Assessing the impact of jigsaw technique for cooperative learning in undergraduate medical education: merits, challenges, and forward prospects.

BACKGROUND: Jigsaw method is a structured cooperative-learning technique that lays the groundwork towards achieving collective competence, which forms the core of effective clinical practice. It promotes deep learning and effectively enhances team-work among students, hence creating a more inclusive environment. OBJECTIVE: Present study was designed to introduce jigsaw model of cooperative learning to early-year undergraduate medical students, measure its effectiveness on their academic performance, and evaluate the perspectives of both students and faculty members regarding the same. METHODS: It was a mixed method research, involving eighty second-year undergraduate medical students. The jigsaw cooperative learning approach was introduced in two themes within neurosciences module. Students were divided into two equal groups, with one group experiencing typical small-group discussions (SGDs) in first theme and other group exposed to jigsaw approach. The groups were then reversed for second theme. Following the activity, an assessment comprising multiple-choice-questions was conducted to evaluate the impact of jigsaw technique on students' academic performance, with scores from both groups compared. Student perspectives were gathered through self-designed and validated questionnaire, while faculty perceptions were obtained through focus group discussions. Quantitative data were analyzed using SPSS v22, while thematic analysis was performed for qualitative data. RESULTS: The students of jigsaw group displayed significantly higher median assessment score percentage compared to control group (p = 0.003). Moreover, a significantly greater number of students achieved scores ≥ 60% in jigsaw group compared to control group (p = 0.006). The questionnaire responses indicated a favorable perception of this technique among students, in terms of acceptance, positive interdependence, improvement of interpersonal skills, and comparison with typical SGDs. This technique was also well-perceived within the educational context by faculty members. CONCLUSION: The jigsaw method is associated with higher levels of academic performance among students when compared to typical small-group discussion. The students and faculty perceived this technique to be an effective cooperative learning strategy in terms of enhanced student engagement, active participation, and a sense of inclusivity.

The Effect of Vitamin D3 Intervention on the Association Among Vitamin D3, Adiponectin, and Body Mass Index in Pregnant Women With Gestational Diabetes.

INTRODUCTION: Vitamin D3 (VD3) deficiency is a strong predictor of gestational diabetes. Therefore, VD3 supplementation during the antenatal period could prevent the development of gestational diabetes via its effects on insulin secretion, insulin sensitivity, body mass index (BMI), and adiponectin production. OBJECTIVES: To observe the effect of VD3 supplementation on adiponectin and BMI and to explore the effect of VD3 supplementation on the association among VD3, adiponectin, and BMI in pregnant women with gestational diabetes. METHODS: A randomized control trial was performed after receiving consent at Postgraduate Medical Institute, Lahore. Subjects at 20-26 weeks of gestation with gestational diabetes and with a deficiency/insufficiency of VD3 were included. The study excluded those who were smokers, had multiple pregnancies, or had other gestational complications. Subjects were categorized into interventional (VD3 supplementation) and control groups. The institutional ethical committee approved the study. Serum samples were used for enzyme-linked immunosorbent assay estimation of VD3 and adiponectin levels. Statistical Product and Service Solutions (SPSS) (IBM SPSS Statistics for Windows, Version 21.0, Armonk, NY) software was used to analyze data. Student t-tests were applied to compare quantitative variables, and Chi-square tests were utilized to compare qualitative variables. Pearson's correlation and linear regressions were performed to explore the association. At a 95% confidence interval, a p-value of ≤0.05 was taken as significant. RESULTS: With an increase in serum VD3 levels, a decrease in serum adiponectin level was observed in pregnant women with gestational diabetes (interventional group: r = -0.088, p = 0.74); however, after the intervention of VD3 supplementation in the same subjects, an increase in serum adiponectin level was noted with an increase in VD3 (interventional group: r = 0.273, p = 0.28). A significant direct relationship was found between BMI and adiponectin in the same study population (interventional group: r = 0.7, p = 0.001). Interestingly, after the intervention, BMI tends to be less likely to increase adiponectin levels (interventional group: r = 0.09, p = 0.73). Moreover, an inverse association was exhibited between BMI and VD3 levels in all the study groups before intervention (control group: r = -0.07, p = 0.78; interventional group: r = -0.035, p = 0.89) and after intervention (interventional group: r = -0.12, p = 0.65), except in the control group after the intervention span, where BMI mildly raises the VD3 levels (r = -0.12, p = 0.65). CONCLUSION: BMI increases with an increase in serum adiponectin levels in gestational diabetic women, but after VD3 supplementation, BMI was less likely to influence adiponectin. Also, with an increase in BMI, a decrease in the VD3 in all study groups was observed except in the control group after VD3 supplementation.

Effectiveness of analog of Humanin in ameliorating streptozotocin-induced diabetic nephropathy in Sprague Dawley rats.

Diabetes mellitus (DM) is associated with numerous complications, including nephropathy, which principally occur due to hyperglycemia-induced oxidative stress and inflammation. Humanin (HN), a novel peptide generated from mitochondria, has anti-oxidant and anti-inflammatory potential as observed in different disease models. However, role of HN in diabetic nephropathy (DN) has not yet been explored. This study aimed to evaluate biochemical and molecular aspects of the effects of HN analog, Humanin-glycine ([S14G]-humanin) on streptozotocin (STZ)-induced rat model of DN. Ninety Sprague Dawley (SD) rats were randomly segregated into three groups - A (control), B (disease control) and C (treatment). DM type-I was induced in group B and C via single intra-peritoneal dose of STZ (45 mg/Kg). Seven days following STZ injection, rats were deemed diabetic if their blood glucose level was > 250 mg/dL. Subsequently, diabetic rats in group C were injected with [S14G]-humanin intra-peritoneally (0.4 mg/Kg/day) for sixteen weeks. Biochemical analysis revealed that diabetic rats had markedly elevated levels of serum glucose, creatinine, BUN, TNF-α, and kidney tissue SOD. Whereas, significant decline was detected in serum insulin and albumin levels. All these parameters were significantly reversed in group C after administering [S14G]-humanin. Moreover, qRT-PCR analysis displayed up-regulation of pro-inflammatory (IL-18, IL-6, IL-1α, IL-1ß, TNF-α) and down-regulation of anti-inflammatory cytokines (IL-10, IL-1RN, IL-4) in diabetic rats (group B). [S14G]-humanin treatment significantly reversed the expression of IL-18 and IL-1α, however, change in relative expression of IL-6, IL-1ß, TNF-α and anti-inflammatory cytokines was insignificant (group C). Conclusively, the findings of this study depicted potential therapeutic role of [S14G]-humanin in pre-clinical rodent model of DN.

The positive impact of introducing modified directed self-learning using pre-small group discussion worksheets as an active learning strategy in undergraduate medical education.

BACKGROUND: Directed self-learning (DSL) is an active learning approach where the learners are provided with predefined learning objectives and some facilitation through the learning process in the form of guidance and supervision. It can help establish a strong foundation for autonomous and deep learning. OBJECTIVE: The aim of this study was to introduce a modified form of DSL to second-year undergraduate medical students using pre-small group discussion (pre-SGD) worksheets. The authors intended to evaluate its effectiveness through theme assessment and investigate students' perceptions using a feedback questionnaire. METHODS: This was an analytical cross-sectional study. Modified DSL (MDSL) was introduced to 96 second-year undergraduate medical students in two themes. Students were divided randomly into two groups. One group was exposed to traditional DSL (TDSL), and the other was introduced to MDSL using pre-SGD worksheets for the first theme. Groups were reversed for the second theme. The activity was followed by a theme assessment, which was scored for research purpose only. The scores of this assessment were compared, and perceptions of the students were gathered using a validated questionnaire. Data were analyzed using IBM's statistical package of social sciences (SPSS) version 22. RESULTS: The comparison of theme assessment scores revealed statistically significant difference (P = 0.002) in median scores between control TDSL and experimental MDSL groups. The percentage of students scoring ≥80% in theme assessment was significantly higher in the experimental group compared to the control group (P = 0.029). This strategy was well perceived by the students in terms of acceptability and effectiveness as depicted by a high degree of agreement on the Likert-scale. CONCLUSION: Modified DSL resulted in significant improvement in academic performance of undergraduate medical students. MDSL was also well perceived as an active learning strategy in terms of acceptability, effectiveness, and comparison with TDSL. [Figure: see text].

Effects of Recombinant Irisin on Body Mass Index, Serum Insulin, Luteinizing Hormone and Testosterone Levels in Obese Female BALB/c Mice.

OBJECTIVE: To determine the effects of recombinant irisin on body mass index (BMI), serum insulin, luteinizing hormone (LH) and testosterone levels, and to correlate the serum insulin levels with serum luteinizing hormone and testosterone levels and to correlate the body mass index with serum insulin levels in obese female BALB/c mice. STUDY DESIGN: Laboratory-based experimental study. PLACE AND DURATION OF STUDY: Department of Physiology, Shifa College of Medicine, Islamabad in collaboration with Research Laboratory of Shifa College of Medicine, National Institute of Health (NIH) and Reproductive Physiology Laboratory, Quaid-e-Azam University, Islamabad, from March 2015 to September 2016. METHODOLOGY: Ninety female BALB/c mice were divided into three equal groups. Group A which was the control group was fed with normal chow diet. Group B and Group C were fed with high fat-high sucrose (HF-HS) diet for five weeks to induce obesity. After four weeks group C was divided into two subgroups. Group C-low dose (LD) was injected with low dose irisin and group C-High dose (HD) was injected with high dose irisin for one week. After five weeks, the BMI, serum insulin, LH and testosterone levels were measured in all the groups. Data was analysed by SPSS version 21. P-value of <0.05 was considered significant. RESULTS: Group B showed statistically significant elevation in BMI, serum insulin, LH and testosterone levels as compared to Group A (p <0.001, <0.001, 0.007 and 0.014, respectively). Group C-HD showed statistically significant decrease in BMI, serum insulin, and LH as compared to Group B (p <0.001, 0.013 and 0.028, respectively). Serum testosterone level was also decreased in group C-HD as compared to Group B, however the difference was not significant. CONCLUSION: Obesity increases the serum insulin, LH and testosterone and irisin significantly lowers the elevated BMI, serum insulin and LH levels in female BALB/c mice. It also lowers the elevated testosterone levels, but not significantly.