The equation for medical multiple-choice question testing time estimation.

Introduction and importance: Multiple-choice questions (MCQs) offer a suitable means to assess the cognitive domain of learners with a high degree of objectivity. The study's objective is to formulate an equation for determining the ideal timing for MCQ examinations, thereby inspiring the development of a model to estimate the duration of these examinations. Methods: The authors generated a specific computer program that integrated with the operating system of the examination. Technical-specific features included the ability to calculate the speed of students taking examinations with images or videos in the questions or options. This bespoke computer program was designed specifically for assessing individual students' MCQ test-taking pace and generating a proctor report in a computer-readable format. Subsequently, data derived from this program underwent regression analysis to determine the speed at which students completed MCQ examinations. Outcomes: The data were collected from a total of 1035 examinees, all of whom were non-native English speakers. The average reading rate was 62.38±20.4 words/min. It was found that the rate decreased significantly in difficult (50.65±6.9 words/min) items compared to easy (82.29±21.3 words/min) and intermediate (60.56±19.1 words/min) items (p<0.001), respectively. The linear regression analysis predicted option selection (words/min) as; 33.92+1.93(%tables/figures)+0.14(%recall)-0.37(%application), r2=0.45, p<0.001. Conclusion: It is not advisable to base the decision solely on reading time or time allocation. Examination administrators are advised to proactively plan ahead, with particular emphasis on establishing a well-defined taxonomy, as it constitutes a fundamental cornerstone in the utilization of the estimation equation.

Mushroom-shaped structures formed in Acinetobacter baumannii biofilms grown in a roller bioreactor are associated with quorum sensing-dependent Csu-pilus assembly.

There is currently a need to develop simple biofilm models that facilitate investigation of the architecture/biology of mature bacterial biofilms in a consistent/standardized manner given their environmental and clinical importance and the need for new anti-biofilm interventions. This study introduces a novel biofilm culture system termed the rolling biofilm bioreactor (RBB). This easily operated system allows adherent microbial cells to be repeatedly exposed to air/solid/liquid interfaces optimizing biofilm growth. The RBB was exploited to investigate biofilm formation in Acinetobacter baumannii. High levels of A. baumannii biofilm biomass reproducibly accumulate in the RBB and, importantly, undergo a maturation step to form large mushroom-shaped structures that had not been observed in other models. Based on image analysis of biofilm development and genetic manipulation, we show how N-acylhomoserine lactone-dependent quorum sensing (QS) impacts on biofilm differentiation, composition and antibiotic tolerance. Our results indicate that extracellular DNA (eDNA) is a key matrix component in mature Acinetobacter biofilms as the mushroom-like structures consist of dense cellular masses encased in an eDNA mesh. Moreover, this study reveals the contribution of QS to A. baumannii biofilm differentiation through Csu pilus assembly regulation. Understanding the mechanisms of structural development of mature biofilms helps to identify new biofilm eradication and removal strategies.

Manifestation of rs1888747 polymorphisms in the FRMD3 gene in diabetic kidney disease and diabetic retinopathy in type 2 diabetes patients.

BACKGROUND: FRMD3 polymorphisms has suggested that they could be an alternative test to differentiate diabetic nephropathy (DN) from nondiabetic renal disease (NDRD) in type 2 diabetes mellitus (DM) patients. This study was performed to investigate the relationship between the FRMD3 gene and clinical characteristics of DN. METHODS: Patients who already had renal pathologic results were tested for FRMD3 polymorphisms. The subjects were classified into three groups; DN with diabetic retinopathy (DR), DN without DR, and DM with NDRD. FRMD3 polymorphisms were analyzed in each group. RESULTS: The prevalence of GG, CG, and CC was 44.4%, 42.2%, and 13.3% respectively. There was no significant difference in clinical parameters, which consisted of disease duration, proteinuria, and complications in DN with or without DR and DM with NDRD. The G allele was mainly found in DN with DR patients (50.8%) whereas the C allele was found in DM with NDRD patients (43.5%) (p = 0.02). There was a significant association between the CC genotype in NDRD when compared to GG (p = 0.001). In addition, the C allele was 2.10-fold more often associated with NDRD than the G allele (p = 0.03). The CC genotype was correlated with risk for NDRD than the GG and GC genotypes, with odds ratios of 6.89 and 4.91, respectively (p = 0.02). CONCLUSION: C allele presentation, especially homozygous CC, was associated with NDRD pathology in patients with overt proteinuria. Hence, kidney biopsy is suggested in those with the C allele or homozygous CC genotype, regardless of retinopathy manifestations.

The Association Between GFR Evaluated by Serum Cystatin C and Proteinuria During Pregnancy.

INTRODUCTION: Physiological changes in pregnancy result in increased cardiac output and renal blood flow, with a consequential increase in proteinuria. Data from studies of the relationship between proteinuria caused by isolated proteinuria and glomerular filtration rate (GFR) are still limited. The objective of this study was to investigate the effects of isolated proteinuria on the cystatin C-based GFR in the third trimester of pregnancy. METHODS: Data were collected from pregnant women in their third trimester whose serum creatinine levels were normal. The GFR of each participant was measured using serum cystatin C levels, and proteinuria was measured using urine protein-creatinine ratios. The participants were divided into 3 groups according to their level of proteinuria: normal (<150 mg/d), physiological (150-300 mg/d), and gestational (>300 mg/d). Changes in GFR were recorded for each group. RESULTS: The study included 89 participants, of whom 66.3% had levels of proteinuria that did not differ from that of the normal population (<150 mg/d). The incidence of physiological and gestational proteinuria was 21.4% and 12.4%, respectively. The results demonstrate that proteinuria >101.50 mg/d was significantly associated with declined estimated glomerular filtration rate (eGFR) (r = -0.34, P = 0.01). The analysis found that proteinuria >491.27 mg/d led to a risk of GFR <90 ml/min with an odds ratio of 12.69, P = 0.02 when adjusted for systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index. CONCLUSION: This study suggests that the term "physiological proteinuria" is a misnomer. When used in the traditional manner, creatinine level has inadequate sensitivity to estimate GFR in pregnant women. We found that there is a significant decline in GFR when urine protein > 101.5 mg/d, which could be an early biomarker for renal pathology rather than pregnancy physiology, suggesting that further workup and precaution is required.

Assessment of preeclampsia risk by use of serum ionized magnesium-based equation.

BACKGROUND: Preeclampsia is a common medical complication in pregnancy. It has been reported to be associated with decreased serum magnesium levels. However, there has not been evidence demonstrating utilization of change in magnesium for prediction of preeclampsia. The purpose of this study was to develop magnesium fraction-based equations which took other significant clinical risk factors into consideration for prediction of preeclampsia. METHODS: We collected serum total and ionized magnesium ionized magnesium levels from 84 pregnant women diagnosed with preeclampsia after week 20 of pregnancy. The ionized magnesium fraction was then calculated by the percentage ratio of ionized and total magnesium level. RESULTS: Sixty-four (76.19%) women had normal pregnancy and 20 (23.81%) developed preeclampsia. The ionized magnesium fraction was significantly lower in preeclampsia group (23.95 ± 4.7% vs. 26.28 ± 2.3%, p = .04). Additionally, lower ionized magnesium fraction (24.67%), teenage and elderly primigravida were significantly associated with preeclampsia (OR = 4.41, 95% CI: 1.46-13.40, OR = 5.47, 95% CI: 1.85-35.42 and OR = 11.11, 95% CI: 1.09-113.78, respectively). Consequently, we attempted to develop ionized magnesium fraction-based equations calculate risk scores for preeclampsia. The area of ROC for predictive accuracy of the model was 0.77 (p < .001) and ROC suggested that the score of 0.27 would be a threshold for screening preeclampsia with 70% sensitivity and 81% specificity. CONCLUSIONS: Ionized magnesium fraction may have been appropriate for screening of preeclampsia. We suggested blood testing on total and ionized magnesium concentrations as well as calculation of ionized magnesium fraction in addition to routine antenatal care for better screening of the disease.

Cystatin C as a novel predictor of preterm labor in severe preeclampsia.

BACKGROUND: The most common cause of acute kidney injury (AKI) in pregnancy is preeclampsia. Serum cystatin C (CysC) is a potential biomarker of early kidney damage as its levels are not disturbed by volume status changes in pregnancy, and serum CysC levels could serve as a replacement for conventionally used creatinine. In this study, we investigated the serum levels of CysC in severe preeclampsia cases and the associations between CysC levels and poor obstetric outcomes. METHODS: Our cohort included severe preeclampsia patients with a normal serum creatinine level. Creatinine was measured to calculate estimated glomerular filtration rate (eGFR) based on the Cockcroft and Gault, Modification of Diet in Renal Disease Study (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, while CysC was measured to calculated eGFR based on a CysC-based equation. We then evaluated the correlations between serum CysC level, eGFR, and obstetric outcomes. RESULTS: Twenty-six patients were evaluated of which 38.5% delivered preterm and 30.8% had low-birth weight babies. Unlike creatinine-based eGFR and CysC-based eGFR, serum CysC demonstrate significant negative correlation with gestational age. Receiver operating characteristic curve analysis indicated that serum CysC is a potential biomarker of preterm delivery with a cut-off serum level of 1.48 mg/L with 80% sensitivity and 75% specificity. CONCLUSION: GFR estimation using CysC is likely to be inaccurate in pregnancy. However, we found a significant correlation between preterm delivery and serum CysC level. Our results suggest that serum CysC level has the potential to predict preterm delivery in severe preeclampsia patients.

Effect of Magnesium on Glomerular Filtration Rate and Recovery of Hypertension in Women with Severe Preeclampsia.

INTRODUCTION: Magnesium sulfate is used for preventing seizures in patients with severe preeclampsia. Previous studies have demonstrated that magnesium plays a significant role in the endothelial function and might have clinically beneficial vasodilating properties. OBJECTIVES: This study is aimed at evaluating the effect of magnesium sulfate on the glomerular filtration rate (GFR) during the first 24 h after delivery and during the duration of recovery from hypertension in preeclampsia. METHODS: Severe preeclamptic patients who had normal serum creatinine levels (0.4-0.8 mg/dL) were included in the study. Twenty-three women with severe preeclampsia were divided into groups of 9, 8, and 6, and given 1.0, 1.5, and 2.0 g/h of magnesium sulfate, respectively. Magnesium sulfate infusion was used as seizure prophylaxis for 24 h after delivery. The cystatin C-based GFR was monitored for 24 h, and the blood pressure was recorded for 12 weeks postpartum. RESULTS: Despite the minimal improvement of GFR 24-h after treatment initiation, survival analysis demonstrated a statistically significant relationship (log rank, p = 0.04) between magnesium dosage and recovery period from hypertension. The group receiving 2.0 g/h of magnesium experienced the shortest recovery period from hypertension (6.5 ± 1.8 days). Meanwhile, the other groups required 66.0 ± 26.9 and 48.3 ± 15.6 days to recover after 1.0 and 1.5 g/h of magnesium infusion, respectively. CONCLUSION: Magnesium sulfate has no impact on GFR improvement during the first 24 h after delivery. However, magnesium maintenance infusion at 2.0 g/h is capable of preventing seizure by optimizing the therapeutic magnesium level (4.8-8.4 mg/dL) and shortening the hypertensive episode in preeclampsia.