Climate Change and Diabetes Mellitus - Emerging Global Public Health Crisis: Observational Analysis.

Climate change is the most pressing challenge of the 21st century. It's immediate impacts on the environment are extreme weather conditions such as heatwaves, storms, rains, floods, sealevel rise, the disruption of crops, agricultural systems, water, vector-borne diseases, and ecosystems. The weather-related disasters disturbed the natural biological environment and dislocated millions of people from their homes. The extreme weather conditions caused the deaths of about two million people and $4.3 trillion in economic loss over the past half a century, and 90% of deaths were reported from developing countries. It has also been predicted that between 2030 and 2050, climate change is presumed to cause about 250,000 additional deaths per annum. The rapid rise in temperatures, frequencies of heat waves, wildfires, storms, and other weather extremes conditions could affect human health in many ways. The one-degree Celsius rise in outdoor temperature causes over 100,000 new cases of diabetes mellitus per annum. Climate change compromised body metabolism, vasodilation, sweating, insulin resistance and cause Type-2 diabetes mellitus and gestational diabetes Mellitus.

Brain drain of healthcare professionals from Pakistan from 1971 to 2022: Evidence-based analysis.

Since the creation of Pakistan in August 1947, political instability has been a persistent issue in the country, causing a migration of highly qualified, skilled people, and healthcare professionals. From 1971 to 2022 the total number of highly qualified and skilled people including healthcare professionals who migrated from the country is 60,19,888. Among them, 251677 (4.18%), were highly qualified, 455097 (7.55%) were highly skilled, and 5313114 (88.27%) were skilled professionals. Moreover, 50110 (0.83%) were healthcare professionals including doctors 31418 (62.69%), nurses 12853 (25.64%), and pharmacists 5839 (11.65%). The unsustainable political environment, lack of advanced technology-based institutes, poor healthcare infrastructure, low job opportunities and salary benefits in Pakistan caused the brain drain of highly qualified people including healthcare professionals. It adversely affected the academic institutes, the healthcare system, socio-economic growth, research productivity, and the development of the nation. The government of Pakistan must establish sustainable policies to minimize the brain drain of highly qualified people, and healthcare professionals, and recuperate the prosperity of their academic institutes and healthcare system for better healthcare services, and the advancement and sustainable development of the nation.

Perceptions about the Implementation and Education of Telemedicine among University Students in Riyadh, Saudi Arabia.

Objectives: This study evaluated and compared the perceptions, awareness, and experiences of telemedicine among university students in Riyadh. Methods: In this cross-sectional study, a questionnaire was distributed electronically to undergraduate university students in Riyadh. The study was conducted from September 2021 to March 2022. Five-point Likert scale data were reported as percent agreement, while open-text comments were reported as recurring themes. Besides, the perceptions of medical students were compared with students from other disciplines. Results: Of 564 participants, 209 (37%) were medical students. Most respondents agreed that telemedicine could save patients' time (77.7%) and improve access to healthcare (73.4%). The agreement was low for the statements that doctors would effectively evaluate the clinical features (39.2%) and that patients would effectively communicate their illnesses (44.3%). The agreement of medical students compared to students from other disciplines was even lower for these statements (25% vs. 47%; p<0.001) and (37% vs. 48%; p=0.03), respectively. Most medical students reported that they never learned about telemedicine (65%) and its tools (69%). Lack of awareness, training of healthcare workers and perceived lower quality of healthcare emerged as the most relevant factors for the limited acceptance of telemedicine. Conclusions: Most participants perceived that telemedicine could save patients' time and improve access to healthcare. The low agreement, especially of medical students, for the ability of physicians to evaluate clinical features and of patients to communicate illnesses effectively possibly represented suboptimal education of telemedicine in medical curricula. Thus, incorporating telemedicine into medical curricula and improving public awareness might expedite telemedicine implementation.

Human Monkeypox: Old virus with new Epidemiological and Transmission Trends.

Human monkeypox is an emerging zoonotic disease caused by a monkeypox virus. The monkeypox virus history originated in 1958 after the occurrence of a pox-like illness in monkeys. In September 1970, the first case of human monkeypox was identified in the Democratic Republic of Congo, Africa. This year, from January 01, to September 30, 2022, the virus swiftly spread from endemic to non-endemic counties, involving 106 states, infecting 68,017 people; 689 cases from 07 endemic African countries and 67,328 cases in 99 non-endemic countries in Europe, America, Asia and Oceania continents. The disease caused 27 deaths in 13 countries worldwide. The human monkeypox disease significantly affects the population in South, North and Central America 34767 (51.11%), Europe 32047 (47.11%), Africa 707 (1.03%), Asia 351 (0.51%), and Australia and Oceania continent 145 (0.21%). The occurrence of the disease is high in males with age ranges of 21-55 years. The common clinical features in monkeypox patients are skin rashes (95%), fever (72%), malaise (69%), chills (67%), pruritis (64%), headache (64%), enlarged lymph nodes (63%) myalgia (60%) and nausea and vomiting (20%). The transmission trends of the disease are rapidly changing; the virus is not limited to close contact with humans. It can spread through body fluids, respiratory droplets, and sexual contact. The disease can transmit during travelling, contact with soiled materials, infected cloths, bed linen, objects, air pollutants, and in various workplace environments. The monkeypox virus has adopted multiple transmission routes, and swiftly spreading and developing challenging and threatening situations worldwide.

Human Monkeypox: Fifty-Two Years based analysis and Updates.

The growing prevalence of human monkeypox infection has developed an alarming situation worldwide. Monkeypox virus was first time found in 1958 in monkeys and later spread to humans. The first case of human monkeypox was reported in September 1970 in the Democratic Republic of the Congo. Human monkeypox was found outside Africa in the year 2003 in United States. More recently, from May 7 2022 to June 29, 2022, the monkeypox cases are swiftly spread worldwide, involving over 50 countries, and affecting 5115 people in Europe, the United Kingdom, North America, and South America, Asia, Australia, and the Middle East. The confirmed monkeypox cases in the United Kingdom from May 7, 2022 to June 29, 2022, are 1076 (21.03%); Germany 874 (17.08%); Spain 800 (15.64%); France 440 (8.60%); Portugal 391 (7.64%); United States 350 (6.84); Canada 276 (5.39%); Netherlands 257 (5.02%); Italy 159 (3.10); Belgium 117 (2.28%); Switzerland 81 (1.58%); Israel 33 (0.64%), and Ireland 31 (0.60%). However, in about 35 countries, the cases are less than 20 in each country. The epidemiological trends of the human monkeypox infection are swiftly shifting from endemic regions to non-endemic countries. The global health authorities must take priority-based preventive measures to stop the outbreaks of monkeypox disease across the globe.

Impact of COVID-19 pandemic on sleep quality among medical and general science students: King Saud University Experience.

Objectives: Sleep is a vital component for overall health and well-being, and it plays an essential role in social, physical, psychological, and cognitive health. This study aimed to appraise the sleep quality in medical and science students during the COVID-19 pandemic. Methods: This questionnaire-based cross sectional study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia, during September-December 2020. In this study, a validated self-administered electronic questionnaire was distributed to 1000 students, 782 (78.2%) of whom completed the study. The selection of students was based on using the stratified random sampling. The Pittsburgh Sleep Quality Index (PSQI) instrument scale was used to assess the sleep quality among medical and general sciences students. Results: Out of 782 respondents, 410 (52.4%) were medical students, and 372 (47.6%) were science students, including Physics, Chemistry, Mathematics, Statistics, Botany, and Zoology. Among the medical students, 143 (34.9%) were in pre-clinical years (1st and 2nd), while 266 (64.9%) of them were in clinical years (3rd, 4th, and 5th). Among all medical and general sciences students, it was found that 669 (85.5%) had poor sleep quality with a mean PSQI global score (mean 8.356) among them 336 (50.2%) were medical, and 333 (49.8%) were science students. Science students' sleep quality was poorer (mean 8.78) than their medical counterparts (mean= 7.93). Conclusion: The COVID-19 pandemic has a significant negative impact on students' mental health and sleep quality. Both medical and general science students showed alarming levels of sleep deprivation and concerning low sleep quality during the COVID-19 pandemic. The sleep deprivation among students may be due to the sudden change of pedagogy in education driven by the COVID-19 pandemic. Sleep quality is quite a critical issue to be evaluated and addressed nationally and globally.

Incense Burning Indoor Pollution: Impact on the prevalence of prediabetes and Type-2 Diabetes Mellitus.

Objectives: Incense burning is a well-known practice in Asian and Middle Eastern cultures for ceremonial and religious purposes. The excessive use of incense burning has become a critical environmental health concern. The incense sellers are more exposed to incense allied air pollution. This study examines the association between prediabetes and type 2 diabetes mellitus (T2DM) in incense sellers. Methods: This cross-sectional prevalence study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia" during the period July 2019 to January 2020. After medical history and examinations had been performed, a total of 265 non-smoking volunteers male incense sellers were selected. American Diabetes Association (ADA) criteria were followed, people with "HbA1c less than 5.7% were considered normal; HbA1c 5.7%-6.4% were pre-diabetics, and HbA1c > 6.4% were considered people with diabetes". In shops, the incense sellers were exposed to incense-related pollution for 8 hours daily, seven days a week. The mean age for the participants was 25±5.5 years, and body mass index was 19±2.8 (kg/m)2. Results: In incense sellers, the pre-diabetic was 125 (47.2%), and diabetes was 75 (28.3%). However, 65 (24.5 %) incense sellers were without prediabetes and diabetes. There was an increase in HbA1c levels with increasing working exposure to incense shops. Conclusions: The prevalence of pre-diabetic and type-2 diabetes was increased in incense sellers. The prevalence of pre-diabetic and type-2 diabetes was further increased with the increasing working duration of incense sellers. The study findings call for safe practice and avoiding indoor burning incense. It is suggested that well-ventilated areas with proper masks for the workers may reduce the incense-related pollution effects.

Doctor of Science (D.Sc.): Time to move towards Higher Doctorate Degrees.

The present most modern and highly advanced 21'st century is the era of science and technology. In human history, universities are the basic birthplace of higher education, research, and innovation and play a significant role in the countries' performance, prosperity, and economic progress. Worldwide, there is a swift shift in the pattern of biological, environmental, economic, and educational systems. This broader change is rotating around the higher academia and its allied innovative research impact. The leading universities develop a culture and curricula as per need and demand and produce knowledge and skills-based professional graduates. The universities prepare graduates to keep in view their country's requirements and compete with their peers at international levels. Moreover, worldwide, universities are transforming towards higher doctorate degrees (D.Sc / S.Dc) to provide an elevated helipad to the applicant to compete in this modern and highly advanced era. The higher doctoral degree, D.Sc, is earned 6-8 years after the post Ph.D. The candidates with higher academic titles, professional skills, and innovative research could compete and achieve top-ranked positions worldwide. Many universities worldwide, including the United States of America, the United Kingdom, Australia, and New Zealand, promote D.Sc degree programs in various science disciplines, including medical sciences. This manuscript explores the dynamics of a higher doctorate and its significance, need, and demand in academia to compete globally.

Prevalence of Prediabetes and Type-2 Diabetes Mellitus in Cricket Players: Multi-Cricket Clubs Cross Sectional Study.

BACKGROUND & OBJECTIVES: Sports activities are highly beneficial for improving the human health and reducing the risk of diseases. This cross sectional study aimed to investigate the prevalence of prediabetes and Type-2 diabetes mellitus in cricket players compared to population based non-elite athlete control subjects. METHODS: The present matched cross sectional study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia during the period October 2019 to February 2020. Initially, 700 volunteer males, (300) cricket players and (400) population based non-elite athlete control subjects were interviewed. After socio-demographic and medical history, (200) nonsmoker cricket players and (300) nonsmoker control subjects were recruited. The age of cricket players was 34 (32-37) years, weight 81 (76-84) kg, height 1.79 (1.74-1.84) meters, and body mass index (BMI) was 25.09 (23.66-26.76) kg/m2. The cricket players have been playing cricket for 4 (3-4) hours per day; 3.50 (3-4) days per week; for the total period of 24 (12-36) months. American Diabetes Association (ADA) based criteria on Glycated Hemoglobin (HbA1c) was used to investigate the prediabetes and Type-2 diabetes mellitus. RESULTS: In cricket players, the prevalence of prediabetes was 23 (11.5%) and Type-2 diabetes mellitus (T2DM) was 7 (3.5%) compared to population based matched non-elite athlete control subjects the prediabetes was 73 (24.34%) and T2DM was 63 (21.1%) (p=0.001). Among cricket players, there was a 6-folds decrease in T2DM compared to control subjects. CONCLUSIONS: The cricket sports activities decrease the prevalence of prediabetes and Type-2 diabetes mellitus (T2DM) among the cricket players compared to population based matched non-elite athlete control subjects. The study findings demonstrate the urgent need for promoting sports activities, more cricket grounds as a physiological preventive strategy against the global growing diabetes epidemic.

Perceived effectiveness of learning methods among preclinical medical students - role of personality and changes over time.

BACKGROUND AND OBJECTIVES: Active learning methods are vital in inculcating skills of critical thinking, lifelong learning and effective communication. Personality may influence learning method preferences and academic performance. The aim of this cross sectional study was to examine the relationship between students' personality and their predilection for learning methods and academic performance. METHODS: Perceived effectiveness of learning methods was assessed over time. Second- and third-year medical students (n=112) completed a questionnaire consisting of Big Five Inventory to measure the personality dimensions, and evaluated lecture, problem-based learning (PBL) and team-based learning (TBL) for their helpfulness in learning. Grade point average (GPA), PBL and TBL grades were obtained. Correlation coefficients were calculated between personality traits and learning method effectiveness scores, and grades. Learning methods effectiveness was compared between second- and third-year students. RESULTS: Positive correlations were identified between conscientiousness and lecture (r = 0.30), agreeableness and lecture (r = 0.20), and agreeableness and TBL (r = 0.23). Likewise, positive correlations were seen between extraversion and PBL grade (r=0.20), and conscientiousness and GPA (r = 0.23). In third year, significant decline in perceived effectiveness of lecture was seen (81% vs 57%; p = 0.006), while increased perceived effectiveness for PBL (38% vs. 50%) was not statistically significant (p = 0.22). CONCLUSIONS: The findings provide an evidence for modest correlations between personality and perceived effectiveness of learning methods. Remarkably, perceived effectiveness decreased for the lecture and increased for the PBL over time. The findings may help educators in better implementing active learning modalities. Besides, an earlier introduction may help students becoming acquainted with and getting the most out of PBL.

Chest Trauma Experience: Incidence, associated factors, and outcomes among patients in Saudi Arabia.

BACKGROUND AND OBJECTIVE: Worldwide chest trauma is considered one of the leading causes of morbidity and mortality. There is a lack of sufficient information on the etiology, pattern, and management of these injuries in Saudi Arabia. Therefore, the current study was conducted to determine the spectrum of chest trauma and its associated factors among patients admitted to King Khalid University Hospital, Riyadh, Saudi Arabia. METHODS: A quantitative observational cross-sectional analysis was performed, data obtained from the medical records of the chest trauma patients which were admitted in the thoracic surgery unit, King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia from January 2013 to Jan 2019. The records of all these patients were reviewed and data were collected and analyzed prospectively. RESULTS: A total of 236 patients (male: 87.3%; mean age: 32.4 years) were included in the analyses. The majority of these chest trauma cases (n=205; 86.9%) were caused by road traffic accidents (RTA). Blunt trauma predominated the cases n=225 (95.3%). Ribs fracture had the highest prevalence among the chest injuries with a number of 150 (63.5%) followed by lung contusion 140 (59.3%). Pneumothorax occurred in 131 (55.5%) and hemothorax occurred in 80 (33.8%) with most common indication for emergency thoracotomy. Extra-thoracic injuries involving the head/brain, limbs, and abdominal organs occurred in 189 (80%). 130 (55%) were intubated and ventilated, and almost half of the patients 115 (48.7%) were required a chest tube insertion. CONCLUSIONS: Chest trauma is a major health issue particularly in young male adults and road traffic accidents are the leading cause of chest trauma in Saudi Arabia. Early recognition of the patterns, etiology and appropriate management of trauma reduce the incidence of chest trauma related injuries.

Vertical integration of head, neck, and special senses module in undergraduate medical curriculum.

Vertical integration is believed to increase motivation by providing context for the learning. In this quasi-experimental study, cohort I took two horizontally integrated modules: structure and function of head, neck, and special senses in the second year, and pathophysiology and clinical sciences in the third year. Cohort II took a combined, vertically integrated module in the second year. Data from the questionnaire and examination scores were compared. Response rate was 80.1% (125/156) for cohort I and 57.6% (98/170) for cohort II. Response to the statement that vertical integration provides context to basic sciences was mixed with a higher agreement in cohort II (51.5 vs. 37.2%; P = 0.04). Cohort II was least satisfied with the appropriateness of self-study time (52.0 vs. 34.7%; P = 0.01). However, cohort II felt that the basic sciences lectures (90.8 vs. 69.4%; P < 0.01) and the clinical skills sessions (85.7 vs. 62.1%; P < 0.01) were more effective. Cohort II was less satisfied with clinical lectures (80.6 vs. 56.1%; P < 0.01) and was less confident in achieving clinical learning objectives (72.8 vs. 40.8%; P < 0.01). Mean multiple-choice questions and problem-based learning scores were similar. However, the short-answer question score was higher for cohort I [82.48 (SD 14.9) vs. 70.74 (SD 17.9); P < 0.01]. Overall, the idea of early vertical integration had a mixed response. It improved the effectiveness of basic sciences lectures and clinical skills sessions. Achievement of clinical learning outcomes was compromised. A disparity in the module's duration and curricular content, and students' ability to grasp clinical concepts and faculty's expectations are the possible reasons. Increased duration and better communication with clinical faculty may improve early introduction of vertical integration.

Fingolimod (FTY720) Preserves High Energy Phosphates and Improves Cardiac Function in Heterotopic Heart Transplantation Model.

During heart transplantation, donor heart leads to reduced oxygen supply resulting in low level of high energy phosphate (HEP) reserves in cardiomyocyte. Lower HEP is one of the underlying reasons of cell death due to ischemia. In this study we investigated the role of Fingolimod (FTY720) in heart transplantation ischemia. Eight groups of Sprague-Dawley rats (n = 5 for each subgroup) were made, A1 and C1 were given FTY720 1 mg/kg while B1 and D1 were given normal saline. The hearts were implanted into another set of similar rats after preservation period of 1 h at 4-8 °C. Significantly higher Left ventricular systolic pressure (LVSP), dP/dT maximum (p < 0.05), dP/dT minimum (p < 0.05) were recorded in the FTY720 treated group after 24 h of reperfusion while after 1 h of reperfusion, there were no significant differences in LVSP, maximum and negative dP/dT, and Left ventricular end diastolic pressure (LVEDP) between the control and the FTY720-treated transplant groups. Coronary blood flow (CBF) was enhanced (p < 0.05) in the FTY720 treated group after 1 and 24 h. ATP p < 0.001, p < 0.05 at 1 and 24 h, ADP p < 0.001, p > 0.05 at 1 and 24 h, and phosphocreatine p < 0.05, p > 0.05 at 1 and 24 h were better preserved by FTY720 treatment as compared to control group. The study concluded that pretreatment of grafted hearts with FTY720 improved hemodynamics, CBF, high energy phosphate reserves, reduces the peroxynitrite level and poly (ADP ribose) polymerase (PARP) inhibition that prevents ischemia-reperfusion injury.

Medical students' readiness and perceptions about Interprofessional Education: A cross sectional study.

OBJECTIVES: Interprofessional Education (IPE) provides an environment where learners demonstrate the knowledge, skills and attitude required to manage the complex clinical scenarios in a collaborative and interprofessional manner. The actual sphere of influence of Interprofessional Education in many medical schools has been limited. Therefore, the present study aim was to evaluate the medical students' readiness and perception of Interprofessional Education in a medical college in Saudi Arabia. METHODS: This questionnaire based cross sectional study was executed in the Department of Physiology, College of Medicine, King Saud University during the period September 2016 to December 2017, using the 19-item Readiness for Interprofessional Learning Scale (RIPLS) with four subscales teamwork and collaboration, negative professional identity, positive professional identity and roles and responsibilities. The questionnaire was e-mailed to 1411 medical students and responses were analyzed using 5-point Likert scale. RESULTS: A total of 158 medical students and trainees responded to the survey, 69 (43.6%) were males and 89 (56.4%) were females. The majority of participants 122-148 (77-94%) acknowledged the positive impact of IPE on teamwork and collaboration, more than two thirds 105 (64.45%) disagreed with negative attitude and 110-126 (70-80%) showed positive professional identity. CONCLUSIONS: Medical students showed a positive perception and ready to adopt the Interprofessional Educational allied activities in medical schools. The shared academic events would improve in clarifying the roles and responsibilities of medical students in health care professions.

Effect of Cigarette and Shisha smoking on cognitive functions impairment: A cross sectional study.

OBJECTIVES: Cigarette and Shisha smoking is becoming a common practice in young generation worldwide. Since, this is a growing threat to public health, our study aims to investigate the cognitive function responses of cigarette and Shisha inhalation in adolescents. METHODS: This retrospective cross sectional study comprised three groups, cigarette smoker, Shisha smoker, and nonsmoker control group (each n=25). All the participants were apparently healthy male volunteers aged 21-24 years. Cognitive functions were assessed by employing "Cambridge Neuropsychological Test Automated Battery". The cognitive functions outcome variables were response time tasks (attention switching task (AST) and the percentage of correct answers pattern recognition memory (PRM) task. RESULTS: Cigarette and Shisha smokers exhibited a considerable decline in cognitive performance parameters, AST mean correct latency (p=0.001), AST mean correct latency (congruent) (p=0.001), AST mean correct latency (incongruent) (p=0.001) and AST mean correct latency (switching) (p=0.001) compared to matched control group. CONCLUSIONS: Cigarette and Shisha smokers exhibited significant impairment in their cognitive functions. The present study findings convince that cigarette and Shisha smokers should quit smoking.

The association of smart mobile phone usage with cognitive function impairment in Saudi adult population.

BACKGROUND & OBJECTIVES: Excessive use of mobile phones has raised a great concern about adverse health effects on human health. The present study's aim was to investigate the association of the usage of smartphones with cognitive function impairment in the Saudi adult population. METHODS: The present cross-sectional study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia during September 2019 to January 2020. A total of 251 Saudi adults who were using mobile phones were recruited, and knowledge, attitude and practices were assessed by interview using a predesigned proforma. The Montreal Cognitive Assessment (MOCA) tool was employed to assess the cognitive functions, comparison was made between daily mobile phone usage group and their correlated Montreal Cognitive Score (MOCA). RESULTS: The mean age for 251 Saudi adult participants was 32.43 ± 12.8 years. More than 80% of the participants used their mobile phone for more than two hours daily. About 61% of the participants were not aware of the side effect of the radiation generated from mobile phone. The participants showed a decrease in MOCA score with increased daily mobile phone usage (MOCA=26.8 for <1 hour daily usage, 26.1 for 1-2 hours, and 24.6 for >2 hours with P< 0.05). In addition, participants showed decreased MOCA score by keeping their mobile phone near their pillow while sleeping; MOCA=24.35 for near pillow groups and >25.5 for the groups that placed their mobile phone away from the pillow. CONCLUSIONS: Excessive use of mobile phones can cause cognitive function impairment. Strict policies must be implemented to control the use of smartphones in order to minimize the effects on mobile phone radiation on cognition. The media has to be on the forefront in educating the public about the proper usage of mobile phones.

COVID-19 Pandemic: Impact of Quarantine on Medical Students' Mental Wellbeing and Learning Behaviors.

BACKGROUND AND OBJECTIVES: The novel coronavirus COVID-19 pandemic causes great public health and socioeconomic harms. Worldwide many countries implemented quarantine policies to minimize the spread of this highly contagious disease. The present study aim was to investigate the impact of quarantine on the medical students' mental wellbeing and learning behaviors. METHODS: In this descriptive study, we used a questionnaire with a Five-Point Likert Scale to collect the information. The questionnaire was distributed among 625 medical students through their emails with a response rate of 530 (84.8%), majority 294 (55.47%) being female. The survey questionnaire consisted of total 20 items; 12 items were related to psychological wellbeing and stress-allied queries and 08 items were about learning behaviors. RESULTS: The findings encompass two important characteristics related to quarantine, psychological wellbeing, and learning behaviors. A combined cohort of 234 medical students, either female or male, (which was 44.1% of the total responders) showed a sense of being emotionally detached from family, friends and fellow students, 125/ 530 (23.5%) medical students felt disheartened. Both female and male medical students showed a marked decrease in their overall work performance. Moreover, 56.2% of the total students (61.5% of the females and 49.5% of the males) felt a decrease in the time they spent studying. CONCLUSIONS: Both female and male medical students have identified that quarantine has caused them to feel emotionally detached from family, fellows, and friends and decrease their overall work performance and study period. The findings also show that one fourth of the medical students who participated in this study felt disheartened during the quarantine period. The long-term quarantine due to COVID-19 pandemics may causes further worsening in the psychological and learning behaviors of these medical students.

Prevalence of Pre Diabetes and Type 2 Diabetes Mellitus among cement industry workers.

OBJECTIVES: Occupational and environmental pollution have become an imperative jeopardy for developing devastating metabolic diseases. Limited animal model studies have examined the impact of exposure to cement dust on metabolic conditions. This study aimed to assess the prevalence of pre-diabetes and Type-2 diabetic mellitus (T2DM) among non-smoking cement mill workers. METHODS: This epidemiological cross sectional study was conducted in the "Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia" during the period Oct 2016 to June 2017. Initially 310 cement mill workers were interviewed; after the interview and clinical history taking, 186 non-smoking cement mill employees were finally recruited. The cement mill employees were exposed to cement dust-related pollution in a cement industry for eight hours a day for six days a week. The mean age was 36.56 ± 0.78 years, mean BMI was 25.70 ± 0.29 m/kg2, and mean period of employment in the cement industry was 82.77 ± 6.95 months. HbA1c was measured using the Dimension Xpand Plus Integrated Chemistry System (USA). RESULTS: The cement mill employees were divided into three groups: non-diabetics group, with glycated hemoglobin (HbA1c) <5.7%; pre-diabetics group, with HbA1c 5.7-6.4%; and diabetics group, with HbA1c >6.4%. Among the cement mill personnel, 79 (42.47%) were non-diabetics, 28 (15.05%) were pre-diabetics, and 79 (42.47%) were diabetics. The prevalence of pre-diabetes and T2DM among cement mill employees was considerably associated with the period of employment in the cement industry (p=0.032). CONCLUSIONS: Exposure to cement dust was associated with an increased prevalence of pre- diabetes and T2DM among cement industry employees.

Fingolimod Plays Role in Attenuation of Myocardial Injury Related to Experimental Model of Cardiac Arrest and Extracorporeal Life Support Resuscitation.

BACKGROUND: Sudden cardiac arrest is a major global health concern, and survival of patients with ischemia-reperfusion injury is a leading cause of myocardial dysfunction. The mechanism of this phenomenon is not well understood because of the complex pathophysiological nature of the disease. Aim of the study was to investigate the cardioprotective role of fingolimod in an in vivo model of cardiac arrest and resuscitation. METHODS: In this study, an in vivo rat model of cardiac arrest using extracorporeal membrane oxygenation resuscitation monitored by invasive hemodynamic measurement was developed. At the beginning of extracorporeal life support (ECLS), animals were randomly treated with fingolimod (Group A, n = 30) or saline (Group B, n = 30). Half of the animals in each group (Group A1 and B1, n = 15 each) were sacrificed after 1 h, and the remaining animals (Group A2 and B2) after 24 h of reperfusion. Blood and myocardial tissues were collected for analysis of cardiac features, inflammatory biomarkers, and cell signaling pathways. RESULTS: Treatment with fingolimod resulted in activation of survival pathways resulting into reduced inflammation, myocardial oxidative stress and apoptosis of cardiomyocytes. This led to significant improvement in systolic and diastolic functions of the left ventricle and improved contractility index. CONCLUSIONS: Sphingosine1phosphate receptor activation with fingolimod improved cardiac function after cardiac arrest supported with ECLS. Present study findings strongly support a cardioprotective role of fingolimod through sphingosine-1-phosphate receptor activation during reperfusion after circulatory arrest.

Integrated undergraduate dental curriculum.

OBJECTIVE: To develop a blueprint for producing an integrated undergraduate curriculum for dental schools in the region. METHODS: The study framework was designed at Islamic International Dental College- Riphah International University, Islamabad during May 2016-January 2017. Integrated curriculum was developed by using themes described as modules, such as organs, science of oral diagnosis, aesthetics and dental rehabilitation. Contents or topics from different disciplines having similar focussed learning outcomes were united in one particular module. Horizontal and vertical homogenisations of various modules were achieved by displaying them in a specific way on Bloom's ladder . RESULTS: All modules were free of boundaries of traditional subjects. For example, dental emergency was a theme (module) which carried assorted contents associated with dental emergency from endodontic, oral surgery, prosthetic disciplines etc. CONCLUSIONS: The framework provided an outline and pattern to develop integrated undergraduate curriculum for dental schools.