miRNAs dysregulation in ankylosing spondylitis: A review of implications for disease mechanisms, and diagnostic markers

Epigenetic processes, including non-coding RNA, histone modifications, and DNA methylation, play a vital role in connecting the environment to the development of a disorder, especially when there is a favorable genetic background. Ankylosing Spondylitis (AS) is a chronic type of spinal arthritis that highlights the significance of epigenetics in diseases related to autoimmunity and inflammation. MicroRNAs (miRNAs) are small non-coding RNAs that are involved in both normal and aberrant pathological and physiological gene expression. This study focuses on the pathophysiological pathways to clarify the role of miRNAs in AS. We have conducted a thorough investigation of the involvement of miRNAs in several processes, including inflammation, the production of new bone, T-cell activity, and the regulation of pathways such as BMP, Wnt, and TGFβ signaling. Undoubtedly, miRNAs play a crucial role in enhancing our comprehension of the pathophysiology of AS, and their promise as a therapeutic strategy is quickly expanding.

Tracking the therapeutic efficacy of a ketone mono ester and β-hydroxybutyrate for ulcerative colitis in rats: New perspectives

Ulcerative colitis (UC) is an inflammatory condition that affects the colon's lining and increases the risk of colon cancer. Despite ongoing research, there is no identified cure for UC. The recognition of NLRP3 inflammasome activation in the pathogenesis of UC has gained widespread acceptance. Notably, the ketone body β-hydroxybutyrate inhibits NLRP3 demonstrating its anti-inflammatory properties. Additionally, BD-AcAc 2 is ketone mono ester that increases β-hydroxybutyrate blood levels. It has the potential to address the constraints associated with exogenous β-hydroxybutyrate as a therapeutic agent, including issues related to stability and short duration of action. However, the effects of β-hydroxybutyrate and BD-AcAc 2 on colitis have not been fully investigated. This study found that while both exogenous β-hydroxybutyrate and BD-AcAc 2 produced the same levels of plasma β-hydroxybutyrate, BD-AcAc 2 demonstrated superior effectiveness in mitigating dextran sodium sulfate-induced UC in rats. The mechanism of action involves modulating the NF-κB signaling, inhibiting the NLRP3 inflammasome, regulating antioxidant capacity, controlling tight junction protein expression and a potential to inhibit apoptosis and pyroptosis. Certainly, BD-AcAc 2's anti-inflammatory effects require more than just increasing plasma β-hydroxybutyrate levels and other factors contribute to its efficacy. Local ketone concentrations in the gastrointestinal tract, as well as the combined effect of specific ketone bodies, are likely to have contributed to the stronger protective effect observed with ketone mono ester ingestion in our experiment. As a result, further investigations are necessary to fully understand the mechanisms of BD-AcAc 2 and optimize its use.

Item analysis: the impact of distractor efficiency on the difficulty index and discrimination power of multiple-choice items

BACKGROUND

Distractor efficiency (DE) of multiple-choice questions (MCQs) responses is a component of the psychometric analysis used by the examiners to evaluate the distractors' credibility and functionality. This study was conducted to evaluate the impact of the DE on the difficulty and discrimination indices.

METHODS

This cross-sectional study was conducted from April to June 2023. It utilizes the final exam of the Principles of Diseases Course with 45 s-year students. The exam consisted of 60 type A MCQs. Item analysis (IA) was generated to evaluate KR20, difficulty index (DIF), discrimination index (DIS), and distractor efficiency (DE). DIF was calculated as the percentage of examinees who scored the item correctly. DIS is an item's ability to discriminate between higher and lower 27% of examinees. For DE, any distractor selected by less than 5% is considered nonfunctional, and items were classified according to the non-functional distractors. The correlation and significance of variance between DIF, DI, and DE were evaluated.

RESULTS

The total number of examinees was 45. The KR-20 of the exam was 0.91. The mean (M), and standard deviation (SD) of the DIF of the exam was 37.5(19.1), and the majority (69.5%) were of acceptable difficulty. The M (SD) of the DIS was 0.46 (0.22), which is excellent. Most items were excellent in discrimination (69.5%), only two were not discriminating (13.6%), and the rest were of acceptable power (16.9%). Items with excellent and good efficiency represent 37.3% each, while only 3.4% were of poor efficiency. The correlation between DE and DIF (p = 0.000, r= -0.548) indicates that items with efficient distractors (low number of NFD) are associated with those having a low difficulty index (difficult items) and vice versa. The correlation between DE and DIS is significantly negative (P = 0.0476, r=-0.259). In such a correlation, items with efficient distractors are associated with low-discriminating items.

CONCLUSIONS

There is a significant moderate negative correlation between DE and DIF (P = 0.00, r = -0.548) and a significant weak negative correlation between DE and DIS (P = 0.0476, r = -0.259). DIF has a non-significant negative correlation with DIS (P = 0.7124, r = -0.0492). DE impacts both DIF and DIS. Items with efficient distractors (low number of NFD) are associated with those having a low difficulty index (difficult items) and discriminating items. Improving the quality of DE will decrease the number of NFDs and result in items with acceptable levels of difficulty index and discrimination power.

The role of matrix metalloproteinase-2 and miR-196a2 in bronchial asthma pathogenesis and diagnosis

Background

Bronchial asthma is a persistent inflammatory respiratory condition that restricts the passage of air and causes hyperresponsiveness. Chronic asthma can be classified into three categories: mild, moderate, and severe. Remodeling took place as the extracellular matrix accumulated in the walls of the airways. Inflammation occurs as a result of the damage caused by matrix metalloproteinase-2 (MMP-2) to basement membrane type IV collagen. The severity of asthma may be associated with miR-196a2. The objective of our study was to investigate the underlying mechanisms and clinical relevance of miR-196a2 and MMP-2 serum levels in relation to the severity of asthma.

Methods

This study recruited 85 controls and 95 asthmatics classified as mild, moderate, or severe. Expression of miR-196a2 was measured by quantitative reverse transcriptase PCR. Using the enzyme-linked immunosorbent assay (ELISA), MMP-2, IL-6, and total immunoglobulin E (IgE) levels in the serum of asthmatics of various grades were compared to a control group. MMP-2's diagnostic and prognostic potential was determined using ROC curve analysis. This study also measured blood Eosinophils and PFTs. We examined MMP-2's connections with IgE, blood Eosinophils, and PFTs.

Results

The current investigation found that miR-196a2 expression was significantly higher in the control group than in asthmatic patients as a whole. The study found that severe asthmatics had higher MMP-2, IL-6, and IgE serum levels than healthy controls. We identified the MMP-2 serum concentration cutoff with great sensitivity and specificity. Significant relationships between MMP-2 serum level and miR-196a2 expression in the patient group with severe asthmatics were found. The MMP-2, IL-6, and IgE serum levels were considerably higher in mild, moderate, and severe asthmatics than controls. The miR-196a2 expression and MMP-2 serum concentration correlated positively with IgE and blood eosinophils % and negatively with all lung function tests in the asthmatic patient group.Conclusion: the study revealed that the elevated miR-196a2 expression and serum concentration of MMP-2, IL-6, and IgE associated with elevated blood eosinophils % is associated with pathophysiology and degree of asthma severity. The miR-196a2 expression and MMP-2 serum concentration have a promising diagnostic and prognostic ability in bronchial asthma.

AI in medical education: uses of AI in construction type A MCQs

BACKGROUND

The introduction of competency-based education models, student centers, and the increased use of formative assessments have led to demands for high-quality test items to be used in assessments. This study aimed to assess the use of an AI tool to generate MCQs type A and evaluate its quality.

METHODS

The study design was cross-sectional analytics conducted from June 2023 to August 2023. This study utilized formative TBL. The AI tool (ChatPdf.com) was selected to generate MCQs type A. The generated items were evaluated using a questionnaire for subject experts and an item (psychometric) analysis. The questionnaire to the subject experts about items was formed based on item quality and rating of item difficulty.

RESULTS

The total number of recurrent staff members as experts was 25, and the questionnaire response rate was 68%. The quality of the items ranged from good to excellent. None of the items had scenarios or vignettes and were direct. According to the expert's rating, easy items represented 80%, and only two had moderate difficulty (20%). Only one item out of the two moderate difficulties had the same difficulty index. The total number of students participating in TBL was 48. The mean mark was 4.8 ± 1.7 out of 10. The KR20 is 0.68. Most items were of moderately difficult (90%) and only one was difficult (10%). The discrimination index of the items ranged from 0.77 to 0.15. Items with excellent discrimination represented 50% (5), items with good discrimination were 3 (30%), and only one time was poor (10%), and one was none discriminating. The non-functional distractors were 26 (86.7%), and the number of non-functional distractors was four (13.3%). According to distractor analysis, 60% of the items were excellent, and 40% were good. A significant correlation (p = 0.4, r = 0.30) was found between the difficulty and discrimination indices.

CONCLUSION

Items constructed using AI had good psychometric properties and quality, measuring higher-order domains. AI allows the construction of many items within a short time. We hope this paper brings the use of AI in item generation and the associated challenges into a multi-layered discussion that will eventually lead to improvements in item generation and assessment in general.

Morphological Correlation between the Diameters of the Left Main Coronary Artery and its Branches Measured by QCA and Derived by Finet's Law

BACKGROUND

Coronary artery diseases are the leading cause of death worldwide. Stenting or angioplasty of coronary arteries as interventional management requires knowledge about the morphology of the coronary tree, including luminal diameters.

OBJECTIVE

This work aimed to study the diameters of the left main coronary artery and its branches measured by QCA in relation to the diameters derived by Finet's law.

METHODS

This was a cross-sectional, retrospective, hospital-based study. The number of angiograms used was 357. The diameters of the left main coronary artery (LM1), left anterior interventricular artery (LAD1), and left circumflex artery (LCx1) were measured by QCA. The diameter of LM1 was measured by 5 mm before its termination, and the diameters of LAD1 and LCx1 were obtained by 5 mm from their origins. Finet's law was used to calculate the diameters of LM2, LAD2 and LCx2 using the QCA measurements.

RESULTS

The mean age of participants was 53.3±8.8 years. Female patients represented 58.9%. The mean diameter of the left main coronary using QCA was 3.75±0.85 mm, and the diameter calculated using Finet's law was 3.89±0.80 mm. The diameters of LAD1 and LCx1 were larger than those calculated with Finet's law. The Z-test showed a significant difference between the diameter of the LM1 calculated by Finet's law; both diameters were positively associated. The diameters of LAD1 and LAD2 showed a non-significant correlation (r = 0.0653, P = 0.259526) and a negative correlation between LCx1 and LCX2 (r = -0.2659, P = 0.00001). The Z-test showed a significant difference in the diameter of LAD and LCx measured by QCA and Finet's law.

CONCLUSION

An association was found between the diameter of LM measured by QCA and calculated with Finet's law; the diameter calculated by Finet's law was larger. The diameters of LAD and LCx measured by QCA were larger than those calculated by Finet's law. A positive correlation existed between the diameters measured by QCA and Finet's law, and they had significant differences. Finet's law can assist in the selection of stent size. Despite the literature about Finet's law, generalising its use requires more studies on different ethnicities.

Itraconazole halts hepatocellular carcinoma progression by modulating sonic hedgehog signaling in rats: A novel therapeutic approach

Liver cancer stands as the fourth leading global cause of death, and its prognosis remains grim due to the limited effectiveness of current medical interventions. Among the various pathways implicated in the development of hepatocellular carcinoma (HCC), the hedgehog signaling pathway has emerged as a crucial player. Itraconazole, a relatively safe and cost-effective antifungal medication, has gained attention for its potential as an anticancer agent. Its primary mode of action involves inhibiting the hedgehog pathway, yet its impact on HCC has not been elucidated. The main objective of this study was to investigate the effect of itraconazole on diethylnitrosamine-induced early-stage HCC in rats. Our findings revealed that itraconazole exhibited a multifaceted arsenal against HCC by downregulating the expression of key components of the hedgehog pathway, shh, smoothened (SMO), and GLI family zinc finger 1 (GLI1), and GLI2. Additionally, itraconazole extended survival and improved liver tissue structure, attributed mainly to its inhibitory effects on hedgehog signaling. Besides, itraconazole demonstrated a regulatory effect on Notch1, and Wnt/β-catenin signaling molecules. Consequently, itraconazole displayed diverse anticancer properties, including anti-inflammatory, antiangiogenic, antiproliferative, and apoptotic effects, as well as the potential to induce autophagy. Moreover, itraconazole exhibited a promise to impede the transformation of epithelial cells into a more mesenchymal-like phenotype. Overall, this study emphasizes the significance of targeting the hedgehog pathway with itraconazole as a promising avenue for further exploration in clinical studies related to HCC treatment.

Learning style preferences among medical students in the College of Medicine, University of Bisha, Saudi Arabia (2018)

OBJECTIVES

This research aims to describe the learning styles among undergraduate medical students at the College of Medicine, University of Bisha.

MATERIALS AND METHODS

Type of study is a cross-sectional. Students preference of learning styles was assessed through VARK (abbreviation stands for Visual, Aural, Read/Write, and Kinesthetic learning style) inventory questionnaire version 7.1. The questionnaire was bilingually translated. Data from the questionnaire were analyzed by SPSS (V20). Data were presented in the form of descriptive statistics. One-way ANOVA and Kruskal-Wallis test were used to assess the relations between study variables.

RESULTS

One hundred and eighteen students (86.8%) were unimodal in their learning preference, and 18 students (13.3%) were multimodal. The dominant unimodal style was aural (55.9%), and the lowest was reading (5.1%). Among multimodal the commonest preference was AK (77.8%) followed by VR and VK equally (11.1%). The multimodal pattern is limited to students in level one. Visual style increases in percentage with the academic levels.

CONCLUSION

Students in the College of Medicine, University of Bisha (UBCOM) have different patterns and types of learning style. Aural is the dominant unimodal style. The visual style is widely distributed among students of different levels. Planning and implementation of educational activities that satisfy all learning styles will support the learning process.

Variations of the gallbladder in Sudanese subjects with literature review

BACKGROUND

Advances in the use of laparoscopic surgery, especially in the biliary apparatus interference makes the need to revise the anatomical data of the gallbladder (GB) more important. Variations of the extra-hepatic biliary apparatus are characterized by large varieties of configurations.

OBJECTIVE

The aim of this article was to study the morphology of the GB in Sudanese subjects and review the common variations.

MATERIALS AND METHODS

Dissection of formalin-fixed cadavers' abdomens.

RESULTS

GB is larger in Sudanese subjects than what is described in the standard text books.

CONCLUSION

Congenital anomalies and anatomical variations of the extra-hepatic biliary tree, although not uncommon, can be of clinical importance. There are some differences in the only size of GB in Sudanese.