Radical reform of the undergraduate medical education program in a developing country: the Egyptian experience.

Medical educators are in a continuous quest to close the gap between the needs of medical practice and the rising expectations of the communities in their countries. During the past two decades, competency-based medical education has been evolving as an appealing strategy to close this gap. In 2017, the Egyptian medical education authorities mandated all medical schools to change their curricula to comply with revised national academic reference standards, which changed from outcome-based to competency-based. In parallel, they also changed the timeline of all medical programs for six years of studentship and one-year internship to five years and two years, respectively. This substantial reform involved the assessment of the existing situation, an awareness campaign for the proposed changes and an extensive national faculty development program. Monitoring the implementation of this substantial reform was performed through surveys, field visits and meetings with students, teaching staff and program directors. In addition to the expected challenges, the COVID-19-associated restrictions presented a significant further challenge during the implementation of this reform. This article presents the rationale for and steps of this reform, the challenges faced and how they were addressed.

Molecular and Cellular Mechanisms Involved in Adipose-derived stem cell and their extracellular vesicles in an Experimental Model of Cardio- renal Syndrome type 3: Histological and Biochemical Study.

A cardio-renal syndrome (CRS) is a medical condition in which kidney problems are accompanied by heart problems and diagnosed when acute kidney injury contributes to the development of acute cardiac injury. Regenerative medicine is becoming increasingly interested in adipose stem cells. We evaluated the effect of both adipose-derived stem cell extracellular vesicles (ADSCs-EVs) and adipose stem cells (ADSCs) on an experimental model of CRSIII. In this study, isolation, and further identification of ADSCs and ADSCs-EVs by transmission electron microscopy and flow cytometric analysis. Cardio-renal syndrome in rats was induced by renal artery ligation RAL followed by a single dose injection of both ADSCs and ADSCs-EVs in separate groups. The effects of ADSCs-EVs and ADSCs against induced CRSIII were evaluated by both renal and cardiac oxidant/antioxidant biomarkers, renal function, and mRNA gene expression quantitation for atrial natriuretic peptide (ANP), p300, and myocyte enhancer factor 2 (MEF2C and MEF2A), as well as myocardin (MYOCD), as molecules associated with cardiac hypertrophy. Additionally, histological and immunohistochemical studies of cardiac and renal tissues were done. ADSCs-EVs were effectively isolated and characterized. ADSCs-EVs and ADSCs reversed induced CRSIII, evidenced by considerably decreased serum urea and creatinine levels. Returned oxidant/antioxidant stability, and decreased caspase 3-mediated apoptotic programmed cell death in cardiac and renal tissues. Additionally, they led to successful down-regulation of hypertrophic cardiac genes levels and reversed histopathological cardiac and renal injures. ADSCs-derived extracellular vesicles and ADSCs injection restored damaged cardiac and renal tissue and improved its function greatly following induced CRSIII. They could therefore be useful as a means of protecting the heart from the deleterious effects of acute renal injury and reprogramed injured cardiac cells by activating regenerative processes. SIMPLE SUMMARY: Cardiorenal syndrome (CRS) type III is a subcategory of CRS whereby acute kidney injury (AKI) could contribute to the development of acute cardiac dysfunction. This study provided innovatory data regarding the role of adipose-derived stem cell extracellular vesicles ADSCs-EVs and adipose stem cells (ADSCs) in acute renal and cardiac dysfunction and renal biopsy specimens in the form of interstitial inflammation/tubular degeneration. The main cause of renal and cardiac dysfunction is identified to be the activation and accumulation of inflammatory cells and oxidants in the interstitium, surrounded by increased amounts of extracellular matrix, and ADSCs-EVs have been proposed as a contributor factor. The study has evidenced that both ADSCs-EVs and adipose stem cells display beneficial effects on renal and cardiac tissues survival in terms of the frequent occurrence of cardio-renal syndrome, ADSC-EVs treatment repaired damaged renal and cardiac tissues and recovered their function. ADSC-EVs reversed the effects of cardio-renal syndrome and reprogramed injured cells by activating regenerative processes. The clinical significance of the results presented in future studies needs to be investigated further.

The Effect of Selenium Nanoparticles versus Royal Jelly against Cisplatin-Induced Testicular Toxicity in Adult Male Albino Rats: A Light and Transmission Electron Microscopic Study.

Background and Aim: Cisplatin (Cis) is a highly effective chemotherapeutic agent. However, it produces severe testicular toxicity. It was reported that some antioxidants could overcome this toxicity. Selenium nanoparticles and royal jelly (RJ) were among these reported antioxidants. Therefore, this study was designed to compare these two antioxidants in protecting the testes against Cis-induced toxicity. Materials and Methods: This study was conducted on sixty healthy adult male albino rats (weight: 200-220 g) randomized into six groups, ten animals each. Group I (control), Group II (animals received intragastric Nano Selenium), Group III (animals received intragastric RJ), Group IV (animals received an IP injection of Cis 7 mg/kg), Group V (animals received intragastric Nano Selenium, and Cis injection), and Group VI (animals received intragastric RJ and Cis injection). After 10 days, the animals were sacrificed by cervical decapitation. The testes were weighted, and specimens from the left testis were processed for histological and immunohistochemical techniques, whereas specimens from the right testes were prepared for transmission electron microscopic examination. Results: Cis-treated animals had significantly reduced weight of their testes. Light microscopic examination revealed severe histopathological changes in the germinal epithelium and Leydig cells, confirmed with electron microscopic examination. There was a significant increase in the color area percentage of Caspase-3 immunostaining of the germinal epithelium and Leydig cells, compared to that of the control group. Group II and III were similar to control group. Both Groups V and VI revealed significant preservation compared to the Cis group. Conclusion: Selenium nanoparticles and RJ partially improved testis from Cis-induced toxicity, However, there was no significant difference between both groups.

Effect of mesenchymal stem cells versus aloe vera on healing of deep second-degree burn.

BACKGROUND: Burn injuries constitute a major health problem which cause more severe physiological stress than other traumas. Aloe vera has been used in traditional medicine for a long time for burn treatment. Mesenchymal stem cells (MSCs) have delivered new approaches to the management of deep burns. The present study assessed the effect of aloe vera versus MSCs on experimentally induced deep second-degree burn. METHODS: Sixty adult female albino rats randomized into 6 groups: group I served as negative control, group II received topical aloe vera only, group III were injected intradermally with MSCs, group IV subjected to burn injury, group V received topical aloe vera post burn and group VI were injected intradermally with MSCs post burn. Healing of burn injury was evaluated grossly. Skin specimens were obtained after 14 & 21-days post-burn induction and prepared for histological techniques (H&E and Masson's trichrome stain). Polymerase chain reaction (PCR) analysis of Sry gene for group VI was done. RESULTS: After 14 days, groups V&VI showed fully regenerated epidermis with a significant increase in the epidermal thickness and a significant decrease in the optical density of collagen fibers compared to control groups. After 21 days, group V showed less epidermal thickness compared to that of day 14 and nearly normal collagen fibers arrangement. However, group VI showed a significant increase in the epidermal thickness compared to groups V&I and an interwoven collagen fibers arrangement with a significant decrease in the optical density of collagen fibers in comparison to control groups. PCR results of the tested samples revealed that 100% of the recipient rats contain Sry positive gene. CONCLUSIONS: Topical aloe vera promoted burn wound healing faster and better than intradermal injection of MSCs.

Developing, Validating, and Implementing a Tool for Measuring the Readiness of Medical Teachers for Online Teaching Post-COVID-19: A Multicenter Study.

BACKGROUND: While online education is by no means a new concept, it was recently thrust into the spotlight after school campuses all over the world were forced to close because of the COVID-19 pandemic. The sudden need to shift revealed emerging challenges to online teaching, both logistic and personal. One important challenge is the ability to assess the readiness of educators for online teaching, so that appropriate and specific feedback/training can be offered to those in need. This study aims at developing, validating, and implementing a tool to measure the teachers' readiness for online teaching in three medical schools from three different countries. METHODS: This was a multi-center, cross-sectional study that involved developing a survey through review of literature and previous studies, item development and revision, and pilot testing. The survey was then distributed electronically to a convenient sample of 217 teaching faculty members of different academic ranks from three medical schools in Egypt, Saudi Arabia, and Bahrain. Exploratory factor analysis and reliability study were performed. Descriptive statistics were applied, and the statistical significance level was set at 0.05. RESULTS: Factor analysis produced the following five factors: "Online Teaching and Course Design Skills", "Digital Communication", "Basic Computer Skills", "Advanced Computer Skills" and "Using Learning Management Systems". The tool showed high reliability (alpha = 0.94). Survey results showed highest mean scores for Basic Computer Skills with lower scores for Online Teaching and Course Design Skills and Using Learning Management Systems. ANOVA revealed statistically significant differences between the three studied schools regarding Digital Communication (F=5.13; p=0.007) and Basic Computer Skills (F=4.47; p=0.012) factors. CONCLUSION: The tool proved to be reliable and valid. Results indicated an overall acceptable readiness in the three involved schools, with a need for improvement in "Online Teaching and Course Design" and Using Learning Management Systems.

The Effect of Intra-articular versus Intravenous Injection of Mesenchymal Stem Cells on Experimentally-Induced Knee Joint Osteoarthritis.

BACKGROUND: Osteoarthritis (OA) is a chronic degenerative debilitating disease, primarily affects joints, particularly weight-bearing areas. The surface layer of the articular cartilage breaks down and wears away leading to rubbing of bones, pain, swelling, and joint stiffness. AIM AND OBJECTIVES: This study investigates the possible therapeutic effects of intra-articular versus intravenous injection of umbilical cord blood mesenchymal stem cells (UCB-MSCs) against mono-iodoacetate-induced OA of the knee joints in male albino rats, using histological and immunohistochemical techniques. MATERIALS AND METHODS: Thirty male adult albino rats were randomized into five groups as follows: Group (I) and (II): Served as control. Group (III): Osteoarthritic group. Group IV: Osteoarthritic and intraarticularly-injected MSCs. Group V: Osteoarthritic and intravenously-injected MSCs. Animals were sacrificed 1 month after stem cell injection, the right knee was prepared for histological techniques (Hematoxylin and Eosin and Toluidine blue stains) and immunohistochemical technique (Bax stain). Prussian blue stain was used to assess homing of MSCs in Groups IV and V. RESULTS: Knee joint surface was irregular, fissured, and fragmented in Group III. In Groups IV and V, affected area was filled with newly formed tissue. Toluidine blue showed a decrease in matrix staining in Group III compared to both control and MSCs-treated groups. Chondrocytes in Group III showed strong Bax immunoreactivity and this reaction decreased in Group IV and V; however, Group V immunoreactivity was more than Group IV. Prussian blue stain showed labeled UCB-MSCs in many chondrocytes in Group IV and few chondrocytes in Group V. CONCLUSION: Intraarticularly-injected UCB-MSCs showed better healing of knee OA than intravenously-injected UCB-MSCs.

Artificial Intelligence in COVID-19 Ultrastructure.

Artificial intelligence has found its way into numerous fields of medicine in the past decade, spurred by the availability of big data and powerful processors. For the COVID-19 pandemic, aside from predicting its onset, artificial intelligence has been used to track disease spread, detect pulmonary involvement in computed tomography scans, risk-stratify patients, and model virtual protein structure and potential therapeutic agents. This mini-review briefly discusses the potential applications of artificial intelligence in COVID-19 microscopy.

Expression of long intergenic non-coding RNA, regulator of reprogramming, and its prognostic value in patients with glioblastoma.

BACKGROUND: Long intergenic non-coding RNA, regulator of reprogramming ( LINC-ROR) is a newly identified cytoplasmic long non-coding RNA (lncRNA), which has been found to be dysregulated in different cancers. The present work aimed to quantify LINC-ROR expression profile and assess the tumor proteins p53 and caspase 3 expressions in glioblastoma tissue specimens compared to non-cancer tissues, and to correlate these expression levels with the available clinicopathological and survival data. METHODS: LINC-ROR relative expression in 57 glioblastoma cancer tissues and 10 non-cancer tissues was quantified by real-time polymerase chain reaction (qPCR). In addition, methylation-specific PCR of O-6-methylguanine-DNA methyltransferase ( MGMT) promoter and immunohistochemical expression of apoptosis related proteins: p53 and caspase 3 were performed. RESULTS: The up-regulation of LINC-ROR was encountered in 89.5% of patients. The higher expression of LINC-ROR was associated with poor disease progression-free and overall survival as well as a younger age of patients ( P=0.036). p53 protein was expressed only in glioblastoma but not in non-cancer tissues while caspase 3 was weakly expressed in most non-cancer tissues and in varying degrees in glioblastoma (24% weak, 30% moderate, and 16% strong expression). The Kaplan-Meier survival plot illustrated poor survival in glioblastoma patients with over-expressed LINC-ROR ( P=0.010) and down-regulated p53 ( P=0.002). Multivariate analysis showed that glioblastoma patients were clustered into two distinct groups based on LINC-ROR expression profile, p53 staining levels and patients' overall survival. CONCLUSIONS: LINC-ROR up-regulation may have a role in glioblastoma tumorigenesis and could be a potential prognostic marker for this fatal disease.

Application of Modified Team-Based Learning Approach for Enhancing Undergraduate Medical Educational Seminars.

BACKGROUND: Team-Based Learning (TBL) is an instructor-led, structured form of cooperative learning that promotes self-directed learning and teamwork while equipping students with the problem-solving and collaborative skills needed to meet the demands of their future professions. This study examines the impact of applying a modified TBL approach to enhance educational seminars in a PBL-adopted curriculum. METHODS: A total of 300 students participated in the study. Students' Individual Readiness Assurance Test (IRAT) mean scores were compared with mean scores of the same students' Group Readiness Assurance Test (GRAT). Student satisfaction was determined on a scale with 6 options in response to 13 questions to compare different aspects of traditional and TBL educational seminars. RESULTS: Comparison between IRAT and GRAT scores showed consistently higher GRAT scores. The majority of students expressed their overall satisfaction in favor of the TBL seminar, especially regarding seminar organization, knowledge acquisition, and team work skills. CONCLUSION: Application of the TBL approach in educational seminars increased second- and third-year medical students' engagement and satisfaction and improved their test performance.

Oncogenic long noncoding RNA MALAT1 and HCV-related hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related mortality worldwide. The oncogenic function of the long non-coding RNA; metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) in HCC remains unclear. We aimed to evaluate MALAT1 serum expression profile in HCC and explore its relation to the clinicopathological features. Quantitative Real Time-Polymerase Chain Reaction was applied in 70 cohorts (30 HCC, 20 HCV, 20 controls). Further meta-analysis of clinical studies and in vitro validated experiments was employed. Serum MALAT1 showed area under the curve of 0.79 and 0.70 to distinguish patients with cancer from normal and cirrhotic individuals at fold change of 1.0 and 1.26, respectively. Expression level was significantly higher in males (P <0.001) and patients with massive ascites (P = 0.005). Correlation analysis showed positive correlation of MALAT1 with total bilirubin (r = 0.456, P <0.001) and AST (r = 0.280, P = 0.019), and negative correlation with the hemoglobin level (r = 0.312, P = 0.009). Meta-analysis showed that the over-expressed MALAT1 was linked to tumor number [Cohen's d = 0.450, 95% CI (0.21 to 0.68)], clinical stage [Cohen's d = 0.048, 95% CI (-0.83 to 0.74)], and AFP level [Cohen's d = 0.354, 95% CI (0.1 to 0.57)]. In silico data analysis and systematic review confirmed MALAT1 oncogenic function in cancer development and progression. In conclusion, circulatory MALAT1 might represent a putative non-invasive prognostic biomarker indicating worse liver failure score in HCV-related HCC patients with traditional markers. Large-scale verification is warranted in future studies.

Development, implementation, and evaluation of an integrated multidisciplinary Objective Structured Clinical Examination (OSCE) in primary health care settings within limited resources.

BACKGROUND: In ordinary circumstances, objective structured clinical examination (OSCE) is a resource-intensive assessment method. In case of developing and implementing multidisciplinary OSCE, there is no doubt that the cost will be greater. AIM: Through this study a research project was conducted to develop, implement and evaluate a multidisciplinary OSCE model within limited resources. METHODS: This research project went through the steps of blueprinting, station writing, resources reallocation, implementation and finally evaluation. RESULTS: The developed model was implemented in the Primary Health Care (PHC) program which is one of the pillars of the Community-Based undergraduate curriculum of the Faculty of Medicine, Suez Canal University (FOM-SCU). Data for evaluation of the implemented OSCE model were derived from two resources. First, feedback of the students and assessors through self-administered questionnaires was obtained. Second, evaluation of the OSCE psychometrics was done. The deliverables of this research project included a set of validated integrated multi-disciplinary and low cost OSCE stations with an estimated reliability index of 0.6. CONCLUSION: After having this experience, we have a critical mass of faculty members trained on blueprinting and station writing and a group of trained assessors, facilitators and role players. Also there is a state of awareness among students on how to proceed in this type of OSCE which renders future implementation more feasible.

Pilot Study of Serum MicroRNA-21 as a Diagnostic and Prognostic Biomarker in Egyptian Breast Cancer Patients.

BACKGROUND: MicroRNAs are small RNA molecules that bind to complementary sequences of target messenger RNAs and down-regulate their translation to protein or degrade them. MicroRNAs play critical roles in many different cellular processes. Hence, aberrant microRNA expression is common in a variety of disorders, including cancer. PATIENTS AND METHODS: In this work, we quantified serum microRNA-21 (miR-21) expression levels in 30 breast cancer patients, 30 cancer-free individuals with risk factors for developing breast cancer, and another 30 controls without risk factors, in order to test the role of miR-21 as a possible diagnostic and prognostic biomarker in breast cancer. RESULTS: Our results indicated that miR-21 expression was elevated in asymptomatic high-risk individuals (2.98-fold) compared with healthy non-risk controls (p < 0.001), and was increased in almost all sera of cancer patients (12.72-fold) compared with healthy controls (p < 0.001). Higher levels of serum miR-21 were also correlated with tumors of higher grades, more nodal involvement, distal metastasis and advanced clinical stages (p < 0.01). Furthermore, over-expression levels declined towards normal after surgical tumor resection (p < 0.001). CONCLUSION: In conclusion, our findings demonstrate that serum miR-21 expression profile may serve as a potential non-invasive diagnostic and prognostic biomarker for breast cancer.

Is our medical school socially accountable? The case of Faculty of Medicine, Suez Canal University.

BACKGROUND: Faculty of Medicine, Suez Canal University (FOM/SCU) was established as community oriented school with innovative educational strategies. Social accountability represents the commitment of the medical school towards the community it serves. AIMS: To assess FOM/SCU compliance to social accountability using the "Conceptualization, Production, Usability" (CPU) model. METHODS: FOM/SCU's practice was reviewed against CPU model parameters. CPU consists of three domains, 11 sections and 31 parameters. Data were collected through unstructured interviews with the main stakeholders and documents review since 2005 to 2013. RESULTS: FOM/SCU shows general compliance to the three domains of the CPU. Very good compliance was shown to the "P" domain of the model through FOM/SCU's innovative educational system, students and faculty members. More work is needed on the "C" and "U" domains. CONCLUSION: FOM/SCU complies with many parameters of the CPU model; however, more work should be accomplished to comply with some items in the C and U domains so that FOM/SCU can be recognized as a proactive socially accountable school.

Teaching evidence-based medicine using a problem-oriented approach.

BACKGROUND: Faculty of Medicine, Suez Canal University is adopting an innovative curriculum. Evidence-based medicine (EBM) has been integrated into problem based learning (PBL) sessions as a responsive innovative paradigm for the practice and teaching of clinical medicine. AIMS: To integrate EBM in the problem based sessions of the sixth-year students, and to assess students' and tutor satisfaction with this change. METHODS: EBM training was conducted for sixth-year students (196) including four theoretical, and eight practical sessions. Sixteen EBM educational scenarios (problems) were formulated, according to sixth-year curriculum. Each problem was discussed in two sessions through steps of EBM, namely: formulating PICO questions, searching for and appraising evidence, applying the evidence to the clinical scenario and analysing the practice. Students and tutors satisfaction were evaluated using a 3-point ratings questionnaire. RESULTS: The majority of students and faculty expressed their satisfaction about integrating EBM with PBL and agreed that the problems were more stimulating. However, 33.6% of students indicated that available time was insufficient for searching literatures. CONCLUSION: Integrating EBM into PBL sessions tends to be more interesting and stimulating than traditional PBL sessions for final year students and helps them to practice and implement EBM in clinical context.

Integrating interprofessional education in community-based learning activities: case study.

Faculty of Medicine/Suez Canal University (FOM/SCU) students are exposed to clinical practice in primary care settings within the community, in which they encounter patients and begin to work within interprofessional health teams. However, there is no planned curricular interaction with learners from other professions at the learning sites. As in other schools, FOM/SCU faces major challenges with the coordination of community-based education (CBE) program, which include the complexity of the design required for Interprofessional Education (IPE) as well as the attitudinal barriers between professions. The aim of the present review is to: (i) describe how far CBE activities match the requirements of IPE, (ii) explore opinions of graduates about the effectiveness of IPE activities, and (iii) present recommendations for improvement. Graduates find the overall outcome of their IPE satisfactory and believe that it produces physicians who are familiar with the roles of other professions and can work in synergy for the sake of better patient care. However, either a specific IPE complete module needs to be developed or more IPE specific objectives need to be added to current modules. Moreover, coordination with stakeholders from other health profession education institutes needs to be maximized to achieve more effective IPE.

Introducing computer-assisted training sessions in the clinical skills lab at the Faculty of Medicine, Suez Canal University.

BACKGROUND: The Faculty of Medicine, Suez Canal University clinical skills lab was established in 1981 as the first skills lab in Egypt to cope with innovation in medical education adopted since school inauguration in 1978. Students are trained using their peers or models. Training is done weekly, guided by checklists tested for validity and reliability and updated regularly. Students receive immediate feedback on their performance. Recently, the number of students has increased, leading to challenges in providing adequate supervision and training experiences. A project to design and implement a computer-assisted training (CAT) system seemed to be a plausible solution. AIMS: To assess the quality of a newly developed CAT product, faculty and students' satisfaction with it, and its impact on the learning process. METHODS: The project involved preparation of multimedia video-films with a web interface for links of different scientific materials. The project was implemented on second year students. A quality check was done to assess the product's scientific content, and technical quality using questionnaires filled by 84 faculty members (139 filled forms) and 175 students (924 filled forms). For assessment of impact, results of examinations after project implementation were compared with results of 2nd year students of previous 3 years. RESULTS: More faculty (96.3%) were satisfied with the product and considered its quality good to excellent, compared to 93.9% of students, p < 0.001. Most faculty (76.2%) have agreed on its suitability for self-learning, while most students considered the product would be suitable after modification. The percentage of students' failures was lower after project implementation, compared to previous 3 years, p < 0.05. CONCLUSION: CAT materials developed for training of second year students in skills lab proved to be of good scientific content and quality, and suitable for self-learning. Their use was associated with lower failure rates among students. A randomized trial is recommended to ascertain the effectiveness of its application.

Review of the utilization of HEEPF--competitive projects for educational enhancement in the Egyptian medical sector.

In Egypt, the medical sector has been facing the same problems that challenged the system of higher education in the past decades, mainly an increasing student enrollment, limited resources, and old governance and bylaws. These constraints and the escalating paucity of resources have had a major negative influence on quality of education. Consequently, thoughts of educational reform came forward in the form of competitive projects, which have attracted several institutes from the health sector to improve their educational performance. The aim of this paper is to review the share of the medical sector in the higher education enhancement project fund (HEEPF), its outcomes, sustainability, and to provide recommendations for keeping the momentum of reform pursuit in the future. The methodology included obtaining statistics pertaining to the medical sector in Egypt as regards colleges, students, and staff. We also reviewed the self-studies of the medical sector colleges, HEEPF projects reports, performance appraisal reports, and World Bank reports on HEEPF achievements in order to retrieve the required data. Results showed that medical sector had a large share of the HEEPF (28.5% of projects) as compared to its size (8% of student population). The projects covered 10 areas; the frequency distribution of which ranged between 4.4% (creation of new programs) to 97.8% (human resource development). In conclusion, educational enhancement in the medical sector in Egypt could be apparently achieved through the HEEPF competitive projects. A study of the long-term impact of these projects on the quality of education is recommended.