The emerging role of miRNAs in myocardial infarction: From molecular signatures to therapeutic targets.

Globally, myocardial infarction (MI) and other cardiovascular illnesses have long been considered the top killers. Heart failure and mortality are the results of myocardial apoptosis, cardiomyocyte fibrosis, and cardiomyocyte hypertrophy, all of which are caused by MI. MicroRNAs (miRNAs) play a crucial regulatory function in the progression and advancement of heart disease following an MI. By consolidating the existing data on miRNAs, our aim is to gain a more comprehensive understanding of their role in the pathological progression of myocardial injury after MI and to identify potential crucial target pathways. Also included are the primary treatment modalities and their most recent developments. miRNAs have the ability to regulate both normal and pathological activity, including the key signaling pathways. As a result, they may exert medicinal benefits. This review presents a comprehensive analysis of the role of miRNAs in MI with a specific emphasis on their impact on the regeneration of cardiomyocytes and other forms of cell death, such as apoptosis, necrosis, and autophagy. Furthermore, the targets of pro- and anti-MI miRNAs are comparatively elucidated.

The Primary Healthcare Physician's Awareness and Engagement in Community-Based Medical Education: A Mixed Qualitative and Quantitative Study.

BACKGROUND: Community-based medical education (CBME) is an essential component of medical education, where primary healthcare physicians (PCPs) play a crucial role. This study explores PCPs' awareness and engagement in CBME and investigates the factors influencing their participation. METHODS: This mixed study was conducted in two phases. In the first phase, a qualitative study was conducted using semi-structured interviews with PCPs as well as thematic analysis related to their awareness and engagement in CBME. In the second phase, a quantitative survey was conducted on 72 PCPs' pre- and post-training programs. RESULTS: Primary healthcare physicians had a positive attitude toward community-based medical education. The participants had an acceptable level of awareness and engagement, which increased substantially by (p-value = 0.03) and (p-value = 0.003), respectively. Logistical analysis indicated that non-Saudi physicians were more likely to participate in the CBME (p-value = 0.001). Professions and academic experiences influenced their willingness to engage and participate in CBME (OR = 7.5, p-value = 0.001) and (OR = 0.21, p-value = 0.001), respectively. CONCLUSION: The study findings highlighted the importance of increased awareness and the factors that enhance PCPs' engagement in CBME. This positive perspective of the PCPs will help build effective partnerships and facilitate the extension of the curriculum to apply CBME.

Predictors of Neonatal Intensive Care Unit Admission and Adverse Outcomes Related to Gestational Diabetes.

BACKGROUND: Gestational diabetes mellitus (GDM) is a type of diabetes that manifests itself in pregnant women. It poses a significant risk to the mother's health as well as the health of the infant, including more babies being brought to the neonatal intensive care unit (NICU). It puts both the mother's and the child's health at serious risk, increasing the likelihood that newborns may need to be treated in a neonatal critical care unit. This study aimed to determine the factors that predict GDM-related NICU admission and other adverse newborn outcomes. METHODS: The study was a cross-sectional analysis of 175 pregnant women who presented with gestational diabetes at the Maternity and Children's Hospital in Bisha (MCH-Bisha), Saudi Arabia, between January 1 and December 31, 2022. A logistic regression model was used to analyze the data to predict adverse outcomes for newborns and NICU admissions and identify associations between maternal variables and outcomes. RESULTS: Maternal characteristics highly associated with adverse neonatal outcomes included advanced maternal age (greater than 30 years), a family history of DM, and a history of greater than or equal to four previous pregnancies. Logistic regression models revealed that newborns delivered to mothers older than 30 years were 7.17 times more likely to be admitted to the NICU than newborns born to mothers younger than 30 years. Saudi nationality, urban residence, and cesarean section delivery factors account for nearly all adverse neonatal outcomes (91%, 75%, and 91%, respectively). Newborns delivered by cesarean section were 3.38 times more likely to be admitted to NICU, and the association was significant. CONCLUSIONS: Maternal age greater than 30 years and a history of more than or equal to four pregnancies were the strongest indicators of infant adverse outcomes and NICU admittance among women with gestational diabetes. These findings highlight the need for approaches to GDM management that are efficient, thorough, and multidisciplinary.

Breast Cancer Awareness Among Medical Students, University of Bisha, Saudi Arabia.

Objective: Breast cancer (BC) is a major public health problem in Saudi Arabia and worldwide and significantly affects the health of Saudi women. This study investigates the awareness and predictors of breast cancer among medical students at the University of Bisha, Saudi Arabia. Methods: This cross-sectional study involved 391 medical students from the University of Bisha (Medicine and Applied Medical sciences) conducted from June to December 2022. Data were collected using a questionnaire with 27 questions. Data were analyzed using Stata/ BE 17.0 for Mac (Intel 64-bit) 1985-2021 Stata Corp LLC. All ethical issues were addressed honestly, including IRB and student consent. Results: In our study, almost half of the participants (49.36%) had suboptimal knowledge of general BC awareness, which was statistically significantly related to gender and previous participation in BC education (p-value < 0.05). Of the students (57%) showed a positive intention to participate in BC activities. Logistic regression models were used to identify factors that positively predicted student participation and engagement in BC activities. These factors showed a statistically significant relationship (p-value < 0.05), including previous participation (OR =1.557143), female (OR =1.412844), living in rural areas (OR =1.7075471), and medical applied sciences students (OR =1.439252). Conclusion: Despite half of the participants having suboptimal awareness of BC, there was a significant willingness to engage in BC prevention activities. Therefore, we recommend further analysis to identify gaps in the medical curriculum and update it accordingly, as well as to plan an extracurricular activity to increase student awareness of breast cancer as part of the University of Bisha's social accountability.

Differential impact of the angiotensin-converting enzyme-2 (ACE2 rs4343 G>A) and miR-196a2 rs11614913 C>T gene alterations in COVID-19 disease severity and mortality.

The recent coronavirus outbreak from Wuhan China in late 2019 caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) resulted in a global pandemic of coronavirus-19 disease (COVID-19). Understating the underlying mechanism of the pathogenesis of coronavirus infection is important not only because it will help in accurate diagnosis and treatment of the infection but also in the production of effective vaccines. The infection begins when SARS-CoV-2 enters the cells through binding of its envelope glycoprotein to angiotensin-converting enzyme2 (ACE2). Gene variations of ACE2 and microRNA (miR)-196 are associated with viral infection and other diseases. The present study investigated the association of the ACE2 rs4343 G>A and miR-196a2 rs11614913 C>T gene polymorphisms with severity and mortality of COVID-19 using amplification refractory mutation system PCR in 117 COVID-19 patients and 103 healthy controls from three regions of Saudi Arabia. The results showed that ACE2 rs4343 GA genotype was associated with severity of COVID-19 (OR=2.10, P-value 0.0028) and ACE2 rs4343 GA was associated with increased mortality with OR=3.44, P-value 0.0028. A strong correlation between the ACE2 rs4343 G>A genotype distribution among COVID-19 patients was reported with respect to their comorbid conditions including sex (P<0.023), coronary artery disease (P<0.0001), oxygen saturation <60 mm Hg (P<0.0009) and antiviral therapy (0.003). The results also showed that the CT genotype and T allele of the miR-196a2 rs11614913 C>T were associated with decreased risk to COVID-19 with OR=0.76, P=0.006 and OR=0.54, P=0.005, respectively. These results need to be validated with future molecular genetic studies in a larger sample size and different populations.

Potential impact of GCK, MIR-196A-2 and MIR-423 gene abnormalities on the development and progression of type 2 diabetes mellitus in Asir and Tabuk regions of Saudi Arabia.

Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by persistent hyperglycemia and is associated with serious complications. The risk factors for T2DM include both genetic and lifestyle factors. Genome­wide association studies have indicated the association of genetic variations with many diseases, including T2DM. Glucokinase (GCK) plays a key role in the regulation of insulin release in the pancreas and catalyzes the first step in glycolysis in the liver. Genetic alterations in the GCK gene have been implicated in both hyperglycemia and hypoglycemia. MicroRNAs (miRNAs/miRs) are small non­coding RNA molecules that are involved in the important physiological processes including glucose metabolism. In the present study, the association of the single nucleotide polymorphisms (SNPs) in the GCK, MIR­196A­2 and MIR­423 genes with susceptibility to T2DM in patients from two regions of Saudi Arabia were examined, using the tetra­primer amplification refractory mutation system. The results showed that the AA genotype and the A allele of GCK rs1799884 were associated with T2DM [odds ratio (OR)=2.25, P=0.032 and OR=1.55, P=0.021, respectively]. Likewise, the CT genotype and T allele of MIR­196A­2 rs11614913 were associated with an increased risk of T2DM (OR=2.36, P=0.0059 and OR=1.74, P=0.023, respectively). In addition, the CA genotype of MIR­423 rs6505162 C>A was found to be linked with T2DM (OR=2.12 and P=0.021). It was concluded in the present research study that gene variations in GCK, MIR­196A­2 and MIR­423 are potentially associated with an increased risk of T2DM. These results, in the future, may help in the identification and stratification of individuals susceptible to T2DM. Future longitudinal studies with larger sample sizes and in different ethnic populations are recommended to validate these findings.

Students' Anxiety during the COVID-19 Pandemic in Saudi Arabia: An Exploratory Study.

The sudden outbreak of the COVID-19 pandemic prompted educational institutions to close down worldwide. This unprecedented step led to a feeling of anxiety in the student community that encountered obstacles in shifting to an online education mode. Saudi Arabia also followed these steps to minimize the loss of life, but simultaneously, the administration also assured people that they had nothing to fear as the country was prepared to support them in every way. The current study was accordingly commissioned between April 21, 2020, and May 20, 2020, to assess the impact of the new developments on the anxiety of 119 students from the College of Medicine, University of Bisha, Saudi Arabia, using an adapted Generalized Anxiety Disorder Scale - 7 (GAD-7). The findings showed that 46.22% of respondents had minimal anxiety, 26.89% had mild anxiety, 12.60% had moderate anxiety, and 14.29% had severe anxiety. The findings indicate that Saudi University students had minimal anxiety issues concomitant to the pandemic. The results also significantly show that students' anxiety or its absence was a factor of gender and the students' current level of education in the university. CONTEXT: The sudden outbreak of the COVID-19 pandemic prompted educational institutions to close down worldwide. This unprecedented step led to a feeling of anxiety in the student community that encountered obstacles in shifting to an online education mode. Saudi Arabia also followed these steps to minimize the loss of life, but simultaneously, the administration also assured people that they had nothing to fear as the country was prepared to support them in every way. AIM: To assess the impact of the new developments on the anxiety. SETTINGS AND DESIGN: An exploratory cross-sectional study was conducted between April 21, 2020, and May 20, 2020 at the College of Medicine, University of Bisha, Saudi Arabia. METHODS AND MATERIAL: The students were asked to complete a self-administered questionnaire form, using an adapted GAD-7. RESULTS: The findings showed that 46.22% of respondents had minimal anxiety, 26.89% had mild anxiety, 12.60% had moderate anxiety, and 14.29% had severe anxiety. The findings indicate that Saudi University students had minimal anxiety issues concomitant to the pandemic.

Strong Association of Angiotensin Converting Enzyme-2 Gene Insertion/Deletion Polymorphism with Susceptibility to SARS-CoV-2, Hypertension, Coronary Artery Disease and COVID-19 Disease Mortality.

BACKGROUND: The ongoing outbreak of SARS-CoV-2 represents a significant challenge to international health. Several reports have highlighted the importance of ACE2 on the pathogenesis of COVID-19. The spike protein of SARS-CoV-2 efficiently binds to the angiotensin-converting enzyme 2 (ACE2) receptors and facilitates virus entry into the host cell. In the present study, we hypothesize that a functional insertion/deletion polymorphism-rs4646994 I/D and rs4240157 T > C in the ACE gene could be associated with SARS-CoV-2 infection and mortality. METHODOLOGY: This study included 117 consecutive COVID-19 patients and 150 age matched healthy controls (ACE2-rs4646994 I/D) and 100 age matched healthy controls with ACE2 rs4240157 T > C. We used Mutation specific PCR (MSP) for ACE2-rs4646994 I/D genotyping and amplification refractory mutation system (ARMS-PCR) for ACE2 rs4240157 T > C genotyping. RESULTS: Results indicated that there were significant differences in the genotype distributions of ACE2-rs4646994 I/D polymorphisms (p < 0.030) and ACE2 rs4240157 T > C between COVID-19 patients and controls (p-values < 0.05). Higher frequency of DD genotype (48.71%) and D allele (0.67) was reported in COVID-19 patients than controls. Our results showed that the ACE2-DD genotype was strongly associated with increased COVID-19 severity (OR 2.37 (95%) CI = (1.19-4.70), RR = 1.39 (1.09-1.77), p < 0.013) and also a strong association was seen with ACE2-ID genotype with COVID-19 severity (OR 2.20 (95%) CI = (1.08-4.46), p < 0.020) in the codominant model. In allelic comparison, the D allele was strongly associated with COVID-19 severity (OR 1.58 (95% CI) (1.11-2.27), RR 1.21 (1.05-1.41) p < 0.010). A significant correlation of ACE2-I/D genotypes was reported with Age (p < 0.035), T2D (p < 0.0013), hypertension (p < 0.0031) and coronary artery disease (p < 0.0001). Our results indicated ACE2-DD genotype was strongly associated with increased COVID-19 mortality (OR 8.25 (95%) CI = (2.40 to 28.34), p < 0.008) and also ACE2-DD + DI genotype was strongly associated with increased COVID-19 mortality with OR 4.74 (95%) CI = (1.5214 to 14.7915), p < 0.007. A significant correlation was reported between COVID-19 patients and age matched controls (p < 0.0007). Higher frequency of heterozygosity TC (40%) followed by ACE2-CC genotype (24.78%) was reported among COVID-19 patients. Using multivariate analysis, ACE2-CT genotype was strong associated with SARS-CoV-2 severity with an OR 2.18 (95% CI) (1.92-3.99), p < 0.010 and also ACE2-CC genotype was linked with COVID-19 severity with an OR 2.66 (95% CI) (1.53-4.62), p < 0.005. A significant correlation of ACE2-T > C genotypes was reported with gender (p < 0.04), T2D (p < 0.035). ACE2-CC genotype was strongly associated with increased COVID-19 mortality OR 3.66 (95%) CI = (1.34 to 9.97), p < 0.011 and also ACE2-C allele was associated with COVID-19 mortality OR 2, 01 (1.1761-3.45), p < 0.010. CONCLUSIONS: It is concluded that ACE-DD genotype and D allele was strongly associated with increased COVID-19 patient severity. In addition, ACE I/D polymorphism were strongly associated with advanced age, diabetes and ischemic heart disease in COVID-19 patients whereas ACE-II genotype was a protective factor against the development of severe COVID-19. ACE2-DD genotype was strongly associated with increased COVID-19 mortality. Additionally, ACE2-CC and CT genotypes were strongly associated with COVID-19 severity. Therefore, our study might be useful for identifying the susceptible population groups for targeted interventions and for making relevant public health policy decisions.

Premenstrual Syndrome and Its Impact on the Quality of Life of Female Medical Students at Bisha University, Saudi Arabia.

OBJECTIVE: The severity and chronicity of PMS can lead to the impairment of studies, and it can also affect relationships, activities, quality of life (QoL), and academic performance. This study aimed to determine PMS frequency and its associated factors in order to assess the quality of life (QoL) among female medical students at Bisha University, Saudi Arabia. METHODS: This study was cross-sectional and included 388 female medical students in the Faculty of Medical Applied Sciences and the Faculty of Medicine at Bisha University. The participants all filled in a self-administered questionnaire. The Premenstrual Syndrome Scale (PSS) was used based on the diagnostic and statistical criteria for PMS assessment. PMS was diagnosed after the presence of five or more severe premenstrual symptoms had been resolved following menstruation (adapted from American Psychiatric Association). DATA ANALYSIS: The data obtained were analyzed using SPSS 25.0. A chi-square test was used to test the associations between the study variables. A logistic regression analysis technique was used to select the group of variables. Participants were asked to provide consent to participate in the study. IRB was obtained from the University of Bisha, College of Medicine. RESULTS: The participants were aged 19.5 ± 4.9 years, and the prevalence of PMS was 64.9%. Most of the female students were of extroverted personality types (35%). In addition, 13.4% were obese or overweight, and 19.5% of the 50% with PMS exercised regularly (p < 0.05). Menstruation significantly influenced the related quality of life subscales (p < 0.05). CONCLUSION: PMS significantly influenced daily activities related to quality of life and homework. Moreover, almost half of the female students experienced the effects of menstruation in their learning environment. Therefore, among female students, the modification of risk factors should be considered a critical intervention point.

Awareness of diabetes risk factors among Bisha Residents Southwestern Saudi Arabia.

Introduction: In the past few decades, the prevalence of type 2 diabetes has increased dramatically in many countries. While primary preventive measures can reduce the prevalence of diabetes, knowledge of the risk factors of diabetes mellitus has many benefits for patients with diabetes. The study aimed to assess diabetes mellitus risk factors (DM-RFs) awareness among adults residing in Bisha, Southwestern Saudi Arabia. Awareness of the risk factors of diabetes mellitus was reported to be highest for obesity, sweet intake, and family history of diabetes. Methods: The study participants were 404 adults (225 males and 179 females) with an age range of 18-65 (mean age: 40.83+/-9.3). People with diabetes and those without diabetes were involved in the study. The study was conducted in Bisha city, southwestern Saudi Arabia, using an online random sampling technique and a structured and validated questionnaire, and analysis was by SPSS V 24. Results: This study showed that 168 (41.6%) participants had diabetes and 236 (58.4%) were non-diabetics; 64.9% of the respondents were aware of the DM-RFs. Among the people with diabetes, 128 (76.2%) agreed that obesity is a DM-RF, while 210 (89%) of the non-diabetics were aware that obesity was a DM-RF. Further, 77.7% of the respondents agreed that the risk factors were avoidable, with 50.7% willing to know more about DM-RFs. Conclusion: The study found a high level of awareness of DM-RFs among diabetes and non-diabetics in Bisha, southwestern Saudi Arabia.

Psychometric analysis of multiple-choice questions in an innovative curriculum in Kingdom of Saudi Arabia.

BACKGROUND AND AIMS: Worldwide, medical education and assessment of medical students are evolving. Psychometric analysis of the adopted assessment methods is thus, necessary for an efficient, reliable, valid and evidence based approach to the assessment of the students. The objective of this study was to determine the pattern of psychometric analysis of our courses conducted in the academic year 2018-2019, in an innovative curriculum. METHODS: It was a cross-sectional-design study involving review of examination items over one academic session -2018/2019. All exam item analysis of courses completed within the three phases of the year were analyzed using SPSS V20 statistical software. RESULTS: There were 24 courses conducted during the academic year 2018-2019, across the three academic phases. The total examination items were 1073 with 3219 distractors in one of four best option multiple choice questions (MCQs). The item analysis showed that the mean difficulty index (DIF I) was 79.1 ± 3.3. Items with good discrimination have a mean of 65 ± 11.2 and a distractor efficiency of 80.9%. Reliability Index (Kr20) across all exams in the three phases was 0.75. There was a significant difference within the examination items block (F = 12.31, F critical = 3.33, P < 0.05) across all the phases of the courses taken by the students. Similarly, significant differences existed among the three phases of the courses taken (F ratio = 12.44, F critical 4.10, P < 0.05). CONCLUSION: The psychometric analysis showed that the quality of examination questions was valid and reliable. Though differences were observed in items quality between different phases of study as well as within courses of study, it has generally remained consistent throughout the session. More efforts need to be channeled towards improving the quality in the future is recommended.

Effect of blueprinting methods on test difficulty, discrimination, and reliability indices: cross-sectional study in an integrated learning program.

PURPOSE: Exam blueprinting achieves valid assessment of students by defining exactly what is intended to be measured in which learning domain and defines what level of competence is required. We aimed to detect the impact of newly applied method for blueprinting that depends on total course credit hours and relate the results with item analysis reports for students' performance. PARTICIPANTS AND METHODS: A new method for blueprint construction was created. This method utilizes course credit hours for blueprint creation. Survey analysis was conducted for two groups of students (n=80); one utilized our new method (credit hours based) for blueprinting and the other used traditional method depending on exam duration and time for individual test items. RESULTS: Results of both methods were related to item analysis of students' achievements. No significant difference was found between both groups in terms related to test difficulty, discrimination, or reliability indices. Both achieved close degrees of test validity and reliability measures. CONCLUSION: We concluded that our method using credit hours system for blueprinting could be considered easy and feasible and may eventually be utilized for blueprint construction and implementation.

Assessment of professionalism among medical students at a regional university in Saudi Arabia.

Professionalism is the relationship that is built on trust between the medical profession and their community. We aim to assess the understanding and the perception of professionalism by the medical students at University of Bisha (UB) in Saudi Arabia. This was an observational, descriptive, and cross-sectional study conducted among the medical students at UB. A validated questionnaire containing nine questions was distributed to all medical students. The questionnaire addresses the knowledge, attitudes, and perception toward professionalism. Out of the all 122 students studying at the university, 97 responded by filling the questionnaire giving a response rate of 79.5%. Most of the responders gave a positive attitude and perception when asked about presumed scenarios addressing professionalism. The majority of the participants (83.5%) mentioned that it is necessary for the medical student to wear lab coat in the hospital, 67.0% disagreed on medical student to wear accessories during work, and 67.0% disagreed to request your friend to sign on behalf of you when you are absent. Only 15.5% accepted to report on an incidence during daily activities or exam, and 72.2% did not accept to discuss patients issues in public. Most of the medical students enrolled in this study seems to have positive attitude and perception regarding professionalism.

The Effectiveness of Problem-based Learning in Acquisition of Knowledge, Soft Skills During Basic and Preclinical Sciences: Medical Students' Points of View.

BACKGROUND: Students' opinions about their medical curriculum is essential process for evaluating program strength and weakness. Aim: We aimed to assess the benefits and effectiveness of PBL in acquisition of knowledge and soft skills during basic (Phase I) and preclinical (Phase II) sciences. METHODS: Across-sectional study was conducted at the University of Bisha, College of Medicine, Saudi Arabia. Students at Phase I and Phase II were involved. A validated self-administered questionnaire used for data collection. Responses to the questionnaire items regarding PBL benefits, preferences and effectiveness in acquisition of knowledge and soft skills were ordinal following a four-point Likert scale format. Independent and paired t tests were used to compare between the means and SD of each two variables. A p value ≤ 0.05 considered as statistically significant. RESULTS: Most of students (86.3%) reported a positive perception on all the items assessing the benefits of PBL approach. Students' responses on PBL relating to the acquisition of knowledge (3.27±0.46) and soft skill (3.32±0.45) were high. There were no significant differences determined in the mean score and SD of acquisition of knowledge (p=0.768) and soft skills (p=0.297) between second and third year students. PBL was preferred in Phase II comparable to Phase I modules (3.371±0.299 vs. 3.026±0.627; p=0.001). CONCLUSION: Effectiveness of PBL found to be high and increasing after taking a series of modules. Although PBL methodology has impact in acquisition of knowledge and skills, intended program outcome should be determined to assess the effects of PBL.

Experience of the health promotion clinics in Aseer region, Saudi Arabia.

CONTEXT: Health promotion is the most important element of primary health care. Therefore, it is essential for the health team to apply such activity. OBJECTIVE: To describe a newly established health promotion clinic at primary health care centers, in Abha city, KSA. MATERIALS AND METHODS: The study was conducted during the year 2009. The files of 429 individuals were reviewed after one year from attending the health promotion clinics in Abha city, KSA. Master sheet was designed based on the relevant items of the file. The health promotion services used in the study were based on the recommendation of the relevant guidelines. Data entry and analysis was carried out using Statistical Program for the Social Sciences (SPSS). P-values less than 0.05 were selected for statistical significance. RESULTS: After one year, the percentage of the individuals who intake imbalanced diet and did not perform any type of physical activity was more than 90% while 8% are currently smokers and 14% had depression. Clinical examination and investigation revealed that more than one quarter of our subjects were overweight. Obesity was 42% in males versus 51% in females (P<0.04). Pre-hypertension and hypertension were detected among 44 and 12% respectively. About one fifth of our subjects had pre-diabetes 21% and 3% were confirmed to have diabetes mellitus. Diet and physical activity counseling was given to all participants while referral to concerned clinics was done for individuals who suffer from high blood sugar, abnormal lipid profile, obesity and depression. CONCLUSION: This study demonstrated that health promotion clinics provided by trained professional health care team can be used as a new approach for early detection and management of the common health problems in primary health care centers.