Input, Process and Output: system approach in education to assure the quality and excellence in performance

http://dx.doi.org/10.3329/bjms.v14i1.21553 Bangladesh Journal of Medical Science Vol.14(1) 2015 p.1-2

Evaluation of doctors' performance as facilitators in basic medical science lecture classes in a new Malaysian medical school

BACKGROUND

Didactic lecture is the oldest and most commonly used method of teaching. In addition, it is considered one of the most efficient ways to disseminate theories, ideas, and facts. Many critics feel that lectures are an obsolete method to use when students need to perform hands-on activities, which is an everyday need in the study of medicine. This study evaluates students' perceptions regarding lecture quality in a new medical school.

METHODS

This was a cross-sectional study conducted of the medical students of Universiti Sultan Zainal Abidin. The study population was 468 preclinical medical students from years 1 and 2 of academic year 2012-2013. Data were collected using a validated instrument. There were six different sections of questions using a 5-point Likert scale. The data were then compiled and analyzed, using SPSS version 20.

RESULTS

The response rate was 73%. Among 341 respondents, 30% were male and 70% were female. Eighty-five percent of respondents agree or strongly agree that the lectures had met the criteria with regard to organization of lecture materials. Similarly, 97% of students agree or strongly agree that lecturers maintained adequate voices and gestures.

CONCLUSION

Medical students are quite satisfied with the lecture classes and the lectures. However, further research is required to identify student-centered teaching and learning methods to promote active learning.

Whole-exome sequencing improves mutation detection in a diagnostic epidermolysis bullosa laboratory

BACKGROUND

Subtypes of inherited epidermolysis bullosa (EB) vary significantly in their clinical presentation and prognosis. Establishing an accurate diagnosis is important for genetic counselling and patient management. Current approaches in EB diagnostics involve skin biopsy for immunohistochemistry and transmission electron microscopy, and Sanger sequencing of candidate genes. Although informative in most cases, this approach can be expensive and laborious and may fail to identify pathogenic mutations in ~15% of cases.

OBJECTIVES

Next-generation DNA sequencing (NGS) technologies offer a fast and efficient complementary diagnostic strategy, but the value of NGS in EB diagnostics has yet to be explored. The aim of this study was to undertake whole-exome sequencing (WES) in nine cases of EB in which established diagnostic methods failed to make a genetic diagnosis.

METHODS

Whole-exome capture was performed using genomic DNA from each case of EB, followed by massively parallel sequencing. Resulting reads were mapped to the human genome reference hg19. Potentially pathogenic mutations were subsequently confirmed by Sanger sequencing.

RESULTS

Analysis of WES data disclosed biallelic pathogenic mutations in each case, with all mutations occurring in known EB genes (LAMB3, PLEC, FERMT1 and COL7A1). This study demonstrates that NGS can improve diagnostic sensitivity in EB compared with current laboratory practice.

CONCLUSIONS

With appropriate diagnostic platforms and bioinformatics support, WES is likely to increase mutation detection in cases of EB and improve EB diagnostic services, although skin biopsy remains an important diagnostic investigation in current clinical practice.

Abstract P1-06-11: Tumor-associated macrophages: CD206 expression and patient outcomes in locally advanced breast cancer

Introduction

The ability of a tumor to recur is related to the complex molecular biology of the tumor cells and the surrounding microenvironment. Tumor-associated macrophages (TAMs) account for up to 50% of the cell mass within a breast tumor, and the M2 macrophage phenotype has been reported to have pro-tumor activity. The mannose receptor, CD206, is a transmembrane receptor expressed predominantly in macrophages and shown in mouse studies to promote M2/TAM activity. This study evaluates CD206 expression in the tumor stroma with patient outcomes in locally advanced breast cancer.

Methods

The Scott & White tumor registry was queried for consecutive cases of women diagnosed with stage 3, HER-2 negative breast cancer between January 1999 and December 2006. To meet inclusion criteria, all biopsies must have been performed at S&W and patients must have had at least 5 years of follow up in our system documenting status of cancer (complete remission vs. metastatic recurrence). Archived formalin fixed and paraffin embedded tissue breast tissue from initial surgical biopsies was obtained from the Scott & White Pathology Department. Sections were cut at 4 microns thick and slides were stained for CD206. Two pathologists without knowledge of the patients’ clinical backgrounds reviewed each slide. The hot spot method was employed at 20x power to identify the 3 spots in tumor stroma that stained most heavily. The number of CD206+ cells in each of 3 hot spots was counted, and the mean number of CD206+ cells per hot spot reported by two independent pathologists was averaged for analysis.

Results

65 patients met inclusion criteria, of these 31 had a recurrence within 5 years of diagnosis. There was no correlation between likelihood of recurrence or overall survival and CD206 expression. In the 31 patients that had a recurrence, a high CD206 count of greater than or equal to 15 was associated with a shorter time to recurrence than a CD206 count of less than 15 (14.8 months vs. 22 months, respectively, p = 0.028). Mean age at diagnosis in the recurrence group was 59.6 vs. 60 years, and 15 (60%) vs. 2(33%) patients were ER positive in the low CD206 (<15) vs. high CD206 ( = >15) groups, respectively.

Conclusion

High expression of CD206 in the tumor stroma was associated with a shorter time to recurrence in patients with stage 3, HER-2 negative breast cancer; however, there were more ER negative tumors in the high CD 206 group. Our research supports in vitro data that high CD206 expression in macrophages may represent a more aggressive tumor phenotype. Future studies focusing on studying CD206 expression in HER-2 positive breast tumors along with histological stratification are needed to confirm this finding.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-06-11.

Synthesis, characterization, and evaluation of chitosan-complexed starch nanoparticles on the physical properties of recycled paper furnish

The objectives of the current research were to synthesize and characterize chitosan-complexed starch nanoparticles and examine their effect on the physical performance of recycled pulp, specifically old corrugated containerboard (OCC). This new approach provides a uniquely renewable and useful approach to enhance mechanical properties of pulp while maintaining environmental compatibility, industrial compatibility, and paper qualities. The starch nanoparticles used for the research were prepared from cooked cornstarch gel with ethanol and reacted with diethylenetriamine pentaacetic acid (DTPA) in the presence of sodium hypophosphite. Thereupon, the DTPA-modified starch nanoparticles (SNs) were complexed with chitosan as part of a general chemical strategy to improve their incorporation into an OCC matrix and increase interfiber bonding. Spectral characterization of the SNs was done using TGA, DSC, FT-IR, and SEM to analyze their composition and structure. Approximately 2% chitosan-complexed starch nanoparticle derivatives by mass (SNX/C) of OCC-based slurry were thoroughly mixed before manufacturing a two-dimensional sheet for physical testing. The tensile and burst strength of the modified OCC pulp sheet increased 50 and 49%, respectively, albeit having a decreased tear strength compared to the control sample. However, when the OCC pulp sheet was coated with a 1% SNX/C by mass solution, the tensile and burst strength increased 120 and 70%, respectively, while also providing significantly increased gloss, decreased roughness, and tear strength. Because the mechanical properties are the most critical property facing the recyclability of OCCs, the tremendous gains afforded by the starch nanoparticle-DTPA-chitosan proposed give the system enormous potential applicability as a viable dry strength agent for paper substrates.

Assessment in Undergraduate Medical Education: Bangladesh Perspectives

Background: Medical education in Bangladesh is totally controlled by the Government and run a unique undergraduate curriculum throughout the country in both public and private sectors. This paper is aimed to briefly describe the medical education reform in Bangladesh and suggests further assessment changes. The present official form of undergraduate medical curriculum has first evolved in 1988 followed by revision in 2002 and 2012. Assessment and teaching are the two sides of the same coin. Assessment drives learning and learning drives practices. Following the curriculum reform since 2002, the assessment in undergraduate medical education has been greatly changed. There are a lot of in-course formative assessments which include item examination, card final and term final, designed to improve the quality of education. Ten percent marks of summative written examinations derive from formative assessment. Traditional oral examination has been changed to structured form to ensure greater reliability. Even then, teachers are not yet building up to conduct oral examination in such a structured way. Examiners differ in their personality, style and level of experience with variation of questioning and scoring from student to students. Weakness of reliability on oral examination still exists. Students also feel very stressful during the oral examinations. Moreover, to conduct such oral examination, three to four months times per year are lost by the faculties which can be efficiently utilised for teaching and research purposes. Worlds' leading medical schools now-a-days used oral examination only for borderline and distinction students. Bangladesh also must consider oral examination only for borderline and distinction students. DOI: http://dx.doi.org/10.3329/bjms.v12i4.16658 Bangladesh Journal of Medical Science Vol. 12 No. 04 October ’13 Page 357-363

Mineral content of different bottled water available in Bangladesh: Assessment of their compliance with current regulations

Nine bottled water brands collected from retail shops and food shops beside the University of Dhaka were analyzed for their major and trace element constituents to ascertain their suitability for human consumption. The results obtained were compared with parametric values (PVs) set by European Community Council Directive 98/83/EC and the guideline values (GVs) recommended by WHO. It was found that the majority of the brands tested were low in mineral contents. Moreover, lower values of hardness, TDS and conductivity than the prescribed limits of WHO showed that water was deficient in essential minerals. Minerals like magnesium, potassium, calcium were present in some cases in such a low concentration that water seemed to be as good as distilled water. In case of heavy metals, only lead and cadmium were found to be below the detection limit (0.001 mg/L) which indicates bottled water brands are better for drinking. DOI: http://dx.doi.org/10.3329/jasbs.v38i1.15316 J. Asiat. Soc. Bangladesh, Sci. 38(1): 7-15, June 2012

Removal of Remazol Red from Textile Waste Water Using Treated Sawdust - An Effective Way of Effluent Treatment

Activated carbon prepared from sawdust is endeavored as adsorbent for the removal of reactive dye, namely Remazol Red (RR) from aqueous media. The adsorption of RR has been studied onto activated sawdust at various particle size, adsorbent dose, temperature and pH values. The adsorptions of the above mentioned dye were designed for the Langmuir and Freundlich Isotherms. Pseudo first and second order kinetic models were used to calculate the amount adsorbed at equilibrium (q_e). The calculated values of qe for pseudo-second order equation were found to be in good agreement with those of experimental values. The monolayer capacity (qm) for treated sawdust (8.00 mg g–1) is greater than commercial charcoal (0.074 mg g–1). It is established that treated sawdust has been used as a better adsorbent for the removal of RR as compared to commercial charcoal. This process may eventually be used to get industrial waste free purified water. DOI: http://dx.doi.org/10.3329/bpj.v16i1.14501 Bangladesh Pharmaceutical Journal 16(1): 93-98, 2013

Immediate adverse reactions to platelet transfusions: whole blood derived versus apheresis platelets

The transfusion of whole blood derived platelets (WBDPs) or apheresis platelets (APs) is standard support for cancer patients. However, disputes remain about which type of platelets are ideal in terms of efficacy, cost, and the risk of adverse reactions. This cross sectional study included 141 cancer patients who underwent chemotherapy or hematopoietic progenitor cell transplantation and received platelet transfusions at The University of Texas M.D. Anderson Cancer Center between 2002 and 2003 were retrospectively evaluated. A total of 141 patients who did not differ significantly in terms of age or sex had a reaction to transfusions (WBDPs, n=123; APs, n=18), for a frequency of 0.66% in patients who received WBDPs and 0.45% in patients who received APs, but this difference was not statistically significant (p=0.13). More WBDP-related reactions occurred in patients transfused with older platelets (>2 days old) than in patients transfused with fresh platelets, but the difference compared with AP-associated reactions was not statistically significant. However, the rate of reactions to WBDP may increase if WBDPs are stored for a prolonged time (>2 days). Until evidence becomes available that clearly refutes this; the more fresh platelets as possible may be used.

Source Identification of Carbonaceous Aerosols During Winter Months in the Dhaka City

Air particulate matter samples were collected using Air Metrics samplers from 11 - 17 January  and 19 - 27 January, 2012 at Amin Bazar and Farm Gate sites, respectively. The sampling time was  from 8 a.m. - 4 p.m. Three samplers were used of which two samplers were for PM2.5 samples,  using Teflon and quartz filters and the others for PM10 samples using Teflon filter. Organic and  elemental carbons (OC and EC) were measured in PM2.5 samples at both sites. It has been found  that the EC concentration at Amin Bazar is higher than in Farm Gate. The contribution of EC may  come from diesel, gasoline and coal/wood combustions in the Amin Bazar site. The present  OC/EC data were compared with the previous data. It was found that the concentration of EC became higher than those in the previous year. During last couple of years, Government   implemented different policies specially in case of motor vehicles to improve the air quality. But  due to the use of diesel in quick rental power plants, the air quality start to deteriorate. BC plays an  important role to change the climate. Hence, government should think of alternatives to meet the  power demand in place of diesel. DOI: http://dx.doi.org/10.3329/jbas.v36i2.12970 Journal of Bangladesh Academy of Sciences, Vol. 36, No. 2, 241-250, 2012  

Lesson plan on new method of teeth identification introduced at dental schools in Malaysia and Pakistan

This article describes a new tooth notation system designed to be implemented for educational purposes in dental schools in Malaysia and Pakistan for identification of teeth and subsequently dental communication for wellness of dental patients. Its format is constructed as a lesson plan to present an uncomplicated tooth notation system by first letter of each tooth class (I-incisor, C-canine, P-premolar, and M-molar) to describe and communicate dental information. The new system is a promising and potential educational lesson that is innovative in its contents, easily understandable, and usable in dental charting as indicated by the results of a pilot study. However, further studies are required to investigate the strength of this new system.