). Twenty-five (21%) patients were using opioids preoperatively and 50 (42%) postoperatively. Of those using opioids preoperatively, six (24%) patients used the anti-inflammatory bundle alone and avoided opioids postoperatively. CONCLUSIONS: For 58% of our patients, an anti-inflammatory bundle alone provided adequate pain control after a low-risk outpatient operation, such as hernia repair. Our practice uses the anti-inflammatory bundle for all patients. Our goal is to reduce both the need for opioids and the surgeon's contribution to the opioid epidemic.

The Diagnostic and Prognostic Significance of EFEMP1 in Breast Cancer: An Immunohistochemistry Study.

EGF-containing fibulin-like extracellular matrix protein 1 (EFEMP1) has been associated to a variety of malignancies. Because EFEMP1 can act as both a tumor suppressor and an oncogene, this study aimed to evaluate the expression of EFEMP1 at mRNA and protein in breast cancer and to ascertain the diagnostic and prognostic value of EFEMP1 in relation to clinical features of breast cancer. Several bioinformatics websites such as GEPIA and Oncomine databases were used to analyze the mRNA level of EFEMP1. Immunohistochemistry assay was used to detect EFEMP1 immunoexpression using tissue microarray (TMA) and clinical breast cancer samples. EFEMP1 was shown to be overexpressed in breast cancer in some study cohorts while being low expressed in others. In TMA, 86 patients (39.1%) with a high H-score and 134 patients (60.9%) with a low H-score had EFEMP1 positive for breast cancer. While HER2 breast cancer and normal breast tissues had the lowest expression of EFEMP1, it was shown to be highly expressed in Luminal B, A, and TNBC. EFEMP1 H-score is associated with tumor stage and indicates poor overall survival in breast cancer. EFEMP1 H-score was high in the clinical tumor tissues compared with adjacent normal tissue (n = 20), therefore, it would to be a sensitive biomarker for breast cancer. EFEMP1 is a key indicator for assessing the clinical prognosis and diagnosis of patients with breast cancer, as evidenced by the higher expression of EFEMP1 in tumor tissue compared to normal tissue and its association with poor overall survival.

Abdominal peer learning: advantages and lessons learned.

In 2017, our tertiary hospital-based imaging practice transitioned from score-based peer review to the peer learning methodology for learning and improvement. In our subspecialized practice, peer learning submissions are reviewed by domain experts, who then provide feedback to individual radiologists, curate cases for group learning sessions, and develop associated improvement initiatives. In this paper, we share lessons learned from our abdominal imaging peer learning submissions with the assumption that trends in our practice likely mimic others', and hope that other practices can avoid future errors and elevate the level of the quality of their own performance. Adoption of a nonjudgmental and efficient method to share peer "learning opportunities" and "great calls" has increased participation in this activity and increased transparency into our practice, thus allowing for visualization of trends in performance. Peer learning allows us to bring our own individual knowledge and practices together for group review in a collegial and safe environment. We learn from each other and decide how to improve together.

The effect of vagotomy on c-fos expression in the reticular formation areas following cystometry in cyclophosphamide-induced cystitis in rats.

BACKGROUND: The involvement of the vagus nerve in the supraspinal neural circuits that control the urinary bladder function, especially during pathological conditions, became increasingly evident. However, the role of brainstem areas in these circuits is not studied yet. METHODS: In the present study, using c-fos immunohistochemistry, the roles of the vagus nerve to the responses of the reticular formation to cystometry in cyclophosphamide-treated rats were investigated. RESULTS: Cyclophosphamide treatment significantly increased the c-fos expression in the lateral reticular nucleus (LRt), lateral paragigantocellular nucleus (LPGi), caudal part of the ventrolateral reticular nucleus (CVL), and gigantocellular reticular nucleus (Gi) following cystometry. However, cyclophosphamide treatment didn't have significant effect on c-fos expression in ventrolateral reticular nucleus (VL), rostral part of VL (RVL), raphe pallidus nucleus (RPa), and raphe obscurus nucleus (Rob). Vagotomy significantly demolished the effect of cyclophosphamide in the LRt and LPGi areas without having any significant effect on other reticular formation areas. Whereas, in comparison to normal animals, the vagotomised animals didn't show any significant changes in c-fos expression. CONCLUSION: The results of this study demonstrate the involvement of the reticular formation areas, particularly the ventral part, in processing urinary bladder function under cystitis condition. It also demonstrates the contribution of the vagus nerve in these processes.

Myositis ossificans of the chest wall in an 8-year-old boy: a case report of a diagnostic pitfall.

Myositis ossificans of the chest wall is extremely unusual with fewer than a dozen reported cases. In addition, the occurrence in children younger than 10 years is extremely rare. We report a case of an 8-year-old male who presented with painful and progressively enlarging left-sided chest wall mass. The tumor showed close histo-morphological mimicry with osteosarcoma. Moreover, the characteristic radiographic findings of myositis ossificans were absent. The age of the patient and the absence of attachment to the rib helped exclude extra-skeletal and parosteal osteosarcomas, respectively. The patient was doing well 4 months after surgery.

The Impact of DTYMK as a Prognostic Marker in Colorectal Cancer.

Background: Overexpression of deoxythymidylate kinase (DTYMK) has been associated with more aggressiveness and pathological behaviors in hepatocellular carcinoma (HCC) and non-small cell lung cancer (NSCLC). However, the expression of DTYMK and its prognostic significance in colorectal cancer (CRC) patients are yet unknown. The goal of this study was to investigate the DTYMK immunohistochemistry reactivity in CRC tissues and to see how it correlated with various histological and clinical features as well as survival. Methods: Several bioinformatics databases and two tissue microarrays (TMAs) of 227 cases were used in this study. Immunohistochemistry assay was used to study the protein expression of DTYMK. Results: Based on the GEPIA, UALCAN, and Oncomine databases, DTYMK expression has increased in tumor tissues at both RNA and protein levels in colorectal adenocarcinoma (COAD) compared to normal tissues. A high DTYMK H-score was found in 122/227 (53%) of the cases, whereas a low DTYMK H-score was found in 105/227. The age at diagnosis (P = 0.036), stage of the disease (P = 0.038), and site of origin (P = 0.032) were all linked to a high DTYMK H-score. Patients with high level of DTYMK had bad overall survival. Interestingly, high DTYMK protein level was associated with PSM2 (P = 0.002) and MSH2 (P = 0.003), but not with MLH2 or MSH6. Conclusion: This is the first study to cover the expression and prognostic significance of DTYMK in CRC. DTYMK was upregulated in CRC and could be considered as a prognostic biomarker.

Cohort monitoring of persons with diabetes mellitus in a primary healthcare clinic for Palestine refugees in Jordan.

OBJECTIVE: To illustrate the method of cohort reporting of persons with diabetes mellitus (DM) in a primary healthcare clinic in Amman, Jordan, serving Palestine refugees with the aim of improving quality of DM care services. METHOD: A descriptive study using quarterly and cumulative case findings, as well as cumulative and 12-month analyses of cohort outcomes collected through E-Health in UNRWA Nuzha Primary Health Care Clinic. RESULTS: There were 55 newly registered patients with DM in quarter 1, 2012, and a total of 2851 patients with DM ever registered on E-Health because this was established in 2009. By 31 March 2012, 70% of 2851 patients were alive in care, 18% had failed to present to a healthcare worker in the last 3 months and the remainder had died, transferred out or were lost to follow-up. Cumulative and 12-month cohort outcome analysis indicated deficiencies in several components of clinical care: measurement of blood pressure, annual assessments for foot care and blood tests for glucose, cholesterol and renal function. 10-20% of patients with DM in the different cohorts had serious late complications such as blindness, stroke, cardiovascular disease and amputations. CONCLUSION: Cohort analysis provides data about incidence and prevalence of DM at the clinic level, clinical management performance and prevalence of serious morbidity. It needs to be more widely applied for the monitoring and management of non-communicable chronic diseases.

Cohort monitoring of persons with hypertension: an illustrated example from a primary healthcare clinic for Palestine refugees in Jordan.

OBJECTIVE: Recording and reporting systems borrowed from the DOTS framework for tuberculosis control can be used to record, monitor and report on chronic disease. In a primary healthcare clinic run by UNRWA in Amman, Jordan, serving Palestine refugees with hypertension, we set out to illustrate the method of cohort reporting for persons with hypertension by presenting on quarterly and cumulative case finding, cumulative and 12-month analysis of cohort outcomes and to assess how these data may inform and improve the quality of hypertension care services. METHOD: This was a descriptive study using routine programme data collected through E-Health. RESULTS: There were 97 newly registered patients with hypertension in quarter 1, 2012, and a total of 4130 patients with hypertension ever registered since E-Health started in October 2009. By 31 March 2012, 3119 (76%) of 4130 patients were retained in care, 878 (21%) had failed to present to a healthcare worker in the last 3 months and the remainder had died, transferred out or were lost to follow-up. Cumulative and 12-month cohort outcome analysis indicated deficiencies in several components of clinical performance related to blood pressure measurements and fasting blood glucose tests to screen simultaneously for diabetes. Between 8% and 15% of patients with HT had serious complications such as cardiovascular disease and stroke. CONCLUSION: Cohort analysis is a valuable tool for the monitoring and management of non-communicable chronic diseases such as HT.

Intraosseous inflammatory pseudotumor of the maxilla: A case report.

Inflammatory pseudotumors are benign lesions that are rarely reported in the head and neck. Moreover, intraosseous inflammatory pseudotumors of the maxilla are extremely rare, with less than 10 cases reported. A 52-year-old woman presented with recurrent dental infections; computed tomography scan of the osteolytic maxillary bone lesion and incisional biopsy were performed. Histopathological examination revealed that the lesion was composed of fascicles of fibroblasts and myofibroblasts, in addition to sheets of plasma cells, lymphocytes, and occasional other inflammatory cells. An infiltrative growth pattern was observed. Immunohistochemical staining confirmed an inflammatory pseudotumor. A partial maxillectomy was performed. There was no evidence of recurrence during the 4-month follow-up period. Inflammatory pseudotumors should be considered when treating destructive maxillary lesions. Immunohistochemical staining was performed to confirm polyclonal plasma cell proliferation.

A radiologist's guide to novel anticancer therapies in the era of precision medicine.

Novel anticancer agents have replaced conventional chemotherapy as first line agents for many cancers, with continued new and expanding indications. Small molecule inhibitors act on cell surface or intracellular targets and prevent the downstream signaling that would otherwise permit tumor growth and spread. Anticancer antibodies can be directed against growth factors or may be immunotherapeutic agents. The latter act by inhibiting mechanisms that cancer cells use to evade the immune system. Hormonal agents act by decreasing levels of hormones that are necessary for the growth of certain cancer cells. Cancer therapy protocols often include novel anticancer agents and conventional chemotherapy used successively or in combination, in order to maximize survival and minimize morbidity. A working knowledge of anti-cancer drug classification will aid the radiologist in assessing response on imaging.

Importance of tumor subtypes in cancer imaging.

Cancer therapy has evolved from being broadly directed towards tumor types, to highly specific treatment protocols that target individual molecular subtypes of tumors. With the ever-increasing data on imaging characteristics of tumor subtypes and advancements in imaging techniques, it is now often possible for radiologists to differentiate tumor subtypes on imaging. Armed with this knowledge, radiologists may be able to provide specific information that can obviate the need for invasive methods to identify tumor subtypes. Different tumor subtypes also differ in their patterns of metastatic spread. Awareness of these differences can direct radiologists to relevant anatomical sites to screen for early metastases that may otherwise be difficult to detect during cursory inspection. Likewise, this knowledge will help radiologists to interpret indeterminate findings in a more specific manner.

Live in Front of Students Teaching Sessions (LISTS): a Novel Learning Experience from Jordan During the COVID-19 Pandemic.

Objective: The COVID-19 pandemic uncovered innovative approaches in medical education. Modifications are needed to overcome the drawbacks of pure online teaching. Our study aimed at testing a hybrid method of live online practical anatomy sessions in which an element of face-to-face teacher-student interaction is maintained. Methods: We performed an experiment with a one-group design in which medical and medical laboratory sciences students were taught different practical anatomy topics using either purely online or live in front of students teaching sessions (LISTS). Students' performance and perceptions were quantitatively assessed. Results: For 108 medical laboratory sciences students, the mean quiz scores were significantly higher for the topics taught by the LISTS approach (p = 0.025). For two groups of 13 and 17 medical students, the performance in exams was significantly higher for the topics taught using the LISTS method (p = 0.000 and 0.011, respectively) with large effect sizes. Students' perceptions of preference, enjoyment, and satisfaction were all in favor of LISTS. Conclusions: Our results confirmed that keeping at least a minimum of interaction between the teacher and students can have a significant improvement in the performance and engagement in practical anatomy sessions for health professionals. The results indicate that the extra effort of LISTS was worth it.