Item Analysis of Multiple-Choice Question (MCQ)-Based Exam Efficiency Among Postgraduate Pediatric Medical Students: An Observational, Cross-Sectional Study From Saudi Arabia.

BACKGROUND: Several modalities of written examination have been employed in medical education, with multiple-choice questions (MCQs) being the most frequently used and preferred format. This underlines the need to regularly assess and monitor the quality of MCQs in medical exams. Such assessment of MCQs helps to ensure that these exams are well­designed and adequately powered to evaluate students' performance. Hence, the current study assessed the efficiency of an MCQ-based examination, in a cohort of pediatric post-graduate students in Saudi Arabia. METHODS: This observational, cross-sectional study examined the efficiency of MCQs in terms of their validity, reliability, difficulty index (DFI), discrimination index (DI), and distractor efficiency (DE). The exam consisted of a total of 48 MCQs, 144 distractors, a total score of 48, and no negative marking. RESULTS: The reliability index of 0.76 showed the consistency and reproducibility of the exam results. The exam had a DFI of 69.77%, indicating an overall moderate level of difficulty. The exam had a balanced mix of 23 easy (47.9%), 20 (41.7%) moderately difficult, and five (10.4%) tough questions. Twenty (41.6%) items had a DI of ≥0.3, indicating good discrimination of high and low performers, while the remaining 28 MCQs (58.3%) had a lower DI of ≤0.19, implying poor discriminative ability. The DE was 81.25%, indicating that the majority of distractors in the exam were functional. CONCLUSION: To the best of the author's knowledge, this is the first study among post-graduate pediatric students from Saudi Arabia, to present the results of item analysis of an MCQ-based exam. The study highlights the importance of optimizing the quality of MCQs by following established guidelines, to make MCQ-based clinical assessments more effective. It reiterates the importance of a reasonable DFI well aligned with students' knowledge levels, maximum distractor functionality, and an impactful DI, in developing high-quality MCQs.

Maternal supplementation of curcumin-olive oil nanocomposite improves uteroplacental blood flow, placental growth and antioxidant capacity in goats.

This experiment was designed to investigate the impact of curcumin-olive oil nanocomposite (CONC) supplementation on uteroplacental hemodynamics and ultrasonographic measurements as well as maternal oxidative status in midgestating goats. Twelve synchronized pregnant goats (85.58 ± 1.08 days of gestation; mean ± SD) were uniformly assigned to two groups (n = 6/group); the first group received daily oral supplementation of CONC (3 mg/kg body weight; nanocurcumin [NC] group) for 32 days, and the second group was offered physiological saline (control) following the NC group timeline. The goats of both groups were examined at 3-day intervals for middle uterine (MUA) and umbilical (UMA) arteries hemodynamics (pulsatility index [PI], resistive index [RI], systole/diastole [S/D] and blood flow rate [BFR]) and diameters, uteroplacental thickness (UPT), placentomes' diameter (PD) and echogenicity, steroid hormones (progesterone and estradiol 17ß), oxidative biomarkers (total antioxidant capacity [TAC], catalase [CAT], malondialdehyde [MDA]), nitric oxide (NO) and blood cells DNA integrity. The UPT (p = 0.012) and PD (p = 0.021) values were higher in the NC group than in their counterparts' control group (D11-32). There were increases in diameter (p = 0.021 and p = 0.012) and decreases (p = 0.021, p = 0.016 and p = 0.041 [MUA]; p = 0.015, p = 0.023 and p = 0.011 [UMA] respectively) in Doppler indices (PI, RI and S/D) of the MUA and UMA in the NC group compared to the control group (D14-32). On D20-32 (MUA) and D14-32 (UMA), the NC goats had higher BFR than the control group (p = 0.021, 0.018 respectively). The means of blood cells with fragmented DNA were lower (p = 0.022) in the NC group than in the control group on Days 8 and 21 postsupplementation. There were increases in CAT and NO (D20-32; p = 0.022 and p = 0.004 respectively), and TAC (D17-32; p = 0.007) levels in the NC goats compared to the control ones. The NC group had lower (p = 0.029) concentrations of MDA than the control group on Day 20 postsupplementation onward. In conclusion, oral supplementation of CONC improved uteroplacental blood flow and the antioxidant capacity of midgestating goats.

Approaches for Stereotactic Radiosurgery (SRS)/Stereotactic Radiotherapy (SRT) in brain metastases using different radiotherapy modalities (Feasibility study).

BACKGROUND: SRS and SRT are precise treatments for brain metastases, delivering high doses while minimizing doses to nearby organs. Modern linear accelerators enable the precise delivery of SRS/SRT using different modalities like three-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), and Rapid Arc (RA). OBJECTIVE: This study aims to compare dosimetric differences and evaluate the effectiveness of 3DCRT, IMRT, and Rapid Arc techniques in SRS/SRT for brain metastases. METHODS: 10 patients with brain metastases, 3 patients assigned for SRT, and 7 patients for SRS. For each patient, 3 treatment plans were generated using the Eclipse treatment planning system using different treatment modalities. RESULTS: No statistically significant differences were observed among the three techniques in the homogeneity index (HI), maximum D2%, and minimum D98% doses for the target, with a p > 0.05. The RA demonstrated a better conformity index of 1.14±0.25 than both IMRT 1.21±0.26 and 3DCRT 1.37±0.31. 3DCRT and IMRT had lower Gradient Index values compared to RA, suggesting that they achieved a better dose gradient than RA. The mean treatment time decreased by 26.2% and 10.3% for 3DCRT and RA, respectively, compared to IMRT. In organs at risk, 3DCRT had lower maximum doses than IMRT and RA, but some differences were not statistically significant. However, in the brain stem and brain tissues, RA exhibited lower maximum doses compared to IMRT and 3DCRT. Additionally, RA and IMRT had lower V15Gy, V12Gy, and V9Gy values compared to 3DCRT. CONCLUSION: While 3D-CRT delivered lower doses to organs at risk, RA and IMRT provided better conformity and target coverage. RA effectively controlled the maximum dose and irradiated volume of normal brain tissue. Overall, these findings indicate that 3DCRT, RA, and IMRT are suitable for treating brain metastases in SRS/SRT due to their improved dose conformity and target coverage while minimizing dose to healthy tissues.

Anatomical, histological, and histochemical alterations in portio vaginalis uteri with an evaluation of the vaginal artery vascularity during the luteal and early pregnant stages in domestic buffaloes (Bubalus bubalis).

The portio-vaginalis uteri (PVU) and its mucus secretion have shown an essential role in conception. A significant endeavour to improve buffaloes' reproductive efficiency is the investigation of their basic reproductive pattern, which provides a reference for applications in breeding and pregnancy. The present study aimed to evaluate the anatomical and histological alterations in PVU regarding to the vaginal artery (VA) hemodynamic at luteal and early pregnant stages in buffalos. Egyptian live buffaloes (n = 16) and fresh genitals (n = 25) of mature buffalo were used. Different luteal and early pregnant stages were macroscopically identified with the shape and mucosal colouration with discharges of the PVU. Histological examination showed a significant difference in area % of alcian blue and periodic acid Schiff positive granules which considered an indication for presence of acidic and neutral mucins respectively in the epithelial cells of PVU mucosa which increased in pregnant stage than in other luteal stages. VA assessment demonstrated an increase in luminal diameter and thickness of tunica muscularis in pregnant stage than other stages (P < 0.05). Middle uterine (MUA) and VA arteries peak velocity point (PSV mm/sec) were elevated (P < 0.05) in pregnant stage, with a marked reduction in both resistance and pulsatility indices (RI and PI), and ratio of systolic /diastolic (S/D). Positive correlation was detected between VA. PSV and, MUA. PSV (r = 0.87), but a negative relation was detected with VA. S/D (r = -0.77), VA.PI (r = -0.89), VA. RI (r = -0.97), MUA. S/D (r = -0.94), MUA. PI (r = -0.85), and MUA. RI (r = -0.88). Doppler indices were negatively corrected with the VA. PSV (r = -0.68). It was concluded that there was a significant alterations in histological features of the cervical PVU at different physiological stages (luteal and early pregnant) in buffalos in relation to the MUA and VA hemodynamic pattern and that hypotheses can be established regarding the female cyclicity that affected by both arteries hemodynamics change.

Effect of pentoxifylline on the testicular hemodynamic, volume, testosterone, nitric oxide levels and semen quality in Ossimi rams during non breeding-season.

During the non-breeding season, Ossimi rams have testicular regression, including reductions in blood flow, size and spermatogenesis. The objective was to determine the effect of pentoxifylline (PTX) on Ossimi rams during the non-breeding season. Fifteen sexually mature Ossimi rams were allotted to three groups: (1) G0 (n = 5) control group (basic diet, no PTX); (2) G1 (n = 5) 10 mg/kg BW PTX; and (3) G2 (n = 5) 20 mg/kg BW PTX. The PTX was given orally once daily for 7 weeks (wk1 to wk7), whereas ultrasonographic assessment of testes, and collection of semen and blood started 1 week before PTX and were done weekly for 8 weeks (wk0 to wk7). In G2, there was a decrease(P < 0.05) in both Doppler indices (resistive index, pulsatility index) in G2 from wk2 to wk4 and an increase(P < 0.05) in ultrasonographic testicular coloration from wk2 to wk7. Moreover, G2 had the highest (P < 0.05) testicular volume (wk5 to wk7), individual motility, sperm viability and acrosome integrity (wk4 to wk7) and sperm cell concentration (wk6 and wk7). Blood concentrations of testosterone and nitric oxide were increased (P < 0.05) concurrent with decreased Doppler indices. In conclusion, PTX enhanced testicular blood flow and volume, semen quality, and concentrations of testosterone and nitric oxide potential in Ossimi rams during the non-breeding season, with potential to ameliorate deleterious effects of heat stress and perhaps enhance ram fertility.

Efficacy of Intratesticular Glycerol Injection as Male Cat Contraception in Comparison with Two Surgical Approaches.

The objectives of the current study were to compare the use of a single bilateral intratesticular injection of 2 different volumes of glycerol 70% (0.5 and 1.0 mL) as a method of chemical sterilization and the application of 2 surgical procedures (orchiectomy and vasoligation). Animals were classified into 4 groups. Group 1:10 cats were subjected to a conventional bilateral orchidectomy. Group 2:6 cats were subjected to a bilateral vasoligation of the testicular blood supply without removing the testicles. Group 3:7 cats were subjected to a single intratesticular injection of 0.5 mL glycerol bilaterally and Group 4:7 cats were subjected to a single intratesticular injection of 1.0 mL glycerol bilaterally. Serum testosterone concentration (ng/mL) and average testicular length (cm) were measured just before (control) and weekly after orchiectomy (only serum testosterone concentration), vasoligation, and intratesticular treatment for 3 consecutive weeks. After 2 months from testicular vasoligation (group 2) and intratesticular administration (group 3 and 4), castration was performed for all cats. The epididymal sperm count and the histopathological findings were recorded for all groups after the orchidectomy. In group 2 serum testosterone level was significantly (P ˂ .01) decreased from (4.14 ± 1.10 ng/mL) before vasoligation (control) to (1.71 ± 0.34 ng/mL) 3 weeks postoperation. In group 4 a significant (P ˂ .01) decrease in serum testosterone concentration was recorded 2 and 3 weeks postinjection (1.41 ± 0.31 and 1.32 ± 0.21 ng/mL, respectively). There was a significant decrease in the testicular length 1 week after the vasoligation (group 2) and the testicular treatment (group 4) compared with preoperative controls of the 2 groups. Besides, the epididymal samples collected from groups (2 and 4) showed azoospermia. In conclusion, a bilateral intratesticular injection of 1.0 mL glycerol (70%) as a chemical method of tomcat sterilization can replace the surgical orchidectomy besides being less invasive and less traumatic and gave better results than using the intratesticular injection of 0.5 mL glycerol.

Endoscopic papillary large balloon dilatation for the extraction of common bile duct stones

Background and aim: endoscopic papillary large balloon dilatation (EPLBD) is increasingly accepted as an appropriate option for the management of difficult common bile duct stones (CBDS). This study aimed to evaluate the safety and efficacy of EPLBD with a relatively large balloon (15-20 mm) for the extraction of difficult CBDS. Patients and methods: a total of 40 patients were recruited with obstructive jaundice and dilated CBD (≥ 10 mm) subsequent to a single large CBDS of ≥ 10 mm or multiple stones (≥ 3). All patients underwent endoscopic retrograde cholangio-pancreatography (ERCP) with limited sphincterotomy and large balloon dilatation followed by stone extraction using an extraction balloon or dormia basket, without lithotripsy, stenting or further ERCP sessions. Results: successful stone extraction was achieved in 34 patients (85%) and stone extraction failure occurred in six patients (15%). Complications included minimal pancreatitis in four cases (10%), mild pancreatitis in two cases (5%), cholangitis in two cases (5%) and bleeding in two cases (5%). There were no recorded cases of perforation or mortality subsequent to the procedure. Conclusion: EPLBD is a safe and efficient procedure for the extraction of difficult CBDS and may be advisable in patients with a bleeding risk or abnormal papillary anatomy

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Endoscopic papillary large balloon dilatation for the extraction of common bile duct stones.

BACKGROUND AND AIM: endoscopic papillary large balloon dilatation (EPLBD) is increasingly accepted as an appropriate option for the management of difficult common bile duct stones (CBDS). This study aimed to evaluate the safety and efficacy of EPLBD with a relatively large balloon (15-20 mm) for the extraction of difficult CBDS. PATIENTS AND METHODS: a total of 40 patients were recruited with obstructive jaundice and dilated CBD (≥ 10 mm) subsequent to a single large CBDS of ≥ 10 mm or multiple stones (≥ 3). All patients underwent endoscopic retrograde cholangio-pancreatography (ERCP) with limited sphincterotomy and large balloon dilatation followed by stone extraction using an extraction balloon or dormia basket, without lithotripsy, stenting or further ERCP sessions. RESULTS: successful stone extraction was achieved in 34 patients (85%) and stone extraction failure occurred in six patients (15%). Complications included minimal pancreatitis in four cases (10%), mild pancreatitis in two cases (5%), cholangitis in two cases (5%) and bleeding in two cases (5%). There were no recorded cases of perforation or mortality subsequent to the procedure. CONCLUSION: EPLBD is a safe and efficient procedure for the extraction of difficult CBDS and may be advisable in patients with a bleeding risk or abnormal papillary anatomy.

Comparative Study between Measurement Data and Treatment Planning System (TPS) in Small Fields for High Energy Photon Beams.

To achieve tumor control for radiotherapy, a dose distribution is planned which has a good chance of sterilizing all cancer cells without causing unacceptable normal tissue complications. The aim of the present study was to achieve an accurate calculation of dose for small field dimensions and perform this by evaluating the accuracy of planning system calculation. This will be compared with real measurement of dose for the same small field dimensions using different detectors. Practical work was performed in two steps: (i) determination of the physical factors required for dose estimation measured by three ionization chambers and calculated by treatment planning system (TPS) based on the latest technical report series (IAEATRS-398) and (ii) comparison of the calculated and measured data. Our data analysis for small field is irradiated by photon energy matched with the data obtained from the ionization chambers and the treatment planning system. Radiographic films were used as an additional detector for the obtained data and showed matching with TPS calculation. It can be concluded that studied small field dimensions were averaged 6% and 4% for 6 MV and 15 MV, respectively. Radiographic film measurements showed a variation in results within ±2% than TPS calculation.

Pegylated interferon de novo-induce autoimmune haemolytic anaemia in chronic hepatitis C patient.

A 55-year-old Egyptian woman with chronic hepatitis C undergoing treatment with pegylated interferon (Peg-IFN) alfa-2a plus ribavirin was referred to our hospital on November 2010 with prolonged easy fatigability and an attack of syncope; she had no prior history of autoimmune disorders or allergy. Laboratory investigations documented the presence of Peg-IFN induced autoimmune haemolytic anaemia and autoimmune thyroiditis. Intravenous γ globulin (IVGG) failed to correct the autoimmune process; on the other hand steroid therapy dramatically corrected both haematological and thyroid values, and step down the immune process. Our report indicated that Peg-IFN de novo-induce autoimmune haemolysis, documenting a previous report. IVGG failed to step down the immune process in our case.