Correction: The effectiveness of problem based learning in improving critical thinking, problem-solving and self-directed learning in first-year medical students: A meta-analysis.

[This corrects the article DOI: 10.1371/journal.pone.0277339.].

The effectiveness of problem based learning in improving critical thinking, problem-solving and self-directed learning in first-year medical students: A meta-analysis.

BACKGROUND: The adaptation process for first-year medical students is an important problem because it significantly affects educational activities. The previous study showed that 63% of students had difficulties adapting to the learning process in their first year at medical school. Therefore, students need the most suitable learning style to support the educational process, such as Problem-based learning (PBL). This method can improve critical thinking skills, problem-solving and self-directed learning. Although PBL has been adopted in medical education, the effectiveness of PBL in first-year medical students is still not yet clear. The purpose of this meta-analysis is to verify whether the PBL approach has a positive effect in improving knowledge, problem-solving and self-directed learning in first-year medical students compared with the conventional method. METHODS: We searched PubMed, ScienceDirect, Cochrane, and Google Scholar databases until June 5, 2021. Search terms included problem-based learning, effectiveness, effectivity, and medical student. We excluded studies with the final-year medical student populations. All analyses in our study were carried out using Review Manager version 5.3 (RevMan Cochrane, London, UK). RESULT: Seven eligible studies (622 patients) were included. The pooled analysis demonstrated no significant difference between PBL with conventional learning method in critical thinking/knowledge assessment (p = 0.29), problem-solving aspect (p = 0.47), and self-directed learning aspect (p = 0.34). CONCLUSION: The present study concluded that the PBL approach in first-year medical students appeared to be ineffective in improving critical thinking/knowledge, problem-solving, and self-directed compared with the conventional teaching method.

Chaperone-Based Therapeutic Target Innovation: Heat Shock Protein 70 (HSP70) for Type 2 Diabetes Mellitus.

Type 2 diabetes mellitus (T2DM) is still a global health problem. Current T2DM treatments are limited to curing the symptoms and have not been able to restore insulin sensitivity in insulin-sensitive tissues that have become resistant. In the past decade, some studies have shown the significant role of a chaperone family, heat shock protein 70 (HSP70), in insulin resistance pathogenesis that leads to T2DM. HSP70 is a cytoprotective molecular chaperone that functions in protein folding and degradation. In general, studies have shown that decreased concentration of HSP70 is able to induce inflammation process through JNK activation, inhibit fatty acid oxidation by mitochondria through mitophagy decrease and mitochondrial biogenesis, as well as activate SREBP-1c, one of the lipogenic gene transcription factors in ER stress. The overall molecular pathways are potentially leading to insulin resistance and T2DM. Increased expression of HSP70 in brain tissues is able to improve insulin sensitivity and glycemic control specifically. HSP70 modulation-targeting strategies (including long-term physical exercise, hot tub therapy (HTT), and administration of alfalfa-derived HSP70 (aHSP70)) in subjects with insulin resistance are proven to have therapeutic and preventive potency that are promising in T2DM management.

High level of individual lipid profile and lipid ratio as a predictive marker of poor glycemic control in type-2 diabetes mellitus.

Introduction: Diabetes is often accompanied by undiagnosed dyslipidemia. The aim of the study is to investigate the clinical relevance of lipid profiles and lipid ratios as predictive biochemical models for glycemic control in patients with type 2 diabetes mellitus (T2DM). Methods: This is a retrospective study recruiting 140 patients with T2DM during a one-year period, 2018-2019, at the Diabetic Center Sanglah General Hospital and Internal Medicine Polyclinic Puri Raharja General Hospital. Demographic characteristics, glycosylated hemoglobin (HBA1c) , and lipid profile were recorded and analyzed using SPSS version 25.0 for Windows. The sample is then classified into good (HBA1c≤7) and poor (HBA1c>7) glycemic control. Risk analysis model, receiver operator characteristics (ROC) analysis, and correlation test were used to evaluate the association of HBA1c level with lipid profile and lipid ratio parameters. Result: Lipid profile findings such as total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) , triglycerides (TG), and lipid ratio parameter (LDL-C to high-density lipoprotein cholesterol (HDL-C) ratio) were higher in patients in the poor glycemic control group (p<0.05) and HDL-C was significantly lower in patients with poor glycemic control (p=0.001). There is a significant positive correlation between LDL, total cholesterol, LDL-C, TG, and TC to HDL-C ratio, triglycerides, and TC/HDL-C ratio with HBA1c level. Meanwhile, a negative correlation was observed on HDL-C with the HBA1c level. Only TC/HDL-C ratio and LDL-C/HDL-C ratio parameters may be used as predictive models (AUC>0.7), with cutoff point, sensitivity, and specificity of 4.68 (77%; 52%) and 3.06 (98%; 56%) respectively. A risk analysis model shows that the LDL-C/HDL-C ratio parameter is the most influential risk factor in the occurrence of poor glycemic control (adjusted OR =38.76; 95% CI: 27.32-56.64; p<0.001). Conclusion: Lipid profiles (LDL-C) and lipid ratios (LDL-C/HDL-C and TC/HDL-C ratio) show potential markers that can be used in predicting glycemic control in patients with T2DM.

Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer

Background: Inflammation represents a pivotal role in the progression of cervical cancer. The hematological markers of inflammation in complete blood count (CBC) panel are potentially useful in determining the prognosis of the disease. Objective: The aim of the study was to investigate whether the pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) could be used as in predicting the stage of cervical cancer. Methods: A retrospective cross-sectional study involving 282 patients with cervical cancer was enrolled at Sanglah General Hospital for five years (2013-2017). The histopathological records and complete blood counts (CBC) of the patients were collected and analyzed using SPSS ver. 16 software. FIGO stage I­II and III-IV were classified as early and advance stage respectively. Results: The median NLR and PLR were significantly higher in the advance stage compared with early stage (7.58 (1.36-33.20) and 247.89 (97.10-707.11); p-value = 0.001). A strong positive correlation was found between the staging of cervical cancer and NLR (r=0.638) and PLR (r=0.668). The AUC, sensitivity, and specificity value of NLR and PLR were 0.803 (82%; 71%) and 0.716 (72%; 70%). Advanced stage of cervical cancer was found in high NLR (adjusted OR: 9.02; 95%CI=2.42-33.64; p=0.001) and PLR (adjusted OR = 2.47; 95% CI = 1.45-4.85; p = 0.032). Conclusion: Increased pretreatment NLR and PLR values may provide a useful information in predicting the staging of cervical cancer.

Management of ST-elevation myocardial infarction in the setting of anterior epistaxis: focused on antiplatelet and antithrombotic therapies.

BACKGROUND: Antiplatelet and antithrombotic therapies are part of standard core treatments for ST-elevation myocardial infarction (STEMI). Effectiveness of these therapies, however, is often offset by the resultant hemorrhagic complications, which in turn possess significantly worse prognosis. Acute myocardial infarction (AMI) accompanied by acute bleeding, such as anterior epistaxis, is common and arise potential dilemma in deciding appropriate management as a standard medical strategy that may put patients in immediate threat as it increases the ongoing bleeding event. CASE DESCRIPTION: A 46-year-old male patient with late-onset infero-posterolateral STEMI and anterior epistaxis was admitted to the emergency ward of Mangusada Regional Hospital. The patient had long-standing history of uncontrolled hypertension and previously been treated with tranexamic acid to stop nasal bleeding. Neither percutaneous coronary intervention nor fibrinolysis was performed due to financial issue, and patient only managed conservatively with adequate medications including dual antiplatelet with aspirin and clopidogrel and anticoagulant with unfractionated heparin. No active bleeding was observed during in-hospital treatment and the patient was then discharged after 8 days with complete improvement of symptoms and ST-segment elevation resolution. CONCLUSION: This case report highlights the treatment strategy for patients with myocardial infarction in the setting of acute bleeding focusing on antiplatelet and anticoagulant therapies. We also discussed the potential association between tranexamic acid and arterial thromboembolic complication resulting in AMI.