Assessment of learning environment among the first year Malaysian medical students

Objectives: The quality of the learning environment has been identified to be crucial for effective learning. Medical students' perceptions of learning environments provide a useful foundation for modifying and improving the quality of medical education. The aim of this study was to assess first-year medical students' perceptions of the learning environment in Universiti Kebangsaan Malaysia [UKM]

Methods: The Dundee Ready Educational Environment Measure [DREEM] questionnaire was distributed to all 213 first-year medical students of UKM. The questionnaire contained 50 items scored on a 0-4 Likert scale [total scores could range from 0 to 200]. There were five subscales in the questionnaire, including students' perceptions about learning, teachers, atmosphere, academic self-perceptions, and social self-perceptions

Results: The total DREEM score recorded in this study was 135.6/200, which indicated that medical students' perceptions of the learning environment at UKM were more positive than negative. Students' perceptions of learning, students' perceptions of teachers, students' academic self-perceptions, students' perceptions of atmosphere and students' social self-perceptions scores were 33.04/48, 29.68/44, 22.16/32, 33.11/48 and 17.62/28, respectively. The total DREEM score was significantly higher among female [137.02/200] than male medical students [130.84/200] [p < 0.05]. There was no relationship between the students' perceptions of the learning environment and their academic performance [R = -0.06, p > 0.05]

Conclusion: The study showed that first-year medical students at UKM positively perceived their learning environment. Some low-scoring areas of the learning environment were also identified, which require improvement in the future

systematic review and meta-analysis comparing intravitreal ranibizumab with bevacizumab for the treatment of myopic choroidal neovascularisation

Intravitreal injections of ranibizumab [IVR] and bevacizumab [IVB] have both been used as treatments for myopic choroidal neovascularisation. We aimed to produce a meta-analysis of published literature comparing IVR with IVB for the treatment of myopic choroidal neovascularisation, by searching electronic databases from January 1950 to March 2013. Our search produced three suitable studies that reported on 117 patients in total. The results of the meta-analysis demonstrated that the mean number of lines improvement after IVR appeared better compared with IVB [fixed effects model: SMD = 0.46, 95% CI [0.09, 0.83], z = 2.44, p = 0.01]. The number of patients who had a greater than 3 line improvement was similar between groups [fixed effects model: RR = 0.95, 95% CI [0.67, 1.32], z = 0.33, p = 0.74]. At follow up there was no difference in number of those who had an absence of leakage [fixed effects model: RR = 1.04, 95% CI [0.93, 1.16], z = 0.64, p = 0.52]. There was no statistical significance between the two groups in relation to the number of injections [random effects model: SMD = -0.25, 95% CI [-1.12, 0.61], z = 0.57, p = 0.57]. Early evidence therefore suggests that intravitreal injections of ranibizumab are comparable to intravitreal injections of bevacizumab in the treatment of myopic choroidal neovascularisation. Both treatments result in a statistically significant increase in visual acuity with high numbers of patients maintaining stable vision. Further studies are still needed to strengthen results

Potency and persistence of the bacterial mosquitocide bacillus sphaericus against culicine mosquitoes under field conditions

The biopesticide Bacillus sphaericus represents one of the important tools used in the control of mosquito larvae after chemical insecticides. The present study was conducted to investigate the efficacy B. sphaericus 2362 [VectoLex] in two different technical powders, ABG-6232 and ABG-6491 against larvae of two mosquitoes, Culex pipiens and Aedes caspius in El-Arish city, North Sinai, Egypt. The mosquito larvae were collected from polluted and fresh water [Cx. Pipiens] and saline water [Ae. Caspius]. The physicochemical characteristics of larval breeding water sites were measured as salinity, conductivity, pH values and temperature. Susceptibility bioassays showed that Cx. pipiens larvae from polluted water sites have high susceptibility to B. sphaericus 2362 formulation ABG-6232 [LC[50] 0.15-0.33 ppm, LC[90]: 0.73-9.68 ppm]. In case of ABG-6491 formulation, the values were LC[50]: 0.15-0.33 ppm and LC[90]: 1.73-9.83 ppm. Cx. pipiens larvae collected from fresh water habitat in El-Qusiema, outside El-Arish city, susceptibility to B. sphaericus 2362 ABG-6232 had LC[50] values ranging between 0.12 and 0.28 ppm, while LC[90] ranged between 1.59 and 4.13 ppm. In case of ABG-6491, the LC[50] values ranged between 0.13 and 0.28 ppm, while LC[90] values ranged between 1.46 and 8.93 ppm. For Ae. caspius larvae from saline water and treated with B. sphaericus 2362 ABG-6232, LC[50] values ranged between 0.31 and 1.36 ppm, while LC[90] ranged between 1.92 and 9.75 ppm. In case of ABG- 6491, the LC[5o] values ranged between 0.34 and 0.59 ppm, while LC[90] values ranged between 1.79 and 11.56 ppm

Beliefs about euthanasia among university students: perspectives from Pakistan

Opinions of university students about euthanasia were studied in 4 cities in Pakistan using convenience sampling. A total of 836 students [316 males and 520 females] completed a questionnaire in which euthanasia was defined as deliberate administration of an overdose of a drug by a doctor to relieve pain and suffering of a dying patient at his/her explicit request to end his/her life. Only 25.6% of students agreed that euthanasia should be legalized in Pakistan. The most common reason cited for legalization of euthanasia was to relieve patient's suffering but only when a committee of physicians agreed to recommend it Students who opposed legalization [74.4%] cited impediments to future medical research as the most common reason, followed by the risk of misuse by physicians or family members. Only 8.9% of students cited religious beliefs as a reason against legalization. There is a need in Pakistan for more debate about euthanasia

biological effects of the insect growth regulators; pyriproxyfen and diflubenzuron on the mosquito Aedes aegypti

The biological effects of two insect growth regulators [IGRs], pyriproxyfen and diflubenzuron against larvae of the mosquito Aedes aegypti [L.] have been evaluated. Mosquitoes were collected from Jeddah governorate, west of the Kingdom of Saudi Arabia and maintained in the laboratory. According to IC[50] values obtained [concentrations which inhibit the emergence of 50% of adults], diflubenzuron [0.00036 ppm] proved to be more effective by 11.4 fold of pyriproxyfen [0.0041ppm]. In addition to the delayed lethal action, larval treatment with the two IGRs, pyriproxyfen and diflubenzuron led to pronounced reduction in the reproductive potential of mosquito adults that emerged from these treatments. Pyriproxyfen caused a 33.2% decrease in egg production compared to 25.5% for diflubenzuron. The reduction in egg hatchability was by 40.6 and 36.2 % for pyriproxyfen and diflubenzuron, respectively, with up to 4 fold higher reduction rates than in the control tests. These results shed light on the extended biological effects of IGRs on mosquitoes and encourage further testing of IGRs for wider use in the control of Ae. aegypti and other important disease vectors in Arabia and the world

Seroprevalence of human toxocariasis [visceral larva migrans]

A total of 455 patients who fulfilled the inclusion criteria were included in the study. The enrolled patients were subjected to a questionnaire [including sociodemographic and other risk factors] and thorough clinical examination was done for the patients. Sera were collected from patients and tested for anti-Toxocara IgG antibodies using ELISA. The overall and- Toxocara sero-positive was [7.7%]. It was significantly higher than among the randomly selected 30 healthy controls. There were no significant differences between the seropositive and seronegative patients regarding age, sex, educational level and monthly family income of the patient. However, rural residence, poor house, pet's ownership and frequent contact with soil were found to be significant. Patients who had confirmed bronchial asthma were more than 2 times at higher risk of developing toxocariasis [OR, 2.33; 95% CL 1.09-4.98] than those with other clinical diagnosis [PUO, hepato-megaly or heptosplenomegaly, lympha-denopathy, neurological disorders, gastrointestinal troubles and dermatitis]. Patients with eosinophilia were at 149 times greater risk of being Toxocara seropositive compared to those without eosinophilia [OR, 148.7; 95% CI: 53.5-413.3]. Multivariate regression analysis showed eosinophilia and contact with soil were the most important predictors of toxocariasis. OD of anti-Toxocara antibodies [ELISA] was significantly positive with eosinophilia level

Immunological studies on avian E.coli vaccine with special reference to preparation and evaluation

Local prepared E.coli F11 fimbriae vaccine was prepared and compared with an imported one against chicken E.coli infection. The antibody response in sera of chickens vaccinated with the prepared E.coli F11 fimbriae vaccine [group 1] and the antibody response in sera of chickens vaccinated with oil imported E.coli vaccine [group 2] as determined by ELISA were similar. The antibody response in sera of chickens of groups 1 and 2 appeared from the first week post vaccination and reached the maximum at the third week post second vaccination. Challenge of vaccinated and control chickens were done at the third week post second vaccination. Chickens of groups 1 and 2 have decreased number of lesion scores than the control one. Also, chickens of groups 1 and 2 and challenged with heterologous. E.coli strains [08, 114, and 119] have increased number of lesion scores than that challenged with homologous E.coli strains [01, 02, and 078]. In addition, chickens of groups 1 and 2 have higher percent of protection [PIS: had 84, 70, 80, and 67% respectively] than the control one [PIS: 34%]. In conclusion, the prepared F11 fimbriae vaccine from a combination of 01, 02 and 078 E.coli strains was seemed to cover good range of protection and has been elicited a protective immune response against virulent E.coli challenge with homologous and hetorologous strains. Over all, strong correlation was found between antibody response in vaccinated groups and low lesion score that indicated a good protection

Clinical spectrum of non alcoholic cirrhosis

Cirrhosis liver is a major health problem worldwide and specially in developing countries like Pakistan. It is defined as necrosis of liver followed by fibrosis and regeneration. Alcohol and viral hepatitis are the two important causes of cirrhosis. Clinical presentation of cirrhosis depends on stage of cirrhosis whether compensated or de-compensated. Most of the clinical features are common to all types but there are certain features, which are more common in one type than the other. This prospective study was conducted to find the frequency of various clinical features of non-alcoholic cirrhosis and to compare it with those reported in literature. Hundred patients of cirrhosis admitted to Medical Unit of Khyber Teaching Hospital Peshawar between March 1997 to Dec 1997 were included in the study. All the relevant details regarding history, clinical examination and investigations were recorded in specially designed proforma. The commonest presenting features were abdominal distension [61%], generalized weakness [55%], pain abdomen [52%], anorexia [45%], fatigue [38%], low grade fever [38%], nausea and vomiting [36%], swelling of feet [35%], haematemesis [33%], loss of libido [33%] and weight loss [25%]. The commonest signs observed were splenomegaly [75%], anaemia [72%], ascites [65%], oedema feet [43%], jaundice [40%], leukonychia [40%], palmer erythema [35%], hepatomegaly naevi [18%], testicular atrophy [15%] and gynaecomastia [12%]. Viruses specially HBC and HCV were the main aetiological factors[76%]. The data indicates that clinical features found in this study are not very different from other parts of Pakistan. Dupuytren's contractures, parotid gland enlargement and gynaecomastia are rare in our population as compared to that in western literature [alcohol in the west and viral hepatitis in our population]

Leiomyosarcoma of the bladder in a 16-year-old girl with a history of cyclophosphamide therapy for bilateral retinoblastoma during infancy

A 16-year-old female with bladder leiomyosarcoma had a history of bilateral retinoblastoma at 6 months of life. She received cyclophosphamide chemotherapy after surgical enucleation. In this report, we discussed the possible role of retinoblastoma or cyclophosphamide as a target for the development of bladder leiomyosarcoma

Repair of inguinal hernia as day care [ambularoty] vs inpatient [routine] surgery, study at Mayo Hospital, Lahore

This cross sectional, comparative study carried out in the Department of Surgery, Mayo Hospital, Lahore over a period of one year. Study include 80 patients divided in two equal groups i.e., day care [ambulatory] and inpatient [routine]. To compare postoperative complication, economic benefits, routine daily activity and also to evaluate acceptance of day surgery in our set up. Those belonging to day surgery were worked up on OPD basis and in combination and procedures performed were herniotomy or herniorrhaphy. The final results were conclusive enough to show that day care hernia can be successfully performed in one set up and comparable results in terms of operative and postoperative complications can be obtained and are matchable to any hernia centre. Hospital stay and expenses of treatment on hospital resources are significantly reduced

Selection of medical students and its implication for students at King Faisal university

The appropriate selection of medical students is a challenging task. It requires that important assessment criteria principally based upon cognitive skills that include the matriculation and admission test scores of the applicants be fulfilled. Non-cognitive skills are also important, but used to a lower degree include intellectual flexibility, inquisitiveness, critical reasoning, logical thinking, tolerance, ability to cope with uncertainty and problem solving. Other criteria that are also considered important for selection include personal qualities and attitudes of the applicants that reflect directly on doctor-patient relationship. In contrast, such demographic factors as age, gender, race, religion, socio-economic status and schooling should not influence the selection process. The admission criteria adopted at King Faisal University Medical College focus basically on cognitive criteria. Other criteria whether non-cognitive or personal quality assessment are also taken into account through interviews and completed questionnaires

Tubularized incised plate [TIP] urethroplasty: extended use in hypospadias re-operation

Objective: Recently, tubularized incised plate [TIP] urethroplasty [Snodgrass repair] has gained popularity for the primary repair of distal and proximal hypospadias. This study was carried out to evaluate TIP urethroplasty in the repair of failed and complicated hypospadias cases

Patients and Methods: This study was carried out in the pediatric surgery unit, Departments of General Surgery and Urology, Zagazig University Hospital. Twenty-four patients with failed and complicated hypospadias with an intact urethral plate were included in this work. Thirteen patients [54%] were younger than 3 years, and 3 patients [13%] older than 6 years. The original hypospadias was coronal in 4, midshaft in 11 and penoscrotal in 9 cases. Wide fistula was present in 8 cases [32%] and dehiscence was found in 6 cases [26%]. Previous procedures included meatal advancement and glanuloplasty incorporated [MAGPI] in 5 [21%] cases, Mathieu procedure in 4 [17%], and preputial flaps in 13 [55%] cases. Two patients [8%] had been subjected to previous TIP urethroplasty. Twenty cases had had a single preceding procedure, while 4 cases had been subjected to two previous trials of correction. The time that had elapsed before re-operation was less than 6 months in 14 cases [58%]

Results: Fistula occurred in 3 cases, two of them had had preoperative fistula. Meatal and anastomotic strictures occurred in 2 cases each and were completely managed by dilatation for 3-6 months. Wound infection occurred in 5 cases. Good cosmetic and functional results were achieved in 15 cases [63%]. TIP urethroplasty was found to be suitable for re-operating previously failed hypospadias cases because it reconstructs the urethra entirely from the urethral plate which is the least affected part after all types of repair. Also, no relation was found between the morphology of the urethral plate and the success of TIP repair. Most of the cases had an intact urethral plate which had not been incised in the primary procedure. Further studies are needed to assess the possibility of using a urethral plate which was previously incised in a primary procedure

Conclusion: TIP urethroplasty could be a reasonable procedure in failed and complicated hypospadias cases. It provides good cosmetic and functional results and can be done using minimal residual tissues remaining after primary procedures

Physicians' knowledge, attitude and practice towards erectile dysfunction in Saudi Arabia

We aimed to test the knowledge, attitude and practice [KAP] of physicians towards erectile dysfunction in the Eastern province of Saudi Arabia. At a scientific meeting about erectile dysfunction, 159 physicians from both government and private sectors answered a 34-item questionnaire in private. The mean total KAP score for the group was below the expected st and ard of 60%. Male physicians scored significantly higher than females. Urologists scored the highest, followed by and rologists. Surprisingly, physicians with higher qualifications scored lower than those with intermediate qualifications and even less than general practitioners. Those who had practised for >/= 10 years scored better than those with < 10 years practice. The role of cardiologists in the diagnosis and management of erectile dysfunction is discussed

Investigation on three types of aloe species from Bangladesh

Comparative studies on three species of Aloe from Bangladesh have been done for their growth performances, aloin content and laxative properties. Aloe indica found suitable in respect of rapid multiplication and growth, A. Vera for Albin content followed by Aloe species. The laxative properties was found higher in Aloe sp

New insights into the modulatory role of serotonin reuptake inhibitors in myocardial ischemia reperfusion injury in rabbits

In view of the importance of serotonin in the pathogenesis of myocardial infarction [MI] and the reported decrease in platelet serotonin concentration associated with the treatment with selective serotonin reuptake inhibitors [SSRIs], the present study was planned to test the hypothesis of decreased risk of MI associated with the use of SSRIs in rabbits exposed to myocardial ischemia reperfusion injury [MIRI], with or without cigarette smoking. The present study was conducted on 50 New Zealand White male rabbits grouped into: group I [sham-operated], group II [coronary artery ligated and reperfused for induction of MIRI], group III [smoking for eight weeks and then coronary artery ligated and reperfused], group IV [treated with fluoxetine for three weeks before coronary artery ligation and reperfusion] and group V [smoking for eight weeks and treated with fluoxetin for three weeks, starting from the 6[th] week of smoking, before coronary artery ligation and reperfusion]. Six hours following coronary artery ligation and reperfusion, relaxation response of left anterior coronary artery [LACA] segments to acetylcholine [Ach] was assessed and plasma cardiac troponin T[cTnT], homocysteine [Hcy] and urinary cotinine concentrations as well as percentage of platelet aggregation in response to adenosine diphosphate [ADP] were measured. MIRI resulted in a significant attenuation of ACh-induced relaxation in LACA segments compared to normal sham-operated rabbits. A significant decrease in Ach-induced relaxation in smoking MIRI compared to non-smoking MIRI rabbits could be also detected. A significant increase in percentage of platelet aggregation in response to ADP and in plasma Hcy and cTnT concentrations could be detected in MIRI rabbits compared to sham-operated rabbits with a significant difference between smoking and non-smoking MIRI rabbits. Fluoxetine treatment significantly improved endothelium-dependent relaxation to ACh in LACA segments obtained from nonsmoking and smoking MIRI rabbits. Fluoxetine treatment also resulted in significant decrease in plasma Hyc and cTnT concentrations and in percent of platelet aggregation compared to non-treated smoking and non-smoking MIRI rabbits. The data of the present study support the notion that platelets play a role in MI. It could be concluded that SSRIs could be protective against MI by inhibiting serotonin-mediated platelet activation and exerting favorable effect on endothelial function. Future clinical trials, well designed and carefully conducted should elucidate the potential benefits of SSRIs in multiple thrombotic events like MI and unstable angina

Risk assessment of spontaneous abortion in Cairo: a case control study

There is an increased risk of spontaneous abortion with high level of chemicals exposures as shown for some occupational groups. Howevere, there are substantial gaps in our knowledge about whether exposure to environmental chemicals has an impact on spontaneous abortion for the general population. The study aimed to measure the blood lead level and investigate the risk factors of spontaneous abortion among married women in Cairo governorate. A case-control-hospital based study was carried out in four different types of hospitals at the emergency and outpatients clinics. The subjects composed of 2 groups, control group [a]: normal pregnant females [232 subjects] attending the hospital after 28th week of gestation and spontaneous abortion group [b]: 230 cases attended the emergency room of the studied hopitals. The researchers collected the required data through an interviewing questionnaire then blood samples from them were collected and analzed for blood lead level by the atomic absorption method. The study revealed that women at high risk of developing spontaneous abortion are those with smoker husbandss, low educational level, low income, living nearby chimney, irregular and painful menstruation. Also women with previous history of abortion[s], congenital anomalies, pelvis operation[s] and abortion investigations are at more risk for the development of spontaneous abortion than the normal pregnancy ones. We have recommended that women who are at the spontaneous abortion risk during pregnancy should have a more frequent antenatal care for monitoring and evaluation. Also, there is a great need for a well developed occupational health programs and studies in this arena