Muhamed T. Osman

The Malaysia DREEM: perceptions of medical students about the learning environment in a medical school in Malaysia

Background Students’ perceptions of their learning environment, by defining its strengths and weaknesses, are important for continuous improvement of the educational environments and curriculum. Therefore, the aim of this study was to explore students’ perceptions of their learning environment, among medical students in Malaysia. Various aspects of the education environment were compared between year levels and sex. Methods This cross-sectional study was conducted at the Management and Science University, Shah Alam, Malaysia in 2012. A total number of 438 medical students participated in this study, and the response rate was 87.6%. Data were analyzed using SPSS. Comparisons of the mean scores of Dundee Ready Education Environment Measure (DREEM) subscales were calculated. The t-test was used to determine statistically significant differences. Results The majority of the study participants were female, Malay, and from year 3 (68.7%, 65.3%, and 55.7%; respectively). Analysis of each of the 50 items of the DREEM inventory showed that 47 items scored ranged between 2.00 and 3.00, and three items scored below 2.00. These were identified as problem areas in this medical school that are required to be critically addressed. The overall score showed that the medical students’ perceptions were positive. The students’ perception toward educational environment was positive for all five DREEM subscales. Conclusion The study found that, in general, the perceptions of the participants about the learning environment were positive. Nevertheless, the study also found there is a need for curriculum improvement in this school and identified priority areas for such improvement.

Assessment of the response to gluten-free diet in an Iraqi population with coeliac disease. A histological and serological follow-up study

Introduction Coeliac disease (CD) is a common diagnosis among children and adults in Iraq; however, removal of gluten from the diet is essential for patients with CD. The aim of this study, the first such study in Iraq, was to assess the serological and histological recovery profiles of coeliac patients, in both children and adults groups after commencing a gluten-free diet (GFD) for at least 1 year ± 1 month. Material and methods The study group comprised 78 proved coeliac patients (46 children and 32 adults, median age: 15 years, range: 1–66 years) who all agreed to undergo endoscopy in addition to serological assessment before and after treatment. The duodenal biopsies were interpreted histologically according to modified Marsh criteria and the sera were tested for anti-gliadin antibody (AGA), endomysium antibody (EMA) and anti-tissue transglutaminase antibody (tTG). Results Complete histological remission was seen in 29 (63.1%) of 46 treated children CD patients, while only 5 (10.9%) showed Marsh IIIa changes compared with 11 (24%) before GFD. Similarly none of the 32 adults after GFD showed Marsh IIIb and Marsh IIIc compared with 46.9% and 28.1% before treatment respectively (p = 001). Meanwhile, there was strongly significant reduction in AGA, EMA, and tTG antibodies levels (p = 0.00001) following GFD. Conclusions Repeating the duodenal biopsy 1 year ±1 month after diagnosis and starting a GFD supports the routine measurement of using histological findings as a gold standard test to confirm recovery of Iraqi CD patients along with using known coeliac serology antibodies.

Teaching of Pathology in a Hybrid Integrated Curriculum at a Malaysian Medical School

Hybrid integrated curriculum (HIC) is a pathway of teaching aims to innovate without sacrificing the best of the old, and to balance the latest developments in medical science with the age-old values of healing. From 2010, onwards, the curriculum in Faculty of Medicine, Universiti Teknologi MARA Malaysia (UiTM), was modified to a HIC to accom- modate a variety of learning styles and incorporates a range of carefully planned teaching strategies to get the objective of the inte- gration of all pedagogical elements around a core of student-directed learning including learning of pathology. Pathology teaching now is being directed to the teaching of clinico-pathological correlation with the mechanisms of disease. Exposure of clinical years students (3rd, 4th, and 5th years), to pathology museum has been initiated, and students have given a back seat to pathology, in order to invigorate and inspire them to revisit their pathology knowledge.

EVALUATION OF DIAGNOSTIC UTILITY OF USING TWO SUBSTRATES FOR ENDOMYSIUM ANTIBODIES TEST WITH COMPARISON WITH HISTOLOGICAL FINDINGS IN IRAQI COELIAC PATIENTS

Purpose: A case-control study was carried out to elucidate prospectively the sensitivity and specificity of endomysium antibodies by using two substrates in the diagnosis of coeliac disease as a first attempt in an Iraqi population with comparison with histological findings. Methods: The study consisted of 314 patients and 100 normal controls. Oesophago-gastroduodenoscopy was done to each patient and three biopsies from distal duodenum were taken. Venous blood sample was also obtained from each patient and normal subjects. The sera were tested for endomysium antibodies (EMA) by using two substrates; monkey esophagus and human umbilical cord by indirect immunofluorescent technique (IIF). Results: The sensitivity of EMA (monkey oesophagus) test among both children and adults was 93.8% and 100% respectively, while the sensitivity of EMA (umbilical cord) test among children and adults was 96.6% and 100% respectively. Conclusions: The human umbilical cord tissue is better for using as a substrate than the monkey esophagus tissue among Iraqi ceoliac patients. Therefore, the test is suitable as a diagnostic and screening tool for the disease. Key wordsCoeliac disease, Endomysium antibody , Indirect immunofluorescent technique, Monkey esophagus, Human umbilical cord. International Journal of Medical and Clinical Research ISSN:0976-5530 & E-ISSN:0976-5549, Volume 3, Issue 3, 2012 Introduction Coeliac Disease (CD), also known as gluten-sensitive enteropathy, was traditionally considered an intestinal disease occurs in both children and adults, characterized by malabsorption, diarrhoea, weight loss, abnormal stools and abdominal distention. [1] However more than half of CD patients do not exhibit these “typical” symptoms. The vast array of symptoms that may indicate CD include dermatitis herpetiformis, psychiatric illness, short stature, infertility, malignancy of the gastrointestinal tract, recurrent abdominal pain, indigestion, anemia, macrocytosis and folate deficiency. [2, 3] The mucosal lesion develops in genetically susceptible individuals after ingestion of dietary gluten and recovers when glutencontaining cereals, wheat, rye and barley are withdrawn from the diet. [4] The disease should be detected as early as possible, because untreated CD is associated with many severe complications such as intestinal lymphoma or cancer and osteoporosis.[4] Serological tests developed in the last two decades to simplify and shorten the time for the diagnosis of CD providing a non-invasive tool to screen both individuals at risk for the disease and the general population. [3, 5] However, the current gold standard for the diagnosis of coeliac disease remains histological confirmation of the intestinal damage in serologically positive individuals. [6] Measurement of IgA antibodies recognizing endomysium by indirect immunofluorescence has historically been considered the gold standard serologic assay for CD. These autoantibodies recognize an intermyofibril substance found in primate smooth muscle connective tissue. [7, 8] The tissue of choice for detection of Citation: Muhamed T. Osman, et al (2012) Evaluation of Diagnostic Utility of Using Two Substrates for Endomysium Antibodies Test with Comparison with Histological Findings in Iraqi Coeliac Patients. International Journal of Medical and Clinical Research, ISSN:0976-5530 & E -ISSN:0976-5549, Volume 3, Issue 3, pp.-127-131. Copyright: Copyright©2012 Muhamed T. Osman, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

Refractory Coeliac Disease; Role of Nigella sativa as Immunomodulator

Aim: The aim of this study was to assess the immunological and histological profiles of adult coeliac patients after commencing Nigella sativa (NS) oil with gluten free diet (GFD) for a period of 1 year ± 1month to prove its validity in treatment of refractory coeliac disease (CD). Methodology: Thirty two adult coeliac patients who all accepted to do endoscopy and duodenal biopsy in addition to serological assessment before and after treatment of GFD alone or with NS oil capsules for a period of 1 year ± 1 month. Duodenal biopsies were interpreted histologically according to modified Marsh criteria and the sera were tested for antigliadin antibody (AGA), anti tissue transglutaminase antibody (tTG) and endomysium antibody (EMA). Results: The response to gluten withdrawal with NS oil for a period of 1 year ± 1 month in CD patients was better than GFD alone with significant response to serological markers.

Clinical Presentations and Pathogenic Agents of Bloody Diarrhoea among Iraqi Children

Diarrhea is the second leading cause of child morbidity and mortality, especially in the developing countries. A Cross-sectional study study was conducted with the objectives of determining the clinical features and pathogenic agents caused bloody diarrhea among Iraqi children. Random sample of 1500 children age less than or equal to 10 years old having diarrhoea were participated in this study. Stool samples were examined by divided each one into two portions, one portion used for direct general examination while the other was cultured for the detection the causative. The prevalence of childhood bloody diarrhea was 28%. Entamoeba histolytica infected all age groups with highest (97.5%), and lowest (20%) prevalence among age groups 1-3years and 4-6years old respectively. Salmonella and Shigella were found, 42.1%, 15.8% respectively more among the age group 4-6 years, 42.1%, 15.8% respectively. In conclusion, the prevalence of bloody diarrhoea among children less than 10 years of age presenting with diarrhoea in Baghdad is (28%). However, En- tamoeba histolytica is the commonest and most frequent causative agent of bloody diarrhoea in children.. Meanover, fever, tenesmus, severe dehydration and convulsion were the significant characteristics of bloody diarrhoea among Iraqi children.