“The Great College Escape”-the most difficult choice offered to COVID-19 generation of global students

The much hyped “Great Resignation” in the world of economic forecasting has opened a big door for the students to take an easy and timely exit from education. Is it a revolving door or a one-way exit with no easy return. There are more job openings for unskilled workers, luring students to leave their studies incomplete and take over odd jobs. Remote education experience changed hearts and minds of the global students and created a survival mindset. Pandemic without question has caused significant loss of lives with profound disruption to lives and livelihoods. As the pandemic is lingering on with uncertainty and ambiguity, students are tempted to leave studies in search of more money, more flexibility, and more happiness. With the fallout of COVID-19 yet to be fully realized and fixed, the predictive-enrollment models that traditionally used to plan classes won’t hold up in the post-pandemic world. We surveyed the current student population across different continents, Asia, Europe, Russia, US and tried to figure out the mindset of student enrollment and attrition. The perception and trends data from 300 respondents across the globe showed a significant economic impact on international students failing to register for higher education abroad in western hemisphere. Majority of students surveyed believe that the education system may have oversold the value of remote education and classroom technology. Free and open-source technologies available to both teachers and students have created a monster of virtual global education. For students in Eastern part of the world, the pandemic has offered new perks. Most students reported that they are rethinking their education needs and reimagining how knowledge and learning could best shape their careers.

Immune and hematological disorders in Primary Immunodeficiency in children

Primary immunodeficiency (PID) was previously considered an extremely rare pathology in childhood, now it has been established that congenital deficit of quantity and functional activity of the lymphocytes, platelets and neutrophils occurs in 1:500–1:4000 newborns. Severe chronic neutropenia in PID is characterized by a stable decrease or absence of circulating neutrophils (<500/cm) and accompanied with recurrent bacterial skin and lung infections. We identified 135 patients with PID. Patient’s examination included clinical observation, general blood test, immunological tests, X-ray of chest and ultrasound examination. We report that six children with PID had significant hematological disorders. The age of these patients was from 1 month to 13 years. Four of them were born from consanguineous marriages, 3 patients died before the age of 5 years. 2 patients with PID had congenital neutropenia, repeated skin infections, pneumonia, diarrhea, stomatitis. Two brothers with WAS syndrome had repeated bleeding, skin hemorrhages, anemia, lymphadenitis, hepatosplenomegaly. The platelet count was about 30–70/ml. Genetic analysis in these patients revealed a hemizygous c.12_13insGG mutation in exon 1 of the WAS gene. 2 children with SCID were found to be carriers of thalassemia B. All our patients showed a significant decrease in Ig classes, CD3+, CD4+, CD8+ and NBT test. We conclude that patients with suspected PID should be continuously monitored by Immunologists and Hematologists. Timely detection of hematological disorders in patients with PID allows for correct diagnosis and prevents fatal complications. Genetic testing can help in making a definitive diagnosis.

Supported by Azerbaijan Medical University

Female minority students-plight of staying alive in education during an unending pandemic!

COVID-19 pandemic laid bare deep inequalities and inequities. Disruptions brought to light by the ongoing pandemic are exacerbating risks and vulnerabilities both within education careers and personal lives. Widespread economic, sociological, and psychological damage has challenged female minority students in education more than their male counterparts. We surveyed female minority students as compared to male students at Chicago State University and found mixed ideas and opinions. The concerns on top of the list were fear of contracting COVID-19, existential epiphanies, and poor study conditions. More women, conditioned to design their lives around education are not enrolling for educational opportunities. One reason is that they can’t find childcare; another is they struggle with education/life balance. It's not one cause but the pandemic has made it complex and multi-faceted. For other students, the pandemic offered many new opportunities that were practically never heard off. Some of the most common perks were, i.e., the ability to study remotely from anywhere, cutting out big city commutes, being able to give peak time to family, and greater flexibility in setting daily chores. A common theme for most of the surveyed students was that changes forced by the current pandemic are playing out a new social justice awakening on college campuses especially minority institutions like Chicago State University. Overarching suggestion was that right decisions made today in the context of a pandemic will have long-term consequences for the future of education. Overwhelming minority students proposed a faculty mentor and a peer-mentor to address the academic advising as well as personal guide to facilitate upheavals in pandemic situations.

Pharmacy Immunology-challenges of teaching a new course in a COVID-affected world of education

Immunology education in US schools and colleges of pharmacy do not have a standardized curriculum. Half of 142 colleges of pharmacies have a dedicated course of Immunology with three fourth of them in the first year of pharmacy education. Although it is a part of core curriculum yet more private than public schools allocate about 3 credit hours. Chicago State University College of Pharmacy offered a new 2-credit course of “Pharmacy Immunology'' in the fall of 2021 to twenty-four second year pharmacy students for the first time. Ten lectures on basic immunology, i.e., innate and adaptive immunity, prepared the students to understand disorders and diseases associated with the immune system. Four workshops of 3-hours each, on Hypersensitivities, Autoimmunity, Transplantation and Tumor Immunology were added to the syllabus. The workshops employed a Modified Flipped Classroom, Team-Based Learning (TBL), Case-Based Learning (CBL), YouTube videos as a combination of various teaching methods. The course was offered as a standard in-class on-campus module. Student’s performance was assessed by tRAT and iRAT. Data of student performance and perception was collected and analyzed. 58.3% of students agreed that the workshop's mode of learning helped them. TBL appealed to 29.2%, CBL 45.8%, and PowerPoint lectures 79.2% of the students. Overall, 33.3% of the students disliked workshops as a tool for offering an interactive educational tool. Assessment data confirmed that the pass rate was 100%, with 20.8% passing in iRAT as compared to 79.2% in tRAT. Final assessment and course evaluation data suggest that a hybrid approach including a blended learning technique was the best option, catering for the needs of most students having a diverse learning style.

To Sir with Love! Students Feedback from an Immunology Course

Students are obligated to write reviews and evaluate both their courses as well as their teachers at the end of the semester in anonymous surveys. The response rates from students have been continuously on decline as reported by third party evaluation companies. This has resulted in both failure of the purpose of evaluations as well as validity and statistical significance of these responses. We provided a non-binding, open and forum-like tool to get the perceptions and trends from Chicago State University College of Pharmacy students. Anonymous survey was sent using google form at the end of an Immunology course being offered to year-2 pharmacy students. Data from 29 respondents were collected and most significant results are summarized. When asked about their learning style; 45% loved traditional PowerPoint presentations as compared to 7% recorded lectures, 10% made their own notes, 3% were small group learners, while 31% solely relied on studying practice tests. When asked about the use of YouTube; 62% preferred random searches while 39% found Khan Academy videos as very useful. When asked about major barrier in learning Immunology; 38% reported test anxiety, 14% personal issues, 10% overwhelmed with curriculum, and 7% cited lack of motivation. In response to assessment questions, 92% students suggested that Instructors should not have more than 60 questions in 2-hour exam. Regarding exam question types, 90% preferred MCQs, 7% Essay, 14% Case-based, and 31% True/False. Following a 16-week, 2-credit course of Immunology, 54% got motivated to do research in Immunology. When asked about overall sentiments after taking a first course in Immunology. The unanimous response was that they all felt as if they were taking a course in a foreign language.

Pandemic-induced pan-academic educational response in a minority university

Education system is extremely vulnerable to the consequences caused by COVID-19, especially the need to strengthen pharmacy education. We utilized this opportunity to rebuild education post-pandemic at Chicago State University College of Pharmacy. Of many avenues opened to development, teachers obligated to update their digital competencies. The pandemic had widened achievement gaps and exposed weaknesses in education systems we had an opportunity now to reimagine a more equitable and resilient education system that delivered a better education to all minority students. Current educational set up was built when our understanding of human learning and learners, knowledge, and skills, as well as teaching pedagogy and teachers’ expertise was quite different from present. Pandemic gave us one-time life window of opportunity to pause and update our educational needs. The purpose of this project was to support such a process of exchange of knowledge. The panic button was sounding and both educators and students were baffled by how to proceed in the wake of pandemic. We encouraged to implementing technology into science education in a way allowing both teachers and students to develop collaborative skill sets and advance adaptability. We recognized the need to support not only students but also students’ families, especially in vulnerable minority communities. We found a “spring effect” and found that pandemic-induced suppression of education bounced back and even rise above the level of past normal. Since it has involved the whole world (pandemic) the educational response should be (pan-academic) and hopefully it will serve as a solution to global problem (panacea) like (vaccine) for all.

Is it not over yet? – pandemic-induced ongoing burn out continues for students in Azerbaijan

In a nagging pandemic, while there will be some regression when the dust from pandemic settles, online, remote and hybrid education seems to stay for good and is expected to maintain a substantial portion of education. Students chronic burnout continues with more questions raised every day than the answers and promises made. It is a known psychological fact that when a younger generation of students encounters life-threatening events, they tend to reflect on death and uncertainty and take stock of their lives with defining what to make of their lives and how to achieve that. We surveyed mental health, social life and its impact on academics of medical and engineering students in Azerbaijan and reported the following data. Out of 274 respondents were 51% female and 48.2% male. 86.5% were from the age group (18–25) and 12.5% from (25–35) years. Majority of the students found themselves juggling with too many balls at the same time, not everyone could keep the focus, skill set and training to succeed. Female students delayed their cultural-ordained marriageable age in pursuit of a well-settled career partner, while male students found themselves looking for an alternative career path. Majority of professional students burn-out by a loss of at least two years of their professional education. This seemed to play out more for medical students as they were not able to find experiential training and hospital residencies. This included medical and engineering students who were ambitious to seek western education but lockdowns and visa regulations held them hostage at their home countries. Azerbaijan students however, were resilient enough to withstand the dual trauma of war with their neighboring country while fighting a global war against COVID-19 pandemic.

“Heard immunity”-pandemic teaches immunology vocabulary through hearing from news and social media outlets

COVID-19 surprised the world and brought with it free immunology lessons. Ever since the pandemic news broke, the public were bombarded with immunological vocabulary. Immunology as a biomedical science had never attained student interest, let alone having an overwhelming global attention among the general public. The purpose of our study was to evaluate the extent to which immunology had become a common knowledge because of the main stream media and social outlets broadcasting news. We conducted a global survey of all people, regardless of gender identity, age, education, and geographical location to ask if they knew the meanings of specific immunological terms used in mainstream news outlets and social media. The words included, but were not limited to, antigen, antibody, T-cell, B-cell, mRNA, DNA, coronavirus, quarantine, lockdown, social distancing, PCR, rapid antigen tests, outbreak, herd immunity, vaccine, viral infections, infection rate, mortality rate, immunotherapy, and immune boosting drugs, etc. When we analyzed the data, we found the following trends. 139/179 (77.7%) said 'yes', they did learn about immunology in lockdown. 100/179 (55.9%) said they learnt about Pfizer, followed by Moderna (33.5%), BioNTech (31.8%), and AstraZeneca (29.6%). 86/179 (48%) learnt about the body's defense system, while 20.7% of people already knew about T cells, B cells, immune therapy, and immunity. 95/179 (53.1%) of people asked learned about airborne infections, making them the most common type of respiratory infections learnt about during COVID-19. The word ‘pandemic’ was learnt by 111/179 (62%) people. Overall, COVID-19 has propelled immunology into the general public’s vocabulary and knowledge in a way that has never been done before.

Instagram-a non-conventional learning tool in post-covid educational world. Repurposing of an entertainment app

Who would have thought that social media will ever be employed as a non-conventional learning tool. Before March 2020 everybody would have raised eyebrows and shunned the practice of even going in that direction. Pandemic changed the world! A tool of pure entertainment and pleasure had a positive effect on the generations “Z” and “X”. Little did the educators realize that one of the most intrinsic tool of self-directed learning is to stay “relevant” stay “motivated: and staying “alive” in a COVID-19 deadly environment was an app called “Instagram”. We conducted a global survey from university students across Asia, Europe, Russia, and Americas. In the current study we used “instagram” as a tool to collect anonymous data from more than 500 respondents and summarized the following points. Firstly, 80% of the respondents were females, and between the age group of 15–25 years. Only 9% reported negative mental health issues while the rest of respondents reported a positive, competitive, and highly focussed group of students who helped each other in small or large social circles to keep reminding each other of educational needs, helping with difficult assignments, and small group studying and quizzing each other. 50% of the respondents reported to get more work accomplished by communicating through messaging, pictures and videos. There was a small 10% of the students who got distracted and sometimes would get carried away but still performed well in learning objectives as compared to those who did not join the trends. 30% of the students did notice impulsiveness, increased anxiety and burnt out by excessive multitasking. Overall, we report that the best purpose for the use of instagram may not be a tool in teachers locker but definitely a peer-mentoring source.

Role of HbA1c in diagnosis of gestational diabetes mellitus

OBJECTIVE

To evaluate glycated haemoglobin as a biomarker for diagnosing gestational diabetes mellitus while keeping the oral glucose tolerance test as the gold standard.

METHODS

The cross-sectional study was conducted from Januray, 2016, to January, 2018, at PNS Hafeez Hospital, Islamabad, Pakistan and comprised of pregnant subjects who were first subjected to 2-hour oral glucose tolerance test along with the first evaluation of glycated haemoglobin. Clinical evaluation, including history and measurements of anthropometric indices and blood pressure, were also done. On the basis of the results, the subjects were grouped as those having gestational diabetes mellitus (group A) and those without it (group B). Data was analysed using SPSS 15.

Results

Of the 280 subjects, gestational diabetes mellitus was found in 50(17.85%). Differences in glycated haemoglobin between the groups was significant (p<0.002). Glycated haemoglobin test provided sensitivity of 70% and specificity of 84.78%.

CONCLUSIONS

With due adjustments, glycated haemoglobin testing can help in reducing the frequency of oral glucose tolerance test.

The global digital divide: Younger and older teachers at odds in this COVID19-induced remote teaching experiment

COVID-19 was anticipated to target aging population and surely it did in world of health, but did collateral damage in education. Lack of preparedness and digital divide became more obvious among old-aged teachers as compared to younger faculty. The later found themselves more equipped with skill sets and more motivated to embrace the realities of the virtual world. We studied a cohort of teachers across the spectrum of age or years of service compared to younger or newly hired faculty. We solicited teachers in both cohorts from Asia, Europe and Americas and surveyed their responses to a given set of questions. We also recruited a group of students to independently and anonymously verify if they noticed any major effect in their learning process. Our global data showed a clear digital divide among the aged and younger faculty. Both groups found themselves unprepared and lacking necessary skill set to deal with this unprecedented, sudden and mandatory online education being forced upon them. However, younger faculty reported to have adapted to the onslaught of technology in an abrupt and timely manner as compared to their senior colleagues. Mostly, both group of teachers considered the learning experience at best as “on job training module”. High anxiety levels with fear of lack of performance, proper delivery methods also played a role in this panic-stricken educational world. Both group of teachers also reported lack of historical perspective and pilot studies for the use of technological gadgets as one of the artifacts in this experiment. The students being at the recipient end also reported in their surveys that the haste and rush of delivery and assessment methods negatively influenced the teaching methods and reciprocally their learning process.

Pan-academic in Pandemic! Remote learning goes viral, mostly out of control

A pandemic of viral origin has caused a pan-academic in the educational world as well. The younger student population though felt safe owing to their robust immune response but took a big hit in their emergency academic response to COVID-19 times. A pandemic needed a pan-academic response. The students were obviously not prepared and equipped for such an abrupt behavioral adaptation, with no second choice offered. Now it has evolved into global research in progress and Educators are experimenting on no-so-willing students. We studied a robust group of 138 medical students across 3 medical schools in Azerbaijan and gathered enormous amounts of data set points. Some of the major takes from our surveys proved the dichotomy and split among the medical students have in terms of coping with the unprecedented circumstances. The challenges included using combination of distance-learning platforms, i.e., synchronous lessons (similar to zoom sessions), pre-recorded lectures, powerpoint presentations, question-banks, etc. A significant difference was found between time spent on online platforms before COVID-19 (10.86%), as compared to (46.37%) during lock-down, while average students were online &gt;15 hours per week. The commonly perceived barriers to using online teaching included, poor internet connection (72.5%), cost of technology, and distractions while studying at home (56.5%). For one group of students remote learning seemed cheaper and flexible than traditional class (saved rent, food, traffic woes). Most of the students’ settled for hybrid learning, thus giving equal weight to in-class vs remote learning experiences. We conclude that there seems to be no one size fits all-approach, we suggest a blended, hybrid, multi thronged system.

Using practice tests as a vaccine to desensitize test anxiety in vulnerable students during pandemic induced lock-down

Field of education psychology seeks bridging gap between research and theory on teaching and classroom practice. Students’ struggle when content matter gets increasingly intense especially when subjects need plenty of rote memory. Covid-19 took a heavy toll on students who were already prone to test anxiety. The current research hypothesized that utilization of practice tests for first-year pharmacy microbiology and immunology course will enhance students learning, understanding and comprehension of complicated material. Since pandemic anxiety added to pre-existing anxiety among pharamacy students we used this measure to mitigate. A cohort of sixty students taking a 4-credit course of Microbiology/Immunology were recruited in this study. Students’ voluntarily declared their fears of superadded anxiety levels because of pandemic. A pool of exam ‘questions collected over the last five years were accurately screened and 300 questions were selected based on the criteria of lectures topics, difficulty level and meeting the specific objectives for every lecture that was presented to students and covered in the exams. Two groups were analyzed based upon their use of practice exams offered and their willingness to utilize them. The data based upon their performance was collected at the end of final examination to assess the benefit of study guide to students. Likert-type Ordinary Scale data analysis was used to determine if hypothesis was supported. The analysis of primary endpoint indicated that majority of students (69.87%) who used the practice exams performed better. In the feedback they reportedly strongly agreed that it helped them to make their study more focused and improved their pre-existing anxiety levels during pandemic.

Oxytocin is required for remote learning. Students need a bonding-hormone to improve their learning

Humans being a social animal need physical presence of their own kind to learn and educate themselves. COVID-19 has increased the need and desire for oxytocin more than any time in history of education. The purpose of this research project was to look at how pandemic-induced remote learning has reduced students’ social interaction, and impacted their education. With the ability to turn off audio and camera, struck in unproductive environments, students feel not only disengaged, isolated but overly anti-social. For our research, we recruited 25 undergraduate biomedical students at the University of Plymouth, England to survey their experiences with online learning, engagement with the technology and how it has affected their ability to learn in the void of physical presence. Our preliminary data suggests that (84%) of these students agreed that online/remote learning has impacted learning and made them crave for bonding to their classmates. However, for a small percentage (16%) said it did not make any difference. This initially highlights the issue that online learning is of the students seem to have no effect. These cohort of the students also seem to identify themselves as “introverts” and they also seem to have enjoyed being less sociable. We conclude that a statistically significant number of students proved to need a social environment conducive to learning and current pandemic limited that aspect. A social and a societal element of a happy civil environment is needed for not only healthy mind and body but also for a healthy and fruitful education world. A well-known bonding hormone “Oxytocin” is a prerequisite for human learning environment, and we don’t see the virtual world to take that over in any time soon.

Genetic studies play an important role in the correct diagnosis of congenital immunodeficiency conditions

More than 350 kinds of PID (Primary Immunodeficiency disorders) related gene defects have been found, which lead to multiple clinical manifestations including repeated infection or opportunistic bacterial infections, autoimmune and malignant tumors. The 6-year-old boy was born from third pregnancy and not related parents. His oldest brother died at the age of 3 from unknown disease, second sibling, 11 years old, is alive. Until the age of 3 patient developed normally, when he started exhibiting swelling in the lymph node and temperature increased to 38–40°C. Lymph node biopsy showed tuberculosis. Bilateral pneumonia and the swollen right ankle, right and left elbow with purulent abscesses in the ankles and elbows. Surgical treatment gave a short-term relieve. At the age of 5, the disease recurred and all treatments were ineffective. CBC, biochemical, serological, immunological analysis and X-ray, US, MRT were done. Genetic sequence analysis of the 207 genes listed in the Genes Analyzed section (Invitae Primary Immunodeficiency Panel) was carried out. On objective examination, the anterior cervical lymph node and the axillary lymph nodes were swollen on both sides. Aplasia of tonsils, “high palate”, hepatomegaly and splenomegaly were detected. Lab results showed severe anemia and high CRP (60 mq/l), however, HbsAg, HCV, Anti-Syphilis, Brucella antibodies were negative. Genetic examination: heterozygous mutations in CASP10, CLPB, CSF3R, CTPS1, IL17RC, LRBA, NLRP12, RFX5 genes were found. Diagnostic genetic testing to clarify the severity of disease and assistance with a personalized treatment may help management of patient.

COVID-19 affected “face to face” interaction with the professors. Lessons learned from traditional learning

Many university programs have implemented/utilized online teaching platforms for various reasons over the last decade. This has allowed for both students and professors to track progress in the course, as well as providing a method to submit assignments over the traditional paper submission. These are just a few of the reasons that online platforms have gained popularity, though many have been caught off-guard by the sudden full transition from traditional/hybrid learning to online learning. Through the use of surveys, we have aimed to study the effects, both positive and negative, that this transition to online learning has had on university students. Our group has pooled our questions into a larger set of survey questions that have been broken into smaller surveys, so that we can encourage a response rate that allows us to maximize our results without having students lose interest in answering all of our questions. In this current research, we have focused on the major loss in the current pandemic induced learning. Our preliminary data suggests that one of the major things that students feel is that they miss face to face interactions with their professors. Since we looked at a cohort of professional pharmacy school students where experiential education is one of the major aspects of training future pharmacists. The students believe that the practical aspect of learning needs supervision, oversight, mentoring, and physical presence of teachers. Most of the students feel that no matter how realistic the internet world of learning seems, it can not compensate the training and practice required in a professional school of pharmacy. We conclude that nothing can compensate or simulate the loss of profound student-teacher interaction.

Old is Gold! Old School is Back to a New School of Learning

COVID-19 has challenged the way students' learn and gain knowledge. The purpose of this research project was to investigate how students adapted to remote learning due to COVID-19. We selected a group of undergraduate Biomedical Science students at the University of Birmingham, England with the intent of understanding their new approaches to learning and whether remote teaching discriminated against the less fortunate. Our google form survey received 40 responses. 27 students said they forgot how to learn, with only 15 obtaining new ways of learning. This demonstrated how the adjustment to online teaching detracted from the time and energy students could put into learning. 75% of students did not enjoy university as much as they did pre COVID-19, and 3 students liked no aspects of online teaching. 22 students learnt worse online, while 10 felt no difference. Choosing when to watch lectures improved some students time management, self motivation and discipline. However, lack of externally-imposed routine brought new challenges as students had no time pressure, making it easier to fall behind. Cancelled laboratory work meant students missed out on vital skills. Our data showed that student satisfaction decreased, traditional learning methods were lost, and new ways of learning were hard to attain when transitioning to online teaching. With the prospect of learning returning to what the student’s consider normal, students fear this will accentuate how they have forgotten to learn in the traditional way, posing another disruption to their studies as they readjust to a post COVID world, whenever it comes. We anticipate that lessons learnt and forgotten in a pandemic-induced remote environment will remain a challenge to current students at large.

Disadvantaged students at minority serving institutions became disproportionally affected by the current COVID-19 pandemic

Learning has been a complex human skill. Humans have gone through a gradual learning experience spanning hundreds of years. Never in the history mankind have been tested with learning a tsunami of information in a very short period. Last couple of decades have stressed out not only the neurobiology of learning but tested the maximum limits of human capacities. If not all, some of the population group like students have burnt out. To add further stress to depleting limits of human capacities the current pandemic totally exhausted even their reserves. We at College of Pharmacy Chicago State University tested and other stressor being minority serving university and having a major population of disadvantage students. We did a survey of under graduate students and asked them this question to identify only one and most important challenge they faced in this time of pandemic induced remote learning. Not to our surprise we found that a statistically significant number of students declared that the cost of paying for technology to survive in this remote learning was the major factor that impacted their learning and lead to a major challenge for them. Most of the students suffered financial stress with loss of jobs, declining college loans, lack of motivation for a successful career. More specifically these disadvantage students could not keep up with the rising cost of wifi, laptop, cell phones and opting for additional online learning tools. To give an example, one student told us that she would go to near by Starbucks to get online assignments done in a timely manner. In the current lock down even the public libraries are closed and students struggle. Our study suggests that the universities set aside a special budget to financially help these disadvantage students.

Impact of COVID-19 on percutaneous coronary intervention for ST-elevation myocardial infarction

BACKGROUND

The objective of the study was to identify any changes in primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in England by analysing procedural numbers, clinical characteristics and patient outcomes during the COVID-19 pandemic.

METHODS

We conducted a retrospective cohort study of patients who underwent PCI in England between January 2017 and April 2020 in the British Cardiovascular Intervention Society-National Institute of Cardiovascular Outcomes Research database. Analysis was restricted to 44 hospitals that reported contemporaneous activity on PCI. Only patients with primary PCI for STEMI were included in the analysis.

RESULTS

A total of 34 127 patients with STEMI (primary PCI 33 938, facilitated PCI 108, rescue PCI 81) were included in the study. There was a decline in the number of procedures by 43% (n=497) in April 2020 compared with the average monthly procedures between 2017 and 2019 (n=865). For all patients, the median time from symptom to hospital showed increased after the lockdown (150 (99-270) vs 135 (89-250) min, p=0.004) and a longer door-to-balloon time after the lockdown (48 (21-112) vs 37 (16-94) min, p<0.001). The in-hospital mortality rate was 4.8% before the lockdown and 3.5% after the lockdown (p=0.12). Following adjustment for baseline characteristics, no differences were observed for in-hospital death (OR 0.87, 95% CI 0.45 to 1.68, p=0.67) and major adverse cardiovascular events (OR 0.71, 95% CI 0.39 to 1.32, p=0.28).

CONCLUSIONS

Following the lockdown in England, we observed a decline in primary PCI procedures for STEMI and increases in overall symptom-to-hospital and door-to-balloon time for patients with STEMI. Restructuring health services during COVID-19 has not adversely influenced in-hospital outcomes.

Comparison of Reproductive Hormonal Profile and Sexual Performance Satisfaction among Type-2 Diabetes Mellitus and Controls

OBJECTIVE

To evaluate reproductive hormonal profile among three groups with varying sexual performance satisfaction (erectile dysfunction) with or without type-2 diabetes (T2DM).

STUDY DESIGN

Comparative cross-sectional analysis.

PLACE AND DURATION OF STUDY

Department of Pathology, PNS Hafeez Hospital, Islamabad, from January to December, 2018.

METHODOLOGY

One hundred and twenty-one subjects including T2DM and age-matched controls were segregated into three groups based upon their sexual performance satisfaction. These groups were evaluated by one-way ANOVA for various anthropometric, glycemic indices and reproductive hormones and free androgen indices (FAI). A general linear model (GLM) was utilised using HbA1c and FAI as dependent variable with sexual performance satisfaction as fixed and quantitative CRP and urinary albumin creatinine ratio (UACR) as random variables to evaluate diabetes complication and inflammation on sexual performance.

RESULTS

Comparison between three groups suggested a rising trend for FAI as: FAI: {Non-satisfied (n=43):41.78 (95%CI:36.67-46.90)}, {Just satisfied (n=38):48.81(95%CI: 42.96-54.66)}, {Satisfied (n=40):51.86 (95%CI:45.27-58.44)}, [p=0.041]. GLM model evaluation suggestion that for any particular degree of reported ED, HbA1c demonstrated a higher trend from non-satisfied subjects to satisfied subjects with inflammation following a rise with HbA1c levels, identifying inflammation as more related with worsening diabetes than with sexual performance satisfaction. FAI levels were higher among subjects who showed no erectile dysfunction than subjects with less satisfied groups with both inflammation (qCRP) and nephropathy (UACR) causing across the group decline for FAI among all ED groups.

CONCLUSION

Sexual performance satisfaction and FAI decline with rise in HbA1c. Moreover, subjects having nephropathy or higher inflammation (qCRP) were found to have lower FAI and ED, both in controls and T2DM.

Comparison of Various Abdominal Obesity Measures for Predicting Metabolic Syndrome, Diabetes, Nephropathy, and Dyslipidemia

OBJECTIVE

To evaluate abdominal volume index (AVI), body roundness index (BRI), body adiposity index (BAI), a body shape index (ABSI) and conicity index (C-Index) for differences in subjects with or without metabolic syndrome, diabetes, nephropathy, and dyslipidemia; and secondly, to evaluate the diagnostic performance through measuring area under curve (AUC) by ROC curve analysis for new and conventional obesity measures in diagnosing metabolic syndrome.

STUDY DESIGN

Cross-sectional analytical study.

PLACE AND DURATION OF STUDY

PNS Hafeez Hospital, Islamabad, from January 2016 to December 2018.

METHODOLOGY

Baseline anthropometric measures including BMI, WHpR, WHtR, AVI, BRI, BAI, ABSI and C-Index were measured for 232 subjects along with measurement of various biochemical parameters. Differences among subjects with and without metabolic syndrome, diabetes, nephropathy, and groups based upon insulin resistance were noted. ROC curve analysis was utilised to measure AUC for all anthropometric measures for diagnosing metabolic syndrome.

RESULTS

Pearson's correlation between obesity measures and lipid indices suggested highest correlation for AVI for most lipid indices followed by WHpR and WHtR. Mean AUC for obesity measures were greater than 0.80 for WHtR and AVI, followed by other parameters. The least AUC i.e. 0.320, was observed for ABSI. The differences between various anthropometric measures for groups based upon metabolic syndrome, diabetes, nephropathy, and insulin resistance remain variable indicating that each anthropometric index may depict a different aspect of the metabolic risk.

CONCLUSION

WHtR and AVI showed the highest AUC to diagnose metabolic syndrome and were better associated with metabolic diseases.

The Use of Moodle Apps and Khan Academy Short Videos to Engage Students to Learn Microbiology/Immunology

The purpose of this research project was to look at the use of technology in Immunology education. There have been reports that non-conventional ways do not effectively deliver the content matter to the students. We used Moodle and online resources to evaluate ways to enhance student engagement and participation. In the past we have investigated and published innovative methods to accomplish this goal. In the current study we used pre-lectures as a tool to enhance student learning and performance. The intent was to enforce and supplement classroom teaching and not introduce an alternative. During the spring semester a didactic course of Immunology is taught to first year pharmacy students at Chicago State University. Prior to this investigation we surveyed and determined that students are challenged with this course of Immunology. Other than being introduced to Immunology for the first time, they struggle with getting used to workload in a professional school and time management. Since our preliminary survey showed that students do not always have enough time to watch one-hour long lecture videos, we decided to use short and topic-focused videos &lt;10 minutes. Students could listen driving to school, work, or during the 10-minute breaks between classes. For the purpose of this research project we selected reliable online resources that offered information via short lecture videos. Usage data showed that Khan Academy videos were among the top choices among students. We selected Immunology short videos and provided links to via Moodle, which allowed us the pertinent usage data over the entire semester. Our data showed that those students who listened to pre-lectures Immunology videos performed significantly better in exams than those who did not.

The Use of Interactive Educational Tools to Engage Students in Microbiology and Immunology Classroom

Microbiology and Immunology is a required 4 credit hour course for pharmacy students to progress in Chicago State University College of Pharmacy program. Twenty lectures are offered to first-year pharmacy students to grasp fundamentals of Immunology. We surveyed this course for five weeks and observed the classroom lectures, student’s participation, and the learning materials that were provided to students to use in this course. We noticed the major hindrance in learning was lack of student engagement in the classroom. Our survey indicated 77.6% of the students could not focus during lectures for more than 10 minutes. In the classroom environment, traditional PowerPoint lectures were given, students were quizzed during the lecture to keep them attentive, but still there was an obvious lack in lively participation and learning process. The objective of this study was to use interactive educational tools to help engage students. Our hypothesis was that interactive educational tools will improve student’s engagement in the classroom and possibly enhanced student learning. We experimented with various interactive educational tools, such as Moodle (Millionaire game, Quiz, Adaptive Quiz), Facebook livestream, and a private YouTube channel to keep students engaged in the classroom. We observed that simply using various diverse educational tools during the lectures drew student attention and participation rather than sticking to only one method or tool of teaching. The results showed that students were not bored and seemed to enjoy learning and lively contributed to their own learning process. In conclusion, the use of interactive educational tools improved both student engagement in the class as well as boosted the morale of the Instructor.

Hot Spot-type Questions offered via ExamSoft to learn Immunology

There are many ways to promote meaningful student learning of Immunology. Hot Spot question format is a new type of active learning tool. It indicates that having planned repetition over an extended period of time leads to better retention by including images with text during instruction. This leads to long-term retention and improved student outcomes. In Hot Spot, users indicate the answer by clicking a specific area of an image. First year pharmacy students participated in a 3-hour long Immunology workshop. The students reviewed a video and handout explaining Hot Spot before coming to the workshop. Hot Spot questions containing basic Immunology were prepared for the workshop. A class of sixty two students were given ExamSoft online platform to take a pre-workshop quiz. The students were split into small learning groups and were given half an hour to discuss the pre-workshop content of basic Immunology. After half an hour, the students were randomly asked to pick up a partner to take ExamSoft quiz assessment again in pairs. The difference between pre- and post-workshop was that the students were paired in post-workshop quiz and were allowed to discuss concepts of Immunology with their partners. This pairing exercise and use of Hot Spot type assessment enhanced learning of basic concepts of Immunology and was evident from post-workshop quiz grades. The students not only did better on assessment grades but the post-workshop student feed back surveys also greatly commended this type of learning method. Therefore, we recommend learning basic Immunology through workshops, pairing of students and use of Hot Spot assessments. We also advocate teaching all basic pharmaceutical sciences via interactive educational tools for enhancing student learning.

Single-center report of antibody deficiencies in Azerbaijan

The most common type of Primary Immune Deficiencies (PID) are Antibody Deficiencies (AD) characterized by the recurrent bacterial infections. Usually the immune disbalance is observed as a decrease in B-cell function, hypogammaglobulinemia and deficiency of IgG and IgA or all three IgG, IgA and IgM antibodies. Early onset acute or chronic infections in gastrointestinal, respiratory and urinary tract are the most common symptoms of AD. The aim of the study was to analyze the data of 126 pediatric and adult patients diagnosed as AD in our PID center between 2010–2019. Immune status of the patients was examined by phenotyping of immune cells in peripheral blood, measurement of serum IgM, IgG, IgA and IgE levels, evaluation of phagocytic activity by NBT, and detection of CIC by photometric method. Additional abdominal CT and ultrasound examinations were also performed. From 126 pediatric and adult patients registered in PID Center, Baku, Azerbaijan, 9 patients were diagnosed with sIgA deficiency, 26 were common variable immune deficiency, 9-Bruton disease and 2 patients with Hyper IgM syndrome. Patient cohort included 5 adults and 41 between 12 months to 11 years age. At the time of the study, 37 patients were receiving intravenous immune globulin (IVIG) as a replacement therapy (31 patients were on regular IVIG). IVIG therapy was associated with decreased incidence of infections and overall improvement in well-being of the patients. It is important to consider hypogammaglobulinemia in patients with a history of recurrent and severe infections. We recommend that patients’ immune status should be examined including evaluation of serum immunoglobulin levels and B and T-cell subsets.

Glucose Tolerance versus HbA1c Results as Depictive of Gestational Diabetes Mellitus

OBJECTIVE

To evaluate glucose tolerance patterns in pregnant ladies undergoing 2-hour oral glucose tolerance test (OGTT) for comparing fasting, 1-hour, 2-hour post-glucose load results, HbA1c, sum of all glucose readings with and without gestational diabetes mellitus (GDM) using International Association of the Diabetes and Pregnancy Study Group (IADPSG) diagnostic criteria.

STUDY DESIGN

Cross-sectional analysis.

PLACE AND DURATION OF STUDY

PNS Hafeez, Naval Hospital, Islamabad, from January 2016 to July 2017.

METHODOLOGY

For 280 evaluated subjects reporting in mid-pregnancy for OGTT, results were segregated into four groups based upon comparison of 2-hour glucose result with 1-hour glucose. Group-1 2-hour results drop being >2.0 mmol/L than1-hour results, group-2 with 2-hour result between <2.0 to >0.5 mmol/L than peak at 1-hour, and group-3 with either 2-hour glucose drop being <0.5mmol/L or >1-hour results. Further, the ROC curve analysis was performed to compare the AUC for fasting plasma glucose, 1-hour post OGTT result, 2-hour post-OGTT result, factor additive of all OGTT readings and HbA1c.

RESULTS

There was a progressive rise in HbA1c from group-1 to group-3 (p<0.001). Area under curve (AUC) for various diagnostic parameters for diagnosing GDM for additive value of all glucose results was 0.962 (95% CI: 0.935-0.988), 0.881 (95% CI: 0.818-0944) for plasma glucose at 2-hour, for plasma glucose at 1-hour 0.898 (95% CI: 0.0.842-0.954), 0.831 (95% CI: 0.0.762-0.901) for fasting plasma glucose and 0.668 (95% CI: 0.0.578-0.759) for HbA1c (p<0.001).

CONCLUSION

Pregnant ladies demonstrating poor tolerance to glucose at 2-hour were observed to have higher HbA1c levels.

Friedewald's equation for calculating LDL-cholesterol: Is it the time to say "Goodbye" and adopt direct LDL cholesterol methods?

Objectives:

To measure correlation and concordance between measured LDL cholesterol (mLDLc) and Friedewald’s calculated LDL cholesterol (cLDLc). To compare the mLDLc and cLDLc values for various anthropometric measures and biochemical indices including insulin resistance, nephropathy, glycated hemoglobin and triglycerides.

Methods:

Two hundred thirty two subjects were included in this cross-sectional analysis from Jan-2016 to July-2017 from a target population visiting PNS HAFEEZ hospital. Mean age of the subjects was 46.56(±11.95) years (n=232). These subjects underwent clinical evaluation including measurement of anthropometric measurements, biochemical testing for fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), lipid profile, urine albumin creatinine ratio (UACR), and insulin. Correlation and concordance between mLDLc and Friedewald’s cLDLc were measured. Finally, Comparison of risk evaluation for mLDLc and cLDLc between groups formulated based upon UACR (Based upon a cut off of 2.5 mg/g) and fasting triglycerides (Group-1 :< 1.0 mmol/L, Group-2: 1.0-1.99 mmol/L and Group-3 :> 1.99 mmol/) was carried out.

Results:

There was significant positive linear correlation between mLDLc and cLDLc [r=0.468, <0.001]. Kendall’s Coefficient of concordance between mLDLc and cLDLc was 0.055 (p<0.001). Differences evaluated by one way ANOVA analysis for mLDLc between various triglycerides groups were only significant between group-1 and group-2 [{Group-1:Mean=2.40, (2.19-2.61), n=43}, {Group-2:Mean=2.81, (2.69-2.92), n=136}, [{Group-3:Mean=2.59,(2.37-2.81), n=53}],(p=0.004) in comparison to cLDLc [{Group-1:Mean=2.63, (2.43-2.84), n=43}, {Group-2:Mean=2.85, (2.76-2.93), n=136}, [{Group-3:Mean=2.75, (2.60-2.90), n=53}]. Calculated method for LDLc showed higher UACR than mLDLc. (p=0.021)

Conclusion:

cLDLc over estimates LDL-cholesterol in comparison to mLDLc. The correlation between cLDLc and mLDLc was only moderate. However, cLDLc provided better degree of risk prediction for nephropathy and glycated hemoglobin than mLDLc.

Genetic Immune Pathologies Are Common in Azerbaijan

Genetic immune pathologies are common in Azerbaijan. Primary immune deficiencies (PID) include more than 300 rare congenital diseases. There are more than 250 genes known to be involved in different immune disorders, especially in PID. Around 30% of patients are not diagnosed on time despite having clinical and laboratory evidences. Primary immunodeficiency disorders may be caused by mutations in one or several specific genes. The exact diagnosis of PID patients requires genetic analysis. The diagnosis is not always made timely because genetic tests are not carried out in many countries like Azerbaijan and are quite expensive. We present data of clinical and genetic analyses PIDs in Azerbaijan. During 2010–2019 we studied 111 PID patients. Genetic results obtained from 18 of these patients revealed that the mutations were located mainly in 7 groups of genes. These genetic mutations had clinical manifestations in the form of PID variants, i.e., WAS syndrome, X link agammaglobulinemia, HIGM syndrome, and Ataxia-Telangiectasia. AT patients were analyzed through linkage analysis with D11S384, D11S2179 and D11S1294 genetic markers. Immune analyses included; phenotyping of leucocyte subset in peripheral blood, serum IgM, IgG, IgA, IgE levels, phagocytic activity of neutrophils by NBT. Additional tests such as X-ray, computer tomography and ultrasound investigations were used. Genotyping of mutations was performed through sequence-based methods. In PID patients mutations in the following genes were identified; CCCG&gt;C deletion on TBX1 gene, c.12_13insGG hemizygous mutation on exon 1 of WAS gene, Gln234stop mutation and T&gt;A SNP on 100614289 location of BTKgene, c.6010C&gt;T and c.6671G&gt;A mutations on LRBAgene, c.135T&gt;A on CD40LGgene.

An online workshop integrated into Immunology course to teach pharmacogenomics to the first-year pharmacy students

Genetic basis of antibody structure is taught as a part of didactic course of Immunology to first-year pharmacy students. Therefore, we designed a three-hour workshop for P-1 students as a part of didactic Immunology course. Online workshops offer a rich multimedia learning experience, the interactive format includes guided learning videos, engaging discussion, assessment and comprehensive survey. Accreditation Council for Pharmacy Education (ACPE) Standards 2016 include pharmacogenomics, it is the responsibility of pharmacy schools to prepare pharmacists entering clinical practice to effectively use genetic data in the delivery of precision medicine. However, in a 2010 survey the state of pharmacogenomics instruction at most pharmacy schools was reported as “poor” or “not at all adequate”. Pharmacogenomics is defined as the study of how genes affects a person’s response to drugs. We proposed a new method of instruction using online learning resources to drive better learning and awareness of pharmacogenomics at a very early stage in pharmacy education. 64 students were included in this study. Two YouTube videos 45 minutes each, i.e., one describing basic genetics and the other pharmacogenomics were posted on Moodle. A case-study model was used to bring home the basic concepts. A pre- and post-workshop google forum was posted to assess student’s learning. A Moodle-based chat forum was also incorporated to take students questions during the workshop. The data showed that most of the students were unware of the importance and relevance of pharmacogenomics and the workshop improved learning this significantly. Online learning tools like workshops were found to be student-friendly and a flexible format with no scheduled meeting times.

The new paradigm shift in microbiology and immunology education in Azerbaijan Medical University Baku Azerbaijan

Medical Schools in USA and the rest of western world are launching their first major redesign of its early curriculum since the 1980s, integrating multiple disciplines into single courses and introducing earlier clinical immersion and flipped classrooms. It will require medical students to learn more actively, rather than cram and memorize material, and that it seeks to reflect how medicine has changed over the last four decades. Medical curricular change is part of a broader shift in medical education from asking students to memorize material to emphasizing its application. The new paradigm is driven by new innovations in medicine as well as new needs in medicine. Azerbaijan is a central Asian country at the cross roads of Western and Eastern cultures. As a former member of the Soviet Union, Azerbaijan science and education developed in last century on the basis of German-Russian model. However, in recent years, scientific, medical, and education fields are also drawing on American, British, French and Turkish models in developing new research/education standards. In this study we used innovative teaching techniques and modern web-based tools to advance student’s learning and comprehension. These parameters were evaluated in proposing a new paradigm shift in medical curriculum design at Azerbaijan Medical University via discussions, dialogues and planning, envision and strategize future efforts to slowly mold towards short-term and long-term goals. A pilot online course in Medical Microbiology and Immunology was tested for students registered in medicine, dental, pharmacy and public health faculties. Data from student and faculty surveys showed a marked acceptance of the need for a curricular redesign and welcoming paradigm shift.

Cinemimmunology-the use of cinema to learn immunology

Film can be a powerful educational tool known as cinemeducation. We at College of Pharmacy applied this universal learning method to the first year pharmacy class of basic immunology. Two workshops were introduced to the course and the student’s assessment pre- and post-workshop were analyzed. We used two Hollywood blockbuster movies, i.e., The Incredibles 1 and 2 to enhance first year pharmacy students to grasp concepts of basic immunology. The students watched movies. The main plot was that the immune system is like a family with dad, mom, girls, boys and babies. Giving due credit to Brad Bird, the writer and director of The Incredibles. In his words (changed within brackets)-quoted as follows: The characters of “The dad is always expected in the family to be strong, so we made him (T cell) strong. The moms are always pulled in a million different directions, so we made her stretch like taffy (B cell). Teenagers, particularly teenage girls, are insecure and defensive, so we made her turn invisible and turn on shields (Antibody). And ten-year-old boys are hyperactive energy balls. Babies are unrealized potential. So, we made babies as cytokines.” Our results showed a significantly enhanced conceptual learning and long-term retention of immunological concepts. Even students with severe learning difficulties and disabilities who struggle with any kind of academic curriculum can often relate to film. It was also an example of associated learning using common movies with high yield of performance within a short period of time. We recommend the use of such strategies in immunology education. Commonly accepted education method is known as cinemeducation for imparting medical education and when we used it to teach immunology, we called it cinemimmunology.

Comparison of various steady state surrogate insulin resistance indices in diagnosing metabolic syndrome

BACKGROUND

Insulin resistance is core cause of metabolic syndrome. Determining insulin resistance is one of the foremost requirements imperative to understanding the pathophysiology of disease. The gold standard "Euglycaemic clamp test" is cumbersome, long and non-feasible in routine clinical setups to diagnose metabolic syndrome. Various continuous and steady state insulin resistance indices are now available in literature. We plan to evaluate commonly utilized steady state insulin resistance indices directly and Homeostasis Model Assessment for Insulin Resistance (HOMAIR) with added triglyceride (HOMA-TG index).

METHODS

The cross-sectional study was carried from Jan-2016 to Dec-2018 at PNS HAFEEZ and department of chemical pathology, AFIP with following objectives: (1) To evaluate steady state insulin resistance markers for diagnosing metabolic syndrome as per IDF defined criteria by ROC curve analysis, (2) to measure Kendal Concordance between various insulin resistance indices and (3) to correlate steady state insulin resistance markers with anthropometric and lipid indices. After several exclusions we selected 224 subjects based upon "non-probability convenience sampling" for inclusion in study. Clinical history, anthropometric measures were calculated and sampling was done for insulin, glucose and other biochemical parameters. Metabolic syndrome was diagnosed as per IDF criteria, while HbA1c was utilized to diagnose diabetes mellitus. Pearson correlation was used to correlate various steady state insulin resistance indices including HOMAIR, HOMA2 index, QUICKI, G/I ratio, HOMA-TG index and serum insulin. AUC was calculated by ROC analysis for all surrogate insulin measures in diagnosis of metabolic syndrome.

RESULTS

"HOMA-TG index" has shown the highest AUC for diagnosing metabolic syndrome along with higher correlation with lipid markers and anthropometric indices in comparison to other steady-state insulin resistance markers. Furthermore, QUICKI and G/I ratio showed the lowest AUC for detection of metabolic syndrome.

CONCLUSION

"HOMA-TG index" has shown highest AUC for metabolic syndrome diagnosis. However, QUICKI and G/I ration showed the lowest AUC for detection of metabolic syndrome. It is hoped that the potential "HOMA-TG index" may provide better diagnostic efficiency for diagnosing metabolic syndrome.

Bombyx mori derived scaffolds and their use in cartilage regeneration: a systematic review

For the last two decades, silk has been extensively used as scaffolds in tissue engineering because of its remarkable properties. Unfortunately, the aneural property of cartilage limits its regenerative potential which can be achieved using tissue engineering approach. A lot of research has been published searching for the optimization of silk fibroin (SF) and its blends in order to get the best cartilage mimicking properties. However, according to our best knowledge, there is no systematic review available regarding the use of Bombyx mori derived biomaterials limited to cartilage related studies. This systematic review highlights the in vitro and in vivo work done for the past 7 years on structural and functional properties of B. mori derived biomaterials together with different parameters for cartilage regeneration. PubMed database was searched focusing on in vitro and in vivo studies using the search thread "silk fibroin" and "cartilage". A total of 40 articles met the inclusion criteria. All the articles were deeply studied for cell types, scaffold types and animal models used along with study design and results. Five types of cells were used for in vitro while seven types of cells were used for in vivo studies. Three types of animal models were used for scaffold implantation purpose. Moreover, different types of scaffolds either seeded with cells or supplemented with various factors were explored and discussed in detail. Results suggest the suitability of silk as a better biomaterial because of its cartilage mimicking properties.

Association of metabolic risks with subclinical hypothyroidism: A cross-sectional analysis

Objective:

To compare lipid parameters, HbA1c, uric acid and albumin creatinine ratio (UACR) among subjects having euthyroidism, Sub-Clinical Hypothyroidism (SCH) and overt hypothyroidism.

Methods:

This comparative cross-sectional analysis was carried out from Dec-2015 to Oct-2016 in collaboration between PNS HAFEEZ hospital and department of chemical pathology and endocrinology, Armed Forces Institute of Pathology, Rawalpindi. Biochemical parameters including lipid indices, HbA1c and UACR were compared between euthyroidism (TSH: 0.5 to 4.0 mIU/L, n=163), subclinical hypothyroidism (TSH: 4.0 to 10 mIU/L, n=16) and overt hypothyroidism (TSH:≥ 10.0 mIU/L, n=9).

Results:

LDL-cholesterol, non-HDL-cholesterol and UACR results were as: [(Euthyroid: 2.66 ± 0.73), (SCH: 2.68 ± 0.51) and (Overt hypothyroidism: 3.23 ± 0.59), p-value=0.063], [(Euthyroid: 3.49 ± 0.64), (SCH: 3.35 ± 0.59) and (Overt hypothyroidism: 4.01 ± 0.30), p-value=0.033] and [{Euthyroid: 2.48 (95% CI: 1.63-3.33)}, {SCH: 2.27 (95% CI: 0.37-4.90)} and {Overt hypothyroidism: 14.95 (95% CI: 10.71-19.14){, (p-value< 0.001)] Results for total cholesterol, triglycerides and HDL-cholesterol though increased in overt hypothyroid group were not found to be statistically significant.

Conclusion:

LDL-cholesterol, non-HDL-cholesterol and UACR increased from euthyroid subjects to overt hypothyroidism group. However, these changes were found to be more subtle in the subclinical hypothyroid subjects than cases with overt hypothyroidism.

The prevalence of digital note-taking trends in professional pharmacy students

The use of technology in the classroom may have positive and negative effects on student learning. We determined the use of note taking technologies to precept students learning. The research in question is to find out the use of integration of modern technology into didactic courses of pharmacy education. We surveyed students’ perceptions of note taking regarding the type, frequency, and appropriateness of use of note-taking technology in the classroom. We carefully prepared 10 questions for an anonymous survey pertaining to students’ perception of habits and ways of taking notes in the class and how it affected their learning capability in the school. A questionnaire survey was delivered to 59 P1 students in the classroom. 100% of the students who responded owned electronic device and use it while in school. The data determined the following trends. When students were asked about which operating system they are using, 39% used MacBook, 34% used windows and 21% reported use of Ipad for their notes-taking needs. 60% of the students either used a digital product to take notes or used windows. 71% of students who responded said that they take 75-100% of their notes on electronic devices in the P1 courses. The majority of those students used a laptop to take notes during class, 60% of students reported using Notability for note taking while in classrooms. Among other digital products PDF writer, Evernote, and OneNote were also used. 23% of the students still prefer taking notes the old traditional way by printing the lectures and writing notes on paper. This study demonstrated how modern digital technology helps and enhances note-taking ability among pharmacy students. Price and easy use of technological gadgets influences the final selection for students.

Status of non-HDL-cholesterol and LDL-cholesterol among subjects with and without metabolic syndrome

OBJECTIVE

To to compare non-high-density lipoprotein and low-density lipoprotein cholesterol among subjects with or without metabolic syndrome, glycation status and nephropathic changes.

METHODS

The comparative cross-sectional study was carried out from Dec 21, 2015, to Nov 15, 2016, at the department of pathology and medicine PNS HAFEEZ and department of chemical pathology and clinical endocrinology (AFIP), and comprised patients of either gender visiting the out-patient department for routine screening. They were evaluated for anthropometric indices, blood pressure and sampled for lipid profile, fasting plasma glucose, glycated haemoglobin, insulin, and urine albumin-to-creatinine ratio. Subjects were segregated based upon presence (Group1) or absence (Group2) of metabolic syndrome based upon criteria of National Cholesterol Education Programme and the International Diabetes Federation. Differences in high and low density lipoprotein cholesterols were calculated between the groups.

RESULTS

Of the 229 subjects, 120(52.4%) were women and 109(47.6%) were men. Overall, there were 107(46.7%) subjects in Group 1, and 122(53.3%) in Group 2. Non-high-density lipoprotein cholesterol was significantly different between subjects with and without metabolic syndrome as per both the study criteria (p<0.05 each). .

CONCLUSIONS

Non-high-density lipoprotein cholesterol levels were higher in subjects with metabolic syndrome.

Metabolic clustering of risk factors: evaluation of Triglyceride-glucose index (TyG index) for evaluation of insulin resistance

BACKGROUND

Metabolic syndrome over the years have structured definitions to classify an individual with the disease. Literature review suggests insulin résistance is hallmark of these metabolic clustering. While measuring insulin resistance directly or indirectly remains technically difficult in general practice, along with multiple stability issues for insulin, various indirect measures have been suggested by authorities. Fasting triglycerides-glucose (TyG) index is one such marker, which is recently been suggested as a useful diagnostic marker to predict metabolic syndrome. However, limited data is available on the subject with almost no literature from our region on the subject.

OBJECTIVE

1. To correlate TyG index with insulin resistance, anthropometric indices, small dense LDLc, HbA1c and nephropathy. 2. To evaluate TyG index as a marker to diagnose metabolic syndrome in comparison to other available markers.

DESIGN-CROSS-SECTIONAL ANALYSIS

Place and duration of study-From Jun-2016 to July-2017 at PSS HAFEEZ hospital Islamabad.

SUBJECTS AND METHODS

From a finally selected sample size of 227 male and female subjects we evaluated their anthropometric data, HbA1c, lipid profile including calculated sdLDLc, urine albumin creatinine raito(UACR) and insulin resistance (HOMAIR). TyG index was calculated using formula of Simental-Mendía LE et al. Aforementioned parameters were correlated with TyG index, differences between subjects with and without metabolic syndrome were calculated using Independent sample t-test. Finally ROC curve analysis was carried out to measure AUC for candidate parameters including TyG Index for comparison.

RESULTS

TyG index in comparison to other markers like fasting triglycerides, HOMAIR, HDLc and non-HDLc demonstrated higher positive linear correlation with BMI, atherogenic dyslipidemia (sdLDLc), nephropathy (UACR), HbA1c and insulin resistance. TyG index showed significant differences between various markers among subjects with and without metabolic syndrome as per IDF criteria. AUC (Area Under Curve) demonstrated highest AUC for TyG as [(0.764, 95% CI 0.700-0.828, p-value ≤ 0.001)] followed by fasting triglycerides [(0.724, 95% CI 0.656-0.791, p-value ≤ 0.001)], sdLDLc [(0.695, 95% CI 0.626-0.763, p-value ≤ 0.001)], fasting plasma glucose [(0.686, 95% CI 0.616-0.756, p-value ≤ 0.001)], Non-HDLc [(0.640, 95% CI 0.626-0.763, p-value ≤ 0.001)] and HOMAIR [(0.619, 95% CI 0.545-0.694, p-value ≤ 0.001)].

CONCLUSION

TyG index, having the highest AUC in comparison to fasting glucose, triglycerides, sdLDLc, non-HDLc and HOMAIR can act as better marker for diagnosing metabolic syndrome.

Abstract 2662: Statins modulate MMP-9 and beta catenin in epithelial cells

The effect of statins (Simvastatins) mediated mechanisms that affect inflammatory or non-inflammatory pathways causing formation and progression of cancer need to be investigated. Currently, sufficient data are lacking to support the use of statins for the prevention of cancer and further research is clearly warranted. We studied these antineoplastic mechanisms in rodent inflammatory model, which might be instrumental in drug discovery research for the development of future cancer therapeutics. MMP9 is a member of the family of zinc-containing endopeptidases, which degrade various components of the extracellular matrix, thereby regulating matrix remodeling. Since matrix remodeling plays an important role during growth and progression of cancer and considering the fact that, tumor cells switch to aerobic glycolysis as its major energy source, this study was designed to analyze the effect of Statins on MMP9 and epithelial cell integrity at gastrointestinal gut barrier. We used an established model of thermal injury (TI) to study the effects of simvastatins. We found that the percentage of stained MMP-9 in the control tissue and TI+SMV tissue was lower than the percentage in thermal injury tissue (P&lt; 0.05). Moreover, fluorescent stained sections of intestinal epithelial from control, thermal injury and thermal injury+SMV. β-catenin determination was performed with fluorescence microscope. β-catenin levels were significantly (p&lt;0.05) decreased in thermal injury tissue, which was reversed by statins. Our studies conclude that statins have anti-neoplastic effects and affect metallopeptidases, β-catenin and e-cadherins.

Note: This abstract was not presented at the meeting.

Citation Format: Nadeem Fazal, Walid Al-Ghoul. Statins modulate MMP-9 and beta catenin in epithelial cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2662. doi:10.1158/1538-7445.AM2017-2662

Insulin Resistance and Glucose Levels in Subjects with Subclinical Hypothyroidism

OBJECTIVE

To compare insulin resistance and glycemic indicators among subjects with euthyroidism and subclinical hypothyroidism.

STUDY DESIGN

Comparative cross-sectional study.

PLACE AND DURATION OF STUDY

Department of Pathology and Medicine, PNS Hafeez, Islamabad, in collaboration with the Department of Chemical Pathology and Endocrinology at the Armed Forces Institute of Pathology (AFIP), Rawalpindi, from December 2015 to September 2016.

METHODOLOGY

Subjects referred for executive screening of apparently healthy population (without any known history of diabetes, hypertension, heart disease or other chronic ailments), were included. Subjects were grouped as euthyroidism and subclinical hypothyroidism.

RESULTS

Median (IQR) insulin resistance indices including fasting insulin and Homeostasis Model Assessment for Insulin Resistance in subjects with group-1 (n=176, 87%, Thyroid Stimulating Hormone: 0.5 - 3.5 mIU/L) and group-2 (n=26, 13%, Thyroid Stimulating Hormone: 3.51 - 15 mIU/L) were 7.6 (6.70) vs. 11.4 (13.72, p=0.040) and 1.77 (1.79) vs. 2.8 (3.07, p=0.071). The median differences for fasting plasma glucose were 5.0 (1.0) in group-1 vs. 5.0 (1.47) for Group-2 [p=0.618], and glycated hemoglobin was 5.60 (1.1) vs. 5.60 (1.7, p=0.824). Homeostasis Model Assessment for beta sensitivity index in paradox showed slightly higher values for group-2 [median (IQR) 86.67 (92.94)] than group-1 [111.6 (189.64, p= 0.040)].

CONCLUSION

Measures of insulin resistance including Homeostasis Model Assessment for Insulin Resistance and fasting insulin levels were significantly different between subjects with euthyroidism and having subclinical hypothyroidism.

The impact of using web conferencing system on student learning, engagement and performance in Immunology Course

The increasing complexity of pharmacy curricula has been a continuing challenge for both students and faculty. The technology learning platforms currently used in Chicago State University College of Pharmacy are Moodle, Livetext and ExamSoft. The aim of this study was to develop and investigate certain tools instituted by Moodle. We wanted to study the impact of using podcasts on student learning, engagement and performance in Immunology. Our focus was on assessing the full functionality of Moodle features and study its effects in improving learning outcomes, classroom performance and student involvement. Our objective was to explore Moodle-based web conferencing system called BigBlueButton (BBB) in learning immunology. The study was an observational, cohort study with 86 students who were enrolled in Microbiology/Immunology offered to P-1 students at Chicago State University College of Pharmacy. BBB is a web conferencing system, which allows for distant lecture delivery and stores audio/visual content into Moodle. Delivery time was set up according to lecture time. Recordings were automatically uploaded into the course in Moodle within 30 minutes. BBB module was available at no charge on the Moodle service to supplement lecture information. Students have the ability to review recorded lectures at any time, anywhere and on any device with satisfactory picture and sound quality. Recorded podcasts can remain on the Moodle course for a year, and are easily transferable to an upcoming lecture course. Our data shows a positive correlation between the BBB videos watched by the students and their performance. Further studies may need to be done to assess the duration of time spent by students outside of the classroom in reviewing the podcasts.

TLR4 Activation of Small GTPase RhoA Signaling Mediates Endotoxin-Induced Endothelial Barrier Dysfunction

Sepsis is an uncontrolled activation of immune response, leads to multi-organ failure and high rate of mortality. Studies show the role of increase in endothelial activation and barrier dysfunction significantly contribute to the pathophysiology in sepsis. Endothelial cells form a tight barrier between blood and underlying tissue, and thus maintain an anti-inflammatory milieu. Here, we investigated the role of small GTPase, RhoA activation in regulating the increase in human coronary artery endothelial (HCAE) permeability in response to TLR4-receptor agonist, endotoxin lipopolysaccharide (LPS). Endothelial permeability was determined by determining the influx of Evans blue-labeled albumin across endothelial monolayer on 0.4μ Transwell filters. Our data show that LPS induced RhoA activation and resulted in increase in HCAE cell monolayer permeability. Thus, we tested the hypothesis that LPS mediated induction of RhoA activates pro-inflammatory signaling and eliciting endothelial barrier dysfunction. Knockdown of RhoA using siRNA approach abrogated LPS induced increase in endothelial permeability. Rho-associated kinase (ROCK) is an effector of the RhoA. To further determine the molecular mechanism involved downstream of RhoA activation, we pretreated the cell with ROCK inhibitor (Y-27632) and we found that LPS failed to induce endothelial permeability in cells treated with Y-27642. In conclusion, our study shows that LPS induces activation of the RhoA - ROCK signaling pathway, which leads to increase in endothelial permeability and barrier dysfunction. Therefore, ROCK emerges as a potential drug target to treat sepsis induced endothelial permeability and inflammation.

Use of Twitter in classroom attendance and participation in a Microbiology & Immunology course

The use of social media in education has become increasingly prominent in recent years by educators in an attempt to improve students’ learning and to increase interaction in large classroom lectures. Among the popular social networking websites, Twitter is of particular interest due to its ease of use, micro blogging and hash tag capabilities. The objective of this study was to assess the use of Twitter in classroom attendance among professional first-year students. This study is distinguished by its focus on the pharmacy curricula, and among first year pharmacy students at CSU College of Pharmacy. All students enrolled in Microbiology and Immunology in the spring semester were included in the study. Students were permitted to use mobile devices in class and were recommended to create a Twitter account and add fellow colleagues and the course coordinator to participate in the study. Data from attendance was collected and analyzed according to the number of students that were present at the beginning of lecture, the number of students that were present until the end of lecture, the number of students that tweeted, the number of students that missed the tweet, and the number of students that tweeted their presence but were not actually in class. Since the study was voluntary, a total of 72 students signed a consent form to participate. An average of 59 students were present at the beginning and stayed until the end of lecture for the duration of the study. The analysis of variance (ANOVA) model was used to assess for differences in attendance at the beginning of class and at the end of class. This study demonstrates that the use of Twitter to take classroom attendance is more useful compared to traditional methods of roll call and sign-in sheets and announcements.

Integrating Group-Learning for First-Year Pharmacy Immunology Course to Enhance Students Understanding and Comprehension

This research hypothesizes that integrating group-learning oriented multiple-choice study guides for first-year pharmacy immunology course will enhance students learning, understanding and comprehension of complicated material. Immunology questions (300 MCQs) were selected based on the criteria of lectures topics, difficulty level and meeting the specific objectives for every lecture that was presented to students and covered in this exam. Study guide was uploaded to Moodle three weeks before the examination and students were given a free access to it with the ability to download and print it. The survey was taken at the end of examination to assess the benefit of study guide to students. Likert-type Ordinary Scale data analysis was used to determine if hypothesis was supported and study endpoints were met. Primary endpoint was to determine the effectiveness of utilizing the study guide in student learning. Secondary endpoint was to determine if students prefer to study in learning groups and what resources were most commonly utilized to find answers to questions. Our studies found that the majority of the students 69% indicated study guide was very beneficial to them and helped to make their study more focused and practicing questions helped them to understand complicated immunology concepts better. Moreover, 65% of the students agreed or strongly agreed that study guide helped them not only to prepare to examination but also to improve the overall exam score. In conclusion, the results of this study suggest that group-based learning approach utilizing a multiple-choice study guide was very beneficial to a first-year pharmacy immunology course and positively supplemented materials being covered in a classroom lecture setting.

Kinesthetic Learning Modalities’ Approach in Understanding Concepts of Hypersensitivities Immunological Reactions

It is now generally accepted that there are four learning modalities. Auditory learners learn best by listening so lecturing would be the way they would prefer to learn. Visual learners are those who prefer the printed word. They would learn best by reading or responding to the use of an overhead projector type of teaching. Tactile learners learn best by manipulating objects so they would prefer laboratory exercises. Kinesthetic (also known as whole body learners) prefer to learn through physical activities. This is the group of learners who would benefit most by this type of role-playing workshop. There are three basic modalities to process information to memory: visual (learning by seeing), auditory (learning by hearing), and kinesthetic (learning by doing). We tested role-playing modality at College of Pharmacy Chicago State University. This was done during spring semester where pharmacy year 1 students were taking Immunology as a didactic course. The students were divided into different small learning groups of 7–10 students in a class of 90 students and were made to role-play different types of hypersensitivity reactions. The role-playing acts were acted up in front of the whole class and also recorded. Asking Likert-type ordinary scale data analysis questions assessed the effectiveness of this modality and student learning. A statistically significant number of students found this immunology role-playing exercise as a fun and very beneficial activity. Students strongly agreed that this group-base role-playing approach was very powerful in conceptual understanding of hypersensitivity reactions, which is a clinically important and significant immunology topic.

Use of social media like Facebook in learning and teaching immunology at college of pharmacy: synergy or rivalry? (EDU1P.217)

It is proven that today’s students spend majority of their time on Facebook. To help students stay more focused on studying a Facebook group about Immunology was created. It was hypothesized that Facebook will create an interest and impulse for first year pharmacy students to help increase participation in the class and help understand key concepts of Immunology. For those students that are visual learners and seem to struggle with understanding key concepts of immunology, uploading videos can help them with grasping this knowledge.The purpose of this project was to determine if creating a Facebook group would be beneficial for the Pharmacy Year 1 (P-1) class to help them get a better understanding of the Immunology through videos. The P1 class had the option of watching the videos and completing the surveys. While the results were promising in the first week, they slowly depleted as the study proceeded. After the second week there were numerous surveys completed that were not in favor of the videos or topic discussions. This trend continued until the last week of the study where it was not approved by the vast majority of the students. Based upon this research we concluded that Facebook did create an initial interest especially for visual learners but that seemed to wane away over time. Students were unable to remain focussed over time during the length of Immunology course. They preferred textbook reading and interactive discussion among small groups more than Facebook.

Supplementation of first-year pharmacy immunology course with a YouTube channel to enhance student learning and comprehension (EDU1P.219)

Teaching Immunology course at Pharmacy schools remains an uphill task. Faculty members in colleges and schools of pharmacy engage in numerous techniques to help students develop into knowledgeable practitioners that are critical thinkers, able to problem solve and communicate efficiently. Increased attention is being paid to curricular integration in pharmacy education. The objective of this study was to determine if watching pertinent educational videos, organized on a virtual environment as a channel, supplement the traditional classroom-setting lectures. YouTube videos less than 20 minutes in length were searched for accuracy, relevance, and thoroughness for specified topics discussed in Immunology course. They were than uploaded to a virtual file-sharing site called “Box”. All students enrolled in the course near the end of the semester were given a 10-question Likert-type survey with responses ranging from strongly agree, agree, neutral, disagree, and strongly disagree. Likert-type ordinal scale analysis was completed to determine the amount of support for the primary, secondary, and tertiary endpoints respectively as follows: a) to determine the effectiveness of the channel in students learning Immunology, to determine if students would like the channel continued and created for other courses as well, and if YouTube channel was efficient to host the site. In conclusion, our data shows strong support that videos can successfully supplement a first-year Immunology course.

Evidence for simvastatin anti-inflammatory actions based on quantitative analyses of NETosis and other inflammation/oxidation markers

Simvastatin (SMV) has been shown to exhibit promising anti-inflammatory properties alongside its classic cholesterol lowering action. We tested these emerging effects in a major thermal injury mouse model (3rd degree scald, ~20% TBSA) with previously documented, inflammation-mediated intestinal defects. Neutrophil extracellular traps (NETs) inflammation measurement methods were used alongside classic gut mucosa inflammation and leakiness measurements with exogenous melatonin treatment as a positive control. Our hypothesis is that simvastatin has protective therapeutic effects against early postburn gut mucosa inflammation and leakiness. To test this hypothesis, we compared untreated thermal injury (TI) adult male mice with TI littermates treated with simvastatin (0.2 mg/kg i.p., TI + SMV) immediately following burn injury and two hours before being sacrificed the day after; melatonin-treated (Mel) (1.86 mg/kg i.p., TI + Mel) mice were compared as a positive control. Mice were assessed for the following: (1) tissue oxidation and neutrophil infiltration in terminal ileum mucosa using classic carbonyl, Gr-1, and myeloperoxidase immunohistochemical or biochemical assays, (2) NETosis in terminal ileum and colon mucosa homogenates and peritoneal and fluid blood samples utilizing flow cytometric analyses of the surrogate NETosis biomarkers, picogreen and Gr-1, and (3) transepithelial gut leakiness as measured in terminal ileum and colon with FITC-dextran and transepithelial electrical resistance (TEER). Our results reveal that simvastatin and melatonin exhibit consistently comparable therapeutic protective effects against the following: (1) gut mucosa oxidative stress as revealed in the terminal ileum by markers of protein carbonylation as well as myeloperoxidase (MPO) and Gr-1 infiltration, (2) NETosis as revealed in the gut milieu, peritoneal lavage and plasma utilizing picogreen and Gr-1 flow cytometry and microscopy, and (3) transepithelial gut leakiness as assessed in the ileum and colon by FITC-dextran leakiness and TEER. Thus, simvastatin exhibits strong acute anti-inflammatory actions associated with marked decreases in gut tissue and systemic NETosis and decreased gut mucosa leakiness.

OX62+OX6+OX35+ rat dendritic cells are unable to prime CD4+ T cells for an effective immune response following acute burn injury

Co-stimulatory molecules expressed on Dendritic Cells (DCs) function to coordinate an efficient immune response by T cells in the peripheral lymph nodes. We hypothesized that CD4+ T cell-mediated immune suppression following burn injury may be related to dysfunctional DCs residing in gut associated lymphoid tissues (GALT), such as Mesenteric Lymph Nodes (MLN). Therefore, we studied co-stimulatory molecules expressed on burn rat MLN DCs as an index of functional DCs that would mount an effective normal CD4+ T cell immune response. In a rat model of 30% Total Body Surface Area (TBSA) scald burn, OX62+OX6+OX35+ DCs and CD4+ T cells were isolated from MLN of day 3 post-burn and sham control rats. DCs were tested for their expression of co-stimulatory molecules, and prime CD4+ T cell (DC:CD4+T cell co-culture assays) to determine an effector immune response such as CD4+ T cell proliferation. The surface receptor expressions of MLN DCs co-stimulatory molecules, i.e., MHC-II, CD40, CD80 (B7-1), and CD86 (B7-2) were determined by Flow cytometry (quantitatively) and confocal microscopy (qualitatively). Tritiated thymidine and CFDA-SE determined CD4+ T cell proliferation following co-incubation with DCs. Cytokine milieu of MLN (IL-12 and IL-10) was assessed by mRNA determination by RT-PCR. The results showed down-regulated expressions of co-stimulatory markers (CD80, CD86, CD40 and MHC-II) of MLN DCs obtained from burn-injured rats, as well as lack of ability of these burn-induced DCs to stimulate CD4+ T cell proliferation in co-culture assays, as compared to the sham rats. Moreover, anti-CD40 stimulation of affected burn MLN DCs did not reverse this alteration. Furthermore, a marked up-regulation of mRNA IL-10 and down-regulation of mRNA IL-12 in burn MLN as compared to sham animals was also observed. To surmise, the data indicated that dysfunctional OX62+OX6+OX35+ rat MLN DCs may contribute to CD4+ T-cell-mediated immune suppression observed following acute burn injury.

Use of in vivo caspase inhibitor in rat burn and infection injury prevents gut bacterial translocation and modulates CD4+ T cell effector immune response. (P3272)

Our previous studies have focused on gut-associated lymphoid tissues, failure of intestinal gut barrier, bacterial translocation, and sepsis exploring the roles of antigen-presenting cells, DCs, CD4+ T cell and regulatory T cells in immunosuppression following acute burn and/or burn-plus-infection injury. In an established rodent model of burn plus infection we tested in vivo use of caspase inhibitor and studied T cell effector immune response and gut barrier function. Z-VAD-FMK, a highly specific, cell-permeable, and irreversible inhibitor of caspases was given to rats and were then assessed for mortality, bacterial translocation, T cell receptor expression and apoptosis. The results suggested an increase in CD4+CD25+ T cell phenotype in splenocytes of burn as compared to sham rats, however such an elevation in CD4+CD25+ expression was reduced in CLP and CLP+Burn+Caspase-Inhibitor groups. The results also showed that there was an increase in adhesion receptors (LFA) and decrease in CD62L in burn, whereas no difference in these adhesion receptor expressions was ascertained in Burn+CLP and Burn+CLP+Caspase-Inhibitor treated rats. A decrease in homing receptor (CD49d) was also noticed in Burn+CLP and Burn+CLP+Caspase-Inhibitor-treated animals. The Colony Forming Unit (CFU) results showed absence of bacterial translocation in rats that were subjected to burn+CLP+Caspase-Inhibitor, however there was significant bacterial translocation in rats from the group of CLP and burn only.

Burn-injury affects gut-associated lymphoid tissues derived CD4+ T cells

After scald burn-injury, the intestinal immune system responds to maintain immune balance. In this regard CD4+T cells in Gut-Associated Lymphoid Tissues (GALT), like mesenteric lymph nodes (MLN) and Peyer's patches (PP) respond to avoid immune suppression following major injury such as burn. Therefore, we hypothesized that the gut CD4+T cells become dysfunctional and turn the immune homeostasis towards depression of CD4+ T cell-mediated adaptive immune responses. In the current study we show down regulation of mucosal CD4+ T cell proliferation, IL-2 production and cell surface marker expression of mucosal CD4+ T cells moving towards suppressive-type. Acute burn-injury lead to up-regulation of regulatory marker (CD25+), down regulation of adhesion (CD62L, CD11a) and homing receptor (CD49d) expression, and up-regulation of negative co-stimulatory (CTLA-4) molecule. Moreover, CD4+CD25+ T cells of intestinal origin showed resistance to spontaneous as well as induced apoptosis that may contribute to suppression of effector CD4+ T cells. Furthermore, gut CD4+CD25+ T cells obtained from burn-injured animals were able to down-regulate naïve CD4+ T cell proliferation following adoptive transfer of burn-injured CD4+CD25+ T cells into sham control animals, without any significant effect on cell surface activation markers. Together, these data demonstrate that the intestinal CD4+ T cells evolve a strategy to promote suppressive CD4+ T cell effector responses, as evidenced by enhanced CD4+CD25+ T cells, up-regulated CTLA-4 expression, reduced IL-2 production, tendency towards diminished apoptosis of suppressive CD4+ T cells, and thus lose their natural ability to regulate immune homeostasis following acute burn-injury and prevent immune paralysis.