Integrated assessment in medical education

Background: Integrated assessment has become imperative especially after applying the new integrated curriculum

Aim: To shed the light on some strategies for incorporating integrated assessment when implementing the new integrated curriculum

Conclusion: Integrated assessments must be applied in educational institutions. These assessments provide important ways to enhance student outcomes. Several strategies could be applied which should be selected in accordance to students' learning outcome

role of hyperlipidemia on nerve conduction

Previous reports suggested a relationship between hyperlipidemia and neuropathy as a cause of focal neuropathy or generalized poly-neuropathy. Only few cases were reported and they are often involved individuals with other illnesses which cause neuropathy, such as diabetes mellitus, hypertension, hyperuricemia and fatty liver. To study the association of peripheral neuropathy with hyperlipidemia and to detect the type of peripheral neuropathy and its distribution. Prospective study. Neurophysiology unit in Basra teaching hospital and the department of physiological chemistry, College of Medicine, University of Baghdad. Sixty-eight patients [38 males and 30 females] aged 25-77 years with a mean age of [48.9 +/- 13.5] years. Forty-two healthy subjects [24 males and 18 females] of matching age were enrolled as control. Biochemical investigations included lipid profile, post parandial blood glucose, blood urea, serum creatinin and uric acid. Electrophysiological investigations included: 1. Sensory nerve conduction study: measurement of sensory latency, amplitude and conduction velocity of median, ulnar, common peroneal and posterior tibial nerves bilaterally. 2. Motor nerve conduction study: measurement of latency amplitude and conduction velocity of the CMAP of median, ulnar, common peroneal and posterior tibial bilaterally. 3. F-wave conduction study: measurement of minimal f-wave latency and conduction velocity of median and common peroneal nerves bilaterally. The result of the sensory nerve conduction study revealed variable levels of significance between measured parameters of the same nerve and between different nerves. As for the motor nerve conduction study and f-wave conduction study, they were all normal and with no abnormality that could be elicited. Hyperlipidemia could be associated with subclinical peripheral neuropathy which may occur more frequently in patients with very high levels of TG, TC and LDL. The type of peripheral neuropathy that occurs is mainly a sensory type, although motor neuropathy cannot be excluded

Age related changes in cardiovascular response to oxidative stress induced by exercise

There are many circulatory changes that occur during exercise in order to supply the tremendous blood flow required by the muscles during the stimulatory effects on circulation by the mass sympathetic discharge, the increased arterial pressure and cardiac output. The metabolic effects and the oxidative stress as a result of the work load on cardiac and skeletal muscles could also show changes. This study was designed to investigate the effects of aging process on the vascular response during exercise and also in the oxidative stress according to age. Eight healthy Iraqi subjects were enrolled in this study. Divided into three groups according to age, group I [age range 20-29], group II [age range 30-39], and group III [age range 40-49]. They were asked to exercise according to modified Bruce protocol. Blood samples were taken from each subject pre and post exercise for biochemical tests. The test included were creatine kinase, uric acid, malonedialdehyde [MDA], lipid profile [triglycerides, cholesterol, high density lipoprotein HDL]. Low density lipoprotein LDL was calculated. There is a statistical significance increase in heart rate and systolic blood pressure after exercise in all groups however diastolic blood pressure showed a decrease. A positive linear correlation is present. Mean serum levels of uric acid was shown to be elevated after exercise, meanwhile triglycerides levels decreased significantly in all age groups after exercise and also cholesterol. LDL on the other hand showed a decrease in the younger age group. The results obtained set a normative data for the studied parameters for the age group included in the study to be used in the future for the detection and differentiation of any cardiovascular abnormality from age related changes. These data have important clinical implications if we are to prevent the frailty and morbidity associated with old age

Exercise induced growth hormone and the effect of age and oxidative stress parameters in Iraqi subjects

Exercise is a potent stimulus for growth hormone [GH]. Age and oxidative stress are associated with a diminution of GH secretion. The aim is to explore the changes that occur in such parameters with exercise in an attempt to determine which one is more important for growth hormone production in order to set a milestone for overcoming such a cause in the future. This is one of many steps in trying to improve the life quality and style in elderly subjects. Sixty healthy Iraqi subjects were enrolled in this study. Divided into three groups according to age, group I [age range 20-29], group II [age range 30-39], and group III [age range 40-49]. They were asked to exercise according to modified Bruce protocol. Blood samples were taken from each subject pre and post exercise for biochemical tests. The test included were GH, creatin kinase, uric acid, malonedialdehyde [MDA], lipid profile [triglycerides, cholesterol, high density lipoprotein HDL]. Low density lipoprotein LDL was calculated. The same trend of having high triglyceride level had been shown in all groups in males and females before and after exercise and decrease after that. However the level is lower in the age group 20-29 and increases with increasing age. Same can be said about cholesterol. But HDL has a plateau pattern in all three groups but it decreases with increasing age. LDL on the other hand shows a significant decrease after exercise in both males and females in the small age group. Such a behavior can also be observed in the two other age groups but with less significance. The behavior of MDA and CK is the same in all age groups with a significant increase after exercise. One characteristic important finding is that the level of growth hormone in the females shows a significant increase after exercise in all age groups when compared with males although its level is less in the higher age group than in the lower. Mean serum levels of uric acid showed an elevation after exercise from its basic level before exercise. A significant difference was found between group I and group III. In conclusion regular exercise increases the secretion of growth hormone which in turns leads to an increase in physical fitness thus delays aging process despite the oxidative stress process that occur during these events. These conclusions have important clinical implications if we are to prevent the frailty and morbidity associated with old age

Improvement in sperm motility viability and normality after treatment with prednisolone, antisperm antibody separation and in vitro sperm activation in immunologically infertile men

Antisperm antibody [ASA] as a cause of men infertility was fist reported in 1954. Different assays were developed for the detection of scrum-bound antibodies. The objective of this study is to study the effect of prednisolone, antisperm antibody separation [ASAS] and in vitro sperm activation on sperm motility, viability and morphology in immunologically infertile patients. Semen samples of 250 immunologically infertile patients were examined by seminal fluid analysis and microagglutination test to check the presence of sperm agglutination and antisperm antibodies [ASA]. The patients received 5mg prednisolone three times per day for two weeks then the dose was reduced to two tablets per day for four days and further reduced to one tablet for three days followed by one week of rest period. The treatment regimen was continued for three months and seminal fluid analysis was performed before and after the treatment. Sperm motility percent, sperm grade activity, sperm motility index, normal sperm morphology and sperm viability after the treatment were significantly improved [P< 0.001] while the percent of sperm agglutination, shaky head sperm movement percent of abnormal sperm morphology were significantly decreased [P < 0.0001]. the progress in the improvement of sperm quality was started at the end of 4[th] week after treatment and increased gradually up to the end of the 12[th] week. Application of prednisolone therapy, ASAS technique and in vitro sperm activation found to be effective and resulted in significant improvement sperm quality. These active and viable sperm following treatment may be used for intrauterine insemination or in vitro fertilization [IVF] and embryo transfer [ET] for the treatment of immunological infertile men