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Background: Problems posed in problem based learning (PBL) cases used during pre-clinical teaching-framework are typically a set of descriptions of events in need of explanations and resolution. The objectives of this study were to analyze the problems in PBL cases aimed to suggest areas for improvement.Methods: It was a review of cases used in PBL in undergraduate medical curriculum at UKM Medical Centre. Problems in PBL cases were labeled as ‘Triggers’ and ‘Patient Information Sheets’ which were disclosed as prescribed in structured facilitators’ guide. Six of the 10 PBL cases used in semester-1, session 2013-2014 were selected randomly for analysis.Results: Problems in 50% cases were overloaded and in 50% cases sequences of problem-disclosure were disorderly-labeled, though the flow of descriptions were alright. Averagely, 82% faculty-intended learning issues prescribed in facilitators’ guide were connected with problems. Unconnected learning issues were the result of faculty directed teacher-centered approach of guidance, while important learning issues that could have been derived against problems were un-identified.Conclusion: Connectivity of average 82% faculty-intended learning issues with problems reflect as good quality of PBL problems in UKM Medical Centre. However, problem disclosers in disorderly-labeled fashion, unconnected and unidentified issues against some problems in spite of conducting a good numbers of faculty development workshops, raised the issue of needs of further research on standard of training workshops. Educational leaders should give due importance on professionalism and needs of high-quality training for faculty to enhance PBL skills either by utilizing and mobilizing existing properly trained faculty or by hiring appropriate trained faculty.Bangladesh Journal of Medical Science Vol.17(3) 2018 p.417-423

Inflammation is a possible mediator of the relationship between metabolic syndrome (MetS) and osteoporosis. Palm tocotrienol, an anti-inflammatory agent, has been reported to exert beneficial effects for the treatment of MetS and osteoporosis individually. This study aimed to investigate the potential role of palm tocotrienol in preventing both MetS and bone loss in male rats via alleviating the inflammatory response. In this study, MetS was established in the rats fed with HCHF diet. This was accompanied by bone loss and elevated pro-inflammatory cytokine levels. Supplementation of palm tocotrienol improved MetS parameters, trabecular bone microstructure, bone strength, and reduced pro-inflammatory cytokines in the HCHF rats. A dose-dependent effect of palm tocotrienol was also observed in preventing MetS conditions. In conclusion, palm tocotrienol prevents both MetS and bone loss, possibly through its anti-inflammatory properties.

This study aimed to investigate the bone quality in rats induced with metabolic syndrome (MetS) using high-carbohydrate high-fat (HCHF) diet. Male Wistar rats (n = 14) were randomized into two groups. The normal group was given standard rat chow. The MetS group was given HCHF diet. Diet regimen was assigned for a period of 20 weeks. Metabolic syndrome parameters were measured monthly until MetS was established. Left tibiae were scanned using micro-computed tomography at week 0, 8, 12, 16, and 20 to analyze the trabecular and cortical bone structure. At the end of the study, rats were euthanized and their bones were harvested for analysis. Metabolic syndrome was established at week 12 in the HCHF rats. Significant deterioration of trabecular bone was observed at week 20 in the HCHF group (p 0.05). The HCHF diet also decreased cortical and tissue area significantly (p 0.05), but did not affect cortical thickness and bone calcium content (p 0.05). Femur length and width in the HCHF group were significantly shorter than the normal group (p 0.05). The biomechanical strength test showed that the femur of the HCHF rats could endure significantly lower force, but significantly higher displacement and strain compared to the normal rats (p 0.05). In conclusion, HCHF diet-induced MetS can cause adverse effects on the bone.

Excessive expression and activity of 11β-hydroxysteroid dehydrogenase enzyme type 1 (11β-HSD1) enzyme in mature adipocyte leads to obesity and metabolic syndrome. Fructose in drinking water was proven to induce metabolic syndrome in male Wistar rat. Hence, the aim of the study was to assess the effects of expression and activity of 11β-HSD1 enzyme in the liver in an established metabolic syndrome rat model induced by fructose drinking water. Twelve male Wistar rats were randomly divided into two groups: Control group, C (n=6) and Fructose drinking water 20%, F20 (n=6). The food and fluid intake were given as ad libitum for eight weeks. At the end of the experiment, the expression of 11β-HSD1 enzyme in the liver was measured by immunohistochemical staining method. The score was given according to the intensity of the staining of the granules in the hepatocyte cytoplasm which was measured using double-blinded method. Meanwhile, the activity of 11β-HSD1 enzyme in the liver was measured using ELISA technique. Following eight weeks of consumption of fructose drinking water, the F20 group showed an increased in both expression and activity of 11β-HSD1 in the liver. The obtained data clearly suggest that 11β-HSD1 enzymes in the liver may play a role in the development of metabolic syndrome and its complications in male Wistar rat.

The beneficial effects of vitamin E in improving components of MetS or bone loss have been established. This study aimed to investigate the potential of palm vitamin E (PVE) as a single agent, targeting MetS and bone loss concurrently, using a MetS animal model. Twelve-week-old male Wistar rats were divided into five groups. The baseline group was sacrificed upon arrival. The normal group was given standard rat chow. The remaining three groups were fed with high-carbohydrate high-fat (HCHF) diet and treated with tocopherol-stripped corn oil (vehicle), 60 mg/kg or 100 mg/kg PVE. At the end of the study, the rats were evaluated for MetS parameters and bone density. After euthanasia, blood and femurs were harvested for the evaluation of lipid profile, bone histomorphometric analysis, and remodeling markers. PVE improved blood pressure, glycemic status, and lipid profile, increased osteoblast surface, osteoid surface, bone volume, and trabecular thickness, as well as decreased eroded surface and single-labeled surface. Administration of PVE also significantly reduced leptin level in the HCHF rats. PVE is a potential agent in concurrently preventing MetS and protecting bone loss. This may be, in part, achieved by reducing the leptin level and modulating the bone remodeling activity in male rats.

A constellation of medical conditions inclusive of central obesity, hyperglycemia, hypertension, and dyslipidemia is known as metabolic syndrome (MetS). The safest option in curtailing the progression of MetS is through maintaining a healthy lifestyle, which by itself, is a long-term commitment entailing much determination. A combination of pharmacological and non-pharmacological approach, as well as lifestyle modification is a more holistic alternative in the management of MetS. Vitamin E has been revealed to possess anti-oxidative, anti-inflammatory, anti-obesity, anti-hyperglycemic, anti-hypertensive and anti-hypercholesterolemic properties. The pathways regulated by vitamin E are critical in the development of MetS and its components. Therefore, we postulate that vitamin E may exert some health benefits on MetS patients. This review intends to summarize the evidence in animal and human studies on the effects of vitamin E and articulate the contrasting potential of tocopherol (TF) and tocotrienol (T3) in preventing the medical conditions associated with MetS. As a conclusion, this review suggests that vitamin E may be a promising agent for attenuating MetS.

Long-term glucocorticoid treatment induces oxidative stress that cause osteoporosis is an antioxidant and has protective effects against free radical associated diseases. Annatto tocotrienol is a tocopherol free tocotrienol mixture. The purpose of this study was to determine the effects of annatto tocotrienol against glucocorticoid-induced osteoporosis. 32 adult male Sprague-Dawley rats were used in this study. 16 rats were adrenalectomized and divided into two groups; Adrx+Dexa and Adrx+Dexa+ATT and were administered with intramuscular injection of dexamethasone 120 μg/kg/ day. Eight rats underwent sham procedure and the other 8 serves as baseline group. The Adrx+Dexa group was given vehicle palm olein 0.1 ml/kg/day orally while Adrx+Dexa+ATT group was supplemented with annatto tocotrienol 60 mg/ kg/day. The sham operated rats were given vehicle palm olein 0.05 ml/kg/day by intramuscular injection and 0.1 ml/ kg/day orally. The treatments were given for two months before the rats were euthanized. The femurs were tested for biomechanical strength and analyzed for bone histomorphometry. The results showed that long-term glucocorticoid treatment increased, bone resorption marker (CTX), lipid peroxidation; and decreased superoxide dismutase (SOD) activity with no significant changes to serum osteocalcin. Bone biomechanical strength was compromised with reduction in structural, static and dynamic parameters of bone histomorphometry. Annatto tocotrienol supplementation had maintained lipid peroxidation, CTX level, SOD activity and protected bone histomorphometric parameters and biomechanical strength. The results of this study suggested that annatto tocotrienol may have protective effects against osteoporosis induced by glucocorticoids and may be used as prophylaxis for patients on long term glucocorticoid therapy.

Metabolic syndrome (MetS) consists of several medical conditions that collectively predict the risk for cardiovascular disease better than the sum of individual conditions. The risk of developing MetS in human depends on synergy of both genetic and environmental factors. Being a multifactorial condition with alarming rate of prevalence nowadays, establishment of appropriate experimental animal models mimicking the disease state in humans is crucial in order to solve the difficulties in evaluating the pathophysiology of MetS in human. This review aims to summarize the underlying mechanisms involved in the pathophysiology of dietary, genetic, and pharmacological models of MetS. Furthermore, we will discuss the usefulness, suitability, pros and cons of these animal models. Even though numerous animal models of MetS have been established, further investigations on the invention of new animal model and clarification of plausible mechanisms are still necessary to confer a better understanding to researchers on the selection of animal models for their studies.

OBJECTIVES: Previous studies have reported that osteoporosis due to estrogen deficiency influences fracture healing. Transforming growth factor (TGF-b) has been found to be involved in fracture healing via the regulation of the differentiation and activation of osteoblasts and osteoclasts. The current study aimed to determine the effects of estrogen on the expression of TGF-β1 during fracture healing in ovariectomized rats. METHODS: Thirty female Sprague-Dawley rats weighing 200-250 g were assigned to: (i) a sham-operated group that was given a normal saline; (ii) an ovariectomized control group that was given a normal saline; or (iii) an ovariectomized + estrogen (100 mg/kg/day) group that was treated with conjugated equine estrogen. The right femur of all rats was fractured, and a Kirschner wire was inserted six weeks post-ovariectomy. Treatment with estrogen was given for another six weeks post-fracture. At the end of the study, blood samples were taken, and the right femur was harvested and subjected to biomechanical strength testing. RESULTS: The percentage change in the plasma TGF-β1 level before treatment was significantly lower in the ovariectomized control and estrogen groups when compared with the sham group (p

Osteoporosis is a global problem which results in increased fractures risk. The reports from earlier studies were inconsistent with the aging factor as well as the time which is needed to induce bone loss post-ovariectomy. This study aimed to determine the short-term effects of estrogen deficiency on bone structural histomorphometric parameters in young rats. 30 Sprague-Dawley female rats weighing 250 to 300 g were assigned to baseline, sham-operated and ovariectomy groups. The baseline group (n = 10) was sacrificed immediately. Sham-operated rats (SO, n = 10) underwent sham operation while ovariectomised group (OVX, n =10) underwent bilateral ovariectomy. All the rats were sacrificed 6 weeks post-ovariectomy. Following sacrifice, the right femora were dissected and subjected to the histomorphometric analysis using modified Von Kossa method. Bone volume/tissue volume (BV/TV) and trabecular number (Tb.N) reduced significantly, while trabecular separation (Tb.Sp) increased significantly in the ovariectomized rats, compared to the baseline and sham groups 6 weeks postovariectomy (P

Metabolic syndrome (MetS) and osteoporosis are two major healthcare problems worldwide. Metabolic syndrome is a constellation of medical conditions consisting of central obesity, hyperglycemia, hypertension, and dyslipidemia, in which each acts on bone tissue in different ways. The growing prevalence of MetS and osteoporosis in the population along with the controversial findings on the relationship between both conditions suggest the importance for further investigation and discussion on this topic. This review aims to assess the available evidence on the effects of each component of MetS on bone metabolism from the conventional to the contemporary. Previous studies suggested that the two conditions shared some common underlying pathways, which include regulation of calcium homeostasis, receptor activator of NF-κB ligand (RANKL)/receptor activator of the NF-κB (RANK)/osteoprotegerin (OPG) and Wnt-β-catenin signaling pathways. In conclusion, we suggest that MetS may have a potential role in developing osteoporosis and more studies are necessary to further prove this hypothesis.

The influence of osteoporosis on fracture healing is a complex phenomenon. Oxidative stress is considered as a pathogenic factor for bone loss and delayed fracture healing. Piper sarmentosum is known to possess an antioxidant and anti-inflammatory properties. This study aimed to investigate the fracture healing properties of P. sarmentosum aqueous extract in ovariectomised rats by observing changes in the biomechanical properties of femora. Forty female Sprague-Dawley rats (200 to 250 g) assigned into 4 groups: Sham-operated; ovariectomised-control; ovariectomised + conjugated equine oestrogen, 100 µg/kg/day, and ovariectomised + P. sarmentosum extract, 125 mg/kg/day. All the rats underwent mid-diaphyseal closed fracture of the right femur with K-wire fixation 6 weeks postovariectomy. Following the fracture, all the rats received the aforementioned treatment orally for 6 weeks. Biomechanical analysis revealed that, the flexure load, flexure stress and Young’s modulus for the P. sarmentosum -treated group increased significantly compared to the control group (P 0.05). The biomechanical strength parameters in the sham, oestrogen and P. sarmentosum groups were identical (P>0.05). In conclusion, effective supplementation of P. sarmentosum extract restored the biomechanical property of the healed bone. Hence, it may be beneficial for fracture healing in the oestrogen deficient state.

Osteoporosis is considered a serious debilitating disease.Cosmos caudatus(ulam raja), a plant containing antioxidant compounds and minerals, may be used to treat and prevent osteoporosis. This study determines the effectiveness ofC. caudatusas bone protective agent in postmenopausal osteoporosis rat model. Thirty-two female rats, aged 3 months old, were divided into 4 groups. Group one was sham operated (sham) while group two was ovariectomized. These two groups were given ionized water by forced feeding. Groups three and four were ovariectomized and given calcium 1% ad libitum and force-fed withC. caudatusat the dose of 500 mg/kg, respectively. Treatments were given six days per week for a period of eight weeks. Body weight was monitored every week and structural bone histomorphometry analyses of the femur bones were performed. Ovariectomy decreased trabecular bone volume (BV/TV), decreased trabecular number (Tb.N), and increased trabecular separation (Tb.Sp). Both calcium 1% and 500 mg/kgC. caudatusreversed the above structural bone histomorphometric parameters to normal level.C. caudatusshows better effect compared to calcium 1% on trabecular number (Tb.N) and trabecular separation (Tb.Sp). Therefore,Cosmos caudatus500 mg/kg has the potential to act as the therapeutic agent to restore bone damage in postmenopausal women.

Nigella sativaseeds (NS) has been used traditionally for various illnesses. The most abundant and active component of NS is thymoquinone (TQ). Animal studies have shown that NS and TQ may be used for the treatment of diabetes-induced osteoporosis and for the promotion of fracture healing. The mechanism involved is unclear, but it was postulated that the antioxidative, and anti-inflammatory activities may play some roles in the treatment of osteoporosis as this bone disease has been linked to oxidative stress and inflammation. This paper highlights studies on the antiosteoporotic effects of NS and TQ, the mechanisms behind these effects and their safety profiles. NS and TQ were shown to inhibit inflammatory cytokines such as interleukin-1 and 6 and the transcription factor, nuclear factorκB. NS and TQ were found to be safe at the current dosage for supplementation in human with precautions in children and pregnant women. Both NS and TQ have shown potential as antiosteoporotic agent but more animal and clinical studies are required to further assess their antiosteoporotic efficacies.

Osteoporosis is a socio-public health issue which led to a rise in risk of fractures with subsequent delay in fracture healing. Fracture healing is a complex physiological process which involves four overlapping phases that is, haematoma formation, inflammation, repair and remodelling phases. It involves a series of biological cascades which resemble tissues differentiation that occur during foetal skeletal development. Several studies have been carried out to investigate the different traditional medicines using plants known for their fracture healing properties. Piper sarmentosum (Daun Kaduk) is widely distributed in South East Asia and used traditionally to treat many diseases such as diabetes mellitus, fungoid dermatitis and joint ache. The high costs and adverse effects of conventional treatment modalities may favor the wide usage of traditional herbal medicines. The current review focused on the usage of traditional herbal medicine to treat fractures healing in osteoporotic state. Key words

INTRODUCTION: Prolonged steroid treatment administered to any patient can cause visceral obesity, which is associated with metabolic disease and Cushing's syndrome. Glucocorticoids have a profound negative effect on adipose tissue mass, giving rise to obesity, which in turn is regulated by the 11β-hydroxysteroid dehydrogenase type 1 enzyme. Adrenalectomized rats treated with dexamethasone exhibited an increase in visceral fat deposition but not in body weight. OBJECTIVES: The main aim of this study was to determine the effect of dexamethasone on the histomorphometric characteristics of perirenal adipocytes of adrenalectomized, dexamethasone-treated rats (ADR+Dexa) and the association of dexamethasone treatment with the expression and activity of 11 β-hydroxysteroid dehydrogenase type 1 (11 β-hydroxysteroid dehydrogenase type 1). METHODS: A total of 20 male Sprague Dawley rats were divided into 3 groups: a baseline control group (n = 6), a sham-operated group (n = 7) and an adrenalectomized group (n=7). The adrenalectomized group was given intramuscular dexamethasone (ADR+Dexa) 2 weeks post adrenalectomy, and the rats from the sham-operated group were administered intramuscular vehicle (olive oil). RESULTS: Treatment with 120 μg/kg intramuscular dexamethasone for 8 weeks resulted in a significant decrease in the diameter of the perirenal adipocytes (p

Teaching and learning of medical sciences in nursing was identified as the cause of anxiety among students, teachers and the organizations. The aim of this study was to determine the difficulties faced by nursing students in those modules. An action research was conducted on 1st and 2nd year of Bachelor of Nursing students. Results showed that, relationship between CGPA, students’ guide book (p= 0.021, 0.018), lectures timetable (p =0.032), lectures (p=0.034, 0.043) and learning package (p=0.008, 0.016) of physiology and biochemistry influenced the teaching and learning of medical science subjects.