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Perceptions of the usefulness of an online simulated clinical examination

Kumar A, Sarkar M, Fullerton P, Vickers J, Barton P

Int J Med Educ, 2025 Feb 27;16:45-51.
PMID: 40026140 DOI: 10.5116/ijme.679e.067d

OBJECTIVES: This study aims at evaluating the role of Monash Online Simulated Clinical Examination (MONSCE, where students demonstrate their clinical consultation, problem solving and counselling skills in a virtual encounter) in relation to the Observed Structured Clinical Examination (OSCE). The study addresses feasibility and application, student, tutor and Simulated Patient (SP) acceptance and also assessing future role in student assessment.
METHODS: Drawing on social constructivism, the study employed a qualitative methodology to explore perspectives of medical students, examiners and SPs across metropolitan Melbourne, rural Victoria and Malaysia. Data included individual interviews with nine examiners, eleven SPs, and three focus groups with students. Data were transcribed and thematically analysed using framework analysis.
RESULTS: Analysis demonstrated overlapping perspectives with five themes - fit for purpose assessment, focus on dynamics of online discourse, perceiving realism, readiness for practice and implications for future, with ongoing role in Telehealth. Readiness or preparation for practice was acknowledged through impact on student performance for progression, examiners' focus on assessment rigour replicating chaos and complexity of real life and SPs drew analogy with real-life clinical consultations.
CONCLUSIONS: MONSCE assessments appear to be useful for student assessment of skills like history taking and clinical counselling. Their role was considered complementary to in-person clinical skills assessment but not replace the complexity of real life or replicate skills assessment of empathy, physical examination, and difficult communication, where in-person assessment may be preferred.
Fulltext Recent Progress in Synthesis, POM Analyses and SAR of Coumarin-Hybrids as Potential Anti-HIV Agents-A Mini Review

Suleiman M, Almalki FA, Ben Hadda T, Kawsar SMA, Chander S, Murugesan S, et al.

Pharmaceuticals (Basel), 2023 Oct 31;16(11).
PMID: 38004404 DOI: 10.3390/ph16111538

The human immunodeficiency virus (HIV) is the primary cause of acquired immune deficiency syndrome (AIDS), one of the deadliest pandemic diseases. Various mechanisms and procedures have been pursued to synthesise several anti-HIV agents, but due to the severe side effects and multidrug resistance spawning from the treatment of HIV/AIDS using highly active retroviral therapy (HAART), it has become imperative to design and synthesise novel anti-HIV agents. Literature has shown that natural sources, particularly the plant kingdom, can release important metabolites that have several biological, mechanistic and structural representations similar to chemically synthesised compounds. Certainly, compounds from natural and ethnomedicinal sources have proven to be effective in the management of HIV/AIDS with low toxicity, fewer side effects and affordability. From plants, fungi and bacteria, coumarin can be obtained, which is a secondary metabolite and is well known for its actions in different stages of the HIV replication cycle: protease, integrase and reverse transcriptase (RT) inhibition, cell membrane fusion and viral host attachment. These, among other reasons, are why coumarin moieties will be the basis of a good building block for the development of potent anti-HIV agents. This review aims to outline the synthetic pathways, structure-activity relationship (SAR) and POM analyses of coumarin hybrids with anti-HIV activity, detailing articles published between 2000 and 2023.
Fulltext Galactoside-Based Molecule Enhanced Antimicrobial Activity through Acyl Moiety Incorporation: Synthesis and In Silico Exploration for Therapeutic Target

Ahmmed F, Al-Mijalli SH, Abdallah EM, Eissa IH, Ali F, Bhat AR, et al.

Pharmaceuticals (Basel), 2023 Jul 13;16(7).
PMID: 37513910 DOI: 10.3390/ph16070998

In this study, a series of galactoside-based molecules, compounds of methyl β-d-galactopyranoside (MDGP, 1), were selectively acylated using 2-bromobenzoyl chloride to obtain 6-O-(2-bromobenzoyl) substitution products, which were then transformed into 2,3,4-tri-O-6-(2-bromobenzoyl) compounds (2-7) with various nontraditional acyl substituents. The chemical structures of the synthesized analogs were characterized by spectroscopic methods and physicochemical and elemental data analyses. The antimicrobial activities of the compounds against five human pathogenic bacteria and two phyto-fungi were evaluated in vitro and it was found that the acyl moiety-induced synthesized analogs exhibited varying levels of antibacterial activity against different bacteria, with compounds 3 and 6 exhibiting broad-spectrum activity and compounds 2 and 5 exhibiting activity against specific bacteria. Compounds 3 and 6 were tested for MIC (minimum inhibitory concentration) and MBC (minimum bactericidal concentration) based on their activity. The synthesized analogs were also found to have potential as a source of new antibacterial agents, particularly against gram-positive bacteria. The antifungal results suggested that the synthesized analogs could be a potential source of novel antifungal agents. Moreover, cytotoxicity testing revealed that the compounds are less toxic. A structure-activity relationship (SAR) investigation revealed that the lauroyl chain [CH3(CH2)10CO-] and the halo-aromatic chain [3(/4)-Cl.C6H4CO-] in combination with sugar, had the most potent activity against bacterial and fungal pathogens. Density functional theory (DFT)-calculated thermodynamic and physicochemical parameters, and molecular docking, showed that the synthesized molecule may block dengue virus 1 NS2B/NS3 protease (3L6P). A 150 ns molecular dynamic simulation indicated stable conformation and binding patterns in a stimulating environment. In silico ADMET calculations suggested that the designed (MDGP, 1) had good drug-likeness values. In summary, the newly synthesized MDGP analogs exhibit potential antiviral activity and could serve as a therapeutic target for dengue virus 1 NS2B/NS3 protease.
Green synthesis, antibacterial and antifungal evaluation of new thiazolidine-2,4-dione derivatives: molecular dynamic simulation, POM study and identification of antitumor pharmacophore sites

Ahmed S, Bhat AR, Rahiman AK, Dongre RS, Hasan AH, Niranjan V, et al.

J Biomol Struct Dyn, 2023 Sep 28.
PMID: 37768136 DOI: 10.1080/07391102.2023.2258404

In this study, a series of thiazolidine-2,4-dione derivatives 3a-i were synthesized and evaluated for antibacterial activity against Gram-positive and Gram-negative strains of Bacillus licheniformis, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. Newly prepared thiazolidine (TZD) derivatives were further screened separately for in vitro antifungal activity against cultures of fungal species, namely, Aspergillus niger, Alternaria brassicicola, Chaetomium murorum, Fusarium oxysporum, Lycopodium sp. and Penicillium notatum. The electron-donating substituents (-OH and -OCH3) and electron-withdrawing substituents (-Cl and -NO2) on the attached arylidene moieties of five-membered heterocyclic ring enhanced the broad spectrum of antimicrobial and antifungal activities. The molecular docking study has revealed that compound 3h strongly interacts with the catalytic residues of the active site of the β-carbonic anhydrase (P. aeruginosa) and has the best docking score. In silico pharmacokinetics studies showed the drug-likeness and non-toxic nature of the synthesized compounds, which indicates the combined antibacterial, antiviral and antitumor pharmacophore sites of the targeted drug. This work demonstrates that potential TZD derivatives bind to different types of bacterial and fungal pathogens for circumventing their activities and opens avenues for the development of newer drug candidates that can target bacterial and fungal pathogens.Communicated by Ramaswamy H. Sarma.
Fulltext Efficient Synthesis, Structural Characterization, Antibacterial Assessment, ADME-Tox Analysis, Molecular Docking and Molecular Dynamics Simulations of New Functionalized Isoxazoles

Arzine A, Hadni H, Boujdi K, Chebbac K, Barghady N, Rhazi Y, et al.

Molecules, 2024 Jul 17;29(14).
PMID: 39064944 DOI: 10.3390/molecules29143366

This work describes the synthesis, characterization, and in vitro and in silico evaluation of the biological activity of new functionalized isoxazole derivatives. The structures of all new compounds were analyzed by IR and NMR spectroscopy. The structures of 4c and 4f were further confirmed by single crystal X-ray and their compositions unambiguously determined by mass spectrometry (MS). The antibacterial effect of the isoxazoles was assessed in vitro against Escherichia coli, Bacillus subtilis, and Staphylococcusaureus bacterial strains. Isoxazole 4a showed significant activity against E. coli and B. subtilis compared to the reference antibiotic drugs while 4d and 4f also exhibited some antibacterial effects. The molecular docking results indicate that the synthesized compounds exhibit strong interactions with the target proteins. Specifically, 4a displayed a better affinity for E. coli, S. aureus, and B. subtilis in comparison to the reference drugs. The molecular dynamics simulations performed on 4a strongly support the stability of the ligand-receptor complex when interacting with the active sites of proteins from E. coli, S. aureus, and B. subtilis. Lastly, the results of the Absorption, Distribution, Metabolism, Excretion and Toxicity Analysis (ADME-Tox) reveal that the molecules have promising pharmacokinetic properties, suggesting favorable druglike properties and potential therapeutic agents.
Oral Administration of Lingzhi or Reishi Medicinal Mushroom Ganoderma lucidum (Agaricomycetes) Extract Protects Gingival Tissues against Proinflammatory TNF-α and Oxidative Stress in Periodontitis Model Rats

Hossain S, Rahman MA, Uddin B, Nahar T, Sarkar M, Joy SI, et al.

Int J Med Mushrooms, 2024;26(8):1-11.
PMID: 38967207 DOI: 10.1615/IntJMedMushrooms.2024053946

Ganoderma lucidum is a medicinal mushroom that has been used since ancient times. We studied whether chronic oral administration of G. lucidum extract withstands increases in levels of proinflammatory TNF-α and lipid peroxide (LPO), an indicator of oxidative stress, in the gingival tissues of periodontitis model rats. G. lucidum extract was initially examined for inhibition of in vitro oxidative stress, produced by Fenton's reagents in whole homogenates of fresh gum tissues from rats. Prior to in vivo and in vitro experiments with rats, G. lucidum extract was quantitatively tested for its total polyphenol and/or flavonoid contents and ability to scavenge 2,2-diphenyl-1-picrylhydrazyl (DPPH)-free radicals. Chronic oral administration of G. lucidum extract (300 mg/kg BW) significantly decreased TNF-α and LPO levels in the gingival tissues of periodontitis model rats. G. lucidum extract also inhibited (P < 0.05) in vitro oxidative stress, as indicated by reduced levels of LPO in G. lucidum extract-preincubated gum tissue homogenates of fresh rats. The in vitro results were, thus, consistent with the in vivo inhibition of lipid peroxidation, DPPH free radical-scavenging effects, and the presence of total polyphenols/flavonoids in G. lucidum extract. Our results provide the evidence, at least partially, for the beneficial effects of G. lucidum on periodontitis, an inflammatory condition of gums which is associated with oxidative stress and preceded by infectious gum diseases.
In vitro and in vivo evaluation of the antimicrobial, antioxidant, cytotoxic, hemolytic activities and in silico POM/DFT/DNA-binding and pharmacokinetic analyses of new sulfonamide bearing thiazolidin-4-ones

Hassan SA, Aziz DM, Abdullah MN, Bhat AR, Dongre RS, Hadda TB, et al.

J Biomol Struct Dyn, 2024 Apr;42(7):3747-3763.
PMID: 37402503 DOI: 10.1080/07391102.2023.2226713

In this work, Schiff bases and Thiazolidin-4-ones, were synthesized using Sonication and Microwave techniques, respectively. The Schiff base derivatives (3a-b) were synthesized via the reaction of Sulfathiazole (1) with benzaldehyde derivatives (2a-b), followed by the synthesis of 4-thiazoledinone (4a-b) derivatives by cyclizing the synthesized Schiff bases through thioglycholic acid. All the synthesized compounds were characterized by spectroscopic techniques such as FT IR, NMR and HRMS. The synthesized compounds were tested for their in vitro antimicrobial and antioxidant and in vivo cytotoxicity and hemolysis ability. The synthesized compounds displayed better antimicrobial and antioxidant activity and low toxicity in comparison to reference drugs and negative controls, respectively. The hemolysis test revealed the compounds exhibit lower hemolytic effects and hemolytic values are comparatively low and the safety of compounds is in comparison with standard drugs. Theoretical calculations were carried out by using the molecular operating environment (MOE) and Gaussian computing software and observations were in good agreement with the in vitro and in vivo biological activities. Petra/Osiris/Molinspiration (POM) results indicate the presence of three combined antibacterial, antiviral and antitumor pharmacophore sites. The molecular docking revealed the significant binding affinities and non-bonding interactions between the compounds and Erwinia Chrysanthemi (PDB ID: 1SHK). The molecular dynamics simulation under in silico physiological conditions revealed a stable conformation and binding pattern in a stimulating environment. HighlightsNew series of Thaiazolidin-4-one derivatives have been synthesized.Sonication and microwave techniques are used.Antimicrobial, Antioxidant, cytotoxicity, and hemolysis activities were observed for all synthesized compounds.Molecular Docking and DFT/POM analyses have been predicted.Communicated by Ramaswamy H. Sarma.
Fulltext Using contribution analysis to evaluate health professions and health sciences programs

Choi T, Sarkar M, Bonham M, Brock T, Brooks IA, Diug B, et al.

Front Med (Lausanne), 2023;10:1146832.
PMID: 37849488 DOI: 10.3389/fmed.2023.1146832

INTRODUCTION/BACKGROUND: Course evaluation in health education is a common practice yet few comprehensive evaluations of health education exist that measure the impact and outcomes these programs have on developing health graduate capabilities.
AIM/OBJECTIVES: To explore how curricula contribute to health graduate capabilities and what factors contribute to the development of these capabilities.
METHODS: Using contribution analysis evaluation, a six-step iterative process, key stakeholders in the six selected courses were engaged in an iterative theory-driven evaluation. The researchers collectively developed a postulated theory-of-change. Then evidence from existing relevant documents were extracted using documentary analysis. Collated findings were presented to academic staff, industry representatives and graduates, where additional data was sought through focus group discussions - one for each discipline. The focus group data were used to validate the theory-of-change. Data analysis was conducted iteratively, refining the theory of change from one course to the next.
RESULTS: The complexity in teaching and learning, contributed by human, organizational and curriculum factors was highlighted. Advances in knowledge, skills, attitudes and graduate capabilities are non-linear and integrated into curriculum. Work integrated learning significantly contributes to knowledge consolidation and forming professional identities for health professional courses. Workplace culture and educators' passion impact on the quality of teaching and learning yet are rarely considered as evidence of impact.
DISCUSSION: Capturing the episodic and contextual learning moments is important to describe success and for reflection for improvement. Evidence of impact of elements of courses on future graduate capabilities was limited with the focus of evaluation data on satisfaction.
CONCLUSION: Contribution analysis has been a useful evaluation method to explore the complexity of the factors in learning and teaching that influence graduate capabilities in health-related courses.
Self-Reported Delayed Adverse Events and Flare Following COVID-19 Vaccination Among Patients With Autoimmune Rheumatic Disease (AIRD) in Malaysia: Results From the COVAD-2 Study

Shaharir SS, Nawi AM, Mariamutu TN, Kamaruzaman L, Said MSM, Rajalingham S, et al.

Int J Rheum Dis, 2025 Jan;28(1):e70043.
PMID: 39791506 DOI: 10.1111/1756-185X.70043

OBJECTIVES: To determine the prevalence of self-reported delayed adverse events (DAEs), major AEs, and flares following COVID-19 vaccinations among patients with autoimmune rheumatic diseases (AIRDs) in Malaysia.
METHODOLOGY: An electronically validated survey from the COVID-19 vaccination in autoimmune diseases (COVAD) study group was distributed in July 2021 to patients with autoimmune diseases and healthy controls (HCs). The survey collected data on DAEs (any AE that persisted or occurred after 7 days of vaccination), any early or delayed major adverse events (MAEs), and flares following COVID-19 vaccination. Generalized estimating equation (GEE) models were performed to determine the factors associated with repeated events of DAEs, MAEs, and flares.
RESULTS: A total of 556 vaccines were administered to 204 subjects (150 AIRDs and 54 HCs), with 72.1% completing 3 doses. In multivariate GEE analysis, there was a greater frequency of minor DAEs among AIRDs versus HCs (OR 5.65, p = 0.052). The occurrence of MAEs was higher in AIRDs versus HCs (4.9% vs. 1.3%, p = 0.052), but it was no longer significant in the GEE model. In the AIRDs group, the BNT162b2 vaccine increased the risk for minor DAEs (OR4.68, p = 0.02) while patients with autoimmune multimorbidity showed a greater risk for MAEs (OR 8.25, p = 0.007). The rate of flare was 10.6% and multivariate GEE analysis revealed that The rate of flare was 10.6% and multivariate GEE analysis revealed that systemic lupus erythematosus (SLE) (OR0.31, p = 0.03) and hydroxychloroquine (HCQ) (OR 0.16, p