Students' perception of asynchronous versus synchronous distance learning during COVID-19 pandemic in a medical college, southwestern region of Saudi Arabia.

BACKGROUND: COVID-19 preventive measures required a drastic shift to online teaching-learning in most of countries. Institutions used different combinations of live online lectures (synchronous) requiring students to attend the class in real-time, as well as recorded lectures uploaded by the instructors to be accessed by students as per their own convenience (asynchronous). We undertook this study to assess and compare the perceptions of students regarding their learning experiences in the synchronous versus asynchronous mode of instruction using  their teaching-learning during the compulsory online mode of instruction at the peak of the COVID-19 pandemic. METHODOLOGY: This cross-sectional questionnaire-based study received responses from 122 final-year medical students studying at the College of Medicine, King Khalid University, Abha, Saudi Arabia. An online 5-point Likert scale-based questionnaire was used to collect data regarding experience and perception towards synchronous and asynchronous learning. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A P-value less than 0.05 was considered significant. RESULT: All the students found both synchronous and asynchronous learning to be equally satisfying, enjoyable and comfortable. No statistically significant difference was found when both the methods were analyzed for enhancement of knowledge. The students opined that asynchronous learning helped them manage their time better whereas synchronous learning encouraged more interaction during the live lectures. CONCLUSION: Overall, the students' perceptions regarding both synchronous and asynchronous online learning were positive. As both methods have their advantages/limitations, a mix of both synchronous and asynchronous methods may be adopted depending upon the content of the topic and the desired learning outcomes.

Antimicrobial, Antidiabetic, Antioxidant, and Anticoagulant Activities of Cupressus sempervirens In Vitro and In Silico.

In the last decade, the urgent need to explore medicinal plants or drug development has increased enormously around the world to overcome numerous health problems. In the present investigation, HPLC indicated the existence of 18 phenolic and flavonoid compounds in the Cupressus sempervirens extract. Hesperetin represents the greatest concentration (25,579.57 µg/mL), while other compounds, such as pyro catechol, rutin, gallic acid, chlorogenic acid, naringenin, and quercetin, were recognized in concentrations of 2922.53 µg/mL, 1313.26 µg/mL, 1107.26 µg/mL, 389.09 µg/mL, 156.53 µg/mL, and 97.56 µg/mL, respectively. The well diffusion method documented the antibacterial/antifungal activity of C. sempervirens extract against E. faecalis, E. coli, C. albicans, S. typhi, S.aureus, and M. circinelloid with 35, 33, 32, 25, 23, and 21 mm inhibition zones, respectively, more than the standard antibiotic/antifungal agent. Low values ranging from 7.80 to 15.62 µg/mL of MIC and MBC were recorded for E. faecalis, E. coli, and C. albicans. From the 1- diphenyl-2-picryl hydrazyl (DPPH) assay, promising antioxidant activity was recorded for C. sempervirens extract with IC50 of an 8.97 µg/mL. Moreover, ferric reducing antioxidant power (FRAP) and total antioxidant capacity assays (TAC) confirmed the antioxidant activity of the extract, which was expressed as the ascorbic acid equivalent (AAE) of 366.9 ± 0.2 µg/mg and 102 ± 0.2 µg/mg of extracts, respectively. α-amylase and α-glucosidase inhibition % were determined to express the antidiabetic activity of the extract in vitro, with promising IC50 value (27.01 µg/mL) for α-amylase compared to that of acarbose (50.93 µg/mL), while IC50 value of the extract for α-glucosidase was 19.21µg/mL compared to that of acarbose 4.13 µg/mL. Prothrombin time (PT) and activated partial thromboplastin time (APTT) revealed the role of C. sempervirens extract as an anticoagulant agent if compared with the activity of heparin. Binding interactions of hesperetin and gallic acid were examined via the Molecular Operating Environment (MOE) Dock software against E. faecalis (PDB ID: 3CLQ), C. albicans (PDB ID: 7RJC), α-amylase (PDB ID: 4W93), and α-glucosidase (PDB ID: 3TOP). The obtained results shed light on how molecular modeling methods might inhibit the tested compounds, which have the potential to be useful in the treatment of target proteins.

Postintubation Tracheal Perforation While on Long-Term Steroid Therapy: A Case Report.

BACKGROUND: Endotracheal intubation is an essential basic skill for emergency physicians. The procedure can cause complications that should be recognized. Awareness and early identification of complications are needed to allow early intervention to optimize outcomes. The risk factors for tracheal perforation during intubation are typically related to the physician skill and experience and to the patient's comorbidities, including body habitus and chronic use of certain medications. CASE REPORT: We report a case of a 45-year-old man with renal transplant on tacrolimus and prednisolone for 16 years. He presented with decreased level of consciousness due to an acute intracranial hemorrhage and was intubated for airway protection. Post intubation, a significant subcutaneous emphysema was noted on the patient's neck and chest, which was subsequently determined to be caused by a tracheal perforation. The management of tracheal injury depends on the size and location of the tear, as well as the patient's clinical status and comorbidities. In this case, the tracheal perforation was treated conservatively and was successful. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case has been reported to increase awareness about this rare and potentially life-threatening event. The prevention of this rare injury can be difficult but use of a slightly smaller endotracheal tube in a high-risk patient can be of benefit. In addition, early consideration of this complication when there is an acute change in physiologic status will allow for rapid facilitated management.

A Case of Self-Induced Hydrostatic Colonic Perforation.

INTRODUCTION: Constipation is a common complaint. The elderly are five times more prone to constipation than young people because of the effects of medication, immobility, and a blunted urge to defecate. Many of these patients are demented, have cognitive deficits, or suffer from a psychiatric disorder. Colonic perforation caused by hydrostatic pressure is rare, and this typically occurs during fluoroscopic studies resulting when there is excessive intraluminal colonic pressure. Self-induced colonic perforation is even rarer. CASE REPORT: We report the case of a 95-year-old man who presented to the emergency department with an acute surgical abdomen and symptoms of sepsis. He had a history of longstanding constipation. He gave a history of frequent insertion of a rubber hose into his anal canal to relieve his constipation while rinsing his anus after defecation. After resuscitation, an emergency operation was performed, and sigmoid colon perforation was found in addition to pre-existing diverticular disease. Hartmann's procedure was performed after abdominal washout. Unfortunately, the patient died of multi-organ failure two days after surgery. CONCLUSION: Self-induced hydrostatic colonic perforation is rare. The consequence is fatal, especially in the elderly or in cases of delayed presentation.

Imaging Approach to the Diagnosis of Acute Appendicitis in a Group of Teaching Hospitals With 24/7 In-house Availability of Ultrasound Technologist: Effect of Timing of Request on Imaging Modality.

PURPOSE: The study sought determine effect of requisition timing on the initial-choice imaging modality in appendicitis evaluation. METHODS: This was an institutional review board-approved retrospective study, encompassing 3 University of Toronto teaching hospitals, offering 24/7 radiology coverage. All surgically proven appendicitis cases, from 2012-2014, were included and presurgical ultrasound (US) or computed tomography (CT) reports were analysed. Examinations were all requested by the emergency department, performed by the same technologists and reviewed or finalized by the same radiology group (residents fellows or attending). Two coverage categories, namely regular hours (8 am-5 pm, Monday-Friday) or after hours (5 pm-8 am, Monday-Friday and weekends) were compared. The percentage of the starting modality (US or CT), the rate of CT following an indeterminate US, and the sensitivity of each modality was compared between the 2 categories, utilising Mann-Whitney U and chi-square tests. RESULTS: Presurgical US or CT studies of 494 patients, from February 2012-August 2014, were evaluated. Regular-hours and after-hours coverage demonstrated 174 (89:85 women:men) and 320 (141:179 women:men; P < .04) patients. The average age, 37.9 ± 17.1 women versus 35.2 ± 13.7 men was not statistically different (P = .8). Regular hours included 89 of 174 (51.1%) of US-only examinations, 50 of 174 (29%) of CT-only examinations, and 35 of 174 (20%) of US examinations followed by CT examinations. After hours included 147 of 320 (46%) of US-only examinations, 147 of 320 (46%) of CT-only examinations, and 26 of 320 (8%) of US examinations followed by CT examinations (P < .001). The total diagnostic sensitivities for US and CT were 86% (81% regular hours, 90% after hours; P = .041) and 99.2% (100% regular hours, 99% after hours; P > .05), respectively. CONCLUSIONS: US was less utilised in acute appendicitis detection after hours, although its diagnostic sensitivity was better than regular-hours coverage.

Malignancy in a Solitary Thyroid Nodule: A Retrospective Histopathological Evaluation.

Objective: This study aimed to assess the presence and type of malignancy in patients who underwent thyroid surgery for solitary thyroid nodules. Methods: A retrospective review was performed of the case notes of all adult patients with solitary thyroid nodules who underwent thyroid surgery from 1 January 2019 to 31 October 2022. All patients had solitary thyroid nodules identified by ultrasonography. The electronic records of our pathology department were used to determine the pathological diagnosis. Results: Forty-two patients with solitary thyroid nodules underwent thyroid surgery. The mean age at presentation was 39.1 ± 12.6 years, and 76.2% of patients were female. The malignancy rate was 31%. Further histopathological analysis found that malignant solitary thyroid nodules were mostly papillary carcinoma. Conclusion: This study indicates that solitary thyroid nodules should be evaluated thoroughly and treated with a high index of suspicion because they have a high chance (31%) of being malignant.

Weakened continental lithosphere beneath the northern Red Sea inferred from elastic thickness.

The northern Red Sea (NRS) is considered an extended continental region that has resulted in a rift system. Gravity and bathymetry data were used to estimate the Moho depth and the elastic thickness Te of the lithosphere beneath the NRS region to characterize its flexural rigidity and understand its mechanical behavior. Focusing on the Mabahiss Deep in NRS, we analyzed the lithosphere's flexural rigidity. The observed long-wavelength positive Bouguer anomaly is attributed to crustal thinning and lithospheric mantle uplift. The crustal thickness varies from 28 km in coastal areas to 24 km beneath the axial rift, supporting a regional compensation model over the Airy model. Forward modeling suggests that the optimal model explaining the regional Bouguer anomaly is a flexural model with Te equal to 7 km, indicating a weak and irregular continental crust. The primary factor contributing to this weakness is heating activity. Given the weakened state of the crust and the ongoing extension in the region, the NRS rift could evolve into a rupture, potentially leading to the formation of oceanic crust.

GIS- and Multivariate-Based Approaches for Assessing Potential Environmental Hazards in Some Areas of Southwestern Saudi Arabia.

Soil contamination is a major issue that endangers the ecology in most countries. Total concentrations of As, Cd, Co, Cr, Cu, Mn, Ni, Pb, VFe, and Zn were determined by analyzing soil samples from 32 surface soil samples in southwest Saudi Arabia, including certain areas of Al-Baha. Kriging techniques were used to create maps of the distribution of metal. To assess the levels of soil contamination in the research area, principal component analysis (PCA), contamination factors (CF), and pollution load index were used. The results show the stable model gave the best fit to the As and Zn semivariograms. The circular model fits the Cd, Co, and Ni semivariograms the best, while the exponential model fits the Cr, V, and Fe semivariograms the best. For Ni and Pb, respectively, spherical and Gaussian models are fitted. The findings demonstrated two clusters containing different soil heavy metal concentrations. According to the data, there were two different pollution levels in the research region: 36.58% of it is strongly contaminated, while 63.41% of it has a moderate level of contamination (with average levels of these metals 5.28 ± 5.83, 0.81 ± 0.19, 18.65 ± 6.22, 45.15 ± 23.25, 60.55 ± 23.74, 972.30 ± 223.50, 33.45 ± 14.11, 10.05 ± 5.13, 84.15 ± 30.72, 97.40 ± 30.05, and 43,245.00 ± 8942.95 mg kg-1 for As, Cd, Co, Cr, Cu, Mn, Ni, Pb, V, Fe, and Zn, respectively). The research area's poor management practices are reflected in the current results, which raised the concentration of harmful elements in the soil's surface layers. Ultimately, the outcomes of pollution concentration and spatial distribution maps could aid in informing decision-makers when creating suitable heavy metal mitigation strategies.

An Unusual Cause of Lung Abscess in a Previously Healthy Girl.

CASE PRESENTATION: A 15-year-old girl presented to her local hospital with a 4-month history of fatigue, anorexia, and a 6-kg weight loss. She also reported fever, productive cough, and chest pain on the left lower chest posteriorly for 4 days before admission. Her medical history and systemic review were unremarkable for any respiratory or other organ disease. The patient was taking iron and multivitamin supplements. At her local hospital, she was febrile; chest radiography showed anemia and a left lower lobe infiltrate. She received a transfusion and was started on empiric antibiotics that were continued for 10 days without improvement. Subsequently, CT scan of the chest and upper abdomen showed a lung abscess and left renal mass that led to a referral to our center.

Endovascular Repair in Blunt Thoracic Aortic Injury: A 10-Year Single Center Experience.

BACKGROUND: Life-threatening blunt thoracic aortic injury (BTAI) typically occurs alongside multiple other traumatic injuries. Symptoms of BTAI can range from being asymptomatic in the case of intimal tears to becoming catastrophic in the case of uncontained aortic ruptures. The aim of this research was to examine the clinical outcomes for those who underwent thoracic endovascular aortic repair (TEVAR) in hospital settings.  Methods: A cross-sectional retrospective study was conducted using patient data that were extracted from Al-Noor Specialist Hospital, Makkah, Saudi Arabia, for the duration between January 2011 and December 2021. This study included data from all patients aged 18 and up who had been diagnosed with BTAI and had undergone TEVAR. The BTAI diagnoses were confirmed using CT scans. Logistic regression was utilized to identify predictors of patients' health status improvement and length of stay. RESULTS: A total of 80 patients were involved. Around 50.0% (n=40) of the patients had grade 3 thoracic aortic injuries. The median duration of stay was 14.00 days (Interquartile range 21.00). Only one patient developed post-procedure complications (1.3%). Almost one-third (31.3%; n=25) of the patients required subclavian coverage. One patient developed intraoperative endoleak (1.3%). One patient developed an access site complication (1.3%). The mortality rate within 30 days of the operation was 1.3%. The vast majority of the patients (92.5%; n=74) showed improvement upon discharge from the hospital. The baseline patient characteristics and length of hospitalization had no effect on the improvement of patient status upon discharge or their length of stay (p>0.05). CONCLUSION: Patients with BTAI have shown an excellent success rate with TEVAR and a low complication rate. Predictors of procedure success and length of stay need to be identified; however, this can't be done without larger-scale investigations. This can aid in the development of preventative measures that improve clinical outcomes for the patients.

Controllable synthesis of a hybrid mesoporous sheets-like Fe0.5NiS2@ P, N-doped carbon electrocatalyst for alkaline oxygen evolution reaction.

Owing to the high cost of precious metal catalysts for the oxygen evolution reaction (OER), the production of highly efficient and affordable electrocatalysts is important for generating pollution-free and renewable energy via electrochemical processes. A facile hydrothermal approach was employed to synthesize hybrid mesoporous iron-nickel bimetallic sulfides @ P, N-doped carbon for the OER. The prepared Fe0.5NiS2@C exhibited an overpotential (η) of 250 mV at 10 mA/cm2. This exceeded the overpotentials recently reported for surface-modified P, N-doped carbon-based catalysts for the OER in a 1 M KOH medium. Moreover, the Fe0.5NiS2@C catalyst showed a notable Tafel slope of 90.5 mV/dec with long-dated stability even after 24 h at 10 mA/cm2. The superior OER performance of the Fe0.5NiS2@C catalysts may be due to their large surface area, sheet-like morphology with abundant active sites, fast transfer of mass and electrons, control of the electronic structure by co-treatment with heteroatoms (e.g., P and N), and the synergistic effect of bimetallic sulfides, making them favorable catalysts for the oxygen evolution reaction. Density functional theory (DFT) calculations showed that the Fe0.5NiS2@C catalyst exhibited strong H2O-adsorption energy. The enhanced OER activity of Fe0.5NiS2@C was attributed to its higher surface area, favorable H2O adsorption energy, improved electron transfer efficiency, and lower Gibbs free energy compared to those of the other proposed catalysts.

Tailored portable electrochemical sensor for dopamine detection in human fluids using heteroatom-doped three-dimensional g-C3N4 hornet nest structure.

BACKGROUND: There is widespread interest in the design of portable electrochemical sensors for the selective monitoring of biomolecules. Dopamine (DA) is one of the neurotransmitter molecules that play a key role in the monitoring of some neuronal disorders such as Alzheimer's and Parkinson's diseases. Facile synthesis of the highly active surface interface to design a portable electrochemical sensor for the sensitive and selective monitoring of biomolecules (i.e., DA) in its resources such as human fluids is highly required. RESULTS: The designed sensor is based on a three-dimensional phosphorous and sulfur resembling a g-C3N4 hornet's nest (3D-PS-doped CNHN). The morphological structure of 3D-PS-doped CNHN features multi-open gates and numerous vacant voids, presenting a novel design reminiscent of a hornet's nest. The outer surface exhibits a heterogeneous structure with a wave orientation and rough surface texture. Each gate structure takes on a hexagonal shape with a wall size of approximately 100 nm. These structural characteristics, including high surface area and hierarchical design, facilitate the diffusion of electrolytes and enhance the binding and high loading of DA molecules on both inner and outer surfaces. The multifunctional nature of g-C3N4, incorporating phosphorous and sulfur atoms, contributes to a versatile surface that improves DA binding. Additionally, the phosphate and sulfate groups' functionalities enhance sensing properties, thereby outlining selectivity. The resulting portable 3D-PS-doped CNHN sensor demonstrates high sensitivity with a low limit of detection (7.8 nM) and a broad linear range spanning from 10 to 500 nM. SIGNIFICANCE: The portable DA sensor based on the 3D-PS-doped CNHN/SPCE exhibits excellent recovery of DA molecules in human fluids, such as human serum and urine samples, demonstrating high stability and good reproducibility. The designed portable DA sensor could find utility in the detection of DA in clinical samples, showcasing its potential for practical applications in medical settings.

Mesenchymal stem cells and their potential therapeutic benefits and challenges in the treatment and pathogenesis of gastric cancer.

Mesenchymal stem/stromal cells (MSCs) are acknowledged for their remarkable ability to undergo differentiation into various cell types. In addition, they exhibit anti-tumor characteristics, prompting endeavors to modify MSCs for employment in cancer therapies. On the contrary, it is imperative to recognize that MSCs have been extensively linked to pathways that facilitate the advancement of tumors. Numerous research studies have sought to modify MSCs for clinical application; however, the outcomes have been ambiguous, potentially due to the heterogeneity of MSC populations. Furthermore, the conflicting roles of MSCs in suppressing and promoting tumor growth present a challenge to the appropriateness of their use in anti-cancer therapies. Currently, there exists a lack of comprehensive comprehension concerning the anti-tumor and pro-tumor characteristics of MSCs for gastric cancer (GC). This article discusses the influence of MSCs on GC, the underlying mechanisms, the origins of MSCs, and their effects. This review article also elucidates how MSCs exhibit dual characteristics of promoting and inhibiting tumor growth. Hence, it is of utmost importance that clinical inquiries aimed at utilizing MSCs as a therapeutic intervention for cancer consider the potentiality of MSCs to accelerate the progression of GC. It is crucial to exercise caution throughout the process of developing MSC-based cellular therapies to enhance their anti-cancer attributes while simultaneously eliminating their tumor-promoting impacts.

Does the Repair of an Accidentally Discovered Hiatal Hernia and Gastropexy Affect the Incidence of De Novo Postoperative GERD Symptoms After Laparoscopic Sleeve Gastrectomy?

Background: The relationship between laparoscopic sleeve gastrectomy (LSG) and gastroesophageal reflux disease (GERD) is intricate. Hiatal hernia repair or gastropexy can have an impact on postoperative GERD. Aim: To assess the effect of the repair of an accidentally discovered HH and/or gastropexy on the development of de novo postoperative GERD symptoms after LSG. Methods: This retrospective study included all obese patients who underwent LSG at our hospital from January 2018 to June 2022. The data retrieved from patients' files comprised demographic and clinical data, including BMI, GERD symptoms, and comorbidities. Hiatal hernias, surgical technique, gastropexy, duration, and intraoperative complications were recorded. Postoperative data included early and late postoperative complications, weight loss, de novo GERD, and medication use. Results: The study included 253 patients, 89 males (35.2%) and 164 females (64.8%), with a mean age of 33.3±10.04 years. De novo GERD was detected in 94 individuals (37.15%). HH was accidentally found and repaired in 29 patients (11.5%). Only 10.3% of LSG and HH repair patients had de novo GERD symptoms, compared to 40.6% of non-HH patients. 149 patients (58.9%) had gastropexy with LSG. Postoperative de novo GERD symptoms were comparable for LSG with gastropexy (40.5%) and LSG alone (40.9%). Conclusion: After one year, concurrent hiatal hernia repair and LSG seem to be safe and beneficial in lowering postoperative de novo GERD symptoms. The inclusion of gastropexy with LSG had no significant impact on postoperative de novo GERD. Both HH repair and gastropexy lengthened the operation but did not increase its complications.

Patterns of Prescribing Postoperative Analgesic Medication After Thyroid Surgery: A Retrospective Cohort Study.

Background: Mild-to-moderate postoperative pain is common after surgical procedures of the thyroid. Opioid analgesics have been commonly prescribed in such cases, but their use has been debated owing to concerns regarding the addictive nature of opioids. Recently, experts from the Endocrine Surgery Section of the American Head and Neck Society released a consensus document to limit the use of opioids as the first-line pain control medication after head and neck or endocrine procedures. However, differences in pain management prescriptions have been noted in many settings. This study aims to assess the post-thyroid surgery pain control medication prescription practices of head and neck and endocrine surgeons. Methods: This study retrospectively reviewed the charts of 105 adult patients who underwent thyroid surgery (total thyroidectomy, thyroid lobectomy, or subtotal thyroidectomy) by head and neck or endocrine surgeons. The type of prescribed pain medication at hospital discharge postoperatively was then retrieved from each patient's discharge medication list. Descriptive statistics mean, standard deviations, frequencies, and percentages were computed, while the Chi-square test was applied to measure the significant differences among variables at a 5.00% significant level. Results: An outpatient oral opioid, in the form combining paracetamol and codeine, was prescribed for 62 (59%) patients, whereas 43 (41%) were discharged on paracetamol only. Conclusion: The use of opioids is the practice pattern for pain management among some head and neck or endocrine surgeons despite emerging evidence that supports the use of non-opioid and other alternative analgesic strategies in outpatient thyroid and parathyroid surgery. Further research and quality improvement interventions should be geared towards leading all health professionals to appropriate prescription practices to improve patient safety and reduce unnecessary opioid prescriptions.

Assessment of human health risks of toxic elements in coastal area between Al-Khafji and Al-Jubail, Saudi Arabia.

The present work aims to document the distribution of toxic elements (TEs) and assess the human health risk posed by the TEs in the marine sediment of the Arabian Gulf, Saudi Arabia. The descending order of TE averages (µg/g) was as follows: Ni > Cr > V > Zn > Pb > Cu > As > Co. Based on the enrichment factor values, only minor enrichment for Pb, As, Cr, and Ni was noted. The hazard index (HI) values for the non-carcinogenic risk of the TEs were less than 1.0, and the lifetime cancer risk values for carcinogenic Pb, Cr, and As ranged between 2.96 × 10-8 and 5.44 × 10-5, indicating no significant health hazards for the inhabitants of the study area.