Investing in scholarship for health professions education: Learning from the past to move into the future.

There have been recent discourses of what scholarship means for health professions education (HPE) and how it may need a rethink during the pandemic. One key take home message from these discourses is the role of institutions in nurturing and investing in scholarship. Given the current challenges faced by both higher education and healthcare, there is a risk that activities and resources for scholarship in HPE may be neglected. How do institutions make a case for continuous investment in HPE scholarship? Despite being a relatively new and small private university with no public funding, IMU has made fairly significant progress in delivering a unique model of HPE programmes with HPE scholarly output. This commentary discusses the importance of investing in scholarship for HPE with the International Medical University (IMU) in Kuala Lumpur, Malaysia as a case study. Examples of institutional initiatives that support and enhance scholarship are presented based on the recent AMEE guide (142) on redefining scholarship.

Transfer of knowledge, skills and confidence from a faculty development programme for health professions educators into practice.

BACKGROUND: Faculty development programmes should incorporate the transfer of knowledge, skills, and confidence from the training to educational practice. However, there is a risk that transfer may fail due to inadequate integration of knowledge, skills, and confidence. The study evaluated transfer levels, guided by learned principles from a faculty development programme. METHOD: The submitted self-reports on a pedagogical intervention of 92 out of 190 health professions educators who participated in a mandatory teaching and learning training programme, were analysed by a mixed-method approach guided by a structured conceptual framework. RESULTS: Overall 93.4% reported the successful transfer of learning. Participants incorporated sustainable changed practice (level A, 57.6%), showed reflection on the impact of changed practice (level B, 21.7%), and performed effect analysis (level C, 14.1%). The rest planned application of learning (level D, 4.4%) and identified gaps in current practice or developed an idea for educational intervention but did not implement (level E, 2.2%). CONCLUSION: The majority of participants transferred their learning. Faculty development programmes must ensure successful transfer of knowledge, skills, and confidence from the training to educational practice to ensure sustainable development of teaching and learning practices.

Evaluation of serum MMP-9 as predictive biomarker for antisense therapy in Duchenne.

Duchenne Muscular Dystrophy (DMD) is a severe muscle disorder caused by lack of dystrophin. Predictive biomarkers able to anticipate response to the therapeutic treatments aiming at dystrophin re-expression are lacking. The objective of this study is to investigate Matrix Metalloproteinase-9 (MMP-9) as predictive biomarker for Duchenne. Two natural history cohorts were studied including 168 longitudinal samples belonging to 66 patients. We further studied 1536 samples obtained from 3 independent clinical trials with drisapersen, an antisense oligonucleotide targeting exon 51: an open label study including 12 patients; a phase 3 randomized, double blind, placebo controlled study involving 186 patients; an open label extension study performed after the phase 3. Analysis of natural history cohorts showed elevated MMP-9 levels in patients and a significant increase over time in longitudinal samples. MMP-9 decreased in parallel to clinical stabilization in the 12 patients involved in the open label study. The phase 3 study and subsequent extension study clarified that the decrease in MMP-9 levels was not predictive of treatment response. These data do not support the inclusion of serum MMP-9 as predictive biomarker for DMD patients.

Serum matrix metalloproteinase-9 (MMP-9) as a biomarker for monitoring disease progression in Duchenne muscular dystrophy (DMD).

To identify serum biomarkers that allow monitoring of disease progression and treatment effects in Duchenne muscular dystrophy (DMD) patients, levels of matrix metalloproteinase-9 (MMP-9), tissue inhibitors of metalloproteinase-1 (TIMP-1) and osteopontin (OPN) were determined in 63 DMD patients on corticosteroid therapy. These proteins were selected for their role in the pathogenesis of muscular dystrophy. Levels of MMP-9 and TIMP-1 were significantly higher in sera of DMD patients compared to healthy controls, whereas the OPN levels showed no significant difference. MMP-9 levels were also observed to be significantly higher in older, nonambulant patients, compared to ambulant patients. Longitudinal data from a smaller cohort of DMD patients followed up for over 4years showed that MMP-9, but not TIMP-1 increased significantly with age. Hence, MMP-9 is a potential DMD biomarker for disease progression. Future studies have to confirm whether serum MMP-9 levels can be used to monitor therapeutic response.

Evaluation of difference in the neurotoxicity produced by dermal application of chlorpyrifos on the neonatal and adult mice.

Dermal exposure to organophosphate pesticide is important because of its popular use. This study planned to compare the changes in serum acetylcholinesterase, paraoxonase and neuronal density of hippocampus and iso-cortex between two age groups of Swiss albino mice (18-day-old and 150-day-old) after dermal application of (1/2) LD50 of chlorpyrifos for 14 days. Statistically significant reduction was observed in serum acetylcholinesterase (Mann-Whitney test, p<0.05) and neuronal density (Independent samples t-test, p<0.05) in exposed groups compared to the control. The reduction in serum AChE and neuronal density was more pronounced in exposed adult mice than in exposed neonatal mice. The paraoxonase level was insignificant in control neonatal mice, whereas it was 890-fold more in exposed neonatal mice. Upregulated paraoxonase levels may be extrapolated to produce relatively lower reduction of cholinesterase and neuronal density in neonatal mice.

A preliminary study of the bioactivity of vegetative proteins extracted from Malaysian Bacillus thuringiensis isolates.

Vegetative proteins from Malaysian strains of Bacillus thuringiensis israelensis strains (Bt 11, Bt 12, Bt 15, Bt 16, Bt 17, Bt 21 and Bt 22) and Bacillus sphaericus H-25 strains (Bs 1 and Bs 2) were screened for haemolytic, cytotoxic and larvicidal activity. SDS-PAGE profiles of the Bacillus thuringiensis strains studied consistently showed major bands of 33-37 kDa and 47 kDa. Bt 16 also showed two bands of 66 kDa and 45 kDa similar to the previously reported binary vegetative protein, Vip1Ac (66 kDa) and Vip 2Ac (45 kDa). Both the Bacillus sphaericus strains showed a 35 kDa band that was similiar to a previously reported vegetative protein, the Mtx2 protein. Bs 2 also contains a 37 kDa band, similar to another vegetative protein, the Mtx 3 protein. With the exception of Bt 17 and Bt 21, vegetative proteins from all Bacillus thuringiensis and Bacillus sphaericus strains were highly haemolytic to human erythrocytes, causing more than 75% haemolysis at the highest concentration of 200 microg/ml. High haemolytic activity was associated with high cytotoxic activity with most of the haemolytic strains being indiscriminately cytotoxic to both CEM-SS (human T lymphoblastoid) and HeLa (human uterus cervical cancer) cell lines. Interestingly, the less haemolytic vegetative proteins from Bt 17 and Bt 21 demonstrated cytotoxic activity comparable to that of the highly haemolytic vegetative proteins. Bt 21 displayed toxicity towards both cell lines while Bt 17 was more toxic towards CEM-SS cells. Bioassay against Aedes aegypti and Culex quinquefasciatus larvae revealed that vegetative proteins from the Bacillus thuringiensis strains had activity against both species of larvae but vegetative proteins from Bacillus sphaericus were weakly larvicidal towards Cx. quinquefasciatus only.

Selective cytotoxic activity against leukemic cell lines from mosquitocidal Bacillus thuringiensis parasporal inclusions.

The discovery of parasporin has triggered an interest in examining various Bacillus thuringiensis (Bt) isolates for specific anti-cancer activity. The aim of this study was to determine the potency and specificity of parasporal inclusions from Malaysian mosquitocidal Bt isolates against a leukemic cell line (CEM-SS). The Bt isolates used in this study were identified as having weak to potent larvicidal activity against Aedes aegypti and varying hemolytic activity. The 12 mosquitocidal Bt isolates examined in this study showed low to moderate cytotoxicity when tested against CEM-SS and HeLa. Interestingly the parasporal inclusions of Bt 18 (non-hemolytic isolate), showed therapeutic potential demonstrating specificity for CEM-SS compared to HeLa, whilst being non-cytotoxic to normal T lymphocytes. The mode of cell death by Bt 18 was shown to be initially apoptotic. SDS-PAGE analysis and N-terminal sequencing of the upper and lower bands of Bt 18 showed similarity between Bt 18 parasporal inclusions with Cry 24Aa and 25Aa of Bacillus thuringiensis subsp jegathesan and Cry 15Aa of Bacillus thuringiensis subsp israelensis. Although the BLAST analysis did not show sequence similarity between Bt 18 and Parasporin, we propose that the Bt 18 parasporal inclusions share similar characteristics to Parasporin since Bt 18 is not hemolytic but discriminately cytotoxic towards leukemic cell lines.

A preliminary finding: immunohistochemical localisation and distribution of placental angiotensin II receptor subtypes in normal and preeclamptic pregnancies.

Pre-eclampsia or pregnancy induced hypertension (PIH) affects 6-8% of all pregnancies. Although the underlying mechanism of PIH is still unknown, it is widely believed that the placenta plays an important role. It was thought that an ischemic placenta due to poor perfusion can precipitate the signs and symptoms of PIH. This study aims to investigate the possible role of Type 1(AT1) and Type 2 (AT2) angiotensin II receptor subtypes in the mechanism of PIH. AT1 receptor stimulation causes vasoconstriction and AT2 receptor stimulation causes vasodilatation. Investigating the interactions of these two receptors in the placenta provides an insight as to the balance that may exist between AT1 and AT2 receptors in normal pregnancy. Any disruption to the balance might cause a disruption of the blood flow in the placenta, leading to PIH. Placentas were collected from 11 PIH patients and 11 normal patients. Immunohistochemistry techniques were performed on the placental tissue to determine the distribution of AT1 and AT2 receptors in the placental tissue qualitatively and quantitatively. It was observed that in normal patients, the balance between AT1 and AT2 receptors is that the level of AT2 receptors is higher than the level of AT1 receptors. However in the PIH patient, it was observed that the normal balance was disrupted. In PIH patients the level of AT1 receptors was observed to be higher than the level of AT2 receptors. This study suggests that disruption of the balance between AT1 and AT2 receptors observed in PIH placentas might cause a decrease in blood flow to the placenta, causing it to be poorly perfused. This may cause placental ischemia which may lead to PIH.

Malaysian mosquitocidal soil bacterium (Bacillus thuringiensis) strains with selective hemolytic and lectin activity against human and rat erythrocytes.

The objective of this study is to determine the role of carbohydrates on the toxic effect of parasporal inclusion proteins isolated from Malaysian mosquitocidal Bacillus thuringiensis (Bt) strains on erythrocytes (human and rat). Dose response analyses on the effect of these parasporal inclusions on human and rat erythrocytes suggest that toxin action is selective depending on bacterial strains and source of erythrocytes. Results from this study suggest Bt toxin is a lectin which recognizes specific plasma membrane glycoconjugate receptor(s) with a terminal residue of either D-mannose (Man), N-acetyl-D-galactosamine (GalNAc), N-acetyl-D-glucosamine (GlcNAc) or even a combination of these monosaccharides.