The short-term impact of high energy nutritional supplements on energy balance in underweight primi-gravidae: A randomized controlled trial.

OBJECTIVE: To determine the impact of high-energy nutritional supplements on appetite, appetite regulators, energy intake and macronutrients level among underweight primigravidae. Methods: The single-blind randomised controlled trial was conducted from April 26, 2018, to August 10, 2019, in tertiary care hospitals of Khyber Pakhtunkhwa province of Pakistan, after approval from the ethics review committee of Khyber Medical University, Peshawar, and comprised underweight primigravidae who were randomly allocated to high energy nutritional supplement group A and placebo group B. Appetite questionnaires were filled and blood samples were obtained in fasting state, at 30, 60, 120, 210 and 270 minutes to measure blood glucose, insulin, peptide YY and cholecystokinin. Breakfast and lunch were served at 30 minutes and 210 minutes after supplementation, respectively. Data was analysed using SPSS 20. RESULTS: Of the 36 subjects, 19(52.8%) were in group A and 17(47.2%) were in group B. The overall mean age was 18.66 ± 2.5 years. Energy intake in group A was significantly higher than group B (p<0.001), and so were mean protein and fats (p<0.001). The subjective appetite perceptions for 'hunger' and 'desire to eat' were significantly lower (p<0.001) before lunch in group A. Plasma concentrations of appetite hormones corresponded to the appetite perceptions and were significantly higher in group A after breakfast and lunch for peptide YY, cholecystokinin and insulin compared to group B (p<0.001). CONCLUSIONS: High-energy nutritional supplement was found to have short-term suppressive effect on energy intake and appetite. Trial registration: ClinicalTrials.gov Identifier: ISRCTN 10088578. Registered on 27 March 2018. https://www.isrctn.com/ ISRCTN10088578.

Effect of Lipid-Based Multiple Micronutrients Supplementation in Underweight Primigravida Pre-Eclamptic Women on Maternal and Pregnancy Outcomes: Randomized Clinical Trial.

Background and Objectives: In pre-eclampsia, restricted blood supply due to the lack of trophoblastic cell invasion and spiral artery remodeling is responsible for adverse pregnancies and maternal outcomes, which is added to by maternal undernutrition. This study was designed to observe the effect of multiple nutritional micronutrient supplements on the pregnancy outcomes of underweight pre-eclamptic women. To investigate the effects of lipid-based multiple micr supplementations (LNS-PLW) on pregnancy and maternal outcomes in underweight primigravida pre-eclamptic women. Materials and Methods: A total of 60 pre-eclamptic, underweight primigravida women from the antenatal units of tertiary care hospitals in the Khyber Pakhtunkhwa Province, Pakistan, were randomly divided into two groups (Group 1 and Group 2). The participants of both groups were receiving routine treatment for pre-eclampsia: iron (60 mgs) and folic acid (400 ug) IFA daily. Group 2 was given an additional sachet of 75 gm LNS-PLW daily till delivery. The pregnancy outcomes of both groups were recorded. The clinical parameters, hemoglobin, platelet count, and proteinuria were measured at recruitment. Results: The percentage of live births in Group 2 was 93% compared to 92% in Group 1. There were more normal vaginal deliveries (NVDs) in Group 2 compared to Group 1 (Group 2, 78% NVD; group 1, 69% NVD). In Group 1, 4% of the participants developed eclampsia. The frequency of cesarean sections was 8/26 (31%) in Group 1 and 6/28 (22%) in Group 2. The number of intrauterine deaths (IUDs) was only 1/28 (4%) in Group 2, while it was 2/26 (8%) in Group 1. The gestational age at delivery significantly improved with LNS-PLW supplementation (Group 2, 38.64 ± 0.78 weeks; Group 1, 36.88 ± 1.55 weeks, p-value 0.006). The Apgar score (Group 2, 9.3; Group 1, 8.4) and the birth weight of the babies improved with maternal supplementation with LNS-PLW (Group 2, 38.64 ± 0.78 weeks: Group 1, 36.88 ± 1.55; p-value 0.003). There was no significant difference in systolic blood pressure, while diastolic blood pressure (Group 2, 89.57 ± 2.08 mmHg; Group 1, 92.17 ± 5.18 mmHg, p-value 0.025) showed significant improvement with LNS-PLW supplementation. The hemoglobin concentration increased with the LNS-PLW supplement consumed in Group 2 (Group 2, 12.15 ± 0.78 g/dL; Group 1, 11.39 ± 0.48 g/dL, p-value < 0.001). However, no significant difference among the platelet counts of the two groups was observed. Conclusions: The pregnancy and maternal outcomes of underweight pre-eclamptic women can be improved by the prenatal daily supplementation of LNS-PLW during pregnancy, along with IFA and regular antenatal care and follow-up.

Effects of lipid based Multiple Micronutrients Supplement on the birth outcome of underweight pre-eclamptic women: A randomized clinical trial.

BACKGROUND AND OBJECTIVE: Maternal under nutrition and low birth weight babies are among the common tragedies of developing countries like Pakistan. Preeclampsia and its significant association with fetal growth restriction due to spiral arteries remodeling and trophoblastic invasion decreases nutritional supply to growing fetus added by maternal under nutrition. This study was designed to see the effects of lipid based nutritional supplements for pregnant and lactating women LNS-PLW on maternal and fetal outcome of pre-eclampsia. METHODS: Sixty underweight pre-eclamptic women were randomly assigned into two study Groups from April 2018 to December 2019 at the antenatal units of the tertiary Health care facilities of Lady Reading Hospital, Hayatabad Medical Complex Peshawar and Civil Hospital Matta Swat, KPK Pakistan in a randomized clinical trial. Participants were on routine drugs for pre-eclampsia and Iron and Folic Acid (60mg, 400 µg) daily, while participant of Group-2 (n=30) received one sachet of Lipid based nutritional supplement for pregnant and lactating women LNS-PLW in addition daily till delivery. The birth weight, gestational age, head-circumference, and birth length of babies were measured. RESULTS: The significant improvement found in the birth weight (p-value 0.003), gestational age (p-value 0.006), head circumference (P-value of 0.0006) and birth length (P-value of 0.0017) of babies of Group-2 women. We observed that addition of Lipid based nutritional supplement for pregnant and lactating women LNS-LPW improved the birth outcome in underweight women of pre-eclampsia. CONCLUSION: The Prenatal supplementation of Lipid based nutritional supplement for pregnant and lactating women LNS-PLW can improve birth weight, gestational age, length and head circumference of babies of underweight preeclamptic women.

Effect of time-restricted feeding on metabolic risk and circadian rhythm associated with gut microbiome in healthy males.

Time-restricted feeding (TRF) confers protection against nutritional challenges that predispose obesity and metabolic risks through involvement of circadian locomotor output cycles protein kaput genes and gut microbiome, but the underlying mechanism is not clearly understood. Therefore, the present study examined the effects of TRF on metabolic markers and circadian rhythm associated with gut microbiota in healthy males. Two groups (TRF, n 56; non-TRF, n 24) of male adults were enrolled. The TRF group provided blood at pre-TRF and post-TRF, while non-TRF one time after 25 d of trial. Serum lipid and liver profiles were determined. Real time-PCR was applied for circadian and inflammatory gene expression. The 16S rRNA genes were sequenced on the Illumina Miseq v3 platform to comprehensively catalogue the composition and abundance of bacteria in stool. We showed that TRF ameliorated the serum lipid and liver profiles of the individuals. In the TRF group, gut microbial richness was significantly enhanced, with enrichment of Prevotellaceae and Bacteroideaceae. TRF enhanced circadian gene expression probably by activation of sirtuin-1, which is positively associated with gut microbiome richness. TRF could be a safe remedy for the prevention of metabolic diseases related to dyslipidaemia, as it regulates circadian rhythm associated with gut microbiome modulation.

Association of single nucleotide polymorphism in CD28(C/T-I3 + 17) and CD40 (C/T-1) genes with the Graves' disease.

OBJECTIVE: To find out a correlation between the single nucleotide polymorphisms in cluster of differentiation 28 and cluster of differentiation 40 genes with Graves' disease, if any. METHODS: This case-control study was conducted at the Multan Institute of Nuclear Medicine and Radiotherapy, Multan, Pakistan, and comprised blood samples of Graves' disease patients and controls. Various risk factors were also correlated either with the genotype at each single-nucleotide polymorphism or with various combinations of genotypes studied during present investigation. RESULTS: Of the 160 samples, there were 80(50%) each from patients and controls. Risk factor analysis revealed that gender (p=0.008), marital status (p<0.001), education (p<0.001), smoking (p<0.001), tri-iodothyronine (P <0.001), thyroxin (p<0.001) and thyroid-stimulating hormone (p<0.000) levels in blood were associated with Graves' disease. CONCLUSIONS: Both single-nucleotide polymorphisms in both genes were not associated with Graves' disease, either individually or in any combined form.

Supplementation of garlic and coriander seed powder: Impact on body mass index, lipid profile and blood pressure of hyperlipidemic patients.

Garlic and coriander play an obligatory role in the metabolism of lipids leading to the reduction of CVD development. We hypothesized that garlic, coriander and their mixture improves the lipid profile, BMI and blood pressure of CVD patients. Eighty patients were partitioned into 4 groups, each group consisting of twenty patients. The groups were randomly assigned to three supplements i.e. garlic powder (GP), coriander seed powder (CSP) and mixture (1:1 dry weight basis) of GP and CSP at a dose rate of 2 g/day. The fourth group was kept as placebo. The patients were examined for serum lipid profile, BMI and blood pressure at the start (0 day), 20, 40 and 60th day of supplementation. The initial 40 days were the intervention period whereas the last 20 days were the follow up period. The results indicated that all the supplements significantly (p<0.05) influenced the BMI, HDL, total cholesterol, triglycerides, LDL and systolic blood pressure of the patients. Among the supplements, GP had the highest influenced on BMI, TC, LDL and HDL whereas the impact of GP-CSP and CSP was more pronounced on TGL and blood pressure of the patients, respectively. All the parameters decreased with supplementation except HDL, which increased with the consumption of supplements. It was concluded that consumption of garlic, coriander and their mixture at a dose rate of 2 g/day is improving the lipid parameters of the patients.

Endostatin Concentration In Plasma Of Healthy Human Volunteers.

BACKGROUND: Angiogenesis is involved in many cardiovascular and cancerous diseases, including atherosclerosis and is controlled by a fine balance between angiogenic and angiostatic mediators. Endostatin is one of the main angiostatic mediators, and inhibits angiogenesis and prevents progression of atherosclerosis. The available literature shows a broad range of concentrations in relatively small samples of healthy controls and is calculated by using different techniques. This study was aimed to determine the basal endostatin concentration in plasma of healthy volunteers, to fully understand its physiological role. METHODS: Fifty healthy adult volunteers were recruited to the study. Participants were advised not to participate in any physical activity on the day before the blood sampling. The volunteers' physical activity, height, weight, heart rate and blood pressure were recorded. The samples were analysed for plasma endostatin concentration, using ELISA. The participants were divided by gender and ethnic groups to calculate any difference. RESULTS: Endostatin and other variables were normally distributed. Most of the participants had a moderate level of physical activity with no gender related difference (p=0.370). The mean value for plasma endostatin in all samples was 105±12 ng/ml with range of 81-132 ng/ml. For males, it was 107±13 ng/ml, while for females; 102±12 ng/ml. There were no significant gender or ethnicity related differences in endostatin concentration. Moreover, endostatin was not significantly related with any anthropometric and physical variable. CONCLUSIONS: This study gives endostatin levels in normal healthy people and show no gender and ethnicity related differences in endostatin levels. Endostatin was not related with any anthropometric and physical variable.

EXPRESSION OF PEROXISOME-PROLIFERATOR ACTIVATED RECEPTORS-γ IN DIABETICS, OBESE AND NORMAL SUBJECTS.

BACKGROUND: Current researcn in type 2 diabetes mellitus focuses on the role of Peroxisome- Proliferator Activated Receptors (PPARs) in the pathogenesis of the Insulin Resistance Syndrome (IRS), which are pre-diabetic lesion and the hallmark of fully developed type 2 diabetes mellitus. This study aims at identifying the abnormal status of the PPAR-γ in adipose tissues of type 2 diabetes mellitus patients, when compared with matched normal controls. METHODS: This cross-sectional study was conducted in Ayub Medical College, Abbottabad, from 2012 to 2014. Sample included three equal groups of patients. Group-1 with diagnosed type 2 diabetes mellitus, aged 40-65 years, acting as the test group, Group-2 included non-diabetic obese, and Group-3 with normal subjects. Transcription Factor Assay for Peroxisome Proliferator Activated Receptor Gamma (gamma PPAR) was done on ELISA Technique from Nuclear Extract procured from Adipose Tissue of the subjects. RESULTS: Mean age of enrolled participants was 48.93 SD ± 6.52 years. Patients ranged between ages of 40 years to 67 years. The mean values of PPAR in normal, obese and diabetic group were 1.72 SD ± 0.28, 1.282 SE ± 0.18 and 1.283 SE ± 0.18 respectively. The difference in mean values of PPAR was significant p < 0.05: CONCLUSION: The levels of PPAR-γ in patients with type 2 Diabetes Mellitus and Obese cases are significantly lower than normal controls.

Why should the faculty adopt reciprocal teaching as part of the medical curriculum?

Understanding the text is crucial to achieve depth in understanding of complex concepts for students at all levels of education for whom English is not their first language. Reciprocal teaching is an instructional activity that stimulate learning through a dialogue between teachers and students regarding segments of text. The process of summarizing, question-generating, clarifying and predicting allows the gaps to be recognised and filled by the student, who is in control of the learning process and able to analyse and reflect upon the reading material. Whereas reciprocal teaching has been applied at school and college level, little is known about its effectiveness in medical education. Incorporating reciprocal teaching in early years of medical education such as reading the literature and summarizing the flow of information in the study of integrated body systems could be an area to explore. Feasibility exercises and systematic validation studies are required to confirm authors' assertion.

Appetite Regulation In Relation To Energy Provision.

BACKGROUND: Appetite control is a very complex process which influences the short term feeding behaviour and a long term adaptive process that responds to the energy input. Appetite control and food intake is influenced by a combination of behavioural, psychological and neuro-endocrine influences. METHODS: For identification of articles search engines of the databases EMBASE, OVID, Pub med and MEDLINE were used for papers published from 2002 to 2015 in English language. RESULTS: The higher endogenous peptide YY (PYY) and cholecystokinin (CCK) and lower ghrelin levels are not always associated with subjective feelings of fullness or hunger and a decreased energy intake which highlights the fact that appetite control and food intake is a very intricate process. CONCLUSIONS: When food is ingested, numerous physiological, hormonal, social and psychological processes are triggered in an intricate manner. Therefore, it can be said that ghrelin, PYY and CCK are just few pieces, which contributes to the process of appetite control and energy intake.

Poisons Implicated In Homicidal, Suicidal And Accidental Cases In North-West Pakistan.

BACKGROUND: Pakistan has one of the highest prevalence of poisoning in the world. However, limited data exist on the frequency of poisons implicated in homicidal, suicidal, and accidental cases in North-West Pakistan (Khyber Pakhtunkhwa). METHODS: This retrospective study of 353 cases and biological specimens of poisoning received at the department of Forensic medicine and toxicology, Khyber Medical College Peshawar from 13 districts of Khyber Pakhtunkhwa. Frequency of poisoning was assessed by testing each specimen for 17 different poisons. RESULTS: Of all the specimens, 250 (70.8%) specimens tested positive and the rest didn't show any indication of poisoning (n=103, 29.2%). The most frequent poisons detected were benzodiazepines (total n=75), organophosphates (total n=58), phencyclidine (total n=30) and morphine (total n=23). Gender had a significant association with benzodiazepines (p=0.011), tricyclic antidepressants (p=0.001), and organophosphates (p<0.001). Organophosphates were the most common cause of poisoning in females while benzodiazepines were the most common cause of poisoning in males. CONCLUSIONS: Poisoning by benzodiazepines, organophosphates and phencyclidine are the most common causes of intoxication in population of Khyber Pakhtunkhwa. Source of poisoning varies with gender for organophosphates, benzodiazepines and tricyclic antidepressants.

Adipokine Serum visfatin level in pregnancy induced hypertension and uncomplicated pregnancy.

BACKGROUND AND OBJECTIVES: Hypertensive disorder in pregnancy is the significant disease that badly affects the maternal and fetal prognosis and lead to higher mortality and morbidity in the prenatal period. Visfatin, potentially a new adipokine has emerged having high contribution in pathogenesis of pre-eclampsia. The objective of the study was to find the level of Visfatin in pregnancy induced hypertension and normal pregnant women. METHODS: This study was carried out in tertiary care hospitals, Peshawar from March-October 2014. A total of 234 pregnant women (gestational age >20 weeks) were included in the study with distribution as Preeclampsia (PE=86), Eclampsia (E=74) and control (N=74). Blood was taken for measuring Visfatin level by Enzyme Linked Immunosorbent Assay (ELISA) technique. SPSS version 19 was used for statistical analysis. Student's t test was performed to evaluate the mean differences in patients and control. RESULTS: Serum level of visfatin was significantly higher in pregnancy induced hypertension when compared with control (P value<0.001).: Comparisons of mean value of visfatin with age group of 21-40 years, body mass index (BMI), primary parous and parity 2-4, gestational age of >36 weeks and both systolic and diastolic blood pressure were highly significant in pregnancy induced hypertension when compared with control (p value<0.001). CONCLUSION: Pregnancy induced hypertensive women showed increased level of serum Visfatin than normal pregnant women.

Response of appetite and potential appetite regulators following intake of high energy nutritional supplements.

BACKGROUND: The net clinical benefit of high-energy nutritional supplements (HENSDs) consumption is lower than expected. OBJECTIVES: To investigate the extent to which consumption of oral HENSD in the fasted state reduces energy intake in slim females during consecutive breakfast and lunch, and whether this relates to changes in appetite and metabolic appetite regulators. DESIGN: Twenty three females of 24.4 ± 2.8 years with BMI of 18.2 ± 0.8 kg/m(2) consumed HENSD (2.5 MJ) or PLACEBO (0.4 MJ) in fasted state in a single blind randomized cross-over study. Appetite and metabolic rate measurements and blood collection were conducted prior to and during 240 min after the intake of the supplements. Energy intake was recorded during ad libitum buffet breakfast and lunch served 60 min and 240 min post supplementation respectively. RESULTS: Energy intake during breakfast was significantly (P < 0.01) lower in the HENSD trial but the net cumulative effect on energy intake was 1.07 ± 0.34 MJ higher in the HENSD compared to PLACEBO. Plasma concentration of CCK and PYY and insulin and were significantly (P < 0.05) higher in the HENSD trial while appetite measures were not significantly different between HENSD and PLACEBO trials. Correlations for the within participant relations between the responses of plasma hormones and appetite scores were significant (P < 0.05) for PYY and insulin but not CCK. The energy expended above resting metabolic rate was significantly (P < 0.05) higher in the HENDS trial but relative increase in energy expenditure was not significantly different between the two trials. CONCLUSION: Oral high-energy nutritional supplements have a partial and relatively short lived suppressive action on energy intake and can be expected to increase net energy intake by approximately half the energy value of the supplement consumed.

WHAT ARE THE PRACTICALITIES OF MAPPING MINOR CURRICULUM?

BACKGROUND: Many under graduate medical colleges are in the process of mapping their curriculum. This process was investigated in three typical medical schools of Pakistan by semi-structured interviews of the senior faculty members. Conclusions were made and discussed. METHODS: Semi-structured interviews were conducted with the senior faculty curriculum managers concerned with mapping Human Nutrition in three medical schools in Khyber Pakhtunkhwa (KPK) province of Pakistan. Issues relating to the principles and processes used in mapping minor curriculum themes were explored, and the costs and benefits were identified. RESULTS: It was reported that fixed curricular criteria were published by the Pakistan Medical and Dental Council (PMDC) and therefore curriculum mapping was not necessary, with an intention to map minor curriculum themes eventually. Learning outcomes of curriculum themes were not recognized or described. There is no consensus by curriculum managers, evaluating authorities, implementing authorities or senior faculty members about the principles and process of curriculum mapping. Public pressure may cause resistance to any change in the curricula. Action was limited by lack of resources. CONCLUSION: Lack of awareness of the significance of curriculum mapping, as a tool for quality assurance, evaluation and management is prevalent and is the main factor in limiting this technique. Further research is required to establish what has been done in other medical colleges of Pakistan regarding mapping of curriculum themes and what the difficulties are. This analysis will lead to a strategy for improvement, and collaboration of all medical colleges in Pakistan.

NUTRITIONAL SUPPLEMENTS AND THEIR USE IN THE TREATMENT OF MALNUTRITION IN DEVELOPING COUNTRIES.

BACKGROUND: Despite the high global prevalence of malnutrition, it remains under-treated, or undetected. The high energy nutritional supplements are usually prescribed to promote rapid weight gain. However, there is no consensus on the most effective way to treat mild to moderate malnutrition. METHODS: For identification of articles search engines of the databases OVID, MEDLINE, EMBASE and Pub med were used for papers published from 2003 to 2014 in English language. RESULTS: The total energy intake including the supplements is significantly improved. However, the rate of weight gain by the high energy nutritional supplements in moderately malnourished children is less than the expected weight gain. CONCLUSION: While assessing the impact of the supplementation on child nutritional status, other factors should also be taken into account, including appetite suppression, replacement of habitual food intake and compliance to the intervention.

COMPARISON OF PEAK EXPIRATORY FLOW RATE AND LIPID PROFILE IN ASYMPTOMATIC SMOKERS AND NON-SMOKERS.

BACKGROUND: Tobacco is the major risk factor for chronic obstructive airway disease (COAD), other pulmonary diseases, cancer, cardiovascular and cerebrovascular diseases. The objective of study was to determine the mean Peak Expiratory Flow Rate (PEFR) and serum lipid profile. in apparently healthy male smokers and non-smokers. METHODS: This cross-sectional study was conducted in Ayub Teaching Hospital, Abbottabad from 15th December, 2009 to 15th June, 2010. Apparently healthy smokers and non-smokers from population coming to Hospital as attendants of the patients or as employees of the hospital were inducted in the study. PEFR and lipid profile of all the subjects was accessed. RESULTS: There were total of 300 male subjects, 150 smokers and 150 non-smokers. The mean age of study subjects was 26.6 +/- 5.5 years. The mean PEFR of smokers was 450.621/min and that of non-smokers was 494.81 L/min, the difference being statistically significant (p-value <0.05).The mean total cholesterol of smokers is 5.30 +/- 0.86 mmol/l and it was 3.84 +/- 0.54 mmol/l in non-smokers. Mean serum Triacyl Glycerols (TAGs) and Low Density Lipoproteins (LDL) cholesterol of smokers was 2.04 +/- 0.38 and 3.5 +/- 0.83 mmol/l whereas it was 1.44 +/- 0.52 and 2.02 +/- 0.66 mmol/l in non-smokers. Mean High Density Lipo-protein (HDL) of smokers was 0.86 +/- 0.30 mmol/l and of non-smoke is 1.20 +/- 0.41 mmo/l. There was statistically significant difference between serum lipid profile of smokers and non-smokers (p<0.05). the mean serum Total Cholesterol (TC), TAGs and LDL were significantly higher in smokers as compared to non-smokers. However HDL was significantly lower in smokers in comparison to non-smokers. CONCLUSION: There was statistically significant difference between PEFR of smokers and non-smokers.

Frequency of albuminuria in diabetic patients presenting with macrovascular complications.

BACKGROUND: Diabetes mellitus is major cause of morbidity and premature mortality from its long-term complications such as cardiovascular disease, blindness, renal failure, amputation and stroke. The study was conducted to determine the frequency of albuminuria in diabetic patients presenting with macro-vascular complications like myocardial infarction (MI) and stroke. METHODS: This descriptive study was conducted at Ayub Medical College, Abbottabad from December 2010 to May 2011. Total 88 diabetic patients admitted with macro-vascular disease were included in this study. The patients were subjected to two urine specimen's examination, one for routine examination for infection and dipstick analysis for albuminuria. Second was tested for albumin was tested in the urine. RESULTS: Out of 88 patients with a mean 47.12 ± 7.58 years, 39 (44.32%) were female while 49 (55.68%) were male. Overall albuminuria was detected in the urine of 81 out of total 88 patients (92%) when tested by heating method whereas it was detected in 41 (46.6%) cases by the dipstick method. CONCLUSION: Frequency of albuminuria is much.higher in diabetic population with macro-vascular complications; hence albumin in the urine of diabetic patient can be regarded as an indicator for impending macro-vascular complications of diabetes.

Developing and piloting an online course on osteoporosis using a multidisciplinary multi-institute approach- a cross-sectional qualitative study.

INTRODUCTION: Postgraduate medical trainees (PGs) in developing nations face various educational hurdles due to limited access to quality resources and training facilities. This study aimed to assess the effectiveness of e-learning, particularly Massive Open Online Courses (MOOCs), within postgraduate medical education. It involved the development of a customized online course focused on osteoporosis for PGs and an examination of their perspectives and preferences concerning online learning methods like Virtual Learning Environment (VLE) platforms. METHODS: The study was conducted from January 2018 to December 2020. A multi-institutional, multidisciplinary team was assembled to design an osteoporosis course on the VLE platform. PGs (n = 9) from diverse disciplines and institutions were selected with informed consent. Focus group discussions (FGDs) among these PGs identified their preferences for the online course, which subsequently guided the development of the MOOC. The modular MOOC comprised recorded micro-lectures, flashcards, videos, case challenges, and expert interviews. The educational impact of the VLE was assessed using pre- and post-module tests among the participants, and their perceptions of the PGs and course facilitators were gathered via an online survey. RESULTS: The study identified the involvement of PGs in the course design process as beneficial, as it allowed for content customization and boosted their motivation for peer-to-peer learning. During the FGDs, PGs expressed a strong preference for flexible learning formats, particularly short downloadable presentations, and micro-lectures. They also identified challenges related to technology, institutional support, and internet connectivity. In the subsequently customized MOOC course, 66% of PGs (n = 6) attempted the pre-test, achieving a mean score of 43.8%. Following the VLE module, all PGs (n = 9) successfully passed the end-of-module test, averaging a score of 96%, highlighting its impact on learning. The majority (n = 8, 88.9%) agreed that the course content could be applied in clinical practice, and 66.7% (n = 6) expressed extreme satisfaction with the learning objectives and content. Participants favoured end-of-module assessments and the use of best-choice questions for evaluation. CONCLUSION: This study highlights the importance of virtual learning, particularly MOOCs, in addressing the educational challenges faced by developing nations. It emphasizes the need for tailored online courses that cater to the preferences and requirements of PGs. The findings suggest that MOOCs can foster collaboration, networking, and opportunities for professional development, and interdisciplinary collaboration among faculty members can be a key strength in course development. This research provides valuable insights for educators, institutions, and e-learning developers seeking to enhance their teaching methodologies and establish accessible educational environments in the digital age.

Lipid-based Nutritional Supplement Impact on Energy Intake, Appetite, Glucose and Insulin Levels in Under-Weight Pregnant and Lactating Women with Preeclampsia.

OBJECTIVE: To investigate the response of nutritional supplement (LNS-PLW) on appetite score, energy intake, insulin and glucose levels in preeclamptic women. DESIGN & PARTICIPANTS: Sixty under-weight preeclamptic primigravida were divided into two groups randomly and provided LNS-PLW/Placebo in the fasted state. Blood samples were collected at fasting state, after 30mins of supplementation, "ad libitum buffet" breakfast and lunch for glucose and insulin levels. RESULTS: Total energy intake was higher significantly in the LNS-PLW group, although during breakfast it was significantly reduced. The insulin and glucose concentration was significantly increased after 30min of supplementation in the LNS-PLW group. CONCLUSION: Intake of the LNS-PLW by pre-eclamptic women had short-term suppression on subsequent meal but improved total energy intake during trial.

Effects of Oral Lipid-Based nutritional supplements on appetite, energy intake, and lipid profile of moderately underweight children.

Oral lipid-based nutritional supplements (LNS) are designed to ensure dietary adequacy and to improve malnourishment in children. Therefore, this study investigated the effects of 4 weeks of LNS on appetite, energy intake, and lipid profile of moderately underweight children (5-10 years old) with BMI-Z score between -2 and - 3 SDS, recruited in a single-blind randomized control trial. In addition to the regular dietary intake, fasting blood samples, anthropometric measurements, energy intake, and appetite responses were obtained before and after 4 weeks of LNS (535 kcal) or PLACEBO (92 kcal). After 4 weeks of supplementation mean energy intake (kcal) (p < .001), body weight (kg) (p < .001), BMI (kg/m2) (p < .01), mid-upper arm circumference (cm) (p < .01), total cholesterol (mg/dl) (p < .01) and fasting glucose (mg/dl) (p < .01) were raised significantly in the LNS group as compared to the PLACEBO group. No significant changes were detected in appetite responses (p > 0.05). In conclusion, LNS increases the overall energy intake, but does not affect the appetite but may induce hyperglycemia and hyperlipidemia.