Evidence of learning in workplace-based assessments in a Family Medicine Training Programme.

BACKGROUND:  Learning portfolios (LPs) provide evidence of workplace-based assessments (WPBAs) in clinical settings. The educational impact of LPs has been explored in high-income countries, but the use of portfolios and the types of assessments used for and of learning have not been adequately researched in sub-Saharan Africa. This study investigated the evidence of learning in registrars' LPs and the influence of the training district and year of training on assessments. METHODS:  A cross-sectional study evaluated 18 Family Medicine registrars' portfolios from study years 1-3 across five decentralised training sites affiliated with the University of the Witwatersrand. Descriptive statistics were calculated for the portfolio and quarterly assessment (QA) scores and self-reported clinical skills competence levels. The competence levels obtained from the portfolios and university records served as proxy measures for registrars' knowledge and skills. RESULTS:  The total LP median scores ranged from 59.9 to 81.0, and QAs median scores from 61.4 to 67.3 across training years. The total LP median scores ranged from 62.1 to 83.5 and 62.0 to 67.5, respectively in QAs across training districts. Registrars' competence levels across skill sets did not meet the required standards. Higher skills competence levels were reported in the women's health, child health, emergency care, clinical administration and teaching and learning domains. CONCLUSION:  The training district and training year influence workplace-based assessment (WPBA) effectiveness. Ongoing faculty development and registrar support are essential for WPBA.Contribution: This study contributes to the ongoing discussion of how to utilise WPBA in resource-constrained sub-Saharan settings.

Research Frameworks: Critical Components for Reporting Qualitative Health Care Research.

Qualitative health care research can provide insights into health care practices that quantitative studies cannot. However, the potential of qualitative research to improve health care is undermined by reporting that does not explain or justify the research questions and design. The vital role of research frameworks for designing and conducting quality research is widely accepted, but despite many articles and books on the topic, confusion persists about what constitutes an adequate underpinning framework, what to call it, and how to use one. This editorial clarifies some of the terminology and reinforces why research frameworks are essential for good-quality reporting of all research, especially qualitative research.

Workplace-based learning opportunities in a South African family medicine training programme.

BACKGROUND: Workplace-based learning (WBL) provides authentic learning opportunities to develop fit-for-practice healthcare workers. Different types of WBL opportunities have been described in high-income countries, but the opportunities in the district health systems of sub-Saharan Africa have not been characterised. AIM: This study explored family physicians' (FPs) and registrars' perceptions of WBL opportunities in a decentralised postgraduate family medicine registrar training programme. SETTING: The study was conducted at five decentralised training sites across two provinces affiliated with the University of the Witwatersrand in South Africa. METHODS: This instrumental case study involved semi-structured qualitative interviews with 11 FPs and 11 registrars purposively sampled across the training sites. The verbatim transcripts were thematically analysed using Braun and Clark's six-step approach. RESULTS: Workplace-based learning opportunities were grouped into four themes: Learning from interpersonal interactions, learning from district activities, self-directed learning and contextual influences on learning opportunities. Registrars learnt from patients, peers, FPs and other professionals. Feedback, self-reflection, portfolio use, involvement in various district events, such as student and staff teaching, and continuous medical education augmented learning. Contextual influences originated from health facilities, resource availability, district management and university support, excessive workload and a need for standardised district learning opportunities. CONCLUSION: Registrars are exposed to several types of WBL opportunities in district health systems. Effective engagement with available opportunities and addressing contextual challenges could enhance registrar learning.Contribution: Maximising learning opportunities to promote registrars' acquisition of required skills and competencies to efficiently address community needs in a middle-income country such as South Africa.

Medical students' views on what professionalism means: an Ubuntu perspective.

Medical training has become a global phenomenon, and the Physician's Charter (PC), as a missionary document, is key to training those outside the Global North. Undergraduate and postgraduate students in the medical profession are sometimes trained in contexts foreign to their social and ontological backgrounds. This might lead to confusion and blunders, creating an impression of what might look and feel unprofessional to those unfamiliar with the local context. Understanding the cultural backgrounds of the trainees is crucial, and the reverse is also as important. It is essential for clinicians and trainees to understand the cultural backgrounds of their patients to avoid miscommunication. In this phenomenological study, we recruited participants in 2020 who were in their first to fourth year of study of medical training during the #FeesMustFall protests. We used data from this extensive study looking at students' experiences during their training amidst protest and social upheavals in a South African tertiary institution. For this paper, we examined what professionalism means to the student participants using an African Ubuntu lens. Ubuntu and the Collective Finger theory were used to investigate what professionalism means to participants. The Ubuntu philosophy was compared to the PC. In the findings, the clinical space is hierarchical, silencing and the opposite of what Ubuntu means. In comparison to the PC, respect is overarching while compassion and responsibility are the most comparable to the Charter. This study adds an African voice to the professionalism discourse while showing African elements that could be aligned to the PC to challenge the current global discourses.

Transcriptomic classes of BCR-ABL1 lymphoblastic leukemia.

In BCR-ABL1 lymphoblastic leukemia, treatment heterogeneity to tyrosine kinase inhibitors (TKIs), especially in the absence of kinase domain mutations in BCR-ABL1, is poorly understood. Through deep molecular profiling, we uncovered three transcriptomic subtypes of BCR-ABL1 lymphoblastic leukemia, each representing a maturation arrest at a stage of B-cell progenitor differentiation. An earlier arrest was associated with lineage promiscuity, treatment refractoriness and poor patient outcomes. A later arrest was associated with lineage fidelity, durable leukemia remissions and improved patient outcomes. Each maturation arrest was marked by specific genomic events that control different transition points in B-cell development. Interestingly, these events were absent in BCR-ABL1+ preleukemic stem cells isolated from patients regardless of subtype, which supports that transcriptomic phenotypes are determined downstream of the leukemia-initialing event. Overall, our data indicate that treatment response and TKI efficacy are unexpected outcomes of the differentiation stage at which this leukemia transforms.

Graduates' Reflections on Professionalism and Identity: Intersections of Race, Gender, and Activism.

Phenomenon: Professionalism as a construct is weaponized to police and punish those who do not fit the norm of what a medical professional should look like or behave, more so when medical professionals in training engage in protests for social justice. In addition, professionalism silences trainees, forcing them not to question anything that looks or feels wrong in their eyes. Socialization in medicine, in both the undergraduate and postgraduate training spaces, poses challenges for contemporary medical professionals who are expected to fit the shape of the 'right kind of doctor.' Intersectionality seems to impact how medical trainees experience professionalism, be it intersections of gender, race, how they dress or adorn themselves, how they carry themselves and who they identify as. Although there is literature on the challenges pertaining to professionalism, not much has been written about the weaponization of professionalism in medical training, particularly in the South African context. There is also a paucity of data on experiences of professionalism during or after social upheaval. Approach: This is part of a study that explored the experiences of professionalism of five medical trainees during protests and after protests, extending into their postgraduate training. The main study had 13 participants, eight students and five graduates, who were all interviewed in 2020, five years after the #FeesMustFall protests. For the five postgraduate participants, we looked at how gender, race, hairstyles, adornment, and protests played out in the experiences of professionalism as medical trainees at a South African university. We employed a qualitative phenomenological approach. An intersectional analytical lens was used in analyzing the transcripts of the five graduate participants. Each transcript was translated as the story of that participant. These stories were compared, looking for commonalities and differences in terms of their experiences. Findings: The participants, four males (three Black and one white) and one Black female, were victimized or judged based on their activism for social justice, gender, and race. They were made to feel that having African hairstyles or piercings was not professional. Insights: Society and the medical profession has a narrow view of what a doctor should look like and behave - it should not be someone who wears their hair in locks, has body piercing, or is an activist, least of all if she is a woman, as professionalism is used as a weapon against all these characteristics. Inclusivity should be the norm in medical education.

A Case of an Atraumatic Posterior Perirenal Lumbar Hernia.

Retroperitoneal lumbar hernias are a rare entity. Atraumatic posterior perirenal hernias are an exceptionally rare form of retroperitoneal lumbar hernias. Because of their infrequency, there are no standardized methods of surgical care for the treatment of atraumatic (primary spontaneous) posterior perirenal hernias. This report documents the finding and management of an atraumatic posterior perirenal lumbar hernia in a 69-year-old female.

Rethinking professional identity formation amidst protests and social upheaval: a journey in Africa.

The under-representation of minoritized or previously oppressed groups in research challenges the current universal understanding of professional identity formation (PIF). To date, there has been no recognition of an African influence on PIF, which is crucial for understanding this phenomenon in places like South Africa, a society in which the inequity of the apartheid era still prevails. In addition, there is little data examining how social upheaval could impact PIF. This study uses interviews with medical students to explore PIF within the context of social upheaval during the 2015-2016 protests that rocked South Africa when students challenged asymmetries of power and privilege that persisted long after the country's democratic transition. The combination of the primary author's autoethnographic story, weaved into the South African sociohistorical context and ubuntu philosophy, contributes to this study of PIF in the South African context. The use of an African metaphor allowed the reorientation of PIF to reflect the influence of an ubuntu-based value system. Using the calabash as a metaphor, participants' experiences were framed and organized in two ways: a calabash worldview and the campus calabash. The calabash worldview is a multidimensional mixture of values that include ubuntu, reflections of traditional childhoods, and the image of women as igneous rocks, which recognizes the power and influence on PIF of the women who raised the participants. Introducing an African ubuntu-based perspective into the PIF discourse may redirect the acknowledgement of context and local reality in developing professional identity.

Single Mowing Event Does Not Reduce Abundance of Ixodes scapularis (Acari: Ixodidae) and Dermacentor variabilis (Acari: Ixodidae) on Recreational Hiking Trails.

Nuisance and medically important ticks can be abundant in a variety of forested landscapes, including recreational parks. Strategies to reduce the abundance of host-seeking ticks in high-use areas within parks are limited. Mowing vegetation is a recommended method to control ticks, but few studies have evaluated the efficacy of this practice. The goal of this study was to determine if a single mowing event could reduce the abundance of host-seeking ticks on recreational trails. Ticks were collected by dragging trails at three recreational parks in northern Minnesota during June and July, 2021. A pre-intervention sample was taken followed by six consecutive weeks of tick sampling. We encountered a total of 3,456 ticks (2,459 Ixodes scapularis Say and 997 Dermacentor variabilis L.) during the 7-week study period. There were no significant differences in the abundance of I. scapularis (adults) or D. variabilis (adults only) between control and mown trail sections. Mowing was a significant predictor of nymphal I. scapularis abundance but trended towards more ticks in mown sections compared to controls. These results suggest that a single mowing intervention during early June is likely to be ineffective as a strategy to reduce the risk of human contacts with ticks on trails.

Evaluating postgraduate family medicine supervisor feedback in registrars' learning portfolios.

BACKGROUND:  Postgraduate supervision forms a vital component of decentralised family medicine training. While the components of effective supervisory feedback have been explored in high-income countries, how this construct is delivered in resource-constrained low- to middle-income countries has not been investigated adequately. AIM:  This article evaluated supervisory feedback in family medicine registrars' learning portfolios (LPs) as captured in their learning plans and mini-Clinical Evaluation Exercise (mini-CEX) forms and whether the training district or the year of training affected the nature of the feedback. SETTING:  Registrars' LPs from 2020 across five decentralised sites affiliated with the University of the Witwatersrand in South Africa were analysed. METHODS:  Two modified tools were used to evaluate the quantity of the written feedback in 38 learning plans and 57 mini-CEX forms. Descriptive statistics, Fisher's exact and Wilcoxon rank-sum tests were used for analysis. Content analysis was used to derive counts of areas of feedback. RESULTS:  Most learning plans (61.2%) did not refer to registrars' clinical knowledge or offer an improvement strategy (86.1%). The 'extent of supervisors' feedback' was rated as 'poor' (63.2%), with only 14.0% rated as 'good.' The 'some' and 'no' feedback categories in the mini-CEX competencies (p  0.001 to p = 0.014) and the 'extent of supervisors' feedback' (p  0.001) were significantly associated with training district. Feedback focused less on clinical reasoning and negotiation skills. CONCLUSION:  Supervisors should provide specific and constructive narrative feedback and an action plan to improve registrars' future performance.Contribution: Supervisory feedback in postgraduate family medicine training needs overall improvement to develop skilled family physicians.

Perceptions of resources available for postgraduate family medicine training at a South African university.

BACKGROUND:  Clinical training is one of the roles of family physicians (FPs) in decentralised postgraduate training. Effective training requires skilled trainers and sufficient resources. Little is known about the resources available for decentralised clinical training in district health systems in low- to middle-income countries, especially in sub-Saharan Africa. AIM:  To explore FPs' and registrars' perceptions of the available resources in a decentralised postgraduate family medicine (FM) training programme. SETTING:  Five decentralised training sites affiliated with the University of the Witwatersrand across two provinces in South Africa. METHODS:  This qualitative study forms part of a broader project evaluating a FM registrar training programme using the logic model. Semistructured interviews were conducted with a purposive sample of 11 FPs and 11 registrars. The interviews were transcribed verbatim and analysed thematically. RESULTS:  Three themes were identified: 'Impact of resource constraints', 'Family physicians' skills and knowledge could be further improved' and 'Family physicians need additional support to optimise their training role'. The additional resources needed include more FPs, equipment, infrastructure and funding. Knowledge and skills of FPs were reported variable and needed further improvement. Additional support was required from peers, the district management and the university. CONCLUSION:  Well-resourced decentralised training environments with sufficient skilled trainers and adequate resources are needed to positively influence FP training and supervision, especially in middle-income countries like South Africa.Contribution: Clinical trainers need adequate resources and support from peers, district management and the university for effective decentralised clinical training.

Transitional Challenges and Role of Preceptor among New Nursing Graduates.

Introduction: The period of transition from nursing student to professional nurse is demanding. Most often the challenges among the novice nurses are attributed to the number of patients with complex illness and co-morbidities, inaccessible mentors, performance anxiety, communication difficulties, and blame/complaint culture. Transitional challenges could result in work dissatisfaction forcing novice nursing graduates to quit their jobs that result in a high turnover rate. The study aimed to identify the transitional challenges among new nursing graduates and the role of preceptor in various transitional challenges. Methods: The study adopted descriptive correlational design. The data were collected from 314 participants working in six different tertiary level public hospitals situated in six states of India. Casey-Fink graduate nurse experience survey-revised was used to collect the data and methods of this study were in line with the guidelines of Strengthening the Reporting of Observational studies in Epidemiology (STROBE). Descriptive and Inferential statistics were calculated using SPSS software version 16. Results: The study found that new nursing graduates are uncomfortable in performing numerous procedures independently and in accordance with them increased support would help them feel more supported or integrated into the unit. The study also found positive relationship between preceptor support and organizing and prioritizing, communication/leadership, professional satisfaction, and job satisfaction. Conclusion: New nursing graduates experience various challenges during their transition period in the areas of role expectation, confidence, workload, orientation, and fears. The preceptors and the nursing administrators needs to bring forth significant strategies to address these challenges.

Perceptions of postgraduate family medicine supervision at decentralised training sites, South Africa.

BACKGROUND:  Specialist training in family medicine (FM) is growing rapidly in sub-Saharan Africa. The strong emphasis on workplace-based learning for speciality training makes it vital to gain in-depth insights into registrar supervision. Previous studies have explored aspects of supervision at decentralised sites in high-income countries, however, little is known about the benefits and constraints of decentralised postgraduate supervision in low- to middle-income countries, especially in Africa. AIM:  This study aimed to explore family physicians' and registrars' perceptions of the strengths and challenges of clinical and educational supervision across decentralised training sites. SETTING:  The study was conducted across two provinces at five decentralised training sites affiliated with the University of the Witwatersrand, Johannesburg. METHODS:  This qualitative study involved semi-structured interviews with a purposive sample of 11 FPs and 11 registrars. The data were thematically analysed. RESULTS:  Two of the four themes identified, 'supervision is context-specific and supervisor-dependent', and 'the nature of engagement matters', involved strengths and challenges. The other two, 'supervision is not ideal' and 'the training environment is challenging', focussed on challenges. CONCLUSION:  Supervisors and registrars described the postgraduate FM supervision as context-specific and supervisor-dependent. Supervisors displayed good clinical-teacher characteristics and supervisory relationships. However, several challenges, including registrars' workload, resource shortages and a lack of standardisation across training sites, need to be addressed. Regular faculty development is essential for supervisors to be aware of relevant aspects of, and current trends in, postgraduate training.

Skeletal and dentoalveolar contributions during Class II correction with Forsus™ FRD appliances : Quantitative evaluation.

PURPOSE: Primary objective of the study is to quantify and evaluate the skeletal and dental contributions during sagittal Class II correction with the Forsus™ fatigue resistant device (FRD; 3M Unitek Corp., Monrovia, CA, USA). Secondary objective is to evaluate the overall vertical, soft tissue and chin-throat relation changes with the Forsus™ appliance. PATIENTS AND METHODS: A retrospective sample of 27 Class II patients treated with the Forsus™ FRD appliance was compared to 20 untreated control subjects who were matched according to age and craniofacial morphology. Pre-Forsus™ (T0) and Post-Forsus™ (T1) cephalograms were subjected to composite cephalometric analysis. Growth changes were subtracted from the treatment changes to obtain the treatment effects of the appliance. The data were analyzed using Student's t­test and independent t test. RESULTS: Significant differences were found between the treated and the control group in 16 of 29 measured variables. The overjet and molar relation improved by 4.23 mm and 4.49 mm, respectively. This was mainly achieved by backward movement of maxillary incisors (1.4 mm) and molars (1.22 mm) and forward movement of mandibular incisors (2.26 mm) and molars (2.70 mm). Overbite decreased by 2.24 mm with no changes in mandibular and nasal plane angles. CONCLUSION: The Forsus™ FRD was effective in correcting Class II malocclusion mainly at the dentoalveolar level. The net skeletal and dentoalveolar contributions towards both overjet and molar correction was 13% and 87%, respectively. The improvement in soft tissue profile and chin-throat configuration was statistically insignificant.

Management of necrotic immature permanent maxillary incisors using a modified technique of revascularisation.

The management of necrotic immature permanent teeth has always been a challenge to endodontists. Various treatment modalities have been tried and tested for achieving a successful outcome. Revascularisation is one among these treatment options, which is gaining widespread attention among endodontists. The growing body of evidence demonstrating the success of revascularisation has led to different variations of this treatment option. Clinicians have over time used different scaffolds such as blood clot, collagen, platelet-rich fibrin (PRF) and platelet-rich plasma for revascularisation. This case report outlines the management of immature maxillary central incisors with pulp necrosis and large periapical lesions in a 19-year-old female patient with a modified technique of revascularisation by combining PRF and blood clot. At the end of 12 months, the patient was completely asymptomatic along with regression of the periapical lesions.

CAR T-cells that target acute B-lineage leukemia irrespective of CD19 expression.

Chimeric antigen receptor (CAR) T-cells targeting CD19 demonstrate remarkable efficacy in treating B-lineage acute lymphoblastic leukemia (BL-ALL), yet up to 39% of treated patients relapse with CD19(-) disease. We report that CD19(-) escape is associated with downregulation, but preservation, of targetable expression of CD20 and CD22. Accordingly, we reasoned that broadening the spectrum of CD19CAR T-cells to include both CD20 and CD22 would enable them to target CD19(-) escape BL-ALL while preserving their upfront efficacy. We created a CD19/20/22-targeting CAR T-cell by coexpressing individual CAR molecules on a single T-cell using one tricistronic transgene. CD19/20/22CAR T-cells killed CD19(-) blasts from patients who relapsed after CD19CAR T-cell therapy and CRISPR/Cas9 CD19 knockout primary BL-ALL both in vitro and in an animal model, while CD19CAR T-cells were ineffective. At the subcellular level, CD19/20/22CAR T-cells formed dense immune synapses with target cells that mediated effective cytolytic complex formation, were efficient serial killers in single-cell tracking studies, and were as efficacious as CD19CAR T-cells against primary CD19(+) disease. In conclusion, independent of CD19 expression, CD19/20/22CAR T-cells could be used as salvage or front-line CAR therapy for patients with recalcitrant disease.

Predictive validity of the National Benchmark Test and National Senior Certificate for the academic success of first-year medical students at one South African university.

BACKGROUND: South African medical schools use the results of the National Senior Certificate (NSC) examination for selecting students. Five of the nine medical schools also use the National Benchmark Test (NBT). The University of the Witwatersrand weights the NSC and NBT results equally in the selection process. This study addresses the predictive validity of the NBT and NSC for academic success. The association between the NBT proficiency levels and students' progression outcomes was also investigated. METHODS: Data obtained from the University's Business Intelligence Services for 1652 first-year medical students from 2011 to 2017 were analysed using hierarchical regression models and chi-square tests. The three NBT domains and four of the NSC subjects were the independent variables in the regression models, with the first-year grade point average for students who passed the first year as the dependant variable. The NBT performance levels and first-year progression outcome (passed, failed, or cancelled) were used in the chi-square analysis. Frequency tables were used to describe the cohort's demographic details and NBT results. Crosstabs were used to analyse student performance according to the school quintile system. RESULTS: The three NBT domains explained 26% of the variance, which was statistically significant, R2 = 0.263, F (3, 1232) = 146.78, p < 0.000. When the NSC subjects (Life Sciences, English, Mathematics, and Physical Science) were added to the regression equation, they accounted for an additional 19% of the variance, R2 = 0.188, F (3, 1229) = 137.14, p < 0.000. All independent variables contributed 45% of the variance, R2 = 0.451, F (6, 1229) = 166.29, p < 0.000. A strong association between the NBT proficiency levels and first-year students' progression outcomes was observed. CONCLUSION: The NBT results, when weighted equally to the NSC results, explained more variance than the NSC alone in predicting academic success in the first year of the medical degree. The NBT should not only be used for selecting medical students but should also be used to place students with lower entry-level skills in appropriate foundation programmes and to identify students who are admitted to regular programmes who may need additional support.

Doctor retention and distribution in post-apartheid South Africa: tracking medical graduates (2007-2011) from one university.

BACKGROUND: Doctor emigration from low- and middle-income countries represents a financial loss and threatens the equitable delivery of healthcare. In response to government imperatives to produce more health professionals to meet the country's needs, South African medical schools increased their student intake and changed their selection criteria, but little is known about the impact of these changes. This paper reports on the retention and distribution of doctors who graduated from the University of the Witwatersrand, South Africa (SA), between 2007 and 2011. METHODS: Data on 988 graduates were accessed from university databases. A cross-sectional descriptive email survey was used to gather information about graduates' demographics, work histories, and current work settings. Frequency and proportion counts and multiple logistic regressions of predictors of working in a rural area were conducted. Open-ended data were analysed using content analysis. RESULTS: The survey response rate was 51.8%. Foreign nationals were excluded from the analysis because of restrictions on them working in SA. Of 497 South African respondents, 60% had completed their vocational training in underserved areas. At the time of the study, 89% (444) worked as doctors in SA, 6.8% (34) practised medicine outside the country, and 3.8% (19) no longer practised medicine. Eighty percent of the 444 doctors still in SA worked in the public sector. Only 33 respondents (6.6%) worked in rural areas, of which 20 (60.6%) were Black. Almost half (47.7%) of the 497 doctors still in SA were in specialist training appointments. CONCLUSIONS: Most of the graduates were still in the country, with an overwhelmingly urban and public sector bias to their distribution. Most doctors in the public sector were still in specialist training at the time of the study and may move to the private sector or leave the country. Black graduates, who were preferentially selected in this graduate cohort, constituted the majority of the doctors practising in rural areas. The study confirms the importance of selecting students with rural backgrounds to provide doctors for underserved areas. The study provides a baseline for future tracking studies to inform the training of doctors for underserved areas.

Dysregulation of miR-146a by periodontal pathogens: A risk for acute coronary syndrome.

BACKGROUND: Periodontitis is a polymicrobial, chronic inflammatory disease leading to loss of tooth-supporting structures. The bacteremia, endotoxemia, and systemic low-grade inflammation associate periodontitis with systemic illnesses such as diabetes mellitus and coronary artery disease. Periodontal pathogens have been detected from atheromatous plaque by amplification of the genetic material by using specific oligonucleotide primers in polymerase chain reaction. Though the association between periodontitis and cardiovascular diseases has been ascertained by systematic reviews and meta-analyses, its pathophysiology is not lucid. MicroRNAs are currently implicated in the regulation of many cellular processes including inflammation and may play a vital role in our understanding of this disease association. In this case-control study, we explored the role of the inflammatory microRNA, miR-146a, in acute coronary syndrome (ACS) subjects with and without chronic periodontitis (CP) and its regulation of the innate immune host response to periodontal pathogens. METHODS: Three groups each comprising 66 patients each, namely group 1 (ACS patients without CP), group 2 (ACS patients with CP) and group 3 (CP only) formed the study population. Subgingival plaque samples and serum samples were subjected to quantitative Polymerase Chain Reaction (qPCR) for detection of Porphyromonas gingivalis, a keystone pathogen and to assess the levels of circulating miR-146a and associated proinflammatory cytokines. RESULTS: miR-146a associated significantly in group 2 subjects with an odds ratio 1.434, 95% confidence interval 1.013-2.030, P < 0.042, and a predictive percentage of 83.3% and group 1 with a predictive percentage of 76.0.% The associated cytokines interleukin-6 (IL-6), tumor necrosis factor-α, and IL-1ß also showed an upregulation with statistical significance (P < 0.05). CONCLUSION: microRNA-146a is a key molecule associating periodontitis with acute coronary syndrome.