Virtual versus paper-based PBL in a pulmonology course for medical undergraduates.

BACKGROUND: Problem-based learning (PBL) remains a valid and effective tool for small-group medical education. Using Virtual patients (VP) case simulation in PBL is a recognizable educational method that has successfully prepared students to focus learning on core information that uses realistic patient-based cases relating to everyday clinical scenarios. Using other modalities as the virtual patient in PBL instead of the paper-based methods remains debatable. This study aimed to evaluate the effectiveness of using VP case simulation mannequin in PBL versus the PBL in paper-based cases in improving the cognitive skills by comparing the grades of a multiple-choice question test and assess its ability to reach students' satisfaction using questionnaire with Likert survey instrument. METHODS: The study was conducted on 459 fourth-year medical students studying in the pulmonology module of the internal medicine course, Faculty of Medicine, October 6 University. All students were divided into 16 PBL classes and randomly divided into groups A and B by simple manual randomization. The groups were parallel with a controlled cross-over study between paper-based and virtual patient PBL. RESULTS: The pre-test showed no significant difference between both, while post-test scores were significantly higher in both VP PBL cases 1 discussing COPD (6.25 ± 0.875) and case 2 discussing pneumonia (6.56 ± 1.396) compared to paper-based PBL (5.29 ± 1.166, 5.57 ± SD1.388, respectively) at p < 0.1 When students in Group A experienced PBL using VP in case 2 after paper-based PBL in case 1, their post-test score improved significantly. (from 5.26 to 6.56, p < .01). Meanwhile, there was a significant regression in the post-test score of the students in Group B when they experienced the paper-based PBL session in case 2 after using PBL using VP in case 1, (from 6.26 to 5.57, p < .01). Most of the students recommended using VP in PBL as they found VP was more engaging and inducing concentration in gathering the information needed to characterize the patient's problem than in a classroom- paper-based cases session. They also enjoyed the teaching of the instructor and found it a suitable learning style for them. CONCLUSION: Implementing virtual patients in PBL increased knowledge acquisition and understanding in medical students and was more motivating for students than paper based PBL to gather the needed information.

Subacute right ventricle perforation: a pacemaker lead complication.

Myocardial perforation is an uncommon but potentially life-threatening complication of pacemaker and implantable cardioverter-defibrillator. Myocardial perforation may be acute, subacute or chronic when it occurs within 24 hours of the device insertion; between 1 day and 30 days; and more than 30 days after implantation. This complication may occur in 1.7%-7% of patients. However, subacute myocardial perforation is rare and affects 0.5%-1.2% of patients. We report the case of an 85-year-old patient with a pacemaker failure 10 days after implantation due to a subacute myocardial perforation caused by an active fixation ventricular lead. Transthoracic echocardiography showed penetration of the ventricular lead through the right ventricular apex into the pericardium without any pericardial effusion. We confirmed myocardial perforation by a CT scan. We referred her to the surgery ward where she was successfully managed.

Antimicrobial properties, compressive strength and fluoride release capacity of essential oil-modified glass ionomer cements-an in vitro study.

OBJECTIVES: This study was designed to investigate the antimicrobial properties, compressive strength and fluoride release capacities of high-viscous glass ionomer cements (GICs) after incorporation of cinnamon and thyme essential oils. MATERIALS AND METHODS: Experimental-modified GICs were prepared by incorporation of thyme and cinnamon essential oils into the liquid phase of the cement at 5 and 10% v/v. Antimicrobial activity against selected microorganisms (Streptococcus mutans and Candida albicans) was done using direct contact test. Compressive strength of the four new formulations and control group was tested using a universal testing machine while fluoride ion release was measured by ion-selective electrode at 1, 7, 14 and 28 days. Data analysis and comparisons between groups were performed using factorial and one-way ANOVA and Tukey's tests. RESULTS: All newly formulated GICs exhibited significantly higher inhibitory effects against both Streptococcus mutans and Candida albicans growth when compared to conventional GIC (p < 0.05). Compressive strength of 5% cinnamon-modified GIC (MPa = 160.32 ± 6.66) showed no significant difference when compared with conventional GIC (MPa = 165.7 ± 5.769) (p value > 0.05). Cumulative fluoride-releasing pattern at days 7, 14, and 28 were 10% cinnamon-GIC > 5% thyme-GIC > 5% cinnamon-GIC > 10% thyme GIC > conventional GIC. CONCLUSIONS: Incorporation of 5% cinnamon oil into glass ionomer resulted in better antimicrobial effects against S. mutans and C. albicans and increased fluoride-release capacity without jeopardizing its compressive strength. CLINICAL RELEVANCE: The 5% cinnamon-modified GIC appears to be a promising alternative restorative material in ART technique.

1,3,4-oxadiazole/chalcone hybrids: Design, synthesis, and inhibition of leukemia cell growth and EGFR, Src, IL-6 and STAT3 activities.

A new series of 1,3,4-oxadiazole/chalcone hybrids was designed, synthesized, identified with different spectroscopic techniques and biologically evaluated as inhibitors of EGFR, Src, and IL-6. The synthesized compounds showed promising anticancer activity, particularly against leukemia, with 8v being the most potent. The synthesized compounds exhibited strong to moderate cytotoxic activities against K-562, KG-1a, and Jurkat leukemia cell lines in MTT assays. Compound 8v showed the strongest cytotoxic activity with IC50 of 1.95 µM, 2.36 µM and 3.45 µM against K-562, Jurkat and KG-1a leukemia cell lines, respectively. Moreover; the synthesized compounds inhibited EGFR, Src, and IL-6. Compound 8v was most effective at inhibiting EGFR (IC50 = 0.24 µM), Src (IC50 = 0.96 µM), and IL-6 (% of control = 20%). Additionally, most of the compounds decreased STAT3 activation.

Associations among two vitamin D receptor (VDR) gene polymorphisms (ApaI and TaqI) in acne vulgaris: A pilot susceptibility study.

BACKGROUND: Acne vulgaris (AV) pathogenesis is multifactorial. Vitamin D (VitD) plays an important role in sebocytes' differentiation and function. Most VitD functions are mediated by the nuclear VitD receptor (VDR) following binding of its biologically active form (1,25 dihydroxyvitamin D3). Genetic variations in VDR gene may cause significant receptor dysfunction and have been found to be associated with many inflammatory skin diseases. Two adjacent single nucleotide polymorphisms of VDR, ApaI (rs7975232) and TaqI (rs731236), were commonly studied. OBJECTIVE: To evaluate the association between VDR ApaI and TaqI gene polymorphism and AV. METHODS: This case control study included 30 Egyptian acne patients who attended Dermatology Outpatient Clinic of Al-Zahraa University and Misr University for Science and Technology Hospitals. Thirty age- and sex-matched healthy individuals participated as controls. VDR gene ApaI and TaqI polymorphisms were examined by polymerase chain reaction restriction fragment length polymorphism. Serum 25(OH)D was measured in all participants. RESULTS: Patients had significant decrease in ApaI A allele and AATT combined genotype (60%, 3.3%) than controls (78.3%, 20%), respectively, and significant increase in TaqI tt genotype and t allele (46.7%, 63.3%) than controls (13.3%, 41.7%), respectively. Patients showed significantly lower serum 25(OH)D3 concentration than controls. CONCLUSION: Polymorphisms of ApaI and TaqI may have a role in the pathogenesis of AV as A allele and AATT combined genotype could be considered protective against acne development and tt genotype and t allele may increase the risk of AV development. VitD deficiency can be considered as a risk factor for AV development.

Diagnostic value of anti-microbial peptide, cathelicidin in congenital pneumonia.

OBJECTIVE: To evaluate the diagnostic value of anti-microbial peptide (cathelicidin), LL-37, in congenital pneumonia and its relation to 25 hydroxycholecalciferol [(25 OH)D] status. METHODS: The study included 30 neonates with congenital pneumonia and culture proven sepsis admitted to neonatal intensive care unit of Ain Shams University and 30 healthy neonates as control group. All neonates were subjected to history taking, clinical examination and measurement of serum 25(OH)D and cathelicidin. RESULTS: Neonates with congenital pneumonia had significantly higher serum cathelicidin and lower serum 25(OH)D compared to controls. Serum cathelicidin was negatively correlated with Apgar score at 1 and 5 min and positively correlated with length of stay among patient group. CONCLUSION: Cut-off value of cathelicidin to diagnose congenital pneumonia was 17 pg/mmol with 93% sensitivity and 86% specificity. Neonates with congenital pneumonia had significantly high cathelicidin and low 25(OH)D suggesting a possible role of fetal 25(OH)D deficiency as predisposing factor for congenital pneumonia.

CD4+CD25+ T regulatory cells and MMP-9 as diagnostic salivary biomarkers in oral lichen planus.

Oral lichen planus (OLP) is a chronic inflammatory disease characterized by a dense subepithelial lymphocytic infiltrate, degeneration of basal keratinocytes and basement membrane disruption. Non-specific mechanisms include mast cell degranulation and matrix metalloproteinase (MMP) activation in OLP lesions. These mechanisms may combine to cause T-cell accumulation in the superficial lamina propria, basement membrane disruption, intra-epithelial T-cell migration, and keratinocyte apoptosis in OLP. Obviously, abnormality of immunological regulation may contribute to its pathogenesis. This study aimed at evaluating the role of salivary CD4+CD25+ T regulatory cells & Matrix Metalloproteinase-9 (MMP.9) as salivary biomarkers in patients with OLP. Twenty patients with various forms of OLP were investigated: 8 with bullous erosive form, 7 with atrophic and 5 with reticular forms. From each patient saliva was collected, and used for assessment of salivary T regulatory cells by immunoflourescent and MMP9 expression by quantitative RT-PCR. Nine out of the twenty patients showed CD4+CD25+ Tregs in saliva by immunoflourescent staining with sensitivity (90%), specificity (83.3%) and diagnostic accuracy (87.5%). molecular detection of salivary MMP-9 levels in CD4+CD25+ Tregs +ve cases showed a significant increase in CD4+CD25+ Tregs +ve cases. In conclusion, salivary CD4+CD25+ T regs and MMP-9 could be considered as sensitive and specific diagnostic & prognostic biomarkers in the detection of OLP.