Ibrahim M. Inuwa

Eutopic Endometrium From Women With Endometriosis Shows Altered Ultrastructure and Glycosylation Compared to That From Healthy Controls—A Pilot Observational Study

Endometrial curettings from a cohort of 24 women with endometriosis were compared with matched biopsies from 14 healthy, fertile women and examined for ultrastructural changes and the secretion of glycans bound by the lectin from Dolichos biflorus. Ultrastructural analysis of glandular endometrial tissue from women with stages I to III endometriosis showed heterogeneous responses to the disease, biopsies often showing a mixture of features, combining delays in the maturation sequence with characteristics of later phenotypes particularly in the mid-late secretory phase of the menstrual cycle. Expression of glycans bound by Dolichos biflorus agglutinin was very variable in these cases but generally matched the observed ultrastructure. Biopsies from women with stage IV endometriosis showed immature gland morphology later in the cycle and also failed to express Dolichos biflorus agglutinin—binding glycans, suggesting an association between histological and biochemical function in advanced disease states. These findings may explain in part endometriosis-associated subfertility as blastocyst attachment is intimately associated with appropriate glycosylation and gland morphology.

Anatomy Practical Examinations: How Does Student Performance on Computerized Evaluation Compare with the Traditional Format?.

Practical examinations in anatomy are usually conducted on specimens in the anatomy laboratory (referred to here as the “traditional” method). Recently, we have started to administer similar examinations online using the quiz facility in Moodle™. In this study, we compare student scores between two assessment environments viz. online and traditional environments. We hypothesized that regardless of the examination medium (traditional or online) overall student performance would not be significantly different. For the online medium, radiological images, prosected specimens, and short video clips demonstrating muscle action were first acquired from resources used for teaching during anatomy practical classes. These were optimized for online viewing and then uploaded onto Moodle learning management software. With regards to the traditional format, actual specimens were usually laid out in a circular stream. Identification tags were then attached to specific spots on the specimens and questions asked regarding those identified spots. A cohort of students taking practical examinations in six courses was studied. The courses were divided into three pairs with each pair credit‐weight matched. Each pair consisted of a course where the practical examination was conducted online and the other in the traditional format. There was no significant difference in the mean scores within each course pair. In addition, a significant positive correlation between score in traditional and online formats was found. We conclude that mean grades in anatomy practical examination conducted either online or in the traditional format were comparable. These findings should reassure teachers intending to use either format for their practical examinations. Anat Sci Educ.

Long-term ingestion of Hibiscus sabdariffa calyx extract enhances myocardial capillarization in the spontaneously hypertensive rat:

The effects of Hibiscus sabdariffa (HS) in lowering blood pressure in human and animal hypertension have been documented. This study investigated the effect of the water extract of the dried calyx of HS and Hibiscus anthocyanins (HAs) on left ventricular myocardial capillary length and surface area in spontaneously hypertensive rats (SHRs). Twelve-week-old male SHRs were divided into eight groups (six rats in each group). Three groups were given three doses; 10%, 15% and 20% of the water extract of HS in lieu of drinking water for 10 consecutive weeks (HS10, HS15 and HS20) with one group kept as control (C). Another three groups were given three doses of the HAs orally at doses of 50, 100 and 200 mg/kg for five consecutive days with one group kept as a control (C). Systolic (SBP) and diastolic (DBP) blood pressures, as well as heart rate (HR), were measured weekly. After the experimental protocols, the left ventricles (LV) of all rats were obtained. Capillary surface area density and length density were determined by unbiased sterological methods on 3 μm LV tissue samples from perfusion-fixed hearts. HS ingestion significantly reduced SBP, DBP and LV mass in a dose-dependent fashion but did not affect the HR. HS significantly increased surface area and length density of myocardial capillaries by 59%, 65% and 86%, and length density by 57%, 77% and 57%, respectively. Myocyte nuclear volume was significantly decreased in HS-treated rats. There was a decrease (although insignificant) in SBP and DBP with HA ingestion compared with controls. These changes suggest that the observed beneficial effect of HS on high BP in SHRs could be mediated through a reduction in the diffusion distance between capillaries and myocytes, as well as new vessel formation. It is proposed that these effects might be beneficial in restoring myocyte normal nutritional status compromised by the hypertrophic state of hypertension.

Implementing a modified team-based learning strategy in the first phase of an outcome-based curriculum – Challenges and prospects

Background: Team-based learning (TBL) is an innovative form of collaborative learning. The aim of TBL is to create a motivational context in which students become accountable for their learning. Aim: Student attendance at didactic lecture sessions in our school is usually poor. A modified TBL approach in lieu of lectures was undertaken for the first time in a large class (150 students). This communication reports on the challenges of its implementation in our setting and preliminary data on its effects on student performance. Method: Using computer-based evaluation followed by an in-class activity, a modified TBL approach was implemented over two semesters during an introductory basic science course. Data on student performance, student motivation and faculty reflection were collected and analysed. Results: This strategy had significantly enhanced students’ class attendance. They performed better on the built-in TBL assessment (IRAT) compared to standard in-course tests. Besides content mastery, TBL approach could also instill useful attitudinal outcomes such as self-directed learning. Conclusions: The TBL strategy is a viable and refreshing alternative to the usual didactic faculty engagement with the teaching process. Students appear to do better in tests built-in within TBL as compared to stand-alone in-course tests.

Renal and myocardial histopathology and morphometry in rats with adenine - induced chronic renal failure: influence of gum acacia.

Background/Aim: Chronic kidney disease (CKD) is associated with increased occurrence of cardiovascular system dysfunction. Previous studies have revealed a number of alterations in the kidneys and heart during CKD. However, unbiased quantitative studies on these structures in this disease have so far not been addressed. Materials and Methods: We induced CKD in rats by feeding adenine (0.75% w/w, four weeks) and using unbiased stereological methods, investigated the effect of the ensuing CKD on the kidneys and left ventricular structure. Since gum acacia (GA) has previously been shown to ameliorate the severity of CKD in humans and rodents, we investigated the effect of giving GA (15% w/v in the drinking water concomitantly with adenine) on the kidneys and left ventricular structure using the above model. Results: The CKD was confirmed by standard biochemical indices in plasma and urine and by accumulation of the uremic toxin indoxyl sulfate. Additionally, it increased blood pressure. In rats with CKD absolute volume of left ventricle was significantly increased, and the volume density and absolute volume of myocardial capillaries were decreased, whilst the same parameters of myocardium and interstitial tissue were increased. Renal morphometry demonstrated significant increase in kidney volume and interstitial tissue in adenine- treated rats. Similarly, glomerular Bowmans capsule was significantly thickened. The myocardial and renal changes were significantly mitigated by GA treatment. Conclusions: These results add to our existing knowledge of the pathophysiology of adenine - CKD and provides plausible histopathological and morphometric evidence for the usefulness of GA in CKD.

“Between a Rock and a Hard Place” : The discordant views among medical teachers about anatomy content in the undergraduate medical curriculum

The last two decades of medical education have been marked by a persistent push towards curricular reform. Anatomy as a discipline, the unshakable foundation of medical teaching for hundreds of years, has been at the centre of this development. Although it is widely agreed that for doctors to be competent, they need an adequate knowledge of anatomy underpinning medicine, there is much less agreement over the quantity required, and who should decide and define it. Many clinicians feel medical students are being under-trained in this basic medical science before reaching the clinical stages. Professional accreditation boards advocate the reduction of factual information in undergraduate medical courses. Anatomists complain of a progressive erosion of the time allocated to the subject. Caught in the midst of this controversy is the student of anatomy who is left bewildered and confused about what is required from him to become a safe and competent health professional. The way forward might, first, be for medical schools to facilitate discussions between students, anatomy professors, and clinicians to bring these divergent perspectives into alignment. Second, the anatomists need to re-invent themselves in two principal frameworks: first, to present the subject in the context within which it will be utilised by the student, and second to employ the overwhelming learning tool of today, i.e. technology, in their teaching and assessment of the subject.

Left Ventricle Myocardium Volume Densities in Spontaneously Hypertensive Rats (SHR) Following Combination of Exercise and ACE Inhibitor Treatment: A Stereological Study

Este estudio fue disenado para probar los posibles efectos de una combinacion de ejercicios y una intervencion de terapia farmacologica en las estructuras del miocardio del ventriculo izquierdo, en ratas espontaneamente hipertensivas (SHR). Ratas de 20 semanas espontaneamente hipertensas (n = 40) fueron divididas en cuatro grupos: sedentarias (Sed) y controles, solamente con ejercicio (Ejer), solamente con lisinopril con 20mg/kg/dia (Lis), y ejercicios + lisinopril (LisEjer). Los ejercicios fueron ejecutados en una maquina de entrenamiento (5m/min.) por 60 minutos/dia, 5 dias/semana por 10 semanas. Al termino de las 10 semanas, las ratas fueron sacrificadas bajo anestesia, el corazon fue detenido en diastole usando procaina intravenosa. Los animales fueron perfundidos a traves de la parte abdominal de la aorta, usando solucion de Karnovsky (pH 7.24). El corazon fue removido y tanto al ventriculo izquierdo como al septo interventricular se les realizaron cortes seriados de 3 µm. Una pieza fue seleccionados al azar, y sumergida en resina JB4. Fueron obtenidas 6 secciones de cada bloque y luego tenidas con azul de toluidina:fucsina acida. Las mediciones de fraccion volumetrica (Vf) del miocardio, capilares, e intersticio fueron obtenidas usando un software de estereologia (Histometrix MIL6 Kinetic imaging Ltd.). El promedio Vf de capilares en el grupo Sed, fue 0.114 ± 0.01 (SEM). Este fue significativamente mayor en el grupo LisExer. El Vf de musculo en Sed fue 0.795 ± 0.02 (SEM). Este fue significativamente menor en Lis pero no vario en el grupo Ejer. Vf capilares fue significativamente alto en LisExjr, si es comparado con los grupos Lis o Ejer (p<0.05). En Vf musculo no hubo diferencias entre los grupos LisEjer y Lis. El resultado de estos cambios pudo deberse a un mejor funcionamiento cardiaco en ratas hipertensa,s producto de ejercicios combinados y tratamiento con inhibidor ACE, que en aquellos en que se efecto un solo procedimiento

There are Doctors and there are 'Doctors': Creating a dichotomy between physicians' roles.

Sir, I remember being a PhD student in the UK some 20 years ago and being asked by the cashier at a checkout counter in one shopping mall, “Are you a real doctor or a PhD doctor?” This was her response to seeing my name, which was preceded by ‘Dr.’ on my debit card. To many people, real doctors are those who actually write prescriptions or perform surgical procedures. Any other person with the title is either a PhD or does not fall within their own understanding of the role of doctors, by which they mean ‘physicians’. One could overlook this general perception of the role of physicians by a section of the general public but it would be unfortunate if this perception were to be held by physicians themselves regarding the roles some of them play in health care systems. This is because there has been a recent disturbing trend amongst some physicians to introduce a dichotomy into the role they play (i.e. medical practice) in health care delivery systems. This trend attempts to define medical (meaning clinical) practice as direct patient care, including prescribing medications, or performing surgical or invasive procedures. This writer would like to argue that it is unhelpful and restrictive to describe clinical practice in this narrow way. A passing knowledge of the workings of medical practice would reveal that physicians have many roles, including health administration, quality control and assurance, patient care, medical research, and medical education. Some physicians solely perform one or a combination of the aforementioned roles. I would like to argue that clinical practice is a spectrum that encompasses the whole sphere of practising medicine starting from the education and training of doctors and continuing throughout their active practice. This spectrum obviously commences at the undergraduate stage, runs through doctors’ postgraduate training, and continues with the revalidation of those already trained.1 Therefore, it is practically impossible to dissociate the education and training of medical and dental students and of doctors and dentists from the care such professionals provide to patients. The physician-educator, whose role either in basic medical sciences (‘on the bench’), the community (‘in the bush’), or the ward (‘at the bedside’) ensures that educational theory informs how s/he imparts the science and art of medicine, is as crucial a player as any other contributor to patient care. A couple of other examples may help to underscore this point. Doctors working in radiology and pathology, are often regarded as working in ‘orphan specialties’ because they do not have their own patients. In spite of this, these specialties are as indispensable as the downstream end of the patient-care continuum where the prescription is written or the surgical procedure is performed! Second, consider the physician-administrator who oversees the entire health system by prioritising resource allocation, planning strategic health care interventions, and ensuring that the quality of health care delivery is also essential to patient care. Therefore, the attempt at separation and categorisation of doctors based on what role they play is, in my opinion, not helpful to the profession. In reality, no one single role physicians play is more important than any other. It is worthwhile to note that in its guidance on continuous professional development (CPD) of doctors, the UK’s General Medical Council (GMC) sets out the principles and values on which good medical practice is founded. These include all activities that doctors perform, from patient care to teaching and appraising trainees, and working with other professionals.2 The statutory requirement of CPD applies to all doctors regardless of the nature of their medical practice. In addition, it is worthwhile to learn from the experience of other countries about the effects that such a separation between patient care and the training of patient-carers has had on the whole medical practice continuum.3 In short, this separation has led to the devastation of such specialty areas as basic medical sciences, public health, health care planning and administration, etc. Many medical graduates decline to take up such specialties, which are indispensable to both the training of medical practitioners of the future as well as to comprehensive health care delivery. This is because they have no incentive to take up these roles since they have been accorded less ‘professional value’ than those of their clinical colleagues. If this circumstance were to be replicated elsewhere, it would likely have an adverse effect on the implementation of any modern undergraduate or postgraduate medical training where the input of doctors is highly required. Finally, I would like to submit that it may not be in the overall long-term interest of the medical profession in any setting to create an unnecessary dichotomy between physicians based on a very restrictive definition of ‘medical (clinical) practice’. This is especially so if this dichotomy is for the purposes of remuneration. I would welcome further discussion, responses, and alternative opinions on this subject.